Search results for: lower and higher risk category

Authors: Rahil Bahrami, Kaveh Ashenayi

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This paper presents a systematic classification and comparative analysis of non-isolated bi-directional DC-DC converters. The increasing demand for efficient energy conversion in diverse applications has spurred the development of various converter topologies. In this study, we categorize bi-directional converters into three distinct classes: Inverting, Non-Inverting, and Interleaved. Each category is characterized by its unique operational characteristics and benefits. Furthermore, a practical comparison is conducted by evaluating the results of simulation of each bi-directional converter. BDCs can be classified into isolated and non-isolated topologies. Non-isolated converters share a common ground between input and output, making them suitable for applications with minimal voltage change. They are easy to integrate, lightweight, and cost-effective but have limitations like limited voltage gain, switching losses, and no protection against high voltages. Isolated converters use transformers to separate input and output, offering safety benefits, high voltage gain, and noise reduction. They are larger and more costly but are essential for automotive designs where safety is crucial. The paper focuses on non-isolated systems.The paper discusses the classification of non-isolated bidirectional converters based on several criteria. Common factors used for classification include topology, voltage conversion, control strategy, power capacity, voltage range, and application. These factors serve as a foundation for categorizing converters, although the specific scheme might vary depending on contextual, application, or system-specific requirements. The paper presents a three-category classification for non-isolated bi-directional DC-DC converters: inverting, non-inverting, and interleaved. In the inverting category, converters produce an output voltage with reversed polarity compared to the input voltage, achieved through specific circuit configurations and control strategies. This is valuable in applications such as motor control and grid-tied solar systems. The non-inverting category consists of converters maintaining the same voltage polarity, useful in scenarios like battery equalization. Lastly, the interleaved category employs parallel converter stages to enhance power delivery and reduce current ripple. This classification framework enhances comprehension and analysis of non-isolated bi-directional DC-DC converters. The findings contribute to a deeper understanding of the trade-offs and merits associated with different converter types. As a result, this work aids researchers, practitioners, and engineers in selecting appropriate bi-directional converter solutions for specific energy conversion requirements. The proposed classification framework and experimental assessment collectively enhance the comprehension of non-isolated bi-directional DC-DC converters, fostering advancements in efficient power management and utilization.The simulation process involves the utilization of PSIM to model and simulate non-isolated bi-directional converter from both inverted and non-inverted category. The aim is to conduct a comprehensive comparative analysis of these converters, considering key performance indicators such as rise time, efficiency, ripple factor, and maximum error. This systematic evaluation provides valuable insights into the dynamic response, energy efficiency, output stability, and overall precision of the converters. The results of this comparison facilitate informed decision-making and potential optimizations, ensuring that the chosen converter configuration aligns effectively with the designated operational criteria and performance goals.

Keywords: bi-directional, DC-DC converter, non-isolated, energy conversion

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Authors: Xiao Hu

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Children’s social and emotional development is critical for developing their future relationships and behaviors, and poor social skills may result in serious emotional externalizations such as anxiety, distress and aggression. Recent research has emphasized the role of family socio-economic status on children’s emotional development, and this study contributes to this academic discussion by reviewing how socio-economic status affects children at three critical development stages: infancy (0-3months), pre-school (4 months-5 years) and school aged (6-10 years). Results show a consensus in the research literature on a positive relationship between family socio-economic status and children’s emotional development. Socialization, a crucial development milestone, is highly affected by a family’s socio-economic status, as families with higher incomes have access to improved social environments, healthier parenting styles and greater access to social capital and peer support. In contrast, families with lower income and SES (socio-economic status) have lower access to these benefits and are frequently ignored within social environments. This review concludes with a critical discussion on how family income affects children’s social environment, highlighting the important role that “permanent” income plays in children’s development. Consequently, the review suggests that future governments should provide temporary economic support for lower-income families, allowing children to be raised in a healthy social environment with limited economic fluctuation.

Keywords: family socio-economic status, parenting style, children’s emotional development, family permanent income

Procedia PDF Downloads 141

Authors: Onur Arugaslan, Ajay Samant, Devrim Yaman

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Financial advisors and investors seek new assets which could potentially increase portfolio returns and decrease portfolio risk. Cryptocurrencies represent a relatively new asset class which could serve in both these roles. There has been very little research done in the area of the risk/return tradeoff in a portfolio consisting of fixed income assets, stocks, and cryptocurrency. The objective of this study is a rigorous examination of this issue. The data used in the study are the monthly returns on 4-week US Treasury Bills, S&P Investment Grade Corporate Bond Index, Bitcoin and the S&P 500 Stock Index. The methodology used in the study is the application Modern Portfolio Theory to evaluate the risk-adjusted returns of portfolios with varying combinations of these assets, using Sharpe, Treynor and Jensen Indexes, as well as the Sortino and Modigliani measures. The results of the study would include the ranking of various investment portfolios based on their risk/return characteristics. The conclusions of the study would include objective empirical inference for investors who are interested in including cryptocurrency in their asset portfolios but are unsure of the risk/return implications.

Keywords: financial economics, portfolio diversification, fixed income securities, cryptocurrency, stock indexes

Procedia PDF Downloads 73

Authors: Errol J. Haarhoff

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Housing in New Zealand, particularly in Auckland, is dominated by low-density suburbs. Over the past 20 years, housing intensification policies aimed to curb outward low-density sprawl and to concentrate development within an urban boundary have been implemented. This requires the greater deployment of attached housing typologies such apartments, duplexes and terrace housing. There has been strong market response and uptake for higher density development, with the number of building approvals received by the Auckland Council for attached housing units increasing from around 15 percent in 2012/13, to 54 percent in 2017/18. A key question about intensification and strong market uptake in a city where lower density has been the norm, is whether higher density neighborhoods will deliver necessary housing satisfaction? This paper reports on the findings to a questionnaire survey and focus group discussions probing resident perceptions to living at higher density in relation to their dwellings, the neighborhood and their sense of community. The findings reveal strong overall housing satisfaction, including key aspects such as privacy, noise and living in close proximity to neighbors. However, when residents are differentiated in terms of length of tenure, age or whether they are bringing up children, greater variation in satisfaction is detected. For example, residents in the 65-plus age cohort express much higher levels of satisfaction, when compared to the 18-44 year cohorts who more likely to be binging up children. This suggests greater design sensitivity to better accommodate the range of household types. Those who have live in the area longer express greater satisfaction than those with shorter duration, indicating time for adaption to living at higher density. Findings strongly underpin the instrumental role that the public amenities play in overall housing satisfaction and the emergence of a strong sense of community. This underscores the necessity for appropriate investment in the public amenities often lacking in market-led higher density housing development. We conclude with an evaluation of the PPP model, and its part in delivering housing satisfaction. The findings should be of interest to cities, housing developers and built environment professional pursuing housing policies promoting intensification and higher density.

