Search results for: Diagnostic errors
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1969

Search results for: Diagnostic errors

619 Accuracy of Trauma on Scene Triage Screen Tool (Shock Index, Reverse Shock Index Glasgow Coma Scale, and National Early Warning Score) to Predict the Severity of Emergency Department Triage

Authors: Chaiyaporn Yuksen, Tapanawat Chaiwan

Abstract:

Introduction: Emergency medical service (EMS) care for trauma patients must be provided on-scene assessment and essential treatment and have appropriate transporting to the trauma center. The shock index (SI), reverse shock index Glasgow Coma Scale (rSIG), and National Early Warning Score (NEWS) triage tools are easy to use in a prehospital setting. There is no standardized on-scene triage protocol in prehospital care. The primary objective was to determine the accuracy of SI, rSIG, and NEWS to predict the severity of trauma patients in the emergency department (ED). Methods: This was a retrospective cross-sectional and diagnostic research conducted on trauma patients transported by EMS to the ED of Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand, from January 2015 to September 2022. We included the injured patients receiving prehospital care and transport to the ED of Ramathibodi Hospital by the EMS team from January 2015 to September 2022. We compared the on-scene parameter (SI, rSIG, and NEWS) and ED (Emergency Severity Index) with the area under ROC. Results: 218 patients were traumatic patients transported by EMS to the ED. 161 was ESI level 1-2, and 57 was level 3-5. NEWS was a more accurate triage tool to discriminate the severity of trauma patients than rSIG and SI. The area under the ROC was 0.743 (95%CI 0.70-0.79), 0.649 (95%CI 0.59-0.70), and 0.582 (95%CI 0.52-0.65), respectively (P-value <0.001). The cut point of NEWS to discriminate was 6 points. Conclusions: The NEWs was the most accurate triage tool in prehospital seeing in trauma patients.

Keywords: on-scene triage, trauma patient, ED triage, accuracy, NEWS

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618 Correction Factors for Soil-Structure Interaction Predicted by Simplified Models: Axisymmetric 3D Model versus Fully 3D Model

Authors: Fu Jia

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The effects of soil-structure interaction (SSI) are often studied using axial-symmetric three-dimensional (3D) models to avoid the high computational cost of the more realistic, fully 3D models, which require 2-3 orders of magnitude more computer time and storage. This paper analyzes the error and presents correction factors for system frequency, system damping, and peak amplitude of structural response computed by axisymmetric models, embedded in uniform or layered half-space. The results are compared with those for fully 3D rectangular foundations of different aspect ratios. Correction factors are presented for a range of the model parameters, such as fixed-base frequency, structure mass, height and length-to-width ratio, foundation embedment, soil-layer stiffness and thickness. It is shown that the errors are larger for stiffer, taller and heavier structures, deeper foundations and deeper soil layer. For example, for a stiff structure like Millikan Library (NS response; length-to-width ratio 1), the error is 6.5% in system frequency, 49% in system damping and 180% in peak amplitude. Analysis of a case study shows that the NEHRP-2015 provisions for reduction of base shear force due to SSI effects may be unsafe for some structures and need revision. The presented correction factor diagrams can be used in practical design and other applications.

Keywords: 3D soil-structure interaction, correction factors for axisymmetric models, length-to-width ratio, NEHRP-2015 provisions for reduction of base shear force, rectangular embedded foundations, SSI system frequency, SSI system damping

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617 One Way to Address the Complications of Dental Implantology

Authors: Predrag Kavaric, Vladimir L. Jubic, Maxim Cadenovic

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The patient was transferred from his dentist to our tertiary medical institution. In anamnesis, we got information that his dental intervention was two years ago when he got dental implants but because of the coronavirus pandemic event, he didn’t finish the whole procedure. After two years, he decided that he will continue his work at his dentist, then his dentist noticed that there is no earlier inserted implant in the upper jaw on the right side. They do Panoramic X-ray and find that the implant is all in the maxillary sinus cavity. The flour of the maxilla was intact without any fistula on the place where the implant was inserted in the maxilla bone, After that initial diagnostic they sent the patient to maxillofacial surgery and otorhinolaryngology. We asked for a CT scan of paranasal sinuses, which confirmed the foreign body in the right maxillary sinus. The plan was that in general anesthesia we do FESS and try to find a foreign body in the maxillary sinus or in case of failure to do Caldwel Luc on that side. After preoperative preparation in GA, we do FESS. In inspection, we find small polyps and chronically changed mucosa of osteomeatal complex and right maxillary sinus. After removing polyps we did uncinectomy and medial maxillectomy. With Heuweiser Antrum grasping forceps after several attempts we managed to extract a foreign body from the bottom of the right maxillary sinus. On the first postoperative day we did detamponade, and then we discharge the patient from hospital. The Covid pandemic has contributed to the postponement of a large number of planned operations, which has resulted in various complications in the treatment of a number of patients. In this case, it happened that the implant was most likely rejected by the bone but in the direction of the maxillary sinus, which is not a common cause. On the other hand, the success was that less traumatic intervention was able to remove the foreign body from the maxillary sinus in which it was located. Since the sinus floor is free of bone defects, it can be continued relatively quickly with dental procedures.

Keywords: x-ray, surgery, maxillar sinus, complication, fees

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616 Forecasting Lake Malawi Water Level Fluctuations Using Stochastic Models

Authors: M. Mulumpwa, W. W. L. Jere, M. Lazaro, A. H. N. Mtethiwa

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The study considered Seasonal Autoregressive Integrated Moving Average (SARIMA) processes to select an appropriate stochastic model to forecast the monthly data from the Lake Malawi water levels for the period 1986 through 2015. The appropriate model was chosen based on SARIMA (p, d, q) (P, D, Q)S. The Autocorrelation function (ACF), Partial autocorrelation (PACF), Akaike Information Criteria (AIC), Bayesian Information Criterion (BIC), Box–Ljung statistics, correlogram and distribution of residual errors were estimated. The SARIMA (1, 1, 0) (1, 1, 1)12 was selected to forecast the monthly data of the Lake Malawi water levels from August, 2015 to December, 2021. The plotted time series showed that the Lake Malawi water levels are decreasing since 2010 to date but not as much as was the case in 1995 through 1997. The future forecast of the Lake Malawi water levels until 2021 showed a mean of 474.47 m ranging from 473.93 to 475.02 meters with a confidence interval of 80% and 90% against registered mean of 473.398 m in 1997 and 475.475 m in 1989 which was the lowest and highest water levels in the lake respectively since 1986. The forecast also showed that the water levels of Lake Malawi will drop by 0.57 meters as compared to the mean water levels recorded in the previous years. These results suggest that the Lake Malawi water level may not likely go lower than that recorded in 1997. Therefore, utilisation and management of water-related activities and programs among others on the lake should provide room for such scenarios. The findings suggest a need to manage the Lake Malawi jointly and prudently with other stakeholders starting from the catchment area. This will reduce impacts of anthropogenic activities on the lake’s water quality, water level, aquatic and adjacent terrestrial ecosystems thereby ensuring its resilience to climate change impacts.

