Search results for: Jan Christopher Cardenas
128 Gallbladder Amyloidosis Causing Gangrenous Cholecystitis: A Case Report
Authors: Christopher Leung, Guillermo Becerril-Martinez
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Amyloidosis is a rare systemic disease where abnormal proteins invade various organs and impede their function. Occasionally, they can manifest in a solidary organ such as the heart, lung, and nervous systems; rarely do they manifest in the gallbladder. Diagnosis often requires biopsy of the affected area and histopathology shows deposition of abnormally folded globular proteins called amyloid proteins. This case presents a 69-year-old male with a 3-month history of RUQ pain, diarrhea and non-specific symptoms of tiredness, etc. On imaging, both his US and CT abdomen showed gallbladder wall thickening and pericholecystic fluid, which may represent acute cholecystitis with hypodense lesions around the gallbladder, possibly representing liver abscesses. Given his symptoms of abdominal pain and imaging findings, this gentleman eventually had a laparoscopic cholecystectomy showing a gangrenous gallbladder with a mass on the liver bed. On histopathology, it showed amorphous hyaline eosinophilic material, which Congo-stained confirmed amyloidosis. Amyloidosis explained his non-specific symptoms, he avoided further biopsy, and he was commenced immediately on Lenalidomide. Involvement of the gallbladder is extremely rare, with less than 30 cases around the world. Half of the cases are reported as primary amyloidosis. This case adds to the current literature regarding primary gallbladder amyloidosis. Importantly, this case highlights how laparoscopic cholecystectomy can help with the diagnosis of gallbladder amyloidosis.Keywords: amyloidosis, cholecystitis, gangrenous cholecystitis, gallbladder, systemic amyloidosis
Procedia PDF Downloads 207127 Data Driven Infrastructure Planning for Offshore Wind farms
Authors: Isha Saxena, Behzad Kazemtabrizi, Matthias C. M. Troffaes, Christopher Crabtree
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The calculations done at the beginning of the life of a wind farm are rarely reliable, which makes it important to conduct research and study the failure and repair rates of the wind turbines under various conditions. This miscalculation happens because the current models make a simplifying assumption that the failure/repair rate remains constant over time. This means that the reliability function is exponential in nature. This research aims to create a more accurate model using sensory data and a data-driven approach. The data cleaning and data processing is done by comparing the Power Curve data of the wind turbines with SCADA data. This is then converted to times to repair and times to failure timeseries data. Several different mathematical functions are fitted to the times to failure and times to repair data of the wind turbine components using Maximum Likelihood Estimation and the Posterior expectation method for Bayesian Parameter Estimation. Initial results indicate that two parameter Weibull function and exponential function produce almost identical results. Further analysis is being done using the complex system analysis considering the failures of each electrical and mechanical component of the wind turbine. The aim of this project is to perform a more accurate reliability analysis that can be helpful for the engineers to schedule maintenance and repairs to decrease the downtime of the turbine.Keywords: reliability, bayesian parameter inference, maximum likelihood estimation, weibull function, SCADA data
Procedia PDF Downloads 86126 Sedimentology and Geochemistry of Carbonate Bearing-Argillites on the Southeastern Flank of Mount Cameroon, Likomba
Authors: Chongwain G. Mbzighaa, Christopher M. Agyingi, Josepha-Forba-Tendo
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Background and aim: Sedimentological, geochemical and petrographic studies were carried out on carbonate-bearing argillites outcropping at the southeastern flank of Mount Cameroon (Likomba) to determine the lithofacies and their associations, major element geochemistry and mineralogy. Methods: Major elements of the rocks were analyzed using XRF technique. Thermal analysis and thin section studies were carried out accompanied with the determination of insoluble components of the carbonates. Results: The carbonates are classed as biomicrites with siderite being the major carbonate mineral. Clay, quartz and pyrite constitute the major insoluble components of these rocks. Geochemical results depict a broad variation in their concentrations with silica and iron showing the highest concentrations and sodium and manganese with the least concentrations. Two factors were revealed with the following elemental associations, Fe2O3-MgO-Mn2O3 (72.56 %) and TiO2-SiO2-Al2O3-K2O (23.20%) indicating both Fe-enrichment, the subsequent formation of the siderite and the contribution of the sediments to the formation of these rocks. Conclusion: The rocks consist of cyclic iron-rich carbonates alternating with sideritic-shales and might have been formed as a result of variations in the sea conditions as well as variation in sediment influx resulting from transgression and regression sequences occurring in a shallow to slightly deep marine environments.Keywords: sedimentology, geochemistry, petrography, iron carbonates, Likomba
Procedia PDF Downloads 444125 The Role of Gender in English Language Acquisition for Chinese Medical Students
Authors: Christopher Celozzi, Sarah Kochav
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Our research investigates the numerous challenges faced by Chinese ESL university students enrolled in the medical and related healthcare professional fields. The over-arching research question is how gender influences classroom participation and learning. The second research question addressed is 'what instructional strategies may be utilized to promote student participation and language acquisition?'. Participants’ language ability has been assessed and evaluated in order to facilitate the establishment of a statistical baseline for the subsequent intervention. This research delves deeper into each individual’s personal and academic circumstances, in an effort to reveal any held intrinsic gender beliefs and social identities that may influence learning. Also considered is the impact on learning for a homogenized student population within a uniform, highly structured learning environment. Specially, what is the influence of China’s ‘one-child policy’ on individual learning habits? The impact of their millennial identity and reliance on social media is also examined. A qualitative methodology with a case study approach is employed, with interviews conducted among the participants. Student response to the intervention and selected remediation strategies are documented, analyzed and discussed. The findings of the study may serve to inform educator instructional practice, while advancing the student learner in their pursuit of English competency in highly competitive professions.Keywords: Chinese students, gender, English, language acquisition
Procedia PDF Downloads 205124 Apatite-Forming Ability of Doped-Ceria Coatings for Orthopedic Implants
Authors: Ayda Khosravanihaghighi, Pramod Koshy, Bill Walsh, Vedran Lovric, Charles Christopher Sorrell
