Search results for: hypercapnic respiratory failure

Authors: Henry Gonzalo Acurio Flores, Alvaro Nicolas Corral Naveda, Juan Francisco Fonseca Palacios

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In Ecuador, subventions on fossil fuels for the road transportation sector have always been part of its economy throughout time, mainly because of demagogy and populism from political leaders. It is clearly seen that the government cannot maintain the subsidies anymore due to its commercial balance and its general state budget; subsidies are a key barrier to implementing the use of cleaner technologies. However, during the last few months, the elimination of subsidies has been done gradually with the purpose of reaching international prices. It is expected that with this measure, the population will opt for other means of transportation, and in a certain way, it will promote the use of private electric vehicles and public, e.g., taxis and buses (urban transport). Considering the three main elements of sustainable development, an analysis of the social, economic, and environmental impacts of eliminating subsidies will be generated at the country level. To achieve this, four scenarios will be developed in order to determine how the subsidies will contribute to the promotion of electro-mobility. 1) A Business as Usual BAU scenario; 2) the introduction of 10 000 electric vehicles by 2025; 3) the introduction of 100 000 electric vehicles by 2030; 4) the introduction of 750 000 electric vehicles by 2040 (for all the scenarios buses, taxis, lightweight duty vehicles, and private vehicles will be introduced, as it is established in the National Electro Mobility Strategy for Ecuador). The Low Emissions Analysis Platform (LEAP) will be used, and it will be suitable to determine the cost for the government in terms of importing derivatives for fossil fuels and the cost of electricity to power the electric fleet that can be changed. The elimination of subventions generates fiscal resources for the state that can be used to develop other kinds of projects that will benefit Ecuadorian society. It will definitely change the energy matrix, and it will provide energy security for the country; it will be an opportunity for the government to incentivize a greater introduction of renewable energies, e.g., solar, wind, and geothermal. At the same time, it will also reduce greenhouse gas emissions (GHG) from the transportation sector, considering its mitigation potential, which as a result, will ameliorate the inhabitant quality of life by improving the quality of air, therefore reducing respiratory diseases associated with exhaust emissions, consequently, achieving sustainability, the Sustainable Development Goals (SDGs), and complying with the agreements established in the Paris Agreement COP 21 in 2015. Electro mobility in Latin America and the Caribbean can only be achieved by the implementation of the right policies at the central government, which need to be accompanied by a National Urban Mobility Policy (NUMP) and can encompass a greater vision to develop holistic, sustainable transport systems at local governments.

Keywords: electro mobility, energy, policy, sustainable transportation

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Authors: Nana Gorgiladze, Tamar Gaprindashvili, Mikheil Shavdia, Zurab Pagava

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Introduction/Purpose Chemotherapy is a common treatment for breast cancer, but it can also cause damage to the heart and blood vessels. This damage, known as cancer therapy-related cardiovascular toxicity (CTR-CVT), can increase the risk of heart failure and death in breast cancer patients. The left ventricle is often affected by CTR-CVT, but the right ventricle (RV) may also be vulnerable to CTR-CVT and may show signs of dysfunction before the left ventricle. The study aims to investigate how the RV function changes during chemotherapy for breast cancer by using conventional echocardiographic and global longitudinal strain (GLS) techniques. By measuring the GLS strain of the RV, researchers tend to detect early signs of CTR-CVT and improve the management of breast cancer patients. Methods The study was conducted on 28 women with low cardiovascular risk who received anthracycline chemotherapy for breast cancer. Conventional 2D echocardiography (LVEF, RVS’, TAPSE) and speckle-tracking echocardiography (STE) measurements of the left and right ventricles (LVGLS, RVGLS) were used to assess cardiac function before and after chemotherapy. All patients had normal LVEF at the beginning of the study. Cardiotoxicity was defined as a new LVEF reduction of 10 percentage points to an LVEF of 40-49% and/or a new decline in GLS of 15% from baseline, as proposed by the most recent cardio-oncology guideline. ResultsThe research found that the LVGLS decreased from -21.2%2.1% to -18.6%2.6% (t-test = -4.116; df = 54, p=0.001). The change in value LV-GLS was 2.6%3.0%. The mean percentage change of the LVGLS was 11,6%13,3%; p=0.001. Similarly, the right ventricular global longitudinal strain (RVGLS) decreased from -25.2%2.9% to -21.4%4.4% (t-test = -3.82; df = 54, p=0.001). The RV-GLS value of change was 3.8%3.6%. Likewise, the percentage decrease of the RVGLS was 15,0%14,3%, p=0.001.However, the measurements of the right ventricular systolic function (RVS) and tricuspid annular plane systolic excursion (TAPSE) were insignificant, and the left ventricular ejection fraction ( LVEF) remained unchanged.

