Search results for: failure categorization
623 FE Modelling of Structural Effects of Alkali-Silica Reaction in Reinforced Concrete Beams
Authors: Mehdi Habibagahi, Shami Nejadi, Ata Aminfar
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A significant degradation factor that impacts the durability of concrete structures is the alkali-silica reaction. Engineers are frequently charged with the challenges of conducting a thorough safety assessment of concrete structures that have been impacted by ASR. The alkali-silica reaction has a major influence on the structural capacities of structures. In most cases, the reduction in compressive strength, tensile strength, and modulus of elasticity is expressed as a function of free expansion and crack widths. Predicting the effect of ASR on flexural strength is also relevant. In this paper, a nonlinear three-dimensional (3D) finite-element model was proposed to describe the flexural strength degradation induced byASR.Initial strains, initial stresses, initial cracks, and deterioration of material characteristics were all considered ASR factors in this model. The effects of ASR on structural performance were evaluated by focusing on initial flexural stiffness, force–deformation curve, and load-carrying capacity. Degradation of concrete mechanical properties was correlated with ASR growth using material test data conducted at Tech Lab, UTS, and implemented into the FEM for various expansions. The finite element study revealed a better understanding of the ASR-affected RC beam's failure mechanism and capacity reduction as a function of ASR expansion. Furthermore, in this study, decreasing of the residual mechanical properties due to ASRisreviewed, using as input data for the FEM model. Finally, analysis techniques and a comparison of the analysis and the experiment results are discussed. Verification is also provided through analyses of reinforced concrete beams with behavior governed by either flexural or shear mechanisms.Keywords: alkali-silica reaction, analysis, assessment, finite element, nonlinear analysis, reinforced concrete
Procedia PDF Downloads 156622 Simulation-Based Validation of Safe Human-Robot-Collaboration
Authors: Titanilla Komenda
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Human-machine-collaboration defines a direct interaction between humans and machines to fulfil specific tasks. Those so-called collaborative machines are used without fencing and interact with humans in predefined workspaces. Even though, human-machine-collaboration enables a flexible adaption to variable degrees of freedom, industrial applications are rarely found. The reasons for this are not technical progress but rather limitations in planning processes ensuring safety for operators. Until now, humans and machines were mainly considered separately in the planning process, focusing on ergonomics and system performance respectively. Within human-machine-collaboration, those aspects must not be seen in isolation from each other but rather need to be analysed in interaction. Furthermore, a simulation model is needed that can validate the system performance and ensure the safety for the operator at any given time. Following on from this, a holistic simulation model is presented, enabling a simulative representation of collaborative tasks – including both, humans and machines. The presented model does not only include a geometry and a motion model of interacting humans and machines but also a numerical behaviour model of humans as well as a Boole’s probabilistic sensor model. With this, error scenarios can be simulated by validating system behaviour in unplanned situations. As these models can be defined on the basis of Failure Mode and Effects Analysis as well as probabilities of errors, the implementation in a collaborative model is discussed and evaluated regarding limitations and simulation times. The functionality of the model is shown on industrial applications by comparing simulation results with video data. The analysis shows the impact of considering human factors in the planning process in contrast to only meeting system performance. In this sense, an optimisation function is presented that meets the trade-off between human and machine factors and aids in a successful and safe realisation of collaborative scenarios.Keywords: human-machine-system, human-robot-collaboration, safety, simulation
Procedia PDF Downloads 360621 Simulation of Bird Strike on Airplane Wings by Using SPH Methodology
Authors: Tuğçe Kiper Elibol, İbrahim Uslan, Mehmet Ali Guler, Murat Buyuk, Uğur Yolum
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According to the FAA report, 142603 bird strikes were reported for a period of 24 years, between 1990 – 2013. Bird strike with aerospace structures not only threaten the flight security but also cause financial loss and puts life in danger. The statistics show that most of the bird strikes are happening with the nose and the leading edge of the wings. Also, a substantial amount of bird strikes is absorbed by the jet engines and causes damage on blades and engine body. Crash proof designs are required to overcome the possibility of catastrophic failure of the airplane. Using computational methods for bird strike analysis during the product development phase has considerable importance in terms of cost saving. Clearly, using simulation techniques to reduce the number of reference tests can dramatically affect the total cost of an aircraft, where for bird strike often full-scale tests are considered. Therefore, development of validated numerical models is required that can replace preliminary tests and accelerate the design cycle. In this study, to verify the simulation parameters for a bird strike analysis, several different numerical options are studied for an impact case against a primitive structure. Then, a representative bird mode is generated with the verified parameters and collided against the leading edge of a training aircraft wing, where each structural member of the wing was explicitly modeled. A nonlinear explicit dynamics finite element code, LS-DYNA was used for the bird impact simulations. SPH methodology was used to model the behavior of the bird. Dynamic behavior of the wing superstructure was observed and will be used for further design optimization purposes.Keywords: bird impact, bird strike, finite element modeling, smoothed particle hydrodynamics
Procedia PDF Downloads 325620 Diagnostics and Explanation of the Current Status of the 40- Year Railway Viaduct
Authors: Jakub Zembrzuski, Bartosz Sobczyk, Mikołaj MIśkiewicz
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Besides designing new constructions, engineers all over the world must face another problem – maintenance, repairs, and assessment of the technical condition of existing bridges. To solve more complex issues, it is necessary to be familiar with the theory of finite element method and to have access to the software that provides sufficient tools which to enable create of sometimes significantly advanced numerical models. The paper includes a brief assessment of the technical condition, a description of the in situ non-destructive testing carried out and the FEM models created for global and local analysis. In situ testing was performed using strain gauges and displacement sensors. Numerical models were created using various software and numerical modeling techniques. Particularly noteworthy is the method of modeling riveted joints of the crossbeam of the viaduct. It is a simplified method that consists of the use of only basic numerical tools such as beam and shell finite elements, constraints, and simplified boundary conditions (fixed support and symmetry). The results of the numerical analyses were presented and discussed. It is clearly explained why the structure did not fail, despite the fact that the weld of the deck plate completely failed. A further research problem that was solved was to determine the cause of the rapid increase in values on the stress diagram in the cross-section of the transverse section. The problems were solved using the solely mentioned, simplified method of modeling riveted joints, which demonstrates that it is possible to solve such problems without access to sophisticated software that enables to performance of the advanced nonlinear analysis. Moreover, the obtained results are of great importance in the field of assessing the operation of bridge structures with an orthotropic plate.Keywords: bridge, diagnostics, FEM simulations, failure, NDT, in situ testing
