Search results for: spiral model

Authors: Xin Li, Yan-Rong Guo, Jin-Fang Lin, Yi Feng, Håkan Billig, Ruijin Shao

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Background: Young women with polycystic ovary syndrome (PCOS) have a high risk of developing endometrial carcinoma. There is a need for the development of new medical therapies that can reduce the need for surgical intervention so as to preserve the fertility of these patients. The aim of the study was to describe and discuss cases of PCOS and insulin resistance (IR) women with early endometrial carcinoma while being co-treated with Diane-35 and metformin. Methods: Five PCOS-IR women who were scheduled for diagnosis and therapy for early endometrial carcinoma were recruited. The hospital records and endometrial pathology reports were reviewed. All patients were co-treated with Diane-35 and metformin for 6 months to reverse the endometrial carcinoma and preserve their fertility. Before, during, and after treatment, endometrial biopsies and blood samples were obtained and oral glucose tolerance tests were performed. Endometrial pathology was evaluated. Body weight (BW), body mass index (BMI), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), sex hormone-binding globulin (SHBG), free androgen index (FAI), insulin area under curve (IAUC), and homeostasis model assessment of insulin resistance (HOMA-IR) were determined. Results: Clinical stage 1a, low grade endometrial carcinoma was confirmed before treatment. After 6 months of co-treatment, all patients showed normal epithelia. No evidence of atypical hyperplasia or endometrial carcinoma was found. Co-treatment resulted in significant decreases in BW, BMI, TT, FAI, IAUC, and HOMA-IR in parallel with a significant increase in SHBG. There were no differences in the FSH and LH levels after co-treatment. Conclusions: Combined treatment with Diane-35 and metformin has the potential to revert the endometrial carcinoma into normal endometrial cells in PCOS-IR women. The cellular and molecular mechanisms behind this effect merit further investigation.

Keywords: PCOS, progesterone resistance, insulin resistance, steroid hormone receptors, endometrial carcinoma

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Authors: Priya Nambisan, Lien B. Nguyen

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Women participate extensively in the healthcare field, professionally (as physicians, nurses, dietitians, etc.) as well as informally (as caregivers at home). This provides them with a better understanding of the health needs of people. Women are also in the forefront of using social media and other mobile health related apps. Further, many health mobile apps are specifically designed for women users. All of these indicate the potential for women to be successful entrepreneurs in healthcare, especially, in the area of mobile health app development. However, extant research in entrepreneurship has paid limited attention to women entrepreneurship in healthcare. The objective of this study is to determine the key factors that shape the intentions and actions of women entrepreneurs with regard to their entrepreneurial pursuits in the healthcare field. Specifically, the study advances several hypotheses that relate key variables such as personal skills and capabilities, experience, support from institutions and family, and perceptions regarding entrepreneurship to individual intentions and actions regarding entrepreneurship (specifically, in the area of mobile apps). The study research model will be validated using survey data collected from potential women entrepreneurs in the healthcare field – students in the area of health informatics and engineering. The questionnaire-based survey relates to woman respondents’ intention to become entrepreneurs in healthcare and the key factors (independent variables) that may facilitate or inhibit their entrepreneurial intentions and pursuits. The survey data collection is currently ongoing. We also plan to conduct semi-structured interviews with around 10-15 women entrepreneurs who are currently developing mobile apps to understand the key issues and challenges that they face in this area. This is an exploratory study and as such our goal is to combine the findings from the regression analysis of the survey data and that from the content analysis of the interview data to inform on future research on women entrepreneurship in healthcare. The study findings will hold important policy implications, specifically for the development of new programs and initiatives to promote women entrepreneurship, particularly in healthcare and technology areas.

Keywords: women entrepreneurship, healthcare, mobile apps, health apps

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Authors: E. N. Masri, E. Takács

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Amplitude Versus Offset (AVO) and simultaneous model-based impedance inversion techniques have not been utilized for geothermal exploration commonly; however, some recent publications called the attention that they can be very useful in the geothermal investigations. In this study, we present rock physical attributes obtained from 3D pre-stack seismic data and well logs collected in a study area of the NW part of Pannonian Basin where the geothermal reservoir is located in the fractured zones of Triassic basement and it was hit by three productive-injection well pairs. The holes were planned very successfully based on the conventional 3D migrated stack volume prior to this study. Subsequently, the available geophysical-geological datasets provided a great opportunity to test modern inversion procedures in the same area. In this presentation, we provide a summary of the theory and application of the most promising seismic inversion techniques from the viewpoint of geothermal exploration. We demonstrate P- and S-wave impedance, as well as the velocity (Vp and Vs), the density, and the Vp/Vs ratio attribute volumes calculated from the seismic and well-logging data sets. After a detailed discussion, we conclude that P-wave impedance and Vp/Vp ratio are the most helpful parameters for lithology discrimination in the study area. They detect the hot water saturated fracture zone very well thus they can be very useful in mapping the investigated reservoir. Integrated interpretation of all the obtained rock-physical parameters is essential. We are extending the above discussed pre-stack seismic tools by studying the possibilities of Elastic Impedance Inversion (EII) for geothermal exploration. That procedure provides two other useful rock-physical properties, the compressibility and the rigidity (Lamé parameters). Results of those newly created elastic parameters will also be demonstrated in the presentation. Geothermal extraction is of great interest nowadays; and we can adopt several methods have been successfully applied in the hydrocarbon exploration for decades to discover new reservoirs and reduce drilling risk and cost.

