Search results for: quality assurance education

Authors: Ena Arora, Rong Fan, Aleksandr Fuks, Kolawole Felix Akinnawonu

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Introduction: Leiomyomas are benign tumors that are derived from the overgrowth of uterine smooth muscle cells. Women with symptomatic leiomyomas who desire future fertility, myomectomy should be the standard surgical treatment. Perioperative hemorrhage is a common complication in myomectomy. We performed the study to investigate blood transfusion rate in abdominal myomectomies, risk factors influencing blood loss and modalities to improve perioperative blood loss. Methods: Retrospective chart review was done for patients who underwent myomectomy from 2016 to 2022 at Queens hospital center, New York. We looked at preoperative patient demographics, clinical characteristics, intraoperative variables, and postoperative outcomes. Mann-Whitney U test were used for parametric and non-parametric continuous variable comparisons, respectively. Results: A total of 159 myomectomies were performed between 2016 and 2022, including 1 laparoscopic, 65 vaginal and 93 abdominal. 44 patients received blood transfusion during or within 72 hours of abdominal myomectomy. The blood transfusion rate was 47.3%. Blood transfusion rate was found to be twice higher than the average documented rate in literature which is 20%. Risk factors identified were black race, preoperative hematocrit<30%, preoperative blood transfusion within 72 hours, large fibroid burden, prolonged surgical time, and abdominal approach. Conclusion: Preoperative optimization with iron supplements or GnRH agonists is important for patients undergoing myomectomy. Interventions to decrease intra operative blood loss should include cell saver, tourniquet, vasopressin, misoprostol, tranexamic acid and gelatin-thrombin matrix hemostatic sealant.

Keywords: myomectomy, perioperative blood loss, cell saver, tranexamic acid

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Authors: Shahla Rostamirad

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Purpose: Giardiasis is a widespread infection in humans caused by Giardia lamblia. The prevalence of this parasite among children in Isfahan of Iran is unknown. This study intended to estimate Giardia lamblia infection prevalence and identify possible associated risk factors in a healthy pediatric population living in the Isfahan, a metropolitan city of Iran. Methods: Between September 2010 and March 2012, 1448 stool sample from children with clinical manifestation that refer to clinical lab in Isfahan city for stool examination were collected and analyzed. About 1218 samples were positive for parasitic disease. All of samples were examined and diagnosed by direct examination and formalin-ether concentration of stools. Results: A total of 1218 positive cases were analyzed in this study. The findings showed that 92.5% of patients were infected by protozoa and 7.5 percent with helminth infection. The highest and lowest rate of infection belongs to Giardia lamblia and Entamoeba histolytica with 75% and 1.1%, respectively. Other infection cases were included of Blastocystys hominis 9.9%, E. coli 6.5%, H. nana 1.3%, Enterobious vermicolaris 4% and Ascaris lumbricoides 2.2% percent. The population studied revealed a gender distribution of 53.2% male and 46.8% female. Age distribution was 57.3% between 0-5 years and 42.7% between 6-15 years.The prevalence was higher among children aged 0-5 years (57.8%), than among older children (42.2%). Conclusion: The prevalence of protozoan parasite, especially Giardiasis, in children residing in the region of Isfahan is high. Several risk factors were associated with this prevalence and highlight the importance of parents' education and sanitation conditions in the children's well being. The association between Giardia lamblia and H. pylori seems an important issue deserving further investigation in order to promote prevention or treatment strategies. Other risk factor include presence of Helicobacter pylori infection, living in houses with own drainage system and reported household, pet contact, especially with cat and dog.

Keywords: Giardia duodenalis, prevalence, risk factors, children, Isfahan, Iran

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Authors: Chantel Snyman, Chrizanne van Eeden, Marita Heyns

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Autism spectrum disorder (ASD) is one of the most common disabilities in schools, with up to50% of children displaying behaviors that challenge, bringing about demanding teaching circumstances. The teachers and teaching assistants of such learners often experience a negative impact on their own quality of life. Research globally and in South Africa about the teachers of ASD learners and teaching interventions, especially positive psychology approaches aimed at supporting learners with ASD, is limited. The primary research aim of this study was to investigate the feasibility as well as the effect of a strength-based intervention for teachers on the behavior of their learners with ASD and on the wellbeing and self-efficacy of teachers and assistants over time. This quantitative study used a pre-experimental group design with a pre-test-post-test method for the proposed school-based intervention. Teachers and teaching assistants completed the Difficult Behavior Self-Efficacy Scale, the Mental Health Questionnaire, and the short Behaviors That Challenge Checklist for learners with ASD. The six-week intervention on character strengths was delivered by the researcher as part of Teacher Staff Development. Results were generally significant on a practical level (based on practical effect sizes), which indicate that the intervention had a visible effect on behaviors that challenge. Research scores over time suggested a positive effect of the intervention in the well-being of participants and an overall positive effect on behaviors that challenge of ASD learners. Results showed that the character strengths intervention shows promise as a simple but effective intervention for teachers and teaching assistants, with positive effects for learners and teaching staff in the ASD classroom. It is recommended that this intervention should be repeated over a longer period of time and with a larger sample to determine its validity.

Keywords: autism spectrum disorder (ASD), behavior that challenge, character strengths, disabilities, self-efficacy, teachers, teaching assistants, well-being

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Authors: Mohammad Rahim Rahimi, Yuji Hoshino

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Building Information Management (BIM) at recent years has widespread consideration on the Architecture, Engineering and Construction (AEC). BIM has been bringing innovation in AEC industry and has the ability to improve the construction industry with high quality, reduction time and budget of project. Meanwhile, BIM support model and process in AEC industry, the process include the project time cycle, estimating, delivery and generally the way of management of project but not limited to those. This research carried the BIM advantages, adaptation and challenges of implementation in Kabul region. Capital Region Independence Development Authority (CRIDA) have responsibilities to implement the development projects in Kabul region. The method of study were considers on advantages and reasons of BIM performance in Afghanistan based on online survey and data. Besides that, five projects were studied, the reason of consideration were many times design revises and changes. Although, most of the projects had problems regard to designing and implementation stage, hence in canal project was discussed in detail with the main reason of problems. Which were many time changes and revises due to the lack of information, planning, and management. In addition, two projects based on BIM utilization in Japan were also discussed. The Shinsuizenji Station and Oita River dam projects. Those are implemented and implementing consequently according to the BIM requirements. The investigation focused on BIM usage, project implementation process. Eventually, the projects were the comparison with CRIDA and BIM utilization in Japan. The comparison will focus on the using of the model and the way of solving the problems based upon on the BIM. In conclusion, that BIM had the capacity to prevent many times design changes and revises. On behalf of achieving those objectives are required to focus on data management and sharing, BIM training and using new technology.

