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Control of Heating, Ventilating, and Air Conditioning (HVAC) aims to provide a comfortable environment for human life in terms of temperature and humidity and improve indoor air quality. The HVAC system is multi-input multi-output, where the control design of this system is challenging due to its strong nonlinearity and the coupled influence of both system controllers on the temperature within the thermal zone. The aim of this study is to design a dual-controller for the HVAC system. The first controller is a non-linear feedback controller which is devoted to control the humidity ratio of the thermal zone with the desired characteristic. While for the second one, a robust controller is designed to maintain the desired thermal zone temperature based on the adaptive sliding mode controller (ASMC). Using the ASMC enabled us to design the second controller without the need to know the uncertainty bound on the HVAC system model. Additionally, the stability of the proposed control system was verified using the Lyapunov theory. To construct the sliding variable for the temperature control, the error state which is the difference between the thermal zoon temperature and the desired value and its derivative is needed. Due to the uncertainty in the error state derivative, a robust differentiator was designed using the approximate classical sliding mode differentiator (ACSMD). Finally, the performance of the control system is confirmed via numerical simulation. The results showed the robust ability of the control system to make the humidity and temperature of the thermal area follow the required values and with high accuracy.

With many different operative techniques in use to reduce the incidence of incisional hernias (IH) following a midline laparotomy, there is no consensus among the clinicians on the efficacy and safety of any particular repair technique. This meta-analysis compares the prophylactic onlay mesh repair (POMR) and primary suture repair (PSR) for the incidence of IH. A meta-analysis and systematic review of MEDLINE, PubMed Central (via PubMed), Embase (via Ovid), SCOPUS, ScienceDirect, Google Scholar, SCI and Cochrane Library databases were undertaken. Seven randomized controlled trials assessing the outcomes of PSR and POMR were analyzed in accordance with the PRISMA statement. The risk of bias was assessed using the Rob2 tool. According to the pooled analysis, POMR significantly reduced the incidence of IH compared to the PSR (OR 5.82 [95% CI 2.69, 12.58] P

Objective: COVID-19 is a very serious disease and is considered a pandemic by the WHO. The aim of this study is to determine the renal function and serum osmolality among COVID-19 patients in Khartoum state, Sudan. Method: This is retrospective study was conducted in Gebra Hospital, Khartoum state, Sudan from April 2021 to August 2021. The study enrolled 50 patients with Covid-19 and 50 healthy individuals as a control group. After all the enrolled participants signed the informed consent the samples were analyzed for Creatinine, Urea, Sodium, and potassium. By using an A25 fully automated chemistry analyzer, and serum Osmolality (mOsm / kg) was calculated according to Smithline and Gardner formula. Results: The study revealed a significant increase of the mean of Urea (P.value = 0.001), Creatinine (P.value = 0.001), however significant decrease in the mean of e GFR (P.value

Objective: Psychosocial trauma was associated with developing conversion disorder (also known as functional neurological disorder) before Freud, though why a particular symptom should arise is unknown. We aimed to determine if there was a relationship between trauma type and symptom. Methods: We retrospectively reviewed the medical records of patients attending Australia’s first functional neurology clinic, including referral, clinic letters and a clinic questionnaire. Results: There were 106 females, 43 males and five transgender patients. Sensory (51%), motor (47%) and seizures (39%) were the commonest functional symptoms. Most patients (92%) reported stressors associated with symptom onset. Multiple trauma/symptom type associations were found: patients with in-law problems experienced more cognitive symptoms ( p = .036), for example, while expressive speech problems more commonly followed relationship difficulties ( p = .021). Conclusion: Associations were found between type of traumatic events and type of symptoms in conversion disorder. This will require verification in a larger sample.

With lifetime intimate partner violence (IPV) victimization rates for self-identified men between 14% and 20%, and an expanding understanding of gender as a nonbinary construct, practitioners in some clinical environments have expressed interest in screening all patients for IPV. Yet, few IPV screening instruments have been validated for use in nonfemale populations. This research tests the appropriateness and acceptability of a screening instrument developed for use with women. A literature review was completed to determine the current state of research into IPV screening practices tailored to men. Next, cognitive interviews were conducted to test a 9-question IPV screening instrument with men considered at average and elevated risk for experiencing partner violence. Participants were read the questions aloud and asked about item comprehension and question appropriateness and acceptability. The literature review uncovered no published reports describing routine clinic based IPV screening of men, and only two screening instruments had been validated with men. Twenty men participated in cognitive interviews from a variety of settings in a large urban center. All participants accurately described the intended meaning of each question and verified the appropriateness of asking the questions. This work addresses the gap in research on routine IPV screening with men, building on efforts to screen individuals and support improved health and response to violence to those across the gender spectrum.

