Search results for: Caleb Eaton

Authors: Matthew Pleshaw, Caroline Lynch, Caleb Eaton, Ali Kiapour

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The problem addressed in this proposal is that of the lacking comfort and safety of inpatient rooms, specifically at Boston Children’s Hospital, with the implementation of a system that will allow inpatient children to feel more comfortable in the unfamiliar environment of a hospital. The focus is that of advancing and enhancing the healing process for children in a long-term inpatient stay at the hospital, though a combination of announcing a clinician or hospital staff’s arrival utilizing RFID (Fig. 1), and improving communication between clinicians, parents/guardians, patients, etc. by integrating a mobile application.

Keywords: Pediatrics, Hospital, RFID, Technology

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Authors: Karima Boukhadia

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In the present study, the subsonic flow in an asymmetrical diffuser was simulated numerically using code CFX 11.0 and its generator of grid ICEM CFD. Two models of turbulence were tested: K- ε and K- ω SST. The results obtained showed that the K- ε model singularly over-estimates the speed value close to the wall and that the K- ω SST model is qualitatively in good agreement with the experimental results of Buice and Eaton 1997. They also showed that the separation and reattachment of the fluid on the tilted wall strongly depends on its angle of inclination and that the length of the zone of separation increases with the angle of inclination of the lower wall of the diffuser.

Keywords: asymmetric diffuser, separation, reattachment, tilt angle, separation zone

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Authors: Jenifer Alam, Rima Chatterjee

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Upper Assam sedimentary basin is one of the oldest commercially producing basins of India. Being in a tectonically active zone, estimation of tectonic strain and stress magnitudes has vast application in hydrocarbon exploration and exploitation. This East North East –West South West trending shelf-slope basin encompasses the Bramhaputra valley extending from Mikir Hills in the southwest to the Naga foothills in the northeast. Assam Shelf lying between the Main Boundary Thrust (MBT) and Naga Thrust area is comparatively free from thrust tectonics and depicts normal faulting mechanism. The study area is bounded by the MBT and Main Central Thrust in the northwest. The Belt of Schuppen in the southeast, is bordered by Naga and Disang thrust marking the lower limit of the study area. The entire Assam basin shows low-level seismicity compared to other regions of northeast India. Pore pressure (PP), vertical stress magnitude (SV) and horizontal stress magnitudes have been estimated from two wells - N1 and T1 located in Upper Assam. N1 is located in the Assam gap below the Bramhaputra river while T1, lies in the Belt of Schuppen. N1 penetrates geological formations from top Alluvial through Dhekiajuli, Girujan, Tipam, Barail, Kopili, Sylhet and Langpur to the granitic basement while T1 in trusted zone crosses through Girujan Suprathrust, Tipam Suprathrust, Barail Suprathrust to reach Naga Thrust. Normal compaction trend is drawn through shale points through both wells for estimation of PP using the conventional Eaton sonic equation with an exponent of 1.0 which is validated with Modular Dynamic Tester and mud weight. Observed pore pressure gradient ranges from 10.3 MPa/km to 11.1 MPa/km. The SV has a gradient from 22.20 to 23.80 MPa/km. Minimum and maximum horizontal principal stress (Sh and SH) magnitudes under isotropic conditions are determined using poroelastic model. This approach determines biaxial tectonic strain utilizing static Young’s Modulus, Poisson’s Ratio, SV, PP, leak off test (LOT) and SH derived from breakouts using prior information on unconfined compressive strength. Breakout derived SH information is used for obtaining tectonic strain due to lack of measured SH data from minifrac or hydrofracturing. Tectonic strain varies from 0.00055 to 0.00096 along x direction and from -0.0010 to 0.00042 along y direction. After obtaining tectonic strains at each well, the principal horizontal stress magnitudes are calculated from linear poroelastic model. The magnitude of Sh and SH gradient in normal faulting region are 12.5 and 16.0 MPa/km while in thrust faulted region the gradients are 17.4 and 20.2 MPa/km respectively. Model predicted Sh and SH matches well with the LOT data and breakout derived SH data in both wells. It is observed from this study that the stresses SV>SH>Sh prevailing in the shelf region while near the Naga foothills the regime changes to SH≈SV>Sh area corresponds to normal faulting regime. Hence this model is a reliable tool for predicting stress magnitudes from well logs under active tectonic regime in Upper Assam Basin.