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There is an increasing demand for orthopedic implants owing to the increasing numbers of the aging population. Titanium alloy (Ti6Al4V) is a common material used for orthopedic implants owing to its advantageous properties in terms of good corrosion resistance, minimal elastic modulus mismatch with bone, bio-inertness, and high mechanical strength. However, it is important to improve the bioactivity and osseointegration of the titanium alloy and this can be achieved by coating the implant surface with suitable ceramic materials. In the present work, pure and doped-ceria (CeO₂) coatings were deposited by spin coating on the titanium alloy surface in order to enhance the biological interactions between the surface of the implant and the surrounding tissue. In order to examine the bone-binding ability of an implant, simulated body fluid (SBF) tests were conducted in order to assess the capability of apatite layer formation on the surface and thus predict in vivo bone bioactivity. Characterization was done using scanning electron microscopy (SEM) and X-ray diffraction (XRD) analyses to determine the extent of apatite formation. Preliminary tests showed that the CeO₂ coatings were biocompatible and that the extent of apatite formation and its characteristics can be enhanced by doping with suitable metal ions.Keywords: apatite layer, biocompatibility, ceria, orthopaedic implant, SBF, spin coater, Ti-implant
Procedia PDF Downloads 161123 Factors Associated with the Use of Long-Acting Reversible Contraceptive Methods among Women of Reproductive Age 15-49 Years in Jinja District
Authors: Helen Nelly Naiga, Christopher Garimoi Orach
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Introduction: Long-acting reversible contraceptive (LARC) methods are highly effective. However, LARC use in Uganda is low (13%). We assessed the factors associated with the use of long-acting reversible contraceptives among women of reproductive age (15-49 yrs) in Jinja District. Methods: We conducted a facility-based cross-sectional study. A total of 314 women aged 15–49 years attending public health facilities (1 hospital and 3 health center IV) in Jinja district, were randomly selected. A total of 6 key informants and 6 in-depth interviews were conducted. Logistic regression analysis was conducted using Stata version 14. Qualitative data were analysed using thematic analysis. Results: The study found that 40.45% of the respondents had ever used LARC. The commonest LARC method used was implanting (38.22%). The factors significantly associated with use of LARC were employment (AOR =2.91; 95% CI (1.05-8.08), access to LARC methods (AOR =4.48; 95% CI (1.24-16.21), husband support (AOR =4.90; 95% CI (1.56-15.41), and experience of no side effects (AOR =3.48; 95% CI (1.00-12.19). Conclusion and recommendations: The study showed that 4 in 10 women of reproductive age in Jinja District were using LARC. The factors associated with LARC use were employment, husband support, access to LARC methods, and the lack of side effects. There is a need to strengthen client education, improve accessibility to LARC methods at all levels of health centers, improve male partner’s decision-making in LARC use and manage the side effects effectively.Keywords: family planning, implants, intrauterine device, long-acting reversible contraceptives (LARC)
Procedia PDF Downloads 245122 Investigation on Scattered Dose Rate and Exposure Parameters during Diagnostic Examination Done with an Overcouch X-Ray Tube in Nigerian Teaching Hospital
Authors: Gbenga Martins, Christopher J. Olowookere, Lateef Bamidele, Kehinde O. Olatunji
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The aims of this research are to measure the scattered dose rate during an X-ray examination in an X-ray room, compare the scattered dose rate with exposure parameters based on the body region examined, and examine the X-ray examination done with an over couch tube. The research was carried out using Gamma Scout software installation on the computer system (Laptop) to record the radiation counts, pulse rate, and dose rate. The measurement was employed by placing the detector at 900 to the incident X-ray. Proforma was used for the collection of patients’ data such as age, sex, examination type, and initial diagnosis. Data such as focus skin distance (FSD), body mass index (BMI), body thickness of the patients, the beam output (kVp) were collected at Obafemi Awolowo University, Ile-Ife, Western Nigeria. Total number of 136 patients was considered during this research. Dose rate range between 14.21 and 86.78 µSv/h for the plain abdominal region, 85.70 and 2.86 µSv/h for the lumbosacral region,1.3 µSv/yr and 3.6 µSv/yr in the pelvis region, 2.71 µSv/yr and 28.88 µSv/yr for leg region, 3.06 µSv/yr and 29.98 µSv/yr in hand region. The results of this study were compared with those of other studies carried out in other countries. The findings of this study indicated that the number of exposure parameters selected for each diagnostic examination contributed to the dose rate recorded. Therefore, these results call for a quality assurance program (QAP) in diagnostic X-ray units in Nigerian hospitals.Keywords: X-radiation, exposure parameters, dose rate, pulse rate, number of counts, tube current, tube potential, diagnostic examination, scattered radiation
Procedia PDF Downloads 116121 Intercultural Trainings for Future Global Managers: Evaluating the Effect on the Global Mind-Set
Authors: Nina Dziatzko, Christopher Stehr, Franziska Struve
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Intercultural competence as an explicit required skill nearly never appears in job advertisements in international or even global contexts. But especially those who have to deal with different nationalities and cultures in their everyday business need to have several intercultural competencies and further a global mind-set. This way the question arises how potential future global managers can be trained to learn these competencies. In this regard, it might be helpful to see if different types of intercultural trainings have different effects on those skills. This paper outlines lessons learned based on the evaluation of two different intercultural trainings for management students. The main differences between the observed intercultural trainings are the amount of theoretical input in relation to hands-on experiences, the number of trainers as well as the used methods to teach implicit cultural rules. Both groups contain management students with the willingness and perspective to work abroad or to work in international context. The research is carried out with a pre-training-survey and a post-training-survey which consists of questions referring the international context of the students and a self-estimation of 19 identified intercultural and global mind-set skills, such as: cosmopolitanism, empathy, differentiation and adaptability. Whereas there is no clear result which training gets overall a significant higher increase of skills, there is a clear difference between the focus of competencies trained by each of the intercultural trainings. This way this research provides a guideline for both academicals institutions as well as companies for the decision between different types of intercultural trainings, if the to be trained required skills are defined. Therefore the efficiency and the accuracy of fit of the education of future global managers get optimized.Keywords: global mind-set, intercultural competencies, intercultural training, learning experiences
Procedia PDF Downloads 276120 Robotic Lingulectomy for Primary Lung Cancer: A Video Presentation
Authors: Abraham J. Rizkalla, Joanne F. Irons, Christopher Q. Cao