Keywords: construction information management, implementation and adaptation of BIM, project management, developing countries

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Authors: Nayan Kishore Giri, Ramakar Jha

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Water is a major element for the life of all the mankind in the earth. India’s surface water flows through fourteen major streams. Indian rivers are the main source of potable water in India. In the eastern part of India many toxic hazardous metals discharged into the river from mining industries, which leads many deadly diseases to human being. So the potable water quality is very significant and vital concern at present as it is related with the present and future health perspective of the human race. Consciousness of health risks linked with unsafe water is still very low among the many rural and urban areas in India. Only about 7% of total Indian people using water purifier. This unhealthy situation of water is not only present in India but also present in many underdeveloped countries. The major reason behind this is the high cost of water purifier. This current study geared towards development of economical and efficient technology for the removal of maximum possible toxic metals and pathogen bacteria. The work involves the design of portable purification system and purifying material. In this design Coconut shell granular activated carbon(GAC) and polypropylene filter cloths were used in this system. The activated carbon is impregnated with Iron(Fe). Iron is used because it enhances the adsorption capacity of activated carbon. The thorough analysis of iron impregnated activated carbon(Fe-AC) is done by Scanning Electron Microscope (SEM), X-ray diffraction (XRD) , BET surface area test were done. Then 10 ppm of each toxic metal were infiltrated through the designed purification system and they were analysed in Atomic absorption spectrum (AAS). The results are very promising and it is low cost. This work will help many people who are in need of potable water. They can be benefited for its affordability. It could be helpful in industries and other domestic usage.

Keywords: potable water, coconut shell GAC, polypropylene filter cloths, SEM, XRD, BET, AAS

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Authors: Parmeet Kaur, Nighat Yaseen Sofi, Shakti Kumar Gupta, Veena Pandey, Rajvaedhan Azad

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Nutritional status and prevailing blood glucose level trends amongst hospitalized patients has been linked to clinical outcome. Therefore, the present study was undertaken to assess hospitalized Diabetic Eye Disease (DED) patients' anthropometric and dietary intake trends. DED patients with type 1 or 2 diabetes > 20 years were enrolled. Actual food intake was determined by weighed food record method. Mifflin St Joer predictive equation multiplied by a combined stress and activity factor of 1.3 was applied to estimate caloric needs. A questionnaire was further administered to obtain reasons of inadequate dietary intake. Results indicated validity of joint analyses of body mass index in combination with waist circumference for clinical risk prediction. Dietary data showed a significant difference (p < 0.0005) between average daily caloric and carbohydrate intake and actual daily caloric and carbohydrate needs. Mean fasting and post-prandial plasma glucose levels were 150.71 ± 72.200 mg/dL and 219.76 ± 97.365 mg/dL, respectively. Improvement in food delivery systems and nutrition educations were indicated for reducing plate waste and to enable better understanding of dietary aspects of diabetes management. A team approach of nurses, physicians and other health care providers is required besides the expertise of dietetics professional. To conclude, findings of the present study will be useful in planning nutritional care process (NCP) for optimizing glucose control as a component of quality medical nutrition therapy (MNT) in hospitalized DED patients.

Keywords: nutritional status, diabetic eye disease, nutrition care process, medical nutrition therapy

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Authors: Sokkhey Phauk, Takeo Okazaki

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The challenging task in educational institutions is to maximize the high performance of students and minimize the failure rate of poor-performing students. An effective method to leverage this task is to know student learning patterns with highly influencing factors and get an early prediction of student learning outcomes at the timely stage for setting up policies for improvement. Educational data mining (EDM) is an emerging disciplinary field of data mining, statistics, and machine learning concerned with extracting useful knowledge and information for the sake of improvement and development in the education environment. The study is of this work is to propose techniques in EDM and integrate it into a web-based system for predicting poor-performing students. A comparative study of prediction models is conducted. Subsequently, high performing models are developed to get higher performance. The hybrid random forest (Hybrid RF) produces the most successful classification. For the context of intervention and improving the learning outcomes, a feature selection method MICHI, which is the combination of mutual information (MI) and chi-square (CHI) algorithms based on the ranked feature scores, is introduced to select a dominant feature set that improves the performance of prediction and uses the obtained dominant set as information for intervention. By using the proposed techniques of EDM, an academic performance prediction system (APPS) is subsequently developed for educational stockholders to get an early prediction of student learning outcomes for timely intervention. Experimental outcomes and evaluation surveys report the effectiveness and usefulness of the developed system. The system is used to help educational stakeholders and related individuals for intervening and improving student performance.

Keywords: academic performance prediction system, educational data mining, dominant factors, feature selection method, prediction model, student performance

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Authors: Ibrahim Hakeem

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Biosolids are stabilised sewage sludge produced from wastewater treatment processes. Biosolids contain valuable plant nutrient which facilitates their beneficial reuse in agricultural land. However, the increasing levels of legacy and emerging contaminants such as heavy metals (HMs), PFAS, microplastics, pharmaceuticals, microbial pathogens etc., are restraining the direct land application of biosolids. Pyrolysis of biosolids can effectively degrade microbial and organic contaminants; however, HMs remain a persistent problem with biosolids and their pyrolysis-derived biochar. In this work, we demonstrated the integrated processing of biosolids involving the acid pre-treatment for HMs removal and selective reduction of ash-forming elements followed by the bench-scale pyrolysis of the treated biosolids to produce quality biochar and bio-oil enriched with valuable platform chemicals. The pre-treatment of biosolids using 3% v/v H₂SO₄ at room conditions for 30 min reduced the ash content from 30 wt% in raw biosolids to 15 wt% in the treated sample while removing about 80% of limiting HMs without degrading the organic matter. The preservation of nutrients and reduction of HMs concentration and mobility via the developed hydrometallurgical process improved the grade of the treated biosolids for beneficial land reuse. The co-removal of ash-forming elements from biosolids positively enhanced the fluidised bed pyrolysis of the acid-treated biosolids at 700 ℃. Organic matter devolatilisation was improved by 40%, and the produced biochar had higher surface area (107 m²/g), heating value (15 MJ/kg), fixed carbon (35 wt%), organic carbon retention (66% dry-ash free) compared to the raw biosolids biochar with surface area (56 m²/g), heating value (9 MJ/kg), fixed carbon (20 wt%) and organic carbon retention (50%). Pre-treatment also improved microporous structure development of the biochar and substantially decreased the HMs concentration and bioavailability by at least 50% relative to the raw biosolids biochar. The integrated process is a viable approach to enhancing value recovery from biosolids.

