Search results for: end stage renal failure

Authors: Jaan-Willem Simon, Bertram Stier, Brett Bednarcyk, Evan Pineda, Stefanie Reese

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Textile composites, in which the reinforcing fibers are woven or braided, have become very popular in numerous applications in aerospace, automotive, and maritime industry. These textile composites are advantageous due to their ease of manufacture, damage tolerance, and relatively low cost. However, physics-based modeling of the mechanical behavior of textile composites is challenging. Compared to their unidirectional counterparts, textile composites introduce additional geometric complexities, which cause significant local stress and strain concentrations. Since these internal concentrations are primary drivers of nonlinearity, damage, and failure within textile composites, they must be taken into account in order for the models to be predictive. The macro-scale approach to modeling textile-reinforced composites treats the whole composite as an effective, homogenized material. This approach is very computationally efficient, but it cannot be considered predictive beyond the elastic regime because the complex microstructural geometry is not considered. Further, this approach can, at best, offer a phenomenological treatment of nonlinear deformation and failure. In contrast, the mesoscale approach to modeling textile composites explicitly considers the internal geometry of the reinforcing tows, and thus, their interaction, and the effects of their curved paths can be modeled. The tows are treated as effective (homogenized) materials, requiring the use of anisotropic material models to capture their behavior. Finally, the micro-scale approach goes one level lower, modeling the individual filaments that constitute the tows. This paper will compare meso- and micro-scale approaches to modeling the deformation, damage, and failure of textile-reinforced polymer matrix composites. For the mesoscale approach, the woven composite architecture will be modeled using the finite element method, and an anisotropic damage model for the tows will be employed to capture the local nonlinear behavior. For the micro-scale, two different models will be used, the one being based on the finite element method, whereas the other one makes use of an embedded semi-analytical approach. The goal will be the comparison and evaluation of these approaches to modeling textile-reinforced composites in terms of accuracy, efficiency, and utility.

Keywords: multiscale modeling, continuum damage model, damage interaction, textile composites

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Authors: S. F. Halim, H. F. Naguib, S. N. Lawandy, R. S. Hegazy, M. N. Baheg

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The main drawbacks of the traditional carbon fabric reinforced epoxy resin (CFRP) are low strain failure, delamination between composites layers, and low impact resistance due to the brittleness of epoxy resin. The aim of this study is to enhance the fracture properties of the CFRP composites laminates via the variation of composite's designs. A series of composites were fabricated in which bidirectional (00/900) carbon fabric (CF) layers were laid inside the resin matrix with orientation codes as F1 [(00, 900)/ (00, 900)], F2 [(900, 00)/ (00, 900)] and F3 [(00,900)/ (900, 00). The mechanical and dynamic properties of the composites were estimated. In addition, the morphology of samples surface was examined by scanning electron microscope (SEM) after impact fracture. The results revealed that the CFRP properties could be tailored fitting specific applications by controlling the fabric orientation inside the CFRP composite design. F2 orientation [(900, 00)/ (00.900)] showed the highest tensile and flexural strength values. On the other hand, the impact strength values of composites were in the order F1 > F2 > F3. The storage modulus, loss modulus, and glass transition temperature Tg values obtained from the dynamic mechanical analysis (DMA) examination was in the order F1 > F2 > F3. The variation in the properties of the composite was clearly explained by the SEM micrographs as the failure of F3 orientation properties was referred to as the complete breakage of the CF layers upon fracture.

Keywords: carbon fiber, CFRP, composites, epoxy resins, flexural strength

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Authors: Suchart Tripopsakul

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This paper uses data from the Global Entrepreneurship Monitor (GEM) to investigate the difference of attitudes towards entrepreneurial intention (EI). EI is generally assumed to be the single most relevant predictor of entrepreneurial behavior. The aim of this paper is to examine a range of attitudes effect on individual’s intent to start a new venture. A cross-cultural comparison between Asia and Europe is used to further investigate the possible differences between potential entrepreneurs from these distinct national contexts. The empirical analysis includes a GEM data set of 10 countries (n = 10,306) which was collected in 2013. Logistic regression is used to investigate the effect of individual’s attitudes on EI. Independent variables include individual’s perceived capabilities, the ability to recognize business opportunities, entrepreneurial network, risk perceptions as well as a range of socio-cultural attitudes. Moreover, a cross-cultural comparison of the model is conducted including six ASEAN (Malaysia, Indonesia, Philippines, Singapore, Vietnam and Thailand) and four European nations (Spain, Sweden, Germany, and the United Kingdom). The findings support the relationship between individual’s attitudes and their entrepreneurial intention. Individual’s capability, opportunity recognition, networks and a range of socio-cultural perceptions all influence EI significantly. The impact of media attention on entrepreneurship and was found to influence EI in ASEAN, but not in Europe. On the one hand, Fear of failure was found to influence EI in Europe, but not in ASEAN. The paper develops and empirically tests attitudes toward Entrepreneurial Intention between ASEAN and Europe. Interestingly, fear of failure was found to have no significant effect in ASEAN, and the impact of media attention on entrepreneurship and was found to influence EI in ASEAN. Moreover, the resistance of ASEAN entrepreneurs to the otherwise high rates of fear of failure and high impact of media attention are proposed as independent variables to explain the relatively high rates of entrepreneurial activity in ASEAN as reported by GEM. The paper utilizes a representative sample of 10,306 individuals in 10 countries. A range of attitudes was found to significantly influence entrepreneurial intention. Many of these perceptions, such as the impact of media attention on entrepreneurship can be manipulated by government policy. The paper also suggests strategies by which Asian economy in particular can benefit from their apparent high impact of media attention on entrepreneurship.

Keywords: an entrepreneurial intention, attitude, GEM, ASEAN and Europe

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Authors: Liliia N. Butymova, Vladimir Y. Modorsky, Nikolai A. Shevelev

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Prediction of vibration processes in gas transmittal units (GTU) is an urgent problem. Despite numerous scientific publications on the problem of vibrations in general, there are not enough works concerning FSI-modeling interaction processes between several deformable blades in gas-dynamic flow. Since it is very difficult to solve the problem in full scope, with all factors considered, a unidirectional dynamic coupled 1FSI model is suggested for use at the first stage, which would include, from symmetry considerations, two blades, which might be considered as the first stage of solving more general bidirectional problem. ANSYS CFX programmed multi-processor was chosen as a numerical computation tool. The problem was solved on PNRPU high-capacity computer complex. At the first stage of the study, blades were believed oscillating with the same frequency, although oscillation phases could be equal and could be different. At that non-stationary gas-dynamic forces distribution over the blades surfaces is calculated in run of simulation experiment. Oscillations in the “gas — structure” dynamic system are assumed to increase if the resultant of these gas-dynamic forces is in-phase with blade oscillation, and phase shift (φ=0). Provided these oscillation occur with phase shift, then oscillations might increase or decrease, depending on the phase shift value. The most important results are as follows: the angle of phase shift in inter-blade oscillation and the gas-dynamic force depends on the flow velocity, the specific inter-blade gap, and the shaft rotation speed; a phase shift in oscillation of adjacent blades does not always correspond to phase shift of gas-dynamic forces affecting the blades. Thus, it was discovered, that asynchronous oscillation of blades might cause either attenuation or intensification of oscillation. It was revealed that clocking effect might depend not only on the mutual circumferential displacement of blade rows and the gap between the blades, but also on the blade dynamic deformation nature.

