Search results for: transfer function
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 7298

Search results for: transfer function

1478 Adaptive Reuse of Lost Urban Space

Authors: Rana Sameeh

Abstract:

The city is the greatest symbol of human civilization and has been built for safety and comfort. However, uncontrolled urban growth caused some anonymous and unsightly images of the cities such as unused or abandoned spaces. When social interaction is missed in a public space it means the public space is lost since public spaces reflect the social life and interaction of people. Accordingly; this space became one of the most meaningless parts of the cities and has broken the continuity of the urban fabric. Lost urban spaces are the leftover unstructured landscape within the urban fabric. They are generally the unrecognized urban areas that are in need of redesign, since they have a great value that can add to their surrounding urban context. The research significance lies within the importance of urban open spaces, their value and their impact on the urban fabric. The research also addresses the reuse and reclamation of lost urban spaces in order to increase the percentage of green areas along the urban fabric, provide urban open spaces, develop a sustainable approach towards urban landscape and enhance the quality of the public open space and user experience. In addition, the reuse of lost space will give it the identity and function it lacks while also providing places for presence, spending time and observing. Creating continuity in a broken urban fabric represents an exploratory process in the relationship between infrastructure and the urban fabric and seeks to establish an architectural solution to leftover space within the city. In doing so, the research establishes a framework (criteria) for adaptive reuse of lost urban space throughout inductive and deductive methodology, analytical methodology; by analyzing some relevant examples and similar cases of lost spaces and finally through field methodology; by applying the achieved criteria on a case study in Alexandria and carrying on SWOT analysis and evaluation of the potentials of this case study.

Keywords: adaptive reuse, lost urban space, quality of public open space, urban fabric

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1477 Regeneration Study on the Athens City Center: Transformation of the Historical Triangle to “Low Pollution and Restricted Vehicle Traffic Zone”

Authors: Chondrogianni Dimitra, Yorgos J. Stephanedes

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The impact of the economic crisis, coupled with the aging of the city's old core, is reflected in central Athens. Public and private users, residents, employees, visitors desire the quality upgrading of abandoned buildings and public spaces through environmental upgrading and sustainable mobility, and promotion of the international metropolitan character of the city. In the study, a strategy for reshaping the character and function of the historic Athenian triangle is proposed, aiming at its economic, environmental, and social sustainable development through feasible, meaningful, and non-landscaping solutions of low cost and high positive impact. Sustainable mobility is the main principle in re-planning the study area and transforming it into a “Low Pollution and Limited Vehicle Traffic Zone” is the main strategy. Τhe proposed measures include the development of pedestrian mobility networks by expanding the pedestrian roads and limited-traffic routes, of bicycle networks based on the approved Metropolitan Bicycle Route of Athens, of public transportation networks with new lines of electric mini-buses, and of new regulations for vehicle mobility in the historic triangle. In addition, complementary actions are proposed regarding the provision of Wi-Fi on fixed track media, development of applications that facilitate combined travel and provide real-time data, integration of micromobility (roller skates, Segway, Hoverboard), and its enhancement as a flexible means of personal mobility, and development of car-sharing, ride-sharing and dynamic carpooling initiatives.

Keywords: regeneration plans, sustainable mobility, environmental upgrading, athens historical triangle

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1476 Spironolactone in Psoriatic Arthritis: Safety, Efficacy and Effect on Disease Activity

Authors: Ashit Syngle, Inderjit Verma, Pawan Krishan

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Therapeutic approaches used previously relied on disease-modifying antirheumatic drugs (DMARDs) that had only partial clinical benefit and were associated with significant toxicity. Spironolactone, an oral aldosterone antagonist, suppresses inflammatory mediators. Clinical efficacy of spironolactone compared with placebo in patients with active psoriatic arthritis despite treatment with prior traditional DMARDs. In the 24-week, placebo-controlled study patients (n=31) were randomized to placebo and spironolactone (2 m/kg/day). Patients on background concurrent DMARDs continued stable doses (methotrexate, leflunomide, and/or sulfasalazine). Primary outcome measures were the assessment of disease activity measures i.e. 28-joint disease activity score (DAS28) and diseases activity in psoriatic arthritis (DAPSA) at week 24. The key secondary endpoint was change from baseline in Health Assessment Questionnaire–Disability Index (HAQ-DI) at week 24. Additional efficacy outcome measures at week 24 included improvements in the markers of inflammation (ESR and CRP) and pro-inflammatory cytokines TNF-α, IL-6 and IL-1. At week 24, spironolactone significantly reduced disease activity measure DAS-28 (p<0.001) and DAPSA (p=0.001) compared with placebo. Significant improvements in key secondary measures HAQ-DI (disability index) were evident with spironolactone (p=0.02) versus placebo. After week 24, there was significant reduction in pro-inflammatory cytokines level TNF-α, IL-6 (p<0.01) as compared with placebo group. However, there was no significant improvement in IL-1 in both treatment and placebo groups. There were minor side effects which did not mandate stopping of spironolactone. No change in any biochemical profile was noted after spironolactone treatment. Spironolactone was effective in the treatment of PsA, improving disease activity, physical function and suppressing the level of pro-inflammatory cytokines. Spironolactone demonstrated an acceptable safety profile and was well tolerated.

Keywords: spironolactone, inflammation, inflammatory cytokine, psoriatic arthritis

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1475 Efficient Compact Micro Dielectric Barrier Discharge (DBD) Plasma Reactor for Ozone Generation for Industrial Application in Liquid and Gas Phase Systems

Authors: D. Kuvshinov, A. Siswanto, J. Lozano-Parada, W. Zimmerman

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Ozone is well known as a powerful fast reaction rate oxidant. The ozone based processes produce no by-product left as a non-reacted ozone returns back to the original oxygen molecule. Therefore an application of ozone is widely accepted as one of the main directions for a sustainable and clean technologies development. There are number of technologies require ozone to be delivered to specific points of a production network or reactors construction. Due to space constrains, high reactivity and short life time of ozone the use of ozone generators even of a bench top scale is practically limited. This requires development of mini/micro scale ozone generator which can be directly incorporated into production units. Our report presents a feasibility study of a new micro scale rector for ozone generation (MROG). Data on MROG calibration and indigo decomposition at different operation conditions are presented. At selected operation conditions with residence time of 0.25 s the process of ozone generation is not limited by reaction rate and the amount of ozone produced is a function of power applied. It was shown that the MROG is capable to produce ozone at voltage level starting from 3.5kV with ozone concentration of 5.28E-6 (mol/L) at 5kV. This is in line with data presented on numerical investigation for a MROG. It was shown that in compare to a conventional ozone generator, MROG has lower power consumption at low voltages and atmospheric pressure. The MROG construction makes it applicable for emerged and dry systems. With a robust compact design MROG can be used as incorporated unit for production lines of high complexity.

