MIMO Radar-Based System for Structural Health Monitoring and Geophysical Applications

The paper presents a methodology for real-time structural health monitoring and geophysical applications. The key elements of the system are a high performance MIMO RADAR sensor, an optical camera and a dedicated set of software algorithms encompassing interferometry, tomography and photogrammetry. The MIMO Radar sensor proposed in this work, provides an extremely high sensitivity to displacements making the system able to react to tiny deformations (up to tens of microns) with a time scale which spans from milliseconds to hours. The MIMO feature of the system makes the system capable of providing a set of two-dimensional images of the observed scene, each mapped on the azimuth-range directions with noticeably resolution in both the dimensions and with an outstanding repetition rate. The back-scattered energy, which is distributed in the 3D space, is projected on a 2D plane, where each pixel has as coordinates the Line-Of-Sight distance and the cross-range azimuthal angle. At the same time, the high performing processing unit allows to sense the observed scene with remarkable refresh periods (up to milliseconds), thus opening the way for combined static and dynamic structural health monitoring. Thanks to the smart TX/RX antenna array layout, the MIMO data can be processed through a tomographic approach to reconstruct the three-dimensional map of the observed scene. This 3D point cloud is then accurately mapped on a 2D digital optical image through photogrammetric techniques, allowing for easy and straightforward interpretations of the measurements. Once the three-dimensional image is reconstructed, a 'repeat-pass' interferometric approach is exploited to provide the user of the system with high frequency three-dimensional motion/vibration estimation of each point of the reconstructed image. At this stage, the methodology leverages consolidated atmospheric correction algorithms to provide reliable displacement and vibration measurements.

Millennials' Viewpoints about Sustainable Hotels' Practices in Egypt: Promoting Responsible Consumerism

Millennials are a distinctive and dominant consumer group whose behavior, preferences and purchase decisions are broadly explored but not fully understood yet. Making up the largest market segment in the world, and in Egypt, they have the power to reinvent the hospitality industry and contribute to forming prospective demand for green hotels by showing willingness to adopting their environmental-friendly practices. The current study aims to enhance better understanding of Millennials' perception about sustainable initiatives and to increase the prediction power of their intentions regarding green hotel practices in Egypt. In doing so, the study is exploring the relation among different factors; Millennials' environmental awareness, their acceptance of green practices and their willingness to pay more for them. Millennials' profile, their preferences and environmental decision-making process are brought under light to stimulate actions of hospitality decision-makers and hoteliers. Bearing in mind that responsible consumerism is depending on understanding the different influences on consumption. The study questionnaire was composed of four sections and it was distributed to random Egyptian travelers' blogs and Facebook groups, with approximately 8000 members. Analysis of variance test (ANOVA) was used to examine the study variables. The findings indicated that Millennials' environmental awareness will not be a significant factor in their acceptance of hotel green practices, as well as, their willingness to pay more for them. However, Millennials' acceptance of the level of hotel green practices will have an impact on their willingness to pay more. Millennials were found to have a noticeable level of environmental awareness but lack commitment to tolerating hotel green practices and their associated high prices.

The Use of Different Methodological Approaches to Teaching Mathematics at Secondary Level

The article describes methods of preparation of future teachers that includes the entire diversity of traditional and computer-oriented methodological approaches. The authors reveal how, in the specific educational environment, a teacher can choose the most effective combination of educational technologies based on the nature of the learning task. The key conditions that determine such a choice are that the methodological approach corresponds to the specificity of the problem being solved and that it is also responsive to the individual characteristics of the students. The article refers to the training of students in the proper use of mathematical electronic tools for educational purposes. The preparation of future mathematics teachers should be a step-by-step process, building on specific examples. At the first stage, students optimally solve problems aided by electronic means of teaching. At the second stage, the main emphasis is on modeling lessons. At the third stage, students develop and implement strategies in the study of one of the topics within a school mathematics curriculum. The article also recommended the implementation of this strategy in preparation of future teachers and stated the possible benefits.

