Search results for: mortality improvement

Authors: Eva Kirzner

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Based on outcome studies published over the past two decades, in 2018, the ACC/AHA published new guidelines for the management of hypercholesterolemia that incorporate the use of coronary artery calcium (CAC) scanning as a decision tool for ascertaining which patients may benefit from statin therapy. This use is based on the recognition that the absence of calcium on CAC scanning (i.e., a CAC score of zero) usually signifies the absence of significant atherosclerotic deposits in the coronary arteries. Specifically, in patients with a high risk for atherosclerotic cardiovascular disease (ASCVD), initiation of statin therapy is generally recommended to decrease ASCVD risk. However, among patients with intermediate ASCVD risk, the need for statin therapy is less certain. However, there is a need for new outcome studies that provide evidence that the management of hypercholesterolemia based on these new ACC/AHA recommendations is safe for patients. Based on a Pub-Med and Google Scholar literature search, four relevant population-based or patient-based cohort studies that studied the relationship between CAC scanning, risk assessment or mortality, and statin therapy that were published between 2017 and 2021 were identified (see references). In each of these studies, patients were assessed for their baseline risk for atherosclerotic cardiovascular disease (ASCVD) using the Pooled Cohorts Equation (PCE), an ACC/AHA calculator for determining patient risk based on assessment of patient age, gender, ethnicity, and coronary artery disease risk factors. The combined findings of these four studies provided concordant evidence that a zero CAC score defines patients who remain at low clinical risk despite the non-use of statin therapy. Thus, these new studies confirm the use of CAC scanning as a safe tool for reducing the potential overuse of statin therapy among patients with zero CAC scores. Incorporating these new data suggest the following best practice: (1) ascertain ASCVD risk according to the PCE in all patients; (2) following an initial attempt trial to lower ASCVD risk with optimal diet among patients with elevated ASCVD risk, initiate statin therapy for patients who have a high ASCVD risk score; (3) if the ASCVD score is intermediate, refer patients for CAC scanning; and (4) and if the CAC score is zero among the intermediate risk ASCVD patients, statin therapy can be safely withheld despite the presence of an elevated serum cholesterol level.

Keywords: cholesterol, cardiovascular disease, statin therapy, coronary calcium

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Authors: Stephen O. Amaraihu

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This research investigated the effect of Computer Based Instruction on Students’ interest, achievement, and retention in Algebra in Abia State College of Education (Technical), Arochukwu. Three research questions and two hypotheses guided the study. Two instruments, Maths Achievement Test (MAT) and Maths Interest Inventory were employed, to test a population of three hundred and sixteen (316) NCE 1 students in algebra. It is expected that this research will lead to the improvement of students’ performance and enhance their interest and retention of basic algebraic concept. It was found that the majority of students in the college are not proficient in the use of ICT as a result of a lack of trained personnel. It was concluded that the state government was not ready to implement the usage of mathematics in Abia State College of Education. The paper recommends, amongst others, the employment of mathematics Lectures with competent skills in ICT and the training of lecturers of mathematics.

Keywords: achievement, computer based instruction, interest, retention

Procedia PDF Downloads 189

Authors: Arun Goel

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Prediction of maximum local scour is necessary for the safety and economical design of the bridges. A number of equations have been developed over the years to predict local scour depth using laboratory data and a few pier equations have also been proposed using field data. Most of these equations are empirical in nature as indicated by the past publications. In this paper, attempts have been made to compute local depth of scour around bridge pier in dimensional and non-dimensional form by using linear regression, simple regression and SVM (Poly and Rbf) techniques along with few conventional empirical equations. The outcome of this study suggests that the SVM (Poly and Rbf) based modeling can be employed as an alternate to linear regression, simple regression and the conventional empirical equations in predicting scour depth of bridge piers. The results of present study on the basis of non-dimensional form of bridge pier scour indicates the improvement in the performance of SVM (Poly and Rbf) in comparison to dimensional form of scour.

Keywords: modeling, pier scour, regression, prediction, SVM (Poly and Rbf kernels)

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Authors: Intissar Benrhouma, Marta Victoria, Ignacio Anton, Bechir Chaouachi

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Concentrating photovoltaic systems CPV use optical elements, such as Fresnel lenses, to concentrate solar intensity. The concentrated solar energy is delivered to the solar cell from 20 to 100 W/cm². Some of this energy is converted to electricity, while the rest must be disposed of as a residual heat. Solar cells cooling should be a necessary part of CPV modeling because these systems allowed increasing the power received by the cell. This high power can rise the electrons’ potential causing the heating of the cell, which reduces the global module’s efficiency. This work consists of modeling a concentrating photovoltaic module with and without a cooling system. We have established a theoretical model based on energy balances carried out on a photovoltaic module using solar radiation concentration cells. Subsequently, we developed a calculation program on Matlab which allowed us to simulate the functioning of this module. The obtained results show that the addition of a cooling system to the module improves greatly the performance of our CPV system.