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Purpose: Lobectomy was considered the standard of care for early-stage non-small lung cancer (NSCLC) after the Lung Cancer Study Group trial demonstrated increased locoregional recurrence for sublobar resections. However, there has been heightened interest in segmentectomies for selected patients with peripheral lesions ≤2cm, as investigated by the JCOG0802 and CALGB140503 trials. Minimally invasive robotic surgery facilitates segmentectomies with improved maneuverability and visualization of intersegmental planes using indocyanine green. We hereby present a patient who underwent robotic lingulectomy for an undiagnosed ground-glass opacity. Methodology: This video demonstrates a robotic portal lingulectomy using three 8mm ports and a 12mm port. Stereoscopic direct vision facilitated the identification of the lingula artery and vein, and intra-operative bronchoscopy was performed to confirm the lingula bronchus. The intersegmental plane was identified by indocyanine green and a near-infrared camera. Thorough lymph node sampling was performed in accordance with international standards. Results: The 18mm lesion was successfully excised with clear margins to achieve R0 resection with no evidence of malignancy in the 8 lymph nodes sampled. Histopathological examination revealed lepidic predominant adenocarcinoma, pathological stage IA. Conclusion: This video presentation exemplifies the standard approach for robotic portal lingulectomy in appropriately selected patients.Keywords: lung cancer, robotic segmentectomy, indocyanine green, lingulectomy
Procedia PDF Downloads 67119 Decision-Making Under Uncertainty in Obsessive-Compulsive Disorder
Authors: Helen Pushkarskaya, David Tolin, Lital Ruderman, Ariel Kirshenbaum, J. MacLaren Kelly, Christopher Pittenger, Ifat Levy
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Obsessive-Compulsive Disorder (OCD) produces profound morbidity. Difficulties with decision making and intolerance of uncertainty are prominent clinical features of OCD. The nature and etiology of these deficits are poorly understood. We used a well-validated choice task, grounded in behavioral economic theory, to investigate differences in valuation and value-based choice during decision making under uncertainty in 20 unmedicated participants with OCD and 20 matched healthy controls. Participants’ choices were used to assess individual decision-making characteristics. Compared to controls, individuals with OCD were less consistent in their choices and less able to identify options that were unambiguously preferable. These differences correlated with symptom severity. OCD participants did not differ from controls in how they valued uncertain options when outcome probabilities were known (risk) but were more likely than controls to avoid uncertain options when these probabilities were imprecisely specified (ambiguity). These results suggest that the underlying neural mechanisms of valuation and value-based choices during decision-making are abnormal in OCD. Individuals with OCD show elevated intolerance of uncertainty, but only when outcome probabilities are themselves uncertain. Future research focused on the neural valuation network, which is implicated in value-based computations, may provide new neurocognitive insights into the pathophysiology of OCD. Deficits in decision-making processes may represent a target for therapeutic intervention.Keywords: obsessive compulsive disorder, decision-making, uncertainty intolerance, risk aversion, ambiguity aversion, valuation
Procedia PDF Downloads 615118 Nucleophile Mediated Addition-Fragmentation Generation of Aryl Radicals from Aryl Diazonium Salts
Authors: Elene Tatunashvili, Bun Chan, Philippe E. Nashar, Christopher S. P. McErlean
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The reduction of aryl diazonium salts is one of the most efficient ways to generate aryl radicals for use in a wide range of transformations, including Sandmeyer-type reactions, Meerwein arylations of olefins and Gomberg-Bachmann-Hey arylations of heteroaromatic systems. The aryl diazonium species can be reduced electrochemically, by UV irradiation, inner-sphere and outer-sphere single electron transfer processes (SET) from metal salts, SET from photo-excited organic catalysts or fragmentation of adducts with weak bases (acetate, hydroxide, etc.). This paper details an approach for the metal-free reduction of aryl diazonium salts, which facilitates the efficient synthesis of various aromatic compounds under exceedingly mild reaction conditions. By measuring the oxidation potential of a number of organic molecules, a series of nucleophiles were identified that reduce aryl diazonium salts via the addition-fragmentation mechanism. This approach leads to unprecedented operational simplicity: The reactions are very rapid and proceed in the open air; there is no need for external irradiation or heating, and the process is compatible with a large number of radical reactions. We illustrate these advantages by using the addition-fragmentation strategy to regioselectively arylate a series of heterocyclic compounds, to synthesize ketones by arylation of silyl enol ethers, and to synthesize benzothiophene and phenanthrene derivatives by radical annulation reactions.Keywords: diazonium salts, hantzsch esters, oxygen, radical reactions, synthetic methods
Procedia PDF Downloads 149117 Material Choice Driving Sustainability of 3D Printing
Authors: Jeremy Faludi, Zhongyin Hu, Shahd Alrashed, Christopher Braunholz, Suneesh Kaul, Leulekal Kassaye
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Environmental impacts of six 3D printers using various materials were compared to determine if material choice drove sustainability, or if other factors such as machine type, machine size, or machine utilization dominate. Cradle-to-grave life-cycle assessments were performed, comparing a commercial-scale FDM machine printing in ABS plastic, a desktop FDM machine printing in ABS, a desktop FDM machine printing in PET and PLA plastics, a polyjet machine printing in its proprietary polymer, an SLA machine printing in its polymer, and an inkjet machine hacked to print in salt and dextrose. All scenarios were scored using ReCiPe Endpoint H methodology to combine multiple impact categories, comparing environmental impacts per part made for several scenarios per machine. Results showed that most printers’ ecological impacts were dominated by electricity use, not materials, and the changes in electricity use due to different plastics was not significant compared to variation from one machine to another. Variation in machine idle time determined impacts per part most strongly. However, material impacts were quite important for the inkjet printer hacked to print in salt: In its optimal scenario, it had up to 1/38th the impacts coreper part as the worst-performing machine in the same scenario. If salt parts were infused with epoxy to make them more physically robust, then much of this advantage disappeared, and material impacts actually dominated or equaled electricity use. Future studies should also measure DMLS and SLS processes / materials.Keywords: 3D printing, additive manufacturing, sustainability, life-cycle assessment, design for environment
Procedia PDF Downloads 495116 Phenolic Compounds and Antioxidant Capacity of Tuckeroo (Cupaniopsis anacardioides) Fruits
Authors: Ngoc Minh Quynh Pham, Quan V. Vuong, Michael C. Bowyer, Christopher J. Scarlett