Keywords: medium density, housing satisfaction, neighborhoods, sense of community

Procedia PDF Downloads 137

Authors: Thimira Pasas P, Nirmala Priyadarshani M, Ishani R

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Obesity is a global health issue. Early identification is essential to plan interventions and intervene than to reduce the worsening of obesity and its consequences on the health issues of the individual. Childhood obesity is multifactorial, with both modifiable and unmodifiable risk factors. A genetically susceptible individual (unmodifiable), when placed in an obesogenic environment (modifiable), is likely to become obese in onset and progression. The present study was conducted to identify the age of onset of childhood obesity and the influence of modifiable risk factors for childhood obesity among school children living in a suburban area of Sri Lanka. The study population was aged 11-12 years of Piliyandala Educational Zone. Data were collected from 11–12-year-old school children attending government schools in the Piliyandala Educational Zone. They were using a validated, pre-tested self-administered questionnaire. A stratified random sampling method was performed to select schools and to select a representative sample to include all 3 types of government schools of students due to the prevailing pandemic situation, information from the last school medical inspection on data from 2020used for this purpose. For each obese child identified, 2 non-obese children were selected as controls. A single representative from the area was selected by using a systematic random sampling method with a sampling interval of 3. Data was collected using a validated, pre-tested self-administered questionnaire and the Child Health Development Record of the child. An introduction, which included explanations and instructions for filing the questionnaire, was carried out as a group activity prior to distributing the questionnaire among the sample. The results of the present study aligned with the hypothesis that the age of onset of childhood obesity and prediction must be within the first two years of child life. A total of 130 children (66 males: 64 females) participated in the study. The age of onset of obesity was seen to be within the first two years of life. The risk of obesity at 11-12 years of age was Obesity risk was identified at 3-time s higher among females who underwent rapid weight gain within their infancy period. Consuming milk prior to breakfast emerged as a risk factor that increases the risk of obesity by three times. The current study found that the drink before breakfast tends to increase the obesity risk by 3-folds, especially among obese females. Proper monitoring must be carried out to identify the rapid weight gain, especially within the first 2 years of life. Consumption of mug milk before breakfast tends to increase the obesity risk by 3 times. Identification of the confounding factors, proper awareness of the mothers/guardians and effective proper interventions need to be carried out to reduce the obesity risk among school children in the future.

Keywords: childhood obesity, school children, age of onset, weight gain, feeding pattern, activity level

Procedia PDF Downloads 141

Authors: Rohit Shrivastava, Stefan Luding

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A mechanical wave is propagation of vibration with transfer of energy and momentum. Studying the energy as well as spectral energy characteristics of a propagating wave through disordered granular media can assist in understanding the overall properties of wave propagation through inhomogeneous materials like soil. The study of these properties is aimed at modeling wave propagation for oil, mineral or gas exploration (seismic prospecting) or non-destructive testing for the study of internal structure of solids. The study of Energy content (Kinetic, Potential and Total Energy) of a pulse propagating through an idealized one-dimensional discrete particle system like a mass disordered granular chain can assist in understanding the energy attenuation due to disorder as a function of propagation distance. The spectral analysis of the energy signal can assist in understanding dispersion as well as attenuation due to scattering in different frequencies (scattering attenuation). The selection of one-dimensional granular chain also helps in studying only the P-wave attributes of the wave and removing the influence of shear or rotational waves. Granular chains with different mass distributions have been studied, by randomly selecting masses from normal, binary and uniform distributions and the standard deviation of the distribution is considered as the disorder parameter, higher standard deviation means higher disorder and lower standard deviation means lower disorder. For obtaining macroscopic/continuum properties, ensemble averaging has been used. Interpreting information from a Total Energy signal turned out to be much easier in comparison to displacement, velocity or acceleration signals of the wave, hence, indicating a better analysis method for wave propagation through granular materials. Increasing disorder leads to faster attenuation of the signal and decreases the Energy of higher frequency signals transmitted, but at the same time the energy of spatially localized high frequencies also increases. An ordered granular chain exhibits ballistic propagation of energy whereas, a disordered granular chain exhibits diffusive like propagation, which eventually becomes localized at long periods of time.

Keywords: discrete elements, energy attenuation, mass disorder, granular chain, spectral energy, wave propagation

Procedia PDF Downloads 291

Authors: Toyosi Yewande Tunde-Akintunde, Grace Oluwatoyin Ogunlakin, Bosede Folake Olanipekun

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Peppers are excellent sources of nutrients but its high moisture content makes it susceptible to spoilage. Drying, a common processing method, results in a reduction of these nutrients in the final product. Pre-treatment of pepper before drying can be used to reduce the level of degradation of nutrients. Thus this study investigated the effect of pre-treatment (hot water blanching and soaking in brine-sodium chloride) and drying methods (oven, microwave and sun) on selected quality parameters (proximate composition, capsaicin, reducing sugar and phenolic content, pH, total solid (TS), Titratable acidity (TA), water absorption capacity (WAC) and colour) of pepper. The protein and moisture content value ranged from 9.09 to 10.23% and 5.63 to 8.48% respectively. Sun dried samples had the highest value while oven dried samples had the lowest. Brine treated samples had higher protein but lower moisture content than blanched samples. Capsaicin, reducing sugar and phenolic content values ranged from 0.68 to 0.87 mg/dm3; 3.18 to 3.79 µg/ml; and 40.67 to 84.01 mg GAE/100 g d.m respectively. The sun dried samples had higher values while the lowest values were from microwave dried samples. The brine treated samples had higher values in capsaicin while the blanched samples had higher reducing sugar and phenolic contents. The values of L, a* and b* for the dried pepper varied from 58.76 to 63.13; 7.09 to 7.34; and 11.79 to 12.36 respectively. Oven dried samples had the lowest values for a*, while its L values were the highest. The L and a* values for brine treated samples were higher than blanched samples. The pre-treatment and drying method considered resulted in different values of the quality parameters considered which indicates that drying and pre-treatment has an effect on the quality of the final dried pepper samples.

