Search results for: general hospital

Authors: DRIS Mohammed El-Amine, BOUNIF Abdelhamid

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This paper considers an experimental and numerical investigation of variable density in axisymmetric turbulent free jets. Special attention is paid to the study of the scalar dissipation rate. In this case, dynamic field equations are coupled to scalar field equations by the density which can vary by the thermal effect (jet heating). The numerical investigation is based on the first and second order turbulence models. For the discretization of the equations system characterizing the flow, the finite volume method described by Patankar (1980) was used. The experimental study was conducted in order to evaluate dynamical characteristics of a heated axisymmetric air flow using the Laser Doppler Anemometer (LDA) which is a very accurate optical measurement method. Experimental and numerical results are compared and discussed. This comparison do not show large difference and the results obtained are in general satisfactory.

Keywords: Scalar dissipation rate, thermal effects, turbulent axisymmetric jets, second order modelling, Velocimetry Laser Doppler.

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Authors: Brian J. Kozak, Joshua D. Shipman, Peng Hao Wang, Blake Shipp

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The unmanned aerial system (UAS) industry is growing at a rapid pace. This growth has increased the demand for low cost, custom made and high strength unmanned aerial vehicles (UAV). The area of most growth is in the area of 25 kg to 200 kg vehicles. Vehicles this size are beyond the size and scope of simple wood and fabric designs commonly found in hobbyist aircraft. These high end vehicles require stronger materials to complete their mission. Traditional aircraft construction materials such as aluminum are difficult to use without machining or advanced computer controlled tooling. However, by using general aviation composite aircraft homebuilding techniques and materials, a large scale UAV can be constructed cheaply and easily. Furthermore, these techniques could be used to easily manufacture cost made composite shapes and airfoils that would be cost prohibitive when using metals. These homebuilt aircraft techniques are being demonstrated by the researchers in the construction of a 75 kg aircraft.

Keywords: composite aircraft, homebuilding, unmanned aerial system industry, UAS, unmanned aerial vehicles, UAV

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Authors: Guillermo Cardoso-Landa, Ana Julita Cuenca-Castro

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The present paper focuses to research the possible causes of curtain failure of dam "El Batan" in Querétaro, Mexico, including the design of the fineness of the employee filter during the construction of the curtain was verified since this depends greatly on the proper functioning of this filter. To carry out the required analysis, it was necessary to document elements provided understanding about the composition and behavior of the land curtain, and the main types of failure in these curtains. The general characteristics of the curtain dam "El Batan", the composition of the filter, as well as possible causes resulted in the failure were also analyzed. Once obtained data starting, the actual analysis was carried out by reviewing the following possible causes of failure: fails due to a poor constructive process of the curtain, failure due to hydraulic suppression, fails due to a structural design wrong, fails due to a geotechnical design wrong, fails due to a hydraulic design wrong, fails due to an inadequate design of the curtain filter. It is concluded that the type of the filter employed in the land dam curtain of "El Batan", located in the municipality of Querétaro, México, do not have adequate characteristics, outside of the ranges of design, using the curves: Terzaghi criteria, Sherard and Dunnigan criteria, UCSCS criteria, and Foster and Fell criteria.

Keywords: failure, dam, filter, curtain

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Authors: Novawiguna Kemalasari, Ahmad Badawi Saluy

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Recent economic developments are more dependent on the value created by intangible assets than tangible company's assets. Intangible assets in question is intellectual capital that is recognized as the basis of individual, organizational, and general competition in the 21st century. The rapid global economy and technological innovations that have led to tough competition in the business world, make IC creation, management, measurement, and evaluation an important indicator in improving company performance that will affect the value of the company in the future. This study aims to determine the strong influence of intellectual capital on corporate performance, and how the influence of human capital on structural capital and relation capital. By distributing questionnaires to 100 employees of banking companies in Jakarta with middle and upper positions. Approach method used is Partial Least Square (PLS) Based on research that has been done, it can be concluded that human capital has influence on relation capital and structural capital. Similarly, the influence on the performance of the company turned out to human capital and relation capital has a significant influence, but structural capital has a non-significant effect on company performance.

Keywords: human capital, structural capital, relation capital, corporate performance

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Authors: Harini Aiyer, Kalyani Premkumar

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Health professionals are the key players who can help achieve the goals of population health equity. Social accountability (SA) of health professionals emphasizes their role in addressing issues of equity in the population they serve. Therefore, health professional education must focus on instilling SA in health professionals. There is limited literature offering a longitudinal perspective of how students sustain the practice of SA in later life. This project aims to identify the drivers of social accountability among physicians. This study employed an exploratory mixed methods design (QUAL-> Quant) to explore alumni perceptions and experiences. The qualitative data, collected via 20 in-depth, semi-structured interviews, provided an understanding of the perceptions of the alumni regarding the influence of their undergraduate learning environment on their SA. This was followed by a quantitative portion -a questionnaire designed from the themes identified from the qualitative data. Emerging themes from the study highlighted community-centered education and a focus on social and preventative medicine in both curricular and non-curricular facilitators of SA among physicians. Curricular components included opportunities to engage with the community, such as roadside clinics, community-orientation programs, and postings at a secondary hospital. Other facilitators that emerged were the faculty leading by example, a subsidized fee structure, and a system that prepared students for practice in rural and remote areas. The study offers a fresh perspective and dimension on how SA is addressed by medical schools. The findings may be adapted by medical schools to understand how their own SA initiatives have been sustained among physicians over the long run.

