Assessment of Predictive Confounders for the Prevalence of Breast Cancer among Iraqi Population: A Retrospective Study from Baghdad, Iraq

Although breast cancer prevalence continues to increase, mortality has been decreasing as a result of early detection and improvement in adjuvant systemic therapy. Nevertheless, this disease required further efforts to understand and identify the associated potential risk factors that could play a role in the prevalence of this malignancy among Iraqi women. The objective of this study was to assess the perception of certain predictive risk factors on the prevalence of breast cancer types among a sample of Iraqi women diagnosed with breast cancer. This was a retrospective observational study carried out at National Cancer Research Center in College of Medicine, Baghdad University from November 2017 to January 2018. Data of 100 patients with breast cancer whose biopsies examined in the National Cancer Research Center were included in this study. Data were collected to structure a detailed assessment regarding the patients’ demographic, medical and cancer records. The majority of study participants (94%) suffered from ductal breast cancer with mean age 49.57 years. Among those women, 48.9% were obese with body mass index (BMI) 35 kg/m2. 68.1% of them had positive family history of breast cancer and 66% had low parity. 40.4% had stage II ductal breast cancer followed by 25.5% with stage III. It was found that 59.6% and 68.1% had positive oestrogen receptor sensitivity and positive human epidermal growth factor (HER2/neu) receptor sensitivity respectively. In regard to the impact of prediction of certain variables on the incidence of ductal breast cancer, positive family history of breast cancer (P < 0.0001), low parity (P< 0.0001), stage I and II breast cancer (P = 0.02) and positive HER2/neu status (P < 0.0001) were significant predictive factors among the study participants. The results from this study provide relevant evidence for a significant positive and potential association between certain risk factors and the prevalence of breast cancer among Iraqi women.

An Analysis of Language Borrowing among Algerian University Students Using Online Facebook Conversations

The rapid development of technology has led to an important context in which different languages and structures are used in the same conversations. This paper investigates the practice of language borrowing within social media platform, namely, Facebook among Algerian Vernacular Arabic (AVA) students. In other words, this study will explore how Algerian students have incorporated lexical English borrowing in their online conversations. This paper will examine the relationships between language, culture and identity among a multilingual group. The main objective is to determine the cultural and linguistic functions that borrowing fulfills in social media and to explain the possible factors underlying English borrowing. The nature of the study entails the use of an online research method that includes ten online Facebook conversations in the form of private messages collected from Bachelor and Masters Algerian students recruited from the English department at the University of Oum El-Bouaghi. The analysis of data revealed that social media platform provided the users with opportunities to shift from one language to another. This practice was noticed in students’ online conversations. English borrowing was the most relevant language performance in accordance with Arabic which is the mother tongue of the chosen sample. The analysis has assumed that participants are skilled in more than one language.

Effect of Leaks in Solid Oxide Electrolysis Cells Tested for Durability under Co-Electrolysis Conditions

Solid oxide electrolysis cells have an immense potential in converting CO2 and H2O into syngas during co-electrolysis operation. The produced syngas can be further converted into hydrocarbons. This kind of technology is called power-to-gas or power-to-liquid. To produce hydrocarbons via this route, durability of the cells is still a challenge, which needs to be further investigated in order to improve the cells. In this work, various nickel-yttria stabilized zirconia (Ni-YSZ) fuel electrode supported or YSZ electrolyte supported cells, cerium gadolinium oxide (CGO) barrier layer, and an oxygen electrode are investigated for durability under co-electrolysis conditions in both galvanostatic and potentiostatic conditions. While changing the gas on the oxygen electrode, keeping the fuel electrode gas composition constant, a change in the gas concentration arc was observed by impedance spectroscopy. Measurements of open circuit potential revealed the presence of leaks in the setup. It is speculated that the change in concentration impedance may be related to the leaks. Furthermore, the cells were also tested under pressurized conditions to find an inter-play between the leak rate and the pressure. A mathematical modeling together with electrochemical and microscopy analysis is presented.