Plate girders are used as an alternative in construction when hot rolled I-shaped beams show poor strength or do not meet design requirements. Under high bending moments and shear forces, it is more efficient to use tapered plate girders. Current design codes lack specific design rules to estimate shear strength of plate girders with tapered web. The aim of this research is to investigate the elastic buckling and ultimate shear strengths of tapered end web panels in plate girders. More than two hundred detailed finite element models of plate girders with tapered end web panels are constructed and analyzed to cover a wide range of geometric parameters including: aspect ratio of end web panel, depth–to-thickness ratio of end web plate, inertia of intermediate stiffeners, and angle of tapering. Upon validation of the numerical solution, numerical results are used to establish a mathematical expression for the ultimate shear strength of prismatic and tapered end web panels. Design requirements of intermediate stiffeners are also proposed to achieve >95% of shear strength of web when stiffened with infinitely rigid stiffeners.

Concentrically braced frames (CBFs) represent one of the most efficient lateral-load-resisting systems considering its numerous advantages. Using concrete filled tube (CFT) columns provides many economical and aesthetical benefits; however, it requires the use of complex connections. Many alternatives exist in shape and detailing of these connections. Unfortunately, designers are usually faced by lack of supporting procedures related to modelling, design, and detailing of such connections. An extensive study was performed to investigate behavior of different connection configurations to CFT columns. Summary of research results are outlined. Afterwards, influence of different details on the general performance of CBF with concrete filled tube columns under cyclic loading is investigated through an experimental study. Five concentrically braced frames are tested under displacement-based cyclic loading to evaluate their behavior, lateral drift, load capacity, hysteresis responses, ductility, and stiffness degradation. Connections details include gusset plates welded to the outside shell of steel columns with and without shear connectors. Results are investigated and discussed.

Background: Sepsis is a leading cause of morbidity and mortality that has a global burden. Early recognition of sepsis and differentiating it from similar conditions is crucial. Objective: In the present study we aimed to measure the serum level of decoy receptor 3 (DcR3) in sepsis patients to study its role as a promising biomarker for bacterial sepsis. Methodology: The present study included 30 patients, divided into a sepsis group (n=15) and a systemic inflammatory response syndrome (SIRS) group (n=15), and 15 healthy controls. Sepsis patients were identified by positive blood culture or positive 16S ribosomal DNA (rDNA) polymerase chain reaction (PCR) results. SIRS patients were identified by negative blood culture or negative 16S rDNA PCR results. Serum DcR3 level was measured by quantitative enzyme-linked immunosorbent assay (ELISA). Receiver-operating characteristic (ROC) curve analysis was performed for DcR3 and C-reactive protein (CRP) alone and in combination. Results: The serum DcR3 level was significantly higher in sepsis than SIRS patients and healthy controls (5.21 ± 2.28 ng/mL, 1.96 ± 0.90 ng/mL, and 0.95 ± 0.79 ng/mL, respectively). The ROC area under the curve (AUC) of DcR3 for sepsis versus SIRS was 0.920 at a cut-off >2.4 ng/mL, with 93.33% sensitivity and 86.67% specificity. The AUC of combined positive DcR3 and positive CRP for sepsis versus SIRS was 0.967 with 93.33% sensitivity and 100% specificity. Conclusion: DcR3, alone or in combination with CRP, is a promising biomarker for distinguishing sepsis from SIRS patients and may efficiently guide physicians to identifying sepsis patients, for whom the further usage of new diagnostics can be cost-effective.

