Search results for: rational emotive behaviour therapy

Authors: Zahra Hamedani

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Many wonderful technological developments in recent years has opened up the possibility of using intelligent buildings for a number of important applications, ranging from minimizing resource usage as well as increasing building efficiency to maximizing comfort, adaption to inhabitants and responsiveness to environmental changes. The concept of an intelligent building refers to the highly embedded, interactive environment within which by exploiting the use of artificial intelligence provides the ability to know its configuration, anticipate the optimum dynamic response to prevailing environmental stimuli, and actuate the appropriate physical reaction to provide comfort and efficiency. This paper contains a general identification of the intelligence paradigm and its impacts on the architecture arena, that with examining the performance of artificial intelligence, a mechanism to analyze and finally for decision-making to control the environment will be described. This mechanism would be a hierarchy of the rational agents which includes decision-making, information, communication and physical layers. This multi-agent system relies upon machine learning techniques for automated discovery, prediction and decision-making. Then, the application of this mechanism regarding adaptation and responsiveness of intelligent building will be provided in two scales of environmental and user. Finally, we review the identifications of sustainability and evaluate the potentials of intelligent building systems in the creation of sustainable architecture and environment.

Keywords: artificial intelligence, intelligent building, responsiveness, adaption, sustainability

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Authors: S. Louhibi-Fasla, H. Achour, B. Amrani

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The purpose of this work is to provide some additional information to the existing data on the physical properties of AlBi with state-of-the-art first-principles method of the full potential linear augmented plane wave (FPLAPW). Additionally to the structural properties, the electronic properties have also been investigated. The dependence of the volume, the bulk modulus, the variation of the thermal expansion α, as well as the Debye temperature are successfully obtained in the whole range from 0 to 30 GPa and temperature range from 0 to 1200 K. The latter are the basis of solid-state science and industrial applications and their study is of importance to extend our knowledge on their specific behaviour when undergoing severe constraints of high pressure and high temperature environments.

Keywords: AlBi, FP-LAPW, structural properties, electronic properties

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Authors: Pierobon Enrico, Missiaggia Marta, Castelluzzo Michele, Tommasino Francesco, Ricci Leonardo, Scifoni Emanuele, Vincezo Monaco, Boscardin Maurizio, La Tessa Chiara

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Clinical outcomes collected over the past three decades have suggested that ion therapy has the potential to be a treatment modality superior to conventional radiation for several types of cancer, including recurrences, as well as for other diseases. Although the results have been encouraging, numerous treatment uncertainties remain a major obstacle to the full exploitation of particle radiotherapy. To overcome therapy uncertainties optimizing treatment outcome, the best possible radiation quality description is of paramount importance linking radiation physical dose to biological effects. Microdosimetry was developed as a tool to improve the description of radiation quality. By recording the energy deposition at the micrometric scale (the typical size of a cell nucleus), this approach takes into account the non-deterministic nature of atomic and nuclear processes and creates a direct link between the dose deposited by radiation and the biological effect induced. Microdosimeters measure the spectrum of lineal energy y, defined as the energy deposition in the detector divided by most probable track length travelled by radiation. The latter is provided by the so-called “Mean Chord Length” (MCL) approximation, and it is related to the detector geometry. To improve the characterization of the radiation field quality, we define a new quantity replacing the MCL with the actual particle track length inside the microdosimeter. In order to measure this new quantity, we propose a two-stage detector consisting of a commercial Tissue Equivalent Proportional Counter (TEPC) and 4 layers of Low Gain Avalanche Detectors (LGADs) strips. The TEPC detector records the energy deposition in a region equivalent to 2 um of tissue, while the LGADs are very suitable for particle tracking because of the thickness thinnable down to tens of micrometers and fast response to ionizing radiation. The concept of HDM has been investigated and validated with Monte Carlo simulations. Currently, a dedicated readout is under development. This two stages detector will require two different systems to join complementary information for each event: energy deposition in the TEPC and respective track length recorded by LGADs tracker. This challenge is being addressed by implementing SoC (System on Chip) technology, relying on Field Programmable Gated Arrays (FPGAs) based on the Zynq architecture. TEPC readout consists of three different signal amplification legs and is carried out thanks to 3 ADCs mounted on a FPGA board. LGADs activated strip signal is processed thanks to dedicated chips, and finally, the activated strip is stored relying again on FPGA-based solutions. In this work, we will provide a detailed description of HDM geometry and the SoC solutions that we are implementing for the readout.

Keywords: particle tracking, ion therapy, low gain avalanche diode, tissue equivalent proportional counter, microdosimetry

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Authors: Mithil Pandey, Ragunathan Bala Subramanian

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One of the major conversion technologies in the oil refinery industry is Fluid catalytic cracking (FCC) which produces the majority of the world’s gasoline. Some useful products are generated from the vacuum gas oil, heavy gas oil and residue feedstocks by the FCC unit in an oil refinery. Moreover, Zeolite catalysts (zeo-catalysts) have found widespread applications and have proved to be substantial and paradigmatic in oil refining and petrochemical processes, such as FCC because of their porous features. Several famous zeo-catalysts have been fabricated and applied in industrial processes as milestones in history, and have brought on huge changes in petrochemicals. So far, more than twenty types of zeolites have been industrially applied, and their versatile porous architectures with their essential features have contributed to affect the catalytic efficiency. This poster depicts the evolution of pore models in zeolite catalysts which are accompanied by an increase in environmental and demands. The crucial roles of modulating pore models are outlined for zeo-catalysts for the enhancement of their catalytic performances in various industrial processes. The development of industrial processes for the FCC process, aromatic conversions and olefin production, makes it obvious that the pore architecture plays a very important role in zeo-catalysis processes. By looking at the different necessities of industrial processes, rational construction of the pore model is critically essential. Besides, the pore structure of the zeolite would have a substantial and direct effect on the utilization efficiency of the zeo-catalyst.

Keywords: catalysts, fluid catalytic cracking, industrial processes, zeolite

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Authors: Pritika Ramharack, Mahmoud E. S. Soliman

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The re-emerging Zika virus is an arthropod-borne virus that has been described to have explosive potential as a worldwide pandemic. The initial transmission of the virus was through a mosquito vector, however, evolving modes of transmission has allowed the spread of the disease over continents. The virus already been linked to irreversible chronic central nervous system (CNS) conditions. The concerns of the scientific and clinical community are the consequences of Zika viral mutations, thus suggesting the urgent need for viral inhibitors. There have been large strides in vaccine development against the virus but there are still no FDA-approved drugs available. Rapid rational drug design and discovery research is fundamental in the production of potent inhibitors against the virus that will not just mask the virus, but destroy it completely. In silico drug design allows for this prompt screening of potential leads, thus decreasing the consumption of precious time and resources. This study demonstrates an optimized and proven screening technique in the discovery of two potential small molecule inhibitors of Zika virus Methyltransferase and RNA-dependent RNA polymerase. This in silico “per-residue energy decomposition pharmacophore” virtual screening approach will be critical in aiding scientists in the discovery of not only effective inhibitors of Zika viral targets, but also a wide range of anti-viral agents.

