Search results for: elevated creatinine clearance level

Authors: Po-Ching Chou, Wen-Chen Liang, I. Chen Chen, Jong-Hau Hsu, Yuh-Jyh Jong

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Background：Cardiopulmonary complications seem to cause high morbidity and mortality in patients with neuromuscular diseases (NMD) but so far there is no domestic data reported in Taiwan. We, therefore attempted to analyze the factors to cause the death in NMD patients from our cohort. Methods：From 1998 to 2013, we retrospectively collected the information of the NMD patients treated and followed up in Kaohsiung Medical University Hospital. Forty-two patients with NMD who expired during these fifteen years were enrolled. The medical records of these patients were reviewed and the causes of death and the associated affecting factors were analyzed. Results：Eighteen patients with NMD (mean age=13.3, SD=12.4) with complete medical record and detailed information were finally included in this study, including spinal muscular atrophy (SMA) (n=9, 7/9: type 1), Duchenne muscular dystrophy (n=6), congenital muscular dystrophy (n=1), carnitine acyl-carnitine translocase (CACT) deficiency (n=1) and spinal muscular atrophy with respiratory distress (SMARD)(n=1). The place of death was in ICU (n=11, 61%), emergency room (n=3, 16.6%) or home (n=4, 22.2%). For SMA type 1 patients, most of them (71.4%, 5/7) died in emergency room or home and the other two expired during an ICU admission. The causes of death included acute respiratory failure due to pneumonia (n=13, 72.2 %), ventilator failure or dislocation (n=2, 11.1%), suffocation/choking (n=2, 11.1%), and heart failure with hypertrophic cardiomyopathy (n=1, 5.55%). Among the 15 patients died of respiratory failure or choking, 73.3% of the patients (n=11) received no ventilator care at home. 80% of the patients (n=12) received no cough assist at home. The patient died of cardiomyopathy received no medications for heart failure until the last admission. Conclusion: Respiratory failure and choking are the leading causes of death in NMD patients. Appropriate respiratory support and airway clearance play the critical role to reduce the mortality.

Keywords: neuromuscular disease, cause of death, tertiary care hospital, medical sciences

Procedia PDF Downloads 527

Authors: Muner M. B. Mohamed, Vipin Varghese, Dustin Chalmers, Khalid M. G. Mohammed, Juan Carlos Q. Velez

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Background: Urinary waxy casts (uWxC) are traditionally described in textbooks as indicative of chronic renal parenchymal disease. However, data supporting this contention is lacking. uWxC can be seen in the context of various renal syndromes, including acute kidney injury, chronic kidney disease, rapidly progressive glomerulonephritis (GN), and nephrotic syndrome. Thus, we investigated the correlation between the identification of uWxC and renal pathological findings. Methods: We prospectively collected data of patients seen in nephrology consultation with a urine specimen subjected to the microscopic examination of the urinary sediment (MicrExUrSed) over a 3-year period. Within this cohort, we identified cases in which a kidney biopsy was concomitantly performed. We assessed the association of uWxC with glomerular or tubular pathology and with chronicity [interstitial fibrosis and tubular atrophy (IFTA) and glomerular obsolescence (GO)]. Results: Among 683 patients with MicrExUrSed,103 (15%) underwent kidney biopsy and were included. The mean age was 55 years, 51% women, 50% white, and 38% self-identified black. Median serum creatinine was 3.2 (0-7-15.6) mg/dL and not significantly different between those with and without uWxC (4.7 vs 3.8 mg/dL, p=0.13). uWxC was identified in 35 (34%) cases. A glomerulopathy was diagnosed in 79 (77%). Among those with uWxC (n=35), a glomerulopathy was more likely to be found with concomitant acute tubular injury (ATI) than without ATI (57% vs. 23%, p=0.0006), whereas among those without uWxC, glomerulopathies were found with or without concomitant ATI with similar frequency (41% vs. 34%, p=0.48). Overall (n=103), more patients with uWxC had ≥ 20% IFTA compared to those without uWxC (74% vs 51%, p=0.03). Among those with glomerulopathy (n=79), more patients with uWxC had ≥ 20% IFTA compared to those without uWxC (89% vs. 56%, p=0.004). uWxC did not correlate with GO. Conclusion: Identification of uWxC denotes a greater likelihood of finding evidence of ATI superimposed with a glomerulopathy rather than finding an isolated glomerular lesion. uWxC is associated with a greater probability of finding ≥ 20% IFTA in a kidney biopsy specimen, particularly in those with a glomerular pathology. This observation may help clinicians weigh on the suitability of a kidney biopsy when chronicity or coexistence of ATI is in question.

Keywords: waxy cast, kidney biopsy, acute tubular injury, glomerulopathy

Procedia PDF Downloads 88

Authors: Salam M. H. Kareem

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Instructional or teaching procedures and their proper sequence are essential for high-quality learning outcomes. These actions are the path that the teacher takes during the learning process after setting the learning objectives. Teachers and specialists in the education field should include teaching procedures with putting in place an effective mechanism for the procedure’s implementation to achieve a logical sequence with the desired output of overall education process. Determining the sequence of these actions may be a strategic process outlined by a strategic educational plan or drawn by teachers with a high level of experience, enabling them to determine those logical procedures. While specific actions may be necessary for a specific form, many Physical Education (PE) teachers can work out on various sports disciplines. This study was conducted to investigate the impact of using the teaching sequence of the teaching pyramid in raising the level of enjoyment in swimming classes. Four months later of teaching swimming skills to the control and experimental groups of the study, we figured that using the tools shown in the teaching pyramid with the experimental group led to statistically significant differences in the positive tendencies of students to participate in the swimming classes by using the traditional procedures of teaching and using of successive procedures in the teaching pyramid, and in favor of the teaching pyramid, The students are influenced by enhancing their tendency to participate in swimming classes when the teaching procedures followed are sensitive to individual differences and are based on the element of pleasure in learning, and less positive levels of the tendency of students when using traditional teaching procedures, by getting the level of skills' requirements higher and more difficult to perform. The level of positive tendencies of students when using successive procedures in the teaching pyramid was increased, by getting the level of skills' requirements higher and more difficult to perform, because of the high level of motivation and the desire to challenge the self-provided by the teaching pyramid.