Procedia PDF Downloads 71619 Correlation between Cephalometric Measurements and Visual Perception of Facial Profile in Skeletal Type II Patients
Authors: Choki, Supatchai Boonpratham, Suwannee Luppanapornlarp
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The objective of this study was to find a correlation between cephalometric measurements and visual perception of facial profile in skeletal type II patients. In this study, 250 lateral cephalograms of female patients from age, 20 to 22 years were analyzed. The profile outlines of all the samples were hand traced and transformed into silhouettes by the principal investigator. Profile ratings were done by 9 orthodontists on Visual Analogue Scale from score one to ten (increasing level of convexity). 37 hard issue and soft tissue cephalometric measurements were analyzed by the principal investigator. All the measurements were repeated after 2 weeks interval for error assessment. At last, the rankings of visual perceptions were correlated with cephalometric measurements using Spearman correlation coefficient (P < 0.05). The results show that the increase in facial convexity was correlated with higher values of ANB (A point, nasion and B point), AF-BF (distance from A point to B point in mm), L1-NB (distance from lower incisor to NB line in mm), anterior maxillary alveolar height, posterior maxillary alveolar height, overjet, H angle hard tissue, H angle soft tissue and lower lip to E plane (absolute correlation values from 0.277 to 0.711). In contrast, the increase in facial convexity was correlated with lower values of Pg. to N perpendicular and Pg. to NB (mm) (absolute correlation value -0.302 and -0.294 respectively). From the soft tissue measurements, H angles had a higher correlation with visual perception than facial contour angle, nasolabial angle, and lower lip to E plane. In conclusion, the findings of this study indicated that the correlation of cephalometric measurements with visual perception was less than expected. Only 29% of cephalometric measurements had a significant correlation with visual perception. Therefore, diagnosis based solely on cephalometric analysis can result in failure to meet the patient’s esthetic expectation.Keywords: cephalometric measurements, facial profile, skeletal type II, visual perception
Procedia PDF Downloads 137618 Impact of Massive Weight Loss Body Contouring Surgery in the Patient’s Quality of Life
Authors: Maria Albuquerque, Miguel Matias, Ângelo Sá, Juliana Sousa, Maria Manuel Mouzinho
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Obesity is a frequent disease in Portugal. The surgical treatment is very effective and has an indication when there is a failure of the medical treatment. Although massive weight loss is associated with considerable health gains, these patients are characterized by a variable degree of dermolipodistrophy. In some cases, there is even the development of physical symptoms such as intertriginous, and some degree of psychological distress is present. In almost all cases, a desire for a better body contour, which inhibits some aspects of social life, is a fact. A prospective study was made to access the impact of body contouring surgery in the quality of life of patients who underwent a massive weight lost correction surgical procedure at Centro Hospitalar de Lisboa Central between January 2020 and December 2021. The patients were submitted to the Body Q subjective questionnaire adapted for the Portuguese language and accessed for the following categories: Anguish with Appearance, Contempt with Body Image, Satisfaction with the Abdomen, and Overall Satisfaction with the Body. The questionnaire was repeated at the 6 months mark. A total of 80 patients were sampled. The sex distribution was 79 female and 1 male. The median BMI index before surgery was inferior to 28%. The pre operatory questionnaire showed high scores for Anguish with Appearance and low scores for the body image self-evaluation. Overall, there was an improvement of at least 50% in all the evaluated scores. Additionally, a correlation was found between abdominoplasty and the contempt with body image and satisfaction with the abdomen (p-value <0.05). Massive weight loss is associated with important body deformities that have a significant impact on the patient’s personal and social life. Body contouring surgery is then vital for these patients as it implicates major aesthetic and functional benefits.Keywords: abdominoplasty, cruroplasty, obesity, massive weight loss
Procedia PDF Downloads 155617 Creep Behaviour of Asphalt Modified by Waste Polystyrene and Its Hybrids with Crumb Rubber and Low-Density Polyethylene
Authors: Soheil Heydari, Ailar Hajimohammadi, Nasser Khalili
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Polystyrene, being made from a monomer called styrene, is a rigid and easy-to mould polymer that is widely used for many applications, from foam packaging to disposable containers. Considering that the degradation of waste polystyrene takes up to 500 years, there is an urgent need for a sustainable application for waste polystyrene. This study evaluates the application of waste polystyrene as an asphalt modifier. The inclusion of waste plastics in asphalt is either practised by the dry process or the wet process. In the dry process, plastics are added straight into the asphalt mixture and in the wet process, they are mixed and digested into bitumen. In this article, polystyrene was used as an asphalt modifier in a dry process. However, the mixing process is precisely designed to make sure that the polymer is melted and modified in the binder. It was expected that, due to the rigidity of polystyrene, it will have positive effects on the permanent deformation of the asphalt mixture. Therefore, different mixtures were manufactured with different contents of polystyrene and Marshall specimens were manufactured, and dynamic creep tests were conducted to evaluate the permanent deformation of the modification. This is a commonly repeated loading test conducted at different stress levels and temperatures. Loading cycles are applied to the AC specimen until failure occurs; with the amount of deformation constantly recorded the cumulative, permanent strain is determined and reported as a function of the number of cycles. Also, to our best knowledge, hybrid mixes of polystyrene with crumb rubber and low-density polyethylene were made and compared with a polystyrene-modified mixture. The test results of this study showed that the hybrid mix of polystyrene and low-density polyethylene has the highest resistance against permanent deformation. However, the polystyrene-modified mixture outperformed the hybrid mix of polystyrene and crumb rubber, and both demonstrated way lower permanent deformation than the unmodified specimen.Keywords: permanent deformation, waste plastics, polystyrene, hybrid plastics, hybrid mix, hybrid modification, dry process
Procedia PDF Downloads 104616 Decision Making in Medicine and Treatment Strategies
Authors: Kamran Yazdanbakhsh, Somayeh Mahmoudi