Keywords: solar energy, photovoltaic, concentration, cooling, performance improvement

Procedia PDF Downloads 385

Authors: Ali̇ Si̇nan Soğanci

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The cement stabilization is one of the ground improvement method applied worldwide to increase the strength of clayey soils. The using of cement has got lots of advantages compared to other stabilization methods. Cement stabilization can be done quickly, the cost is low and creates a more durable structure with the soil. Cement can be used in the treatment of a wide variety of soils. The best results of the cement stabilization were seen on silts as well as coarse-grained soils. In this study, blocks of clay were taken from the Apa-Hotamış conveyance channel route which is 125km long will be built in Konya that take the water with 70m3/sec from Mavi tunnel to Hotamış storage. Firstly, the index properties of clay samples were determined according to the Unified Soil Classification System. The experimental program was carried out on compacted soil specimens with 0%, 7 %, 15% and 30 % cement additives and the results of unconfined compression strength were discussed. The results of unconfined compression tests indicated an increase in strength with increasing cement content.

Keywords: cement stabilization, unconfined compression test, clayey soils, unified soil classification system.

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Authors: Ying Xin, Shigeki Kametani

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This paper deals the energy saving performance of GHP (Gas engine heat pump) air conditioning system has improved with time-series variation. There are two types of air conditioning systems, VRF (Variable refrigerant flow) and central cooling and heating system. VRF is classified as EHP (Electric driven heat pump) and GHP. EHP drives the compressor with electric motor. GHP drives the compressor with the gas engine. The electric consumption of GHP is less than one tenth of EHP does. In this study, the energy consumption data of GHP installed the junior high schools was collected. An annual and monthly energy consumption per rated thermal output power of each apparatus was calculated, and then their energy efficiency was analyzed. From these data, we investigated improvement of the energy saving of the GHP air conditioning system by the change in the generation.

Keywords: energy-saving, variable refrigerant flow, gas engine heat pump, electric driven heat pump, air conditioning system

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Authors: Kebron Abich Asnake

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The outbreak of COVID-19 has had far-reaching socio-economic consequences globally, and Ethiopia is no exception. This abstract provides a summary of a research study on the socio-economic impact of COVID-19 in Ethiopia. The study analyzes the health impact, economic repercussions, social consequences, government response measures, and opportunities for post-crisis recovery. In terms of health impact, the research explores the spread and transmission of the virus, the capacity and response of the healthcare system, and the mortality rate, with a focus on vulnerable populations. The economic impact analysis entails investigating the contraction of the GDP, employment and income loss, disruption in key sectors such as agriculture, tourism, and manufacturing, and the specific implications for small and medium-sized enterprises (SMEs), foreign direct investment, and remittances. The social impact section looks at the disruptions in education and the digital divide, food security and nutrition challenges, increased poverty and inequality, gender-based violence, and mental health issues. The research also examines the measures taken by the Ethiopian government, including health and safety regulations, economic stimulus packages, social protection programs, and support for vulnerable populations. Furthermore, the study outlines long-term recovery prospects, social cohesion, and community resilience challenges. It highlights the need to strengthen the healthcare system and finds a balance between health and economic priorities. The research concludes by presenting recommendations for policy-makers and stakeholders, emphasizing opportunities for post-crisis recovery such as diversification of the economy, enhanced healthcare infrastructure, investment in digital infrastructure and technology, and support for domestic tourism and local industries. This research provides valuable insights into the socio-economic impact of COVID-19 in Ethiopia, offering a comprehensive analysis of the challenges faced and potential pathways towards recovery.

Keywords: impact, covid, ethiopia, health

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Authors: Asmaa Shehata

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Prior research indicates that second language (L2) learners encounter difficulty in the distinguishing novel L2 contrasting sounds that are not contrastive in their native languages. L2 orthographic information, however, is found to play a positive role in the acquisition of non-native phoneme contrasts. While most studies have mainly involved a familiar written script (i.e., the Roman script), the influence of a foreign, unfamiliar script is still unknown. Therefore, the present study asks: Does unfamiliar L2 script play a role in creating distinct phonological representations of novel contrasting phonemes? It is predicted that subjects’ performance in the unfamiliar orthography group will outperform their counterparts’ performance in the control group. Thus, training that entails orthographic inputs can yield a significant improvement in L2 adult learners’ identification and lexical encoding of novel L2 consonant contrasts. Results are discussed in terms of their implications for the type of input introduced to L2 learners to improve their language learning.

Keywords: Arabic, consonant contrasts, foreign script, lexical encoding, orthography, word learning

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Authors: Y. Galerkin, E. Popova, K. Soldatova

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There is an evident trend to elevate pressure ratio of a single stage of a turbo compressors - axial compressors in particular. Whilst there was an opinion recently that a pressure ratio 1,9 was a reasonable limit, later appeared information on successful modeling tested of stages with pressure ratio up to 2,8. The Authors recon that lack of information on high pressure stages makes actual a study of rational choice of design parameters before high supersonic flow problems solving. The computer program of an engineering type was developed. Below is presented a sample of its application to study possible parameters of the impeller of the stage with pressure ratio π*=3,0. Influence of two main design parameters on expected efficiency, periphery blade speed and flow structure is demonstrated. The results had lead to choose a variant for further analysis and improvement by CFD methods.