Keywords: community-based work, global health, health education, medical education, providing health in remote areas, social accountability

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Authors: Goitom Molalign Takele, Tsegalem Hailemariam Ballo, Kiros Belay Gebrekidan, Birhan Gebresilassie Gebregiorgis

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Background: Emergency medical services (EMS) are services that provide out-of-hospital emergency medical care to injured or ill peoples, and transporting to definitive care. EMS is an integral part of the emergency medical system and has been associated with decreased morbidity and mortality related to emergency cases. The aim of this study was to assess the utilization, barriers, and determinants of EMS in Mekelle, Ethiopia. Methods: A community-based cross-sectional study was conducted in selected sub-cities of Mekelle. A multistage sampling method was employed to recruit study participants, and data were collected by trained data collectors using an interviewer-administered questionnaire. Multivariate logistic regression analysis was used to examine the statistical association of the determinants of EMS utilization. Results: Half (50.5%) of the respondents had experienced or witnessed an emergency incident in the past year. The common means of transportations used were Bajaj’s (39.2%) and ambulances (22.7%). Majority (88.1%) of the respondents did not knew the EMS access phone number of an ambulance. As their preferred mode of transportation in case of emergency conditions, 42.2% of the participants reported an ambulance, followed by Bajaj 33.7%. Where participants who had gynecologic emergencies were 9.4 times (AOR=9.4, 95% CI: 1.04, 85, p=0.046), and those who knew any ambulance numbers were 3.6 times (AOR=3.6, 95% CI: 1.22, 10.8, p=0.02) more likely to use ambulance services in case of emergencies. Conclusion: The ambulance utilization level in Mekelle city was low and victims of emergency conditions were being transported mainly using public transports such as Bajaj’s and taxis. Even though the perception of the public towards EMS services is favorable, lack of awareness of EMS access, and lack of integrated EMS system in the city are the barriers that may have contributed to the low utilization. Actions to improve EMS access and integrating the system are warranted to promote the services utilization.

Keywords: emergency medical services, utilization, Mekelle, barriers

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Authors: Sonia Achour

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Owing to the outbreak of the Corona pandemic, the shift to online learning took place abruptly. Neither practitioners nor learners were prepared for this sudden move. Higher education providers were compelled to implement online courses on a very short notice. Sultan Qaboos University is one among these. The question of motivation attracted a great number of educators. A case study was carried out so as to shed some lights on students' perceptions towards virtual learning and how it influenced their motivation to learning. The data was collected by means of semi-structured interviews of a focused group of 16 students along with classroom observation over a 12 week period. Both interviews and class observation revealed that there was a general negative feeling about the online teaching platform and its impact on the learners' motivation. Several factors were identified, namely the absence of interaction, social isolation, inconsistency of instructional knowledge, unfamiliarity with the new learning environment, IT illiteracy, and teacher development. The researcher aims at demonstrating the effect of virtual classrooms on students' motivation to acquire L2. The findings may be used to inform future decisions about courses, curriculum design. And teacher development

Keywords: online learning, motivation, EFL context, virtual setting

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Authors: Seung Won Park

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Pornographic images are becoming increasingly normalized as innovations in media technology arise, the porn industry explosively grows, and transnational capitalism spreads due to government deregulation and privatization of media. As the media evolves, pornography has become more and more violent and non-consensual; this growth of ‘raunch culture’ reifies the traditional power balance between men and women in which men are dominant, and women are submissive. This male domination objectifies and commodifies women, reducing them to merely sexual objects for the gratification of men. Women are exposed to pornographic images at younger and younger ages, providing unhealthy sexual role models and teaching them lessons on sexual behavior before the onset of puberty. The increasingly sexualized depiction of women in particular positions them as appropriately desirable and available to men. As a result, women are not only viewed as sexual prey but also end up treating themselves primarily as sexual objects, basing their worth off of their sexuality alone. Although many scholars are aware of and have written on the great lack of agency exercised by women in these representations, the general public tends to view some of these women as being empowered, rather than exploited. Scholarly discourse is constrained by the popular misconception that the construction of women’s sexuality in the media is controlled by women themselves.

Keywords: construction of gender, hypersexualization, media, objectification

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Authors: Mohammad Faheem, M. Tabish Rehman, Mohd Danishuddin, Asad U. Khan

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The worldwide dissemination of CTX-M type β-lactamases is a threat to human health. Previously, we have reported the spread of blaCTX-M-15 gene in different clinical strains of Enterobacteriaceae from the hospital settings of Aligarh in north India. In view of the varying resistance pattern against cephalosporins and other β-lactam antibiotics, we intended to understand the correlation between MICs and catalytic activity of CTX-M-15. In this study, steady-state kinetic parameters and MICs were determined on E. coli DH5α transformed with blaCTX-M-15 gene that was cloned from Enterobacter cloacae (EC-15) strain of clinical background. The effect of conventional β-lactamase inhibitors (clavulanic acid, sulbactam and tazobactam) on CTX-M-15 was also studied. We have found that tazobactam is the best among these inhibitors against CTX-M-15. The inhibition characteristic of tazobactam is defined by its very low IC50 value (6 nM), high affinity (Ki = 0.017 µM) and better acylation efficiency (k+2/K9 = 0.44 µM-1s-1). It forms an acyl-enzyme covalent complex, which is quite stable (k+3 = 0.0057 s-1). Since increasing resistance has been reported against conventional b-lactam antibiotic-inhibitor combinations, we aspire to design a non-b-lactam core containing b-lactamase inhibitor. For this, we screened ZINC database and performed molecular docking to identify a potential non-β-lactam based inhibitor (ZINC03787097). The MICs of cephalosporin antibiotics in combination with this inhibitor gave promising results. Steady-state kinetics and molecular docking studies showed that ZINC03787097 is a reversible inhibitor which binds non-covalently to the active site of the enzyme through hydrogen bonds and hydrophobic interactions. Though, it’s IC50 (180 nM) is much higher than tazobactam, it has good affinity for CTX-M-15 (Ki = 0.388 µM). This study concludes that ZINC03787097 compound can be used as seed molecule to design more efficient non-b-lactam containing b-lactamase inhibitor that could evade pre-existing bacterial resistance mechanisms.

