Search results for: Minkowski dimension
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1030

Search results for: Minkowski dimension

850 Community Forest Management and Ecological and Economic Sustainability: A Two-Way Street

Authors: Sony Baral, Harald Vacik

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This study analyzes the sustainability of community forest management in two community forests in Terai and Hills of Nepal, representing four forest types: 1) Shorearobusta, 2) Terai hardwood, 3) Schima-Castanopsis, and 4) other Hills. The sustainability goals for this region include maintaining and enhancing the forest stocks. Considering this, we analysed changes in species composition, stand density, growing stock volume, and growth-to-removal ratio at 3-5 year intervals from 2005-2016 within 109 permanent forest plots (57 in the Terai and 52 in the Hills). To complement inventory data, forest users, forest committee members, and forest officials were consulted. The results indicate that the relative representation of economically valuable tree species has increased. Based on trends in stand density, both forests are being sustainably managed. Pole-sized trees dominated the diameter distribution, however, with a limited number of mature trees and declined regeneration. The forests were over-harvested until 2013 but under-harvested in the recent period in the Hills. In contrast, both forest types were under-harvested throughout the inventory period in the Terai. We found that the ecological dimension of sustainable forest management is strongly achieved while the economic dimension is lacking behind the current potential. Thus, we conclude that maintaining a large number of trees in the forest does not necessarily ensure both ecological and economical sustainability. Instead, priority should be given on a rational estimation of the annual harvest rates to enhance forest resource conditions together with regular benefits to the local communities.

Keywords: community forests, diversity, growing stock, forest management, sustainability, nepal

Procedia PDF Downloads 67
849 Hybrid Approach for Face Recognition Combining Gabor Wavelet and Linear Discriminant Analysis

Authors: A: Annis Fathima, V. Vaidehi, S. Ajitha

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Face recognition system finds many applications in surveillance and human computer interaction systems. As the applications using face recognition systems are of much importance and demand more accuracy, more robustness in the face recognition system is expected with less computation time. In this paper, a hybrid approach for face recognition combining Gabor Wavelet and Linear Discriminant Analysis (HGWLDA) is proposed. The normalized input grayscale image is approximated and reduced in dimension to lower the processing overhead for Gabor filters. This image is convolved with bank of Gabor filters with varying scales and orientations. LDA, a subspace analysis techniques are used to reduce the intra-class space and maximize the inter-class space. The techniques used are 2-dimensional Linear Discriminant Analysis (2D-LDA), 2-dimensional bidirectional LDA ((2D)2LDA), Weighted 2-dimensional bidirectional Linear Discriminant Analysis (Wt (2D)2 LDA). LDA reduces the feature dimension by extracting the features with greater variance. k-Nearest Neighbour (k-NN) classifier is used to classify and recognize the test image by comparing its feature with each of the training set features. The HGWLDA approach is robust against illumination conditions as the Gabor features are illumination invariant. This approach also aims at a better recognition rate using less number of features for varying expressions. The performance of the proposed HGWLDA approaches is evaluated using AT&T database, MIT-India face database and faces94 database. It is found that the proposed HGWLDA approach provides better results than the existing Gabor approach.

Keywords: face recognition, Gabor wavelet, LDA, k-NN classifier

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848 Exploration of Two Selected Sculptural Forms in the Department of Fine and Applied Arts, Federal Capital Territory College of Education Zuba-Abuja, Nigeria as Motifs for Wax Print Pattern and Design

Authors: Adeoti Adebowale, Abduljaleel, Ejiogu Fidelis Onyekwo

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Form and image development are fundamental to creative expression in visual arts. The form is an element that distinguishes the difference between two-dimension and three-dimension among the branches of visual arts. Particularly, the sculpture is a three-dimensional form, while the textile design is a two-dimensional form of its visual appearance. The visual expression of each of them is embedded in the creative practice of the artist, which is easily understood and interpreted by the viewer. In this research, an attempt is made to explore and analyse sculptural forms adopted as a motif for wax print in textile design, aiming at breeding yet another pattern and motif suitable for various design uses. For instance, the dynamics of sculptural form adaptation into other areas of creativity, such as architecture, pictorial arts and pottery, as well as automobile bodies, is a discernible image everywhere. The research is studio exploratory, while a camera and descriptive analysis were used to process the data. Two sculptural forms were adopted from the Department of Fine and Applied Arts, Federal Capital Territory College of Education Zuba-Abuja, in this study due to the uniqueness of their technique of execution. The findings resulted in ten (10) paper designs showing the dexterity of studio practice in the development of design for various fashion and textile uses. However, the paper concludes that sculptural form is a source of inspiration for generating design concepts for a textile designer.

Keywords: exploration, design, motifs, sculptural forms, wax print

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847 The Relations between Coping Strategies, Caregiver Bonding, and Dating Violence of Emerging Adults: Cross-Cultural Comparison between China and Turkiye

Authors: Zubaidan Yushan, Hudayar Cıhan

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Turkiye and China are countries that have collective cultures, but they have different cultural backgrounds. They have different cultures, different religions, and different levels of economic development. The aim of this study is to test the moderation effect of caregiver bonding on the relationship between dating violence and coping strategies among unmarried emerging adults in China and Turkiye. Participants ages were 19 and 26 years (X=23.66, SD=3.66), unmarried emerging adults Turkish 171 participants (72.5% women, 24% men, 3.5% prefer not to say), Chinese 170 participants (71.8% women, 21.8% men, 6.5% prefer not to say). All participants had been in a relationship for more than six months. Participants completed The Conflict Tactics Scales—(CTS2), The Cope Inventory, and The Parental Bonding Instrument (PBI). Examining the dating violence and coping strategies of the participant's relationship through caregiver bonding moderation analysis was performed using the Jamovi. Significance was tested using the bootstrapping method with bias-corrected confidence estimates. The outcome variable for analysis was dating violence, and the predictor variable for the analysis was coping strategies. The moderator variable evaluated for the analysis was parent attachment. Before the analysis, the mean-centered scores of each variable and moderator were calculated. Furthermore, the moderation analysis was conducted separately for each outcome. The Moderation analysis results show that the sub-dimension of over-protection moderates psychological aggression perpetration and avoidance coping in China. The sub-dimension of care moderates injury victimization and avoidance management in Turkiye; also, over-protection moderates injury victimization and social support coping. Moreover, the sub-dimension of care moderates sexual coercion perpetration and avoidance coping. In the results, caregiver bonding moderates the relationship between coping strategies and dating violence, which may be explained by the fact that our ways of coping with problems are learned, and people are influenced by their parents when they face problems. Therefore, problem-solving is permanently fixed, and each person has his or her fixed solution, which leads to a habit of using solutions to problems. However, sometimes, these solutions become the justification for the injured or abusive person. The quality of the attachment between parents can regulate this state. The results are somewhat similar to and slightly different from those in the previous literature. These mixed results indicate the need for further exploration. Many other factors, such as alcohol, drug violence, and pathological problems, maybe the reasons for these differences. In addition, diverse factors such as the study environment and the applied measurement scales may also affect the results.

