Search results for: Richard Patrick Kabuye
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 450

Search results for: Richard Patrick Kabuye

240 Assessing the Risk of Pressure Injury during Percutaneous Nephrolithotomy Using Pressure Mapping

Authors: Jake Tempo, Taylor Smithurst, Jen Leah, Skye Waddingham, Amanda Catlin, Richard Cetti

Abstract:

Introduction: Percutaneous nephrolithotomy (PCNL) is the gold-standard procedure for removing large or complex renal stones. Many operating positions can be used, and the debate over the ideal position continues. PCNL can be a long procedure during which patients can sustain pressure injuries. These injuries are often underreported in the literature. Interface pressure mapping records the pressure loading between a surface and the patient. High pressures with prolonged loading result in ischaemia, muscle deformation, and reperfusion which can cause skin breakdown and muscular injury. We compared the peak pressure indexes of common PCNL positions to identify positions which may be at high risk of pressure injuries. We hope the data can be used to adapt high-risk positions so that the PPI can be lessened by either adapting the positions or by using adjuncts to lower PPI. Materials and Methods: We placed a 23-year-old male subject in fourteen different PCNL positions while performing interface pressure mapping. The subject was 179 cm with a weight of 63.3 kg, BMI 19.8kg/m². Results: Supine positions had a higher mean PPI (119mmHg (41-137)) compared to prone positions (64mmHg (32-89)) (p=0.046 two tailed t-test). The supine flexed position with a bolster under the flank produced the highest PPI (194mmHg), and this was at the sacrum. Peak pressure indexes >100mmHg were recorded in eight PCNL positions. Conclusion: Supine PCNL positions produce higher PPI than prone PCNL positions. Our study shows where ‘at risk’ bony prominences are for each PCNL position. Surgeons must ensure these areas are protected during prolonged operations.

Keywords: PCNL, pressure ulcer, interface pressure mapping, surgery

Procedia PDF Downloads 59
239 Effect of Atrial Flutter on Alcoholic Cardiomyopathy

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

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

Keywords: alcoholic cardiomyopathy, atrial flutter, cardiomyopathy, arrhythmia

Procedia PDF Downloads 87
238 Community Engagement Policy for Decreasing Childhood Lead Poisoning in Philadelphia

Authors: Hasibe Caballero-Gomez, Richard Pepino

Abstract:

Childhood lead poisoning is an issue that continues to plague major U.S. cities. Lead poisoning has been linked to decreases in academic achievement and IQ at levels as low as 5 ug/dL. Despite efforts from the Philadelphia Health Department to curtail systemic childhood lead poisoning, children continue to be identified with elevated blood lead levels (EBLLs) above the CDC reference level for diagnosis. This problem disproportionately affects low-income Black communities. At the moment, remediation is costly, and with the current policies in place, comprehensive remediation seems unrealistic. This research investigates community engagement policy and the ways pre-exisiting resources in target communities can be adjusted to decrease childhood lead poisoning. The study was done with two methods: content analysis and case studies. The content analysis includes 12 interviews from stakeholders and five published policy recommendations. The case studies focus on Baltimore, Chicago, Rochester, and St. Louis, four cities with significant childhood lead poisoning. Target communities were identified by mapping five factors that indicate a higher risk for lead poisoning. Seven priority zipcodes were identified for the model developed in this study. For these urban centers, 28 policy solutions and suggestions were identified, with three being identified at least four times in the content analysis and case studies. These three solutions create an interdependent model that offers increased community awareness and engagement with the issue that could potentially improve health and social outcomes for at-risk children.

Keywords: at-risk populations, community engagement, environmental justice, policy translation

Procedia PDF Downloads 93
237 Design Study on a Contactless Material Feeding Device for Electro Conductive Workpieces

Authors: Oliver Commichau, Richard Krimm, Bernd-Arno Behrens

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A growing demand on the production rate of modern presses leads to higher stroke rates. Commonly used material feeding devices for presses like grippers and roll-feeding systems can only achieve high stroke rates along with high gripper forces, to avoid stick-slip. These forces are limited by the sensibility of the surfaces of the workpieces. Stick-slip leads to scratches on the surface and false positioning of the workpiece. In this paper, a new contactless feeding device is presented, which develops higher feeding force without damaging the surface of the workpiece through gripping forces. It is based on the principle of the linear induction motor. A primary part creates a magnetic field and induces eddy currents in the electrically conductive material. A Lorentz-Force applies to the workpiece in feeding direction as a mutual reaction between the eddy-currents and the magnetic induction. In this study, the FEA model of this approach is shown. The calculation of this model was used to identify the influence of various design parameters on the performance of the feeder and thus showing the promising capabilities and limits of this technology. In order to validate the study, a prototype of the feeding device has been built. An experimental setup was used to measure pulling forces and placement accuracy of the experimental feeder in order to give an outlook of a potential industrial application of this approach.

Keywords: conductive material, contactless feeding, linear induction, Lorentz-Force

Procedia PDF Downloads 158
236 Architecture - Performance Relationship in GPU Computing - Composite Process Flow Modeling and Simulations

Authors: Ram Mohan, Richard Haney, Ajit Kelkar

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Current developments in computing have shown the advantage of using one or more Graphic Processing Units (GPU) to boost the performance of many computationally intensive applications but there are still limits to these GPU-enhanced systems. The major factors that contribute to the limitations of GPU(s) for High Performance Computing (HPC) can be categorized as hardware and software oriented in nature. Understanding how these factors affect performance is essential to develop efficient and robust applications codes that employ one or more GPU devices as powerful co-processors for HPC computational modeling. This research and technical presentation will focus on the analysis and understanding of the intrinsic interrelationship of both hardware and software categories on computational performance for single and multiple GPU-enhanced systems using a computationally intensive application that is representative of a large portion of challenges confronting modern HPC. The representative application uses unstructured finite element computations for transient composite resin infusion process flow modeling as the computational core, characteristics and results of which reflect many other HPC applications via the sparse matrix system used for the solution of linear system of equations. This work describes these various software and hardware factors and how they interact to affect performance of computationally intensive applications enabling more efficient development and porting of High Performance Computing applications that includes current, legacy, and future large scale computational modeling applications in various engineering and scientific disciplines.