Keywords: dielectric barrier discharge (DBD), micro reactor, ozone, plasma

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1474 Analytical Slope Stability Analysis Based on the Statistical Characterization of Soil Shear Strength

Authors: Bernardo C. P. Albuquerque, Darym J. F. Campos

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Increasing our ability to solve complex engineering problems is directly related to the processing capacity of computers. By means of such equipments, one is able to fast and accurately run numerical algorithms. Besides the increasing interest in numerical simulations, probabilistic approaches are also of great importance. This way, statistical tools have shown their relevance to the modelling of practical engineering problems. In general, statistical approaches to such problems consider that the random variables involved follow a normal distribution. This assumption tends to provide incorrect results when skew data is present since normal distributions are symmetric about their means. Thus, in order to visualize and quantify this aspect, 9 statistical distributions (symmetric and skew) have been considered to model a hypothetical slope stability problem. The data modeled is the friction angle of a superficial soil in Brasilia, Brazil. Despite the apparent universality, the normal distribution did not qualify as the best fit. In the present effort, data obtained in consolidated-drained triaxial tests and saturated direct shear tests have been modeled and used to analytically derive the probability density function (PDF) of the safety factor of a hypothetical slope based on Mohr-Coulomb rupture criterion. Therefore, based on this analysis, it is possible to explicitly derive the failure probability considering the friction angle as a random variable. Furthermore, it is possible to compare the stability analysis when the friction angle is modelled as a Dagum distribution (distribution that presented the best fit to the histogram) and as a Normal distribution. This comparison leads to relevant differences when analyzed in light of the risk management.

Keywords: statistical slope stability analysis, skew distributions, probability of failure, functions of random variables

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1473 The Knowledge-Behavior Gap in the Online Information Seeking Process

Authors: Yen-Mei Lee

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The concept of a knowledge-behavior gap has been discussed for several years. It is addressed that an individual’s knowledge does not sufficiently transfer to his or her actual actions. This concept is mostly focused on fields related to medicine or applied to health care issues to explain how people or patients connect their personal knowledge to actual health care behaviors. To our knowledge, seldomly has this research been applied to discuss people’s online information seeking behavior. In the current study, the main purpose is to investigate the relationship between web users’ personal values and their actual performances when seeking information on the Internet. The total number of twenty-eight participants, divided into one experienced group (n=14) and one novice group (n=14), were recruited and asked to complete a self-report questionnaire of fifty items related to information seeking actions and behaviors. During the execution, participants needed to rate the importance level (how important each item is) and the performance level (how often they actually do each item) from 1 to 10 points on each item. In this paper, the mean scores of the importance and the performance level are analyzed and discussed. The results show that there is a gap between web user’s knowledge and their actual online seeking behaviors. Both experienced group and novice group have higher average scores of the importance level (experienced group = 7.57, novice group = 6.01) than the actual performance level (experienced group = 6.89, novice group = 5.00) in terms of the fifty online information seeking actions. On the other hand, the experienced group perceives more importance of the fifty online seeking actions and performs actual behaviors better than the novice group. Moreover, experienced participants express a consistent result between their concept knowledge and actual behaviors. For instance, they feel extending a seeking strategy is important and frequently perform this action when seeking online. However, novice participants do not have a consistency between their knowledge and behaviors. For example, though they perceive browsing and judging information are less important than they get lost in the online information seeking process. However, in the actual behavior rating, the scores show that novices do browsing and judge information more often than they get lost when seeking information online. These results, therefore, help scholars and educators have a better understanding of the difference between experienced and novice web users regarding their concept knowledge and actual behaviors. In future study, figuring out how to narrow down the knowledge-behavior gap and create practical guidance for novice users to increase their online seeking efficiency is crucial. Not only could it help experienced users be aware of their actual information seeking behaviors, but also help the novice become mastery to concisely obtain information on the Internet.

Keywords: experienced web user, information seeking behavior, knowledge-behavior gap, novice, online seeking efficiency

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1472 Anaphora and Cataphora on the Selected State of the City Addresses of the Mayor of Dapitan

Authors: Mark Herman Sumagang Potoy

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State of the City Address (SOCA) is a speech, modelled after the State of the Nation Address, given not as mandated by law but usually a matter of practice or tradition delivered before the chief executive’s constituents. Through this, the general public is made to know the performance of the local government unit and its agenda for the coming year. Therefore, it is imperative for SOCAs to clearly convey its message and carry out the myriad function of enlightening its readers which could be achieved through the proper use of reference. Anaphora and cataphora are the two major types of reference; the former refer back to something that has already been mentioned while the latter points forward to something which is yet to be said. This paper seeks to identify the types of reference employed on the SOCAs from 2014 to 2016 of Hon. Rosalina Garcia Jalosjos, Mayor of Dapitan City and look into how the references contribute to the clarity of the message of the text. The qualitative method of research is used in this study through an in-depth analysis of the corpus. As soon as the copies of the SOCAs are secured from the Office of the City Mayor, they are then analyzed using documentary technique categorizing the types of reference as to anaphora and cataphora, counting each of these types and describing the implications of the dominant types used in the addresses. After a thorough analysis, it is found out that the two reference types namely, anaphora and cataphora are both employed on the three SOCAs, the former being used more frequently than the latter accounting to 80% and 20% of actual usage, respectively. Moreover, the use of anaphors and cataphora on the three addresses helps in conveying the message clearly because they primarily become aids to avoid the repetition of the same element in the text especially when there wasn’t a need to emphasize a point. Finally, it is recommended that writers of State of the City Addresses should have a vast knowledge on how reference should be used and the functions they take in the text since this is a vital tool to clearly transmit a message. Moreover, English teachers should explicitly teach the proper usage of anaphora and cataphora, as instruments to develop cohesion in written discourse, to enable students to write not only with sense but also with fluidity in tying utterances together.

Keywords: anaphora, cataphora, reference, State of the City Address

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1471 CFD Modeling of Stripper Ash Cooler of Circulating Fluidized Bed

Authors: Ravi Inder Singh

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Due to high heat transfer rate, high carbon utilizing efficiency, fuel flexibilities and other advantages numerous circulating fluidized bed boilers have grown up in India in last decade. Many companies like BHEL, ISGEC, Thermax, Cethar Limited, Enmas GB Power Systems Projects Limited are making CFBC and installing the units throughout the India. Due to complexity many problems exists in CFBC units and only few have been reported. Agglomeration i.e clinker formation in riser, loop seal leg and stripper ash coolers is one of problem industry is facing. Proper documentation is rarely found in the literature. Circulating fluidized bed (CFB) boiler bottom ash contains large amounts of physical heat. While the boiler combusts the low-calorie fuel, the ash content is normally more than 40% and the physical heat loss is approximately 3% if the bottom ash is discharged without cooling. In addition, the red-hot bottom ash is bad for mechanized handling and transportation, as the upper limit temperature of the ash handling machinery is 200 °C. Therefore, a bottom ash cooler (BAC) is often used to treat the high temperature bottom ash to reclaim heat, and to have the ash easily handled and transported. As a key auxiliary device of CFB boilers, the BAC has a direct influence on the secure and economic operation of the boiler. There are many kinds of BACs equipped for large-scale CFB boilers with the continuous development and improvement of the CFB boiler. These ash coolers are water cooled ash cooling screw, rolling-cylinder ash cooler (RAC), fluidized bed ash cooler (FBAC).In this study prototype of a novel stripper ash cooler is studied. The Circulating Fluidized bed Ash Coolers (CFBAC) combined the major technical features of spouted bed and bubbling bed, and could achieve the selective discharge on the bottom ash. The novel stripper ash cooler is bubbling bed and it is visible cold test rig. The reason for choosing cold test is that high temperature is difficult to maintain and create in laboratory level. The aim of study to know the flow pattern inside the stripper ash cooler. The cold rig prototype is similar to stripper ash cooler used industry and it was made after scaling down to some parameter. The performance of a fluidized bed ash cooler is studied using a cold experiment bench. The air flow rate, particle size of the solids and air distributor type are considered to be the key parameters of the operation of a fluidized bed ash cooler (FBAC) are studied in this.