Hematopoietic stem cell transplant (HSCT) recipients are at increased risk of mortality and morbidity with coronavirus disease 2019 (COVID-19) due to severe immune dysfunction.A literature search was performed on PubMed, Cochrane, and Clinical trials.gov from the date of inception to 12/08/2021. We identified 19 original studies reporting data on COVID-19 in HSCT recipients after screening 292 articles. Data were extracted following preferred reporting items for systematic reviews and meta-analysis guidelines. Quality evaluation was done using the National Institutes of Health (NIH) quality assessment tool. Inter-study variance was calculated using Der Simonian-Laird Estimator. Pooled analysis was conducted using MetaXL. A random-effects model was used to estimate the proportions with 95% confidence intervals (CI).Of 6711 patients in 19 studies, 2031 HSCT patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were analyzed. The median age of patients was 56.9 (range 1-81.6) years, and 63% patients were men according to 14 studies. The median time from transplant to SARS-CoV-2 infection for autologous (auto) and allogeneic (allo) HSCT patients was 23.2 (0.33-350.5) months and 16.4 (0.2-292.7) months, respectively. The median follow-up time after COVID-19 diagnosis was 28 (0-262) days. The COVID-19 mortality rate was 19% (95% CI 0.15-0.24, IHSCT recipients have a high risk of mortality and clinical complications due to COVID-19. There is a need for ongoing vigilance, masks, and social distancing, vaccination, and aggressive management of SARS-CoV-2 infection in HSCT recipients.

In this paper, I use some artificial intelligence techniques algorithms, which are the algorithms of the artificial immune system (positive selection algorithm and negative selection algorithm). Through these two algorithms, it is distinguished between the original and distorted English letters. Through the results of the patterns, which were obtained after the implementation of these two algorithms, I observed that the percentage of discrimination was 85% for the positive selection algorithm, and 80% for the negative selection algorithm. This discrimination was applied after the images had been divided into blocks, and then the properties of the images had been extracted by adopting the method of seven undependable momentums in order to gain patterns which are close to the original pattern of the introduced English letter.

Adverse life events precede the onset of functional neurological disorder (FND, also known as conversion disorder) more commonly than other neuropsychiatric conditions, but their aetiological role is unclear. We conducted a systematic review and quantitative analysis of the type, timing and number of life events preceding the onset of FND in adults, and a meta-analysis of the proportions of types of events in controlled studies. Fifty-one studies of different designs, covering 4247 patients, were eligible for inclusion. There was no clear majority of any type of preceding event. Family problems were the most common category of events, followed by relationship problems. Females were more likely to experience preceding family/relationship problems than males, who reported more work problems. Family problems were the commonest type of preceding event in studies in developing countries, whereas family and health problems were equally common in developed countries. Abuse was associated with early symptom onset, while patients with later onset were more likely to report family problems. The median number of events was one, and the events occurred closer to onset than in controls. Meta-analysis found that family, relationship and work events were all relatively more common in patients than pathological controls, as were events where symptoms might provide a solution to the stressor. In conclusion, although a range of events precede the onset of FND, they do not appear to do so uniformly. This may support a different aetiological role for stressors than in other disorders, although the support is indirect and the quality generally low.

Background During March of 2020 the Centers for Disease Control and Prevention (CDC) announced non-pharmaceutical intervention (NPI) guidance as the primary mitigation strategy against growing COVID-19 community spread due to the absence of a vaccine or effective treatment at that time. CDC guidance states that NPIs are most effective when instituted in an early, targeted, and layered fashion. NPIs are effective in slowing spread, and measures should be custom-tailored to each population. This study examines factors associated with implementation and timing of NPI interventions across large public and private U.S. universities at the onset of the COVID-19 pandemic. Methods NPI decisions of interest include when U.S. universities canceled international travel, shifted to online learning, moved faculty/staff to remote work, limited campus housing, and closed campus for all non-essential personnel. Cox proportional hazard analyses of retrospective data were conducted to assess the time to NPI events. Hazard ratios were calculated for university governance, campus setting, religious affiliation, health infrastructure, faculty diversity, and student demographics. The methods control for variance inflation factors, COVID case prevalence, and time varying covariates of spring break and states’ state of emergency (SOE) orders. This study captures NPI decisions at 575 U.S. universities during spring of 2020 which affected the movement of seven million students and two million employees. Results Universities located in districts represented by Democratic party congressional members reported earlier NPI implementation than Republican (Cox proportional hazard ratio (HR) range 0.61–0.80). University religious affiliation was not associated with the timing any of the NPI decisions. Universities with more diverse faculty showed an association with earlier NPI implementation (HR range 0.65–0.76). The existence of university-affiliated health infrastructure was not associated with NPI timing. Conclusion University NPI implementation was largely driven by local COVID-19 epidemiology, culture and political concerns. The timing of university NPI decisions varied by regional politics, faculty demographics, university governance, campus setting, and foreign student prevalence adjusting for COVID-19 state case prevalence and spring break timing. Religious affiliation and presence of university health infrastructure were not associated with timing.

