Search results for: lost to follow up

Authors: Ghorbeli Eya, Naija Lamia, Khessairi Nayssem, Saadallah Fatma, Slimane Maher, Tarek Ben Dhiab

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INTRODUCTION: Borderline ovarian tumors account for 15 to 20% of ovarian tumors. Prognostic factors of recurrence include the stage of the disease, presence of peritoneal implants, micropapillary pattern, microinvasion and intra-epithelial carcinoma. Fertility sparing constitutes a major therapeutic issue in young patients that leads to conservative surgical treatment in specific cases. METHODS: We conducted a retrospective descriptive study including patients treated at the Salah Azaiez Institute for Borderline Ovarian Tumor who underwent conservative surgical treatment from 2003 to 2018. RESULTS: Nine patients were included in our study. The median age was 33 years. Three patients were nulliparous. Given the age, conservative treatment was indicated in all these patients. Cystectomy without ovariectomy was indicated in 5 of the 9 women, which was within the margin of tumor resection on definitive anatomopathic examination in 3 of the 5 women. In contrast, given the impossibility of ovarian conservation, total annexectomy was carried out in 4 of all these women. All of the patients were followed regularly postoperatively; three had a carcinomatous transformation as an ovarian adenocarcinoma at an average interval of 18 months. Among these three patients, a single one presented intra-peritoneal metastases, requiring radical surgical treatment and adjuvant chemotherapy with 6 cures of Carbo-Taxol, with a good tolerance and a complete response. Moreover, one patient had a recurrence on the contralateral ovary as a Borderline mucinous ovarian tumor. For the remaining four women, after a median follow-up of 35 months, one patient fell spontaneously pregnant during follow-up, and three patients were in complete remission at 16 months. CONCLUSION: Borderline tumors of the ovary usually occur in young patients, which makes conservative treatment advisable if possible, but this always comes with a risk of recurrence and/or carcinomatous transformation, especially if the conservative surgical procedure was a cystectomy instead of a total annexectomy, and even more so if the resection margins were tumoral.

Keywords: ovarian tumor, conservative treatment, surgical management, borderline ovarian tumor, recurrence management

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Authors: Kholood Baron

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Chest radiography (CXR) is one of the most important diagnostic examinations in pediatric radiography for diagnosing various diseases. Since, chest X-ray use ionizing radiation to obtain image radiographers should follow strict radiation protection strategies and ALARA principle to ensure that pediatrics receive the lowest dose possible [1] [2]. The aim is to evaluate different criteria related to pediatric CXR examinations performed in the radiology department in five hospitals in Kuwait. Methods: Data collected from a questionnaire and Entrance Skin Dose (ESD) measurements during CXR. 100 responses were collected and analyzed to highlight issues related to immobilization devices, radiation protection issues and repeat rate. While ThermoLumenince Dosimeters (TLDs) measured ESD during 25 CXR for pediatric patients. In addition, other aspects on the radiographer skills and information written in patient requests were collected and recorded. Results: Questionnaires responses showed that most radiographers do follow most radiation protection guidelines, but need to focus on improving their skills in collimation to ROI, dealing with immobilization tools and exposure factors. Since the first issue was least applied to young pediatrics, and the latter two were the common reasons for repeating an image. The ESD measurements revealed that the averaged dose involved in pediatric CXR is 143.9 µGy, which is relatively high but still within the limits of the recommended values [2-3] . The data suggests that this relatively high ESD values can be the result of using higher mAs and thus it I recommended to lower it according to ALARA principle. In conclusion, radiographers have the knowledge and the tools to reduce the radiation dose to pediatric patients but few lack the skills to optimize the collimation, immobilization application and exposure factors. The ESD were within recommended values. This research recommends that more efforts in the future should focus on improving the radiographer commitment to radiation protection and their skills in dealing with pediatric patient. This involves lowering the mAs used during DR.

Keywords: pediatric radiography, dosimetry, ESD measurements, radiation protection

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Authors: Anne N. Heirman, Song Duimel, Rob van Son, Lisette van der Molen, Richard Dirven, Gyorgi B. Halmos, Julia van Weert, Michiel W.M. van den Brekel

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Objectives: Treatments for head-neck cancer are drastic and often significantly impact the quality of life and appearance of patients. Shared decision-making (SDM) beholds a collaboration between patient and doctor in which the most suitable treatment can be chosen by integrating patient preferences, values, and medical information. SDM has a lot of advantages that would be useful in making difficult treatment choices. The objective of this study was to determine the current level of SDM among patients and head-and-neck surgeons. Methods: Consultations of patients with a non-cutaneous head-and-neck malignancy facing a treatment decision were selected and included. If given informed consent, the consultation was recorded with an audio recorder, and the patient and surgeon filled in a questionnaire immediately after the consultation. The SDM level of the consultation was scored objectively by independent observers who judged audio recordings of the consultation using the OPTION5-scale, ranging from 0% (no SDM) to 100% (optimum SDM), as well as subjectively by patients (using the SDM-Q-9 and Control preference scale) and clinicians (SDM-Q-Doc, modified control preference scale) percentages. Preliminary results: Five head-neck surgeons have each at least seven recorded conversations with different patients. One of them was trained in SDM. The other four had no experience with SDM. Most patients were male (74%), and oropharyngeal carcinoma was the most common diagnosis (41%), followed by oral cancer (33%). Five patients received palliative treatment of which two patients were not treated recording guidelines. At this moment, all recordings are scored by the two independent observers. Analysis of the results will follow soon. Conclusion: The current study will determine to what extent there is a discrepancy between the objective and subjective level of shared decision-making (SDM) during a doctor-patient consultation in Head-and-Neck surgery. The results of the analysis will follow shortly.