Keywords: CFD, Eulerian-Eulerian, Eulerian-Lagraingian model, parallel simulations

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1470 Developing a DNN Model for the Production of Biogas From a Hybrid BO-TPE System in an Anaerobic Wastewater Treatment Plant

Authors: Hadjer Sadoune, Liza Lamini, Scherazade Krim, Amel Djouadi, Rachida Rihani

Abstract:

Deep neural networks are highly regarded for their accuracy in predicting intricate fermentation processes. Their ability to learn from a large amount of datasets through artificial intelligence makes them particularly effective models. The primary obstacle in improving the performance of these models is to carefully choose the suitable hyperparameters, including the neural network architecture (number of hidden layers and hidden units), activation function, optimizer, learning rate, and other relevant factors. This study predicts biogas production from real wastewater treatment plant data using a sophisticated approach: hybrid Bayesian optimization with a tree-structured Parzen estimator (BO-TPE) for an optimised deep neural network (DNN) model. The plant utilizes an Upflow Anaerobic Sludge Blanket (UASB) digester that treats industrial wastewater from soft drinks and breweries. The digester has a working volume of 1574 m3 and a total volume of 1914 m3. Its internal diameter and height were 19 and 7.14 m, respectively. The data preprocessing was conducted with meticulous attention to preserving data quality while avoiding data reduction. Three normalization techniques were applied to the pre-processed data (MinMaxScaler, RobustScaler and StandardScaler) and compared with the Non-Normalized data. The RobustScaler approach has strong predictive ability for estimating the volume of biogas produced. The highest predicted biogas volume was 2236.105 Nm³/d, with coefficient of determination (R2), mean absolute error (MAE), and root mean square error (RMSE) values of 0.712, 164.610, and 223.429, respectively.

Keywords: anaerobic digestion, biogas production, deep neural network, hybrid bo-tpe, hyperparameters tuning

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1469 Modified Weibull Approach for Bridge Deterioration Modelling

Authors: Niroshan K. Walgama Wellalage, Tieling Zhang, Richard Dwight

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State-based Markov deterioration models (SMDM) sometimes fail to find accurate transition probability matrix (TPM) values, and hence lead to invalid future condition prediction or incorrect average deterioration rates mainly due to drawbacks of existing nonlinear optimization-based algorithms and/or subjective function types used for regression analysis. Furthermore, a set of separate functions for each condition state with age cannot be directly derived by using Markov model for a given bridge element group, which however is of interest to industrial partners. This paper presents a new approach for generating Homogeneous SMDM model output, namely, the Modified Weibull approach, which consists of a set of appropriate functions to describe the percentage condition prediction of bridge elements in each state. These functions are combined with Bayesian approach and Metropolis Hasting Algorithm (MHA) based Markov Chain Monte Carlo (MCMC) simulation technique for quantifying the uncertainty in model parameter estimates. In this study, factors contributing to rail bridge deterioration were identified. The inspection data for 1,000 Australian railway bridges over 15 years were reviewed and filtered accordingly based on the real operational experience. Network level deterioration model for a typical bridge element group was developed using the proposed Modified Weibull approach. The condition state predictions obtained from this method were validated using statistical hypothesis tests with a test data set. Results show that the proposed model is able to not only predict the conditions in network-level accurately but also capture the model uncertainties with given confidence interval.

Keywords: bridge deterioration modelling, modified weibull approach, MCMC, metropolis-hasting algorithm, bayesian approach, Markov deterioration models

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1468 Combustion Characteristic of Propane/Acetylene Fuel Blends Pool Fire

Authors: Yubo Bi, Xiao Chen, Shouxiang Lu

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A kind of gas-fueled burner, named Burning Rate Emulator, was proposed for the purpose of the emulation of condensed fuel recently. The gaseous fuel can be pure combustible fuel gas or blends of gaseous fuel or inert gas. However, this concept was recently proposed without detailed study on the combustion characteristic of fuel blends. In this study, two kinds of common gaseous fuels were selected, propane and acetylene, to provide the combustion heat as well as a large amount of smoke, which widely exists in liquid and solid fuel burning process. A set of experiments were carried out using a gas-fueled burner with a diameter of 8 cm. The total volume flow rate of propane and acetylene was kept at 3 liters per minute. The volume fraction of propane varied from 0% to 100% at interval of 10%. It is found that the flame height increases with propane volume fraction, which may be caused by the increase of heat release rate, as the energy density of propane is larger than that of acetylene. The dimensionless flame height is correlated against dimensionless heat release rate, which shows a power function relationship. The radiation fraction of the flame does not show a monotonic relationship with propane volume fraction. With the increase of propane volume fraction from 0% to 100%, the value of radiation fraction increases first and reach a maximum value around 0.46 at a propane volume fraction of 10%, and then decreases continuously to a value of 0.25 at the propane volume fraction of 100%. The flame radiation is related to the soot in the flame. The trend of the radiation fraction reflects that there may be a synergistic effect of soot formation between propane and acetylene which can be guessed from the significantly high radiation fraction at a propane volume fraction of 10%. This work provides data for combustion of gaseous fuel blends pool fire and also give reference on the design of Burning Rate Emulator.

Keywords: Burning Rate Emulator, fuel blends pool fire, flame height, radiation fraction

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1467 Bahrain Experience in Supporting Small and Medium Enterprises by the Utilization of E-Government

Authors: Najla Alhkalaf

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The focus of this study is answering the following question: How do e-government services in Bahrain support the productivity of SMEs? This study examines the current E-government function in enhancing SME productivity in Bahrain through analysing the efficiency of e- government by viewing its facilitators and barriers from the perspective of different stakeholders. The study aims to identify and develop best practice guidelines with the end-goal of creating a standardised channel of communication between e-government and SMEs that fulfil the requirement of SME owners, and thus achieve the prime objective of e-government. E-government services for SMEs have been offered in Bahrain since 2005. However, the current services lack the required mechanism for SMEs to fully take advantage of these services because of lagging communication between service provider and end-user. E-government employees believe that a lack of awareness and trust are the main stumbling block, whereas the SME owners believe that there is a lack of sufficiency in the content and efficiency provided through e- services. A questionnaire has been created based on a pilot study that highlighted the main indicators of e-government efficiency and SMEs productivity as well as previous studies conducted on this subject. This allowed for quantitative data to be extracted. Also interviews were conducted with SME owners and government employees from both case studies, which formed the qualitative data for this study. The findings portray that both the service provider and service receiver largely agree on the existence of most of the technical and administrative barriers. However, the data reflects a level of dissatisfaction from the SME side, which contradicts with the perceived level of satisfaction from the government employees. Therefore, the data supports the argument that assures the existence of a communication gap between stakeholders. To this effect, this research would help build channels of communication between stakeholders, and then induces a plan unlocking the potential of e-government application. The conclusions of this study will help devise an optimised E-government strategy for Bahrain.