Keywords: cardiotoxicity, chemotherapy, GLS, right ventricle

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Authors: Lian Song, Shao-Bo Kang, Bo Yang

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Concrete filled steel tubular (CFST) structure has been widely used in construction practices due to its superior performances under various loading conditions. However, limited studies are available when this type of structure is subjected to impact or explosive loads. Current methods in relevant design codes are not specific for preventing progressive collapse of CFST structures. Therefore, it is necessary to carry out numerical simulations on CFST structure under impact loads. In this study, finite element analyses are conducted on the mechanical behaviour of composite frames which composed of CFST columns and steel beams subject to impact loading. In the model, CFST columns are simulated using finite element software ABAQUS. The model is verified by test results of solid and hollow CFST columns under lateral impacts, and reasonably good agreement is obtained through comparisons. Thereafter, a multi-scale finite element modelling technique is developed to evaluate the behaviour of a five-storey three-span planar composite frame. Alternate path method and direct simulation method are adopted to perform the dynamic response of the frame when a supporting column is removed suddenly. In the former method, the reason for column removal is not considered and only the remaining frame is simulated, whereas in the latter, a specific impact load is applied to the frame to take account of the column failure induced by vehicle impact. Comparisons are made between these two methods in terms of displacement history and internal force redistribution, and design recommendations are provided for the design of CFST structures under impact loads.

Keywords: planar composite frame, collapse analysis, impact loading, direct simulation method, alternate path method

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Authors: Berna Istegun, Erkan Celebi

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The main objective of this experimental study is to assess the shear strength and the crack behavior of the triplets built of perforated brickwork masonry elements. In order to observe the influence of shear resistance and energy dissipating before and after retrofitting applications by using the reinforcing system, static-cyclic shear tests were employed in the structural mechanics laboratory of Sakarya University. The reinforcing system is composed of hybrid multiaxial seismic fabric consisting of alkali resistant glass and polypropylene fibers. The plaster as bonding material used in the specimen’s retrofitting consists of expanded glass granular. In order to acquire exact measuring data about the failure behavior of the two mortar joints under shear stressing, vertical load-controlled cylinder having force capacity of 50 kN and loading rate of 1.5 mm/min. with an internal inductive displacement transducers is carried out perpendicular to the triplet specimens. In this study, a total of six triplet specimens with textile reinforcement were prepared for these shear bond tests. The three of them were produced as single-sided reinforced triplets with seismic fabric, while the others were strengthened on both sides. In addition, three triplet specimens without retrofitting and plaster were also tested as reference samples. The obtained test results were given in the manner of force-displacement relationships, ductility coefficients and shear strength parameters comparatively. It is concluded that two-side seismic textile applications on masonry elements with relevant plaster have considerably increased the sheer force resistance and the ductility capacity.