Keywords: head-and-neck oncology, patient involvement, physician-patient relations, shared decision making

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Authors: Praveen S. Muthukumarana, Achala C. Aponso

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A large percentage of global crop harvest is lost due to crop diseases. Timely identification and treatment of crop diseases is difficult in many developing nations due to insufficient trained professionals in the field of agriculture. Many crop diseases can be accurately diagnosed by visual symptoms. In the past decade, deep learning has been successfully utilized in domains such as healthcare but adoption in agriculture for plant disease detection is rare. The literature shows that models trained with popular datasets such as PlantVillage does not generalize well on real world images. This paper attempts to find out how to make plant disease identification models that generalize well with real world images.

Keywords: agriculture, convolutional neural network, deep learning, plant disease classification, plant disease detection, plant disease diagnosis

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Authors: Arun Das

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Indian agriculture is acclaimed from the dates of Indus civilization (2500 BC). Since this time until the day, there were tremendous expansion in terms of space and technology has taken place. Abrupt growth in technology took place past one and half century. Consequent to this development, the land which was brought under agriculture in the initial stages of introducing agriculture for the first time, that land is not possessing the same physical condition. Either it has lost the productive capacity or modified into semi agriculture land. On the grounds of its capacity and interwoven characteristics seven phases of agriculture scenario has been identified. Most of the land is on the march of desertification. Identifying the stages and the phase of the agriculture scenario is most relevant from the point of view of food security at regional, national and at global level. Secondly decisive measure can put back the degenerating environmental condition into arrest. GIS and Remote sensing applications have been used to identify the phases of agriculture.

Keywords: agriculture phases, desertification, deforestation, foods security, transmigration

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Authors: Arben Murtezani, Shefqet Mrasori, Vančo Spirov, Bukurije Rama, Oliver Dimitrovski, Visar Bunjaku

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Overview: Temporomandibular disorders (TMDs) are chronic musculoskeletal pain conditions. Clinical indicators of discomfort are related to the use of the joint stiffness during first motions after extended rest and restricted joint range of motion can cause substantial pain and disability. There is little evidence that physical therapy methods of management cause long-lasting reduction in signs and symptoms. Exercise programs premeditated to improve physical fitness have beneficial effects on chronic pain and disability of the musculoskeletal system. Objective: The aim of this study was to assess the effectiveness of physical therapy interventions in the management of temporomandibular disorders. Materials and Methods: A prospective comparative study with a 2-month follow-up period was conducted between April 2016 and June 2016 at the Physical Medicine and Rehabilitation Clinic in Prishtina. Forty six patients with TMDs, (more than three months duration of symptoms) were randomized into two groups: the TENS therapy group (n=24) and combination of active exercise and manual therapy group (n=22). The TENS therapy group patients were treated with twelve sessions of TENS. The treatment period of both groups was 3 weeks at an outpatient clinic. Following main outcome measures were evaluated: (1) pain at rest (2) pain at stress (3) impairment (4) mouth opening at base-line, before and after treatment and at 3 month follow-up. Results: Significant reduction in pain was observed in both treatment groups. In the TENS group 73% (16/22) achieved at least 80% improvement from baseline in TMJ pain at 2 months compared with 54% (13/24) in the exercise group (difference of 19%; 95% confidence interval 220 to 30%). Active and passive maximum mouth opening has been greater in the TENS group (p < 0.05). Conclusion: Exercise therapy in combination with TENS seems to be useful in the treatment of temporomandibular disorders.

Keywords: temporomandibular joint disorders, TENS, manual therapy, exercise

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Authors: Mindaugas Kazlauskas

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In this paper, it is presupposed that the description of the relationship between animal and human should begin with a description of the direct experience of the animal and how, in this experience, the human experiences itself (a self awareness mode). A human is concerned first and foremost with himself as a human through the experience of another as an animal. The questionsare: In the encounter with an animal, how is the animal constituted in the acts of human experience? How does human-animal interaction influence human behavioral patterns, and how does the human identifies itself in this interaction? The paper will present the results of interpretative phenomenological descriptions (IPA) of the relationship between human and animal in the face of death phenomenon through the experience of pet owners who lost their beloved companions and hunters, veterinatians, and farmers who face animal death. The results of IPA analysis reveal different relations such as the identification with an animal, the alienation experience, the experience of resistance, and an experience of detachment. Within these themes, IPA qualitative research results will be presented by highlighting patterns of human behavior, following Friedrich Schlachermacher's hermeneutics methodological principles, and reflecting on changes in value and attitude within society during daily interaction with the animal.

