Search results for: recovery ratio
Commenced in January 2007
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Edition: International
Paper Count: 6236

Search results for: recovery ratio

4406 Turkish Validation of the Nursing Outcomes for Urinary Incontinence and Their Sensitivities on Nursing Interventions

Authors: Dercan Gencbas, Hatice Bebis, Sue Moorhead

Abstract:

In the nursing process, many of the nursing classification systems were created to be used in international. From these, NANDA-I, Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC). In this direction, the main objective of this study is to establish a model for caregivers in hospitals and communities in Turkey and to ensure that nursing outputs are assessed by NOC-based measures. There are many scales to measure Urinary Incontinence (UI), which is very common in children, in old age, vaginal birth, NOC scales are ideal for use in the nursing process for comprehensive and holistic assessment, with surveys available. For this reason, the purpose of this study is to evaluate the validity of the NOC outputs and indicators used for UI NANDA-I. This research is a methodological study. In addition to the validity of scale indicators in the study, how much they will contribute to recovery after the nursing intervention was assessed by experts. Scope validations have been applied and calculated according to Fehring 1987 work model. According to this, nursing inclusion criteria and scores were determined. For example, if experts have at least four years of clinical experience, their score was 4 points or have at least one year of the nursing classification system, their score was 1 point. The experts were a publication experience about nursing classification, their score was 1 point, or have a doctoral degree in nursing, their score was 2 points. If the expert has a master degree, their score was 1 point. Total of 55 experts rated Fehring as a “senior degree” with a score of 90 according to the expert scoring. The nursing interventions to be applied were asked to what extent these indicators would contribute to recovery. For coverage validity tailored to Fehring's model, each NOC and NOC indicator from specialists was asked to score between 1-5. Score for the significance of indicators was from 1=no precaution to 5=very important. After the expert opinion, these weighted scores obtained for each NOC and NOC indicator were classified as 0.8 critical, 0.8 > 0.5 complements, > 0.5 are excluded. In the NANDA-I / NOC / NIC system (guideline), 5 NOCs proposed for nursing diagnoses for UI were proposed. These outputs are; Urinary Continence, Urinary Elimination, Tissue Integrity, Self CareToileting, Medication Response. After the scales are translated into Turkish, the weighted average of the scores obtained from specialists for the coverage of all 5 NOCs and the contribution of nursing initiatives exceeded 0.8. After the opinions of the experts, 79 of the 82 indicators were calculated as critical, 3 of the indicators were calculated as supplemental. Because of 0.5 > was not obtained, no substance was removed. All NOC outputs were identified as valid and usable scales in Turkey. In this study, five NOC outcomes were verified for the evaluation of the output of individuals who have received nursing knowledge of UI and variant types. Nurses in Turkey can benefit from the outputs of the NOC scale to perform the care of the elderly incontinence.

Keywords: nursing outcomes, content validity, nursing diagnosis, urinary incontinence

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4405 The Effect of Zeolite on Sandy-Silt Soil Mechanical Properties

Authors: Shahryar Aftabi, Saeed Fathi, Mohammad H. Aminfar

Abstract:

It is well known that cemented sand is one of the best approaches for soil stabilization. In some cases, a blend of sand, cement and other pozzolan materials such as zeolite, nano-particles and fiber can be widely (commercially) available and be effectively used in soil stabilization, especially in road construction. In this research, we investigate the effects of CaO which is based on the geotechnical characteristics of zeolite composition with sandy silt soil. Zeolites have low amount of CaO in their structures, that is, varying from 3% to 10%, and by removing the cement paste, we want to investigate the effect of zeolite pozzolan without any activator on soil samples strength. In this research, experiments are concentrated on various weight percentages of zeolite in the soil to examine the effect of the zeolite on drainage shear strength and California Bearing Ratio (CBR) both with and without curing. The study also investigates their liquid limit and plastic limit behavior and makes a comparative result by using Feng's and Wroth-Wood's methods in fall cone (cone penetrometer) device; in the final the SEM images have been presented. The results show that by increasing the percentage of zeolite in without-curing samples, the fine zeolite particles increase some soil's strength, but in the curing-state we can see a relatively higher strength toward without-curing state, since the zeolites have no plastic behavior, the pozzolanic property of zeolites plays a much higher role than cementing properties. Indeed, it is better to combine zeolite particle with activator material such as cement or lime to gain better results.

Keywords: California bearing ratio, CBR, direct shear, fall-cone, sandy silt, SEM, zeolite

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4404 Investigating the Effect of the Shape of the Side Supports of the Gates of the Gotvand Reservoir Dam (from the Peak Overflows) on the Narrowing Coefficients

Authors: M. Abbasi

Abstract:

A spillway structure is used to pass excess water and floods from upstream or upstream to downstream or tributary. The spillway is considered one of the most key members of the dam, and the failure of many dams is attributed to the inefficiency of their spillway. Weirs should be selected as strong, reliable and high-performance structures, and weirs should be ready for use in all conditions and able to drain the flood so that we do not witness many casualties and financial losses when a flood occurs. The purpose of this study is to simulate the flow pattern passing over the peak spillway in order to optimize and adjust the height of the spillway walls. In this research, the effect of the shape of the side wings on the flow pattern over the peak spillways of the Gotvand reservoir dam was simulated and modelled using Flow3D software. In this research, side wings with rounded walls with six different approach angles were used. In addition, the different value of H/Hd was used to check the effect of the tank head. The results showed that with the constant H/Hd ratio and the increase of the approach angle of the side wing, the flow depth first decreases and then increases. These changes were the opposite regarding the depth average speed of the flow and the depth average concentration of the air entering the flow. At the same time, with the constant angle of approach of the side wing and with the increase of H/Hd ratio, the flow depth increases. In general, a correct understanding of the operation of overflows and a correct design can significantly reduce construction costs and solve flooding problems.

