Search results for: early childhood center

Authors: Rabie Fadil, Parshuram Aarotale, Shubha Majumder, Bijay Guargain

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Hemorrhage is the loss of blood from the circulatory system and leading cause of battlefield and postpartum related deaths. Early detection of hemorrhage remains the most effective strategy to reduce mortality rate caused by traumatic injuries. In this study, we investigated the physiological changes via non-invasive cardiac signals at rest and under different hemorrhage conditions simulated through graded lower-body negative pressure (LBNP). Simultaneous electrocardiogram (ECG), photoplethysmogram (PPG), blood pressure (BP), impedance cardiogram (ICG), and phonocardiogram (PCG) were acquired from 10 participants (age:28 ± 6 year, weight:73 ± 11 kg, height:172 ± 8 cm). The LBNP protocol consisted of applying -20, -30, -40, -50, and -60 mmHg pressure to the lower half of the body. Beat-to-beat heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean aerial pressure (MAP) were extracted from ECG and blood pressure. Systolic amplitude (SA), systolic time (ST), diastolic time (DT), and left ventricle Ejection time (LVET) were extracted from PPG during each stage. Preliminary results showed that the application of -40 mmHg i.e. moderate stage simulated hemorrhage resulted significant changes in HR (85±4 bpm vs 68 ± 5bpm, p < 0.01), ST (191 ± 10 ms vs 253 ± 31 ms, p < 0.05), LVET (350 ± 14 ms vs 479 ± 47 ms, p < 0.05) and DT (551 ± 22 ms vs 683 ± 59 ms, p < 0.05) compared to rest, while no change was observed in SA (p > 0.05) as a consequence of LBNP application. These findings demonstrated the potential of cardiac signals in detecting moderate hemorrhage. In future, we will analyze all the LBNP stages and investigate the feasibility of other physiological signals to develop a predictive machine learning model for early detection of hemorrhage.

Keywords: blood pressure, hemorrhage, lower-body negative pressure, LBNP, machine learning

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Authors: Linus O. Asuquo

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Mining in Nigeria and development effort of metallurgical technologies at National Metallurgical Development Centre Jos has been addressed in this paper. The paper has looked at the history of mining in Nigeria, the impact of mining on social and industrial development, and the contribution of the mining sector to Nigeria’s Gross Domestic Product (GDP). The paper clearly stated that Nigeria’s mining sector only contributes 0.5% to the nation’s GDP unlike Botswana that the mining sector contributes 38% to the nation’s GDP. Nigeria Bureau of Statistics has it on record that Nigeria has about 44 solid minerals awaiting to be exploited. Clearly highlighted by this paper is the abundant potentials that exist in the mining sector for investment. The paper made an exposition on the extensive efforts made at National Metallurgical Development Center (NMDC) to develop metallurgical technologies in various areas of the metals sector; like mineral processing, foundry development, nonferrous metals extraction, materials testing, lime calcination, ANO (Trade name for powder lubricant) wire drawing lubricant, refractories and many others. The paper went ahead to draw a conclusion that there is a need to develop the mining sector in Nigeria and to give a sustainable support to the efforts currently made at NMDC to develop metallurgical technologies which are capable of transforming the metals sector in Nigeria, which will lead to industrialization. Finally the paper made some recommendations which traverse the topic for the best expectation.

Keywords: mining, minerals, technologies, value addition

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Authors: L. P. K. Liyanage, N. R. P. Withana, A. L. Sandika

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The purpose of this study was to determine tourist and community perception-based sustainable tourism indicators as well as Human Pressure Index (HPI) and Tourist Activity Index (TAI). Study was carried out in Sinharaja forest which is considered as one of the major eco-tourism destination in Sri Lanka. Data were gathered using a pre-tested semi-structured questionnaire as well as records from Forest department. Convenient sampling technique was applied. For the majority of issues, the responses were obtained on multi-point Likert-type scales. Visual portrayal was used for display analyzed data. The study revealed that the host community of the Kudawa gets many benefits from tourism. Also, tourism has caused negative impacts upon the environment and community. The study further revealed the need of proper waste management and involvement of local cultural events for the tourism business in the Kudawa conservation center. The TAI, which accounted to be 1.27 and monthly evolution of HPI revealed that congestion can be occurred in the Sinharaja rainforest during peak season. The results provide useful information to any party involved with tourism planning anywhere, since such attempts would be more effective once the people’s perceptions on these aspects are taken into account.

Keywords: Kudawa Conservation Center, Sinharaja World Heritage Rainforest, sustainability indicators, community perception

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Authors: Nomfundo Ngombane, Topside E. Mathonsi

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Remote sensing and satellite imaging have been widely used to detect wildfires; nevertheless, the technologies present some limitations in terms of early wildfire detection as the technologies are greatly influenced by weather conditions and can miss small fires. The fires need to have spread a few kilometers for the technologies to provide accurate detection. The South African Advanced Fire Information System uses MODIS (Moderate Resolution Imaging Spectroradiometer) as satellite imaging. MODIS has limitations as it can exclude small fires and can fall short in validating fire vulnerability. Thus in the future, a Machine Learning algorithm will be designed and implemented for the early detection of wildfires. A simulator will be used to evaluate the effectiveness of the proposed solution, and the results of the simulation will be presented.

Keywords: moderate resolution imaging spectroradiometer, advanced fire information system, machine learning algorithm, detection of wildfires

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Authors: Amarachukwu B. Isiaka, Vivian N. Anakwenze, Chinyere C. Ezemba, Chiamaka R. Ilodinso, Chikodili G. Anaukwu, Chukwuebuka M. Ezeokoli, Ugonna H. Uzoka