Microwave Plasma Dry Reforming of Methane at High CO2/CH4 Feed Ratio

Dry reforming of methane that converts two greenhouses gases (CH4 and CO2) to synthesis gas (a mixture of H2 and CO) was studied in a commercial bench scale microwave (MW) plasma reactor system at atmospheric pressure. The CO2, CH4 and N2 conversions; H2, CO selectivities and yields, and syngas ratio (H2/CO) were investigated in a wide range of total feed flow rate (0.45 – 2.1 L/min), MW power (700 – 1200 watt) and CO2/CH4 molar ratio (2 – 5). At the feed flow rates of CH4, CO2 and N2 of 0.2, 0.4 and 1.5 L/min respectively, and the MWs input power of 700 W, the highest conversions of CH4 and CO2, selectivity and yield of H2, CO and H2/CO ratio of 79.35%, 44.82%, 50.12, 58.42, 39.77%, 32.89%, and 0.86, respectively, were achieved. The results of this work show that the product ratio increases slightly with the increasing total feed flow rate, but it decreases significantly with the increasing MW power and feeds CO2/CH4 ratio.

Data Gathering and Analysis for Arabic Historical Documents

This paper introduces a new dataset (and the methodology used to generate it) based on a wide range of historical Arabic documents containing clean data simple and homogeneous-page layouts. The experiments are implemented on printed and handwritten documents obtained respectively from some important libraries such as Qatar Digital Library, the British Library and the Library of Congress. We have gathered and commented on 150 archival document images from different locations and time periods. It is based on different documents from the 17th-19th century. The dataset comprises differing page layouts and degradations that challenge text line segmentation methods. Ground truth is produced using the Aletheia tool by PRImA and stored in an XML representation, in the PAGE (Page Analysis and Ground truth Elements) format. The dataset presented will be easily available to researchers world-wide for research into the obstacles facing various historical Arabic documents such as geometric correction of historical Arabic documents.

Plasterwork Ornamentation Finds of Hoşap Castle Archeological Excavation (2007-2015)

Plaster material has been a preferred material especially in the Middle East geography in terms of economy, easy process and thermal insulation since very old times. However, due to the unstable nature of the material, very little has been reached today. For this reason, both finds and studies about stucco ornamentation are very few. In this study, the excavated plasterwork finds used in the architectural ornamentation in the Hosap Castle (Van/Turkey) were considered worth examining since they are rare examples. The stucco relief finds that were found in the castle is discussed. The finds of engraved artifacts on the plasterworks were not addressed. Only the pieces found in Area II and Area III (harem) and surrounding during the cleaning and excavation work carried out at Hosap Kalesi between 2007-2015, will be discussed. This is a general assessment about the finds. It is unknown where many of the pieces found. For this reason, only general appraisal was able to done. Most of the parts are made of mold technique. The motifs on the fragments are similar to the motifs of Ottoman period tiles. Parallel to the settlement history of the castle, thought that these plaster pieces belong to the 16th-17th centuries.

A Preliminary Study on Factors Determining the Success of High Conservation Value Area in Oil Palm Plantations

High Conservation Value (HCV) is an area with conservation function within oil palm plantation. Despite the important role of HCV area in biodiversity conservation and various studies on HCV, there was a lack of research studying the factors determining its success. A preliminary study was conducted to identify the determinant factor of HCV that affected the diversity. Line transect method was used to calculate the species diversity of butterfly, birds, mammals, and herpetofauna species as well as their richness. Specifically for mammals, camera traps were also used. The research sites comprised of 12 HCV areas in 3 provinces of Indonesia (Central Kalimantan, Riau, and Palembang). The relationship between the HCV biophysical factor with the species number and species diversity for each wildlife class was identified using Chi-Square analysis with Cross tab (contingency table). Results of the study revealed that species diversity varied by research locations. Four factors determining the success of HCV area in relations to the number and diversity of wildlife species are land cover types for mammals, the width of area and distance to rivers for birds, and distance to settlements for butterflies.

Factors that Contribute to the Improvement of the Sense of Self-Efficacy of Special Educators in Inclusive Settings in Greece

