Quantitative assessment of self-management in patients with nonalcoholic fatty liver disease: An unmet clinical need

In this editorial we comment on the article titled“Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease”by Zeng et al published in a recent issue of the World Journal of Gastroenterology.Non-alcoholic fatty liver disease(NAFLD)represents one of the current challenges in hepatology and public health,due to its continuous growing prevalence and the rising incidence of NAFLD-related fibrosis,non-alcoholic steatohepatitis and cirrhosis.The only effective therapeutic strategy for this dis-ease is represented by encouraging patients to improve their lifestyle through the modification of dietary intake and increased physical exercise,but the effective application of such modifications is often limited by various factors such as lack of information,psychological barriers or poor social support.While poor adherence to a healthy lifestyle can be decisive in determining the clinical outcome,in daily practice there is a lack of quantitative instruments aimed at identifying patients with the lowest adherence to lifestyle changes and higher risk of disease progre-ssion in the course of follow-up.In this article,Zeng et al propose a quantitative scale to assess the grade of adherence of patients with NAFLD to hea-lthy lifestyle intervention,called the Exercise and Diet Adherence Scale(EDAS).This scale,consisting of 33 items divided into 6 dimensions which relates to six subjective aspects in the self-management of NAFLD,has shown a good correlation with the identification of the sub-cohort of patients with the highest reduction in caloric intake,increase in physical exercise,probability of a reduction in liver stiffness measurement and alanine aminotransferase levels.The cor-relation among clinical outcomes and specific dimensions of this scale also highlights the pivotal role of a good and confidential doctor-patient relationship and of an effective communication.There is an urgent need for practical and effective instruments to assess the grade of self-management of NAFLD patients,together with the development of multidisciplinary teams with the aim of applying structured behavioral interventions.

Influencing factors of self-management ability among dry eye patients in west China

AIM:To investigate the current situation and influencing factors of self-management ability in dry eye patients in west China.METHODS:A total of 265 patients clinically diagnosed with dry eye received a convenience survey questionnaire at West China Hospital of Sichuan University.All participants completed the rating scale of health self-management skill for adults(AHSMSRS),Huaxi Emotional-Distress Index(HEI),e-health literacy scale(e-HEALS)and Brief Illness Perception Questionnaire(Brief-IPQ).A generalized linear model was employed to establish a multivariate linear model with demographic data,psychological state,e-HEALS,and illness perception as independent variables and health selfmanagement skill score as the dependent variable.RESULTS:The mean score for health self-management skill was 165.58±15.79.Multivariate analysis revealed that advanced age,better illness perception and improved psychological state were associated with better health selfmanagement ability among dry eye patients.Furthermore,the health self-management ability of patients with a disease duration less than 1y was found to be higher compared to those with a disease duration exceeding 1y.CONCLUSION:The health self-management ability of dry eye patients in west China is relatively high.Age,duration of disease,illness perception and psychological state are the influencing factors on the health selfmanagement ability of dry eye patients.

Effect of Diabetes Self-Management Education on Glycaemic Control in Sudanese Adults with Type 2 Diabetes

Research Background: The high prevalence of diabetes in Sudan, estimated at 16%, highlights the importance of effective health education in diabetes management. Diabetes self-management education has been identified as a crucial tool in enhancing the knowledge, attitudes, and abilities necessary for self-management among individuals with diabetes. Aim: To assess the impact of diabetes self-management education on medication adherence and glycemic control in Sudanese adults with type 2 diabetes before and 3 months after the DSME intervention. Method: The study was conducted in Sudan between September 2022 and March 2023, it was an interventional, one-group, pre- and post-test study that aimed to assess the impact of diabetes self-management education (DSME) on medication adherence and diabetes control in Sudanese adults with type 2 diabetes. The research was conducted in primary health care centers in six cities in Sudan and involved 244 participants. The data entry and statistical analysis were conducted using the Statistical Package for Social Sciences version 27.0. A paired t test was used for analysis. Results: The study included 244 participants, 67% of whom were males. The age mean ± SD was 48.6 ± 9.3 years, and 85.3% of participants were married. Age at onset of diabetes mean ± SD was 40.60 ± 7.81 years;44.6% had diabetes for less than 5 years;and 84.1% had a positive family history of diabetes mellitus. The levels of poor, low, and partial adherence to medication decreased by 8.2%, 4%, and 20.6%, respectively, after the intervention. The levels of good and high medication regime adherence increased by 13% and 19.8%, respectively;BMI decreased by 1.1 ± 0.73 kg/m2 (p = 0.005). The fasting blood sugar decreased by 69 ± 32.9 mg/dl (p = 0.049), and the glycated hemoglobin decreased by 1.21 ± 0.28% (p = 0.001). Conclusions: The findings of this study reinforce the importance of patient education in improving glycemic control and enhancing self-management behaviors. Patient education plays a critical role in enhancing glycemic control and self-management behaviors. It is essential for healthcare providers to adopt a patient-centered approach, taking into account the individual's beliefs, attitudes, and knowledge about their illness and treatment. Overcoming these challenges necessitates a comprehensive approach, including enhancing healthcare professionals’ knowledge and communication skills, offering accessible and culturally sensitive diabetes education programs, and addressing barriers to resources and support for self-management.

