Search results for: hospital costs

Authors: Wissem Abdaoui, Nizar M. Mhaidat, Ilhem Mokhtari, Adel Gouri

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Colorectal cancer (CRC) is one of the most common tumors all over the world. Obesity, considered a risk factor of CRC, is characterized by a high level of secreted cytokines from adipose tissue. Among these inflammatory molecules, leptin is considered the key mediator for CRC cancer development and progression by activation of mitogenic and anti apoptotic signaling pathways. Gene expression can be significantly modulated by alterations in DNA methylation patterns. The aim of this study is to investigate the impact of leptin gene methylation on CRC prognosis and sensitivity to chemotherapy. The study involved 70 CRC tissue samples collected from King Abdullah University Hospital (KAUH) from which only 53 was analyzed because of bisulfate fragmentation and low yield of DNA extracted from FFPE tissues. A total of 22 blood samples were collected from healthy volunteers and enrolled as a control group. Leptin promoter methylation was analyzed by methylation specific PCR after bisulfate conversion. Results revealed that the incidence of leptin gene methylation was significantly higher in CRC patients in comparison to that of controls (P < 0.05). The correlation between patient’s demographics and leptin gene methylation was not significant (P < 0.05). However, a significant correlation between leptin gene methylation status and early cancer stages (I, II and III) was found in male but not in female (p < 0.05). Moreover, a significant correlation was found between leptin promoter methylation and early tumor localization T1-2 (p < 0.05). The correlation between epigenetic regulation of leptin and chemosensitivity was not significant. Taken together, these results suggest the possibility to use leptin gene methylation as a biomarker for the evaluation of CRC prognosis and metastasis.

Keywords: colorectal cancer, obesity, leptin, DNA methylation, disease prognosis, bisulfate conversion, chemoresistance

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Authors: G. Murtaza, H. Faiza, M. Rafiq, S. Gul, F. Raza, Sarwat Anjum

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Our objective was to investigate whether and how extensively there is a correlation between aging in men, gonadotropin hormone regulation, and a decline in sperm parameters and whether it is possible to identify an age limit beyond which the decrease in sperm feature and hormonal regulation reaches statistical significance. A total of one hundred and twenty men (age: 20–50 years) were divided into two groups; each group contained 60 males (Group A with a young age of 20–35 years and Group B with an older age of 36–50 years) who visited the Center for Reproductive Medicine (CRM) in Peshawar General Hospital (PGH) Peshawar, Pakistan. Clinical assessment and sperm analysis were investigated. Hormone testing and semen analysis were carried out in accordance with World Health Organization (WHO) guidelines. Hormone tests, sperm morphology, and the total motile spermatozoa count (TMS) were computed. SPSS 20.0 (SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. It was observed that the testosterone levels in Group A (mean = 3.770) and Group B (mean = 3.995) were comparable, with a significant P-value <0.005 in both age groups. Furthermore, similar levels are shown by follicle-stimulating hormone (FSH) (Group A mean = 19.73, Group B mean = 15.64) and luteinizing hormone (LH) (Group A mean = 12.25, Group B mean = 11.93) in both groups, with a significant P = <0.005. Sperm concentrations were most similar in Group A, with a mean of 4.44, and in Group B, with a mean of 4.42 and a significant P value of 0.005 in both groups. Additionally, it was discovered that sperm motility was higher in Group A, with a mean of 22.40 and a P-value of 0.052, which was non-significant when compared to Group B. Morphological differences were also observed in both age groups. This research found that advancing in male age does not affect sex hormone regulation; in contrast, the fraction of motile and morphologically normal spermatozoa decreases as male age increases, with the strongest evidence being when the age exceeds 40 years. To clarify the causes and clinical implications of these correlations, more research is necessary.

Keywords: gonadotropins, motility, spermatozoa, testosterone

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Authors: R. Padmini, G. V. Manoj Kumar

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Structural insulated panels (SIPs) are a high-performance building system for residential and light commercial construction. The panels consist of an insulating foam core sandwiched between two structural facings, typically oriented strand board (OSB). SIPs are manufactured under factory controlled conditions and can be fabricated to fit nearly any building design. The result is a building system that is extremely strong, energy efficient and cost effective. Building with SIPs will save you time, money and labor. Building with SIPs generally costs about the same as building with wood frame construction when you factor in the labor savings resulting from shorter construction time and less job-site waste. Other savings are realized because smaller heating and cooling systems are required with SIP construction. Structural insulated panels (SIPs) are one of the most airtight and well-insulated building systems available, making them an inherently green product. An airtight SIP building will use less energy to heat and cool, allow for better control over indoor environmental conditions, and reduce construction waste. Green buildings use less energy, reducing carbon dioxide emissions and playing an important role in combating global climate change. Buildings also use a tremendous amount of natural resources to construct and operate. Constructing green buildings that use these resources more efficiently, while minimizing pollution that can harm renewable natural resources, is crucial to a sustainable future.