Keywords: biosolids, pyrolysis, biochar, heavy metals

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Authors: Julius Adebayo John

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The objective of this study is to compare the use of medicinal plants and Conventional medicine intervention in the management of HBV among Ibadan populace. A purposive sampling technique was used to administer questionnaires at 2 places, namely, the University College Hospital and Total Healthcare Diagnostic Centre, Ibadan, where viral loads are carried out. A EuroQol (EQ – 5D) was adopted to collect data. Descriptive and inferential analyses were performed. Also, ANOVA, Correlation, charts, and tables were used. Findings revealed a high prevalence of HBV among female respondents and sample between ages 26years to 50years. Results showed that the majority discovered their health status through free HBV tests. Analysis indicated that the use of medicinal plant extract is cost-effective in 73% of cases. Rank order utility derived from medicinal plants is higher than other interventions. Correlation analysis performed for the current health status of respondents were significant at P<0.01 against the intervention management adopted (0.046), cost of treatment (0.549), utility (0.407) at P<0.00, duration of the treatment (0.604) at P<0.01; viral load before treatment (-0.142) not significant at P<0.01, the R2 (72.2%) showed the statistical variance in respondents current health status as explained by the independent variables. Respondents gained quality-adjusted life-years (QALYs) of between 1year to 3years. Suggestions were made for a public-private partnership effort against HBV with emphasis on periodic screening, viral load test subsidy, and free vaccination of people with –HBV status. Promoting phytomedicine through intensive research with strong regulation of herbal practitioners will go a long way in alleviating the burdens of the disease in society.

Keywords: medicinal plant, HBV management interventions, utility, QALYs, ibadan metropolis

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Authors: Jonathan A. Akinwale, Ibukun J. Agotola

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There is a need to rethink how technology is being disseminated to end users in order to ensure wide adoption and utilisation. Aflasafe bio-control was developed to combat aflatoxin in maize to ensure food safety for the end users. This study was designed to assess how the pull mechanism is enhancing the utilisation of this proven technology among maize farmers in Oyo State, Nigeria. The study determines the awareness of farmers on Aflasafe, sources of purchase of Aflasafe, incentives towards the usage of Aflasafe, constraints to farmers’ utilisation and factors influencing farmers’ utilisation of Aflasafe bio-control measures. Respondents were selected using a multi-stage sampling procedure. Data were collected from respondents through interview schedule and analyzed using descriptive statistics (means, frequencies, and percentages) and inferential statistics (Pearson Product Moment Correlation and regression analysis). The result showed that 89% of the farmers indicated implementers as the outlet for the purchase of Aflasafe. Also, premium payment and provision of technical assistance were the highly ranked incentives to the utilisation of Aflasafe among the farmers. The study also revealed that the major constraints face by respondents were low access to credit facility, inadequate sources of purchase, and lack of storage facilities. A little above half (54%) of the farmers were found to have fully utilized Aflasafe in maize production. Pearson Product Moment Correlation (PPMC) analysis revealed that there was a significant correlation between incentives and utilisation of Aflasafe (r-value=0.274; p ≤ 0.01). The result of the regression analysis indicated maize production experience (β=0.572), output (β=0.531), years of formal education (β=0.404) and household size (β=0.391) as the leading factors influencing farmers utilisation of Aflasafe bio-control in maize production. The study, therefore, recommends that governments and non-governmental organisations should be interested in making Aflasafe available to the maize farmers either through loan provision or price subsidy.

Keywords: Aflasafe bio-control, maize production, production incentives, pull mechanism, utilisation

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Authors: Toka Aly

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Historically, marketplaces were the most important nodes and focal points of cities, where different activities took place. Commercial streets offer more than just spaces for shopping; they also offer choices for social activities and cultural exchange. They are considered the backbone of the city’s vibrancy and vitality. Despite that, the public life in Cairo’s commercial streets has deteriorated, where the shopping activities became reliant mainly on 'planned formal places', mainly in privatized or indoor spaces like shopping malls. The main aim of this paper is to explore the key elements and tools of assessing the successfulness of commercial streets in Cairo. The methodology followed in this paper is based on a case study methodology (multiple cases) that is based on assessing and analyzing the physical and social elements in historical and contemporary commercial streets in El Muiz Street and Baghdad Street in Cairo. The data collection is based on personal observations, photographs, maps and street sections. Findings indicate that the key factors of analyzing commercial streets are factors affecting the sensory experience, factors affecting the social behavior, and general aspects that attract people. Findings also indicate that urban features have clear influence on shopping pedestrian activities in both streets. Moreover, in order for a commercial street to be successful, shopping patterns must provide people with a quality public space that can provide easy navigation and accessibility, good visual continuity, and well-designed urban features and social gathering. Outcomes of this study will be a significant endeavor in providing a good background for urban designers on analyzing and assessing successfulness of commercial streets. The study will also help in understanding the different physical and social pattern of vending activities taking place in Cairo.

Keywords: activities, commercial street, marketplace, successful, vending

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Authors: L. Angiuli, L. Trizio, R. Giua, A. Digilio, M. Tutino, P. Dambruoso, F. Mazzone, C. M. Placentino

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In the winter of 2014 a series of measurements were performed to evaluate the behavior of real-time PAHs and black carbon analyzers in a coke oven plant located in Taranto, a city of Southern Italy. Data were collected both insides than outside the plant, at air quality monitoring sites. Contemporary measures of PM2.5 and PM1 were performed. Particle-bound PAHs were measured by two methods: (1) aerosol photoionization using an Ecochem PAS 2000 analyzer, (2) PM2.5 and PM1 quartz filter collection and analysis by gas chromatography/mass spectrometry (GC/MS). Black carbon was determined both in real-time by Magee Aethalometer AE22 analyzer than by semi-continuous Sunset Lab EC/OC instrument. Detected PM2.5 and PM1 levels were higher inside than outside the plant while PAHs real-time values were higher outside than inside. As regards PAHs, inside the plant Ecochem PAS 2000 revealed concentrations not significantly different from those determined on the filter during low polluted days, but at increasing concentrations the automated instrument underestimated PAHs levels. At the external site, Ecochem PAS 2000 real-time concentrations were steadily higher than those on the filter. In the same way, real-time black carbon values were constantly lower than EC concentrations obtained by Sunset EC/OC in the inner site, while outside the plant real-time values were comparable to Sunset EC values. Results showed that in a coke plant real-time analyzers of PAHs and black carbon in the factory configuration provide qualitative information, with no accuracy and leading to the underestimation of the concentration. A site specific calibration is needed for these instruments before their installation in high polluted sites.