Assessing the relationship between health literacy intervention and hypertension self-management:A 7-year systematic review from January 2016 to December 2022

Hypertension(HTN)is one of the most common chronic diseases affecting over 30%of the adult population globally,with a growing incidence rate.This review assesses the relationship between health literacy(HL)intervention and hypertension(HTN)self-management among people with HTN.The study design was a systematic review of empirical research articles using a well-defined strategy.Online journals were accessed through databases such as PubMed,CINAHL,Google Scholar,ProQuest,Global Health,WHOLIS,Embase,and EbscoHost,spanning from January 2016 to December 2022 as the scope of the study.Articles selected for inclusion were those published in English during the specified time frame and adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Sample,Phenomenon of Interest,Design,Evaluation,Research Type framework for systematic review,focusing on criteria related to the sample,the phenomenon of interest,study design,evaluation,and research type.Out of 180 studies initially identified in the database search,20 studies were ultimately included in the review.The findings were reported based on these five emerging themes:Relationship between HL and HTN self-management;Effect of HL intervention on HTN self-management;Factors predicting self-care behaviors among HTN patients with low HL;Effect of HL and self-management efficacy on health-related quality of life(HRQoL);and level of self-care practices.This review highlights a relationship between HL,self-efficacy,self-care,and HRQoL,underscoring the necessity for further well-designed intervention studies focused on enhancing HL in individuals with HTN in Nigeria to enhance their quality of life.

Self-management in patients with diabetic foot ulcer:a concept analysis

Objective:This paper presents an analysis of the concept of patient outcomes.Methods:The present study conducted searches on various databases,including Wanfang,Sinomed,CNKI,Pub Med,Cochrane Library,Embase,Web of Science,and Ovid.The paper followed the Walker and Avant concept-analysis approach.Results:Initially,899 pieces of literature were identified through the search process,and after screening,41 of them were ultimately included in the analysis.The identified attributes of the concept included(1)capability,(2)decision making,and(3)action.These antecedents were shaped by factors such as illness perception,self-efficacy,and family and social.The consequences included(1)physiological effects,(2)psychological effects,and(3)social influence.Conclusions:The concept analysis of self-management in patients with diabetic foot ulcers(DFUs)not only aids in clinical practice and suppor ts interventions,but also contributes to the development of self-management theory.The common goal of clinical medical staff is to assist DFU patients in improving cognitive ability,making correct self-management decisions,and enhancing self-management behavior.

Application Effect of WeChat Platform Continuity of Care Model Based on KAP Theory on Self-Management of Stroke Patients with Hypertension

Objective: To explore the impact of the WeChat platform continuity of care model based on the KAP (knowledge, attitudes, and practices) theory on the self-management of stroke patients with hypertension after discharge from the hospital. Methods: 62 stroke patients with hypertension discharged from the rehabilitation department of a tertiary A hospital in Nanning City, Guangxi Zhuang Autonomous Region, from October 2022 to April 2023 were sampled by convenience sampling method. Patients discharged from Rehabilitation I were included in the control group, and conventional nursing care was used;while patients discharged from Rehabilitation II were included in the observation group, and WeChat platform continuity of nursing care model based on the KAP theory was implemented. The intervention effect of the two groups was compared. Results: After 4 and 12 weeks of intervention, the diastolic and systolic blood pressure of the patients in the observation group were lower than those in the control group (P < 0.05);after 12 weeks of intervention, the rate of medication adherence and the score of adherence to hypertension treatment in the observation group were significantly higher than those in the control group (P < 0.05). Conclusion: The application of the WeChat platform continuity of care model based on KAP theory to stroke patients with hypertension can improve blood pressure, medication adherence rate, hypertension treatment adherence, and overall enhance the self-management level of these patients.