Keywords: effect of the shape, gotvand reservoir dam, narrowing coefficients, supports of the gates

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4403 Effect of Nitrogen-Based Cryotherapy on the Calf Muscle Spasticity in Stroke Patients

Authors: Engi E. I. Sarhan, Usama M. Rashad, Ibrahim M. I. Hamoda, Mohammed K. Mohamed

Abstract:

Background: This study aimed to know the effect of nitrogen-based cryotherapy on the spasticity of calf muscle in stroke patients. Patients were selected from the outpatient clinic of Neurology, Al-Mansoura general hospital, Al-Mansoura University. Subjects and methods: Thirty Stroke Patients of both sexes ranged from 45 to 60 years old were divided randomly into two equal groups, a study group (A) received a nitrogen-based cryotherapy, a selective physical therapy program and ankle foot orthosis (AFO), while as patients in control group (B) received the same program and AFO only. The treatment duration was three times per week for four weeks for both groups. We assessed spasticity of calf muscle before and after treatment subjectively using modified Ashworth scale (MAS) and objectively via measuring H / M ratio on electromyography machine. We also assessed ankle dorsiflexion ROM objectively using two dimensions motion analysis (2D). Results: After treatment, there was a highly significant improvement in the study group compared to the control group regarding the score of MAS, no significant difference in the study group compared to the control group regarding the readings of H / M ratio, highly significant improvement in the study group compared to the control group regarding the 2D motion analysis findings. Conclusion: This modality considers effective in reducing spasticity in the calf muscle and improving ankle dorsiflexion of the affected limb.

Keywords: ankle foot orthosis, nitrogen-based cryotherapy, stroke, spasticity

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4402 Comparing the Effectiveness of the Crushing and Grinding Route of Comminution to That of the Mine to Mill Route in Terms of the Percentage of Middlings Present in Processed Lead-Zinc Ore Samples

Authors: Chinedu F. Anochie

Abstract:

The presence of gangue particles in recovered metal concentrates has been a serious challenge to ore dressing engineers. Middlings lower the quality of concentrates, and in most cases, drastically affect the smelter terms, owing to exorbitant amounts paid by Mineral Processing industries as treatment charge. Models which encourage optimization of liberation operations have been utilized in most ore beneficiation industries to reduce the presence of locked particles in valuable concentrates. Moreover, methods such as incorporation of regrind mills, scavenger, rougher and cleaner cells, to the milling and flotation plants has been widely employed to tackle these concerns, and to optimize the grade–recovery relationship of metal concentrates. This work compared the crushing and grinding method of liberation, to the mine to mill route, by evaluating the proportion of middlings present in selectively processed complex Pb-Zn ore samples. To establish the effect of size reduction operations on the percentage of locked particles present in recovered concentrates, two similar samples of complex Pb- Zn ores were processed. Following blasting operation, the first ore sample was ground directly in a ball mill (Mine to Mill Route of Comminution), while the other sample was manually crushed, and subsequently ground in the ball mill (Crushing and Grinding Route of Comminution). The two samples were separately sieved in a mesh to obtain the desired representative particle sizes. An equal amount of each sample that would be processed in the flotation circuit was then obtained with the aid of a weighing balance. These weighed fine particles were simultaneously processed in the flotation circuit using the selective flotation technique. Sodium cyanide, Methyl isobutyl carbinol, Sodium ethyl xanthate, Copper sulphate, Sodium hydroxide, Lime and Isopropyl xanthate, were the reagents used to effect differential flotation of the two ore samples. Analysis and calculations showed that the degree of liberation obtained for the ore sample which went through the conventional crushing and grinding route of comminution, was higher than that of the directly milled run off mine (ROM) ore. Similarly, the proportion of middlings obtained from the separated galena (PbS) and sphalerite (ZnS) concentrates, were lower for the crushed and ground ore sample. A concise data which proved that the mine to mill method of size reduction is not the most ideal technique for the recovery of quality metal concentrates has been established.

Keywords: comminution, degree of liberation, middlings, mine to mill

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4401 Beam Coding with Orthogonal Complementary Golay Codes for Signal to Noise Ratio Improvement in Ultrasound Mammography

Authors: Y. Kumru, K. Enhos, H. Köymen

Abstract:

In this paper, we report the experimental results on using complementary Golay coded signals at 7.5 MHz to detect breast microcalcifications of 50 µm size. Simulations using complementary Golay coded signals show perfect consistence with the experimental results, confirming the improved signal to noise ratio for complementary Golay coded signals. For improving the success on detecting the microcalcifications, orthogonal complementary Golay sequences having cross-correlation for minimum interference are used as coded signals and compared to tone burst pulse of equal energy in terms of resolution under weak signal conditions. The measurements are conducted using an experimental ultrasound research scanner, Digital Phased Array System (DiPhAS) having 256 channels, a phased array transducer with 7.5 MHz center frequency and the results obtained through experiments are validated by Field-II simulation software. In addition, to investigate the superiority of coded signals in terms of resolution, multipurpose tissue equivalent phantom containing series of monofilament nylon targets, 240 µm in diameter, and cyst-like objects with attenuation of 0.5 dB/[MHz x cm] is used in the experiments. We obtained ultrasound images of monofilament nylon targets for the evaluation of resolution. Simulation and experimental results show that it is possible to differentiate closely positioned small targets with increased success by using coded excitation in very weak signal conditions.

Keywords: coded excitation, complementary golay codes, DiPhAS, medical ultrasound

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4400 A Practice Model for Quality Improvement in Concrete Block Mini Plants Based on Merapi Volcanic Sand

Authors: Setya Winarno

Abstract:

Due to abundant Merapi volcanic sand in Yogyakarta City, many local people have utilized it for mass production of concrete blocks through mini plants although their products are low in quality. This paper presents a practice model for quality improvement in this situation in order to supply the current customer interest in good quality of construction material. The method of this research was to investigate a techno economic evaluation through laboratory test and interview. Samples of twenty existing concrete blocks made by local people had only 19.4 kg/cm2 in average compression strength which was lower than the minimum Indonesian standard of 25 kg/cm2. Through repeat testing in laboratory for fulfilling the standard, the concrete mix design of water cement ratio should not be more than 0.64 by weight basis. The proportion of sand as aggregate content should not be more than 9 parts to 1 part by volume of Portland cement. Considering the production cost, the basic price was Rp 1,820 for each concrete block, comparing to Rp 2,000 as a normal competitive market price. At last, the model describes (a) maximum water cement ratio is 0.64, (b) maximum proportion of sand and cement is 1:9, (c) the basic price is about Rp. 1,820.00 and (d) strategies to win the competitive market on mass production of concrete blocks are focus in quality, building relationships with consumer, rapid respond to customer need, continuous innovation by product diversification, promotion in social media, and strict financial management.

