Search results for: Increased intrauterine pressure
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 11717

Search results for: Increased intrauterine pressure

3497 Physiological Normoxia and Cellular Adhesion of Diffuse Large B-Cell Lymphoma Primary Cells: Real-Time PCR and Immunohistochemistry Study

Authors: Kamila Duś-Szachniewicz, Kinga M. Walaszek, Paweł Skiba, Paweł Kołodziej, Piotr Ziółkowski

Abstract:

Cell adhesion is of fundamental importance in the cell communication, signaling, and motility, and its dysfunction occurs prevalently during cancer progression. The knowledge of the molecular and cellular processes involved in abnormalities in cancer cells adhesion has greatly increased, and it has been focused mainly on cellular adhesion molecules (CAMs) and tumor microenvironment. Unfortunately, most of the data regarding CAMs expression relates to study on cells maintained in standard oxygen condition of 21%, while the emerging evidence suggests that culturing cells in ambient air is far from physiological. In fact, oxygen in human tissues ranges from 1 to 11%. The aim of this study was to compare the effects of physiological lymph node normoxia (5% O2), and hyperoxia (21% O2) on the expression of cellular adhesion molecules of primary diffuse large B-cell lymphoma cells (DLBCL) isolated from 10 lymphoma patients. Quantitative RT-PCR and immunohistochemistry were used to confirm the differential expression of several CAMs, including ICAM, CD83, CD81, CD44, depending on the level of oxygen. Our findings also suggest that DLBCL cells maintained at ambient O2 (21%) exhibit reduced growth rate and migration ability compared to the cells growing in normoxia conditions. Taking into account all the observations, we emphasize the need to identify the optimal human cell culture conditions mimicking the physiological aspects of tumor growth and differentiation.

Keywords: adhesion molecules, diffuse large B-cell lymphoma, physiological normoxia, quantitative RT-PCR

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3496 Social Security Reform and Management: The Case of Three Member Territories of the Organisation of Eastern Caribbean States

Authors: Cleopatra Gittens

Abstract:

It has been recognized that some social security and national insurance systems in the Eastern Caribbean are experiencing ageing populations and economic and other crises that will present a financial challenge of being unable to pay pension benefits in fifteen to twenty years. This has implications for the fiscal and economic positions of the countries themselves. Hence, organizations would need to address the issue urgently. The study adds to the body of knowledge on social security systems and social security reforms in small island developing states (SIDS). It also makes recommendations for the types of reforms that social security systems in other SIDS can implement given their special circumstances. Secondary research is used to gather financial and other related information on three social security schemes in the Eastern Caribbean. Actuarial and financial reports and other documents of the social security systems are analysed to obtain financial and static data on each of the schemes. The findings show that the three schemes studied are experiencing steady increases in benefit expenditure versus contributions and increasing pensioner to insured ratios. The schemes will deplete their reserves between 2038 and 2050. Two of the schemes have increased their retirement age while the other has not embarked on any reforms. One scheme has made changes to its contribution percentages. Due to their small size, small populations and other unique circumstances, the social security schemes in the identified territories are not likely to be able to take advantage of all of the reform initiatives that the developed world embarked on when faced with similar problems. These schemes will need to make incremental changes that align with the timeframes recommended by the actuarial studies.

Keywords: benefits, pension, small island developing states, social security reform

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3495 Study of Expatriation as Countermeasure to Citizenship-Based Taxation

Authors: Gabriele Palumbo

Abstract:

This research empirically examines some of the reasons behind the fact that recently the number of people giving up their American citizenship for tax purposes has recently increased drastically. The United States Jurisdiction represents a unicum in the practice of taxing worldwide income not only to residents of the United States but also to U.S. citizens living abroad. The worldwide income taxation also affects people defined as “Accidental Americans” who are unaware that they are U.S. citizens. Those people are considered Americans even though they have not been to the United States. American residents abroad can rely on United States income tax treaties and some national law provisions, such as the exclusion of foreign income and foreign tax credits, which are designed specifically to avoid double taxation. However, this mechanism may prove unsatisfactory for people who have not been linked anymore or individuals who have never had relations with the United States. U.S. citizens who are determined to cut all of the ties between themselves and the United States, especially those that involve tax implications, can renounce their U.S. citizenship with the expatriation procedure. The expatriation process represents the extrema ratio and implicates several steps which must be followed carefully. This paper shows the complexity of the procedure that a U.S. citizen who is resident in a foreign country would have to follow to relinquish U.S. citizenship for tax purposes. The mechanism is intended to discourage people from renounce. Going beyond the question of whether U.S. tax regulation is fair or not, this principle nowadays characterizes a popular topic that many scholars and lawyers are discussing. The outcome provides interesting implications that could induce the Congress to rethink the definition of citizenship for both fiscal and nationality law purposes. Indeed, even if a sort of checks and balances has the task of mitigating the renunciation of U.S. citizenship, more and more U.S. citizens desire to get rid of their citizenship.

Keywords: double taxation, expatriation tax, international taxation, relinquishment of United States citizenship

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3494 Effects of Nut Quality and Yield by Raising Poultry in Chestnut Tree Plantation

Authors: Yunmi Park, Mahn-Jo Kim

Abstract:

The purpose of this research is to find out the effect of raising poultry in environment-friendly producing area to fruit quality and crop within chestnut tree yield. This study was conducted on chestnut tree cultivation sites raising poultry at intervals of five to ten days for three years in the mountainous area which was located in the middle corner of Chungcheongbuk-do province, Korea. The quality of chestnut fruit and the control effects of harmful insects have been investigated between the sites raising poultry and control sites for three years. As a result, the harvest yielded were two to five kilograms higher in the chestnut tree cultivation sites raising poultry compared with the control site without poultry. Also, for the purposes of determining the price when selling, the ratio of the biggest fruit is higher by 3% to 14% in the chestnut tree cultivation sites raising poultry. In order to investigate the effects of pest control through raising poultry, the ratio of harmful insect species to treatment sites was relatively low compared to control site. The appreciable result is that the control effect of larvae of the chestnut leaf-cut weevil was higher in the position where raising the poultry of 4 to 5 weeks compared to the position where raising the poultry of 12 weeks. This study found that the spread of poultry in the cultivation of chestnut trees increased the fruit quality by improving the size of fruits and lowering the dosage of harmful insect, chestnut leaf-cut weevil. Also, the eco-friendly chicken produced by these mountainous regions is expected to contribute to enhancing the incomes of the farmers by differentiating themselves from existing products.

