Search results for: post facial syndrome

Authors: Ying Zhu

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Recent years have witnessed a boom of foreign investments in the field of artificial intelligence (AI). Foreign investments provide critical capital for AI development but also trigger national security concerns of host states. A notable example is an increasing number of cases in which the Committee on Foreign Investment in the United States (CFIUS) has denied Chinese acquisitions of US technology companies on national security grounds. On July 19, 2018, the Congress has reached a deal on the final draft of a new provision to strengthen CFIUS’s authority to review overseas transactions involving sensitive US technology. The question is: how to reconcile the emerging tension between, on the one hand, foreign AI investors’ expectations of a predictable investment environment, and on the other hand, host states’ regulatory power on national security? This paper provides a methodology to reconcile this tension under international investment law. Based on an examination, the national security exception clauses in international investment treaties and the application of national security justification in investor-state arbitration jurisprudence, the paper argues that a traditional interpretation of the national security exception, based on the necessity concept in customary international law, fails to take into account new risks faced by countries, including security concerns over strategic industries such as AI. To overcome this shortage, the paper proposes to incorporate an integrated national security clause in international investment treaties, which includes a two-tier test: a ‘self-judging’ test in the pre-establishment period and a ‘proportionality’ test in the post-establishment period. At the end, the paper drafts a model national security clause for future treaty-drafting practice.

Keywords: foreign investment, artificial intelligence, international investment law, national security exception

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Authors: Edoardo Lomi

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A problem of central interest in anthropology concerns the ethnographic displacement of modernity’s conceptual sovereignty over that of native collectives worldwide. Part of this critical project has been the association of Western modernity with a dualist, naturalist ontology. Despite its demonstrated value for comparative work, this association often comes at the cost of reproducing ideas that lack an empirical ethnographic basis. This paper proposes a way forward by bringing to bear some of the results produced by an ethnographic study of a village in Wiltshire, South England. Due to its picturesque qualities, this village has served for decades as a ready-made set for fantasy movies and a backdrop to fictional stories. These forms of mediation have in turn generated some apparent paradoxes, such as fictitious characters that affect actual material changes, films that become more real than history, and animated stories that, while requiring material grounds to unfold, inhabit a time and space in other respects distinct from that of material processes. Drawing on ongoing fieldwork and interviews with locals and tourists, this paper considers the ways villagers engage with fiction as part of their everyday lives. The resulting image is one of convergence, in the same landscape, of people and things having different ontological status. This study invites reflection on the implications of this image for diversifying our imagery of Western lifeworlds. To this end, the notion of ‘real fictions’ is put forth, connecting the ethnographic blurring of modernist distinctions–such as sign and signified, mind and matter, materiality and immateriality–with discussions on anthropology’s own reliance on fictions for critical comparative work.

Keywords: England, ethnography, landscape, modernity, mediation, ontology, post-structural theory

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Authors: Kin Yan Ho

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Negative brand news (such as Volkswagen’s faulty carbon emission reports, China’s Luckin Coffee scandal, and bribery in reputable US universities) influence how people perceive a company. Germany’s citizens claimed Volkswagen’s scandal as a national embarrassment and cannot recover their psychological damages through monetary and non-monetary compensation. The main research question is to examine how consumers evaluate and respond to embarrassing brand publicity. The cognitive appraisal theory is used as a theoretical foundation. This study describes the use of scenario-based experiment. The findings suggest that consumers with different levels of embarrassment evaluate brand remedial offers from emotion-focused and task-focused restorative justice perspectives (newly derived from the well-established scales of perceived justice). When consumers face both negative and positive brand information (i.e., negative publicity news and a remedial offer), they change their appraisal criterion. The social situation in the cognitive reappraisal process influences the quality of the customer-brand relationship and the customer’s recovery from brand embarrassment. The results also depict that the components of recovery compensation cause differences in emotion recovery, relationship quality, and repurchase intentions. This study extends embarrassment literature in an embarrassing brand publicity context. The emotional components of brand remedial tactics provide insights to brand managers on how to handle different consumers’ emotions, consumer satisfaction, and foster positive future behavior.