Keywords: high performance, under factory controlled, wood frame, carbon dioxide emissions, natural resources

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Authors: Khairul Zahreen Mohd Arof, Rahimah Muhamad

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Oil palm fiber (OPF) is a fibrous material produced from the waste of palm oil industry which is suitable to be used in construction industry. The applications of OPF in concrete can reduce the material costs and enhance concrete behavior. Dog-bone test provides significant results for investigating the behavior of fiber reinforced concrete under tensile loading. It is able to provide stress-strain profile, modulus of elasticity, stress at cracking point and total crack width. In this research, dog-bone tests have been conducted to analyze total crack width, stress-strain profile, and modulus of elasticity of OPFC. Specimens are in a dog-bone shape with a long notch in the middle as compared to the end, to ensure cracks occur only within the notch. Tests were instrumented using a universal testing machine Shimadzu 300kN, a linear variable differential transformer and two strain gauges. A total of nine specimens with different fibers at fiber volume fractions of 0.75%, 1.00%, and 1.25% have been tested to analyze the behavior under tensile loading. Also, three specimens of plain concrete fiber have been tested as control specimens. The tensile test of all specimens have been carried out for concrete age exceed 28 days. It shows that OPFC able to reduce total crack width. In addition, OPFC has higher cracking stress than plain concrete. The study shows plain concrete can be improved with the addition of OPF.

Keywords: cracks, crack width, dog-bone test, oil palm fiber concrete

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Authors: Jaylo Abalos, Sophia Zamora

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BACKGROUND: Various gastrointestinal (GI) symptoms, including diarrhea, nausea/vomiting and abdominal pain, have been reported in patients with Coronavirus disease 2019 (COVID-19). In this context, the presence of GI symptoms is variably associated with poor clinical outcomes in COVID-19. We aim to determine the outcomes of hospitalized COVID-19 patients with gastrointestinal symptoms. METHODOLOGY: This is a retrospective cohort study that used medical records of admitted COVID-19 patients from March 2020- March 2021 in a tertiary hospital in Pangasinan. Data records were evaluated for the presence of gastrointestinal manifestations, including diarrhea, nausea, vomiting and abdominal pain at the time of admission. Comparison between cases or COVID-19 patients presenting with GI manifestations to controls or COVID-19 patients without GI manifestation was made. RESULTS: Four hundred three patients were included in the study. Of these, 22.3% presented with gastrointestinal symptoms, while 77.7% comprised the study controls. Diarrhea was the most common GI symptom (10.4%). No statistically significant difference was observed in comorbidities and laboratory findings. Mortality was the primary outcome of the study that did not reach statistical significance between cases and controls (13.33% vs. 16.30%, p =0.621). There were also no significant differences observed in the secondary outcomes, mean length of stay, (14 [12-18 days] in cases vs 14 [12- 17.5 days] in controls, p = 0.716) and need for mechanical ventilation (12.22% vs 16.93%, p = 0.329). CONCLUSION: The results of the study revealed no association of the GI symptoms to poor outcomes, including a high rate of mortality, prolonged length of stay and increased need for mechanical ventilation.

Keywords: gastrointestinal symptoms, COVID-19, outcomes, mortality, length of stay

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Authors: Jameela Ali, Hamid A. Jalab, Loay E. George, Abdul Rahim Ahmad, Azizah Suliman, Karim Al-Jashamy

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Red blood cells (RBC) are the most common types of blood cells and are the most intensively studied in cell biology. The lack of RBCs is a condition in which the amount of hemoglobin level is lower than normal and is referred to as “anemia”. Abnormalities in RBCs will affect the exchange of oxygen. This paper presents a comparative study for various techniques for classifyig the red blood cells as normal, or abnormal (anemic) using WEKA. WEKA is an open source consists of different machine learning algorithms for data mining applications. The algorithm tested are Radial Basis Function neural network, Support vector machine, and K-Nearest Neighbors algorithm. Two sets of combined features were utilized for classification of blood cells images. The first set, exclusively consist of geometrical features, was used to identify whether the tested blood cell has a spherical shape or non-spherical cells. While the second set, consist mainly of textural features was used to recognize the types of the spherical cells. We have provided an evaluation based on applying these classification methods to our RBCs image dataset which were obtained from Serdang Hospital-Malaysia, and measuring the accuracy of test results. The best achieved classification rates are 97%, 98%, and 79% for Support vector machines, Radial Basis Function neural network, and K-Nearest Neighbors algorithm respectively

Keywords: red blood cells, classification, radial basis function neural networks, suport vector machine, k-nearest neighbors algorithm

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Authors: Nouf Alharbi, James O'shea

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For decades, renewable energy sources have received considerable global interest due to the increase in fossil fuel consumption. The abundant energy produced by sunlight makes dye-sensitised solar cells (DSSCs) a promising alternative compared to conventional silicon and thin film solar cells due to their transparency and tunable colours, which make them suitable for applications such as windows and glass facades. The transfer of an excited electron onto the surface is an important procedure in the DSSC system, so different groups of dye molecules were studied on the rutile TiO2 (110) surface. Currently, the study of organic dyes has become an interest of researchers due to ruthenium being a rare and expensive metal, and metal-free organic dyes have many features, such as high molar extinction coefficients, low manufacturing costs, and ease of structural modification and synthesis. There are, of course, some groups that have developed organic dyes and exhibited lower light-harvesting efficiency ranging between 4% and 8%. Since most dye molecules are complicated or fragile to be deposited by thermal evaporation or sublimation in the ultra-high vacuum (UHV), all dyes (i.e, D5, SC4, and R6) in this study were deposited in situ using the electrospray deposition technique combined with X-ray photoelectron spectroscopy (XPS) as an alternative method to obtain high-quality monolayers of titanium dioxide. These organic molecules adsorbed onto rutile TiO2 (110) are explored by XPS, which can be used to obtain element-specific information on the chemical structure and study bonding and interaction sites on the surface.