Keywords: physical education, swimming classes, teaching process, teaching pyramid

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Authors: Kyle Burke Pfeiffer, Carmella Burdi, Karen Marsh

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The evacuation and shelter-in-place planning process employed by most jurisdictions within the United States is not informed by a scientifically-derived framework that is inclusive of the behavioral and policy-related indicators of public compliance with evacuation orders. While a significant body of work exists to define these indicators, the research findings have not been well-integrated nor translated into useable planning factors for public safety officials. Additionally, refinement of the planning factors alone is insufficient to support science-based evacuation planning as the behavioral elements of evacuees—even with consideration of policy-related indicators—must be examined in the context of specific regional transportation and shelter networks. To address this problem, the Federal Emergency Management Agency and Argonne National Laboratory developed an agent-based model to support regional analysis of zone-based evacuation in southeastern Georgia. In particular, this model allows public safety officials to analyze the consequences that a range of hazards may have upon a community, assess evacuation and shelter-in-place decisions in the context of specified evacuation and response plans, and predict outcomes based on community compliance with orders and the capacity of the regional (to include extra-jurisdictional) transportation and shelter networks. The intention is to use this model to aid evacuation planning and decision-making. Applications for the model include developing a science-driven risk communication strategy and, ultimately, in the case of evacuation, the shortest possible travel distance and clearance times for evacuees within the regional boundary conditions.

Keywords: agent-based modeling for evacuation, decision-support for evacuation planning, evacuation planning, human behavior in evacuation

Procedia PDF Downloads 228

Authors: Yeasir Arafat Alve, Nazmun Nahar, Salma BeguM

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Introduction / Rationale: Caregivers of stroke survivors have experienced financial, emotional, physical and mental anxiety and have influence of family bonding and social customs, where 80% of caregivers were women and majority of the patients were cared for by immediate family members for example a spouse, son/daughter, son-in-law, daughter-in-law, siblings and they are significantly feel burden as a caregiver. In Bangladeshi context, there has a limitation of knowledge about the level of caregiver burden. This study could be suggested the health professional to focus on the care giving stress to provide a better support to them and also it will be advisable to provide equivalent services for caregivers and their families. Objectives: The study finds out the socio-demographic image of caregivers of stroke survivors in Bangladesh as well as discovers the level of burden of caregiver of stroke survivor in relation to general strain, isolation, disappointment, emotional involvement and environment. The study will find out the association between level of burden among caregivers and onset of stroke of survivors & duration of care giving. As well as to determine the association between level of burden among caregivers and caregiver’s age, gender, occupation and caregiver’s relationship with stroke survivors. Method / Approach: The study is a non experimental cross-sectional study design where 151 participants were selected through purposive comprehensive sampling. Data were selected from occupational therapy outdoor and stroke rehab unit, CRP (Savar & Mirpur) where using the Caregiver Burden Scale (a structured questionnaire) with face to face interview. Results: Most of the caregivers (78.8%) of stroke survivors faced moderate level of burden in general strain (37.7%), isolation (27.2%) but in case of disappointment (60.3%) feel higher burden and lower burden in emotional involvement (9.9%) and environment (0.7%). Caregiver burden level was significantly associated with caregivers’ age (P=0.006), sex (P=0.002), occupation (p= 0.04), relationship with stroke survivors (P=0.02), care giving duration (P=0.000), care giving hours (P=0.009), and onset of stroke (P=0.000) of stroke survivors. Conclusion: The study findings revealed that most of the caregivers faced moderate burden where no environmental burden for them, this is possibly in case of Bangladeshi culture where people hospitable. Through this study, it was also found that there is a possibility to have the higher burden. Finally, it is being also suggested that appropriate advice and support may preserve care giving which eventually enables the survivors to live a longer and more fulfilling life in the community.

Keywords: caregiver, level of caregiver burden, stroke survivor, stroke rehab unit

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Authors: Muhammad Hamza

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This research is based on the effect of self-questioning strategy on reading comprehension of second language learners at medium level. This research is conducted to find out the effects of self-questioning strategy and how self-questioning strategy helps English learners to improve their reading comprehension. In this research study the researcher has analyzed that how much self-questioning is effective in the field of learning second language and how much it helps second language learners to improve their reading comprehension. For this purpose, the researcher has studied different reading strategies, analyzed, collected data from certificate level class at NUML, Peshawar campus and then found out the effects of self-questioning strategy on reading comprehension of ESL learners. The researcher has randomly selected the participants from certificate class. The data was analyzed through pre-test and post-test and then in the final stage the results of both tests were compared. After the pre-test and post-test, the result of both pre-test and post-test indicated that if the learners start to use self-questioning strategy before reading a text, while reading a text and after reading a particular text there’ll be improvement in comprehension level of ESL learners. The present research has addressed the benefits of self-questioning strategy by taking two tests (pre and post-test).After the result of post-test it is revealed that the use of the self-questioning strategy has a significant effect on the readers’ comprehension thus, they can improve their reading comprehension by using self-questioning strategy.