Keywords: supersonic stage, impeller, efficiency, flow rate coefficient, work coefficient, loss coefficient, oblique shock, direct shock

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Authors: Pedro Esteban

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Planning a hybrid power system (HPS) that integrates renewable generation sources, non-renewable generation sources and energy storage, involves determining the capacity and size of various components to be used in the system to be able to supply reliable electricity to the connected load as required. Nowadays it is very common to integrate solar photovoltaic (PV) power plants for renewable generation as part of HPS. The solar PV system is usually balanced via a second form of generation (renewable such as wind power or using fossil fuels such as a diesel generator) or an energy storage system (such as a battery bank). Hybrid power systems can also provide other forms of power such as heat for some applications. Modern hybrid power systems combine power generation and energy storage technologies together with real-time energy management and innovative power quality and energy efficiency improvement functionalities. These systems help customers achieve targets for clean energy generation, they add flexibility to the electrical grid, and they optimize the installation by improving its power quality and energy efficiency.

Keywords: microgrids, hybrid power systems, energy storage, grid code compliance

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Authors: Hamza A. Al-Sewadi, Akram N. A. Aldakari

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Copyright protection and ownership proof of digital multimedia are achieved nowadays by digital watermarking techniques. A text watermarking algorithm for protecting the property rights and ownership judgment of color images is proposed in this paper. Embedding is achieved by inserting texts elements randomly into the color image as noise. The YIQ image processing model is found to be faster than other image processing methods, and hence, it is adopted for the embedding process. An optional choice of encrypting the text watermark before embedding is also suggested (in case required by some applications), where, the text can is encrypted using any enciphering technique adding more difficulty to hackers. Experiments resulted in embedding speed improvement of more than double the speed of other considered systems (such as least significant bit method, and separate color code methods), and a fairly acceptable level of peak signal to noise ratio (PSNR) with low mean square error values for watermarking purposes.

Keywords: steganography, watermarking, time complexity measurements, private keys

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Authors: Wenxuan Li, Lei Li, Jin Li, Yuanhang He

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This paper designed a secure chip for IoT communication security integrated with the PUF-based firmware protection scheme. Then, the Xilinx Kintex-7 and STM-32 were used for the prototype verification. Firmware protection worked well on FPGA and embedded platforms. For the ASIC implementation of the PUF module, contact PUF is chosen. The post-processing method and its improvement are analyzed with emphasis. This paper proposed a more efficient post-processing method for contact PUF named SXOR, which has practical value for realizing lightweight security modules in IoT devices. The analysis was carried out under the hypothesis that the contact holes are independent and combine the existing data in the open literature. The post-processing effects of SXOR and XOR are basically the same under the condition that the proposed post-processing circuit occupies only 50.6% of the area of XOR. The average Hamming weight of the PUF output bit sequence obtained by the proposed post-processing method is 0.499735, and the average Hamming weight obtained by the XOR-based post-processing method is 0.499999.

Keywords: PUF, IoT, authentication, secure communication, encryption, XOR

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Authors: Melba Sheila D'Souza, Anandhi Amirtharaj, Shreedevi Balachandran

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Background: Type 2 diabetes has a significant impact on individuals’ health and well-being. Glycemic control may influence self-efficacy and self-care behaviors, and reduce the risk of complications among adults with type 2 diabetes. Type 2 diabetes has substantial morbidity and mortality and 60% of adults’ poor self-care. Glycemic control is associated with reported self-efficacy and self-care behavior. Adults with type 2 diabetes with less information were less likely to take diabetes self-care. Aim: To examine the relationship between glycemic control, demographic factors, clinical factors on self-efficacy, self-care behaviors among Omani adults with type 2 diabetes. Methods: A correlational, descriptive study was used. Omani adults with type 2 diabetes (n=140) were recruited from a public hospital in Oman. The data were collected during January-March 2015. Ethical approval was given by the college research and ethics committee, College of Nursing, and the Hospital, Sultan Qaboos University Data was collected on self-efficacy, self-care behaviors and glycemic control. The study was approved by the Institution Ethics and Research Committee. Bivariate and multivariate analyses were conducted. Results: Most adults had a fasting blood glucose >7.2mmol/L (90.7%), with the majority demonstrating ‘uncontrolled or poor HbA1c of > 8%’ (65%). Variance of self-care behavior (20.6%) and 31.3% of the variance of the self-efficacy was explained by the age, duration of diabetes, medication, HbA1c and prevention of activities of living. Adults with type 2 diabetes with poor glycemic control were more likely to have poor self-efficacy and poor self-care behaviors. Conclusion: This study confirms that self-efficacy model on outcome predicts self-efficacy and self-care behavior. Higher understanding of diabetes, prevention of normal daily activities, higher ability to fit diabetes life in a positive manner and high patient-physician communication were significant with self-efficacy and self-care behaviors. Hence, glycemic control has a high effect on improving self-care behaviors like diet, exercise, medication, foot care and self-efficacy among type 2 diabetes. Implications: Using these findings to improve self-efficacy, individualized self-care management is recommended for better self-efficacy and self-care behaviors among adults with type 2 diabetes.