Keywords: concrete block, good quality, improvement model, diversification

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4399 Working Towards More Sustainable Food Waste: A Circularity Perspective

Authors: Rocío González-Sánchez, Sara Alonso-Muñoz

Abstract:

Food waste implies an inefficient management of the final stages in the food supply chain. Referring to Sustainable Development Goals (SDGs) by United Nations, the SDG 12.3 proposes to halve per capita food waste at the retail and consumer level and to reduce food losses. In the linear system, food waste is disposed and, to a lesser extent, recovery or reused after consumption. With the negative effect on stocks, the current food consumption system is based on ‘produce, take and dispose’ which put huge pressure on raw materials and energy resources. Therefore, greater focus on the circular management of food waste will mitigate the environmental, economic, and social impact, following a Triple Bottom Line (TBL) approach and consequently the SDGs fulfilment. A mixed methodology is used. A total sample of 311 publications from Web of Science database were retrieved. Firstly, it is performed a bibliometric analysis by SciMat and VOSviewer software to visualise scientific maps about co-occurrence analysis of keywords and co-citation analysis of journals. This allows for the understanding of the knowledge structure about this field, and to detect research issues. Secondly, a systematic literature review is conducted regarding the most influential articles in years 2020 and 2021, coinciding with the most representative period under study. Thirdly, to support the development of this field it is proposed an agenda according to the research gaps identified about circular economy and food waste management. Results reveal that the main topics are related to waste valorisation, the application of waste-to-energy circular model and the anaerobic digestion process towards fossil fuels replacement. It is underlined that the use of food as a source of clean energy is receiving greater attention in the literature. There is a lack of studies about stakeholders’ awareness and training. In addition, available data would facilitate the implementation of circular principles for food waste recovery, management, and valorisation. The research agenda suggests that circularity networks with suppliers and customers need to be deepened. Technological tools for the implementation of sustainable business models, and greater emphasis on social aspects through educational campaigns are also required. This paper contributes on the application of circularity to food waste management by abandoning inefficient linear models. Shedding light about trending topics in the field guiding to scholars for future research opportunities.

Keywords: bibliometric analysis, circular economy, food waste management, future research lines

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4398 Application of Artificial Intelligence in EOR

Authors: Masoumeh Mofarrah, Amir NahanMoghadam

Abstract:

Higher oil prices and increasing oil demand are main reasons for great attention to Enhanced Oil Recovery (EOR). Comprehensive researches have been accomplished to develop, appraise, and improve EOR methods and their application. Recently, Artificial Intelligence (AI) gained popularity in petroleum industry that can help petroleum engineers to solve some fundamental petroleum engineering problems such as reservoir simulation, EOR project risk analysis, well log interpretation and well test model selection. This study presents a historical overview of most popular AI tools including neural networks, genetic algorithms, fuzzy logic, and expert systems in petroleum industry and discusses two case studies to represent the application of two mentioned AI methods for selecting an appropriate EOR method based on reservoir characterization infeasible and effective way.

Keywords: artificial intelligence, EOR, neural networks, expert systems

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4397 Contrast-to-Noise Ratio Comparison of Different Calcification Types in Dual Energy Breast Imaging

Authors: Vaia N. Koukou, Niki D. Martini, George P. Fountos, Christos M. Michail, Athanasios Bakas, Ioannis S. Kandarakis, George C. Nikiforidis

Abstract:

Various substitute materials of calcifications are used in phantom measurements and simulation studies in mammography. These include calcium carbonate, calcium oxalate, hydroxyapatite and aluminum. The aim of this study is to compare the contrast-to-noise ratio (CNR) values of the different calcification types using the dual energy method. The constructed calcification phantom consisted of three different calcification types and thicknesses: hydroxyapatite, calcite and calcium oxalate of 100, 200, 300 thicknesses. The breast tissue equivalent materials were polyethylene and polymethyl methacrylate slabs simulating adipose tissue and glandular tissue, respectively. The total thickness was 4.2 cm with 50% fixed glandularity. The low- (LE) and high-energy (HE) images were obtained from a tungsten anode using 40 kV filtered with 0.1 mm cadmium and 70 kV filtered with 1 mm copper, respectively. A high resolution complementary metal-oxide-semiconductor (CMOS) active pixel sensor (APS) X-ray detector was used. The total mean glandular dose (MGD) and entrance surface dose (ESD) from the LE and HE images were constrained to typical levels (MGD=1.62 mGy and ESD=1.92 mGy). On average, the CNR of hydroxyapatite calcifications was 1.4 times that of calcite calcifications and 2.5 times that of calcium oxalate calcifications. The higher CNR values of hydroxyapatite are attributed to its attenuation properties compared to the other calcification materials, leading to higher contrast in the dual energy image. This work was supported by Grant Ε.040 from the Research Committee of the University of Patras (Programme K. Karatheodori).

Keywords: calcification materials, CNR, dual energy, X-rays

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4396 First Documented Anesthesia with Use of Low Doses of Tiletamine-Zolazepam Combination in Ovoviparous Amazon Tree Boa Undergoing Emergency Coeliotomy-Case Report

Authors: Krzysztof Buczak, Sonia Lachowska, Pawel Kucharski, Agnieszka Antonczyk

Abstract:

Tiletamine - zolazepam combination is increasingly used in veterinary anaesthesiology in wild animals, including snakes. The available literature shows a lack of information about anesthesia in this mixture in ovoviviparous snakes. The studies show the possibility of using the combination at a dose of 20 mg/kg or more for snake immobilization. This paper presents an anesthetic protocol with the use of a combination of tiletamine - zolazepam at the dose of 10 mg/kg intramuscularly and maintenance with inhalant anesthesia with isoflurane in pure oxygen. The objective of this study was to evaluate the usefulness of the anesthetic protocol to proceed with coeliotomy in Amazon Tree Boa. The patient was a five years old bicolor female Amazon Tree Boa (Corallus hortulanus) with dystocia. The clinical examination reveals significant emaciation (bodyweight 520g), high degree of dehydration, heart rate (HR = 60 / min), pale mucous membranes and poor reactivity. Meloxicam (1 mg/kg) and tramadol (10 mg/kg) were administered subcutaneously and the patient was placed in an incubator with access to fresh oxygen. Four hours later, the combination of tiletamine - zolazepam (10 mg/kg) was administered intramuscularly for induction of anesthesia. The snake was intubated and connected to inhalant anesthesia equipment. For maintenance, the anesthesia isoflurane in pure oxygen was used due to apnea, which occurs 30 minutes after the induction semi-closed system was attached and the ventilator was turned on (PCV system, four breaths per minute, 8 cm of H2O). Cardiopulmonary parameters (HR, RR, SPO2, ETCO2, ETISO) were assessed throughout the procedure. During the entire procedure, the operating room was heated to a temperature of 26 degrees Celsius. Additionally, the hose was placed on a heating mat, which maintained a temperature of 30 degrees Celsius. For 15 minutes after induction, the loss of muscle tone was observed from the head to the tail. Induction of general anesthesia was scored as good because of the possibility of intubation. During the whole procedure, the heart rate was at the rate of 58 beats per minute (bpm). Ventilation parameters were stable throughout the procedure. The recovery period lasts for about 4 hours after the end of general anesthesia. The muscle tension returned from tail to head. The snake started to breathe spontaneously within 1,5 hours after the end of general anesthesia. The protocol of general anesthesia with the combination of tiletamine- zolazepam with a dose of 10 mg/kg is useful for proceeding with the emergency coeliotomy in maintenance with isoflurane in oxygen. Further study about the impact of the combination of tiletamine- zolazepam for the recovery period is needed.