Keywords: strategy, self-questioning, comprehension, intermediate level ESL learner

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Authors: Firman Riyudha, Endrik Mifta Shaiful

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The spread of drug users is one kind of behavioral epidemiology that becomes a threat to every country in the world. This problem caused various crisis simultaneously, including financial or economic crisis, social, health, until human crisis. Most drug users are teenagers at school age. A new deterministic model would be constructed to determine the dynamics of the spread of drug users by considering level of education in a susceptible population. Based on the analytical model, two equilibria points were obtained; there were E₀ (zero user) and E₁ (endemic equilibrium). Existence of equilibrium and local stability of equilibria depended on the Basic Reproduction Ratio (R₀). This parameter was defined as the expected rate of secondary prevalence and primary prevalence in virgin population along spreading primary prevalence. The zero-victim equilibrium would be locally asymptotically stable if R₀ < 1 while if R₀ > 1 the endemic equilibrium would be locally asymptotically stable. The result showed that R₀ was proportional to the rate of interaction of each susceptible population based on educational level with the users' population. It is concluded that there was a need to be given a control in interaction, so that drug users population could be minimized. Numerical simulations were also provided to support analytical results.

Keywords: drugs users, level education, mathematical model, stability

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Authors: N. Damenia, E. Kharaishvili, N. Sagareishvili, M. Saghareishvili

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Women's Employment is one of the most important issues in the global economy. The article discusses the stated topic in Georgia, through historical content, Soviet experience, and modern perspectives. The paper discusses segmentation insa terms of employment and related problems. Based on statistical analysis, women's unemployment rate and its factors are analyzed. The level of employment of women in Transcaucasia (Georgia, Armenia, and Azerbaijan) is discussed and is compared with Baltic countries (Lithuania, Latvia, and Estonia). The study analyzes women’s level of development, according to the average age of marriage and migration level. The focus is on Georgia's Association Agreement with the EU in 2014, which includes economic, social, trade and political issues. One part of it is gender equality at workplaces. According to the research, the average monthly remuneration of women managers in the financial and insurance sector equaled to 1044.6 Georgian Lari, while in overall business sector average monthly remuneration equaled to 961.1 GEL. Average salaries are increasing; however, the employment rate remains problematic. For example, in 2017, 74.6% of men and 50.8% of women were employed from a total workforce. It is also interesting that the proportion of men and women at managerial positions is 29% (women) to 71% (men). Based on the results, the main recommendation for government and civil society is to consider women as a part of the country’s economic development. In this aspect, the experience of developed countries should be considered. It is important to create additional jobs in urban or rural areas and help migrant women return and use their working resources properly.

Keywords: employment of women, segregation in terms of employment, women's employment level in Transcaucasia, migration level

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Authors: Jing Yu, Hongyang Liu, Dong Hao

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On-Orbit Refueling is of great significance in extending space crafts' lifetime. The problem of minimum-fuel, time-fixed, Peer-to-Peer On-Orbit Refueling mission planning is addressed here with the particular aim of assigning fuel-insufficient satellites to the fuel-sufficient satellites and optimizing each rendezvous trajectory. Constraints including perturbation, communication link, sun illumination, hold points for different rendezvous phases, and sensor switching are considered. A planning model has established as well as a two-level solution method. The upper level deals with target assignment based on fuel equilibrium criterion, while the lower level solves constrained trajectory optimization using special maneuver strategies. Simulations show that the developed method could effectively resolve the Peer-to-Peer On-Orbit Refueling mission planning problem and deal with complex constraints.

Keywords: mission planning, orbital rendezvous, on-orbit refueling, space mission

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Authors: Pitimanus Bunlue

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This research aim (1) to determine the content of communication, social capital and cultural capital to promote tourism in the province to create awareness, motivation and desire to tourists visiting Thailand (2) to evaluate the performance of innovation communication social capital and cultural capital to promote tourism southern of Thailand. This research is a qualitative research. A research synthesis projects on social capital and cultural capital by use focus group discussions with media professionals and academics to communicate using a random sample specific. The result show that (1) Innovative communication, social capital and cultural capital and effective communication innovations after everyone wants to travel to Ranong province is the very highest level. (2) Information and experience about Ranong at a high level. (3) The data shows the strengths of each of the attractions at a high level. (4) The data shows a lifestyle that is unique to the province is moderate.

Keywords: innovative communication, promoting tourism, southern of Thailand, social capital

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Authors: G. Farkas, K. Mathis, J. Pilch, P. Minarik

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Deformation mechanisms in an Mg-Al-Ca alloy reinforced with short alumina fibres were studied by acoustic emission and in-situ neutron diffraction method. The fibres plane orientation with respect to the loading axis was found to be a key parameter, which influences the acting deformation processes, such as twinning or dislocation slip. In-situ neutron diffraction tests were measured at different temperatures from room temperature (RT) to 200°C. The measurement shows the lattice strain changes in the matrix and also in the reinforcement phase depending on macroscopic compressive deformation and stress. In case of parallel fibre plane orientation, the increment of compressive lattice strain is lower in the matrix and higher in the fibres in comparison to perpendicular fibre orientation. Furthermore, acoustic emission results indicate a larger twinning activity and more frequent fibre cracking in sample with perpendicular fibre plane orientation. Both types of mechanisms are more dominant at elevated temperatures.

Keywords: neutron diffraction, acoustic emission, magnesium based composite, deformation mechanisms

Procedia PDF Downloads 157

Authors: Ibrahim Khalil Ibrahim, Enas Mohamed Shahine, Abeer Shawky El Hadedy, Emmanuel Kamal Aziz Saba, Ghada Salah Attia Hussein

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Osteoarthritis (OA) is a multifactorial disease characterized by a progressive degradation of articular cartilage and is the leading cause of disability in elderly persons. IL-18 contributes to the destruction of cartilage and bone in the disease process of arthritis. The aim of the study was to investigate the role of IL-18 in primary knee OA patients. Serum level of IL-18 was assessed by enzyme-linked immunosorbent assay in 30 primary knee OA patients and compared to 20 age and gender-matched healthy volunteers as a control group. Radiographic severity of OA was assessed by Kellgren and Lawrence (KL) global scale. Pain, stiffness and functional assessment were done using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). OA patients had significantly higher serum IL-18 level than in control group (420.93 ± 345.4 versus 151.03 ± 144.16 pg/ml, P=0.001). Serum level of IL-18 was positively correlated with KL global scale (P=0.001). There were no statistically significant correlations between serum level of IL-18 and pain, stiffness, function subscales and total WOMAC index scores among the studied patients. In conclusions, IL-18 has a role in the pathogenesis of OA and it is positively correlated with the radiographic damage of OA.

