Search results for: solution focused group therapy
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 17141

Search results for: solution focused group therapy

16151 Synthesis of Na-LSX Zeolite and Hydrosodalite from Polish Fly Ashes

Authors: Barbara Bialecka, Zdzislaw Adamczyk, Magdalena Cempa

Abstract:

In the work, the results of investigations into the hydrothermal zeolitization of fly ash from hard coal combustion in one of Polish Power Station have been presented. The chemical composition of the ash was determined by the method of X-ray fluorescence (XRF), whereas the phases of both fly ash and the products after synthesis were identified using microscopic observations, X-ray diffraction analysis (XRD) as well as electron scanning microscopy with measurements of the chemical compositions in micro areas (SEM/EDS). The synthesis was carried out with various concentrations of NaOH solution (3M, 4M and 6M) in the following conditions: synthesis temperature – 80ᵒC, synthesis time – 16 hours, volume of NaOH solution – 350ml, fly ash mass – 14g. The main chemical components of fly ash were SiO₂ and Al₂O₃, the contents of which reached 51.62 and 28.14%mas., respectively. The input ash contained mainly such phases as mullite, quarz, magnetite, and glass. The research results indicate that the phase composition of products after zeolitization was differentiated. The material after synthesis in 3M NaOH solution was found to contain mullite, quarz, magnetite, and Na-LSX zeolite. The products of synthesis in 4M NaOH solution were very similar to those in 3M solution (mullite, quarz, magnetite, Na-LSX zeolite), but they additionally contained hydrosodalite. The material after synthesis in 6M NaOH solution contains mullite, quarz, magnetite (similarly to synthesis in 3M and 4M NaOH solition) and additionally hydrosodalite. Therefore, the products of synthesis contain relic components from the fly ash input sample in the form of mullite, quarz, and magnetite, as well as new phases, which are Na-LSX zeolite and hydrosodalite. It should be noted that the products of synthesis in the case of 4M NaOH solution contained both new phases (Na-LSX zeolite and hydrosodalite), while the products from the extreme concentration of NaOH solutions (3M and 6M) contained only one of them. Observations in the scanning electron microscope revealed the new phases’ morphology. It was found that Na-LSX zeolite formed cubic crystals, whereas hydrosodalite formed characteristic aggregations. The results of investigations into the chemical composition in the micro area of phase grains in the products after synthesis reveal some dependencies, among others a characteristic increase in the content of sodium, related to the increased concentration of NaOH solution.

Keywords: Na-LSX, fly ash, hydrosodalite, zeolite

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16150 Assessment of Cardioprotective Effect of Deferiprone on Doxorubicin-Induced Cardiac Toxicity in a Rat Model

Authors: Sadaf Kalhori

Abstract:

Introduction: Doxorubicin (DOX)-induced cardiotoxicity is widely known as the most severe complication of anthracycline-based chemotherapy in patients with cancer. It is unknown whether Deferiprone (DFP), could reduce the severity of DOX-induced cardiotoxicity by inhibiting free radical reactions. Thus, this study was performed to assess the protective effect of Deferiprone on DOX-induced cardiotoxicity in a rat model. Methods: The rats were divided into five groups. Group one was a control group. Group 2 was DOX (2 mg/kg/day, every other day for 12 days), and Group three to five which receiving DOX as in group 2 and DFP 75,100 and 150 mg/kg/day, for 19 days, respectively. DFP was starting 5 days prior to the first DOX injection and two days after the last DOX injection throughout the study. Electrocardiographic and hemodynamic studies, along with histopathological examination, were conducted. In addition, serum sample was taken and total cholesterol, Malone dialdehyde, triglyceride, albumin, AST, ALT, total protein, lactate dehydrogenase, total anti-oxidant and creatine kinase were assessed. Result: Our results showed the normal structure of endocardial, myocardial and pericardial in the control group. Pathologic data such as edema, hyperemia, bleeding, endocarditis, myocarditis and pericarditis, hyaline degeneration, cardiomyocyte necrosis, myofilament degeneration and nuclear chromatin changes were assessed in all groups. In the DOX group, all pathologic data was seen with mean grade of 2±1.25. In the DFP group with a dose of 75 and 100 mg, the mean grade was 1.41± 0.31 and 1±.23, respectively. In DFP group with a dose of 150, the pathologic data showed a milder change in comparison with other groups with e mean grade of 0.45 ±0.19. Most pathologic data in DFP groups showed significant changes in comparison with the DOX group (p < 0.001). Discussion: The results also showed that DFP treatment significantly improved DOX-induced heart damage, structural changes in the myocardium, and ventricular function. Our data confirm that DFP is protective against cardiovascular-related disorders induced by DOX. Clinical studies are needed to be involved to examine these findings in humans.

Keywords: cardiomyopathy, deferiprone, doxorubicin, rat

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16149 Comparisons of Individual and Group Replacement Policies for a Series Connection System with Two Machines

Authors: Wen Liang Chang, Mei Wei Wang, Ruey Huei Yeh

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This paper studies the comparisons of individual and group replacement policies for a series connection system with two machines. Suppose that manufacturer’s production system is a series connection system which is combined by two machines. For two machines, when machines fail within the operating time, minimal repair is performed for machines by the manufacturer. The manufacturer plans to a preventive replacement for machines at a pre-specified time to maintain system normal operation. Under these maintenance policies, the maintenance cost rate models of individual and group replacement for a series connection system with two machines is derived and further, optimal preventive replacement time is obtained such that the expected total maintenance cost rate is minimized. Finally, some numerical examples are given to illustrate the influences of individual and group replacement policies to the maintenance cost rate.

Keywords: individual replacement, group replacement, replacement time, two machines, series connection system

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16148 Contribution to the Analytical Study of Barrier Surface Waves: Decomposition of the Solution

Authors: T. Zitoun, M. Bouhadef

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When a partially or completely immersed solid moves in a liquid such as water, it undergoes a force called hydrodynamic drag. Reducing this force has always been the objective of hydrodynamic engineers to make water slide better on submerged bodies. This paper deals with the examination of the different terms composing the analytical solution of the flow over an obstacle embedded at the bottom of a hydraulic channel. We have chosen to use a linear method to study a two-dimensional flow over an obstacle, in order to understand the evolution of the drag. We set the following assumptions: incompressible inviscid fluid, irrotational flow, low obstacle height compared to the water height. Those assumptions allow overcoming the difficulties associated with modelling these waves. We will mathematically formulate the equations that allow the determination of the stream function, and then the free surface equation. A similar method is used to determine the exact analytical solution for an obstacle in the shape of a sinusoidal arch.