Keywords: forecasting, Lake Malawi, water levels, water level fluctuation, climate change, anthropogenic activities

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615 Regulation Aspects for a Radioisotope Production Installation in Brazil

Authors: Rian O. Miranda, Lidia V. de Sa, Julio C. Suita

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The Brazilian Nuclear Energy Commission (CNEN) is the main manufacturer of radiopharmaceuticals in Brazil. The Nuclear Engineering Institute (IEN), located at Rio de Janeiro, is one of its main centers of research and production, attending public and private hospitals in the state. This radiopharmaceutical production is used in diagnostic and therapy procedures and allows one and a half million nuclear medicine procedures annually. Despite this, the country is not self-sufficient to meet national demand, creating the need for importation and consequent dependence on other countries. However, IEN facilities were designed in the 60's, and today its structure is inadequate in relation to the good manufacturing practices established by sanitary regulator (ANVISA) and radiological protection leading to the need for a new project. In order to adapt and increase production in the country, a new plant will be built and integrated to the existing facilities with a new 30 MeV Cyclotron that is actually in project detailing process. Thus, it is proposed to survey current CNEN and ANVISA standards for radiopharmaceutical production facilities, as well as the radiological protection analysis of each area of the plant, following good manufacturing practices recommendations adopted nationally besides licensing exigencies for radioactive facilities. In this way, the main requirements for proper operation, equipment location, building materials, area classification, and maintenance program have been implemented. The access controls, interlocks, segregation zones and pass-through boxes integrated into the project were also analyzed. As a result, IEN will in future have the flexibility to produce all necessary radioisotopes for nuclear medicine application, more efficiently by simultaneously bombarding two targets, allowing the simultaneous production of two different radioisotopes, minimizing radiation exposure and saving operating costs.

Keywords: cyclotron, legislation, norms, production, radiopharmaceuticals

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614 The Quality Assessment of Seismic Reflection Survey Data Using Statistical Analysis: A Case Study of Fort Abbas Area, Cholistan Desert, Pakistan

Authors: U. Waqas, M. F. Ahmed, A. Mehmood, M. A. Rashid

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In geophysical exploration surveys, the quality of acquired data holds significant importance before executing the data processing and interpretation phases. In this study, 2D seismic reflection survey data of Fort Abbas area, Cholistan Desert, Pakistan was taken as test case in order to assess its quality on statistical bases by using normalized root mean square error (NRMSE), Cronbach’s alpha test (α) and null hypothesis tests (t-test and F-test). The analysis challenged the quality of the acquired data and highlighted the significant errors in the acquired database. It is proven that the study area is plain, tectonically least affected and rich in oil and gas reserves. However, subsurface 3D modeling and contouring by using acquired database revealed high degrees of structural complexities and intense folding. The NRMSE had highest percentage of residuals between the estimated and predicted cases. The outcomes of hypothesis testing also proved the biasness and erraticness of the acquired database. Low estimated value of alpha (α) in Cronbach’s alpha test confirmed poor reliability of acquired database. A very low quality of acquired database needs excessive static correction or in some cases, reacquisition of data is also suggested which is most of the time not feasible on economic grounds. The outcomes of this study could be used to assess the quality of large databases and to further utilize as a guideline to establish database quality assessment models to make much more informed decisions in hydrocarbon exploration field.

Keywords: Data quality, Null hypothesis, Seismic lines, Seismic reflection survey

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613 Industrial Rock Characterization using Nuclear Magnetic Resonance (NMR): A Case Study of Ewekoro Quarry

Authors: Olawale Babatunde Olatinsu, Deborah Oluwaseun Olorode

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Industrial rocks were collected from a quarry site at Ewekoro in south-western Nigeria and analysed using Nuclear Magnetic Resonance (NMR) technique. NMR measurement was conducted on the samples in partial water-saturated and full brine-saturated conditions. Raw NMR data were analysed with the aid of T2 curves and T2 spectra generated by inversion of raw NMR data using conventional regularized least-squares inversion routine. Results show that NMR transverse relaxation (T2) signatures fairly adequately distinguish between the rock types. Similar T2 curve trend and rates at partial saturation suggests that the relaxation is mainly due to adsorption of water on micropores of similar sizes while T2 curves at full saturation depict relaxation decay rate as: 1/T2(shale)>1/ T2(glauconite)>1/ T2(limestone) and 1/T2(sandstone). NMR T2 distributions at full brine-saturation show: unimodal distribution in shale; bimodal distribution in sandstone and glauconite; and trimodal distribution in limestone. Full saturation T2 distributions revealed the presence of well-developed and more abundant micropores in all the samples with T2 in the range, 402-504 μs. Mesopores with amplitudes much lower than those of micropores are present in limestone, sandstone and glauconite with T2 range: 8.45-26.10 ms, 6.02-10.55 ms, and 9.45-13.26 ms respectively. Very low amplitude macropores of T2 values, 90.26-312.16 ms, are only recognizable in limestone samples. Samples with multiple peaks showed well-connected pore systems with sandstone having the highest degree of connectivity. The difference in T2 curves and distributions for the rocks at full saturation can be utilised as a potent diagnostic tool for discrimination of these rock types found at Ewekoro.

Keywords: Ewekoro, NMR techniques, industrial rocks, characterization, relaxation

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612 Assessment of the Impact of the Application of Kinesiology Taping on Joint Position Sense in Knee Joint

Authors: Anna Słupik, Patryk Wąsowski, Anna Mosiołek, Dariusz Białoszewski

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Introduction: Kinesiology Taping is one of the most popular techniques used for treatment and supporting physiological processes in sports medicine and physiotherapy. Often it is used to sensorimotor skills of lower limbs by athletes. The aim of the study was to determine the effect of the application of muscle Kinesiology Taping to feel the position setting in motion the joint active. Material and methods: The study involved 50 healthy people between 18 and 30 years of age, 30 men and 20 women (mean age 23.24 years). The participants were divided into two groups. The study group was qualified for Kinesiology Taping application (muscle application, type Y, for quadriceps femoris muscle), while the remaining people used the application made of plaster (placebo group). Testing was performed prior to applying taping, with the applied application (after 30 minutes), then 24 hours after wearing, and after removing the tape. Each evaluated joint position sense - Error of Active Reproduction of Joint Position. Results: The survey revealed no significant differences in measurement between the study group and the placebo group (p> 0.05). No significant differences in time taking into account all four measurements in the group with the applied CT application, which was supported by pairs (p> 0.05). Also in the placebo group showed no significant differences over time (p> 0.05). There was no significant difference between the errors committed in the direction of flexion and extension. Conclusions: 1. Application muscle Kinesiology Taping had no significant effect on the knee joint proprioception. Its use in order to improve sensorimotor seems therefore unjustified. 2. There are no differences between applications Kinesiology Taping and placebo indicates that the clinical effect of stretch tape is minimal or absent. 3. The results are the basis for the continuation of prospective, randomized trials of numerous and study group.