Keywords: Bell pepper, microwave drying, oven drying, quality, sun drying

Procedia PDF Downloads 345

Authors: Amanda R. R. Oliveira, Caio F. F. C. Cunha, Juan C. L. Junior, Amorim H. P. Junior

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Children deaths are traumatic events that most often can be prevented. The technology of prevention and intervention in cases of infant deaths is available at low cost and with solid evidence and favorable results, however, with low access cover. Weight is one of the main factors related to death in the neonatal period, so the newborns of low birth weight are a population at high risk of death in the neonatal period, especially early neonatal period. This paper describes the development of a model based in neural network analysis to predict the mortality risk rating in the early neonatal period for newborns of low birth weight to identify the individuals of this population with increased risk of death. The neural network applied was trained with a set of newborns data obtained from Brazilian health system. The resulting network presented great success rate in identifying newborns with high chances of death, which demonstrates the potential for using this tool in an integrated manner to the health system, in order to direct specific actions for improving prognosis of newborns.

Keywords: low birth weight, neonatal death risk, neural network, newborn

Procedia PDF Downloads 448

Authors: M. J. Reis Lima, J. Oliveira, M. Brito, C. Lemos, A. Mascarenhas, E. Teixeira Lemos

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Hypertension is a common condition causing cardio and cerebrovascular complications. Portugal has one of the highest mortality rates from stroke and a high prevalence of hypertension. Systolic blood pressure (SBP) is an important risk factor for cardiovascular events (myocardial infarction and stroke) and premature mortality, particularly in the elderly population. The present study aims to estimate the prevalence of hypertension in a Portuguese population living in a coastal city and to identify some of its determinants (namely gender, age, the body mass index and physical activity frequency). A total of 91 adults who attended three pharmacies of a coastal city in the center of Portugal, between May and August of 2013 were evaluated. Attendants who reported to have diabetes or taking antihypertensive drugs in the 2 previous weeks were excluded from the study. Sociodemographic factors, BMI, habits of exercise and BP were assessed. Hypertension was defined as blood pressure ≥140/90 mmHg. The majority of the studied population was constituted by women (75.8%), with a mean age of 54.2±1.6 years old, married or living in civil union and that had completed secondary school or had higher education (40%). They presented a mean BMI of 26.2±4.76 Kg/m2. and were sedentary. The mean BP was 127.0±17.77mmHg- 74.69 ± 9.53. In this population, we found 4.3% of people with hypertension and 16.1% with normal high blood pressure. Men exhibit a tendency to present higher systolic blood pressure values than women. Of all the factors considered, SBP values also tended to be higher with age and higher BMI values. Despite the fact that the mean values of SBP did not present values higher than 140 mmHg we must be concerned because the studied population is undiagnosed for hypertension. Our study even with some limitations might be a prelude to the upcoming research about the underlying factors responsible for the occurrence of SBP.

Keywords: hypertension, age, exercise, obesity and gender

Procedia PDF Downloads 544

Authors: Kamesh Gupta, Nitin Jain, Anurag Rohatgi

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Objective: To study Vitamin B12 levels and presence of peripheral neuropathy among diabetes mellitus patients on metformin therapy. Method: The observational study was conducted from November 2014 to March 2015. Patients were selected from the Lady Hardinge Medical College, Delhi, India. Exhaustive history regarding dietary habits and metformin usage was taken. Lab tests including HbA1c levels and Vit B12 assays were done, on the basis of which patients were classified into subgroups. Peripheral neuropathy was detected by both clinical scoring and electrophysiological studies. Appropriate Statistical analysis for observational studies was done to evaluate the data. Results: The average duration of metformin usage was higher in patients with definite B12 deficiency (9.4y) than patients with normal B12 levels (5.6 y). Patients in the definite B12 deficiency group had much higher incidence of neuropathy (89%) than patients with no deficiency (27%). The incidence of neuropathy was higher in cases with longer metformin usage (100% with 18-22y of use and 83% with 14-17y of use) than shorter periods (29% with 2-5y of use and 75% with 6-9y of use). Conclusion: Thus patients on long-term metformin therapy are at a high risk for Vitamin B12 deficiency. Definite and possible Vitamin B12 deficiency on metformin had an earlier onset of neuropathy than the subgroup with normal Vitamin B12 levels.

Keywords: diabetic neuroptahy, cobalamine deficiency, metformin, nerve conduction studies

Procedia PDF Downloads 365

Authors: M. V. Shivaani, P. K. Jain, Surendra S. Yadav

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Worldwide regulators, practitioners and researchers view risk-disclosure as one of the most important steps that will promote corporate accountability and transparency. Recognizing this growing significance of risk disclosures, the paper first develops a risk disclosure index. Covering 69 risk items/themes, this index is developed by employing thematic content analysis and encompasses three attributes of disclosure: namely, nature (qualitative or quantitative), time horizon (backward-looking or forward-looking) and tone (no impact, positive impact or negative impact). As the focus of study is on substantive rather than symbolic disclosure, content analysis has been carried out manually. The study is based on non-financial companies of Nifty500 index and covers a ten year period from April 1, 2005 to March 31, 2015, thus yielding 3,872 annual reports for analysis. The analysis reveals that (on an average) only about 14% of risk items (i.e. about 10 out 69 risk items studied) are being disclosed by Indian companies. Risk items that are frequently disclosed are mostly macroeconomic in nature and their disclosures tend to be qualitative, forward-looking and conveying both positive and negative aspects of the concerned risk. The second objective of the paper is to gauge the factors that affect the level of disclosures in annual reports. Given the panel nature of data, and possible endogeneity amongst variables, Diff-GMM regression has been applied. The results indicate that age and size of firms have a significant positive impact on disclosure quality, whereas growth rate does not have a significant impact. Further, post-recession period (2009-2015) has witnessed significant improvement in quality of disclosures. In terms of corporate governance variables, board size, board independence, CEO duality, presence of CRO and constitution of risk management committee appear to be significant factors in determining the quality of risk disclosures. It is noteworthy that the study contributes to literature by putting forth a variant to existing disclosure indices that not only captures the quantity but also the quality of disclosures (in terms of semantic attributes). Also, the study is a first of its kind attempt in a prominent emerging market i.e. India. Therefore, this study is expected to facilitate regulators in mandating and regulating risk disclosures and companies in their endeavor to reduce information asymmetry.