Keywords: analytical solution, free-surface wave, hydraulic channel, inviscid fluid

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16147 Development of Verification System of Workspace Clashes Between Construction Activities

Authors: Hyeon-Seung Kim, Sang-Mi Park, Min-Seo Kim, Jong-Myeung Shin, Leen-Seok Kang

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Recently, the use of Building Information Modeling (BIM) in public construction works has become mandatory in some countries and it is anticipated that BIM will be applied to the actual field of civil engineering projects. However, the BIM system is still focused on the architectural project and the design phase. Because the civil engineering project is linear type project and is focused on the construction phase comparing with architectural project, 3D simulation is difficult to visualize them. This study suggests a method and a prototype system to solve workspace conflictions among construction activities using BIM simulation tool.

Keywords: BIM, workspace, confliction, visualization

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16146 Internal Capital Market Efficiency Study Based on Improved Cash Flow Sensitivity Coefficient - Take Tomorrow Group as an Example

Authors: Peng Lu, Liu Ting

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Because of the difficulty of financing from the external capital market, the reorganization and merger of private enterprises have formed a family group, seeking the help of the internal capital market to alleviate the capital demand. However, the inefficiency of the internal capital market can damage the effect it should have played, and even hinder the development of enterprises. This paper takes the "Tomorrow Group" as the research object to carry on the case analysis. After using the improved cash flow sensitivity coefficient to measure the efficiency of the internal capital market of Tomorrow Group, the inefficiency phenomenon is found. Then the analysis reveals that the reasons for its inefficiency include that the pyramidal equity structure is conducive to control, the separation of cash flow rights and control rights, the concentration of equity leads to poor balance, the abandonment of real industries and information asymmetry.

Keywords: tomorrow group, internal capital market, related-party transactions, Baotou tomorrow technology Co., LTD

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16145 Metabolic Syndrome and Mental Health in Post Traumatic Stress Disorder Patient

Authors: Hassan Shahmiri Barzoki

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Background: Posttraumatic stress disorder (PTSD) is an abnormal physiologic and psychological reaction in person with severe traumatic history. In recent studies, the relationship between PTSD and some other disease apparently unrelated to psychological situations, such as cardiovascular diseases, diabetes, and metabolic syndrome, has been revealed. Thus, the aim of this study was to survey the prevalence of metabolic syndrome and mental health in PTSD patients. Methods: The research design was retrospective cohort study. Subjects were consisted of 142 Iran-Iraq war veterans with PTSD (age: 40-60 years), and the control group was consisted of 153 veterans without PTSD. Data was collected using questionnaires, physical exams and laboratory tests. Results: Prevalence of metabolic syndrome was 45.1%in PTSD group and 17% in control group. In addition, blood pressure, triglyceride and fasting blood sugar in PTSD group were significantly higher than control group (p<0.05). Also, PTSD patients had significant high rates of psychiatric disorders. Conclusion: PTSD patients are more prone to metabolic syndrome and psychiatric disorders than control group.

Keywords: mental health, metabolic syndrome, post traumatic stress disorder, patient

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16144 Effects of Exercise in the Cold on Glycolipid Metabolism and Insulin Sensitivity in Obese Rats

Authors: Chaoge Wang, Xiquan Weng, Yan Meng, Wentao Lin

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Objective: Cold exposure and exercise serve as two physiological stimuli to glycolipid metabolism and insulin sensitivity. So far, it remains to be elucidated whether exercise plus cold exposure can produce an addictive effect on promoting glycolipid metabolism and insulin sensitivity. Methods: 64 SD rats were subjected to high-fat and high-sugar diets for 9-week and sucessfully to establish an obesity model. They were randomly divided into 8 groups: normal control group (NC), normal exercise group (NE), continuous cold control group (CC), continuous cold exercise group (CE), acute clod control group (AC), acute cold exercise group (AE), intermittent cold control group (IC) and intermittent cold exercise group (IE). For continuous cold exposure, the rats stayed in a cold environment all day; for acute cold exposure, the rats were exposed to cold for only 4h before the end of the experiment; for intermittent cold exposure, the rats were exposed to cold for 4h per day. The protocol for treadmill runnings were as follows: 25m/min (speed), 0°C (slope), 30 mins each time, an interval for 10 mins between two runnings, twice/two days, lasting for 5 weeks. Sampling were conducted on the 5th weekend. Blood lipids, free fatty acids, blood glucose (FBG), and serum insulin (FINS) were examined, and the insulin resistance index (HOMA-IR = FBG (mmol/L)×FINS(mIU/L)/22.5) was calculated. SPSS 22.0 was used for statistical analysis of the experimental results, and the ANOVA analysis was performed between groups (p < 0.05 was significant). Results: (1) Compared with the NC group, the FBG of the rats was significantly declined in the NE, CE, AC, AE, and IE groups (p < 0.05), the FINS of the rats was significantly declined in the AE group (p < 0.05), the HOMA-IR of the rats was significantly declined in the NE, CE, AC, AE and IE groups (p < 0.05). Compared with the NE group, the FBG of the rats was significantly declined in the CE, AE, and IE groups (p < 0.05), the FINS and HOMA-IR of the rats were significantly declined in the AE group (p < 0.05). (2) Compared with the NC group, the CHO, TG, LDL-C, and FFA of the rats were significantly declined in CE and IE groups (p < 0.05), the HDL-C of the rats was significantly higher in NE, CC, CE, AE, and IE groups (p < 0.05). Compared with the NE group, the HDL-C of the rats was significantly higher in the CE and IE groups (p < 0.05). Conclusions: Sedentariness or exercise in the acute cold doesn't make sense in the treatment of type 2 diabetes, which led to one-off increases of the body's insulin sensitivity. Exercise in the continuous and intermittent cold can effectively decline the FBG, TC, TG, LDL-C, and FFA levels and increase the HDL-C level and insulin sensitivity in obese rats. These results can impact the prevention and treatment of type 2 diabetes.

Keywords: cold, exercise, insulin sensitivity, obesity

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16143 Investigation of Cold Atmospheric Plasma Exposure Protocol on Wound Healing in Diabetic Foot Ulcer

Authors: P. Akbartehrani, M. Khaledi Pour, M. Amini, M. Khani, M. Mohajeri Tehrani, E. Ghasemi, P. Charipoor, B. Shokri

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A common problem between diabetic patients is foot ulcers which are chronic and require specialized treatment. Previous studies illustrate that Cold atmospheric plasma (CAP) has beneficial effects on wound healing and infection. Nevertheless, the comparison of different cap exposure protocols in diabetic ulcer wound healing remained to be studied. This study aims to determine the effect of two different exposure protocols on wound healing in diabetic ulcers. A prospective, randomized clinical trial was conducted at two clinics. Diabetic patients with G1 and G2 wanger classification diabetic foot ulcers were divided into two groups of study. One group was treated by the first protocol, which was treating wounds by argon-generated cold atmospheric plasma jet once a week for five weeks in a row. The other group was treated by the second protocol, which was treating wounds every three days for five weeks in a row. The wounds were treated for 40 seconds/cubic centimeter, while the nozzle tip was moved nonlocalized 1 cm above the wounds. A patient with one or more wounds could participate in different groups as wounds were separately randomized, which allow a participant to be treated several times during the study. The study's significant findings were two different reductions rate in wound size, microbial load, and two different healing speeds. This study concludes that CAP therapy by the second protocol yields more effective healing speeds, reduction in wound sizes, and microbial loads of foot ulcers in diabetic patients.