Keywords: joint position sense, kinesiology taping, knee joint, proprioception

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611 Sensor and Actuator Fault Detection in Connected Vehicles under a Packet Dropping Network

Authors: Z. Abdollahi Biron, P. Pisu

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Connected vehicles are one of the promising technologies for future Intelligent Transportation Systems (ITS). A connected vehicle system is essentially a set of vehicles communicating through a network to exchange their information with each other and the infrastructure. Although this interconnection of the vehicles can be potentially beneficial in creating an efficient, sustainable, and green transportation system, a set of safety and reliability challenges come out with this technology. The first challenge arises from the information loss due to unreliable communication network which affects the control/management system of the individual vehicles and the overall system. Such scenario may lead to degraded or even unsafe operation which could be potentially catastrophic. Secondly, faulty sensors and actuators can affect the individual vehicle’s safe operation and in turn will create a potentially unsafe node in the vehicular network. Further, sending that faulty sensor information to other vehicles and failure in actuators may significantly affect the safe operation of the overall vehicular network. Therefore, it is of utmost importance to take these issues into consideration while designing the control/management algorithms of the individual vehicles as a part of connected vehicle system. In this paper, we consider a connected vehicle system under Co-operative Adaptive Cruise Control (CACC) and propose a fault diagnosis scheme that deals with these aforementioned challenges. Specifically, the conventional CACC algorithm is modified by adding a Kalman filter-based estimation algorithm to suppress the effect of lost information under unreliable network. Further, a sliding mode observer-based algorithm is used to improve the sensor reliability under faults. The effectiveness of the overall diagnostic scheme is verified via simulation studies.

Keywords: fault diagnostics, communication network, connected vehicles, packet drop out, platoon

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610 An Educational Application of Online Games for Learning Difficulties

Authors: Maria Margoudi, Zacharoula Smyraniou

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The current paper presents the results of a conducted case study, which was part of the author’s master thesis. During the past few years the number of children diagnosed with Learning Difficulties has drastically augmented and especially the cases of ADHD (Attention Deficit Hyperactivity Disorder). One of the core characteristics of ADHD is a deficit in working memory functions. The review of the literature indicates a plethora of educational software that aim at training and enhancing the working memory. Nevertheless, in the current paper, the possibility of using for the same purpose free, online games will be explored. Another issue of interest is the potential effect of the working memory training to the core symptoms of ADHD. In order to explore the abovementioned research questions, three digital tests are employed, all of which are developed on the E-slate platform by the author, in order to check the level of ADHD’s symptoms and to be used as diagnostic tools, both in the beginning and in the end of the case study. The tools used during the main intervention of the research are free online games for the training of working memory. The research and the data analysis focus on the following axes: a) the presence and the possible change in two of the core symptoms of ADHD, attention and impulsivity and b) a possible change in the general cognitive abilities of the individual. The case study was conducted with the participation of a thirteen year-old, female student, diagnosed with ADHD, during after-school hours. The results of the study indicate positive changes both in the levels of attention and impulsivity. Therefore we conclude that the training of working memory through the use of free, online games has a positive impact on the characteristics of ADHD. Finally, concerning the second research question, the change in general cognitive abilities, no significant changes were noted.

Keywords: ADHD, attention, impulsivity, online games

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609 Exploring SL Writing and SL Sensitivity during Writing Tasks: Poor and Advanced Writing in a Context of Second Language other than English

Authors: Sandra Figueiredo, Margarida Alves Martins, Carlos Silva, Cristina Simões

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This study integrates a larger research empirical project that examines second language (SL) learners’ profiles and valid procedures to perform complete and diagnostic assessment in schools. 102 learners of Portuguese as a SL aged 7 and 17 years speakers of distinct home languages were assessed in several linguistic tasks. In this article, we focused on writing performance in the specific task of narrative essay composition. The written outputs were measured using the score in six components adapted from an English SL assessment context (Alberta Education): linguistic vocabulary, grammar, syntax, strategy, socio-linguistic, and discourse. The writing processes and strategies in Portuguese language used by different immigrant students were analysed to determine features and diversity of deficits on authentic texts performed by SL writers. Differentiated performance was based on the diversity of the following variables: grades, previous schooling, home language, instruction in first language, and exposure to Portuguese as Second Language. Indo-Aryan languages speakers showed low writing scores compared to their peers and the type of language and respective cognitive mapping (such as Mandarin and Arabic) was the predictor, not linguistic distance. Home language instruction should also be prominently considered in further research to understand specificities of cognitive academic profile in a Romance languages learning context. Additionally, this study also examined the teachers representations that will be here addressed to understand educational implications of second language teaching in psychological distress of different minorities in schools of specific host countries.

Keywords: home language, immigrant students, Portuguese language, second language, writing assessment

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608 ADCOR © Muscle Damage Rapid Detection Test Based on Skeletal Troponin I Immunochromatography Reaction

Authors: Muhammad Solikhudin Nafi, Wahyu Afif Mufida, Mita Erna Wati, Fitri Setyani Rokim, M. Al-Rizqi Dharma Fauzi

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High dose activity without any pre-exercise will impact Delayed Onset Muscle Soreness (DOMS). DOMS known as delayed pain post-exercise and induce skeletal injury which will decrease athletes’ performances. From now on, post-exercise muscle damage can be detected by measuring skeletal troponin I (sTnI) concentration in serum using ELISA but this method needs more time and cost. To prevent decreased athletes performances, screening need to be done rapidly. We want to introduce our new prototype to detect DOMS acutely. Rapid detection tests are based on immunological reaction between skeletal troponin I antibodies and sTnI in human serum or whole blood. Chemical methods that are used in the manufacture of diagnostic test is lateral flow immunoassay. The material used is rat monoclonal antibody sTnI, colloidal gold, anti-mouse IgG, nitrocellulose membrane, conjugate pad, sample pad, wick and backing card. The procedure are made conjugate (colloidal gold and mAb sTnI) and insert into the conjugate pad, gives spray sTnI mAb and anti-mouse IgG into nitrocellulose membrane, and assemble RDT. RDT had been evaluated by measuring the sensitivity of positive human serum (n = 30) and negative human serum (n = 30). Overall sensitivity value was 93% and specificity value was 90%. ADCOR as the first rapid detection test qualitatively showed antigen-antibody reaction and showed good overall performances for screening of muscle damage. Furthermore, these finding still need more improvements to get best results.