Keywords: NS5 protein inhibitors, per-residue decomposition, pharmacophore model, virtual screening, Zika virus

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Authors: Mohammad Farooq Wani

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Tribological characterization of ZrN coatings deposited on titanium modified austenitic stainless steel (alloy D-9) substrates has been investigated. The coatings were deposited in the deposition temperature range 300–873 K, using the pulsed magnetron sputtering technique. Scratch adhesion tests were carried out using Rc indenter under various conditions of load. Detailed tribological studies were conducted to understand the friction and wear behaviour of these coatings. For all tribological studies steel and ceramic balls were used as counter face material. 3D-Surface profiles of all wear tracks was carried out using 3D universal profiler.

Keywords: ZrN, Surafce coating, thin film, tribology, friction and wear

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Authors: Eun Jae Ko, In Young Sung, Eui Soo Joeng

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Cognitive impairment is commonly encountered problem in children with various clinical diseases, including Down syndrome, autism spectrum disorder, brain injury, and others. Cognitive impairment limits participation in education and society, and this further hinders development in cognition. However, young children with cognitive impairment tend not to respond well to traditional cognitive treatments, therefore alternative treatment choices are need. As a cognitive training program, touch screen technology can easily be applied to very young children by involving visual and auditory support. Injini was developed as tablet computer based cognitive rehabilitation program for young children or individuals with severe cognitive impairment, which targeted on cognitive ages of 18 to 36 months. The aim of this study was to evaluate the efficacy of a tablet computer based cognitive rehabilitation program (Injini) for children with cognitive impairment. 38 children between cognitive ages of 18 to 36 months confirmed by cognitive evaluations were recruited and randomly assigned to the intervention group (n=20) and the control group (n=18). The intervention group received tablet computer based cognitive rehabilitation program (Injini) for 30 minutes per session, twice a week, over a period of 12 weeks, in addition to the traditional rehabilitation program. The control group received traditional rehabilitation program only. Mental score of Bayley Scales of Infant Development II (BSID II), Pediatric Evaluation of Disability Inventory (PEDI), Laboratory Temperament Assessment Battery (Lab-TAB), Early Childhood Behavior Questionnaire (ECBQ), and Goal Attainment Scale (GAS) were evaluated before and after 12 weeks of therapeutic intervention. When comparing the baseline characteristics, there was no significant difference between the two groups in the measurements of cognitive function. After 12 weeks of treatment, both group showed improvements in all measurements. However, in comparison of improvements after treatment, the intervention group showed more improvements in the mental score of BSID II, social function domain of PEDI, observation domain of Lab-TAB, and GAS, as compared to the control group. Application of the tablet computer based cognitive rehabilitation program (Injini) would be beneficial for improvement of cognitive function in young children with cognitive impairment.

Keywords: cognitive therapy, computer-assisted therapy, early intervention, tablets

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Authors: O. F. Elkommos

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Teaching and learning EFL speaking modules is one of the most challenging productive modules for both instructors and learners. In a student-centered interactive communicative language teaching approach, learners and instructors should be aware of the fact that the target language must be taught as/for communication. The student must be empowered by tools that will work on more than one level of their communicative competence. Communicative learning will need a teaching and learning methodology that will address the goal. Teaching turn-taking rules, pragmatic principles and speech acts will enhance students' sociolinguistic competence, strategic competence together with discourse competence. Sociolinguistic competence entails the mastering of speech act conventions and illocutionary acts of refusing, agreeing/disagreeing; emotive acts like, thanking, apologizing, inviting, offering; directives like, ordering, requesting, advising, and hinting, among others. Strategic competence includes enlightening students’ consciousness of the various particular turn-taking systemic rules of organizing techniques of opening and closing conversation, adjacency pairs, interrupting, back-channeling, asking for/giving opinion, agreeing/disagreeing, using natural fillers for pauses, gaps, speaker select, self-select, and silence among others. Students will have the tools to manage a conversation. Students are engaged in opportunities of experiencing the natural language not as a mere extra student talking time but rather an empowerment of knowing and using the strategies. They will have the component items they need to use as well as the opportunity to communicate in the target language using topics of their interest and choice. This enhances students' communicative abilities. Available websites and textbooks now use one or more of these tools of turn-taking or pragmatics. These will be students' support in self-study in their independent learning study hours. This will be their reinforcement practice on e-Learning interactive activities. The students' target is to be able to communicate the intended meaning to an addressee that is in turn able to infer that intended meaning. The combination of these tools will be assertive and encouraging to the student to beat the struggle with what to say, how to say it, and when to say it. Teaching the rules, principles and techniques is an act of awareness raising method engaging students in activities that will lead to their pragmatic discourse competence. The aim of the paper is to show how the suggested pragmatic model will empower students with tools and systems that would support their learning. Supporting students with turn taking rules, speech act theory, applying both to texts and practical analysis and using it in speaking classes empowers students’ pragmatic discourse competence and assists them to understand language and its context. They become more spontaneous and ready to learn the discourse pragmatic dimension of the speaking techniques and suitable content. Students showed a better performance and a good motivation to learn. The model is therefore suggested for speaking modules in EFL classes.