Keywords: wound healing, diabetic ulcers, cold atmospheric plasma, cold argon jet

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16142 The Hypolipidemic and Anti-Nephrotoxic Potentials of Vernonia calvoana Extract in Acetaminophen-Treated Male Wistar Rats

Authors: Godwin E. Egbung, Item J. Atangwho, Diana O. Odey, Eyong U. Eyong

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Background of the study: The frequent abuse of acetaminophen by field workers in Calabar metropolis necessitated the present study on the hypolipidemic and anti-nephrotoxic potentials of Vernonia calvoana (VC) extract in acetaminophen (paracetamol) treated male albino Wistar rats Methods:. Thirty-five (35) male albino Wistar rats weighing 100-150 g were divided into five (5) groups of seven rats each. Group 1 served as normal control, group 2 received normal saline after treatment with Acetaminophen (PCM), group 3 was treated with VC extracts (200 mg/kg body weight), group 4 received VC extracts ( 400 mg/kg body weight) and group 5 was administered 100 mg/kg body weight of Vitamin E. At the end of the 21 days treatment period, the animals were sacrificed using chloroform vapours, and blood was collected via cardiac puncture and used for analyses of haematological as well as biochemical indices. Results: Results indicated significant decreases (p < 0.001) in LDL-c, TC and TG levels in groups 3,4 and 5 relative to both the control as well as group 2, the atherogenic index showed a significant decrease at p < 0.001) in all treated groups compared with control and PCM- treated group. However, both extracts treated groups and vitamin E treated group showed significant (p < 0.001) increase in HDL-c relative to the control and PCM treated group. Serum potassium concentration was significantly (p < 0.05 and 0.001) reduced across all the treated groups compared with control and PCM- treated groups. Group 4 showed significant (p < 0.001) increase in RBC count, Hb, and PCV compared with PCM- treated group. Conclusions: We therefore conclude that ethanolic leaf extract of VC possesses probable anti-anemic, hypolipidemic potentials, and also ameliorates serum electrolyte imbalance in paracetamol- induced toxicity.

Keywords: acetaminophen, haematological indices, hypolipidemic potentials, serum lipid profile, vernonia calvoana, wistar rats

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16141 A Comparative Study of High Order Rotated Group Iterative Schemes on Helmholtz Equation

Authors: Norhashidah Hj. Mohd Ali, Teng Wai Ping

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In this paper, we present a high order group explicit method in solving the two dimensional Helmholtz equation. The presented method is derived from a nine-point fourth order finite difference approximation formula obtained from a 45-degree rotation of the standard grid which makes it possible for the construction of iterative procedure with reduced complexity. The developed method will be compared with the existing group iterative schemes available in literature in terms of computational time, iteration counts, and computational complexity. The comparative performances of the methods will be discussed and reported.

Keywords: explicit group method, finite difference, helmholtz equation, rotated grid, standard grid

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16140 The Effect of 6 Weeks Endurance Swimming Training on Blood Glucose and Cardiac Tissue Antioxidants in Diabetic Rats

Authors: Kh. Dehkordi, R. Sharifi Gholam, S. Arshadi

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Objective: Oxidative stress is produced under diabetic conditions and possibly causes various forms of tissue damage inpatients with diabetes. Antioxidants defend against the harmful effect of free radicals, which are associated with heart disease, cancer, arthritis, aging and many other diseases1). Antioxidants are very stable molecules capable of neutralizing free radicals by donating an electron to them.The aim of this study was to examine the effect of swimming training, fenugreek seed extract and glibenclamide on plasma glucose and cardiac antioxidants activity in diabetic rats. Design: For this purpose, fifty male wistar rats were divided into five groups, two groups of control rats (diabetic control [DC] and healthy control [HC]), one group of endurance swimming training (EST), one group of fenugreek seed extract highdose (F1, 1.74 g/kg b.w), one group of fenugreek seed extract middle dose (F2, 0.87 g/kg b.w), one group of glibenclamide (G, 0.5 mg/kg b.w). Materials and Methods: Diabetes induced by streptozotocine (STZ), data was analyzed using the one-way ANOVA followed by a Tukey test. Significance level was 0.05. Results: All of the groups' exception of HC showed significant decrease in body weight (P < 0.05), but the diabetic control and swimming training group exhibited a more decrease. All of the groups have shown a significant decrease in plasma glucose than DC group (P < 0.05) but this reduction was more in G group than DC no HC group. S, G and HC groups have shown significant increase in cardiac antioxidant than DC group (P < 0.05) but there wasn't significant difference in other groups (P > 0.05). Conclusion: The present results indicate that regular swimming training lead to decrease in plasma glucose and enhanced cardiac antioxidants in diabetic rats.

Keywords: swimming, glucose, cardiac, antioxidants

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16139 Health Care Students' Attitudes, Knowledge and Use of Complementary and Alternative Medicine: A Cross Sectional Study

Authors: Caterina Grandi, Lukas Lochner, Marco Padovan, Mirco Rizzi, Paola Sperinde, Fabio Vittadello, Luisa Cavada