Keywords: dyes, deposition, electrospray, molecules, organic, rutile, sensitised, XPS

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

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Background: Obstructive Sleep apnea syndrome (OSAS) is a common respiratory disorder during sleep. In addition, Body parameters were identified high predictive importance for OSAS severity. However, the effects of body parameters on OSAS severity remain unclear. Objective: In this study, the objective is to establish a prediction model for OSAS by using body parameters and investigate the effects of body parameters in OSAS. Methodologies: Severity was quantified as the polysomnography and the mean hourly number of greater than 3% dips in oxygen saturation during examination in a hospital in New Taipei City (Taiwan). Four levels of OSAS severity were classified by the apnea and hypopnea index (AHI) with American Academy of Sleep Medicine (AASM) guideline. Body parameters, including neck circumference, waist size, and body mass index (BMI) were obtained from questionnaire. Next, dividing the collecting subjects into two groups: training and testing groups. The training group was used to establish the random forest (RF) to predicting, and test group was used to evaluated the accuracy of classification. Results: There were 3330 subjects recruited in this study, whom had been done polysomnography for evaluating severity for OSAS. A RF of 1000 trees achieved correctly classified 79.94 % of test cases. When further evaluated on the test cohort, RF showed the waist and BMI as the high import factors in OSAS. Conclusion It is possible to provide patient with prescreening by body parameters which can pre-evaluate the health risks.

Keywords: apnea and hypopnea index, Body parameters, obstructive sleep apnea syndrome, Random Forest

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

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

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

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Authors: Abdul Murad Zainal Abidin, Tuan Suhaimi Salleh, Siti Nor Azila Khalid, Noryati Mustapa

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Quarry dust is a quarry end product from rock crushing processes, which is a concentrated material used as an alternative to fine aggregates for concreting purposes. In quarrying activities, the rocks are crushed into aggregates of varying sizes, from 75mm until less than 4.5 mm, the size of which is categorized as quarry dust. The quarry dust is usually considered as waste and not utilized as a recycled aggregate product. The dumping of the quarry dust at the quarry plant poses the risk of environmental pollution and health hazard. Therefore, the research is an attempt to identify the potential of quarry dust as an alternative building material that would reduce the materials and construction costs, as well as contribute effort in mitigating depletion of natural resources. The objectives are to conduct material characterization and evaluate the properties of fresh and hardened engineering brick with quarry dust mix proportion. The microstructures of quarry dust and the bricks were investigated using scanning electron microscopy (SEM), and the results suggest that the shape and surface texture of quarry dust is a combination of hard and angular formation. The chemical composition of the quarry dust was also evaluated using X-ray fluorescence (XRF) and compared against sand and concrete. The quarry dust was found to have a higher presence of alumina (Al₂O₃), indicating the possibility of an early strength effect for brick. They are utilizing quarry dust waste as replacement material has the potential of conserving non-renewable resources as well as providing a viable alternative to disposal of current quarry waste.

Keywords: building materials, cement replacement, quarry microstructure, quarry product, sustainable materials

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Authors: Elise Machline

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In the late 1980’s, sustainable urban development emerged in Europe. Sustainable neighborhoods are one attempt to implement sustainable urban energy planning in the city. So, for twenty years, projects of sustainable neighborhoods (or ‘eco-neighborhoods’) have emerged in Europe. Debates about sustainability no longer restrict it to environmental concerns (to limit greenhouse gas emissions), but rather extend to the economic and social dimensions. A growing number of empirical studies demonstrate that sustainable urbanism yield rental/sale premia, as well as higher occupancy rates and thus higher asset values. For example, European eco neighborhood projects usually focus on the middle to upper classes, given the costs involved in renting or buying the dwellings built in such projects. As a result sustainable residential buildings are not affordable and their construction tends to have a gentrifying effect. An increasing number of countries are institutionalizing green strategies for affordable housing. In France, the sustainable neighborhoods ‘ecoquartier’ must meet environmental performance criteria, have a potential for economic development and, provide social and functional diversity. The issue of social diversity trough the provision of affordable housing has emerged as a dimension of public housing policies. Thus, the ecoquartier residential buildings must be both energy efficient and affordable. Through the Parisian example our study considers how the concept of social diversity and other elements of sustainability are illustrated in the ecoquartiers and whether the authorities have been able to avoid gentrification when implementing a sustainable urban policy.

Keywords: sustainable neighborhoods, social diversity, social housing policies, green buildings

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Authors: Rodrigo A. Schiller, Rubens C. Da Silva, Kazuo Nishimoto, Claudio M. P. Sampaio

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The need to reduce fossil fuels consumption due to the current scenario of trying to restrain global warming effects and reduce air pollution is dictating a series of transformations in shipping. This study introduces, at first, the changes of the regulatory framework concerning gas emissions control and fuel consumption efficiency on merchant ships. Secondly, the main operational procedures with high potential reduction of fuel consumption are discussed, with focus on existing vessels, using ship speed reduction procedure. This procedure shows the positive impacts on both operating costs reduction and also on energy efficiency increase if correctly applied. Finally, a numerical analysis of the fuel consumption variation with the speed was carried out for a Suezmax class oil tanker, which has been adapted to oil offloading operations for FPSOs in Brazilian offshore oil production systems. In this analysis, the discussions about the variations of vessel energy efficiency from small speed rate reductions and the possible applications of this improvement, taking into account the typical operating profile of the vessel in such a way to have significant economic impacts on the operation. This analysis also evaluated the application of two different numerical methods: one based only on regression equations produced by existing data, semi-empirical method, and another using a CFD simulations for estimating the hull shape parameters that are most relevant for determining fuel consumption, analyzing inaccuracies and impact on the final results.