Keywords: ESBL, non-b-lactam-b-lactamase inhibitor, bioinformatics, biomedicine

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Authors: Merrylord Harb-Azar

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Traditionally, PTSD treatment has involved trauma-focused cognitive behaviour therapy (TF CBT) to consolidate traumatic memories. A piloted integrated treatment of TF CBT and eye movement desensitisation reprocessing therapy (EMDR) of eight phases will fasten the rate memory is being consolidated and enhance cognitive functioning in patients with PTSD. Patients spend a considerable amount of time in treatment managing their traumas experienced firsthand, or from aversive details ranging from war, assaults, accidents, abuse, hostage related, riots, or natural disasters. The time spent in treatment or as inpatient affects overall quality of life, relationships, cognitive functioning, and overall sense of identity. EMDR is being offered twice a week in conjunction with the standard prolonged exposure as an inpatient in a private hospital. Prolonged exposure for up to 5 hours per day elicits the affect response required for EMDR sessions in the afternoon to unlock unprocessed memories and facilitate consolidation in the amygdala and hippocampus. Results are indicating faster consolidation of memories, reduction in symptoms in a shorter period of time, reduction in admission time, which is enhancing the quality of life and relationships, and improved cognition. The impact of events scale (IES) results demonstrate a significant reduction in symptoms, trauma symptoms inventory (TSI), and posttraumatic stressor disorder check list (PCL) that demonstrates large effect sizes to date. An integrated treatment approach for PTSD achieves a faster resolution of memories, improves cognition, and reduces the amount of time spent in therapy.

Keywords: EMDR enhances cognitive functioning, faster consolidation of trauma memory, integrated treatment of TF CBT and EMDR, reduction in inpatient admission time

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Authors: Mana Pirhadi, Maryam Pirhadi, Fatemeh Tavakoli

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As there are several styles and attitudes among the practitioners of the present time, it is difficult to achieve a definition of beauty for contemporary architecture and aesthetic concepts has different frameworks in various disciplines. Beauty can be regarded as one of the most important elements of architecture; therefore, having a clear understanding of beauty can help architects and audiences to create or analyze an architectural work. This paper investigates the assumption that we can have a clearer understanding of the concept of aesthetics in architecture by analyzing the ideas of the contemporary analyst of architectural aesthetics, Jörg Greuther. Thus, the question is how the concept of aesthetics in architecture will be analyzed in their thoughts. In general, the paper aims to examine aesthetic concepts in the contemporary era that are expressed relying on Greuther's views. The paper adopts a descriptive-analytic approach in terms of methodology. Finally, through the study of the viewpoints of various scholars and specifically considering Greuther's definition that focuses on the effect of psychological-social factors on human perception and formation of the schema, it could be said that aesthetics means to have a good knowledge of truth and understand it.

Keywords: aesthetics, beauty perception, contemporary architecture, Jörg Greuther

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Authors: Edward Guillén, Jeisson Sánchez, Carlos Omar Ramos

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In recent years, a wide variety of applications are developed with Support Vector Machines -SVM- methods and Artificial Neural Networks -ANN-. In general, these methods depend on intrusion knowledge databases such as KDD99, ISCX, and CAIDA among others. New classes of detectors are generated by machine learning techniques, trained and tested over network databases. Thereafter, detectors are employed to detect anomalies in network communication scenarios according to user’s connections behavior. The first detector based on training dataset is deployed in different real-world networks with mobile and non-mobile devices to analyze the performance and accuracy over static detection. The vulnerabilities are based on previous work in telemedicine apps that were developed on the research group. This paper presents the differences on detections results between some network scenarios by applying traditional detectors deployed with artificial neural networks and support vector machines.

Keywords: anomaly detection, back-propagation neural networks, network intrusion detection systems, support vector machines

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Authors: Leila Jafari, Viliam Makis, G. B. Akram Khaleghei

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In this paper, we present a maintenance model of a two-unit series system with economic dependence. Unit#1, which is considered to be more expensive and more important, is subject to condition monitoring (CM) at equidistant, discrete time epochs and unit#2, which is not subject to CM, has a general lifetime distribution. The multivariate observation vectors obtained through condition monitoring carry partial information about the hidden state of unit#1, which can be in a healthy or a warning state while operating. Only the failure state is assumed to be observable for both units. The objective is to find an optimal opportunistic maintenance policy minimizing the long-run expected average cost per unit time. The problem is formulated and solved in the partially observable semi-Markov decision process framework. An effective computational algorithm for finding the optimal policy and the minimum average cost is developed and illustrated by a numerical example.