Performance Assessment of a Variable-Flux Permanent-Magnet Memory Motor

The variable flux permanent magnet synchronous motor (VF-PMSM), also called "Memory Motor", is a new generation of motor capable of modifying the magnetization state with short pulses of current during operation or standstill. The impact of such operation is the expansion of the operating range in the torque-speed characteristic and an improvement in energy efficiency at high-speed in comparison to conventional permanent magnet synchronous machines (PMSMs). This paper reviews the operating principle and the unique features of the proposed memory motor. The benefits of this concept are highlighted by comparing the performance of the rotor of the VF-PMSM to that of two PM rotors that are typically found in the industry. The investigation emphasizes the properties of the variable magnetization and presents the comparison of the torque-speed characteristic with the capability of loss reduction in a VF-PMSM by means of experimental results, especially when tests are conducted under identical conditions for each rotor (same stator, same inverter and same experimental setup). The experimental results demonstrated that the VF-PMSM gives an additional degree of freedom to optimize the efficiency over a wide speed range. Thus, with a design easy to manufacture and with the possibility of controlling the magnetization and the demagnetization of the magnets during operations, the VF-PMSM can be interesting for various applications.

Context Aware Anomaly Behavior Analysis for Smart Home Systems

The Internet of Things (IoT) will lead to the development of advanced Smart Home services that are pervasive, cost-effective, and can be accessed by home occupants from anywhere and at any time. However, advanced smart home applications will introduce grand security challenges due to the increase in the attack surface. Current approaches do not handle cybersecurity from a holistic point of view; hence, a systematic cybersecurity mechanism needs to be adopted when designing smart home applications. In this paper, we present a generic intrusion detection methodology to detect and mitigate the anomaly behaviors happened in Smart Home Systems (SHS). By utilizing our Smart Home Context Data Structure, the heterogeneous information and services acquired from SHS are mapped in context attributes which can describe the context of smart home operation precisely and accurately. Runtime models for describing usage patterns of home assets are developed based on characterization functions. A threat-aware action management methodology, used to efficiently mitigate anomaly behaviors, is proposed at the end. Our preliminary experimental results show that our methodology can be used to detect and mitigate known and unknown threats, as well as to protect SHS premises and services.

Deep Learning Based Fall Detection Using Simplified Human Posture

Falls are one of the major causes of injury and death among elderly people aged 65 and above. A support system to identify such kind of abnormal activities have become extremely important with the increase in ageing population. Pose estimation is a challenging task and to add more to this, it is even more challenging when pose estimations are performed on challenging poses that may occur during fall. Location of the body provides a clue where the person is at the time of fall. This paper presents a vision-based tracking strategy where available joints are grouped into three different feature points depending upon the section they are located in the body. The three feature points derived from different joints combinations represents the upper region or head region, mid-region or torso and lower region or leg region. Tracking is always challenging when a motion is involved. Hence the idea is to locate the regions in the body in every frame and consider it as the tracking strategy. Grouping these joints can be beneficial to achieve a stable region for tracking. The location of the body parts provides a crucial information to distinguish normal activities from falls.

Analyzing the Impact of Indian Architecture on the Architecture of Cambodia, Thailand and Indonesia

To appreciate Indian art and architecture by studying it in India alone will only lead to partial understanding of the whole story and the variety of the statement has been amply proved by subsequent decades of patient research. The results of the work of the Archaeological Survey of India forms only one half of the picture, the other half emerges with the studies of the archaeology and art of the Far East that progressed almost simultaneously under the Archaeological Survey of the Dutch East Indies, the École française d'Extrême-Orient (EFEO), or French School of Asian Studies, and allied institutions. The conclusions arrived at have only rendered the assertion that India produced her ultimate master pieces only through foreign influences and in foreign lands (the South-Eastern peninsular and archipelagic regions) almost axiomatic. Angkor in Cambodia and Borobudur in Java, undoubtedly the two greatest architectural marvels of Indian genius, for in content and spirit these (and other monuments of varying magnitudes), are purely Indian, would well illustrate the statement mentioned earlier. Stimulated research followed the discoveries and among the many studies and publications of such pioneers like Coedes, Parmentier, Coomaraswamy and many others in Dutch, French and English made growing contributions to the subject. This paper will discuss in detail the impact of India on the architecture of South East Asia by detailed comparison of architectural styles, elements, and construction materials of a few specific architectural master pieces, in both India and South East Asian countries. It will also analyze the reasoning behind the influence of India on South East Asian countries in spite of them being exposed to the equally culturally rich and civilized kingdoms of China. The intention of this paper is to understand that, conquest by war is not always the only reason for architectural influences and impacts.