Keywords: expanded glass granular, perforated brickwork, retrofitting, seismic fabric, triplet shear tests

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Authors: Mohsen Masoomi, Fazel Asadi Amjad, Monireh Arvin

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According to Naturalistic principles, human destiny in the form of blind chance and determinism, entraps the individual, so man is a defenceless creature unable to escape from the ruthless paws of a stoical universe. In Naturalism; nonetheless, melodrama mirrors a conscious alternative with a peculiar function. A typical American Naturalistic character thus cannot be a subject for social criticism of American society since they are not victims of the ongoing virtual slavery, capitalist system, nor of a ruined milieu, but of their own volition, and more importantly, their character frailty. Through a Postmodern viewpoint, each Naturalistic work can encompass some entropic trends and changes culminating in an entire failure and devastation. Frank Norris in McTeague displays the futile struggles of ordinary men and how they end up brutes. McTeague encompasses intoxication, abuse, violation, and ruthless homicides. Norris’ depictions of the falling individual as a demon represent the entropic dimension of Naturalistic novels. McTeague’s defeat is somewhat his own fault, the result of his own blunders and resolution, not the result of sheer accident. Throughout the novel, each character is a kind of insane quester indicating McTeague’s decadence and, by inference, the decadence of Western civilisation. McTeague seems to designate Norris’ solicitude for a community fabricated by the elements of human negative demeanours and conducts hauling acute symptoms of infectious dehumanisation. The aim of this article is to illustrate how one specific negative human disposition gradually, like a running fire, can spread everywhere and burn everything in itself. The author applies the concept of entropy metaphorically to describe the individual devolutions that necessarily comprise community entropy in McTeague, a dying universe.

Keywords: animal imagery, entropy, Gypsy, melodrama

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Authors: Mohamad Sukeri Khalid, Che Su Mustaffa, Mohd Najib Marzuki, Mohd Fo’ad Sakdan, Sapora Sipon, Mohd Taib Ariffin, Shazwani Shafiai

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This paper describes the issues relating to the role of the flash flood early warning system provided by the Malaysian Government to the communities in Malaysia, specifically during the flash flood disaster in the Cameron Highlands, Malaysia. Normally, flash flood disasters can occur as a result of heavy rainfall in an area, and that water may possibly cause flooding via streams or narrow channels. For this study, the flash flood disaster in the Cameron Highlands occurred on 23 October 2013, and as a result the Sungai Bertam overflowed after the release of water from the Sultan Abu Bakar Dam. This release of water from the dam caused flash flooding which led to damage to properties and also the death of residents and livestock in the area. Therefore, the effort of this study is to identify the perceptions of the flash flood victims on the role of the flash flood early warning system. For the purposes of this study, data collection was gathered from those flood victims who were willing to participate in this study through face-to-face interviews. This approach helped the researcher to glean in-depth information about their feeling and perceptions on the role of the flash flood early warning system offered by the government. The data were analysed descriptively and the findings show that the respondents of 22 flood victims believe strongly that the flash flood early warning system was confusing and dysfunctional, and communities had failed to response positively to it. Therefore, most of the communities were not well prepared for the releasing of water from the dam that caused property damage and 3 people were killed in Cameron Highland flash flood disaster.

Keywords: communities affected, disaster management, early warning system, flash flood disaster

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Authors: Maha Tichetti, Barzi Redouane, Selim Kanat

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In the European Union (EU), where economic, political, and cultural ties converge, strategic alliances play a pivotal role in shaping the collaborative landscape. This paper embarks on a journey into the EuroSphere, offering a comprehensive analysis review that unravels the dynamics of these alliances within the European context. The focus is specifically directed towards understanding their profound impact on creative synergy and innovation among teams. In our analysis, we provide theoretical explanations for key terms such as "creative synergy" and "strategic alliances." We outline various types of competitive strategies, delve into the motivations prompting the formation of strategic alliances, and critically examine the success and failure factors in these kinds of collaboration. Additionally, we explore the goals achievable through strategic alliances, especially in the context of external growth. A central focus of this paper focus on how strategic alliances can significantly impact creative synergy within the European landscape. Through a theoretical lens, we explore the interplay between collaborative strategies and the enhancement of creative thinking within teams engaged in strategic alliances. The article goes beyond theoretical frameworks to present a tangible example of a strategic alliance emerging in the European market. This case study illuminates how such alliances have empowered European companies to enhance their competitive positions on the global stage while concurrently fostering creative synergy among their teams. This comprehensive review not only contributes to the theoretical understanding of strategic alliances and creative synergy but also offers practical insights for businesses navigating the collaborative landscape within the EuroSphere. As we unravel the complexities of these alliances, we uncover valuable lessons and opportunities for future research, providing a roadmap for those seeking to harness the full potential of strategic collaborations in the dynamic European context.