Keywords: self-efficacy, self-care behaviors, self-care management, glycemic control, type 2 diabetes, nurse

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Authors: Fahad R. Choudhry., Khadeeja Munawar

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This clinical case presents a 24 years old, Muslim Pakistani girl with a history of conversion disorder. Her symptoms comprised fits, restlessness, numbness in legs, poor coordination and balance, burning during urination and retention. A cognitive-behavioral model was used for conceptualizing her problem and devising a management plan based on cognitive behavioral therapy (CBT) and culturally adapted coping statements. She took 13 therapy sessions and was presented with idiosyncratic case conceptualization. Psychoeducation, coping statements, extinction, verbal challenging, and behavioral activation techniques were practiced in a collaborative way for cognitive restructuring of the client. Focus of terminal sessions was on anger management. The client needed a couple of more sessions in order to help her manage her anger. However, the therapy was terminated on the part of the client after attainment of short term goals. The client reported to have a 75 % improvement in her overall condition and remained compliant throughout the therapy.

Keywords: cognitive behavioral therapy, conversion disorder, female, Muslim, Pakistani

Procedia PDF Downloads 180

Authors: Hernán A. Perez, Luis J. Armando, Néstor H. García

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Background and aims Cardiovascular disease rates are very high in patients with renal failure (CRF), but the underlying mechanisms are incompletely understood. Traditional cardiovascular risk factors do not explain the increased risk, and observational studies have observed paradoxical or absent associations between classical risk factors and mortality in dialysis patients. A large randomized controlled trial, the 4D Study, the AURORA and the ALERT study found that statin therapy in CRF do not reduce cardiovascular events. These results may be the results of ‘accelerated atherosclerosis’ observed on these patients. The objective of this study was to investigate if carotid total plaque area (TPA), a measure of carotid plaque burden growth is increased at progressively lower creatinine clearance in patients with CRF. We studied a cohort of patients with CRF not on dialysis, reasoning that risk factor associations might be more easily discerned before end stage renal disease. Methods: The Blossom DMO Argentina ethics committee approved the study and informed consent from each participant was obtained. We performed a cohort study in 412 patients with Stage 1, 2 and 3 CRF. Clinical and laboratory data were obtained. TPA was determined using bilateral carotid ultrasonography. Modification of Diet in Renal Disease estimation formula was used to determine renal function. ANOVA was used when appropriate. Results: Stage 1 CRF group (n= 16, 43±2yo) had a blood pressure of 123±2/78±2 mmHg, BMI 30±1, LDL col 145±10 mg/dl, HbA1c 5.8±0.4% and had the lowest TPA 25.8±6.9 mm2. Stage 2 CRF (n=231, 50±1 yo) had a blood pressure of 132±1/81±1 mmHg, LDL col 125±2 mg/dl, HbA1c 6±0.1% and TPA 48±10mm2 ( p< 0.05 vs CRF stage 1) while Stage 3 CRF (n=165, 59±1 yo) had a blood pressure of 134±1/81±1, LDL col 125±3 mg/dl, HbA1c 6±0.1% and TPA 71±6mm2 (p < 0.05 vs CRF stage 1 and 2). Conclusion: Our data indicate that TPA increases along the renal function deterioration, and it is not related with the LDL cholesterol and triglycerides levels. We suggest that mechanisms other than the classics are responsible for the observed excess of cardiovascular disease in CKD patients and finally, determination of total plaque area should be used to measure effects of antiatherosclerotic therapy.

Keywords: hypertension, chronic renal failure, atherosclerosis, cholesterol

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Authors: Sateesh Kumar Pisini, Swetha Priya Darshini Thammadi, Sanjay Kumar Shukla

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Granular piles are a popular ground improvement technique in soft cohesive soils as well as for loose non-cohesive soils. The present experimental study has been carried out on granular piles in loose (Relative density = 30%) and medium dense (Relative density = 60%) sands with geogrid reinforcement within the sand bed over the granular piles. A group of five piles were installed in the sand at different spacing, s = 2d, 3d and 4d, d being the diameter of the pile. The length (L = 0.4 m) and diameter (d = 50 mm) of the piles were kept constant for all the series of experiments. The load-settlement behavior of reinforced sand bed and granular piles system was studied by applying the load on a square footing. The results show that the effect of reinforcement increases the load bearing capacity of the piles. It is also found that an increase in spacing between piles decreases the settlement for both loose and medium dense soil.