Keywords: caregiver bonding, coping strategies, dating violence, emerging adulthood, cross-cultural, comparison

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846 Elements of a Culture of Quality in the Implementation of Quality Assurance Systems of Countries in the European Higher Education Area

Authors: Laura Mion

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The implementation of quality management systems in higher education in different countries is determined by national regulatory choices and supranational indications (such as the European Standard Guidelines for Quality Assurance). The effective functioning and transformative capacity of these quality management systems largely depend on the organizational context in which they are applied and, more specifically, on the culture of quality developed in single universities or in single countries. The University's concept of quality culture integrates the structural dimension of QA (quality management manuals, process definitions, tools) with the value dimension of an organization (principles, skills, and attitudes). Within the EHEA (European Higher Education Area), countries such as Portugal, the Netherlands, the UK, and Norway demonstrate a greater integration of QA principles in the various organizational levels and areas of competence of university institutions or have greater experience in implementation or scientific and political debate on the matter. Therefore, the study, through an integrative literature review, of the quality management systems of these countries is aimed at determining a framework of the culture of quality, helpful in defining the elements which, both in structural-organizational terms and in terms of values and skills and attitudes, have proved to be factors of success in the effective implementation of quality assurance systems in universities and in the countries considered in the research. In order for a QA system to effectively aim for continuous improvement in a complex and dynamic context such as the university one, it must embrace a holistic vision of quality from an integrative perspective, focusing on the objective of transforming the reality being evaluated.

Keywords: higher education, quality assurance, quality culture, Portugal, Norway, Netherlands, United Kingdom

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845 A Theoretical Framework: The Influence of Luxury Companies' Corporate Social Activities on Consumer Purchase Intention

Authors: Kveta Olsanova, Gina Cook, Marija Zlatic

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This paper discusses the theoretical framework suggesting the dependencies between luxury brands’ CSR (Corporate Social Responsibility) variables and the purchase intention of luxury shoppers. The framework is based on a literature review and in-depth individual interviews with a sample of luxury users and buyers. The measures of the model are based on existing research and the authors' qualitative research results. The model suggests that purchase intention in the luxury segment is dependent on the luxury values (symbolic, experiential, functional and social), individual sustainable dimension (composed of societal, environmental and economic variables) and awareness of the brand’s CSR, the last two relationships being potentially moderated by certain conditions such as demographics and general attitudes towards CSR and sustainability. The model’s output is in the formulation of several hypotheses, to be tested in an upcoming quantitative study. The qualitative phase indicated that the perceived symbolic, functional and experiential value dimensions of luxury brands were stronger drivers of purchase intention compared to the sustainable dimension. The contribution of the research consists of highlighting CSR’s impact on customer purchase intent as a potential implication for luxury brand management due to two aspects: (i) consumer awareness of the existing CSR activities of luxury brands is low, and this might be challenged by the demands of Gen Z entrants into the lux industry as they are known for their positive approach to CSR; (ii) the UN’s SDGs will bring CSR to the attention of all industries, including currently 'CSR silent' segments represented by luxury. Our research should contribute to incorporation of strategic CSR into the policies and strategies of the luxury segment by providing evidence that luxury customers do care.

Keywords: CSR, luxury shoppers, purchase intention, sustainability

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844 Patient Engagement in Healthcare and Health Literacy in China: A Survey in China

Authors: Qing Wu, Xuchun Ye, Qiuchen Wang, Kirsten Corazzini

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Objective: It’s increasing acknowledged that patient engagement in healthcare and health literacy both have positive impact on patient outcome. Health literacy emphasizes the ability of individuals to understand and apply health information and manage health. Patients' health literacy affected their willingness to participate in decision-making, but its impact on the behavior and willingness of patient engagement in healthcare is not clear, especially in China. Therefore, this study aimed to explore the correlation between the behavior and willingness of patient engagement and health literacy. Methods: A cross-sectional survey was employed using the behavior and willingness of patient engagement in healthcare questionnaire, Chinese version All Aspects of Health Literacy Scale (AAHLS). A convenient sample of 443 patients was recruited from 8 general hospitals in Shanghai, Jiangsu Province and Zhejiang Province, from September 2016 to January 2017. Results: The mean score for the willingness was (4.41±0.45), and the mean score for the patient engagement behavior was (4.17±0.49); the mean score for the patient's health literacy was (2.36±0.29),the average score of its three dimensions- the functional literacy, the Communicative/interactive literacy and the Critical literacy, was (2.26±0.38), (2.28±0.42), and (2.61±0.43), respectively. Patients' health literacy was positively correlated with their willingness of engagement (r = 0.367, P < 0.01), and positively correlated with patient engagement behavior (r = 0.357, P < 0.01). All dimensions of health literacy were positively correlated with the behavior and willingness of patient engagement in healthcare; the dimension of Communicative/interactive literacy (r = 0.312, P < 0.01; r = 0.357, P < 0.01) and the Critical literacy (r = 0.357, P < 0.01; r = 0.357, P < 0.01) are more relevant to the behavior and willingness than the dimension of basic/functional literacy (r=0.150, P < 0.01; r = 0.150, P < 0.01). Conclusions: The behavior and willingness of patient engagement in healthcare are positively correlated with health literacy and its dimensions. In clinical work, medical staff should pay attention to patients’ health literacy, especially the situation that low literacy leads to low participation and provide health information to patients through health education or communication to improve their health literacy as well as guide them to actively and rationally participate in their own health care.