Keywords: risk disclosure, voluntary disclosures, corporate governance, Diff-GMM

Procedia PDF Downloads 162

Authors: Yen-Fen Shen, Meng-Fan Li

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The study aims to investigate the effect of full-body vertical rhythmic training on fatigue, physical activity, and quality of life among middle-aged and elderly hemodialysis patients. The study adopted a quasi-experimental research method and recruited 43 long-term hemodialysis patients from a medical center in northern Taiwan, with 23 and 20 participants in the experimental and control groups, respectively. The experimental group received full-body vertical rhythmic training as an intervention, while the control group received standard hemodialysis care without any intervention. Both groups completed the measurements by using "Fatigue Scale", "Physical Activity Scale" and "Chinese version of the Kidney Disease Quality of Life Questionnaire" before and after the study. The experimental group underwent a 10-minute full-body vertical rhythmic training three times per week, which lasted for eight weeks before receiving regular hemodialysis treatment. The data were analyzed by SPSS 25 software, including descriptive statistics such as frequency distribution, percentages, means, and standard deviations, as well as inferential statistics, including chi-square, independent samples t-test, and paired samples t-test. The study results are summarized as follows: 1. There were no significant differences in demographic variables, fatigue, physical activity, and quality of life between the experimental and control groups in the pre-test. 2. After the intervention of the “full-body vertical rhythmic training,” the experimental group showed significantly better results in the category of "feeling tired and fatigued in the lower back", "physical functioning role limitation", "bodily pain", "social functioning", "mental health", and "impact of kidney disease on life quality." 3. The paired samples t-test results revealed that the control group experienced significant differences between the pre-test and post-test in the categories of feeling tired and fatigued in the lower back, bodily pain, social functioning mental health, and impact of kidney disease on life quality, with scores indicating a decline in life quality. Conversely, the experimental group only showed a significant worsening in bodily pain" and the impact of kidney disease on life quality, with lower change values compared to the control group. Additionally, there was an improvement in the condition of "feeling tired and fatigued in the lower back" for the experimental group. Conclusion: The intervention of the “full-body vertical rhythmic training” had a certain positive effect on the quality of life of the experimental group. While it may not entirely enhance patients' quality of life, it can mitigate the negative impact of kidney disease on certain aspects of the body. The study provides clinical practice, nursing education, and research recommendations based on the results and discusses the limitations of the research.

Keywords: hemodialysis, full-body vertical rhythmic training, fatigue, physical activity, quality of life

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Authors: Muhammad Arzim Naim, Saiful Azhar Rosly, Mohamad Sahari Nordin

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The objective of this study is to investigate the factors affecting the rise of Shariah non-compliance risk that can bring Islamic banks to succumb to monetary loss. Prior literatures have never analyzed such risk in details despite lots of it arguing on the validity of some Shariah compliance products. The Shariah non-compliance risk in this context is looking to the potentially failure of the facility to stand from the court test say that if the banks bring it to the court for compensation from the defaulted clients. The risk may also arise if the customers refuse to make the financing payments on the grounds of the validity of the contracts, for example, when relinquishing critical requirement of Islamic contract such as ownership, the risk that may lead the banks to suffer loss when the customer invalidate the contract through the court. The impact of Shariah non-compliance risk to Islamic banks is similar to that of legal risks faced by the conventional banks. Both resulted into monetary losses to the banks respectively. In conventional banking environment, losses can be in the forms of summons paid to the customers if they won the case. In banking environment, this normally can be in very huge amount. However, it is right to mention that for Islamic banks, the subsequent impact to them can be rigorously big because it will affect their reputation. If the customers do not perceive them to be Shariah compliant, they will take their money and bank it in other places. This paper provides new insights of risks faced by credit intensive Islamic banks by providing a new extension of knowledge with regards to the Shariah non-compliance risk by identifying its individual components that directly affecting the risk together with empirical evidences. Not limited to the Islamic banking fraternities, the regulators and policy makers should be able to use findings in this paper to evaluate the components of the Shariah non-compliance risk and make the necessary actions. The paper is written based on Malaysia’s Islamic banking practices which may not directly related to other jurisdictions. Even though the focuses of this study is directly towards to the Bay Bithaman Ajil or popularly known as BBA (i.e. sale with deferred payments) financing modality, the result from this study may be applicable to other Islamic financing vehicles.

Keywords: Islamic banking, Islamic finance, Shariah Non-compliance risk, Bay Bithaman Ajil (BBA), principal axis factoring

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Authors: Daniel Mokatsanyane, Johnny Jansen Van Rensburg

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This paper is a concise introduction of the risk management on the water derivatives market. Water, a new commodity in the market, is one of the most important commodity on earth. As important to life and planet as crops, metals, and energy, none of them matters without water. This paper presents a brief overview of water as a tradable commodity via a new first of its kind futures contract on the Nasdaq Veles California Water Index (NQH2O) derivative instrument, TheGeneralised Autoregressive Conditional Heteroscedasticity (GARCH) statistical model will be the used to measure the water price volatility of the instrument and its performance since it’s been traded. describe the main products and illustrate their usage in risk management and also discuss key challenges with modeling and valuation of water as a traded commodity and finally discuss how water derivatives may be taken as an alternative asset investment class.

Keywords: water derivatives, commodity market, nasdaq veles california water Index (NQH2O, water price, risk management

Procedia PDF Downloads 136

Authors: Vineet Agrawal, Deepanjali S., Medha R., Subitha L.

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Background. Hospital malnutrition is a highly prevalent issue and is known to increase the morbidity, mortality, length of hospital stay, and cost of care. In India, studies on hospital malnutrition have been restricted to ICU, post-surgical, and cancer patients. We designed this study to assess the impact of hospital malnutrition on 30-day post-discharge and in-hospital mortality in patients admitted in the general medicine department, irrespective of diagnosis. Methodology. All patients aged above 18 years admitted in the medicine wards, excluding medico-legal cases, were enrolled in the study. Nutritional assessment was done within 72 h of admission, using Subjective Global Assessment (SGA), which classifies patients into three categories: Severely malnourished, Mildly/moderately malnourished, and Normal/well-nourished. Anthropometric measurements like Body Mass Index (BMI), Triceps skin-fold thickness (TSF), and Mid-upper arm circumference (MUAC) were also performed. Patients were followed-up during hospital stay and 30 days after discharge through telephonic interview, and their final diagnosis, comorbidities, and cause of death were noted. Multivariate logistic regression and cox regression model were used to determine if the nutritional status at admission independently impacted mortality at one month. Results. The prevalence of malnourishment by SGA in our study was 67.3% among 395 hospitalized patients, of which 155 patients (39.2%) were moderately malnourished, and 111 (28.1%) were severely malnourished. Of 395 patients, 61 patients (15.4%) expired, of which 30 died in the hospital, and 31 died within 1 month of discharge from hospital. On univariate analysis, malnourished patients had significantly higher morality (24.3% in 111 Cat C patients) than well-nourished patients (10.1% in 129 Cat A patients), with OR 9.17, p-value 0.007. On multivariate logistic regression, age and higher Charlson Comorbidity Index (CCI) were independently associated with mortality. Higher CCI indicates higher burden of comorbidities on admission, and the CCI in the expired patient group (mean=4.38) was significantly higher than that of the alive cohort (mean=2.85). Though malnutrition significantly contributed to higher mortality on univariate analysis, it was not an independent predictor of outcome on multivariate logistic regression. Length of hospitalisation was also longer in the malnourished group (mean= 9.4 d) compared to the well-nourished group (mean= 8.03 d) with a trend towards significance (p=0.061). None of the anthropometric measurements like BMI, MUAC, or TSF showed any association with mortality or length of hospitalisation. Inference. The results of our study highlight the issue of hospital malnutrition in medicine wards and reiterate that malnutrition contributes significantly to patient outcomes. We found that SGA performs better than anthropometric measurements in assessing under-nutrition. We are of the opinion that the heterogeneity of the study population by diagnosis was probably the primary reason why malnutrition by SGA was not found to be an independent risk factor for mortality. Strategies to identify high-risk patients at admission and treat malnutrition in the hospital and post-discharge are needed.