Deep Injection Wells for Flood Prevention and Groundwater Management

With its arid climate, Qatar experiences low annual rainfall, intense storms, and high evaporation rates. However, the fast-paced rate of infrastructure development in the capital city of Doha has led to recurring instances of surface water flooding as well as rising groundwater levels. Public Work Authority (PWA/ASHGHAL) has implemented an approach to collect and discharge the flood water into a) positive gravity systems; b) Emergency Flooding Area (EFA) – Evaporation, Infiltration or Storage off-site using tankers; and c) Discharge to deep injection wells. As part of the flood prevention scheme, 21 deep injection wells have been constructed to discharge the collected surface and groundwater table in Doha city. These injection wells function as an alternative in localities that do not possess either positive gravity systems or downstream networks that can accommodate additional loads. These injection wells are 400-m deep and are constructed in a complex karstic subsurface condition with large cavities. The injection well system will discharge collected groundwater and storm surface runoff into the permeable Umm Er Radhuma Formation, which is an aquifer present throughout the Persian Gulf Region. The Umm Er Radhuma formation contains saline water that is not being used for water supply. The injection zone is separated by an impervious gypsum formation which acts as a barrier between upper and lower aquifer. State of the art drilling, grouting, and geophysical techniques have been implemented in construction of the wells to assure that the shallow aquifer would not be contaminated and impacted by injected water. Injection and pumping tests were performed to evaluate injection well functionality (injectability). The results of these tests indicated that majority of the wells can accept injection rate of 200 to 300 m3 /h (56 to 83 l/s) under gravity with average value of 250 m3 /h (70 l/s) compared to design value of 50 l/s. This paper presents design and construction process and issues associated with these injection wells, performing injection/pumping tests to determine capacity and effectiveness of the injection wells, the detailed design of collection system and conveying system into the injection wells, and the operation and maintenance process. This system is completed now and is under operation, and therefore, construction of injection wells is an effective option for flood control.

The Democratization of 3D Capturing: An Application Investigating Google Tango Potentials

The appearance of 3D scanners and then, more recently, of image-based systems that generate point clouds directly from common digital images have deeply affected the survey process in terms of both capturing and 2D/3D modelling. In this context, low cost and mobile systems are increasingly playing a key role and actually paving the way to the democratization of what in the past was the realm of few specialized technicians and expensive equipment. The application of Google Tango on the ancient church of Santa Maria delle Vigne in Pratica di Mare – Rome presented in this paper is one of these examples.

Effect of Supplementary Premium on the Optimal Portfolio Policy in a Defined Contribution Pension Scheme with Refund of Premium Clauses

In this paper, we studied the effect of supplementary premium on the optimal portfolio policy in a defined contribution (DC) pension scheme with refund of premium clauses. This refund clause allows death members’ next of kin to withdraw their relative’s accumulated wealth during the accumulation period. The supplementary premium is to help sustain the scheme and is assumed to be stochastic. We considered cases when the remaining wealth is equally distributed and when it is not equally distributed among the remaining members. Next, we considered investments in cash and equity to help increase the remaining accumulated funds to meet up with the retirement needs of the remaining members and composed the problem as a continuous time mean-variance stochastic optimal control problem using the actuarial symbol and established an optimization problem from the extended Hamilton Jacobi Bellman equations. The optimal portfolio policy, the corresponding optimal fund size for the two assets and also the efficient frontier of the pension members for the two cases was obtained. Furthermore, the numerical simulations of the optimal portfolio policies with time were presented and the effect of the supplementary premium on the optimal portfolio policy was discussed and observed that the supplementary premium decreases the optimal portfolio policy of the risky asset (equity). Secondly we observed a disparity between the optimal policies for the two cases.

