Search results for: final outcome

Authors: Christophe Spaas, Lies Pottel, Joke De Ceulaer, Johan Abeloos, Philippe Lamoral, Tom De Backer, Calix De Clercq

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We aimed to evaluate the accuracy of an in-house developed low-cost computer-assisted surgery (CAS) protocol for osseous free flap mandibular reconstruction. All patients who underwent primary or secondary mandibular reconstruction with a free (solely or composite) osseous flap, either a fibula free flap or iliac crest free flap, between January 2014 and December 2017 were evaluated. The low-cost protocol consisted out of a virtual surgical planning, a prebend custom reconstruction plate and an individualized free flap positioning guide. The accuracy of the protocol was evaluated through comparison of the postoperative outcome with the 3D virtual planning, based on measurement of the following parameters: intercondylar distance, mandibular angle (axial and sagittal), inner angular distance, anterior-posterior distance, length of the fibular/iliac crest segments and osteotomy angles. A statistical analysis of the obtained values was done. Virtual 3D surgical planning and cutting guide design were performed with Proplan CMF® software (Materialise, Leuven, Belgium) and IPS Gate (KLS Martin, Tuttlingen, Germany). Segmentation of the DICOM data as well as outcome analysis were done with BrainLab iPlan® Software (Brainlab AG, Feldkirchen, Germany). A cost analysis of the protocol was done. Twenty-two patients (11 fibula /11 iliac crest) were included and analyzed. Based on voxel-based registration on the cranial base, 3D virtual planning landmark parameters did not significantly differ from those measured on the actual treatment outcome (p-values >0.05). A cost evaluation of the in-house developed CAS protocol revealed a 1750 euro cost reduction in comparison with a standard CAS protocol with a patient-specific reconstruction plate. Our results indicate that an accurate transfer of the planning with our in-house developed low-cost CAS protocol is feasible at a significant lower cost.

Keywords: CAD/CAM, computer-assisted surgery, low-cost, mandibular reconstruction

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Authors: Norsyamimi Hassim, Masturah Markom

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Supercritical fluid extraction (SFE) has been known as a sustainable and safe extraction technique for plant extraction due to the minimal usage of organic solvent. In this study, a scale-up process for the selected herbal plant (Phyllanthus niruri) was investigated by using supercritical carbon dioxide (SC-CO2) with food-grade (ethanol-water) cosolvent. The quantification of excess ethanol content in the final dry extracts was conducted to determine the safety of enriched extracts. The extraction yields obtained by scale-up SFE unit were not much different compared to the predicted extraction yields with an error of 2.92%. For component contents, the scale-up extracts showed comparable quality with laboratory-scale experiments. The final dry extract showed that the excess ethanol content was 1.56% g/g extract. The fish embryo toxicity test (FETT) on the zebrafish embryos showed no toxicity effects by the extract, where the LD50 value was found to be 505.71 µg/mL. Thus, it has been proven that SFE with food-grade cosolvent is a safe extraction technique for the production of bioactive compounds from P. niruri.

Keywords: scale-up, supercritical fluid extraction, enriched extract, toxicity, ethanol content

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Authors: Hannah K. M. Tang, Muhammad Ateeq, Mark J. Lake, Badr Abdullah, Frederic A. Bezombes

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There is little research applying virtual reality (VR) to the treatment of musculoskeletal injury in athletes. This is despite their prevalence, and the implications for physical and psychological health. Nevertheless, developments of wireless VR headsets better facilitate dynamic movement in VR environments (VREs), and more research is expected in this emerging field. This systematic review identified publications that used VR interventions for the analysis or treatment of lower-limb musculoskeletal injury of athletes. It established a search protocol, and through narrative discussion, identified existing trends. Database searches encompassed four term sets: 1) VR systems; 2) musculoskeletal injuries; 3) sporting population; 4) movement outcome analysis. Overall, a total of 126 publications were identified through database searching, and twelve were included in the final analysis and discussion. Many of the studies were pilot and proof of concept work. Seven of the twelve publications were observational studies. However, this may provide preliminary data from which clinical trials will branch. If specified, the focus of the literature was very narrow, with very similar population demographics and injuries. The trends in the literature findings emphasised the role of VR and attentional focus, the strategic manipulation of movement outcomes, and the transfer of skill to the real-world. Causal inferences may have been undermined by flaws, as most studies were limited by the practicality of conducting a two-factor clinical-VR-based study. In conclusion, by assessing the exploratory studies, and combining this with the use of numerous developments, techniques, and tools, a novel application could be established to utilise VR with dynamic movement, for the effective treatment of specific musculoskeletal injuries of athletes.

Keywords: athletes, lower-limb musculoskeletal injury, rehabilitation, return-to-sport, virtual reality

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Authors: Chao Jen-Chih, Hsu Kuo-Wei

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Climate change and natural disasters take effect on urban development. It has been discussed urban renewals can prevent natural disasters. Integrating green infrastructure and urban renewals may have great effect on adapting the impact of climate change. To highlight the economic value of green infrastructure development on urban renewals, some strategies need to be carry on to reduce environmental impact. A number of urban renewals studies has been conducted on right transfer, financial risk, urban renewal policy, and public participation. Little research has been devoted on the subject of the economic value of green infrastructure development on urban renewals. The purpose of this study is to investigate the affecting factors on the economic value of green infrastructure development on urban renewals. This study will present the benefits of green infrastructure development and summarize the critical factors of green infrastructure develop on urban renewals for real essence and non-real essence on economic value from literature. Our results indicate that factors of housing price, land value, floor area incentive, and facilitation of the construction industry affect the outcome of real essence economic value. Factors of enhancement of urban disaster prevention, improvement of urban environment and landscape, crime reduction, climate control, pollution reduction, biological diversity, health impacts, and leisure space affects the outcome of non-real essence economic value.