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Tuckeroo (Cupaniopsis anacardioides) is an Australian native plant and is grown in the coastal regions in New South Wales, Queensland and Northern Australia. Its fruits have been eaten by birds; however there is no information on phytochemical and antioxidant capacity of these fruits. This study aimed to determine the phenolic compounds (TPC), flavonoids (TFC), proanthocyanidins (TPro) and antioxidant capacity in the whole or different parts of tuckeroo fruit including skin, flesh and seed. Whole and partly tuckeroo fruits were collected and immediately freeze dried to constant weight and then ground to small particle sizes (<1mm mesh). Samples were extracted in 50% methanol using an ultrasonic bath set at temperature 40 °C for 30 minutes. TPC, TFC, TPro and antioxidant capacity were measured by spectrophotometric analysis. The results showed that the whole fruits contained 106.23 mg GAE/g of TPC, 67.67 mg CAE/g of TFC and 56.74 mg CAE/g of TPro. These fruits also possessed high antioxidant capacity (DPPH: 263.78 mg TroE/g, ABTS: 346.98 mg TroE/g, CUPRAC: 370.12 mg TroE/g and FRAP: 176.30 mg TroE/g), revealing that these fruits are rich source of antioxidants. The results also showed that distribution of the antioxidants was varied in different parts of the fruits. Skin had the highest levels of TPC, TFC, and TPro as well as antioxidant properties, followed by the seed and flesh had the lowest levels of phenolic compounds and antioxidant capacity. Of note, levels of phenolic compounds and antioxidant capacity of the skin were significantly higher than those of the whole fruits. Therefore, the skin of tuckeroo fruits is recommended as a starting material for extraction and purification of phenolic compounds as potential antioxidants for further utilisation in the food and pharmaceutical industries.Keywords: antioxidant capacity, Cupaniopsis anacardioides, phenolic compounds, tuckeroo fruit
Procedia PDF Downloads 399115 A Controlled Natural Language Assisted Approach for the Design and Automated Processing of Service Level Agreements
Authors: Christopher Schwarz, Katrin Riegler, Erwin Zinser
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The management of outsourcing relationships between IT service providers and their customers proofs to be a critical issue that has to be stipulated by means of Service Level Agreements (SLAs). Since service requirements differ from customer to customer, SLA content and language structures vary largely, standardized SLA templates may not be used and an automated processing of SLA content is not possible. Hence, SLA management is usually a time-consuming and inefficient manual process. For overcoming these challenges, this paper presents an innovative and ITIL V3-conform approach for automated SLA design and management using controlled natural language in enterprise collaboration portals. The proposed novel concept is based on a self-developed controlled natural language that follows a subject-predicate-object approach to specify well-defined SLA content structures that act as templates for customized contracts and support automated SLA processing. The derived results eventually enable IT service providers to automate several SLA request, approval and negotiation processes by means of workflows and business rules within an enterprise collaboration portal. The illustrated prototypical realization gives evidence of the practical relevance in service-oriented scenarios as well as the high flexibility and adaptability of the presented model. Thus, the prototype enables the automated creation of well defined, customized SLA documents, providing a knowledge representation that is both human understandable and machine processable.Keywords: automated processing, controlled natural language, knowledge representation, information technology outsourcing, service level management
Procedia PDF Downloads 432114 An Application of Path Planning Algorithms for Autonomous Inspection of Buried Pipes with Swarm Robots
Authors: Richard Molyneux, Christopher Parrott, Kirill Horoshenkov
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This paper aims to demonstrate how various algorithms can be implemented within swarms of autonomous robots to provide continuous inspection within underground pipeline networks. Current methods of fault detection within pipes are costly, time consuming and inefficient. As such, solutions tend toward a more reactive approach, repairing faults, as opposed to proactively seeking leaks and blockages. The paper presents an efficient inspection method, showing that autonomous swarm robotics is a viable way of monitoring underground infrastructure. Tailored adaptations of various Vehicle Routing Problems (VRP) and path-planning algorithms provide a customised inspection procedure for complicated networks of underground pipes. The performance of multiple algorithms is compared to determine their effectiveness and feasibility. Notable inspirations come from ant colonies and stigmergy, graph theory, the k-Chinese Postman Problem ( -CPP) and traffic theory. Unlike most swarm behaviours which rely on fast communication between agents, underground pipe networks are a highly challenging communication environment with extremely limited communication ranges. This is due to the extreme variability in the pipe conditions and relatively high attenuation of acoustic and radio waves with which robots would usually communicate. This paper illustrates how to optimise the inspection process and how to increase the frequency with which the robots pass each other, without compromising the routes they are able to take to cover the whole network.Keywords: autonomous inspection, buried pipes, stigmergy, swarm intelligence, vehicle routing problem
Procedia PDF Downloads 166113 Examination of the Self-Expression Model with Reference to Luxury Watches with Particular Regard of the Buying-Reasons
Authors: Christopher Benedikt Jakob
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Human beings are intrigued by luxury watches for decades. It is fascinating that customers pay an enormous amount of money for specific wristwatch models. It is fascinating that customers of the luxury watch industry accept a yearly price increase. This behavior increases their desirability even more. Luxury watches are perceived as status symbols, but they are additionally accepted as a currency without the disadvantage of currency fluctuations. It is obvious that the symbolic value is more important as the functional value with reference to the buying-reasons as regards luxury watches. Nowadays human beings do not need a wristwatch to read the time. Tablets, notebooks, smartphones, the watch in the car and watches on public places are used to inform people about the current time. This is one of the reasons why there is a trend that people do not wear wristwatches anymore. Due to these facts, this study has the intention to give answers to the question why people invest an enormous amount of money on the consumption of luxury watches and why those watches are seen as a status symbol. The study examines why the luxury watch industry records significant growth rates. The self-expression model is used as an appropriate methodology to find reasons why human beings purchase specific luxury watches. This evaluative approach further discusses if human beings are aware of their current self and their ideal self and how they express them. Furthermore, the research critically evaluates the people’s social self and their ideal social self. One of the goals is to identify if customers know why they like specific luxury watches and dislike others although they have the same quality and cost comparable prices.Keywords: luxury watch, brand awareness, buying-behaviour, consumer, self-expression
Procedia PDF Downloads 162112 Hybrid Solutions in Physicochemical Processes for the Removal of Turbidity in Andean Reservoirs