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Background: In recent years, the use of Complementary Alternative Medicine (CAM) has achieved worldwide popularity. With the increased public interest in CAMs, attention to it within Health Care Schools and Colleges has also improved. Studies generally assess the knowledge and attitudes regarding CAMs in medical and nursing students. The current study focused on the knowledge, attitudes and practice of CAM in healthcare students. Aim: To assess the knowledge and attitudes regarding complementary and alternative medicine (CAM) in healthcare students in South Tyrol, a region in Northern Italy. Methodology: This cross-sectional study was carried out among 361 students. Self-administered questionnaire was adapted and modified by the researchers from several questionnaires. The instrument consisted of three sections: 1) demographical characteristics (gender, place of residence and year of study); 2) general attitudes towards CAM, evaluated through 11 items using a Likert scale (agree, partly agree, partly disagree, disagree); 3) knowledge and use about any particular CAM practices (acupuncture, aromatherapy, creative therapies, diet/nutritional therapies, phytotherapy/herbal therapies, compresses, massage therapy, Ayurvedic therapy, Tibetan medicine, naturopathy, homeopathy, pet therapy, reflexology, therapeutic touch, chiropractic/osteopathy). Results: The sample consisted of 63 males and 297 females, 58% living in villages. 151 students (42%) were in the first year, 99 (27%) in the second and 106 (30%) in the third. Both men and women agreed with statements about the utility and benefits of CAMs. Women were significantly more likely than men to agree that the CAM practices should be included in the curriculum (p < 0.004), that the health professionals should be able to advice their patients about commonly used CAM methods (p < 0.002) and that the clinical care should integrate CAM practices (p < 0.04). Students in the second year showed the highest mean score for the statement 'CAM includes ideas and methods from which conventional medicine could benefit' (p = 0.049), highlighting a positive attitude, while students in the third year achieved the lowest mean score for the negative statement 'The results of CAM are in most cases due to a placebo effect'. Regarding this statement, participants living in villages disagreed significantly than students living in the city (p < 0.001). Females appeared to be significantly more familiar with homeopathy (p < 0.002), aromatherapy (p < 0.033), creative therapies (p < 0.001) and herbal therapies (p<0.002) than males. Moreover, women were likely to use CAM more frequently than men, particularly to solve psychological problems (p < 0.004). In addition, women perceived the benefit significantly more positive than men (p < 0.001). Students in the second year revealed to use the CAM mostly to improve the quality of life (p < 0.023), while students in the third year used CAMs particularly for chronic diseases (p < 0.001). Conclusions: Results from this study suggested that female students show more positive attitudes on CAM than male students. Moreover, the prevalence of CAM use and its perceived benefits differ between males and females, so that women are more willing to use CAM practices.

Keywords: attitude, CAM, complementary and alternative medicine, healthcare students, knowledge

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16138 Investment Projects Selection Problem under Hesitant Fuzzy Environment

Authors: Irina Khutsishvili

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In the present research, a decision support methodology for the multi-attribute group decision-making (MAGDM) problem is developed, namely for the selection of investment projects. The objective of the investment project selection problem is to choose the best project among the set of projects, seeking investment, or to rank all projects in descending order. The project selection is made considering a set of weighted attributes. To evaluate the attributes in our approach, expert assessments are used. In the proposed methodology, lingual expressions (linguistic terms) given by all experts are used as initial attribute evaluations, since they are the most natural and convenient representation of experts' evaluations. Then lingual evaluations are converted into trapezoidal fuzzy numbers, and the aggregate trapezoidal hesitant fuzzy decision matrix will be built. The case is considered when information on the attribute weights is completely unknown. The attribute weights are identified based on the De Luca and Termini information entropy concept, determined in the context of hesitant fuzzy sets. The decisions are made using the extended Technique for Order Performance by Similarity to Ideal Solution (TOPSIS) method under a hesitant fuzzy environment. Hence, a methodology is based on a trapezoidal valued hesitant fuzzy TOPSIS decision-making model with entropy weights. The ranking of alternatives is performed by the proximity of their distances to both the fuzzy positive-ideal solution (FPIS) and the fuzzy negative-ideal solution (FNIS). For this purpose, the weighted hesitant Hamming distance is used. An example of investment decision-making is shown that clearly explains the procedure of the proposed methodology.

Keywords: In the present research, a decision support methodology for the multi-attribute group decision-making (MAGDM) problem is developed, namely for the selection of investment projects. The objective of the investment project selection problem is to choose the best project among the set of projects, seeking investment, or to rank all projects in descending order. The project selection is made considering a set of weighted attributes. To evaluate the attributes in our approach, expert assessments are used. In the proposed methodology, lingual expressions (linguistic terms) given by all experts are used as initial attribute evaluations since they are the most natural and convenient representation of experts' evaluations. Then lingual evaluations are converted into trapezoidal fuzzy numbers, and the aggregate trapezoidal hesitant fuzzy decision matrix will be built. The case is considered when information on the attribute weights is completely unknown. The attribute weights are identified based on the De Luca and Termini information entropy concept, determined in the context of hesitant fuzzy sets. The decisions are made using the extended Technique for Order Performance by Similarity to Ideal Solution (TOPSIS) method under a hesitant fuzzy environment. Hence, a methodology is based on a trapezoidal valued hesitant fuzzy TOPSIS decision-making model with entropy weights. The ranking of alternatives is performed by the proximity of their distances to both the fuzzy positive-ideal solution (FPIS) and the fuzzy negative-ideal solution (FNIS). For this purpose, the weighted hesitant Hamming distance is used. An example of investment decision-making is shown that clearly explains the procedure of the proposed methodology.

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16137 Application of Micro-Tunneling Technique to Rectify Tilted Structures Constructed on Cohesive Soil

Authors: Yasser R. Tawfic, Mohamed A. Eid

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Foundation differential settlement and supported structure tilting is an occasionally occurred engineering problem. This may be caused by overloading, changes in ground soil properties or unsupported nearby excavations. Engineering thinking points directly toward the logic solution for such problem by uplifting the settled side. This can be achieved with deep foundation elements such as micro-piles and macro-piles™, jacked piers and helical piers, jet grouted soil-crete columns, compaction grout columns, cement grouting or with chemical grouting, or traditional pit underpinning with concrete and mortar. Although, some of these techniques offer economic, fast and low noise solutions, many of them are quite the contrary. For tilted structures, with limited inclination, it may be much easier to cause a balancing settlement on the less-settlement side which shall be done carefully in a proper rate. This principal has been applied in Leaning Tower of Pisa stabilization with soil extraction from the ground surface. In this research, the authors attempt to introduce a new solution with a different point of view. So, micro-tunneling technique is presented in here as an intended ground deformation cause. In general, micro-tunneling is expected to induce limited ground deformations. Thus, the researchers propose to apply the technique to form small size ground unsupported holes to produce the target deformations. This shall be done in four phases: •Application of one or more micro-tunnels, regarding the existing differential settlement value, under the raised side of the tilted structure. •For each individual tunnel, the lining shall be pulled out from both sides (from jacking and receiving shafts) in slow rate. •If required, according to calculations and site records, an additional surface load can be applied on the raised foundation side. •Finally, a strengthening soil grouting shall be applied for stabilization after adjustment. A finite element based numerical model is presented to simulate the proposed construction phases for different tunneling positions and tunnels group. For each case, the surface settlements are calculated and induced plasticity points are checked. These results show the impact of the suggested procedure on the tilted structure and its feasibility. Comparing results also show the importance of the position selection and tunnels group gradual effect. Thus, a new engineering solution is presented to one of the structural and geotechnical engineering challenges.