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Three reasons make good use of the decision theory in medicine: 1. Increased medical knowledge and their complexity makes it difficult treatment information effectively without resorting to sophisticated analytical methods, especially when it comes to detecting errors and identify opportunities for treatment from databases of large size. 2. There is a wide geographic variability of medical practice. In a context where medical costs are, at least in part, by the patient, these changes raise doubts about the relevance of the choices made by physicians. These differences are generally attributed to differences in estimates of probabilities of success of treatment involved, and differing assessments of the results on success or failure. Without explicit criteria for decision, it is difficult to identify precisely the sources of these variations in treatment. 3. Beyond the principle of informed consent, patients need to be involved in decision-making. For this, the decision process should be explained and broken down. A decision problem is to select the best option among a set of choices. The problem is what is meant by "best option ", or know what criteria guide the choice. The purpose of decision theory is to answer this question. The systematic use of decision models allows us to better understand the differences in medical practices, and facilitates the search for consensus. About this, there are three types of situations: situations certain, risky situations, and uncertain situations: 1. In certain situations, the consequence of each decision are certain. 2. In risky situations, every decision can have several consequences, the probability of each of these consequences is known. 3. In uncertain situations, each decision can have several consequences, the probability is not known. Our aim in this article is to show how decision theory can usefully be mobilized to meet the needs of physicians. The decision theory can make decisions more transparent: first, by clarifying the data systematically considered the problem and secondly by asking a few basic principles should guide the choice. Once the problem and clarified the decision theory provides operational tools to represent the available information and determine patient preferences, and thus assist the patient and doctor in their choices.Keywords: decision making, medicine, treatment strategies, patient
Procedia PDF Downloads 578615 Damage Mesomodel Based Low-Velocity Impact Damage Analysis of Laminated Composite Structures
Authors: Semayat Fanta, P.M. Mohite, C.S. Upadhyay
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Damage meso-model for laminates is one of the most widely applicable approaches for the analysis of damage induced in laminated fiber-reinforced polymeric composites. Damage meso-model for laminates has been developed over the last three decades by many researchers in experimental, theoretical, and analytical methods that have been carried out in micromechanics as well as meso-mechanics analysis approaches. It has been fundamentally developed based on the micromechanical description that aims to predict the damage initiation and evolution until the failure of structure in various loading conditions. The current damage meso-model for laminates aimed to act as a bridge between micromechanics and macro-mechanics of the laminated composite structure. This model considers two meso-constituents for the analysis of damage in ply and interface that imparted from low-velocity impact. The damages considered in this study include fiber breakage, matrix cracking, and diffused damage of the lamina, and delamination of the interface. The damage initiation and evolution in laminae can be modeled in terms of damaged strain energy density using damage parameters and the thermodynamic irreversible forces. Interface damage can be modeled with a new concept of spherical micro-void in the resin-rich zone of interface material. The damage evolution is controlled by the damage parameter (d) and the radius of micro-void (r) from the point of damage nucleation to its saturation. The constitutive martial model for meso-constituents is defined in a user material subroutine VUMAT and implemented in ABAQUS/Explicit finite element modeling tool. The model predicts the damages in the meso-constituents level very accurately and is considered the most effective technique of modeling low-velocity impact simulation for laminated composite structures.Keywords: mesomodel, laminate, low-energy impact, micromechanics
Procedia PDF Downloads 219614 Drone On-Time Obstacle Avoidance for Static and Dynamic Obstacles
Authors: Herath M. P. C. Jayaweera, Samer Hanoun
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Path planning for on-time obstacle avoidance is an essential and challenging task that enables drones to achieve safe operation in any application domain. The level of challenge increases significantly on the obstacle avoidance technique when the drone is following a ground mobile entity (GME). This is mainly due to the change in direction and magnitude of the GME′s velocity in dynamic and unstructured environments. Force field techniques are the most widely used obstacle avoidance methods due to their simplicity, ease of use, and potential to be adopted for three-dimensional dynamic environments. However, the existing force field obstacle avoidance techniques suffer many drawbacks, including their tendency to generate longer routes when the obstacles are sideways of the drone′s route, poor ability to find the shortest flyable path, propensity to fall into local minima, producing a non-smooth path, and high failure rate in the presence of symmetrical obstacles. To overcome these shortcomings, this paper proposes an on-time three-dimensional obstacle avoidance method for drones to effectively and efficiently avoid dynamic and static obstacles in unknown environments while pursuing a GME. This on-time obstacle avoidance technique generates velocity waypoints for its obstacle-free and efficient path based on the shape of the encountered obstacles. This method can be utilized on most types of drones that have basic distance measurement sensors and autopilot-supported flight controllers. The proposed obstacle avoidance technique is validated and evaluated against existing force field methods for different simulation scenarios in Gazebo and ROS-supported PX4-SITL. The simulation results show that the proposed obstacle avoidance technique outperforms the existing force field techniques and is better suited for real-world applications.Keywords: drones, force field methods, obstacle avoidance, path planning
Procedia PDF Downloads 91613 A Damage Level Assessment Model for Extra High Voltage Transmission Towers
Authors: Huan-Chieh Chiu, Hung-Shuo Wu, Chien-Hao Wang, Yu-Cheng Yang, Ching-Ya Tseng, Joe-Air Jiang
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Power failure resulting from tower collapse due to violent seismic events might bring enormous and inestimable losses. The Chi-Chi earthquake, for example, strongly struck Taiwan and caused huge damage to the power system on September 21, 1999. Nearly 10% of extra high voltage (EHV) transmission towers were damaged in the earthquake. Therefore, seismic hazards of EHV transmission towers should be monitored and evaluated. The ultimate goal of this study is to establish a damage level assessment model for EHV transmission towers. The data of earthquakes provided by Taiwan Central Weather Bureau serve as a reference and then lay the foundation for earthquake simulations and analyses afterward. Some parameters related to the damage level of each point of an EHV tower are simulated and analyzed by the data from monitoring stations once an earthquake occurs. Through the Fourier transform, the seismic wave is then analyzed and transformed into different wave frequencies, and the data would be shown through a response spectrum. With this method, the seismic frequency which damages EHV towers the most is clearly identified. An estimation model is built to determine the damage level caused by a future seismic event. Finally, instead of relying on visual observation done by inspectors, the proposed model can provide a power company with the damage information of a transmission tower. Using the model, manpower required by visual observation can be reduced, and the accuracy of the damage level estimation can be substantially improved. Such a model is greatly useful for health and construction monitoring because of the advantages of long-term evaluation of structural characteristics and long-term damage detection.Keywords: damage level monitoring, drift ratio, fragility curve, smart grid, transmission tower
Procedia PDF Downloads 298612 The Role of the Federal Supreme Court in Preventing the Exercise of the Right to Self-Determination
Authors: Shaho Ghafur Ahmed