Keywords: anesthesia, corallus hortulanus, ovoviparous, snake, tiletamine, zolazepam

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4395 A Second Law Assessment of Organic Rankine Cycle Depending on Source Temperature

Authors: Kyoung Hoon Kim

Abstract:

Organic Rankine Cycle (ORC) has potential in reducing fossil fuels and relaxing environmental problems. In this work performance analysis of ORC is conducted based on the second law of thermodynamics for recovery of low temperature heat source from 100°C to 140°C using R134a as the working fluid. Effects of system parameters such as turbine inlet pressure or source temperature are theoretically investigated on the exergy destructions (anergies) at various components of the system as well as net work production or exergy efficiency. Results show that the net work or exergy efficiency has a peak with respect to the turbine inlet pressure when the source temperature is low, however, increases monotonically with increasing turbine inlet pressure when the source temperature is high.

Keywords: Organic Rankine Cycle (ORC), low temperature heat source, exergy, source temperature

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4394 Effect of Knowledge of Bubble Point Pressure on Estimating PVT Properties from Correlations

Authors: Ahmed El-Banbi, Ahmed El-Maraghi

Abstract:

PVT properties are needed as input data in all reservoir, production, and surface facilities engineering calculations. In the absence of PVT reports on valid reservoir fluid samples, engineers rely on PVT correlations to generate the required PVT data. The accuracy of PVT correlations varies, and no correlation group has been found to provide accurate results for all oil types. The effect of inaccurate PVT data can be significant in engineering calculations and is well documented in the literature. Bubble point pressure can sometimes be obtained from external sources. In this paper, we show how to utilize the known bubble point pressure to improve the accuracy of calculated PVT properties from correlations. We conducted a systematic study using around 250 reservoir oil samples to quantify the effect of pre-knowledge of bubble point pressure. The samples spanned a wide range of oils, from very volatile oils to black oils and all the way to low-GOR oils. A method for shifting both undersaturated and saturated sections of the PVT properties curves to the correct bubble point is explained. Seven PVT correlation families were used in this study. All PVT properties (e.g., solution gas-oil ratio, formation volume factor, density, viscosity, and compressibility) were calculated using the correct bubble point pressure and the correlation estimated bubble point pressure. Comparisons between the calculated PVT properties and actual laboratory-measured values were made. It was found that pre-knowledge of bubble point pressure and using the shifting technique presented in the paper improved the correlation-estimated values by 10% to more than 30%. The most improvement was seen in the solution gas-oil ratio and formation volume factor.

Keywords: PVT data, PVT properties, PVT correlations, bubble point pressure

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4393 F-IVT Actuation System to Power Artificial Knee Joint

Authors: Alò Roberta, Bottiglione Francesco, Mantriota Giacomo

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The efficiency of the actuation system of lower limb exoskeletons and of active orthoses is a significant aspect of the design of such devices because it affects their efficacy. F-IVT is an innovative actuation system to power artificial knee joint with energy recovery capabilities. Its key and non-conventional elements are a flywheel, that acts as a mechanical energy storage system, and an Infinitely Variable Transmission (IVT). The design of the F-IVT can be optimized for a certain walking condition, resulting in a heavy reduction of both the electric energy consumption and of the electric peak power. In this work, by means of simulations of level ground walking at different speeds, it is demonstrated how F-IVT is still an advantageous actuator, even when it does not work in nominal conditions.

Keywords: active orthoses, actuators, lower extremity exoskeletons, knee joint

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4392 The Value of Serum Procalcitonin in Patients with Acute Musculoskeletal Infections

Authors: Mustafa Al-Yaseen, Haider Mohammed Mahdi, Haider Ali Al–Zahid, Nazar S. Haddad

Abstract:

Background: Early diagnosis of musculoskeletal infections is of vital importance to avoid devastating complications. There is no single laboratory marker which is sensitive and specific in diagnosing these infections accurately. White blood cell count, erythrocyte sedimentation rate, and C-reactive protein are not specific as they can also be elevated in conditions other than bacterial infections. Materials Culture and sensitivity is not a true gold standard due to its varied positivity rates. Serum Procalcitonin is one of the new laboratory markers for pyogenic infections. The objective of this study is to assess the value of PCT in the diagnosis of soft tissue, bone, and joint infections. Patients and Methods: Patients of all age groups (seventy-four patients) with a diagnosis of musculoskeletal infection are prospectively included in this study. All patients were subjected to White blood cell count, erythrocyte sedimentation rate, C-reactive protein, and serum Procalcitonin measurements. A healthy non infected outpatient group (twenty-two patients) taken as a control group and underwent the same evaluation steps as the study group. Results: The study group showed mean Procalcitonin levels of 1.3 ng/ml. Procalcitonin, at 0.5 ng/ml, was (42.6%) sensitive and (95.5%) specific in diagnosing of musculoskeletal infections with (positive predictive value of 87.5% and negative predictive value of 48.3%) and (positive likelihood ratio of 9.3 and negative likelihood ratio of 0.6). Conclusion: Serum Procalcitonin, at a cut – off of 0.5 ng/ml, is a specific but not sensitive marker in the diagnosis of musculoskeletal infections, and it can be used effectively to rule in the diagnosis of infection but not to rule out it.