Keywords: differential settlement, micro-tunneling, soil-structure interaction, tilted structures

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16136 Chat-Based Online Counseling for Enhancing Wellness of Undergraduates with Emotional Crisis Tendency

Authors: Arunya Tuicomepee

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During the past two decades, there have been the increasing numbers of studies on online counseling, especially among adolescents who are familiar with the online world. This can be explained by the fact that via this channel enables easier access to the young, who may not be ready for face-to-face service, possibly due to uneasiness to reveal their personal problems with a stranger, the feeling that their problems are to be shamed, or the need to protect their images. Especially, the group of teenagers prone to suicide or despair, who tend to keep things to or isolate from the society to themselves, usually prefer types of services that require no face-to-face encounter and allow their anonymity, such as online services. This study aimed to examine effectiveness of chat-based online counseling for enhancing wellness of undergraduates with emotional crisis tendency. Experimental with pretest-posttest control group design was employed. Participants were 47 undergraduates (10 males and 37 females) with high emotional crisis tendency. They were randomly assigned to experimental group (24 students) and control group (23 students). Participants in the experimental group received a 60-minute, 4-sessions of individual chat-based online counseling led by counselor. Those in control group received no counseling session. Instruments were the Emotional Crisis Scale and Wellness Scales. Two-way mixed-design multivariate analysis of variance was used for data analysis. Finding revealed that the posttest scores on wellness of those in the experimental group were higher than the scores of those in the control group. The posttest scores on emotional crisis tendency of those in the experimental group were lower than the scores of those in the control group. Hence, this study suggests chat-based online counseling services can become a helping source that increasing more adolescents would recognize and turn to in the future and that will receive more attention.

Keywords: chat-based online counseling, emotional crisis, undergraduate student, wellness

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16135 Group Decision Making through Interval-Valued Intuitionistic Fuzzy Soft Set TOPSIS Method Using New Hybrid Score Function

Authors: Syed Talib Abbas Raza, Tahseen Ahmed Jilani, Saleem Abdullah

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This paper presents interval-valued intuitionistic fuzzy soft sets based TOPSIS method for group decision making. The interval-valued intuitionistic fuzzy soft set is a mutation of an interval-valued intuitionistic fuzzy set and soft set. In group decision making problems IVIFSS makes the process much more algebraically elegant. We have used weighted arithmetic averaging operator for aggregating the information and define a new Hybrid Score Function as metric tool for comparison between interval-valued intuitionistic fuzzy values. In an illustrative example we have applied the developed method to a criminological problem. We have developed a group decision making model for integrating the imprecise and hesitant evaluations of multiple law enforcement agencies working on target killing cases in the country.

Keywords: group decision making, interval-valued intuitionistic fuzzy soft set, TOPSIS, score function, criminology

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16134 The Role of Group Interaction and Managers’ Risk-willingness for Business Model Innovation Decisions: A Thematic Analysis

Authors: Sarah Müller-Sägebrecht

Abstract:

Today’s volatile environment challenges executives to make the right strategic decisions to gain sustainable success. Entrepreneurship scholars postulate mainly positive effects of environmental changes on entrepreneurship behavior, such as developing new business opportunities, promoting ingenuity, and the satisfaction of resource voids. A strategic solution approach to overcome threatening environmental changes and catch new business opportunities is business model innovation (BMI). Although this research stream has gained further importance in the last decade, BMI research is still insufficient. Especially BMI barriers, such as inefficient strategic decision-making processes, need to be identified. Strategic decisions strongly impact organizational future and are, therefore, usually made in groups. Although groups draw on a more extensive information base than single individuals, group-interaction effects can influence the decision-making process - in a favorable but also unfavorable way. Decisions are characterized by uncertainty and risk, whereby their intensity is perceived individually differently. The individual risk-willingness influences which option humans choose. The special nature of strategic decisions, such as in BMI processes, is that these decisions are not made individually but in groups due to their high organizational scope. These groups consist of different personalities whose individual risk-willingness can vary considerably. It is known from group decision theory that these individuals influence each other, observable in different group-interaction effects. The following research questions arise: i) How does group interaction shape BMI decision-making from managers’ perspective? ii) What are the potential interrelations among managers’ risk-willingness, group biases, and BMI decision-making? After conducting 26 in-depth interviews with executives from the manufacturing industry, applied Gioia methodology reveals the following results: i) Risk-averse decision-makers have an increased need to be guided by facts. The more information available to them, the lower they perceive uncertainty and the more willing they are to pursue a specific decision option. However, the results also show that social interaction does not change the individual risk-willingness in the decision-making process. ii) Generally, it could be observed that during BMI decisions, group interaction is primarily beneficial to increase the group’s information base for making good decisions, less than for social interaction. Further, decision-makers mainly focus on information available to all decision-makers in the team but less on personal knowledge. This work contributes to strategic decision-making literature twofold. First, it gives insights into how group-interaction effects influence an organization’s strategic BMI decision-making. Second, it enriches risk-management research by highlighting how individual risk-willingness impacts organizational strategic decision-making. To date, it was known in BMI research that risk aversion would be an internal BMI barrier. However, with this study, it becomes clear that it is not risk aversion that inhibits BMI. Instead, the lack of information prevents risk-averse decision-makers from choosing a riskier option. Simultaneously, results show that risk-averse decision-makers are not easily carried away by the higher risk-willingness of their team members. Instead, they use social interaction to gather missing information. Therefore, executives need to provide sufficient information to all decision-makers to catch promising business opportunities.

Keywords: business model innovation, cognitive biases, group-interaction effects, strategic decision-making, risk-willingness

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16133 Triangular Hesitant Fuzzy TOPSIS Approach in Investment Projects Management

Authors: Irina Khutsishvili

Abstract:

The presented study develops a decision support methodology for multi-criteria group decision-making problem. The proposed methodology is based on the TOPSIS (Technique for Order Performance by Similarity to Ideal Solution) approach in the hesitant fuzzy environment. The main idea of decision-making problem is a selection of one best alternative or several ranking alternatives among a set of feasible alternatives. Typically, the process of decision-making is based on an evaluation of certain criteria. In many MCDM problems (such as medical diagnosis, project management, business and financial management, etc.), the process of decision-making involves experts' assessments. These assessments frequently are expressed in fuzzy numbers, confidence intervals, intuitionistic fuzzy values, hesitant fuzzy elements and so on. However, a more realistic approach is using linguistic expert assessments (linguistic variables). In the proposed methodology both the values and weights of the criteria take the form of linguistic variables, given by all decision makers. Then, these assessments are expressed in triangular fuzzy numbers. Consequently, proposed approach is based on triangular hesitant fuzzy TOPSIS decision-making model. Following the TOPSIS algorithm, first, the fuzzy positive ideal solution (FPIS) and the fuzzy negative-ideal solution (FNIS) are defined. Then the ranking of alternatives is performed in accordance with the proximity of their distances to the both FPIS and FNIS. Based on proposed approach the software package has been developed, which was used to rank investment projects in the real investment decision-making problem. The application and testing of the software were carried out based on the data provided by the ‘Bank of Georgia’.