Keywords: European Union, strategic alliances, creative synergy, competitiveness

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Authors: Saniye Çeşmecioğlu

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The importance of project sustainability and success has become increasingly significant due to the proliferation of external environmental factors that have decreased project resistance in contemporary times. The primary approach to forestall the failure of projects is to ensure their long-term viability through the strategic selection of projects as creating judicious project selection framework within the organization. Decision-makers require precise decision contexts (models) that conform to the company's business objectives and sustainability expectations during the project selection process. The establishment of a rational model for project selection enables organizations to create a distinctive and objective framework for the selection process. Additionally, for the optimal implementation of this decision-making model, it is crucial to establish a Project Management Office (PMO) team and Project Steering Committee within the organizational structure to oversee the framework. These teams enable updating project selection criteria and weights in response to changing conditions, ensuring alignment with the company's business goals, and facilitating the selection of potentially viable projects. This paper presents a multi-criteria decision model for selecting project sustainability and project success criteria that ensures timely project completion and retention. The model was developed using MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique) and was based on broadcaster companies’ expectations. The ultimate results of this study provide a model that endorses the process of selecting the appropriate project objectively by utilizing project selection and sustainability criteria along with their respective weights for organizations. Additionally, the study offers suggestions that may ascertain helpful in future endeavors.

Keywords: project portfolio management, project selection, multi-criteria decision making, project sustainability and success criteria, MACBETH

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Authors: Marziye Hadian, Alireza Jabbari

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Background: Each year, tropical diseases affect large numbers of tropical or subtropical populations and give rise to irreparable financial and human damage. Among these diseases, some are known as Neglected Tropical Disease (NTD) that may cause unusual dangers; however, they have not been appropriately accounted for. Taking into account the priority of eradication of the disease, this study explored the causes of failure to eradicate neglected tropical diseases. Method: This study was a systematized review that was conducted in January 2021 on the articles related to neglected tropical diseases on databases of Web of Science, PubMed, Scopus, Science Direct, Ovid, Pro-Quest, and Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as well as Critical Appraisal Skills Program (CASP) for articles and AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) for grey literature (provides five criteria for judging the quality of grey information) were integrated. Finding: The challenges in controlling and eradicating neglected tropical diseases in four general themes are as follows: shortcomings in disease management policies and programs, environmental challenges, executive challenges in policy disease and research field and 36 sub-themes. Conclusion: To achieve the goals of eradicating forgotten tropical diseases, it seems indispensable to free up financial, human and research resources, proper management of health infrastructure, attention to migrants and refugees, clear targeting, prioritization appropriate to local conditions and special attention to political and social developments. Reducing the number of diseases should free up resources for the management of neglected tropical diseases prone to epidemics as dengue, chikungunya and leishmaniasis. For the purpose of global support, targeting should be accurate.

Keywords: neglected tropical disease, NTD, preventive, eradication

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Authors: Sang-Keun Moon, Hong-Rok Lim, Jin-O Kim