Keywords: procalcitonin, infection, labratory markers, musculoskeletal

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4391 EMG Based Orthosis for Upper Limb Rehabilitation in Hemiparesis Patients

Authors: Nancy N. Sharmila, Aparna Mishra

Abstract:

Hemiparesis affects almost 80% of stroke patients each year. It is marked by paralysis or weakness on one half of the body. Our model provides both assistance and physical therapy for hemiparesis patients for swift recovery. In order to accomplish our goal a force is provided that pulls the forearm up (as in flexing the arm), and pushes the forearm down (as in extending the arm), which will also assist the user during ADL (Activities of Daily Living). The model consists of a mechanical component which is placed around the patient’s bicep and an EMG control circuit to assist patients in daily activities, which makes it affordable and easy to use. In order to enhance the neuromuscular system’s effectiveness in synchronize the movement, proprioceptive neuromuscular facilitation (PNF) concept is used. The EMG signals are acquired from the unaffected arm as an input to drive the orthosis. This way the patient is invigorated to use the orthosis for regular exercise.

Keywords: EMG, hemiparesis, orthosis, rehabilitation

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4390 The Relationship between Lithological and Geomechanical Properties of Carbonate Rocks. Case study: Arab-D Reservoir Outcrop Carbonate, Central Saudi Arabia

Authors: Ammar Juma Abdlmutalib, Osman Abdullatif

Abstract:

Upper Jurrasic Arab-D Reservoir is considered as the largest oil reservoir in Saudi Arabia. The equivalent outcrop is exposed near Riyadh. The study investigates the relationships between lithofacies properties changes and geomechanical properties of Arab-D Reservoir in the outcrop scale. The methods used included integrated field observations and laboratory measurements. Schmidt Hammer Rebound Hardness, Point Load Index tests were carried out to estimate the strength of the samples, ultrasonic wave velocity test also was applied to measure P-wave, S-wave, and dynamic Poisson's ratio. Thin sections have been analyzed and described. The results show that there is a variation in geomechanical properties between the Arab-D member and Upper Jubaila Formation at outcrop scale, the change in texture or grain size has no or little effect on these properties. This is because of the clear effect of diagenesis which changes the strength of the samples. The result also shows the negative or inverse correlation between porosity and geomechanical properties. As for the strength, dolomitic mudstone and wackestone within Upper Jubaila Formation has higher Schmidt hammer values, wavy rippled sandy grainstone which is rich in quarts has the greater point load index values. While laminated mudstone and breccias, facies has lower strength. This emphasizes the role of mineral content in the geomechanical properties of Arab-D reservoir lithofacies.

Keywords: geomechanical properties, Arab-D reservoir, lithofacies changes, Poisson's ratio, diageneis

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4389 Case Report: Complex Regional Pain Syndrome

Authors: Farah Al Zaabi, Sarah Amrani

Abstract:

Complex regional pain syndrome (CRPS) is a chronic pain condition that develops in an extremity following a fracture, soft tissue injury, or surgery. It is a neuropathic pain disorder that is accompanied by the characteristic skin manifestations that are needed for the diagnosis. We report the case of a 30 year old male, who has findings consistent with CRPS and has been followed for over two years by multiple specialties within the healthcare system without obtaining a diagnosis. The symptoms he presented with were treated based on the specialty he was seeing, rather than unified and recognized as a single disease process. Our case highlights the complexity of chronic pain, which can sometimes present with skin manifestations, and the importance of involving a pain specialist early for both the medical and physical recovery of CRPS patients.

Keywords: complex regional pain syndrome, chronic pain, skin changes of CRPS, dermatological manifestions of CRPS

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4388 Study of a Few Additional Posterior Projection Data to 180° Acquisition for Myocardial SPECT

Authors: Yasuyuki Takahashi, Hirotaka Shimada, Takao Kanzaki

Abstract:

A Dual-detector SPECT system is widely by use of myocardial SPECT studies. With 180-degree (180°) acquisition, reconstructed images are distorted in the posterior wall of myocardium due to the lack of sufficient data of posterior projection. We hypothesized that quality of myocardial SPECT images can be improved by the addition of data acquisition of only a few posterior projections to ordinary 180° acquisition. The proposed acquisition method (180° plus acquisition methods) uses the dual-detector SPECT system with a pair of detector arranged in 90° perpendicular. Sampling angle was 5°, and the acquisition range was 180° from 45° right anterior oblique to 45° left posterior oblique. After the acquisition of 180°, the detector moved to additional acquisition position of reverse side once for 2 projections, twice for 4 projections, or 3 times for 6 projections. Since these acquisition methods cannot be done in the present system, actual data acquisition was done by 360° with a sampling angle of 5°, and projection data corresponding to above acquisition position were extracted for reconstruction. We underwent the phantom studies and a clinical study. SPECT images were compared by profile curve analysis and also quantitatively by contrast ratio. The distortion was improved by 180° plus method. Profile curve analysis showed increased of cardiac cavity. Analysis with contrast ratio revealed that SPECT images of the phantoms and the clinical study were improved from 180° acquisition by the present methods. The difference in the contrast was not clearly recognized between 180° plus 2 projections, 180° plus 4 projections, and 180° plus 6 projections. 180° plus 2 projections method may be feasible for myocardial SPECT because distortion of the image and the contrast were improved.

Keywords: 180° plus acquisition method, a few posterior projections, dual-detector SPECT system, myocardial SPECT

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4387 Vibration Analysis of Magnetostrictive Nano-Plate by Using Modified Couple Stress and Nonlocal Elasticity Theories

Authors: Hamed Khani Arani, Mohammad Shariyat, Armaghan Mohammadian

Abstract:

In the present study, the free vibration of magnetostrictive nano-plate (MsNP) resting on the Pasternak foundation is investigated. Firstly, the modified couple stress (MCS) and nonlocal elasticity theories are compared together and taken into account to consider the small scale effects; in this paper not only two theories are analyzed but also it improves the MCS theory is more accurate than nonlocal elasticity theory in such problems. A feedback control system is utilized to investigate the effects of a magnetic field. First-order shear deformation theory (FSDT), Hamilton’s principle and energy method are utilized in order to drive the equations of motion and these equations are solved by differential quadrature method (DQM) for simply supported boundary conditions. The MsNP undergoes in-plane forces in x and y directions. In this regard, the dimensionless frequency is plotted to study the effects of small scale parameter, magnetic field, aspect ratio, thickness ratio and compression and tension loads. Results indicate that these parameters play a key role on the natural frequency. According to the above results, MsNP can be used in the communications equipment, smart control vibration of nanostructure especially in sensor and actuators such as wireless linear micro motor and smart nano valves in injectors.