Keywords: condition-based maintenance, semi-Markov decision process, multivariate Bayesian control chart, partially observable system, two-unit system

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Authors: Fabio Rodriguez Sanchez, Josef Bruers, Iciar Arteagoitia, Carlos Rodriguez Andres

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Background: Oral implants are a routine treatment to replace lost teeth. Although they have a high rate of success, implant failures do occur. Perioperative antibiotics have been suggested to prevent postoperative infections and dental implant failures, but they remain a controversial treatment among healthy patients. The objective of this study was to determine whether antibiotic prophylaxis is a common treatment in the Netherlands among general dentists, maxillofacial-surgeons, periodontists and implantologists in conjunction with oral implant surgery among healthy patients and to assess the nature of antibiotics prescriptions in order to evaluate whether any consensus has been reached and the current recommendations are being followed. Methodology: Observational cross-sectional study based on a web-survey reported according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. A validated questionnaire, developed by Deeb et al. (2015), was translated and slightly adjusted to circumstances in the Netherlands. It was used with the explicit permission of the authors. This questionnaire contained both close-ended and some open-ended questions in relation to the following topics: demographics, qualification, antibiotic type, prescription-duration and dosage. An email was sent February 2018 to a sample of 600 general dentists and all 302 oral implantologists, periodontists and maxillofacial surgeons who were recognized by the Dutch Association of Oral Implantology (NVOI) as oral health care providers placing oral implants. The email included a brief introduction about the study objectives and a link to the web questionnaire, which could be filled in anonymously. Overall, 902 questionnaires were sent. However, 29 questionnaires were not correctly received due to an incorrect email address. So a total number of 873 professionals were reached. Collected data were analyzed using SPSS (IBM Corp., released 2012, Armonk, NY). Results: The questionnaire was sent back by a total number of 218 participants (response rate=24.2%), 45 female (20.8%) and 171 male (79.2%). Two respondents were excluded from the study group because they were not currently working as oral health providers. Overall 151 (69.9%) placed oral implants on regular basis. Approximately 79 (52.7%) of these participants prescribed antibiotics only in determined situations, 66 (44.0%) prescribed antibiotics always and 5 dentists (3.3%) did not prescribe antibiotics at all when placing oral implants. Overall, 83 participants who prescribed antibiotics, did so both pre- and postoperatively (58.5%), 12 exclusively postoperative (8.5%), and 47 followed an exclusive preoperative regime (33.1%). A single dose of 2,000 mg amoxicillin orally 1-hour prior treatment was the most prescribed preoperative regimen. The most frequent prescribed postoperative regimen was 500 mg amoxicillin three times daily for 7 days after surgery. On average, oral health professionals prescribed 6,923 mg antibiotics in conjunction with oral implant surgery, varying from 500 to 14,600 mg. Conclusions: Antibiotic prophylaxis in conjunction with oral implant surgery is prescribed in the Netherlands on a rather large scale. Dutch professionals might prescribe antibiotics more cautiously than in other countries and there seems to be a lower range on the different antibiotic types and regimens being prescribed. Anyway, recommendations based on last-published evidence are frequently not being followed.

Keywords: clinical decision making, infection control, antibiotic prophylaxis, dental implants

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Authors: Ramesh Chand Chauhan, Sanjay Kumar Rai, Shashi kant, Rakesh Lodha, Nand Kumar

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Background: With a better understanding of HIV pathogenesis and availability of antiretroviral therapy more children are growing and entering in teenage group; informing children of their own HIV status has become an important aspect of long-term disease management. There is little evidence of how and when this type of disclosure takes place in a resource-limited setting. Methods: A cross-sectional study was conducted from June 2010 to May 2011 among a dyads of 156 HIV-infected children and their caregivers, those were visiting pediatric clinic at a tertiary care hospital in Delhi, India. The study protocol was approved by the Institute Ethics Committee. After taking written informed consent; pretested structured questionnaire was administered to caregivers during routine clinic visits. Information regarding socio-demographic characteristics, awareness of HIV infection status among children and their perception regarding disclosure was collected. Mean and frequencies were calculated and chi-square and logistic regression test were applied. Results: The mean age of children was 8.4 ±3.45 years. Among them 73.7% were male and 39.1% were orphans. Among 156 enrolled children, 74.4% (n=116) were of ≥ 6 years and were assessed for disclosure. Only 18.1% (n=21) children had been informed of their HIV status. Of those under 9 years, 6.4% knew their status, whereas 18.4% of 9-11 years and 35.5% of 12-14 years children knew they had HIV. Awareness among males (23.3%) was higher than females (3.3%). Both age and sex of child were significantly (p<0.01) associated with disclosure status. Other factors favoring disclosure were orphan-hood, non-perinatal mode of transmission (OR = 4.32; 95% CI 1.01-7.12), ART initiation (OR = 4.21; 95% CI 1.03-6.98), and caregiver educated beyond primary level (OR = 1.89; 95% CI 1.03-3.26). Repeated enquiry regarding the visit to clinic was the most common reason (66.6%) for disclosure. In 52.4% children disclosure was done with the involvement of other family members. 82.5% caregivers felt the age of > 10 years is appropriate for disclosing the HIV infection status to the child. Conclusion: Detailed guidelines on disclosure are required focusing on children of school-going age with perinatal infection who are not on ART and with caregivers of low educational status.

Keywords: HIV, children, India, disclosure

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Authors: Nazira B. Bekenova, Lydia A. Mukovozova, Andrej M. Grjibovski, Alma Z. Tokayeva, Yerbol M. Smail, Nurlan E. Aukenov