Keywords: graphical processing unit, software development and engineering, performance analysis, system architecture and software performance

Procedia PDF Downloads 332
235 In Vitro Antibacterial Activity of Selected Tanzania Medicinal Plants

Authors: Mhuji Kilonzo, Patrick Ndakidemi, Musa Chacha

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Objective: To evaluate antibacterial activity from four selected medicinal plants namely Mystroxylon aethiopicum, Lonchocarpus capassa, Albizia anthelmentica and Myrica salicifolia used for management of bacterial infection in Tanzania. Methods: Minimum Inhibitory Concentration (MIC) of plants extracts against the tested bacterial species was determined by using 96 wells microdilution method. In this method, 50 μL of nutrient broth were loaded in each well followed by 50 μL of extract (100 mg/mL) to make a final volume of 100 μL. Subsequently, 50 μL were transferred from first rows of each well to the second rows and the process was repeated down the columns to the last wells from which 50 μL were discarded. Thereafter, 50 μL of the selected bacterial suspension were added to each well thus making a final volume of 100 μL. The lowest concentration which showed no bacterial growth was considered as MIC. Results: It was revealed that L. capassa leaf ethyl acetate extract exhibited antibacterial activity against Salmonella kisarawe and Salmonella typhi with MIC values of 0.39 and 0.781 mg/mL respectively. Likewise, L. capassa root bark ethyl acetate extracts inhibited growth of S. typhi and E. coli with MIC values of 0.39 and 0.781 mg/mL respectively. The M. aethiopicum leaf and root bark chloroform extracts displayed antibacterial activity against S. kisarawe and S. typhi respectively with MIC value of 0.781 mg/mL. The M. salicifolia stem bark ethyl acetate exhibited antibacterial activity against P. aeruginosa with MIC value of 0.39 mg/mL whereas the methanolic stem and root bark of the same plant inhibited the growth of Proteus mirabilis and Klebsiella pneumoniae with MIC value of 0.781 mg/mL. Conclusion: It was concluded that M. aethiopicum, L. capassa, A. anthelmentica and M. salicifolia are potential source of antibacterial agents. Further studies to establish structures of antibacterial and evaluate active ingredients are recommended.

Keywords: Albizia anthelmentica, Lonchocarpus capassa, Mystroxylon aethiopicum, Myrica salicifolia

Procedia PDF Downloads 193
234 Gender Responsiveness of Water, Sanitation Policies and Legal Frameworks at Makerere University

Authors: Harriet Kebirungi, Majaliwa Jackson-Gilbert Mwanjalolo, S. Livingstone Luboobi, Richard Joseph Kimwaga, Consolata Kabonesa

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This paper assessed gender responsiveness of water and sanitation policies and legal frameworks at Makerere University, Uganda. The objectives of the study were to i) examine the gender responsiveness of water and sanitation related policies and frameworks implemented at Makerere University; and ii) assess the challenges faced by the University in customizing national water and sanitation policies and legal frameworks into University policies. A cross-sectional gender-focused study design was adopted. A checklist was developed to analyze national water and sanitation policies and legal frameworks and University based policies. In addition, primary data was obtained from Key informants at the Ministry of Water and Environment and Makerere University. A gender responsive five-step analytical framework was used to analyze the collected data. Key findings indicated that the policies did not adequately address issues of gender, water and sanitation and the policies were gender neutral consistently. The national policy formulation process was found to be gender blind and not backed by situation analysis of different stakeholders including higher education institutions like Universities. At Makerere University, due to lack of customized and gender responsive water and sanitation policy and implementation framework, there were gender differences and deficiencies in access to and utilization of water and sanitation facilities. The University should take advantage of existing expertise within them to customize existing national water policies and gender, and water and sanitation sub-sector strategy. This will help the University to design gender responsive, culturally acceptable and environmental friendly water and sanitation systems that provide adequate water and sanitation facilities that address the needs and interests of male and female students.

Keywords: gender, Makerere University, policies, water, sanitation

Procedia PDF Downloads 368
233 Contribution of Different Farming Systems to Soil and Ecological Health in Trans Nzoia County, Kenya

Authors: Janeth Chepkemoi, Richard Onwonga, Noel Templer, Elkana Kipkoech, Angela Gitau

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Conventional agriculture is one of the leading causes of land degradation, threatening the sustainability of food production. Organic farming promotes practices that have the potential of feeding the world while also promoting ecological health. A study was therefore carried out with the aim of conceptualizing how such farming systems are contributing to ecological health in Trans Nzoia County. 71 farmers were interviewed and data was collected on parameters such as land preparation, agroforestry, soil fertility management, soil and water conservation, and pests and diseases. A soil sample was also collected from each farm for laboratory analysis. Data collected were analyzed using Microsoft Excel and SPSS version 21. Results showed that 66% of the respondents practiced organic farming whereas 34% practiced conventional farming. Intercropping and crop rotations were the most common cropping systems and the most preferred land preparation tools among both organic and conventional farmers were tractors and hand hoes. Organic farms fared better in agroforestry, organic soil amendments, land and water conservation, and soil chemical properties. Pests and disease, however, affected organic farms more than conventional. The average nitrogen (%), K (Cmol/ kg and P (ppm) of organic soils were 0.26, 0.7 and 26.18 respectively, conventional soils were 0.21, 0.66 and 22.85. Soil organic carbon content of organic farms averaged a higher percentage of 2.07% as compared to 1.91 for the conventional. In conclusion, most farmers in Trans Nzoia County had transitioned into ecologically friendly farming practices that improved the quality and health of the soil and therefore promoted its sustainability.

Keywords: organic farming, conventional farming, ecological health, soil health

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232 Study of the Effect of the Contra-Rotating Component on the Performance of the Centrifugal Compressor

Authors: Van Thang Nguyen, Amelie Danlos, Richard Paridaens, Farid Bakir

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This article presents a study of the effect of a contra-rotating component on the efficiency of centrifugal compressors. A contra-rotating centrifugal compressor (CRCC) is constructed using two independent rotors, rotating in the opposite direction and replacing the single rotor of a conventional centrifugal compressor (REF). To respect the geometrical parameters of the REF one, two rotors of the CRCC are designed, based on a single rotor geometry, using the hub and shroud length ratio parameter of the meridional contour. Firstly, the first rotor is designed by choosing a value of length ratio. Then, the second rotor is calculated to be adapted to the fluid flow of the first rotor according aerodynamics principles. In this study, four values of length ratios 0.3, 0.4, 0.5, and 0.6 are used to create four configurations CF1, CF2, CF3, and CF4 respectively. For comparison purpose, the circumferential velocity at the outlet of the REF and the CRCC are preserved, which means that the single rotor of the REF and the second rotor of the CRCC rotate with the same speed of 16000rpm. The speed of the first rotor in this case is chosen to be equal to the speed of the second rotor. The CFD simulation is conducted to compare the performance of the CRCC and the REF with the same boundary conditions. The results show that the configuration with a higher length ratio gives higher pressure rise. However, its efficiency is lower. An investigation over the entire operating range shows that the CF1 is the best configuration in this case. In addition, the CRCC can improve the pressure rise as well as the efficiency by changing the speed of each rotor independently. The results of changing the first rotor speed show with a 130% speed increase, the pressure ratio rises of 8.7% while the efficiency remains stable at the flow rate of the design operating point.