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Infectious diseases continue to pose significant threats to global public health, necessitating advanced and timely detection methods for effective outbreak management. This study explores the integration of artificial intelligence (AI) in the early detection and management of infectious disease outbreaks. Leveraging vast datasets from diverse sources, including electronic health records, social media, and environmental monitoring, AI-driven algorithms are employed to analyze patterns and anomalies indicative of potential outbreaks. Machine learning models, trained on historical data and continuously updated with real-time information, contribute to the identification of emerging threats. The implementation of AI extends beyond detection, encompassing predictive analytics for disease spread and severity assessment. Furthermore, the paper discusses the role of AI in predictive modeling, enabling public health officials to anticipate the spread of infectious diseases and allocate resources proactively. Machine learning algorithms can analyze historical data, climatic conditions, and human mobility patterns to predict potential hotspots and optimize intervention strategies. The study evaluates the current landscape of AI applications in infectious disease surveillance and proposes a comprehensive framework for their integration into existing public health infrastructures. The implementation of an AI-driven early detection system requires collaboration between public health agencies, healthcare providers, and technology experts. Ethical considerations, privacy protection, and data security are paramount in developing a framework that balances the benefits of AI with the protection of individual rights. The synergistic collaboration between AI technologies and traditional epidemiological methods is emphasized, highlighting the potential to enhance a nation's ability to detect, respond to, and manage infectious disease outbreaks in a proactive and data-driven manner. The findings of this research underscore the transformative impact of harnessing AI for early detection and management, offering a promising avenue for strengthening the resilience of public health systems in the face of evolving infectious disease challenges. This paper advocates for the integration of artificial intelligence into the existing public health infrastructure for early detection and management of infectious disease outbreaks. The proposed AI-driven system has the potential to revolutionize the way we approach infectious disease surveillance, providing a more proactive and effective response to safeguard public health.

Keywords: artificial intelligence, early detection, disease surveillance, infectious diseases, outbreak management

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Authors: Achinthya Bandara

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The Portuguese were the first known European Nation to colonize Ceylon during the early 16th century. When the Portuguese set sail in the late 15th century towards the East and West, they first landed in Pondicherry (Pondicherry), an eastern coastal location of early India and established their trade in the Indian Oceanic regions. Sri Lanka (Ceylon until 1972) made its first contact with the Portuguese just a few years after they anchored in India, the Luso-Sri Lankan contact was initiated and became prominent across the time, even during the later colonial rules, i.e., Dutch and British. Such connections created a Luso-Asian hybrid culture in Ceylon that shared both Sri Lankan and European identities. Portuguese Creole communities were prominent among them as an ethnic group with Portuguese descent interwoven with local traditions and customs, yet outcast by the mainstream Portuguese colonials. Hugh Nevil, a British Civil Servant who served Ceylon in the early 1800s, had collected a considerable amount of such Luso-Asian Literature belonging to Sri Lankan Portuguese creole communities, including 180 Portuguese creole verses sung by the creole communities in Eastern Sri Lanka. Though the collection was studied to uncover literature traits, few or no known studies focused on the anti-colonial subaltern discourse appearing in the shades of this work. It is evident that these verses contain local anti-colonial ideologies that create a platform to place them as elements of Luso-Asian subaltern literature. This research explores how the language and content of these verses contradict the mainstream colonial ideologies we intend to position within a regional anti-colonial subaltern context. As this is part of a long-term research project that translates the whole collection into Sinhalese and Tamil, this study will show evidence from early 1800s verses to suggest how Luso-Asian communities create a unique subaltern linguistic and literary discourse.

Keywords: Luso Asian creoles, Luso Asian subalterns, anti-colonial ideologies, Sri Lanka Portuguese creole

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Authors: Wiriranai Brilliant Masara

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The African Peace and Security Architecture is widely celebrated and revered as a paragon of the will to address peace and security challenges in Africa. However, like any other institution, it is embedded with operational and institutional challenges that prevent it from effectively carrying out its mandate and turning goals into achieved results. The article examines the fundamental flaws and weaknesses of the African Peace and Security Architecture by focusing on its institutions, norms, instruments, and its relationship to Africa’s Regional Economic Communities. Therefore, the article reviews the flaws of the five elements of the African Peace and Security Architecture which are the Peace and Security Council, Panel of the Wise, Continental Early Warning System, African Standby Force, and Peace Fund.

Keywords: African Union, African Peace and Security Architecture, peace and security council, continental early warning system, African Standby Force, Panel of the Wise, Peace Fund

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Authors: Ferdi Afian, Inne Yuliawati

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Background: The change in causes of death from infectious diseases to non-communicable diseases also occurs in the aviation community in Indonesia. Non-communicable diseases are influenced by several internal risk factors, such as age, lifestyle changes and the presence of other diseases. These risk factors will increase the incidence of heart diseases resulting in the incapacity of Indonesian aviators which will disrupt flight safety. Method: The study was conducted by collecting secondary data. The retrieval of primary data was obtained from medical records at the Indonesian Aviation Health Center in 2016-2017. The subjects in this study were all cases of incapacity in Indonesian aviators medical conditions. Results: In this study, there were 15 cases of aviators in Indonesia who experienced incapacity of medical conditions related to heart and lung diseases in 2016-2017. Based on the secondary data contained in the flight medical records at the Aviation Health Center Aviation, it was found that several factors related to aviators incapacity causing its inability to carried out flight duties. Conclusion: Incapacity of Indonesian aviators medical conditions are most affected by the high value of Body Mass Index (86%) and less affected by high of Uric Acid in the blood (26%) and Hyperglycemia (26%).

Keywords: incapacity, aviators, flight, Indonesia

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Authors: Roshan Kamal Topno, Maneesh Kumar, Manas Ranjan Dikhit, Krishna Pandey, Major Madhukar, Vidhya Nand Rabidas, Vahab Ali, Ganesh Chandra Sahoo, Bhawana, Devendra Prasad Yadav, Rishikesh Kumar, Pradeep Das

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A diagnostic marker for asymptomatic subject becomes a crucial need for advocating early prophylactic majors to control protozoal infection. The main issue in epidemiological affected regions is the presence of an asymptomatic individual that might potentially convert to a symptomatic visceral leishmaniasis (VL). The epidemiological study has been conducted at highly VL endemic Moriyama village in Patna district, Bihar, India that covers total population of 1540 individuals. Here, 1104(74.02%) people had been randomly screened and only 46 (4.17%) asymptomatic individuals were found sero-positive by the rK39 test. After taking signed informed consent form, blood samples were collected from 46 asymptomatic subjects for further hematological and immunological tests. Total leukocyte count, hemoglobin (gm%), neutrophil, lymphocyte, platelet count and interleukin-10 (IL-10) had been included as diagnostic markers. Interestingly only 5 (10.86%) individuals showed their asymptomatic conversion into symptomatic VL patients during quarterly surveillance. In overall analysis only two markers are suggestive for disease conversion that is hemoglobin (gm%) and IL-10. In all the infected patients, both the mean decrease in hemoglobin and mean increase of IL-10 was 19.23% from its normal value. The results might suggest that hematological and immunological changes would become helpful for early diagnosis of asymptomatic to symptomatic VL conversion.