Keywords: communicative competence, EFL, empowering learners, enhance learning, speech acts, teaching speaking, turn taking, learner centred, pragmatics

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Authors: E. Kilicay, Z. Karahaliloglu, B. Hazer, E. B. Denkbas

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In this study, we have prepared concanavaline A (ConA) functionalized curcumin (CUR) loaded PHBHHx (poly(3-hydroxybutyrate-co-3-hydroxyhexanoate)) nanoparticles as a novel and efficient drug delivery system. CUR is a promising anticancer agent for various cancer types. The aim of this study was to evaluate therapeutic potential of curcumin loaded PHBHHx nanoparticles (CUR-NPs) and concanavaline A conjugated curcumin loaded NPs (ConA-CUR NPs) for ovarian cancer treatment. ConA was covalently connected to the carboxylic group of nanoparticles by EDC/NHS activation method. In the ligand attachment experiment, the binding capacity of ConA on the surface of NPs was found about 90%. Scanning electron microscopy (SEM) and atomic force microscopy (AFM) analysis showed that the prepared nanoparticles were smooth and spherical in shape. The size and zeta potential of prepared NPs were about 228±5 nm and −21.3 mV respectively. ConA-CUR NPs were characterized by FT-IR spectroscopy which confirmed the existence of CUR and ConA in the nanoparticles. The entrapment and loading efficiencies of different polymer/drug weight ratios, 1/0.125 PHBHHx/CUR= 1.25CUR-NPs; 1/0.25 PHBHHx/CUR= 2.5CUR-NPs; 1/0.5 PHBHHx/CUR= 5CUR-NPs, ConA-1.25CUR NPs, ConA-2.5CUR NPs and ConA-5CUR NPs were found to be ≈ 68%-16.8%; 55%-17.7 %; 45%-33.6%; 70%-15.7%; 60%-17%; 51%-30.2% respectively. In vitro drug release showed that the sustained release of curcumin was observed from CUR-NPs and ConA-CUR NPs over a period of 19 days. After binding of ConA, the release rate was slightly increased due to the migration of curcumin to the surface of the nanoparticles and the matrix integrities was decreased because of the conjugation reaction. This functionalized nanoparticles demonstrated high drug loading capacity, sustained drug release profile, and high and long term anticancer efficacy in human cancer cell lines. Anticancer activity of ConA-CUR NPs was proved by MTT assay and reconfirmed by apoptosis and necrosis assay. The anticancer activity of ConA-CUR NPs was measured in ovarian cancer cells (SKOV-3) and the results revealed that the ConA-CUR NPs had better tumor cells decline activity than free curcumin. The nacked nanoparticles have no cytotoxicity against human ovarian carcinoma cells. Thus the developed functionalized nanoformulation could be a promising candidate in cancer therapy.

Keywords: curcumin, curcumin-PHBHHx nanoparticles, concanavalin A, concanavalin A-curcumin PHBHHx nanoparticles, PHBHHx nanoparticles, ovarian cancer cell

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Authors: Les Moncrieff

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In a world awash with potent opioids flaming an international crisis, the need to explore safe alternatives has never been more urgent. Bio-electrode Therapy is a novel adjunctive treatment method for relieving acute opioid withdrawal symptoms and many types of complex acute and chronic pain (often the underlying cause of opioid dependence). By combining the science of developmental bioelectricity with Traditional Chinese Medicine’s theory of meridians, rapid relief from pain is routinely being achieved in the clinical setting. Human body functions are dependent on electrical factors, and acupuncture points on the body are known to have higher electrical conductivity than surrounding skin tissue. When tiny gold- and silver-plated electrodes are secured to the skin at specific acupuncture points using established Chinese Medicine principles and protocols, an enhanced microcurrent and electrical field are created between the electrodes, influencing the entire meridian and connecting meridians. No external power source or electrical devices are required. Endogenous DC electric fields are an essential fundamental component for development, regeneration, and wound healing. Disruptions in the normal ion-charge in the meridians and circulation of blood will manifest as pain and development of disease. With the application of these simple electrodes (gold acting as cathode and silver as anode) according to protocols, the resulting microcurrent is directed along the selected meridians to target injured or diseased organs and tissues. When injured or diseased cells have been stimulated by the microcurrent and electrical fields, the permeability of the cell membrane is affected, resulting in an immediate relief of pain, a rapid balancing of positive and negative ions (sodium, potassium, etc.) in the cells, the restoration of intracellular fluid levels, replenishment of electrolyte levels, pH balance, removal of toxins, and a re-establishment of homeostasis.

Keywords: bioelectricity, electrodes, electrical fields, acupuncture meridians, complex pain, opioid withdrawal management

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Authors: Seyed Reza Alvani, Norzarina Mohd Zaharim

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Diabetes mellitus is one of the chronic, progressive illnesses that has reached a widespread level all over the world and considered an extreme life-threatening condition in South East Asian countries region include Malaysia. Co-morbid psychological factors like diabetes-related distress and low level of psychological well-being are related to high levels of blood sugar and hypo/hyperglycemia complications. As a result, the implementation of any effective psychological interventions among diabetes patients is necessary. One such intervention is cognitive behavioural therapy (CBT) that is approved and suggested by many professionals as an empirically-supported technique of treatment for people how are suffering from diabetes around the world where there is no clear evidence of using this technique in Malaysia. The target of this study was to see whether or not participation in group CBT would end in an improvement of psychological well-being (by decreasing the levels of depression and anxiety) and diabetes-related distress followed by lower level of blood sugar level. The sample of the present study was 60 type 2 diabetes adults (ages 20-65) with HbA1c ≥ 7 from Universiti Sains Malaysia (USM) clinic. All participants were selected by the convenience sampling technique. Participants completed Well-Being Questionaire (W-BQ) and Distress Scale (DDS-17) after signing written consent form. Those participants who were interested to join CBT groups were placed to the experimental groups, and people who were not interested were assigned to the control group. The experimental groups (n = 30) received group CBT, whereas participants in the control group (n = 30) did not receive any kind of psychological intervention. For testing the effect of intervention, mixed between-within ANOVA used. The entire intervention program took three months, and a significant improvement in the level of psychological well-being and decline in the level of diabetes distress observed among participants from experimental group, but not for those in the control group. Additionally, the result of the study suggested that group CBT could help participants in experimental group achieve more acceptable HbA1c levels in comparison with those in the control group. Malaysian Ministry of Health, researcher and governors should give due interest and commitment to psychological care as a pathway to diabetes mitigation among Malaysian adults.

Keywords: cognitive behavioral therapy, diabetes related distress, diabetes type 2, Malaysia, well-being

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Authors: G. Kontochristopoulos, T. Spiliopoulos, V. Markantoni, E. Platsidaki, A. Kouris, E. Balamoti, C. Bokotas, G. Haidemenos