Keywords: Eaton, strain, stress, poroelastic model

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Authors: Divnesh Lingam, Devi Rengamani Seenivasagam, Prashant Chand, Caleb Yee, John Chief, Rajeshkannan Ananthanarayanan

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Telecommuting Post-Pandemic: Barriers, Solutions, and Strategies. Amidst the COVID-19 outbreak in 2020, remote work emerged as a vital business continuity measure. This study investigates telecommuting’s modern work model, exploring its benefits and obstacles. Utilizing Interpretive Structural Modelling uncovers barriers hindering telecommuting adoption. A validated set of thirteen barriers is examined through departmental surveys, revealing interrelationships. The resulting model highlights interactions and dependencies, forming a foundational framework. By addressing dominant barriers, a domino effect on subservient barriers is demonstrated. This research fosters further exploration, proposing management strategies for successful telecommuting adoption and reshaping the traditional workspace.

Keywords: barriers, interpretive structural modelling, post-pandemic, telecommuting

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Authors: Ravi Soni, Irfan Pathan, Manish Pande

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The current product development process needs simultaneous consideration of different physics. The performance of the product needs to be considered under both structural and fluid loads. Examples include ducts and valves where structural behavior affects fluid motion and vice versa. Simulation of fluid-structure interaction involves modeling interaction between moving components and the fluid flow. In these scenarios, it is difficult to calculate the damping provided by fluid flow because of dynamic motions of components and the transient nature of the flow. Abaqus Explicit offers general capabilities for modeling fluid-structure interaction with the Coupled Eulerian-Lagrangian (CEL) method. The Coupled Eulerian-Lagrangian technique has been used to simulate fluid spillage through fuel valves during dynamic closure events. The technique to simulate pressure drops across Eulerian domains has been developed using stagnation pressure. Also, the fluid flow is calculated considering material flow through elements at the outlet section of the valves. The methodology has been verified on Eaton products and shows a good correlation with the test results.

Keywords: Coupled Eulerian-Lagrangian Technique, fluid structure interaction, spillage prediction, stagnation pressure

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Authors: Ben-Caleb Egbide, Omolehinwa O. Eddy, Adeyemi S. Keyinde, Eriabie Sylvester, Ojeka Stephen

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The national budget remains an integral part of the developmental plan of the economy of any country. The budget reflects the fundamental values underlying the government’s economic policies and objectives and whose execution is expected to realize national/public desires. In Nigeria, over three decades budget had failed to deliver the desired benefits, suggesting the existence of infractions, which are yet to be empirically ascertained. This paper attempts a diagnosis of the infractions peculiar to Nigeria budgetary system and their suggested panacea. Data were collected through the administration of questionnaire to a cross section of organizations/institutions representing government agencies and the general public. Mann-Whitney U test was employed to gauge the consistency in perception of the two groups. The result revealed that budget indiscipline, official corruption, allocative inefficiency and poor budget governance are the most influential infractions of budgeting in Nigeria. Consequently, it was suggested that budget transparency, target budgeting, zero tolerance on corruption and budget discipline are the most cogent therapies to the malfunctioning in Nigerian budgetary system.

Keywords: budgeting, budget maladies, budget therapies, Nigeria

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Authors: Caleb B. Sagwa, Tobias O. Okeno, Alexander K. Kahi

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Dairy cattle production plays an important role in the Kenyan economy. However, high incidences of mastitis is a major setback to the productivity in this industry. The current dairy cattle breeding objective in Kenya does not include mastitis resistance, mainly because the economic value of mastitis resistance has not been determined. Therefore this study aimed at estimating the economic value of mastitis resistance in dairy cattle in Kenya. Initial input parameters were obtained from literature on dairy cattle production systems in the tropics. Selection index methodology was used to derive the economic value of mastitis resistance. Somatic cell count (SCC) was used an indicator trait for mastitis resistance. The economic value was estimated relative to milk yield (MY). Economic values were assigned to SCC in a selection index such that the overall gain in the breeding goal trait was maximized. The option of estimating the economic value for SCC by equating the response in the trait of interest to its index response was considered. The economic value of mastitis resistance was US $23.64 while maximum response to selection for MY was US $66.01. The findings of this study provide vital information that is a pre-requisite for the inclusion of mastitis resistance in the current dairy cattle breeding goal in Kenya.