Keywords: asymptomatic, epidemiological, symptomatic visceral leishmaniasis, hemoglobin (gm%), interleukin-10, diagnosis

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Authors: Alicia Curtin, Kathy Hall

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This paper explores research and practice shared on a masters University module entitled Children's Literature as Pedagogy. Issues explored include the meaning of childhood and literature; the definition of what counts as text, textual and literacy practice for children and adolescents. A sociocultural framework is used to define literacy practice from this perspective and student voice and experience remains central. Lessons from classroom experience and the use of innovative, multi modal and non traditional texts and pedagogical approaches are offered as examples of innovative and inclusive pedagogy in the field of literacy practice.

Keywords: non traditional, pedagogy, practice, sociocultural

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Authors: Ayten Tahirli

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Settlements and grave monuments discovered by archeological excavations conducted in Nakhchivan Autonomous Republic have a special place in studying the Ancient history of Azerbaijan between the 4th century B.C. and the 3rd century A.C. From this point of view, the archeological excavations and investigations conducted at Oglankala, Goshatapa, Babatapa, Pusyan, Agvantapa, Meydantapa and other monuments in Nakhchivan have a specific place. From this point of view, the conclusions of archeological research conducted at the Oglankala settlement enable studying of Nakhchivan history, economic life and trade relationships broadly. Oglankala, which is located on Garatapa Mountain with a space of 50 ha, was the largest fortress in Nakhchivan and one of the largest fortresses in the South Caucasus during the Middle Iron Age. The territory where the monument is located is very important in terms of keeping Sharur Lowland, which has great importance for agriculture and is the most productive territory in Nakhchivan, where Arpachay passes starting from the Lesser Caucasus. During the excavations between 1988 and 1989 at Oglankala, covering the fortress's history belonging to the Early and Middle Iron Ages, indisputable proofs showing that the territory was an important political center were discovered at that territory. Oglankala was the capital city of an independent government during the Middle Iron Age. It maintained economic and cultural relationships with the neighboring Urartu Government and was the capital city of a city government covered by a strong protection system in the centuries after the collapse of the Achaemenid Empire. It is need say that broader archeological excavations at Oglankala City were first started by Vali Bakhshaliyev, the Department Head of the Institute of History, Ethnography and Archeology of ANAS Nakhchivan Branch. Between 1988 and 1989, V.B. Bakhshaliyev conducted an excavation within an area of 320 square meters at Oglankala. Since 2006, Oglankala has become a research object for the International Azerbaijan-USA archeological expedition. In 2006, Lauren Ristvet from Pennsylvania State University, Veli Bakhshaliyev from the Nakhchivan Branch of Azerbaijan National Academy of Sciences and Safar Ashurov from Baku Office of Azerbaijan National Academy of Sciences, together with their other colleagues and students, started to study the ancient history of that magic area. During the archeological research conducted by an international expedition between 2008 and 2011 under the supervision of Vali Bakhshaliyev, the remnants of a palace and the protective walls of a citadel constructed between late 9th century B.C. and early 8th century A.C. were discovered in that residential area. It was found out that Oglankala was the capital city of a small government established at Sharur Lowland during the Middle Iron Age and struggled against the Urartu by establishing a union with the local tribes. That government had a specific cuneiform script. Between the 4th and 2nd centuries B.C., Oglankala and the territory it covered was one of the major political centers of the Atropathena Government.

Keywords: Nakhchivan, Oglankala, settlement, ceramic, archaeological excavation

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Authors: Cassey Younghans

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Background: Current health care trends demonstrate that there is an increasing number of patients being hospitalized with complex comorbidities. These complex needs require advanced therapies, and treatment goals often focus on doing everything possible to prolong life rather than focusing on the individual patient’s quality of life which is the goal of palliative care efforts. Patients benefit from palliative care in the early stages of the illness rather than after the disease progressed or the state of acuity has advanced. The clinical problem identified was that palliative care was not being implemented early enough in the disease process with patients who had complex medical conditions and who would benefit from the philosophy and skills of palliative care professionals. Purpose: The purpose of this quality improvement study was to increase the number of palliative care screenings and consults completed on adults after being admitted to one Non-ICU and Non-COVID hospital unit. Methods: A retrospective chart review assessing for possible missed opportunities to introduce palliation was performed for patients with six primary diagnoses, including heart failure, liver failure, end stage renal disease, chronic obstructive pulmonary disease, cerebrovascular accident, and cancer in a population of adults over the ago of 19 on one medical-surgical unit over a three-month period prior to the intervention. An educational session with the nurses on the benefits of palliative care was conducted by the researcher, and a screening tool was implemented. The expected outcome was to have an increase in early palliative care consultation with patients with complex comorbid conditions and a decrease in missed opportunities for the implementation of palliative care. Another retrospective chart review was completed following completion of the three month piloting of the tool. Results: During the retrospective chart review, 46 patients were admitted to the medical-surgical floor with the primary diagnoses identified in the inclusion criteria. Six patients had palliative care consults completed during that time. Twenty-two palliative care screening tools were completed during the intervention period. Of those, 15 of the patients scored a 7 or higher, suggesting that a palliative care consultation was warranted. The final retrospective chart review identified that 4 palliative consults were implemented during that time of the 31 patients who were admitted over the three month time frame. Conclusion: Educating nurses and implementing a palliative care screening upon admission can be of great value in providing early identification of patients who might benefit from palliative care. Recommendations – It is recommended that this screening tool should be used to help identify the patents of whom would benefit from a palliative care consult, and nurses would be able to initiated a palliative care consultation themselves.

Keywords: palliative care, screening, early, palliative care consult

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Authors: D. Tohlob, E. Abo Hashem, N. Ghareeb, M. Ghanem, R. Elfarahaty, S. A. Roberts, P. Pemberton, L. Mohiyiddeen, W. G. Newman

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Gonadotropin stimulation is used in females undergoing assisted reproductive treatment for ovulation induction, but ovarian response is variable and unpredictable in these women. More effective protocols and individualization of treatment are needed to increase the success rate of IVF/ICSI cycles. We genotyped seven variants reported in previous studies to be associated with ovarian response (number of ova retrieved and total gonadotropin dose) in women undergoing IVF treatment including FSHR variants Asn 680 Ser (c.2039 A > G), Thr 307 Ala (c. 919 > A), -29 G > A, HRG c.610 C > T gene, BMP15 -9 C > G, AMH Ile 49 Ser (c.146 G > T), and AMHR -489A˃G in 118 Egyptian females attending Mansoura Integrated Fertility Center in Egypt, these females were undergoing their first cycle of controlled ovarian hyper stimulation for IVF/ICSI treatment. They were analyzed by TaqMan allelic discrimination assay in Manchester Center of Genomic Medicine. We found no evidence of any significant difference (p value < 0.05) in the number of eggs retrieved or the gonadotropin dose used between individuals in all genotypes except for HRG c.610 C > T gene polymorphism where regression analysis gives a p value of 0.04 with a fewer eggs number in TT genotyped females. These results indicate that these variants do not provide sufficient clinically relevant data to individualize the treatment protocols.