Keywords: black carbon, coke oven plant, PAH, PAS, aethalometer

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Authors: Randa M. Ali, Naguiba F. Loutfy, Osama M. Awad

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Background: Leishmaniasis is a worldwide disease, affecting 88 countries, it is estimated that about 350 million people are at risk of leishmaniasis. Overall prevalence is 12 million people with annual mortality of about 60,000. Annual incidence is 1,500,000 cases of cutaneous leishmaniasis (CL) worldwide and half million cases of visceral Leishmaniasis (VL). Objectives: The objective of this study was to assess primary health care physicians knowledge (PHP) and attitude about leishmaniasis and to assess awareness of local inhabitants about the disease and its vector in four areas in west Alexandria, Egypt. Methods: This study was a cross sectional survey that was conducted in four PHC units in west Alexandria. All physicians currently working in these units during the study period were invited to participate in the study, only 20 PHP completed the questionnaire. 60 local inhabitant were selected randomly from the four areas of the study, 15 from each area; Data was collected through two different specially designed questionnaires. Results: 11(55%) percent of the physicians had satisfactory knowledge, they answered more than 9 (60%) questions out of a total 14 questions about leishmaniasis and sandfly. The second part of the questionnaire is concerned with attitude of the primary health care physicians about leishmaniasis, 17 (85%) had good attitude and 3 (15%) had poor attitude. The second questionnaire showed that the awareness of local inhabitants about leishmaniasis and sandly as a vector of the disease is poor and needs to be corrected. Most of the respondents (90%) had not heard about leishmaniasis, Only 3 (5%) of the interviewed inhabitants said they know sandfly and its role in transmission of leishmaniasis. Conclusions: knowledge and attitudes of physicians are acceptable. However, there is, room for improvement and could be done through formal training courses and distribution of guidelines. In addition to raising the awareness of primary health care physicians about the importance of early detection and notification of cases of lesihmaniasis. Moreover, health education for raising awareness of the public regarding the vector and the disease is necessary because related studies have demonstrated that if the inhabitants do not perceive mosquitoes to be responsible for diseases such as malaria they do not take enough measures to protect themselves against the vector.

Keywords: leishmaniasis, PHP, knowledge, attitude, local inhabitants

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Authors: Maryam Jaberi, Siavosh Shayan, Mojtaba Yamani

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Habble-Rud River basin (HR), up to 100 km length, one of the largest watersheds which drain into deserts to the north of Central Iran (Dasht-e Kavir). This stream is oblique with the NE-SW trending, flow in the southern range of central Alborz Mountains and the northern border of Central Iran. The end of the ~17 km suddenly change direction and with the southern trending to have a morphology which meanders passes through the Alborz Mountain ridge and flows into the Garmsar plain where it forms one of the largest alluvial fans in Iran, i.e. the vast Garmsar alluvial fan with an area of 476 km2. This study was carried out through morphometric analyses, longitudinal river profiles, and study of geomorpholic evidence such as fluvial terraces, gypsum-salt domes, seismic data, and satellite images. This study aimed to investigate the changes in the pattern of rivers in the southern part of the HR river basin. The southern part of HR river basin located at the southern foothills of the Central Alborz is characterized the thrust faults (Sorkheh-Kalut and Garmsar faults), folds,diapirs and arid climate. The activity of more than 10 salt domes that belong to the Oligocene-Miocene period has considerably influenced the pattern of streams in this region. Dissolution of these domes has not only reduced the quality of water and soil resources, but also has led to the formation of badlands and gullies.Our results indicated that the pattern of rivers in the southern part of HR river basin was influenced by discharge of the HR river in Quaternary, geological structure, subsidence of Central Iran and vertical uplift of Alborz mountain. These agents caused the formation meanders in the southern part of the HR River and evaluation of the seasonal rivers like Shoor-Darre and Garmabsar.

Keywords: geomorphologic evaluation, rivers pattern, Habble-Rud River basin, seasonal rivers

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Authors: Angkayarkan Vinayakaselvi

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This paper aims at unpacking the questions of subjectivity and their role in altering and redefining the constructed images of self and community as represented in chosen Indian women’s autobiographies. India is a country of plurality and this plurality is further extended by diasporic explorations. As the third world feminism questioned the Euro-American views on homogenizing the socio-cultural condition of women of all over the world, Indian feminism needs to critique the view that all Indian women are one and the same. Similar to the plural nature of nation, the nature and condition of women, too, are plural in India. Indian women are differentiated by caste, class, and region. A critical scrutiny of autobiographies written by Indian women belong to different socio-cultural groups – Northeast Indian, Dalit and Diasporic categories – will assess the impact of education, profession and socio-cultural and economic status on Indian Women. Such a critique would highlight the heterogeneous subjectivity of Indian women. The images/selves of women as represented through these autobiographies are chosen with an aim to unmask and challenge, through ordering and positioning, the capitalist politics of literary representations of Indian women’s formation of 'her-self'. Methodologies and subjects associated with literature are considered essential for understanding and combating women’s oppression and empowerment. The representation of self in personal autobiographical history could be treated as the history of entire nation as personal is always political in feminist writings. The chosen narrators who are well-educated, well-settled, professional women of letters are capable of assessing, critiquing and re/articulating the shifting paradigms of women’s lives. Despite these factors, the textual spaces possess evidences to establish the facts that these women undergo sufferings, and they counter design cultural specific strategies for their empowerment. These metafictional self-conscious synecdoches extend to include the world of entire women. Thus these autobiographical texts could be reinterpreted as a searing critique of Indian society based on woman’s personal life.