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The right to self-determination of peoples is a fundamental human right recognized by the principles of international law. It could be embodied in the internal level in the form of federalism. Most federal constitutions prevented the secession of constituent entities, while some remained silent, as the case of Iraq, and rare instances of them recognize it. But, after the failure of federalism, these entities seek to separate whenever the opportunity arises. In several cases, they have resort to peaceful methods in some others they resort to force. The constitutional Supreme Court, which guaranty the unity and integrity of the State, often prevent these attempts. After not a commitment of federalism in Iraq, which has been founded since 2004, the Kurdistan region, as the only federated entity, has conducted a unilateral referendum on 25 September 2017 for its independence. The Iraqi government refused it. The Iraqi Federal Supreme Court, through interpreting the constitutional provisions, decided that this referendum and it’s purposes, which was the independence of the region, was unconstitutional. Subsequently, the Iraqi government used forces and blockaded the region so as to force it to turn off this process. So, in this paper, the right to self-determination of the peoples in federated entities and its obstacles will be discussed through the comparative legal basis and analyzing the decisions of the Federal Constitutional Courts. We will compare the role that the Supreme Court of Canada played regarding the referendum that operated in Quebec in 1995, in which it refused only the unilaterally attempts for the independence of this province. While, in the case of the Kurdistan region, the Iraqi Federal Supreme Court has definitively refused this right. No measures were taken by this Court to protect the region from the Iraqi government reactions. This decision led to the questioning of the neutrality of this Court. So, from the point of view of the Kurdistan region, this Court became a political instrument to prevent it to be independent in the international community, in the absence of a clear constitutional provision, through an abstract and an incomplete interpretation of federal constitutional provisions.Keywords: right of self-determination, federal supreme court, supremacy of federal constitution
Procedia PDF Downloads 166611 Change Management as a Critical Success Factor In E-Government initiatives
Authors: Mohammed Alassim
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In 2014, a UN survey stated that: "The greatest challenge to the adoption of whole-of government, which fundamentally rests on increased collaboration, is resistance to change among government actors". Change management has experienced both theoretically and practically many transformation over the years. When organizations have to implement radical changes, they have to encounter a plethora of issues which leads to ineffective or inefficient implementation of change in most cases. 70% of change projects fail because of human issues. It has been cited that” most studies still show a 60-70% failure rate for organizational change projects — a statistic that has stayed constant from the 1970’s to the present.”. E-government involves not just technical change but cultural, policy, social and organizational evolution. Managing change and overcoming resistance to change is seen as crucial in the success of E-government projects. Resistance can be from different levels in the organization (top management, middle management or employees at operational levels). There can be many reasons for resistance including fear of change and insecurity, lack of knowledge and absence of commitment from management to implement the change. The purpose of this study is to conduct in-depth research to understand the process of change and to identify the critical factors that have led to resistance from employees at different levels (top management, Middle management and operational employees) during e-government initiatives in the public sector in Saudi Arabia. The study is based on qualitative and empirical research methods conducted in the public sector in the Kingdom of Saudi Arabia. This research will use triangulation in data method (interview, group discussion and document review). This research will contribute significantly to knowledge in this field and will identify the measures that can be taken to reduce resistance to change, Upon analysis recommendations or model will be offered which can enable decision makers in public sector in Saudi Arabia how to plan, implement and evaluate change in e-government initiatives via change management strategy.Keywords: change management, e-government, managing change, resistance to change
Procedia PDF Downloads 315610 Factors Associated with Acute Kidney Injury in Multiple Trauma Patients with Rhabdomyolysis
Authors: Yong Hwang, Kang Yeol Suh, Yundeok Jang, Tae Hoon Kim
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Introduction: Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. Acute kidney injury is a potential complication of severe rhabdomyolysis and the prognosis is substantially worse if renal failure develops. We try to identify the factors that were predictive of AKI in severe trauma patients with rhabdomyolysis. Methods: This retrospective study was conducted at the emergency department of a level Ⅰ trauma center. Patients enrolled that initial creatine phosphokinase (CPK) levels were higher than 1000 IU with acute multiple trauma, and more than 18 years older from Oct. 2012 to June 2016. We collected demographic data (age, gender, length of hospital day, and patients’ outcome), laboratory data (ABGA, lactate, hemoglobin. hematocrit, platelet, LDH, myoglobin, liver enzyme, and BUN/Cr), and clinical data (Injury Mechanism, RTS, ISS, AIS, and TRISS). The data were compared and analyzed between AKI and Non-AKI group. Statistical analyses were performed using IMB SPSS 20.0 statistics for Window. Results: Three hundred sixty-four patients were enrolled that AKI group were ninety-six and non-AKI group were two hundred sixty-eight. The base excess (HCO3), AST/ALT, LDH, and myoglobin in AKI group were significantly higher than non-AKI group from laboratory data (p ≤ 0.05). The injury severity score (ISS), revised Trauma Score (RTS), Abbreviated Injury Scale 3 and 4 (AIS 3 and 4) were showed significant results in clinical data. The patterns of CPK level were increased from first and second day, but slightly decreased from third day in both group. Seven patients had received hemodialysis treatment despite the bleeding risk and were survived in AKI group. Conclusion: We recommend that HCO3, CPK, LDH, and myoglobin should be checked and be concerned about ISS, RTS, AIS with injury mechanism at the early stage of treatment in the emergency department.Keywords: acute kidney injury, emergencies, multiple trauma, rhabdomyolysis
Procedia PDF Downloads 338609 IgA/λ Plasma Cell Myeloma with λ Light Chain Amyloidosis: A Case Report
Authors: Kai Pei Huang, Ting Chung Hung, Li Ching Wu
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Amyloidosis refers to a variety of conditions wherein amyloid proteins are abnormally deposited in organ or tissues and cause harm. Among the several forms of amyloidosis, the principal types of that in inpatient medical services are the AL amyloidosis (primary) and AA amyloidois (secondary). AL Amyloidois is due to deposition of protein derived from overproduction of immunoglobulin light chain in plasma cell myeloma. Furthermore, it is a systemic disorder that can present with a variety of symptoms, including heavy proteinemia and edema, heptosplenomegaly, otherwise unexplained heart failure. We reported a 78-year-old female presenting dysuria, oliguria and leg edema for several months. Laboratory data showed proteinuria (UPCR:1679.8), leukocytosis (WBC:16.2 x 10^3/uL), results of serum urea nitrogen (39mg/dL), creatinine (0.76 mg/dL), IgG (748 mg/dL.), IgA (635 mg/dL), IgM (63 mg/dL), kappa light chain(18.8 mg/dL), lambda light chain (110.0 mg/dL) and kappa/lambda ratio (0.17). Renal biopsy found amyloid fibrils in glomerular mesangial area, and Congo red stain highlights amyloid deposition in glomeruli. Additional lab studies included serum protein electrophoresis, which shows a major monoclonal peak in β region and minor small peak in gamma region, and the immunotyping studies for serum showed two IgA/λ type. We treated sample with beta-mercaptoethanol which reducing the polymerized immunoglobulin to clarify two IgA/λ are secreted from the same plasma cell clone in bone marrow. Later examination confirmed it existed plasma cell infiltration in bone marrow, and the immunohistochemical staining showed monotypic for λ light chain and are positive for IgA. All findings mentioned above reveal it is a case of plasma cell myeloma with λ Light Chain Amyloidosis.Keywords: amyloidosis, immunoglobulin light chain, plasma cell myeloma, serum protein electrophoresis