Keywords: centrifugal compressor, contra-rotating, interaction rotor, vacuum

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231 In vitro Antioxidant Properties and Phytochemistry of Some Philippine Creeping Medicinal Plants

Authors: Richard I. Licayan, Aisle Janne B. Dagpin, Romeo M. Del Rosario, Nenita D. Palmes

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Hiptage benghalensis, Antigonon leptopus, Macroptillium atropurpureum, and Dioscorea bulbifera L. are herbal weeds that have been used by traditional healers in rural communities in the Philippines as medicine. In this study, the basic pharmacological components of the crude secondary metabolites extracted from the four herbal weeds and their in vitro antioxidant properties was investigated to provide baseline data for the possible development of these metabolites in pharmaceutical products. Qualitative screening of the secondary metabolites showed that alkaloids, tannins, saponins, steroids, and flavonoids were present in their leaf extracts. All of the plant extracts showed varied antioxidant activity. The greatest DPPH radical scavenging activity was observed in H. begnhalensis (84.64%), followed by A. leptopus (68.21%), M. atropurpureum (26.62%), and D. bulbifera L. (19.04%). The FRAP assay revealed that H. benghalensis had the highest antioxidant activity (8.32 mg/g) while ABTS assay showed that M. atropurpureum had the strongest scavenging ability of free radicals (0.0842 mg Trolox/g). The total flavonoid content (TFC) analysis showed that D. bulbifera L. had the highest TFC (420.35 mg quercetin per gram-dried material). The total phenolic content (TPC) of the four herbal weeds showed large variations, between 26.56±0.160 and 55.91±0.087 mg GAE/g dried material. The plant leaf extracts arranged in increasing values of TPC are H. benghalensis (26.565) < A. leptopus (37.29) < D. bulbifera L. (46.81) < M. atropurpureum (55.91). The obtained results may support their use in herbal medicine and as baseline data for the development of new drugs and standardized phytomedicines.

Keywords: antioxidant properties, total flavonoids, total phenolics, creeping herbal weeds

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230 Assessing the Feasibility of Commercial Meat Rabbit Production in the Kumasi Metropolis of Ghana

Authors: Nana Segu Acquaah-Harrison, James Osei Mensah, Richard Aidoo, David Amponsah, Amy Buah, Gilbert Aboagye

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The study aimed at assessing the feasibility of commercial meat rabbit production in the Kumasi Metropolis of Ghana. Structured and unstructured questionnaires were utilized in obtaining information from two hundred meat consumers and 15 meat rabbit farmers. Data were analyzed using Net Present Value (NPV), Internal Rate of Return (IRR), Benefit Cost Ratio (BCR)/Profitability Index (PI) technique, percentages and chi-square contingency test. The study found that the current demand for rabbit meat is low (36%). The desirable nutritional attributes of rabbit meat and other socio economic factors of meat consumers make the potential demand for rabbit meat high (69%). It was estimated that GH¢5,292 (approximately $ 2672) was needed as a start-up capital for a 40-doe unit meat rabbit farm in Kumasi Metropolis. The cost of breeding animals, housing and equipment formed 12.47%, 53.97% and 24.87% respectively of the initial estimated capital. A Net Present Value of GH¢ 5,910.75 (approximately $ 2984) was obtained at the end of the fifth year, with an internal rate return and profitability index of 70% and 1.12 respectively. The major constraints identified in meat rabbit production were low price of rabbit meat, shortage of fodder, pest and diseases, high cost of capital, high cost of operating materials and veterinary care. Based on the analysis, it was concluded that meat rabbit production is feasible in the Kumasi Metropolis of Ghana. The study recommends embarking on mass advertisement; farmer association and adapting to new technologies in the production process will help to enhance productivity.

Keywords: feasibility, commercial meat rabbit, production, Kumasi, Ghana

Procedia PDF Downloads 93
229 Role of ABC Transporters in Non-Target Site Herbicide Resistance in Black Grass (Alopecurus myosuroides)

Authors: Alina Goldberg Cavalleri, Sara Franco Ortega, Nawaporn Onkokesung, Richard Dale, Melissa Brazier-Hicks, Robert Edwards

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Non-target site based resistance (NTSR) to herbicides in weeds is a polygenic trait associated with the upregulation of proteins involved in xenobiotic detoxification and translocation we have termed the xenome. Among the xenome proteins, ABC transporters play a key role in enhancing herbicide metabolism by effluxing conjugated xenobiotics from the cytoplasm into the vacuole. The importance of ABC transporters is emphasized by the fact that they often contribute to multidrug resistance in human cells and antibiotic resistance in bacteria. They also play a key role in insecticide resistance in major vectors of human diseases and crop pests. By surveying available databases, transcripts encoding ABCs have been identified as being enhanced in populations exhibiting NTSR in several weed species. Based on a transcriptomics data in black grass (Alopecurus myosuroides, Am), we have identified three proteins from the ABC-C subfamily that are upregulated in NTSR populations. ABC-C transporters are poorly characterized proteins in plants, but in Arabidopsis localize to the vacuolar membrane and have functional roles in transporting glutathionylated (GSH)-xenobiotic conjugates. We found that the up-regulation of AmABCs strongly correlates with the up-regulation of a glutathione transferase termed AmGSTU2, which can conjugate GSH to herbicides. The expression profile of the ABC transcripts was profiled in populations of black grass showing different degree of resistance to herbicides. This, together with a phylogenetic analysis, revealed that AmABCs cluster in different groups which might indicate different substrate and roles in the herbicide resistance phenotype in the different populations

Keywords: black grass, herbicide, resistance, transporters

Procedia PDF Downloads 125
228 DOG1 Expression Is in Common Human Tumors: A Tissue Microarray Study on More than 15,000 Tissue Samples