Keywords: fractured zone, seismic, well-logging, inversion

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Authors: Mahmoud T. Alwidyan, Ahmad Alrawashdeh, Alaa O. Oteir

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Background: Emergency medical service (EMS) providers, oftentimes, use the lights and sirens (L&S) of their ambulances to warn road users, navigate through traffic, and expedite transport to save lives of ill and injured patients. Despite the contribution of road users in the effectiveness of reducing transport time of EMS ambulances using L&S, there is a lack of empirical assessments exploring the road user’s attitude and behavior in such situations. This study, therefore, aimed to assess the attitude and behavior of road users in response to EMS ambulances with warning L&S in use. Methods: This was a cross-sectional survey developed and distributed to adult road users in Northern Jordan. The questionnaire included 20 items addressing demographics, attitudes, and behavior toward emergency ambulances. We described the participants’ responses and assessed the association between demographics and attitude statements using logistic regression. Results: A total of 1302 questionnaires were complete and appropriate for analysis. The mean age was 34.2 (SD± 11.4) years, and the majority were males (72.6%). About half of road users (47.9%) in our sample would perform inappropriate action in response to EMS ambulances with L&S in use. The multivariate logistic regression model show that being female (OR, 0.63; 95% CI = 0.48-0.81), more educated (OR, 0.68; 95% CI = 0.53-0.86), or public transport driver (OR, 0.55; 95% CI = 0.34-0.90) is significantly associated with inappropriate response to EMS ambulances. Additionally, a significant proportion of road users may perform inappropriate and lawless driving practices such as crossing red traffic lights or following the passing by EMS ambulances, which would, in turn, increase the risk on ambulances and other road users. Conclusions: A large proportion of road users in Jordan may respond inappropriately to the EMS ambulances, and many engage in risky driving behaviors due perhaps to the lack of procedural knowledge. Policy-related interventions and educational programs are crucially needed to increase public awareness of the traffic law concerning EMS ambulances and to enhance appropriate driving behavior, which, in turn, improves the efficiency of ambulance services.

Keywords: EMS ambulances, lights and sirens, road users, attitude and behavior

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Authors: Kayode Ilesanmi Ebenezer Bowale, Dominic Azuh, Busayo Aderounmu, Alfred Ilesanmi

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There has been a debate among scholars and policymakers about the effects of oil exploration and production on industrial development. In Nigeria, there were many reforms resulting in an increase in crude oil production in the recent past. There is a controversy on the importance of oil production in the development of the manufacturing sector in Nigeria. Some scholars claim that oil has been a blessing to the development of the manufacturing sector, while others regard it as a curse. The objective of the study is to determine if empirical analysis supports the presence of Dutch Disease and de-industrialisation in the Nigerian manufacturing sector between 2019- 2022. The study employed data that were sourced from World Development Indicators, Nigeria Bureau of Statistics, and the Central Bank of Nigeria Statistical Bulletin on manufactured exports, manufacturing employment, agricultural employment, and service employment in line with the theory of Dutch Disease using the unit root test to establish their level of stationarity, Engel and Granger cointegration test to check their long-run relationship. Autoregressive. Distributed Lagged bound test was also used. The Vector Error Correction Model will be carried out to determine the speed of adjustment of the manufacturing export and resource movement effect. The results showed that the Nigerian manufacturing industry suffered from both direct and indirect de-industrialisation over the period. The findings also revealed that there was resource movement as labour moved away from the manufacturing sector to both the oil sector and the services sector. The study concluded that there was the presence of Dutch Disease in the manufacturing industry, and the problem of de-industrialisation led to the crowding out of manufacturing output. The study recommends that efforts should be made to diversify the Nigerian economy. Furthermore, a conducive business environment should be provided to encourage more involvement of the private sector in the agriculture and manufacturing sectors of the economy.

Keywords: Dutch disease, resource movement, manufacturing sector performance, Nigeria

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Authors: J. Van der Walt, N. A. Plastow, M. Unger

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Gross and fine motor skill difficulties among children affect their ability to learn and progress in school. Research indicates that children in low socio-economic areas are at a higher risk of motor skill difficulties, while therapy resources are limited. The Hopscotch motor skill programme is a well-researched accessible in-school intervention developed by occupational and physiotherapists through complex intervention development. The development stage of the complex intervention development model firstly included a prevalence study in a low-resourced area in the West Coast of South Africa, indicating a high prevalence with significant motor skill difficulties among pre-school children at 14.5% with fine motor skill difficulties at 24.6%. A scoping review identifies motor skill interventions for pre-school children and a proposed a framework of fundamental concepts to consider when developing a motor skill intervention. a Delphi-study considered the framework and encouraged collaboration between therapists and educators to make the programme accessible, resource and cost effective, specifically geared towards a rural, low resourced area. The results from the Delphi study, together with the proposed framework from the scoping review was used to develop the Hopscotch programme, adopting a task-shifting approach. The eight-week small-group programme is facilitated by teachers with the support of therapists. The programme aims to improve the motor skills of pre-school aged children with motor skill difficulties to promote academic readiness through obstacle courses, ball skill games and fine motor games and crafts. A randomised controlled trial is planned as a next stage to determine the preliminary effect of the programme on the motor and early academic skills of pre-school children.

Keywords: accesible learning, motor skill intervention, school readiness, task shifting

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Authors: Soo-Bi Lee, Jun Young Jeong, Zehgn Lin, Chenminxi

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Background: In South Korea, a problematic phenomenon has recently arisen whereby adult children continue to receive parentalcaregivingin some cases. These phenomena has been shown to affect the mental health of mothers. Study Goals: The purposes of this study are to verify whether the mediating effects of stress on the relationship between a woman’s care burden for their adult children and depression are moderated by their satisfaction about their husbands’ sharing of the caregiving. Methodology: This study analyzed 3,053 married women with adult children using the most recent data from the “Korean Longitudinal Survey of Women & Families 7th(2018)" conducted at the national level. The analysis was conducted using the SPSS Process Macro Model 7 to verify the moderated mediating effects and subsequently confirm their significance based on the bootstrapping method. Results and Implications: (1) Stress was identified a mediating factor in the relationship between the care burden for adult children and depression; and (2) the mediating effects of stress on depression from the burden of caring for adult children are modulated by the woman's satisfaction with her husband’s sharing of the care burden. In other words, the higher the caring burden of adult children, the higher the mother's stress, which increases depression. At this time, the higher the their satisfaction with the husband's share of care in the path of mother's care burden and stress, the lower the mother's stress and, ultimately, the depression be alleviated. Conclusion: Programs that promote the mental health of married women heavily with the caring burden for their adult children, as well as those that improve social awareness regarding husbands' sharing of the care burden, should be implemented. Also, social welfare policy alternatives are needed at the national level to reduce the caring burden caused by adult children.