Keywords: controlled ovarian hyperstimulation, gene variants, ovarian response, assisted reproduction

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Authors: George Abu-Aqil, Leah Tsror, Elad Shufan, Shaul Mordechai, Mahmoud Huleihel, Ahmad Salman

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Pectobacterium and Dickeya spp which negatively affect a wide range of crops are the main causes of the aggressive diseases of agricultural crops. These aggressive diseases are responsible for a huge economic loss in agriculture including a severe decrease in the quality of the stored vegetables and fruits. Therefore, it is important to detect these pathogenic bacteria at their early stages of infection to control their spread and consequently reduce the economic losses. In addition, early detection is vital for producing non-infected propagative material for future generations. The currently used molecular techniques for the identification of these bacteria at the strain level are expensive and laborious. Other techniques require a long time of ~48 h for detection. Thus, there is a clear need for rapid, non-expensive, accurate and reliable techniques for early detection of these bacteria. In this study, infrared spectroscopy, which is a well-known technique with all its features, was used for rapid detection of Pectobacterium and Dickeya spp. at the strain level. The bacteria were isolated from potato plants and tubers with soft rot symptoms and measured by infrared spectroscopy. The obtained spectra were analyzed using different machine learning algorithms. The performances of our approach for taxonomic classification among the bacterial samples were evaluated in terms of success rates. The success rates for the correct classification of the genus, species and strain levels were ~100%, 95.2% and 92.6% respectively.

Keywords: soft rot enterobacteriaceae (SRE), pectobacterium, dickeya, plant infections, potato, solanum tuberosum, infrared spectroscopy, machine learning

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Authors: Mahmoud Reza Hosseini

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The universe is in a continuous expansion process, resulting in the reduction of its density and temperature. Also, by extrapolating back from its current state, the universe at its early times has been studied known as the big bang theory. According to this theory, moments after creation, the universe was an extremely hot and dense environment. However, its rapid expansion due to nuclear fusion led to a reduction in its temperature and density. This is evidenced through the cosmic microwave background and the universe structure at a large scale. However, extrapolating back further from this early state reaches singularity which cannot be explained by modern physics and the big bang theory is no longer valid. In addition, one can expect a nonuniform energy distribution across the universe from a sudden expansion. However, highly accurate measurements reveal an equal temperature mapping across the universe which is contradictory to the big bang principles. To resolve this issue, it is believed that cosmic inflation occurred at the very early stages of the birth of the universe According to the cosmic inflation theory, the elements which formed the universe underwent a phase of exponential growth due to the existence of a large cosmological constant. The inflation phase allows the uniform distribution of energy so that an equal maximum temperature could be achieved across the early universe. Also, the evidence of quantum fluctuations of this stage provides a means for studying the types of imperfections the universe would begin with. Although well-established theories such as cosmic inflation and the big bang together provide a comprehensive picture of the early universe and how it evolved into its current state, they are unable to address the singularity paradox at the time of universe creation. Therefore, a practical model capable of describing how the universe was initiated is needed. This research series aims at addressing the singularity issue by introducing an energy conversion mechanism. This is accomplished by establishing a state of energy called a “neutral state”, with an energy level which is referred to as “base energy” capable of converting into other states. Although it follows the same principles, the unique quanta state of the base energy allows it to be distinguishable from other states and have a uniform distribution at the ground level. Although the concept of base energy can be utilized to address the singularity issue, to establish a complete picture, the origin of the base energy should be also identified. This matter is the subject of the first study in the series “A Conceptual Study for Investigating the Creation of Energy and Understanding the Properties of Nothing” which is discussed in detail. Therefore, the proposed concept in this research series provides a road map for enhancing our understating of the universe's creation from nothing and its evolution and discusses the possibility of base energy as one of the main building blocks of this universe.

Keywords: big bang, cosmic inflation, birth of universe, energy creation

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Authors: Mustafa Metin Donma, Orkide Donma

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Obesity in children particularly draws attention because it may threaten the individual’s future life due to many chronic diseases it may lead to. Most of these diseases, including obesity itself altogether are related to inflammation. For this reason, inflammation-related parameters gain importance. Within this context, complete blood cell counts, ratios or indices derived from these counts have recently found some platform to be used as inflammatory markers. So far, mostly adipokines were investigated within the field of obesity. The liver is at the center of the metabolic pathways network. Metabolic inflammation is closely associated with cellular dysfunction. In this study, hematologic inflammatory markers and two major hepatokines, cytokines produced predominantly by the liver, fibroblast growth factor-21 (FGF-21) and fetuin A were investigated in pediatric obesity. Two groups were constituted from seventy-six obese children based on World Health Organization criteria. Group 1 was composed of children whose age- and sex-adjusted body mass index (BMI) percentiles were between 95 and 99. Group 2 consists of children who are above the 99ᵗʰ percentile. The first and the latter groups were defined as obese (OB) and morbid obese (MO). Anthropometric measurements of the children were performed. Informed consent forms and the approval of the institutional ethics committee were obtained. Blood cell counts and ratios were determined by an automated hematology analyzer. The related ratios and indexes were calculated. Statistical evaluation of the data was performed by the SPSS program. There was no statistically significant difference in terms of neutrophil-to lymphocyte ratio, monocyte-to-high density lipoprotein cholesterol ratio and the platelet-to-lymphocyte ratio between the groups. Mean platelet volume and platelet distribution width values were decreased (p<0.05), total platelet count, red cell distribution width (RDW) and systemic immune inflammation index values were increased (p<0.01) in MO group. Both hepatokines were increased in the same group; however, increases were not statistically significant. In this group, also a strong correlation was calculated between FGF-21 and RDW when controlled by age, hematocrit, iron and ferritin (r=0.425; p<0.01). In conclusion, the association between RDW, a hematologic inflammatory marker, and FGF-21, an inflammation-related hepatokine, found in MO group is an important finding discriminating between OB and MO children. This association is even more powerful when controlled by age and iron-related parameters.