Keywords: Interlukin-18, knee osteoarthritis, primary osteoarthritis, WOMAC scale

Procedia PDF Downloads 380

Authors: Yi-Shuan ShaoShao, Yen-An Tsai, Chia-Huang Chang, Kai-Wei Liao, Ming-Song Tsai, Mei-Lien Chen

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Organophosphate pesticides (OPs) is an environmental hormone with proven endocrine-disrupting effects that may affect the growth and development in human. A large amount of organophosphate pesticides (OPs) is used throughout Taiwan, and human may be exposed through dietary intake or residential use. During pregnancy, OPs can be transferred to the blood stream reaching the fetus through the placenta. The aim of this study was to explore the association between maternal OPs exposure levels and fetal developments and birth outcomes. A birth cohort was follow-up. Maternal urine sample were collected at the first, second, and third gestational trimester. Fetal growth characteristics were measured by ultrasonic scan and birth outcomes were assessed by pediatrician. Urinary metabolite of organophosphate pesticides were assessed using gas chromatography-mass spectrometry. The analytes included dimethylphosphate (DMP), dimethylthiophosphate (DMTP), dimethyldithiophosphates (DMDTP), diethylphosphate (DEP), diethylthiophosphate (DETP), and diethyldithiophosphate (DEDTP). We found that all of urine samples in each trimester were detected at least one metabolite for dialkyl phosphate (DAP). The detection rate range of OP urinary metabolites were from the lowest 22% DEDTP to the highest 100% DMP and DMTP. And to compared geometric means (GM) of urinary metabolites with three trimesters, that third trimester had the highest concentration for DMPs, DEPs, and DAPs in pregnant women were 368.01, 169.85 and 543.75 nmol/g creatinine, respectively. We observed that DAPs concentration in first and second trimester were significantly negative association with head circumference. DMPs in first trimester was significantly negative association with thoracic circumference (p=0.05) by spearman correlation. Our results support associations with prenatal OPs exposure with fetal head circumference and thoracic circumference. It provided that maternal OPs exposure might affect birth outcomes. Thus, prenatal exposure to OPs and health risk worthy of attention and concern.

Keywords: DAPs, birth outcomes, organophosphate pesticides, prenatal

Procedia PDF Downloads 338

Authors: Nuseiba M. Altarawneh, Suhuai Luo, Brian Regan, Guijin Tang

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Liver segmentation from medical images poses more challenges than analogous segmentations of other organs. This contribution introduces a liver segmentation method from a series of computer tomography images. Overall, we present a novel method for segmenting liver by coupling density matching with shape priors. Density matching signifies a tracking method which operates via maximizing the Bhattacharyya similarity measure between the photometric distribution from an estimated image region and a model photometric distribution. Density matching controls the direction of the evolution process and slows down the evolving contour in regions with weak edges. The shape prior improves the robustness of density matching and discourages the evolving contour from exceeding liver’s boundaries at regions with weak boundaries. The model is implemented using a modified distance regularized level set (DRLS) model. The experimental results show that the method achieves a satisfactory result. By comparing with the original DRLS model, it is evident that the proposed model herein is more effective in addressing the over segmentation problem. Finally, we gauge our performance of our model against matrices comprising of accuracy, sensitivity and specificity.

Keywords: Bhattacharyya distance, distance regularized level set (DRLS) model, liver segmentation, level set method

Procedia PDF Downloads 309

Authors: K. Srujana, Vinay U. Rao, M. Sudhakar

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Isoniazide (INH) a freely water soluble and pyrazinamide (Z) a practically water insoluble first line anti tubercular (TB) drugs were identified as candidates for optimizing the Moisture Activated Dry Granulation (MADG) process. The work focuses on identifying the effect of binder type and concentration as well as the effect of magnesium stearate level on critical quality attributes of Disintegration time (DT) and in vitro dissolution test when the tablets are processed by the MADG process. Also, the level of the drug concentration, binder concentration and fluid addition during the agglomeration stage of the MADG process was evaluated and optimized. For INH, it was identified that for tablets with HPMC as binder at both 2% w/w and 5% w/w level and Magnesium stearate upto 1%w/w as lubrication the DT is within 1 minute and the dissolution rate is the fastest (> 80% in 15 minutes) as compared to when PVP or pregelatinized starch is used as binder. Regarding the process, fast disintegrating and rapidly dissolving tablets are obtained when the level of drug, binder and fluid uptake in agglomeration stage is 25% w/w 0% w/w binder and 0.033%. w/w. At the other 2 levels of these three ingredients, the DT is significantly impacted and dissolution is also slower. For pyrazinamide,it was identified that for the tablets with 2% w/w level of each of PVP as binder and Cross Caramellose Sodium disintegrant the DT is within 2 minutes and the dissolution rate is the fastest(>80 in 15 minutes)as compared to when HPMC or pregelatinized starch is used as binder. This may be attributed to the fact that PVP may be acting as a solubilizer for the practically insoluble Pyrazinamide. Regarding the process,fast dispersing and rapidly disintegrating tablets are obtained when the level of drug, binder and fluid uptake in agglomeration stage is 10% w/w,25% w/w binder and 1% w/w.At the other 2 levels of these three ingredients, the DT is significantly impacted and dissolution is comparatively slower and less complete.