Teacher’s sense of self-efficacy can affect significantly both teacher’s and student’s performance. More specific, self-efficacy is associated with the learning outcomes as well as student’s motivation and self-efficacy. For example, teachers with high sense of self-efficacy are more open to innovations and invest more effort in teaching. In addition to this, effective inclusive education is associated with higher levels of teacher’s self-efficacy. Pre-service teachers with high levels of self-efficacy could handle student’s behavior better and more effectively assist students with special educational needs. Teacher preparation programs are also important, because teacher’s efficacy beliefs are shaped early in learning, as a result the quality of teacher’s education programs can affect the sense of self-efficacy of pre-service teachers. Usually, a number of pre-service teachers do not consider themselves well prepared to work with students with special educational needs and do not have the appropriate sense of self-efficacy. This study aims to investigate the factors that contribute to the improvement of the sense of self-efficacy of pre-service special educators by using an academic practicum training program. The sample of this study is 159 pre-service special educators, who also participated in the academic practicum training program. For the purpose of this study were used quantitative methods for data collection and analysis. Teacher’s self-efficacy was assessed by the teachers themselves with the completion of a questionnaire which was based on the scale of Teacher’s Sense of Efficacy Scale. Pre and post measurements of teacher’s self-efficacy were taken. The results of the survey are consistent with those of the international literature. The results indicate that a significant number of pre-service special educators do not hold the appropriate sense of self-efficacy regarding teaching students with special educational needs. Moreover, a quality academic training program constitutes a crucial factor for the improvement of the sense of self-efficacy of pre-service special educators, as additional for the provision of high quality inclusive education.

Inductive Grammar, Student-Centered Reading, and Interactive Poetry: The Effects of Teaching English with Fun in Schools of Two Villages in Lebanon

Teaching English as a Second Language (ESL) is a common practice in many Lebanese schools. However, ESL teaching is done in traditional ways. Methods such as constructivism are seldom used, especially in villages. Here lies the significance of this research which joins constructivism and Piaget’s theory of cognitive development in ESL classes in Lebanese villages. The purpose of the present study is to explore the effects of applying constructivist student-centered strategies in teaching grammar, reading comprehension, and poetry on students in elementary ESL classes in two villages in Lebanon, Zefta in South Lebanon and Boqaata in Mount Lebanon. 20 English teachers participated in a training titled “Teaching English with Fun”, which focused on strategies that create a student-centered class where active learning takes place and there is increased learner engagement and autonomy. The training covered three main areas in teaching English: grammar, reading comprehension, and poetry. After participating in the training, the teachers applied the new strategies and methods in their ESL classes. The methodology comprised two phases: in phase one, practice-based research was conducted as the teachers attended the training and applied the constructivist strategies in their respective ESL classes. Phase two included the reflections of the teachers on the effects of the application of constructivist strategies. The results revealed the educational benefits of constructivist student-centered strategies; the students of teachers who applied these strategies showed improved engagement, positive attitudes towards poetry, increased motivation, and a better sense of autonomy. Future research is required in applying constructivist methods in the areas of writing, spelling, and vocabulary in ESL classrooms of Lebanese villages.

Perception of Predictive Confounders for the Prevalence of Hypertension among Iraqi Population: A Pilot Study

Background: Hypertension is considered as one of the most important causes of cardiovascular complications and one of the leading causes of worldwide mortality. Identifying the potential risk factors associated with this medical health problem plays an important role in minimizing its incidence and related complications. The objective of this study is to explore the prevalence of receptor sensitivity regarding assess and understand the perception of specific predictive confounding factors on the prevalence of hypertension (HT) among a sample of Iraqi population in Baghdad, Iraq. Materials and Methods: A randomized cross sectional study was carried out on 100 adult subjects during their visit to the outpatient clinic at a certain sector of Baghdad Province, Iraq. Demographic, clinical and health records alongside specific screening and laboratory tests of the participants were collected and analyzed to detect the potential of confounding factors on the prevalence of HT. Results: 63% of the study participants suffered from HT, most of them were female patients (P < 0.005). Patients aged between 41-50 years old significantly suffered from HT than other age groups (63.5%, P < 0.001). 88.9% of the participants were obese (P < 0.001) and 47.6% had diabetes with HT. Positive family history and sedentary lifestyle were significantly higher among all hypertensive groups (P < 0.05). High salt and fatty food intake was significantly found among patients suffered from isolated systolic hypertension (ISHT) (P < 0.05). A significant positive correlation between packed cell volume (PCV) and systolic blood pressure (SBP) (r = 0.353, P = 0.048) found among normotensive participants. Among hypertensive patients, a positive significant correlation found between triglycerides (TG) and both SBP (r = 0.484, P = 0.031) and diastolic blood pressure (DBP) (r = 0.463, P = 0.040), while low density lipoprotein-cholesterol (LDL-c) showed a positive significant correlation with DBP (r = 0.443, P = 0.021). Conclusion: The prevalence of HT among Iraqi populations is of major concern. Further consideration is required to detect the impact of potential risk factors and to minimize blood pressure (BP) elevation and reduce the risk of other cardiovascular complications later in life.