Keywords: animal human interaction, phenomenology, philosophy, death phenomenon

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Authors: Stoyanka Vladeva, Elena Kirilova, Nikola Kirilov

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Background: The creatinine clearance is a widely used value to estimate the GFR. Increased creatinine clearance is often called hyperfiltration and is usually seen during pregnancy, patients with diabetes mellitus preceding the diabetic nephropathy. It may also occur with large dietary protein intake or with plasma volume expansion. Renal injury in lupus nephritis is known to affect the glomerular, tubulointerstitial, and vascular compartment. However high creatinine clearance has not been found in patients with SLE, Target: Follow-up of creatinine clearance values in patients with systemic lupus erythematosus without history of kidney injury. Material and methods: We observed the creatinine, creatinine clearance, GFR and dipstick protein values of 7 women (with a mean age of 42.71 years) with systemic lupus erythematosus. Patients with active lupus have been monthly tested in the period of 13 months. Creatinine clearance has been estimated by Cockcroft-Gault Equation formula in ml/sec. GFR has been estimated by MDRD formula (The Modification of Diet in renal Disease) in ml/min/1.73 m2. Proteinuria has been defined as present when dipstick protein > 1+.Results: In all patients without history of kidney injury we found elevated creatinine clearance levels, but GFRremained within the reference range. Two of the patients were in remission while the other five patients had clinically and immunologically active Lupus. Three of the patients had a permanent presence of high creatinine clearance levels and proteinuria. Two of the patients had periodically elevated creatinine clearance without proteinuria. These results show that kidney disturbances may be caused by the vascular changes typical for SLE. Glomerular hyperfiltration can be result of focal segmental glomerulosclerosis caused by a reduction in renal mass. Probably lupus nephropathy is preceded not only by glomerular vascular changes, but also by tubular vascular changes. Using only the GFR is not a sufficient method to detect these primary functional disturbances. Conclusion: For early detection of kidney injury in patients with SLE we determined that the follow up of creatinine clearance values could be helpful.

Keywords: systemic Lupus erythematosus, kidney injury, elevated creatinine clearance level, normal glomerular filtration rate

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Authors: P. Weerkamp Bartholomeus

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Autism treatment evaluation is crucial for monitoring the development of an intervention at an early stage. ‘ReAttach’ is a new intervention based on the principles of attachment and social cognitive training. Practical research suggests promising results on a variety of developmental areas. Five years after the first ReAttach sessions these findings can be extended with qualitative research by means of follow-up interviews. The potential impact of this treatment on daily life functioning and well-being of autistic persons becomes clear.

Keywords: autism, innovation, treatment, social cognitive training

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Authors: Ece Kaya

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Urban waterfront re-development is a well-established phenomenon internationally since 1960s. In cities throughout the world, old industrial waterfront land is being redeveloped into luxury housing, offices, tourist attractions, cultural amenities and shopping centres. These developments are intended to attract high-income residents, tourists and investors to the city. As urban waterfronts are iconic places for the cities and catalyst for further development. They are often referred as flagship project. In Sydney, the re-development of industrial waterfront has been exposed since 1980s with Darling Harbour Project. Darling Harbour waterfront used to be the main arrival and landing place for commercial and industrial shipping until 1970s. Its urban development has continued since the establishment of the city. It was developed as a major industrial and goods-handling precinct in 1812. This use was continued by the mid-1970s. After becoming a redundant industrial waterfront, the area was ripe for re-development in 1984. Darling Harbour is now one of the world’s fascinating waterfront leisure and entertainment destinations and its transformation has been considered as a success story. It is a contradictory statement for this paper. Data collection was carried out using an extensive archival document analysis. The data was obtained from Australian Institute of Architects, City of Sydney Council Archive, Parramatta Heritage Office, Historic Houses Trust, National Trust, and University of Sydney libraries, State Archive, State Library and Sydney Harbour Foreshore Authority Archives. Public documents, primarily newspaper articles and design plans, were analysed to identify possible differences in motives and to determine the process of implementation of the waterfront redevelopments. It was also important to obtain historical photographs and descriptions to understand how the waterfront had been altered. Sites maps in different time periods have been identified to understand what kind of changes happened on the urban landscape and how the developments affected areas. Newspaper articles and editorials have been examined in order to discover what aspects of the projects reflected the history and heritage. The thematic analysis of the archival data helped determine Darling Harbour is a historically important place as it had represented a focal point for Sydney's industrial growth and the cradle of industrial development in European Australia. It has been found that the development area was designated in order to be transformed to a place for tourist, education, recreational, entertainment, cultural and commercial activities and as a result little evidence remained of its industrial past. This paper aims to discuss the industrial significance of Darling Harbour and to explain the changes on its industrial landscape. What is absent now is the layer of its history that creates the layers of meaning to the place so its historic industrial identity is effectively lost.

Keywords: historical significance, industrial heritage, industrial waterfront, re-development

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Authors: Armita Ghobadi, Samantha Emerson, Seyda Ozcaliskan