Keywords: fuzzy TOPSIS approach, investment project, linguistic variable, multi-criteria decision making, triangular hesitant fuzzy set

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16132 Integrating Student Engagement Activities into the Learning Process

Authors: Yingjin Cui, Xue Bai, Serena Reese

Abstract:

Student engagement and student interest during class instruction are important conditions for active learning. Engagement, which has an important relationship with learning motivation, influences students' levels of persistence in overcoming challenges. Lack of student engagement and absence from face-to-face lectures and tutorials, in turn, can lead to poor academic performance. However, keeping students motivated and engaged in the learning process in different instructional modes poses a significant challenge; students can easily become discouraged from attending lectures and tutorials across both online and face-to-face settings. Many factors impact students’ engagement in the learning process. If you want to keep students focused on learning, you have to invite them into the process of helping themselves by providing an active learning environment. Active learning is an excellent technique for enhancing student engagement and participation in the learning process because it provides means to motivate the student to engage themselves in the learning process through reflection, analyzing, applying, and synthesizing the material they learn during class. In this study, we discussed how to create an active learning class (both face-to-face and synchronous online) through engagement activities, including reflection, collaboration, screen messages, open poll, tournament, and transferring editing roles. These activities will provide an uncommon interactive learning environment that can result in improved learning outcomes. To evaluate the effectiveness of those engagement activities in the learning process, an experimental group and a control group will be explored in the study.

Keywords: active learning, academic performance, engagement activities, learning motivation

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16131 The Investigation of Precipitation Conditions of Chevreul’s Salt

Authors: Turan Çalban, Fatih Sevim, Oral Laçin

Abstract:

In this study, the precipitation conditions of Chevreul’s salt were evaluated. The structure of Chevreul’s salt was examined by considering the previous studies. Thermodynamically, the most important precipitation parameters were pH, temperature, and sulphite-copper(II) ratio. The amount of Chevreul’s salt increased with increasing the temperature and sulphite-copper(II) ratio at the certain range, while it increased with decreasing the pH value at the chosen range. The best solution medium for recovery of Chevreul’s salt is sulphur dioxide gas-water system. Moreover, the soluble sulphite salts are used as efficient precipitating reagents. Chevreul’s salt is generally used to produce the highly pure copper powders from synthetic copper sulphate solutions and impure leach solutions. When the pH of the initial ammoniacal solution is greater than 8.5, ammonia in the medium is not free, and Chevreul’s salt from solution does not precipitate. In contrast, copper ammonium sulphide is precipitated. The pH of the initial solution containing ammonia for precipitating of Chevreul’s salt must be less than 8.5.

Keywords: Chevreul's salt, production, copper sulfites, copper compound

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16130 July 15 Coup Attempt and the Use of New Communication Technologies

Authors: Yasemin Gulsen Yilmaz, Suleyman Hakan Yilmaz, Muhammet Erbay

Abstract:

The new communication technologies have gradually improved its efficiency in all fields of life and made its presence irreplaceable. These technologies which appear in every aspect of life differently showed itself during the failed coup attempt in Turkey too. The evening of July 15, 2016, have already taken its place in the Turkish political history. In the evening of July 15, Turkish nation confronted to a coup attempted by a group within the Turkish Armed Forces. That evening, the scene of the confrontation between the coup attempters and the resisting civilians were watched minute-by-minute by the people using the new communication technologies. Pro-coup soldiers and the resisting groups that came face to face in the streets of metropolitan cities, made their in-group communications by using new media tools very actively. New media turned into the most important weapon both for coup plotters and for those who resisted. In the morning of next day, whoever used these tools better had the upper hand. The civilians were successful in protecting democracy not only by resisting against tanks and bullets but also by following the internet, organising in social media, sharing information-photos on the net and telling large masses their experiences through these technologies. In this study, we focused on and analysed the use of new media both by coup soldiers and resisting civilians during the failed coup attempt in July 15. Within the scope of this study, coup attempt news that took place in printed media within one week were examined; the information about the use of new media tools during the night of failed coup were compiled; and it was determined how, to what extend and what for these tools were used and how effective they were.

Keywords: communication, July 15, new media, media

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16129 A Twelve-Week Intervention Programme to Improve the Gross Motor Skills of Selected Children Diagnosed with Autism Spectrum Disorder

Authors: Eileen K. Africa, Karel J. van Deventer

Abstract:

Neuro-typical children develop the motor skills necessary to play, do schoolwork and interact with others. However, this is not observed in children who have learning or behavioural problems. Children with Autism Spectrum Disorder (ASD) are often referred to as clumsy because their body parts do not work well together in a sequence. Physical Activity (PA) has shown to be beneficial to the general population, therefore, providing children with ASD opportunities to take part in PA programmes, could prove to be beneficial in many ways and should be investigated. The purpose of this study was to design a specialised group intervention programme, to attempt to improve gross motor skills of selected children diagnosed with ASD between the ages of eight and 13 years. A government school for ASD learners was recruited to take part in this study, and a sample of convenience (N=7) was selected. Children in the experimental group (n=4) participated in a 12-week group intervention programme twice per week, while the control group continued with their normal daily routine. The Movement Assessment Battery for Children-Second Edition (MABC-2), was administered pre- and post-test to determine the children’s gross motor proficiency and to determine if the group intervention programme had an effect on the gross motor skills of the experimental group. Statistically significant improvements were observed in total motor skill proficiency (p < 0.05), of the experimental group. These results demonstrate the importance of gross motor skills interventions for children diagnosed with ASD. Future research should include more participants to ensure that the results can be generalised.