Keywords: married women, adult children care burden, stress, depression, satisfaction with husbands sharing of the care

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Authors: Ririt Aprilin Sumarsono

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Composite member (concrete and steel) has been widely advanced for structural utilization due to its best performance in resisting load, reducing the total weight of the structure, increasing stiffness, and other available advantages. On the other hand, the environment load such as corrosion (e.g. chloride ingress) creates significant time-dependent degradation for steel. Analysis performed in this paper is mainly considered uniform corrosion for evaluating the composite beam without examining the pit corrosion as the initial corrosion formed. Corrosion level in terms of weight loss is modified in yield stress and modulus elasticity of steel. Those two mechanical properties are utilized in this paper for observing the stresses due to corrosion attacked. As corrosion level increases, the effective width of the composite beam in the concrete section will be wider. The position of a neutral axis of composite section will indicate the composite action due to corrosion of composite beam so that numerous shear connectors provided must be reconsidered. Flexure capacity quantification provides stresses, and shear capacity calculation derives connectors needed in overcoming the shear problem for composite beam under corrosion. A model of simply supported composite beam examined in this paper under uniform corrosion where the stresses as the focus of the evaluation. Principal stress at the first stage of composite construction decline as the corrosion level incline, parallel for the second stage stress analysis where the tension region held by the steel undergoes lower capacity due to corrosion. Total stresses of the composite section for steel to be born significantly decreases particularly in the outermost fiber of tension side. Whereas, the available compression side is smaller as the corrosion level increases so that the stress occurs on the compression side shows reduction as well. As a conclusion, the increment of corrosion level will degrade both compression and tension side of stresses.

Keywords: composite beam, modulus of elasticity, stress analysis, yield strength, uniform corrosion

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Authors: Chinyere Ori Elom, Ikechukwu Ogeze Ukeje, Chukwudum Collins Umoke

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This paper aims to stimulate scholarly interest in AI, ICT and the existing (complex) systems trajectory- theory, practice, and aspirations within the African continent and to shed fresh light on the shortcomings of the higher education sector (HEs) through the prism of AI-driven Solutions for enhancing Guidance and Counseling and sound governance framework (SGF) in higher education modeling. It further seeks to investigate existing prospects yet to be realized in Nigerian universities by probing innovation neglect in the localities, exploring practices in the global ICT spaces neglected by Nigeria universities’ governance regimes (UGRs), and suggesting area applicability, sustainability and solution modeling in response to peculiar ‘wicked ICT-driven problems’ and or issues facing the continent as well as other universities in emerging societies. This study will adopt a mixed-method approach to collect both qualitative and quantitative data. This paper argues that it will command great relevance in the local and global university system by developing ICT relevance sustainability policy initiatives (SPIs) powered by a multi-stakeholder engagement governance model (MSEGm) that is sufficiently dynamic, eclectic and innovative to surmount complex and constantly rising challenges of the modern-developing world. Hence, it will consider diverse actors both as producers and users alike as victims and beneficiaries of common concerns in the ICT world; thereby providing pathways on how AI’s integration into education governance can significantly reduce counseling gaps, ensuring more students are attended to especially when human counselors are unavailable.

Keywords: AI-counseling solution, stakeholder engagement, university governance, higher education

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Authors: T. Goldstein, E. Serok, J. D. Kark

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Background and Aim: The prevalence of obesity is increasing worldwide and in Israel. To meet this challenge, our study tests a new educational approach through a controlled school-based trial to achieve an improvement in eating habits, aerobic activity, and reduced obesity in Grades 2-3. Methods and Design: A cluster randomized controlled trial allocated 4 elementary schools (3rd and 2nd-grade classes each) to intervention or control groups. This allocation was switched with the next cohort of children. Recruitment was in first grade, randomization at the beginning of second grade, evaluation of results at the end of second grade and the beginning of third grade — intervention: 5 joint parent-children classroom activities on health topics and 5 educational workshops for parents only. Alfred Adler's concepts were guiding principles. Subjects: Of 743 children in 23-second grade classes, parents provided informed consent for 508 (68%). Information of retention health habits continued for third grade. Additional parental approvals were required. Parents provided informed consent for third-grade follow-up for 432. Results: At the end of 2nd grade, the amount of aerobic activity increased in the intervention group in comparison with the control group, the difference being marginally statistically significant (p=0.061). There is a significant difference between the groups in the percentage of "no activity being done" reported at the end of second grade when in the experimental group, the percentage is lower than the control. There are differences between genders in the percentage of aerobic activity at the end of second grade (p=0.044) and in the third grade (p < 0.0001). Height increased significantly (p=0.030 ), and waist circumference declined significantly (p=0.021) in the intervention compared with the control group. There were no significant between-group differences in BMI and weight. Conclusion: There were encouraging changes in aerobic activity and in anthropometric measurements. To maintain changes over longer periods, refreshing these nutrition and activity themes annually in school using the model is required.

Keywords: aerobic activity, child obesity, Alfred Adler, schoolchildren

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Authors: Enes Yasa, Guven Fidan

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Building Simulation tools need to better evaluate convective heat exchanges between external air and wall surfaces. Previous analysis demonstrated the significant effects of convective heat transfer coefficient values on the room energy balance. Some authors have pointed out that large discrepancies observed between widely used building thermal models can be attributed to the different correlations used to calculate or impose the value of the convective heat transfer coefficients. Moreover, numerous researchers have made sensitivity calculations and proved that the choice of Convective Heat Transfer Coefficient values can lead to differences from 20% to 40% of energy demands. The thermal losses to the ambient from a building surface or a roof mounted solar collector represent an important portion of the overall energy balance and depend heavily on the wind induced convection. In an effort to help designers make better use of the available correlations in the literature for the external convection coefficients due to the wind, a critical discussion and a suitable tabulation is presented, on the basis of algebraic form of the coefficients and their dependence upon characteristic length and wind direction, in addition to wind speed. Many research works have been conducted since early eighties focused on the convection heat transfer problems inside buildings. In this context, a Computational Fluid Dynamics (CFD) program has been used to predict external convective heat transfer coefficients at external building surfaces. For the building facades model, effects of wind speed and temperature differences between the surfaces and the external air have been analyzed, showing different heat transfer conditions and coefficients. In order to provide further information on external convective heat transfer coefficients, a numerical work is presented in this paper, using a Computational Fluid Dynamics (CFD) commercial package (CFX) to predict convective heat transfer coefficients at external building surface.