Effects of Intercropping Maize (Zea mays L.) with Jack Beans (Canavalia ensiformis L.) at Different Spacing and Weeding Regimes on Crops Productivity

A field experiment was conducted at Ido town in Ido Local Government Area of Oyo state, Nigeria to determine the effects of intercropping maize (Zea mays L.) with Jack bean (Canavalia ensiformis L.) at different spacing and weeding regimes on crops productivity. The treatments were 2 x 2 x 3 factorial arrangement involving two spatial crop arrangements. Spacing of 75 cm x 50 cm and 90 cm x 42 cm (41.667 cm) with two plants per stand resulted in plant population of approximately 53,000 plants/hectare. Also, Randomized Complete Block Design (RCBD) with two cropping patterns (sole and intercrop), three weeding regimes (weedy check, weeds once, and weed twice) with three replicates was used. Data were analyzed with SAS (Statistical Analysis System) and statistical means separated using Least Significant Difference (LSD) (P ≤ 0.05). Intercropping and crop spacing did not have significant influence on the growth parameters and yield parameters. The maize grain yield of 1.11 t/ha obtained under sole maize was comparable to 1.05 t/ha from maize/jack beans. Weeding regime significantly influenced growth and yields of maize in intercropping with Jack beans. Weeding twice resulted in significantly higher growth than that of the other weeding regimes. Plant height at 6 Weeks After Sowing (WAS) under weeding twice regime (3 and 6 WAS) was 83.9 cm which was significantly different from 67.75 cm and 53.47 cm for weeding once (3 WAS) and no weeding regimes respectively. Moreover, maize grain yield of 1.3 t/ha obtained from plots weeded twice was comparable to that of 1.23 t/ha from single weeding and both were significantly higher than 0.71 t/ha maize grain yield obtained from the no weeding control. The dry matter production of Jack beans reduced at some growth stages due to intercropping of maize with Jack beans though with no significance effect on the other growth parameters of the crop. There was no effect on the growth parameters of Jack beans in maize/jack beans intercrop based on cropping spacing while comparable growth and dry matter production in Jack beans were produced in maize/Jack beans mixture with single weeding.

Performances Analysis of the Pressure and Production of an Oil Zone by Simulation of the Flow of a Fluid through the Porous Media

This work is the modeling and simulation of fluid flow (liquid) through porous media. This type of flow occurs in many situations of interest in applied sciences and engineering, fluid (oil) consists of several individual substances in pure, single-phase flow is incompressible and isothermal. The porous medium is isotropic, homogeneous optionally, with the rectangular format and the flow is two-dimensional. Modeling of hydrodynamic phenomena incorporates Darcy's law and the equation of mass conservation. Correlations are used to model the density and viscosity of the fluid. A finite volume code is used in the discretization of differential equations. The nonlinearity is treated by Newton's method with relaxation coefficient. The results of the simulation of the pressure and the mobility of liquid flowing through porous media are presented, analyzed, and illustrated.

Restoring, Revitalizing and Recovering Brazilian Rivers: Application of the Concept to Small Basins in the City of São Paulo, Brazil

Watercourses in Brazilian urban areas are constantly being degraded due to the unplanned use of the urban space; however, due to the different contexts of land use and occupation in the river watersheds, different intervention strategies are required to requalify them. When it comes to requalifying watercourses, we can list three main techniques to fulfill this purpose: restoration, revitalization and recovery; each one being indicated for specific contexts of land use and occupation in the basin. In this study, it was demonstrated that the application of these three techniques to three small basins in São Paulo city, listing the aspects involved in each of the contexts and techniques of requalification. For a protected watercourse within a forest park, renaturalization was proposed, where the watercourse is preserved in a state closer to the natural one. For a watercourse in an urban context that still preserves open spaces for its maintenance as a landscape element, an intervention was proposed following the principles of revitalization, integrating the watercourse with the landscape and the population. In the case of a watercourse in a harder context, only recovery was proposed, since the watercourse is found under the road system, which makes it difficult to integrate it into the landscape.