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Erysipelas is an infectious disease with socio-economic significance and prone to prolonged recurrent course (30%). Contribution of genetic factors, in particular the gene polymorphism of cytokines, can be essential in disease etiology and pathogenesis. Interleukin – 17 A are produced by T helpers of 17 type and plays a key role in development of local inflammation process. Local inflammatory process is a dominant in the clinic of erysipelas. Established that the skin and mucosas are primary areas of migration (homing) Th17-cell and their cytokines are stimulate the barrier function of the epithelium. We studied associations between gene polymorphism of IL-17A (C737T) rs 8193036 and IL-17A level in patients with erysipelas Kazakh population. Altogether, 90 cases with erysipelas and 90 healthy controls from an ethnic Kazakh population comprised the sample. Cases were identified at Clinical Infectious Diseases Hospital of Semey (Kazakhstan). The IL-17A (rs8193036) polymorphism was analyzed by a real time polymerase chain reaction. Plasma levels of IL-17 A were assessed by immuneenzyme analysis method using ‘Vector-Best’ test-system (Russia). Differences in levels of IL-17 A between CC, TT, CT groups were studied using Kruskal — Wallis test. Pairwise comparisons were performed using Mann-Whitney tests with Bonferroni correction (New significance level was set to 0.025). We found, that in patients with erysipelas with CC genotype the level of IL-17 A was higher (p= 0, 010) compared to the carriers of CT genotype. When compared the level of IL – 17 A between the patients with TT genotype and patients with CC genotype, also between the patients with CT genotype and patients with TT genotype statistically significant differences are not revealed (p = 0.374 and p = 0.043, respectively). Comparisons of IL-17 A plasma levels between the CC and CT genotypes, between the CC and TT genotypes, and between the TT and CT in healthy patients did not reveal significant differences (p = 0, 291). Therefore, we are determined the associations of gene polymorphism of IL-17 A (C737T) with its level in patients erysipelas carriers CC genotype.

Keywords: erysipelas, interleukin – 17 A, Kazakh, polymorphism

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Authors: Mikiyas Yonas Fufa

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- Maternal and child health service was a critical service which may have many risks and many maternal and newborn mortality is there if not managed properly. In middle and low countries like Ethiopia accessibility and quality of MCH service is low. During this COVID-19 Pandemics even the pervious access of MCH will be decreased. So many pregnant mothers are not attending their ANC, Delivery and other services in the hospital because they think they are more vulnerable to COVID-19. This condition may make an increase of maternal and neonatal morbidity and mortality. The innovation is an idea (which is development of a mobile app prepared by Maternity Foundation organization that focuses on midwifery care. The app has detailed videos on danger signs in pregnancy and procedures during labor and delivery). By telling this to clients it is planned to explore the perception, attitude towards this innovation and barriers to accepting it. What is planned to study is to explore the perceptions and barriers towards using of new idea which is innovation of mHealth on the MCH services. It is planned to interview the pregnant mothers who come for ANC at health facility and mothers who are absent from their appointment of services. In this way it is planned to explore how the mothers accept this idea and what barriers make them from accepting this idea. This is a phenomenological qualitative study and application of diffusion of innovation theory on the MCH services. The participant will be selected by using quota sampling methods for the mother who are interviewed at hospitals and snowball/quota sampling methods for the mother who are absent from their appointment/visits. Sample size of the participant depends on the saturation of data/idea. Each participant will be interviewed based the open-ended questionnaires, and the interview will be recorded then transcribed then finally analyzed by the open code 4.03. Beneficiaries: The federal ministry of health prepares them to develop the apk of mhealth. Health professionals in the MCH will have a low overload and accessibility and the quality of care will be increased during COVID-19 Different collaborations will be participated and promote the mother to enjoy the new idea.

Keywords: COVID-19, m health, MCH, diffusion of innovation

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Authors: Hsin-Yu Lin, Ching-Hsia Hung

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Obstructive sleep apnea (OSA) is characterized by a complete or partial obstruction of the upper airway during sleep. The vulnerable sites of upper airway collapses are consequences of sleep state-dependent reductions in tone in specific pharyngeal dilators. Clinical examinations reveal multilevel collapses of the upper airway among the patients with OSA. Therefore, an anatomically-based oropharyngeal rehabilitation should comprise a multilevel approach, including retropalatal, retroglossal, hypopharyngeal, temporomandibular, and facial levels, all of which involve different muscle groups and contribute to multifunctional interaction and coordination, such as swallowing, breathing, and phonation. The purpose of the study was to exam the effects of this rehabilitation program with a multilevel approach. In this study, fifteen subjects with newly diagnosed moderate or severe OSA (Apnea-Hypopnea-Index≥15) were randomized into an intervention group and control group. The intervention group (N=8) underwent a 12-week-intervention of a hospital-based rehabilitation program, while the control group (N=7) was kept on the waiting list. The 12-week-intervention comprised an anatomically based multilevel approach. The primary outcome was Polysomnography (PSG) data, and the secondary outcome was oropharyngeal and respiratory muscle function. In the intervention group, Apnea-Hypopnea-Index significantly improved (46.96±19.45 versus 32.78±10.78 events/h, p=0.017) compared with control group (35.77±17.49 versus 42.96±17.32 events/h, p=0.043). While the control group remained no change, the intervention group demonstrated other PSG outcomes significantly improvement, including arousal index (46.04±18.9 versus 32.98±8.35/h, p=0.035), mean SpO2 (92.88±2.1 versus 94.13±1.46%, p=0.039). Besides, the intervention group demonstrated significant improvement in oropharyngeal and respiratory muscle function compared to the control group. This anatomically-based oropharyngeal rehabilitation with a multilevel approach can be proven as a non-invasive therapy for patients with OSA.

Keywords: obstructive sleep apnea, upper airway, oropharyngeal rehabilitation, multilevel approach

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Authors: Abdorreza Rabiee, Shahla Mohammad Hoseini Mirzaei

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The advantages of distributed generations (DGs) based on renewable energy sources (RESs) leads to high penetration level of DGs in distribution network. With incorporation of DGs in distribution systems, the system reliability and security, as well as voltage profile, is improved. However, the protection of such systems is still challenging. In this paper, at first, the related papers are reviewed and then a practical scheme is proposed for coordination of OCRs in distribution system with DGs. The coordination problem is formulated as a nonlinear programming (NLP) optimization problem with the object function of minimizing total operating time of OCRs. The proposed method is studied based on a simple test system. The optimization problem is solved by General Algebraic Modeling System (GAMS) to calculate the optimal time dial setting (TDS) and also pickup current setting of OCRs. The results show the effectiveness of the proposed method and its applicability.