Keywords: somatic cell count, milk quality, payment system, breeding goal

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Authors: Ben-Caleb Egbide, Egharevba Mathew, Achugamonu Uzoma, Faboyede Samuel

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The importance of budgeting in government and corporate entities as medium for the efficient management of scarce resources is self-evident. But when it comes to home or personal budgeting, there seem to be lingering misconceptions as regards its relevance. While most people view personal budgeting merely as a tool for tracking expenses and schedule for paying bills and indebtedness, very few consider it as one of the most important device for sound financial planning, money management instrument and/or wealth-creation mechanism. This paper is conceptualised to investigate the association between personal budgeting and financial well-being among staffers of tertiary institution in the South West Nigeria. Underpinned by the individualistic/cultural theory of well-being and the adoption of a survey research design, a structured questionnaire was used to gather data from a cross section of staff of tertiary Institutions in Ogun State. A Spearman Rank Correlation was utilised for analysis of data. The result indicates a high positive relationship between personal budgeting and tendencies for enhanced financial well-being among staff. The paper established that a change of value and behavioural pattern by individuals and household, especially in the areas of personal spending and budgeting could drastically reduce the incidence of the severity of financial stress, hence, enhanced wellness among staff.

Keywords: personal budgeting, financial well-being, tertiary institutions staffers, Nigeria

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Authors: Ben-Caleb Egbide, Iyoha Francis, Egharevba Mathew, Oduntan Emmanuel

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The prosperity of any nation is determined not just by the availability of resources, but also by the discipline exercised in the management of those resources. This paper examines the functional association between adherence to budgetary estimates or budget discipline (BDISC) and national prosperity proxied by Real Gross Domestic Product (RGDP) and Relative Poverty Index (RPI)/Human Development Index (HDI). Adopting a longitudinal retrospective research strategy, time series data relating to both the endogenous and exogenous variables were extracted from official government publications for 36 years’ (1980-2015 in the case of RGDP and RPI), and for 26 years (1990-2015 in the case of HDI). Ordinary Least Square (OLS), as well as cointegration regressions, were employed to gauge both the short term and long term impact of BDISC on RPI/HDI and RGDP. The results indicated that BDISC is directly related with RGDP but indirectly related with RPI. The implication is that while adherence to budgetary estimate can enhance economic growth, it has the capacity to slow down the rate of poverty in the long run. The paper, therefore, recommend stricter adherence to budgets as a way out of economic under performance in Nigeria and engender the process of promoting human development and national prosperity.

Keywords: budget discipline, human development index, national prosperity, Nigeria

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Authors: Oladipo Joseph Ajayi, Yakubu Muhammed, Caleb Galadima

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This study was conducted to examine the income diversification of smallholder farmers in Bosso Local Government area of Niger state, Nigeria. The specific objectives were to examine the socio-economic characteristics of the farmers, identify the sources of income among the farmers, determine the pattern of income diversification and evaluate the determinants of income diversification of farmers in the study area. A multi-stage sampling technique was used to select 94 respondents for the study. Primary data were used, and these were collected with aid of a well structured interview schedule. Descriptive statistics, diversity index, and Tobit regression model were employed to analyze the data. The mean age of the farmers was 44 years. The average household size was 8 members per household, and the average farming experience was 12 years. 21.27 percent did not have formal education. It was further found that 69.1 percent of the respondents had an income diversity index of 0.3-0.4. This indicated that their level of income diversification was moderately low. The determinants of income diversification in the study area were education, household size, marital status, and primary income. These variables were positively related to income diversification. The study revealed that diversification into various income sources has helped to increase household income to sustain the family demands even though their level of income diversification was low within the study area.