IntroductionIndividuals who engage with sex work face barriers to maintaining overall health and well-being such as criminalization, stigmatization, and violence. An emerging approach to facilitating exiting sex work for individuals is through programs applying the Critical Time Intervention (CTI) model. CTI represents a time-limited practice that supports vulnerable individuals during periods of transition. The objectives of this study were to apply an existing CTI fidelity assessment to the sex work exiting program Exit Doors Here (EDH) to (1) report on the program’s fidelity and (2) discuss the effectiveness of CTI for supporting these groups. MethodsTo determine the applicability to the EDH of an existing fidelity assessment tool, we consulted with program staff through in person meetings. Staff highlighted areas for adaptation. We adapted the tool based on this feedback and used it to assess program fidelity by analyzing data from 8 participants’ CTI notes. Fidelity ratings were computed and interpreted according to established guidelines. ResultsConsultations with program staff resulted in adaptations to seven items out of the 12 comprising the fidelity assessment tool. The majority of adaptations surrounded the time-limited nature of CTI and unique needs of the program participants. In regards to the fidelity assessment using the adapted tool, half of the items were ideally implemented, one was well implemented, one was fairly implemented and two were respectively found to be poorly implemented and not implemented at all. Conclusions Difficulties in implementing selected program components with high fidelity can be attributed to specificities of the target population and to contextual factors, which are hard to control from a staff and program standpoint. This assessment reiterates the importance of considering such factors when developing and implementing programs aimed at improving the health and well-being of marginalized women such as those who engage in sex work.

The COVID-19 pandemic and associated public health preventive measures such as lockdown and home confinement have posed unique challenges to female sex workers (FSW) globally, including in Canada where the sex trade is not formally recognized. In this commentary, we discuss the unintended consequences the pandemic has had on various social determinants of health among FSW. We draw on a review of scholarly and grey literature, complemented by our experience with the Exit Doors Here program, a sex work exiting program implemented in Toronto, Canada. Due to COVID-19, many FSW suddenly lost their main source of income, work conditions became riskier, and sheltering-in-place presented challenges for women with no safe housing. The slowdown of social and health care services also meant FSW were not receiving the required attention. We make recommendations for intersectoral mitigation strategies to limit the short- and long-term impacts of COVID-19 on FSW health and livelihoods. Recommendations focus on addressing women’s marginalizing circumstances and speak to a gender transformative approach to the COVID-19 recovery. Our recommendations are relevant to FSW and other marginalized groups, in the current context and in the context of future health, social, and economic crises.

Background For women who want to, exiting sex work can be challenging. Numerous programs strive to help women wanting to exit sex work and secure alternative sources of income by providing targeted support at key moments during the transition, yet few of those initiatives are rigorously evaluated. In 2017 “Exit Doors Here”, a 9-month sex work exiting program based on the critical time intervention (CTI) approach, was developed to provide wrap-around support services (e.g., health, addiction, housing, education, and employment supports) to women wishing to transition towards exiting sex work. Methods We present the design of an evaluation study of Exit Doors Here which combines quantitative and qualitative methods to assess participant recruitment and retention into the program, program fidelity, and relationships with service providers (process evaluation), as well as progress made by participants in terms of strengthening their social support networks and moving closer to achieving their housing, pre-employment (i.e., educational, training and volunteering), and income-related goals, as well as their involvement in sex work (outcome evaluation). Each year for 4 years, between 25 and 30 Exit Doors Here clients will be invited to complete an interviewer-administered questionnaire at the beginning and after completing the program, and to share data from their CTI charts and related documentation. Once a year, program staff and peer workers will be interviewed, and service providers will be surveyed. Discussion Conducting a formative (process) evaluation will allow us to inform program implementation and improve program delivery early on for maximum benefit. The summative (outcome) evaluation will provide much needed evidence on the effectiveness of CTI in supporting a traditionally underserved population to achieve the housing, pre-employment and income-related goals they value, and their progress towards reducing their involvement in, and eventually exiting, sex work.