Keywords: granular pile, load-carrying capacity, settlement, geogrid reinforcement, sand

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Authors: Shefeen Maliyakkal, Pranav Satheesh, Steve Simon, Sharath Kuruppath

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This paper researches the impact of battery voltage sag on the performance and efficiency of E-motor in electric cars. Terminal voltage of battery reduces with the S.o.C. This results in the downward shift of torque-speed curve of E-motor and increased copper losses in E-motor. By introducing a buck-boost inverter between the battery and E-motor, an additional degree of freedom was achieved. By boosting the AC voltage, the dependency of voltage sag on the performance of E-motor was eliminated. A strategy was also proposed for the operation of the buck-boost inverter to minimize copper and iron losses in E-motor to maximize efficiency. MATLAB-SIMULINK model of E-drive was used to obtain simulation results. The temperature rise in the E-motor was reduced by 14% for a 10% increase in AC voltage. From the results, it was observed that a 20% increase in AC voltage can result in improvement of running torque and maximum torque of E-motor by 44%. Hence it was concluded that using a buck-boost inverter for E-drive significantly improves both performance and efficiency of E-motor.

Keywords: buck-boost, E-motor, battery, voltage sag

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Authors: Jaisoon Baek, Gyuhwan Oh

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In this study, we developed a puzzle game based on coding and a web-based management system to observe the user's learning status in real time and maximize the understanding of the coding of elementary students. We have improved upon and existing coding game which cannot be connected to textual language coding or comprehends learning state. We analyzed the syntax of various coding languages for the curriculum and provided a menu to convert icon into textual coding languages. In addition, the management system includes multiple types of tutoring, real-time analysis of user play data and feedback. Following its application in regular elementary school software classes, students reported positive effects on understanding and interest in coding were shown by students. It is expected that this will contribute to quality improvement in software education by providing contents with proven educational value by breaking away from simple learning-oriented coding games.

Keywords: coding education, serious game, coding, education management system

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Authors: Gang Liu, Can Wang, Runnan Zhang, Quan Wang, Huimin Song, Shaomin Ji

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Biba model can protect information integrity but might deny various non-malicious access requests of the subjects, thereby decreasing the availability in the system. Therefore, a mechanism that allows exceptional access control is needed. Break the Glass (BTG) strategies refer an efficient means for extending the access rights of users in exceptional cases. These strategies help to prevent a system from stagnation. An approach is presented in this work for integrating Break the Glass strategies into the Biba model. This research proposes a model, BTG-Biba, which provides both an original Biba model used in normal situations and a mechanism used in emergency situations. The proposed model is context aware, can implement a fine-grained type of access control and primarily solves cross-domain access problems. Finally, the flexibility and availability improvement with the use of the proposed model is illustrated.

Keywords: Biba model, break the glass, context, cross-domain, fine-grained

Procedia PDF Downloads 529

Authors: Fati̇h Apaydin

Abstract:

Education technology is an area which constantly changes and creates innovations. As an inevitable part of the changing circumstances, the societies who have a tendency to the improvements keep up with these innovations by using the methods and strategies which have been designed for education technology. At this point, education technology has taken the responsibility to help the individuals improve themselves and teach the effective teaching methods by filling the airs in theoretical information, information security and the practice. The technology which comes to the core of our lives by raising the importance of it day by day and it enforced its position in computer- based environments. As a result, ‘being ready for technological innovations, improvement on computer-based talent, information, ability and attitude’ doctrines have to be given. However, it is today quite hard to deal with the security and reinforcement of this information. The information which is got illegally gives harm to society from every aspect, especially education. This study includes how and to what extent to use these innovative appliances such as computers and the factor of information security of these appliances in computer-based education. As the use of computer is constantly becoming prevalent in our country, both education and computer will never become out of date, so how computer-based education affects our lives and the study of information security for this type of education are important topics.

Keywords: computer, information security, education, technology, development

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Authors: Devendra Gupta, S. P. Ambesh, P. K Singh

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Introduction: Minimally invasive coronary artery bypass grafting (MICABG) is a less invasive method of performing surgical revascularization. Minimally invasive direct coronary artery bypass (MIDCAB) provides many anesthetic challenges including one lung ventilation (OLV), managing myocardial ischemia, and pain. We present an early and midterm result of the use of this technique with OLV. Method: We enrolled 62 patients for analysis operated between 2008 and 2012. Patients were anesthetized and left endobronchial tube was placed. During the procedure left lung was isolated and one lung ventilation was maintained through right lung. Operation was performed utilizing off pump technique of coronary artery bypass grafting through a minimal invasive incision. Left internal mammary artery graft was done for single vessel disease and radial artery was utilized for other grafts if required. Postoperative ventilation was done with single lumen endotracheal tube. Median follow-up is 2.5 years (6 months to 4 years). Results: Median age was 58.5 years (41-77) and all were male. Single vessel disease was present in 36, double vessel in 24 and triple vessel disease in 2 patients. All the patients had normal left ventricular size and function. In 2 cases difficulty were encounter in placement of endobronchial tube. In 1 case cuff of endobronchial tube was ruptured during intubation. High airway pressure was developed on OLV in 1 case and surgery was accomplished with two lung anesthesia with low tidal volume. Mean postoperative ventilation time was 14.4 hour (11-22). There was no perioperative and 30 day mortality. Conversion to median sternotomy to complete the operation was done in 3.23% (2 out of 62 patients). One patient had acute myocardial infarction postoperatively and there were no deaths during follow-up. Conclusion: MICABG is a safe and effective method of revascularization with OLV in low risk candidates for coronary artery bypass grafting.