Keywords: patient engagement, health literacy, healthcare, correlation

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843 Current Status and Influencing Factors of Transition Status of Newly Graduated Nurses in China: A Multi-center Cross-sectional Study

Authors: Jia Wang, Wanting Zhang, Yutong Xv, Zihan Guo, Weiguang Ma

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Background: Before becoming qualified nurses, newly graduated nurses(NGNs) must experience a painful transition period, even transition shocks. Transition shocks are public health issues. To address the transition issue of NGNs, many programs or interventions have been developed and implemented. However, there are no studies to understand and assess the transition state of newly graduated nurses from work to life, from external abilities to internal emotions. Aims: Assess the transition status of newly graduated nurses in China. Identify the factors influencing the transition status of newly graduated nurses. Methods: The multi-center cross-sectional study design was adopted. From May 2022 to June 2023, 1261 newly graduated nurse in hospitals were surveyed online with the the Demographic Questionnaire and Transition Status Scale for Newly Graduated Nurses. SPSS 26.0 were used for data input and statistical analysis. Statistic description were adopted to evaluate the demographic characteristics and transition status of NGNs. Independent-samples T-test, Analysis of Variance and Multiple regression analysis was used to explore the influencing factors of transition status. Results: The total average score of Transition Status Scale for Newly Graduated Nurses was 4.00(SD = 0.61). Among the various dimensions of Transition Status, the highest dimension was competence for nursing work, while the lowest dimension was balance between work and life. The results showed factors influencing the transition status of NGNs include taught by senior nurses, night shift status, internship department, attribute of working hospital, province of work and residence, educational background, reasons for choosing nursing, types of hospital, and monthly income. Conclusion: At present, the transition status score of new nurses in China is relatively high, and NGNs are more likely to agree with their own transition status, especially the dimension of competence for nursing work. However, they have a poor level of excess in terms of life-work balance. Nursing managers should reasonably arrange the working hours of NGNs, promote their work-life balance, increase the salary and reward mechanism of NGNs, arrange experienced nursing mentors to teach, optimize the level of hospitals, provide suitable positions for NGNs with different educational backgrounds, pay attention to the culture shock of NGNs from other provinces, etc. Optimize human resource management by intervening in these factors that affect the transition of new nurses and promote a better transition of new nurses.

Keywords: newly graduated nurse, transition, humanistic car, nursing management, nursing practice education

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842 Elite Child Athletes Are Our Future: Cardiac Adaptation to Monofin Training in Prepubertal Egyptian Athletes

Authors: Magdy Abouzeid, Nancy Abouzeid, Afaf Salem

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Background: The elite child athletes are one who has superior athletic talent. Monofin (a single surface swim fin) swimming already proved to be the most efficient method of swimming for human being. This is a novel descriptive study examining myocardial function indices in prepubertal monofin children. The aim of the present study was to determine the influence of long-term monofin training (LTMT), 36 weeks, 6 times per week, 90 min per unit on Myocardial function adaptation in elite child monofin athletes. Methods: 14 elite monofin children aged 11.95 years (± 1.09 yr) took part for (LTMT). All subjects underwent two-dimension, M-mode, and Doppler echocardiography before and after training to evaluate cardiac dimensions and function; septal and posterior wall thickness. Statistical methods of SPSS, means ± SD and paired t test, % of improvement were used. Findings: There was significant difference (p<0.01) and % improvement for all echocardiography parameter after (LTMT). Inter ventricular septal thickness in diastole and in systole increased by 27.9 % and 42.75 %. Left ventricular end systolic dimension and diastole increased by 16.81 % and 42.7 % respectively. Posterior wall thickness in systole very highly increased by 283.3 % and in diastole increased by 51.78 %. Left ventricular mass in diastole and in systole increased by 44.8 % and 40.1 % respectively. Stroke volume (SV) and resting heart rate (HR) significant changed (sv) 25 %, (HR) 14.7 %. Interpretation: the unique swim fin tool and create propulsion and overcome resistance. Further researches are needed to determine the effects of monofin training on right ventricular in child athletes.

Keywords: prepubertal, monofin training, heart athlete's, elite child athlete, echocardiography

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841 An Education Profile for Indonesian Youth Development

Authors: Titia Izzati, Pebri Hastuti, Gusti Ayu Arwati

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Based on the program of The Ministry of Youth and Sports of Republic of Indonesia, this study compares the Statistikdata of the educational factors and the number of young people to a survey conducted in the five years, 2009-2013. As a result, significant trends are traced through an era filled with events that deeply affected the lives of young people, such as the peak and the ending of the political issues. Changing values under examination include attitudes toward authority and obligations toward others; social values dealing with attitudes toward the work ethic; marriage, family, and the importance of money in defining the meaning of success; and self-fulfillment. While the largest portion of the sample contains college youth, other people between the ages of 16 and 30 are considered, including high school students, blue collar workers, housewives, and high school dropouts. The report provides an overview and interpretation of the data with the presents the research contrasting the values of the college and non-college youth. In the other hand, the youth education profile data also can be utilized in making arrange the youth development index, especially in educational dimension. In order to the formulation of this youth development index, the basic needs of youth in Indonesia have to be listed as the variables. So that, the indicators of the youth development index are really in accordance withthe actual conditions of Indonesian youth. The indicators are the average number of old-school youth, the rate of youth illiterate people, the numbers of youth who are continuing their studies or who have completed the study in college, the number of youth graduate high school/vocational or college graduates were engaged in the labor fair. The formula for the youth development index is arranged in educational dimension with all actual indicators

Keywords: education, young people, Indonesia, ministry programs, youth index development

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840 Inner Derivations of Low-Dimensional Diassociative Algebras

Authors: M. A. Fiidow, Ahmad M. Alenezi

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In this work, we study the inner derivations of diassociative algebras in dimension two and three, an algorithmic approach is adopted for the computation of inner derivation, using some results from the derivation of finite dimensional diassociative algebras. Some basic properties of inner derivation of finite dimensional diassociative algebras are also provided.

Keywords: diassociative algebras, inner derivations, derivations, left and right operator

Procedia PDF Downloads 241
839 Research on Coordinated Development Mechanism of Semi-urbanized Areas under the Background of Guangdong-Hong Kong-Macao Greater Bay Area: A Case Study of 'Baiyun-Nanhai' Pilot Area

Authors: Cheng Fang Wang, Fu Li Gao, Jian Ying Zhou

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The '1+4' integration pilot area in the border area of Guangzhou-Foshan is an important platform for Guangzhou-Foshan strategic cooperation, as well as a typical semi-urbanized area with mixed urban and rural landscapes, of which the Baiyun-Nanhai pilot area is one of them. Baiyun district and Nanhai district are only separated by the Pearl River. In this paper, the three dimensions, which include production, living, and ecology, have been put forward, as well as cross-regional multi-agency negotiation mechanism has been discussed. Taking 'Baiyun-Nanhai' pilot area as a case study, POI (Point of Interest) data to analyze the distribution characteristics of 'production-living-ecological space' from the spatial dimension has been introduced in this paper, as well as the land-use change of 'production-living-ecological space' in western region of Baiyun district in 2007 and 2017 from the temporal dimension has been analyzed. Based on the above analysis, the integration development strategy and rethinking of cross-administrative region based on 'production-living-ecological integration' mechanism have been discussed later. It will explore the mechanism of industrial collaborative innovation, infrastructure co-construction, and ecological co-protection in semi-urban areas across borders. And it is expected to provide a reference for the integrated construction of the Guangdong-Hong Kong-Macao Greater Bay Area.