Keywords: childhood obesity, fetuin A , fibroblast growth factor-21, hematologic markers, red cell distribution width

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Authors: Shaik Asha Begum, S. Joshna Rani, Shaik Abdul Rahaman

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INTRODUCTION: Breast cancer is a disease that creates in breast cells. "KAP" study estimates the Knowledge, Attitude, and Practices of a local area. More than 1.5 million ladies (25% of all ladies with malignancy) are determined to have bosom disease consistently all through the world. Understanding the degrees of Knowledge, Attitude and Practice will empower a more effective cycle of mindfulness creation as it will permit the program to be custom-made all the more properly to the necessities of the local area. OBJECTIVES: The objective of this study is to assess the knowledge on signs and symptoms, risk factors, provide awareness on the practicing of the early detection techniques of breast cancer and provide knowledge on the overall breast cancer including preventive techniques. METHODOLOGY: This is an expressive cross-sectional investigation. This investigation of KAP was done in the Nirmala Educational Institutions from January to April 2021. A total of 300 participants are included from women students in pharmacy graduates & lecturers, and also from graduates other than the pharmacy. The examiners are taken from the BCAM (Breast Cancer Awareness Measure), tool compartment (Version 2). RESULT: According to the findings of the study, the majority of the participants were not well informed about breast cancer. A lump in the breast was the most commonly mentioned sign of breast cancer, followed by pain in the breast or nipple. The percentage of knowledge related to the breast cancer risk factors was also very less. The correct answers for breast cancer risk factors were radiation exposure (58.20 percent), a positive family history (47.6 percent), obesity (46.9 percent), a lack of physical activity (43.6 percent), and smoking (43.2 percent). Breast cancer screening, on the other hand, was uncommon (only 30 and 11.3 percent practiced clinical breast examination and mammography respectively). CONCLUSION: In this study, the knowledge on the signs and symptoms, risk factors of breast cancer - pharmacy graduates have more knowledge than the non-pharmacy graduates but in the preventive techniques and early detective tools of breast cancer -had poor knowledge in the pharmacy and non-pharmacy graduate. After the awareness program, pharmacy and non-pharmacy graduates got supportive knowledge on the preventive techniques and also practiced the early detective techniques of breast cancer.

Keywords: breast cancer, mammography, KAP study, early detection

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Authors: Angélique Laurent, Marie-Josée Letarte, Jean-Pascal Lemelin, Marie-France Morin

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This study aims at exploring teacher-child interactions within learning contexts in public prekindergartens of the province of Québec (Canada). It is based on previous research showing that teacher-child interactions in preschools have direct and determining effects on the quality of early childhood education and could directly or indirectly influence child development. However, throughout a typical preschool day, children experience different learning contexts to promote their learning opportunities. Depending on these specific contexts, teacher-child interactions could vary, for example, between free play and shared book reading. Indeed, some studies have found that teacher-directed or child-directed contexts might lead to significant variations in teacher-child interactions. This study drew upon both the bioecological and the Teaching Through Interactions frameworks. It was conducted through a descriptive and correlational design. Fifteen teachers were recruited to participate in the study. At Time 1 in October, they completed a diary to report the learning contexts they proposed in their classroom during a typical week. At Time 2, seven months later (May), they were videotaped three times in the morning (two weeks’ time between each recording) during a typical morning class. The quality of teacher-child interactions was then coded with the Classroom Assessment Scoring System (CLASS) through the contexts identified. This tool measures three main domains of interactions: emotional support, classroom organization, and instruction support, and10 dimensions scored on a scale from 1 (low quality) to 7 (high quality). Based on the teachers’ reports, five learning contexts were identified: 1) shared book reading, 2) free play, 3) morning meeting, 4) teacher-directed activity (such as craft), and 5) snack. Based on preliminary statistical analyses, little variation was observed within the learning contexts for each domain of the CLASS. However, the instructional support domain showed lower scores during specific learning contexts, specifically free play and teacher-directed activity. Practical implications for how preschool teachers could foster specific domains of interactions depending on learning contexts to enhance children’s social and academic development will be discussed.

Keywords: teacher practices, teacher-child interactions, preschool education, learning contexts, child development

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Authors: Ella Abaev, Shany Segal, Miri Gabay

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Background: Choking is a blockage of airways that prevents efficient breathing and air flow to the lungs. Choking may be partial or full and is an emergency situation. Complete or prolonged choking leads to apnea, lack of oxygen in the tissues of the body and brain, and can cause death. There are three mechanisms of choking: obstruction of internal respiratory tracts by food or object aspiration, any material that blocks or covers external air passages, external pressure on the neck or trapping between objects. Children's airways are narrower than that of adults and therefore the risk of choking is greater, due to the aspiration of food and other foreign bodies into the lungs. In the Child Development Center at Safra Children’s Hospital, Tel Hashomer in Israel are treated infants, toddlers, and children aged 0-18 years with various developmental disabilities. Due to the increase in reports of ‘almost an event’ of choking in the past year and the serious consequences of choking event, it was decided to give an emphasis to the issue. Incidence and methods: The number of reports of ‘almost an event’ or a choking event was examined at the center during the years 2013-2018 and a thorough research work was conducted on the subject in order to build a prevention program. Findings: Between 2013 and 2018 the center reported about ten cases of ‘almost choking events’. In the middle of 2018 alone three cases of ‘almost an event’ were reported. Objective: Providing knowledge leads to awareness raise, change of perception, change in behavior and prevention. The center employs more than 130 staff members from various sectors so that it is the work of multi-professional teams to promote the quality and safety of the treatment. The familiarity of the staff with risk factors, prevention guidelines, identification of choking signs, and treatment are most important and significant in determining the outcome of a choking event. Conclusions and recommendations: After in-depth research work was carried out in cooperation with the Risk Management Unit on the subject of choking, which include a description of the definitions, mechanisms, risk factors, treatment methods and extensive recommendations for prevention (e.g. using treatment and stimulation accessories with standards association stamps and adjustment of the type of food and the way it is served to match to the child's age and the ability to swallow). The expected stages of development and emphasis on the population of children with special needs were taken into account. The research findings will be published by the staff and parents of the patients, professional publications, and lectures and there is an expectation to decrease the number of choking events in the next years.