Keywords: MIDCABG, one lung ventilation, coronary artery bypass grafting, endobronchial tube

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Authors: Iliana Georganta, Clare Deehan, Marysia Thomson, Miriam McDonald, Kerrie McNulty, Anna Strachan, Elizabeth Anderson, Alyaa Mostafa

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Context: A meta-analysis of randomized controlled trials (RCTs) comparing hysterectomy versus endometrial ablation and resection in the management of heavy menstrual bleeding. Objective: To evaluate the clinical efficacy, satisfaction rates and adverse events of hysterectomy compared to more minimally invasive techniques in the treatment of HMB. Evidence Acquisition: A literature search was performed for all RCTs and quasi-RCTs comparing hysterectomy with either endometrial ablation endometrial resection of both. The search had no language restrictions and was last updated in June 2020 using MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, PubMed, Google Scholar, PsycINFO, Clinicaltrials.gov and Clinical trials. EU. In addition, a manual search of the abstract databases of the European Haemophilia Conference on women's health was performed and further studies were identified from references of acquired papers. The primary outcomes were patient-reported and objective reduction in heavy menstrual bleeding up to 2 years and after 2 years. Secondary outcomes included satisfaction rates, pain, adverse events short and long term, quality of life and sexual function, further surgery, duration of surgery and hospital stay and time to return to work and normal activities. Data were analysed using RevMan software. Evidence synthesis: 12 studies and a total of 2028 women were included (hysterectomy: n = 977 women vs endometrial ablation or resection: n = 1051 women). Hysterectomy was compared with endometrial ablation only in five studies (Lin, Dickersin, Sesti, Jain, Cooper) and endometrial resection only in five studies (Gannon, Schulpher, O’Connor, Crosignani, Zupi) and a mixture of the Ablation and Resection in two studies (Elmantwe, Pinion). Of the 1² studies, 10 reported women’s perception of bleeding symptoms as improved. Meta-analysis showed that women in the hysterectomy group were more likely to show improvement in bleeding symptoms when compared with endometrial ablation or resection up to 2-year follow-up (RR 0.75, 95% CI 0.71 to 0.79, I² = 95%). Objective outcomes of improvement in bleeding also favored hysterectomy. Patient satisfaction was higher after hysterectomy within the 2 years follow-up (RR: 0.90, 95%CI: 0.86 to 0.94, I²:58%), however, there was no significant difference between the two groups at more than 2 years follow up. Sepsis (RR: 0.03, 95% CI 0.002 to 0.56; 1 study), wound infection (RR: 0.05, 95% CI: 0.01 to 0.28, I²: 0%, 3 studies) and Urinary tract infection (UTI) (RR: 0.20, 95% CI: 0.10 to 0.42, I²: 0%, 4 studies) all favoured hysteroscopic techniques. Fluid overload (RR: 7.80, 95% CI: 2.16 to 28.16, I² :0%, 4 studies) and perforation (RR: 5.42, 95% CI: 1.25 to 23.45, I²: 0%, 4 studies) however favoured hysterectomy in the short term. Conclusions: This meta-analysis has demonstrated that endometrial ablation and endometrial resection are both viable options when compared with hysterectomy for the treatment of heavy menstrual bleeding. Hysteroscopic procedures had better outcomes in the short term with fewer adverse events including wound infection, UTI and sepsis. The hysterectomy performed better when measuring more long-term impacts such as recurrence of symptoms, overall satisfaction at two years and the need for further treatment or surgery.

Keywords: menorrhagia, hysterectomy, ablation, resection

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Authors: Alireza Pour Ebrahimi, Vahid Abasi

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Recently by the extension of internet usage, Research on the intrusion detection system takes a significant importance. Many of improvement systems prevent internal and external network attacks by providing security through firewalls and antivirus. In recently years, intrusion detection systems gradually turn from host-based systems and depend on O.S to the distributed systems which are running on multiple O.S. In this work, by considering the diversity of computer networks whit respect to structure, architecture, resource, services, users and also security goals requirement a fully distributed collaborative intrusion detection system based on peer to peer architecture is suggested. in this platform each partner device (matched device) considered as a peer-to-peer network. All transmitted information to network are visible only for device that use security scanning of a source. Experimental results show that the distributed architecture is significantly upgradeable in respect to centralized approach.