Keywords: economic value, green infrastructure, urban renewals, urban development

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Authors: Seyed-Ahmad Shahidi, Salemeh Kazemzadeh, Mehdi Sharifi Soltani, Azade Ghorbani-HasanSaraei

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The kinetics of colour changes of American Pokeweed extract, due to concentration by various heating methods was studied. Three different heating/evaporation processes were employed for production of American Pokeweed extract concentrate. The American Pokeweed extract was concentrated to a final 40 °Brix from an initial °Brix of 4 by microwave heating, rotary vacuum evaporator and evaporating at atmospheric pressure. The final American Pokeweed extract concentration of 40 °Brix was achieved in 188, 216 and 320 min by using microwave, rotary vacuum and atmospheric heating processes, respectively. The colour change during concentration processes was investigated. Total colour differences, Hunter L, a and b parameters were used to estimate the extent of colour loss. All Hunter colour parameters decreased with time. The zero-order, first-order and a combined kinetics model were applied to the changes in colour parameters. All models were found to describe the L, a and b-data adequately. Results indicated that variation in TCD followed both first-order and combined kinetics models. This model implied that the colour formation and pigment destruction occurred during concentration processes of American Pokeweed extract.

Keywords: American pokeweed, colour, concentration, kinetics

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Authors: Ahmed Mostafa, Mohamed Mahmoud, Nesreen H. Hafez, Mohamed Fahim

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This retrospective study includes 60 patients with pre-invasive breast cancer. Aim of the study: Evaluation of premalignant lesions of the breast (DCIS), different treatment methods and outcome. Patients and methods: 60 patients with DCIS were studied from the period between 2005 to 2012, for 38 patients the primary surgical method was wide local resection (WLE) (63.3%) and the other cases (22 patients, 36.7%) had mastectomy, fourteen cases from those who underwent local excision received radiotherapy, while no adjuvant radiotherapy was given for those who underwent mastectomy. In case of hormonal receptor positive DCIS lesions hormonal treatment (Tamoxifen) was given after local control. Results: No difference in overall survival between mastectomy & breast conserving therapy (wide local excision and adjuvant radiotherapy), however local recurrence rate is higher in case of breast conserving therapy, also no role of Axillary evacuation in case of DCIS. The use of hormonal therapy decreases the incidence of local recurrence by about 98%. Conclusion: The main management of DCIS is local treatment (wide local excision and radiotherapy) with hormonal treatment in case of hormone receptor positive lesions.

Keywords: ductal carcinoma in situ, surgical treatment, radiotherapy, breast conserving therapy, hormonal treatment

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Authors: Peng Zhang, Lihui Zheng, Xiangchun Wang, Xiaopan Kou

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Quantitative research on the main control factors of lost circulation has few considerations and single data source. Using Unmanned Intervention Algorithm to find the main control factors of lost circulation adopts all measurable parameters. The degree of lost circulation is characterized by the loss rate as the objective function. Geological, engineering and fluid data are used as layers, and 27 factors such as wellhead coordinates and WOB are used as dimensions. Data classification is implemented to determine function independent variables. The mathematical equation of loss rate and 27 influencing factors is established by multiple regression method, and the undetermined coefficient method is used to solve the undetermined coefficient of the equation. Only three factors in t-test are greater than the test value 40, and the F-test value is 96.557%, indicating that the correlation of the model is good. The funnel viscosity, final shear force and drilling time were selected as the main control factors by elimination method, contribution rate method and functional method. The calculated values of the two wells used for verification differ from the actual values by -3.036m3/h and -2.374m3/h, with errors of 7.21% and 6.35%. The influence of engineering factors on the loss rate is greater than that of funnel viscosity and final shear force, and the influence of the three factors is less than that of geological factors. Quantitatively calculate the best combination of funnel viscosity, final shear force and drilling time. The minimum loss rate of lost circulation wells in Shunbei area is 10m3/h. It can be seen that man-made main control factors can only slow down the leakage, but cannot fundamentally eliminate it. This is more in line with the characteristics of karst caves and fractures in Shunbei fault solution oil and gas reservoir.

Keywords: drilling and completion, drilling fluid, lost circulation, loss rate, main controlling factors, unmanned intervention algorithm

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Authors: Azade Ghorbani-HasanSaraei, Seyed-Ahmad Shahidi, Sakineh Alizadeh, Adeleh Maghsoudlou

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Improvement of color, as a quality attribute of Plum Concentrate, has been made possible by the increase in knowledge of kinetic of color change. Three different heating/evaporation processes were employed for the production of pPlum juice concentrate. The Plum juice was concentrated to a final 55 °Bx from an initial °Bx of 15 by microwave heating, rotary vacuum evaporator and evaporating at atmospheric pressure. The final Plum juice concentration of 55 °Bx was achieved in 17, 24 and 57 min by using the microwave, rotary vacuum and atmospheric heating processes, respectively. The colour change during concentration processes was investigated. Total colour differences, Hunter L, a and b parameters were used to estimate the extent of colour loss. All Hunter colour parameters decreased with time. The zero-order, first-order and a combined kinetics model were applied to the changes in colour parameters. Results indicated that variation in TCD followed both first-order and combined kinetics models, and parameters L, a and b followed only combined model. This model implied that the colour formation and pigment destruction occurred during concentration processes of plum juice.

Keywords: colour, kinetics, concentration, plum juice

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Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

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Introduction: To improve early detection and mortality rate of in-hospital cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditons and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90 mmHg, respiratory rate <8 or >28 breaths per minute, O2 saturation <90%, acute change in conscious state, acute chest pain or worry about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in in-hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in in-hospital cardiac arrest and overall hospital mortality rate, we conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed chi-square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010, 139 calls in 2011 and 245 calls in 2012. The number of ERT calls per 1000 admissions in year 2009-10 was 7.69; 5.61 in 2011 and 9.38 in 2013. The number of code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001 ). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, but we have not found difference in overall hospital mortality rate.