Keywords: chestnut tree, environment-friendly, fruit quality, raising poultry

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3493 Anesthetic Considerations for Carotid Endarterectomy: Prospective Study Based on Clinical Trials

Authors: Ahmed Yousef A. Al Sultan

Abstract:

Introduction: The aim of this review is based on clinical research that studies the changes in middle cerebral artery velocity using Transcranial Doppler (TCD) and cerebral oxygen saturation using cerebral oximetry in patients undergoing carotid endarterectomy (CEA) surgery under local anesthesia (LA). Patients with or without neurological symptoms during the surgery are taking a role in this study using triplet method of cerebral oximetry, transcranial doppler and awake test in detecting any cerebral ischemic symptoms. Methods: about one hundred patients took part during their CEA surgeries under local anesthesia, using triple assessment mentioned method, Patients requiring general anesthesia be excluded from analysis. All data were recorded at eight surgery stages separately to serve this study. Results: In total regional cerebral oxygen saturation (rSO2), middle cerebral artery (MCA) velocity, and pulsatility index were significantly decreased during carotid artery clamping step in CEA procedures on the targeted carotid side. With most observed changes in MCA velocity during the study. Discussion: Cerebral oxygen saturation and middle cerebral artery velocity were significantly decreased during clamping step of the procedures on the targeted side. The team with neurological symptoms during the procedures showed higher changes of rSO2 and MCA velocity than the team without neurological symptoms. Cerebral rSO2 and MCA velocity significantly increased directly after de-clamping of the internal carotid artery on the affected side.

Keywords: awake testing, carotid endarterectomy, cerebral oximetry, Tanscranial Doppler

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3492 Early-Onset Asthma and Early Smoking Increase Risk of Bipolar Disorder in Adolescents and Young Adults

Authors: Meng-Huan Wu, Wei-Er Wang, Tsu-Nai Wang, Wei-Jian Hsu, Vincent Chin-Hung Chen

Abstract:

Objective: Studies have reported a strong link between asthma and bipolar disorder. We conducted a 17-year community-based large cohort study to examine the relationship between asthma, early smoking initiation, and bipolar disorder during adolescence and early adulthood. Methods: A total of 162,766 participants aged 11–16 years were categorized into asthma and non-asthma groups at baseline and compared within the observation period. Covariates during late childhood or adolescence included parental education, cigarette smoking by family members of participants, and participant’s gender, age, alcohol consumption, smoking, and exercise habits. Data for urbanicity, prednisone use, allergic comorbidity, and Charlson comorbidity index were acquired from the National Health Insurance Research Database. The Cox proportional-hazards model was used to evaluate the association between asthma and bipolar disorder. Results: Our findings revealed that asthma increased the risk of bipolar disorder after adjustment for key confounders in the Cox proportional hazard regression model (adjusted HR: 1.31, 95% CI: 1.12-1.53). Hospitalizations or visits to the emergency department for asthma exhibited a dose–response effect on bipolar disorder (adjusted HR: 1.59, 95% CI: 1.22-2.06). Patients with asthma with onset before 20 years of age who smoked during late childhood or adolescence had the greatest risk for bipolar disorder (adjusted HR: 3.10, 95% CI: 1.29-7.44). Conclusions: Patients newly diagnosed with asthma had a 1.3 times higher risk of developing bipolar disorder. Smoking during late childhood or adolescence increases the risk of developing bipolar disorder in patients with asthma.

Keywords: adolescence, asthma, smoking, bipolar disorder, early adulthood

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3491 Educational Debriefing in Prehospital Medicine: A Qualitative Study Exploring Educational Debrief Facilitation and the Effects of Debriefing

Authors: Maria Ahmad, Michael Page, Danë Goodsman

Abstract:

‘Educational’ debriefing – a construct distinct from clinical debriefing – is used following simulated scenarios and is central to learning and development in fields ranging from aviation to emergency medicine. However, little research into educational debriefing in prehospital medicine exists. This qualitative study explored the facilitation and effects of prehospital educational debriefing and identified obstacles to debriefing, using the London’s Air Ambulance Pre-Hospital Care Course (PHCC) as a model. Method: Ethnographic observations of moulages and debriefs were conducted over two consecutive days of the PHCC in October 2019. Detailed contemporaneous field notes were made and analysed thematically. Subsequently, seven one-to-one, semi-structured interviews were conducted with four PHCC debrief facilitators and three course participants to explore their experiences of prehospital educational debriefing. Interview data were manually transcribed and analysed thematically. Results: Four overarching themes were identified: the approach to the facilitation of debriefs, effects of debriefing, facilitator development, and obstacles to debriefing. The unpredictable debriefing environment was seen as both hindering and paradoxically benefitting educational debriefing. Despite using varied debriefing structures, facilitators emphasised similar key debriefing components, including exploring participants’ reasoning and sharing experiences to improve learning and prevent future errors. Debriefing was associated with three principal effects: releasing emotion; learning and improving, particularly participant compound learning as they progressed through scenarios; and the application of learning to clinical practice. Facilitator training and feedback were central to facilitator learning and development. Several obstacles to debriefing were identified, including mismatch of participant and facilitator agendas, performance pressure, and time. Interestingly, when used appropriately in the educational environment, these obstacles may paradoxically enhance learning. Conclusions: Educational debriefing in prehospital medicine is complex. It requires the establishment of a safe learning environment, an understanding of participant agendas, and facilitator experience to maximise participant learning. Aspects unique to prehospital educational debriefing were identified, notably the unpredictable debriefing environment, interdisciplinary working, and the paradoxical benefit of educational obstacles for learning. This research also highlights aspects of educational debriefing not extensively detailed in the literature, such as compound participant learning, display of ‘professional honesty’ by facilitators, and facilitator learning, which require further exploration. Future research should also explore educational debriefing in other prehospital services.

Keywords: debriefing, prehospital medicine, prehospital medical education, pre-hospital care course

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3490 The Effect of Using Levels of Red Tiger Shrimp Meal in Starter Broiler Diet upon Growth Performance

Authors: Mohammed I.A. Al-Neemi, Mohammed S.B., Al-Hlawee, Ilham N. Ezaddin, Soz A. Faris, Omer E. Fakhry, Heemen S. Mageed

Abstract:

This objective of this study was to measure the effect of replacing different levels of animal protein concentrate with Red Tiger shrimp meal (RTSM: 60 % crude protein, 2400 M.E kcal/kg and the source of RTSM was imported from china) in the broiler starter diets. A total 300 broiler chicks (Ross-308) were randomly assigned in treatments dietary contained three different levels of RTSM (0.00, 4.16 and 8.32 %) in experimental diet with a completely randomized design (CRD). Each treatment included four replicates (floor pens) and 25 broilers in each replication (Pen). Therefore, floor space for each boilers was 900 cm2. Initially, the broilers where exposed to a continues lighting of 23:30 hours and dark period of 30 minutes in each 24 hours. Feed and water were supplied ad libitum to the broilers throughout the experimental period (1-21 days). The results of this study indicated that body weight (B.W.), body weight gain (B.W.G), conversion ratio of feed, protein and energy (F.CR, P.C.R and E.C.R) were significantly (p ≤ 0.05) decreased by complete substituting (RTSM) for animal protein concentration (third treatment). Mortality percentage significantly (p ≤ 0.05) increased for third dietary treatment. No significant differences were found for feed, protein and energy intake among treatments during the experimental period (three weeks). In conclusion, (RTSM) could be included to 4.16% in the broiler starter diet or substitute the protein Red Tiger shrimp as alternative of protein animal protein concentrate as much as 50%.