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Introduction: There is a high patient demand for periorbital rejuvenation since the facial area is often the first to show visible signs of aging. With advancing age, there are sometimes marked changes that occur in the skin, fat, muscle and bone of the periorbital region, resulting to wrinkles and skin laxity. These changes are among the easiest areas to correct using several minimally invasive techniques, which have become increasingly popular over the last decade. Lasers, radiofrequency, botulinum toxin, fat grafting and fillers are available treatments sometimes in combination to traditional blepharoplasty. This study attempts to show the benefits of a minimally invasive approach to periorbital wrinkles and skin laxity that combine microneedling and 10% trichloroacetic acid (TCA) peels. Method: Eleven female patients aged 34-72 enrolled in the study. They all gave informed consent after receiving detailed information regarding the treatment procedure. Exclusion criteria in the study were previous treatment for the same condition in the past six months, pregnancy, allergy or hypersensitivity to the components, infection, inflammation and photosensitivity on the affected region. All patients had diffuse periorbital wrinkles and mild to moderate upper or lower eyelid skin laxity. They were treated with Automatic Microneedle Therapy System-Handhold and topical application of 10% trichloroacetic acid solution to each periorbital area for five minutes. Needling at a 0,25 mm depth was performed in both latelar (x-y) directions. Subsequently, the peeling agent was applied to each periorbital area for five minutes. Patients were subjected to the above combination every two weeks for a series of four treatments. Subsequently they were followed up regularly every month for two months. The effect was photo-documented. A Physician's and a Patient's Global Assessment Scale was used to evaluate the efficacy of the treatment (0-25% indicated poor response, 25%-50% fair, 50%-75% good and 75%-100% excellent response). Safety was assessed by monitoring early and delayed adverse events. Results: At the end of the study, almost all patients demonstrated significant aesthetic improvement. Physicians assessed a fair and a good improvement in 9(81.8% of patients) and 2(18.1% of patients) participants respectively. Patients Global Assessment rated a fair and a good response in 6 (54.5%) and 5 (45.4%) participants respectively. The procedure was well tolerated and all patients were satisfied. Mild discomfort and transient erythema were quite common during or immediately after the procedure, however only temporary. During the monthly follow up, no complications or scars were observed. Conclusions: Microneedling is known as a simple, office–based collagen induction therapy. Low concentration TCA solution applied to the epidermis that has been more permeable by microneedling, can reach the dermis more effectively. In the present study, chemical peels with 10% TCA acted as an adjuvant to microneedling, as it causes controlled skin damage, promoting regeneration and rejuvenation of tissues. This combined therapy improved periorbital fine lines, wrinkles, and overall appearance of the skin. Thus it constitutes an alternative treatment of periorbital skin aging, with encouraging results and minor side-effects.

Keywords: chemical peels, microneedling, periorbital wrinkles, skin laxity

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Authors: H. K. Bonsu-Owu

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Media portrayal of women in traditional stereotypical roles such as mothers, or seductress has been the norm for years. However, the changing socioeconomic and political environment and advancement of women in today’s society have given rise to questions on the appropriate portrayal of women in the media today. The purpose of the study is to analyze the portrayal of women in Ghanaian newspapers and find women’s perception on the issue. The study uses a three step approach in gathering data for analysis. Using the stratified sampling method, it analyzes front page images of women from 210 issues of the selected newspapers. Further, it administers questionnaires to 100 female students to find out how they relate to the images of women in the selected newspapers. Finally, editors of the newspapers are interviewed to find their rational for portraying women as seen on their front pages. The findings suggest that the newspapers portray women for varied reasons such as promoting sales and influencing the public agenda. Further, the female students claim that in spite of women’s vast contribution to the growth of society, the media continue to marginalize them. They add that such portrayals promote and reinforce social construct, however, refuse to see themselves through the male gaze concept. The study concludes that the stereotyped portrayal of women is likely to continue if the government, regulatory bodies, the media and society do not make a conscious effort to address this problem.

Keywords: women, newspaper, portrayal, social construct

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Authors: Guna Raj Dhungana, Roshan Nepal, Apshara Parajuli, , Archana Maharjan, Shyam K. Mishra, Pramod Aryal, Rajani Malla

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Introduction: Klebsiella pneumoniae is a well-known opportunistic human pathogen, primarily causing healthcare-associated infections. The global emergence of carbapenemase-producing K. pneumoniaeis a major public health burden, which is often extensively multidrug resistant.Thus, because of the difficulty to treat these ‘superbug’ and menace and some term as ‘apocalypse’ of post antibiotics era, an alternative approach to controlling this pathogen is prudent and one of the approaches is phage mediated control and/or treatment. Objective: In this study, we aimed to isolate novel bacteriophage against carbapenemase-producing K. pneumoniaeand characterize for potential use inphage therapy. Material and Methods: Twenty lytic phages were isolated from river water using double layer agar assay and purified. Biological features, physiochemical characters, burst size, host specificity and activity spectrum of phages were determined. One most potent phage: Phage TU_Kle10O was selected and characterized by electron microscopy. Whole genome sequences of the phage were analyzed for presence/absence of virulent factors, and other lysin genes. Results: Novel phage TU_Kle10O showed multiple host range within own genus and did not induce any BIM up to 5th generation of host’s life cycle. Electron microscopy confirmed that the phage was tailed and belonged to Caudovirales family. Next generation sequencing revealed its genome to be 166.2 Kb. bioinformatical analysis further confirmed that the phage genome ‘did not’ contain any ‘bacterial genes’ within phage genome, which ruled out the concern for transfer of virulent genes. Specific 'lysin’ enzyme was identified phages which could be used as 'antibiotics'. Conclusion: Extensively multidrug resistant bacteria like carbapenemase-producing K. pneumoniaecould be treated efficiently by phages.Absence of ‘virulent’ genes of bacterial origin and presence of lysin proteins within phage genome makes phages an excellent candidate for therapeutics.

Keywords: bacteriophage, Klebsiella pneumoniae, MDR, phage therapy, carbapenemase,

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Authors: Santony Santony, Teguh Rahayu Sartono, Iin Noor Chozin