BACKGROUND The popularity of mobile health (mHealth) technology has resulted in the development of numerous apps for almost every condition and disease management. mHealth and eHealth solutions for increasing awareness about, and safety around, intimate partner violence are no exception. These apps allow women to control access to these resources and provide unlimited, and with the right design features, safe access when these resources are needed. Few apps, however, have been designed in close collaboration with intended users to ensure relevance and effectiveness. OBJECTIVE The objective of this paper is to discuss the design of a suite of evidence-based mHealth and eHealth apps to facilitate early identification of unsafe relationship behaviors and tailored safety planning to reduce harm from violence including the methods by which we collaborated with and sought input from a population of intended users. METHODS A user-centered approach with aspects of human-centered design was followed to design a suite of 3 app-based safety planning interventions. RESULTS This review of the design suite of app-based interventions revealed challenges faced and lessons learned that may inform future efforts to design evidence-based mHealth and eHealth interventions. CONCLUSIONS Following a user-centered approach can be helpful in designing mHealth and eHealth interventions for marginalized and vulnerable populations, and led to novel insights that improved the design of our interventions.

BackgroundChildhood epilepsy can have a significant impact on family functioning with high rates of patent anxiety and depression being reported.ObjectivesTo demonstrate the frequency of depression, anxiety and distress among the parents of epileptic children.Patients and MethodsA cross sectional study design was carried out on 100 children and their parents attending the outpatient clinics in Minia University Hospital, arranged in two groups, Group (A) consisted of 50 epileptic children and their caregivers. On the other hand, Group (B) consisted of 50 age- and sex matched controls. Comprehensive Assessment was carried out. A well-prepared sheet had been used for the evaluation of subjects of the study. Twenty-one item Depression Anxiety Stress Scale (DASS-21), Hamilton Anxiety Scale (HAM - A) and Hamilton Rating Scale for Depression (HRSD) were used for interviewing the parents of the epileptic children to screen for depression, anxiety, stress in those parents. This process preceded by full explanation of all the previous tools.There was statistically significant difference between the parents of the epileptic group and the control group regarding DASS score, and HAM-A score. There was no statistically significance between the 2 groups regarding the HRSD. The parents group of generalized fits shows to have a higher score of DASS (9.5±4.7), HDRS (5.1±3.3). In contrast to the focal fits group. On the other hand, the parents of group of generalized fits shows to have lower score of HAM-A (6.7±4) in contrast to the focal fits group but not statistically significant.Compliant group shows to have higher score of HAM-A, HDRS score in contrast to non-compliant group. These correlations were not statistically significant.ConclusionsParents of the epileptic children had more anxiety, depression and stress than the control. Lower parental education was associated with more distress and anxiety.Ploy-therapy increased parent anxiety and depression. Compliance on treatment decreased parent distress but increased parent anxiety and depression.

The timing of the pandemic response decision can affect the national mass migration of millions of students back to campus thus limiting community spread. During the initial stages of the COVID-19 pandemic, universities across the United States were faced with making difficult decisions often without explicit or uniform guidance from state and national leadership. This study examines how and when public universities responded to the U.S. COVID-19 outbreak, regarding decisions to cancel international travel, switch to online learning, transition faculty and staff to remote work, limiting on-campus housing, and implementing campus closures. Data was collected on university timing and decision making for medium to large public universities with more than 5,000 enrolled students, representing 412 institutions, 7M people, and all 50 states and Puerto Rico, between February 27 and March 31st, 2020. Substantial heterogeneity in decision making and the timing of those decisions as they relate to key state, national, and global emergency announcements were observed. The WHO pandemic declaration coincided with announcements to move away from on-campus learning. Universities decisions were made largely at the university level and not coordinated by government agencies, leading to staggered announcements and major variations in university timelines between states and within states. The importance of synchronizing university decisions in a national emergency scenario cannot be understated. Dissonant university decisions and announcement dates may potentially lead to mixed messaging and a reduction of the effectiveness of early interventions. Clear guidance is needed moving forward regarding university operations for fall and summer.