Keywords: feedback control system, magnetostrictive nano-plate, modified couple stress theory, nonlocal elasticity theory, vibration analysis

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4386 Optimal Image Representation for Linear Canonical Transform Multiplexing

Authors: Navdeep Goel, Salvador Gabarda

Abstract:

Digital images are widely used in computer applications. To store or transmit the uncompressed images requires considerable storage capacity and transmission bandwidth. Image compression is a means to perform transmission or storage of visual data in the most economical way. This paper explains about how images can be encoded to be transmitted in a multiplexing time-frequency domain channel. Multiplexing involves packing signals together whose representations are compact in the working domain. In order to optimize transmission resources each 4x4 pixel block of the image is transformed by a suitable polynomial approximation, into a minimal number of coefficients. Less than 4*4 coefficients in one block spares a significant amount of transmitted information, but some information is lost. Different approximations for image transformation have been evaluated as polynomial representation (Vandermonde matrix), least squares + gradient descent, 1-D Chebyshev polynomials, 2-D Chebyshev polynomials or singular value decomposition (SVD). Results have been compared in terms of nominal compression rate (NCR), compression ratio (CR) and peak signal-to-noise ratio (PSNR) in order to minimize the error function defined as the difference between the original pixel gray levels and the approximated polynomial output. Polynomial coefficients have been later encoded and handled for generating chirps in a target rate of about two chirps per 4*4 pixel block and then submitted to a transmission multiplexing operation in the time-frequency domain.

Keywords: chirp signals, image multiplexing, image transformation, linear canonical transform, polynomial approximation

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4385 Convolution Neural Network Based on Hypnogram of Sleep Stages to Predict Dosages and Types of Hypnotic Drugs for Insomnia

Authors: Chi Wu, Dean Wu, Wen-Te Liu, Cheng-Yu Tsai, Shin-Mei Hsu, Yin-Tzu Lin, Ru-Yin Yang

Abstract:

Background: The results of previous studies compared the benefits and risks of receiving insomnia medication. However, the effects between hypnotic drugs used and enhancement of sleep quality were still unclear. Objective: The aim of this study is to establish a prediction model for hypnotic drugs' dosage used for insomnia subjects and associated the relationship between sleep stage ratio change and drug types. Methodologies: According to American Academy of Sleep Medicine (AASM) guideline, sleep stages were classified and transformed to hypnogram via the polysomnography (PSG) in a hospital in New Taipei City (Taiwan). The subjects with diagnosis for insomnia without receiving hypnotic drugs treatment were be set as the comparison group. Conversely, hypnotic drugs dosage within the past three months was obtained from the clinical registration for each subject. Furthermore, the collecting subjects were divided into two groups for training and testing. After training convolution neuron network (CNN) to predict types of hypnotics used and dosages are taken, the test group was used to evaluate the accuracy of classification. Results: We recruited 76 subjects in this study, who had been done PSG for transforming hypnogram from their sleep stages. The accuracy of dosages obtained from confusion matrix on the test group by CNN is 81.94%, and accuracy of hypnotic drug types used is 74.22%. Moreover, the subjects with high ratio of wake stage were correctly classified as requiring medical treatment. Conclusion: CNN with hypnogram was potentially used for adjusting the dosage of hypnotic drugs and providing subjects to pre-screening the types of hypnotic drugs taken.

Keywords: convolution neuron network, hypnotic drugs, insomnia, polysomnography

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4384 A Mixed Integer Linear Programming Model for Container Collection

Authors: J. Van Engeland, C. Lavigne, S. De Jaeger

Abstract:

In the light of the transition towards a more circular economy, recovery of products, parts or materials will gain in importance. Additionally, the EU proximity principle related to waste management and emissions generated by transporting large amounts of end-of-life products, shift attention to local recovery networks. The Flemish inter-communal cooperation for municipal solid waste management Meetjesland (IVM) is currently investigating the set-up of such a network. More specifically, the network encompasses the recycling of polyvinyl chloride (PVC), which is collected in separate containers. When these containers are full, a truck should transport them to the processor which can recycle the PVC into new products. This paper proposes a model to optimize the container collection. The containers are located at different Civic Amenity sites (CA sites) in a certain region. Since people can drop off their waste at these CA sites, the containers will gradually fill up during a planning horizon. If a certain container is full, it has to be collected and replaced by an empty container. The collected waste is then transported to a single processor. To perform this collection and transportation of containers, the responsible firm has a set of vehicles stationed at a single depot and different personnel crews. A vehicle can load exactly one container. If a trailer is attached to the vehicle, it can load an additional container. Each day of the planning horizon, the different crews and vehicles leave the depot to collect containers at the different sites. After loading one or two containers, the crew has to drive to the processor for unloading the waste and to pick up empty containers. Afterwards, the crew can again visit sites or it can return to the depot to end its collection work for that day. All along the collection process, the crew has to respect the opening hours of the sites. In order to allow for some flexibility, a crew is allowed to wait a certain amount of time at the gate of a site until it opens. The problem described can be modelled as a variant to the PVRP-TW (Periodic Vehicle Routing Problem with Time Windows). However, a vehicle can at maximum load two containers, hence only two subsequent site visits are possible. For that reason, we will refer to the model as a model for building tactical waste collection schemes. The goal is to a find a schedule describing which crew should visit which CA site on which day to minimize the number of trucks and the routing costs. The model was coded in IBM CPLEX Optimization studio and applied to a number of test instances. Good results were obtained, and specific suggestions concerning route and truck costs could be made. For a large range of input parameters, collection schemes using two trucks are obtained.