Keywords: distributed generation, DG, distribution network, over current relay, OCR, protection coordination, pickup current, time dial setting, TDS

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Authors: Gunalan Vasudevan

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The Malaysia construction industry generates a large quantity of construction and demolition waste nowadays. In the handbook for demolition work only comprised small portion of demolition waste management. It is important to study and determine the ways to provide a practical guide for the professional in the building industry about handling the demolition waste. In general, demolition defined as tearing down or wrecking of structural work or architectural work of the building and other infrastructures work such as road, bridge and etc. It’s a common misconception that demolition is nothing more than taking down a structure and carrying the debris to a landfill. On many projects, 80-90% of the structure is kept for reuse or recycling which help the owner to save cost. Demolition contractors required a lot of knowledge and experience to minimize the impact of demolition work to the existing surrounding area. For data collecting method, postal questionnaires and interviews have been selected to collect data. Questionnaires have distributed to 80 respondents from the construction industry in Klang Valley. 67 of 80 respondents have replied the questionnaire while 4 people have interviewed. Microsoft Excel and Statistical Package for Social Science version 17.0 were used to analyze the data collected.

Keywords: demolition, waste management, construction material, Malaysia

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Authors: Soumaya Mrabet, Imen Akkari, Amira Atig, Elhem Ben Jazia

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Introduction: Celiac disease (CD) is a chronic autoimmune inflammatory enteropathy caused by gluten. The clinical presentation is very variable. Malabsorption in the MC is responsible for an alteration of the bone metabolism. Our purpose is to study the osteoarticular manifestations related to this condition. Material and methods: It is a retrospective study of 41 cases of CD diagnosed on clinical, immunological, endoscopic and histological arguments, in the Internal Medicine and Gastroenterology Department of Farhat Hached Hospital between September 2005 and January 2016. Results: Osteoarticular manifestations were found in 9 patients (22%) among 41 patients presenting CD. These were 7 women and 2 men with an average age of 35.7 years (25 to 67 years). These manifestations were revelatory of CD in 3 cases. Abdominal pain and diarrhea were present in 6 cases. Inflammatory polyarthralgia of wrists and knees has been reported in 7 patients. Mechanical mono arthralgia was noted in 2 patients. Biological tests revealed microcytic anemia by iron deficiency in 7 cases, hypocalcemia in 5 cases, Hypophosphatemia in 3 cases and elevated alkaline phosphatases in 3 cases. Upper gastrointestinal endoscopy with duodenal biopsy found villous atrophy in all cases. In immunology, Anti-transglutaminase antibodies were positive in all patients, Anti-endomysium in 7 cases. Measurement of bone mineral density (BMD) by biphotonic X-ray absorptiometer with evaluation of the T-score and the Z-score was performed in Twenty patients (48.8%). It was normal in 7 cases (33%) and showed osteopenia in 5 patients (25%) and osteoporosis in 2 patients (10%). All patients were treated with a Gluten-free diet associated with vitamin D and calcium substitution in 5 cases. The evolution was favorable in all cases with reduction of bone pain and normalization of the phosphocalcic balance. Conclusion: The bone impact of CD is frequent but often asymptomatic. Patients with CD should be evaluated by the measurement of bone mineral density and monitored for calcium and vitamin D deficiencies.

Keywords: bone mineral density, celiac disease, osteoarticular manifestations, vitamin D and calcium

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Authors: S. J. Taylor, S. Chowdhury, T. A. Pychyl

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Attention Deficit Hyperactivity Disorder (ADHD) and procrastination are often discussed in relation to problems with self-regulation and executive functioning (EF). The small body of extant research that has explored the relations between these variables has many limitations particularly in terms of the samples used and the measurement of procrastination. In this study, we recruited a sample of undergraduate students with a confirmed clinical diagnosis of ADHD (n = 48, 66.7% females) as well as a sample of student volunteers without ADHD (n = 68, 75.8% females) to investigate the relations between ADHD subtypes, EF, procrastination and other forms of delay. We used the newly developed Multidimensional Measure of Academic Procrastination and Delay Questionnaire. As hypothesized, the results revealed that individuals with ADHD displayed significantly more irrational delay, general procrastination and academic procrastination compared to individuals without ADHD. This study contributed to the research literature indicating that individuals with ADHD struggle with procrastination as a result of symptoms of ADHD and EF deficits. Theses results provide support for adopting a new language when describing procrastination problems among individuals with ADHD, and they have implications for the nature of academic accommodations and interventions for individuals with ADHD.

Keywords: ADHD, delay, executive functioning, procrastination, self-regulation

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Authors: Syeda Faiza Gardazi, Syed Ahsan Ali Gardazi, Ajmal Waheed

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The trend of overtime is increasing among workers due to more pressure to perform workloads, job insecurity, and financial issues. Overtime work affects the work-life balance conflict negatively as well positively. Work-life balance conflict has become an important issue as traditional work and family roles have changed. The purpose of the current research was to study the impact of overtime work on work-life balance conflict along with the moderating role of job satisfaction. For this purpose, data is collected from the employees working in different public and private sectors of Pakistan using simple random sampling technique. Descriptive statistics was used for data presentation and analysis. Correlation and regression analysis were used to test four research hypotheses proposed on the basis of research framework. The findings led to the acceptance of four hypotheses. The results show that high working hours and overtime in general lead to high work-life balance conflict. Moreover, job satisfaction moderates the relationship between overtime work and work-life balance conflict.