Conceptual Analysis of Self-Management in Patients with Hypertension

Objective:To clarify the concept of self-management in hypertensive patients by analyzing the definition,attributes,and measurement tools through a literature review.Methods:An Internet-based search of the databases was conducted using Academic Search Complete,Medical Line,CINAHL,Health Source:Nursing/Scholarly Edition,and Google Scholar.In the search process,keywords or free text were combined by using Boolean operators,with the search terms“self of management”or“self-management,”“concept*analysis”or“concept*definition,”and Walker and Avant’s concept analysis method was used.Results:Analysis of relevant literature summarized the conceptual attributes of self-management in hypertensive patients as the active participation of patients in the treatment process;the presence of interaction provided by patients and health care providers;the use of certain health management tools;and the aim of maintaining and improving the health status and living capacity of hypertensive patients.Conclusion:The concept of self-management for hypertensive patients was clarified,which helps to promote the application of hypertensive self-management in clinical work and improve outcomes and quality of life for patients with hypertension.

Cumulative effects of excess high-normal alanine aminotransferase levels in relation to new-onset metabolic dysfunction-associated fatty liver disease in China

BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations between repeated high-normal ALT measurements and the risk of new-onset MAFLD prospectively.METHODS A cohort of 3553 participants followed for four consecutive health examinations over 4 years was selected.The incidence rate,cumulative times,and equally and unequally weighted cumulative effects of excess high-normal ALT levels(ehALT)were measured.Cox proportional hazards regression was used to analyse the association between the cumulative effects of ehALT and the risk of new-onset MAFLD.RESULTS A total of 83.13%of participants with MAFLD had normal ALT levels.The incidence rate of MAFLD showed a linear increasing trend in the cumulative ehALT group.Compared with those in the low-normal ALT group,the multivariate adjusted hazard ratios of the equally and unequally weighted cumulative effects of ehALT were 1.651[95%confidence interval(CI):1.199-2.273]and 1.535(95%CI:1.119-2.106)in the third quartile and 1.616(95%CI:1.162-2.246)and 1.580(95%CI:1.155-2.162)in the fourth quartile,respectively.CONCLUSION Most participants with MAFLD had normal ALT levels.Long-term high-normal ALT levels were associated with a cumulative increased risk of new-onset MAFLD.

Factors related to self-management behavior among persons with mild-to-moderate chronic obstructive pulmonary disease in Wenzhou,China

Objective:To describe the self-management(SM)behavior among persons with mild-to-moderate chronic obstructive pulmonary disease(COPD),and it examines the correlation between COPD knowledge,self-efficacy,perceived social support,and SM behavior among persons with mild-to-moderate COPD in Wenzhou,China.Methods:A simple random sampling technique was used to recruit 121 persons with mild-to-moderate COPD who visited the respiratory outpatient department of the First Affiliated Hospital of Wenzhou Medical University in Wenzhou,China.Research instruments include a demographic data questionnaire,COPD SM scale,COPD knowledge questionnaire,6-item chronic disease self-efficacy scale,and perceived social suppor t scale.Descriptive statistics and Pearson's Correlation were used for data analysis.Results:The findings show that the mean score of COPD SM scale was 2.70(SD=0.45).The Pearson correlation analysis revealed that the COPD knowledge(r=0.47,P<0.001),self-efficacy(r=0.28,P=0.001),and perceived social support(r=0.48,P<0.001)were positively correlated to the COPD SM behavior among persons with mild-to-moderate COPD in Wenzhou,China.Conclusions:The findings indicate that disease knowledge,self-efficacy,and perceived social support were related to SM behavior in persons with mild-to-moderate COPD,which provides a theoretical basis for developing SM interventions for persons with mildto-moderate COPD and improving this population's SM behavior.

Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Dynamics of information diffusion and disease transmission in time-varying multiplex networks with asymmetric activity levels

While the interaction between information and disease in static networks has been extensively investigated,many studies have ignored the characteristics of network evolution.In this study,we construct a new two-layer coupling model to explore the interactions between information and disease.The upper layer describes the diffusion of disease-related information,and the lower layer represents the disease transmission.We then use power-law distributions to examine the influence of asymmetric activity levels on dynamic propagation,revealing a mapping relationship characterizing the interconnected propagation of information and diseases among partial nodes within the network.Subsequently,we derive the disease outbreak threshold by using the microscopic Markov-chain approach(MMCA).Finally,we perform extensive Monte Carlo(MC)numerical simulations to verify the accuracy of our theoretical results.Our findings indicate that the activity levels of individuals in the disease transmission layer have a more significant influence on disease transmission compared with the individual activity levels in the information diffusion layer.Moreover,reducing the damping factor can delay disease outbreaks and suppress disease transmission,while improving individual quarantine measures can contribute positively to disease control.This study provides valuable insights into policymakers for developing outbreak prevention and control strategies.

Effects of the self-management training program on self-management behavior and blood pressure levels among elderly people with hypertension

Objective:To determine the effects of the Self-Management Training Program on self-management behavior and blood pressure(BP)levels among elderly people with hypertension(HT).Methods:This study was based on a quasi-experimental design using sampling groups composed of elderly residents of Pathum Thani Province with HT.Simple random sampling was applied to two sampling groups,an experimental group and a control group.However,the experimental group had been on the Self-Management Training Program based on the Creer concept.The Program’s contents included small-group health-education sessions and the patients’manual,Self-Management Training Skills for Self-Management Behavior.Small group discussions were held for self-reflection,to stimulate follow-up for self-management behavior training during home visits.The Self-Management Training Program was compared with programs involving the more usual care.Data were collected using the Self-Management Behavior for Hypertension Control Questionnaire and BP assessment tests.Data were analyzed using a descriptive statistic,chi-square test,pair t-test,repeated-measures Analysis of Variance(ANOVA),and repeated-measures Analysis Covariance(ANCOVA).Results:It was found that at 13 weeks after entering the program,the experimental group demonstrated a significantly lower systolic and diastolic BP with a baseline statistical significance(P<0.005),and that at the 4th week and the 13th week,there was a decrease in BP in the experimental group.The experimental group also had above-baseline self-management behavior scores that were higher than in the control group(P<0.01).Conclusions:Results from this study show that the Self-Management Program was useful for BP control and promoted sustainable self-management behavior.

Dynamic characteristics of coal specimens with varying static preloading levels under low-frequency disturbance load

The mechanical properties of residual coal pillars under the influence of upward mining disturbances significantly affect the safety of residual mining activities on working faces.This study conducted low-frequency disturbance dynamic uniaxial compression tests on coal specimens using a self-developed dynamic-static load coupling electro-hydraulic servo system,and studied the strength evolutions,surface deformations,acoustic emission(AE)characteristic parameters,and the failure modes of coal specimens with different static preloading levels were studied.The disturbance damage is positively correlated with the coal specimen static preload level.Specifically,the cumulative AE count rates of the initial accelerated damage stage for the coal specimens with static preloading level of 60%and 70%of the uniaxial compressive strength(UCS)were 2.66 and 3.19 times that of the 50%UCS specimens,respectively.Macroscopically,this behaviour manifested as a decrease in the compressive strength,and the mean strengths of the disturbance-damaged coal specimens with 60%and 70%of UCS static preloading decreased by 8.53%and 9.32%,respectively,compared to those of the specimens under pure static loading.The crack sources,such as the primary fissures,strongly control the dynamic response of the coal specimen.The difference between the dynamic responses of the coal specimens and that of dense rocks is significant.