Keywords: red tiger shrimp, broiler, starter diet, growth performance, animal protein concentrate

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3489 Mechanical Behavior of Sandwiches with Various Glass Fiber/Epoxy Skins under Bending Load

Authors: Emre Kara, Metehan Demir, Şura Karakuzu, Kadir Koç, Ahmet F. Geylan, Halil Aykul

Abstract:

While the polymeric foam cored sandwiches have been realized for many years, recently there is a growing and outstanding interest on the use of sandwiches consisting of aluminum foam core because of their some of the distinct mechanical properties such as high bending stiffness, high load carrying and energy absorption capacities. These properties make them very useful in the transportation industry (automotive, aerospace, shipbuilding industry), where the "lightweight design" philosophy and the safety of vehicles are very important aspects. Therefore, in this study, the sandwich panels with aluminum alloy foam core and various types and thicknesses of glass fiber reinforced polymer (GFRP) skins produced via Vacuum Assisted Resin Transfer Molding (VARTM) technique were obtained by using a commercial toughened epoxy based adhesive with two components. The aim of this contribution was the analysis of the bending response of sandwiches with various glass fiber reinforced polymer skins. The three point bending tests were performed on sandwich panels at different values of support span distance using a universal static testing machine in order to clarify the effects of the type and thickness of the GFRP skins in terms of peak load, energy efficiency and absorbed energy values. The GFRP skins were easily bonded to the aluminum alloy foam core under press machine with a very low pressure. The main results of the bending tests are: force-displacement curves, peak force values, absorbed energy, collapse mechanisms and the influence of the support span length and GFRP skins. The obtained results of the experimental investigation presented that the sandwich with the skin made of thicker S-Glass fabric failed at the highest load and absorbed the highest amount of energy compared to the other sandwich specimens. The increment of the support span distance made the decrease of the peak force and absorbed energy values for each type of panels. The common collapse mechanism of the panels was obtained as core shear failure which was not affected by the skin materials and the support span distance.

Keywords: aluminum foam, collapse mechanisms, light-weight structures, transport application

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3488 Calibration of Contact Model Parameters and Analysis of Microscopic Behaviors of Cuxhaven Sand Using The Discrete Element Method

Authors: Anjali Uday, Yuting Wang, Andres Alfonso Pena Olare

Abstract:

The Discrete Element Method is a promising approach to modeling microscopic behaviors of granular materials. The quality of the simulations however depends on the model parameters utilized. The present study focuses on calibration and validation of the discrete element parameters for Cuxhaven sand based on the experimental data from triaxial and oedometer tests. A sensitivity analysis was conducted during the sample preparation stage and the shear stage of the triaxial tests. The influence of parameters like rolling resistance, inter-particle friction coefficient, confining pressure and effective modulus were investigated on the void ratio of the sample generated. During the shear stage, the effect of parameters like inter-particle friction coefficient, effective modulus, rolling resistance friction coefficient and normal-to-shear stiffness ratio are examined. The calibration of the parameters is carried out such that the simulations reproduce the macro mechanical characteristics like dilation angle, peak stress, and stiffness. The above-mentioned calibrated parameters are then validated by simulating an oedometer test on the sand. The oedometer test results are in good agreement with experiments, which proves the suitability of the calibrated parameters. In the next step, the calibrated and validated model parameters are applied to forecast the micromechanical behavior including the evolution of contact force chains, buckling of columns of particles, observation of non-coaxiality, and sample inhomogeneity during a simple shear test. The evolution of contact force chains vividly shows the distribution, and alignment of strong contact forces. The changes in coordination number are in good agreement with the volumetric strain exhibited during the simple shear test. The vertical inhomogeneity of void ratios is documented throughout the shearing phase, which shows looser structures in the top and bottom layers. Buckling of columns is not observed due to the small rolling resistance coefficient adopted for simulations. The non-coaxiality of principal stress and strain rate is also well captured. Thus the micromechanical behaviors are well described using the calibrated and validated material parameters.

Keywords: discrete element model, parameter calibration, triaxial test, oedometer test, simple shear test

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3487 Study on the Effects of Geometrical Parameters of Helical Fins on Heat Transfer Enhancement of Finned Tube Heat Exchangers

Authors: H. Asadi, H. Naderan Tahan

Abstract:

The aim of this paper is to investigate the effect of geometrical properties of helical fins in double pipe heat exchangers. On the other hand, the purpose of this project is to derive the hydraulic and thermal design tables and equations of double heat exchangers with helical fins. The numerical modeling is implemented to calculate the considered parameters. Design tables and correlated equations are generated by repeating the parametric numerical procedure for different fin geometries. Friction factor coefficient and Nusselt number are calculated for different amounts of Reynolds, fluid Prantle and fin twist angles for the range of laminar fluid flow in annular tube with helical fins. Results showed that friction factor coefficient and Nusselt number will be increased for higher Reynolds numbers and fins’ twist angles in general. These two parameters follow different patterns in response to Reynolds number increment. Thermal performance factor is defined to analyze these different patterns. Temperature and velocity contours are plotted against twist angle and number of fins to describe the changes in flow patterns in different geometries of twisted finned annulus. Finally twisted finned annulus friction factor coefficient, Nusselt Number and thermal performance factor are correlated by simulating the model in different design points.

Keywords: double pipe heat exchangers, heat exchanger performance, twisted fins, computational fluid dynamics

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3486 European Union Health Policy and the Response to COVID-19 Pandemic: Building a European Health Union

Authors: Aikaterini Tsalampouni

Abstract:

The European Union has long been the most developed model of economic and political integration that has brought a common market, a common currency and a standardization of national policies in certain areas in consistent with EU values and principles. To this direction, there is a parallel process of social integration that effect public policy decisions of member states. Even though social policy, i.e. social protection and moreover healthcare policy, still remains in state's responsibility to develop, EU applies different mechanisms in order to influence health policy systems, since from a more federalist point of view, EU ought to expand its regulatory and legislative roles in as many policy areas as possible. Recently, the pandemic has become a turning point for health care provision and at the same time has also highlighted the need to strengthen the EU’s role in coordinating health care. This paper analyses the EU health policy in general, as well as the response to COVID-19 pandemic with an attempt to identify indications of interaction between EU policies and the promotion of sustainable and resilient health systems. More analytically, the paper investigates the EU binding legal instruments, non-binding legal instruments, monitoring and assessment instruments and instruments for co-financing concerning health care provision in member states and records the evolution of health policies before and during the COVID-19 pandemic. The paper concludes by articulating some remarks regarding the improvement of health policy in EU. Since the ability to deal with a pandemic depends on continuous and increased investment in health systems, the involvement of the EU can lead to a policy convergence, necessary for the resilience of the systems, maintaining at the same time, a strong health policy framework in Europe.