Keywords: semi-urbanization, production-living-ecological integration, multi-agency negotiation, Guangzhou-Foshan integration, synergetic development

Procedia PDF Downloads 121
838 Structural Analysis of Polymer Thin Films at Single Macromolecule Level

Authors: Hiroyuki Aoki, Toru Asada, Tomomi Tanii

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The properties of a spin-cast film of a polymer material are different from those in the bulk material because the polymer chains are frozen in an un-equilibrium state due to the rapid evaporation of the solvent. However, there has been little information on the un-equilibrated conformation and dynamics in a spin-cast film at the single chain level. The real-space observation of individual chains would provide direct information to discuss the morphology and dynamics of single polymer chains. The recent development of super-resolution fluorescence microscopy methods allows the conformational analysis of single polymer chain. In the current study, the conformation of a polymer chain in a spin-cast film by the super-resolution microscopy. Poly(methyl methacrylate) (PMMA) with the molecular weight of 2.2 x 10^6 was spin-cast onto a glass substrate from toluene and chloroform. For the super-resolution fluorescence imaging, a small amount of the PMMA labeled by rhodamine spiroamide dye was added. The radius of gyration (Rg) was evaluated from the super-resolution fluorescence image of each PMMA chain. The mean-square-root of Rg was 48.7 and 54.0 nm in the spin-cast films prepared from the toluene and chloroform solutions, respectively. On the other hand, the chain dimension in a bulk state (a thermally annealed 10- μm-thick sample) was observed to be 43.1 nm. This indicates that the PMMA chain in the spin-cast film takes an expanded conformation compared to the unperturbed chain and that the chain dimension is dependent on the solvent quality. In a good solvent, the PMMA chain has an expanded conformation by the excluded volume effect. The polymer chain is frozen before the relaxation from an un-equilibrated expanded conformation to an unperturbed one by the rapid solvent evaporation.

Keywords: chain conformation, polymer thin film, spin-coating, super-resolution optical microscopy

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837 Solving LWE by Pregressive Pumps and Its Optimization

Authors: Leizhang Wang, Baocang Wang

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General Sieve Kernel (G6K) is considered as currently the fastest algorithm for the shortest vector problem (SVP) and record holder of open SVP challenge. We study the lattice basis quality improvement effects of the Workout proposed in G6K, which is composed of a series of pumps to solve SVP. Firstly, we use a low-dimensional pump output basis to propose a predictor to predict the quality of high-dimensional Pumps output basis. Both theoretical analysis and experimental tests are performed to illustrate that it is more computationally expensive to solve the LWE problems by using a G6K default SVP solving strategy (Workout) than these lattice reduction algorithms (e.g. BKZ 2.0, Progressive BKZ, Pump, and Jump BKZ) with sieving as their SVP oracle. Secondly, the default Workout in G6K is optimized to achieve a stronger reduction and lower computational cost. Thirdly, we combine the optimized Workout and the Pump output basis quality predictor to further reduce the computational cost by optimizing LWE instances selection strategy. In fact, we can solve the TU LWE challenge (n = 65, q = 4225, = 0:005) 13.6 times faster than the G6K default Workout. Fourthly, we consider a combined two-stage (Preprocessing by BKZ- and a big Pump) LWE solving strategy. Both stages use dimension for free technology to give new theoretical security estimations of several LWE-based cryptographic schemes. The security estimations show that the securities of these schemes with the conservative Newhope’s core-SVP model are somewhat overestimated. In addition, in the case of LAC scheme, LWE instances selection strategy can be optimized to further improve the LWE-solving efficiency even by 15% and 57%. Finally, some experiments are implemented to examine the effects of our strategies on the Normal Form LWE problems, and the results demonstrate that the combined strategy is four times faster than that of Newhope.

Keywords: LWE, G6K, pump estimator, LWE instances selection strategy, dimension for free

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836 Digital Adoption of Sales Support Tools for Farmers: A Technology Organization Environment Framework Analysis

Authors: Sylvie Michel, François Cocula

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Digital agriculture is an approach that exploits information and communication technologies. These encompass data acquisition tools like mobile applications, satellites, sensors, connected devices, and smartphones. Additionally, it involves transfer and storage technologies such as 3G/4G coverage, low-bandwidth terrestrial or satellite networks, and cloud-based systems. Furthermore, embedded or remote processing technologies, including drones and robots for process automation, along with high-speed communication networks accessible through supercomputers, are integral components of this approach. While farm-level adoption studies regarding digital agricultural technologies have emerged in recent years, they remain relatively limited in comparison to other agricultural practices. To bridge this gap, this study delves into understanding farmers' intention to adopt digital tools, employing the technology, organization, environment framework. A qualitative research design encompassed semi-structured interviews, totaling fifteen in number, conducted with key stakeholders both prior to and following the 2020-2021 COVID-19 lockdowns in France. Subsequently, the interview transcripts underwent thorough thematic content analysis, and the data and verbatim were triangulated for validation. A coding process aimed to systematically organize the data, ensuring an orderly and structured classification. Our research extends its contribution by delineating sub-dimensions within each primary dimension. A total of nine sub-dimensions were identified, categorized as follows: perceived usefulness for communication, perceived usefulness for productivity, and perceived ease of use constitute the first dimension; technological resources, financial resources, and human capabilities constitute the second dimension, while market pressure, institutional pressure, and the COVID-19 situation constitute the third dimension. Furthermore, this analysis enriches the TOE framework by incorporating entrepreneurial orientation as a moderating variable. Managerial orientation emerges as a pivotal factor influencing adoption intention, with producers acknowledging the significance of utilizing digital sales support tools to combat "greenwashing" and elevate their overall brand image. Specifically, it illustrates that producers recognize the potential of digital tools in time-saving and streamlining sales processes, leading to heightened productivity. Moreover, it highlights that the intent to adopt digital sales support tools is influenced by a market mimicry effect. Additionally, it demonstrates a negative association between the intent to adopt these tools and the pressure exerted by institutional partners. Finally, this research establishes a positive link between the intent to adopt digital sales support tools and economic fluctuations, notably during the COVID-19 pandemic. The adoption of sales support tools in agriculture is a multifaceted challenge encompassing three dimensions and nine sub-dimensions. The research delves into the adoption of digital farming technologies at the farm level through the TOE framework. This analysis provides significant insights beneficial for policymakers, stakeholders, and farmers. These insights are instrumental in making informed decisions to facilitate a successful digital transition in agriculture, effectively addressing sector-specific challenges.