Keywords: cardiac arrest, outcome, in-hospital, ERT

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Authors: Sharadha G., Suresh Kanakkanavar

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Background: Placenta previa is a condition characterized by partial or complete implantation of the placenta in the lower uterine segment. It is one of the main causes of vaginal bleeding in the third trimester and a significant cause of maternal and perinatal morbidity and mortality. Materials and Methods: This is an observational study involving 130 patients diagnosed with placenta previa and satisfying inclusion criteria. The demographic data, clinical, surgical, and treatment, along with maternal and neonatal outcome parameters, were noted in proforma. Results: The incidence of placenta previa among scarred uterus was 1.32%, and in unscarred uterus was 0.67%. The mean age of the study population was 27.12±4.426years. High parity, high abortion rate, multigravida status, and less gestational age at delivery were commonly seen in scarred uterus compared to unscarred uterus. Complete placenta previa, anterior placental position, and adherent placenta were significantly associated with a scarred uterus compared to an unscarred uterus. The rate of caesarean hysterectomy was higher in the scarred uterus, along with statistical association to previous lower-segment caesarean sections. Intraoperative procedures like uterine artery ligation, bakri balloon insertion, and iliac artery ligation were higher in the scarred group. The maternal intensive care unit admission rate was higher in the scarred group and also showed its statistical association with previous lower segment caesarean section. Neonatal outcomes in terms of pre-term birth, still birth, neonatal intensive care unit admission, and neonatal death, though higher in the scarred group, did not differ statistically among the groups. Conclusion: Advancing maternal age, multiparity, prior uterine surgeries, and abortions are independent risk factors for placenta previa. Maternal morbidity is higher in the scarred uterus group compared to the unscarred group. Neonatal outcomes did not differ statistically among the groups. This knowledge would help the obstetricians to take measures to reduce the incidence of placenta previa and scarred uterus which would improve the fetomaternal outcome of placenta previa.

Keywords: placenta previa, scarred uterus, unscarred uterus, adherent placenta

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Authors: Mohamed Abo El Nasr, Mohamed Shoeib, Abdelhamid Abdelkhalik, Amro Serag

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Background: Early assessment of severity of chest trauma, either blunt or penetrating is of critical importance in prediction of patient outcome. Different trauma scoring systems are widely available and are based on anatomical or physiological parameters to expect patient morbidity or mortality. Up till now, there is no ideal, universally accepted trauma score that could be applied in all trauma centers and is suitable for assessment of severity of chest trauma patients. Aim: Our aim was to compare various trauma scoring systems regarding their predictability of morbidity and mortality in chest trauma patients. Patients and Methods: This study was a prospective study including 400 patients with chest trauma who were managed at Tanta University Emergency Hospital, Egypt during a period of 2 years (March 2014 until March 2016). The patients were divided into 2 groups according to the mode of trauma: blunt or penetrating. The collected data included age, sex, hemodynamic status on admission, intrathoracic injuries, and associated extra-thoracic injuries. The patients outcome including mortality, need of thoracotomy, need for ICU admission, need for mechanical ventilation, length of hospital stay and the development of acute respiratory distress syndrome were also recorded. The relevant data were used to calculate the following trauma scores: 1. Anatomical scores including abbreviated injury scale (AIS), Injury severity score (ISS), New injury severity score (NISS) and Chest wall injury scale (CWIS). 2. Physiological scores including revised trauma score (RTS), Acute physiology and chronic health evaluation II (APACHE II) score. 3. Combined score including Trauma and injury severity score (TRISS ) and 4. Chest-Specific score Thoracic trauma severity score (TTSS). All these scores were analyzed statistically to detect their sensitivity, specificity and compared regarding their predictive power of mortality and morbidity in blunt and penetrating chest trauma patients. Results: The incidence of mortality was 3.75% (15/400). Eleven patients (11/230) died in blunt chest trauma group, while (4/170) patients died in penetrating trauma group. The mortality rate increased more than three folds to reach 13% (13/100) in patients with severe chest trauma (ISS of >16). The physiological scores APACHE II and RTS had the highest predictive value for mortality in both blunt and penetrating chest injuries. The physiological score APACHE II followed by the combined score TRISS were more predictive for intensive care admission in penetrating injuries while RTS was more predictive in blunt trauma. Also, RTS had a higher predictive value for expectation of need for mechanical ventilation followed by the combined score TRISS. APACHE II score was more predictive for the need of thoracotomy in penetrating injuries and the Chest-Specific score TTSS was higher in blunt injuries. The anatomical score ISS and TTSS score were more predictive for prolonged hospital stay in penetrating and blunt injuries respectively. Conclusion: Trauma scores including physiological parameters have a higher predictive power for mortality in both blunt and penetrating chest trauma. They are more suitable for assessment of injury severity and prediction of patients outcome.

Keywords: chest trauma, trauma scores, blunt injuries, penetrating injuries

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Authors: Azad Khalid, Ime Akanyeti

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About 68% of the urban solid waste generated in Turkish Republic of Northern Cyprus TRNC is household solid waste, at present, its disposal in landfills. In other hand more than 3000 ton per year of sewage sludge produces in Nicosia waste water treatment plant, the produced sludge piled up without any processing. Co-composting of organic fraction of municipal solid waste and sewage sludge is diverting of municipal solid waste from landfills and best disposal of wastewater sewage sludge. Three 10 L insulated bioreactor R1, R2 and R3 obtained with aeration rate 0.05 m3/h.kg for R2 and R3, R1 was without aeration. The mixture was destined with ratio of sewage sludge: food waste: sawdust; 1:5:0.8 (w/w). The effective of aeration monitored during 42 days of process through investigation in key parameter moisture, C/N ratio, temperature and pH. Results show that the high moisture content cause problem and around 60% recommend, C/N ratio decreased about 17% in aerated reactors and 10% in without aeration and mixture volume reduced in volume 40% in final compost with size of 1.00 to 20.0 mm. temperature in reactors with aeration reached thermophilic phase above 50 °C and <40 °C in without aeration. The final pH is 6.1 in R1, 8.23 in R2 and 8.1 in R3.