Keywords: ethnicity and diversity, gender studies, Indian women’s autobiographies, subjectivity

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Authors: Mailin Misson, Bo Jin, Sheng Dai, Hu Zhang

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Advances in biotechnology have witnessed a growing interest in enzyme applications for the development of green and sustainable bio processes. While known as powerful bio catalysts, enzymes are no longer of economic value when extended to large commercialization. Alternatively, immobilization technology allows enzyme recovery and continuous reuse which subsequently compensates high operating costs. Employment of enzymes on nano structured materials has been recognized as a promising approach to enhance enzyme catalytic performances. High porosity, inter connectivity and self-assembling behaviors endow nano fibers as exciting candidate for enzyme carrier in bio reactor systems. In this study, nano fibers were successfully fabricated via electro spinning system by optimizing the polymer concentration (10-30 %, w/v), applied voltage (10-30 kV) and discharge distance (11-26 cm). Microscopic images have confirmed the quality as homogeneous and good fiber alignment. The nano fibers surface was modified using strong oxidizing agent to facilitate bio molecule binding. Bovine serum albumin and β-galactosidase enzyme were employed as model bio catalysts and immobilized onto the oxidized surfaces through covalent binding. Maximum enzyme adsorption capacity of the modified nano fibers was 3000 mg/g, 3-fold higher than the unmodified counterpart (1000 mg/g). The highest immobilization yield was 80% and reached the saturation point at 2 mg/ml of enzyme concentration. The results indicate a significant increase of activity retention by the enzyme-bound modified nano fibers (80%) as compared to the nascent one (60%), signifying excellent enzyme-nano carrier bio compatibility. The immobilized enzyme was further used for the bio conversion of dairy wastes into value-added products. This study demonstrates great potential of acid-modified electrospun polystyrene nano fibers as enzyme carriers.

Keywords: immobilization, enzyme, nanocarrier, nanofibers

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Authors: Do Su Park, Sang Jun Park, Cheon Soon Jeong

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This study was performed in order to investigate the optimum ripening conditions for the marketing of Squash. Research sample 'Bochang' was grown at Hongcheonin in Gangwon province in August 2014. Ripening the samples were stored under the conditions of 25℃, 30℃, and 35℃ with the humidity RH70 ± 5%. They were checked every 3 days for 21 days. The respiration rate, water loss, hardness, coloration, the contents of soluble solids, starch, total sugar were evaluated after storage. Respiration rate was reduced in all treatments with longer storage period. Water loss was increased in the higher temperature. The 13% water loss was found at 35℃ on 21st storage day. The store initially 25℃ and 30℃ Hardness 47N and the ripening 21 days decreased slightly. On the other hand, in the case of 35℃ showed a large reduction than 25℃ and 30℃. Soluble solid contents were increased with longer ripening period. 30℃ and 35℃ was highest ripening 15 days. In the case of 25℃, it was highest on 21th day. The higher the temperature, the higher the soluble solids content are. 25℃ and 30℃ Coloration was increased rapidly until the ripening 12 days. In case of 35℃, continued increase up to 21 days. 25℃ and 30℃ showed no differences. Meanwhile, in case of 35℃, appearance quality was reduced in Occurrence of yellowing phenomenon of pericarp occurs from after ripening for 9 days. The coloration of fruit flesh is increase until after ripening for 9 days and decrease from after ripening for 9 days. There was no significant difference depending on the conditions of temperature. The higher the temperature, the lower the content of the starch. In case of 30℃ and 35℃, was reduced with longer storage period. 25℃ was minimal content change. Total sugar was increased in all treatments with longer storage period. The higher the temperature, the higher the amount of total sugar content is. Therefore, at 25℃ for 18-21 days and at 30℃ for 12-15 days is suitable for ripening.

Keywords: marketing, ripening, temperature, winter squash

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Authors: O. O. Olawusi-Peters, M. O. Adediran, O. A. Ajibare

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Etheria elliptica population is declining due to various human activities on the freshwater habitat. This necessitate the habitat study of the mussel in river Ogbese and Owena reservoir in Ondo state, Nigeria in order to know the status of the organism within the ecosystem. Thirty (30) specimens each from River Ogbese and Owena reservoir were sampled between May and August 2012. The meristic variables such as length, breadth, shell thickness and weight of the mussel were measured. Also, some physico-chemical parameters, flow rate and soil profile of the two rivers were studied. In River Ogbese, the weight, length, breadth and thickness variables obtained were; 49.73g, 8.42cm, 3.78cm and 0.53cm respectively. In Owena reservoir, the values were; 111.17g, 8.80cm, 6.64cm, 0.22cm respectively. The condition factor showed that the samples from Owena reservoir (K = 16.33) were healthier than River Ogbese (K = 8.34). Also, the length-weight relationship indicated isometric growth in both water bodies (Ogbese r2 = 0.68; Owena r2 = 0.66). In River Ogbese, the physico-chemical parameters obtained were; temperature (24.3oC), pH (7.12), TDS (72ppm), DO (3.2mg/l), conductivity (145µ), BOD (0.7mg/l). The mean temperature (24.1oC), pH (7.69), TDS (102ppm), DO (3.1mg/l), conductivity (183µ), BOD (0.8mg/l) were obtained from Owena reservoir. The soil samples values obtained from both water bodies are; River Ogbese –phosphorus; 78.78, calcium; 3.60, magnesium; 1.90 and organic matter; 0.17. Owena reservoir - Phosphorus; 3.34, calcium; 4.40, magnesium; 1.20 and organic matter; 0.66. The river flow rate was 0.22m/s for Owena reservoir and 0.26m/s for river Ogbese. The study revealed that Etheria elliptica in Owena reservoir and Ogbese were in good and healthy conditions despite the various human activities on the water bodies. The water quality parameters obtained were within the preferred requirements of the mussels.

Keywords: Etheria elliptica, mussels, Owena reservoir, River Ogbese

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Authors: Laura Florez

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The construction industry is labour intensive, and the behaviour and management of workers have a direct impact on the performance of construction projects. One of the issues it currently faces is how to recruit and maintain its workers. Construction is known as an industry where workers face the problem of short employment durations, frequent layoffs, and periods of unemployment between jobs. These challenges not only creates pressures on the workers but also project managers have to constantly train new workers, face skills shortage, and uncertainty on the quality of the workers it will attract. To consider worker’s needs and project managers expectations, one practice that can be implemented is to schedule construction projects to maintain a stable workforce. This paper proposes a mixed integer programming (MIP) model to schedule projects with the objective of maximising social sustainability of construction projects, that is, maximise labour stability. Aside from the social objective, the model accounts for equipment and financial resources required by the projects during the construction phase. To illustrate how the solution strategy works, a construction programme comprised of ten projects is considered. The projects are scheduled to maximise labour stability while simultaneously minimising time and minimising cost. The tradeoff between the values in terms of time, cost, and labour stability allows project managers to consider their preferences and identify which solution best suits their needs. Additionally, the model determines the optimal starting times for each of the projects, working patterns for the workers, and labour costs. This model shows that construction projects can be scheduled to not only benefit the project manager, but also benefit current workers and help attract new workers to the industry. Due to its practicality, it can be a valuable tool to support decision making and assist construction stakeholders when developing schedules that include social sustainability factors.