Shear Layer Investigation through a High-Load Cascade in Low-Pressure Gas Turbine Conditions

This paper deals with the steady and unsteady flow behavior on the separation bubble occurring on the rear portion of the suction side of T106A blade. The first phase was to implement the steady condition capturing the separation bubble. To accurately predict the separated region, the effects of three different turbulence models and computational grids were separately investigated. The results of Large Eddy Simulation (LES) model on the finest grid structure are acceptably in a good agreement with its relevant experimental results. The second phase is mainly to address the effects of wake entrance on bubble disappearance in unsteady situation. In the current simulations, from what was suggested in an experiment, simulating the flow unsteadiness, with concentrations on small scale disturbances instead of simulating a complete oncoming wake, is the key issue. Subsequently, the results from the current strategy to apply the effects of the wake and two other experimental work were compared to be in a good agreement. Between the two experiments, one of them deals with wake passing unsteady flow, and the other one implements experimentally the same approach as the current Computational Fluid Dynamics (CFD) simulation.

Machine Translation Analysis of Chinese Dish Names

This article presents a comparative study evaluating and comparing the quality of machine translation (MT) output of Chinese gastronomy nomenclature. Chinese gastronomic culture is experiencing an increased international acknowledgment nowadays. The nomenclature of Chinese gastronomy not only reflects a specific aspect of culture, but it is related to other areas of society such as philosophy, traditional medicine, etc. Chinese dish names are composed of several types of cultural references, such as ingredients, colors, flavors, culinary techniques, cooking utensils, toponyms, anthroponyms, metaphors, historical tales, among others. These cultural references act as one of the biggest difficulties in translation, in which the use of translation techniques is usually required. Regarding the lack of Chinese food-related translation studies, especially in Chinese-Spanish translation, and the current massive use of MT, the quality of the MT output of Chinese dish names is questioned. Fifty Chinese dish names with different types of cultural components were selected in order to complete this study. First, all of these dish names were translated by three different MT tools (Google Translate, Baidu Translate and Bing Translator). Second, a questionnaire was designed and completed by 12 Chinese online users (Chinese graduates of a Hispanic Philology major) in order to find out user preferences regarding the collected MT output. Finally, human translation techniques were observed and analyzed to identify what translation techniques would be observed more often in the preferred MT proposals. The result reveals that the MT output of the Chinese gastronomy nomenclature is not of high quality. It would be recommended not to trust the MT in occasions like restaurant menus, TV culinary shows, etc. However, the MT output could be used as an aid for tourists to have a general idea of a dish (the main ingredients, for example). Literal translation turned out to be the most observed technique, followed by borrowing, generalization and adaptation, while amplification, particularization and transposition were infrequently observed. Possibly because that the MT engines at present are limited to relate equivalent terms and offer literal translations without taking into account the whole context meaning of the dish name, which is essential to the application of those less observed techniques. This could give insight into the post-editing of the Chinese dish name translation. By observing and analyzing translation techniques in the proposals of the machine translators, the post-editors could better decide which techniques to apply in each case so as to correct mistakes and improve the quality of the translation.

The Influence of Beta Shape Parameters in Project Planning

Networks can be utilized to represent project planning problems, using nodes for activities and arcs to indicate precedence relationship between them. For fixed activity duration, a simple algorithm calculates the amount of time required to complete a project, followed by the activities that comprise the critical path. Program Evaluation and Review Technique (PERT) generalizes the above model by incorporating uncertainty, allowing activity durations to be random variables, producing nevertheless a relatively crude solution in planning problems. In this paper, based on the findings of the relevant literature, which strongly suggests that a Beta distribution can be employed to model earthmoving activities, we utilize Monte Carlo simulation, to estimate the project completion time distribution and measure the influence of skewness, an element inherent in activities of modern technical projects. We also extract the activity criticality index, with an ultimate goal to produce more accurate planning estimations.