Keywords: aeration, sewage sludge, food waste, sawdust, composting

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Authors: Kulsum Maula, Md Kamrul Alam, Md Ibrahim Khalil, Md Nazmul Hasan, Mohammad Omar Faruq

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Background: Percutaneous Tube Thoracostomy (PTT) is an invasive procedure that can save a life now and then in different traumatic and non-traumatic conditions. But still, it is an enigma; how our trainee surgeons are at home in this procedure. Objectives: To evaluate the outcome of the percutaneous tube thoracostomy performed by trainees in both trauma and non-trauma patients. Study design: Prospective, Observational Study. The duration of the study was September 2018 to February 2019. Methods: All patients who need PTT in traumatic and non-traumatic conditions were selected by purposive sampling. Thereafter, they were scrutinized according to eligibility criteria and 96 patients were finalized. A pre-tested, observation-based, peer-reviewed data collection sheet was prepared before the study. Data regarding clinical and surgical outcome profiles were recorded. Data were compiled, edited, and analyzed. Results: Among 96 patients, the highest 32.29% belonged to age group 31-40 years and the lowest 9.37% belonged to the age group ≤20. The mean age of the respondents was 29.19±9.81. We found out of 96 patients, 70(72.91%) were indicated PTT for traumatic conditions and the rest 26(27.08%) were indicated PTT for non-traumatic chest conditions, where 36(37.5%) had simple penumothorax, 21(21.87%) haemothorax, 14(14.58%) massive pleural effusion, 13(13.54%) tension pneumothorax, 10(10.41%) haemopneumothorax, and 2(2.08%) had pyothorax respectively. In 53.12% of patients had right-sided intercostal chest tube (ICT) insertion, whereas 46.87% had left-sided ICT insertion. In our study, 89.55 % of the tube was placed at the normal anatomical position. Besides, 10.41% of tube thoracostomy were performed deviated from anatomical site. Among 96 patients 62.5% patients had length of incision 2-3cm, 35.41% had >3cm and 2.08% had <2cm respectively. Out of 96 patients, 75(78.13%) showed uneventful outcomes, whereas 21(21.87%) had complications, including 11.15%(11) each had wound infection, 4.46%(4) subcutaneous emphysema, 4.28%(3) drain auto expulsion, 2.85%(2) hemorrhage, 1.45%(1) had a non-functioning drain and empyema with ascending infection respectively (p=<0.05). Conclusion: PTT is a life-saving procedure that is most frequently implemented in chest trauma patients in our country. In the majority of cases, the outcome of PTT was uneventful (78.13). Besides this, more than one-third of patients had a length of incision more than 3 cm that needed extra stitches and 10.41% of cases of PTT were placed other than the normal anatomical site. Trainees of Dhaka Medical College Hospitals are doing well in their performance of PTT insertion, but still, some anatomical orientations are necessary to avoid operative and post-operative complications.

Keywords: PTT, trainee, trauma, non-chest trauma patients

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Authors: Javeria Arain, Saad Malik

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The management of solid waste is a crucial and essential aspect of urban environmental management especially in a city with an ever increasing population such as Karachi. The total amount of municipal solid waste generated from Gulshan e Iqbal town on average is 444.48 tons per day and landfill sites are a widely accepted solution for final disposal of this waste. However, an improperly selected site can have immense environmental, economical and ecological impacts. To select an appropriate landfill site a number of factors should be kept into consideration to minimize the potential hazards of solid waste. The purpose of this research is to analyse the study area for the construction of an appropriate landfill site for disposal of municipal solid waste generated from Gulshan e-Iqbal Town by using geospatial techniques considering hydrological, geological, social and geomorphological factors. This was achieved using analytical hierarchy process and fuzzy analysis as a decision support tool with integration of geographic information sciences techniques. Eight most critical parameters, relevant to the study area, were selected. After generation of thematic layers for each parameter, overlay analysis was performed in ArcGIS 10.0 software. The results produced by both methods were then compared with each other and the final suitability map using AHP shows that 19% of the total area is Least Suitable, 6% is Suitable but avoided, 46% is Moderately Suitable, 26% is Suitable, 2% is Most Suitable and 1% is Restricted. In comparison the output map of fuzzy set theory is not in crisp logic rather it provides an output map with a range of 0-1, where 0 indicates least suitable and 1 indicates most suitable site. Considering the results it is deduced that the northern part of the city is appropriate for constructing the landfill site though a final decision for an optimal site could be made after field survey and considering economical and political factors.

Keywords: Analytical Hierarchy Process (AHP), fuzzy set theory, Geographic Information Sciences (GIS), Multi-Criteria Decision Analysis (MCDA)

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Authors: Petr Daniel Kovarik, Matt Kennedy, James Adams, Ajay Wilson, Andy Burns, Charles Kelly, Malcolm Jackson, Rahul Patil, Shahid Iqbal

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Introduction: Osteoradionecrosis (ORN) is a recognised toxicity of radiotherapy (RT) for head and neck cancer (HNC). Existing literature lacks any generally accepted definition and staging system for this toxicity. Objective: The objective is to analyse the outcome of the surgical and nonsurgical treatments of ORN. Material and Method: Data on 2303 patients treated for HNC with radical or adjuvant RT or RT-chemotherapy from January 2010 - December 2021 were retrospectively analysed. Median follow-up to the whole group of patients was 37 months (range 0–148 months). Results: ORN developed in 185 patients (8.1%). The location of ORN was as follows; mandible=170, maxilla=10, and extra oral cavity=5. Multiple ORNs developed in 7 patients. 5 patients with extra oral cavity ORN were excluded from treatment analysis as the management is different. In 180 patients with oral cavity ORN, median follow-up was 59 months (range 5–148 months). ORN healed in 106 patients, treatment failed in 74 patients (improving=10, stable=43, and deteriorating=21). Median healing time was 14 months (range 3-86 months). Notani staging is available in 158 patients with jaw ORN with no previous surgery to the mandible (Notani class I=56, Notani class II=27, and Notani class III=76). 28 ORN (mandible=27, maxilla=1; Notani class I=23, Notani II=3, Notani III=1) healed spontaneously with a median healing time 7 months (range 3–46 months). In 20 patients, ORN developed after dental extraction, in 1 patient in the neomandible after radical surgery as a part of the primary treatment. In 7 patients, ORN developed and spontaneously healed in irradiated bone with no previous surgical/dental intervention. Radical resection of the ORN (segmentectomy, hemi-mandibulectomy with fibula flap) was performed in 43 patients (all mandible; Notani II=1, Notani III=39, Notani class was not established in 3 patients as ORN developed in the neomandible). 27 patients healed (63%); 15 patients failed (improving=2, stable=5, deteriorating=8). The median time from resection to healing was 6 months (range 2–30 months). 109 patients (mandible=100, maxilla=9; Notani I=3, Notani II=23, Notani III=35, Notani class was not established in 9 patients as ORN developed in the maxilla/neomandible) were treated conservatively using a combination of debridement, antibiotics and Pentoclo. 50 patients healed (46%) with a median healing time 14 months (range 3–70 months), 59 patients are recorded with persistent ORN (improving=8, stable=38, deteriorating=13). Out of 109 patients treated conservatively, 13 patients were treated with Pentoclo only (all mandible; Notani I=6, Notani II=3, Notani III=3, 1 patient with neomandible). In total, 8 patients healed (61.5%), treatment failed in 5 patients (stable=4, deteriorating=1). Median healing time was 14 months (range 4–24 months). Extra orally (n=5), 3 cases of ORN were in the auditory canal and 2 in mastoid. ORN healed in one patient (auditory canal after 32 months. Treatment failed in 4 patients (improving=3, stable=1). Conclusion: The outcome of the treatment of ORN remains in general, poor. Every effort should therefore be made to minimise the risk of development of this devastating toxicity.