Keywords: family to work conflict, overtime work, work to family conflict, work-life balance conflict

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Authors: Saira Baloch, Mohsin Ali Baloch

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Background: Malaria is a potentially life-threatening disease and also a major public health problem in Pakistan. Renal failure is an emerging problem correlated with morbidity and mortality, however can be diagnosed and treated in the early stages. Objectives: To elucidate the biochemical renal parameters in patients with falciparum malaria and comparison with healthy control subjects. Method: 80 patients, who were diagnosed to be affected by falciparum malaria. Detailed history, general physical and systemic examination and necessary pathological, biochemical renal laboratory parameters and investigations were done. Results: Among the 80 patients, 43 were males and 37 were females. All patients were infected with P. falciparum. All patients had increased serum creatinine and urea levels and urine output of less than 400 ml/day were categorized as suffering from renal failure. Conclusion: Patients infected with P. falciparum are at an increased risk of developing renal failure when compared to patients infected with other complications. P. vivax has massive potential to cause life threatening complications and even death. Further research is required to understand the exact pathogenesis of various complications encountered in vivax malaria.

Keywords: falciparum malaria, renal failure, biochemical parameters, pathogenesis

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Authors: Wafa Al Jabri

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Sickle cell disease (SCD) is a genetic blood disorder that is characterized by a severe painful crisis. SCD among children requires long term dependencies and high caregiving demands that increase the overall family burdens. It is, therefore, essential to examine, support, and promote the well-being of families of children with SCD. Although there has been considerable progress in the international research on family quality of life (FQOL) in recent years; however, research in this field is relatively recent and diverse. Oman is a country in which family quality of life has definitely been under-researched. Therefore, the purpose of the study is to describe the FQOL in families of children with SCD in Oman. The study will also examine the relationships between child, mother, and family-related factors that may influence the overall FQOL. Theoretical Framework: The study is guided by the unified theory of family quality of life to help in understanding the concept of FQOL and the factors that shape it. Method:A convenience sample of 98 mothers of children with SCD will be recruited from the pediatric hematology clinic at Sultan Qaboos University Hospital in Oman to participate in this descriptive, cross sectional, correlational study. Data will be obtained using a self-administered questionnaire that includes child and mother socio-demographic data, questions about the number of visits and admissions to health care facilities for vaso- occlusive crises (VOCs), the Perceived Stress Scale-10, and the Beachcenter-FQOL scale. Anticipated Results: It is expected to find an association among frequency of VOCs, mother’s perceived stress level, and FQOL in families of children with SCD in Oman. Family type, socio-economic status, and number of SCD children in the family are also expected to influence the overall FQOL. Conclusion: The findings of the study might be pivotal in designing and implementing tailored family-based interventions to improve families’ wellbeing.

Keywords: family quality of life, sickle cell disaes, children, family well-being

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Authors: Zak Maas, Daniel Carson, Rachel McIntyre, Mark Omundsen, Teresa Holm

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Aim: After hemicolectomy a period of obligatory bowel dysfunction is expected, termed postoperative ileus (POI). Prolonged postoperative ileus (PPOI), typically four or more days, is associated with higher morbidity and extended inpatient stay. This leads to significant financial and resource-related burdens on healthcare systems. Several studies including a meta-analysis have compared rates of PPOI in left vs right hemicolectomy, which suggest that right-sided resections may be more likely to result in PPOI. Our study aims to further investigate whether significant differences in PPOI and obligatory POI exist between right versus extended right hemicolectomy. Methods: This is a retrospective review assessing rates of PPOI in patients who underwent right vs extended right hemicolectomy at Tauranga Hospital. Patients were divided and compared depending on approach (open versus laparoscopic) and acuity (acute versus elective). Exclusion criteria included synchronous major operations and patients preoperatively on parenteral nutrition. Primary outcome was PPOI as pre-defined in contemporary literature. Secondary outcomes were time to passage of flatus, passage of stool, toleration of oral diet and rate of complications. Results: There were 669 patients identified for analysis (507 laparoscopic vs 162 open; 194 acute vs 475 elective). Early analysis indicates rates of PPOI was significantly increased in patients undergoing extended right hemicolectomy. Factors including age, gender, ethnicity, preoperative haemaglobin, preoperative albumin and diagnosis of inflammatory bowel disease were examined by multivariate analysis to determine correlation with PPOI. Conclusion: PPOI is a common complication of hemicolectomy surgery. Higher rates of PPOI in extended right vs right hemicolectomy warrants further research into determining the cause. This study examines some other factors which may contribute to PPOI.

Keywords: hemicolectomy, colorectal, complications, postoperative ileus

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Authors: Ahmad Rasyadan Arshad, A. Rahman A. Jamal, N. Mohamed Ibrahim, Nor Azian Abdul Murad