Keywords: energy efficiency, offloading operations, speed reduction, Suezmax oil tanker

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Authors: Raja Ezman Raja Shariff

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Acute kidney injury (AKI) is commonly seen in inpatients, and places a great cost on the NHS and patients. Timely and appropriate management is both nephron sparing and potentially life-saving. Ultrasound scanning (USS) is a well-recognised method for stratifying patients. Subsequently, the NICE AKI guidance has defined groups in whom scanning is recommended within 6 hours of request (pyonephrosis), within 24 hours (obstruction/cause unknown), and in whom routine scanning isn't recommended (cause for AKI identified). The audit looks into whether Stockport NHS Trust USS practice was in line with such recommendations. The audit evaluated 92 patients with AKI who had USS, between 01/01/14 to 30/04/14. Data collection was divided into 2 parts. Firstly, radiology request cards and the online imaging software (PACS) were evaluated. Then, the electronic case notes (ADVANTIS) was evaluated further. Based on request cards, 10% of requests were for pyonephrosis. Only 33% were scanned within 6hours and a further 33% within 24hours. 75% were requested for possible obstructions and unknown cause collectively. Of those due to possible obstruction, 71% of patients were scanned within 24 hours. Of those with unknown cause, 50% were scanned within 24 hours. 15% of requests had a cause declared and so potentially did not require scanning. Evaluation of the patients’ notes suggested further interesting findings. Firstly, potentially 39% of patients had a known cause for AKI, therefore, did not need USS. Subsequently, the cohort of unknown cause and possible obstruction was collectively reduced to 45%. Alarmingly the patient cohort with possible pyonephrosis went up to 16%, suggesting an under-recognition of this life-threatening condition. We plan to highlight these findings within our institution and make changes to encourage more appropriate requesting and timely scanning. Time will tell if we manage to save or increase our costs in this cost-conscious NHS. Patient benefits, though, seem to be guaranteed.

Keywords: AKI, ARF, kidney, renal

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Authors: Dylber Qema

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Driven by recent developments in technology and the growing concern about the sustainability and environmental impact of conventional fuel use, the possibility of producing clean and sustainable energy in significant quantities from renewable energy sources has sparked interest all over the world. Solar energy is one of the sources for the generation of electricity, with no emissions or environmental pollution. The electricity produced by photovoltaics can supply a home or business and can even be sold or exchanged with the grid operator. A very positive effect of using photovoltaic modules is that they do not produce greenhouse gases and do not produce chemical waste, unlike all other forms of energy production. Photovoltaics are becoming one of the largest investments in the field of renewable generating units. Improving the reliability of the electric power system is one of the most important impacts of the installation of photovoltaics (PV). Renewable energy sources are so large that they can meet the energy demands of the whole world, thus enabling sustainable supply as well as reducing local and global atmospheric emissions. Albania is rated by experts as one of the most favorable countries in Europe for the production of electricity from solar panels. But the country currently produces about 1% of its energy from the sun, while the rest of the needs are met by hydropower plants and imports. Albania has very good characteristics in terms of solar radiation (about 1300–1400 kW/m2). Solar energy has great potential and is a permanent source of energy with greater economic efficiency. Photovoltaic energy is also seen as an alternative, as long periods of drought in Albania have produced crises and high costs for securing energy in the foreign market.

Keywords: capacity, ministry of tourism and environment, obstacles, photovoltaic energy, sustainable

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Authors: Iqraq Kamal, Akmal Razif, Sivadas Chandra Sekaran, Ahmad Syazwan Hisaburi

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Painting plays a crucial role in the aerospace manufacturing industry, serving both protective and cosmetic purposes for components. However, the traditional manual painting method is time-consuming and labor-intensive, posing challenges for the sector in achieving higher efficiency. Additionally, the current automated robot path planning has been a bottleneck for spray painting processes, as typical manual teaching methods are time-consuming, error-prone, and skill-dependent. Therefore, it is essential to develop automated tool path planning methods to replace manual ones, reducing costs and improving product quality. Focusing on flat panel painting in aerospace manufacturing, this study aims to address issues related to unreliable part identification techniques caused by the high-mixture, low-volume nature of the industry. The proposed solution involves using a spray gun and a UR10 robotic arm with a vision system that utilizes one-shot object detection (OS2D) to identify parts accurately. Additionally, the research optimizes path planning by concentrating on the region of interest—specifically, the identified part, rather than uniformly covering the entire painting tray.

Keywords: aerospace manufacturing, one-shot object detection, automated spray painting, vision-based path optimization, deep learning, automation, robotic arm

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Authors: Adel Nikfarjam, Hamed Tayebi, Sadoullah Ebrahimnejad

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This paper considers a two-echelon inventory system with a number of warehouses and a single retailer. The retailer replenishes its required items from warehouses, and assembles them into a single final product. We assume that each warehouse supplies only one kind of the raw material for the retailer. The demand process of the final product is assumed to be Poissson, and unsatisfied demand of the final product will be lost. The retailer applies one-for-one-period ordering policy which is also known as (1, T) ordering policy. In this policy the retailer orders to each warehouse a fixed quantity of each item at fixed time intervals, which the fixed quantity is equal to the utilization of the item in the final product. Since, this policy eliminates all demand uncertainties at the upstream echelon, the standard lot sizing model can be applied at all warehouses. In this paper, we calculate the total cost function of the inventory system. Then, based on this function, we present a procedure to obtain the optimal time interval between two consecutive order placements from retailer to the warehouses, and the optimal order quantities of warehouses (assuming that there are positive ordering costs at warehouses). Finally, we present some numerical examples, and conduct numerical sensitivity analysis for cost parameters.