Keywords: agglomeration stage, isoniazide, MADG, moisture distribution stage, pyrazinamide

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Authors: Yu-Lin Shen, Ming-Kuen Chang

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In addition to a considerable amount of machinery and equipment, intricacies of the transmission pipeline exist in Petrochemical plants. Long term corrosion may lead to pipeline thinning and rupture, causing serious safety concerns. With the advances in non-destructive testing technology, more rapid and long-range ultrasonic detection techniques are often used for pipeline inspection, EMAT without coupling to detect, it is a non-contact ultrasonic, suitable for detecting elevated temperature or roughened e surface of line. In this study, we prepared artificial defects in pipeline for Electromagnetic Acoustic Transducer testing (EMAT) to survey the relationship between the defect location, sizing and the EMAT signal. It was found that the signal amplitude of EMAT exhibited greater signal attenuation with larger defect depth and length. In addition, with bigger flat hole diameter, greater amplitude attenuation was obtained. In summary, signal amplitude attenuation of EMAT was affected by the defect depth, defect length and the hole diameter and size.

Keywords: EMAT, artificial defect, NDT, ultrasonic testing

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Authors: Omid Kalatpour, Mohammadreza Ajdari

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This article studied the possible causes of human error-induced incidents in the petrochemical industry maintenance activities by using Human Factors Analysis and Classification System (HFACS). The purpose of the study was anticipating and identifying these causes and proposing corrective and preventive actions. Maintenance department in a petrochemical company was selected for research. A checklist of human error-induced incidents was developed based on four HFACS main levels and nineteen sub-groups. Hierarchical task analysis (HTA) technique was used to identify maintenance activities and tasks. The main causes of possible incidents were identified by checklist and recorded. Corrective and preventive actions were defined depending on priority. Analyzing the worksheets of 444 activities in four levels of HFACS showed 37.6% of the causes were at the level of unsafe actions, 27.5% at the level of unsafe supervision, 20.9% at the level of preconditions for unsafe acts and 14% of the causes were at the level of organizational effects. The HFACS sub-groups showed errors (24.36%) inadequate supervision (14.89%) and violations (13.26%) with the most frequency. According to findings of this study, increasing the training effectiveness of operators and supervision improvement respectively are the most important measures in decreasing the human error-induced incidents in petrochemical industry maintenance.

Keywords: human error, petrochemical industry, maintenance, HFACS

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Authors: S. Nikpour, S. Vahidi, H. Haghani

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Introduction: Exercise has mental and physical health benefits for patients with advanced stage cancer who actively receive chemotherapy, yet little is known about patients’ levels of interest in becoming more active or their confidence in increasing their activity level. Methods and materials: A convenience sample of 200 patients with advanced-stage cancer who were receiving chemotherapy completed self-report measures assessing physical activity level, mood, and quality-of-life variables. Qualitative data on patient-perceived benefits of, and barriers to, physical activity also were collected, coded by independent raters, and organized by predominant themes. Results: Current physical activity level, physical activity outcome expectations, and positive mood were significantly associated with self-efficacy. Fatigue was the most frequently listed barrier to physical activity; improved physical strength and health were the most commonly listed benefits. Participants identified benefits related to both general health and cancer-symptom management that were related to exercise. 59.5% of participants reported that they were seriously planning to increase or maintain their physical activity level, and over 40% reported having interest in receiving an intervention to become more active. Conclusion: These results suggested that many advanced-stage cancer patients who receive chemotherapy are interested in maintaining or increasing their physical activity level and in receiving professional support for exercise. In addition, these individuals identified general health and cancer-specific benefits of, and barriers to, physical activity. Future research will investigate how these findings may be incorporated into physical activity interventions for advanced-stage oncology patients receiving medical treatment.

Keywords: physical activity, cancer, self-efficacy

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Authors: Charles Horace Ampong

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Non-linear models have been found to be useful in modeling the elasticity (measure of degree of responsiveness) of a dependent variable with respect to a set of independent variables ceteris paribus. This constant elasticity principle was applied to the dependent variable (Compressive Strength of Concrete in MPa) which was found to be non-linearly related to the independent variable (Water-Cement ratio in kg/m3) for given Ages of Concrete in days (3, 7, 28) at different levels of admixtures Superplasticizer (in kg/m3), Blast Furnace Slag (in kg/m3) and Fly Ash (in kg/m3). The levels of the admixtures were categorized as: S1=Some Plasticizer added & S0=No Plasticizer added; B1=some Blast Furnace Slag added & B0=No Blast Furnace Slag added; F1=Some Fly Ash added & F0=No Fly Ash added. The number of observations (samples) used for the research was one-hundred and thirty-two (132) in all. For Superplasticizer, it was found that Compressive Strength of Concrete was more elastic with regards to Water-Cement ratio at S1 level than at S0 level for the given ages of concrete 3, 7and 28 days. For Blast Furnace Slag, Compressive Strength with regards to Water-Cement ratio was more elastic at B0 level than at B1 level for concrete ages 3, 7 and 28 days. For Fly Ash, Compressive Strength with regards to Water-Cement ratio was more elastic at B0 level than at B1 level for Ages 3, 7 and 28 days. The research also tested for different combinations of the levels of Superplasticizer, Blast Furnace Slag and Fly Ash. It was found that Compressive Strength elasticity with regards to Water-Cement ratio was lowest (Elasticity=-1.746) with a combination of S0, B0 and F0 for concrete age of 3 days. This was followed by Elasticity of -1.611 with a combination of S0, B0 and F0 for a concrete of age 7 days. Next, the highest was an Elasticity of -1.414 with combination of S0, B0 and F0 for a concrete age of 28 days. Based on preceding outcomes, three (3) non-linear model equations for predicting the output elasticity of Compressive Strength of Concrete (in %) or the value of Compressive Strength of Concrete (in MPa) with regards to Water to Cement was formulated. The model equations were based on the three different ages of concrete namely 3, 7 and 28 days under investigation. The three models showed that higher elasticity translates into higher compressive strength. And the models revealed a trend of increasing concrete strength from 3 to 28 days for a given amount of water to cement ratio. Using the models, an increasing modulus of elasticity from 3 to 28 days was deduced.