Procedia PDF Downloads 212608 The Flexural Behavior of Reinforced Concrete Beams Externally Strengthened with CFRP Composites Exposed for Different Environment Conditions
Authors: Rajai Al-Rousan
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The repair and strengthening of concrete structures is a big challenge for the concrete industry for both engineers and contractors. Due to increasing economical constraints, the current trend is to repair/upgrade deteriorated and functionally obsolete structures rather than replacing them with new structures. CFRP has been used previously by air space industries regardless of the high costs. The decrease in the costs of the composite materials, as results of the technology improvement, has made CFRP an alternative to conventional materials for many applications. The primary objective of this research is to investigate the flexural behavior of reinforced concrete (RC) beams externally strengthened with CFRP composites exposed for three years for the following conditions: (a) room temperature, (b) cyclic ponding in 15% salt-water solution, (c) hot-water of 65oC, and (d) rapid freeze/thaw cycles. Results indicated that the after three years of various environmental conditions, the bond strength between the concrete beams and CFRP sheets was not affected. No signs of separation or debonding of CFRP sheets were observed before testing. Also, externally strengthening RC beams with CFRP sheets leads to a substantial increase in the ductility of concrete structures. This is a result of forcing the concrete to undergo inelastic deformation, resulting in compression failure of the structure after yielding of steel reinforcement. In addition, exposure to heat water tank for three years reduces the ultimate load by about 11%. This 11% reduction in the ultimate load equates to about 53%, 46% and 68% loss of the gain of the strength attributed to the CFRP of 2/3 Layer, 1 Layers and 2 Layers CFRP Sheets respectively. This mean that with decreasing of number of layers the environmental exposure had an efficient effect on concrete by protection concrete from environmental effect and adverse effect on the bond performance.Keywords: flexural, behavior, CFRP, composites, environment, conditions
Procedia PDF Downloads 308607 Site Investigations and Mitigation Measures of Landslides in Sainj and Tirthan Valley of Kullu District, Himachal Pradesh, India
Authors: Laxmi Versain, R. S. Banshtu
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Landslides are found to be the most commonly occurring geological hazards in the mountainous regions of the Himalaya. This mountainous zone is facing large number of seismic turbulences, climatic changes, and topography changes due to increasing urbanization. That eventually has lead several researchers working for best suitable methodologies to infer the ultimate results. Landslide Hazard Zonation has widely come as suitable method to know the appropriate factors that trigger the lansdslide phenomenon on higher reaches. Most vulnerable zones or zones of weaknesses are indentified and safe mitigation measures are to be suggested to mitigate and channelize the study of an effected area. Use of Landslide Hazard Zonation methodology in relative zones of weaknesses depend upon the data available for the particular site. The causative factors are identified and data is made available to infer the results. Factors like seismicity in mountainous region have closely associated to make the zones of thrust and faults or lineaments more vulnerable. Data related to soil, terrain, rainfall, geology, slope, nature of terrain, are found to be varied for various landforms and areas. Thus, the relative causes are to be identified and classified by giving specific weightage to each parameter. Factors which cause the instability of slopes are several and can be grouped to infer the potential modes of failure. The triggering factors of the landslides on the mountains are not uniform. The urbanization has crawled like ladder and emergence of concrete jungles are in a very fast pace on hilly region of Himalayas. The local terrains has largely been modified and hence instability of several zones are triggering at very fast pace. More strategic and pronounced methods are required to reduce the effect of landslide.Keywords: zonation, LHZ, susceptible, weightages, methodology
Procedia PDF Downloads 195606 Young Female’s Heart Was Bitten by Unknown Ghost (Isolated Cardiac Sarcoidosis): A Case Report
Authors: Heru Al Amin
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Sarcoidosis is a granulomatous inflammatory disorder of unclear etiology that can affect multiple different organ systems. Isolated cardiac sarcoidosis is a very rare condition that causes lethal arrhythmia and heart failure. A definite diagnosis of cardiac sarcoidosis remains challenging. The use of multimodality imaging plays a pivotal role in the diagnosis of this entity. Case summary: In this report, we discuss a case of a 50-year-old woman who presented with recurrent palpitation, dizziness, vertigo and presyncope. Electrocardiogram revealed variable heart blocks, including first-degree AV block, second-degree AV block, high-degree AV block, complete AV block, trifascicular block and sometimes supraventricular arrhythmia. Twenty-four hours of Holter monitoring show atrial bigeminy, first-degree AV block and trifascicular block. Transthoracic echocardiography showed Thinning of basal anteroseptal and inferred septum with LV dilatation with reduction of Global Longitudinal Strain. A dual-chamber pacemaker was implanted. CT Coronary angiogram showed no coronary artery disease. Cardiac magnetic resonance revealed basal anteroseptal and inferior septum thinning with focal edema with LGE suggestive of sarcoidosis. Computed tomography of the chest showed no lymphadenopathy or pulmonary infiltration. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) of the whole body showed. We started steroids and followed up with the patient. Conclusion: This case serves to highlight the challenges in identifying and managing isolated CS in a young patient with recurrent syncope with variable heart block. Early, even late initiation of steroids can improve arrhythmia as well as left ventricular function.Keywords: cardiac sarcoidosis, conduction abnormality, syncope, cardiac MRI
Procedia PDF Downloads 88605 A Resource-Based Understanding of Health and Social Care Regulation
Authors: David P. Horton, Gary Lynch-Wood
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Western populations are aging, prone to various lifestyle health problems, and increasing their demand for health and social care services. This demand has created enormous fiscal and regulatory challenges. In response, government institutions have deployed strategies of behavior modification to encourage people to exercise greater personal responsibility over their health and care needs (i.e., welfare responsibilisation). Policy strategies are underpinned by the assumption that people if properly supported, will make better health and lifestyle selections. Not only does this absolve governments of the responsibility for meeting all health and care needs, but it also enables government institutions to assert fiscal control over welfare spending. Looking at the regulation of health and social care in the UK, the authors identify and outline a suite of regulatory tools that are designed to extract and manage the resources of health and social care services users and to encourage them to make (‘better’) use of these resources. This is important for our understanding of how health and social care regulation is responding to ongoing social and economic challenges. It is also important because there has been a failure to systematically examine the relevance of resources for regulation, which is surprising given that resources are crucial to how and whether regulation succeeds or fails. In particular, drawing from the regulatory welfare state concept, the authors analyse the key legal and regulatory changes and mechanisms that have been introduced since the 2008 financial crisis, focusing on critical measures such as the Health and Social Care Act and regulations introduced under the National Health Service Act. The authors show how three types of user resources (i.e., tangible, labor, and data) are being used to assert fiscal control and increase welfare responsibilisation. Amongst other things, the paper concludes that service users have become more than rule followers and targets of behavioral modification; rather, they are producers of resources that regulatory systems have come to rely on.Keywords: health care, regulation, resources, social care