Keywords: autism spectrum disorder, children, gross motor skills, group intervention programme

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16128 Effect of Zidovudine on Hematological and Virologic Parameters among Female Sex Workers Receiving Antiretroviral Therapy (ART) in North-Western Nigeria

Authors: N. M. Sani, E. D. Jatau, O. S. Olonitola, M. Y. Gwarzo, P. Moodley, N. S. Mujahid

Abstract:

Haemoglobin (HB) indicates anaemia level and by extension may reflect the nutritional level and perhaps the immunity of an individual. Some antiretroviral drugs like zidovudine are known to cause anaemia in People living with HIV/AIDS (PLWHA). A cross-sectional study using demographic data and blood specimen from 218 female commercial sex workers attending antiretroviral therapy (ART) clinics was conducted between December 2009 and July 2011 to assess the effect of zidovudine on haematologic and RNA viral load of female sex workers receiving antiretroviral treatment in north-western Nigeria. Anaemia is a common and serious complication of both HIV infection and its treatment. In the setting of HIV infection, anaemia has been associated with decreased quality of life, functional status, and survival. Antiretroviral therapy, particularly the highly active antiretroviral therapy (HAART), has been associated with a decrease in the incidence and severity of anaemia in HIV-infected patients who have received a HAART regimen for at least 1 year. In this study, result has shown that out of 218 patients, 26 with haemoglobin count between 5.1–10 g/dl were observed to have the highest viral load count of 300,000–350,000 copies/ml. It was also observed that most patients (190) with HB of 10.1–15.0 g/dl had viral load count of 200,000–250,000 copies/ml. An inverse relationship therefore exists, i.e. the lower the haemoglobin level, the higher the viral load count, even though the test statistics did not show any significance between the two (P=0.206). This shows that multivariate logistic regression analysis demonstrated that anaemia was associated with a CD4+ cell count below 50/µL in female sex workers with a viral load above 100,000 copies/mL who use zidovudine. Severe anaemia was less prevalent in this study population than in historical comparators; however, mild to moderate anaemia rates remain high. The study, therefore, recommends that hematological and virologic parameters be monitored closely in patients receiving first line ART regimen.

Keywords: anaemia, female sex worker, haemoglobin, Zidovudine

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16127 Changes in Serum Neopterin in Workers Exposed to Different Mineral Dust

Authors: Gospodinka Prakova, Pavlina Gidikova, Gergana Sandeva, Kamelia Haracherova, Emil Slavov

Abstract:

Neopterin was demonstrated to be a sensitive marker of cell-mediated immune reactions which plays a key role in the interaction of monocyte / macrophage activation. The purpose of this work was to investigate changes in serum neopterin in workers exposed to different composition of mineral dust. Material and Methods: Serum neopterin was studied in 193 exposed workers, divided into three groups, depending on the mineral dust and content of the quartz in the respirable fraction. The I-st group-coal dust containing less than 2% free crystalline silica (n=44), II-nd group-coal dust containing over 2% free crystalline silica (n=94) and the III-rd group-mixed dust with corundum and carborundum (n=55). The control group was composed of 21 individuals without exposure to dust. Serum neopterin was investigated by Elisa method in ng/ml according to the instructions of the manufacturer. Results and Discussion: It was found significantly higher level of serum neopterin in exposed workers of mineral dust (2,10 ± 0,62 ng / ml), compared with that of the control group (1,10 ± 0,85 ng/ml; p < 0,05). Neopterin levels in workers exposed to coal dust (1,87 ± 0,42 ng / ml-I-st and 3,32 ± 0,77 ng / ml-II-nd group) were significantly higher compared with those exposed to a mixed dust (1,31±0,68 mg / ml-third) and control group (p < 0,05). No significant difference in serum neopterin when exposed to a mixed dust composed of corundum and carborundum (III-rd) and a control group. Conclusion: The results of this study indicate activates a cell-mediated immune response when exposed to a mineral dust. The level of that activation depends mainly on the composition of the dust and is significantly highest in workers exposed to coal dust.

Keywords: mineral dust, neopterin, occupational exposure, respirable crystalline silica

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16126 Populism and National Unity: A Discourse Analysis of Poverty Eradication Strategies of Three Malaysian Prime Ministers

Authors: Khairil Ahmad, Jenny Gryzelius, Mohd Helmi Mohd Sobri

Abstract:

With the waning support for centrist ‘third-way’ politics across the Western world, there has been an increase in political parties and individual candidates relying on populist political discourse and rhetoric in order to capitalize on the sense of frustration apparent within the electorate. What is of note is the divergence in the discourses employed. On the one hand, there is a polarization between a growing wave of populist right-wing parties and politicians, employing a mixture of economic populism with divisive nationalistic ideals such as restricted immigration, for example, the UK’s UKIP and Donald Trump in the US. On the other hand, there are resurgent, often grassroots-led, left-wing movements and politicians, such as Podemos in Spain and Jeremy Corbyn in the UK, focusing on anti-austerity measures and inclusive policies. In general, the concept of populism is often ascribed in a pejorative way. This is despite the success of populist left-wing governments across Latin America in recent times, especially in terms of reducing poverty. Nonetheless, recently, scholars such as Ernesto Laclau have tried to rethink populism as a social scientific concept which is essential in helping us make sense of contemporary political articulations. Using Laclau’s framework, this paper seeks to analyze poverty reduction policies in different iterations in the context of the tenures of three Prime Ministers of Malaysia. The first is Abdul Razak Hussein’s New Economic Policy, which focused on uplifting the economic position of Malaysia’s majority Malay population. The second is Mahathir Mohamad’s state-led neo-liberalization of the Malaysian economy, which focused on the creation of a core group of crony elites in order to spearhead economic development. The third is current Prime Minister Najib Razak’s targeted poverty eradication strategy through a focused program which directly provides benefits to recipients such as through direct cash transfers. The paper employs a discursive approach to trace elements of populism in these cases and highlight instances of how their strategies are articulated in ways that seek to appeal towards particular visions of national unity.

Keywords: discourse analysis, Malaysia, populism, poverty eradication

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16125 Generic Hybrid Models for Two-Dimensional Ultrasonic Guided Wave Problems

Authors: Manoj Reghu, Prabhu Rajagopal, C. V. Krishnamurthy, Krishnan Balasubramaniam

Abstract:

A thorough understanding of guided ultrasonic wave behavior in structures is essential for the application of existing Non Destructive Evaluation (NDE) technologies, as well as for the development of new methods. However, the analysis of guided wave phenomena is challenging because of their complex dispersive and multimodal nature. Although numerical solution procedures have proven to be very useful in this regard, the increasing complexity of features and defects to be considered, as well as the desire to improve the accuracy of inspection often imposes a large computational cost. Hybrid models that combine numerical solutions for wave scattering with faster alternative methods for wave propagation have long been considered as a solution to this problem. However usually such models require modification of the base code of the solution procedure. Here we aim to develop Generic Hybrid models that can be directly applied to any two different solution procedures. With this goal in mind, a Numerical Hybrid model and an Analytical-Numerical Hybrid model has been developed. The concept and implementation of these Hybrid models are discussed in this paper.