Keywords: two-echelon supply chain, multi-vendor-single-buyer inventory system, lost sales, Poisson demand, one-for-one-period policy, lot sizing model

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Authors: Kuen Ming Shu, Ren Kai Ho

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Ultrasonic horn has the functions of amplifying amplitude and reducing resonant impedance in ultrasonic system. Its primary function is to amplify deformation or velocity during vibration and focus ultrasonic energy on the small area. It is a crucial component in design of ultrasonic vibration system. There are five common design methods for ultrasonic horns: analytical method, equivalent circuit method, equal mechanical impedance, transfer matrix method, finite element method. In addition, the general optimization design process is to change the geometric parameters to improve a single performance. Therefore, in the general optimization design process, we couldn't find the relation of parameter and objective. However, a good optimization design must be able to establish the relationship between input parameters and output parameters so that the designer can choose between parameters according to different performance objectives and obtain the results of the optimization design. In this study, an ultrasonic horn provided by Maxwide Ultrasonic co., Ltd. was used as the contrast of optimized ultrasonic horn. The ANSYS finite element analysis (FEA) software was used to simulate the distribution of the horn amplitudes and the natural frequency value. The results showed that the frequency for the simulation values and actual measurement values were similar, verifying the accuracy of the simulation values. The ANSYS DesignXplorer was used to perform Response Surface optimization, which could shows the relation of parameter and objective. Therefore, this method can be used to substitute the traditional experience method or the trial-and-error method for design to reduce material costs and design cycles.

Keywords: horn, natural frequency, response surface optimization, ultrasonic vibration

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Authors: Yinglisong, Jingge Chen, Jingxuan Chen, Yan Wang, Hui Huang, Jing Zhnag, Qianqian Zhang, Zhenzhen Zhang, Ji Zhang

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Purpose: The study aims to establish a nomogram prediction model for postpartum hemorrhage (PPH) in vaginal delivery. Patients and Methods: Clinical data were retrospectively collected from vaginal delivery patients admitted to a hospital in Zhengzhou, China, from June 1, 2022 - October 31, 2022. Univariate and multivariate logistic regression were used to filter out independent risk factors. A nomogram model was established for PPH in vaginal delivery based on the risk factors coefficient. Bootstrapping was used for internal validation. To assess discrimination and calibration, receiver operator characteristics (ROC) and calibration curves were generated in the derivation and validation groups. Results: A total of 1340 cases of vaginal delivery were enrolled, with 81 (6.04%) having PPH. Logistic regression indicated that history of uterine surgery, induction of labor, duration of first labor, neonatal weight, WBC value (during the first stage of labor), and cervical lacerations were all independent risk factors of hemorrhage (P <0.05). The area-under-curve (AUC) of ROC curves of the derivation group and the validation group were 0.817 and 0.821, respectively, indicating good discrimination. Two calibration curves showed that nomogram prediction and practical results were highly consistent (P = 0.105, P = 0.113). Conclusion: The developed individualized risk prediction nomogram model can assist midwives in recognizing and diagnosing high-risk groups of PPH and initiating early warning to reduce PPH incidence.

Keywords: vaginal delivery, postpartum hemorrhage, risk factor, nomogram

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Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Majed Ahmed Al-Mansoub, Muhammad Qamar

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There is a progressive increase in the prevalence of early onset Type 2 diabetes mellitus. Early detection of Type 2 diabetes enhances the length and/or quality of life which might result from a reduction in the severity, frequency or prevent or delay of its long-term complications. The study aims to determine the onset age for the first diagnosis of Type 2 diabetes mellitus. A retrospective study conducted in the endocrine clinic at Hospital Pulau Pinang in Penang, Malaysia, January- December 2016. Records of 519 patients with Type 2 diabetes mellitus were screened to collect demographic data and determine the age of first-time diabetes mellitus diagnosis. Patients classified according to the age of diagnosis, gender, and ethnicity. The study included 519 patients with age (55.6±13.7) years, female 265 (51.1%) and male 254 (48.9%). The ethnicity distribution was Malay 191 (36.8%), Chinese 189 (36.4%) and Indian 139 (26.8%). The age of Type 2 diabetes diagnosis was (42±14.8) years. The female onset of diabetes mellitus was at age (41.5±13.7) years, while male (42.6±13.7) years. Distribution of diabetic onset by ethnicity was Malay at age (40.7±13.7) years, Chinese (43.2±13.7) years and Indian (42.3±13.7) years. Diabetic onset was classified by age as follow; ≤20 years’ cohort was 33 (6.4%) cases. Group >20- ≤40 years was 190 (36.6%) patients, and category >40- ≤60 years was 270 (52%) subjects. On the other hand, the group >60 years was 22 (4.2%) patients. The range of diagnosis was between 10 and 73 years old. Conclusion: Malay and female have an earlier onset of diabetes than Indian, Chinese and male. More than half of the patients had diabetes between 40 and 60 years old. Diabetes mellitus is becoming more common in younger age <40 years. The age at diagnosis of Type 2 diabetes mellitus has decreased with time.