Keywords: labour stability, mixed-integer programming (MIP), scheduling, workforce management

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Authors: Chimuanya Osuji, Kido Uyamasi, Morgan Bradley

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Introduction: Obesity is a major risk factor for many chronic diseases, with higher rates occurring among certain populations. Even though disparities in obesity rates exist for those with disabilities, few studies have assessed the association between disability and obesity status. This study aims to examine the association between type of disability and obesity status among US adults during the Covid-19 pandemic (2019-2021). Methods: Data for this cross-sectional study was obtained from the 2019, 2020 and 2021 NHIS. Multinomial logistic regressions were used to assess the relationship between each type of disability and obesity status (reference= normal/underweight). Each model adjusted for demographic, health status and health-related quality of life variables. Statistical analyses were conducted using SAS version 9.4. Results: Of the 82,632 US adults who completed the NHIS in 2019, 2020, and 2021. 8.9% (n= 7,354) reported at least 1 disability-related condition. Respondents reported having a disability across vision (1.5%), hearing (1.5%), mobility (5.3%), communication (0.8%), cognition (2.4%) and self-care (1.1%) domains. After adjusting for covariates, adults with at least 1 disability-related condition were about 30% more likely to have moderate-severe obesity (AOR=1.3; 95% CI=1.11, 1.53). Mobility was the only disability category positively associated with mild obesity (AOR=1.16; 95% CI=1.01, 1.35) and moderate/severe obesity (AOR=1.6; 95% CI=1.35, 1.89). Individuals with vision disability were about 35% less likely to have mild obesity (AOR=0.66; 95% CI=0.51, 0.86) and moderate-severe obesity (AOR=0.66; 95% CI= 0.48, 0.9). Individuals with hearing disability were 28% less likely to have mild obesity (AOR=0.72; 95% CI= 0.56, 0.94). Individuals with communication disability were about 30% less likely to be overweight (AOR=0.66; 95% CI=0.47, 0.93) and 50% less likely to have mild obesity (AOR=0.45; 95% CI= 0.29, 0.71). Individuals with cognitive disability were about 25% less likely to have mild obesity and about 35% less likely to have moderate-severe obesity. Individuals with self-care disability were about 30% less likely to be overweight. Conclusion: Mobility-related disabilities are significantly associated with obesity status among adults residing in the United States. Researchers and policy makers should implement obesity intervention methods that can address the gap in obesity prevalence rates among those with and without disabilities.

Keywords: cognition, disability, mobility, obesity

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Authors: M. R. Akbari, M. Sadeghi, R. Faghihi, M. A. Mosleh-Shirazi, A. R. Khorrami-Moghadam

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Proton radiotherapy (PRT) is becoming an established treatment modality for cancer. The localized tumors, the same as undifferentiated thyroid tumors are insufficiently handled by conventional radiotherapy, while protons would propose the prospect of increasing the tumor dose without exceeding the tolerance of the surrounding healthy tissues. In spite of relatively high advantages in giving localized radiation dose to the tumor region, in proton therapy, secondary neutron production can have significant contribution on integral dose and lessen advantages of this modality contrast to conventional radiotherapy techniques. Furthermore, neutrons have high quality factor, therefore, even a small physical dose can cause considerable biological effects. Measuring of this neutron dose is a very critical step in prediction of secondary cancer incidence. It has been found that FLUKA Monte Carlo code simulations have been used to evaluate dose due to secondaries in proton therapy. In this study, first, by validating simulated proton beam range in water phantom with CSDA range from NIST for the studied proton energy range (34-54 MeV), a proton therapy in thyroid gland cancer was simulated using FLUKA code. Secondary neutron dose equivalent of some organs and tissues after the target volume caused by 34 and 54 MeV proton interactions were calculated in order to evaluate secondary cancer incidence. A multilayer cylindrical neck phantom considering all the layers of neck tissues and a proton beam impinging normally on the phantom were also simulated. Trachea (accompanied by Larynx) had the greatest dose equivalent (1.24×10-1 and 1.45 pSv per primary 34 and 54 MeV protons, respectively) among the simulated tissues after the target volume in the neck region.

Keywords: FLUKA code, neutron dose equivalent, proton therapy, thyroid gland

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Authors: Rakibul Islam Sagor, Sadia Ibnat Raisa

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Many nations across the globe, including Dhaka, are facing challenges in meeting the needs for a satisfactory quality of life due to the combination of a growing population and limited land resources. As a result, maximum spaces in modern cities are engulfed by concrete infrastructure, and there are hardly any open spaces in the urban neighborhoods. Although vertical movement has predominantly been employed for residential and commercial applications, the notion of vertical recreational and sports facilities remains unsettled. The primary objective of this study is to explore the feasibility of implementing vertical adaptations in urban recreational spaces, drawing upon the principles of high-rise theory. This article presents an analysis of the open spaces in Gulshan, Dhaka, focusing on the evaluation of the demand for open recreational and sports facilities that adequately cater to the existing population of the region. Initially, the study tried to identify and examine all potential open spaces within the designated area. Following that, an acceptable place is selected utilizing space syntax analysis, which takes into account the most conveniently accessible space for social interactions in the neighborhood. In addition, socioeconomic conditions of the area have been studied in order to determine the feasibility of the area. Finally, the study presented viable options for vertical urban sports facilities in the context of Dhaka, Bangladesh. Additionally, it seeks to develop strategies for maximizing the use of vertical expansions, thereby promoting a healthier and more active lifestyle among the city's residents. This approach aims to effectively handle the issue of limited land availability and enhance the efficiency of recreational areas around the globe.