Keywords: aeroelasticity, ANSYS CFX, oscillation, phase shift, clocking effect, vibrations

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Authors: Udayan Patankar, Shashwati Bhagat, Vilas Nitneware, Ants Koel

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An ISM band power amplifier is a type of electronic amplifier used to convert a low-power radio-frequency signal into a larger signal of significant power, typically used for driving the antenna of a transmitter. Due to drastic changes in telecommunication generations may lead to the requirements of improvements. Rapid changes in communication lead to the wide implementation of WLAN technology for its excellent characteristics, such as high transmission speed, long communication distance, and high reliability. Many applications such as WLAN, Bluetooth, and ZigBee, etc. were evolved with 2.4GHz to 5 GHz ISM Band, in which the power amplifier (PA) is a key building block of RF transmitters. There are many manufacturing processes available to manufacture a power amplifier for desired power output, but the major problem they have faced is about the power it consumed for its proper working, as many of them are fabricated on the GaN HEMT, Bi COMS process. In this paper we present a CMOS Base two stage cascode design of power amplifier working on 2.4GHz ISM frequency band. To lower the costs and allow full integration of a complete System-on-Chip (SoC) we have chosen 0.13µm low power CMOS technology for design. While designing a power amplifier, it is a real task to achieve higher power efficiency with minimum resources. This design showcase the Multi biased Cascode methodology to implement a two-stage CMOS power amplifier using ADS and LTSpice simulating tool. Main source is maximum of 2.4V which is internally distributed into different biasing point VB driving and VB driven as required for distinct stages of two stage RF power amplifier. It shows maximum power added efficiency near about 70.195% whereas its Power added efficiency calculated at 1 dB compression point is 44.669 %. Biased MOSFET is used to reduce total dc current as this circuit is designed for different wireless applications comes under 2.4GHz ISM Band.

Keywords: RFIC, PAE, RF CMOS, impedance matching

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Authors: C. Temaneh-Nyah

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Electromagnetic compatibility (EMC) is the ability of a Radio Communication Equipment (RCE) to operate with a desired quality of service in a given Electromagnetic Environment (EME) and not to create harmful interference with other RCE. This paper presents an algorithm which improves the simulation speed of estimating EMC of RCE in a complex EME, based on a stage by stage frequency-energy criterion of filtering. This algorithm considers different interference types including: Blocking and intermodulation. It consist of the following steps: simplified energy criterion where filtration is based on comparing the free space interference level to the industrial noise, frequency criterion which checks whether the interfering emissions characteristic overlap with the receiver’s channels characteristic and lastly the detailed energy criterion where the real channel interference level is compared to the noise level. In each of these stages, some interference cases are filtered out by the relevant criteria. This reduces the total number of dual and different combinations of RCE involved in the tedious detailed energy analysis and thus provides an improved simulation speed.

Keywords: electromagnetic compatibility, electromagnetic environment, simulation of communication network

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Authors: Xing Lv, Hui-Qin Xu

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The present study aimed to reveal the mechanism in aggravating STZ induced diabetic nephropathy (DN) by AGEs (advanced glycation end products). At the eighth day, 20 diabetic mice were randomly divided into STZ group and combination (combine AGEs with STZ) group. Simultaneously, AGEs group and normal group were set. Only mice in AGEs group, combination group were fed with high-AGEs diets. Mice diabetic conventional indicators, biochemical analysis were measured. Among the indictors, food consumptions, water intake, urine output, blood glucose, urine protein, urine creatinine, serum urea nitrogen were increased significantly in STZ, combination groups. The AGEs levels in combination group increased significantly when compared with STZ group. Weights and insulin levels in the STZ, combination groups were decreased significantly when compared with normal group, and the difference was significantly between AGEs group and STZ group. As a conclusion, AGEs play an important role in the DN development, inducing kidney damages.

Keywords: AGEs, diabetic nephropathy, serum urea nitrogen, urine protein

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Authors: P. Parthiban, Sonu Rajak, R. Dhanalakshmi

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This paper presents an Ant Colony Optimization (ACO) approach, combined with a Speed Optimization Algorithm (SOA) to solve the Vehicle Routing Problem (VRP) with environmental considerations, which is well known as Pollution-Routing Problem (PRP). It consists of routing a number of vehicles to serve a set of customers, and determining fuel consumption, driver wages and their speed on each route segment, while respecting the capacity constraints and time windows. Since VRP is NP-hard problem, so PRP also a NP-hard problem, which requires metaheuristics to solve this type of problems. The proposed solution method consists of two stages. Stage one is to solve a Vehicle Routing Problem with Time Window (VRPTW) using ACO and in the second stage, a SOA is run on the resulting VRPTW solution. Given a vehicle route, the SOA consists of finding the optimal speed on each arc of the route to minimize an objective function comprising fuel consumption costs and driver wages. The proposed algorithm tested on benchmark problem, the preliminary results show that the proposed algorithm can provide good solutions within reasonable computational time.

Keywords: ant colony optimization, CO2 emissions, speed optimization, vehicle routing

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Authors: Yun-Ching Tu, Yu-Chun Chih

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People with aphasia (PWA) may have communicative difficulties in their daily lives, but research on functional communication in aphasia is still limited in Taiwan. The aim of the study was to investigate the impact of aphasia-related factors on functional communication assessment. This study adopted a convenience sampling method. Thirty aphasic participants participated in the study. During the test, the examiner would ask questions that are encountered in daily life and record the participant‘s responses. Some questions would provide pictures to simulate situations in daily life. The results showed that the non-fluent aphasia group performed significantly worse than the fluent aphasia group. In addition, patients with severe aphasia performed significantly lower scores than patients with moderate aphasia and mild aphasia. However, group differences in the chronic stage and acute stage were not significant. In sum, since communication in daily life is diverse and language is still needed in the communication process, patients with aphasia who have better language ability may have relatively better functional communication. In contrast, the more severely impaired the language ability of a patient with aphasia is, the more functional communication will be affected, resulting in poor communication performance in daily life.