Keywords: EU health policy, EU response to COVID-19, European Health Union, health systems in Europe

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3485 Preparation of Catalyst-Doped TiO2 Nanotubes by Single Step Anodization and Potential Shock

Authors: Hyeonseok Yoo, Kiseok Oh, Jinsub Choi

Abstract:

Titanium oxide nanotubes have attracted great attention because of its photocatalytic activity and large surface area. For enhancing electrochemical properties, catalysts should be doped into the structure because titanium oxide nanotubes themselves have low electroconductivity and catalytic activity. It has been reported that Ru and Ir doped titanium oxide electrodes exhibit high efficiency and low overpotential in the oxygen evolution reaction (OER) for water splitting. In general, titanium oxide nanotubes with high aspect ratio cannot be easily doped by conventional complex methods. Herein, two types of facile routes, namely single step anodization and potential shock, for Ru doping into high aspect ratio titanium oxide nanotubes are introduced in detail. When single step anodization was carried out, stability of electrodes were increased. However, onset potential was shifted to anodic direction. On the other hand, when high potential shock voltage was applied, a large amount of ruthenium/ruthenium oxides were doped into titanium oxide nanotubes and thick barrier oxide layers were formed simultaneously. Regardless of doping routes, ruthenium/ ruthenium oxides were homogeneously doped into titanium oxide nanotubes. In spite of doping routes, doping in aqueous solution generally led to incorporate high amount of Ru in titanium oxide nanotubes, compared to that in non-aqueous solution. The amounts of doped catalyst were analyzed by X-ray photoelectron spectroscopy (XPS). The optimum condition for water splitting was investigated in terms of the amount of doped Ru and thickness of barrier oxide layer.

Keywords: doping, potential shock, single step anodization, titanium oxide nanotubes

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3484 Psychosocial Determinants of Quality of Life After Treatment for Breast Cancer - A Systematic Review

Authors: Lakmali Anthony, Madeline Gillies

Abstract:

Purpose: Decreasing mortality has led to increased focus on patient-reported outcomes such as quality of life (QoL) in breast cancer. Breast cancer patients often have decreased QoL even after treatment is complete. This systematic review of the literature aims to identify psychosocial factors associated with decreased QoL in post-treatment breast cancer patients. Methodology: This systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The search was conducted in MEDLINE, EMBASE, and PsychINFO using MeSH headings. The two authors screened studies for relevance and extracted data. Results: Seventeen studies were identified, including 3,150 total participants (mean = 197) with a mean age of 51.9 years. There was substantial heterogeneity in measures of QoL. The most common was the European Organisation for Research and Treatment of Cancer QLQ-C30 (n=7, 41.1%). Most studies (n=12, 70.5%) found that emotional distress correlated with poor QoL, while 3 found no significant association. The most common measure of emotional distress was the Hospital Anxiety and Depression Scale (n=12, 70.5%). Other psychosocial factors associated with QoL were unmet needs, problematic social support, and negative affect. Clinicopathologic determinants included mastectomy without reconstruction, stage IV disease, and adjuvant chemotherapy. Conclusion: This systematic review provides a summary of the psychosocial determinants of poor QoL in post-treatment breast cancer patients, as well as the most commonly reported measures of these. An understanding of these potentially modifiable determinants of poor outcome is pivotal to the provision of quality, patient-centred care in surgical oncology.

Keywords: breast cancer, quality of life, psychosocial determinants, cancer surgery

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3483 Study on the Spatial Evolution Characteristics of Urban Agglomeration Integration in China: The Case of Chengdu-Chongqing Urban Agglomeration

Authors: Guoqin Ge, Minhui Huang, Yazhou Zhou

Abstract:

The growth of the Chengdu-Chongqing urban agglomeration has been designated as a national strategy in China. Analyzing its spatial evolution characteristics is crucial for devising relevant development strategies. This paper enhances the gravitational model by using temporal distance as a factor. It applies this improved model to assess the economic interconnection and concentration level of each geographical unit within the Chengdu-Chongqing urban agglomeration between 2011 and 2019. On this basis, this paper examines the spatial correlation characteristics of economic agglomeration intensity and urban-rural development equalization by employing spatial autocorrelation analysis. The study findings indicate that the spatial integration in the Chengdu-Chongqing urban agglomeration is currently in the "point-axis" development stage. The spatial organization structure is becoming more flattened, and there is a stronger economic connection between the core of the urban agglomeration and the peripheral areas. The integration of the Chengdu-Chongqing urban agglomeration is currently hindered by conflicting interests and institutional heterogeneity between Chengdu and Chongqing. Additionally, the connections between the relatively secondary spatial units are largely loose and weak. The strength and scale of economic ties and the level of urban-rural equilibrium among spatial units within the Chengdu-Chongqing urban agglomeration have increased, but regional imbalances have continued to widen, and such positive and negative changes have been characterized by the spatial and temporal synergistic evolution of the "core-periphery". Ultimately, this paper presents planning ideas for the future integration development of the Chengdu-Chongqing urban agglomeration, drawing from the findings.

Keywords: integration, planning strategy, space organization, space evolution, urban agglomeration

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3482 The Prevalence of Postpartum Stress among Jordanian Women

Authors: Khitam Ibrahem Shlash Mohammad

Abstract:

Background: Postnatal depression is a focus of considerable research attention, but little is known about the pattern of stress across this period. Objective: to investigate the prevalence of stress after childbirth for Jordanian women and identify associated risk factors. Method: Design: A descriptive cross-sectional study. Participants were recruited six to eight weeks postpartum, provided personal, social and obstetric information, and completed the stress subscale of Depression Anxiety and Stress Scale (DASS-S), the Maternity Social Support Scale (MSSS), and Perceived Self-Efficacy Scale (PSES). Setting: maternal and child health care clinics in four health care centres in Maan city in Southern Jordan. Participants: Arabic speaking women (n = 324) between the ages of 18 and 45 years, six to eight weeks postpartum, primiparous or multiparous at low risk for obstetric complications. Data collection took place between October 2015 and January 2016. Ethical clearance was obtained prior to data collection. Results: The prevalence of postpartum stress among Jordanian women was 39.8 %. A regression analysis revealed that occupation, low social support, financial problems, difficult marital relationships, difficult relationship with family-in-law, giving birth to a female baby, difficult childbirth, and low self-efficacy were associated with postpartum stress. Conclusions and implications for practice: Jordanian women need support during pregnancy, during and after childbirth. Postpartum emotional support and assessment of symptoms of stress need to be incorporated into routine practice. The opportunity for open discussion along with increased awareness and clarification of common misconceptions about postpartum stress is necessary.