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Introduction: Pneumonia is acute inflammation on lung parenchyma which is caused by bacteria, virus, fungi, or parasite. In Indonesia, Pneumonia is among the ten inpatient cases. Length of stay is related to the increased morbidity rate, nosocomial infection, and costs. The aim of this study is to assess the effect of pulmonary rehabilitation on the difference in length of stay and the level of Interleukin 6 (IL-6) as an inflammation biomarker for community-acquired pneumonia (CAP) patients in non-intensive rooms. Therefore, pulmonary rehabilitation as adjunctive therapy can be routinely exercised in order to shorten the length of stay, along with the decrease in IL-6 level. Methods: This study was conducted from May to October 2019 at Saiful Anwar General Hospital, Malang. 40 community-acquired pneumonia patients in non-intensive rooms were divided into two groups. 20 patients in the treatment group and 20 patients in the control group, all of them were selected through both inclusion and exclusion criteria. This study used simple consecutive random sampling. In the treatment group, pulmonary rehabilitation performed was composed of breathing exercise, effective coughing technique, clapping (percussion), postural drainage, as well as respiratory muscle training using incentive spirometry device. Pulmonary rehabilitation was conducted twice over five days with a minimum duration of 15 minutes. Blood samples were taken both on the first and the fifth day of the treatment to measure IL-6 level as an inflammation biomarker. Result: For the treatment group, the length of stay was 5.35 days whereas the control group 7.6 days. It can be seen that the treatment group had a shorter length of stay by 2.25 days (P<0,001). The IL-6 level on the first day for the treatment group was 36.27 pg/ml, whereas on the fifth day was 34.36 pg/ml. There was a decrease in IL-6 level on the fifth day of treatment even though it was not statistically significant (P=0.628). IL-6 level on the control group for the first day was 67.76 pg/ml, and after the fifth day, the level decreased to 54.43 pg/ml. There seemed to be a decrease in the IL-6, but it was not statistically significant (P=0.502). On the fifth day, the treatment group showed an average IL-6 level of 34.36 pg/ml. This value was lower than that of the control group which did not receive pulmonary rehabilitation having an IL-6 level of 54.43 pg/ml, even though it was not statistically significant (p=0.221). Conclusion: This study concluded that pulmonary rehabilitation as an adjunctive therapy shortened length of stay by 2.25 days for community-acquired pneumonia patients in a non-intensive room. Both groups experienced a decrease in IL-6 level on the fifth day in comparison with the first day even though it was not statistically significant P>0,05. IL-6 level as an inflammation biomarker decreased on the fifth day of treatment which was in accordance with improvement on pneumonia patients.

Keywords: community-acquired pneumonia, interleukin-6, length of stay, pulmonary rehabilitation

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Authors: Rute Martins, Margarida Mascarenhas, Elsa Pereira

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The importance between sport and the natural environment was researched through a systematic literature in order to analyse the available scientific articles on the association of sport -angling also the physical activity, active leisure and recreation- and environmental behaviour. The collected data were gathered within the last five years (from 2013 to April 2018) in the Scopus, Web of Science, ScienceDirect, Sage, Green Leaf Online Library, GreenFile (EBSCO) and Wiley online Library databases. The content analysis based on the qualitative methods employed in this study was made with Nvivo software. Regarding only the inclusion of scientific articles, more than half of the collected papers highlighted tourism as the main area where sports is being researched with regard to the environmental theme. Thus, it is possible to extract a perspective of the orientations of the ecological concerns in the sports tourism industry. As such, in the winter sports, the climate change is already an identified issue, wondering about the impact of the environment on the sports practice. In this context, there is a focus on the possible adaptative strategies, researching the characteristics of the sports tourist and the winter sports industry. Regarding the natural parks and protected areas (such as reefs), most of the research is on the environmental impact of the sports tourism, choosing the conservation and the protection of nature as the core topics. The research of the sports tourist profile is addressed by many articles, where the motives for practice and the environmental values are being scanned, and relations to the recreation specialization, environmental responsibility, environmental education, and place-attachment concepts are being made. Regarding the sustainable management, the sports tourism study area is approaching the research in a more holistic way; exploring the stakeholder’s interconnection, focusing on landscape planning and environmentally sustainable practices of sport tourism organizations. The natural parks, protected areas, coral reefs, and snow areas serve as the preferred case-studies for investigating the environmental impact and the ecotourism, in particular, studied through hiking and diving in the great majority. The results of the study are a valuable resource to understand the importance of the sports tourism in the environmental and sustainable action along with the need of embracing all stakeholders within the relationship between the sport and the natural environment.

Keywords: ecotourism, environmental behaviour, outdoor recreation, sport tourism

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Authors: Likewin Thomas, M. V. Manoj Kumar, B. Annappa

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The aim of this study was to develop an Artificial Neural Network0 s recommendation model for an online process using the complexity of load, performance, and average servicing time of the resources. Here, the proposed model investigates the resource performance using stochastic gradient decent method for learning ranking function. A probabilistic cost function is implemented to identify the optimal θ values (load) on each resource. Based on this result the recommendation of resource suitable for performing the currently executing task is made. The test result of CoSeLoG project is presented with an accuracy of 72.856%.

Keywords: ADALINE, neural network, gradient decent, process mining, resource behaviour, polynomial regression model

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Authors: Safiah Ahmed Yahya Madkhali

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The aim of the present paper is to provide a characterization of the expression of comparison in the language of the Qur’an, the language of the Divine Book of the Muslim nation. It focuses on quantitative as well as qualitative comparisons. While works on comparison constructions in Arabic focus on a type(s) of the comparison construction and exclude another and investigate its behaviour in Standard Arabic, the paper aims to be inclusive of the varied instances that are scalar comparison constructions and describe its aspects in the language of the Qur’an. To the best of my knowledge, comparative constructions in the language of the Qur’an has not been tackled before and hence the characterization provided in the paper would be the contribution of the present work. The paper highlights the several rhetorical features of the construction as present in the different verses in the Qur’an which set them distinct from the ordinary use of the construction in the different verities of the Arabic language.

Keywords: comparison constructions, inequality, comparative, superlative, equality

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Authors: Akbar Haghzadeh Saraskanroud, Amir Hossein Yahyavi Zanjani, Niloofar Kargar, Hanieh Ahrabi

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Cervical cancer refers to an unusual growth of cells in the cervix. The cervix is the lower part of the uterus, which connects to the vagina. Various risk factors such as human papillomavirus (HPV), having a weakened immune system, smoking or breathing in secondhand smoke, reproductive factors, and obesity play important roles in causing most cervical cancers. When cervical cancer happens, surgery is often the first treatment option to remove it. Other treatments might include chemotherapy and targeted therapy medicines. Radiation therapy with high-energy photon beams also may be used. Sometimes combined treatment, including radiation with low-dose chemotherapy, was applied. Intracavitary brachytherapy is an integral part of radiotherapy for locally advanced gynecologic malignancies such as cervical cancer. In the treatment of cervical cancer, there are different tools for doing brachytherapy. Two combinations of different applicators for this purpose are Tandem and Ovoid and Tandem and Ring. This study evaluated the dose differences between these two methods in the organs at risk of the rectum, sigmoid, and bladder. In this study, the treatment planswere simulated by the Oncentra treatment planning system and Tandem, Ovid, and Rings of different sizes. CT scan images of 23 patients were treated with HDR_BT Elekta Flexitron system were used for this study. Contouring of HR-CTV, rectum and bladder was performed for all patients. Then, the received dose of 0.1 and 0.2cc volumes of organs at risk were obtained and compared for these two methods: T-Ovoid and T-Ring. By doing investigations and dose measurements of points A and B and the volumes specified by ICRU, it seems that when comparing ring and ovoid to tandem and ovoid, the total dose to the rectum was lower by about 11%, and the bladder was 7%. In the case of HR CTV, this comparison showed that this ratio is about 7% better. Figure 1 shows the amount of decrease in rectum dose in the T-Ring method compared to T-Ovoid. Figure 2 indicates the amount of decrease in bladder dose in the T-Ring method compared to T-Ovoid. Finally, figure 3 illustrates the amount of HR-CTV coverage in the T-Ring method compared to the T-Ovoid.