Keywords: adoption, digital agriculture, e-commerce, TOE framework

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835 Determination of Unsaturated Soil Permeability Based on Geometric Factor Development of Constant Discharge Model

Authors: A. Rifa’i, Y. Takeshita, M. Komatsu

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After Yogyakarta earthquake in 2006, the main problem that occurred in the first yard of Prambanan Temple is ponding area that occurred after rainfall. Soil characterization needs to be determined by conducting several processes, especially permeability coefficient (k) in both saturated and unsaturated conditions to solve this problem. More accurate and efficient field testing procedure is required to obtain permeability data that present the field condition. One of the field permeability test equipment is Constant Discharge procedure to determine the permeability coefficient. Necessary adjustments of the Constant Discharge procedure are needed to be determined especially the value of geometric factor (F) to improve the corresponding value of permeability coefficient. The value of k will be correlated with the value of volumetric water content (θ) of an unsaturated condition until saturated condition. The principle procedure of Constant Discharge model provides a constant flow in permeameter tube that flows into the ground until the water level in the tube becomes constant. Constant water level in the tube is highly dependent on the tube dimension. Every tube dimension has a shape factor called the geometric factor that affects the result of the test. Geometric factor value is defined as the characteristic of shape and radius of the tube. This research has modified the geometric factor parameters by using empty material tube method so that the geometric factor will change. Saturation level is monitored by using soil moisture sensor. The field test results were compared with the results of laboratory tests to validate the results of the test. Field and laboratory test results of empty tube material method have an average difference of 3.33 x 10-4 cm/sec. The test results showed that modified geometric factor provides more accurate data. The improved methods of constant discharge procedure provide more relevant results.

Keywords: constant discharge, geometric factor, permeability coefficient, unsaturated soils

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834 Exploring the Effect of Nursing Students’ Self-Directed Learning and Technology Acceptance through the Use of Digital Game-Based Learning in Medical Terminology Course

Authors: Hsin-Yu Lee, Ming-Zhong Li, Wen-Hsi Chiu, Su-Fen Cheng, Shwu-Wen Lin

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Background: The use of medical terminology is essential to professional nurses on clinical practice. However, most nursing students consider traditional lecture-based teaching of medical terminology as boring and overly conceptual and lack motivation to learn. It is thus an issue to be discussed on how to enhance nursing students’ self-directed learning and improve learning outcomes of medical terminology. Digital game-based learning is a learner-centered way of learning. Past literature showed that the most common game-based learning for language education has been immersive games and teaching games. Thus, this study selected role-playing games (RPG) and digital puzzle games for observation and comparison. It is interesting to explore whether digital game-based learning has positive impact on nursing students’ learning of medical terminology and whether students can adapt well on this type of learning. Results can be used to provide references for institutes and teachers on teaching medical terminology. These instructions give you guidelines for preparing papers for the conference. Use this document as a template if you are using Microsoft Word. Otherwise, use this document as an instruction set. The electronic file of your paper will be formatted further at WASET. Define all symbols used in the abstract. Do not cite references in the abstract. Do not delete the blank line immediately above the abstract; it sets the footnote at the bottom of this column. Page margins are 1,78 cm top and down; 1,65 cm left and right. Each column width is 8,89 cm and the separation between the columns is 0,51 cm. Objective: The purpose of this research is to explore respectively the impact of RPG and puzzle game on nursing students’ self-directed learning and technology acceptance. The study further discusses whether different game types bring about different influences on students’ self-directed learning and technology acceptance. Methods: A quasi-experimental design was adopted in this study so that repeated measures between two groups could be conveniently conducted. 103 nursing students from a nursing college in Northern Taiwan participated in the study. For three weeks of experiment, the experiment group (n=52) received “traditional teaching + RPG” while the control group (n=51) received “traditional teaching + puzzle games”. Results: 1. On self-directed learning: For each game type, there were significant differences for the delayed tests of both groups as compared to the pre and post-tests of each group. However, there were no significant differences between the two game types. 2. On technology acceptance: For the experiment group, after the intervention of RPG, there were no significant differences concerning technology acceptance. For the control group, after the intervention of puzzle games, there were significant differences regarding technology acceptance. Pearson-correlation coefficient and path analysis conducted on the results of the two groups revealed that the dimension were highly correlated and reached statistical significance. Yet, the comparison of technology acceptance between the two game types did not reach statistical significance. Conclusion and Recommend: This study found that through using different digital games on learning, nursing students have effectively improved their self-directed learning. Students’ technology acceptances were also high for the two different digital game types and each dimension was significantly correlated. The results of the experimental group showed that through the scenarios of RPG, students had a deeper understanding of medical terminology, which reached the ‘Understand’ dimension of Bloom’s taxonomy. The results of the control group indicated that digital puzzle games could help students memorize and review medical terminology, which reached the ‘Remember’ dimension of Bloom’s taxonomy. The findings suggest that teachers of medical terminology could use digital games to assist their teaching according to their goals on cognitive learning. Adequate use of those games could help improve students’ self-directed learning and further enhance their learning outcome on medical terminology.

Keywords: digital game-based learning, medical terminology, nursing education, self-directed learning, technology acceptance model

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833 Conflicts and Epidemiology of HIV/AIDS: Gender Dimension in Rain Forest Zone of Nigeria

Authors: K. K. Bolarinwa, A. F. O. Ayinde, B. B. Abiona, O. Oyekunle

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Conflict and HIV/AIDS infection have had a profound impact on the Sub-Saharan African societies, individually and collectively. Nigeria has been experiencing several violent conflicts in many communities across the geographical spread of the country. These conflicts which often lead to loss of lives, properties and loss of livelihoods are mainly felt by women in terms of increased responsibility towards affected family members with attendant decrease in livelihood options. Despite these, conflict issues have not really received enough focal attention by Nigerian academics. It is against this backdrop that this study was undertaken to describe the respondents, the most prevalent conflict repercussions and most prevalent STDs, in conflict areas. Data were collected using interview schedule to elicit a response from 122 respondents in Southwest Nigeria, through a multi-stage sampling technique involving stratification of respondents into violent conflict areas (VCA) and non-violent conflict areas (NVCA). The data collected were analysed using descriptive statistics and correlation analysis. Results revealed that majority (86.5% and 70.5 %) of the respondents were in the age bracket of 10-39 years in both the VCA and NVCA respectively; 35.5% and 40.2% of the respondents were literate in VCA and NVCA, respectively while 76.5% and 55.8% of the respondents were in the lower income groups in VCA and NVCA, respectively. HIV/AIDS and gonorrhoea were the more predominant (75.2% and 55.6% respectively) STDs in the VCA as against 33.2% and 38.3% respectively in the NVCA. Further, significant (p<0.05) correlation existed between conflict incidence and spread of HIV/AIDS, rape and torture, maltreatment of women as well as sexual harassment; in both VCA and NVCA among others. The study concluded that conflict situations in the study area aggravated incidence of HIV/AIDS and made the women more vulnerable to inhuman treatments such as rape, torture and harassment with attendant reduction in sources of livelihoods. The study recommended among others that sensitisation on control and preventive measures of HIV/AID and other sexually transmitted diseases should be included in programme designed to mitigate against conflicts in the study areas.