BackgroundThe Centers for Disease Control and Prevention (CDC) publishes COVID-19 non-pharmaceutical intervention (NPI) guidance for specific institutional audiences to limit community spread. Audiences include: business, clinical, public health, education, community, and state/local government. The swift, severe, and global nature of COVID-19 offers an opportunity to systematically obtain a national view of how larger institutions of higher education adopted NPI guidance at the onset of the pandemic.MethodAn original database of COVID-19-related university NPI policy changes was compiled. Survey team members manually combed university websites and official statements capturing implementation decisions and dates for five NPI variables from 575 U.S. universities, across 50 states and the District of Columbia, during March of 2020. The universities included in this study were selected from the Department of Education Integrated Postsecondary Education Data System (IPEDS), which provides a set of university explanatory variables. Using IPEDS as the basis for the organizational data allows consistent mapping to event-time and institutional characteristic variables including public health announcements, geospatial, census, and political affiliation.ResultsThe dataset enables event-time analysis and offers a variety of variables to support institutional level study and identification of underlying biases like educational attainment. A descriptive analysis of the dataset reveals that there was substantial heterogeneity in the decisions that were made and the timing of these decisions as they temporally related to key state, national, and global emergency announcements. The WHO pandemic declaration coincided with the largest number of university decisions to implement NPIs.ConclusionThis study provides descriptive observations and produced an original dataset that will be useful for future research focused on drivers and trends of COVID-19 NPIs for U.S. Universities. This preliminary analysis suggests COVID-19 university decisions appeared to be made largely at the university level, leading to major variations in the nature and timing of the responses both between and within states, which requires further study.

Beams with web openings represent an attractive system for multi-storey buildings characterized by long spans. Openings in web of steel beams enable building services to be integrated within the constructional depth of the floor, thus reducing the total floor depth. This paper employs the general finite element software ABAQUS to numerically model the behaviour of restrained structural subassemblies of steel beam with web openings to concrete filled tubular column under fire loading scenarios. Steel beams, in this case, are axially restrained which results in a drastically different behaviour when compared to unrestrained beams. In this research, a comprehensive finite element (FE) study of the behaviour of structural subassemblies of steel beams with openings under fire scenarios is conducted. Four sizes of perforated steel sections with seven different opening configurations are modelled and studied in order to understand the significance of their effects. Moreover, the influence of applied load ratios in addition to the level of axial restraint are examined. Consequently, considerations for the performance of axially restrained perforated steel beams under fire scenarios is provided.

Fully Autonomous Driving is considered as one of the difficult problems faced the automotive applications. It is forbidden due to the presence of some restricted Laws that prevent cars from being autonomous for the fear of accidents occurrence. However, researchers try to reach autonomous driving as a new area for research for the aim of having a strong push against these restricted Laws. Crash Avoidance functionality is one of the most important features in Self-Driving Cars that is partially integrated recently. We propose an end-to-end Crash Avoidance Deep IoT solution which is decomposed into two main parts: a) Detection Deep Neural Network which aims to detect accident occurrence in front of the ego-vehicle, and b) Accident Information Spreading IoT which is responsible for informing upcoming vehicles that there is an accident, then these vehicles will be able to take the reasonable actions either changing their routes, or changing their lanes avoiding crash. Due to the lack of Crash benchmarks, we build our own benchmark, depending only on a front camera, using ROS-Gazebo Simulation environment covering various crashes situations. In General, our proposed idea is the first solution that merges Deep Learning with IoT in automotive applications.

Background The popularity of mobile health (mHealth) technology has resulted in the development of numerous apps for almost every condition and disease management. mHealth and eHealth solutions for increasing awareness about, and safety around, intimate partner violence are no exception. These apps allow women to control access to these resources and provide unlimited, and with the right design features, safe access when these resources are needed. Few apps, however, have been designed in close collaboration with intended users to ensure relevance and effectiveness. Objective The objective of this paper is to discuss the design of a suite of evidence-based mHealth and eHealth apps to facilitate early identification of unsafe relationship behaviors and tailored safety planning to reduce harm from violence including the methods by which we collaborated with and sought input from a population of intended users. Methods A user-centered approach with aspects of human-centered design was followed to design a suite of 3 app-based safety planning interventions. Results This review of the design suite of app-based interventions revealed challenges faced and lessons learned that may inform future efforts to design evidence-based mHealth and eHealth interventions. Conclusions Following a user-centered approach can be helpful in designing mHealth and eHealth interventions for marginalized and vulnerable populations, and led to novel insights that improved the design of our interventions.