Delineating Concern Ground in Block Caving – Underground Mine Using Ground Penetrating Radar

Mining by block or panel caving is a mining method that takes advantage of fractures within an ore body, coupled with gravity, to extract material from a predetermined column of ore. The caving column is weakened from beneath through the use of undercutting, after which the ore breaks up and is extracted from below in a continuous cycle. The nature of this method induces cyclical stresses on the pillars of excavations as stress is built up and released over time, which has a detrimental effect on both the installed ground support and the rock mass itself. Ground support capacity, especially on the production where excavation void ratio is highest, is subjected to heavy loading. Strain above threshold of the elongation of support capacity can yield resulting in damage to excavations. Geotechnical engineers must evaluate not only the remnant capacity of ground support systems but also investigate depth of rock mass yield within pillars, backs and floors. Ground Penetrating Radar (GPR) is a geophysical method that has the ability to evaluate rock mass damage using electromagnetic waves. This paper illustrates a case study from the Grasberg mining complex where non-invasive information on the depth of damage and condition of the remaining rock mass was required. GPR with 100 MHz antenna resolution was used to obtain images of the subsurface to determine rehabilitation requirements prior to recommencing production activities. The GPR surveys were used to calibrate the reflection coefficient response of varying rock mass conditions to known Rock Quality Designation (RQD) parameters observed at the mine. The calibrated GPR survey allowed site engineers to map subsurface conditions and plan rehabilitation accordingly.

Three-Dimensional Generalized Thermoelasticity with Variable Thermal Conductivity

In this paper, a three-dimensional model of the generalized thermoelasticity with one relaxation time and variable thermal conductivity has been constructed. The resulting non-dimensional governing equations together with the Laplace and double Fourier transforms techniques have been applied to a three-dimensional half-space subjected to thermal loading with rectangular pulse and traction free in the directions of the principle co-ordinates. The inverses of double Fourier transforms, and Laplace transforms have been obtained numerically. Numerical results for the temperature increment, the invariant stress, the invariant strain, and the displacement are represented graphically. The variability of the thermal conductivity has significant effects on the thermal and the mechanical waves.

Developing Proof Demonstration Skills in Teaching Mathematics in the Secondary School

The article describes the theoretical concept of teaching secondary school students proof demonstration skills in mathematics. It describes in detail different levels of mastery of the concept of proof-which correspond to Piaget’s idea of there being three distinct and progressively more complex stages in the development of human reflection. Lessons for each level contain a specific combination of the visual-figurative components and deductive reasoning. It is vital at the transition point between levels to carefully and rigorously recalibrate teaching to reflect the development of more complex reflective understanding. This can apply even within the same age range, since students will develop at different speeds and to different potential. The authors argue that this requires an aware and adaptive approach to lessons to reflect this complexity and variation. The authors also contend that effective teaching which enables students to properly understand the implementation of proof arguments must develop specific competences. These are: understanding of the importance of completeness and generality in making a valid argument; being task focused; having an internalised locus of control and being flexible in approach and evaluation. These criteria must be correlated with the systematic application of corresponding methodologies which are best likely to achieve success. The particular pedagogical decisions which are made to deliver this objective are illustrated by concrete examples from the existing secondary school mathematics courses. The proposed theoretical concept formed the basis of the development of methodological materials which have been tested in 47 secondary schools.