Keywords: children with special needs, choking, educational system, prevention guidelines

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Authors: Cangir Uyarlar, Ismail Bayram, Ibrahim Sadi Cetingul, Mustafa Kabu, Eyup Eren Gultepe

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This study was conducted to determine the effects of organic chromium and organic chromium+propylene glycol on milk yield and some blood parameters related with liver fatty acid metabolism in early lactation dairy cows. Thirty multiparous Holstein dairy cows were used as study material. Cows assigned to three groups as control (C), chromium (Cr) and chromium+propylene glycol (CP). Live weight, parity and body condition score were used as covariates for statistical analyses. The study began at calving and finished at 3 weeks after calving. All cows were consumed same diet. Organic chromium and organic chromium+propylene glycol were orally administrated to cows in treatment groups shortly after the morning milking. Blood samples were collected from all cows on 0 (calving), 3rd, 6th, 9th, 12th, 15th, 18th, 21th days after calving. Then, samples were analyzed for BHBA (Betahydroxybutiric acids), NEFA (Non Esterified Fatty Acids), urea, total protein (TP) and glucose concentrations. Weekly milk yields were calculated from daily milk data on farm. Organic chromium treatment had no significant differences on serum biochemical parameters and milk yields. However, administration of organic chromium and propylene glycol combination decreased serum urea and total protein concentration, helped to protection from subclinical metabolic diseases via decreasing serum NEFA and BHBA concentrations. Also, this combination decreased serum glucose levels of cows. Neither only chromium nor chromium and propylene glycol combination did not affect milk yield throughout the study. These findings were suggested that orally administrations of chromium and propylene glycol combination improved liver glucose and fatty acid metabolism, decreased serum parameters which are representing subclinical diseases in early lactation dairy cows.

Keywords: chromium, early lactation dairy cows, propylene glycol, milk yield

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Authors: Hyun-Woo Cho

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Automatic process monitoring schemes are designed to give early warnings for unusual process events or abnormalities as soon as possible. For this end, various techniques have been developed and utilized in various industrial processes. It includes multivariate statistical methods, representation skills in reduced spaces, kernel-based nonlinear techniques, etc. This work presents a nonlinear empirical monitoring scheme for batch type production processes with incomplete process measurement data. While normal operation data are easy to get, unusual fault data occurs infrequently and thus are difficult to collect. In this work, noise filtering steps are added in order to enhance monitoring performance by eliminating irrelevant information of the data. The performance of the monitoring scheme was demonstrated using batch process data. The results showed that the monitoring performance was improved significantly in terms of detection success rate of process fault.

Keywords: batch process, monitoring, measurement, kernel method

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Authors: Celine Shi Ying Lee, Jong Jian Lee

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Background: Infectious keratitis is one of the leading causes of blindness worldwide. Prompt treatment with effective medication will control the infection early, preventing corneal scarring and visual loss. fluoroquinolones ophthalmic medication is used because of its broad-spectrum properties, potency, good intraocular penetration, and low toxicity. The study aims to evaluate the treatment outcome of corneal ulcers using Levofloxacin 1.5% ophthalmic solution (LVFX) with adjuvant oral ciprofloxacin when indicated and apply this treatment strategy in primary health care as first-line treatment. Methods: Patients with infective corneal ulcer treated in an eye center were recruited. Inclusion criteria includes Corneal infection consistent with bacterial keratitis, single or multiple small corneal ulcers. Treatment regime: LVFX hourly for the first 2 days, 2 hourly from the 3rd day, and 3 hourly on the 5th day of review. Adjuvant oral ciprofloxacin 500mg BD was administered for 5 days if there were multiple corneal ulcers or when the location of the cornea ulcer was central or paracentral. Results: 47 subjects were recruited. There were 16 (34%) males and 31 (66%) females. 40 subjects (85%) were contact lens (CL) related to corneal ulcer, and 7 subjects (15%) were non-contact lens related. 42 subjects (89%) presented with one ulcer, of which 20 of them (48%) needed adjuvant therapy. 5 subjects presented with 2 or 3 ulcers, of which 3 needed adjuvant therapy. A total of 23 subjects (49%) was given adjuvant therapy (oral ciprofloxacin 500mg BD for 5 days).21 of them (91%) were CL related. All subjects recovered fully, and the average duration of treatment was 3.7 days, with 49% of the subjects resolved on the 3rd day, 38% on the 5thday of and 13% on the 7thday. All subjects showed symptoms of relief of pain, light-sensitivity, and redness on the 3rd day with full visual recovery post-treatment. No adverse drug reactions were recorded. Conclusion: Our treatment regime demonstrated good clinical outcome as first-line treatment for corneal ulcers. A corneal ulcer is a common eye condition in Singapore, mainly due to CL wear. Pseudomonas aeruginosa is the most frequent and potentially sight-threatening pathogen involved in CL related corneal ulcer. Coagulase-negative Staphylococci, Staphylococcus aureus, and Streptococcus Pneumoniae were seen in non-CL users. All these bacteria exhibit good sensitivity rates to ciprofloxacin and levofloxacin. It is therefore logical in our study to use LVFX Eyedrops and adjuvant ciprofloxacin oral antibiotics when indicated as first line treatment for most corneal ulcers. Our study of patients, both CL related and non-CL related, have shown good clinical response and full recovery using the above treatment strategy. There was also a full restoration of visual acuity in all the patients. Eye-trained primary Healthcare practitioners can consider adopting this treatment strategy as first line treatment in patients with corneal ulcers. This is relevant during the COVID pandemic, where hospitals are overwhelmed with patients and in regions with limited access to specialist eye care. This strategy would enable early treatment with better clinical outcome.

Keywords: corneal ulcer, levofloxacin hydrate, treatment strategy, ciprofloxacin

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Authors: Claudia Carbajal, Jija Dutt, Smriti Pahwa, Sumukhi Vaid, Karishma Vats

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ASER Centre, the research and assessment arm of Pratham Education Foundation sees measurement as the first stage of action. ASER uses primary research to push and give empirical foundations to policy discussions at a multitude of levels. At a household level, common citizens use a simple assessment (a floor-level test) to measure learning across rural India. This paper presents the evidence on the applicability of an ASER approach to the health sector. A citizen-led assessment was designed and executed that collected information from young mothers with children up to a year of age. The pilot assessments were rolled-out in two different models: Paid surveyors and student volunteers. The survey covered three geographic areas: 1,239 children in the Jaipur District of Rajasthan, 2,086 in the Rae Bareli District of Uttar Pradesh, and 593 children in the Bhuj Block in Gujarat. The survey tool was designed to study knowledge of health-related issues, daily practices followed by young mothers and access to relevant services and programs. It provides insights on behaviors related to infant and young child feeding practices, child and maternal nutrition and supplementation, water and sanitation, and health services. Moreover, the survey studies the reasons behind behaviors giving policy-makers actionable pathways to improve implementation of social sector programs. Although data on health outcomes are available, this approach could provide a rapid annual assessment of health issues with indicators that are easy to understand and act upon so that measurements do not become an exclusive domain of experts. The results give many insights into early childhood health behaviors and challenges. Around 98% of children are breastfed, and approximately half are not exclusively breastfed (for the first 6 months). Government established diet diversity guidelines are met for less than 1 out of 10 children. Although most households are satisfied with the quality of drinking water, most tested households had contaminated water.