Keywords: DOMS, sTnI, rapid detection test, ELISA

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607 Development of E-Tendering Models for Nigerian Public Procuring Entities

Authors: Bello Abdullahi, Kabir Bala, Yahaya M. Ibrahim, Ahmed D. Ibrahim

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Public sector tendering has traditionally been conducted using manual paper-based processes which are known to be inefficient, less transparent, and more prone to manipulations and errors. However, the advent of the Internet and its associated technologies has led to the development of numerous e-Tendering systems that addressed many of the problems associated with the manual paper-based tendering system. Currently, in Nigeria, the public tendering processes are largely conducted based on manual paper-based system that is bedevilled by a number of problems such as inordinate delays, inefficiencies, manipulation of the tender evaluation process, corruption, lack of transparency and competition, among other problems. These problems can be addressed through the adoption of existing web-based e-Tendering systems which are known to address most of these problems. However, these existing e-Tendering systems that have been developed are not based on the Nigerian legal procurement processes and as such their suitability for local application is very limited. This paper is part of a larger study that attempt to address this problem through the development of an e-Tendering system that is based on the requirements of the Nigerian public procuring entities. In this paper, the identified tendering processes commonly used by Nigerian public procuring entities in the selection of construction sources are presented. A multi-methods research approach was used to identify those tendering processes. Specifically, 19 existing business use cases used by Nigerian public procuring entities were identified and 61 system use cases were prescribed based on the identified business use cases. The use cases were used as the basis for the development of domain and software conceptual models. The models were successfully used to guide the development of an e-Tendering system called NPS-eTender. Ripple and Unified Process were adopted as the software development methodologies.

Keywords: e-tendering, e-procurement, requirement model, conceptual model, public sector tendering, public procurement

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606 Resistance of Haemonchus spp. to Albendazole, Fenbendazole and Levamisole in 4 Goat Farms of Antioquia, Colombia

Authors: Jose D. Zapata-Torres, Esteban Naranjo-Gutiérrez, Angela M. Martínez-Valencia, Jenny J. Chaparro-Gutiérrez, David Villar-Argaiz

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Reports of drug resistance have been made in every livestock host and to every anthelmintic class. In some regions of world, the extremely high prevalence of multi-drug resistance in nematodes of sheep and goats threatens the viability of small-ruminant industries. In the region of Antioquia, Colombia, no reports of nematode resistance have been documented due to a lack of veterinary diagnostic laboratories. The objective of this study was to evaluate the efficacy of albendazole, fenbendazole, and levamisole to control gastrointestinal nematodes in goat farms of Antioquia by doing fecal egg count reduction tests. A total of 139 crossbreed goats from four separate farms were sampled for feces prior to, and 14 days following anthelmintc treatments. Individual fecal egg counts were performed using the modified three chamber McMaster technique. The anthelmintics administered at day 0 were albendazole (farm 1, n=63), fenbendazole (farm 2, n=20), and levamisole (farm 3 and 4, n= 37, and 19). Larval cultures were used to identify the genus of nematodes using Baermann`s technique and the morphological keys for identification of L3 in small ruminants. There was no difference in fecal egg counts between 0 and 14, with means (±SD) of 1681,5 ± 2121,5 and 1715,12 ± 1895,4 epg (eggs per gram), respectively. The egg count reductions for each anthelmintic and farm were 25,86% for albendazole (farm 1), 0% for fenbendazole (farm 2), 0% (farm 3), and 5,5% (farm 4) for levamisole. The genus of nematodes identified was predominantly Haemonchus spp., with 70,27% and 82,81% for samples from day 0 and 14, respectively. These results provide evidence of a total state of resistance to 3 common anthelmintics. Further research is needed to design integrate management programs to control nematodes in small ruminants in Colombia.

Keywords: anthelmintics, goat, haemonchus, resistance

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605 Place of Radiotherapy in the Treatment of Intracranial Meningiomas: Experience of the Cancer Center Emir Abdelkader of Oran Algeria

Authors: Taleb L., Benarbia M., Boutira F. M., Allam H., Boukerche A.

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Introduction and purpose of the study: Meningiomas are the most common non-glial intracranial tumors in adults, accounting for approximately 30% of all central nervous system tumors. The aim of our study is to determine the epidemiological, clinical, therapeutic, and evolutionary characteristics of a cohort of patients with intracranial meningioma treated with radiotherapy at the Emir Abdelkader Cancer Center in Oran. Material and methods: This is a retrospective study of 44 patients during the period from 2014 to 2020. The overall survival and relapse-free survival curves were calculated using the Kaplan-Meier method. Results and statistical analysis: The median age of the patients was 49 years [21-76 years] with a clear female predominance (sex ratio=2.4). The average diagnostic delay was seven months [2 to 24 months], the circumstances of the discovery of which were dominated by headaches in 54.5% of cases (n=24), visual disturbances in 40.9% (n=18), and motor disorders in 15.9% (n=7). The seat of the tumor was essentially at the level of the base of the skull in 52.3% of patients (n=23), including 29.5% (n=13) at the level of the cavernous sinus, 27.3% (n=12) at the parasagittal level and 20.5% (n=9) at the convexity. The diagnosis was confirmed surgically in 36 patients (81.8%) whose anatomopathological study returned in favor of grades I, II, and III in respectively 40.9%, 29.5%, and 11.4% of the cases. Radiotherapy was indicated postoperatively in 45.5% of patients (n=20), exclusive in 27.3% (n=12) and after tumor recurrence in 27.3% of cases (n=18). The irradiation doses delivered were as follows: 50 Gy (20.5%), 54 Gy (65.9%), and 60 Gy (13.6%). With a median follow-up of 69 months, the probabilities of relapse-free survival and overall survival at three years are 93.2% and 95.4%, respectively, whereas they are 71.2% and 80.7% at five years. Conclusion: Meningiomas are common primary brain tumors. Most often benign but can also progress aggressively. Their treatment is essentially surgical, but radiotherapy retains its place in specific situations, allowing good tumor control and overall survival.