Keywords: adult, aphasia, assessment, functional communication

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Authors: Bekalu Melis Alehegn, Dagnenet Sultan Alemu

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The insufficiency of water is the most severe restraint for the expansion of agriculture in arid and semi-arid areas. An important strategy for increasing water productivity and improving water productivity deficit irrigation at different growth stages is important to advance the yield and Water Productivity of barley in water scarce areas. A field experiment was conducted at the Koga irrigation scheme in Ethiopia to examine barley yield response to different irrigation regimes and validate the aqua crop model. The experimental setup comprised six randomized treatments (T) with three replications for one irrigation season because of financial limitations. The irrigation regimes were selected 100%, 75%, and 50% application levels in different growth stages of gross irrigation requirements using trial and error in order to select the optimal water application level. The treatments were: no stress at all (T1), 25% stressed during all crop stages (T2), 50% stressed at all stages (T3), 50% stressed at the development stage (T4), 50% stressed at mid-stage (T5) and 50% stress at initial and late season (T6). The agronomic parameters, including canopy cover, biomass, and grain yield, were collected to compare the ground-based crop yield and the aqua crop model. The results showed that the initial and late stages and stress 25% through the whole season were the right time for practice deficit irrigation without significant yield reduction. The highest (2.62kg/m³) and the lowest (2.03 kg/m³) water productivity were found under T3 and T4, respectively. The stress of 50% at the mid-growth stage and stress 50% of the full irrigation water requirement at all growth stages significantly (α=5%) affected the canopy expansion, biomass and yield production. The aqua Crop model performed well in simulating the yield of barley for most of the treatments (R2 = 0.84 and RMSE = 0.7 t ha–¹).

Keywords: aqua crop, barley, deficit irrigation, irrigation regimes, water productivity

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Authors: Amruta D. S. Pathare, Indira Hinduja, Kusum Zaveri

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Implantation failure (IF) even after the good-quality embryo transfer (ET) in the physiologically normal endometrium is the main obstacle in in vitro fertilization (IVF). Various microarray studies have been performed worldwide to elucidate the genes requisite for endometrial receptivity. These studies have included the population based on different phases of menstrual cycle during natural cycle and stimulated cycle in normal fertile women. Additionally, the literature is also available in recurrent implantation failure patients versus oocyte donors in natural cycle. However, for the first time, we aim to study the genomics of endometrial receptivity in IF patients under controlled ovarian stimulation (COS) during which ET is generally practised in IVF. Endometrial gene expression profiling in IF patients (n=10) and oocyte donors (n=8) were compared during window of implantation under COS by whole genome microarray (using Illumina platform). Enrichment analysis of microarray data was performed to determine dys-regulated biological functions and pathways using Database for Annotation, Visualization and Integrated Discovery, v6.8 (DAVID). The enrichment mapping was performed with the help of Cytoscape software. Microarray results were validated by real-time PCR. Localization of genes related to immune response (Progestagen-Associated Endometrial Protein (PAEP), Leukaemia Inhibitory Factor (LIF), Interleukin-6 Signal Transducer (IL6ST) was detected by immunohistochemistry. The study revealed 418 genes downregulated and 519 genes upregulated in IF patients compared to healthy fertile controls. The gene ontology, pathway analysis and enrichment mapping revealed significant downregulation in activation and regulation of immune and inflammation response in IF patients under COS. The lower expression of Progestagen Associated Endometrial Protein (PAEP), Leukemia Inhibitory Factor (LIF) and Interleukin 6 Signal Transducer (IL6ST) in cases compared to controls by real time and immunohistochemistry suggests the functional importance of these genes. The study was proved useful to uncover the probable reason of implantation failure being imbalance of immune and inflammatory regulation in our group of subjects. Based on the present study findings, a panel of significant dysregulated genes related to immune and inflammatory pathways needs to be further substantiated in larger cohort in natural as well as stimulated cycle. Upon which these genes could be screened in IF patients during window of implantation (WOI) before going for embryo transfer or any other immunological treatment. This would help to estimate the regulation of specific immune response during WOI in a patient. The appropriate treatment of either activation of immune response or suppression of immune response can be then attempted in IF patients to enhance the receptivity of endometrium.

Keywords: endometrial receptivity, immune and inflammatory response, gene expression microarray, window of implantation

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Authors: Yaou Zhang

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Background: Relatively little scholarly attention has been paid to the production of Benjamin Britten’s chamber opera The Turn of the Screw. As one of Britten’s most remarkable operas. The story of the libretto was from Henry James’s novella of the same name. The novella was created in 1898 and one of the primary questions addressed to people in the story is “how real the ghosts are,” which leads the story to a huge ambiguity in readers’ minds. Aims: This research focuses on the experience of seeing the opera on stage over several decades. This study of opera productions over time not only provides insight into how stage performances can alter audience members' perceptions of the opera in the present but also reveals a landscape of shifting aesthetics and receptions. Methods: To examine the hypotheses in interpretation and reception, the qualitative analysis is used to examine the figures of ghosts in different productions across the time from 1954 to 2021 in the UK: by accessing recordings, newspapers, and reviews for the productions that are sourced from online and physical archives. For instance, the field research is conducted on the topic by arranging interviews with the creative team and visiting Opera North in Leeds and Britten-Pears Foundation. The collected data reveals the “hidden identity” in creative teams’ interpretations, social preferences, and rediscover that have previously remained unseen. Results: This research presents an angle of Britten’s Screw by using the third position; it shows how the attention moved from the stage of “do the ghosts really exist” to “traumatised children.” Discussion: Critics and audiences have debated whether the governess hallucinates the ghosts in the opera for decades. While, in recent years, directors of new productions have given themselves the opportunity to go deeper into Britten's musical structure and offer the opera more space to be interpreted, rather than debating if "ghosts actually exist" or "the psychological problems of the governess." One can consider and reflect that the questionable actions of the children are because they are suffering from trauma, whether the trauma comes from the ghosts, the hallucinating governess, or some prior experiences: various interpretations cause one result that children are the recipients of trauma. Arguably, the role of the supernatural is neither simply one of the elements of a ghost story nor simply one of the parts of the ambiguity between the supernatural and the hallucination of the governess; rather, the ghosts and the hallucinating governess can exist at the same time - the combination of the supernatural’s and the governess’s behaviours on stage generates a sharper and more serious angle that draws our attention to the traumatized children.