Keywords: prevalence, postpartum, stress, Jordanian women

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3481 Processing Methods for Increasing the Yield, Nutritional Value and Stability of Coconut Milk

Authors: Archana G. Lamdande, Shyam R. Garud, K. S. M. S. Raghavarao

Abstract:

Coconut has two edible parts, that is, a white kernel (solid endosperm) and coconut water (liquid endosperm). The white kernel is generally used in fresh or dried form for culinary purposes. Coconut testa, is the brown skin, covering the coconut kernel. It is removed by paring of wet coconut and obtained as a by-product in coconut processing industries during the production of products such as desiccated coconut, coconut milk, whole coconut milk powder and virgin coconut oil. At present, it is used as animal feed component after drying and recovering the residual oil (by expelling). Experiments were carried out on expelling of coconut milk for shredded coconut with and without testa removal, in order to explore the possibility of increasing the milk yield and value addition in terms of increased polyphenol content. The color characteristics of coconut milk obtained from the grating without removal of testa were observed to be L* 82.79, a* 0.0125, b* 6.245, while that obtained from grating with removal of testa were L* 83.24, a* -0.7925, b* 3.1. A significant increase was observed in total phenol content of coconut milk obtained from the grating with testa (833.8 µl/ml) when compared to that from without testa (521.3 µl/ml). However, significant difference was not observed in protein content of coconut milk obtained from the grating with and without testa (4.9 and 5.0% w/w, respectively). Coconut milk obtained from grating without removal of testa showed higher milk yield (62% w/w) when compared to that obtained from grating with removal of testa (60% w/w). The fat content in coconut milk was observed to be 32% (w/w), and it is unstable due to such a high fat content. Therefore, several experiments were carried out for examining its stability by adjusting the fat content at different levels (32, 28, 24, and 20% w/w). It was found that the coconut milk was more stable with a fat content of 24 % (w/w). Homogenization and ultrasonication and their combinations were used for exploring the possibility of increasing the stability of coconut milk. The microscopic study was carried out for analyzing the size of fat globules and the degree of their uniform distribution.

Keywords: coconut milk, homogenization, stability, testa, ultrasonication

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3480 Contact Toxicity Effects of Different Formulations of Artemisia Absinthium Extracts on Rose Aphid

Authors: Maryam Atapour

Abstract:

Chemical pesticides, which are widely used in agriculture, cause problems such as soil and water pollution, reducing biodiversity and creating pest resistance. These problems have led to increased attention to alternative and more sustainable methods such as natural-based pesticides. Herbal pesticides have been developed based on essential oils or extracts from different parts of plants, such as leaves, roots, and flowers. Herbal pesticides are compatible with the environment and can be used in integrated pest management programs. Despite the many benefits, herbal pesticides, especially essential oil-based compounds, have low durability in the environment, and their production costs are high, so the use of herbal extracts with appropriate formulations is more justified in all aspects. In the current study and based on the results of previous studies, aqueous and 70% ethanolic extract of Artemisia absinthium L. was prepared by the percolation method and formulated as an emulsion and water-soluble powder. To produce powder formulation, 20% maltodextrin was used with the spray-dryer method. Different concentrations of these compounds were sprayed on bushes infected with rose aphid Macrosiphum rosae (L.). Sampling was done randomly and the percentage of aphids’ mortality was checked. The results showed that the use of different concentrations of ethanolic extracts created a significant difference in the mortality rate of aphids, while water-soluble powder formulation caused less mortality. The current results showed that the extract of this plant has practical usability to control aphids, and with the appropriate formulation, it can be used as a good alternative to chemical pesticides.

Keywords: contact toxicity, formulation, extract, aphid, Artemisia absinthium.

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3479 The Friendship Network Stability of Preschool Children during One Pedagogical Season

Authors: Yili Wang, Jarmo Kinos, Tuire Palonen, Tarja-Riitta Hurme

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This longitudinal study aims to examine how five- and six-year-old children’s peer relationships are formed and fostered during one preschool year in a southwestern Finnish preschool. All 16 kindergarteners participated in the study (at dyad level N=240; i.e., 16 x 15 relationships among the children). The children were divided into four daily groups, based on the table order during the daily routines, and four intervention groups, based on the teachers’ pedagogical plan. During the intervention, one iPad was given to each group in order to stimulate interaction among peers and, thus, enable the children to form new peer relationships. In the data gathering, sociometric nomination techniques were used to investigate the nature (i.e., stability and mutuality) of the peer relationships. The data was collected five times during the year to see what kind of peer relationship changes occurred at the dyad level and the group level, i.e., in establishing and losing friendship ties among the children. Social network analyses were used to analyze the data. The results indicate that the children’s preference for gender segregation was strong compared to age preference and intervention. In all, the number of reciprocal friendship ties and the mutual absence of friendship ties increased towards the end of the year, whereas the number of unilateral friendship ties decreased. This indicates that children’s nominations narrow down; thus, the group structure becomes more crystalized. Instead of extending their friendship networks, children seek stable and mutual relationships with their peers in their middle childhood years. The intervention only had a slightly negative influence on children’s peer relationships.

Keywords: intervention study, peer relationship, preschool education, social network analysis, sociometric ratings

Procedia PDF Downloads 253
3478 Anyword: A Digital Marketing Tool to Increase Productivity in Newly Launching Businesses

Authors: Jana Atteah, Wid Jan, Yara AlHibshi, Rahaf AlRougi

Abstract:

Anyword is an AI copywriting tool that helps marketers create effective campaigns for specific audiences. It offers a wide range of templates for various platforms, brand voice guidelines, and valuable analytics insights. Anyword is used by top global companies and has been recognized as one of the "Fastest Growing Products" in the 2023 software awards. A recent study examined the utilization and impact of AI-powered writing tools, specifically focusing on the adoption of AI in writing pursuits and the use of the Anyword platform. The results indicate that a majority of respondents (52.17%) had not previously used Anyword, but those who had were generally satisfied with the platform. Notable productivity improvements were observed among 13% of the participants, while an additional 34.8% reported a slight increase in productivity. A majority (47.8%) maintained a neutral stance, suggesting that their productivity remained unaffected. Only a minimal percentage (4.3%) claimed that their productivity did not improve with the usage of Anyword AI. In terms of the quality of written content generated, the participants responded positively. Approximately 91% of participants gave Anyword AI a score of 5 or higher, with roughly 17% giving it a perfect score. A small percentage (approximately 9%) gave a low score between 0-2. The mode result was a score of 7, indicating a generally positive perception of the quality of content generated using Anyword AI. These findings suggest that AI can contribute to increased productivity and positively influence the quality of written content. Further research and exploration of AI tools in writing pursuits are warranted to fully understand their potential and limitations.