Authors: Kristina Jansen, Maximilian Lennartz, Patrick Lebok, Guido Sauter, Ronald Simon, David Dum, Stefan Steurer

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DOG1 (Discovered on GIST1) is a voltage-gated calcium-activated chloride and bicarbonate channel that is highly expressed in interstitial cells of Cajal and in gastrointestinal stromal tumors (GIST) derived from Cajal cells. To systematically determine in what tumor entities and normal tissue types DOG1 may be further expressed, a tissue microarray (TMA) containing 15,965 samples from 121 different tumor types and subtypes as well as 608 samples of 76 different normal tissue types were analyzed by immunohistochemistry. DOG1 immunostaining was found in 67 tumor types, including GIST (95.7%), esophageal squamous cell carcinoma (31.9%), pancreatic ductal adenocarcinoma (33.6%), adenocarcinoma of the Papilla Vateri (20%), squamous cell carcinoma of the vulva (15.8%) and the oral cavity (15.3%), mucinous ovarian cancer (15.3%), esophageal adenocarcinoma (12.5%), endometrioid endometrial cancer (12.1%), neuroendocrine carcinoma of the colon (11.1%) and diffuse gastric adenocarcinoma (11%). Low level-DOG1 immunostaining was seen in 17 additional tumor entities. DOG1 expression was unrelated to histopathological parameters of tumor aggressiveness and/or patient prognosis in cancers of the breast (n=1,002), urinary bladder (975), ovary (469), endometrium (173), stomach (233), and thyroid gland (512). High DOG1 expression was linked to estrogen receptor expression in breast cancer (p<0.0001) and the absence of HPV infection in squamous cell carcinomas (p=0.0008). In conclusion, our data identify several tumor entities that can show DOG1 expression levels at similar levels as in GIST. Although DOG1 is tightly linked to a diagnosis of GIST in spindle cell tumors, the differential diagnosis is much broader in DOG1 positive epithelioid neoplasms.

Keywords: biomarker, DOG1, immunohistochemistry, tissue microarray

Procedia PDF Downloads 178
227 Next Generation UK Storm Surge Model for the Insurance Market: The London Case

Authors: Iacopo Carnacina, Mohammad Keshtpoor, Richard Yablonsky

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Non-structural protection measures against flooding are becoming increasingly popular flood risk mitigation strategies. In particular, coastal flood insurance impacts not only private citizens but also insurance and reinsurance companies, who may require it to retain solvency and better understand the risks they face from a catastrophic coastal flood event. In this context, a framework is presented here to assess the risk for coastal flooding across the UK. The area has a long history of catastrophic flood events, including the Great Flood of 1953 and the 2013 Cyclone Xaver storm, both of which led to significant loss of life and property. The current framework will leverage a technology based on a hydrodynamic model (Delft3D Flexible Mesh). This flexible mesh technology, coupled with a calibration technique, allows for better utilisation of computational resources, leading to higher resolution and more detailed results. The generation of a stochastic set of extra tropical cyclone (ETC) events supports the evaluation of the financial losses for the whole area, also accounting for correlations between different locations in different scenarios. Finally, the solution shows a detailed analysis for the Thames River, leveraging the information available on flood barriers and levees. Two realistic disaster scenarios for the Greater London area are simulated: In the first scenario, the storm surge intensity is not high enough to fail London’s flood defences, but in the second scenario, London’s flood defences fail, highlighting the potential losses from a catastrophic coastal flood event.

Keywords: storm surge, stochastic model, levee failure, Thames River

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226 Developing a Spatial Transport Model to Determine Optimal Routes When Delivering Unprocessed Milk

Authors: Sunday Nanosi Ndovi, Patrick Albert Chikumba

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In Malawi, smallholder dairy farmers transport unprocessed milk to sell at Milk Bulking Groups (MBGs). MBGs store and chill the milk while awaiting collection by processors. The farmers deliver milk using various modes of transportation such as foot, bicycle, and motorcycle. As a perishable food, milk requires timely transportation to avoid deterioration. In other instances, some farmers bypass the nearest MBGs for facilities located further away. Untimely delivery worsens quality and results in rejection at MBG. Subsequently, these rejections lead to revenue losses for dairy farmers. Therefore, the objective of this study was to optimize routes when transporting milk by selecting the shortest route using time as a cost attribute in Geographic Information Systems (GIS). A spatially organized transport system impedes milk deterioration while promoting profitability for dairy farmers. A transportation system was modeled using Route Analysis and Closest Facility network extensions. The final output was to find the quickest routes and identify the nearest milk facilities from incidents. Face-to-face interviews targeted leaders from all 48 MBGs in the study area and 50 farmers from Namahoya MBG. During field interviews, coordinates were captured in order to create maps. Subsequently, maps supported the selection of optimal routes based on the least travel times. The questionnaire targeted 200 respondents. Out of the total, 182 respondents were available. Findings showed that out of the 50 sampled farmers that supplied milk to Namahoya, only 8% were nearest to the facility, while 92% were closest to 9 different MBGs. Delivering milk to the nearest MBGs would minimize travel time and distance by 14.67 hours and 73.37 km, respectively.

Keywords: closest facility, milk, route analysis, spatial transport

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225 Molecular Identification and Evolutionary Status of Lucilia bufonivora: An Obligate Parasite of Amphibians in Europe

Authors: Gerardo Arias, Richard Wall, Jamie Stevens

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Lucilia bufonivora Moniez, is an obligate parasite of toads and frogs widely distributed in Europe. Its sister taxon Lucilia silvarum Meigen behaves mainly as a carrion breeder in Europe, however it has been reported as a facultative parasite of amphibians. These two closely related species are morphologically almost identical, which has led to misidentification, and in fact, it has been suggested that the amphibian myiasis cases by L. silvarum reported in Europe should be attributed to L. bufonivora. Both species remain poorly studied and their taxonomic relationships are still unclear. The identification of the larval specimens involved in amphibian myiasis with molecular tools and phylogenetic analysis of these two closely related species may resolve this problem. In this work seventeen unidentified larval specimens extracted from toad myiasis cases of the UK, the Netherlands and Switzerland were obtained, their COX1 (mtDNA) and EF1-α (Nuclear DNA) gene regions were amplified and then sequenced. The 17 larval samples were identified with both molecular markers as L. bufonivora. Phylogenetic analysis was carried out with 10 other blowfly species, including L. silvarum samples from the UK and USA. Bayesian Inference trees of COX1 and a combined-gene dataset suggested that L. silvarum and L. bufonivora are separate sister species. However, the nuclear gene EF1-α does not appear to resolve their relationships, suggesting that the rates of evolution of the mtDNA are much faster than those of the nuclear DNA. This work provides the molecular evidence for successful identification of L. bufonivora and a molecular analysis of the populations of this obligate parasite from different locations across Europe. The relationships with L. silvarum are discussed.