Keywords: diversification, income, households, smallholder farmers

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Authors: Tarek Sabri Duzan

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Knowledge of the magnitude of Geo-pressures (Pore, Fracture & Over-burden pressures) is vital especially during drilling, completions, stimulations, Enhance Oil Recovery. Many times problems, like lost circulation could have been avoided if techniques for calculating Geo-pressures had been employed in the well planning, mud weight plan, and casing design. In this paper, we focused on the relationships between Geo-pressures and wave velocities (P-Wave (Vp) and S-wave (Vs)) in shallow Libyan carbonate reservoir in the western part of the Sirte Basin (Dahra F-Area). The data used in this report was collected from four new wells recently drilled. Those wells were scattered throughout the interested reservoir as shown in figure-1. The data used in this work are bulk density, Formation Mult -Tester (FMT) results and Acoustic wave velocities. Furthermore, Eaton Method is the most common equation used in the world, therefore this equation has been used to calculate Fracture pressure for all wells using dynamic Poisson ratio calculated by using acoustic wave velocities, FMT results for pore pressure, Overburden pressure estimated by using bulk density. Upon data analysis, it has been found that there is a linear relationship between Geo-pressures (Pore, Fracture & Over-Burden pressures) and wave velocities ratio (Vp/Vs). However, the relationship was not clear in the high-pressure area, as shown in figure-10. Therefore, it is recommended to use the output relationship utilizing the new seismic data for shallow carbonate reservoir to predict the Geo-pressures for future oil operations. More data can be collected from the high-pressure zone to investigate more about this area.

Keywords: bulk density, formation mult-tester (FMT) results, acoustic wave, carbonate shalow reservoir, d/jfield velocities

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Authors: Zwalnan Selfa Johnson, Caleb Nanchen Nimyel, Gideon Duvuna Ayuba

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Air conditioning accounts for a significant share of the overall energy consumed in residential buildings. Solar thermal gains in buildings account for a significant component of the air conditioning load in buildings. This study compares the solar thermal gain and air conditioning load of a proposed building design with a typical conventional building in the climatic conditions of Jos, Nigeria, using a combined experimental and computational method using TRNSYS software. According to the findings of this study, the proposed design building's annual average solar thermal gains are lower compared to the reference building's average solar heat gains. The study case building's decreased solar heat gain is mostly attributable to the lower temperature of the building zones because of the greater building volume and lower fenestration ratio (ratio external opening area to the area of the external walls). This result shows that the proposed building design adjusts to the local climate better than the standard conventional construction in Jos to maintain a suitable temperature within the building. This finding means that the air-conditioning electrical energy consumption per volume of the proposed building design will be lower than that of a conventional building design.

Keywords: solar heat gain, building zone, cooling energy, air conditioning, zone temperature

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Authors: Selfa Johnson Zwalnan, Nanchen Nimyel Caleb, Gideon Duvuna Ayuba

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Air conditioning accounts for a significant share of the overall energy consumed in residential buildings. Solar thermal gains in buildings account for a significant component of the air conditioning load in buildings. This study compares the solar thermal gain and air conditioning load of a proposed building design with a typical conventional building in the climatic conditions of Jos, Nigeria, using a combined experimental and computational method using TRNSYS software. According to the findings of this study, the proposed design building's annual average solar thermal gains are lower compared to the reference building's average solar heat gains. The study case building's decreased solar heat gain is mostly attributable to the somewhat lower temperature of the building zones because of the greater building volume and lower fenestration ratio (ratio of external opening area to the area of the external walls). This result shows that the innovative building design adjusts to the local climate better than the standard conventional construction in Jos to maintain a suitable temperature within the building. This finding means that the air-conditioning electrical energy consumption per volume of the proposed building design will be lower than that of a conventional building design.

Keywords: building simulation, solar gain, comfort temperature, temperature, carbon foot print

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Authors: John M. Frimpong, Matilda K. Owusu-Bio, Caleb Annan

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Business today is highly competitive, and the automobile industry is no exception. Therefore, it is necessary to determine the customer value and service quality measures that lead to customer satisfaction which in turn lead to customer loyalty. However, in the automobile industry, the role of logistics service support in these relationships cannot be undermined. It could be inferred that logistics service supports and its management has a direct correlation with customer service and or service quality. But this is not always the same for all industries. Therefore, this study was to investigate how automobile companies implement the concept of customer service through logistics service supports. In order to ascertain this, two automobile companies in Ghana were selected, and these are Toyota Ghana Limited and Mechanical Lloyd Company Ltd. The study developed a conceptual model to depict the study’s objectives from which questionnaires were developed from for data collection. Respondents were made up of customers and staff of the two companies. The findings of the study revealed that the automobile industry partly attributes their customer satisfaction to the customer value, service quality or customer value. It shows a positive relationship between logistics service supports and service quality and customer value. However, the results indicate that customer satisfaction is not predicted by logistics services. This implies that in the automobile industry, it is not always the case that when customer service is implemented through logistics service supports, it leads to customer satisfaction. Therefore, there is the need for all players and stakeholders in the automobile industry investigate other factors which help to increase customer satisfaction in addition to logistics service supports. It is recommended that logistics service supports should be geared towards meeting customer expectations and not just based on the organization’s standards and procedures. It is necessary to listen to the voice of the customer to tailor the service package to suit the needs and expectations of the customer.