Keywords: brand relationship quality, cognitive appraisal, crisis communications, emotion, justice, social presence

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Authors: Hebe Wong, Luz Fernandez Calventos

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Tandem language learning, a language exchange process based on the principles of autonomy and reciprocity, provides opportunities for interlocutors to learn each other’s language by communicating online or face-to-face. While much attention has been paid to the process and outcomes of tandem learning via email, little has been discussed about the effectiveness of face-to-face tandem learning on language and culture exchange for university students. The LACTS (Language and Culture Tandem Scheme), an 8-week project, was set up to study students’ perceptions of conducting tandem learning to assist their language and culture exchange. Students of both post-graduate and undergraduate programmes (N=103) from a Hong Kong SAR university were put in groups of 4 to 6 according to their availability and language preferences and met for an hour a week. While sample task sheets on a range of topics were provided to assist the language exchange, all groups were encouraged to take charge of their meeting format and choose their own topics. At the end of the project, a 19-item questionnaire, which included both open-and closed-ended questions investigating students’ perceptions of reciprocal teaching and cultural exchange, was administered. Thirty-minute individual interviews were conducted to elicit students’ views and experiences in the LACTS activities. Quantitative and qualitative data analysis showed that most students agreed that the project had enhanced their cultural awareness and helped create an inclusive and participatory learning environment. Significant differences were found in students’ confidence in speaking their targeted language after joining the scheme. The interviews also provided rich data on the variety of formats and leadership patterns in student-led meetings, which could shed light on student autonomy and future tandem language learning projects.

Keywords: autonomy, reciprocity, tandem language learning, university students

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Authors: Mohammadjavad Sotoudeheian, Navid Farahmandian

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Kawasaki disease (KD) is the primary cause of acquired pediatric heart disease as an acute vasculitis. In children with prolonged fever, rash, and inflammation of the mucosa KD must be considered as a clinical diagnosis. There is a persuasive suggestion of immune-mediated damage as the pathophysiologic cascade of KD. For example, the invasion of cytotoxic T-cells supports a viral etiology and the inflammasome of the innate immune system is a critical component in the vasculitis formation in KD. Animal models of KD propose the cytokine profiles, such as increased IL-1 and GM-CSF, which cause vascular damage. CRP and IFN-γ elevated expression and the upregulation of IL-6, and IL-10 production are also described in previous studies. Untreated KD is a critical risk factor for coronary artery diseases and myocardial infarction. Vascular damage may encompass amplified T-cell activity. SMAD3 is an essential molecule in down-regulating T-cells and increasing expression of FoxP3. It has a critical effect in the differentiation of regulatory T-cells. The discrepancy of regulatory T-cells and pro-inflammatory Th17 has been studied in acute coronary syndrome during KD. However in the coronary artery damaged lymphocytes and IgA plasma cells are seen at the lesion locations, the major immune cells in the coronary lesions are monocytes/macrophages and neutrophils. These cells secrete TNF-α, and activates matrix metalloprotease (MMP)-9, reducing the integrity of vessels and prompting patients to arise aneurysm. MMPs can break down the components of the extracellular matrix and assist immune cell movement. IVIG as an effective form of treatment clarified the role of the immune system, which may target pathogenic antigens and regulate cytokine production. Several reports have revealed that in the coronary arteries, high expression of MMP-9 in monocyte/macrophage results in pathologic cascades. Curcumin is a potent antioxidant and anti-inflammatory molecule. Curcumin decreases the production of reactive oxygen and nitrogen species and inhibits transcription factors like AP-1 and NF-κB. Curcumin also contains the characteristics of inhibitory effects on MMPs, especially MMP-9. The upregulation of MMP-9 is an important cellular response. Curcumin treatment caused a reverse effect and down-regulates MMP-9 gene expression which may fund the anti-inflammatory effect. Curcumin inhibits MMP-9 expression via PKC and AMPK-dependent pathways in Human monocytes cells. Elevated expression and activity of MMP-9 are correlated with advanced vascular lesions. AMPK controls lipid metabolism and oxidation, and protein synthesis. AMPK is also necessary for the MMP-9 activity and THP-1 cell adhesion to endothelial cells. Curcumin was shown to inhibit the activation of AMPKα. Compound C (AMPK inhibitor) inhibits MMP-9 expression level. Therefore, through inactivating AMPKs and PKC, curcumin decreases the MMP-9 level, which results in inhibiting monocyte/macrophage differentiation. Compound C also suppress the phosphorylation of three major classes of MAP kinase signaling, suggesting that curcumin may suppress MMP-9 level by inactivation of MAPK pathways. MAPK cascades are activated to induce the expression of MMP-9. Curcumin inhibits MAPKs phosphorylation, which contributes to the down-regulation of MMP-9. This study demonstrated that the potential inhibitory properties of curcumin over MMP-9 lead to a therapeutic strategy to reduce the risk of coronary artery involvement during KD.