Keywords: CFD in buildings, external convective heat transfer coefficients, building facades, thermal modelling

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Authors: Abolfazl Zaraki, Yoshikatsu Hayashi, Harry Thorpe, Vincent Strong, Gisle-Andre Larsen, William Holderbaum

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Thanks to the high maneuverability of the cable-driven hyper-redundant manipulators (HRMs), this class of robots has shown a superior capability in highly confined and unstructured space applications. Although the large number of degrees of freedom (DOF) of HRMs enhances the motion flexibility and the robot’s reachability range, it highly increases the complexity of the kinematic configuration which makes the kinematic control problem very challenging or even impossible to solve. This paper presents our current progress achieved on the development of a kinematic-based leader-follower control system which is designed to control not only the robot’s body posture but also to control the trajectory of the robot’s movement in a semi-autonomous manner (the human operator is retained in the robot’s control loop). To obtain the forward kinematic model, the coordinate frames are established by the classical Denavit–Hartenburg (D-H) convention for a hyper-redundant serial manipulator which has a controlled cables-driven mechanism. To solve the inverse kinematics of the robot, unlike the conventional methods, a leader-follower mechanism, based on the sequential inverse kinematic, is followed. Using this mechanism, the inverse kinematic problem is solved for all sequential joints starting from the head joint to the base joint of the robot. To verify the kinematic design and simulate the robot motion, the MATLAB robotic toolbox is used. The simulation result demonstrated the promising capability of the proposed leader-follower control system in controlling the robot motion and trajectory in our confined space application.

Keywords: hyper-redundant robots, kinematic analysis, semi-autonomous control, serial manipulators

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Authors: Rong-Yang Lai, Jia-Yu Wu, Chih-Han Chang, Yung-Chung Chen

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The dental bridge is one of the clinical methods of the treatment for missing teeth. The dental bridge is generally designed for two layers, containing the inner layer of the framework(zirconia) and the outer layer of the porcelain-fused to framework restorations. The design of a conventional bridge is generally based on the antagonist tooth profile so that the framework evenly indented by an equal thickness from outer contour. All-ceramic dental bridge made of zirconia have well demonstrated remarkable potential to withstand a higher physiological occlusal load in posterior region, but it was found that there is still the risk of all-ceramic bridge failure in five years. Thus, how to reduce the incidence of failure is still a problem to be solved. Therefore, the objective of this study is to develop mechanical designs for all-ceramic dental bridges framework by reducing the stress and enhancing fracture resistance under given loading conditions by finite element method. In this study, dental design software is used to design dental bridge based on tooth CT images. After building model, Bi-directional Evolutionary Structural Optimization (BESO) Method algorithm implemented in finite element software was employed to analyze results of finite element software and determine the distribution of the materials in dental bridge; BESO searches the optimum distribution of two different materials, namely porcelain and zirconia. According to the previous calculation of the stress value of each element, when the element stress value is higher than the threshold value, the element would be replaced by the framework material; besides, the difference of maximum stress peak value is less than 0.1%, calculation is complete. After completing the design of dental bridge, the stress distribution of the whole structure is changed. BESO reduces the peak values of principle stress of 10% in outer-layer porcelain and avoids producing tensile stress failure.

Keywords: dental bridge, finite element analysis, framework, automatic program

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Authors: Jitendra Sharma

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Here a Homogeneous Charge is used as in a spark-ignited engine, but the charge is compressed to auto ignition as in a diesel. The main difference compared with the Spark Ignition (SI) engine is the lack of flame propagation and hence the independence from turbulence. Compared with the diesel engine. HCCI has a homogeneous charge and have no problems associated with soot and Nox but HC and CO were higher than in SI mode. It was not possible to achieve high IMEP (Indicated Mean Effective Pressure) values with HCCI. The Homogeneous charge compression ignition (HCCI) is an attractive technology because of its high efficiency and low emissions. However, HCCI lakes a direct combustion trigger making control of combustion timing challenging, especially during transients. To aid in HCCI engine control we present a simple model of the HCCI combustion process valid over a range of intake pressures, intake temperatures, equivalence ratios and engine speeds. HCCI a new combustion technology that may develop as an alternative to diesel engines with high efficiency and low Knox and particulate matter emissions. The homogenous charge compression ignition (HCCI) is a promising new engine technology that combines elements of the diesel and gasoline engine operating cycles. HCCI as a way to increase the efficiency of the gasoline engine. The attractive properties are increased fuel efficiency due to reduced throttling losses, increased expansion ratio and higher thermodynamic efficiency. With the advantages there are some mechanical limitations to the operation of the HCCI engine. The implementation of homogenous charge compression ignition (HCCI) to gasoline engines is constrained by many factors. The main drawback of HCCI is the absence of direct combustion timing control. Therefore all the right conditions for auto ignition have to be set before combustion starts. This paper describes the past and current research done on HCCI engine. Many research got considerable success in doing detailed modeling of HCCI combustion. This paper aims at studying the fundamentals of HCCI combustion, the strategy to control the limitation of HCCI engine.

Keywords: HCCI, diesel engine, combustion, elementary investigation

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Authors: In-Hwan Baek

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Valsartan is a potent and highly selective antagonist of the angiotensin II type 1 receptor, and is widely used for the treatment of hypertension. The aim of this study was to investigate the pharmacokinetic properties of the valsartan in dogs following oral administration of a single dose using quantitative modeling approaches. Forty beagle dogs were randomly divided into two group. Group A (n=20) was administered a single oral dose of valsartan 80 mg (Diovan® 80 mg), and group B (n=20) was administered a single oral dose of valsartan 160 mg (Diovan® 160 mg) in the morning after an overnight fast. Blood samples were collected into heparinized tubes before and at 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, 8, 12 and 24 h following oral administration. The plasma concentrations of the valsartan were determined using LC-MS/MS. Non-compartmental pharmacokinetic analyses were performed using WinNonlin Standard Edition software, and modeling approaches were performed using maximum-likelihood estimation via the expectation maximization (MLEM) algorithm with sampling using ADAPT 5 software. After a single dose of valsartan 80 mg, the mean value of maximum concentration (Cmax) was 2.68 ± 1.17 μg/mL at 1.83 ± 1.27 h. The area under the plasma concentration-versus-time curve from time zero to the last measurable concentration (AUC24h) value was 13.21 ± 6.88 μg·h/mL. After dosing with valsartan 160 mg, the mean Cmax was 4.13 ± 1.49 μg/mL at 1.80 ± 1.53 h, the AUC24h was 26.02 ± 12.07 μg·h/mL. The Cmax and AUC values increased in proportion to the increment in valsartan dose, while the pharmacokinetic parameters of elimination rate constant, half-life, apparent of total clearance, and apparent of volume of distribution were not significantly different between the doses. Valsartan pharmacokinetic analysis fits a one-compartment model with first-order absorption and elimination following a single dose of valsartan 80 mg and 160 mg. In addition, high inter-individual variability was identified in the absorption rate constant. In conclusion, valsartan displays the dose-dependent pharmacokinetics in dogs, and Subsequent quantitative modeling approaches provided detailed pharmacokinetic information of valsartan. The current findings provide useful information in dogs that will aid future development of improved formulations or fixed-dose combinations.