Keywords: hospitalization outcome, length of hospital stay, mortality, malnutrition, subjective global assessment (SGA)

Procedia PDF Downloads 150

Authors: Tennah Safia, Azzag Naouelle, Derdour Salima, Hafsi Fella, Laouadi Mourad, Laamari Abdalouahab, Ghalmi Farida, Kafidi Nacerredine

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Currently, goat farming is widely practiced among the rural population of Algeria. Although milk yield of goats is low (110 liters per goat and per year on average), this milk partly ensures the feeding of small children and provides raw milk, curd, and fermented milk to the whole family. In addition, given its investment cost, which is ten times lower than that of a cow, this level of production is still of interest. This interest is reinforced by the qualities of goat's milk, highly sought after for its nutritional value superior to that of cow's milk. In the same way, its aptitude for the transformation, in particular in quality cheeses, is very sought after. The objective of this study is to give the situation of goat milk production in rural areas of Algeria and to establish a classification of goat breeds according to their production potential. For this, a survey was carried out with goat farmers in Algerian steppe. Three indigenous breeds were encountered in this study: the breed Arabia, Mozabite, and Mekatia; Arabia being the most dominant. The Mekatia breed and the Mozabite breed appear to have higher production and milking abilities than other local breeds. They are therefore indicated to play the role of local dairy breeds par excellence. The other breed that could be improved milk performance is the Arabia breed. There, however, the milk performance of this breed is low. However, in order to increase milk production, uncontrolled crosses with imported breeds (mainly Saanen and Alpine) were carried out. The third population that can be included in the category for dairy production is the dairy breed group of imported origin. There are farms in Algeria composed of Alpine and Saanen breeds born locally. Improved milk performance of local goats, Crusader population, and dairy breeds of imported origin could be done by selection. For this, it is necessary to set up a milk control to detect the best animals. This control could be carried out among interested farmers in each large goat breeding area. In conclusion, sustained efforts must be made to enable the sustainable development of the goat sector in Algeria. It will, therefore, be necessary to deepen the reflection on a national strategy to valorize goat's milk, taking into account the specificities of the environment, the genetic biodiversity, and the eating habits of the Algerian consumer.

Keywords: goat, milk, Algeria, biodiversity

Procedia PDF Downloads 185

Authors: Shervin Rashidinia, Sara Shahmoradi, Seyyed Shahin Eftekhari, Mohsen Talebizadeh, Mohammad Saleh Sadeghi

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Background: Beta-thalassemia Major (BTM) is a kind of hereditary hemolytic anemia which depended on regular monthly blood transfusion. However, iron deposition into the organs leads to multi-organ damage. The present study is the first study which aimed to evaluate the average of five-years serum ferritin level and compared by the prevalence of short stature and hypocalcemia. Materials/Methods: A cross-sectional retrospective study which a total of 140 patients with beta-thalassemia who were referred to Qom Thalassemia Clinic between February 2011 and July 2016 were enrolled to be reviewed. The exclusion criteria were consisting of incomplete medical records, diagnosis less than 2-years-ago and the blood transfusion less than every 4 weeks. The data including age, gender, weight, height, age of initial blood transfusion, age of initial chelation therapy, ferritin, and calcium were collected and analysis by SPSS version 24. Results: A total of 140 patients were enrolled. Of them, 75 (53.4%) were female. The mean age of the patients was 13.4±4.6 years.The mean age of initial diagnosis was 20.2±7.4 months. Hypocalcemia and short stature were occurred in 41 (29.3%) and 37 (26.4%) patients, respectively. The mean five-years serum ferritin level was significantly higher in the patients with short stature and hypocalcemia (P<0.0001). However, rise in serum ferritin level significantly increases the risk of short-stature and hypocalcemia (1.0004- and 1.0029 fold, respectively). Conclusion: We demonstrated that prevalence of short stature and hypocalcemia were significantly higher in the BTM.However, ferritin significantly increases the risk of short stature and hypocalcemia.

Keywords: beta-thalassemia, ferritin, growth retardation, hypocalcemia

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Authors: Muhammad Ridho Fakhrin, Leni Sagita Riantini, Yusuf Latief

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Based on the 2015-2019 RPJMN data, the realization of toll road infrastructure development in Indonesia experienced a delay of 49% or 904 km of the total plan. One of the major causes of delays in development is caused by institutional factors. The case study taken in this research is the construction of the Trans Sumatra Toll Road (JTTS). The purpose of this research is to identify the institutional forms, functions, roles, duties, and responsibilities of each stakeholder and the risks that occur in the Trans Sumatra Toll Road Infrastructure Development. Risk analysis is implemented on functions, roles, duties, responsibilities of each existing stakeholder and is carried out at the Funding Stage, Technical Planning Stage, and Construction Implementation Stage in JTTS. This research is conducted by collecting data through a questionnaire survey, then processed using statistical methods, such as homogeneity, data adequacy, validity, and reliability test, continued with risk assessment based on a risk matrix. The results of this study are the evaluation and development of institutional functions in risk-based JTTS development can improve time performance and minimize delays in the construction process.

Keywords: institutional, risk management, time performance, toll road

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Authors: Jonas Hinker, Lisa Zumholz, Johanna M. A. Myrzik

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Despite strong efforts by the German government to make a transition to higher quality level of building stocks, the rate of renovation continues to remain below the proclaimed level of 2%. As the mandatory standards for residential retrofits are well-balanced in such a way that strict adherence to them guarantees profit from the investment, it becomes difficult to explain the reasons why there are so many people hesitant with their investments. Risks and transaction costs can be understood as socio-technical boundaries and have to be taken into consideration to be able to understand why a worthwhile investment is postponed or rejected. This paper therefore presents a method for investment analyses that is focused on such socio-technical constraints, which helps to reveal the strongest misconceptions of home owners. By depicting sensitivities and risk factors in an integrated and impartial way, such a tool can be utilized by home owners to address reservations and misunderstandings. In the end, this leads to an exploitation of smaller energy efficiency measures that makes up a big demand reduction in the residential sector altogether.