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This paper presents a Power Quality (PQ) modeling and filtering processes for the distribution system disturbances using recognition learning methods. Typical PQ waveforms with mathematical applications and gathered field data are applied to the proposed models. The objective of this paper is analyzing PQ data with respect to monitoring, discriminating, and evaluating the waveform of power disturbances to ensure the system preventative system failure protections and complex system problem estimations. Examined signal filtering techniques are used for the field waveform noises and feature extractions. Using extraction and learning classification techniques, the efficiency was verified for the recognition of the PQ disturbances with focusing on interactive modeling methods in this paper. The waveform of selected 8 disturbances is modeled with randomized parameters of IEEE 1159 PQ ranges. The range, parameters, and weights are updated regarding field waveform obtained. Along with voltages, currents have same process to obtain the waveform features as the voltage apart from some of ratings and filters. Changing loads are causing the distortion in the voltage waveform due to the drawing of the different patterns of current variation. In the conclusion, PQ disturbances in the voltage and current waveforms indicate different types of patterns of variations and disturbance, and a modified technique based on the symmetrical components in time domain was proposed in this paper for the PQ disturbances detection and then classification. Our method is based on the fact that obtained waveforms from suggested trigger conditions contain potential information for abnormality detections. The extracted features are sequentially applied to estimation and recognition learning modules for further studies.

Keywords: power quality recognition, PQ modeling, waveform feature extraction, disturbance trigger condition, PQ signal filtering

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Authors: Faruk Aras, Melih Inal, Tansel Cinar

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The coordination of airport staff especially in the operations and maintenance departments is important for the airport operation. As a result, this coordination will increase the efficiency in all operation. Therefore, a Collaborative Decision-Making (CDM) system targets on improving the overall productivity of all operations by optimizing the use of resources and improving the predictability of actions. Enlarged productivity can be of major benefit for all airport operations. It also increases cost-efficiency. This study explains how predictive maintenance using IoT (Internet of Things), predictive operations and the statistical data such as Mean Time To Failure (MTTF) improves airport terminal operations and utilize airport terminal equipment in collaboration with collaborative decision making system/Airport Operation Control Center (AOCC). Data generated by the predictive maintenance methods is retrieved and analyzed by maintenance managers to predict when a problem is about to occur. With that information, maintenance can be scheduled when needed. As an example, AOCC operator would have chance to assign a new gate that towards to this gate all the equipment such as travellator, elevator, escalator etc. are operational if the maintenance team is in collaboration with AOCC since maintenance team is aware of the health of the equipment because of predictive maintenance methods. Applying predictive maintenance methods based on analyzing the health of airport terminal equipment dramatically reduces the risk of downtime by on time repairs. We can classify the categories as high priority calls for urgent repair action, as medium priority requires repair at the earliest opportunity, and low priority allows maintenance to be scheduled when convenient. In all cases, identifying potential problems early resulted in better allocation airport terminal resources by AOCC.

Keywords: airport, predictive maintenance, collaborative decision-making system, Airport Operation Control Center (AOCC)

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Authors: Maryam Shirmohammadi, Prasad K. D. V. Yarlagadda, YuanTong Gu

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The mechanical damage on the agricultural crop during and after harvesting can create high volume of damage on tissue. Uniaxial compression and tensile loading were performed on flesh and peel samples of pumpkin. To investigate the structural changes on the tissue, Scanning Electron Microscopy (SEM) was used to capture the cellular structure change before and after loading on tissue for tensile, compression and indentation tests. To obtain required mechanical properties of tissue for the finite element analysis (FEA) model, laser measurement sensors were used to record the lateral displacement of tissue under the compression loading. Uniaxial force versus deformation data were recorded using Universal Testing Machine for both tensile and compression tests. The experimental Results were employed to develop a material model with failure criteria. The results obtained by the simulation were compared with those obtained by experiments. Note that although modelling food materials’ behaviour is not a new concept however, majority of previous studies focused on elastic behaviour and damages under linear limit, this study, however, has developed FEA models for tensile and compressive loading of pumpkin flesh and peel samples using, as the first study, both elastic and elasto-plastic material types. In addition, pumpkin peel and flesh tissues were considered as two different materials with different properties under mechanical loadings. The tensile and compression loadings were used to develop the material model for a composite structure for FEA model of mechanical peeling of pumpkin as a tough skinned vegetable.