Keywords: calliphoridae, molecular evolution, myiasis, obligate parasitism

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224 Food Insecurity and Mental Health among Adolescents in Southwest Ethiopia: Structural Equation Modeling Analysis

Authors: Mulusew G. Jebena, David Lindstrom, Tefera Belachew, Craig Hadley, Carl Lachat, Patrick Kolsteren

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Background: The biological and psychosocial consequence of food insecurity on physical health and nutritional status has been reported. But, its effect on mental health during adolescence remains unexplored. Thus, the main aim of this analysis is to examine the mechanism by which food insecurity is linked to mental health among adolescents living in Jimma, Southwest Ethiopia. Methods: We used data from third round observation of Jimma Longitudinal Family and Youth Survey (JLFSY). A total of 1,521 adolescents included for the main analysis. Food insecurity was measured using 5-items scale and The Self Reporting Questionnaire (SRQ-20) was used to measure mental distress. Structural equation modeling analysis was done using maximum likelihood estimation method. Model diagnostics test was reported. All p values were two tailed and P value ≤ 0.05 was used to determine statistical significance. Results: The prevalence of mental distress was 20.8%, 95% CI: (18.8, 22.9). After adjusted for covariates, the final model depicts food insecurity was associated with adolescent mental distress (β=.324). This analysis showed 94.1% of the effect of food insecurity on mental distress is direct. By contrast, 5.9% of the food insecurity effect is mediated by physical health. In addition, Self-rated health (β=.356), socioeconomic status (β=-.078) parental educational (β= .170), living in urban (β= .193) and female headed household (β=.205) were associated with adolescent mental distress. Conclusions: This finding highlights the direct effect of food insecurity on adolescent mental distress. Therefore, any intervention aimed to improve mental distress of adolescents should consider strategies to improve access to sufficient, safe, and nutritious food. Beside this, prevention of underlying factors such as psychosomatic health illness and improving socio economic status is also very critical. Furthermore longitudinal relationship of the long term effect of food insecurity on mental health should be investigated.

Keywords: adolescent, Ethiopia, food insecurity, mental health

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223 Sustainable Renovation of Cultural Buildings Case Study: Red Bay National Historic Site, Canada

Authors: Richard Briginshaw, Hana Alaojeli, Javaria Ahmad, Hamza Gaffar, Nourtan Murad

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Sustainable renovations to cultural buildings and sites require a high level of competency in the sometimes conflicting areas of social/historical demands, environmental concerns, and the programmatic and technical requirements of the project. A detailed analysis of the existing site, building and client program are critical to reveal both challenges and opportunities. This forms the starting point for the design process – empirical explorations that search for a balanced and inspired architectural solution to the project. The Red Bay National Historic Site on the Labrador Coast of eastern Canada is a challenging project to explore and resolve these ideas. Originally the site of a 16ᵗʰ century whaling station occupied by Basque sailors from France and Spain, visitors now experience this history at the interpretive center, along with the unique geography, climate, local culture and vernacular architecture of the area. Working with our client, Parks Canada, the project called for significant alterations and expansion to the existing facility due to an increase in the number of annual visitors. Sustainable aspects of the design are focused on sensitive site development, passive energy strategies such as building orientation and building envelope efficiency, active renewable energy systems, carefully considered material selections, water efficiency, and interiors that respond to human comfort and a unique visitor experience.

Keywords: sustainability, renovations and expansion, cultural project, architectural design, green building

Procedia PDF Downloads 146
222 Association among Trait Mindfulness, Leukocyte Telomere Length, and Psychological Symptoms in Singaporean Han Chinese

Authors: Shian-Ling Keng, Onn Siong Yim, Poh San Lai, Soo Chong Chew, Anne Chong, Richard Ebstein

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Research has demonstrated a positive association between mindfulness meditation and physical health. Little work, however, has examined the association between trait mindfulness and leukocyte telomere length (LTL), an emerging marker of cellular aging. The present study aimed to examine whether facets of trait mindfulness are correlated with longer LTL in a Singaporean Han Chinese sample and whether these facets may mediate the association between psychological symptoms and LTL. 158 adults (mean age = 27.24 years) completed measures assessing trait mindfulness and psychological symptoms (i.e., depression and stress) and provided blood samples for analyses of LTL using qPCR. Multiple regression analyses were conducted to assess the association between facets of trait mindfulness and LTL. Bootstrapping-based mediational analyses were run to examine the role of trait mindfulness as a mediator of the association between psychological symptoms and LTL. Of five facets of trait mindfulness (describe, act with awareness, observe, nonreactivity, and nonjudging), nonreactivity was significantly associated with LTL, after controlling for the effects of age, gender, and education, β = .21, p = .006. Further, there was a trend for overall trait mindfulness, β = .15, p = .06, and nonjudging, β = .13, p = .095, to each predict longer LTL. Nonreactivity significantly mediated the association between depression and LTL, BCa 95% CI [-.004, -.0004], p=.03, as well as the association between stress and LTL, BCa 95% CI [-.004, -.0004], p=.04. The results provide preliminary evidence for a positive association between selected facets of trait mindfulness and slower cellular aging, indexed by LTL. The findings suggest that individuals who are high on equanimity may experience slower aging at the cellular level, presumably through engaging in more effective coping mechanisms and modulation of stress. The findings also highlight the role of nonreactivity as a potential mechanism that underlies the association between LTL and psychological symptoms.