Keywords: energy refurbishment, investment analysis, residential buildings, risk-aware investment strategy

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Authors: Ali Kassem, Sharf Eldeen-Shazly, Alshemaa Lotfy

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Introduction: Contrast-induced nephropathy (CIN) has been the third leading cause of hospital-acquired renal failure. Patients with cardiac diseases are particularly at risk especially with repeated injections of contrast media. CIN is generally defined as an increase in serum creatinine concentration of > 0.5 mg/dL or 25% above baseline within 48 hours after contrast administration. Aim of work: To examine the frequency of CIN for patients undergoing cardiac catheterization at Sohag University Hospital (Upper Egypt) and to identify possible risk factors for CIN in these patients. Material and methods: The study included 104 patients with mean age 56.11 ±10.03, 64(61.5%) are males while 40(38.5%) are females. 44(42.3%) patients are diabetics, 43(41%) patients are hypertensive, 6(5.7%) patients have congestive heart failure, 69(66.3%) patients on statins, 74 (71.2 %) are on ACEIs or ARBs, 19(15.4%) are on metformin, 6 (5.8%) are on NSAIDs, 30(28.8%) are on diuretics. RESULTS: Patients were classified at the end of the study into two groups: Group A: Included 91 patients who did not develop CIN. Group B: Included 13 patients who developed CIN, of which serum creatinine raised > 0.5mg/dl in 6 patients and raised > 25% from the baseline after the procedure in 13 patients. The overall incidence of CIN was 12.5%. CIN increased with older age. There was an increase in the incidence of CIN in diabetic versus non-diabetic patients (20.5% and 6.7%) respectively. (p< 0.03). There was a highly significant increase in the incidence of CIN in patients with CHF versus those without CHF (100% and 71%) respectively, (P<0001). Patients on diuretics showed a significant increase in the incidence of CIN representing 61.5% of all patients who developed CIN. Conclusion: Older patients, diabetic patients, patients with CHF and patients on diuretics have higher risk of developing CIN during coronary catheterization and should receive reno-protective measures before contrast exposure.

Keywords: cardiac diseases, contrast-induced nephropathy, coronary catheterization, CIN

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Authors: Punwath Prum

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Superfund site is recognized publicly to be a severe environmental problem to surrounding communities and biodiversity due to its hazardous chemical waste from industrial activities. It contaminates the soil and water but also is a leading potential point-source pollution affecting ecosystem in watershed areas from chemical substances. The risks of Superfund site on watershed can be effectively measured by utilizing publicly available data and geospatial analysis by free and open source application. This study analyzed the vegetation change within high risked contaminated watersheds in Wisconsin. The high risk watersheds were measured by which watershed contained high number Superfund sites. The study identified two potential risk watersheds in Lafayette and analyzed the temporal changes of vegetation within the areas based on Normalized difference vegetation index (NDVI) analysis. The raster statistic was used to compare the change of NDVI value over the period. The analysis results showed that the NDVI value within the Superfund sites’ boundary has a significant lower value than nearby surrounding and provides an analogy for environmental hazard affect by the chemical contamination in Superfund site.

Keywords: soil contamination, spatial analysis, watershed

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Authors: Junhong Li, Danni Cheng, Yaxin Luo, Xiaowei Yi, Ke Qiu, Wendu Pang, Minzi Mao, Yufang Rao, Yao Song, Jianjun Ren, Yu Zhao

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Background: The number of multiple cancer patients was increasing, and the impact of prior cancer history on salivary gland cancer patients remains unclear. Methods: Clinical, demographic and pathological information on salivary gland cancer patients were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2017, and the characteristics and prognosis between patients with a prior cancer and those without prior caner were compared. Univariate and multivariate cox proportional regression models were used for the analysis of prognosis. A risk score model was established to exam the impact of treatment on patients with a prior cancer in different risk groups. Results: A total of 9098 salivary gland cancer patients were identified, and 1635 of them had a prior cancer history. Salivary gland cancer patients with prior cancer had worse survival compared with those without a prior cancer (p<0.001). Patients with a different type of first cancer had a distinct prognosis (p<0.001), and longer latent time was associated with better survival (p=0.006) in the univariate model, although both became nonsignificant in the multivariate model. Salivary gland cancer patients with a prior cancer were divided into low-risk (n= 321), intermediate-risk (n=223), and high-risk (n=62) groups and the results showed that patients at high risk could benefit from surgery, radiation therapy, and chemotherapy, and those at intermediate risk could benefit from surgery. Conclusion: Prior cancer history had an adverse impact on the survival of salivary gland cancer patients, and individualized treatment should be seriously considered for them.

Keywords: prior cancer history, prognosis, salivary gland cancer, SEER

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Authors: Mahdi Eskandarlou, Mehrdad Taghipour

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Background: Partial-thickness skin graft is the cornerstone for scalp defect repair. Routine donor sites include abdomen, thighs, and buttocks. Given the potential side effects following harvesting from these sites and the potential advantages of harvesting from scalp (broad surface, rapid healing, and better cosmetics results), this study is trying to compare the outcomes of graft harvesting from scalp and lower limb. Methods: This clinical trial is conducted among a sample number of 40 partial thickness graft candidates (20 case and 20 control group) with scalp defect presenting to plastic surgery clinic at Besat Hospital during the time period between 2018 and 2019. Sampling was done by simple randomization using random digit table. Data gathering was performed using a designated checklist. The donor site in case group and control group was scalp and lower limb, respectively. The resultant data were analyzed using chi-squared and t-test and SPPS version 21 (SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). Results: Of the total 40 patients participating in this study, 28 patients (70%) were male, and 12 (30%) were female with and mean age of 63.62 ± 09.73 years. Hypertension and diabetes mellitus were the most common comorbidities among patients with basal cell carcinoma (BCC) and trauma being the most common etiology for the defects. There was a statistically meaningful relationship between two groups regarding the etiology of defect (P=0.02). The most common anatomic location of defect for case and control groups was temporal and parietal, respectively. Most of the defects were deep to galea zone. The mean diameter of defect was 24.28 ± 45.37 mm for all of the patients. The difference between diameter of defect in both groups was statistically meaningful, while no such difference between graft diameter was seen. The graft 'Take' was completely successful in both groups according to evaluations. The level of postoperative pain was lower in the case group compared to the control according to VAS scale, and the satisfaction was higher in them per Likert scale. Conclusion: Scalp can safely be used as donor site for skin graft to be used for scalp defects, which is associated with better results and lower complication rates compared to other donor sites.