Keywords: compressive and tensile response, finite element analysis, poisson’s ratio, elastic modulus, elastic and plastic response, rupture and bio-yielding

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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

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Authors: Aarthi Mariappan, Janani Selvaraj, P. B. Harathi, M. Prashanthi Devi

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Anthropogenic modification of the urban environment has largely increased in the recent years in order to sustain the growing human population. Intense industrial activity, permanent and high traffic on the roads, a developed subterranean infrastructure network, land use patterns are just some specific characteristics. Every day, the urban environment is polluted by more or less toxic emissions, organic or metals wastes discharged from specific activities such as industrial, commercial, municipal. When these eventually deposit into the soil, the physical and chemical properties of the surrounding soil is changed, transforming it into a human exposure indicator. Metals are non-degradable and occur cumulative in soil due to regular deposits are a result of permanent human activity. Due to this, metals are a contaminant factor for soil when persistent over a long period of time and a possible danger for inhabitant’s health on prolonged exposure. Metals accumulated in contaminated soil may be transferred to humans directly, by inhaling the dust raised from top soil, or by ingesting, or by dermal contact and indirectly, through plants and animals grown on contaminated soil and used for food. Some metals, like Cu, Mn, Zn, are beneficial for human’s health and represent a danger only if their concentration is above permissible levels, but other metals, like Pb, As, Cd, Hg, are toxic even at trace level causing gastrointestinal and lung cancers. In urban areas, metals can be emitted from a wide variety of sources like industrial, residential, commercial activities. Our study interrogates the spatial distribution of heavy metals in soil in relation to their permissible levels and their association with the health risk to the urban population in Coimbatore, India. Coimbatore region is a high cancer risk zone and case records of gastro intestinal and respiratory cancer patients were collected from hospitals and geocoded in ArcGIS10.1. The data of patients pertaining to the urban limits were retained and checked for their diseases history based on their diagnosis and treatment. A disease map of cancer was prepared to show the disease distribution. It has been observed that in our study area Cr, Pb, As, Fe and Mg exceeded their permissible levels in the soil. Using spatial overlay analysis a relationship between environmental exposure to these potentially toxic elements in soil and cancer distribution in Coimbatore district was established to show areas of cancer risk. Through this, our study throws light on the impact of prolonged exposure to soil contamination in soil in the urban zones, thereby exploring the possibility to detect cancer risk zones and to create awareness among the exposed groups on cancer risk.

Keywords: soil contamination, cancer risk, spatial analysis, India

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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

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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

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Authors: Despina Giannadaki, Jos Lelieveld, Andrea Pozzer, John Evans

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Outdoor air pollution by fine particles ranks among the top ten global health risk factors that can lead to premature mortality. Epidemiological cohort studies, mainly conducted in United States and Europe, have shown that the long-term exposure to PM2.5 (particles with an aerodynamic diameter less than 2.5μm) is associated with increased mortality from cardiovascular, respiratory diseases and lung cancer. Fine particulates can cause health impacts even at very low concentrations. Previously, no concentration level has been defined below which health damage can be fully prevented. The World Health Organization ambient air quality guidelines suggest an annual mean PM2.5 concentration limit of 10μg/m3. Populations in large parts of the world, especially in East and Southeast Asia, and in the Middle East, are exposed to high levels of fine particulate pollution that by far exceeds the World Health Organization guidelines. The aim of this work is to evaluate the implementation of recent air quality standards for PM2.5 in the EU, the US and other countries worldwide and estimate what measures will be needed to substantially reduce premature mortality. We investigated premature mortality attributed to fine particulate matter (PM2.5) under adults ≥ 30yrs and children < 5yrs, applying a high-resolution global atmospheric chemistry model combined with epidemiological concentration-response functions. The latter are based on the methodology of the Global Burden of Disease for 2010, assuming a ‘safe’ annual mean PM2.5 threshold of 7.3μg/m3. We estimate the global premature mortality by PM2.5 at 3.15 million/year in 2010. China is the leading country with about 1.33 million, followed by India with 575 thousand and Pakistan with 105 thousand. For the European Union (EU) we estimate 173 thousand and the United States (US) 52 thousand in 2010. Based on sensitivity calculations we tested the gains from PM2.5 control by applying the air quality guidelines (AQG) and standards of the World Health Organization (WHO), the EU, the US and other countries. To estimate potential reductions in mortality rates we take into consideration the deaths that cannot be avoided after the implementation of PM2.5 upper limits, due to the contribution of natural sources to total PM2.5 and therefore to mortality (mainly airborne desert dust). The annual mean EU limit of 25μg/m3 would reduce global premature mortality by 18%, while within the EU the effect is negligible, indicating that the standard is largely met and that stricter limits are needed. The new US standard of 12μg/m3 would reduce premature mortality by 46% worldwide, 4% in the US and 20% in the EU. Implementing the AQG by the WHO of 10μg/m3 would reduce global premature mortality by 54%, 76% in China and 59% in India. In the EU and US, the mortality would be reduced by 36% and 14%, respectively. Hence, following the WHO guideline will prevent 1.7 million premature deaths per year. Sensitivity calculations indicate that even small changes at the lower PM2.5 standards can have major impacts on global mortality rates.