Autohydrolysis Treatment of Olive Cake to Extract Fructose and Sucrose

The production of olive oil is considered as one of the most important agri-food industries. However, some of the by-products generated in the process are potential pollutants and cause environmental problems. Consequently, the management of these by-products is currently considered as a challenge for the olive oil industry. In this context, several technologies have been developed and tested. In this sense, the autohydrolysis of these by-products could be considered as a promising technique. Therefore, this study focused on autohydrolysis treatments of a solid residue from the olive oil industry denominated olive cake. This one comes from the olive pomace extraction with hexane. Firstly, a water washing was carried out to eliminate the water soluble compounds. Then, an experimental design was developed for the autohydrolysis experiments carried out in the hydrothermal pressure reactor. The studied variables were temperature (30, 60 and 90 ºC) and time (30, 60, 90 min). On the other hand, aliquots of liquid obtained fractions were analysed by HPLC to determine the fructose and sucrose contents present in the liquid fraction. Finally, the obtained results of sugars contents and the yields of the different experiments were fitted to a neuro-fuzzy and to a polynomial model.

The Virtual Container Yard: Identifying the Persuasive Factors in Container Interchange

The virtual container yard is an effective solution to the container inventory imbalance problem which is a global issue. It causes substantial cost to carriers, which inadvertently adds to the prices of consumer goods. The virtual container yard is rooted in the fundamentals of container interchange between carriers. If carriers opt to interchange their excess containers with those who are deficit, a substantial part of the empty reposition cost could be eliminated. Unlike in other types of ships, cargo cannot be directly loaded to a container ship. Slots and containers are supplementary components; thus, without containers, a carrier cannot ship cargo if the containers are not available and vice versa. Few decades ago, carriers recognized slot (the unit of space in a container ship) interchange as a viable solution for the imbalance of shipping space. Carriers interchange slots among them and it also increases the advantage of scale of economies in container shipping. Some of these service agreements between mega carriers have provisions to interchange containers too. However, the interchange mechanism is still not popular among carriers for containers. This is the paradox that prevails in the liner shipping industry. At present, carriers reposition their excess empty containers to areas where they are in demand. This research applied factor analysis statistical method. The paper reveals that five major components may influence the virtual container yard namely organisation, practice and culture, legal and environment, international nature, and marketing. There are 12 variables that may impact the virtual container yard, and these are explained in the paper.

Metallurgical Analysis of Surface Defect in Telescopic Front Fork

Telescopic Front Fork (TFF) used in two wheelers, mainly motorcycle, is made from high strength steel, and is manufactured by high frequency induction welding process wherein hot rolled and pickled coils are used as input raw material for rolling of hollow tubes followed by heat treatment, surface treatment, cold drawing, tempering, etc. The final application demands superior quality TFF tubes w.r.t. surface finish and dimensional tolerances. This paper presents the investigation of two different types of failure of fork during operation. The investigation consists of visual inspection, chemical analysis, characterization of microstructure, and energy dispersive spectroscopy. In this paper, comprehensive investigations of two failed tube samples were investigated. In case of Sample #1, the result revealed that there was a pre-existing crack, known as hook crack, which leads to the cracking of the tube. Metallographic examination exhibited that during field operation the pre-existing hook crack was surfaced out leading to crack in the pipe. In case of Sample #2, presence of internal oxidation with decarburised grains inside the material indicates origin of the defect from slab stage.

Performance Analysis of Search Medical Imaging Service on Cloud Storage Using Decision Trees

Telemedicine services use a large amount of data, most of which are diagnostic images in Digital Imaging and Communications in Medicine (DICOM) and Health Level Seven (HL7) formats. Metadata is generated from each related image to support their identification. This study presents the use of decision trees for the optimization of information search processes for diagnostic images, hosted on the cloud server. To analyze the performance in the server, the following quality of service (QoS) metrics are evaluated: delay, bandwidth, jitter, latency and throughput in five test scenarios for a total of 26 experiments during the loading and downloading of DICOM images, hosted by the telemedicine group server of the Universidad Militar Nueva Granada, Bogotá, Colombia. By applying decision trees as a data mining technique and comparing it with the sequential search, it was possible to evaluate the search times of diagnostic images in the server. The results show that by using the metadata in decision trees, the search times are substantially improved, the computational resources are optimized and the request management of the telemedicine image service is improved. Based on the experiments carried out, search efficiency increased by 45% in relation to the sequential search, given that, when downloading a diagnostic image, false positives are avoided in management and acquisition processes of said information. It is concluded that, for the diagnostic images services in telemedicine, the technique of decision trees guarantees the accessibility and robustness in the acquisition and manipulation of medical images, in improvement of the diagnoses and medical procedures in patients.