Keywords: depression, mindfulness, stress, telomere length

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221 A Combinatorial Approach of Treatment for Landfill Leachate

Authors: Anusha Atmakuri, R. D. Tyagi, Patrick Drogui

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Landfilling is the most familiar and easy way to dispose solid waste. Landfill is generally received via wastes from municipal near to a landfill. The waste collected is from commercial, industrial, and residential areas and many more. Landfill leachate (LFL) is formed when rainwater passes through the waste placed in landfills and consists of several dissolved organic materials, for instance, aquatic humic substances (AHS), volatile fatty acids (VFAs), heavy metals, inorganic macro components, and xenobiotic organic matters, highly toxic to the environment. These components of LFL put a load on it, hence it necessitates the treatment of LFL prior to its discharge into the environment. Various methods have been used to treat LFL over the years, such as physical, chemical, biological, physicochemical, electrical, and advanced oxidation methods. This study focuses on the combination of biological and electrochemical methods- extracellular polymeric substances and electrocoagulation(EC). The coupling of electro-coagulation process with extracellular polymeric substances (EPS) (as flocculant) as pre and\or post treatment strategy provides efficient and economical process for the decontamination of landfill leachate contaminated with suspended matter, metals (e.g., Fe, Mn) and ammonical nitrogen. Electro-coagulation and EPS mediated coagulation approach could be an economically viable for the treatment of landfill leachate, along with possessing several other advantages over several other methods. This study utilised waste substrates such as activated sludge, crude glycerol and waste cooking oil for the production of EPS using fermentation technology. A comparison of different scenarios for the treatment of landfill leachate is presented- such as using EPS alone as bioflocculant, EPS and EC with EPS being the 1st stage, and EPS and EC with EC being the 1st stage. The work establishes the use of crude EPS as a bioflocculant for the treatment of landfill leachate and wastewater from a site near a landfill, along with EC being successful in removal of some major pollutants such as COD, turbidity, total suspended solids. A combination of these two methods is to be explored more for the complete removal of all pollutants from landfill leachate.

Keywords: landfill leachate, extracellular polymeric substances, electrocoagulation, bioflocculant.

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220 Holographic Visualisation of 3D Point Clouds in Real-time Measurements: A Proof of Concept Study

Authors: Henrique Fernandes, Sofia Catalucci, Richard Leach, Kapil Sugand

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Background: Holograms are 3D images formed by the interference of light beams from a laser or other coherent light source. Pepper’s ghost is a form of hologram conceptualised in the 18th century. This Holographic visualisation with metrology measuring techniques by displaying measurements taken in real-time in holographic form can assist in research and education. New structural designs such as the Plexiglass Stand and the Hologram Box can optimise the holographic experience. Method: The equipment used included: (i) Zeiss’s ATOS Core 300 optical coordinate measuring instrument that scanned real-world objects; (ii) Cloud Compare, open-source software used for point cloud processing; and (iii) Hologram Box, designed and manufactured during this research to provide the blackout environment needed to display 3D point clouds in real-time measurements in holographic format, in addition to a portability aspect to holograms. The equipment was tailored to realise the goal of displaying measurements in an innovative technique and to improve on conventional methods. Three test scans were completed before doing a holographic conversion. Results: The outcome was a precise recreation of the original object in the holographic form presented with dense point clouds and surface density features in a colour map. Conclusion: This work establishes a way to visualise data in a point cloud system. To our understanding, this is a work that has never been attempted. This achievement provides an advancement in holographic visualisation. The Hologram Box could be used as a feedback tool for measurement quality control and verification in future smart factories.

Keywords: holography, 3D scans, hologram box, metrology, point cloud

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219 Security in Cyberspace: A Comprehensive Review of COVID-19 Continued Effects on Security Threats and Solutions in 2021 and the Trajectory of Cybersecurity Going into 2022

Authors: Mojtaba Fayaz, Richard Hallal

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This study examines the various types of dangers that our virtual environment is vulnerable to, including how it can be attacked and how to avoid/secure our data. The terrain of cyberspace is never completely safe, and Covid- 19 has added to the confusion, necessitating daily periodic checks and evaluations. Cybercriminals have been able to enact with greater skill and undertake more conspicuous and sophisticated attacks while keeping a higher level of finesse by operating from home. Different types of cyberattacks, such as operation-based attacks, authentication-based attacks, and software-based attacks, are constantly evolving, but research suggests that software-based threats, such as Ransomware, are becoming more popular, with attacks expected to increase by 93 percent by 2020. The effectiveness of cyber frameworks has shifted dramatically as the pandemic has forced work and private life to become intertwined, destabilising security overall and creating a new front of cyber protection for security analysis and personal. The high-rise formats in which cybercrimes are carried out, as well as the types of cybercrimes that exist, such as phishing, identity theft, malware, and DDoS attacks, have created a new front of cyber protection for security analysis and personal safety. The overall strategy for 2022 will be the introduction of frameworks that address many of the issues associated with offsite working, as well as education that provides better information about commercialised software that does not provide the highest level of security for home users, allowing businesses to plan better security around their systems.

Keywords: cyber security, authentication, software, hardware, malware, COVID-19, threat actors, awareness, home users, confidentiality, integrity, availability, attacks

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218 Excited State Structural Dynamics of Retinal Isomerization Revealed by a Femtosecond X-Ray Laser

Authors: Przemyslaw Nogly, Tobias Weinert, Daniel James, Sergio Carbajo, Dmitry Ozerov, Antonia Furrer, Dardan Gashi, Veniamin Borin, Petr Skopintsev, Kathrin Jaeger, Karol Nass, Petra Bath, Robert Bosman, Jason Koglin, Matthew Seaberg, Thomas Lane, Demet Kekilli, Steffen Brünle, Tomoyuki Tanaka, Wenting Wu, Christopher Milne, Thomas A. White, Anton Barty, Uwe Weierstall, Valerie Panneels, Eriko Nango, So Iwata, Mark Hunter, Igor Schapiro, Gebhard Schertler, Richard Neutze, Jörg Standfuss

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Ultrafast isomerization of retinal is the primary step in a range of photoresponsive biological functions including vision in humans and ion-transport across bacterial membranes. We studied the sub-picosecond structural dynamics of retinal isomerization in the light-driven proton pump bacteriorhodopsin using an X-ray laser. Twenty snapshots with near-atomic spatial and temporal resolution in the femtosecond regime show how the excited all-trans retinal samples conformational states within the protein binding pocket prior to passing through a highly-twisted geometry and emerging in the 13-cis conformation. The aspartic acid residues and functional water molecules in proximity of the retinal Schiff base respond collectively to formation and decay of the initial excited state and retinal isomerization. These observations reveal how the protein scaffold guides this remarkably efficient photochemical reaction.