Keywords: e-government, SME, e-services, G2B, government employees' perspective, entrepreneurs' perspective, enterprise

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1466 Young Female’s Heart Was Bitten by Unknown Ghost (Isolated Cardiac Sarcoidosis): A Case Report

Authors: Heru Al Amin

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Sarcoidosis is a granulomatous inflammatory disorder of unclear etiology that can affect multiple different organ systems. Isolated cardiac sarcoidosis is a very rare condition that causes lethal arrhythmia and heart failure. A definite diagnosis of cardiac sarcoidosis remains challenging. The use of multimodality imaging plays a pivotal role in the diagnosis of this entity. Case summary: In this report, we discuss a case of a 50-year-old woman who presented with recurrent palpitation, dizziness, vertigo and presyncope. Electrocardiogram revealed variable heart blocks, including first-degree AV block, second-degree AV block, high-degree AV block, complete AV block, trifascicular block and sometimes supraventricular arrhythmia. Twenty-four hours of Holter monitoring show atrial bigeminy, first-degree AV block and trifascicular block. Transthoracic echocardiography showed Thinning of basal anteroseptal and inferred septum with LV dilatation with reduction of Global Longitudinal Strain. A dual-chamber pacemaker was implanted. CT Coronary angiogram showed no coronary artery disease. Cardiac magnetic resonance revealed basal anteroseptal and inferior septum thinning with focal edema with LGE suggestive of sarcoidosis. Computed tomography of the chest showed no lymphadenopathy or pulmonary infiltration. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) of the whole body showed. We started steroids and followed up with the patient. Conclusion: This case serves to highlight the challenges in identifying and managing isolated CS in a young patient with recurrent syncope with variable heart block. Early, even late initiation of steroids can improve arrhythmia as well as left ventricular function.

Keywords: cardiac sarcoidosis, conduction abnormality, syncope, cardiac MRI

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1465 2D titanium, vanadium carbide MXene, and Polyaniline heterostructures for electrochemical energy storage

Authors: Ayomide A Sijuade, Nafiza Anjum

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The rising demand to meet the need for clean and sustainable energy solutions has led the market to create effective energy storage technologies. In this study, we look at the possibility of using a heterostructure made of polyaniline (PANI), titanium carbide (Ti₃C₂), and vanadium carbide (V₂C) for energy storage devices. V₂C is a two-dimensional transition metal carbide with remarkable mechanical and electrical conductivity. Ti₃C2 has solid thermal conductivity and mechanical strength. PANI, on the other hand, is a conducting polymer with customizable electrical characteristics and environmental stability. Layer-by-layer assembly creates the heterostructure of V₂C, Ti₃C₂, and PANI, allowing for precise film thickness and interface quality control. Structural and morphological characterization is carried out using X-ray diffraction, scanning electron microscopy, and atomic force microscopy. For energy storage applications, the heterostructure’s electrochemical performance is assessed. Electrochemical experiments, such as cyclic voltammetry and galvanostatic charge-discharge tests, examine the heterostructure’s charge storage capacity, cycle stability, and rate performance. Comparing the heterostructure to the individual components reveals better energy storage capabilities. V₂C, Ti₃C₂, and PANI synergize to increase specific capacitance, boost charge storage, and prolong cycling stability. The heterostructure’s unique arrangement of 2D materials and conducting polymers promotes effective ion diffusion and charge transfer processes, improving the effectiveness of energy storage. The heterostructure also exhibits remarkable electrochemical stability, which minimizes capacity loss after repeated cycling. The longevity and long-term dependability of energy storage systems depend on this quality. By examining the potential of V₂C, Ti₃C₂, and PANI heterostructures, the results of this study expand energy storage technology. These materials’ specialized integration and design show potential for use in hybrid energy storage systems, lithium-ion batteries, and supercapacitors. Overall, the development of high-performance energy storage devices utilizing V₂C, Ti₃C₂, and PANI heterostructures is clarified by this research, opening the door to the realization of effective, long-lasting, and eco-friendly energy storage solutions to satisfy the demands of the modern world.

Keywords: MXenes, energy storage materials, conductive polymers, composites

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1464 Legal Allocation of Risks: A Computational Analysis of Force Majeure Clauses

Authors: Farshad Ghodoosi

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This article analyzes the effect of supervening events in contracts. Contracts serve an important function: allocation of risks. In spite of its importance, the case law and the doctrine are messy and inconsistent. This article provides a fresh look at excuse doctrines (i.e., force majeure, impracticability, impossibility, and frustration) with a focus on force majeure clauses. The article makes the following contributions: First, it furnishes a new conceptual and theoretical framework of excuse doctrines. By distilling the decisions, it shows that excuse doctrines rests on the triangle of control, foreseeability, and contract language. Second, it analyzes force majeure clauses used by S&P 500 companies to understand the stickiness and similarity of such clauses and the events they cover. Third, using computational and statistical tools, it analyzes US cases since 1810 in order to assess the weight given to the triangle of control, foreseeability, and contract language. It shows that the control factor plays an important role in force majeure analysis, while the contractual interpretation is the least important factor. The Article concludes that it is the standard for control -whether the supervening event is beyond the control of the party- that determines the outcome of cases in the force majeure context and not necessarily the contractual language. This article has important implications on COVID-19-related contractual cases. Unlike the prevailing narrative that it is the language of the force majeure clause that’s determinative, this article shows that the primarily focus of the inquiry will be on whether the effects of COVID-19 have been beyond the control of the promisee. Normatively, the Article suggests that the trifactor of control, foreseeability, and contractual language are not effective for allocation of legal risks in times of crises. It puts forward a novel approach to force majeure clauses whereby that the courts should instead focus on the degree to which parties have relied on (expected) performance, in particular during the time of crisis.