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Being a bilingual involves mastery of both speech and gesture patterns in a second language (L2). We know from earlier work in first language (L1) production contexts that speech and co-speech gesture form a tightly integrated system: co-speech gesture mirrors the patterns observed in speech, suggesting an online effect of language on nonverbal representation of events in gesture during the act of speaking (i.e., “thinking for speaking”). Relatively less is known about the online effect of language on gesture in bilinguals speaking structurally different languages. The few existing studies—mostly with small sample sizes—suggests inconclusive findings: some show greater achievement of L2 patterns in gesture with more advanced L2 speech production, while others show preferences for L1 gesture patterns even in advanced bilinguals. In this study, we focus on advanced bilingual speakers of two structurally different languages (Spanish L1 with English L2) in comparison to L1 English speakers. We ask whether bilingual speakers will follow target L2 patterns not only in speech but also in gesture, or alternatively, follow L2 patterns in speech but resort to L1 patterns in gesture. We examined this question by studying speech and gestures produced by 23 advanced adult Spanish (L1)-English (L2) bilinguals (Mage=22; SD=7) and 23 monolingual English speakers (Mage=20; SD=2). Participants were shown 16 animated motion event scenes that included distinct manner and path components (e.g., "run over the bridge"). We recorded and transcribed all participant responses for speech and segmented it into sentence units that included at least one motion verb and its associated arguments. We also coded all gestures that accompanied each sentence unit. We focused on motion event descriptions as it shows strong crosslinguistic differences in the packaging of motion elements in speech and co-speech gesture in first language production contexts. English speakers synthesize manner and path into a single clause or gesture (he runs over the bridge; running fingers forward), while Spanish speakers express each component separately (manner-only: el corre=he is running; circle arms next to body conveying running; path-only: el cruza el puente=he crosses the bridge; trace finger forward conveying trajectory). We tallied all responses by group and packaging type, separately for speech and co-speech gesture. Our preliminary results (n=4/group) showed that productions in English L1 and Spanish L1 differed, with greater preference for conflated packaging in L1 English and separated packaging in L1 Spanish—a pattern that was also largely evident in co-speech gesture. Bilinguals’ production in L2 English, however, followed the patterns of the target language in speech—with greater preference for conflated packaging—but not in gesture. Bilinguals used separated and conflated strategies in gesture in roughly similar rates in their L2 English, showing an effect of both L1 and L2 on co-speech gesture. Our results suggest that online production of L2 language has more limited effects on L2 gestures and that mastery of native-like patterns in L2 gesture might take longer than native-like L2 speech patterns.

Keywords: bilingualism, cross-linguistic variation, gesture, second language acquisition, thinking for speaking hypothesis

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Authors: Akshaya K. Rath, Manjit Mahanta

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The paper aims at examining the oral tradition of the Kondh and Oroan people of Odisha. Highlighting the translated versions of Kondh and Oroan songs—chiefly highlighting issues on agriculture—we argue that the relevance of these songs have fallen apart in the recent decades with the advancement of modern knowledge and thinking. What remains instead is a faint voice in the oral tradition that sings the past indigenous knowledge in the form of oral literature. Though there have been few attempts to document the rich cultural tradition by some individuals—Sitakant Mahapatra’s can be cited as an example—the need to document the tradition remains ever arching. In short, the thesis examines Kondh and Oroan “songs” and argues for a need to document the tradition. It also shows a comparative study on both the tribes on Agriculture which shows their cultural identity and a diversification of both the tribes in nature and how these tribal groups are associated with nature and the cycle of it.

Keywords: oral tradition, Meriah, folklore, karma, Oroan

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Authors: Evgeniya Ivanova

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Nowadays, in the literature, there is still no fixed definition of knowledge management that often remains only as an academic discipline. The current market situation is changing very quickly, the need of new technologies is high, and knowledge management is the area that ensures that the know-how has not been lost during market development and adoption. The study examines how knowledge management is being leveraged and practiced in the management consultancy companies and provides not only the tips and best practices of applied knowledge management approaches but also the validation matrix for its successful or unsuccessful implementation. Different knowledge management approaches are explored on the basis of their practical implementation, including related challenges, knowledge sharing process, and barriers that are typical for consulting firms mostly driven by the agile working culture. The relevance of proposed topic is confirmed by the finding that corporate working culture and the exponentially developing technologies have a direct impact on the success of practical implementation of knowledge management.

Keywords: knowledge management, knowledge management in practice, consulting firm, knowledge management success

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Authors: Amel Ourici

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An electrical machine failure that is not identified in an initial stage may become catastrophic and it may suffer severe damage. Thus, undetected machine faults may cascade in it failure, which in turn may cause production shutdowns. Such shutdowns are costly in terms of lost production time, maintenance costs, and wasted raw materials. Doubly fed induction generators are used mainly for wind energy conversion in MW power plants. This paper presents a detection of an inter turn stator fault in a doubly fed induction machine whose stator and rotor are supplied by two pulse width modulation (PWM) inverters. The method used in this article to detect this fault, is based on Park’s Vector Approach, using a neural network.

Keywords: doubly fed induction machine, PWM inverter, inter turn stator fault, Park’s vector approach, neural network

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Authors: Nizamuddin Khan

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Integrated livestock and cropping system is very old agricultural practice since antiquity. It is an eco-friendly and sustainable farming system in which both the resources are optimally and rationally utilized through the recycling and re-utilization of their by-products. Indian farmers follow in- farm integrated farming system unlike in developed countries where both farm and off-farm system prevailed. The data on different components of the integrated farming system is very limited and that too is not widely available in published form. The primary source is the only option for understanding the mechanism, process, evaluation and performance of integrated livestock cropping system. Researcher generated data through the field survey of sampled respondents from sampled villages from Bulandshahr district of Uttar Pradesh. The present paper aims to understand the component group of system, degree, and level of integration, level of generation of employment, income, improvement in farm ecology, the economic viability of farmers and check in rural-urban migration. The study revealed that area witnessed intra farm integration in which both livestock and cultivation of crops take place on the same farm. Buffalo, goat, and poultry are common components of integration. Wheat, paddy, sugarcane and horticulture are among the crops. The farmers are getting 25% benefit more than those who do not follow the integrated system. Livestock husbandry provides employment and income through the year, especially during agriculture offseason. 80% of farmers viewed that approximately 35% of the total expenditure incurred is met from the livestock sector. Landless, marginal and small farmers are highly benefited from agricultural integration. About 70% of farmers acknowledged that using wastes of animals and crops the soil ecology is significantly maintained. Further, the integrated farming system is helpful in reducing rural to urban migration. An incentive with credit facilities, assured marketing, technological aid and government support is urgently needed for sustainable development of agriculture and farmers.