Keywords: head and neck cancer, radiotherapy, osteoradionecrosis, treatment outcome

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Authors: Twarakavi Venkata Suresh Kumar, Sailaja Kumar, B. Eswara Reddy

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In a world of tremendous technical developments, effective and efficient higher education has always been a major challenge. The rising number of educational institutions have made it mandatory for healthy competitions among the institutions. To evaluate the qualitative competence of these educations institutions in engineering and technology and related disciplines, an efficient assessment technique in internal and external quality has to be followed. To achieve this, the curriculum is to be developed into courses, and each course has to be presented in the form teaching lesson plan consisting of topics and session outcome known as Course Outcomes (COs), that easily map into different Programme Outcomes (POs). The major objective of these methodologies is to provide quality technical education to its students. Detailed clear weightage in CO-PO mapping helps in proper measurable COs and to devise the POs attainment is an important issue. This ensures in assisting the achievement of the POs with proper weightage to POs, and also improves the successive curriculum development. In this paper, we presented a methodology for mapping CO and PO considering the key elements supported by each PO. This approach is useful in evaluating the attainment of POs which is based on the attainment of COs using the existing data from students' marks taken from various test items. Such direct assessment tools are used to measure the degree to which each student has achieved each course learning outcome by the completion of the course. Hence, these results are also useful in measuring the PO attainment for improving the programme vision and mission.

Keywords: attainment, course outcomes, programme outcomes, educational institutions

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Authors: Herlangga Pramaditya, Agus Sulistyono, Risa Etika, Budiono Budiono, Alvin Saputra

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Preterm birth and anemia of prematurity are the most common cause of morbidity and mortality in neonates, and anemia of the preterm neonates has become a major issue. The timing of umbilical cord clamping after a baby is born determines the amount of blood transferred from the placenta to fetus, Delayed Cord Clamping (DCC) has proven to prevent anemia in the neonates but it is constrained concern regarding the delayed in neonatal resuscitation. Umbilical Cord Milking (UCM) could be an alternative method for clamping the umbilical cord due to the active blood transfer from the placenta to the fetus. The aim of this study was to analyze the difference between maternal and neonatal outcome in preterm abdominal delivery who underwent UCM compared to ECC. This was an experimental study with randomized post-test only control design. Analyzed maternal and neonatal outcomes, significant P values (P <0.05). Statistical comparison was carried out using Paired Samples t-test (α two tailed 0,05). The result was the mean of preoperative mother’s hemoglobin in UCM group compared to ECC (10,9 + 0,9 g/dL vs 10,4 + 0,9 g/dL) and postoperative (11,1 + 1,1 g/dL vs 10,5 + 0,7 g/dL), the delta was (0,2 + 0,7 vs 0,1 + 0,6.). It showed no significant difference (P=0,395 vs 0,627). The mean of 3rd phase labor duration in UCM group vs ECC was (20,5 + 3,5 second vs 21,1 + 3,3 second), showed insignificant difference (P=0,634). The amount of bleeding after delivery in UCM group compared to ECC has the median of 190 cc (100-280cc) vs 210 cc (150-330 cc) showed insignificant difference (P=0,083) so the incidence of post-partum bleeding was not found. The mean of the neonates hemoglobin, hematocrit and erythrocytes of UCM group compared to ECC was (19,3 + 0,7 vs 15,9 + 0,8 g/dl), (57,1 + 3,6 % vs 47,2 + 2,8 %), and (5,4 + 0,4 g/dl vs 4,5 + 0,3 g/dl) showed significant difference (P<0,0001). There was no baby in UCM group received blood transfusion and one baby in the control ECC group received blood transfusion was found. Umbilical Cord Milking has shown to increase the baby’s blood component such as hemoglobin, hematocrit, and erythrocytes 6 hours after birth as well as lowering the incidence of blood transfusions. Maternal and neonatal morbidity were not found. Umbilical Cord Milking was the act of clamping the umbilical cord that was more beneficial to the baby and no adverse or negative effects on the mother.

Keywords: umbilical cord milking, early cord clamping, maternal and neonatal outcome, preterm, abdominal delivery

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Authors: Samira Mehrabi

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Geriatric depression is a common late-life mental health disorder that increases morbidity and mortality. It has been shown that exercise is effective in alleviating symptoms of geriatric depression. However, inconsistencies across studies and lack of optimal dose-response of exercise for improving geriatric depression have made it challenging to draw solid conclusions on the effectiveness of exercise in late-life depression. Purpose: To further investigate the moderators of the effectiveness of exercise on geriatric depression across the current body of evidence. Methods: Based on the Arksey and O’Malley framework, an extensive search strategy was performed by exploring PubMed, Scopus, Sport Discus, PsycInfo, ERIC, and IBSS without limitations in the time frame. Eight systematic reviews with empirical results that evaluated the effect of exercise on depression among people aged ≥ 60 years were identified and their individual studies were screened for inclusion. One additional study was found through the hand searching of reference lists. After full-text screening and applying inclusion and exclusion criteria, 21 studies were retained for inclusion. Results: The review revealed high variability in characteristics of the exercise interventions and outcome measures. Sample characteristics, nature of comparators, main outcome assessment, and baseline severity of depression also varied notably. Mind-body and aerobic exercises were found to significantly reduce geriatric depression. However, results on the relationship between resistance training and improvements in geriatric depression were inconsistent, and results of the intensity-related antidepressant effects of exercise interventions were mixed. Extensive use of self-reported questionnaires for the main outcome assessment and lack of evidence on the relationship between depression severity and observed effects were of the other important highlights of the review. Conclusion: Several literature gaps were found regarding the potential effect modifiers of exercise and geriatric depression. While acknowledging the complexity of establishing recommendations on the exercise variables and geriatric depression, future studies are required to understand the interplay and threshold effect of exercise for treating geriatric depression.