Keywords: conflict, gender dimension, HIV/AIDS epidemiology, Nigeria

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832 Identification and Classification of Stakeholders in the Transition to 3D Cadastre

Authors: Qiaowen Lin

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The 3D cadastre is an inevitable choice to meet the needs of real cadastral management. Nowadays, more attention is given to the technical aspects of 3D cadastre, resulting in the imbalance within this field. To fulfill this research gap, the stakeholder, which has been regarded as the determining factor in cadastral change has been studied. Delphi method, Michael rating, and stakeholder mapping are used to identify and classify the stakeholders in 3D cadastre. It is concluded that the project managers should pay more attention to the interesting appeal of the key stakeholders and different coping strategies should be adopted to facilitate the transition to 3D cadastre.

Keywords: stakeholders, three dimension, cadastre, transtion

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831 The Relational Approach under the Angle of the CSR

Authors: Fatima El Kandoussi, Hind Benouakrim, Afafe El Amrani El Hassani

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CSR in the relational approach is imposed today as a matter of concerns lighthouses in the academic environment and managerial. This study presents the issues of the CSR dimension in the field of relationship marketing. This exploratory research was conducted with two groups of Moroccan enterprises having the label of the CSR /CGEM. It presents a better understanding of the approaches taken by the companies interviewed in a CSR and contributed to understand the reasons that lead them to adopt the process of CSR and also allows explaining how these enterprises maintain their relationship with the most important customers in a context of CSR.

Keywords: relationship marketing, CSR, stakeholders, business

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830 Clinical Audit of Selected Nephrology Nursing Procedures Performed in Nephrology Unit of AIIMS with a View to Develop Nephrology Nursing Procedure Protocol

Authors: Mamta Thakur, Dr. Shashi Mawar, Ms. Levis Murry, Dr. D.k.sharma

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Aim: The aim of this study is to develop nephrology nursing procedure protocol after clinical audit of current nephrology nursing practices. Materials and methods: This descriptive observational study was conducted on 40 nurses who were working in Nephrology Department of AIIMS, New Delhi to observe their current practices to assess the existing gaps in the practice. The nurses were enrolled through total enumerative sampling. Sociodemographic profile of nurses and clinical profile for site of procedure was collected. Observation checklist was formed on the basis of standard nursing practices, which included 7 dimensions for hemodialysis procedure and 3 dimensions for procedure of assisting renal biopsy. Based on the gaps identified, nephrology nursing procedure protocol will be developed. Nurses were observed during two shifts, and each nurse was observed once. Scoring of items were done in each dimension, and for acceptable practices, nurses have to score ≥80% in each dimension. Results: Data was analyzed using descriptive statistics. Majority of nurses (73.7%) in nephrology ward and (80.9%) in hemodialysis unit have not undergone any special training in nephrology. Most of nurses (80.9%) followed the acceptable nursing practices for procedure of connection for hemodialysis. None of nurses followed the acceptable level (≥80%) of nursing practices for the procedure of predialysis assessment, the procedure for site preparation, during dialysis assessment and post dialysis assessment. None (100%) showed the acceptable level of nursing practices for all the dimensions of assisting renal biopsy procedure. Nephrology nursing procedure protocol was developed by researcher following a rigorous process, and this will reduce the gaps in the nursing practice. Conclusion: Clinical audit found that there were gaps in the existing nursing practices compared to the standardised nursing practices for procedure of hemodialysis and assisting renal biopsy, and these gaps have been addressed by the development of the protocol.

Keywords: nursing practice, nephrology nursing procedure, nursing protocol, renal biopsy, hemodialysis

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829 A Preliminary Study on the Effects of Equestrian and Basketball Exercises in Children with Autism

Authors: Li Shuping, Shu Huaping, Yi Chaofan, Tao Jiang

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Equestrian practice is often considered having a unique effect on improving symptoms in children with autism. This study evaluated and measured the changes in daily behavior, morphological, physical function, and fitness indexes of two group children with autism by means of 12 weeks of equestrian and basketball exercises. 19 clinically diagnosed children with moderate/mild autism were randomly divided into equestrian group (9 children, age=10.11±1.90y) and basketball group (10 children, age=10.70±2.16y). Both the equestrian and basketball groups practiced twice a week for 45 to 60 minutes each time. Three scales, the Autism Behavior Checklist (ABC), the Childhood Autism Rating Scale (CARS) and the Clancy Autism Behavior Scale (CABS) were used to assess their human behavior and psychology. Four morphological, seven physical function and fitness indicators were measured to evaluate the effects of the two exercises on the children’s body. The evaluations were taken by every four weeks ( pre-exercise, the 4th week, the 8th week and 12th week (post exercise). The result showed that the total scores of ABC, CARS and CABS, the dimension scores of ABC on the somatic motor, language and life self-care obtained after exercise were significantly lower than those obtained before 12 week exercises in both groups. The ABC feeling dimension scores of equestrian group and ABC communication dimension score of basketball group were significantly lower,and The upper arm circumference, sitting forward flexion, 40 second sit-up, 15s lateral jump, vital capacity, and single foot standing of both groups were significantly higher than that of before exercise.. The BMI of equestrian group was significantly reduced. The handgrip strength of basketball group was significantly increased. In conclusion, both types of exercises could improve daily behavior, morphological, physical function, and fitness indexes of the children with autism. However, the behavioral psychological scores, body morphology and function indicators and time points were different in the middle and back of the two interventions.But the indicators and the timing of the improvement were different. To the group of equestrian, the improvement of the flexibility occurred at week 4, the improvement of the sensory perception, control and use their own body, and promote the development of core strength endurance, coordination and cardiopulmonary function occurred at week 8,and the improvement of core strength endurance, coordination and cardiopulmonary function occurred at week 12. To the group of basketball, the improvement of the hand strength, balance, flexibility and cardiopulmonary function occurred at week 4, the improvement of the self-care ability and language expression ability, and core strength endurance and coordination occurred at week 8, the improvement of the control and use of their own body and social interaction ability occurred at week 12. In comparison of the exercise effects, the equestrian exercise improved the physical control and application ability appeared earlier than that of basketball group. Basketball exercise improved the language expression ability, self-care ability, balance ability and cardiopulmonary function of autistic children appeared earlier than that of equestrian group.