Keywords: integrated, recycle, employment, soil ecology, sustainability

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Authors: Peifang Hsieh

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New Taipei city faces increasing number of migrant families, in which the needs of children are sometimes neglected due to insufficient support from communities. Moreover, the traditional mindset of disengagement discourages citizens from preemptively identifying families in need in their communities, resulting in delay of prompt intervention from authorities concerned. To safeguard these vulnerable families, New Taipei city develops the 'Integrated Safety-Net Program for High-Risk Families' from 2011 by implementing the following measures: (A) New attitude and action: Instead of passively receiving reported case of high-risk families, the program takes proactive and preemptive approach to detect and respond at early stage, so the cases are prevented from worsening. In addition, cross-departmental integration mechanism is established to meet multiple needs of high-risk families. The children number added to the government care network is greatly increased to over 10,000, which is around 4.4 times the original number before the program. (B) New service points: 2000 city-wide convenience stores are added as service stations so that children in less privileged families can go to any of 24-hour convenience stores across the city to pick up free meals. This greatly increases the approachability to high-risk families. Moreover, the social welfare institutes will be notified with information left in convenience stores by children and follow up with further assistance, greatly enhancing chances of less privileged families being identified. (C) New Key Figures: Mobilize community officers and volunteers to detect and offer on-site assistance. Volunteer organizations within communities are connected to report and offer follow-up services in a more active manner. In total, from 2011 to 2015, 54,789 cases are identified through active care, benefiting 82,124 children. In addition, 87.49% family-cases in the program receiving comprehensive social assistance are no longer at high risk.

Keywords: cross department, high-risk families, public-private partnership, integrated safety net

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Authors: Chiung-Yao Huang, Yu-Cheng Lin, Chiung-Hui Chen

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This study seeks to examine perceived environmental corporate social responsibility (ECSR) with a focus on negative environmental questions, related to intention of ethical investment intention after a environmental failure recovery. An empirical test was employed to test the hypotheses. We manipulated the information on negative ECSR activities of a hypothetical firm in a experimental design with a failure recovery treatment. The company’s negative ECSR recovery was depicted in a positive perspective (depicting a follow-up strong social action), whereas in the negative ECSR treatment it was described in a negative perspective (depicting a follow-up non social action). In both treatments, information about other key characteristics of the focal company were kept constant. Investors’ intentions to invest in the company’s stock were evaluated by multi-item scales. Results indicate that positive ECSR recovery information about a firm enhances investors’ intentions to invest in the company’s stock. In addition, perceived moral intensity has a significant impact on the intention of ethical investment and that perceived moral intensity also serves as a key moderating variable in the relationship between negative ECSR and the intention of ethical investment. Finally, theoretical and managerial implications of the findings are discussed. Practical implications: The results suggest that managers may need to be aware of perceived moral intensity as a key variable in restoring the intention of ethical investment. The results further suggest that perceived moral intensity has a direct, and it also has an moderating influence between ECSR and the intention of ethical investment. Originality/value: In an attempt to deepen the understanding of how investors perceptions of firm environmental CSR are connected with other investor‐related outcomes through ECSR recovery, the present research proposes a comprehensive model which encompasses ECSR and other key relationship constructs after a ECSR failure and recovery.

Keywords: ethical investment, Environmental Corporate Social Responsibility(ECSR), ECSR recovery, moral intensity

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Authors: Caroline Dupre, David Hupin, Christ Goumou, Francois Belan, Frederic Roche, Thomas Celarier, Bienvenu Bongue

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Background: Previous cohorts have been notably criticized for not studying the different type of physical activity and not investigating household activities. The objective of this work was to analyse the relationship between physical activity and cognitive decline in older people living in the community. Impact of type of physical activity on the results has been realised. Methods: The study used data from the longitudinal and observational study , FrèLE (FRagility: Longitudinal Study of Expressions). The collected data included: socio-demographic variables, lifestyle, and health status (frailty, comorbidities, cognitive status, depression). Cognitive decline was assessed by using: Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Physical activity was assessed by the Physical Activity Scale for the Elderly (PASE). This tool is structured in three sections: the leisure activity, domestic activity, and professional activity. Logistic regressions and proportional hazards regression models (Cox) were used to estimate the risk of cognitive disorders. Results: At baseline, the prevalence of cognitive disorders was 6.9% according to MMSE. In total, 1167 participants without cognitive disorders were included in the analysis. The mean age was 77.4 years, and 52.1% of the participants were women. After a 2 years long follow-up, we found cognitive disorders on 53 participants (4.5%). Physical activity at baseline is lower in older adults for whom cognitive decline was observed after two years of follow-up. Subclass analyses showed that leisure and domestic activities were associated with cognitive decline, but not professional activities. Conclusions: Analysis showed a relationship between cognitive disorders and type of physical activity. The current study will be completed by the MoCA for mild cognitive impairment. These findings compared to other ongoing studies, will contribute to the debate on the beneficial effects of physical activity on cognition.