Keywords: dose-dependent, modeling, pharmacokinetics, valsartan

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Authors: Bibin Sagaram, Ronith Stanly, S. S. Suneesh

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Due to the dwindling supply of fuel reserves, engineers and designers now focus on fuel efficient designs for the solution of any problem; the transportation industry is not new to this kind of approach. Though the aerodynamic benefits of the dimples on a Golf-ball are known, it has never been scientifically tested on how such a design philosophy can improve the fuel efficiency of a real-life vehicle by imparting better aerodynamic performance. The main purpose of the paper is to establish the aerodynamic benefits of the Golf-ball-Inspired Dimpled Design in improving the fuel efficiency of a Super-mileage vehicle, constructed by Team Go Viridis for ‘Shell Eco Marathon Asia 2015’, and to predict the extent to which the results can be held valid for a road car. The body design was modeled in Autodesk Inventor and the Computational Fluid Dynamics (CFD) simulations were carried out using Ansys Fluent software. The aerodynamic parameters of designs (with and without the Golf-ball-Inspired Dimples) have been studied and the results are experimentally validated against those obtained from wind tunnel tests carried out on a 1:10 scaled-down 3D printed model. Test drives of the Super-mileage vehicle were carried out, under various conditions, to compare the variation in fuel efficiency with and without the Golf-ball-Inspired design. Primary investigations reveal an aerodynamic advantage of 25% for the vehicle with the Golf Ball Inspired Dimpled Design as opposed to the normal design. Initial tests conducted by ‘Mythbusters’ on Discovery Network using a modified road car has shown positive results which has motivated us to conduct such a research work using a custom-built experimental Super-Mileage vehicle. The content of the paper becomes relevant to the present Automotive and Energy industry where improving the fuel efficiency is of the top most priority.

Keywords: aerodynamics, CFD, fuel efficiency, golf ball

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

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

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

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Authors: Cuiyang Feng, Xu Tang, Yi Jin

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Coal is the most important primary energy source in China, which exerts a significant influence on the rapid economic growth. However, it makes the water resources to be a constraint on coal industry development, on account of the reverse geographical distribution between coal and water. To ease the pressure on water shortage, the ‘3 Red Lines’ water policies were announced by the Chinese government, and then ‘water for coal’ plan was added to that policies in 2013. This study utilized a structural path analysis (SPA) based on the multi-regional input-output table to quantify the virtual water flows caused by coal consumption in different stages. Results showed that the direct water input (the first stage) was the highest amount in all stages of coal consumption, accounting for approximately 30% of total virtual water content. Regional analysis demonstrated that virtual water trade alleviated the pressure on water use for coal consumption in water shortage areas, but the import of virtual water was not from the areas which are rich in water. Sectoral analysis indicated that the direct inputs from the sectors of ‘production and distribution of electric power and heat power’ and ‘Smelting and pressing of metals’ took up the major virtual water flows, while the sectors of ‘chemical industry’ and ‘manufacture of non-metallic mineral products’ importantly but indirectly consumed the water. With the population and economic growth in China, the water demand-and-supply gap in coal consumption would be more remarkable. In additional to water efficiency improvement measures, the central government should adjust the strategies of the virtual water trade to address local water scarcity issues. Water resource as the main constraints should be highly considered in coal policy to promote the sustainable development of the coal industry.

Keywords: coal consumption, multi-regional input-output model, structural path analysis, virtual water

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Authors: Luke Power, Paul O'Leary

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Research has long described the enhancement of student engagement as a fundamental aim of delivering a consistent, lifelong benefit to student success across the multitude of dimensions a quality HE (higher education) experience offers. Engagement may take many forms, with Universities and Institutes across the world attempting to define the parameters which constitutes a successful student engagement framework and implementation strategy. These efforts broadly include empowering students, encouraging involvement, and the transfer of decision-making power through a variety of methods with the goal of obtaining a meaningful partnership between students and staff. As the Republic of Ireland continues to observe an increasing population transferring directly from secondary education to HE institutions, it falls on these institutions to research and develop effective strategies which insures the growing student population have every opportunity to engage with their education, research community, and staff. This research systematically reviews SPAs (student partnership agreements) which are currently in the process of being defined, and/or have been adopted at HE institutions, worldwide. Despite the demonstrated importance of a student-staff partnership to the overall student engagement experience, there is no obvious framework or model by which to begin this process. This work will therefore provide a novel analysis of student-staff agreements which will focus on examining the factors of success common to each and builds towards a workable and applicable framework using critical review, analysis of the key words, phraseology, student involvement, and the broadly applicable HE traits and values. Following the analysis, this work proposes SPA ‘toolkit’ with input from key stakeholders such as students, staff, faculty, and alumni. The resulting implications for future research and the lessons learned from the development and implementation of the SPA will aid the systematic implementation of student-staff agreements in Ireland and beyond.