The Effect on the Smoking and Health Behavior of Wellness of Students Who Are Learned in the University of Health Sciences

Objective: To evaluate healthcare students’ wellness and to determine the relationship between wellness and other lifestyle-related behaviors including diet, exercise, sleep, stress, and tobacco and alcohol consumption. Material and Method: This descriptive cross-sectional study surveyed 984 students at the University of Health Sciences in Ankara, Turkey. Data were collected using a questionnaire that included questions on sociodemographic characteristics and a Turkish version of an established health and wellness measure. Results: The data revealed that 17.8% of the students smoke. There was no statistically significant difference between the participants' wellness scores and their smoking status. However, the student’s wellness was significantly associated with physical activity (p < 0.001), which, overall, was deemed as insufficient in this population. Statistically significant associations were also identified between participants’ wellness and their ability to cope with stress and regular sleep (p < 0.001). Conclusion: Healthcare students do not engage in sufficient physical activity and that this affects their overall wellness. Therefore, academic institutions should provide more opportunities for students to exert themselves physically through a diversity of inclusive activities. Such efforts, in addition to promoting healthy sleep and stress-coping practices, will greatly benefit students’ short- and long-term health and wellness.

Improving Flash Flood Forecasting with a Bayesian Probabilistic Approach: A Case Study on the Posina Basin in Italy

The Flash Flood Guidance (FFG) provides the rainfall amount of a given duration necessary to cause flooding. The approach is based on the development of rainfall-runoff curves, which helps us to find out the rainfall amount that would cause flooding. An alternative approach, mostly experimented with Italian Alpine catchments, is based on determining threshold discharges from past events and on finding whether or not an oncoming flood has its magnitude more than some critical discharge thresholds found beforehand. Both approaches suffer from large uncertainties in forecasting flash floods as, due to the simplistic approach followed, the same rainfall amount may or may not cause flooding. This uncertainty leads to the question whether a probabilistic model is preferable over a deterministic one in forecasting flash floods. We propose the use of a Bayesian probabilistic approach in flash flood forecasting. A prior probability of flooding is derived based on historical data. Additional information, such as antecedent moisture condition (AMC) and rainfall amount over any rainfall thresholds are used in computing the likelihood of observing these conditions given a flash flood has occurred. Finally, the posterior probability of flooding is computed using the prior probability and the likelihood. The variation of the computed posterior probability with rainfall amount and AMC presents the suitability of the approach in decision making in an uncertain environment. The methodology has been applied to the Posina basin in Italy. From the promising results obtained, we can conclude that the Bayesian approach in flash flood forecasting provides more realistic forecasting over the FFG.

Links between Inflammation and Insulin Resistance in Children with Morbid Obesity and Metabolic Syndrome

Obesity is a clinical state associated with low-grade inflammation. It is also a major risk factor for insulin resistance (IR). In its advanced stages, metabolic syndrome (MetS), a much more complicated disease which may lead to life-threatening problems, may develop. Obesity-mediated IR seems to correlate with the inflammation. Human studies performed particularly on pediatric population are scarce. The aim of this study is to detect possible associations between inflammation and IR in terms of some related ratios. 549 children were grouped according to their age- and sex-based body mass index (BMI) percentile tables of WHO. MetS components were determined. Informed consent and approval from the Ethics Committee for Clinical Investigations were obtained. The principles of the Declaration of Helsinki were followed. The exclusion criteria were infection, inflammation, chronic diseases and those under drug treatment. Anthropometric measurements were obtained. Complete blood cell, fasting blood glucose, insulin, and C-reactive protein (CRP) analyses were performed. Homeostasis model assessment of insulin resistance (HOMA-IR), systemic immune inflammation (SII) index, tense index, alanine aminotransferase to aspartate aminotransferase ratio (ALT/AST), neutrophils to lymphocyte (NLR), platelet to lymphocyte, and lymphocyte to monocyte ratios were calculated. Data were evaluated by statistical analyses. The degree for statistical significance was 0.05. Statistically significant differences were found among the BMI values of the groups (p < 0.001). Strong correlations were detected between the BMI and waist circumference (WC) values in all groups. Tense index values were also correlated with both BMI and WC values in all groups except overweight (OW) children. SII index values of children with normal BMI were significantly different from the values obtained in OW, obese, morbid obese and MetS groups. Among all the other lymphocyte ratios, NLR exhibited a similar profile. Both HOMA-IR and ALT/AST values displayed an increasing profile from N towards MetS3 group. BMI and WC values were correlated with HOMA-IR and ALT/AST. Both in morbid obese and MetS groups, significant correlations between CRP versus SII index as well as HOMA-IR versus ALT/AST were found. ALT/AST and HOMA-IR values were correlated with NLR in morbid obese group and with SII index in MetS group, (p < 0.05), respectively. In conclusion, these findings showed that some parameters may exhibit informative differences between the early and late stages of obesity. Important associations among HOMA-IR, ALT/AST, NLR and SII index have come to light in the morbid obese and MetS groups. This study introduced the SII index and NLR as important inflammatory markers for the discrimination of normal and obese children. Interesting links were observed between inflammation and IR in morbid obese children and those with MetS, both being late stages of obesity.