Keywords: aging, cognitive function, physical activity, mixed models

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Authors: Devendra Gupta, S. P. Ambesh, P. K Singh

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Introduction: Minimally invasive coronary artery bypass grafting (MICABG) is a less invasive method of performing surgical revascularization. Minimally invasive direct coronary artery bypass (MIDCAB) provides many anesthetic challenges including one lung ventilation (OLV), managing myocardial ischemia, and pain. We present an early and midterm result of the use of this technique with OLV. Method: We enrolled 62 patients for analysis operated between 2008 and 2012. Patients were anesthetized and left endobronchial tube was placed. During the procedure left lung was isolated and one lung ventilation was maintained through right lung. Operation was performed utilizing off pump technique of coronary artery bypass grafting through a minimal invasive incision. Left internal mammary artery graft was done for single vessel disease and radial artery was utilized for other grafts if required. Postoperative ventilation was done with single lumen endotracheal tube. Median follow-up is 2.5 years (6 months to 4 years). Results: Median age was 58.5 years (41-77) and all were male. Single vessel disease was present in 36, double vessel in 24 and triple vessel disease in 2 patients. All the patients had normal left ventricular size and function. In 2 cases difficulty were encounter in placement of endobronchial tube. In 1 case cuff of endobronchial tube was ruptured during intubation. High airway pressure was developed on OLV in 1 case and surgery was accomplished with two lung anesthesia with low tidal volume. Mean postoperative ventilation time was 14.4 hour (11-22). There was no perioperative and 30 day mortality. Conversion to median sternotomy to complete the operation was done in 3.23% (2 out of 62 patients). One patient had acute myocardial infarction postoperatively and there were no deaths during follow-up. Conclusion: MICABG is a safe and effective method of revascularization with OLV in low risk candidates for coronary artery bypass grafting.

Keywords: MIDCABG, one lung ventilation, coronary artery bypass grafting, endobronchial tube

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Authors: Syeda Sahra, Abdullah Jahangir, Rachelle Hamadi, Ahmad Jahangir, Allison Glaser

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Background: Antimicrobial resistance is on the rise. The use of redundant and inappropriate antibiotics is contributing to recurrent infections and resistance. Newer antibiotics with more robust coverage for gram-negative bacteria are in great demand for complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), hospital-acquired bacterial pneumonia (H.A.B.P.), and ventilator-associated bacterial pneumonia (V.A.B.P.). Objective: We performed this meta-analysis to evaluate the efficacy and safety profile of a new antibiotic, Imipenem/cilastatin/relebactam, compared to other broad-spectrum antibiotics for complicated infections. Search Strategy: We conducted a systemic review search on PubMed, Embase, and Central Cochrane Registry. Selection Criteria: We included randomized clinical trials (R.C.T.s) with the standard of care as comparator arm with Imipenem/cilastatin/relebactam as intervention arm. Analysis: For continuous variables, the mean difference was used. For discrete variables, we used the odds ratio. For effect sizes, we used a confidence interval of 95%. A p-value of less than 0.05 was used for statistical significance. Analysis was done using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I2 statistic. Results: The authors observed similar efficacy at clinical and microbiologic response levels on early follow-up and late follow-up compared to the established standard of care. The incidence of drug-related adverse events, serious adverse events, and drug discontinuation due to adverse events were comparable across both groups. Conclusion: Imipenem/cilastatin/relebactam has a non-inferior safety and efficacy profile compared to peer antibiotics to treat severe bacterial infections (cUTIs, cIAIs, H.A.B.P., V.A.B.P.).

Keywords: bacterial pneumonia, complicated intra-abdominal infections, complicated urinary tract infection, Imipenem, cilastatin, relebactam

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Authors: Karen Armstrong

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Recent concerns about the value of teaching cursive handwriting in the classroom are based on the belief that cursive handwriting or penmanship is an outdated and unnecessary skill in today’s online world. The discussion of this issue begins with a description of current initiatives to eliminate handwriting instruction in schools. This is followed by a brief history of cursive writing through the ages. Next considered is a description of its benefits as a preliminary process for younger children as compared with immediate instruction in keyboarding, particularly in the areas of vision, cognition, motor skills and automatic fluency. Also considered, is cursive’s companion, paper itself, and the impact of a paperless, “screen and keyboard” environment. The discussion concludes with a consideration of the unique contributions of cursive and keyboarding as written forms of communication, along with their respective surfaces, paper and screen. Finally, an assessment of the practical utility of each skill is followed by an informal assessment of what is lost and what remains as we move from a predominantly paper and pen world of handwriting to texting and keyboarding in an environment of screens.

Keywords: asemic writing, cursive, handwriting, keyboarding, paper

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Authors: Marcho Setiawan Handok, Samuel S. Lemma, Abdoulaye Fofana, Naseef Mansoor

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This paper is proposing a method to predict the outcome of the National Football League match with data from 2019 to 2022 and compare it with other popular models. The model uses open-source statistical data of each team, such as passing yards, rushing yards, fumbles lost, and scoring. Each statistical data has offensive and defensive. For instance, a data set of anticipated values for a specific matchup is created by comparing the offensive passing yards obtained by one team to the defensive passing yards given by the opposition. We evaluated the model’s performance by contrasting its result with those of established prediction algorithms. This research is using a neural network to predict the score of a National Football League match and then predict the winner of the game.

Keywords: game prediction, NFL, football, artificial neural network

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Authors: Mohamed Basheer Abdul Atti Hassan

Abstract:

This research paper will follow the main outlines of the Italian colonization in Libya in a historical geopolitical approach; before we reach the contemporary map. In this study, we are also concerned with following the chain's links, not as drama in time, but as a strategy in place, so that it draws to us a map of power and the distribution of political formations throughout this period within and around Libya. From the sum of these variable distributions and successive balances, we can come up with the basic principles that determined the Italian history in Libya and formed its political entity, which is a compass of guidance and an indication of the future.