Keywords: exercise, geriatric depression, healthy aging, older adults, physical activity intervention, scoping review

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Authors: Rodrigo T. Sepulveda-Hirose, Ana B. Carrera-Aguilar, Francisco Andree Ramirez-Casas, Alondra Orozco-Gomez, Miguel Angel Sanchez-Caro, Carlos Herrera-Ventosa

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High concentrations of particulate matter in the atmosphere pose a threat to human health, especially over areas with high concentrations of population; however, field air pollution monitoring is expensive and time-consuming. In order to achieve reduced costs and global coverage of the whole urban area, remote sensing can be used. This study evaluates PM2.5 concentrations, over the Mexico City´s metropolitan area, are estimated using atmospheric reflectance from LANDSAT 8, satellite imagery and historical PM2.5 measurements of the Automatic Environmental Monitoring Network of Mexico City (RAMA). Through the processing of the available satellite images, a preliminary model was generated to evaluate the optimal bands for the generation of the final model for Mexico City. Work on the final model continues with the results of the preliminary model. It was found that infrared bands have helped to model in other cities, but the effectiveness that these bands could provide for the geographic and climatic conditions of Mexico City is still being evaluated.

Keywords: air pollution modeling, Landsat 8, PM2.5, remote sensing

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Authors: Babatunde Dosumu, Obuks Ejohwomu, Akilu Yunusa-Kaltungo

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Cost estimation in construction is often difficult, particularly when dealing with risks and uncertainties, which are inevitable and peculiar to developing countries like Nigeria. Direct consequences of these are major deviations in cost, duration, and quality. The fundamental aim of this study is to develop a framework for assessing the impacts of risk on cost estimation, which in turn causes variabilities between contract sum and final account. This is very important, as initial estimates given to clients should reflect the certain magnitude of consistency and accuracy, which the client builds other planning-related activities upon, and also enhance the capabilities of construction industry professionals by enabling better prediction of the final account from the contract sum. In achieving this, a systematic literature review was conducted with cost variability and construction projects as search string within three databases: Scopus, Web of science, and Ebsco (Business source premium), which are further analyzed and gap(s) in knowledge or research discovered. From the extensive review, it was found that factors causing deviation between final accounts and contract sum ranged between 1 and 45. Besides, it was discovered that a cost estimation framework similar to Building Cost Information Services (BCIS) is unavailable in Nigeria, which is a major reason why initial estimates are very often inconsistent, leading to project delay, abandonment, or determination at the expense of the huge sum of money invested. It was concluded that the development of a cost estimation framework that is adjudged an important tool in risk shedding rather than risk-sharing in project risk management would be a panacea to cost estimation problems, leading to cost variability in the Nigerian construction industry by the time this ongoing Ph.D. research is completed. It was recommended that practitioners in the construction industry should always take into account risk in order to facilitate the rapid development of the construction industry in Nigeria, which should give stakeholders a more in-depth understanding of the estimation effectiveness and efficiency to be adopted by stakeholders in both the private and public sectors.

Keywords: cost variability, construction projects, future studies, Nigeria

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Authors: Mohammad H. Yarmohammadian, Mehdi Nasr Isfahani, Elham Anbari

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Introduction: The awareness of using chemical, biological, and nuclear agents in everyday industrial and non-industrial incidents has increased recently; release of these materials can be accidental or intentional. Since hospitals are the forefronts of confronting Chemical, Biological, Radiological and Nuclear( CBRN) incidents, the goal of the present research was to provide a generic protocol for CBRN incidents through a comparative review of CBRN protocols and guidelines of different countries and reviewing various books, handbooks and papers. Method: The integrative approach or research synthesis was adopted in this study. First a simple narrative review of programs, books, handbooks, and papers about response to CBRN incidents in different countries was carried out. Then the most important and functional information was discussed in the form of a generic protocol in focus group sessions and subsequently confirmed. Results: Findings indicated that most of the countries had various protocols, guidelines, and handbooks for hazardous materials or CBRN incidents. The final outcome of the research synthesis was a 50 page generic protocol whose main topics included introduction, definition and classification of CBRN agents, four major phases of incident and disaster management cycle, hospital response management plan, equipment, and recommended supplies and antidotes for decontamination (radiological/nuclear, chemical, biological); each of these also had subtopics. Conclusion: In the majority of international protocols, guidelines, handbooks and also international and Iranian books and papers, there is an emphasis on the importance of incident command system, determining the safety degree of decontamination zones, maps of decontamination zones, decontamination process, triage classifications, personal protective equipment, and supplies and antidotes for decontamination; these are the least requirements for such incidents and also consistent with the provided generic protocol.

Keywords: hospital, CBRN, decontamination, generic protocol, CBRN Incidents

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Authors: Samaila Bawa Muazu

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Hydration process, crack potential and setting time of concrete grade C30, C40 and C50 were separately monitored using non-contact electrical resistivity apparatus, a novel plastic ring mould and penetration resistance method respectively. The results show highest resistivity of C30 at the beginning until reaching the acceleration point when C50 accelerated and overtaken the others, and this period corresponds to its final setting time range, from resistivity derivative curve, hydration process can be divided into dissolution, induction, acceleration and deceleration periods, restrained shrinkage crack and setting time tests demonstrated the earliest cracking and setting time of C50, therefore, this method conveniently and rapidly determines the concrete’s crack potential. The highest inflection time (ti), the final setting time (tf) were obtained and used with crack time in coming up with mathematical models for the prediction of concrete’s cracking age for the range being considered. Finally, ANSYS numerical simulations supports the experimental findings in terms of the earliest crack age of C50 and the crack location that, highest stress concentration is always beneath the artificially introduced expansion joint of C50.