Keywords: benjamin britten, chamber opera, production, reception, staging, the turn of the screw

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Authors: Junwon Seo, Bipin Adhikari, Euiseok Jeong

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This paper is intended to evaluate the structural performance of welded electronic road signs under various damage scenarios (DSs) using a finite element (FE) model calibrated with full-scale ultimate load testing results. The tested electronic road sign specimen was built with a back skin made of 5052 aluminum and two channels and a frame made of 6061 aluminum, where the back skin was connected to the frame by welding. The size of the tested specimen was 1.52 m long, 1.43 m wide, and 0.28 m deep. An actuator applied vertical loads at the center of the back skin of the specimen, resulting in a displacement of 158.7 mm and an ultimate load of 153.46 kN. Using these testing data, generation and calibration of a FE model of the tested specimen were executed in ABAQUS, indicating that the difference in the ultimate load between the calibrated model simulation and full-scale testing was only 3.32%. Then, six different DSs were simulated where the areas of the welded connection in the calibrated model were diminished for the DSs. It was found that the corners at the back skin-frame joint were prone to connection failure for all the DSs, and failure of the back skin-frame connection occurred remarkably from the distant edges.

Keywords: computational analysis, damage scenarios, electronic road signs, finite element, welded connections

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Authors: Wanda Luen-Wun Siu, Xiaowen Zhang

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This paper adopted a retrospective review of China’s assistance to Latin America from the1950s to 2020. Findings suggested that China’s assistance to Latin America can be roughly divided into five stages: The 1950s to 1960s was the initial stage of China’s assistance to Latin America, mainly focusing on the establishment of diplomatic relations with Cuba and other Latin American countries. The strategy has a strong ideological basis. The 1980s was the stage of development of China's aid to Latin America, which was characterized by consolidating and expanding diplomatic space, emphasizing the spirit of cooperation of equality, mutual benefit, and common development. 90-20 marked the further development of diplomatic relations with Latin American countries, plus domestic market-oriented reforms, emphasizing the importance of economic considerations and less ideological orientation, and this period also witnessed more Chinese state-owned enterprises going out to invest in Latin America. 2010-2019 marked the further development of Latin American relations. This paper contributes to the literature of diplomacy and health assistance to Latin America and highlights the importance of foreign aid and health assistance in sealing bilateral diplomatic relations.

Keywords: aid, china, latin america, bilateral relations

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Authors: Chao-Ton Su, Li-Fei Chen

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The parameter design is crucial to improving the uniformity of a product or process. In the product design stage, parameter design aims to determine the optimal settings for the parameters of each element in the system, thereby minimizing the functional deviations of the product. In the process design stage, parameter design aims to determine the operating settings of the manufacturing processes so that non-uniformity in manufacturing processes can be minimized. The parameter design, trying to minimize the influence of noise on the manufacturing system, plays an important role in the high-tech companies. Taiwan has many well-known high-tech companies, which show key roles in the global economy. Quality remains the most important factor that enables these companies to sustain their competitive advantage. In Taiwan however, many high-tech companies face various quality problems. A common challenge is related to root causes and defect patterns. In the R&D stage, root causes are often unknown, and defect patterns are difficult to classify. Additionally, data collection is not easy. Even when high-volume data can be collected, data interpretation is difficult. To overcome these challenges, high-tech companies in Taiwan use more advanced quality improvement tools. In addition to traditional statistical methods and quality tools, the new trend is the application of powerful tools, such as neural network, fuzzy theory, data mining, industrial engineering, operations research, and innovation skills. In this study, several examples of optimizing the parameter settings for the manufacturing process in Taiwan’s tech companies will be presented to illustrate proposed approach’s effectiveness. Finally, a discussion of using traditional experimental design versus the proposed approach for process optimization will be made.

Keywords: quality engineering, parameter design, neural network, genetic algorithm, experimental design

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Authors: Hossein Bazmara, Kaamran Raahemifar, Mostafa Sefidgar, Madjid Soltani

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Angiogenesis is formation of new blood vessels from existing vessels. Due to flow of blood in vessels, during angiogenesis, blood flow plays an important role in regulating the angiogenesis process. Multiple mathematical models of angiogenesis have been proposed to simulate the formation of the complicated network of capillaries around a tumor. In this work, a multi-scale model of angiogenesis is developed to show the effect of blood flow on capillaries and network formation. This model spans multiple temporal and spatial scales, i.e. intracellular (molecular), cellular, and extracellular (tissue) scales. In intracellular or molecular scale, the signaling cascade of endothelial cells is obtained. Two main stages in development of a vessel are considered. In the first stage, single sprouts are extended toward the tumor. In this stage, the main regulator of endothelial cells behavior is the signals from extracellular matrix. After anastomosis and formation of closed loops, blood flow starts in the capillaries. In this stage, blood flow induced signals regulate endothelial cells behaviors. In cellular scale, growth and migration of endothelial cells is modeled with a discrete lattice Monte Carlo method called cellular Pott's model (CPM). In extracellular (tissue) scale, diffusion of tumor angiogenic factors in the extracellular matrix, formation of closed loops (anastomosis), and shear stress induced by blood flow is considered. The model is able to simulate the formation of a closed loop and its extension. The results are validated against experimental data. The results show that, without blood flow, the capillaries are not able to maintain their integrity.

Keywords: angiogenesis, endothelial cells, multi-scale model, cellular Pott's model, signaling cascade

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Authors: Pamela Chia, Tay Yoong Chuan