Keywords: donor site, leg, partial-thickness graft, scalp

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Authors: Marinko Maslaric, Maja Jokic

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When searching for fast and long term responses, sustainable logistics and supply chain applications have developed irrefutable theories and hypotheses towards market requirements. Nevertheless, there are certain misunderstandings on how the implementation of sustainability principles (social, economical, and environmental) and concepts should work in practice, more specifically, within a humanitarian supply chain management context. This paper will focus on the review and analysis of risk management concepts in humanitarian supply chain in order to identify their compliance with sustainable principles. In this direction, the study will look for strategies that suggest: minimization of environmental impacts throughout the reduction of resources consumption, depreciation of logistics costs, including supply chain ones, minimization of transportation and service costs, elaboration of quality performance of supply chain and logistics, and reduction of supply chain delivery time. On the side of meeting all defense, trades and humanitarian logistics needs, the research will be aligned to UN Sustainable Development Goals, standards, and performances. It will start with relevant strategies for identification of risk indicators and it will end with suggestion of valuable strategic approaches for their minimization or total prevention. Finally, a content analysis will propose a suitable methodological structure for the creation of most sustainable strategy in risk management of humanitarian supply chain. Content analysis will accompany thorough, consistent and methodical approach of literature review for potential disaster risk management plan. Thereupon, the propositions of this research will look for contemporary literature gaps, with respect to operate the literature analysis and to suggest the appropriate sustained risk low master plan. The indicated is here to secure the high quality of logistics practices in hazardous events.

Keywords: humanitarian logistics, sustainability, supply chain risk, risk management plan

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Authors: Pernille K. Christiansen, Mette Maria Skjøth, Line Lorenzen, Eva Draborg, Christina Anne Vinter, Trine Kjær, Mette Juel Rothmann

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Background and aims: Overweight and obesity are an increasing challenge on a global level. In Denmark, more than one-third of all pregnant women are overweight or obese, and many women exceed the gestational weight gain recommendations from the Institute of Medicine. Being overweight or obese, is associated with a higher risk of adverse maternal and fetal outcomes, including gestational diabetes and childhood obesity. Thus, it is important to focus on the women’s lifestyles between their pregnancies to lower the risk of gestational weight retention in the long run. The objective of this study was to explorer what barriers and challenges postpartum women experience with respect to healthy lifestyles during the postpartum period and to access whether an Information Technology based intervention might be a supportive tool to assist and motivate postpartum women to a healthy lifestyle. Materials and methods: The method is inspired by participatory design. A systematic text condensation was applied to semi-structured focus groups. Five focus group interviews were carried out with a total of 17 postpartum women and two interviews with a total of six health professionals. Participants were recruited through the municipality in Svendborg, Denmark, and at Odense University Hospital in Odense, Denmark, during a four-month period in early 2018. Results: From the women’s perspective, better assistance is needed from the health professionals to obtain or maintain a healthy lifestyle. The women need tools that inform and help them understand and prioritise their own health-related risks, and to motivate them to plan and take care of their own health. As the women use Information Technology on a daily basis, the solution could be delivered through Information Technology. Finally, there is room for engaging the partner more in the communication related to the baby and family’s lifestyle. Conclusion: Postpartum women need tools that inform and motivate a healthy lifestyle postpartum. The tools should allow access to high-quality information from health care professionals, when the information is needed, and also allow engagement from the partner. Finally, Information Technology is a potential tool for delivering tools.

Keywords: information technology, lifestyle, overweight, postpartum

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Authors: Anna Bak-Klimek, Emily Spencer, Siew Lee, Karen Campbell, Wendy McInally

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Background & Significance: Over half of Teenagers and Young Adults (TYAs) say that they experience psychological distress after cancer diagnosis and TYAs with cancer are at higher risk of developing distress compared to other age groups. Despite this there are no age-appropriate interventions to help TYAs manage distress and there is a lack of conceptual understanding of what causes distress in this population group. This makes it difficult to design a targeted, developmentally appropriate intervention. This review aims to identify the key determinants of distress in TYAs affected by cancer and to propose an integrative model of cancer-related distress for TYAs. Method: A literature search was performed in Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, CINAHL, EMBASE and PsycArticles in May-June, 2022. Quantitative literature was systematically reviewed on the relationship between psychological distress experienced by TYAs affected by cancer and a wide range of factors i.e. individual (demographic, psychological, developmental, and clinical factors) and contextual (social/environmental) factors. Evidence was synthesized and correlates were categorized using the Biopsychosocial Model. The full protocol is available from PROSPERO (CRD42022322069) Results: Thirty eligible quantitative studies met criteria for the review. A total of twenty-six studies were cross-sectional, three were longitudinal and one study was a case control study. The evidence on the relationship between the socio-demographic, illness and treatment-related factors and psychological distress is inconsistent and unclear. There is however consistent evidence on the link between psychological factors and psychological distress. For instance, the use of cognitive and defence coping, negative meta-cognitive beliefs, less optimism, a lack of sense of meaning and lower resilience levels were significantly associated with higher psychological distress. Furthermore, developmental factors such as poor self-image, identity issues and perceived conflict were strongly associated with higher distress levels. Conclusions: The current review suggests that psychological and developmental factors such as ineffective coping strategies, poor self-image and identity issues may play a key role in the development of psychological distress in TYAs affected by cancer. The review proposes a Positive Developmental Psychology Model of Distress for Teenagers and Young Adults affected by cancer. The review highlights that implementation of psychological interventions that foster optimism, improve resilience and address self-image may result in reduced distress in TYA’s with cancer.