Keywords: contractual risks, force majeure clauses, foreseeability, control, contractual language, computational analysis

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1463 The Soundscape of Contemporary Buddhist Music in Taiwan: Tzu Chi Vesak Ceremony

Authors: Sylvia Huang

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Contemporary Buddhist music has been emerged at the new forms of large-scale public Buddhist ritual ceremonies that may involve up to 10,000 participants at a time. Since 2007, the Buddha’s Birthday ceremony (Sanskrit, Vesak) by the Buddhist Tzu Chi Foundation has being held at major cities in Taiwan and many affiliated Tzu Chi offices around the world. Analysis of this modern and technologically-dependent ceremony sheds new light on the significance of music in contemporary Buddhist ritual, and also on recently enhanced and increasingly intimate connections between music and Buddhism. Through extensive ethnographic research of ten years (2007-2017), the research explores how the form of contemporary Buddhist music relates to the role of music in participants’ experience of the ritual and the way in which they construct meaning. The theoretical approach draws on both ethnomusicology and Buddhist teachings, Dharma. As soundscape is defined as the entire sonic energy produced by a landscape, the concept of soundscape is utilised to examine the contemporary ritual music in the Tzu Chi Vesak ceremony. The analysis opens new territory in exploring how analysis of Buddhist music can benefit from incorporating Buddhist philosophy within the methodological approach. Main findings are: 1) music becomes a method for Buddhist understanding through a focus in particular on how the ceremonial program is followed by music, and 2) participants engage with each other and entrain with music in the Vesak ceremony. As Buddhist sounding, such as scripture reading, liturgical chanting, and ceremonial music singing, is a sonic epistemological knowing of the conditions in which Buddhism is practiced, experienced, and transmigrated, the research concludes by showing that studies of Buddhist music have the potential to reveal distinctively Buddhist concepts, meaning, and values. Certain principles of Buddhist philosophy are adopted within ethnomusicological analysis to further enhance understandings of the crucial function of music within such a ritual context. Finally, the contemporary Buddhist music performance in the ceremony is possessed as a means of direct access to the spiritual experience in Buddhism.

Keywords: buddhist music, Taiwan, soundscape, Vesak ceremony

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1462 Upside Down Words as Initial Clinical Presentation of an Underlying Acute Ischemic Stroke

Authors: Ramuel Spirituel Mattathiah A. San Juan, Neil Ambasing

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Background: Reversal of vision metamorphopsia is a transient form of metamorphopsia described as an upside-down alteration of the visual field in the coronal plane. Patients would describe objects, such as cups, upside down, but the tea would not spill, and people would walk on their heads. It is extremely rare as a stable finding, lasting days or weeks. We report a case wherein this type of metamorphopsia occurred only in written words and lasted for six months. Objective: To the best of our knowledge, we report the first rare occurrence of reversal of vision metamorphopsia described as inverted words as the sole initial presentation of an underlying stroke. Case Presentation: We report a 59-year-old male with poorly controlled hypertension and diabetes mellitus who presented with a 3-day history of difficulty reading, described as the words were turned upside down as if the words were inverted horizontally then with the progression of deficits such as right homonymous hemianopia and achromatopsia, prosopagnosia. Cranial magnetic resonance imaging (MRI) revealed an acute infarct on the left posterior cerebral artery territory. Follow-up after six months revealed improvement of the visual field cut but with the persistence of the higher cortical function deficits. Conclusion: We report the first rare occurrence of metamorphopsia described as purely inverted words as the sole initial presentation of an underlying stroke. The differential diagnoses of a patient presenting with text reversal metamorphopsia should include stroke in the occipitotemporal areas. It further expands the landscape of metamorphopsias due to its exclusivity to written words and prolonged duration. Knowing these clinical features will help identify the lesion locus and improve subsequent stroke care, especially in time-bound management like intravenous thrombolysis.

Keywords: rare presentation, text reversal metamorphopsia, ischemic stroke, stroke

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1461 Development of Functional Cosmetic Materials from Demilitarized Zone Habiting Plants

Authors: Younmin Shin, Jin Kyu Kim, Mirim Jin, Jeong June Choi

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Demilitarized Zone (DMZ) is a peace region located between South and North Korea border to avoid accidental armed conflict. Because human accessing to the area was forced to be prohibited for more than 60 years, DMZ is one of the cleanest land keeping wild lives as nature itself in South Korea. In this study, we evaluated the biological efficacies of plants (SS, PC, and AR) inhabiting in DMZ for the development of functional cosmetics. First, we tested the cytotoxicity of plant extracts in keratinocyte and melanocyte, which are the major cell components of skin. By 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay with the cell lines, we determined the safety concentrations of the extracts for the efficacy tests. Next, we assessed the anti-wrinkle cosmetic function of SS by demonstrating that SS treatment decreased the expression of Matrix metalloproteinase-1 (MMP-1) in UV-irradiated keratinocytes via real-time PCR. The suppressive effect of SS was greatly potentiated by combination with other DMZ-inhabiting plants, PC and AR. The expression of tyrosinase, which is one the main enzyme that producing melanin in melanocyte, was also down-regulated by the DMZ-inhabiting SS extract. Wound healing activity was also investigated by in vitro test with HaCat cell line, a human fibroblast cell line. All the natural materials extracted form DMZ habiting plants accelerated the recovery of the cells. These results suggested that DMZ is a treasure island of functional plants and DMZ-inhabiting natural products are warranted to develop functional cosmetic materials. This study was carried out with the support of R&D Program for Forest Science Technology (Project No. 2017027A00-1819-BA01) provided by Korea Forest Service (Korea Forestry Promotion Institute).

Keywords: anti-wrinkle, Demilitarized Zone, functional cosmetics, whitening

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1460 Measuring Human Perception and Negative Elements of Public Space Quality Using Deep Learning: A Case Study of Area within the Inner Road of Tianjin City

Authors: Jiaxin Shi, Kaifeng Hao, Qingfan An, Zeng Peng

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Due to a lack of data sources and data processing techniques, it has always been difficult to quantify public space quality, which includes urban construction quality and how it is perceived by people, especially in large urban areas. This study proposes a quantitative research method based on the consideration of emotional health and physical health of the built environment. It highlights the low quality of public areas in Tianjin, China, where there are many negative elements. Deep learning technology is then used to measure how effectively people perceive urban areas. First, this work suggests a deep learning model that might simulate how people can perceive the quality of urban construction. Second, we perform semantic segmentation on street images to identify visual elements influencing scene perception. Finally, this study correlated the scene perception score with the proportion of visual elements to determine the surrounding environmental elements that influence scene perception. Using a small-scale labeled Tianjin street view data set based on transfer learning, this study trains five negative spatial discriminant models in order to explore the negative space distribution and quality improvement of urban streets. Then it uses all Tianjin street-level imagery to make predictions and calculate the proportion of negative space. Visualizing the spatial distribution of negative space along the Tianjin Inner Ring Road reveals that the negative elements are mainly found close to the five key districts. The map of Tianjin was combined with the experimental data to perform the visual analysis. Based on the emotional assessment, the distribution of negative materials, and the direction of street guidelines, we suggest guidance content and design strategy points of the negative phenomena in Tianjin street space in the two dimensions of perception and substance. This work demonstrates the utilization of deep learning techniques to understand how people appreciate high-quality urban construction, and it complements both theory and practice in urban planning. It illustrates the connection between human perception and the actual physical public space environment, allowing researchers to make urban interventions.