Procedia PDF Downloads 94604 Analysis of Farm Management Skills in Broiler Poultry Producers in Botswana
Authors: Som Pal Baliyan
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The purpose of this quantitative study was to analyze farm management skills in broiler poultryproducers in Botswana. The study adopted a descriptive and correlation research design. The population of the study was the poultry farm operators who had been in broiler poultry farming at least for two years. Based on the information from literature, a questionnaire was constructed for data collection on seven areas of farm management skills namely; planning skills, accounting and financial management skills, production management skills, product procurement and marketing skills, decision making skills, risk management skills, and specific technical skills. The validity and reliability of the questionnaire were accomplished by a panel of experts and by calculating the Cronbach’s alpha coefficient, respectively. Data were collected through a survey of 60 randomly sampled poultry farm operators in Botswana. Data were analyzed through descriptive statistical tools whereby the level of farm management skills were determined by calculating means and standard deviations of the management skills among the broiler producers. The level of farm management skills in broilers producers was discussed. All the seven farm management skills were ranked based on their calculated means. The specific technical skills and risk management skills were the highest and the lowest ranked farm management skills, respectively.Findings revealed that the broiler producers had skills above the average level only in specific technical skills whereas the skill levels in the remaining six farm management skills under study were found below the average level. This prevailing low level of farm management skills can be justified asthe cause of failure or poor performance of the broiler poultry farms in Botswana. Therefore, in order to improve the efficiency and productivityin broiler production in the country, it was recommended that the broiler poultry producers should be adequately trained in areas of planning skills, financial management skills, production management skills, product procurement and marketing skills, decision making skills and risk management skills.Keywords: poultry production, broiler production, management skills, levels of skills
Procedia PDF Downloads 398603 Efficacy of Phonological Awareness Intervention for People with Language Impairment
Authors: I. Wardana Ketut, I. Suparwa Nyoman
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This study investigated the form and characteristic of speech sound produced by three Balinese subjects who have recovered from aphasia as well as intervened their language impairment on side of linguistic and neuronal aspects of views. The failure of judging the speech sound was caused by impairment of motor cortex that indicated there were lesions in left hemispheric language zone. Sound articulation phenomena were in the forms of phonemes deletion, replacement or assimilation in individual words and meaning building for anomic aphasia. Therefore, the Balinese sound patterns were stimulated by showing pictures to the subjects and recorded to recognize what individual consonants or vowels they unclearly produced and to find out how the sound disorder occurred. The physiology of sound production by subject’s speech organs could not only show the accuracy of articulation but also any level of severity the lesion they suffered from. The subjects’ speech sounds were investigated, classified and analyzed to know how poor the lingual units were and observed to clarify weaknesses of sound characters occurred either for place or manner of articulation. Many fricative and stopped consonants were replaced by glottal or palatal sounds because the cranial nerve, such as facial, trigeminal, and hypoglossal underwent impairment after the stroke. The phonological intervention was applied through a technique called phonemic articulation drill and the examination was conducted to know any change has been obtained. The finding informed that some weak articulation turned into clearer sound and simple meaning of language has been conveyed. The hierarchy of functional parts of brain played important role of language formulation and processing. From this finding, it can be clearly emphasized that this study supports the role of right hemisphere in recovery from aphasia is associated with functional brain reorganization.Keywords: aphasia, intervention, phonology, stroke
Procedia PDF Downloads 194602 Effective Environmental Planning Management (EPM) as Panacea to Sustainable Urban Development
Authors: Jegede Kehinde Jacob, Ola Akeem Bayonle, Adewale Yemi Yekeen
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The rapid rate of urban growth in most developing countries of the world in recent times is alarming. Mass movement of people from rural areas to the urban centres, the consequence of the uncontrolled rapid urbanisation resulting to many un-conforming environmental challenges such as inadequate infrastructure, land, water and air pollution, poor environmental sanitation, poor and inadequate housing, urban degradation, sprawl and slums, urban violence, crime, robbery and prostitution as well as many other social vices that make the cities unsustainable. The resultant effects of all these are abysmal failure in the management of cities on the part of the governing authorities and other relevant stakeholders as well as unconducive and unwholesome condition of living of the people. This paper attempts to examine holistically the issue of environmental planning management (EPM) process development and management concept with a view for dynamic and interactive approach for various stakeholders as partners in achieving sustainable cities of our dream. The areas of discussion including conceptual and contextual issues, sustainable cities concept, good urban governance including literature review. The paper goes further to examine opportunities and challenges of built environment generally, the nature and context of environmental problems in particular, the role and duties of environmental planning and management (EPM) process in sustainable urban development. The paper further reviewed briefly the various levels of institutionalisation of EPM process with a typical case study of sustainable Ibadan project (SIP). The paper concludes with a list of recommendations to ensure effective and lasting solutions to cities problems through initiation of EPM process achievable in a sustainable manner.Keywords: built environment, environmental planning, sustainable cities, sustainable development, urbanization
Procedia PDF Downloads 262601 Development of a Large-Scale Cyclic Shear Testing Machine Under Constant Normal Stiffness
Authors: S. M. Mahdi Niktabara, K. Seshagiri Raob, Amit Kumar Shrivastavac, Jiří Ščučkaa