Keywords: MMP-9, coronary artery aneurysm, Kawasaki’s disease, curcumin, AMPK, immune system, NF-κB, MAPK

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Authors: Buchh Aqsa, Inayat Umar

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Background- Clonidine, α 2 agonist, possesses several properties to make it valuable adjuvant for spinal anesthesia. The study was aimed to evaluate the clinical effects of oral clonidine premedication for laparoscopic gynecological procedures under subarachnoid block. Patients and method- Sixtyfour adult female patients of ASA physical status I and II, aged 25 to 45 years and scheduled for laparoscopic gynecological procedures under the subarachnoid block, were randomized into two comparable equal groups of 32 patients each to received either oral clonidine, 100 µg (Group I) or placebo (Group II), 90 minutes before the procedure. Subarachnoid block was established with of 3.5 ml of 0.5% hyperbaric bupivacaine in all patients. Onset and duration of sensory and motor block, maximum cephalad level, and the regression time to reach S1 sensory level were assessed as primary end points. Sedation, hemodynamic variability, and respiratory depression or any other side effects were evaluated as secondary outcomes. Results- The demographic profile was comparable. The intraoperative hemodynamic parameters showed significant differences between groups. Oral clonidine was accelerated the onset time of sensory and motor blockade and extended the duration of sensory block (216.4 ± 23.3 min versus 165 ± 37.2 min, P <0.05). The duration of motor block showed no significant difference. The sedation score was more than 2 in the clonidine group as compared to the control group. Conclusion- Oral clonidine premedication has extended the duration of sensory analgesia with arousable sedation. It also prevented the post spinal shivering of the subarachnoid block.

Keywords: oral clonidine, subarachnoid block, sensory analgesia, laparoscopic gynaecological

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Authors: Victor William Harris

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Objective. This study examined the impact of the Positive Behavioral Management Skills (PBMS) online educational program on participants (n = 624) in a Southeastern region of the United States. The PBMS program incorporates established positive psychology behavioral management principles with new research-based practices designed to promote healthy and satisfying relationships between adults and children while constructively managing and preventing problematic behavior. Additionally, the PBMS program assists parents and teachers in recognizing the motivations behind a wide range of misbehaviors. The program also offers to forewarn some of the most common mistakes (or “parent traps”) in child behavioral management and describes how they can be avoided. It also describes how to recognize and capitalize on “teachable moments,” which are indispensable in the developmental process. Design. A retrospective-pre-test-then-post-test design was used to reduce response shift bias when assessing knowledge and skill intervention outcomes for twenty-two behavioral management variables. Results. The PBMS program was shown to be effective for increasing knowledge and skills related to managing misbehavior while reinforcing interpersonal relationships and fostering a sense of responsibility and capability within the child. Large standardized mean effect size changes from before to after program intervention was documented for PBMS participants on all twenty-two variables studied. Conclusion. The PBMS program showed initial positive outcomes to assist participants in the sample studied to increase their knowledge and skills in managing child behavior successfully. Implications for parents, educators and practitioners are discussed.