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Introduction: Parkinson’s disease (PD) is a complex and asymptomatic disease where patients are usually diagnosed at late stage where about 70% of the dopaminergic neurons are lost. Therefore, identification of molecular biomarkers is crucial for early diagnosis of PD. MicroRNA (miRNA) is a short nucleotide non-coding small RNA which regulates the gene expression in post-translational process. The involvement of these miRNAs in neurodegenerative diseases includes maintenance of neuronal development, necrosis, mitochondrial dysfunction and oxidative stress. Thus, miRNA could be a potential biomarkers for diagnosis of PD. Objective: This study aim to identify the miRNA involved in Late Onset PD (LOPD) and Early Onset PD (EOPD) compared to the controls. Methods: This is a case-control study involved PD patients in the Chancellor Tunku Muhriz Hospital at the UKM Medical Centre. miRNA samples were extracted using miRNeasy serum/plasma kit from Qiagen. The quality of miRNA extracted was determined using Agilent RNA 6000 Nano kit in the Bioanalyzer. miRNA expression was performed using GeneChip miRNA 4.0 chip from Affymetrix. Microarray was performed in EOPD (n= 7), LOPD (n=9) and healthy control (n=11). Expression Console and Transcriptomic Analyses Console were used to analyze the microarray data. Result: miR-129-5p was significantly downregulated in EOPD compared to LOPD with -4.2 fold change (p = <0.050. miR-301a-3p was upregulated in EOPD compared to healthy control (fold = 10.3, p = <0.05). In LOPD versus healthy control, miR-486-3p (fold = 15.28, p = <0.05), miR-29c-3p (fold = 12.21, p = <0.05) and miR-301a-3p (fold = 10.01, p =< 0.05) were upregulated. Conclusion: Several miRNA have been identified to be differentially expressed in EOPD compared to LOPD and PD versus control. These miRNAs could serve as the potential biomarkers for early diagnosis of PD. However, these miRNAs need to be validated in a larger sample size.

Keywords: early onset PD, late onset PD, microRNA (miRNA), microarray

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Authors: Tamene Keneni, Tibebu Yohannes

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The prevalence of autism spectrum disorder (ASD) in general and autism in particular is on the rise globally, and the need for evidence-based intervention and care for children with autism has grown, too. However, evidence on autism is scanty in developing countries, including Ethiopia. With the aim to help fill the gap and paucity in research into the issue, the main purpose of this study is to explore, better understand, and document the experiences and perceptions of parents of children with autism. To this end, we used a qualitative survey to collect data from a convenient sample of parents raising a child with autism. The data collected were subjected to qualitative analysis that yielded several themes and subthemes, including late diagnosis, parents’ reactions to diagnosis, sources of information during and after diagnosis, differing reactions to having a child with autism from siblings, extended family members, and the larger community, attribution of autism to several causes by the community, lack of recognition and open discussion of autism and lack of appropriated public educational and health care services for children with autism and their parents. The themes and subthemes identified were discussed in light of existing literature, and implications for practice were drawn.

Keywords: ASD, autism, children with autism, raising children with autism

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Authors: Mujahid Ali, Wasif Mohammed Ali, Meraj Ahmad

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Background: Perforation peritonitis is the most common surgical emergency encountered by surgeons all over the world as well as in India. The etiology of perforation peritonitis in India continues to be different from its western counterparts. The aim of this study is to evaluate the spectrum of cases of perforation peritonitis at our hospital. Methods: A prospective study conducted includes three hundred thirtysix patients of perforation peritonitis at J. N. Medical College from October 2015 to July 2017. The patients were admitted, resuscitated and underwent emergency laparotomy. Data were collected in terms of demographic profile, clinical presentations, site of perforations, causes and surgical outcomes. Results: In this study, the most common cause of perforation peritonitis was peptic ulcer disease (43%), followed by enteric perforation (12.8%), tubercular perforation (12.5%), traumatic perforation (11.9%), appendicular perforation (9.8%), amoebic caecal perforation (3%), malignant perforation (1.5%), etc. The sites of perforations were stomach in majority (38.3%), ileum (31%), appendix (8%), duodenum (5.%), caecum (4.4%) ,colon (3%), jejunum (8.5%) and gall bladder (2%). The overall mortality was 21% in our study. Age >50 years (p= <0.0001, OR= 3.9260, CI= 2.2 to 6.9), organ failure (p= <0.0001, OR= 29.2, CI= 14.8 to 57.6), shock (p=<0.0001, OR=20.20, CI= 10.56 to 38.6), diffuse peritonitis (p<0.0015, OR= 6.8810, CI= 2.09 to 22.57) and faecal exudates (p<0.0001) were found to be significant factors affecting mortality. The most common complication associated was superficial wound infection (40%), followed by burst abdomen seen in 21% cases, intra-abdominal sepsis in 18% cases, electrolyte imbalances in 15% cases, anastomotic leak in 6% cases. Conclusion: In this study, stomach is the most common site of perforation with peptic ulcer disease being the most common etiology. Older age, presence of shock, organ failure and faecal peritonitis were the risk factors affecting the mortality of the patients. Early recognition, adequate resuscitation and referral of patients can influence outcome and reduces mortality as well as morbidity.

Keywords: etiology, mortality, perforation, spectrum

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Authors: Muhammad Sulman, Tabinda Khurshid, Afsheen Masood

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The current research focused on determining the factors that determine the brand loyalty in consumers. It was hypothesized that there are certain demographical features that lead the consumers to adhere more towards certain brands. Cross-sectional research design was used. The sample for the current research comprised of participants (N=500) from age group 16 to 55 years. The data was collected through self-constructed demographic questionnaire as well as from a self-constructed Brand Loyalty Questionnaire. Brand Loyalty Questionnaire was adapted after taking permission from researchers. A pilot study was conducted to chalk out all the ambiguities of the questionnaire. The final version was administered on 250 participants. The descriptive and inferential analyses were carried on through SPSS version 24.00 to explore the factors that determine Brand Loyalty. The findings revealed that there is a relationship between brand loyalty and brand loyalty demographics and certain factors emerged as significant predictors of brand loyalty in young and middle aged consumers. The research findings carry strong implications for organizational and consumer psychologists in particular and for professionals in marketing and policy making in general.

Keywords: consumers, consumer psychologists, marketing, organizational, policy making

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