Keywords: container collection, crew scheduling, mixed integer linear programming, waste management

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4383 Bacteriophage Is a Novel Solution of Therapy Against S. aureus Having Multiple Drug Resistance

Authors: Sanjay Shukla, A. Nayak, R. K. Sharma, A. P. Singh, S. P. Tiwari

Abstract:

Excessive use of antibiotics is a major problem in the treatment of wounds and other chronic infections, and antibiotic treatment is frequently non-curative, thus alternative treatment is necessary. Phage therapy is considered one of the most promising approaches to treat multi-drug resistant bacterial pathogens. Infections caused by Staphylococcus aureus are very efficiently controlled with phage cocktails, containing a different individual phages lysate infecting a majority of known pathogenic S. aureus strains. The aim of the present study was to evaluate the efficacy of a purified phage cocktail for prophylactic as well as therapeutic application in mouse model and in large animals with chronic septic infection of wounds. A total of 150 sewage samples were collected from various livestock farms. These samples were subjected for the isolation of bacteriophage by the double agar layer method. A total of 27 sewage samples showed plaque formation by producing lytic activity against S. aureus in the double agar overlay method out of 150 sewage samples. In TEM, recovered isolates of bacteriophages showed hexagonal structure with tail fiber. In the bacteriophage (ØVS) had an icosahedral symmetry with the head size 52.20 nm in diameter and long tail of 109 nm. Head and tail were held together by connector and can be classified as a member of the Myoviridae family under the order of Caudovirale. Recovered bacteriophage had shown the antibacterial activity against the S. aureus in vitro. Cocktail (ØVS1, ØVS5, ØVS9, and ØVS 27) of phage lysate were tested to know in vivo antibacterial activity as well as the safety profile. Result of mice experiment indicated that the bacteriophage lysate were very safe, did not show any appearance of abscess formation, which indicates its safety in living system. The mice were also prophylactically protected against S. aureus when administered with cocktail of bacteriophage lysate just before the administration of S. aureuswhich indicates that they are good prophylactic agent. The S. aureusinoculated mice were completely recovered by bacteriophage administration with 100% recovery, which was very good as compere to conventional therapy. In the present study, ten chronic cases of the wound were treated with phage lysate, and follow up of these cases was done regularly up to ten days (at 0, 5, and 10 d). The result indicated that the six cases out of ten showed complete recovery of wounds within 10 d. The efficacy of bacteriophage therapy was found to be 60% which was very good as compared to the conventional antibiotic therapy in chronic septic wounds infections. Thus, the application of lytic phage in single dose proved to be innovative and effective therapy for the treatment of septic chronic wounds.

Keywords: phage therapy, S aureus, antimicrobial resistance, lytic phage, and bacteriophage

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4382 Multiaxial Fatigue Analysis of a High Performance Nickel-Based Superalloy

Authors: P. Selva, B. Lorraina, J. Alexis, A. Seror, A. Longuet, C. Mary, F. Denard

Abstract:

Over the past four decades, the fatigue behavior of nickel-based alloys has been widely studied. However, in recent years, significant advances in the fabrication process leading to grain size reduction have been made in order to improve fatigue properties of aircraft turbine discs. Indeed, a change in particle size affects the initiation mode of fatigue cracks as well as the fatigue life of the material. The present study aims to investigate the fatigue behavior of a newly developed nickel-based superalloy under biaxial-planar loading. Low Cycle Fatigue (LCF) tests are performed at different stress ratios so as to study the influence of the multiaxial stress state on the fatigue life of the material. Full-field displacement and strain measurements as well as crack initiation detection are obtained using Digital Image Correlation (DIC) techniques. The aim of this presentation is first to provide an in-depth description of both the experimental set-up and protocol: the multiaxial testing machine, the specific design of the cruciform specimen and performances of the DIC code are introduced. Second, results for sixteen specimens related to different load ratios are presented. Crack detection, strain amplitude and number of cycles to crack initiation vs. triaxial stress ratio for each loading case are given. Third, from fractographic investigations by scanning electron microscopy it is found that the mechanism of fatigue crack initiation does not depend on the triaxial stress ratio and that most fatigue cracks initiate from subsurface carbides.

Keywords: cruciform specimen, multiaxial fatigue, nickel-based superalloy

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4381 Magneto-Hydrodynamic Mixed Convection of Water-Al2O3 Nanofluid in a Wavy Lid-Driven Cavity

Authors: Farshid Fathinia

Abstract:

This paper examines numerically the laminar steady magneto-hydrodynamic mixed convection flow and heat transfer in a wavy lid-driven cavity filled with water-Al2O3 nanofluid using FDM method. The left and right sidewalls of the cavity have a wavy geometry and are maintained at a cold and hot temperature, respectively. The top and bottom walls are considered flat and insulated while, the bottom wall moves from left to right direction with a uniform lid-driven velocity. A magnetic field is applied vertically downward on the bottom wall of the cavity. Based on the numerical results, the effects of the dominant parameters such as Rayleigh number, Hartmann number, solid volume fraction, and wavy wall geometry parameters are examined. The numerical results are obtained for Hartmann number varying as 0 ≤ Ha ≤ 0.6, Rayleigh numbers varying as 103≤ Ra ≤105, and the solid volume fractions varying as 0 ≤ φ ≤ 0.0003. Comparisons with previously published numerical works on mixed convection in a nanofluid filled cavity are performed and good agreements between the results are observed. It is found that the flow circulation and mean Nusselt number decrease as the solid volume fraction and Hartmann number increase. Moreover, the convection enhances when the amplitude ratio of the wavy surface increases. The results also show that both the flow and thermal fields are significantly affected by the amplitude ratio (i.e., wave form) of the wavy wall.

Keywords: nanofluid, mixed convection, magnetic field, wavy cavity, lid-driven, SPH method

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4380 Exploring the Lived Experiences of Breast Cancer Survivors Post-Treatment

Authors: Nova Grail S. Luminang, Gwyneth B. Gortiza, Alvin E. Haboc, Marinol K. Hate, Rhean Mitchel N. Joven, Kara Kate D. Lammao, Rosemarie M. Lambayung, Elmo Carl D. Lardizabal, Zyra B. Linggayo, Rizza Mae G. Liwag, Ronalyn O. Songcuan

Abstract:

Breast cancer survivorship represents a complex and continuous journey extending beyond the completion of treatment, involving coping with physical, emotional, and psychological aspects of life post-treatment. This study aimed to explore the lived experiences of breast cancer survivors after successful treatment in Tabuk City, focusing on their post-treatment experiences, coping mechanisms, and necessary lifestyle changes. Researchers have selected Tabuk City as their research locale. Utilizing Martin Heidegger’s descriptive phenomenological design, this qualitative research included six participants, allowing for data saturation. Purposive sampling was employed to select participants. Researchers used Colaizzi’s Phenomenological Method in analyzing the data in order to achieve a reliable understanding of the participants’ experiences. The findings revealed three main themes: going through post-treatment hurdles, building resilience, and transformative wellness adjustments. Breast cancer survivors faced significant challenges, including physical adversities, emotional turmoil, limited social life, memory lapses, decreased sexual intimacy, and economic constraints. To cope, survivors adjusted their thoughts and attitudes, accepted their situation, relied on religious beliefs, and joined the support group Kalinga Cancer Care Ministry INC. Additionally, they strived to return to a normal life and embraced gratitude. Survivors made essential changes to their daily routines, modifying their diets, exploring herbal remedies, and incorporating physical activities such as walking and household chores. These adjustments helped improve their overall well-being and prevent cancer recurrence. The researchers concluded that the journey of breast cancer survivors is marked by significant challenges and inspiring resilience. The impact of breast cancer treatment extends beyond physical recovery, encompassing profound emotional and social dimensions. Despite these difficulties, survivors demonstrate remarkable strength and adaptability, making positive lifestyle changes that offer a hopeful and inspiring narrative of recovery and perseverance.