Coverage Probability Analysis of WiMAX Network under Additive White Gaussian Noise and Predicted Empirical Path Loss Model

This paper explores a detailed procedure of predicting a path loss (PL) model and its application in estimating the coverage probability in a WiMAX network. For this a hybrid approach is followed in predicting an empirical PL model of a 2.65 GHz WiMAX network deployed in a suburban environment. Data collection, statistical analysis, and regression analysis are the phases of operations incorporated in this approach and the importance of each of these phases has been discussed properly. The procedure of collecting data such as received signal strength indicator (RSSI) through experimental set up is demonstrated. From the collected data set, empirical PL and RSSI models are predicted with regression technique. Furthermore, with the aid of the predicted PL model, essential parameters such as PL exponent as well as the coverage probability of the network are evaluated. This research work may assist in the process of deployment and optimisation of any cellular network significantly.

Evaluation of the Weight-Based and Fat-Based Indices in Relation to Basal Metabolic Rate-to-Weight Ratio

Basal metabolic rate is questioned as a risk factor for weight gain. The relations between basal metabolic rate and body composition have not been cleared yet. The impact of fat mass on basal metabolic rate is also uncertain. Within this context, indices based upon total body mass as well as total body fat mass are available. In this study, the aim is to investigate the potential clinical utility of these indices in the adult population. 287 individuals, aged from 18 to 79 years, were included into the scope of the study. Based upon body mass index values, 10 underweight, 88 normal, 88 overweight, 81 obese, and 20 morbid obese individuals participated. Anthropometric measurements including height (m), and weight (kg) were performed. Body mass index, diagnostic obesity notation model assessment index I, diagnostic obesity notation model assessment index II, basal metabolic rate-to-weight ratio were calculated. Total body fat mass (kg), fat percent (%), basal metabolic rate, metabolic age, visceral adiposity, fat mass of upper as well as lower extremities and trunk, obesity degree were measured by TANITA body composition monitor using bioelectrical impedance analysis technology. Statistical evaluations were performed by statistical package (SPSS) for Windows Version 16.0. Scatterplots of individual measurements for the parameters concerning correlations were drawn. Linear regression lines were displayed. The statistical significance degree was accepted as p < 0.05. The strong correlations between body mass index and diagnostic obesity notation model assessment index I as well as diagnostic obesity notation model assessment index II were obtained (p < 0.001). A much stronger correlation was detected between basal metabolic rate and diagnostic obesity notation model assessment index I in comparison with that calculated for basal metabolic rate and body mass index (p < 0.001). Upon consideration of the associations between basal metabolic rate-to-weight ratio and these three indices, the best association was observed between basal metabolic rate-to-weight and diagnostic obesity notation model assessment index II. In a similar manner, this index was highly correlated with fat percent (p < 0.001). Being independent of the indices, a strong correlation was found between fat percent and basal metabolic rate-to-weight ratio (p < 0.001). Visceral adiposity was much strongly correlated with metabolic age when compared to that with chronological age (p < 0.001). In conclusion, all three indices were associated with metabolic age, but not with chronological age. Diagnostic obesity notation model assessment index II values were highly correlated with body mass index values throughout all ranges starting with underweight going towards morbid obesity. This index is the best in terms of its association with basal metabolic rate-to-weight ratio, which can be interpreted as basal metabolic rate unit.