Keywords: diagnosis, meningioma, surgery, radiotherapy, survival

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604 Teaching English to Rural Students: A Case Study of a Select Batch at SSN College of Engineering, Chennai

Authors: Martha Karunakar

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There exists a wide divide between the urban and the rural students in a vast country like India. This dichotomy is seen in the resources available to them, like the learning facilities, the infra-structure, the learning ambience and meeting of their basic needs of food, clothing and shelter. This paper discusses the effect of English language teaching as a Bridge course on a select batch of rural students at an Engineering college in Chennai, one of the four Metros of India. The study aims to understand how the teacher input and the teacher- peer-student interaction facilitates the acquisition of the basic structures of the English language to a group that is minimally exposed to the language. The objective in conducting the Bridge Course is to integrate these rural students into the mainstream and empower them in terms of English speaking ability; to enable them to comprehend their respective engineering classes where the medium of instruction is English and also to be able to interact with their urban peers. This program is conducted prior to the start of a regular academic session to equip them face the rigors of engineering education. The study is placed within the framework of Interaction theory in second language acquisition. The study evaluates the impact of linking theory and practice by implementing meaningful interaction not only within classrooms but also in the common areas. By providing intensive comprehensible input, it is anticipated that participant’s level of English language improves. The teaching methods and classroom activities included individual and group participation, encompassing all the four skills of listening, speaking, reading and writing (LSRW). The diagnostic tests that were administered before the commencement of the course and the exit test after the completion were used to record the impact of the training.

Keywords: comprehensible input, interaction, rural students, teaching English

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603 Comparison of Deep Learning and Machine Learning Algorithms to Diagnose and Predict Breast Cancer

Authors: F. Ghazalnaz Sharifonnasabi, Iman Makhdoom

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Breast cancer is a serious health concern that affects many people around the world. According to a study published in the Breast journal, the global burden of breast cancer is expected to increase significantly over the next few decades. The number of deaths from breast cancer has been increasing over the years, but the age-standardized mortality rate has decreased in some countries. It’s important to be aware of the risk factors for breast cancer and to get regular check- ups to catch it early if it does occur. Machin learning techniques have been used to aid in the early detection and diagnosis of breast cancer. These techniques, that have been shown to be effective in predicting and diagnosing the disease, have become a research hotspot. In this study, we consider two deep learning approaches including: Multi-Layer Perceptron (MLP), and Convolutional Neural Network (CNN). We also considered the five-machine learning algorithm titled: Decision Tree (C4.5), Naïve Bayesian (NB), Support Vector Machine (SVM), K-Nearest Neighbors (KNN) Algorithm and XGBoost (eXtreme Gradient Boosting) on the Breast Cancer Wisconsin Diagnostic dataset. We have carried out the process of evaluating and comparing classifiers involving selecting appropriate metrics to evaluate classifier performance and selecting an appropriate tool to quantify this performance. The main purpose of the study is predicting and diagnosis breast cancer, applying the mentioned algorithms and also discovering of the most effective with respect to confusion matrix, accuracy and precision. It is realized that CNN outperformed all other classifiers and achieved the highest accuracy (0.982456). The work is implemented in the Anaconda environment based on Python programing language.

Keywords: breast cancer, multi-layer perceptron, Naïve Bayesian, SVM, decision tree, convolutional neural network, XGBoost, KNN

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602 Optimization of Assembly and Welding of Complex 3D Structures on the Base of Modeling with Use of Finite Elements Method

Authors: M. N. Zelenin, V. S. Mikhailov, R. P. Zhivotovsky

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It is known that residual welding deformations give negative effect to processability and operational quality of welded structures, complicating their assembly and reducing strength. Therefore, selection of optimal technology, ensuring minimum welding deformations, is one of the main goals in developing a technology for manufacturing of welded structures. Through years, JSC SSTC has been developing a theory for estimation of welding deformations and practical activities for reducing and compensating such deformations during welding process. During long time a methodology was used, based on analytic dependence. This methodology allowed defining volumetric changes of metal due to welding heating and subsequent cooling. However, dependences for definition of structures deformations, arising as a result of volumetric changes of metal in the weld area, allowed performing calculations only for simple structures, such as units, flat sections and sections with small curvature. In case of complex 3D structures, estimations on the base of analytic dependences gave significant errors. To eliminate this shortage, it was suggested to use finite elements method for resolving of deformation problem. Here, one shall first calculate volumes of longitudinal and transversal shortenings of welding joints using method of analytic dependences and further, with obtained shortenings, calculate forces, which action is equivalent to the action of active welding stresses. Further, a finite-elements model of the structure is developed and equivalent forces are added to this model. Having results of calculations, an optimal sequence of assembly and welding is selected and special measures to reduce and compensate welding deformations are developed and taken.

Keywords: residual welding deformations, longitudinal and transverse shortenings of welding joints, method of analytic dependences, finite elements method

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601 Modified Lot Quality Assurance Sampling (LQAS) Model for Quality Assessment of Malaria Parasite Microscopy and Rapid Diagnostic Tests in Kano, Nigeria

Authors: F. Sarkinfada, Dabo N. Tukur, Abbas A. Muaz, Adamu A. Yahuza

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Appropriate Quality Assurance (QA) of parasite-based diagnosis of malaria to justify Artemisinin-based Combination Therapy (ACT) is essential for Malaria Programmes. In Low and Middle Income Countries (LMIC), resource constrain appears to be a major challenge in implementing the conventional QA system. We designed and implemented a modified LQAS model for QA of malaria parasite (MP) microscopy and RDT in a State Specialist Hospital (SSH) and a University Health Clinic (UHC) in Kano, Nigeria. The capacities of both facilities for MP microscopy and RDT were assessed before implementing a modified LQAS over a period of 3 months. Quality indicators comprising the qualities of blood film and staining, MP positivity rates, concordance rates, error rates (in terms of false positives and false negatives), sensitivity and specificity were monitored and evaluated. Seventy one percent (71%) of the basic requirements for malaria microscopy was available in both facilities, with the absence of certifies microscopists, SOPs and Quality Assurance mechanisms. A daily average of 16 to 32 blood samples were tested with a blood film staining quality of >70% recorded in both facilities. Using microscopy, the MP positivity rates were 50.46% and 19.44% in SSH and UHS respectively, while the MP positivity rates were 45.83% and 22.78% in SSH and UHS when RDT was used. Higher concordance rates of 88.90% and 93.98% were recorded in SSH and UHC respectively using microscopy, while lower rates of 74.07% and 80.58% in SSH and UHC were recorded when RDT was used. In both facilities, error rates were higher when RDT was used than with microscopy. Sensitivity and specificity were higher when microscopy was used (95% and 84% in SSH; 94% in UHC) than when RDT was used (72% and 76% in SSH; 78% and 81% in UHC). It could be feasible to implement an integrated QA model for MP microscopy and RDT using modified LQAS in Malaria Control Programmes in Low and Middle Income Countries that might have resource constrain for parasite-base diagnosis of malaria to justify ACT treatment.