Keywords: cervical cancer, brachytherapy, rectum, tandem and ovoid, tandem and ring.

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Authors: Amin Behradfar

Abstract:

‎Tourism has a direct impact on the national revenue for all touristic countries. It creates work opportunities‎, ‎industries‎, ‎and several investments to serve and raise nations performance and cultures. ‎This paper is devoted to analyze dynamical behaviour of a four-dimensional non-linear tourism-based social-ecological system by using the codimension two bifurcation theory‎. ‎In fact we investigate the cusp bifurcation of that‎. ‎Implications of our mathematical results to the tourism‎ ‎industry are discussed‎. Moreover, profitability‎, ‎compatibility and sustainability of the tourism system are shown by the aid of cusp bifurcation and numerical techniques‎.

Keywords: tourism-based social-ecological dynamical systems, cusp bifurcation, center manifold theory, profitability, ‎compatibility, sustainability

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Authors: Daniel Osorio, Andreas Klenk, Stefan Weihe, Andreas Kopp, Frank Rödiger

Abstract:

Future power plants currently face high design requirements due to worsening climate change and environmental restrictions, which demand high operational flexibility, superior thermal performance, minimal emissions, and higher cyclic capability. The aim of the paper is, therefore, to investigate the creep and thermo-mechanical material behavior of improved materials experimentally and welded joints at component scale under near-to-service operating conditions, which are promising for application in highly efficient and flexible future power plants. These materials promise an increase in flexibility and a reduction in manufacturing costs by providing enhanced creep strength and, therefore, the possibility for wall thickness reduction. At the temperature range between 550°C and 625°C, the investigation focuses on the in-phase thermo-mechanical fatigue behavior of dissimilar welded joints of conventional materials (ferritic and martensitic material T24 and T92) to nickel-based alloys (A617B and HR6W) by means of membrane test panels. The temperature and external load are varied in phase during the test, while the internal pressure remains constant. At the temperature range between 650°C and 750°C, it focuses on the creep behavior under multiaxial stress loading of similar and dissimilar welded joints of high temperature resistant nickel-based alloys (A740H, A617B, and HR6W) by means of a thick-walled-component test. In this case, the temperature, the external axial load, and the internal pressure remain constant during testing. Numerical simulations are used for the estimation of the axial component load in order to induce a meaningful damage evolution without causing a total component failure. Metallographic investigations after testing will provide support for understanding the damage mechanism and the influence of the thermo-mechanical load and multiaxiality on the microstructure change and on the creep and TMF- strength.

Keywords: creep, creep-fatigue, component behaviour, weld joints, high temperature material behaviour, nickel-alloys, high temperature resistant steels

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Authors: Dalia Perkumiene

Abstract:

The process of globalization has several unforeseen negative effects on the quality of the environment, including increased pollution, climate change, and the depletion and destruction of natural resources. The impact of these processes makes it difficult to guarantee citizens' rights to a clean environment, and complex legal solutions are needed to implement this right. In order to implement human rights in a clean and safe environment, international legal documents and court rulings are analyzed. It is important to find a balance between the legal context: the right to a clean environment and environmental challenges such as climate change and global warming. Research Methods: The following methods were used in this study: analytical, analysis, and synthesis of scientific literature and legal documents, comparative analysis of legal acts, and generalization. Major Findings: It is difficult to implement the right to a clean, safe and sustainable environment. The successful implementation of this right depends on the application of various complex ideas and rational, not only legal solutions. Legislative measures aim to maximize the implementation of citizens' rights in the face of climate change and other environmental challenges. This area remains problematic, especially in international law. Concluding Statement: The right to a clean environment should allow a person to live in a harmonious system, where environmental factors do not pose a risk to human health and well-being.

Keywords: clean and safe and clean environmen, environmen, persons’ rights, right to a clean and safe and clean environment

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Authors: H.C. Chen, S. W. C. Chan, K. Cheng, A. Vathsala, H. K. Sran, H. He

Abstract:

Background: End-stage renal disease (ESRD) is the last stage of chronic kidney disease. The numbers of patients with ESRD have increased worldwide due to the growing number of aging, diabetes and hypertension populations. Patients with ESRD suffer from physical illness and psychological distress due to complex treatment regimens, which often affect the patients’ social and psychological functioning. As a result, the patients may fail to perform daily self-care and self-management, and consequently experience worsening conditions. Aims: The study aims to examine the effectiveness of a self-efficacy psychoeducational programme on primary outcome (self-efficacy) and secondary outcomes (psychological wellbeing, treatment adherence, and quality of life) in patients with ESRD and haemodialysis in Singapore. Methodology: A randomised controlled, two-group pretest and repeated posttests design will be carried out. A total of 154 participants (n=154) will be recruited. The participants in the control group will receive a routine treatment. The participants in the intervention group will receive a self-efficacy psychoeducational programme in addition to the routine treatment. The programme is a two-session of educational intervention in a week. A booklet, two consecutive sessions of face-to-face individual education, and an abdominal breathing exercise are adopted in the programme. Outcome measurements include Dialysis Specific Self-efficacy Scale, Kidney Disease Quality of Life- 36 Hospital Anxiety and Depression Scale, Renal Adherence Attitudes Questionnaire and Renal Adherence Behaviour Questionnaire. The questionnaires will be used to measure at baseline, 1- and 3- and 6-month follow-up periods. Process evaluation will be conducted with a semi-structured face to face interview. Quantitative data will be analysed using SPSS21.0 software. Qualitative data will be analysed by content analysis. Significance of the study: This study will identify a clinically useful and potentially effective approach to help patients with end-stage renal disease and haemodialysis by enhancing their self-efficacy in self-care behaviour, and therefore improving their psychological wellbeing, treatment adherence and quality of life. This study will provide information to develop clinical guidelines to improve patients’ disease self-management and to enhance health-related outcomes. Hopefully it will help reducing disease burden.