Keywords: intervention, children with autism, equestrain, basketball

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828 Designing a Crowbar for Women: An Ergonomic Approach

Authors: Prakash Chandra Dhara, Rupa Maity, Mousumi Chatterjee

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Crowbars are used for the gardening purpose. The same tools are used by both male and female gardeners. The existing crowbars are suitable for the female gardeners. The present study was aimed to design a crowbar, which was required to use by the women for the gardening purpose, from the viewpoints of ergonomics. The study was carried out on 50 women in different villages of Howrah districts in West Bengal state. Different models of existing crowbars which were commonly used by the women were collected and evaluated by examining their shape and size. The problems of using existing crowbar were assessed by direct observation during its operation. The musculoskeletal disorder of the subjects for using the crowbar was evaluated by modified Nordic questionnaire method. The anthropometric dimensions, especially hand dimension, of the subjects were taken in standardized static conditions. Considering the problems of using the existing crowbars some design concepts were developed and accordingly three prototypes models (P1, P2, P3) of crowbar were prepared for designing of a modified crowbar for women. Psychophysical analysis of those prototypes was made by paired comparison tests. In the above test subjective preference for different characteristics of the crowbar, e.g., length, weight, length and breadth of the blade, handle diameter, position of the handle, were determined. From the results of the paired comparison test and percentile values of hand dimensions, a modified design of crowbar was suggested. The prototype model P1 possessed more preferred characteristics of the tool than that of other prototype models. In the final design, the weight of the tool and length of the blade was reduced from that of the existing crowbar. Other dimensions were also changed. Two handles were suggested in the redesigned tool for better gripping and operation. The modified crowbar was evaluated by studying the body joint angles, viz., wrist, shoulder and elbow, for assessing the suitability of the design. It was concluded that the redesigned crowbar was suitable for women’s use.

Keywords: body dimension, crowbar, ergo-design, women, hand anthropometry

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827 Responsibility to Protect in Practice: Libya and Syria

Authors: Guram Esakia, Giorgi Goguadze

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The following paper is written due to overview the concept of R2P, this new dimension in International Relations field. Paper contains the general description of previously mentioned concept, its advantages and disadvantages. We also compare each other R2P and“humanitarian intervention“, trying to make clear division between these two approaches in conflict solution. There is also discussed R2P in real action, successful one in Libya and yet failed in Syria. Essay doesn’t claim to be the part of scientific chain and is based only on personal subjection as well on information gathered from various scholars and UN resolutions.

Keywords: the concept of R2P, humanitarian intervention, Libya, Syria

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826 Problem Gambling in the Conceptualization of Health Professionals: A Qualitative Analysis of the Discourses Produced by Psychologists, Psychiatrists and General Practitioners

Authors: T. Marinaci, C. Venuleo

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Different conceptualizations of disease affect patient care. This study aims to address this gap. It explores how health professionals conceptualize gambling problem, addiction and the goals of recovery process. In-depth, semi-structured, open-ended interviews were conducted with Italian psychologists, psychiatrists, general practitioners, and support staff (N= 114), working within health centres for the treatment of addiction (public health services or therapeutic communities) or medical offices. A Lexical Correspondence Analysis (LCA) was applied to the verbatim transcripts. LCA allowed to identify two main factorial dimensions, which organize similarity and dissimilarity in the discourses of the interviewed. The first dimension labelled 'Models of relationship with the problem', concerns two different models of relationship with the health problem: one related to the request for help and the process of taking charge and the other related to the identification of the psychopathology underlying the disorder. The second dimension, labelled 'Organisers of the intervention' reflects the dialectic between two ways to address the problem. On the one hand, they are the gambling dynamics and its immediate life-consequences to organize the intervention (whatever the request of the user is); on the other hand, they are the procedures and the tools which characterize the health service to organize the way the professionals deal with the user’ s problem (whatever it is and despite the specify of the user’s request). The results highlight how, despite the differences, the respondents share a central assumption: understanding gambling problem implies the reference to the gambler’s identity, more than, for instance, to the relational, social, cultural or political context where the gambler lives. A passive stance is attributed to the user, who does not play any role in the definition of the goal of the intervention. The results will be discussed to highlight the relationship between professional models and users’ ways to understand and deal with the problems related to gambling.

Keywords: cultural models, health professionals, intervention models, problem gambling

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825 Optimum Design of Heat Exchanger in Diesel Engine Cold EGR for Pollutants Reduction

Authors: Nasser Ghassembaglou, Armin Rahmatfam, Faramarz Ranjbar

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Using of cold EGR method with variable venturi and turbocharger has a very significant affection on the reduction of NOX and grime simultaneously. EGR cooler is one of the most important parts in the cold EGR circuit. In this paper optimum design of cooler for working in different percents of EGR and for determining of optimum temperature of exhausted gases, growth of efficiency, reduction of weight, reduction of dimension and expenditures, and reduction of sediment and optimum performance by using gas oil which has significant amounts of brimstone are investigated and optimized.

Keywords: cold EGR, NOX, cooler, gas oil

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824 Dwelling in the Built Environment: The Resilience by Design in Modular Thinking toward an Adaptive Alternatives

Authors: Tzen-Ying Ling

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Recently, the resilience of dwellings in urban areas has been deliberated, as to accommodate the growing demand for changing the demography and rapid urbanization. The need to incorporate sustainability and cleaner production thinking have intensified to mitigate climate risks and satisfy the demand for housing. The modular thinking satisfies both the pressing call for fast-tracked housing stocks; while meeting the goal of more sustainable production. In the other side, the importance of the dwelling as a podium for well-being and social connectedness are sought to explore the key human/environment design thinking for the modular system in dwelling. We argue the best practice incorporates the concept of systemic components thinking. The fieldwork reported in this paper illustrates the process of the case study in a modular dwelling unit prototype development; focusing on the systemic frame system design process and adjustment recommendation hereafter. Using a case study method, the study identified that: (1) inclusive human dimensional factoring through systemic design thinking results in affordable implementations possibilities. (2) The environmental dimension encourages the place-based solution suited for the locality and the increasing demand for dwelling in the urban system. (3) Prototype design consideration avails module system component as dwelling construction alternative. (4) Building code often acts as an inhibitor for such dwelling units by the restriction in lot sizes and units placement. The demand for fast-track dwelling construction and cleaner production decisively outweighs the code inhibition; we further underscored the sustainability implication of the alternative prototype as the core of this study. The research suggests that modular thinking results in a resilient solution suited for the locality and the increasing demand for dwelling in the urban system.