Keywords: customer loyalty, customer satisfaction, customer service, customer value, logistics service supports

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Authors: César Ramírez-Dolores, Jorge Wong-Loya, Jorge Andaverde, Caleb Becerra

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Low-depth geothermal energy can take advantage of the use of the subsoil as an air conditioning technique, being used as a passive system or coupled to an active cooling and/or heating system. This source of air conditioning is possible because at a depth less than 10 meters, the subsoil temperature is practically homogeneous and tends to be constant regardless of the climatic conditions on the surface. The effect of temperature fluctuations on the soil surface decreases as depth increases due to the thermal inertia of the soil, causing temperature stability; this effect presents several advantages in the context of sustainable energy use. In the present work, the thermal behavior of a horizontal Air-Water Heat Exchanger (AWHE) is evaluated, and the thermal effectiveness and temperature of the air at the outlet of the prototype immersed in groundwater is experimentally determined. The thermohydraulic aspects of the heat exchanger were evaluated using the Number of Transfer Units-Efficiency (NTU-ε) method under conditions of groundwater flow in a coastal region of sandy soil (southeastern Mexico) and air flow induced by a blower, the system was constructed of polyvinyl chloride (PVC) and sensors were placed in both the exchanger and the water to record temperature changes. The results of this study indicate that when the exchanger operates in groundwater, it shows high thermal gains allowing better heat transfer, therefore, it significantly reduces the air temperature at the outlet of the system, which increases the thermal effectiveness of the system in values > 80%, this passive technique is relevant for building cooling applications and could represent a significant development in terms of thermal comfort for hot locations in emerging economy countries.

Keywords: convection, earth, geothermal energy, thermal comfort

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Authors: George Cudjoe Agbemabiese, John Paul Kosiba, Michael Boadi Nyamekye, Vanessa Narkie Tetteh, Caleb Nunoo, Mohammed Muniru Husseini

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The smartphone industry continues to experience massive growth, evidenced by expanding markets and an increasing number of brands, models and manufacturers. As technology advances rapidly, manufacturers of smartphones are consistently introducing new innovations to keep up with the latest evolving industry trends and customer demand for more modern devices. This study aimed to assess the influence of artificial intelligence (AI) voice assistant (VA) on improving customer experience, resulting in the continuous use of mobile brands. Specifically, this article assesses the role of hedonic, utilitarian, and social benefits provided by AIVA on customer experience and the continuance intention to use mobile phone brands. Using a primary data collection instrument, the quantitative approach was adopted to examine the study's variables. Data from 348 valid responses were used for the analysis based on structural equation modeling (SEM) with AMOS version 23. Three main factors were identified to influence customer experience, which results in continuous usage of mobile phone brands. These factors are social benefits, hedonic benefits, and utilitarian benefits. In conclusion, a significant and positive relationship exists between the factors influencing customer experience for continuous usage of mobile phone brands. The study concludes that mobile brands that invest in delivering positive user experiences are in a better position to improve usage and increase preference for their brands. The study recommends that mobile brands consider and research their prospects' and customers' social, hedonic, and utilitarian needs to provide them with desired products and experiences.

Keywords: artificial intelligence, continuance usage, customer experience, smartphone industry

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Authors: Julia Wong, Hua Beng Lim, Petrina Goh, Johanna Foo, Caleb Ng, Nurul ‘Aqilah Bte Mohd Taufek