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The presence of the discontinuity in the form of joints is one of the most significant factors causing instability in the rock mass. On the other hand, dynamic loads, including earthquake and blasting induce cyclic shear loads along the joints in rock masses; therefore, failure of rock mass exacerbates along the joints due to changing shear resistance. Joints are under constant normal load (CNL) and constant normal stiffness (CNS) conditions. Normal stiffness increases on the joints with increasing depth, and it can affect shear resistance. For correct assessment of joint shear resistance under varying normal stiffness and number of cycles, advanced laboratory shear machine is essential for the shear test. Conventional direct shear equipment has limitations such as boundary conditions, working under monotonic movements only, or cyclic shear loads with constant frequency and amplitude of shear loads. Hence, a large-scale servo-controlled direct shear testing machine was designed and fabricated to perform shear test under the both CNL and CNS conditions with varying normal stiffness at different frequencies and amplitudes of shear loads. In this study, laboratory cyclic shear tests were conducted on non-planar joints under varying normal stiffness. In addition, the effects of different frequencies and amplitudes of shear loads were investigated. The test results indicate that shear resistance increases with increasing normal stiffness at the first cycle, but the influence of normal stiffness significantly decreases with an increase in the number of shear cycles. The frequency of shear load influences on shear resistance, i.e. shear resistance increases with increasing frequency. However, at low shear amplitude the number of cycles does not affect shear resistance on the joints, but it decreases with higher amplitude.Keywords: cyclic shear load, frequency of load, amplitude of displacement, normal stiffness
Procedia PDF Downloads 149600 Evaluating Structural Crack Propagation Induced by Soundless Chemical Demolition Agent Using an Energy Release Rate Approach
Authors: Shyaka Eugene
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The efficient and safe demolition of structures is a critical challenge in civil engineering and construction. This study focuses on the development of optimal demolition strategies by investigating the crack propagation behavior in beams induced by soundless cracking agents. It is commonly used in controlled demolition and has gained prominence due to its non-explosive and environmentally friendly nature. This research employs a comprehensive experimental and computational approach to analyze the crack initiation, propagation, and eventual failure in beams subjected to soundless cracking agents. Experimental testing involves the application of various cracking agents under controlled conditions to understand their effects on the structural integrity of beams. High-resolution imaging and strain measurements are used to capture the crack propagation process. In parallel, numerical simulations are conducted using advanced finite element analysis (FEA) techniques to model crack propagation in beams, considering various parameters such as cracking agent composition, loading conditions, and beam properties. The FEA models are validated against experimental results, ensuring their accuracy in predicting crack propagation patterns. The findings of this study provide valuable insights into optimizing demolition strategies, allowing engineers and demolition experts to make informed decisions regarding the selection of cracking agents, their application techniques, and structural reinforcement methods. Ultimately, this research contributes to enhancing the safety, efficiency, and sustainability of demolition practices in the construction industry, reducing environmental impact and ensuring the protection of adjacent structures and the surrounding environment.Keywords: expansion pressure, energy release rate, soundless chemical demolition agent, crack propagation
Procedia PDF Downloads 61599 The Diverse and Flexible Coping Strategies Simulation for Maanshan Nuclear Power Plant
Authors: Chin-Hsien Yeh, Shao-Wen Chen, Wen-Shu Huang, Chun-Fu Huang, Jong-Rong Wang, Jung-Hua Yang, Yuh-Ming Ferng, Chunkuan Shih
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In this research, a Fukushima-like conditions is simulated with TRACE and RELAP5. Fukushima Daiichi Nuclear Power Plant (NPP) occurred the disaster which caused by the earthquake and tsunami. This disaster caused extended loss of all AC power (ELAP). Hence, loss of ultimate heat sink (LUHS) happened finally. In order to handle Fukushima-like conditions, Taiwan Atomic Energy Council (AEC) commanded that Taiwan Power Company should propose strategies to ensure the nuclear power plant safety. One of the diverse and flexible coping strategies (FLEX) is a different water injection strategy. It can execute core injection at 20 Kg/cm2 without depressurization. In this study, TRACE and RELAP5 were used to simulate Maanshan nuclear power plant, which is a three loops PWR in Taiwan, under Fukushima-like conditions and make sure the success criteria of FLEX. Reducing core cooling ability is due to failure of emergency core cooling system (ECCS) in extended loss of all AC power situation. The core water level continues to decline because of the seal leakage, and then FLEX is used to save the core water level and make fuel rods covered by water. The result shows that this mitigation strategy can cool the reactor pressure vessel (RPV) as soon as possible under Fukushima-like conditions, and keep the core water level higher than Top of Active Fuel (TAF). The FLEX can ensure the peak cladding temperature (PCT) below than the criteria 1088.7 K. Finally, the FLEX can provide protection for nuclear power plant and make plant safety.Keywords: TRACE, RELAP5/MOD3.3, ELAP, FLEX
Procedia PDF Downloads 249598 The Reform of Chinese Migration Law and Its Actual Implementation
Authors: Wang Jie
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This article advances the reform of Chinese migration law through an analysis of the updated and former versions of the Chinese migration law, specifically for the Exit-Entry Administration Law of the People’s Republic of China and Regulations on Foreigners’ Permanent Residence in the People’s Republic of China(Exposure Draft), which was most recently issued in 2012 and 2020 respectively. After a fundamental reform of China’s migration law, China’s immigration legal framework has become relatively well developed compared with the previous one. Immigration procedures are available online and these procedures have become relatively simple. Comparative research for the Chinese migration laws has been done during the past several years for its legislation, legal reference for western countries and its preliminary implementation. Some results show that the reform is a superficial one and may not have a practical effect on China’s current immigration legal framework. However, complete results cannot be obtained only through the comparative research of legal definitions. Some practical case studies will also be required to analyze in detail to demonstrate the reasons that some reforms still remain at the superficial level and what further progress is required in China's immigration legal framework. This is a perspective that has been overlooked in most comparative law studies. In the first part, this article will conduct a simple comparative study of the reform of Chinese migration law and use cases studies to illustrate the reform of Chinese migration law. In the second part, this article will point out another perspective that is easily overlooked, that is, how do the Chinese nationals treat the reform: whether it is a legislative advance or a failure, and whether it deepens social tensions between nationals and immigrants. In the third part, the article will discuss Chinese migration law through China’s international law perspective with international organizations, such as International Organization for Migration and International Labour Organization will also be discussed to dialectically judge the reform of Chinese migration law. This article will adopt case and comparative studies to conduct overall research based on the reform of Chinese migration law and try to put forward more constructive advice for China’s immigration legal framework.Keywords: Chinese migration law, reform, foreigners, immigration legal framework
Procedia PDF Downloads 118597 How Message Framing and Temporal Distance Affect Word of Mouth
Authors: Camille Lacan, Pierre Desmet