Keywords: system prototype, urban resilience, human/environment dimension, modular thinking, dwelling alternative

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823 Impact of Blended Learning in Interior Architecture Programs in Academia: A Case Study of Arcora Garage Academy from Turkey

Authors: Arzu Firlarer, Duygu Gocmen, Gokhan Uysal

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There is currently a growing trend among universities towards blended learning. Blended learning is becoming increasingly important in higher education, with the aims of better accomplishing course learning objectives, meeting students’ changing needs and promoting effective learning both in a theoretical and practical dimension like interior architecture discipline. However, the practical dimension of the discipline cannot be supported in the university environment. During the undergraduate program, the practical training which is tried to be supported by two different internship programs cannot fully meet the requirements of the blended learning. The lack of education program frequently expressed by our graduates and employers is revealed in the practical knowledge and skills dimension of the profession. After a series of meetings for curriculum studies, interviews with the chambers of profession, meetings with interior architects, a gap between the theoretical and practical training modules is seen as a problem in all interior architecture departments. It is thought that this gap can be solved by a new education model which is formed by the cooperation of University-Industry in the concept of blended learning. In this context, it is considered that theoretical and applied knowledge accumulation can be provided by the creation of industry-supported educational environments at the university. In the application process of the Interior Architecture discipline, the use of materials and technical competence will only be possible with the cooperation of industry and participation of students in the production/manufacture processes as observers and practitioners. Wood manufacturing is an important part of interior architecture applications. Wood productions is a sustainable structural process where production details, material knowledge, and process details can be observed in the most effective way. From this point of view, after theoretical training about wooden materials, wood applications and production processes are given to the students, practical training for production/manufacture planning is supported by active participation and observation in the processes. With this blended model, we aimed to develop a training model in which theoretical and practical knowledge related to the production of wood works will be conveyed in a meaningful, lasting way by means of university-industry cooperation. The project is carried out in Ankara with Arcora Architecture and Furniture Company and Başkent University Department of Interior Design where university-industry cooperation is realized. Within the scope of the project, every week the video of that week’s lecture is recorded and prepared to be disseminated by digital medias such as Udemy. In this sense, the program is not only developed by the project participants, but also other institutions and people who are trained and practiced in the field of design. Both academicians from University and at least 15-year experienced craftsmen in the wood metal and dye sectors are preparing new training reference documents for interior architecture undergraduate programs. These reference documents will be a model for other Interior Architecture departments of the universities and will be used for creating an online education module.

Keywords: blended learning, interior design, sustainable training, effective learning.

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822 Effects of Physical Activity Used as Treatment in Community Mental Health Services

Authors: John Olav Bjornestad, Bjorn Tore Johansen

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The number of people suffering from mental illnesses is increasing, and such illness is currently one of the major causes of disability and poor health. The reason for this is most likely a lack of physical activity. The purpose of this study was to discover if physical activity was an effective mode of treatment for psychiatric patients at an out-patient treatment facility. The study included an exploration of whether or not patients having physical activity included as an integral part of their treatment (to a greater degree than do patients who are physically inactive) would achieve 1) an improvement in their physical condition 2) a reduction in symptomatic pressure and 3) an increase in their health-related quality of life. The intervention period lasted a total of 12 weeks. The training group completed a minimum of 2 training sessions per week with an intensity of 60-75% of maximum heart rate. The participants’ health-related quality of life (SF-36), symptomatic pressure (SCL-90-R) and physical condition (UKK-walking test) were measured before and after intervention. Twenty participants were pre-tested, and out of this initial group, nine patients completed the intervention program and participated thereafter in post-testing. The results showed that participants on average improved their physical condition, reduced their symptomatic pressure and increased their health-related quality of life over the course of the intervention period. The training group experienced significant changes in their symptomatic pressure (the anxiety dimension) and health-related quality of life (the mental health dimension) from the pre-testing stage to the post-testing one. Furthermore, there was a significant connection between symptomatic pressure and health-related quality of life. The patients who were admitted to the psychiatric out-patient clinic were in a physical condition that was significantly poorer than that of persons of the same age in the remainder of the population. Experiences from the study and the relatively large defection from it demonstrate that there is a great need for close follow-up of psychiatric patients’ physical activity levels when physical activity and lifestyle changes are included as part of their treatment program.

Keywords: health-related quality, mental health, physical activity, physical condition

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821 Grade and Maximum Tumor Dimension as Determinants of Lymphadenectomy in Patients with Endometrioid Endometrial Cancer (EEC)

Authors: Ali A. Bazzi, Ameer Hamza, Riley O’Hara, Kimberly Kado, Karen H. Hagglund, Lamia Fathallah, Robert T. Morris

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Introduction: Endometrial Cancer is a common gynecologic malignancy primarily treated with complete surgical staging, which may include complete pelvic and para-aortic lymphadenectomy. The role of lymphadenectomy is controversial, especially the intraoperative indications for the procedure. Three factors are important in decision to proceed with lymphadenectomy: Myometrial invasion, maximum tumor dimension, and histology. Many institutions incorporate these criteria in varying degrees in the decision to proceed with lymphadenectomy. This investigation assesses the use of intraoperatively measured MTD with and without pre-operative histologic grade. Methods: This study compared retrospectively EEC patients with intraoperatively measured MTD ≤2 cm to those with MTD >2 cm from January 1, 2002 to August 31, 2017. This assessment compared those with MTD ≤ 2cm with endometrial biopsy (EB) grade 1-2 to patients with MTD > 2cm with EB grade 3. Lymph node metastasis (LNM), recurrence, and survival were compared in these groups. Results: This study reviewed 222 patient cases. In tumors > 2 cm, LNM occurred in 20% cases while in tumors ≤ 2 cm, LNM was found in 6% cases (p=0.04). Recurrence and mean survival based on last follow up visit in these two groups were not statistically different (p=0.78 and 0.36 respectively). Data demonstrated a trend that when combined with preoperative EB International Federation of Gynecology and Obstetrics (FIGO) grade, a higher proportion of patients with EB FIGO Grade 3 and MTD > 2 cm had LNM compared to those with EB FIGO Grade 1-2 and MTD ≤ 2 cm (43% vs, 11%, p=0.06). LNM was found in 15% of cases in which lymphadenectomy was performed based on current practices, whereas if the criteria of EB FIGO 3 and MTD > 2 cm were used the incidence of LNM would have been 44% cases. However, using this criterion, two patients would not have had their nodal metastases detected. Compared to the current practice, the sensitivity and specificity of the proposed criteria would be 60% and 81%, respectively. The PPV and NPV would be 43% and 90%, respectively. Conclusion: The results indicate that MTD combined with EB FIGO grade can detect LNM in a higher proportion of cases when compared to current practice. MTD combined with EB FIGO grade may eliminate the need of frozen section sampling in a substantial number of cases.

Keywords: endometrial cancer, FIGO grade, lymphadenectomy, tumor size

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