Keywords: concrete, compressive strength, elasticity, water-cement

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Authors: Arunima Datta, Prathama Guha Chaudhuri, Ashis Mukhopadhyay

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Background: Acceptance and commitment therapy (ACT) is one of the newer forms (third wave) therapy. This therapy helps a cancer patient to increase acceptance level about their disease as well as their present situation. Breast cancer patients are known to suffer from depression and mild cognitive impairment; both affect their quality of life. Objectives:The present study had assessed effect of structured ACT intervention on cognitive function and acceptance level among breast cancer patients who were undergoing chemotherapy. Method: Data was collected from 123 breast cancer patients those who were undergoing chemotherapy were willing to undergo psychological treatment, with no history of past psychiatric illness. Their baseline of cognitive function and acceptance levels were assessed using validated tools. The effect of sociodemographic factors and clinical factors on cognitive function was determined at baseline.The participants were randomly divided into two groups: experimental (ACT, 4 sessions over 2 months) and control group. Cognitive function and acceptance level were measured during post intervention on 2months follow-up. Appropriate statistical analyses were performed to determine the effect on cognitive function and acceptance level in two groups. Result: At baseline, the factors that significantly influenced slower speed of task performance were ER PR HER2 status; number of chemo cycle, treatment type (Adjuvant and neo-adjuvant) was related with that. Sociodemographic characteristics did not show any significant difference between slow and fast performance. Per and post intervention analysis showed that ACT intervention resulted in significant difference both in terms of speed of cognitive performance and acceptance level. Conclusion: ACT is an effective therapeutic option for treating mild cognitive impairment and improve acceptance level among breast cancer patients undergoing chemotherapy.

Keywords: acceptance and commitment therapy, breast cancer, quality of life, cognitive function

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Authors: K. A. Ghazaryan, T. H. Derdzyan

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For assessment of the soils pollution level of the open mine and tailing dump of surrounding territories of Akhtala ore processing combine by heavy metals in 2013 collected soil samples and analyzed for different heavy metals, such as Cu, Zn, Pb, Ni and Cd. The main soil type in the study sites was the mountain cambisol. To classify soil pollution level contamination indices like Contamination factors (Cf), Degree of contamination (Cd), Pollution load index (PLI) and Geoaccumulation index (I-geo) are calculated. The distribution pattern of trace metals in the soil profile according to I geo, Cf and Cd values shows that the soil is very polluted. And also the PLI values for the 19 sites were >1, which indicates deterioration of site quality.

Keywords: soils pollution, heavy metal, geoaccumulation index, pollution load index, contamination factor

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Authors: Oscar Covarrubias, Diane Ghanem, Christopher Murdock, Babar Shafiq

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Introduction: ChatGPT is an advanced language AI tool designed to understand and generate human-like text. The aim of this study is to assess the ability of ChatGPT-4 to re-write orthopaedic trauma patient education materials at the recommended 6th-grade level. Methods: Two independent reviewers accessed ChatGPT-4 (chat.openai.com) and gave identical instructions to simplify the readability of provided text to a 6th-grade level. All trauma-related articles by the Orthopaedic Trauma Association (OTA) and American Academy of Orthopaedic Surgeons (AAOS) were sequentially provided. The academic grade level was determined using the Flesh-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE). Paired t-tests and Wilcox-rank sum tests were used to compare the FKGL and FRE between the ChatGPT-4 revised and original text. Inter-rater correlation coefficient (ICC) was used to assess variability in ChatGPT-4 generated text between the two reviewers. Results: ChatGPT-4 significantly reduced FKGL and increased FRE scores in the OTA (FKGL: 5.7±0.5 compared to the original 8.2±1.1, FRE: 76.4±5.7 compared to the original 65.5±6.6, p < 0.001) and AAOS articles (FKGL: 5.8±0.8 compared to the original 8.9±0.8, FRE: 76±5.5 compared to the original 56.7±5.9, p < 0.001). On average, 14.6% of OTA and 28.6% of AAOS articles required at least two revisions by ChatGPT-4 to achieve a 6th-grade reading level. ICC demonstrated poor reliability for FKGL (OTA 0.24, AAOS 0.45) and moderate reliability for FRE (OTA 0.61, AAOS 0.73). Conclusion: This study provides a novel, simple and efficient method using language AI to optimize the readability of patient education content which may only require the surgeon’s final proofreading. This method would likely be as effective for other medical specialties.

Keywords: artificial intelligence, AI, chatGPT, patient education, readability, trauma education

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Authors: Kopila Shrestha

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Adolescent sexual reproductive health is one of the most important issues in the world. Reproductive ability is taking place at an earlier age and adolescents are indulging in risk taking behaviors day by day. A descriptive cross-sectional study was conducted in Kathmandu valley to assess the knowledge regarding sexual and reproductive health among adolescent. Total of 200 respondents were selected through non-probability convenient sampling technique. Self-administered written questionnaires using semi-structured questions were used. The collected data were analyzed by using descriptive statistics such as frequency, percentage, mean, standard deviation and inferential statistics such as Chi-square test. The findings revealed that most of the respondents had adequate knowledge regarding transmission and protection of HIV/AIDs and STIs but still some respondents had a misconception regarding it. Few respondents had knowledge regarding legal age for marriage and the minimum age for first child bearing. The statistical analysis revealed that the total mean knowledge score with standard deviation was 45.02±8.674. Nearly half of the respondents (49.5%) had a moderate level of knowledge, followed by an inadequate level of knowledge 29.5% and adequate level of knowledge 21.0% regarding sexual and reproductive health. There was significant association of level of knowledge with area of residence (p-value .002) but no association with age (p-value .067), sex (p-value .999), religion (p-value .082) and ethnicity (p-value .114). Nearly half of the participants possess some knowledge about sexual and reproductive health but still effective educational intervention is required in higher secondary school to encourage more sensible and healthy behaviour.