Authors: María Cárdenas Gaudry, Gonzalo Ramces Fano Miranda
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Sediment removal is very important in the purification of water, not only for reasons of visual perception but also because of its association with odor and taste problems. The Cuchoquesera reservoir, which is in the Andean region of Ayacucho (Peru) at an altitude of 3,740 meters above sea level, visually presents suspended particles and organic impurities indicating that it contains water of dubious quality to deduce that it is suitable for direct consumption of human beings. In order to quantitatively know the degree of impurities, water quality monitoring was carried out from February to August 2018, in which four sampling stations were established in the reservoir. The selected measured parameters were electrical conductivity, total dissolved solids, pH, color, turbidity, and sludge volume. The indicators of the studied parameters exceed the permissible limits except for electrical conductivity (190 μS/cm) and total dissolved solids (255 mg/L). In this investigation, the best combination and the optimal doses of reagents were determined that allowed the removal of sediments from the waters of the Cuchoquesera reservoir, through the physicochemical process of coagulation-flocculation. In order to improve this process during the rainy season, six combinations of reagents were evaluated, made up of three coagulants (ferric chloride, ferrous sulfate, and aluminum sulfate) and two natural flocculants: prickly pear powder (Opuntia ficus-indica) and tara gum (Caesalpinia spinoza). For each combination of reagents, jar tests were developed following the central composite experimental design (CCED), where the design factors were the doses of coagulant and flocculant and the initial turbidity. The results of the jar tests were adjusted to mathematical models, obtaining that to treat the water from the Cuchoquesera reservoir, with a turbidity of 150 UTN and a color of 137 U Pt-Co, 27.9 mg/L of the coagulant aluminum sulfate with 3 mg/L of the natural tara gum flocculant to produce a purified water quality of 1.7 UTN of turbidity and 3.2 U Pt-Co of apparent color. The estimated cost of the dose of coagulant and flocculant found was 0.22 USD/m³. This is how “grey-green” technologies can be used as a combination in nature-based solutions in water treatment, in this case, to achieve potability, making it more sustainable, especially economically, if green technology is available at the site of application of the nature-based hybrid solution. This research is a demonstration of the compatibility of natural coagulants/flocculants with other treatment technologies in the integrated/hybrid treatment process, such as the possibility of hybridizing natural coagulants with other types of coagulants.Keywords: prickly pear powder, tara gum, nature-based solutions, aluminum sulfate, jar test, turbidity, coagulation, flocculation
Procedia PDF Downloads 108111 Communication and Management of Incidental Pathology in a Cohort of 1,214 Consecutive Appendicectomies
Authors: Matheesha Herath, Ned Kinnear, Bridget Heijkoop, Eliza Bramwell, Alannah Frazetto, Amy Noll, Prajay Patel, Derek Hennessey, Greg Otto, Christopher Dobbins, Tarik Sammour, James Moore
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Background: Important incidental pathology requiring further action is commonly found during appendicectomy, macro- and microscopically. It is unknown whether the acute surgical unit (ASU) model affects the management and disclosure of these findings. Methods: An ASU model was introduced at our institution on 01/08/2012. In this retrospective cohort study, all patients undergoing appendicectomy 2.5 years before (traditional group) or after (ASU group) this date were compared. The primary outcomes were rates of appropriate management of the incidental findings and communication of the findings to the patient and to their general practitioner (GP). Results: 1,214 patients underwent emergency appendicectomy; 465 in the traditional group and 749 in the ASU group. 80 (6.6%) patients (25 and 55 in each respective period) had important incidental findings. There were 24 patients with benign polyps, 15 with neuro-endocrine tumour, 11 with endometriosis, 8 with pelvic inflammatory disease, 8 Enterobius vermicularis infection, 7 with low grade mucinous cystadenoma, 3 with inflammatory bowel disease, 2 with diverticulitis, 2 with tubo-ovarian mass, 1 with secondary appendiceal malignancy and none with primary appendiceal adenocarcinoma. One patient had dual pathologies. There was no difference between the traditional and ASU group with regards to communication of the findings to the patient (p=0.44) and their GP (p=0.27), and there was no difference in the rates of appropriate management (p=0.21). Conclusions: The introduction of an ASU model did not change rates of surgeon-to-patient and surgeon-to-GP communication nor affect rates of appropriate management of important incidental pathology during an appendectomy.Keywords: acute care surgery, appendicitis, appendicectomy, incidental
Procedia PDF Downloads 143110 Evaluating a Holistic Fitness Program Used by High Performance Athletes and Mass Participants
Authors: Peter Smolianov, Jed Smith, Lisa Chen, Steven Dion, Christopher Schoen, Jaclyn Norberg
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This study evaluated the effectiveness of an experimental training program used to improve performance and health of competitive athletes and recreational sport participants. This holistic program integrated and advanced Eastern and Western methods of prolonging elite sports participation and enjoying lifelong fitness, particularly from China, India, Russia, and the United States. The program included outdoor, gym, and water training approaches focused on strengthening while stretching/decompressing and on full body activation-all in order to improve performance as well as treat and prevent common disorders and pains. The study observed and surveyed over 100 users of the program including recreational fitness and sports enthusiasts as well as elite athletes who competed for national teams of different countries and for Division I teams of National Collegiate Athletic Association in the United States. Different types of sport were studied, including territorial games (e.g., American football, basketball, volleyball), endurance/cyclical (athletics/track and field, swimming), and artistic (e.g., gymnastics and synchronized swimming). Results of the study showed positive effects on the participants’ performance and health, particularly for those who used the program for more than two years and especially in reducing spinal disorders and in enabling to perform new training tasks which previously caused back pain.Keywords: lifelong fitness, injury prevention, prolonging sport participation, improving performance and health
Procedia PDF Downloads 155109 Meaning and Cultivating Factors of Mindfulness as Experienced by Thai Females Who Practice Dhamma
Authors: Sukjai Charoensuk, Penphan Pitaksongkram, Michael Christopher