Keywords: artificial intelligence, marketing platforms, productivity, user interface

Procedia PDF Downloads 48
3477 Intensity-Enhanced Super-Resolution Amplitude Apodization Effect on the Non-Spherical Near-Field Particle-Lenses

Authors: Liyang Yue, Bing Yan, James N. Monks, Rakesh Dhama, Zengbo Wang, Oleg V. Minin, Igor V. Minin

Abstract:

A particle can function as a refractive lens to focus a plane wave, generating a narrow, high intensive, weak-diverging beam within a sub-wavelength volume, known as the ‘photonic jet’. Refractive index contrast (particle to background media) and scaling effect of the dielectric particle (relative-to-wavelength size) play key roles in photonic jet formation, rather than the shape of particle-lens. Waist (full width of half maximum, FWHM) of a photonic jet could be beyond the diffraction limit and smaller than the Airy disk, which defines the minimum distance between two objects to be imaged as two instead of one. Many important applications for imaging and sensing have been afforded based upon the super-resolution characteristic of the photonic jet. It is known that apodization method, in the form of an amplitude pupil-mask centrally situated on a particle-lens, can further reduce the waist of a photonic nanojet, however, usually lower its intensity at the focus due to blocking of the incident light. In this paper, the anomalously intensity-enhanced apodization effect was discovered in the near-field via numerical simulation. It was also experimentally verified by a scale model using a copper-masked Teflon cuboid solid immersion lens (SIL) with 22 mm side length under radiation of a plane wave with 8 mm wavelength. Peak intensity enhancement and the lateral resolution of the produced photonic jet increased by about 36.0 % and 36.4 % in this approach, respectively. This phenomenon may possess the scale effect and would be valid in multiple frequency bands.

Keywords: apodization, particle-lens, scattering, near-field optics

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3476 Numerical Erosion Investigation of Standalone Screen (Wire-Wrapped) Due to the Impact of Sand Particles Entrained in a Single-Phase Flow (Water Flow)

Authors: Ahmed Alghurabi, Mysara Mohyaldinn, Shiferaw Jufar, Obai Younis, Abdullah Abduljabbar

Abstract:

Erosion modeling equations were typically acquired from regulated experimental trials for solid particles entrained in single-phase or multi-phase flows. Evidently, those equations were later employed to predict the erosion damage caused by the continuous impacts of solid particles entrained in streamflow. It is also well-known that the particle impact angle and velocity do not change drastically in gas-sand flow erosion prediction; hence an accurate prediction of erosion can be projected. On the contrary, high-density fluid flows, such as water flow, through complex geometries, such as sand screens, greatly affect the sand particles’ trajectories/tracks and consequently impact the erosion rate predictions. Particle tracking models and erosion equations are frequently applied simultaneously as a method to improve erosion visualization and estimation. In the present work, computational fluid dynamic (CFD)-based erosion modeling was performed using a commercially available software; ANSYS Fluent. The continuous phase (water flow) behavior was simulated using the realizable K-epsilon model, and the secondary phase (solid particles), having a 5% flow concentration, was tracked with the help of the discrete phase model (DPM). To accomplish a successful erosion modeling, three erosion equations from the literature were utilized and introduced to the ANSYS Fluent software to predict the screen wire-slot velocity surge and estimate the maximum erosion rates on the screen surface. Results of turbulent kinetic energy, turbulence intensity, dissipation rate, the total pressure on the screen, screen wall shear stress, and flow velocity vectors were presented and discussed. Moreover, the particle tracks and path-lines were also demonstrated based on their residence time, velocity magnitude, and flow turbulence. On one hand, results from the utilized erosion equations have shown similarities in screen erosion patterns, locations, and DPM concentrations. On the other hand, the model equations estimated slightly different values of maximum erosion rates of the wire-wrapped screen. This is solely based on the fact that the utilized erosion equations were developed with some assumptions that are controlled by the experimental lab conditions.

Keywords: CFD simulation, erosion rate prediction, material loss due to erosion, water-sand flow

Procedia PDF Downloads 151
3475 The Effect of Geographical Differentials of Epidemiological Transition on Health-Seeking Behavior in India

Authors: Sumit Kumar Das, Laishram Ladusingh

Abstract:

Aim: The aim of the study is to examine the differential of epidemiological transition across fifteen agro-climatic zones of India and its effect on health-seeking behavior. Data and Methods: Unit level data on consumption expenditure on health of India from three decadal rounds conducted by National Sample Survey Organization are used for the analysis. These three rounds are 52nd (1995-96), 60th (2004-05) and 71st (2014-15). The age-adjusted prevalence rate for communicable diseases and non-communicable diseases are estimated for fifteen agro-climatic zones of India for three time periods. Bivariate analysis is used to find out determinants of health-seeking behavior. Multilevel logistic regression is used to examine factors effecting on household health-seeking behavior. Result: The prevalence of communicable diseases is increasing in most of the zones of India. Every South Indian zones, Gujarat plains, and lower Gangetic plain are facing the severe attack of dual burden of diseases. Demand for medical advice has increased in southern zones, and east zones, reliance on private healthcare facilities are increasing in most of the zone. Demographic characteristics of the household head have a significant impact on health-seeking behavior. Conclusion: Proper program implementation is required considering the disease prevalence and differential in the pattern of health seeking behavior. Along with initiation and strengthening of programs for non-communicable, existing programs for communicable diseases need to monitor and supervised strictly.