Keywords: conflict, Mediterranean, colonization, political history

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Authors: Shree Laxmi Prashant, Subhash C. Yaragal, K. S. Babu Narayan

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Concrete is found to undergo degradation when subjected to elevated temperatures and loose substantial amount of its strength. The loss of strength in concrete is mainly attributed to decomposition of C-S-H and release of physically and chemically bound water, which begins when the exposure temperature exceeds 100°C. When such a concrete comes in contact with moisture, the cement paste is found rehydrate and considerable amount of strength lost is found to recover. This paper presents results of an experimental program carried out to investigate the effect of recuring on strength gain of OPC concrete specimens subjected to elevated temperatures from 200°C to 800°C, which were subjected to retention time of two hours and four hours at the designated temperature. Strength recoveries for concrete subjected to 7 designated elevated temperatures are compared. It is found that the efficacy of recuring as a measure of strength recovery reduces with increase in exposure temperature.

Keywords: elevated temperature, recuring, strength recovery, compressive strength

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Authors: Luciano Tarantino, Emanuele Balzano, Aurelio Nasto

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S.R. 53 years. January 2009: HCV-related cirrhosis, Child-Pugh A5 class, EGDS no aesophageal Varices. No important comorbidities. Treated with PEG-IFN+Ribavirin (march-november 2009) with subsequent sustained virologic response. HCVRNA absent overtime. October 2016 :CT detected small HCC nodule in the VIII segment (diam.=12 mm). Treated with US guided RF-ablation. November 2016 CT: complete necrosis. Unfortunately, the patient dropped out US and CT follow-up controls.September 2018: asthenia and weight loss. CT showed a large tumor infiltrating V-VII-VI segments and complete PVTT of right portal vein and its branches . Surgical Consultation excluded indication to Liver resection and OLT . 23 october 2018: ECT of a large peri-hilar area of the tumor including the PVTT. 1 and 3 months post-treatment CT showed complete necrosis and retraction of the thrombus and residual viable tumor in the peripheral portion of the right lobe . Therefor, the patient was reevaluated for OLT and considered eligible in waiting list . March 2019: CT showed no perihilar or portal vein recurrence and distant progression in the right lobe . March 2019 : Trans-arterial-Radio-therapy (TARE) of the right lobe. Post-treatment CT demonstrated no perihilar or portal vein recurrence and extensive necrosis of the residual tumor . December 2019: CT demonstrated several recurrences of HCC infiltrating the VI and VII segment . Howewer no recurrence was observed at hepatic hilum and in portal vessels . Therefore, on February 2020 the patient received OLT. At 44 months follow-up, no complication or recurrence or liver disfunction have been observed.

Keywords: hepatocellular carcinoma, portal vein tumor thrombosis, interventional ultrasound, liver tumor ablation, liver transplantation

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Authors: Mei Sze Wong, Huanyu Mou, Wai-Tong Chien

Abstract:

Background: Breastmilk is the most nutritious food for infants to support their growth and protect them from infection. Therefore, breastfeeding promotion is an important topic for infant health; whereas, different educational and supportive approaches to interventions have been prompted and targeted at antenatal, postnatal, or both periods to promote and sustain exclusive breastfeeding. This systematic review aimed to identify the effective approaches of educational and supportive interventions to improve breastfeeding. Outcome measures were exclusive breastfeeding, partial breastfeeding, and breastfeeding self-efficacy, being analyzed in terms of ≤ 2 months, 3-5 months, and ≥ 6 months postpartum. Method: Eleven electronic databases and the reference lists of eligible articles were searched. English or Chinese articles of randomized controlled trials on educational and supportive intervention with the above breastfeeding outcomes over recent 20 years were searched. Quality appraisal and risk of bias of the studies were checked by Effective Public Health Practice Project tool and Revised Cochrane risk-of-bias tool, respectively. Results: 13 articles that met the inclusion criteria were included; and they had acceptable quality and risk of bias. The optimal structure, format, and delivery of the interventions significantly increased exclusive breastfeeding rate at ≤ 2 months and ≥ 6 months and breastfeeding self-efficacy at ≤ 2 months included: (a) delivering from antenatal to postnatal period, (b) multicomponent involving antenatal group education, postnatal individual breastfeeding coaching and telephone follow-ups, (c) both individual and group basis, (d) being guided by self-efficacy theory, and (e) having ≥ 3 sessions. Conclusion: The findings showed multicomponent theory-based interventions with ≥ 3 sessions that delivered across antenatal and postnatal period; using both face-to-face teaching and telephone follow-ups can be useful to enhance exclusive breastfeeding rate for more than 6 months and breastfeeding self-efficacy over the first two months of postpartum.

Keywords: breastfeeding self-efficacy, education, exclusive breastfeeding, primiparous, support

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Authors: Atilla Tekin

Abstract:

Amorium was one of the biggest cities of Byzantine Empire, located under and around the modern village of Hisarköy, Emirdağ, Afyonkarahisar Province, Turkey. It was situated on the routes of trades and Byzantine military road from Constantinople to Cilicia. In addition, it was on the routes of trades and a center of bishopric. After Arab invasion, Amorium gradually lost importance. The research consists of 1372 pieces of glass bracelet finds from mostly at 1998- 2009 excavations. Most of them were found as glass bracelets fragments. The fragments are of various size, forms, colors, and decorations. During the research, they were measured and grouped according to their crossings, at first. After being photographed, they were sketched by Adobe Illustrator and decoupaged by Photoshop. All forms, colors, and decorations were specified and compared to each other. Thus, they have been tried to be dated and uncovered the place of manufacture. The importance of the research is presenting the perception of image and admiration and comparing with other cultures.