Re-Visiting Rumi and Iqbal on Self-Enhancement for Social Responsibility

The background of this study is the great degree of stress that the world is experiencing today, internationally among the countries, within a community among people, and even individually within one’s own self. The significance of the study is the attempt to find a solution of this stress in the philosophy of the olden times of Jalaluddin Rumi and comparatively recently of that of Allama Iqbal. The methodology adopted in this paper is firstly exploration of the perspectives of these philosophers that are being consolidated by a number of psychic and spiritual experts of today, who are being widely read but less followed. This paper further goes on presenting brief life sketches of Rumi and Iqbal. It expounds the key concepts proposed by them and the social change that was resulted in the times of the two above mentioned metaphysical philosophers. It is further amplified that with the recent advancements, in both metaphysics and the physical sciences, the gap between the two is closing down. Both Rumi and Iqbal emphasized their common essence. The old time's concepts, postulates, and philosophies are hence once again becoming valid. The findings of this paper are that the existence of human empathy, affection and mutual social attraction among humans is still valid. The positive inner belief system that dictates our thoughts and actions is vital. As a conclusion, empathy should enable us solving our problems collectively. We need to strengthen our inner communication system, to listen to the messages that come to our inner-selves. We need to get guidance and strength from them. We need to value common needs and purposes collectively to achieve results. Spiritual energy among us is to be harnessed and utilized. Connectivity is to be recognized to unify and strengthen ties among people. Mutual bonding at small and large group levels is to be employed for the survival of the disadvantaged, and sustainability of the empowering trends. With the above guidelines, hopefully, we can define a framework towards a brave and happy new humane world.

Understanding the Nature of Blood Pressure as Metabolic Syndrome Component in Children

Pediatric overweight and obesity need attention because they may cause morbid obesity, which may develop metabolic syndrome (MetS). Criteria used for the definition of adult MetS cannot be applied for pediatric MetS. Dynamic physiological changes that occur during childhood and adolescence require the evaluation of each parameter based upon age intervals. The aim of this study is to investigate the distribution of blood pressure (BP) values within diverse pediatric age intervals and the possible use and clinical utility of a recently introduced Diagnostic Obesity Notation Model Assessment Tension (DONMA tense) Index derived from systolic BP (SBP) and diastolic BP (DBP) [SBP+DBP/200]. Such a formula may enable a more integrative picture for the assessment of pediatric obesity and MetS due to the use of both SBP and DBP. 554 children, whose ages were between 6-16 years participated in the study; the study population was divided into two groups based upon their ages. The first group comprises 280 cases aged 6-10 years (72-120 months), while those aged 10-16 years (121-192 months) constituted the second group. The values of SBP, DBP and the formula (SBP+DBP/200) covering both were evaluated. Each group was divided into seven subgroups with varying degrees of obesity and MetS criteria. Two clinical definitions of MetS have been described. These groups were MetS3 (children with three major components), and MetS2 (children with two major components). The other groups were morbid obese (MO), obese (OB), overweight (OW), normal (N) and underweight (UW). The children were included into the groups according to the age- and sex-based body mass index (BMI) percentile values tabulated by WHO. Data were evaluated by SPSS version 16 with p < 0.05 as the statistical significance degree. Tension index was evaluated in the groups above and below 10 years of age. This index differed significantly between N and MetS as well as OW and MetS groups (p = 0.001) above 120 months. However, below 120 months, significant differences existed between MetS3 and MetS2 (p = 0.003) as well as MetS3 and MO (p = 0.001). In comparison with the SBP and DBP values, tension index values have enabled more clear-cut separation between the groups. It has been detected that the tension index was capable of discriminating MetS3 from MetS2 in the group, which was composed of children aged 6-10 years. This was not possible in the older group of children. This index was more informative for the first group. This study also confirmed that 130 mm Hg and 85 mm Hg cut-off points for SBP and DBP, respectively, are too high for serving as MetS criteria in children because the mean value for tension index was calculated as 1.00 among MetS children. This finding has shown that much lower cut-off points must be set for SBP and DBP for the diagnosis of pediatric MetS, especially for children under-10 years of age. This index may be recommended to discriminate MO, MetS2 and MetS3 among the 6-10 years of age group, whose MetS diagnosis is problematic.