Several metallic bridges are present in Egypt and form an important part of the transportation network. Many of these bridges exceeded the intended design life. Currently, deterioration of bridge conditions is pronounced and is leading to many problems. In addition, it is feared that lack of corrective procedures may lead to failure within a few years. Periodic maintenance and major repair activities during a structure service life are mandatory to sustain a satisfactory performance that preserves public safety and extends the service life. The current work is carried out to summarize the most frequent structural problems and defects faced during inspection campaign of a group of metallic bridges in Egypt. Reported problems include but are not limited to corrosion, fatigue cracks, and permanent deformations in structural elements. Data are collected through an extensive investigation of several metallic bridges in Egypt. The study included visual inspection, structural analysis under the action of loads imposed by latest design codes, fatigue assessment of different bridge components, and field tests. Observations include problems or defects related to steel superstructure, pedestrian side walkways, sleepers and rails system, bracing systems, in addition to reinforced concrete substructures. The study is meant to shed light upon the current conditions of vital structures and explore the available practical repair techniques.

Background: obesity and iron deficiency anemia are major health problems that are increasing in Egypt especially in females. Aim of work: this study aimed to evaluate the iron status in obese Egyptian females in comparison to normal weight females. Patients and Methods: forty four obese adult female patients and 44 normal weight healthy females as control group were included in this study. They were all tested for iron profile and CRP using semi quantitative rapid latex agglutination test. Results: the patient group in this study showed a significant lower serum Fe and TSI than the control group, while ferritin was higher in patients than the control group. The comparison between the three groups of obesity showed that the grade III patients had the lowest median value in serum iron and the highest median value in TIBC and ferritin, however no statistical significant differences were detected between the three groups of patients (P>0.05). Our results showed that 70.4%) of patients had positive CRP with positive correlation between CRP and BMI. Conclusion and Recommendations: obesity is a low inflammatory disease which affects iron profile and increases CRP. Further, study on larger number of cases is recommended to analyze the exact mechanism of iron deficiency anemia in obese female patients.

Breast cancer considered the most common malignancy .Therefore this study was aimed to review the observations and information on relationship of preoperative level of (HSP70) with hormones receptors (ER,PR,HER-2) and the expression of these receptors in biopsies from patients with different stages and grades of disease by immunohistochemical method. In this study total number of (130)cases was analyzed and most patients diagnosed with stage (T111) then (T11)and (T1) with highly significant difference at (p≤ 0.05) and the same results was obtained from classified tumor grading with (BC)patients. The recent study evaluated level of (HSP70) in all (BC)patients ,the data showed highly significant difference and the mean level was increased in (71)case compared to control ,also we evaluated the relationship between tumor staging and grading with level of (HSP70) and data revealed to high level in (T111) patients while no signification between (T1,T3) ,the same results recorded between tumor grading and level (HSP70), hormones receptors expression (ER,PR,HER-2) and its correlation with (IL-6)level was also determined ,the( HSP70) with (ER+)compared to (ER-) with high significance (p=0.00),the same results shown with (PR+) and(HER-2) expression and (HSP70)in all (BC)patients. The role of (HSP70) in (BC) immunity ,carcinogenesis ,cancer pathogenesis ,tumor initiation ,growth and metastasis .Results also explained correlate of (HSP70)with clinical staging and grading ,these findings pointed to an important role in the progression of (BC) at least in patients with advanced disease stages. Data determined that the (ER+)(PR+) positive tumor more reactive with(HSP70) which explained the effect of this factor on hormones receptors. Moreover present study showed little elevated in concentrate of (HSP70) with Her2+as compared with Her2- but with no significant differences,(p=.158).Immunhistochemical staining was used in this study and results showed variable degree of staining Within invasive ductal and lobular carcinoma types compared to control.

Concrete-filled double skin steel tube (CFDST) beam-columns are widely used in industrial plants, subways, high-rise buildings and arch bridges. The CFDST columns have the same advantages as traditional CFT members. Moreover, they have lighter weight, higher bending stiffness, better cyclic performance, and have higher fire resistance capacities than their CFT counterparts. The scope of this study is to develop finite element models that can predict accepted capacities of double skin concrete-filled tube columns under the combined effect of axial and bending actions. The analysis results were studied to determine the distribution of stresses among the different components and the effect of the concrete core on the outer and inner steel tube. The developed models are first verified against the available experimental data. Accordingly, an extensive parametric study was performed considering different key factors including load eccentricity, slenderness ratio, concrete compressive strength, and steel tube yield strength. The results of the performed parametric study are intended to supplement the experimental research and examine the accuracy of the available design formulas.