Keywords: Amorium, glass bracelets, image, Byzantine empire, jewelry

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Authors: Claudia H. Swanson, Jens Günster

Abstract:

This research addresses the densification via compaction and sintering of naturally occurring rock salt which was motivated by the fact that in a saline environment rock salt is thermodynamically stable and does show a mechanical behavior compatible to the surrounding host material. The sintering of rock salt powder compacts was systematically investigated using temperature and pressure as variables for the sinter process. The behavior of rock salt showed segregations of anhydrite, CaSO4 - the major impurity found in rock salt, to the grain boundaries between individual sodium chloride crystals. Powder compacts treated with lower pressures lost those anhydrite segregates over time while high pressure treated compacts remained with anhydrite segregates. The density reached in this study is 2.008 g cm-3 corresponding to a density of 92.5 % of the theoretical value. This high density is making the sintering a promising technique for rock salt as applications in underground appropriate environment.

Keywords: rock salt, sinter, anhydrite, nuclear safety

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Authors: Winnie Kung, Xinhua Liu, Debbie Huang, Patricia Kim, Keon Kim, Xiaoran Wang, Lawrence Yang

Abstract:

Considerable Asian Americans were exposed to the World Trade Center attack due to the proximity of the site to Chinatown and a sizeable number of South Asians working in the collapsed and damaged buildings nearby. Few studies focused on Asians in examining the disaster’s mental health impact, and even less longitudinal studies were reported beyond the first couple of years after the event. Based on the World Trade Center Health Registry, this study examined the trajectory of PTSD of individuals directly exposed to the attack from 2-3 to 5-6 years after the attack, comparing Asians against the non-Hispanic White group. Participants included 2,431 Asians and 31,455 Whites. Trajectories were delineated into the resilient, chronic, delayed-onset and remitted groups using PTSD checklist cut-off score at 44 at the 2 waves. Logistic regression analyses were conducted to compare the poorer trajectories against the resilient as a reference group, using predictors of baseline sociodemographic, exposure to the disaster, lower respiratory symptoms and previous depression/anxiety disorder diagnosis, and recruitment source as the control variable. Asians had significant lower socioeconomic status in terms of income, education and employment status compared to Whites. Over 3/4 of participants from both races were resilient, though slightly less for Asians than Whites (76.5% vs 79.8%). Asians had a higher proportion with chronic PTSD (8.6% vs 7.4%) and remission (5.9% vs 3.4%) than Whites. A considerable proportion of participants had delayed-onset in both races (9.1% Asians vs 9.4% Whites). The distribution of trajectories differed significantly by race (p<0.0001) with Asians faring poorer. For Asians, in the chronic vs resilient group, significant protective factors included age >65, annual household income >$50,000, and never married vs married/cohabiting; risk factors were direct disaster exposure, job loss due to 9/11, lost someone, and tangible loss; lower respiratory symptoms and previous mental disorder diagnoses. Similar protective and risk factors were noted for the delayed-onset group, except education being protective; and being an immigrant a risk. Between the 2 comparisons, the chronic group was more vulnerable than the delayed-onset as expected. It should also be noted that in both comparisons, Asians’ current employment status had no significant impact on their PTSD trajectory. Comparing between Asians against Whites, the direction of the relationships between the predictors and the PTSD trajectories were mostly the same, although more factors were significant for Whites than for Asians. A few factors showed significant racial difference: Higher risk for lower respiratory symptoms for Whites than Asians, higher risk for pre-9/11 mental disorder diagnosis for Asians than Whites, and immigrant a risk factor for the remitted vs resilient groups for Whites but not for Asians. Over 17% Asians still suffered from PTSD 5-6 years after the WTC attack signified its persistent impact which incurred substantial human, social and economic costs. The more disadvantaged socioeconomic status of Asians rendered them more vulnerable in their mental health trajectories relative to Whites. Together with their well-documented low tendency to seek mental health help, outreach effort to this population is needed to ensure follow-up treatment and prevention.

Keywords: PTSD, Asian Americans, World Trade Center Attack, racial differences

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Authors: Parthasarathi Pramanik

Abstract:

Paediatric blunt abdominal trauma associated with superficial bruise, hematoma, or laceration and internal organ damage secondary to bicycle handlebar is widely documented in the literature. In this article, we have presented a case of bicycle handlebar inflicted fatal neck laceration in a road accident. The deceased sustained a horizontally placed laceration injury over the front and both sides of the middle third of neck (13 cm x 5-8 cm x 2-3.5 cm).The margins of the wound were irregular and focally abraded. The right corner of the injury was pointed whereas the left one was ended with a skin flap. Multiple graze abrasions, contusions and lacerations were found on different parts of body. Autopsy findings and other circumstantial evidences revealed that the victim died due to exsanguination because of severance of carotid artery and jugular vein of both sides. Analysis of the wound suggests the decease sustained the wound by the revolving bicycle handle bar while he had lost the balance.

Keywords: bicycle handle bar, neck injury, lacerated injury, road acident

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