Keywords: citizen-led assessment, rapid health assessment, Infant and Young Children Feeding, water and sanitation, maternal nutrition, supplementation

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Authors: Chiang Wei, Hui-Chung Yeh, Yen-Chang Chen

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The objective of this study is to estimate the rainfall using the new generation Himawari-8 meteorological satellite with multi-band, high-bit format, and high spatiotemporal resolution, ground rainfall data at the Chen-Yu-Lan watershed of Joushuei River Basin (443.6 square kilometers) in Central Taiwan. Accurate and fine-scale rainfall information is essential for rugged terrain with high local variation for early warning of flood, landslide, and debris flow disasters. 10-minute and 2 km pixel-based rainfall of Typhoon Megi of 2016 and meiyu on June 1-4 of 2017 were tested to demonstrate the new generation Himawari-8 meteorological satellite can capture rainfall variation in the rugged mountainous area both at fine-scale and watershed scale. The results provide the valuable rainfall information for early warning of future disasters.

Keywords: estimation, Himawari-8, rainfall, satellite imagery

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Authors: Rufat Nuriyev

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Located in the eastern part of the Republic of Azerbaijan and on the western shore of the Caspian Sea, Gobustan National Reserve was inscribed as Gobustan Rock Art Cultural Landscape into the World Heritage List in 2007. Gobustan is an outstanding rock art landscape, where over 6000 rock engravings were found and registered, since the end of Upper Paleolithic up to the Middle Ages. Being a rock art center, the Gobustan seeks to stimulate public awareness and disseminate knowledge of prehistoric art to enrich educational, cultural and artistic communities regionally, nationally and internationally. Due to the Decree of the President of the Republic of Azerbaijan and the “Action Plan” , planned actions started to realize. Some of them implemented before of stipulated date. For the attraction of visitors and improvement of service quality in the museum-reserve, various activities are organized. The building of a new museum center at the foot of the Beyukdash Mountain has been completed in 2011. Main aims of the new museum building and exhibition was to provide better understanding of the importance of this monument for local community, Azerbaijanian culture and the world. In the Petroglyph Museum at Gobustan, digital and traditional media are closely integrated to reveal the complexity of historical, cultural and artistic meaning of prehistoric rock carvings of Gobustan. Alongside with electronic devices, the visitor gets opportunity of direct contact with artifacts and ancient rock carvings.

Keywords: Azerbaijan, Gobustan, rock art, museum

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Authors: William Elnemer, Nauman Hussain, Samir Al-Ali, Henry Shu, Diane Ghanem, Babar Shafiq

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Introduction: The incidence of infection in open tibial shaft injuries varies depending on the severity of the injury, with rates ranging from 1.8% for Gustilo-Anderson type I to 42.9% for type IIIB fractures. The timely administration of antibiotics upon presentation to the emergency department (ED) is an essential component of fracture management, and evidence indicates that prompt delivery of antibiotics is associated with improved outcomes. The objective of this study is to identify factors that contribute to the expedient administration of antibiotics. Methods: This is a retrospective study of open tibial shaft fractures at an academic Level I trauma center. Current Procedural Terminology (CPT) codes identified all patients treated for open tibial shaft fractures between 2015 and 2021. Open fractures were identified by reviewing ED and provider notes, and with ballistic fractures were considered open. Chart reviews were performed to extract demographics, fracture characteristics, postoperative outcomes, time to operative room, time to antibiotic order, and delivery. Univariate statistical analysis compared patients who received early antibiotics (EA), which were delivered within one hour of ED presentation, and those who received late antibiotics (LA), which were delivered outside of one hour of ED presentation. A multivariate analysis was performed to investigate patient, fracture, and transport/ED characteristics contributing to faster delivery of antibiotics. The multivariate analysis included the dependent variables: ballistic fracture, activation of Delta Trauma, Gustilo-Andersen (Type III vs. Type I and II), AO-OTA Classification (Type C vs. Type A and B), arrival between 7 am and 11 pm, and arrival via Emergency Medical Services (EMS) or walk-in. Results: Seventy ED patients with open tibial shaft fractures were identified. Of these, 39 patients (55.7%) received EA, while 31 patients (44.3%) received LA. Univariate analysis shows that the arrival via EMS as opposed to walk-in (97.4% vs. 74.2%, respectively, p = 0.01) and activation of Delta Trauma (89.7% vs. 51.6%, respectively, p < 0.001) was significantly higher in the EA group vs. the LA group. Additionally, EA cases had significantly shorter intervals between the antibiotic order and delivery when compared to LA cases (0.02 hours vs. 0.35 hours, p = 0.007). No other significant differences were found in terms of postoperative outcomes or fracture characteristics. Multivariate analysis shows that a Delta Trauma Response, arrival via EMS, and presentation between 7 am and 11 pm were independent predictors of a shorter time to antibiotic administration (Odds Ratio = 11.9, 30.7, and 5.4, p = 0.001, 0.016, and 0.013, respectively). Discussion: Earlier antibiotic delivery is associated with arrival to the ED between 7 am and 11 pm, arrival via EMS, and a coordinated Delta Trauma activation. Our findings indicate that in cases where administering antibiotics is critical to achieving positive outcomes, it is advisable to employ a coordinated Delta Trauma response. Hospital personnel should be attentive to the rapid administration of antibiotics to patients with open fractures who arrive via walk-in or during late-night hours.