Keywords: human perception, public space quality, deep learning, negative elements, street images

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1459 A Structure-Based Approach for Adaptable Building System

Authors: Alireza Taghdiri, Sara Ghanbarzade Ghomi

Abstract:

Existing buildings are permanently subjected to change, continuously renovated and repaired in their long service life. Old buildings are destroyed and their material and components are recycled or reused for constructing new ones. In this process, importance of sustainability principles for building construction is obviously known and great significance must be attached to consumption of resources, resulting effects on the environment and economic costs. Utilization strategies for extending buildings service life and delay in destroying have positive effect on environment protection. In addition, simpler alterability or expandability of buildings’ structures and reducing energy and natural resources consumption have benefits for users, producers and environment. To solve these problems, by applying theories of open building, structural components of some conventional building systems have been analyzed and then, a new geometry adaptive building system is developed which can transform and support different imposed loads. In order to achieve this goal, various research methods and tools such as professional and scientific literatures review, comparative analysis, case study and computer simulation were applied and data interpretation was implemented using descriptive statistics and logical arguments. Therefore, hypothesis and proposed strategies were evaluated and an adaptable and reusable 2-dimensional building system was presented which can respond appropriately to dwellers and end-users needs and provide reusability of structural components of building system in new construction or function. Investigations showed that this incremental building system can be successfully applied in achieving the architectural design objectives and by small modifications on components and joints, it is easy to obtain different and adaptable load-optimized component alternatives for flexible spaces.

Keywords: adaptability, durability, open building, service life, structural building system

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1458 A Theory of Aftercare for Human Trafficking Survivors: A Grounded Theory Analysis of Survivors and Aftercare Providers in South Africa

Authors: Robyn L. Curran, Joanne R. Naidoo, Gugu Mchunu

Abstract:

Along with the increasing awareness of human trafficking, is the acknowledgement that it is no longer just a social problem but also a significant public health problem that requires both increased knowledge and the specialist equipping of aftercare providers such as nurses who care for human trafficking survivors. Current discourse regarding aftercare of human trafficking survivors, is that approaches do not clearly explain the function or content of aftercare and what aftercare entails. Although psychological and medical aftercare are emphasized as important components, little practical attention is devoted to what these components actually involve and the effectiveness of current practice in aftercare. Review of the literature on the processes that take place from aftercare to empowerment, revealed the need for emphasis to be placed on the voices of survivors concerning their liberation from oppression. The aim of the study was to develop a theory for aftercare of human trafficking survivors, through analyzing the experiences of survivors and aftercare providers in shelters in three provinces in South Africa. Through using a Straussian grounded theory approach, the researcher developed a theory to inform care of human trafficking survivors in low resource settings using the voice of the survivors and those experienced in direct care of human trafficking survivors. Four human trafficking survivors and three aftercare providers from three shelters in three provinces in South Africa were individually interviewed in order for the theory to emerge. The findings of the study elicited a theoretical model of the renewed self, and the conditions that facilitate this process in care of human trafficking survivors. The process that human trafficking survivors navigate to empowerment require mutual collaboration of the aftercare provider and survivor as the survivor awakens vision, confronts reality, re-salvages autonomy and liberates self. Psychological resilience of the survivor facilitates the transition to renewed self. The recommendations of this study may improve the nursing care provided to human trafficking survivors and equip professionals with knowledge and skills to promote the process of renewing self for survivors.

Keywords: aftercare, aftercare providers, grounded theory, human trafficking survivors

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1457 The Stage as Pulpit; Contemporary Practice of Theatre for Religion in Kenya

Authors: Shikuku Emmanuel Tsikhungu

Abstract:

Theatre and religion have enjoyed a symbiotic relationship from time immemorial, each transforming in different epochs and into different forms of practice but gaining from each other’s growth. Despite the fact that religion has more or less looked at the theatre and its dramatic rituals with distaste, the two human engagements have had dynamic and reciprocal relationships. In Kenya, there is an emerging innovation and transformation of theatre for religion in which churches and sects are consciously developing a youth wing that is vibrant in theatre practice. The imagination that youth and children derive pleasure and vibrancy in theatre has led to a lively competition among churches that is now creating a new form of theatre in Kenya. This has given rise to a practice in which art engages the religious not at the spiritual level but at the social-cultural level. Thus theatre is finding itself in sanctums that it had been banished; not for its own sake but as a tool for keeping the youth nearer the church if not the church This article analyses findings of a study carried out in December of 2017 among theatre festivals for the Catholic Church held in Kitui School, KituiCounty, and the Methodist Church of Kenya festival held in Ntemwene Church, Nkubu, Meru County, Kenya. One of the findings of interest was that while they were not theatres of religion nor religious theatres since they did not fuse the religious rituals with the dramatic rituals, the festivals never the less qualify as theatres for religion for they link the former to the latter. Secondly, while they claimed to be youth or children theatre festivals, they lacked youth-centredness nor child-centredness associated with such. Thirdly and most importantly the style of dramatic execution ranged from bibliodramatic to secular drama with Christian messages. Fourthly, by this stroke of acceptance in formerly forbidden sanctums, theatre is re-inventing itself back to its ‘old’ nature and function. It may be argued conclusively that this sprouting movement of theatre for religion may be comparable to the Jesuit Theatre fronted by Ignatius Loyola but clothed in modern African theatre practice.

Keywords: theatre, religion, theatre for religion, social constructs, socio-cultural

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1456 Microstructural Mechanical Properties of Human Trabecular Bone Based on Nanoindentation Test

Authors: K. Jankowski, M. Pawlikowski, A. Makuch, K. Skalski

Abstract:

Depth-sensing indentation (DSI) or nanoindentation is becoming a more and more popular method of measuring mechanical properties of various materials and tissues at a micro-scale. This technique allows measurements without complicated sample preparation procedures which makes this method very useful. As a result of measurement force and displacement of the intender are obtained. It is also possible to determine three measures of hardness i.e. Martens hardness (HM), nanohardness (HIT), Vickers hardness (HV) and Young modulus EIT. In this work trabecular bone mechanical properties were investigated. The bone samples were harvested from human femoral heads during hip replacement surgery. Patients were of different age, sexes and stages of tissue degeneration caused by osteoarthritis. The specimens were divided into three groups. Each group contained samples harvested from patients of different range of age. All samples were investigated with the same measurement conditions. The maximum load was Pmax=500 mN and the loading rate was 500 mN/min. The tests were held without hold at the peak force. The tests were conducted with indenter Vickers tip and spherical tip of the diameter 0.2 mm. Each trabecular bone sample was tested 7 times in a close area of the same trabecula. The measured loading P as a function of indentation depth allowed to obtain hysteresis loop and HM, HIT, HV, EIT. Results for arbitrarily chosen sample are HM=289.95 ± 42.31 MPa, HIT=430.75 ± 45.37 MPa, HV=40.66 ± 4.28 Vickers, EIT=7.37 ± 1.84 GPa for Vickers tip and HM=115.19 ± 15.03 MPa, HIT=165.80 ± 19.30 MPa, HV=16.90 ± 1.97 Vickers, EIT=5.30 ± 1.31 GPa for spherical tip. Results of nanoindentation tests show that this method is very useful and is perfect for obtaining mechanical properties of trabecular bone. Estimated values of elastic modulus are similar. The differences between hardness are significant but it is a result of using two different types of tips. However, it has to be emphasised that the differences in the values of elastic modulus and hardness result from different testing protocols, anisotropy and asymmetry of the micro-samples and the hydration of bone.