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Introduction: Severe pulmonary hypertension (PH) patients requiring non-cardiac surgery risk have increased mortality rates ranging. These patients are plagued with cardiorespiratory failure, dysrhythmias and anticoagulation potentially with concurrent sepsis and renal insufficiency, perioperative morbidity. We present a deaf-mute patient with severe idiopathic PH emergently prepared for ruptured ectopic laparotomy. Case Report: A 20 year-old female, 62kg (BMI 25 kg/m2) with severe idiopathic PH (2DE Ejection Fraction was 41%, Pulmonary Artery Systolic Pressure (PASP) 105 mmHg, Right ventricle strain and hypertrophy) and selective mutism was rushed in for emergency laparotomy after presenting to the emergency department for abdominal pain. The patient had an NYHA Class II with room air SpO2 93-95%. While awaiting lung transplant, the patient takes warfarin, Sildanefil, Macitentan and even Selexipag for rising PASP. At presentation, vital signs: BP 95/63, HR 119 SpO2 88% (room air). Despite decreasing haemoglobin 14 to 10g/dL, INR 2.59 was reversed with prothrombin concentrate, and Vitamin K. ECG revealed Right Bundle Branch Block with right ventricular strain and x-ray showed cardiomegaly, dilated Right Ventricle, Pulmonary Arteries, basal atelectasis. Arterial blood gas showed compensated metabolic acidosis pH 7.4 pCO2 32 pO2 53 HCO3 20 BE -4 SaO2 88%. The cardiothoracic surgeon concluded no role for Extracorporeal Membrane Oxygenation (ECMO). We inserted invasive arterial and central venous lines with blood transfusion via an 18G cannula before the patient underwent a midline laparotomy, haemostasis of ruptured ovarian cyst with 2.4L of clots under general anesthesia and FloTrac cardiac output monitoring. Rapid sequence induction was done with Midazolam/Propofol, remifentanil infusion, and rocuronium. The patient was maintained on Desflurane. Blood products and colloids were transfused for further 1.5L blood loss. Postoperatively, the patient was transferred to the intensive care unit and was extubated uneventfully 7hours later. The patient went home a week later. Discussion: Emergency hemostasis laparotomy in anticoagulated WHO Class I PH patient awaiting lung transplant with no ECMO backup poses tremendous stress on the deaf-mute patient and the anesthesiologist. Balancing hemodynamics avoiding hypotension while awaiting hemostasis in the presence of pulmonary arterial dilators and anticoagulation requires close titration of volatiles, which decreases RV contractility. We review the contraindicated anesthetic agents (ketamine, N2O), choice of vasopressors in hypotension to maintain Aortic-right ventricular pressure gradients and nitric oxide use perioperatively. Conclusion: Interdisciplinary communication with a deaf-mute moribund patient and anesthesia considerations pose many rare challenges worth sharing.

Keywords: pulmonary hypertension, case report, warfarin reversal, emergency surgery

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Authors: A. S. CohenMiller, Jenifer Lewis, Gwen McEvoy, Kristy Kelly

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This international, interdisciplinary study presents the first stage of a gender mainstreaming project within one university as a microcosm of society in Kazakhstan to make concrete policy recommendations and set up the potential for new research to monitor change over time. Local, regional, and UN representatives have noted the critical need and interest in gender related issues in Kazakhstan. Gender mainstreaming has been noted as a strategy to understand and address gender equality and equity such as within the academy in exploring and examining organizational/management issues, university decision-making and leadership, assessing the overall academic climate, discrimination issues, hiring and promotion, and student recruitment and retention. This presentation provides preliminary findings from the university gender audit, highlighting key elements for moving forward in gender mainstreaming. The full study analyzes findings from the full gender audit including interview with key stakeholders, time-use surveys, participant-observations and interviews with female students, staff and faculty, and reviews of formal organizational policies and practices.

Keywords: academia, equity, Eurasia, gender audit, gender mainstreaming, Kazakhstan, policy, time-use survey

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Authors: Shobha Rani R. Hiremath, Keerthana R., Madhuvan H. S.

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1.BACKGROUND: Type 2 Diabetes is a chronic health condition where the body cannot effectively use the insulin it produces, leading to elevated blood sugar levels It is often associated with lifestyle factors and insulin resistance. Globally, diabetes is on the rise, with urban areas like Bangalore seeing a surge due to lifestyle changes, stress, and dietary habits. To manage diabetes effectively, over 50 medications are available, each serving to regulate blood sugar through different mechanisms. This reflects the complex and individualized nature of diabetes treatment. Given the increase in medications for Type 2 diabetes mellitus, it is important to evaluate their effectiveness and safety so that clinicians can make informed choices while treating their patients. 2.OBJECTIVES: To evaluate the effectiveness of various anti-diabetic medications used in the hospital in Type 2 diabetes patients by monitoring their HbA1c levels. To assess the safety of these medications by monitoring Adverse drug reactions if any. 3. METHODOLOGY: Design : Prospective Cohort study, Study period: 8 months, Sample Size: 100 patients. Inclusion Criteria: Patients above 18 years of both genders who were diagnosed with T2DM and who were prescribed oral hypoglycaemic agents. Exclusion Criteria: Diabetic patients with hepatic/renal failure, patients prescribed with insulin /not prescribed with OHAs and patients who were terminally ill, pregnant and lactating patients. Source of Data: Prescriptions, lab reports, ECG reports. Data collection forms were used to collect data which consisted of patient demographic details, drugs prescribed, laboratory investigations such as HbA1C, FBS, PPBS , ECG and any ADRs experienced. Data was collected at baseline, 3 months, and 6 months. It was statistically analyzed using SPSS (version 26) software. 4. RESULTS: Greater number of patients (46%) were in the age group of greater than 61 years. 43 patients had no co-morbidities whereas 51 patients had Hypertension as the co morbidity. Basically 5 Drug combinations were prescribed as follows. Combination 1: Tablet Metformin HCL + Glimepiride (500, 2 mg) : 1-0-1, Combination 2: Tablet Sitagliptin + Metformin HCL (50, 500 mg) : 1-0-1, Combination 3: Tablet Vildagliptin + Metformin HCL (50, 500 mg): 1-0-1, Combination 4: Tablet Voglibose+ Glimepiride+ Metformin HCL (0.2 ,2 ,500mg): : 1-0-1, Combination 5: Tablet Voglibose+ Glimepiride+ Metformin HCL (0.2, 2 ,500mg): : 1-0-1 and T. Sitagliptin +Metformin HCL (50, 500 mg): 0-1-0. Combination 5 (Voglibose, Glimepiride, Metformin, Sitagliptin) was most effective in reducing HbA1c levels, showing a significant decrease (-0.00682, p = 0.001), followed by Combinations 4 and 3. However, Combination 5 also had the highest incidence of gastrointestinal side effects (72.7%) and ECG abnormalities (27.3%). Combination 1 (Metformin + Glimepiride) had the highest occurrence of hypoglycemia due to Glimepiride's insulin-stimulating effects. Weight loss was most notable in Combination 5, affecting 36.36% of patients. 5.CONCLUSION: The enhanced effectiveness of Combinations 3, 4, and 5 suggests that a multi-drug approach that incorporates different mechanisms of action is more effective in managing HbA1c levels in patients with diabetes. Adverse effect profiles should be considered for personalized treatment strategies.