Monitoring absolute vertical land motions and absolute sea-level changes from GPS and tide gauges data over French Polynesia

In this study,we estimate the absolute vertical land motions at three tidal stations with collocated Global Navigation Satellite System(GNSS)receivers over French Polynesia during the period 2007-2020,and obtain,as ancillary results,estimates of the absolute changes in sea level at the same locations.To verify our processing approach to determining vertical motion,we first modeled vertical motion at the International GNSS Service(IGS)THTI station located in the capital island of Tahiti and compared our estimate with previous independent determinations,with a good agreement.We obtained the following estimates for the vertical land motions at the tide gauges:Tubuai island,Austral Archipelago-0.92±0.17 mm/yr,Vairao village,Tahiti Iti:-0.49±0.39 mm/yr,Rikitea,Gambier Archipelago-0.43±0.17 mm/yr.The absolute variations of the sea level are:Tubuai island,Austral Archipelago 5.25±0.60 mm/yr,Vairao village,Tahiti Iti:3.62±0.52 mm/yr,Rikitea,Gambier Archipelago 1.52±0.23 mm/yr.We discuss these absolute values in light of the values obtained from altimetric measurements and other means in French Polynesia.

Source and level of dietary iron influence semen quality by affecting inflammation, oxidative stress and iron utilization levels in boars

Background Boars fed a mixed form of inorganic and organic iron in excess of the NRC recommended levels still develop anemia,which suggested that the current level and form of iron supplementation in boar diets may be inappropriate.Therefore,56 healthy Topeka E line boars aged 15–21 months were randomly divided into 5 groups:basal diet supplemented with 96 mg/kg ferrous sulfate(FeSO_(4))and 54 mg/kg glycine chelated iron(Gly-Fe,control);80 mg/kg or 115 mg/kg Gly-Fe;80 mg/kg or 115 mg/kg methionine hydroxyl analogue chelated iron(MHA-Fe,from CalimetFe)for 16 weeks.The effects of dietary iron supplementation with different sources and levels on semen quality in boars were investigated.Results 1)Serum Fe and hemoglobin concentrations were not affected by reduced dietary iron levels in the 80 mg/kg or 115 mg/kg Gly-Fe and MHA-Fe groups compared with the control group(P>0.05).2)Serum interleukin-6(IL-6)and sperm malondialdehyde(MDA)levels in the 80 mg/kg or 115 mg/kg MHA-Fe groups were lower than those in the control group(P<0.05),and higher serum superoxide dismutase levels and lower MDA levels in the 115 mg/kg MHA-Fe group(P<0.05).3)Boars in the 80 mg/kg or 115 mg/kg Gly-Fe and MHA-Fe groups had lower serum hepcidin(P<0.01),ferritin(P<0.05),and transferrin receptor(P<0.01)concentrations,and boars in the 115 mg/kg MHA-Fe group had higher seminal plasma Fe concentrations compared with the control group.4)Boars in the 80 mg/kg and 115 mg/kg MHA-Fe groups had lower abnormal sperm rate and in situ oscillating sperm ratio compared to the control group at weeks 12 and/or 16 of the trial.However,the effect of Gly-Fe on improving semen quality in boars was not evident.5)Serum IL-6 level was positively correlated with hepcidin concentration(P<0.05),which in turn was significantly positively correlated with abnormal sperm rate(P<0.05).Furthermore,significant correlations were also found between indicators of iron status and oxidative stress and semen quality parameters.Conclusions Dietary supplementation with 80 mg/kg or 115 mg/kg MHA-Fe did not induce iron deficiency,but rather reduced serum inflammatory levels and hepcidin concentration,alleviated oxidative stress,increased body iron utilization,and improved semen quality in adult boars.

Antibody Levels and Infection Status of Pertussis in the Population under Pertussis Resurgence in Guangxi in 2018:A Cross-Sectional Survey