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In the crowdfunding model, a campaign succeeds by collecting the funds required over a predefined duration. The success of a CF campaign depends both on the capacity to attract members of the online communities concerned, and on the community members’ involvement in online word-of-mouth recommendations. To maximize the campaign's success probability, project creators (i.e., an organization appealing for financial resources) send messages to contributors to ask them to issue word of mouth. Internet users relay information about projects through Word of Mouth which is defined as “a critical tool for facilitating information diffusion throughout online communities”. The effectiveness of these messages depends on the message framing and the time at which they are sent to contributors (i.e., at the start of the campaign or close to the deadline). This article addresses the following question: What are the effect of message framing and temporal distance on the willingness to share word of mouth? Drawing on Perspectives Theory and Construal Level Theory, this study examines the interplay between message framing (Gains vs. Losses) and temporal distance (message while the deadline is coming vs. far) on intention to share word of mouth. A between-subject experimental design is conducted to test the research model. Results show significant differences between a loss-framed message (lack of benefits if the campaign fails) associated with a short deadline (ending tomorrow) compared to a gain-framed message (benefits if the campaign succeeds) associated with a distant deadline (ending in three months). However, this effect is moderated by the anticipated regret of a campaign failure and the temporal orientation. These moderating effects contribute to specifying the boundary condition of the framing effect. Handling the message framing and the temporal distance are thus the key decisions to influence the willingness to share word of mouth.Keywords: construal levels, crowdfunding, message framing, word of mouth
Procedia PDF Downloads 251596 Hematuria Following Magnesium Sulfate Administration in a Pregnant Patient with Renal Tubular Acidosis
Authors: Jan Gayl Barcelon, N. Gorgonio
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Renal tubular acidosis, a medical condition that involves the accumulation of acid in the body due to failure of the kidneys to maintain normal urine and blood pH, is rarely encountered in pregnancy. The effect of renal tubular acidosis in pregnancy is not fully established. It may worsen during pregnancy and cause maternal and fetal morbidity. A 30-year-old primigravida was diagnosed with renal tubular acidosis at age 7, but due to uncontrolled disease progression, she developed rickets at age 10. She was first seen in our institution at eight weeks gestation and maintained on bicarbonate and potassium supplementation. At 26 weeks gestation, she was diagnosed with polyhydramnios, causing on and off irregular uterine contractions. At 30 weeks gestation, despite oral Nifedipine, premature labor was uncontrolled; hence she was admitted for tocolysis. With elevated creatinine (123 umol/L) and a normal blood urea nitrogen level (6.70 mmol/L), she was referred to Nephrology Service, which cleared the patient prior to MgSO₄ drip. Dosing of 4g MgSO₄ over 20 minutes followed by a maintenance of 2g/hour x 24 hours for neuroprotection and tocolysis was ordered. Two hours after MgSO₄ drip initiation, hematuria developed with adequate urine output. The infusion was immediately stopped. The serum magnesium level was high normal at 6.7 mEq/L. After 4 hours of renal clearance, the repeat serum magnesium level was normal (2.7 mEq/L) and with clear urine output. The patient was then given Nifedipine 30mg/tab, 3x a day which controlled the uterine contractions. At 37 weeks gestation, the patient delivered via primary low transverse Cesarean Section to a live female with a birthweight of 2470gm, appropriate for gestational age. The use of MgSO₄ for the control of premature labor in patients with chronic renal disease secondary to renal tubular can cause hematuria.Keywords: hematuria, magnesium sulfate, premature labor, renal tubular acidosis
Procedia PDF Downloads 128595 Destined Failure of Interactions between Israeli-Arabs and Jews - An Analysis of Creative Works’ Presentation of Issues from the Israeli Side
Authors: Tianqi Yin
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Following the establishment of the state of Israel, how to harmonize the relationship between Palestinians and Jews in Israel has always been an intractable problem. As the number of Palestinian Arabs in Israel has increased to over two million, the issue has become more severe. Due to a variety of factors, Israeli Palestinians and Israeli Jews often find it hard to interact with each other, let alone form a relationship. Multiple authors and directors have produced cultural works to touch on the issue, exposing the reasons for the irreconcilable relation between the two ethnic groups. This paper analyzes the representation scenes of the Palestinian-Jewish relationship in three prominent cultural works, each from a distinct perspective, to examine the intrinsic challenges from the Israeli side that curb the two ethnicities from interacting successfully. The first scene is from the Jewish perspective in Amos Oz’s memoir A Tale of Love and Darkness, in which young Oz, a Jewish boy, attempts to interact with Aisha, a young Israeli-Arab girl, but eventually failed because of an accident. The second scene is from a short Israeli film Bus Station which, from an outsider perspective, depicted a brief encounter between an Arab woman and a Jewish woman in Jerusalem. The third scene is the initially successful yet eventually failed relationship between Eyad, a Palestinian boy, and Naomi, a Jewish girl, in an elite Israeli high school from the 2014 film A Borrowed Identity, which is depicted through Eyad’s Arab perspective. Through the analysis of these three narratives, this paper argues that the burden of national responsibility, family influences, and Israeli government’s discriminatory policies are the three main factors on the Jewish side, in ascender order of importance, that make Arab-Jewish interaction hard in Israel.Keywords: arab-Jewish interaction, ethnographic conflicts, israel, Jewish narrative, narrative styles
Procedia PDF Downloads 96594 Uterine Cervical Cancer; Early Treatment Assessment with T2- And Diffusion-Weighted MRI
Authors: Susanne Fridsten, Kristina Hellman, Anders Sundin, Lennart Blomqvist
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Background: Patients diagnosed with locally advanced cervical carcinoma are treated with definitive concomitant chemo-radiotherapy. Treatment failure occurs in 30-50% of patients with very poor prognoses. The treatment is standardized with risk for both over-and undertreatment. Consequently, there is a great need for biomarkers able to predict therapy outcomes to allow for individualized treatment. Aim: To explore the role of T2- and diffusion-weighted magnetic resonance imaging (MRI) for early prediction of therapy outcome and the optimal time point for assessment. Methods: A pilot study including 15 patients with cervical carcinoma stage IIB-IIIB (FIGO 2009) undergoing definitive chemoradiotherapy. All patients underwent MRI four times, at baseline, 3 weeks, 5 weeks, and 12 weeks after treatment started. Tumour size, size change (∆size), visibility on diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) and change of ADC (∆ADC) at the different time points were recorded. Results: 7/15 patients relapsed during the study period, referred to as "poor prognosis", PP, and the remaining eight patients are referred to "good prognosis", GP. The tumor size was larger at all time points for PP than for GP. The ∆size between any of the four-time points was the same for PP and GP patients. The sensitivity and specificity to predict prognostic group depending on a remaining tumor on DWI were highest at 5 weeks and 83% (5/6) and 63% (5/8), respectively. The combination of tumor size at baseline and remaining tumor on DWI at 5 weeks in ROC analysis reached an area under the curve (AUC) of 0.83. After 12 weeks, no remaining tumor was seen on DWI among patients with GP, as opposed to 2/7 PP patients. Adding ADC to the tumor size measurements did not improve the predictive value at any time point. Conclusion: A large tumor at baseline MRI combined with a remaining tumor on DWI at 5 weeks predicted a poor prognosis.Keywords: chemoradiotherapy, diffusion-weighted imaging, magnetic resonance imaging, uterine cervical carcinoma
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