Keywords: breast cancer, lived experiences, breast cancer survivor, post-treatment hurdles, emotional turmoil

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4379 Effect of Bi-Dispersity on Particle Clustering in Sedimentation

Authors: Ali Abbas Zaidi

Abstract:

In free settling or sedimentation, particles form clusters at high Reynolds number and dilute suspensions. It is due to the entrapment of particles in the wakes of upstream particles. In this paper, the effect of bi-dispersity of settling particles on particle clustering is investigated using particle-resolved direct numerical simulation. Immersed boundary method is used for particle fluid interactions and discrete element method is used for particle-particle interactions. The solid volume fraction used in the simulation is 1% and the Reynolds number based on Sauter mean diameter is 350. Both solid volume fraction and Reynolds number lie in the clustering regime of sedimentation. In simulations, the particle diameter ratio (i.e. diameter of larger particle to smaller particle (d₁/d₂)) is varied from 2:1, 3:1 and 4:1. For each case of particle diameter ratio, solid volume fraction for each particle size (φ₁/φ₂) is varied from 1:1, 1:2 and 2:1. For comparison, simulations are also performed for monodisperse particles. For studying particles clustering, radial distribution function and instantaneous location of particles in the computational domain are studied. It is observed that the degree of particle clustering decreases with the increase in the bi-dispersity of settling particles. The smallest degree of particle clustering or dispersion of particles is observed for particles with d₁/d₂ equal to 4:1 and φ₁/φ₂ equal to 1:2. Simulations showed that the reduction in particle clustering by increasing bi-dispersity is due to the difference in settling velocity of particles. Particles with larger size settle faster and knockout the smaller particles from clustered regions of particles in the computational domain.

Keywords: dispersion in bi-disperse settling particles, particle microstructures in bi-disperse suspensions, particle resolved direct numerical simulations, settling of bi-disperse particles

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4378 Evaluating the Use of Swedish by-Product Foundry Sand in Asphalt Mixtures

Authors: Dina Kuttah

Abstract:

It is well known that recycling of by-product materials saves natural resources, reduces by-product volumes, and reduces the need for virgin materials. The steel industry produces a myriad of metal components for industrial chains, which in turn generates mineral discarded sand molds. Although these sands are clean before their use, after casting, they may contain contaminants. Therefore, huge quantities of excess by-product foundry sand (BFS) end up occupying large volumes in landfills. In Sweden, approximately 200000 tonnes of excess BFS end up in landfills. The transportation and construction industries have the greatest potential for reuse by-products because they use vast quantities of earthen materials annually. Accordingly, experimental work has been undertaken to evaluate the possible use of two chosen BFS from two Swedish foundries in a conventional Swedish asphalt mixture. The experimental procedure of this research has focused on the dosage, environmental and technical properties of the same mixture type ABT 11 and the same bitumen (160/220) but at different replacement proportions of the conventional fine sand with the two BFS. The environmental requirements, in addition to the technical requirements, namely, void ratio, static indirect tensile strength ratio, and resilient modulus before and after moisture-induced sensitivity tests of the asphalt mixtures, have been investigated in the current study. The test results demonstrated that the BFS from both foundries can be incorporated in the selected asphalt mixture at specified replacement proportions of the conventional fine sand fraction 0-2 mm, as discussed in the paper.

Keywords: asphalt mixtures, by-product foundry sand, indirect tensile strength, moisture induced sensitivity tests, resilient modulus

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4377 Hematologic Inflammatory Markers and Inflammation-Related Hepatokines in Pediatric Obesity

Authors: Mustafa Metin Donma, Orkide Donma

Abstract:

Obesity in children particularly draws attention because it may threaten the individual’s future life due to many chronic diseases it may lead to. Most of these diseases, including obesity itself altogether are related to inflammation. For this reason, inflammation-related parameters gain importance. Within this context, complete blood cell counts, ratios or indices derived from these counts have recently found some platform to be used as inflammatory markers. So far, mostly adipokines were investigated within the field of obesity. The liver is at the center of the metabolic pathways network. Metabolic inflammation is closely associated with cellular dysfunction. In this study, hematologic inflammatory markers and two major hepatokines, cytokines produced predominantly by the liver, fibroblast growth factor-21 (FGF-21) and fetuin A were investigated in pediatric obesity. Two groups were constituted from seventy-six obese children based on World Health Organization criteria. Group 1 was composed of children whose age- and sex-adjusted body mass index (BMI) percentiles were between 95 and 99. Group 2 consists of children who are above the 99ᵗʰ percentile. The first and the latter groups were defined as obese (OB) and morbid obese (MO). Anthropometric measurements of the children were performed. Informed consent forms and the approval of the institutional ethics committee were obtained. Blood cell counts and ratios were determined by an automated hematology analyzer. The related ratios and indexes were calculated. Statistical evaluation of the data was performed by the SPSS program. There was no statistically significant difference in terms of neutrophil-to lymphocyte ratio, monocyte-to-high density lipoprotein cholesterol ratio and the platelet-to-lymphocyte ratio between the groups. Mean platelet volume and platelet distribution width values were decreased (p<0.05), total platelet count, red cell distribution width (RDW) and systemic immune inflammation index values were increased (p<0.01) in MO group. Both hepatokines were increased in the same group; however, increases were not statistically significant. In this group, also a strong correlation was calculated between FGF-21 and RDW when controlled by age, hematocrit, iron and ferritin (r=0.425; p<0.01). In conclusion, the association between RDW, a hematologic inflammatory marker, and FGF-21, an inflammation-related hepatokine, found in MO group is an important finding discriminating between OB and MO children. This association is even more powerful when controlled by age and iron-related parameters.

Keywords: childhood obesity, fetuin A , fibroblast growth factor-21, hematologic markers, red cell distribution width

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