Keywords: network, intrusion detection system, peer to peer, internal and external network

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Authors: F. Siahmed, A. Lounis, L. Faghi

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The aim of this work is to study mechanical properties of composites based on fiber natural. This material has attracted attention of the scientific community for its mechanical properties, its moderate cost and its specification as regards the protection of environment. In this study the loofah part of the family of the natural fiber has been used for these significant mechanical properties. The fiber has porous structure, which facilitates the impregnation of the resin through these pores. The matrix used in this study is the type of unsaturated polyester. This resin was chosen for its resistance to long term.The work involves: -The chemical treatment of the fibers of loofah by NaOH solution (5%) -The realization of the composite resin / fiber loofah; The preparation of samples for testing -The tensile tests and bending -The observation of facies rupture by scanning electron microscopy The results obtained allow us to observe that the values of Young's modulus and tensile strength in tension is high and open up real prospects. The improvement in mechanical properties has been obtained for the two-layer composite fiber with 7.5% (by weight).

Keywords: loofah fiber, mechanical properties, composite, loofah fiber resin

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Authors: Fatemeh Khalili Varnamkhasti

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In recent times, there has been a notable shift in the application of Total Quality Management (TQM) from manufacturing to service organizations, prompting numerous studies on the subject. TQM has firmly established itself across various sectors, emerging as an approach to process improvement, waste reduction, business optimization, and quality performance. Many researchers and academics have recognized the relevance of TQM for sustainable competitive advantage, particularly in service organizations. In light of this, the purpose of this research study is to explore the applicability of TQM within the service framework. The study delves into existing literature on TQM in service organizations and examines the reasons for its occasional shortcomings. Ultimately, the paper provides systematic guidelines for the effective implementation of TQM in service organizations. The findings of this study offer a much-improved understanding of TQM and its practices, shedding light on the evolution of service organizations. Additionally, the study highlights key insights from recent research on TQM in service organizations and proposes a ten-step approach for the successful implementation of TQM in the service sector. This framework aims to provide service managers and professionals with a comprehensive understanding of TQM fundamentals and encourages a deeper exploration of TQM theory.

Keywords: quality, control, service, management, teamwork

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Authors: Marjeta Misigoj Durakovic, Maroje Soric, Lovro Stefan

Abstract:

Background and aim: Physical inactivity has been linked with increased morbidity and premature mortality and adolescence has been recognised as the critical period for a decline in physical activity (PA) level. In order to properly direct interventions aimed at increasing PA, high-risk groups of individuals should be identified. Therefore, the aim of this study is to describe gender differences in: a) PA level; b) weekly PA patterns. Methods: This investigation is a part of the CRO-PALS study which is an on-going longitudinal study conducted in a representative sample of urban youth in Zagreb (Croatia). CRO-PALS involves 903 adolescents and for the purpose of this study data from a subgroup of 190 participants with information on objective PA level were analysed (116 girls; mean age [SD]=15.6[0.3] years). Duration of moderate and vigorous PA was measured during 5 consecutive by a multiple-sensor physical activity monitor (SenseWear Armband, BodyMedia inc., Pittsburgh, USA). Gender differences in PA level were evaluated using independent samples t-test. Differences in school week and weekend levels of activity were assessed using mixed ANOVA with gender as between-subjects factor. The amount of vigorous PA had to be log-transformed to achieve normality in the distribution. Results: Boys were more active than girls. Duration of moderate-to-vigorous PA averaged 111±44 min/day in boys and 80±38 min/day in girls (mean difference=31 min/day, 95%CI=20-43 min/day). Vigorous PA was 2.5 times higher in boys compared to girls (95%CI=1.9-3.5). Participants were more active during school days than on weekends. The magnitude of the difference in moderate-to-vigorous PA was similar in both gender (p value for time*gender interaction = 0.79) and averaged 19 min/day (95%CI=11-27 min/day). Similarly, vigorous PA was 36% lower on weekends compared with school days (95%CI=22-46%) with no gender difference (p value for time*gender interaction = 0.52). Conclusion: PA level was higher in boys than in girls throughout the week. Still, in both boys and girls, the amount of PA reduced markedly on weekends compared with school days.

Keywords: adolescence, multiple-sensor physical activity monitor, physical activity level, weekly physical activity pattern

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Authors: Alak Kumar Patra, Nilanjan Mitra

Abstract:

Interface fracture toughness of glass-epoxy (G/E) PVC core sandwich composite with and without MWCNT has been investigated through experimental methods. Results demonstrate an improvement in interface fracture toughness values (GC) of samples with a certain percentages of MWCNT. In addition, dispersion of MWCNT in epoxy resin through sonication followed by mixing of hardener and vacuum assisted resin transfer method (VARTM) used in this study is an easy and cost effective methodology in comparison to previously adopted other methods limited to laminated composites. The study also identifies the optimum weight percentage of MWCNT addition in the resin system for maximum performance gain in interfacial fracture toughness. The results are supported by high resolution transmission electron microscope (HRTEM) analysis and fracture micrograph of field emission scanning electron microscope (FESEM) investigation.