Keywords: malaria, microscopy, quality assurance, RDT

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600 A Rare Case of Metastatic Basal Cell Carcinoma

Authors: Nitesh Kumar, Eoin Twohig, jasparl cheema, Sadiq mawji, Yousif al najjar

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Basal cell carcinoma (BCC) is the commonest cutaneous malignancy affecting humans. Despite this, distant spread is exceptionally rare. Metastatic BCC (mBCC) is estimated to occur in 0.0028 - 0.5%. it aim to illustrate with the aid of histological slides, a case of mBCC occurring in a fit and well 67-year-old. Initial diagnosis of desmoplastic BCC was made in 2006 from a scalp biopsy with the lesion then being excised. Re-excision of local recurrence was undertaken the following year. In 2014 the patient presented with an ipsilateral level 2a mass. Fine Needle Aspiration raised the suspicion of metastatic carcinoma. The patient had excision of two nodes from the left neck alongside pharyngeal tonsillectomy and tongue base biopsies. Histologically, the nodes closely resembled the immunophenotype of the initial scalp lesion. The patient subsequently had a modified radical neck dissection, and residual mBCC was excised from the left Sternocleidomastoid muscle. In 2023 the patient developed haematuria. On further investigation bilateral lung lesions on CT were noted with subsequent biopsy confirming mBCC. Spinal and renal lesions have also been found. Histopathology showed clear resemblance of the lung metastases to both those in the neck and the primary (scalp BCC) – with no squamous differentiation seen. The time span from primary to occurrence of lung metastasis (18 years) affirms the indolent and slow growing nature of BCC.  This case fulfils Lattes and Kessler diagnostic criteria. High risk cases are described as those with advanced local presentation, primary tumour on the Head and Neck and locally recurrent lesions.

Keywords: BCC, metastasis, rare, skin cancer

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599 Changes in the Median Sacral Crest Associated with Sacrocaudal Fusion in the Greyhound

Authors: S. M. Ismail, H-H Yen, C. M. Murray, H. M. S. Davies

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A recent study reported a 33% incidence of complete sacrocaudal fusion in greyhounds compared to a 3% incidence in other dogs. In the dog, the median sacral crest is formed by the fusion of sacral spinous processes. Separation of the 1st spinous process from the median crest of the sacrum in the dog has been reported as a diagnostic tool of type one lumbosacral transitional vertebra (LTV). LTV is a congenital spinal anomaly, which includes either sacralization of the caudal lumbar part or lumbarization of the most cranial sacral segment of the spine. In this study, the absence or reduction of fusion (presence of separation) between the 1st and 2ndspinous processes of the median sacral crest has been identified in association with sacrocaudal fusion in the greyhound, without any feature of LTV. In order to provide quantitative data on the absence or reduction of fusion in the median sacral crest between the 1st and 2nd sacral spinous processes, in association with sacrocaudal fusion. 204 dog sacrums free of any pathological changes (192 greyhound, 9 beagles and 3 labradors) were grouped based on the occurrence and types of fusion and the presence, absence, or reduction in the median sacral crest between the 1st and 2nd sacral spinous processes., Sacrums were described and classified as follows: F: Complete fusion (crest is present), N: Absence (fusion is absent), and R: Short crest (fusion reduced but not absent (reduction). The incidence of sacrocaudal fusion in the 204 sacrums: 57% of the sacrums were standard (3 vertebrae) and 43% were fused (4 vertebrae). Type of sacrum had a significant (p < .05) association with the absence and reduction of fusion between the 1st and 2nd sacral spinous processes of the median sacral crest. In the 108 greyhounds with standard sacrums (3 vertebrae) the percentages of F, N and R were 45% 23% and 23% respectively, while in the 84 fused (4 vertebrae) sacrums, the percentages of F, N and R were 3%, 87% and 10% respectively and these percentages were significantly different between standard (3 vertebrae) and fused (4 vertebrae) sacrums (p < .05). This indicates that absence of spinous process fusion in the median sacral crest was found in a large percentage of the greyhounds in this study and was found to be particularly prevalent in those with sacrocaudal fusion – therefore in this breed, at least, absence of sacral spinous process fusion may be unlikely to be associated with LTV.

Keywords: greyhound, median sacral crest, sacrocaudal fusion, sacral spinous process

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598 Thick Data Techniques for Identifying Abnormality in Video Frames for Wireless Capsule Endoscopy

Authors: Jinan Fiaidhi, Sabah Mohammed, Petros Zezos

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Capsule endoscopy (CE) is an established noninvasive diagnostic modality in investigating small bowel disease. CE has a pivotal role in assessing patients with suspected bleeding or identifying evidence of active Crohn's disease in the small bowel. However, CE produces lengthy videos with at least eighty thousand frames, with a frequency rate of 2 frames per second. Gastroenterologists cannot dedicate 8 to 15 hours to reading the CE video frames to arrive at a diagnosis. This is why the issue of analyzing CE videos based on modern artificial intelligence techniques becomes a necessity. However, machine learning, including deep learning, has failed to report robust results because of the lack of large samples to train its neural nets. In this paper, we are describing a thick data approach that learns from a few anchor images. We are using sound datasets like KVASIR and CrohnIPI to filter candidate frames that include interesting anomalies in any CE video. We are identifying candidate frames based on feature extraction to provide representative measures of the anomaly, like the size of the anomaly and the color contrast compared to the image background, and later feed these features to a decision tree that can classify the candidate frames as having a condition like the Crohn's Disease. Our thick data approach reported accuracy of detecting Crohn's Disease based on the availability of ulcer areas at the candidate frames for KVASIR was 89.9% and for the CrohnIPI was 83.3%. We are continuing our research to fine-tune our approach by adding more thick data methods for enhancing diagnosis accuracy.

Keywords: thick data analytics, capsule endoscopy, Crohn’s disease, siamese neural network, decision tree

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597 Energy Consumption Estimation for Hybrid Marine Power Systems: Comparing Modeling Methodologies

Authors: Kamyar Maleki Bagherabadi, Torstein Aarseth Bø, Truls Flatberg, Olve Mo

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Hydrogen fuel cells and batteries are one of the promising solutions aligned with carbon emission reduction goals for the marine sector. However, the higher installation and operation costs of hydrogen-based systems compared to conventional diesel gensets raise questions about the appropriate hydrogen tank size, energy, and fuel consumption estimations. Ship designers need methodologies and tools to calculate energy and fuel consumption for different component sizes to facilitate decision-making regarding feasibility and performance for retrofits and design cases. The aim of this work is to compare three alternative modeling approaches for the estimation of energy and fuel consumption with various hydrogen tank sizes, battery capacities, and load-sharing strategies. A fishery vessel is selected as an example, using logged load demand data over a year of operations. The modeled power system consists of a PEM fuel cell, a diesel genset, and a battery. The methodologies used are: first, an energy-based model; second, considering load variations during the time domain with a rule-based Power Management System (PMS); and third, a load variations model and dynamic PMS strategy based on optimization with perfect foresight. The errors and potentials of the methods are discussed, and design sensitivity studies for this case are conducted. The results show that the energy-based method can estimate fuel and energy consumption with acceptable accuracy. However, models that consider time variation of the load provide more realistic estimations of energy and fuel consumption regarding hydrogen tank and battery size, still within low computational time.