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Preliminary evidences supported the effectiveness of mindfulness-based interventions in reducing symptoms associated with a variety of medical and psychological conditions. However, the measurements of mindfulness are questionable since they have not been developed based-on Buddhist experiences. The purpose of this qualitative study was to describe meaning and cultivating factors of mindfulness as experienced by Thai females who practice Dhamma. Participants were purposively selected to include 2 groups of Thai females who practice Dhamma. The first group consisted of 6 female Buddhist monks, and the second group consisted of 7 female who practice Dhamma without ordaining. Data were collected using in-depth interview. The instruments used were demographic data questionnaire and guideline for in-depth interview developed by researchers. Content analysis was employed to analyze the data. The results revealed that Thai women who practice Dhamma described their experience in 2 themes, which were meaning and cultivating factors of mindfulness. The meaning composed of 4 categories; 1) Being Present, 2) Self-awareness, 3) Contemplation, and 4) Neutral. The cultivating factors of mindfulness composed of 2 categories; In-personal factors and Ex-personal factors. The In-personal cultivating factors included 4 sub-categories; Faith and Love, the Five Precepts, Sound body, and Practice. The Ex-personal cultivating factors included 2 sub-categories; Serenity, and Learning. These findings increase understanding about meaning of mindfulness and its cultivating factors. These could be used as a guideline to promote mental health and develop nursing interventions using mindfulness based, as well as, develop the instrument for assessing mindfulness in Thai context.Keywords: cultivating factor, meaning of mindfulness, practice Dhamma, Thai women
Procedia PDF Downloads 351108 From Liquid to Solid: Advanced Characterization of Glass Applying Oscillatory Rheometry
Authors: Christopher Giehl, Anja Allabar, Daniela Ehgartner
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Rotational rheometry is standard practice for the viscosity measurement of molten glass, neglecting the viscoelastic properties of this material, especially at temperatures approaching the glass transition. Oscillatory rheometry serves as a powerful toolbox for glass melt characterization beyond viscosity measurements. Heating and cooling rates and the time-dependent visco-elastic behavior influence the temperature where materials undergo the glass transition. This study presents quantitative thermo-mechanical visco-elasticity measurements on three samples in the Na-K-Al-Si-O system. The measurements were performed with a Furnace Rheometer System combined with an air-bearing DSR 502 measuring head (Anton Paar) and a Pt90Rh10 measuring geometry. Temperature ramps were conducted in rotation and oscillation, and the (complex) viscosity values were compared to calculated viscosity values based on sample composition. Furthermore, temperature ramps with different frequencies were conducted, also revealing the frequency-dependence of the shear loss modulus G’’ and the shear storage modulus G’. Here, lower oscillatory frequency results in lower glass transition temperature, as defined by the G’-G’’ crossover point. This contribution demonstrates that oscillatory rheometry serves as a powerful toolbox beyond viscosity measurements, as it considers the visco-elasticity of glass melts quantifying viscous and elastic moduli. Further, it offers a strong definition of Tg beyond the 10^12 Pas concept, which cannot be utilized with rotational viscometry data.Keywords: frequency dependent glass transition, Na-K-Al-Si-O glass melts, oscillatory rheometry, visco-elasticity
Procedia PDF Downloads 107107 The Effects of Kinesio Tape® and No Tape for Muscle Facilitation and Inhibition, for Collegiate Athletes with Self-Reported Shoulder Pain
Authors: Gregory Chown, Benjamin Infantolino, Christopher Wise, Rachel Holmes, Samantha O'Donnell, Katelyn Pfeiffer, Victoria Ward
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Background: There is a lack of understanding of how Kinesio Tape® physiologically works. Furthermore, few studies compare Kinesio Tape® to other forms of taping. The research question is: Does Kinesio Tape® cause a difference in muscle facilitation, inhibition, and pain, between Kinesio Tape® and no tape for collegiate athletes with self-reported shoulder pain? Method: This quantitative non-randomized design used a convenience sampling method. There were eleven participants with self-reported shoulder pain who were athletes on the men’s and women’s lacrosse and tennis teams. Participants attended one 30-45 minute session for data collection. Each participant received all three taping conditions and performed four repetitions of 120 degrees of active shoulder flexion for the three separate trials (no tape, Kinesio Tape® inhibition, and Kinesio Tape® facilitation). Surface electromyography (sEMG) electrodes were placed on the anterior deltoid, supraspinatus, and lower trapezius to measure muscle facilitation and inhibition. Each participant completed the visual analogue scale (VAS) before and after each trial to measure pain. Results: No statistical significance was found for pain scores on the VAS between the taping methods of facilitation, inhibition, and no tape (p = .118). No statistical significance was found for the percentage of change in muscle function for each taping method; Anterior deltoid (p = .993), supraspinatus (p = .997) and lower trapezius (p = .922). Conclusion: Based on the results, Kinesio Tape® appears to not have an effect on muscle function or pain when utilizing the facilitation or inhibition taping method when compared to no tape.Keywords: Kinesio tape, muscle facilitation, muscle inhibition, pain
Procedia PDF Downloads 188106 Impact of Lobular Carcinoma in situ on Local Recurrence in Breast Cancer Treated with Breast Conservation Therapy: A Systematic Review and Meta-Analysis
Authors: Christopher G. Harris, Guy D. Eslick
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Purpose: Lobular carcinoma in situ (LCIS) is a known risk factor for breast cancer of unclear significance when detected in association with invasive carcinoma. This meta-analysis aims to determine the impact of LCIS on local recurrence risk for individuals with breast cancer treated with breast conservation therapy to help guide appropriate treatment strategies. Methods: We identified relevant studies from five electronic databases. Studies were deemed suitable for inclusion where they compared patients with invasive breast cancer and concurrent LCIS to those with breast cancer alone, all patients underwent breast conservation therapy (lumpectomy with adjuvant radiation therapy), and local recurrence was evaluated. Recurrence data were pooled by use of a random effects model. Results: From 1488 citations screened by our search, 8 studies were deemed suitable for inclusion. These studies comprised of 908 cases and 10638 controls. Median follow-up time was 90 months. There was a significantly increased overall risk of local breast cancer recurrence for individuals with LCIS in association with breast cancer following breast conservation therapy [pOR 1.87; 95% CI 1.14-3.04; p = 0.012]. The risk of local recurrence was non-significantly increased at 5 [pOR 1.09; 95% CI 0.48-2.48; p = 0.828] and 10 years [pOR 1.90; 95% CI 0.89-4.06; p = 0.096]. Conclusions: Individuals with LCIS in association with invasive breast cancer have an increased risk of local recurrence following breast conservation therapy. This supports consideration of aggressive local control of LCIS by way of completion mastectomy or re-excision for certain high-risk patients.Keywords: breast cancer, breast conservation therapy, lobular carcinoma in situ, lobular neoplasia, local recurrence, meta-analysis
Procedia PDF Downloads 160105 Mesenteric Vasculitis Causing Perforated Diverticulitis Mimicking Abdominal Sepsis
Authors: Christopher Leung, Assad Zahid