Keywords: cancer, determinant, psychological distress, teenager and young adult, theoretical model

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Authors: K. S. Vedasingha, K. K. M. T. Perera, K. I. Hathurusinghe, H. W. I. Akalanka, Nelum Chathuranga Amarasena, Nalaka R. Dissanayake

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Railways provide the most convenient and economically beneficial mode of transportation, and it has been the most popular transportation method among all. According to the past analyzed data, it reveals a considerable number of accidents which occurred at railways and caused damages to not only precious lives but also to the economy of the countries. There are some major issues which need to be addressed in railways of South Asian countries since they fall under the developing category. The goal of this research is to minimize the influencing aspect of railway level crossing accidents by developing the “railway process automation system”, as there are high-risk areas that are prone to accidents, and safety at these places is of utmost significance. This paper describes the implementation methodology and the success of the study. The main purpose of the system is to ensure human safety by using the Internet of Things (IoT) and image processing techniques. The system can detect the current location of the train and close the railway gate automatically. And it is possible to do the above-mentioned process through a decision-making system by using past data. The specialty is both processes working parallel. As usual, if the system fails to close the railway gate due to technical or a network failure, the proposed system can identify the current location and close the railway gate through a decision-making system, which is a revolutionary feature. The proposed system introduces further two features to reduce the causes of railway accidents. Railway track crack detection and motion detection are those features which play a significant role in reducing the risk of railway accidents. Moreover, the system is capable of detecting rule violations at a level crossing by using sensors. The proposed system is implemented through a prototype, and it is tested with real-world scenarios to gain the above 90% of accuracy.

Keywords: crack detection, decision-making, image processing, Internet of Things, motion detection, prototype, sensors

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Authors: Asghar Rahimi, Majid Puryousef

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This study aimed to examine dormancy-breaking of bitter apple (Citrullus colocynthis) seed. Seeds of wild bitter apple collected from the Balochestan zone in east of Iran were subjected to different treatments including temperatures (20 and 30°C) and some dormancy breaking methods on breaking seed dormancy of bitter apple. Only 6 treatments from 12 dormancy breaking treatments were effective in dormancy breaking, therefore only effective treatments were analyzed. In general, germination percentage of cleaved seeds, soaked seeds in hot water (98°c) and soaking in H2SO4 in both temperatures was higher than other treatments and germination percentage of scarified seeds with sandy paper in both temperature was lower than other treatments. Also germination percentage of soaked seeds in hot water (98°c) and naturally cracked seeds in temperature 20°c was higher than 30°c.

Keywords: foliar application, nano chelate, nitrogen, Safflower

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Authors: Makhosazana Dubazana

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Many South Africans commuters use minibus taxis daily and are connected to the informal transport network through metro centres informally known as Taxi Ranks. Taxi ranks form part of an economic nexus for many informal traders, connecting them to commuters, their prime clientele. They work along designated areas along the periphery of the taxi rank and in between taxi lanes. Informal traders are therefore at risk of adverse health effects associated with the inhalation of exhaust fumes from minibus taxis. Of the exhaust emissions, benzene, toluene, ethylbenzene and xylenes (BTEX) have high toxicity. Purpose: The purpose of this study was to conduct a Human Health Risk Assessment for informal traders, looking at their exposure to BTEX compounds. Methods: The study was conducted in a subsection of a taxi rank which is representative of the entire taxi rank. This subsection has a daily average of 400 minibus taxi moving through it and an average of 60 informal traders working in it. In the health risk assessment, a questionnaire was conducted to understand the occupational behaviour of the informal traders. This was used to deduce the exposure scenarios and sampling locations. Three sampling campaigns were run for an average of 10 hours each covering the average working hours of traders. A gas chronographer was used for collecting continues ambient air samples at 15 min intervals. Results: Over the three sampling days, the average concentrations were, 8.46ppb, 0.63 ppb, 1.27ppb and 1.0ppb for benzene, toluene, ethylbenzene, and xylene respectively. The average cancer risk is 9.46E-03. In several cases, they were incidences of unacceptable risk for the cumulative exposure of all four BTEX compounds. Conclusion: This study adds to the body of knowledge on the Human Health Risk effects of urban BTEX pollution, furthermore focusing on the impact of urban BTEX on high risk personal such as informal traders, in Southern Africa.

Keywords: human health risk assessment, informal traders, occupational risk, urban BTEX

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Authors: Vinodhini Elangovan, Jen Heng Pek

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Background: An ectopic pregnancy is defined as any pregnancy implanted outside of the endometrial cavity. Cornual pregnancy, a rare variety of ectopic pregnancies, is seen in about 2-4% of ectopic pregnancies. It develops in the interstitial portion of the fallopian tube and invades through the uterine wall. This case describes a third-trimester cornual pregnancy that resulted in a uterine rupture. Case: A 38-year old Chinese lady was brought to the Emergency Department (ED) as a standby case for hypotension. She was 30+6 weeks pregnant (Gravida 3, Parous 1). Her past obstetric history included a live birth delivered via lower segment Caesarean section due to non-reassuring fetal status in 2002 and a miscarriage in 2012. She developed generalized abdominal pain. There was no per vaginal bleeding or leaking liquor. There was also no fever, nausea, vomiting, constipation, diarrhea, or urinary symptoms. On arrival in the ED, she was pale, diaphoretic, and lethargic. She had generalized tenderness with guarding and rebound over her abdomen. Point of care ultrasound was performed and showed a large amount of intra-abdominal free fluid, and the fetal heart rate was 170 beats per minute. The point of care hemoglobin was 7.1 g/dL, and lactate was 6.8 mmol/L. The patient’s blood pressure dropped precipitously to 50/36 mmHg, and her heart rate went up to 141 beats per minute. The clinical impression was profound shock secondary to uterine rupture. Intra-operatively, there was extensive haemoperitoneum, and the fetus was seen in the abdominal cavity. The fetus was delivered immediately and handed to the neonatal team. On exploration of the uterus, the point of rupture was at the left cornual region where the placenta was attached to. Discussion: Cornual pregnancies are difficult to diagnose pre-operatively with low ultrasonographic sensitivity and hence are commonly confused with normal intrauterine pregnancies. They pose a higher risk of rupture and hemorrhage compared to other types of ectopic pregnancies. In very rare circumstances, interstitial pregnancies can result in a viable fetus. Uterine rupture resulting in hemorrhagic shock is a true obstetric emergency that can result in significant morbidity and mortality for the patient and the fetus, and early diagnosis in the emergency department is crucial. The patient in this case presented with known risk factors of multiparity, advanced maternal age, and previous lower segment cesarean section, which increased the suspicion of uterine rupture. Ultrasound assessment may be beneficial to any patient who presents with symptoms and a history of uterine surgery to assess the possibility of uterine dehiscence or rupture. Management of a patient suspected of uterine rupture should be systematic in the emergency department and follow an ABC approach. Conclusion: This case demonstrates the importance for an emergency physician to maintain the suspicion for ectopic pregnancy even at advanced gestational ages. It also highlights how even though all emergency physicians may not be qualified to do a detailed pelvic ultrasound, it is essential for them to be competent with a point of care ultrasound to make a prompt diagnosis of conditions such as uterine rupture.

Keywords: cornual ectopic , ectopic pregnancy, emergency medicine, obstetric emergencies

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