Keywords: fuel cell, battery, hydrogen, hybrid power system, power management system

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596 Tc-99m MIBI Scintigraphy to Differentiate Malignant from Benign Lesions, Detected on Planar Bone Scan

Authors: Aniqa Jabeen

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The aim of this study was to evaluate the effectiveness of Tc-99m MIBI (Technetium 99-methoxy-iso-butyl-isonitrile) scintigraphy to differentiate malignancies from benign lesions, which were detected on planar bone scans. Materials and Methods: 59 patients with bone lesions were enrolled in the study. The scintigraphic findings were compared with the clinical, radiological and the histological findings. Each patient initially underwent a three-phase bone scan with Tc-99m MDP (Methylene Diphosphonate) and if evidence of lesion found, the patient then underwent a dynamic and static MIBI scintigraphy after three to four days. The MDP and MIBI scans were evaluated visually and quantitatively. For quantitative analysis count ratios of lesions and contralateral normal side (L/C) were taken by region of interests drawn on scans. The Student T test was applied to assess the significant difference between benign and malignant lesions p-value < 0.05 was considered significant. Result: The MDP scans showed the increase tracer uptake, but there was no significant difference between benign and malignant uptake of the radiotracer. However significant difference (p-value 0.015), in uptake was seen in malignant (L/C = 3.51 ± 1.02) and benign lesion (L/C = 2.50±0.42) on MIBI scan. Three of thirty benign lesions did not show significant MIBI uptake. Seven malignant appeared as false negatives. Specificity of the scan was 86.66%, and its Negative Predictive Value (NPV) was 81.25% whereas the sensitivity of scan was 79.31%. In excluding the axial metastasis from the lesions, the sensitivity of MIBI scan increased to 91.66% and the NPV also increased to 92.85%. Conclusion: MIBI scintigraphy provides its usefulness by distinguishing malignant from benign lesions. MIBI also correctly identifies metastatic lesions. The negative predictive value of the scan points towards its ability to accurately diagnose the normal (benign) cases. However, biopsy remains the gold standard and a definitive diagnostic modality in musculoskeletal tumors. MIBI scan provides useful information in preoperative assessment and in distinguishing between malignant and benign lesions.

Keywords: benign, malignancies, MDP bone scan, MIBI scintigraphy

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595 Discrimination and Classification of Vestibular Neuritis Using Combined Fisher and Support Vector Machine Model

Authors: Amine Ben Slama, Aymen Mouelhi, Sondes Manoubi, Chiraz Mbarek, Hedi Trabelsi, Mounir Sayadi, Farhat Fnaiech

Abstract:

Vertigo is a sensation of feeling off balance; the cause of this symptom is very difficult to interpret and needs a complementary exam. Generally, vertigo is caused by an ear problem. Some of the most common causes include: benign paroxysmal positional vertigo (BPPV), Meniere's disease and vestibular neuritis (VN). In clinical practice, different tests of videonystagmographic (VNG) technique are used to detect the presence of vestibular neuritis (VN). The topographical diagnosis of this disease presents a large diversity in its characteristics that confirm a mixture of problems for usual etiological analysis methods. In this study, a vestibular neuritis analysis method is proposed with videonystagmography (VNG) applications using an estimation of pupil movements in the case of an uncontrolled motion to obtain an efficient and reliable diagnosis results. First, an estimation of the pupil displacement vectors using with Hough Transform (HT) is performed to approximate the location of pupil region. Then, temporal and frequency features are computed from the rotation angle variation of the pupil motion. Finally, optimized features are selected using Fisher criterion evaluation for discrimination and classification of the VN disease.Experimental results are analyzed using two categories: normal and pathologic. By classifying the reduced features using the Support Vector Machine (SVM), 94% is achieved as classification accuracy. Compared to recent studies, the proposed expert system is extremely helpful and highly effective to resolve the problem of VNG analysis and provide an accurate diagnostic for medical devices.

Keywords: nystagmus, vestibular neuritis, videonystagmographic system, VNG, Fisher criterion, support vector machine, SVM

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594 The Effect of Foundation on the Earth Fill Dam Settlement

Authors: Masoud Ghaemi, Mohammadjafar Hedayati, Faezeh Yousefzadeh, Hoseinali Heydarzadeh

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Careful monitoring in the earth dams to measure deformation caused by settlement and movement has always been a concern for engineers in the field. In order to measure settlement and deformation of earth dams, usually, the precision instruments of settlement set and combined Inclinometer that is commonly referred to IS instrument will be used. In some dams, because the thickness of alluvium is high and there is no possibility of alluvium removal (technically and economically and in terms of performance), there is no possibility of placing the end of IS instrument (precision instruments of Inclinometer-settlement set) in the rock foundation. Inevitably, have to accept installing pipes in the weak and deformable alluvial foundation that leads to errors in the calculation of the actual settlement (absolute settlement) in different parts of the dam body. The purpose of this paper is to present new and refine criteria for predicting settlement and deformation in earth dams. The study is based on conditions in three dams with a deformation quite alluvial (Agh Chai, Narmashir and Gilan-e Gharb) to provide settlement criteria affected by the alluvial foundation. To achieve this goal, the settlement of dams was simulated by using the finite difference method with FLAC3D software, and then the modeling results were compared with the reading IS instrument. In the end, the caliber of the model and validate the results, by using regression analysis techniques and scrutinized modeling parameters with real situations and then by using MATLAB software and CURVE FITTING toolbox, new criteria for the settlement based on elasticity modulus, cohesion, friction angle, the density of earth dam and the alluvial foundation was obtained. The results of these studies show that, by using the new criteria measures, the amount of settlement and deformation for the dams with alluvial foundation can be corrected after instrument readings, and the error rate in reading IS instrument can be greatly reduced.