Keywords: age of onset, diabetes diagnosis, diabetes mellitus, Malaysia, outpatients, type 2 diabetes, retrospective study

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Authors: Ibrahim Ahmed, Richard Amoateng, Akhil Jain, Mohamed Ahmed

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Alcoholic cardiomyopathy (ACM) is a type of acquired cardiomyopathy caused by chronic alcohol consumption. Frequently ACM is associated with arrhythmias such as atrial flutter. Our aim was to characterize the patient demographics and investigate the effect of atrial flutter (AF) on ACM. This was a retrospective cohort study using the Nationwide Inpatient Sample database to identify admissions in adults with principal and secondary diagnoses of alcoholic cardiomyopathy and atrial flutter from 2019. Multivariate linear and logistic regression models were adjusted for age, gender, race, household income, insurance status, Elixhauser comorbidity score, hospital location, bed size, and teaching status. The primary outcome was all-cause mortality, and secondary outcomes were the length of stay (LOS) and total charge in USD. There was a total of 21,855 admissions with alcoholic cardiomyopathy, of which 1,635 had atrial flutter (AF-ACM). Compared to Non-AF-ACM cohort, AF-ACM cohort had fewer females (4.89% vs 14.54%, p<0.001), were older (58.66 vs 56.13 years, p<0.001), fewer Native Americans (0.61% vs2.67%, p<0.01), had fewer smaller (19.27% vs 22.45%, p<0.01) & medium-sized hospitals (23.24% vs28.98%, p<0.01), but more large-sized hospitals (57.49% vs 48.57%, p<0.01), more Medicare (40.37% vs 34.08%, p<0.05) and fewer Medicaid insured (23.55% vs 33.70%, p=<0.001), fewer hypertension (10.7% vs 15.01%, p<0.05), and more obesity (24.77% vs 16.35%, p<0.001). Compared to Non-AF-ACM cohort, there was no difference in AF-ACM cohort mortality rate (6.13% vs 4.20%, p=0.0998), unadjusted mortality OR 1.49 (95% CI 0.92-2.40, p=0.102), adjusted mortality OR 1.36 (95% CI 0.83-2.24, p=0.221), but there was a difference in LOS 1.23 days (95% CI 0.34-2.13, p<0.01), total charge $28,860.30 (95% CI 11,883.96-45,836.60, p<0.01). In patients admitted with ACM, the presence of AF was not associated with a higher all-cause mortality rate or odds of all-cause mortality; however, it was associated with 1.23 days increase in LOS and a $28,860.30 increase in total hospitalization charge. Native Americans, older age and obesity were risk factors for the presence of AF in ACM.

Keywords: alcoholic cardiomyopathy, atrial flutter, cardiomyopathy, arrhythmia

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Authors: Idris Garba, Aisha Rabiu Abdullahi, Mansur Yahuza, Akintade Dare

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Background: CT urography (CTU) is efficient radiological examination for the evaluation of the urinary system disorders. However, patients are exposed to a significant radiation dose which is in a way associated with increased cancer risks. Objectives: To determine Computed Tomography Dose Index following CTU, and to evaluate organs equivalent doses. Materials and Methods: A prospective cohort study was carried at a tertiary institution located in Kano northwestern. Ethical clearance was sought and obtained from the research ethics board of the institution. Demographic, scan parameters and CT radiation dose data were obtained from patients that had CTU procedure. Effective dose, organ equivalent doses, and cancer risks were estimated using SPSS statistical software version 16 and CT dose calculator software. Result: A total of 56 patients were included in the study, consisting of 29 males and 27 females. The common indication for CTU examination was found to be renal cyst seen commonly among young adults (15-44yrs). CT radiation dose values in DLP, CTDI and effective dose for CTU were 2320 mGy cm, CTDIw 9.67 mGy and 35.04 mSv respectively. The probability of cancer risks was estimated to be 600 per a million CTU examinations. Conclusion: In this study, the radiation dose for CTU is considered significantly high, with increase in cancer risks probability. Wide radiation dose variations between patient doses suggest that optimization is not fulfilled yet. Patient radiation dose estimate should be taken into consideration when imaging protocols are established for CT urography.

Keywords: CT urography, cancer risks, effective dose, radiation exposure

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Authors: Ana Pego

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Environmental technologies were developed for decades. Clean technologies emerged a few years ago. In these perspectives, the use of cleantech technologies has become very important due the fact of new era of environmental feats. As such, the market itself has become more competitive, more collaborative towards a better use of clean technologies. This paper shows the importance of clean technologies in offshore energy sector in Portuguese market, its localization and its impact on economy. Clean technologies are directly related with renewable cluster and concomitant with economic and social resource optimization criteria, geographic aspects, climate change and soil features. Cleantech is related with regional development, socio-technical transitions in organisations. There are an economical and social combinations which allow specialisation of regions in activities, higher employment, reduce of energy costs, local knowledge spillover and, business collaboration and competitiveness. The methodology used will be quantitative (IO matrix for Portugal 2013) and qualitative (questionnaires to stakeholders). The mix of both methodologies will confirm whether the use of technologies will allow a positive impact on economic and social variables used on this model. It is expected a positive impact on Portuguese economy both in investment and employment taking in account the localization of offshore renewable activities. This means that the importance of offshore renewable investment in Portugal has a few points which should be pointed out: the increase of specialised employment, localization of specific activities in territory, and increase of value added in certain regions. The conclusion will allow researchers and organisation to compare the Portuguese model to other European regions in order to a better use of natural and human resources.