Keywords: end-stage renal disease (ESRD), haemodialysis, psychoeducation, self-efficacy

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Authors: R. Dimitri Halley

Abstract:

The research within Jungian Psychology presented here is on the wave state of Self. What has been discovered via shared dreaming, independently correlating dreams across dreamers, is beyond the Self stage into the deepest layer or the wave state Self: the very quantum ocean, the Self archetype is embedded in. A quantum wave or rhyming of meaning constituting synergy across several dreamers was discovered in dreams and in extensively shared dream work with small groups at a post therapy stage. Within the format of shared dreaming, we find synergy patterns beyond what Jung called the Self archetype. Jung led us up to the phase of Individuation and delivered the baton to Von Franz to work out the next synchronistic stage, here proposed as the finding of the quantum patterns making up the wave state of Self. These enfolded synchronistic patterns have been found in group format of shared dreaming of individuals approximating individuation, and the unfolding of it is carried by belief and faith. The reason for this format and operating system is because beyond therapy and of living reality, we find no science – no thinking or even awareness in the therapeutic sense – but rather a state of mental processing resembling more like that of spiritual attitude. Thinking as such is linear and cannot contain the deepest layer of Self, the quantum core of the human being. It is self reflection which is the container for the process at the wave state of Self. Observation locks us in an outside-in reactive flow from a first-person perspective and hence toward the surface we see to believe, whereas here, the direction of focus shifts to inside out/intrinsic. The operating system or language at the wave level of Self is thus belief and synchronicity. Belief has up to now been almost the sole province of organized religions but was viewed by Jung as an inherent property in the process of Individuation. The shared dreaming stage of the synchronistic patterns forms a larger story constituting a deep connectivity unfolding around individual Selves. Dreams of independent dreamers form larger patterns that come together as puzzles forming a larger story, and in this sense, this group work level builds on Jung as a post individuation collective stage. Shared dream correlations will be presented, illustrating a larger story in terms of trails of shared synchronicity.

Keywords: belief, shared dreaming, synchronistic patterns, wave state of self

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Authors: Mohaammad Ahmadpanah, Amineh Akhondi, Mohammad Haghighi, Ali Ghaleiha, Leila Jahangard, Elham Salari

Abstract:

Background: Working memory includes the capability to keep and manipulate information in a short period of time. This capability is the basis of complicated judgments and has been attended to as the specific and constant character of individuals. Children with attention deficit and hyperactivity are among the people suffering from deficiency in the active memory, and this deficiency has been attributed to the problem of frontal lobe. This study utilizes a new approach with suitable tasks and methods for training active memory and assessment of the effects of the trainings. Participants: The children participating in this study were of 7-15 year age, who were diagnosed by the psychiatrist and psychologist as hyperactive and attention deficit based on DSM-IV criteria. The intervention group was consisted of 8 boys and 6 girls with the average age of 11 years and standard deviation of 2, and the control group was consisted of 2 girls and 5 boys with an average age of 11.4 and standard deviation of 3. Three children in the test group and two in the control group were under medicinal therapy. Results: Working memory training meaningfully improved the performance in not-trained areas as visual-spatial working memory as well as the performance in Raven progressive tests which are a perfect example of non-verbal, complicated reasoning tasks. In addition, motional activities – measured based on the number of head movements during computerized measuring program – was meaningfully reduced in the medication group. The results of the second test showed that training similar exercise to teenagers and adults results in the improvement of cognition functions, as in hyperactive people. Discussion: The results of this study showed that the performance of working memory is improved through training, and these trainings are extended and generalized in other areas of cognition functions not receiving any training. Trainings resulted in the improvement of performance in the tasks related to prefrontal. They had also a positive and meaningful impact on the moving activities of hyperactive children.

Keywords: attention deficit hyperactivity disorder, working memory, non-medical treatment, children

Procedia PDF Downloads 365

Authors: Mosses E. Lufuke, Lorna M. Kamau

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This paper attempted to assess whether the size of the regional economic bloc has an impact to the flow of trade to a particular country. Two different sized blocs (COMESA and EAC) and one country (Tanzania) have been used as the point of references. Using the results from of the analyses, the paper also was anticipated to establish whether it was rational for Tanzania to withdraw its membership from COMESA (the larger bloc) to join EAC (the small one). Gravity model has been used to estimate the relationship between the variables, from which the bilateral trade flows between Tanzania and the eighteen member countries of the two blocs (COMESA and EAC) was employed for the time between 2000 and 2013. In the model, the dummy variable for regional bloc (bloc) at which the Tanzania trade partner countries belong are also added to the model to understand which trade bloc exhibit higher trade flow with Tanzania. From the findings, it was noted that over the period of study (2000-2013) Tanzania acknowledged more than 257% of trade volume in EAC than in COMESA. Conclusive, it was noted that the flow of trade is explained by many other variables apart from the size of regional bloc; and that the size by itself offer insufficient evidence in causality relationship. The paper therefore remain neutral on such staggered switching decision since more analyses are required to establish the country’s trade flow, especially when if it had been in multiple membership of COMESA and EAC.

Keywords: economic bloc, flow of trade, size of bloc, switching

Procedia PDF Downloads 246

Authors: Dení Stincer Gómez, Zuraya Monroy Nasr

Abstract:

From the epistemology of emotions, one of the topics of current reflection is the function that emotions fulfill in the rational processes involved in scientific activity. So far, three functions have been assigned to them: selective, heuristic, and carriers of content. In this last function, it is argued that emotions, like our perceptual organs, contribute relevant content to reasoning, which is then converted into linguistic statements or graphic representations. In this paper, of a qualitative and philosophical nature, arguments are provided for two hypotheses 1) if emotions provide content to the mind, which then translates it into language or representations, then it is important to take up the idea of the Saussurean linguistic sign to understand this process. This sign has two elements: the signified and the signifier. Emotions would provide meanings, and reasoning creates the signifier, and 2) the meanings provided by emotions are properties and qualities of phenomena generally not accessible to the sense organs. These meanings must be imagined, and the imagination is nurtured by the feeling that "maybe this is the way." One way to access the content provided by emotions can be through imagined scientific drawings. The atomic models created since Thomson, the structure of crystals by René Just, the representations of lunar eclipses by Johannes, fractal geometry, and the structure of DNA, among others, have resulted fundamentally from the imagination. These representations, not provided by the sense organs, seem to come from the emotional involvement of scientists in their desire to understand, explain and discover.