Keywords: agro-climatic zone, epidemiological transition, health-seeking behavior, multilevel regression

Procedia PDF Downloads 169
3474 Organic Farming for Sustainable Production of Some Promising Halophytic Species in Saline Environment

Authors: Medhat Tawfik, Ezzat Abd El Lateef, Bahr Amany, Mohamed Magda

Abstract:

Applying organic farming systems in biosaline agriculture is unconventional approach for sustainable use of marginal soil and desert land for planting non-traditional halophytic crops such as Leptochloa fusca, Kochia indica, Sporobolus virginicus and Spartina patens. These plants are highly salt tolerant C4 halophytic forage plants grown well in coastal salt marsh. These halophytic plant will take important place in the farming system, especially in the coastal areas and salt-affected land. We can call it environmentally smart crops because they ensure food security, contribute to energy security, guarantee environmental sustainability, and mitigate the negative impacts of climate change. Organic Agriculture is the most important and widely practiced agro-ecological farming system. It is claimed to be the most sustainable approach and long term adaptation strategy. It promotes soil fertility and diversity at all levels and makes soils less susceptible to erosion. It is also reported to be climate change resilience farming systems as it promotes the proper management of soil, water, biodiversity and local knowledge and provides producers with ecologically sound management decisions. A field experiment was carried out at the Model Farm of National Research Centre, El Tour, South Sinai to study the impact of (Mycorrhiza 1kg/fed., charcoal 4 tons/fed., chicken manure 5 tons/fed., in addition to control treatment) on some growth characters, photosynthetic pigments content, and some physiological aspects i.e. prolind and soluble carbohydrates content, succulence and osmotic pressure values, as well as nutritive values i.e. Crude fat (CF), Acid detergent fiber (ADF), Neutral detergent fiber (NDF), Ether extract (EE) and Nitrogen-free extract (NFE) of five halophytic plant species (Leptochloa fusca, Kochia indica, Sporobolus virginicus and Spartina patens). Our results showed that organic fertilizer treatment enhanced all the previous character as compared with control with superiority to chicken manure over the other treatments.

Keywords: organic agriculture, halophytic plants, saline environment, water security

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3473 Effect of Recycled Grey Water on Bacterial Concrete

Authors: T. Deepa, S. R. Inchara, S. V. Venkatesh, Seema Tharannum

Abstract:

Concrete is the most widely used structural material. It is made using locally available materials. However, Concrete has low tensile strength and may crack in the early days with exothermic hydration. Bacillus subtilis bacteria that form endospores is the biological agent considered in this study for Biomineralization or MICP (Microbially Induced Calcite Precipitation) Technique and to address the increased Construction water demand, Recycled Grey Water which is obtained from STP of PES University, opted in place of Potable water. In this work, M30 grade conventional concrete is designed using OPC 53 grade cement, Manufactured Sand, Natural coarse aggregates, and Potable water. Conventional Concrete (CC), Bacterial Concrete with Potable water (BS), and Recycled Grey Water concrete (RGW) are the three different concrete specimens casted. Experimental studies such as the strength test and the surface hardness test are conducted on Conventional and Bacterial concrete samples after 7, 28, and 56 days of curing. Concrete cubes are subjected to a temperature of 50° C to investigate the effect of higher temperature. Cracked cube specimens are observed for Self-healing - as well as microstructure analysis with Scanning Electron Microscope (SEM), Energy Dispersive X-Ray Analysis (EDAX), and X-Ray Diffraction Analysis (XRD).Noticeable Calcium salt deposition is observed on the surface of BS and RGW cracked specimen. Surface hardness and EDAX test gave promising result on the advantage of using spore-forming bacteria in concrete. This is followed by the strength gain in Compression and Flexure. Results also indicate that Recycled Grey Water can be a substitute for Normal water in concrete.

Keywords: bacillus subtilis, bacterial concrete, recycled grey water, self-healing, surface hardness of concrete

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3472 Comparative Study of Stability of Crude and Purified Red Pigments of Pokeberry (Phytolacca Americana L.) Fruits

Authors: Nani Mchedlishvili, Nino Omiadze, Marine Abutidze, Jose Neptuno Rodriguez-Lopez, Tinatin Sadunishvili, Nikoloz Pruidze, Giorgi Kvesitadze

Abstract:

Recently, there is an increased interest in the development of food natural colorants as alternatives to synthetic dyes because of both legislative action and consumer concern. Betalains are widely used in the food industry as an alternative of synthetic colorants. The interest of betalains are caused not only by their coloring effect but also by their beneficial properties. The aim of the work was to study of stability of crude and purified red pigments of pokeberry (Phytolacca america L.). The pokeberry fruit juice was filtrated and concentrated by rotary vacuum evaporator up to 25% and the concentrated juice was passed through the Sepadex-25(fine) column (20×1.1 cm). From the column the pigment elution rate was 18 ml/hr. 1.5ml fractions of pigment were collected. In the fractions the coloring substances were determined using CuS04 x 7 H2O as a standard. From the Sephadex G-25 column only one fraction of the betalain red pigment was eluted with the absorption maximum at 538 nm. The degree of pigment purification was 1.6 and pigment yield from the column was 15 %. It was shown that thermostability of pokeberry fruit red pigment was significantly decreased after the purification. For example, during incubation at 100C for 10 min crude pigment retained 98 % of its color while under the same conditions only 72% of the color of purified pigment was retained. The purified pigment was found to be characterized by less storage stability too. The storage of the initial crude juice and the pigment fraction obtained after the gelfiltration for 10 days at 4°C showed the lost of color by 29 and 74 % respectively. From the results obtained, it can be concluded that during the gelfiltration the pokeberry fruit red pigment gets separated from such substances that cause its stabilization in the crude juice.

Keywords: betalains, gelfiltration, pokeberry fruit, stability

Procedia PDF Downloads 279
3471 Development of a Bioprocess Technology for the Production of Vibrio midae, a Probiotic for Use in Abalone Aquaculture

Authors: Ghaneshree Moonsamy, Nodumo N. Zulu, Rajesh Lalloo, Suren Singh, Santosh O. Ramchuran

Abstract:

The abalone industry of South Africa is under severe pressure due to illegal harvesting and poaching of this seafood delicacy. These abalones are harvested excessively; as a result, these animals do not have a chance to replace themselves in their habitats, ensuing in a drastic decrease in natural stocks of abalone. Abalone has an extremely slow growth rate and takes approximately four years to reach a size that is market acceptable; therefore, it was imperative to investigate methods to boost the overall growth rate and immunity of the animal. The University of Cape Town (UCT) began to research, which resulted in the isolation of two microorganisms, a yeast isolate Debaryomyces hansenii and a bacterial isolate Vibrio midae, from the gut of the abalone and characterised them for their probiotic abilities. This work resulted in an internationally competitive concept technology that was patented. The next stage of research was to develop a suitable bioprocess to enable commercial production. Numerous steps were taken to develop an efficient production process for V. midae, one of the isolates found by UCT. The initial stages of research involved the development of a stable and robust inoculum and the optimization of physiological growth parameters such as temperature and pH. A range of temperature and pH conditions were evaluated, and data obtained revealed an optimum growth temperature of 30ᵒC and a pH of 6.5. Once these critical growth parameters were established further media optimization studies were performed. Corn steep liquor (CSL) and high test molasses (HTM) were selected as suitable alternatives to more expensive, conventionally used growth medium additives. The optimization of CSL (6.4 g.l⁻¹) and HTM (24 g.l⁻¹) concentrations in the growth medium resulted in a 180% increase in cell concentration, a 5716-fold increase in cell productivity and a 97.2% decrease in the material cost of production in comparison to conventional growth conditions and parameters used at the onset of the study. In addition, a stable market-ready liquid probiotic product, encompassing the viable but not culturable (VBNC) state of Vibrio midae cells, was developed during the downstream processing aspect of the study. The demonstration of this technology at a full manufacturing scale has further enhanced the attractiveness and commercial feasibility of this production process.