Keywords: type 2 diabetes, safety, oral anti diabetic medications, effectiveness

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Authors: J. O. Ayinde, S. O. Olatunji

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This study assessed rural youth adoption of cassava production technologies in Southwestern, Nigeria. Specifically, it examine the level of awareness and adoption of cassava production technologies by rural youth, determined the extent of usage of cassava production technologies available to the rural youth, examined constrains to the adoption of cassava production technologies by youth and suggested possible solutions. Multistage sampling procedure was adopted for the study. In the first stage, two states were purposively selected in southwest, Nigeria which are Osun and Oyo states due to high level of cassava production and access to cassava production technology in the areas. In the second stage, purposive sampling technique was used to select two local governments each from the states selected which are Ibarapa central (Igbo-Ora) and Ibarapa East (Eruwa) Local Government Areas (LGAs) in Oyo state; and Ife North (Ipetumodu) and Ede South (Oke Ireesi) LGAs in Osun State. In the third stage, proportionate sampling technique was used to randomly select five, four, six and four communities from the selected LGAs respectively representing 20 percent of the rural communities in them, in all 19 communities were selected. In the fourth stage, Snow ball sampling technique was used to select about 7 rural youths in each community selected to make a total of 133 respondents. Validated structured interview schedule was used to elicit information from the respondents. The data collected were analyzed using both descriptive and inferential statistics to summarize and test the hypotheses of the study. The results show that the average age of rural youths participating in cassava production in the study area is 29 ± 2.6 years and 60 percent aged between 30 and 35 years. Also, more male (67.4 %) were involved in cassava production than females (32.6 %). The result also reveals that the average size of farm land of the respondents is 2.5 ± 0.3 hectares. Also, more male (67.4 %) were involved in cassava production than females (32.6 %). Also, extent of usage of the technologies (r = 0.363, p ≤ 0.01) shows significant relationship with level of adoption of the technologies. Household size (b = 0.183; P ≤ 0.01) and membership of social organizations were significant at 0.01 (b = 0.331; P ≤ 0.01) while age was significant at 0.10 (b = 0.097; P ≤ 0.05). On the other hand 0.01, years of residence (b = - 0.063; P ≤ 0.01) and income (b = - 0.204; P ≤ 0.01) had negative values and implies that a unit increase in each of these variables would decrease extent of usage of the Cassava production technologies. It was concluded that the extent of usage of the technologies in the communities will affect the rate of adoption positively and this will change the negative perception of youths on cassava production thereby ensure food security in the study area.

Keywords: assessment, rural youths’, Cassava production technologies, agricultural production, food security

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Authors: S. Joseph Antony, Z. K. Jahanger

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Soils are subjected to cyclic loading in situ in situations such as during earthquakes and in the compaction of pavements. Investigations on the local scale measurement of the displacements of the grain and failure patterns within the soil bed under the cyclic loading conditions are rather limited. In this paper, using the digital particle image velocimetry (DPIV), local scale displacement fields of a dense sand medium interacting with a rigid footing are measured under the plane-strain condition for two commonly used types of cyclic loading, and the quasi-static loading condition for the purposes of comparison. From the displacement measurements of the grains, the failure envelopes of the sand media are also presented. The results show that, the ultimate cyclic bearing capacity (qultcyc) occurred corresponding to a relatively higher settlement value when compared with that of under the quasi-static loading. For the sand media under the cyclic loading conditions considered here, the displacement fields in the soil media occurred more widely in the horizontal direction and less deeper along the vertical direction when compared with that of under the quasi-static loading. The 'dead zone' in the sand grains beneath the footing is identified for all types of the loading conditions studied here. These grain-scale characteristics have implications on the resulting bulk bearing capacity of the sand media in footing-sand interaction problems.

Keywords: cyclic loading, DPIV, settlement, soil-structure interactions, strip footing

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Authors: Rebecca Dunne, Cormac Small, Geraldine O'Boyle, Nazir Ibrahim, Anisha

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Prostate cancer is the most common cancer among men, excluding non-melanoma skin cancers. It is estimated that approximately 12% of men will develop prostate cancer during their lifetime. Patients with intermediate, high risk, and very-high risk prostate cancer often undergo a combination of radiation treatments. These treatments include external beam radiotherapy with a low-dose rate or high-dose rate brachytherapy boost, often with concomitant androgen deprivation therapy. The literature on follow-up of patients that receive brachytherapy is scarce, particularly follow-up of patients that undergo high-dose rate brachytherapy. This retrospective study aims to investigate the biochemical failure and toxicities associated with triple therapy and external beam radiotherapy given in combination with brachytherapy. Reported toxicities and prostate specific antigen (PSA) were retrospectively evaluated in eighty patients that previously underwent external beam radiotherapy with a low-dose rate or high dose-rate brachytherapy boost. The severity of toxicities were correlated with intra-operative dosing during brachytherapy on ultrasound and CT scan. The results of this study will provide further information for clinicians and patients when considering treatment options.

Keywords: toxicities, combination, brachytherapy, intra-operative dosing, biochemical failure

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Authors: Nautiyal Ruchira, Nautiyal Hemant, Chaudhury Devnanda, Bhargava Surbhi, Chauhan Nidhi

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Introduction: South East Asian region contributes 2.5 million cases of malaria each year to the global burden of 300 to 500 million of which 76% is reported from India. Government of India launched a national program almost half a century ago, still malaria remains a major public health challenge. Pregnant women are more susceptible to severe malaria and its fetomaternal complications. Inadequate surveillance and under-reporting underestimates the problem. Aim: Present study aimed to analyze the clinical course and pattern of malaria during pregnancy and to study the feto-maternal outcome. Methodology: This is a prospective observational study carried out at Himalayan Institute of Medical Sciences – a tertiary care center in the sub-Himalayan state of Uttarakhand, Northern India. All the pregnant women with malaria and its complications were recruited in the study during 2009 to 2014 which included referred cases from the state of western Uttar Pradesh. A thorough history and clinical examination were carried out to assess maternal and fetal condition. Relevant investigations including haemogram, platelet count, LFT, RFT, and USG was done. Blood slides and rapid diagnostic tests were done to diagnose the type of malaria.The primary outcomes measured were the type of malaria infection, maternal complications associated with malaria, outcome of pregnancy and effect on the fetus. Results: 67 antenatal cases with malaria infection were studied. 71% patients were diagnosed with plasmodium vivax infection, 25% cases were plasmodium falciparum positive and in 3% cases mixed infection was found. 38(56%) patients were primigravida and 29(43%) were multiparous. Most of the patients had already received some treatment from their local doctors and presented with severe malaria with the complications. Thrombocytopenia was the commonest manifestation seen in 35(52%) patients, jaundice in 28%, severe anemia in 18%, and severe oligohydramnios in 10% and renal failure in 6% cases. Regarding pregnancy outcome there were 44 % preterm deliveries, 22% had IUFD and abortions in 6% cases.20% of newborn were low birth weight and 6% were IUGR. There was only one maternal death which occurred due to ARDS in falciparum malaria. Although Plasmodium vivax was the main parasite considering the severity of clinical presentation, all the patients received intensive care. As most of the patients had received chloroquine therapy hence they were treated with IV artesunate followed by oral artemesinin combination therapy. Other therapies in the form of packed RBC’s and platelet transfusions, dialysis and ventilator support were provided when required. Conclusion: Even in areas with annual parasite index (API) less than 2 like ours, malaria in pregnancy could be an alarming problem. Vivax malaria cannot be considered benign in pregnancy because of high incidence of morbidity. Prompt diagnosis and aggressive treatment can reduce morbidity and mortality significantly. Increased community level research, integrating ANC checkups with the distribution of insecticide-treated nets in areas of high endemicity, imparting education and awareness will strengthen the existing control strategies.