Keywords: adolescents, higher secondary school, knowledge, sexual and reproductive health

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Authors: Nivedhitha Venkatakrishnan

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Flooding in urban areas in India has become a usual ritual phenomenon and a nightmare to most cities, which is a consequence of man-made disruption resulting in disaster. The City planning in India falls short of withstanding hydro generated disasters. This has become a barrier and challenge in the process of development put forth by urbanization, high population density, expanding informal settlements, environment degradation from uncollected and untreated waste that flows into natural drains and water bodies, this has disrupted the natural mechanism of hazard protection such as drainage channels, wetlands and floodplains. The magnitude and the impact of the mishap was high because of the failure of development policies, strategies, plans that the city had adopted. In the current scenario, cities are becoming the home for future, with economic diversification bringing in more investment into cities especially in domains of Urban infrastructure, planning and design. The uncertainty of the Urban futures in these low elevated coastal zones faces an unprecedented risk and threat. The study on focuses on three major pillars of resilience such as Recover, Resist and Restore. This process of getting ready to handle the situation bridges the gap between disaster response management and risk reduction requires a shift in paradigm. The study involved a qualitative research and a system design approach (framework). The initial stages involved mapping out of the urban water morphology with respect to the spatial growth gave an insight of the water bodies that have gone missing over the years during the process of urbanization. The major finding of the study was missing links between traditional water harvesting network was a major reason resulting in a manmade disaster. The research conceptualized the ideology of a sponge city framework which would guide the growth through institutional frameworks at different levels. The next stage was on understanding the implementation process at various stage to ensure the shift in paradigm. Demonstration of the concepts at a neighborhood level where, how, what are the functions and benefits of each component. Quantifying the design decision with rainwater harvest, surface runoff and how much water is collected and how it could be collected, stored and reused. The study came with further recommendation for Water Mitigation Spaces that will revive the traditional harvesting network.

Keywords: flooding, man made disaster, resilient city, traditional harvesting network, waterbodies

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Authors: Niyom Suwandej

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This research paper investigated the opinions of small and micro community enterprises from Jom Pluak Subdistrict, Bangkhontee District, Samut Songkram Province towards product quality control, and the findings are aimed to disseminate knowledge on quality control for upgrading product standards for small and micro community enterprises. The study employed both qualitative and quantitative methods, in which there were 23 samples in the study. The study was divided into 2 steps which were (1) studying the opinions of the respondents towards the community’s product quality control and upgrading product standards; (2) creating development guidance for product quality control and upgrading product standards for small and micro community enterprise. The demographic findings revealed female respondents as the majority, with most above 50 years of age and married. Most had more than 15 years of working experience. The education level reported by most respondents was primary school or lower followed by secondary school or lower with most respondents was vocational certificate level. Most respondents had the highest level of satisfaction with the existing condition of product quality control knowledge management. Pertaining to opinions on the guidance of knowledge creation for product quality control for small and micro community enterprise, the respondents were willing to apply the knowledge in upgrading their product standards. For the opinions of knowledge creation for product quality control and product standards, the respondents had the highest level of satisfaction. Guidance of knowledge creation for product quality control and product standards for small and micro community enterprises received the highest level of satisfaction from the respondents. Furthermore they had knowledge and comprehension in product quality control and product standards and could apply the knowledge in improving the quality of their production and product standards for small and micro community enterprises.

Keywords: product quality control, product standards, community enterprise, marketing management

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Authors: Teguh Sugiarto

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Background: This study aims to explore the fraud that occurred in the financial statements using the Benford distribution law of 1st and 2nd case study of PT AKR Corporindo Tbk. Research Methods: In this study the authors use the first digit of the analysis and the analysis of the second digit of Bedford’s law. Having obtained the results of the analysis of the first and second digits, authors will make the difference between implementations using the scale above and below 5%. The number that has the level of difference in the range of 5% above or below, then a financial report in may, to analyse in the followup to the direction of the audit investigation, and authors assume happens a confusion in the financial statements. Findings: From research done, we found that there was a difference in the results of the appearance of the first digit of the number with the proper use of Benford's law, according to PT AKR Corporindo financial reports Tbk for the fiscal year 2006-2010, above and below the level the difference in set 5%. Conclusions: From the research that has been done, it can be concluded that on PT AKR Corporindo financial report 2006, 2007, 2008, 2009 and 2010, there is a level difference of appearance of numbers according to Benford's law is significant, as presented in the table analysis.

Keywords: Benford law, first digits, second digits, Indonesian company

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Authors: Paul J Yazaki, Michael Bouvet, John Shively

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Surgery for solid gastrointestinal (GI) cancers such as pancreatic, colorectal, and gastric adenocarcinoma remains the mainstay of curative therapy. Complete resection of the primary tumor with negative margins (R0 resection), its draining lymph nodes, and distant metastases offers the optimal surgical benefit. Real-time fluorescence guided surgery (FGS) promises to improve GI cancer outcomes and is rapidly advancing with tumor-specific antibody conjugated fluorophores that can be imaged using near infrared (NIR) technology. Carcinoembryonic Antigen (CEA) is a non-internalizing tumor antigen validated as a surface tumor marker expressed in >95% of colorectal, 80% of gastric, and 60% of pancreatic adenocarcinomas. Our humanized anti-CEA hT84.66-M5A (M5A) monoclonal antibody (mAb)was conjugated with the NHS-IRDye800CW fluorophore and shown it can rapidly and effectively NIRoptical imageorthotopically implanted human colon and pancreatic cancer in mouse models. A limitation observed is that these NIR-800 dye conjugated mAbs have a rapid clearance from the blood, leading to a narrow timeframe for FGS and requiring high doses for effective optical imaging. We developed a novel antibody-fluorophore conjugate by incorporating a PEGylated sidearm linker to shield or mask the IR800 dye’s hydrophobicity which effectively extended the agent’s blood circulation half-life leading to increased tumor sensitivity and lowered normal hepatic uptake. We hypothesized that our unique anti-CEA linked to the fluorophore, IR800 by PEGylated sidewinder, M5A-SW-IR800 will become the next generation optical imaging agent, safe, effective, and widely applicable for intraoperative image guided surgery in CEA expressing GI cancers.