Keywords: vertical sports, urban open spaces, social interaction, recreational activities

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Authors: Mohammad Zaeimzade

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The development of communication technologies is clearly and rapidly moving towards reducing the distance between the virtual and real worlds. Of course, living in a two-spatial or two-globalized world or any other interpretation that means mixing real and virtual life is still relevant and debatable. In the present age of communication, where social networks have transformed the message equation and turned the audience out of passivity and turned into a user. Platforms have penetrated widely in various aspects of human life, from culture and education and economy. Among the messengers, Instagram, which is one of the most extensive image-based interactive networks, plays a significant role in the new economic life. It doesn't need much explanation that the era of thinking of every messenger as a non-insulating conductor that is just a neutral load has passed. Every messenger has its own economic, political and of course security background, Instagram is no exception to this rule and of course it leaves its effects in bio-economics as well. Iran, as the 19th largest economy in the world, has not been unaffected by new platforms, including Instagram, and their consequences in the economy. Generally, in the policy-making space, there are two simple and inflexible pessimistic or optimistic views on this issue, and each of the holders of these views usually have their own one-dimensional policy recommendations regarding how to deal with Instagram. Prescriptions that are usually very different and sometimes contradictory. In this article, we show that this confusion of policymakers is the result of not accurately describing the reality of its effect, and the reason for this inaccurate description is the existence of a conflict of interests in the eyes of describers and researchers. In this article, we first take a look at the main indicators of the Iranian economy, estimate the role of the digital economy in Iran's economic growth, then study the conflicting descriptions of the Instagram-based digital economy, the statistics that show the tolerance of economic users of Instagram in Iran. 300 thousand to 9 million have been estimated. Finally, we take a look at the government's actions in this matter, especially in the context of street riots in October and November 2022. And we suggest an intermediate idea.

Keywords: digital economy, instagram, conflict of interest, social networks

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Authors: Selina Schwaabe

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Community pharmacies deliver high-quality health care and are responsible for medication safety. During the pandemic, accessibility to the nearest pharmacy became more essential to get vaccinated against Covid-19 and to get medical aid. The government's goal is to ensure nationwide, reachable, and affordable medical health care services by pharmacies. Therefore, the density of community pharmacies matters. Overall, the density of community pharmacies is fluctuating, with slightly decreasing tendencies in some countries. So far, the literature has shown that changes in the system affect prices and density. However, a European overview of the development of the density of community pharmacies and its triggers is still missing. This research is essential to counteract against decreasing density consulting in a lack of professional health care through pharmacies. The analysis focuses on liberal versus regulated market structures, mail-order prescription drug regulation, and third-party ownership consequences. In a panel analysis, the relative influence of the measures is examined across 27 European countries over the last 21 years. In addition, the paper examines seven selected countries in depth, selected for the substantial variance in their pharmacy system: Germany, Austria, Portugal, Denmark, Sweden, Finland and Poland. Overall, the results show that regulated pharmacy markets have over 10.75 pharmacies/100.000 inhabitants more than liberal markets. Further, mail-order prescription drugs decrease the density by -17.98 pharmacies/100.000 inhabitants. Countries allowing third-party ownership have 7.67 pharmacies/100.000 inhabitants more. The results are statistically significant at a 0.001 level. The output of this analysis recommends regulated pharmacy markets, with a ban on mail-order prescription drugs allowing third-party ownership to support nationwide medical health care through community pharmacies.

Keywords: community pharmacy, market conditions, pharmacy, pharmacy market, pharmacy lobby, prescription, e-prescription, ownership structures

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Authors: Saule Shazhanbayeva, Denise van der Merwe

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Study hypothesis: Nazarbayev Intellectual School of Kyzylorda’s Biology teachers can use STEM-integrated learning to improve students' problem-solving ability and responsibility as global citizens. The significance of this study is to indicate how the use of STEM integrative learning during Biology lessons could contribute to forming globally-minded students who are responsible community members. For the purposes of this study, worldview is defined as a view that is broader than the country of Kazakhstan, allowing students to see the significance of their scientific contributions to the world as global citizens. The context of worldview specifically indicates that most students have never traveled outside of their city or region within Kazakhstan. In order to broaden student understanding, it is imperative that students are exposed to different world views and contrasting ideas within the educational setting of Biology as the science being used for the research. This exposure promulgates students understanding of the significance they have as global citizens alongside the obligations which would rest on them as scientifically minded global citizens. Integrative learning should be Biological Science - with Technology and engineering in the form of problem-solving, and Mathematics to allow improved problem-solving skills to develop within the students of Nazarbayev Intellectual School (NIS) of Kyzylorda. The school's vision is to allow students to realise their role as global citizens and become responsible community members. STEM allows integrations by combining four subject skills to solve topical problems designed by educators. The methods used are based on qualitative analysis: for students’ performance during a problem-solution scenario; and Biology teacher interviews to ascertain their understanding of STEM implementation and willingness to integrate it into current lessons. The research indicated that NIS is ready for a shift into STEM lessons to promote globally responsible students. The only additional need is for proper STEM integrative lesson method training for teachers.

Keywords: global citizen, STEM, Biology, high-school

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Authors: R. M. Rajapaksa

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Construction industry is one of the key players in driving the economy of a country to achieve its prosperity. However, a dispute is one of the crucial factors which prevent the completion of construction contracts within the budgeted cost, scheduled time, and accepted quality. Disputes are inevitable in the construction contract. Accordingly, a study has been undertaken to identify the factors affecting contractual disputes in construction projects in Sri Lanka. The study was a mixed approach with major qualitative and minor quantitative. Qualitative study was set in the form of in-depth interviews with eighteen participants, and quantitative study was conducted using a questionnaire with twenty-four respondents from previously implemented projects by the National Water Supply & Drainage Board representing the employer, engineer and the Contractor to identify the factors affecting contractual disputes and to verify most critical factors respectively. Data analysis for qualitative and quantitative studies was carried out by means of transcribing, code & categorizeand average score methods, respectively. The study reveals that there are forty factors affecting the contractual disputes in construction contracts in Sri Lanka. The finding further illustrates that conflicting decisions by inexperience personnel in the higher position of the Employer, ambiguities resulting inadequate descriptions of the preliminary/general items in price schedule, unfair valuation and late confirmation of variations, unfair determination due to lack of experience of the Engineer/Consultant, under certification of progress payments, unfair grant of EOT & application of delay damages, unreasonable claims for variation of works, errors/discrepancies/ambiguities in the contract conditions and discrepancies & errors in designs & specifications are the most critical factors affecting contractual disputes. Finally, the study proposed remedial measures to most critical factors affecting contractual disputes.