Objective Pertussis cases have increased markedly since 2018 in Guangxi.The aim of this study was to evaluate antibody levels and the infection status of pertussis in the resident population.Method A total of 10,215 serum samples from residents were collected from August-November 2018 and tested for anti-pertussis IgG and toxin IgG using the enzyme-linked immunosorbent assay(ELISA).Results Of the collected samples,1,833(17.94%)tested positive for anti-pertussis IgG,with the median concentration of 16.06 IU/mL.Antibody level<10 IU/mL accounted for more than 60%in children under 4 years of age,but declined with age,whereas the percentages of the other three levels(10-40,40-50,and≥50 IU/mL)increased almost with age(P<0.001).Moreover,7,924 samples were selected for anti-pertussis toxin IgG,of which 653(8.24%)tested positive(≥40 IU/mL)with the median concentration of 5.89 IU/mL,and 204 participants(2.56%)had recent pertussis infection(≥100 IU/mL).Among the different age groups,the highest rates of positivity and recent infection were observed at 11-20 years of age,the lowest positivity rate at 5 years of age,and the lowest recent infection rate at 4 years of age(P<0.001,P=0.005,respectively).Conclusion The survey results showed that all age groups in Guangxi lacked immunity against pertussis,which was one of the main factors contributing to the resurgence of pertussis in 2018.In addition,the prevalence of pertussis is relatively high in Guangxi,and its incidence is seriously underestimated,especially in adolescents and adults.

Methodology for local correction of the heights of global geoid models to improve the accuracy of GNSS leveling

At present,one of the methods used to determine the height of points on the Earth’s surface is Global Navigation Satellite System(GNSS)leveling.It is possible to determine the orthometric or normal height by this method only if there is a geoid or quasi-geoid height model available.This paper proposes the methodology for local correction of the heights of high-order global geoid models such as EGM08,EIGEN-6C4,GECO,and XGM2019e_2159.This methodology was tested in different areas of the research field,covering various relief forms.The dependence of the change in corrected height accuracy on the input data was analyzed,and the correction was also conducted for model heights in three tidal systems:"tide free","mean tide",and"zero tide".The results show that the heights of EIGEN-6C4 model can be corrected with an accuracy of up to 1 cm for flat and foothill terrains with the dimensionality of 1°×1°,2°×2°,and 3°×3°.The EGM08 model presents an almost identical result.The EIGEN-6C4 model is best suited for mountainous relief and provides an accuracy of 1.5 cm on the 1°×1°area.The height correction accuracy of GECO and XGM2019e_2159 models is slightly poor,which has fuzziness in terms of numerical fluctuation.

Abnormal Thyroid Stimulating Hormone Level and Heavy Menstrual Bleeding

Heavy Menstrual Bleeding is one of the common Gynaecological issues. There are several causes. Some of the women presented with these issues found to have underling thyroid abnormality which was not discovered earlier. This research tries to find the prevalence of the Thyroid Disorder among the women present with Heavy menstrual bleeding in Sri Lankan women.

The Impact of Sea Level Rise on Roadway Design and Evacuation Routes in Delaware

As the global temperature continues to increase, the sea level continues to rise at a rapid rate that has never been seen before. This becomes an issue for many facets of life but one of the most impacted is the transportation infrastructure. Many people living in low elevation coastal areas can become trapped by flooding with no way in or out. With Delaware being a coastal state, this would affect a large portion of the population and will have detrimental effects over time if nothing is done to combat sea level rise. The issue with sea level rise in transportation is that once the roads become flooded, they become virtually unusable and detour routes would be needed. If all the roads in a coastal area were to be affected by sea level rise, the options for detours would become limited. This article looks at direct solutions to combat sea level rise and indirect solutions that would specifically help transportation infrastructure and evacuation routes in Delaware. There is not one solution that can fix every problem, so many solutions are laid out to see what is applicable to each affected area. Some solutions include defense structures that would be put close to the coast, raising the elevation of vulnerable roads throughout the state and including pumping stations to drain the water on the surface of the road. With an understanding of all these solutions around the world, the ultimate conclusion came in the form of a six-step plan that Delaware should take in order to best design against sea level rise in these coastal areas.

Buckling Optimization of Curved Grid Stiffeners through the Level Set Based Density Method

Stiffened structures have great potential for improvingmechanical performance,and the study of their stability is of great interest.In this paper,the optimization of the critical buckling load factor for curved grid stiffeners is solved by using the level set based density method,where the shape and cross section(including thickness and width)of the stiffeners can be optimized simultaneously.The grid stiffeners are a combination ofmany single stiffenerswhich are projected by the corresponding level set functions.The thickness and width of each stiffener are designed to be independent variables in the projection applied to each level set function.Besides,the path of each single stiffener is described by the zero iso-contour of the level set function.All the single stiffeners are combined together by using the p-norm method to obtain the stiffener grid.The proposed method is validated by several numerical examples to optimize the critical buckling load factor.