Keywords: behavioral management, discipline, parent education, positive parenting, positive psychology-parenting

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Authors: Abraham J. Rizkalla, Tristan D. Yan

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Purpose: Durable mitral valve repair is preferred to a replacement, avoiding the need for anticoagulation or re-intervention, with a reduced risk of endocarditis. Robotic mitral repair has been gaining favour globally as a safe, effective, and reproducible method of minimally invasive valve repair. In this work, we showcase the use of the Davinci© Xi robotic platform to perform several advanced techniques, working synergistically to achieve successful mitral repair in advanced mitral disease. Techniques: We present the case of a Barlow type mitral valve disease with a tall and redundant posterior leaflet resulting in severe mitral regurgitation and systolic anterior motion. Firstly, quadrangular resection of P2 is performed to remove the excess and redundant leaflet. Secondly, a sliding leaflet plasty of P1 and P3 is used to reconstruct the posterior leaflet. To anchor the newly formed posterior leaflet to the papillary muscle, CV-4 Goretex neochordae are fashioned using the innovative string, ruler, and bulldog technique. Finally, mitral valve annuloplasty and closure of a patent foramen ovale complete the repair. Results: There was no significant residual mitral regurgitation and complete resolution of the systolic anterior motion of the mitral valve on post operative transoesophageal echocardiography. Conclusion: This work highlights the robotic approach to complex repair techniques for advanced mitral valve disease. Familiarity with resection and sliding plasty, neochord implantation, and annuloplasty allows the modern cardiac surgeon to achieve a minimally-invasive and durable mitral valve repair when faced with complex mitral valve pathology.

Keywords: robotic mitral valve repair, Barlow's valve, sliding plasty, neochord, annuloplasty, quadrangular resection

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Authors: Thomas J. Bell III

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Pursuing a business degree is fraught with perplexing questions regarding the rising tuition cost and the immediate value of earning a degree. Any decision to pursue an undergraduate business degree is perceived to have value if it facilitates post-graduate job placement. Business programs have decreased value in the absence of innovation in business programs that close the skills gap between recent graduates and employment opportunities. Industry-based certifications are seemingly becoming a requirement differentiator among job applicants. Texas Wesleyan University offers a Computer Information System (CIS) program with an innovative curriculum that integrates industry-recognized certification training into its traditional curriculum with core subjects and electives. This paper explores a culture of innovation in the CIS business program curriculum that creates sustainable stakeholder value for students, employers, the community, and the university. A quantitative research methodology surveying over one-hundred students in the CIS program will be used to examine factors influencing the success or failure of students taking certification exams. Researchers will analyze control variables to identify specific correlations between practice exams, teaching pedagogy, study time, age, work experience, etc. This study compared various exam preparation techniques to corresponding exam results across several industry certification exams. The findings will aid in understanding control variables with correlations that positively and negatively impact exam results. Such discovery may provide useful insight into pedagogical impact indicators that positively contribute to certification exam success and curriculum enhancement.

Keywords: taking certification exams, exam training, testing skills, exam study aids, certification exam curriculum

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Authors: Dipti Parida, Atasi Mohanty