e18611 Background: Coronavirus Disease 2019 (COVID-19) was declared a pandemic on March 11, 2020. COVID-19 has caused over 100 million infections and over 2 million deaths globally. Patients who have received a hematogenic stem cell transplant or cellular therapy (HCT) have a high risk of mortality and morbidity with COVID-19 due to severe immune dysregulation. We conducted a systematic review and meta-analysis aimed to evaluate the outcomes of COVID-19 in HCT patients. Methods: A literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA) guidelines was performed on 3 databases (PubMed, Cochrane, and Clinical trials.gov) from the date of inception to Jan 2021. MeSH terms included ‘hematological malignancies’, ‘hematopoietic stem cell transplantation’, ‘SARS-CoV-2’, and ‘COVID 19’. We screened 99 articles and 6 studies (4 retrospective studies, 2 prospective) were included after excluding review, duplicate, and non-relevant articles. Quality evaluation was done using the NIH quality assessment tool. The Inter-study heterogeneity among the studies was assessed using the Q statistic proposed by Cochrane and the I2 index introduced by Higgins and Thompson. Pooled analysis was done using the ‘metaXL’, and the random effects model was used to estimate the pooled prevalence with 95% CI. Results: Of 1619 patients in 6studies, 646 HCT patients were analyzed (Table ). The median age of patients was 63 years and 59% were males. Median days since HCT for autologous (auto) HCT and allogeneic (allo) HCT patients were 690 and 450 days respectively. The average follow-up duration after COVID-19 was 24 days. COVID-19 mortality in HCT patients was 20% (95%CI 0.17 to 0.23, I2=0). Roedl et al (n=6) reported a mortality of 83% and was excluded from the pooled analysis. The mortality rate was 19% (95% CI 0.15 to 0.24, I2=0%) in auto HCT patients and 21% (95% CI 0.17 to 0.25, I2=0%) in allo HCT patients. Conclusions: The HCT patients are at significant risk of increased mortality and morbidity due to COVID-19. There is a need to prioritize HCT patients for COVID-19 vaccination, close surveillance, and aggressive management.[Table: see text]

e19021 Background: Poor graft function (PGF) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation (allo-HCT) characterized by severe multilineage cytopenia in the absence of mixed donor chimerism, relapse, or severe graft-vs-host disease (GVHD). We present a systemic review and meta-analysis aimed to assess the outcomes with stem cell boost (SCB) for PGF in adult allo-HCT patients. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, 752 articles were screened from 4 databases (PubMed, Embase, Cochrane, and Clinical trials.gov) using MeSH terms and keywords for “hematological malignancies”, “hematopoietic stem cell transplantation”, “CD34 antigen(s)” and “treatment outcome(s)” from the date of inception to Jan 2021. After excluding review, duplicate and non-relevant articles, we included 8 studies (1 prospective, 7 retrospective) reporting hematologic complete/overall response rate (CR/ORR), GVHD and overall survival (OS) after SCB for PGF after Allo-HSCT. Quality evaluation was done using the NIH quality assessment tool. Pooled analysis was done using the ‘meta’ package (Schwarzer et al, R programming language) and proportions with 95% confidence intervals (CI) were computed. Inter-study variance was calculated using Der Simonian-Laird Estimator. Results: We identified 217 patients who received SCB for PGF after allo-HCT. Median age, time since transplant and SCB dose were 48 (37-54) years, 133 (113-450) days and 3.43 (1.7-4.9) million CD34 cells/kg respectively. CR and ORR were 71% (95%CI 0.63-0.77, I216%) and 80% (95%CI 0.74-0.85, I20%) respectively. After median follow up of 41.5 (5-77) months, actuarial survival rate (ASR) was 54% (95%CI 0.48-0.61, I20%). OS was reported from 80% (1y) to 40% (9y) Acute and chronic GVHD incidence after SCB was 17% (95% CI 0.12-0.23, I2=0%) and 17% (95% CI 0.08-0.32, I2=72%, n=197) respectively, and 25% (95% CI 0.14-0.39, I2=63%, n=163) deaths were due to relapse (Table). Conclusions: CD34 SCB improves outcomes after PGF after allo-HSCT with acceptable toxicity profile. However, current literature lacks high-quality randomized evidence and there remains an unmet need for prospective studies to address optimal dosing and manipulation of SCB. Outcomes with SCB for PGF after allo-HCT (n=217).[Table: see text]