Keywords: earth-fill dam, foundation, settlement, finite difference, MATLAB, curve fitting

Procedia PDF Downloads 177
593 An Analysis of Prefabricated Construction Waste: A Case Study Approach

Authors: H. Hakim, C. Kibert, C. Fabre, S. Monadizadeh

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Construction industry is an industry saddled with chronic problems of high waste generation. Waste management that is to ensure materials are utilized in an efficient manner would make a major contribution to mitigating the negative environmental impacts of construction waste including finite resources depletion and growing occupied landfill areas to name a few. Furthermore, ‘material resource efficiency’ has been found an economically smart approach specially when considered during the design phase. One effective strategy is to utilizing off-site construction process which includes a series of prefabricated systems such as mobile, modular, and HUD construction (Department of Housing and Urban Development manufactured buildings). These types of buildings are by nature material and resource-efficient. Despite conventional construction that is exposed to adverse weather conditions, manufactured construction production line is capable of creating repetitive units in a factory controlled environment. A factory can have several parallel projects underway with a high speed and in a timely manner which simplifies the storage of excess materials and re-allocating to the next projects. The literature reports that prefabricated construction significantly helps reduce errors, site theft, rework, and delayed problems and can ultimately lead to a considerable waste reduction. However, there is not sufficient data to quantify this reduction when it comes to a regular modular house in the U.S. Therefore, this manuscript aims to provide an analysis of waste originated from a manufactured factory trend. The analysis was made possible with several visits and data collection of Homes of Merits, a Florida Manufactured and Modular Homebuilder. The results quantify and verify a noticeable construction waste reduction.

Keywords: construction waste, modular construction, prefabricated buildings, waste management

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592 Psychological Alarm among Individuals Suffering from Irritable Bowel Syndrome

Authors: Selim A., Albasher N., Bakrmom G., Alanzi S.

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Irritable bowel syndrome (IBS) is a chronic functional bowel disorder characterized by abdominal discomfort or pain and associated with alteration in frequency and/or form of bowel habit among other symptoms. This diagnosis is associated with increased levels of psychological distress, maladaptive coping, genetic risk factors, abnormal small and colonic intestine transit, change in stool frequency or form and abdominal discomfort or pain. Aim: The aim of the study was to assess psychological alarm among individuals suffering from Irritable Bowel Syndrome (IBS). Methods: A cross-sectional correlational research design was used to conduct the current study. A convenience sample of 504 participants was included in the present study. Data were collected using a self-report questionnaire. The questionnaire included socio-demographic data, ROME III to identify Irritable Bowel Syndrome (IBS) and Psychological Alarm Questionnaire. Results: Out of 504 participants who reported abdominal discomfort, 297 (58.9 %) participants met the diagnostic criteria of IBS. The mean age of the IBS participants was 30.16 years, females composed 75.1% of the IBS participants, and 55.2% did not seek medical help. Psychological alarms such as feeling anxious, feeling depressed, having suicidal ideations, bodily pain, having impaired functioning due to pain and feeling unable to cope with pain were significantly high among IBS individuals when compared to individuals not suffering from IBS. Psychological alarms such as feeling anxious, feeling depressed, having suicidal ideations, bodily pain, having impaired functioning due to pain and feeling unable to cope with pain were significantly high among IBS individuals compared to individuals not suffering from IBS. Conclusion: IBS is highly associated with significant psychological alarms including depression, anxiety and suicidal ideas.

Keywords: abdominal pain , irritable bowel syndrome, distress, psychological alarms

Procedia PDF Downloads 176
591 Category-Base Theory of the Optimum Signal Approximation Clarifying the Importance of Parallel Worlds in the Recognition of Human and Application to Secure Signal Communication with Feedback

Authors: Takuro Kida, Yuichi Kida

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We show a base of the new trend of algorithm mathematically that treats a historical reason of continuous discrimination in the world as well as its solution by introducing new concepts of parallel world that includes an invisible set of errors as its companion. With respect to a matrix operator-filter bank that the matrix operator-analysis-filter bank H and the matrix operator-sampling-filter bank S are given, firstly, we introduce the detailed algorithm to derive the optimum matrix operator-synthesis-filter bank Z that minimizes all the worst-case measures of the matrix operator-error-signals E(ω) = F(ω) − Y(ω) between the matrix operator-input-signals F(ω) and the matrix operator-output signals Y(ω) of the matrix operator-filter bank at the same time. Further, feedback is introduced to the above approximation theory and it is indicated that introducing conversations with feedback does not superior automatically to the accumulation of existing knowledge of signal prediction. Secondly, the concept of category in the field of mathematics is applied to the above optimum signal approximation and is indicated that the category-based approximation theory is applied to the set-theoretic consideration of the recognition of humans. Based on this discussion, it is shown naturally why the narrow perception that tends to create isolation shows an apparent advantage in the short term and, often, why such narrow thinking becomes intimate with discriminatory action in a human group. Throughout these considerations, it is presented that, in order to abolish easy and intimate discriminatory behavior, it is important to create a parallel world of conception where we share the set of invisible error signals, including the words and the consciousness of both worlds.

Keywords: signal prediction, pseudo inverse matrix, artificial intelligence, conditional optimization

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590 p210 BCR-ABL1 CML with CMML Clones: A Rare Presentation

Authors: Mona Vijayaran, Gurleen Oberoi, Sanjay Mishra

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Introduction: p190 BCR‐ABL1 in CML is often associated with monocytosis. In the case described here, monocytosis is associated with coexisting p210 BCR‐ABL and CMML clones. Mutation analysis using next‐generation sequence (NGS) in our case showed TET2 and SRSF2 mutations. Aims & Objectives: A 75-year male was evaluated for monocytosis and thrombocytopenia. CBC showed Hb-11.8g/dl, TLC-12,060/cmm, Monocytes-35%, Platelets-39,000/cmm. Materials & Methods: Bone marrow examination showed a hypercellular marrow with myeloid series showing sequential maturation up to neutrophils with 30% monocytes. Immunophenotyping by flow cytometry from bone marrow had 3% blasts. Making chronic myelomonocytic leukemia as the likely diagnosis. NGS for myeloid mutation panel had TET2 (48.9%) and SRSF2 (32.5%) mutations. This report further supported the diagnosis of CMML. To fulfil the WHO diagnostic criteria for CMML, a BCR ABL1 by RQ-PCR was sent. The report came positive for p210 (B3A2, B2A2) Major Transcript (M-BCR) % IS of 38.418. Result: The patient was counselled regarding the unique presentation of the presence of 2 clones- P210 CML and CMML. After discussion with an international faculty with vast experience in CMML. It was decided to start this elderly gentleman on Imatinib 200mg and not on azacytidine, as ASXL1 was not present; hence, his chances of progressing to AML would be less and on the other end, if CML is left untreated then chances of progression to blast phase would always be a possibility. After 3 months on Imatinib his platelet count improved to 80,000 to 90,000/cmm, but his monocytosis persists. His 3rd month BCR-ABL1 IS% is 0.004%. Conclusion: After searching the literature, there were no case reports of a coexisting CML p210 with CMML. This case might be the first case report. p190 BCR ABL1 is often associated with monocytosis. There are few case reports of p210 BCR ABL1 positivity in patients with monocytosis but none with coexisting CMML. This case highlights the need for extensively evaluating patients with monocytosis with next-generation sequencing for myeloid mutation panel and BCR-ABL1 by RT-PCR to correctly diagnose and treat them.

Keywords: CMML, NGS, p190 CML, Imatinib

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