Keywords: concrete hydration, electrical resistivity, restrained shrinkage crack, setting time, simulation

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Authors: Simona Maria Ignat

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Bullying online has been an increasing studied topic during the last years. Different approaches, psychological, linguistic, or computational, have been applied. To our best knowledge, a definition and a set of characteristics of phenomenon agreed internationally as a common framework are still waiting for answers. Thus, the objectives of this paper are the identification of bullying utterances on Twitter and their algorithms. This research paper is focused on the identification of words or groups of words, categorized as “utterances”, with bullying effect, from Twitter platform, extracted on a set of legislative criteria. This set is the result of analysis followed by synthesis of law documents on bullying(online) from United States of America, European Union, and Ireland. The outcome is a linguistic corpus with approximatively 10,000 entries. The methods applied to the first objective have been the following. The discourse analysis has been applied in identification of keywords with bullying effect in texts from Google search engine, Images link. Transcription and anonymization have been applied on texts grouped in CL1 (Corpus linguistics 1). The keywords search method and the legislative criteria have been used for identifying bullying utterances from Twitter. The texts with at least 30 representations on Twitter have been grouped. They form the second corpus linguistics, Bullying utterances from Twitter (CL2). The entries have been identified by using the legislative criteria on the the BoW method principle. The BoW is a method of extracting words or group of words with same meaning in any context. The methods applied for reaching the second objective is the conversion of parts of speech to alphabetical and numerical symbols and writing the bullying utterances as algorithms. The converted form of parts of speech has been chosen on the criterion of relevance within bullying message. The inductive reasoning approach has been applied in sampling and identifying the algorithms. The results are groups with interchangeable elements. The outcomes convey two aspects of bullying: the form and the content or meaning. The form conveys the intentional intimidation against somebody, expressed at the level of texts by grammatical and lexical marks. This outcome has applicability in the forensic linguistics for establishing the intentionality of an action. Another outcome of form is a complex of graphemic variations essential in detecting harmful texts online. This research enriches the lexicon already known on the topic. The second aspect, the content, revealed the topics like threat, harassment, assault, or suicide. They are subcategories of a broader harmful content which is a constant concern for task forces and legislators at national and international levels. These topic – outcomes of the dataset are a valuable source of detection. The analysis of content revealed algorithms and lexicons which could be applied to other harmful contents. A third outcome of content are the conveyances of Stylistics, which is a rich source of discourse analysis of social media platforms. In conclusion, this corpus linguistics is structured on legislative criteria and could be used in various fields.

Keywords: corpus linguistics, cyberbullying, legislation, natural language processing, twitter

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Authors: Majed Alobudi

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Edward Said is considered among the most prominent figures in postcolonial theoretical studies and his work has largely influenced critical discussion for many decades. And in the globalized world of today where immigration and dislocation are intense and thoroughly discussed, Said`s views on these issues seem more relevant than ever. This paper will endeavor to bring together Said`s theoretical texts and other writings on immigration and exile in parallel. The aim is to try to find a better understanding of Said`s theories on dislocation and exile theoretically and personally. The combination of these two strands of narrative will eventually shed more light on self location in postcolonial theories and further the understanding of Said's theories and personal life narratives. The paper propose the difficulty dislocation poses in counter colonial narratives such as those written by Said. As an exile, the mission of defining the self and the other becomes obscure when place becomes impossible or prohibited. The clear result becomes a self which proclaims rather than inhabits reality, a treat Said criticized in colonial representation. The self becomes trapped between the worlds of distant reality of dislocation and the estranged world of exile. The outcome would reveal a more weakened attempt at defining the self and countering the postcolonial narrative. The reason for such confusion and contradiction is directly connected to place and dis-location. To summarize, the paper proposes to examine and investigate the implications exile and dislocation have inflected on Said as a prominent postcolonial figure and how that affects his theories and personal life. The outcome, it is argued, would be a vast and lasting effect which such colonial and postcolonial phenomenon have on personal and theoretical narratives written by Said.

Keywords: Edward Said, exile, postcolonialism, dislocation

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Authors: Miladi Yasmine, Bouhlel Salah, Garnit Hechmi, David Banks

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The Jebel Mecella F (Ba-Pb-Zn) ore deposits of the Zaghouan district are located in northeastern Tunisia, 60 km south of Tunis. The host rocks belong to the Ressas Formation of Kimmeridgian-Tithonian age and lower Cretaceous layers. Mineralisations occur as stratiform lenses and fracture fillings. The ore mineral assemblage is composed of fluorite, barite, sphalerite galena, and quartz. Primary fluid inclusions in sphalerite have homogenization temperatures ranging from 129 to 145°C final melting temperature range from -14.9 to -10.0, corresponding to salinities of 14.0 to 17.7 wt% NaCl equivalent. Fluid inclusions in fluorite homogenize to the liquid phase between 116 and 160°C. The final ice melting temperature ranges from -23 to -15 °C, corresponding to salinities between 17 and 24 wt% NaCl equivalent. The LAICP-MS analyses of the fluid inclusions in fluorite show that these fluids are dominated by Na>K>Mg. Furthermore, the high K/Na values from fluid inclusions suggest the brine interacted with K-rich rocks in the basement or in siliciclastic sediments in the basins. The ore fluids in Jebel Mecella are highly saline and Na-K dominated with lower Mg concentrations, and come from the leaching of the dolomitic host rocks. These results are compatible with Mississippi-Valley-type mineralizing fluids.

Keywords: Jebel Mecella, fluid inclusions, micro thermometry, LA-ICP-MS

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Authors: Tigist Mekonnen Melesse

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Since rural households are basically entitled to food through own production, improving productivity might lead to enhance the welfare of rural population through higher food availability at the household level and lowering the price of agricultural products. Increasing agricultural productivity through the use of improved technology is one of the desired outcomes from sensible food security and agricultural policy. The ultimate objective of this study was to evaluate the potential impact of improved agricultural technology adoption on smallholders’ crop productivity and welfare. The study is conducted in Ethiopia covering 1500 rural households drawn from four regions and 15 rural villages based on data collected by Ethiopian Rural Household Survey. Endogenous treatment effect model is employed in order to account for the selection bias on adoption decision that is expected from the self-selection of households in technology adoption. The treatment indicator, technology adoption is a binary variable indicating whether the household used improved seeds and chemical fertilizer or not. The outcome variables were cereal crop productivity, measured in real value of production and welfare of households, measured in real per capita consumption expenditure. Results of the analysis indicate that there is positive and significant effect of improved technology use on rural households’ crop productivity and welfare in Ethiopia. Adoption of improved seeds and chemical fertilizer alone will increase the crop productivity by 7.38 and 6.32 percent per year of each. Adoption of such technologies is also found to improve households’ welfare by 1.17 and 0.25 percent per month of each. The combined effect of both technologies when adopted jointly is increasing crop productivity by 5.82 percent and improving welfare by 0.42 percent. Besides, educational level of household head, farm size, labor use, participation in extension program, expenditure for input and number of oxen positively affect crop productivity and household welfare, while large household size negatively affect welfare of households. In our estimation, the average treatment effect of technology adoption (average treatment effect on the treated, ATET) is the same as the average treatment effect (ATE). This implies that the average predicted outcome for the treatment group is similar to the average predicted outcome for the whole population.