Keywords: emotions, epistemic functions of emotions, scientific drawing, linguistic sign

Procedia PDF Downloads 69

Authors: Sheikha Turki Alketbi

Abstract:

Objectives: 1. Documenting the spontaneous resolution of AML following the initiation of anti-TB therapy. 2. Presenting an uncommon type of relapse in Acute Myeloid Leukemia. 3. Highlighting the role of immune markers in the diagnosis of Leukemia cutis. 4. Exploring and highlighting the possibility of skin relapse as the exclusive manifestation, even when skin involvement is known secondary manifestation in AML. Background: Spontaneous remission of Acute Myeloid Leukemia (AML) is a rare phenomenon that has only been reported in some case reports, usually following severe infections. Some studies have described the occurrence of tuberculosis (TB) infection with AML, usually after starting chemotherapy. Spontaneous resolution of AML after starting anti TB therapy (ATT), without starting chemotherapy has never been described in the literature. Moreover, Leukemia cutis is another rare skin manifestation of Acute Myeloid Leukemia as a result of infiltration of the skin or subcutaneous tissue by leukemic cells, in which can present during, precedes, after or independently of systemic leukemia. Methods: Here, we present a case of a 13-year-old male who presented with fever, weight loss, lethargy, epistaxis, bruising and dry cough and was later diagnosed with AML. Before initiating leukemia treatment, the patient was tested for TB and was found to have active TB infection. His leukemia treatment was postponed to clear the TB infection and he was commenced on ATT. Two months later, repeat blood film and bone marrow biopsy showed resolution of his AML. The patient remained in remission for 1 month, after which he presented with symmetrical blue purple well-defined round indurated plaques on the chest and thighs. Our differentials were leukemia cutis and Kaposi sarcoma. Results: Skin Biopsy with immune markers done, showed a picture of Acute Myeloid Leukemia. Immunohistochemistry (IHC) showed neoplastic cells diffusely and strongly positive for LCA, CD2, CD31, MPO, CD117, Lysozymes and TDT, and moderately positive for CD34, CD99, CD43 and CD6 And patchy for CD68. Ki67 showed 60% proliferation index. They were negative for the remaining markers. This suggested acute myeloid leukemia (AML). Conclusion: In summary, we present a rare case of TB with AML that resolved after treatment of TB with ATT but relapsed later as leukemia cutis. While skin involvement might occur as a secondary manifestation of AML, Skin relapse could be the only one.

Keywords: Leukemia cutis, Leukemia relapse, Acute Myeloid Leukemia, spontaneous resolution of AML

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Authors: Mohd Shazad, K. K. Gupta

Abstract:

Vector borne diseases are a serious global concern. Aedes aegypti, the primary vector for viruses that cause dengue fever, dengue haemorrhagic fever, chikungunya and yellow fever is widespread over large areas of the tropics and subtropics. In last decade, diseases transmitted by Aedes aegypti are of serious concern. In past decade, number of cases of dengue fever, dengue hemorrhagic fever, and chikungunya has increased multifold. Present research work focused on impact of ethanol extract of Ocimum sanctum on dengue vector Aedes aegypti. 0-24 hr. old fourth instar larvae of lab-bred population of Aedes aegypti were exposed to ethanol leaf extract of Ocimum with concentrations ranging from 50 ppm to 400 ppm. Survival and development and the treated larvae and reproductive behaviour of the adults emerged from the treated larvae was evaluated. Our results indicated larvicidal potential of the leaf ethanol extract. The influence of the extract was dose dependent. 77.2% mortality was observed in the larvae exposed to 400 ppm for 24 hr. Treatment at lower concentrations revealed delayed toxicity. The larvae survived after treatment showed severe developmental anomalies. Consequently, there was the significant increase in duration of fourth instar larva. The L4 treated with 400-ppm extract moulted after 4.6 days; this was in sharp contrast to control where the larval period of the fourth instar lasts three days. The treated fourth instar larvae in many cases transformed into larva-pupa intermediates with the combination of larva, pupa characters. The larva-pupa intermediates had reduced life span and failed to moult successfully. The adults emerged from the larvae treated with lower doses had reduced reproductive potential. The females exhibited longer preoviposition period, reduced oviposition rate, abnormal oviposition behaviour and decreased fertility. Our studies indicated the possibility of the presence of JH mimic or JH analogue in the leaf ethanol extract of Ocimum. The present research work explored the potentials of Ocimum sanctum, also known as the queen of herbs, in integrated vector management programme of Aedes aegypti, which is a serious threat to human health.

Keywords: Aedes aegypti, development, mortality, Ocimum sanctum reproduction

Procedia PDF Downloads 242

Authors: Joana Gato, Ahmed Abotabekh, Panayoti Bachkangi

Abstract:

Introduction: Oestrogen is an essential gonadal hormone that plays a vital role in the reproductive system of women1. The average age of menopause in the UK is 512. Women who go through premature menopause should be offered Hormone replacement therapy (HRT). Similarly, women who undergo surgical menopause should be offered HRT, unless contraindicated, depending on the indication of their surgery2,3. Aim: To assess if the patients in our department are counselled regarding HRT after surgical treatment and if HRT was prescribed. Methodology: A retrospective audit in a busy district hospital, examining all the patients who had a hysterectomy. The audit examined if HRT was discussed pre-operatively, prescribed on discharge and if a follow up was arranged. For women with contraindication to HRT, the audit assessed if the reasons were discussed pre-operatively and communicated to the Inclusion criteria: woman having a total or subtotal hysterectomy, with or without bilateral salpingo-ophorectomy (BSO), between April and September 2022. Exclusion criteria: woman having a vaginal hysterectomy. Results: 40 patients in total had hysterectomy; 27 (68%) were under the age of 51. 15 out of 27 patients bad BSO. 9 women were prescribed HRT, but 8 were offered HRT immediately, and 1 of them were offered a follow up. Of women who underwent surgical menopause, 7 were not given any HRT. The HRT choice was diverse, however, the majority was prescribed oral HRT. 40% of women undergoing surgical menopause did not have a discussion about HRT prior to their surgery. In postmenopausal women (n=13; 33%), still two were given HRT for preexisting menopausal symptoms. Discussion: Only 59% of the pre-menopausal patients had oophorectomy, therefore undergoing surgical menopause. Of these, 44% were not given any HRT, and 40% had no discussion about HRT prior to surgery. Interestingly, the majority of these women have no obvious contraindication to HRT. The choice of HRT was diverse, but the majority was commenced on oral HRT. Our unit is still working towards meeting all the NICE guidance standards of offering HRT and information prior to surgery to women planning to undergo surgical menopause. Conclusion: Starting HRT at the onset of menopause has been shown to improve quality of life and reduce the risk of cardiovascular disease and osteoporotic fractures4. Our unit still has scope for improvement to comply with the current NICE guidance. All pre-menopausal women undergoing surgical menopause should have a discussion regarding HRT prior to surgery and be offered it if there are no contraindications. This discussion should be clearly documented in the notes. At the time of this report, some of the patients have not yet had a follow up, which we recognize as a limitation to our audit.

Keywords: hormone replacement therapy, menopause, premature ovarian insufficiency, surgical management

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