Keywords: severe malaria, pregnancy, plasmodium vivax, plasmodium falciparum

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Authors: Nadia H. Mohammed, Anmar Al-Taie, Fadia H. Al-Sultany

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Although breast cancer prevalence continues to increase, mortality has been decreasing as a result of early detection and improvement in adjuvant systemic therapy. Nevertheless, this disease required further efforts to understand and identify the associated potential risk factors that could play a role in the prevalence of this malignancy among Iraqi women. The objective of this study was to assess the perception of certain predictive risk factors on the prevalence of breast cancer types among a sample of Iraqi women diagnosed with breast cancer. This was a retrospective observational study carried out at National Cancer Research Center in College of Medicine, Baghdad University from November 2017 to January 2018. Data of 100 patients with breast cancer whose biopsies examined in the National Cancer Research Center were included in this study. Data were collected to structure a detailed assessment regarding the patients’ demographic, medical and cancer records. The majority of study participants (94%) suffered from ductal breast cancer with mean age 49.57 years. Among those women, 48.9% were obese with body mass index (BMI) 35 kg/m². 68.1% of them had positive family history of breast cancer and 66% had low parity. 40.4% had stage II ductal breast cancer followed by 25.5% with stage III. It was found that 59.6% and 68.1% had positive oestrogen receptor sensitivity and positive human epidermal growth factor (HER2/neu) receptor sensitivity respectively. In regard to the impact of prediction of certain variables on the incidence of ductal breast cancer, positive family history of breast cancer (P < 0.0001), low parity (P< 0.0001), stage I and II breast cancer (P = 0.02) and positive HER2/neu status (P < 0.0001) were significant predictive factors among the study participants. The results from this study provide relevant evidence for a significant positive and potential association between certain risk factors and the prevalence of breast cancer among Iraqi women.

Keywords: Ductal Breast Cancer, Hormone Sensitivity, Iraq, Risk Factors

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Authors: M. Moyzykh, I. Klichuk, L. Sabirov, D. Kolomentseva, E. Magommedov

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Modern city electrical grids are forced to increase their density due to the increasing number of customers and requirements for reliability and resiliency. However, progress in this direction is often limited by the capabilities of existing network equipment. New energy sources or grid connections increase the level of short-circuit currents in the adjacent network, which can exceed the maximum rating of equipment–breaking capacity of circuit breakers, thermal and dynamic current withstand qualities of disconnectors, cables, and transformers. Superconducting fault current limiter (SFCL) is a modern solution designed to deal with the increasing fault current levels in power grids. The key feature of this device is its instant (less than 2 ms) limitation of the current level due to the nature of the superconductor. In 2019 Moscow utilities installed SuperOx SFCL in the city power grid to test the capabilities of this novel technology. The SFCL became the first SFCL in the Russian energy system and is currently the most powerful SFCL in the world. Modern SFCL uses second-generation high-temperature superconductor (2G HTS). Despite its name, HTS still requires low temperatures of liquid nitrogen for operation. As a result, Moscow SFCL is built with a cryogenic system to provide cooling to the superconductor. The cryogenic system consists of three cryostats that contain a superconductor part and are filled with liquid nitrogen (three phases), three cryocoolers, one water chiller, three cryopumps, and pressure builders. All these components are controlled by an automatic control system. SFCL has been continuously operating on the city grid for over three years. During that period of operation, numerous faults occurred, including cryocooler failure, chiller failure, pump failure, and others (like a cryogenic system power outage). All these faults were eliminated without an SFCL shut down due to the specially designed cryogenic system backups and quick responses of grid operator utilities and the SuperOx crew. The paper will describe in detail the results of SFCL operation and cryogenic system maintenance and what measures were taken to solve and prevent similar faults in the future.

Keywords: superconductivity, current limiter, SFCL, HTS, utilities, cryogenics

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Authors: Zengda Li

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The tectonic evolution of the Beishan orogen, which forms part of the Central Asian Orogenic Belt, remains debated. This study reports the identification of three Triassic granitic plutons representing two distinct stages of magmatism in southern Beishan orogen. Zircon U–Pb dating constrains the early stage as 238–237 Ma and the late stage as 229–227 Ma. The granitoids belong to high-K calc-alkaline and shoshonitic series and exhibit alkalic-calcic and calc-alkalic features, and are weakly peraluminous rocks. Most of these granitoids are highly fractionated I-type and A-type granites. They have relatively high Isr values (0.7049–0.7086) and weak negative εNd(t) values of −1.5 to −2.1, with young Nd model ages of 1.04–0.91 Ga, indicating a crustal contribution. They also show markedly positive zircon εHf(t) values (+3.4 to +11.8) and two-stage Hf model ages of 1.06–0.69 Ga, indicating a mixture of mantle and crustal components. The lithospheric mantle beneath this region incorporating older subducted materials was metasomatized by fluids or melts. Partial melting of the metasomatized lithospheric mantle resulted in underplated magmas, which provided the heat and material input to generate the granitoids. The Middle Triassic granitic plutons show moderate negative Eu anomalies, enrichment of LILEs and depletion in Nb, Ta, and Ti suggesting partial melting of crustal components in response to the underplated mantle-derived magmas, probably linked to lithospheric delamination and asthenospheric upwelling. The Late Triassic granitic plutons show characteristics of post-orogenic granite with strong negative anomalies of Eu, Ba, Nb, Sr, P, and Ti, indicating fractional crystallization and crustal contamination during the emplacement process.