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The focus of this research is to examine the interaction effect of flipped teaching and traditional teaching mode across two different medium (English and Odia) of instructional groups. Both Science and History subjects were taken to be taught in the Class- VIII in two different instructional mode/s. In total, 180 students of Class-VIII of both Odia and English medium schools were taken as the samples of this study; 90 participants (each group) were from both English and Odia medium schools ; 45 participants of each of these two groups were again assigned either to flip or traditional teaching method. We have two independent variables and each independent variable with two levels. Medium and mode of instruction are the two independent variables. Medium of instruction has two levels of Odia medium and English medium groups. The mode of instruction has also two levels of flip and traditional teaching method. Here we get 4 different groups, such as Odia medium students with traditional mode of teaching (O.M.T), Odia medium students with flipped mode of teaching (O.M.F), English medium students with traditional mode of teaching (E.M.T) and English medium students with flipped mode of teaching (E.M.F). Before the instructional administration, these four groups were given a test on the concerned topic to be taught. Based on this result, a one-way ANOVA was computed and the obtained result showed that these four groups don’t differ significantly from each other at the beginning. Then they were taught the concerned topic either in traditional or flip mode of teaching method. After that a 2×2×2 repeated measures ANOVA was done to analyze the group differences as well as the learning outcome before and after the teaching. The result table also shows that in post-test the learning outcome is highest in case of English medium students with flip mode of instruction. From the statistical analysis it is clear that the flipped mode of teaching is as effective for Odia medium students as it is for English medium students.

Keywords: medium of instruction, mode of instruction, test mode, vernacular medium

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Authors: Amel M. A. Osman, Roy Mahony, Lisa Dann, McKenna S.

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Background: Computed Tomography (CT) is a significant source of radiation in the pediatric population. A new head injury (HI) pathway was introduced in 2021, which altered the previous process of HI being jointly admitted with general pediatrics and surgery to admit these patients under the Emergency Medicine Team. Admitted patients included those with positive CT findings not requiring immediate neurosurgical intervention and those who did not meet current criteria for urgent CT brain as per NICE guidelines but were still symptomatic for prolonged observations. This approach aims to decrease the number of CT scans performed. The main aim is to assess the variation in CT scanning rates since the change in the admitting process. A retrospective review of patients presenting to CHI PECU with HI over 6-month period (01/01/19-31/05/19) compared to a 6-month period post introduction of the new pathway (01/06/2022-31/12/2022). Data was collected from the electronic record databases, symphony, and PACS. Results: In 2019, there were 869 presentations of HI, among which 32 (3.68%) had CT scans performed. 2 (6.25%) of those scanned had positive findings. In 2022, there were 1122 HI presentations, with 47 (4.19%) CT scans performed and positive findings in 5 (10.6%) cases. 57 patients were admitted under the new pathway for observation, with 1 having a CT scan following admission. Conclusion: Quantitative lifetime radiation risks for children are not negligible. While there was no statistically significant reduction in CTs performed amongst HIs presenting to our department, a significant group met the criteria for admission under the PECU consultant for prolonged monitoring. There was also a greater proportion of abnormalities on CT scans performed in 2022, demonstrating improved patient selection for imaging. Further data analysis is ongoing to determine if those who were admitted would have previously been scanned under the old pathway.

Keywords: head injury, CT, admission, guidline

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Authors: Efuwape Bamidele Michael, Efuwape Oluwabunmi Asake

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Nigeria has some deep rural environments that seem secluded from most of the technological amenities for convenient living and learning. Most schools in such environments are yet to be captured in the educational applications of technological facilities. The study explores the facilitation of basic technology instructions with micro-learning and gamification among students in rural Junior Secondary Schools in the Ipokia Local Government Area (LGA) of Ogun state. The study employed a quasi-experimental design, specifically the pre-test and post-test control group design. The study population comprised all Junior Secondary School students in the LGA. Four Junior Secondary Schools in the LGA were randomly selected for the study and classified into two experimental and two control groups. A total sample of 156 students participated in the study. Basic Technology Achievement Test and Junior School Students’ Attitudinal Scale were instruments used for data collection in the study with reliability coefficients of 0.87 and 0.83, respectively. Five hypotheses guided the study and were tested using Analysis of covariance (ANCOVA) at a 0.05 level of significance. Findings from the study established significant marginal differences in students’ academic performance (F = 644.301; p = .000), learning retention (F = 583.335; p = .000), and attitude towards learning basic technology (F = 491.226; p = .000) between the two groups in favour of the experimental group exposed to micro-learning and gamification. As a recommendation, adequate provisions for inclusive educational practices with technological applications should be ensured for all children irrespective of location within the country, especially to encourage effective learning in rural schools.