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Mesenteric vasculitis can often mimic abdominal sepsis in a postoperative setting leading to a predicament where steroids could improve mesenteric vasculitis whilst worsening abdominal sepsis. Here this study presents a unique and rare case of perforated sigmoid diverticulitis secondary to systemic vasculitis. A 68-year-old gentleman presented with perforated sigmoid diverticulitis requiring an emergency Hartmann’s procedure. Early in his postoperative course, he had painful and asymmetrical neuropathy that, after a careful history and examination, revealed a patient with mono neuritis multiplex on a background history of longstanding rheumatoid arthritis. On day seven of his postoperative course, he had rising inflammatory markers and a CT abdomen and pelvis showing fluid around the mesentery. Whilst contamination from sigmoid perforation was somewhat congruent with these signs, a diagnosis of polyarteritis nodosa, a common cause of mononeuritis multiplex, is also possible, although involvement of the large bowel in polyarteritis nodosa is extremely rare. The histopathology from the initial Hartmann’s procedure was re-examined, showing medium vessel disease vasculitis. Given his lack of fevers, absence of abdominal pain, and worsening neurology, he was given a provisional diagnosis of polyarteritis nodosa and was treated successfully, not on IV antibiotics but on steroids. Large bowel involvement of polyarteritis nodosa is extremely rare and this is the first case of polyarteritis nodosa causing perforated diverticulitis. The learning point here is to obtain a good clinical picture of a patient to identify mesenteric vasculitis as compared to abdominal sepsis as the treatment of one worsens the other.Keywords: abdominal sepsis, diverticulitis, mesenteric vasculitis, polyarteritis nodosa
Procedia PDF Downloads 252104 Leading with Skill Development: A Collaborative and Community Based Approach to Ending Open Defecation in Rural India via Computerized Technical Vocational Education and Training
Authors: Srividya Sheshadri, Christopher Coley, Roa. R. Bhavani
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India currently accounts for 60 percent of the open defecation that is practiced globally. While research in the domain of sanitation development makes it apparent that girls and women living in rural India are disproportionately affected, interventions to address this dilemma are lacking. An important but relatively unexplored connection with poor sanitation is that women living in rural India are not only the largest marginalized group without access to adequate sanitation facilities, they also represent a majority of India’s unskilled workers. By training women to build their own toilets, through an approach that has demonstrated success in empowering marginalized communities through technical and vocational education and training (TVET), a collaborative dynamic emerges that can engage entire communities in the movement towards total sanitation. Designed and implemented by Amrita University, this technology-enhanced, community-based approach to skill development, known as Amrita computerized Vocational Education and Training (or Amrita cVET), has begun to show promise in addressing the struggle to end open defecation, and raise sanitation awareness, as well as strengthen personal and community development among women living in rural India. While Amrita cVET project, known as Women Empowerment: Sanitation, is currently in implementation in seven states throughout India, this paper will discuss early stages of the intervention in rural villages within the Indian states of: Karnataka and Goa, where previous sanitation efforts have failed to take hold.Keywords: community based development, empowerment studies, sanitation in India, computerized vocational training
Procedia PDF Downloads 388103 Impulsivity, Emotional Regulation, Problematic Mukbang Watching and Eating Disorders in University Students
Authors: Aqsa Butt, Nida Zafar
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The study assesses the relationship between impulsivity, emotional regulation, problematic mukbang watching, and eating disorders in university students. It was hypothesized there is likely to be a relationship between impulsivity, emotional regulation, problematic mukbang watching, and eating disorders in university students; impulsivity and emotional regulation would predict problematic mukbang watching in university students; problematic mukbang watching would predict eating disorders in university students. A correlational research design was used. A sample of 200 students was taken from different public and private universities in Lahore. Emotional regulation questionnaire (Gross & John, 2003), Abbreviated Barrat Impulsiveness Scale (Christopher et al., 2014), Problematic Mukbang Watching Scale (Kircaburun et al., 2020), and Eating Disorder Diagnostic Scale (Stice et al., 2004) were used for assessment. Results showed a significant positive relationship between impulsivity and expressive suppression with problematic mukbang watching. However, there is a significant negative relationship between cognitive reappraisal and problematic mukbang watching. Problematic mukbang is significantly positively related to bulimia nervosa and binge eating. Furthermore, impulsivity and expressive suppression are significant positive predictors of problematic mukbang watching, and cognitive reappraisal is a significant negative predictor of problematic mukbang watching. Additionally, problematic mukbang watching significantly positively predicts bulimia nervosa and binge eating. The research has important implications for university students to understand that excessive watching of such videos can lead to eating disorders such as bulimia nervosa and binge eating. This research provides an understanding of the effects of Mukbang watching, and it also adds to the existing body of knowledge on eating disorders.Keywords: impulsivity, emotional regulation, problematic Mukbang watching eating disorders, students
Procedia PDF Downloads 60102 Feeding Practices and Malnutrition among under Five Children in Communities of Kuje Area Council, Federal Capital Territory Abuja, Nigeria
Authors: Clementina Ebere Okoro, Olumuyiwa Adeyemi Owolabi, Doris Bola James, Aloysius Nwabugo Maduforo, Andrew Lingililani Mbewe, Christopher Osaruwanmwen Isokpunwu
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Poor dietary practices and malnutrition, including severe acute malnutrition among under-five children in Nigeria has remained a great public health concern. This study assessed infant and young child feeding practices and nutritional status of under-five children to determine the prevalence of malnutrition of under-five children in Kuje area council, Abuja. The study was a cross-sectional study. Multi-stage sampling techniques was used in selecting the population that was studied. Probability proportion by size was applied in choosing 30 clusters for the survey using ENA for SMART software 2011 version. Questionnaires were used to obtain information from the population, while appropriate equipment was used for measurements of anthropometric parameters. The data was also subjected to statistical analysis. Results were presented in tables and figures. The result showed that 96.7% of the children were breastfed, 30.6% had early initiation to breastfeeding within first hour of birth and 22.4% were breastfed exclusively up to 6 months, 69.8% fed infants’ colostrum, while 30.2% discarded colostrum. About half of the respondents (49.1%) introduced complementary feeding before six months and 23.2% introduced it after six months while 27.7% had age appropriate timely introduction of complementary feeding. The anthropometric result showed that the prevalence of global acute malnutrition (GAM) was 12.8%, severe wasting prevalence was 5.4%, moderate wasting was 7.4%, underweight was 24.4%, stunting was 40.3% and overweight was 7.0%. The result showed that there is a high prevalence of malnutrition among under-five children in KujeKeywords: malnutrition, under five children, breastfeeding, complementary feeding