Keywords: bacteriorhodopsin, free-electron laser, retinal isomerization mechanism, time-resolved crystallography

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217 A Reminder of a Rare Anatomical Variant of the Spinal Accessory Nerve Encountered During Routine Neck Dissection: A Case Report and Updated Review of the Literature

Authors: Sophie Mills, Constantinos Aristotelous, Leila L. Touil, Richard C. W. James

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Objectives: Historical studies of the anatomy of the spinal accessory nerve (SAN) have reported conflicting results regarding its relationship with the internal jugular vein (IJV). A literature review was undertaken to establish the prevalence of anatomical variations of the SAN encountered during routine neck dissection surgery in order to increase awareness and reduce morbidity associated with iatrogenic SAN injury. Materials and Methods: The largest systematic review to date was performed using PRISMA-ScR guidelines, which yielded nine articles following the application of inclusion and exclusion criteria. A case report is also included, which demonstrates the rare anatomical relationship of the SAN traversing a fenestrated IJV, seen for the first time in the senior author’s career. Results: The mean number of dissections per study was 119, of which 55.6% (n=5) studies were performed on cadaver subjects, and 44.4% (n=4) were surgical dissections. Incidences of the SAN lateral to the IJV and medial to the IJV ranged from 38.9%-95.7% and 2.8%-57.4%, respectively. Over half of the studies reported incidences of the SAN traversing the IJV in 0.9%-2.8% of dissections. One study reported an isolated variant of the SAN dividing around the IJV with a prevalence of 0.5%. Conclusion: At the level of the posterior belly of the digastric muscle, the surgeon can anticipate the identification of the SAN lateral to the IJV in approximately three-quarters of cases, whilst around one-quarter are estimated to be medial. A mean of 1.6% of SANs traverses a fenestration of the vein. It is essential for surgeons to be aware of these anatomical variations and their prevalence to prevent injury to vital structures during surgery.

Keywords: anatomical variant, internal jugular vein, neck dissection, spinal accessory nerve

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216 A Linearly Scalable Family of Swapped Networks

Authors: Richard Draper

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A supercomputer can be constructed from identical building blocks which are small parallel processors connected by a network referred to as the local network. The routers have unused ports which are used to interconnect the building blocks. These connections are referred to as the global network. The address space has a global and a local component (g, l). The conventional way to connect the building blocks is to connect (g, l) to (g’,l). If there are K blocks, this requires K global ports in each router. If a block is of size M, the result is a machine with KM routers having diameter two. To increase the size of the machine to 2K blocks, each router connects to only half of the other blocks. The result is a larger machine but also one with greater diameter. This is a crude description of how the network of the CRAY XC® is designed. In this paper, a family of interconnection networks using routers with K global and M local ports is defined. Coordinates are (c,d, p) and the global connections are (c,d,p)↔(c’,p,d) which swaps p and d. The network is denoted D3(K,M) and is called a Swapped Dragonfly. D3(K,M) has KM2 routers and has diameter three, regardless of the size of K. To produce a network of size KM2 conventionally, diameter would be an increasing function of K. The family of Swapped Dragonflies has other desirable properties: 1) D3(K,M) scales linearly in K and quadratically in M. 2) If L < K, D3(K,M) contains many copies of D3(L,M). 3) If L < M, D3(K,M) contains many copies of D3(K,L). 4) D3(K,M) can perform an all-to-all exchange in KM2+KM time which is only slightly more than the time to do a one-to-all. This paper makes several contributions. It is the first time that a swap has been used to define a linearly scalable family of networks. Structural properties of this new family of networks are thoroughly examined. A synchronizing packet header is introduced. It specifies the path to be followed and it makes it possible to define highly parallel communication algorithm on the network. Among these is an all-to-all exchange in time KM2+KM. To demonstrate the effectiveness of the swap properties of the network of the CRAY XC® and D3(K,16) are compared.

Keywords: all-to-all exchange, CRAY XC®, Dragonfly, interconnection network, packet switching, swapped network, topology

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215 The Prodomain-Bound Form of Bone Morphogenetic Protein 10 is Biologically Active on Endothelial Cells

Authors: Austin Jiang, Richard M. Salmon, Nicholas W. Morrell, Wei Li

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BMP10 is highly expressed in the developing heart and plays essential roles in cardiogenesis. BMP10 deletion in mice results in embryonic lethality due to impaired cardiac development. In adults, BMP10 expression is restricted to the right atrium, though ventricular hypertrophy is accompanied by increased BMP10 expression in a rat hypertension model. However, reports of BMP10 activity in the circulation are inconclusive. In particular it is not known whether in vivo secreted BMP10 is active or whether additional factors are required to achieve its bioactivity. It has been shown that high-affinity binding of the BMP10 prodomain to the mature ligand inhibits BMP10 signaling activity in C2C12 cells, and it was proposed that prodomain-bound BMP10 (pBMP10) complex is latent. In this study, we demonstrated that the BMP10 prodomain did not inhibit BMP10 signaling activity in multiple endothelial cells, and that recombinant human pBMP10 complex, expressed in mammalian cells and purified under native conditions, was fully active. In addition, both BMP10 in human plasma and BMP10 secreted from the mouse right atrium were fully active. Finally, we confirmed that active BMP10 secreted from mouse right atrium was in the prodomain-bound form. Our data suggest that circulating BMP10 in adults is fully active and that the reported vascular quiescence function of BMP10 in vivo is due to the direct activity of pBMP10 and does not require an additional activation step. Moreover, being an active ligand, recombinant pBMP10 may have therapeutic potential as an endothelial-selective BMP ligand, in conditions characterized by loss of BMP9/10 signaling.