Keywords: cleantech, economic impact, localisation, territory dynamics

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Authors: A. Alhusban, M. Alqawasmeh, F. Alfawares

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Introduction: Despite improvements in stroke management, it remains the leading cause of disability worldwide. It has been suggested that enhancing brain angiogenesis after stroke will improve stroke outcome. Promoting post stroke angiogenesis requires the upregulation of angiogenic factors with a simultaneous reduction of anti-angiogenic factors. Thrombospondin-1 is the main anti-angiogenic protein in the living cells. Counterintuitively, it has been shown that animals with Thrombospondin-1 knockdown will have better stroke outcome. Data about the clinical significance of Thrombspondin-1 levels at the time of admission is still lacking. The objective of this work is to assess the association between serum Thrombospondin-1 levels measured at the time of admission and baseline neurologic severity after stroke. Patients and Methods: Blood samples were collected from patients admitted to the King Abdullah University Hospital (KAUH) with ischemic stroke at the time of admission and serum Thrombopsondin-1 levels were measured using ELISA. Patients neurologic severity was evaluated using the National Institute of Health Stroke Scale (NIHSS). Results: Samples from 50 patients admitted between January 2016 and December 2016 were collected. The median age of participants was 68 years and the median NIHSS was 3. Multinomial regression identified serum Thrombospondin-1 as an independent predictor of stroke outcome (p=0.003). Baseline serum Thrombsopondin-1 was negatively associated with NIHSS at the time of admission (spearman rho correlation coefficient=0.272, p=0.032). Conclusion: Serum Thrombospondin-1 at the time of admission may be a useful marker of stroke severity that predicts more severe neurologic severity.

Keywords: thrombospondin, stroke, neuroprotection, biomarkers

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Authors: Ş. Çiftcioğlu, E. Efe

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In recent years, cancer has been at the top of diseases that cause death in children. Adequate and balanced nutrition plays an important role in the treatment of cancer. Cancer and cancer treatment is affecting food intake, absorption and metabolism, causing nutritional disorders. Appropriate nutrition is very important for the cancerous child to feel well before, during and after the treatment. There are various difficulties in feeding children with cancer. These are the cancer-related factors. Other factors are environmental and behavioral. As health professionals who spend more time with children in the hospital, nurses should be able to support the children on nutrition and help them to have balanced nutrition. This study aimed to evaluate the importance of nursing approaches in the nutrition of children with cancer. This article is planned as a review article by searching the literature on this field. Anorexia may develop due to psychogenic causes or chemotherapeutic agents or accompanying infections and nutrient uptake may be reduced.  In addition, stomatitis, mucositis, taste and odor changes in the mouth, the feeling of nausea, vomiting and diarrhea can also reduce oral intake and result in significant losses in the energy deficit. In assessing the nutritional status of children with cancer, determining weight loss and good nutrition is essential anamnesis of a child.  Some anthropometric measurements and biochemical tests should be used to evaluate the nutrition of the child. The nutritional status of pediatric cancer patients has been studied for a long time and malnutrition, in particular under nutrition, in this population has long been recognized. Yet, its management remains variable with many malnourished children going unrecognized and consequently untreated. Nutritional support is important to pediatric cancer patients and should be integrated into the overall treatment of these children.

Keywords: cancer treatment, children, complication, nutrition, nursing approaches

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Authors: Jennifer Foss, DNP, RN-BC, NEA-BC

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Stress and burnout in the bedside registered nurse have deleterious consequences for registered nurses, patients, and the hospitals that employ them. The objective of this study was to determine whether a sixty-minute mindfulness workshop was effective in reducing perceived levels of stress and decreasing mindfulness in registered nurses working in the acute care setting. Registered nurses at a community hospital in the Northeast part of the country were recruited through e-mail and flyers in breakrooms. Participants completed the Perceived Stress Scale (PSS) and Mindfulness Attention Awareness Scale (MAAS) two weeks prior to taking part in the intervention and two weeks post intervention. Of the twenty-three registered nurses who completed the baseline questionnaires, 91% were female with an average age between 30-39 years. Sixty-five percent of subjects completed the questionnaires two weeks post intervention. Two weeks post intervention, registered nurses reported a decrease in perception of stress (pre and post PSS was .133) and was not significant (t=1.293, df=14, p=.217). Likewise, an increase in mindful attention .325 was reported two-weeks post intervention and indicated a favorable tendency to enter a mindful state. This finding was also not significant (t=-1.990, df=14, p=.066). In this study, nurses reported decreases in perceived stress and increases in mindfulness after attending a sixty-minute mindfulness workshop. Further research is needed to determine the long-term impact of mindfulness-based training on nurses' stress and mindfulness skills. The results of this study add to the body of literature that supports the benefits of mindfulness-based interventions in the healthcare setting.