Keywords: probiotics, abalone aquaculture, bioprocess technology, manufacturing scale technology development

Procedia PDF Downloads 145
3470 Subclinical Renal Damage Induced by High-Fat Diet in Young Rats

Authors: Larissa M. Vargas, Julia M. Sacchi, Renata O. Pereira, Lucas S. Asano, Iara C. Araújo, Patricia Fiorino, Vera Farah

Abstract:

The aim of this study was to evaluate the occurrence of subclinical organ injuries induced by high-fat diet. Male wistar rats (n=5/group) were divided in control diet group (CD), commercial rat chow, and hyperlipidic diet (30% lipids) group (HD) administrated during 8 weeks, starting after weaning. All the procedures followed the rules of the Committee of Research and Ethics of the Mackenzie University (CEUA Nº 077/03/2011). At the end of protocol the animals were euthanized by anesthesia overload and the left kidney was removed. Intrarenal lipid deposition was evaluated by histological analyses with oilred. Kidney slices were stained with picrosirius red to evaluate the area of the Bowman's capsule (AB) and space (SB), and glomerular tuft area (GT). The renal expression of sterol regulatory element–binding protein (SREBP-2) was performed by Western Blotting. Creatinine concentration (serum and urine) and lipid profile were determined by colorimetric kit (Labtest). At the end of the protocol there was no differences in body weight between the groups, however the HD showed a marked increase in lipid deposits, glomeruli and tubules, and biochemical analysis for cholesterol and triglycerides. Moreover, in the kidney, the high-fat diet induced a reduction in the AB (13%), GT (18%) and SB (17%) associated with a reduction in glomerular filtration rate (creatinine clearance). The renal SRBP2 expression was increased in HD group. These data suggests that consumption of high-fat diet starting in childhood is associated with subclinical renal damage and function.

Keywords: high-fat diet, kidney, intrarenal lipid deposition, SRBP2

Procedia PDF Downloads 285
3469 Factors Contributing to Delayed Diagnosis and Treatment of Breast Cancer and Its Outcome in Jamhoriat Hospital Kabul, Afghanistan

Authors: Ahmad Jawad Fardin

Abstract:

Over 60% of patients with breast cancer in Afghanistan present late with advanced stage III and IV, a major cause for the poor survival rate. The objectives of this study were to identify the contributing factors for the diagnosis and treatment delay and its outcome. This cross-sectional study was conducted on 318 patients with histologically confirmed breast cancer in the oncology department of Jamhoriat hospital, which is the first and only national cancer center in Afghanistan; data were collected from medical records and interviews conducted with women diagnosed with breast cancer, linear regression and logistic regression were used for analysis. Patient delay was defined as the time from first recognition of symptoms until first medical consultation and doctor form first consultation with a health care provider until histological confirmation of breast cancer. The mean age of patients was 49.2+_ 11.5years. The average time for the final diagnosis of breast cancer was 8.5 months; most patients had ductal carcinoma 260.7 (82%). Factors associated with delay were low education level 76% poor socioeconomic and cultural conditions 81% lack of cancer center 73% lack of screening 19%. The stage distribution was as follows stage IV 4 22% stage III 44.4% stage II 29.3% stage I 4.3%. Complex associated factors were identified to delayed the diagnosis of breast cancer and increased adverse outcomes consequently. Raising awareness and education in women, the establishment of cancer centers and providing accessible diagnosis service and screening, training of general practitioners; required to promote early detection, diagnosis and treatment.

Keywords: delayed diagnosis and poor outcome, breast cancer in Afghanistan, poor outcome of delayed breast cancer treatment, breast cancer delayed diagnosis and treatment in Afghanistan

Procedia PDF Downloads 170
3468 The Role of Rapid Maxillary Expansion in Managing Obstructive Sleep Apnea in Children: A Literature Review

Authors: Suleman Maliha, Suleman Sidra

Abstract:

Obstructive sleep apnea (OSA) is a sleep disorder that can result in behavioral and psychomotor impairments in children. The classical treatment modalities for OSA have been continuous positive airway pressure and adenotonsillectomy. However, orthodontic intervention through rapid maxillary expansion (RME) has also been commonly used to manage skeletal transverse maxillary discrepancies. Aim and objectives: The aim of this study is to determine the efficacy of rapid maxillary expansion in paediatric patients with obstructive sleep apnea by assessing pre and post-treatment mean apnea-hypopnea index (AHI) and oxygen saturations. Methodology: Literature was identified through a rigorous search of the Embase, Pubmed, and CINAHL databases. Articles published from 2012 onwards were selected. The inclusion criteria consisted of patients aged 18 years and under with no systemic disease, adenotonsillar surgery, or hypertrophy who are undergoing RME with AHI measurements before and after treatment. In total, six suitable papers were identified. Results: Three studies assessed patients pre and post-RME at 12 months. The first study consisted of 15 patients with an average age of 7.5 years. Following treatment, they found that RME resulted in both higher oxygen saturations (+ 5.3%) and improved AHI (- 4.2 events). The second study assessed 11 patients aged 5–8 years and also noted improvements, with mean AHI reduction from 6.1 to 2.4 and oxygen saturations increasing from 93.1% to 96.8%. The third study reviewed 14 patients aged 6–9 years and similarly found an AHI reduction from 5.7 to 4.4 and an oxygen saturation increase from 89.8% to 95.5%. All modifications noted in these studies were statistically significant. A long-term study reviewed 23 patients aged 6–12 years post-RME treatment on an annual basis for 12 years. They found that the mean AHI reduced from 12.2 to 0.4, with improved oxygen saturations from 78.9% to 95.1%. Another study assessed 19 patients aged 9-12 years at two months into RME and four months post-treatment. Improvements were also noted at both stages, with an overall reduction of the mean AHI from 16.3 to 0.8 and an overall increase in oxygen saturations from 77.9% to 95.4%. The final study assessed 26 children aged 7-11 years on completion of individual treatment and found an AHI reduction from 6.9 to 5.3. However, the oxygen saturation remained stagnant at 96.0%, but this was not clinically significant. Conclusion: Overall, the current evidence suggests that RME is a promising treatment option for paediatric patients with OSA. It can provide efficient and conservative treatment; however, early diagnosis is crucial. As there are various factors that could be contributing to OSA, it is important that each case is treated on its individual merits. Going forward, there is a need for more randomized control trials with larger cohorts being studied. Research into the long-term effects of RME and potential relapse amongst cases would also be useful.

Keywords: orthodontics, sleep apnea, maxillary expansion, review

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