Keywords: carbon nanotube, foam, glass-epoxy, interfacial fracture, sandwich composite

Procedia PDF Downloads 416

Authors: Yan Ding, Fei Yan, Ji Liang, Hong Jiang, Xiaoguang Yang, Xu Qian

Abstract:

The health status of GonjiKolela District, Amhara Region, Ethiopia is below its national average, and a sub-project of China UK Global Health Support Programme (GHSP) is expected to increase the uptake of a suite of reproductive, maternal, newborn and child health (RMNCH) interventions there. To explore what is on the ground and what could be helpful for the uptake of RMNCH services in GonjiKolela, a qualitative study was performed as part of the baseline assessment before the implementation of the project. Nine key informants from GonjiKolela were interviewed with self-designed interview guides and they were from the district Health Office, health centers, health posts, women health development army (community volunteer groups), mothers of newborns, and also a gynecologist from the maternal and child health center which is the referral center for pregnant women for this project. The interview were transcribed into words and sorted with qualitative analysis software MAXqda. Content analysis was mainly used to analyze the data. The district health office, the health centers and the health posts all had focal persons taking care of the management and provision of RMNCH services, and RMNCH related indicators were recorded and reported at each level routinely. In addition, district government and administration at community/administrative village level kept a close eye on the reduction of maternal, neonatal and child mortality. Women Health Development Amy at household level supported health workers at community/administrative village level (called health extension workers) in tracing, recording and reporting pregnant women, newborn and under-five children,organizing events for health education, demonstrating and leading health promotion activities, and stimulating the utilization of RMNCH.

Keywords: Reproductive Maternal Newborn and Child Health, Health Care Utilization, Qualitative Study, Ethiopia

Procedia PDF Downloads 285

Authors: Anum Obaid, Bushra Noor, Zoshia Zainab

Abstract:

In South Asian countries, Pakistan faces significant public health challenges regarding maternal and neonatal health (MNH). Despite global efforts to improve maternal, newborn, child, and health (MNCH) outcomes through initiatives like the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), high maternal and neonatal mortality rates persist. In patriarchal societies, cultural norms, family dynamics, and gender roles heavily influence healthcare accessibility and decision-making processes, often leading to delayed and inadequate maternal care. Addressing these socio-cultural barriers and enhancing healthcare resources is crucial to improving maternal health outcomes in areas like Faisalabad. A qualitative study was conducted involving two groups of informants: gynecologists practicing in private clinics and first-time pregnant women receiving care in government hospitals. Data collection included obtaining institutional permission, conducting semi-structured in-depth interviews, and using non-probability sampling techniques. A proactive strategy to overcome maternal health challenges involves using aversion therapy and disseminating knowledge among family members. This approach aims to foster a deep understanding within the family unit regarding the importance of maternal well-being, thereby creating a supportive environment and facilitating informed decision-making related to healthcare access and lifestyle choices. The findings indicate that maternal health is compromised both physiologically and psychologically, with significant implications for the baby's health. Mental well-being, in particular, is profoundly affected, largely due to familial behavior and entrenched cultural taboos.

Keywords: maternal health, neonatal health, socio-cultural norms, primigravida women, gynecologist, familial conduct, cultural taboos

Procedia PDF Downloads 22

Authors: Anum Obaid, Bushra Noor, Zoshia Zainab

Abstract:

In South Asian countries, Pakistan faces significant public health challenges regarding maternal and neonatal health (MNH). Despite global efforts to improve maternal, newborn, child, and health (MNCH) outcomes through initiatives like the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), high maternal and neonatal mortality rates persist. In patriarchal societies, cultural norms, family dynamics, and gender roles heavily influence healthcare accessibility and decision-making processes, often leading to delayed and inadequate maternal care. Addressing these socio-cultural barriers and enhancing healthcare resources is crucial to improving maternal health outcomes in areas like Faisalabad. A qualitative study was conducted involving two groups of informants: gynecologists practicing in private clinics and first-time pregnant women receiving care in government hospitals. Data collection included obtaining institutional permission, conducting semi-structured in-depth interviews, and using non-probability sampling techniques. A proactive strategy to overcome maternal health challenges involves using aversion therapy and disseminating knowledge among family members. This approach aims to foster a deep understanding within the family unit regarding the importance of maternal well-being, thereby creating a supportive environment and facilitating informed decision-making related to healthcare access and lifestyle choices. The findings indicate that maternal health is compromised both physiologically and psychologically, with significant implications for the baby's health. Mental well-being, in particular, is profoundly affected, largely due to familial behavior and entrenched cultural taboos.

Keywords: maternal health, neonatal health, socio-cultural norms, primigravida women, gynecologist, familial conduct, cultural taboos.

Procedia PDF Downloads 17