Keywords: Triassic, magmatism, geochronology, petrogenesis, Beishan orogen

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Authors: Azeez Shaik, Amit Salvi, B. P. Gautham

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Fiber reinforced polymer resin composite materials are finding wide variety of applications in automotive and aerospace industry because of their high specific stiffness and specific strengths when compared to metals. New class of 2D and 3D textile and woven fabric composites offer excellent fracture toughens as they bridge the cracks formed during fracture. Due to complexity of their fiber architectures and its resulting composite microstructures, optimized design and analysis of these structures is very complicated. A traditional homogenization approach is typically used to analyze structures made up of these materials. This approach usually fails to predict damage initiation as well as damage propagation and ultimate failure of structure made up of woven and textile composites. This study demonstrates a methodology to analyze woven and textile composites by using the multi-level multi-scale modelling approach. In this approach, a geometric repetitive unit cell (RUC) is developed with all its constituents to develop a representative volume element (RVE) with all its constituents and their interaction modeled correctly. The structure is modeled based on the RUC/RVE and analyzed at different length scales with desired levels of fidelity incorporating the damage and failure. The results are passed across (up and down) the scales qualitatively as well as quantitatively from the perspective of material, configuration and architecture.

Keywords: cohesive zone, multi-scale modeling, rate dependency, RUC, woven textiles

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Authors: M. P. S. Tomar, Neelam Bansal

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Histomorphological, histochemical and scanning electron microscopic observations were recorded in developing cornea of buffalo fetuses. The samples from fetal cornea were collected in appropriate fixative from slaughter house and Veterinary Clinics, GADVASU, Ludhiana. The microscopic slides were stained for detailed histomorphological and histochemical studies. The scanning electron microscopic studies were performed at Electron microscopy & Nanobiology Lab, PAU Ludhiana. In present study, it was observed that, in 36 days (d) fetus, the corneal epithelium was well marked single layered structure which was placed on stroma mesenchyme. Cornea appeared as the continuation of developing sclera. The thickness of cornea and its epithelium increased as well as the epithelium started becoming double layered in 47d fetus at corneo-scleral junction. The corneal thickness in this stage suddenly increased thus easily distinguished from developing sclera. The separation of corneal endothelium from stroma was evident as a single layered epithelium. The stroma possessed numerous fibroblasts in 49d stage eye. Descemet’s membrane was appeared at 52d stage. The limbus area was separated by a depression from the developing cornea in 61d stage. In 65d stage, the Bowman’s layer was more developed. Fibroblasts were arranged parallel to each other as well as parallel to the surface of developing cornea in superficial layers. These fibroblasts and fibers were arranged in wavy pattern in the center of stroma. Corneal epithelium started to be stratified as a double layered epithelium was present in this age of fetal eye. In group II (>120 Days), the corneal epithelium was stratified towards a well marked irido-corneal angle. The stromal fibroblasts followed a complete parallel arrangement in its entire thickness. In full term fetuses, a well developed cornea was observed. It was a fibrous layer which had five distinct layers. From outside to inwards were described as the outer most layer was the 7-8 layered corneal epithelial, subepithelial basement membrane (Bowman’s membrane), substantia propria or stroma, posterior limiting membrane (Descemet’s membrane) and the posterior epithelium (corneal endothelium). The corneal thickness and connective tissue elements were continued to be increased. It was 121.39 + 3.73µ at 36d stage which increased to 518.47 + 4.98 µ in group III fetuses. In fetal life, the basement membrane of corneal epithelium and endothelium depicted strong to intense periodic Acid Schiff’s (PAS) reaction. At the irido-corneal angle, the endothelium of blood vessels was also positive for PAS activity. However, cornea was found mild positive for alcian blue reaction. The developing cornea showed strong reaction for basic proteins in outer epithelium and the inner endothelium layers. Under low magnification scanning electron microscope, cornea showed two types of cells viz. light cells and dark cells. The light cells were smaller in size and had less number of microvilli in their surface than in the dark cells. Despite these surface differences between light and dark cells, the corneal surface showed the same general pattern of microvilli studding all exposed surfaces out to the cell margin. which were long (with variable height), slight tortuous slender and possessed a micro villus shaft with a very prominent knob.

Keywords: buffalo, cornea, eye, fetus, ontogeny, scanning electron microscopy

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Authors: Mahmoud Meckawey

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This research is dealing with one of the most important aspects of maintenance fields, that is Maintenance Strategy. It's the branch which concerns the concepts and the schematic thoughts in how to manage maintenance and how to deal with the defects in the engineering products (buildings, machines, etc.) in general. Through the papers we will act with the followings: i) The Engineering Product & the Technical Systems: When we act with the maintenance process, in a strategic view, we act with an (engineering product) which consists of multi integrated systems. In fact, there is no engineering product with only one system. We will discuss and explain this topic, through which we will derivate a developed definition for the maintenance process. ii) The factors or basis of the functionality efficiency: That is the main factors affect the functional efficiency of the systems and the engineering products, then by this way we can give a technical definition of defects and how they occur. iii) The legality of occurrence of defects (Legal defects and Illegal defects): with which we assume that all the factors of the functionality efficiency been applied, and then we will discuss the results. iv) The Guarantee, the Functional Span Age and the Technical surplus concepts: In the complementation with the above topic, and associated with the Reliability theorems, where we act with the Probability of Failure state, with which we almost interest with the design stages, that is to check and adapt the design of the elements. But in Maintainability we act in a different way as we act with the actual state of the systems. So, we act with the rest of the story that means we have to act with the complementary part of the probability of failure term which refers to the actual surplus of the functionality for the systems.

Keywords: engineering product and technical systems, functional span age, legal and illegal defects, technical and functional surplus

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Authors: Roni Rachel Mendelson, Caileigh Pudela

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Bacillus cereus is a toxin-producing, facultatively anaerobic gram-positive bacterium that is widely distributed environmentally. It can quickly multiply at room temperature with an abundantly present preformed toxin. When ingested, this toxin can cause gastrointestinal illness, which is the commonly known manifestation of the disease. Bacillus cereus sepsis is a disease that is mostly concerning in the population of the immunocompromised patients. One of them is acute lymphoblastic leukemia’s patients during induction. Pediatric acute lymphoblastic leukemia is a common pediatric hematologic malignancy. It is characterized by the rapid proliferation of poorly differentiated lymphoid progenitor cells inside the bone marrow. We present here a 21-month-old boy undergoing induction chemotherapy for acute lymphoblastic leukemia who developed bacillus sepsis bacteremia and, as a result, multi organ failure leading to seizures and multiple strokes. Our case report highlights the extensive overall and neurological damage that can be caused because of bacillus cereus bacteremia, which can lead to higher mortality rate and decreased in survivorship in a highly curable disease. It is very subtle and difficult to recognize and appears to be deteriorating extremely fast. There should be a low threshold for work up and empiric coverage for neutropenic patients during acute lymphoblastic leukemia induction therapy.

Keywords: acute lymphoblastic leukemia, bacillus cereus, immunocompromised, sepsis

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