Keywords: inclusive education, educational technology, basic technology students, rural areas in Nigeria, micro-learning, gamification

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Authors: Charles W. MacQuarrie, Rachel R. Tatro Duarte

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This paper explores the representation of medieval identity within the world of games such as Dragon Age, Elden Ring, Hellblade: Senua’s sacrifice, fantasy role-playing games that draw effectively and problematically on Celtic and Norse mythologies. Focusing on tattoos, onomastics, and accent as visual and oral markers of status and ethnicity, this study analyzes how the game's interplay between mythology, character narratives, and visual storytelling enriches the themes and offers players an immersive, but sometimes baldly ahistorical, connection to ancient mythologies and contemporary digital storytelling. Dragon Age is a triple a game series, Hellblade Senua’s Sacrifice, and Elden Ring of gamers worldwide with its presentation of an idealized medieval world, inspired by the lore of Celtic and Norse mythologies. This paper sets out to explore the intricate relationships between tattoos, accent, and character narratives in the game, drawing parallels to themes,heroic figures and gods from Celtic and Norse mythologies. Tattoos as Mythic and Ethnic Markers: This study analyzes how tattoos in Dragon Age visually represent mythological elements from both Celtic and Norse cultures, serving as conduits of cultural identity and narratives. The nature of these tattoos reflects the slave, criminal, warrior associations made in classical and medieval literature, and some of the episodes concerning tattoos in the games have either close analogs or sources in literature. For example the elvish character Solas, in Dragon Age Inquisition, removes a slave tattoo from the face of a lower status elf in an episode that is reminiscent of Bridget removing the stigmata from Connallus in the Vita Prima of Saint Bridget Character Narratives: The paper examines how characters' personal narratives in the game parallel the archetypal journeys of Celtic heroes and Norse gods, with a focus on their relationships to mythic themes. In these games the Elves usually have Welsh or Irish accents, are close to nature, magically powerful, oppressed by apparently Anglo-Saxon humans and Norse dwarves, and these elves wear facial tattoos. The Welsh voices of fairies and demons is older than the reference in Shakespeare’s Merry Wives of Windsor or even the Anglo-Saxon Life of Saint Guthlac. The English speaking world, and the fantasy genre of literature and gaming, undoubtedly driven by Tolkien, see Elves as Welsh speakers, and as having Welsh accents when speaking English Comparative Analysis: A comparative approach is employed to reveal connections, adaptations, and unique interpretations of the motifs of tattoos and narrative themes in Dragon Age, compared to those found in Celtic and Norse mythologies. Methodology: The study uses a comparative approach to examine the similarities and distinctions between Celtic and Norse mythologies and their counterparts in video games. The analysis encompasses character studies, narrative exploration, visual symbolism, and the historical context of Celtic and Norse cultures. Mythic Visuals: This study showcases how tattoos, as visual symbols, encapsulate mythic narratives, beliefs, and cultural identity, echoing Celtic and Norse visual motifs. Archetypal Journeys: The paper analyzes how character arcs mirror the heroic journeys of Celtic and Norse mythological figures, allowing players to engage with mythic narratives on a personal level. Cultural Interplay: The study discusses how the game's portrayal of tattoos and narratives both preserves and reinterprets elements from Celtic and Norse mythologies, fostering a connection between ancient cultures and modern digital storytelling. Conclusion: By exploring the interconnectedness of tattoos and character narratives in Dragon Age, this paper reveals the game series' ability to act as a bridge between ancient mythologies and contemporary gaming. By drawing inspiration from Celtic heroes and Norse gods and translating them into digital narratives and visual motifs, Dragon Age offers players a multi-dimensional engagement with mythic themes and a unique lens through which to appreciate the enduring allure of these cultures.