Procedia PDF Downloads 267101 Phage Display-Derived Vaccine Candidates for Control of Bovine Anaplasmosis
Authors: Itzel Amaro-Estrada, Eduardo Vergara-Rivera, Virginia Juarez-Flores, Mayra Cobaxin-Cardenas, Rosa Estela Quiroz, Jesus F. Preciado, Sergio Rodriguez-Camarillo
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Bovine anaplasmosis is an infectious, tick-borne disease caused mainly by Anaplasma marginale; typical signs include anemia, fever, abortion, weight loss, decreased milk production, jaundice, and potentially death. Sick bovine can recover when antibiotics are administered; however, it usually remains as carrier for life, being a risk of infection for susceptible cattle. Anaplasma marginale is an obligate intracellular Gram-negative bacterium with genetic composition highly diverse among geographical isolates. There are currently no vaccines fully effective against bovine anaplasmosis; therefore, the economic losses due to disease are present. Vaccine formulation became a hard task for several pathogens as Anaplasma marginale, but peptide-based vaccines are an interesting proposal way to induce specific responses. Phage-displayed peptide libraries have been proved one of the most powerful technologies for identifying specific ligands. Screening of these peptides libraries is also a tool for studying interactions between proteins or peptides. Thus, it has allowed the identification of ligands recognized by polyclonal antiserums, and it has been successful for the identification of relevant epitopes in chronic diseases and toxicological conditions. Protective immune response to bovine anaplasmosis includes high levels of immunoglobulins subclass G2 (IgG2) but not subclass IgG1. Therefore, IgG2 from the serum of protected bovine can be useful to identify ligands, which can be part of an immunogen for cattle. In this work, phage display random peptide library Ph.D. ™ -12 was incubating with IgG2 or blood sera of immunized bovines against A. marginale as targets. After three rounds of biopanning, several candidates were selected for additional analysis. Subsequently, their reactivity with sera immunized against A. marginale, as well as with positive and negative sera to A. marginale was evaluated by immunoassays. A collection of recognized peptides tested by ELISA was generated. More than three hundred phage-peptides were separately evaluated against molecules which were used during panning. At least ten different peptides sequences were determined from their nucleotide composition. In this approach, three phage-peptides were selected by their binding and affinity properties. In the case of the development of vaccines or diagnostic reagents, it is important to evaluate the immunogenic and antigenic properties of the peptides. Immunogenic in vitro and in vivo behavior of peptides will be assayed as synthetic and as phage-peptide for to determinate their vaccine potential. Acknowledgment: This work was supported by grant SEP-CONACYT 252577 given to I. Amaro-Estrada.Keywords: bovine anaplasmosis, peptides, phage display, veterinary vaccines
Procedia PDF Downloads 141100 Simultaneous Detection of Dopamine and Uric Acid in the Presence of Ascorbic Acid at Physiological Level Using Anodized Multiwalled Carbon Nanotube–Poldimethylsiloxane Paste Electrode
Authors: Angelo Gabriel Buenaventura, Allan Christopher Yago
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A carbon paste electrode (CPE) composed of Multiwalled Carbon Nanotube (MWCNT) conducting particle and Polydimethylsiloxane (PDMS) binder was used for simultaneous detection of Dopamine (DA) and Uric Acid (UA) in the presence of Ascorbic Acid (AA) at physiological level. The MWCNT-PDMS CPE was initially activated via potentiodynamic cycling in a basic (NaOH) solution, which resulted in enhanced electrochemical properties. Electrochemical Impedance Spectroscopy measurements revealed a significantly lower charge transfer resistance (Rct) for the OH--activated MWCNT-PDMS CPE (Rct = 5.08kΩ) as compared to buffer (pH 7)-activated MWCNT-PDMS CPE (Rct = 25.9kΩ). Reversibility analysis of Fe(CN)63-/4- redox couple of both Buffer-Activated CPE and OH--Activated CPE showed that the OH—Activated CPE have peak current ratio (Ia/Ic) of 1.11 at 100mV/s while 2.12 for the Buffer-Activated CPE; this showed an electrochemically reversible behavior for Fe(CN)63-/4- redox couple even at relatively fast scan rate using the OH--activated CPE. Enhanced voltammetric signal for DA and significant peak separation between DA and UA was obtained using the OH--activated MWCNT-PDMS CPE in the presence of 50 μM AA via Differential Pulse Voltammetry technique. The anodic peak currents which appeared at 0.263V and 0.414 V were linearly increasing with increasing concentrations of DA and UA, respectively. The linear ranges were obtained at 25 μM – 100 μM for both DA and UA. The detection limit was determined to be 3.86 μM for DA and 5.61 μM for UA. These results indicate a practical approach in the simultaneous detection of important bio-organic molecules using a simple CPE composed of MWCNT and PDMS with base anodization as activation technique.Keywords: anodization, ascorbic acid, carbon paste electrodes, dopamine, uric acid
Procedia PDF Downloads 28499 Building Biodiversity Conservation Plans Robust to Human Land Use Uncertainty
Authors: Yingxiao Ye, Christopher Doehring, Angelos Georghiou, Hugh Robinson, Phebe Vayanos
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Human development is a threat to biodiversity, and conservation organizations (COs) are purchasing land to protect areas for biodiversity preservation. However, COs have limited budgets and thus face hard prioritization decisions that are confounded by uncertainty in future human land use. This research proposes a data-driven sequential planning model to help COs choose land parcels that minimize the uncertain human impact on biodiversity. The proposed model is robust to uncertain development, and the sequential decision-making process is adaptive, allowing land purchase decisions to adapt to human land use as it unfolds. The cellular automata model is leveraged to simulate land use development based on climate data, land characteristics, and development threat index from NASA Socioeconomic Data and Applications Center. This simulation is used to model uncertainty in the problem. This research leverages state-of-the-art techniques in the robust optimization literature to propose a computationally tractable reformulation of the model, which can be solved routinely by off-the-shelf solvers like Gurobi or CPLEX. Numerical results based on real data from the Jaguar in Central and South America show that the proposed method reduces conservation loss by 19.46% on average compared to standard approaches such as MARXAN used in practice for biodiversity conservation. Our method may better help guide the decision process in land acquisition and thereby allow conservation organizations to maximize the impact of limited resources.Keywords: data-driven robust optimization, biodiversity conservation, uncertainty simulation, adaptive sequential planning
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