Keywords: Endogenous treatment effect, technologies, productivity, welfare, Ethiopia

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Authors: Nasir Ashraf, Sajid Rahid Ahmad, Adeel Ahmad

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Pakistan is a major tea consumer country and ranked as the third largest importer of tea worldwide. Out of all beverage consumed in Pakistan, tea is the one with most demand for which tea import is inevitable. Being an agrarian country, Pakistan should cultivate its own tea and save the millions of dollars cost from tea import. So the need is to identify the most suitable areas with favorable weather condition and suitable soils where tea can be planted. This research is conducted over District Mansehra and District Abbottabad in Khyber Pakhtoonkhwah Province of Pakistan where the most favorable conditions for tea cultivation already exist and National Tea Research Institute has done successful experiments to cultivate high quality tea. High tech approach is adopted to meet the objectives of this research by using the remotely sensed data i.e. Aster DEM, Landsat8 Imagery. The Remote Sensing data was processed in Erdas Imagine, Envi and further analyzed in ESRI ArcGIS spatial analyst for final results and representation of result data in map layouts. Integration of remote sensing data with GIS provided the perfect suitability analysis. The results showed that out of all study area, 13.4% area is highly suitable while 33.44% area is suitable for tea plantation. The result of this research is an impressive GIS based outcome and structured format of data for the agriculture planners and Tea growers. Identification of suitable tea growing areas by using remotely sensed data and GIS techniques is a pressing need for the country. Analysis of this research lets the planners to address variety of action plans in an economical and scientific manner which can lead tea production in Pakistan to meet demand. This geomatics based model and approach may be used to identify more areas for tea cultivation to meet our demand which we can reduce by planting our own tea, and our country can be independent in tea production.

Keywords: agrarian country, GIS, geoinformatics, suitability analysis, remote sensing

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Authors: Auni Idi Muhire

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Background: Prior to April 2012, resuscitations were often ineffective resulting in poor patient outcomes. An initiative was implemented at Rwanda Military Hospital (RMH) to review root causes and plan strategies to improve patient outcomes. An interdisciplinary committee was developed to review this problem. Purpose: Analyze the frequency, obstacles, and outcome of patient resuscitation following cardiac and/or respiratory arrest. Methods: A form was developed to allow recording of all actions taken during resuscitation including response times, staff present, and equipment and medications used. Results:-The patient population requiring the most resuscitation effort are the intensive care patients, most frequently the neonatal the intensive care patients (42.8%) -Despite having trained staff representatives, not all resuscitations follow protocol -Lack of compliance with drug administration guidelines was noted, particularly in initiating use of drugs despite the drug being available (59%). Lesson Learned: Basic Life Support training for interdisciplinary staff resulted in more effective response to cardiac and/or respiratory arrest at RMH. Obstacles to effective resuscitation included number of staff, knowledge and skill level of staff, availability of appropriate equipment and medications, staff communication, and patient Do not Attempt Resuscitation (DNR) status.

Keywords: resuscitation, case analysis of knowledge versus practice, intensive care, critical care

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Authors: Animesh Gupta

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Objective: The purpose of this study is to evaluate the versatility and outcome of lateral supra malleolar flap (LSMF) in soft tissue reconstruction of the regions including the distal leg, ankle, dorsal foot and heel. Methods: From March 2021 to April 2023, 18 patients with soft tissue defects in the regions, including the distal leg, ankle, dorsal foot and heel, who underwent LSMF repair for lower limb wound reconstruction were analyzed. The location, size of the defects, etiology, outcome, complications, and other alternative options were studied and presented. Results: The follow-up period of the cases was 3-6 months after surgery. All flaps were successful; however, one flap was complicated by venous congestion and was managed by loosening a few sutures and the patient was required to elevate the affected limb to resolve the issue. Conclusion: The LSMF has numerous advantages in repairing soft tissue defects in areas involving the ankle, distal leg, heel and dorsum of the foot. In comparison to reverse sural flaps for repairing defects in the heel and lower leg, LSMF offers shorter operation time, shorter hospitalization, lower cost, and fewer postoperative complications.

Keywords: lateral supra malleolar flap, LSMF, soft tissue reconstruction, lower leg defect

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Authors: Rashmi Gupta

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Rewarding stimuli capture attention involuntarily as a result of an association process that develops quickly during value learning, referred to as the reward or value-driven attentional capture. It is essential to compare reward with punishment processing to get a full picture of value-based modulation in visual attention processing. Hence, the present study manipulated both valence/value (reward as well as punishment) and motivational salience (probability of an outcome: high vs. low) together. Series of experiments were conducted, and there were two phases in each experiment. In phase 1, participants were required to learn to associate specific face stimuli with a high or low probability of winning or losing points. In the second phase, these conditioned stimuli then served as a distractor or prime in a speeded letter search task. Faces with high versus low outcome probability, regardless of valence, slowed the search for targets (specifically the left visual field target) and suggesting that the costs to performance on non-emotional cognitive tasks were only driven by motivational salience (high vs. loss) associated with the stimuli rather than the valence (gain vs. loss). It also suggests that the processing of motivationally salient stimuli is right-hemisphere biased. Together, results of these studies strengthen the notion that our visual attention system is more sensitive to affected by motivational saliency rather than valence, which termed here as motivational-driven attentional capture.

Keywords: attention, distractors, motivational salience, valence

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