Keywords: air quality guidelines, outdoor air pollution, particulate matter, premature mortality

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Authors: Ammar Asma, Bouafia Nabiha, Ben Cheikh Asma, Ezzi Olfa, Mahjoub Mohamed, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Ventilator-associated pneumonia (VAP) is currently recognized as one of the most relevant causes of morbidity and mortality among intensive care unit (ICU) patients worldwide. Identifying modifiable risk factors for VAP could be helpful for future controlled interventional studies aiming at improving prevention of VAP. The purposes of this study were to determine the incidence and risk factors for VAP in in a Tunisian medical ICU. Materials / Methods: A retrospective case-control study design based on the prospective database collected over a 14-month period from September 15th, 2015 through November 15th, 2016 in an 8-bed medical ICU. Patients under ventilation for over 48 h were included. The number of cases was estimated by Epi-info Software with the power of statistical test equal to 90 %. Each case patient was successfully matched to two controls according to the length of mechanical ventilation (MV) before VAP for cases and the total length of MV in controls. VAP in the ICU was defined according to American Thoracic Society; Infectious Diseases Society of America guidelines. Early onset or late-onset VAP were defined whether the infectious process occurred within or after 96 h of ICU admission. Patients’ risk factors, causes of admission, comorbidities and respiratory specimens collected were reviewed. Univariate and multivariate analyses were performed to determine variables associated with VAP with a p-value < 0.05. Results: During the period study, a total of 169 patients under mechanical ventilation were considered, 34 patients (20.11%) developed at least one episode of VAP in the ICU. The incidence rate for VAP was 14.88/1000 ventilation days. Among these cases, 9 (26.5 %) were early-onset VAP and 25 (73.5 %) were late-onset VAP. It was a certain diagnosis in 66.7% of cases. Tracheal aspiration was positive in 80% of cases. Multi-drug resistant Acinerobacter baumanii was the most common species detected in cases; 67.64% (n=23). The rate of mortality out of cases was 88.23% (n= 30). In univariate analysis, the patients with VAP were statistically more likely to suffer from cardiovascular diseases (p=0.035) and prolonged duration of sedation (p=0.009) and tracheostomy (p=0.001), they also had a higher number of re-intubation (p=0.017) and a longer total time of intubation (p=0.012). Multivariate analysis showed that cardiovascular diseases (OR= 4.44; 95% IC= [1.3 - 14]; p=0.016), tracheostomy (OR= 4.2; 95% IC= [1.16 -15.12]; p= 0.028) and prolonged duration of sedation (OR=1.21; 95% IC= [1.07, 1.36]; p=0.002) were independent risk factors for the development of VAP. Conclusion: VAP constitutes a therapeutic challenge in an ICU setting, therefore; strategies that effectively prevent VAP are needed. An infection control-training program intended to all professional heath care in this unit insisting on bundles and elaboration of procedures are planned to reduce effectively incidence rate of VAP.

Keywords: case control study, intensive care unit, risk factors, ventilator associated pneumonia

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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

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