Keywords: guided ultrasonic waves, Finite Element Method (FEM), Hybrid model

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16124 Thermosensitive Hydrogel Development for Its Possible Application in Cardiac Cell Therapy

Authors: Lina Paola Orozco Marin, Yuliet Montoya Osorio, John Bustamante Osorno

Abstract:

Ischemic events can culminate in acute myocardial infarction by irreversible cardiac lesions that cannot be restored due to the limited regenerative capacity of the heart. Cell therapy seeks to replace these injured or necrotic cells by transplanting healthy and functional cells. The therapeutic alternatives proposed by tissue engineering and cardiovascular regenerative medicine are the use of biomaterials to mimic the native extracellular medium, which is full of proteins, proteoglycans, and glycoproteins. The selected biomaterials must provide structural support to the encapsulated cells to avoid their migration and death in the host tissue. In this context, the present research work focused on developing a natural thermosensitive hydrogel, its physical and chemical characterization, and the determination of its biocompatibility in vitro. The hydrogel was developed by mixing hydrolyzed bovine and porcine collagen at 2% w/v, chitosan at 2.5% w/v, and beta-glycerolphosphate at 8.5% w/w and 10.5% w/w in magnetic stirring at 4°C. Once obtained, the thermosensitivity and gelation time were determined, incubating the samples at 37°C and evaluating them through the inverted tube method. The morphological characterization of the hydrogels was carried out through scanning electron microscopy. Chemical characterization was carried out employing infrared spectroscopy. The biocompatibility was determined using the MTT cytotoxicity test according to the ISO 10993-5 standard for the hydrogel’s precursors using the fetal human ventricular cardiomyocytes cell line RL-14. The RL-14 cells were also seeded on the top of the hydrogels, and the supernatants were subculture at different periods to their observation under a bright field microscope. Four types of thermosensitive hydrogels were obtained, which differ in their composition and concentration, called A1 (chitosan/bovine collagen/beta-glycerolphosphate 8.5%w/w), A2 (chitosan/porcine collagen/beta-glycerolphosphate 8.5%), B1 (chitosan/bovine collagen/beta-glycerolphosphate 10.5%) and B2 (chitosan/porcine collagen/beta-glycerolphosphate 10.5%). A1 and A2 had a gelation time of 40 minutes, and B1 and B2 had a gelation time of 30 minutes at 37°C. Electron micrographs revealed a three-dimensional internal structure with interconnected pores for the four types of hydrogels. This facilitates the exchange of nutrients, oxygen, and the exit of metabolites, allowing to preserve a microenvironment suitable for cell proliferation. In the infrared spectra, it was possible to observe the interaction that occurs between the amides of polymeric compounds with the phosphate groups of beta-glycerolphosphate. Finally, the biocompatibility tests indicated that cells in contact with the hydrogel or with each of its precursors are not affected in their proliferation capacity for a period of 16 days. These results show the potential of the hydrogel to increase the cell survival rate in the cardiac cell therapies under investigation. Moreover, the results lay the foundations for its characterization and biological evaluation in both in vitro and in vivo models.

Keywords: cardiac cell therapy, cardiac ischemia, natural polymers, thermosensitive hydrogel

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16123 Measuring the Economic Empowerment of Women Using an Index: An Application to Small-Scale Fisheries and Agriculture in Sebaste, Antique

Authors: Ritchie Ann Dionela, Jorilyn Tabuena

Abstract:

This study measured the economic empowerment of women from small-scale fisheries and agriculture sector of Sebaste, Antique. There were a total of 199 respondents selected using stratified random sampling. The Five Domains of Empowerment (5DE) Index was used in measuring the economic empowerment of study participants. Through this composite index, it was determined how women scored in the five domains of empowerment, namely production, resources, income, leadership, and time. The result of the study shows that women fishers are more economically empowered than women farmers. The two sectors showed high disparity in their scores on input in productive decision; autonomy in production; ownership of assets; control over use of income; group member; speaking in public; workload; and leisure. Group member indicator contributed largely to the disempowered population in both sectors. Although income of women farmers is higher than that of women fishers, the latter are still economically empowered which suggests that economic empowerment is not dependent on income alone. The study recommends that fisheries and agriculture organization for women should be established so that their needs and concerns will be heard and addressed. It is further recommended that government projects focused on enhancing women empowerment should also give importance on other factors such as organization and leisure and not just income to totally promote of women empowerment. Further studies on measuring women’s empowerment using other methods should be pursued to provide more information on women’s well-being.

Keywords: agriculture, composite index, fisheries, women economic empowerment

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16122 Evaluation of Role of Surgery in Management of Pediatric Germ Cell Tumors According to Risk Adapted Therapy Protocols

Authors: Ahmed Abdallatif

Abstract:

Background: Patients with malignant germ cell tumors have age distribution in two peaks, with the first one during infancy and the second after the onset of puberty. Gonadal germ cell tumors are the most common malignant ovarian tumor in females aged below twenty years. Sacrococcygeal and retroperitoneal abdominal tumors usually presents in a large size before the onset of symptoms. Methods: Patients with pediatric germ cell tumors presenting to Children’s Cancer Hospital Egypt and National Cancer Institute Egypt from January 2008 to June 2011 Patients underwent stratification according to risk into low, intermediate and high risk groups according to children oncology group classification. Objectives: Assessment of the clinicopathologic features of all cases of pediatric germ cell tumors and classification of malignant cases according to their stage, and the primary site to low, intermediate and high risk patients. Evaluation of surgical management in each group of patients focusing on surgical approach, the extent of surgical resection according to each site, ability to achieve complete surgical resection and perioperative complications. Finally, determination of the three years overall and disease-free survival in different groups and the relation to different prognostic factors including the extent of surgical resection. Results: Out of 131 cases surgically explored only 26 cases had re exploration with 8 cases explored for residual disease 9 cases for remote recurrence or metastatic disease and the other 9 cases for other complications. Patients with low risk kept under follow up after surgery, out of those of low risk group (48 patients) only 8 patients (16.5%) shifted to intermediate risk. There were 20 patients (14.6%) diagnosed as intermediate risk received 3 cycles of compressed (Cisplatin, Etoposide and Bleomycin) and all high risk group patients 69patients (50.4%) received chemotherapy. Stage of disease was strongly and significantly related to overall survival with a poorer survival in late stages (stage IV) as compared to earlier stages. Conclusion: Overall survival rate at 3 three years was (76.7% ± 5.4, 3) years EFS was (77.8 % ±4.0), however 3 years DFS was much better (89.8 ± 3.4) in whole study group with ovarian tumors had significantly higher Overall survival (90% ± 5.1). Event Free Survival analysis showed that Male gender was 3 times likely to have bad events than females. Patients who underwent incomplete resection were 4 times more than patients with complete resection to have bad events. Disease free survival analysis showed that Patients who underwent incomplete surgery were 18.8 times liable for recurrence compared to those who underwent complete surgery, and patients who were exposed to re-excision were 21 times more prone to recurrence compared to other patients.

Keywords: extragonadal, germ cell tumors, gonadal, pediatric

Procedia PDF Downloads 201