Keywords: Stress, burnout, nursing, acute care nursing

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Authors: Juliani Rianto, Emma Lumby, Tracey Smith

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Cancer patients’ survival are growing with the new approach and therapy in oncology medicine. Cancer is now a new chronic disease, and rehabilitation program has become an ongoing program as part of cancer care. The focus of Cancer rehabilitation is maximising person’s physical and emotional function, stabilising general health and reducing unnecessary hospital admission. In Australia there are 150000 newly diagnosed cancer every year, and the most common Cancer are prostate, Breast, Colorectal, Melanoma and Lung Cancer. Through referral from the oncology team, we recruited cancer patient into our cancer rehabilitation program. Patients are assessed by our multi-disciplinary team including rehabilitation specialist, physiotherapist, occupational therapist, dietician, exercise physiologist, and psychologist. Specific issues are identified, including pain, side effect of chemo and radiation therapy and mental well-being. The goals were identified and reassessed every fortnight. Common goals including nutritional status, improve endurance and exercise performance, working on balance and mobility, improving emotional and vocational state, educational program for insomnia and tiredness, and reducing hospitalisation are identified and assessed. Patients are given 2 hours exercise program twice a week for 6 weeks with focus on aerobic and weight exercises and education sessions. Patients are generally benefited from the program. The quality of life is improved, support and interaction from the therapist has played an important factor in directing patient for their goals.

Keywords: cancer, exercises, benefit, mental health

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Authors: Kenneth Harper

Abstract:

The rapid growth of data-driven decision-making across various industries necessitates advanced solutions to ensure data integrity, scalability, and security. This study introduces a decentralized data platform built on blockchain technology to improve data management processes in high-volume environments such as healthcare and financial services. The platform integrates blockchain networks using Cosmos SDK and Polkadot Substrate alongside decentralized storage solutions like IPFS and Filecoin, and coupled with decentralized computing infrastructure built on top of Avalanche. By leveraging advanced consensus mechanisms, we create a scalable, tamper-proof architecture that supports both structured and unstructured data. Key features include secure data ingestion, cryptographic hashing for robust data lineage, and Zero-Knowledge Proof mechanisms that enhance privacy while ensuring compliance with regulatory standards. Additionally, we implement performance optimizations through Layer 2 scaling solutions, including ZK-Rollups, which provide low-latency data access and trustless data verification across a distributed ledger. The findings from this exercise demonstrate significant improvements in data accessibility, reduced operational costs, and enhanced data integrity when tested in real-world scenarios. This platform reference architecture offers a decentralized alternative to traditional centralized data storage models, providing scalability, security, and operational efficiency.

Keywords: blockchain, cosmos SDK, decentralized data platform, IPFS, ZK-Rollups

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Authors: M. Abbasi

Abstract:

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

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

Procedia PDF Downloads 64

Authors: Saker Lilia, Youcef Mellouki, Lakhdar Sellami, Yacine Zerairia, Abdelhaid Zetili, Fatma Guahria, Fateh Kaious, Nesrine Belkhodja, Abdelhamid Mira

Abstract:

Background: Sudden death is regarded as a suspicious demise necessitating autopsy, as stipulated by legal authorities. Chronic disseminated intravascular coagulation (DIC) is an acquired clinical and biological syndrome characterized by a severe and fatal prognosis, stemming from systemic, uncontrolled, diffuse coagulation activation. Irrespective of their origins, DIC is associated with a diverse spectrum of manifestations, encompassing minor biological coagulation alterations to profoundly severe conditions wherein hemorrhagic complications may take precedence. Simultaneously, microthrombi contribute to the development of multi-organ failures. Objective This study seeks to evaluate the role of autopsy in determining the causes of death. Materials and Methods: We present two instances of sudden death involving females who underwent autopsy at the Forensic Medicine Department of the University Hospital of Annaba, Algeria. These autopsies were performed at the request of the prosecutor, aiming to determine the causes of death and illuminate the exact circumstances surrounding it. Methods Utilized: Analysis of the initial information report; Findings from postmortem examinations; Histological assessments and toxicological analyses. Results: The presence of DIC was noted, affecting nearly all veins with distinct etiologies. Conclusion: For the establishment of a meaningful diagnosis: • Thorough understanding of the subject matter is imperative; • Precise alignment with medicolegal data is essential.

Keywords: chronic disseminated intravascular coagulation, sudden death, autopsy, causes of death

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Authors: Y. Moldes-Diz, M. Gamallo, G. Eibes, C. Vazquez-Vazquez, G. Feijoo, J. M. Lema, M. T. Moreira

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Laccases (benzenediol oxygen oxidoreductases, EC 1.10.3.2) are excellent biocatalysts for biotechnological and environmental applications because of their high activity, selectivity, and specificity. Specifically, these characteristics allow them to perform the oxidation of recalcitrant compounds with simple requirements for the catalysis (presence of molecular oxygen). Nevertheless, the low stability under unfavorable conditions (pH, inactivating agents or temperature) and high production costs still limits their use for practical applications. Immobilization of enzymes has proven particularly valuable to avoid some of the aforementioned drawbacks. Magnetic nanoparticles (MNPs) have received increasing attention as carriers for enzyme immobilization since they can potentially provide an easy recovery of the biocatalyst from the reaction medium under an external magnetic field. In the present work, silica-coated magnetic nanoparticles (Fe3O4@SiO2) were prepared, characterized and used for laccase immobilization by covalent binding. The synthesis of Fe3O4@SiO2 was performed in a two-step procedure: co-precipitation and reverse microemulsion. The influence of immobilization conditions: concentrations of the functionalization agent (3-aminopropyl-triethoxy-silane) and the cross-linker (glutaraldehyde) as well as the influence of pH, T or inactivating agents were evaluated. In general, immobilized laccase showed superior stability compared to that of free enzyme. The reusability of the biocatalyst was demonstrated in successive batch reactions, where enzyme activity was maintained above 65% after 8 cycles of oxidation of the substrate 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonate).

Keywords: silica-coated magnetic nanoparticles, laccase, immobilization, regeneration

Procedia PDF Downloads 217