Keywords: student engagement, student partnership agreements, student-staff partnerships, higher education, systematic review, democratising students, empowering students, student unions

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Authors: Hammadi larbi, Laboratory of Rheology Transport, Treatment of the Complex Fluids University of Science, Technology Mohamed Boudiaf Oran Alegria

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The major problem with oil-based drilling muds (reverse emulsions) is their thermodynamic instability and their high tendency to coalescence over time, irreversibly leading to destabilization. Water/Oil reverse emulsion drilling Muds are highly recommended when significant depths are reached. This study aimed to contribute experimentally to the knowledge of the structure (stability) and rheological behavior of drilling mud systems based on water/crude oil inverse emulsions through the investigation of the effect of organophilic clay. The chemical composition of organophilic clay such as VG69 shows a strong presence of silicon oxide (SiO2), followed by aluminum oxide (Al2O3), so these two elements are considered to be the main constituents of organophilic clays. The study also shows that the SiO2/Al2O3 ratio is equal to 3.52, which can be explained by the high content of free silica contained in the organophile clay used. The particle size analysis of the organophilic clays showed that the size of the of the particles analysed is in the range of 30 to 80 μm, this result ensures the correct particle size quality of organophilic clays and allows these powders to be used in Drilling mud systems.The experimental data of steady-state flow measurements are analyzed in the classic way by the Herschel-Bulkley model. Microscopic observation shows that the addition of quantities of organophilic clay type VG69 less than or equal to 3 g leading to the stability of the water/oil inverse emulsions, on the other hand, for quantities greater than 3 g, the emulsions are destabilized. The results obtained also showed that adding 3 g of organophilic clay to the crude oil drilling mud improves their stability by 70%.

Keywords: drilling muds, inverse emulsions, rheological behavior, yield stress, stability, organophilic clay

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Authors: Kenichi Hirota, Jifeng Wang, Sadao Araki, Koji Endo, Hideki Yamamoto

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Zirconium (Zr) has been used as a fuel cladding tube for nuclear reactors, because of the excellent corrosion resistance and the low adsorptive material for neutron. Generally speaking, the natural resource of Zr is often containing Hf that has similar properties. The content of Hf in the Zr resources is about 2~4 wt%. In the industrial use, the content of Hf in Zr resources should be lower than the 100 ppm. However, the separation of Zr and Hf is not so easy, because of similar chemical and physical properties such as melting point, boiling point and things. Solvent extraction method has been applied for the separation of Zr and Hf from Zr natural resources. This method can separate Hf with high efficiency (Hf < 100ppm), however, it needs much amount of organic solvents for solvent extraction and the cost of its disposal treatment is high. Therefore, we attached attention for the fractional crystallization. This separation method depends on the solubility difference of Zr and Hf in the solvent. In this work, hexafluorozirconate (hafnate) (K2Zr(Hf)F6) was used as model compound. Solubility of K2ZrF6 in water showed lower than that of K2HfF6. By repeating of this treatment, it is possible to purify Zr, practically. In this case, 16-18 times of recrystallization stages were needed for its high purification. The improvement of the crystallization process was carried out in this work. Water, hydrofluoric acid (HF) and hydrofluoric acid (HF) +hydrochloric acid (HCl) mixture were chosen as solvent for dissolution of Zr and Hf. In the experiment, 10g of K2ZrF6 was added to each solvent of 100mL. Each solution was heated for 1 hour at 353K. After 1h of this operation, they were cooled down till 293K, and were held for 5 hours at 273K. Concentration of Zr or Hf was measured using ICP analysis. It was found that Hf was separated from Zr-Hf mixed compound with high efficiency, when HF-HCl solution was used for solvent of crystallization. From the comparison of the particle size of each crystal by SEM, it was confirmed that the particle diameter of the crystal showed smaller size with decreasing of Hf content. This paper concerned with purification of Zr from Zr-Hf mixture using crystallization method.

Keywords: crystallization, zirconium, hafnium, separation

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Authors: Juliet Okoli

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The removal of BTEX (Benzene, toluene, Ethylbenzene and p-Xylene) from water by orange peel and eggshell compared to GAC were investigated. The influence of various factors such as contact time, dosage and pH on BTEX removal by virgin orange peel and egg shell were accessed using the batch adsorption set-up. These were also compared to that of GAC which serves as a benchmark for this study. Further modification (preparation of Activated carbon) of these virgin low-cost adsorbents was also carried out. The batch adsorption result showed that the optimum contact time, dosage and pH for BTEX removal by virgin LCAs were 180 minutes, 0.5g and 7 and that of GAC was 30mintues, 0.2g and 7. The maximum adsorption capacity for total BTEX showed by orange peel and egg shell were 42mg/g and 59mg/g respectively while that of GAC was 864mg/g. The adsorbent preference for adsorbate were in order of X>E>T>B. A comparison of batch and column set-up showed that the batch set-up was more efficient than the column set-up. The isotherm data for the virgin LCA and GAC prove to fit the Freundlich isotherm better than the Langmuir model, which produced n values >1 in case of GAC and n< 1 in case of virgin LCAs; indicating a more appropriate adsorption of BTEX onto the GAC. The adsorption kinetics for the three studied adsorbents were described well by the pseudo-second order, suggesting chemisorption as the rate limiting step. This was further confirmed by desorption study, as low levels of BTEX (<10%) were recovered from the spent adsorbents especially for GAC (<3%). Further activation of the LCAs which was compared to the virgin LCAs, revealed that the virgin LCAs had minor higher adsorption capacity than the activated LCAs. Economic analysis revealed that the total cost required to clean-up 9,600m3 of BTEX contaminated water using LCA was just 2.8% lesser than GAC, a difference which could be considered negligible. However, this area still requires a more detailed cost-benefit analysis, and if similar conclusions are reached; a low-cost adsorbent, easy to obtain are still promising adsorbents for BTEX removal from aqueous solution; however, the GAC are still more superior to these materials.