Keywords: bone morphogenetic protein 10 (BMP10), endothelial cell, signal transduction, transforming growth factor beta (TGF-B)

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214 The Methanotrophic Activity in a Landfill Bio-Cover through a Subzero Winter

Authors: Parvin Berenjkar, Qiuyan Yuan, Richard Sparling, Stan Lozecznik

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Landfills highly contribute to anthropological global warming through CH₄ emissions. Landfills are usually capped by a conventional soil cover to control the migration of gases. Methane is consumed by CH₄-oxidizing microorganisms known as methanotrophs that naturally exist in the landfill soil cover. The growth of methanotrophs can be optimized in a bio-cover that typically consists of a gas distribution layer (GDL) to homogenize landfill gas fluxes and an overlying oxidation layer composed of suitable materials that support methanotrophic populations. Materials such as mature yard waste composts can provide an inexpensive and favourable porous support for the growth and activity of methanotrophs. In areas with seasonal cold climates, it is valuable to know if methanotrophs in a bio-cover can survive in winter until the next spring, and how deep they are active in the bio-cover to mitigate CH₄. In this study, a pilot bio-cover was constructed in a closed landfill cell in Winnipeg that has a very cold climate in Canada. The bio-cover has a surface area of 2.5 m x 3.5 m and 1.5 m of depth, filled with 50 cm of gravel as a GDL and 70 cm of biosolids compost amended with yard and leaf waste compost. The observed in situ potential of methanotrophs for CH₄ oxidation was investigated at a specific period of time from December 2016 to April 2017 as well as November 2017 to April 2018, when the transition to surface frost and thawing happens in the bio-cover. Compost samples taken from different depths of the bio-cover were incubated in the laboratory under standardized conditions; an optimal air: methane atmosphere, at 22ºC, but at in situ moisture content. Results showed that the methanotrophs were alive oxidizing methane without a lag, indicating that there was the potential for methanotrophic activity at some depths of the bio-cover.

Keywords: bio-cover, global warming, landfill, methanotrophic activity

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213 Polymer Mixing in the Cavity Transfer Mixer

Authors: Giovanna Grosso, Martien A. Hulsen, Arash Sarhangi Fard, Andrew Overend, Patrick. D. Anderson

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In many industrial applications and, in particular in polymer industry, the quality of mixing between different materials is fundamental to guarantee the desired properties of finished products. However, properly modelling and understanding polymer mixing often presents noticeable difficulties, because of the variety and complexity of the physical phenomena involved. This is the case of the Cavity Transfer Mixer (CTM), for which a clear understanding of mixing mechanisms is still missing, as well as clear guidelines for the system optimization. This device, invented and patented by Gale at Rapra Technology Limited, is an add-on to be mounted downstream of existing extruders, in order to improve distributive mixing. It consists of two concentric cylinders, the rotor and stator, both provided with staggered rows of hemispherical cavities. The inner cylinder (rotor) rotates, while the outer (stator) remains still. At the same time, the pressure load imposed upstream, pushes the fluid through the CTM. Mixing processes are driven by the flow field generated by the complex interaction between the moving geometry, the imposed pressure load and the rheology of the fluid. In such a context, the present work proposes a complete and accurate three dimensional modelling of the CTM and results of a broad range of simulations assessing the impact on mixing of several geometrical and functioning parameters. Among them, we find: the number of cavities per row, the number of rows, the size of the mixer, the rheology of the fluid and the ratio between the rotation speed and the fluid throughput. The model is composed of a flow part and a mixing part: a finite element solver computes the transient velocity field, which is used in the mapping method implementation in order to simulate the concentration field evolution. Results of simulations are summarized in guidelines for the device optimization.

Keywords: Mixing, non-Newtonian fluids, polymers, rheology.

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212 A Comparison of Clinical and Pathological TNM Staging in a COVID-19 Era

Authors: Sophie Mills, Leila L. Touil, Richard Sisson

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Introduction: The TNM classification is the global standard for the staging of head and neck cancers. Accurate clinical-radiological staging of tumours (cTNM) is essential to predict prognosis, facilitate surgical planning and determine the need for other therapeutic modalities. This study aims to determine the accuracy of pre-operative cTNM staging using pathological TNM (pTNM) and consider possible causes of TNM stage migration, noting any variation throughout the COVID-19 pandemic. Materials and Methods: A retrospective cohort study examined records of patients with surgical management of head and neck cancer at a tertiary head and neck centre from November 2019 to November 2020. Data was extracted from Somerset Cancer Registry and histopathology reports. cTNM and pTNM were compared before and during the first wave of COVID-19, as well as with other potential prognostic factors such as tumour site and tumour stage. Results: 119 cases were identified, of which 52.1% (n=62) were male, and 47.9% (n=57) were female with a mean age of 67 years. Clinical and pathological staging differed in 54.6% (n=65) of cases. Of the patients with stage migration, 40.4% (n=23) were up-staged and 59.6% (n=34) were down-staged compared with pTNM. There was no significant difference in the accuracy of cTNM staging compared with age, sex, or tumour site. There was a statistically highly significant (p < 0.001) correlation between cTNM accuracy and tumour stage, with the accuracy of cTNM staging decreasing with the advancement of pTNM staging. No statistically significant variation was noted between patients staged prior to and during COVID-19. Conclusions: Discrepancies in staging can impact management and outcomes for patients. This study found that the higher the pTNM, the more likely stage migration will occur. These findings are concordant with the oncology literature, which highlights the need to improve the accuracy of cTNM staging for more advanced tumours.

Keywords: COVID-19, head and neck cancer, stage migration, TNM staging

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211 Free Will and Compatibilism in Decision Theory: A Solution to Newcomb’s Paradox

Authors: Sally Heyeon Hwang

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Within decision theory, there are normative principles that dictate how one should act in addition to empirical theories of actual behavior. As a normative guide to one’s actual behavior, evidential or causal decision-theoretic equations allow one to identify outcomes with maximal utility values. The choice that each person makes, however, will, of course, differ according to varying assignments of weight and probability values. Regarding these different choices, it remains a subject of considerable philosophical controversy whether individual subjects have the capacity to exercise free will with respect to the assignment of probabilities, or whether instead the assignment is in some way constrained. A version of this question is given a precise form in Richard Jeffrey’s assumption that free will is necessary for Newcomb’s paradox to count as a decision problem. This paper will argue, against Jeffrey, that decision theory does not require the assumption of libertarian freedom. One of the hallmarks of decision-making is its application across a wide variety of contexts; the implications of a background assumption of free will is similarly varied. One constant across the contexts of decision is that there are always at least two levels of choice for a given agent, depending on the degree of prior constraint. Within the context of Newcomb’s problem, when the predictor is attempting to guess the choice the agent will make, he or she is analyzing the determined aspects of the agent such as past characteristics, experiences, and knowledge. On the other hand, as David Lewis’ backtracking argument concerning the relationship between past and present events brings to light, there are similarly varied ways in which the past can actually be dependent on the present. One implication of this argument is that even in deterministic settings, an agent can have more free will than it may seem. This paper will thus argue against the view that a stable background assumption of free will or determinism in decision theory is necessary, arguing instead for a compatibilist decision theory yielding a novel treatment of Newcomb’s problem.

Keywords: decision theory, compatibilism, free will, Newcomb’s problem

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