Keywords: dispute, contractual, factors, employer, engineer, contractor, construction projects

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Authors: Jerzy Smardzewski

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Structures with negative Poisson's ratios are called auxetic. They are characterized by better mechanical properties than conventional structures, especially shear strength, the ability to better absorb energy and increase strength during bending, especially in sandwich panels. Commonly used paper cores of cellular boards are made of hexagonal cells. With isotropic facings, these cells provide isotropic properties of the entire furniture board. Shelves made of such panels with a thickness similar to standard chipboards do not provide adequate stiffness and strength of the furniture. However, it is possible to transform the shape of hexagonal cells into polyhedral auxetic cells that improve the mechanical properties of the core. The work aimed to transform the hexagonal cells of the paper core into auxetic cells and determine their basic mechanical properties. Using numerical methods, it was decided to design the most favorable proportions of cells distinguished by the lowest Poisson's ratio and the highest modulus of linear elasticity. Standard cores for cellular boards commonly used to produce 34 mm thick furniture boards were used for the tests. Poisson's ratios, bending strength, and linear elasticity moduli were determined for such cores and boards. Then, the cells were transformed into auxetic structures, and analogous cellular boards were made for which mechanical properties were determined. The results of numerical simulations for which the variable parameters were the dimensions of the cell walls, wall inclination angles, and relative cell density were presented in the further part of the paper. Experimental tests and numerical simulations showed the beneficial effect of auxeticization on the mechanical quality of furniture panels. They allowed for the selection of the optimal shape of auxetic core cells.

Keywords: auxetics, honeycomb, panels, simulation, experiment

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Authors: Eun Young Park, Jongwon Park

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A physical touch of a product can provide ample diagnostic information about the product attributes and quality. However, consumers’ product judgments and purchases can be erroneously influenced by non-diagnostic haptic information. For example, consumers’ evaluations of the coffee they drink could be affected by the heaviness of a cup that is used for just serving the coffee. This important issue has received little attention in prior research. The present research contributes to the literature by identifying when and how non-diagnostic haptic information can have an influence and why such influence occurs. Specifically, five studies experimentally varied the content of non-diagnostic haptic information, such as the weight of a cup (heavy vs. light) and the texture of a cup holder (smooth vs. rough), and then assessed the impact of the manipulation on product judgments and decisions. Results show that non-diagnostic haptic information has a biasing impact on consumer judgments. For example, the heavy (vs. light) cup increases consumers’ perception of the richness of coffee in it, and the rough (vs. smooth) texture of a cup holder increases the perception of the healthfulness of fruit juice in it, which in turn increases consumers’ purchase intentions of the product. When consumers are cognitively distracted during the touch experience, the impact of the content of haptic information is no longer evident, but the valence (positive vs. negative) of the haptic experience influences product judgments. However, consumers are able to avoid the impact of non-diagnostic haptic information, if and only if they are both knowledgeable about the product category and undistracted from processing the touch experience. In sum, the nature of the influence by non-diagnostic haptic information (i.e., assimilation effect vs. contrast effect vs. null effect) is determined by the content and valence of haptic information, the relative impact of which depends on whether consumers can identify the content and source of the haptic information. Theoretically, to our best knowledge, this research is the first to document the empirical evidence of the interplay between cognitive and affective processes that determines the impact of non-diagnostic haptic information. Managerial implications are discussed.

Keywords: consumer behavior, haptic information, product judgments, touch effect

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Authors: Neslihan Sahin Celik, Ali Eraslan

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As a result of PISA (Program for International Student Assessments) survey that tests how well students can apply the knowledge and skills they have learned at school to real-life challenges, the new and redesigned mathematics education programs in many countries emphasize the necessity for the students to face complex and multifaceted problem situations and gain experience in this sense allowing them to develop new skills and mathematical thinking to prepare them for their future life after school. At this point, mathematical models and modeling approaches can be utilized in the analysis of complex problems which represent real-life situations in which students can actively participate. In particular, model eliciting activities that bring about situations which allow the students to create solutions to problems and which involve mathematical modeling must be used right from primary school years, allowing them to face such complex, real-life situations from early childhood period. A qualitative study was conducted in a university foundation primary school in the city center of a big province in 2013-2014 academic years. The participants were 4th grade students in a primary school. After a four-week preliminary study applied to a fourth-grade classroom, three students included in the focus group were selected using criterion sampling technique. A focus group of three students was videotaped as they worked on the Crime Problem. The conversation of the group was transcribed, examined with students’ written work and then analyzed through the lens of Blum and Ferri’s modeling processing cycle. The results showed that primary fourth-grade students can successfully work with model eliciting problem while they encounter some difficulties in the modeling processes. In particular, they developed new ideas based on different assumptions, identified the patterns among variables and established a variety of models. On the other hand, they had trouble focusing on problems and occasionally had breaks in the process.

Keywords: primary school, modeling, mathematical modeling, crime problem

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Authors: A. D. Zikiryahodjaev, L. V. Bolotina, A. S. Sukhotko

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Purpose. To evaluate the expediency and timeliness of performance of surgical treatment as a component of multi-therapy treatment of patients with stage IV breast cancers. Materials and Methods. This investigation comparatively analyzed the results of complex treatment with or without surgery in patients with metastatic breast cancer. We analyzed retrospectively treatment experience of 196 patients with generalized breast cancer in the department of oncology and breast reconstructive surgery of P.A. Herzen Moscow Cancer Research Institute from 2000 to 2012. The average age was (58±1,1) years. Invasive ductul carcinoma was verified in128 patients (65,3%), invasive lobular carcinoma-33 (16,8%), complex form - 19 (9,7%). Complex palliative care involving drug and radiation therapies was performed in two patient groups. The first group includes 124 patients who underwent surgical intervention as complex treatment, the second group includes 72 patients with only medical therapy. Standard systemic therapy was given to all patients. Results. Overall, 3-and 5-year survival in fist group was 43,8 and 21%, in second - 15,1 and 9,3% respectively [p=0,00002 log-rank]. Median survival in patients with surgical treatment composed 32 months, in patients with only systemic therapy-21. The factors having influencing an influence on the prognosis and the quality of life outcomes for of patients with generalized breast cancer were are also studied: hormone-dependent tumor, Her2/neu hyper-expression, reproductive function status (age, menopause existence). Conclusion.Removing primary breast tumor in patients with generalized breast cancer improve long-term outcomes. Three- and five-year survival increased by 28,7 and 16,3% respectively, and median survival–for 11 months. These patients may benefit from resection of the breast tumor. One explanation for the effect of this resection is that reducing the tumor load influences metastatic growth.

Keywords: breast cancer, combination therapy, factors of prognosis, primary tumor

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