Keywords: activated carbon, BTEX removal, low cost adsorbents, water treatment

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Authors: Joana Margarida Bôto, Belmira Neto, Vera Miguéis, Manuela Meireles, Ada Rocha

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The Mediterranean diet has been recognized as a sustainable model of living with benefits for the environment and human health. However, a complete assessment of its sustainability, encompassing all dimensions and aspects, to our best knowledge, has not yet been realized. This systematic literature review aimed to fill this gap by identifying and describing the indicators used to assess the sustainability of the Mediterranean diet, looking at several dimensions, and presenting the results from their application. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines methodology was used, and searches were conducted in PubMed, Scopus, Web of Science, and GreenFile. There were identified thirty-two articles evaluating the sustainability of the Mediterranean diet. The environmental impact was quantified in twenty-five of these studies, the nutritional quality was evaluated in seven studies, and the daily cost of the diet was assessed in twelve studies. A total of thirty-three indicators were identified and separated by four dimensions of sustainability, specifically, the environmental dimension (ten indicators, namely carbon, water, and ecological footprint), the nutritional dimension (eight indicators, namely Health score and Nutrient Rich Food Index), the economic dimension (one indicator, the dietary cost), the sociocultural dimension (six indicators – with no results). Only eight of the studies used combined indicators. The Mediterranean diet was considered in all articles as a sustainable dietary pattern with a lower impact than Western diets. The carbon footprint ranged between 0.9 and 6.88 kg CO₂/d per capita, the water footprint between 600 and 5280 m³/d per capita, and the ecological footprint between 2.8 and 53.42 m²/d per capita. The nutritional quality was high, obtaining 122 points using the Health score and 12.95 to 90.6 points using the Nutrient Rich Food Index. The cost of the Mediterranean diet did not significantly differ from other diets and varied between 3.33 and 14.42€/d per capita. A diverse approach to evaluating the sustainability of the Mediterranean diet was found.

Keywords: Mediterranean diet, sustainability, environmental indicators, nutritional indicators

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Authors: Anika Chebrolu

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Mono-targeted drugs can be of limited efficacy against complex diseases. Recently, multi-target drug design has been approached as a promising tool to fight against these challenging diseases. However, the scope of current computational approaches for multi-target drug design is limited. DeepLig presents a de-novo drug discovery platform that uses reinforcement learning to generate and optimize novel, potent, and multitargeted drug candidates against protein targets. DeepLig’s model consists of two networks in interplay: a generative network and a predictive network. The generative network, a Stack- Augmented Recurrent Neural Network, utilizes a stack memory unit to remember and recognize molecular patterns when generating novel ligands from scratch. The generative network passes each newly created ligand to the predictive network, which then uses multiple Graph Attention Networks simultaneously to forecast the average binding affinity of the generated ligand towards multiple target proteins. With each iteration, given feedback from the predictive network, the generative network learns to optimize itself to create molecules with a higher average binding affinity towards multiple proteins. DeepLig was evaluated based on its ability to generate multi-target ligands against two distinct proteins, multi-target ligands against three distinct proteins, and multi-target ligands against two distinct binding pockets on the same protein. With each test case, DeepLig was able to create a library of valid, synthetically accessible, and novel molecules with optimal and equipotent binding energies. We propose that DeepLig provides an effective approach to design multi-targeted drug therapies that can potentially show higher success rates during in-vitro trials.

Keywords: drug design, multitargeticity, de-novo, reinforcement learning

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Authors: M. S. Jouini, A. Al-Sumaiti, M. Tembely, K. Rahimov

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Characterizing rock properties of carbonate reservoirs is highly challenging because of rock heterogeneities revealed at several length scales. In the last two decades, the Digital Rock Physics (DRP) approach was implemented successfully in sandstone rocks reservoirs in order to understand rock properties behaviour at the pore scale. This approach uses 3D X-ray Microtomography images to characterize pore network and also simulate rock properties from these images. Even though, DRP is able to predict realistic rock properties results in sandstone reservoirs it is still suffering from a lack of clear workflow in carbonate rocks. The main challenge is the integration of properties simulated at different scales in order to obtain the effective rock property of core plugs. In this paper, we propose several approaches to characterize absolute permeability in some carbonate core plugs samples using multi-scale numerical simulation workflow. In this study, we propose a procedure to simulate porosity and absolute permeability of a carbonate rock sample using textures of Micro-Computed Tomography images. First, we discretize X-Ray Micro-CT image into a regular grid. Then, we use a textural parametric model to classify each cell of the grid using supervised classification. The main parameters are first and second order statistics such as mean, variance, range and autocorrelations computed from sub-bands obtained after wavelet decomposition. Furthermore, we fill permeability property in each cell using two strategies based on numerical simulation values obtained locally on subsets. Finally, we simulate numerically the effective permeability using Darcy’s law simulator. Results obtained for studied carbonate sample shows good agreement with the experimental property.

Keywords: multiscale modeling, permeability, texture, micro-tomography images

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Authors: Jerome Nyameh

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The most valuable asset in the existence of organization is the employees and their ability in maintain appreciable level of performance which support the goal of the organization and the ability to do that depend largely on the organizational culture and culture has been considered most currently as the factor that relate positively to organizational excellence and sustainable employee’s performance over the period of time An employee engagement program will not go far without first establishing the organizational culture that is required to support sustainability. This means integrating sustainability into the overall employee’s performance, with clear vision, goals and metrics. It means having strong culture and a collaborative governance structure that has been develop as a ways of doing things in the organization for decision making and resource allocation. It requires a rewards and recognition program to support and reinforce sustainability behaviors. With such a culture in place, organization will be able to develop a strategy that fully engages employees, while fully realizing the benefits of their contributions. The study investigated empirically the role of organizational culture building sustainable employee’s performance using Zenith bank PLC a model where organizational culture will build sustainable employees performance strategy for a lasting actualization of organizational was developed. In order to achieve the research objectives of (i) to assess how organizational culture can build sustainable employee’s performance (ii) to analyze the gap that exists between organizational culture and sustainable employee’s performance in the organization, a survey questionnaires of 20 items was administered to sixty respondents. The findings of this study have practical implications for organizational leaders, managers and employees, and their organizations, particularly commercial banks in Nigeria, besides offering scope for further research in the area of organizational culture and sustainable employee’s performance. It will also show a significance and positive relationship that exist between organizational culture and sustainable employee’s performance, as means of building viable organization with cultural uniqueness and excellence performance in the world of competition.

Keywords: organizational culture, sustainable employee’s performance, organizations, Zenith Bank PLC Nigeria

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Authors: Renzo Castillo, George Tsatsaronis

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High-temperature ceramic membranes for air separation represents an important option to reduce the significant efficiency drops incurred in state-of-the-art cryogenic air separation for high tonnage oxygen production required in oxyfuel power stations. This study is focused on the thermodynamic analysis of two power plant model designs: the state-of-the-art supercritical 600ᵒC hard coal plant (reference power plant Nordrhein-Westfalen) and the membrane-based oxyfuel concept implemented in this reference plant. In the latter case, the oxygen is separated through a mixed-conducting hollow fiber perovskite membrane unit in the three-end operation mode, which has been simulated under vacuum conditions on the permeate side and at high-pressure conditions on the feed side. The thermodynamic performance of each plant concept is assessed by conventional exergetic analysis, which determines location, magnitude and sources of efficiency losses, and advanced exergetic analysis, where endogenous/exogenous and avoidable/unavoidable parts of exergy destruction are calculated at the component and full process level. These calculations identify thermodynamic interdependencies among components and reveal the real potential for efficiency improvements. The endogenous and exogenous exergy destruction portions are calculated by the decomposition method, a recently developed straightforward methodology, which is suitable for complex power stations with a large number of process components. Lastly, an improvement priority ranking for relevant components, as well as suggested changes in process layouts are presented for both power stations.