Keywords: optical imaging, anti-CEA, cancer, fluorescence-guided surgery

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Authors: Fahad Qureshi

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This paper provides detailed study on the diagnosis of intermittent high vibration spikes at exhaust bearing (Non-Drive End) of Mitsubishi H-25 gas turbine installed in a petrochemical plant in Pakistan. The diagnosis is followed by successful root cause analysis of the issue and recommendations for improving the reliability of machine. Engro Polymer and Chemicals (EPCL), a Chlor Vinyl complex, has a captive power plant consisting of one combined cycle power plant (CCPP), having two gas turbines each having 25 MW capacity (make: Hitachi) and one extraction condensing steam turbine having 15 MW capacity (make: HTC). Besides, one 6.75 MW SGT-200 1S gas turbine (make: Alstom) is also available. In 2018, the organization faced an issue of intermittent high vibration at exhaust bearing of one of H-25 units having tag GT-2101 A, which eventually led to tripping of machine at configured securities. Since the machine had surpassed 64,000 running hours and major inspection was also due, so bearings inspection was performed. Inspection revealed excessive coke deposition at labyrinth where evidence of rotor rub was also present. Bearing clearance was also at upper limit, and slight babbitt (soft metal) chip off was observed at one of its pads so it was preventively replaced. The unit was restated successfully and exhibited no abnormality until October 2020, when these spikes reoccurred, leading to machine trip. Recurrence of the issue within two years indicated that root cause was not properly addressed, so this paper furthers the discussion on in-depth analysis of findings and establishes successful root cause analysis, which captured significant learnings both in terms of machine design deficiencies and gaps in operation & maintenance (O & M) regime. Lastly, revised O& M regime along with set of recommendations are proposed to avoid recurrence.

Keywords: exhaust side bearing, Gas turbine, rubbing, vibration

Procedia PDF Downloads 180

Authors: Mohamed Elkoushy, Sameer Munshi, Waseem Tayeb

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Background: Flexible ureteroscopy (fURS) has dramatically improved the minimally invasive management of complex nephrolithiasis. fUR is increasingly being used as the first-line treatment for patients with renal stones. Stone-free status (SFS) is the primary goal in the management of patients with urolithiasis. However, substantial variations exist in the reported SFS following fURS. Objectives: This study determines the predictors of SFS after a single session of fURS with holmium laser lithotripsy (HLL) for renal calculi. Methods: A retrospective review of prospectively collected data was performed for all consecutive patients undergoing fURS and HLL for renal calculi at a tertiary care center. Patients with previous ipsilateral URS for the same stones were excluded. All patients underwent JJ ureteral stent insertion at the end of the procedure. SFS was defined as the presence of no residuals or ≤4-mm non-obstructing stone and was assessed by CT/KUB imaging after 3-4 weeks post-operatively. Multivariate logistic regression was used to detect possible predictors of SFS. Results: A total of 212 patients were included with a mean age of 52.3±8.3 years and a stone burden <20 mm (49.1%), 20-30 mm (41.0%) and >30 mm (9.9%). Overall SFS after a single session of fURS was 71.7%, 92% and 52% for stones less and larger than 20 mm, respectively. Patients with stones> 20 mm need retreatment with a mean number of 1.8 (1.3-2.7) fURS. SFS was significantly associated with male gender, stone bulk <20 mm (95.7% vs. 56.2%), non-lower pole stones, hydronephrotic kidney, low stone intensity, ureteral access sheath, and preoperative stenting. SFS was associated with a lower readmission rate (5.9% vs. 38.9%) and urinary tract infections (3.8% vs. 25.9%). In multivariate regression analysis, SFS maintains its significant association with low stone burden of <20 mm (OR: 5.21), stone intensity <600 HFU (OR: 2.87), and non-lower caliceal stones (OR: 3.84). Conclusion: Best results after a single-session fURS for renal stone were obtained for the stone burden of less than 20 mm and low stone attenuation. Lower calyceal stones may influence stone clearance and need a different approach than fURS, especially for higher stone burden.

Keywords: ureteroscopy, kidney stone, lithotripsy, stone-free, predictors

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Authors: Hosuk Shin, Young-Hyun Seo, Eunhak Lee, Seung-Young Kho

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Currently, in Seoul, users have the privilege to avoid riding crowded buses with the installation of Bus Information System (BIS). BIS has three levels of on-board bus ridership level information (spacious, normal, and crowded). However, there are flaws in the system due to it being real time which could provide incomplete information to the user. For example, a bus comes to the station, and on the BIS it shows that the bus is crowded, but on the stop that the user is waiting many people get off, which would mean that this station the information should show as normal or spacious. To fix this problem, this study predicts the bus ridership level using smart card data to provide more accurate information about the passenger ridership level on the bus. An Artificial Neural Network (ANN) is an interconnected group of nodes, that was created based on the human brain. Forecasting has been one of the major applications of ANN due to the data-driven self-adaptive methods of the algorithm itself. According to the results, the ANN algorithm was stable and robust with somewhat small error ratio, so the results were rational and reasonable.

Keywords: smartcard data, ANN, bus, ridership

Procedia PDF Downloads 162