Keywords: human bone, mechanical properties, nano hardness nanoindentation, trabecular bone

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1455 Simple Model of Social Innovation Based on Entrepreneurship Incidence in Mexico

Authors: Vicente Espinola, Luis Torres, Christhian Gonzalez

Abstract:

Entrepreneurship is a topic of current interest in Mexico and the World, which has been fostered through public policies with great impact on its generation. The strategies used in Mexico have not been successful, being motivational strategies aimed at the masses with the intention that someone in the process generates a venture. The strategies used for its development have been "picking of winners" favoring those who have already overcome the initial stages of undertaking without effective support. This situation shows a disarticulation that appears even more in social entrepreneurship; due to this, it is relevant to research on those elements that could develop them and thus integrate a model of entrepreneurship and social innovation for Mexico. Social entrepreneurship should be generating social innovation, which is translated into business models in order to make the benefits reach the population. These models are proposed putting the social impact before the economic impact, without forgetting its sustainability in the medium and long term. In this work, we present a simple model of innovation and social entrepreneurship for Guanajuato, Mexico. This algorithm was based on how social innovation could be generated in a systemic way for Mexico through different institutions that promote innovation. In this case, the technological parks of the state of Guanajuato were studied because these are considered one of the areas of Mexico where its main objectives are to make technology transfer to companies but overlooking the social sector and entrepreneurs. An experimental design of n = 60 was carried out with potential entrepreneurs to identify their perception of the social approach that the enterprises should have, the skills they consider required to create a venture, as well as their interest in generating ventures that solve social problems. This experiment had a 2K design, the value of k = 3 and the computational simulation was performed in R statistical language. A simple model of interconnected variables is proposed, which allows us to identify where it is necessary to increase efforts for the generation of social enterprises. The 96.67% of potential entrepreneurs expressed interest in ventures that solve social problems. In the analysis of the variables interaction, it was identified that the isolated development of entrepreneurial skills would only replicate the generation of traditional ventures. The variable of social approach presented positive interactions, which may influence the generation of social entrepreneurship if this variable was strengthened and permeated in the processes of training and development of entrepreneurs. In the future, it will be necessary to analyze the institutional actors that are present in the social entrepreneurship ecosystem, in order to analyze the interaction necessary to strengt the innovation and social entrepreneurship ecosystem.

Keywords: social innovation, model, entrepreneurship, technological parks

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1454 Self-Inflicted Major Trauma: Inpatient Mental Health Management and Patient Outcomes

Authors: M. Walmsley, S. Elmatarri, S. Mannion

Abstract:

Introduction: Self-inflicted injury is a recognised cause of major trauma in adults and is an independent indicator of a reduced functional outcome compared to non-intentional major trauma. There is little literature available on the inpatient mental health (MH) management of this vulnerable group. A retrospective review was conducted of inpatient MH management of major trauma patients admitted to a UK regional Major Trauma Centre (MTC). Their outcomes were compared to all major trauma patients. This group of patients required multiple MH interventions whilst on the Major Trauma Ward (MTW) and a had worse functional outcome compared to non-intentional trauma. Method: The national TARN (Trauma Audit and Research Network) database was used to identify patients admitted to a regional MTC over a 2-year period from June 2018 to July 2020. Patients with an ISS (Injury Severity Score) of greater than 15 with a mechanism of either self-harm or high-risk behavior were included for further analysis. Inpatient medical notes were reviewed for MH interventions on the MTW. Further outcomes, including mortality, length of stay (LOS) and Glasgow Outcome Score (GOS) were compared with all major trauma patients for the same time period. Results: A total of 60 patients were identified in the time period and of those, 27 spent time on the MTW. A total of 23 (85%) had a prior MH diagnosis, with 11 (41%) under the care of secondary MH services. Adequate inpatient records for review were available for 24 patients. During their inpatient stay, 8 (33%) were reviewed on the ward by the inpatient MH team. There were 10 interventions required for 6 (25%) patients on the MTW including, sections under the Mental Health Act, transfer to specialist MH facility, pharmacological sedation and security being called to the MTW. When compared to all major trauma patients, those admitted due to self-harm or high-risk behavior had a statistically significantly higher ISS (31.43 vs 24.22, p=0.0001) and LOS (23.51d vs 16.06d, p=0.002). Functional outcomes using the GOS were reduced in this group of patients, GOS 5 (low disability) (51.66% vs. 61.01%) and they additionally had a higher level of mortality, GOS 1 (15.00% vs 11.67%). Discussion: Intentional self-harm is a recognised cause of major trauma in adults and this patient group sustains more severe injuries, requiring a longer hospital stay with worse outcomes compared to all major trauma patients. Inpatient MH interventions are required for a significant proportion of these patients and therefore, there needs to be a close relationship with MH services. There is limited available evidence for how this patient group is best managed as an inpatient to aid their recovery and further work is needed on how outcomes in this vulnerable group can be improved.

Keywords: adult major trauma, attempted suicide, self-inflicted major trauma, inpatient management

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1453 Effect of Cooking Time, Seed-To-Water Ratio and Soaking Time on the Proximate Composition and Functional Properties of Tetracarpidium conophorum (Nigerian Walnut) Seeds

Authors: J. O. Idoko, C. N. Michael, T. O. Fasuan

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This study investigated the effects of cooking time, seed-to-water ratio and soaking time on proximate and functional properties of African walnut seed using Box-Behnken design and Response Surface Methodology (BBD-RSM) with a view to increase its utilization in the food industry. African walnut seeds were sorted washed, soaked, cooked, dehulled, sliced, dried and milled. Proximate analysis and functional properties of the samples were evaluated using standard procedures. Data obtained were analyzed using descriptive and inferential statistics. Quadratic models were obtained to predict the proximate and functional qualities as a function of cooking time, seed-to-water ratio and soaking time. The results showed that the crude protein ranged between 11.80% and 23.50%, moisture content ranged between 1.00% and 4.66%, ash content ranged between 3.35% and 5.25%, crude fibre ranged from 0.10% to 7.25% and carbohydrate ranged from 1.22% to 29.35%. The functional properties showed that soluble protein ranged from 16.26% to 42.96%, viscosity ranged from 23.43 mPas to 57 mPas, emulsifying capacity ranged from 17.14% to 39.43% and water absorption capacity ranged from 232% to 297%. An increase in the volume of water used during cooking resulted in loss of water soluble protein through leaching, the length of soaking time and the moisture content of the dried product are inversely related, ash content is inversely related to the cooking time and amount of water used, extraction of fat is enhanced by increase in soaking time while increase in cooking and soaking times result into decrease in fibre content. The results obtained indicated that African walnut could be used in several food formulations as protein supplement and binder.