Keywords: exergy, carbon capture and storage, ceramic membranes, perovskite, oxyfuel combustion

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Authors: Hichem Sebai, Mohamed Amine Jabri, Kais Rtibi, Haifa Tounsi, Lamjed Marzouki

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Artemisia campestris has been widely used in Tunisian traditional medicine for its health beneficial effects. However, the present study aims at evaluating the antiulcer effects of Artemisia campestris aqueous extract (ACAE) as well as the mechanism of action involved in such gastroprotection. In this respect, male Wistar rats were divided into seven groups: control, aspirin (ASPR), ASPR + various doses of ACAE (100, 200 and 400 mg/kg, b.w.), ASPR+ famotidine and ASPR+ caffeic acid. Animals were pre-treated with ACAE extract during 10 days. We firstly showed that aspirin administration was accompanied by an oxidative stress status assessed by an increase of malondialdehyde (MDA) level, a decrease of sulfhydryl -(SH) groups content and depletion of antioxidant enzyme activities such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx). Pre-treatment with ACAE protected against aspirin-induced gastric oxidative stress. More importantly, aspirin administration increased plasma and tissue hydrogen peroxide (H₂O₂), free iron and calcium levels while the ACAE pre-treatment reversed all aspirin-induced intracellular mediators disturbance. The results of the present study clearly indicated that AEAC gastroprotection might be related, at least in part, to its antioxidant properties as well as to various gastric mucosal defense mechanisms, including the protection of gastric sulfhydryls and an opposite effect on some intracellular mediators such as free iron, hydrogen peroxide, and calcium. However, our data confirm the use of Artemisia campestris extracts in the Tunisian traditional folk medicine for the treatment of gastrointestinal diseases.

Keywords: gastric ulcer, Artemisia campestris, oxidative stress, sulfhydryl groups, Fenton reaction, rat

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Authors: Lixin Tian, Wei Xue

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Many jobs in society go underground, such as mine mining, tunnel construction and subways, which are vital to the development of society. Once accidents occur in these places, the interruption of traditional wired communication is not conducive to the development of rescue work. In order to realize the positioning, early warning and command functions of underground personnel and improve rescue efficiency, it is necessary to develop and design an emergency ground communication system. It is easy to be subjected to narrowband interference when performing conventional underground communication. Spreading communication can be used for this problem. However, general spread spectrum methods such as direct spread communication are inefficient, so it is proposed to use parallel combined spread spectrum (PCSS) communication to improve efficiency. The PCSS communication not only has the anti-interference ability and the good concealment of the traditional spread spectrum system, but also has a relatively high frequency band utilization rate and a strong information transmission capability. So, this technology has been widely used in practice. This paper presents a PCSS communication model-multiple detection parallel combined spread spectrum (MDPCSS) communication system. In this paper, the principle of MDPCSS communication system is described, that is, the sequence at the transmitting end is processed in blocks and cyclically shifted to facilitate multiple detection at the receiving end. The block diagrams of the transmitter and receiver of the MDPCSS communication system are introduced. At the same time, the calculation formula of the system bit error rate (BER) is introduced, and the simulation and analysis of the BER of the system are completed. By comparing with the common parallel PCSS communication, we can draw a conclusion that it is indeed possible to reduce the BER and improve the system performance. Furthermore, the influence of different pseudo-code lengths selected on the system BER is simulated and analyzed, and the conclusion is that the larger the pseudo-code length is, the smaller the system error rate is.

Keywords: cyclic shift, multiple detection, parallel combined spread spectrum, PN code

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Authors: Nurunnahar Akter, Elena Kulinskaya, Nicholas Steel, Ilyas Bakbergenuly

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Although Hormone Replacement Therapy (HRT) is an effective treatment in ameliorating menopausal symptoms, it has mixed effects on different health outcomes, increasing, for instance, the risk of breast cancer. Because of this, many symptomatic women are left untreated. Untreated menopausal symptoms may result in other health issues, which eventually put an extra burden and costs to the health care system. All-cause mortality analysis may explain the net benefits and risks of the HRT therapy. However, it received far less attention in HRT studies. This study investigated the impact of HRT on all-cause mortality using electronically recorded primary care data from The Health Improvement Network (THIN) that broadly represents the female population in the United Kingdom (UK). The study entry date for this study was the record of the first HRT prescription from 1984, and patients were followed up until death or transfer to another GP practice or study end date, which was January 2017. 112,354 HRT users (cases) were matched with 245,320 non-users by age at HRT initiation and general practice (GP). The hazards of all-cause mortality associated with HRT were estimated by a parametric Weibull-Cox model adjusting for a wide range of important medical, lifestyle, and socio-demographic factors. The multilevel multiple imputation techniques were used to deal with missing data. This study found that during 32 years of follow-up, combined HRT reduced the hazard ratio (HR) of all-cause mortality by 9% (HR: 0.91; 95% Confidence Interval, 0.88-0.94) in women of age between 46 to 65 at first treatment compared to the non-users of the same age. Age-specific mortality analyses found that combined HRT decreased mortality by 13% (HR: 0.87; 95% CI, 0.82-0.92), 12% (HR: 0.88; 95% CI, 0.82-0.93), and 8% (HR: 0.92; 95% CI, 0.85-0.98), in 51 to 55, 56 to 60, and 61 to 65 age group at first treatment, respectively. There was no association between estrogen-only HRT and women’s all-cause mortality. The findings from this study may help to inform the choices of women at menopause and to further educate the clinicians and resource planners.

Keywords: hormone replacement therapy, multiple imputations, primary care data, the health improvement network (THIN)

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