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Animal-assisted therapy (AAT) utilizes human-animal interaction to achieve specific therapeutic goals, and its efficacy has been demonstrated across various settings overseas. The use of AAT in Singapore, however, is still limited. Ang Mo Kio-Thye Hua Kwan (AMKH) is one of the first community hospitals in Singapore to use AAT to complement its occupational therapy services with elderly patients. This study explored the perspectives of AMKH’s occupational therapists (OTs) in relation to AAT to understand barriers and enablers in implementing and practising AAT. We also examined how OTs at-large across practice settings perceive AAT. A mixed method design was used. 64 OTs at-large participated in on online survey, and 7 AMKH OTs were interviewed individually via Zoom. Survey results were analysed with descriptive and Mann-Whitney U tests. Interviews were thematically analysed. AMKH OTs perceived various benefits of AAT articulated in overseas studies in domains such as motivation and participation, emotional, social interaction, sensory tactile stimulation, and cognition. Interestingly, this perception was also supported by 67% of OTs who had responded to the survey, even though most of the OTs who had participated in the survey had no experience in AAT. Despite the perceived benefits of AAT, both OTs from AMKH and those at-large articulated concerns on risks pertaining to AAT (e.g., allergies, unexpected animal behaviour, infections, etc). However, AMKH OTs shared several ways to mitigate these risks, demonstrating their ability to develop a safe program. For e.g., volunteers and their dogs must meet specific recruitment criteria, stringent protocols are used to screen and match dogs with patients, and there are strict exclusion criteria for patients participating in AAT. AMKH OTs’ experience suggests that additional skills and knowledge are required to implement AAT, therefore, healthcare institutions should first consider improving their staff training and risk mitigation knowledge before implementing AAT. They can also refer to AMKH’s AAT protocols and those found in overseas studies, but institutions must adapt the protocols to fit their institutional settings and patients’ profiles.

Keywords: animal-assisted therapy, dog-assisted therapy, occupational therapy, complementary therapy

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Authors: Pascale Brasseur, Binu Gurung, Nicholas Halfpenny, James Eaton

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Development of minimally invasive treatments in recent years provides a potential alternative to invasive surgical interventions which are of limited value to patients with spinal metastases due to short life expectancy. A systematic review was conducted to explore the efficacy and safety of radiofrequency ablation (RFA), a minimally invasive treatment in patients with spinal metastases. EMBASE, Medline and CENTRAL were searched from database inception to March 2017 for randomised controlled trials (RCTs) and non-randomised studies. Conference proceedings for ASCO and ESMO published in 2015 and 2016 were also searched. Fourteen studies were included: three prospective interventional studies, four prospective case series and seven retrospective case series. No RCTs or studies comparing RFA with another treatment were identified. RFA was followed by cement augmentation in all patients in seven studies and some patients (40-96%) in the remaining seven studies. Efficacy was assessed as pain relief in 13/14 studies with the use of a numerical rating scale (NRS) or a visual analogue scale (VAS) at various time points. Ten of the 13 studies reported a significant decrease in pain outcome, post-RFA compared to baseline. NRS scores improved significantly at 1 week (5.9 to 3.5, p < 0.0001; 8 to 4.3, p < 0.02 and 8 to 3.9, p < 0.0001) and this improvement was maintained at 1 month post-RFA compared to baseline (5.9 to 2.6, p < 0.0001; 8 to 2.9, p < 0.0003; 8 to 2.9, p < 0.0001). Similarly, VAS scores decreased significantly at 1 week (7.5 to 2.7, p=0.00005; 7.51 to 1.73, p < 0.0001; 7.82 to 2.82, p < 0.001) and this pattern was maintained at 1 month post-RFA compared to baseline (7.51 to 2.25, p < 0.0001; 7.82 to 3.3; p < 0.001). A significant pain relief was achieved regardless of whether patients had cement augmentation in two studies assessing the impact of RFA with or without cement augmentation on VAS pain scores. In these two studies, a significant decrease in pain scores was reported for patients receiving RFA alone and RFA+cement at 1 week (4.3 to 1.7. p=0.0004 and 6.6 to 1.7, p=0.003 respectively) and 15-36 months (7.9 to 4, p=0.008 and 7.6 to 3.5, p=0.005 respectively) after therapy. Few minor complications were reported and these included neural damage, radicular pain, vertebroplasty leakage and lower limb pain/numbness. In conclusion, the efficacy and safety of RFA were consistently positive between prospective and retrospective studies with reductions in pain and few procedural complications. However, the lack of control groups in the identified studies indicates the possibility of selection bias inherent in single arm studies. Controlled trials exploring efficacy and safety of RFA in patients with spinal metastases are warranted to provide robust evidence. The identified studies provide an initial foundation for such future trials.

Keywords: pain relief, radiofrequency ablation, spinal metastases, systematic review

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