Keywords: African walnut, functional properties, proximate analysis, response surface methodology

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1452 Finite Element Analysis for Earing Prediction Incorporating the BBC2003 Material Model with Fully Implicit Integration Method: Derivation and Numerical Algorithm

Authors: Sajjad Izadpanah, Seyed Hadi Ghaderi, Morteza Sayah Irani, Mahdi Gerdooei

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In this research work, a sophisticated yield criterion known as BBC2003, capable of describing planar anisotropic behaviors of aluminum alloy sheets, was integrated into the commercial finite element code ABAQUS/Standard via a user subroutine. The complete formulation of the implementation process using a fully implicit integration scheme, i.e., the classic backward Euler method, is presented, and relevant aspects of the yield criterion are introduced. In order to solve nonlinear differential and algebraic equations, the line-search algorithm was adopted in the user-defined material subroutine (UMAT) to expand the convergence domain of the iterative Newton-Raphson method. The developed subroutine was used to simulate a challenging computational problem with complex stress states, i.e., deep drawing of an anisotropic aluminum alloy AA3105. The accuracy and stability of the developed subroutine were confirmed by comparing the numerically predicted earing and thickness variation profiles with the experimental results, which showed an excellent agreement between numerical and experimental earing and thickness profiles. The integration of the BBC2003 yield criterion into ABAQUS/Standard represents a significant contribution to the field of computational mechanics and provides a useful tool for analyzing the mechanical behavior of anisotropic materials subjected to complex loading conditions.

Keywords: BBC2003 yield function, plastic anisotropy, fully implicit integration scheme, line search algorithm, explicit and implicit integration schemes

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1451 The Role of Surgery to Remove the Primary Tumor in Patients with Metastatic Breast Cancer

Authors: A. D. Zikiryahodjaev, L. V. Bolotina, A. S. Sukhotko

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Purpose. To evaluate the expediency and timeliness of performance of surgical treatment as a component of multi-therapy treatment of patients with stage IV breast cancers. Materials and Methods. This investigation comparatively analyzed the results of complex treatment with or without surgery in patients with metastatic breast cancer. We analyzed retrospectively treatment experience of 196 patients with generalized breast cancer in the department of oncology and breast reconstructive surgery of P.A. Herzen Moscow Cancer Research Institute from 2000 to 2012. The average age was (58±1,1) years. Invasive ductul carcinoma was verified in128 patients (65,3%), invasive lobular carcinoma-33 (16,8%), complex form - 19 (9,7%). Complex palliative care involving drug and radiation therapies was performed in two patient groups. The first group includes 124 patients who underwent surgical intervention as complex treatment, the second group includes 72 patients with only medical therapy. Standard systemic therapy was given to all patients. Results. Overall, 3-and 5-year survival in fist group was 43,8 and 21%, in second - 15,1 and 9,3% respectively [p=0,00002 log-rank]. Median survival in patients with surgical treatment composed 32 months, in patients with only systemic therapy-21. The factors having influencing an influence on the prognosis and the quality of life outcomes for of patients with generalized breast cancer were are also studied: hormone-dependent tumor, Her2/neu hyper-expression, reproductive function status (age, menopause existence). Conclusion.Removing primary breast tumor in patients with generalized breast cancer improve long-term outcomes. Three- and five-year survival increased by 28,7 and 16,3% respectively, and median survival–for 11 months. These patients may benefit from resection of the breast tumor. One explanation for the effect of this resection is that reducing the tumor load influences metastatic growth.

Keywords: breast cancer, combination therapy, factors of prognosis, primary tumor

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1450 Insulin Resistance in Patients with Chronic Hepatitis C Virus Infection: Upper Egypt Experience

Authors: Ali Kassem

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Background: In the last few years, factors such as insulin resistance (IR) and hepatic steatosis have been linked to progression of hepatic fibrosis.Patients with chronic liver disease, and cirrhosis in particular, are known to be prone to IR. However, chronic HCV (hepatitis C) infection may induce IR, regardless of the presence of liver cirrhosis. Our aims are to study insulin resistance (IR) assessed by HOMA-IR (Homeostatic Model Assessment Insulin Resistance) as a possible risk factor in disease progression in cirrhotic patients and to evaluate the role of IR in hepatic fibrosis progression. The correlations of HOMA-IR values to laboratory, virological and histopathological parameters of chronic HCV are also examined. Methods: The study included 50 people divided into 30 adult chronic hepatitis C patients diagnosed by PCR (polymerase chain reaction) within previous 6 months and 20 healthy controls. The functional and morphological status of the liver were evaluated by ultrasonography and laboratory investigations including liver function tests and by liver biopsy. Fasting blood glucose and fasting insulin levels were measured and body mass index and insulin resistance were calculated. Patients having HOMA-IR >2.5 were labeled as insulin resistant. Results: Chronic hepatitis C patients with IR showed significantly higher mean values of BMI (body mass index) and fasting insulin than those without IR (P < 0.000). Patients with IR were more likely to have steatosis (p = 0.006), higher necroinflammatory activity (p = 0.05). No significant differences were found between the two groups regarding hepatic fibrosis. Conclusion: HOMA-IR measurement could represent a novel marker to identify the cirrhotic patients at greater risk for the progression of liver disease. As IR is a potentially modifiable risk factor, these findings may have important prognostic and therapeutic implications. Assessment of IR by HOMA-IR and improving insulin sensitivity are recommended in patients with HCV and related chronic liver disease.

Keywords: hepatic fibrosis, hepatitis C virus infection, hepatic steatosis, insulin resistance

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1449 Eating Disorders and Eating Behaviors in Morbid Obese Women with and without Type 2 Diabetes

Authors: Azadeh Mottaghi, Zeynab Shakeri

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Background: Eating disorders (ED) are group of psychological disorders that significantly impair physical health and psychosocial function. EDconsists wide range of morbidity such as loss of eating control, binge eating disorder(BED), night eating syndrome (NES), and bulimia nervosa. Eating behavior is a wide range term that includes food choices, eating patterns, eating problems. In this study, current knowledge will be discussed aboutcomparison of eating disorders and eating behaviors in morbid obese women with and without type 2 diabetes. Methods: 231 womenwith morbid obesity were included in the study.Loss of eating control, Binge eating disorder and Bulimia nervosa, Night eating syndrome, and eating behaviors and psychosocial factorswere assessed. SPSS version 20 was used for statistical analysis. A p-value of <0.05 was considered significant. Results: There was a significant difference between women with and without diabetes in case of binge eating disorder (76.3% vs. 47.3%, p=0.001). Women with the least Interpersonal support evaluation list (ISEL) scores had a higher risk of eating disorders, and it is more common among diabetics (29.31% vs. 30.45%, p= 0.050). There was no significant difference between depression level and BDI score among women with or without diabetes. Although 38.5% (n=56) of women with diabetes and 50% (n=71) of women without diabetes had minimal depression. The logistic regression model has shown that women without diabetes had lower odds of exhibiting BED (OR=0.28, 95% CI 0.142-0.552).Women with and without diabetes with high school degree (OR=5.54, 95% CI 2.46-9.45, P= 0.0001 & OR=6.52, 95% CI 3.15-10.56, respectively) and moderate depression level (OR=2.03, 95% CI 0.98-3.95 & OR=3.12, 95% CI 2.12-4.56, P= 0.0001) had higher odds of BED. Conclusion: The result of the present study shows that the odds of BED was lower in non-diabetic women with morbid obesity. Women with morbid obesity who had high school degree and moderate depression level had more odds for BED.

Keywords: eating disorders binge eating disorder, night eating syndrome, bulimia nervosa, morbid obesity

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