Keywords: antibiotics, emergency department, fracture management, open tibial shaft fractures, orthopaedic surgery, time to or, trauma fractures

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Authors: Hang T. T. Tran, Ha T. Le, Hanh T. P. Tran, Hung V. Cao, Giang T. H. Nguyen, Dien M. Tran, Tobias Alfvén, Linus Olson

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Background: Hypoxic Ischemic Encephalopathy is one of the major causes of neonatal death and those who survive with severe encephalopathy are more likely to develop adverse long-term outcomes such as neurocognitive impairment and cerebral palsy, which is a huge burden, especially in low-middle income countries. It is important to have a long-term follow-up for early detection and promote early intervention for these groups of high-risk infants. Aim: To determine the neurological outcome of cooling infants at 18 months and identify an optimized neurological examination scale for Hypoxic Ischemic Encephalopathy infants in Vietnam. Method: Descriptive study of neurodevelopmental outcomes at 18 months of HIE infants who underwent therapeutic hypothermia treatment in Vietnam. All survived cooling infants were assessed at discharge and at 6, 12, and 18 months by a pediatric physical therapist and a neurologist using two assessment tools: Ages and Stages Questionnaires and the Hammersmith Infant Neurological Examination scale to detect impairments and promote early intervention for those who require it. Results: During a 3-year period, a total of 130 neonates with moderate to severe HIE underwent therapeutic hypothermia treatment using Phase change material mattress (65% moderate, 35% severe – Sarnat). 43 (33%) died during hospitalization and infancy; among survivors, 69 (79%) completed 3 follow-ups at 18 months. At 18 months, 25 had cerebral palsy, 11 had mild delayed neurodevelopment. At each time-point, infants with a normal/mildly delayed neurodevelopment had significantly higher Ages and Stages Questionnaires and Hammersmith Infant Neurological Examination scores (p<0.05) than those with cerebral palsy. Conclusion: The study showed that the Ages and Stages Questionnaires and Hammersmith Infant Neurological Examination is a helpful tool in the process of early diagnosis of infants at low and high neurological risk and identifying those infants needing specific rehabilitation programme.

Keywords: encephalopathy, phase-change-material, neurodevelopment, cerebral palsy

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Authors: Rıza Gürhan Korkut, Metin Çelik, Süleyman Özkaynak

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The early-stage design and development projects for the freight village initiatives require a comprehensive analysis of both qualitative and quantitative data. Considering the literature review on structural and operational management requirements, this study proposed an original taxonomy on criterion structure to assess freight village conceptualization. The potential challenges and uncertainties of the developed taxonomy are extended. Besides requirement analysis, this study is also expected to contribute to forthcoming research on benchmarking of freight villages in different regions. The methodology used in this research is a systematic review on several articles as per their modelling approaches, sustainability, entities and decisions made together with the uncertainties and features of their models taken into consideration. The major findings of the study that are the categories for assessing the projects attributes on their environmental, socio-economical, accessibility and location aspects.

Keywords: logistics centers, freight village, operational management, taxonomy

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Authors: Rong-Terng Juang

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Autonomous vehicles offer the possibility of significant benefits to social welfare. However, fully automated cars might not be going to happen in the near further. To speed the adoption of the self-driving technologies, many governments worldwide are passing laws requiring data recorders for the testing of autonomous vehicles. Currently, the self-driving vehicle, (e.g., shuttle bus) has to be monitored from a remote control center. When an autonomous vehicle encounters an unexpected driving environment, such as road construction or an obstruction, it should request assistance from a remote operator. Nevertheless, large amounts of data, including images, radar and lidar data, etc., have to be transmitted from the vehicle to the remote center. Therefore, this paper proposes a data compression method of in-vehicle networks for remote monitoring of autonomous vehicles. Firstly, the time-series data are rearranged into a multi-dimensional signal space. Upon the arrival, for controller area networks (CAN), the new data are mapped onto a time-data two-dimensional space associated with the specific CAN identity. Secondly, the data are sampled based on differential sampling. Finally, the whole set of data are encoded using existing algorithms such as Huffman, arithmetic and codebook encoding methods. To evaluate system performance, the proposed method was deployed on an in-house built autonomous vehicle. The testing results show that the amount of data can be reduced as much as 1/7 compared to the raw data.

Keywords: autonomous vehicle, data compression, remote monitoring, controller area networks (CAN), Lidar

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Authors: Linyi Fan, C.J. Schumaker

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Background: Biomedical efforts to treat Alzheimer’s disease (AD) have typically produced mixed to poor results, while more lifestyle-focused treatments such as exercise may fare better than existing biomedical treatments. A few promising studies have indicated that activities of daily life (ADL) may be a useful way of predicting AD. However, the existing cross-sectional studies fail to show how functional-related issues such as ADL in early years predict AD and how social factors influence health either in addition to or in interaction with individual risk factors. This study would helpbetterscreening and early treatments for the elderly population and healthcare practice. The findings have significance academically and practically in terms of creating positive social change. Methodology: The purpose of this quantitative historical, correlational study was to examine the relationship between early years’ ADL and the development of AD in later years. The studyincluded 4,526participantsderived fromRAND HRS dataset. The Health and Retirement Study (HRS) is a longitudinal household survey data set that is available forresearchof retirement and health among the elderly in the United States. The sample was selected by the completion of survey questionnaire about AD and dementia. The variablethat indicates whether the participant has been diagnosed with AD was the dependent variable. The ADL indices and changes in ADL were the independent variables. A four-step multilevel regression model approach was utilized to address the research questions. Results: Amongst 4,526 patients who completed the AD and dementia questionnaire, 144 (3.1%) were diagnosed with AD. Of the 4,526 participants, 3,465 (76.6%) have high school and upper education degrees,4,074 (90.0%) were above poverty threshold. The model evaluatedthe effect of ADL and change in ADL on onset of AD in late years while allowing the intercept of the model to vary by level of education. The results suggested that the only significant predictor of the onset of AD was changes in early years’ ADL (b = 20.253, z = 2.761, p < .05). However, the result of the sensitivity analysis (b = 7.562, z = 1.900, p =.058), which included more control variables and increased the observation period of ADL, are not supported this finding. The model also estimated whether the variances of random effect vary by Level-2 variables. The results suggested that the variances associated with random slopes were approximately zero, suggesting that the relationship between early years’ ADL were not influenced bysociodemographic factors. Conclusion: The finding indicated that an increase in changes in ADL leads to an increase in the probability of onset AD in the future. However, this finding is not support in a broad observation period model. The study also failed to reject the hypothesis that the sociodemographic factors explained significant amounts of variance in random effect. Recommendations were then made for future research and practice based on these limitations and the significance of the findings.

Keywords: alzheimer’s disease, epidemiology, moderation, multilevel modeling

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