Keywords: comparative analysis, character narratives, video games and literature, tattoos, immersive storytelling, character development, mythological influences, Celtic mythology, Norset mythology

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Authors: Saut Samuel Simamora

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PURPOSE: Nucleus drop is one of the most feared and severe complications of modern cataract surgery. The lens material may drop through iatrogenic breaks of the posterior capsule. The incidence of the nucleus as the complication of phacoemulsification increases concomitant to the increased frequency of phacoemulsification. Pars plana vitrectomy (PPV) followed by endofragmentation and secondary intraocular lens (IOL) implantation is the choice of management procedure. This case report aims to present the outcome of PPV for the treatment dropped nucleus after cataract surgery METHODS: A 65 year old female patient came to Vitreoretina department with chief complaints blurry vision in her left eye after phacoemulsification one month before. Ophthalmological examination revealed visual acuity of the right eye (VA RE) was 6/15, and the left eye (VA LE) was hand movement. The intraocular pressure (IOP) on the right eye was 18 mmHg, and on the left eye was 59 mmHg. On her left eye, there were aphakic, dropped lens nucleus and secondary glaucoma.RESULTS: The patient got antiglaucoma agent until her IOP was decreased. She underwent pars plana vitrectomy to remove dropped nucleus and iris fixated IOL. One week post operative evaluation revealed VA LE was 6/7.5 and iris fixated IOL in proper position. CONCLUSIONS: Nucleus drop generally occurs in phacoemulsification cataract surgery techniques. Retained lens nucleus or fragments in the vitreous may cause severe intraocular inflammation leading to secondary glaucoma. The proper and good management for retained lens fragments in nucleus drop give excellent outcome to patient.

Keywords: secondary glaucoma, complication of phacoemulsification, nucleus drop, pars plana vitrectomy

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Authors: Numair Ahmed Siddiqui, Abdul Hadi bin Abd Rahman, Chow Weng Sum, Wan Ismail Wan Yousif, Asif Zameer, Joel Ben-Awal

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Advances in data capturing from outcrop studies have made possible the acquisition of high-resolution digital data, offering improved and economical reservoir modelling methods. Terrestrial laser scanning utilizing LiDAR (Light detection and ranging) provides a new method to build outcrop based reservoir models, which provide a crucial piece of information to understand heterogeneities in sandstone facies with high-resolution images and data set. This study presents the detailed application of outcrop based sandstone facies connectivity model by acquiring information gathered from traditional fieldwork and processing detailed digital point-cloud data from LiDAR to develop an intermediate small-scale reservoir sandstone facies model of the Miocene Sandakan Formation, Sabah, East Malaysia. The software RiScan pro (v1.8.0) was used in digital data collection and post-processing with an accuracy of 0.01 m and point acquisition rate of up to 10,000 points per second. We provide an accurate and descriptive workflow to triangulate point-clouds of different sets of sandstone facies with well-marked top and bottom boundaries in conjunction with field sedimentology. This will provide highly accurate qualitative sandstone facies connectivity model which is a challenge to obtain from subsurface datasets (i.e., seismic and well data). Finally, by applying this workflow, we can build an outcrop based static connectivity model, which can be an analogue to subsurface reservoir studies.

Keywords: LiDAR, outcrop, high resolution, sandstone faceis, connectivity model

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Authors: Jui-Chen Huang

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The purpose of this study is to explore the effects of telecare on preventing and delaying the quality of disability care in elderly people with portable comfort Bluetooth brainwave devices with remote healthcare functions. Through the teaching videos and remotely teaching the elderly, which had ever learned the care courses of the prevent and delay disability, these elderly did muscle strength training. Then this paper explores the effect of training with the data by SPSS 18.0 statistical software. The data is collected with pre-test, post-test and analyze data from the measure of the Bluetooth brain wave equipment including the pressure index, relaxation index, attention and fatigue index of the elderly. In this study, 30 elderly people who had taken preventive and delayed disability care courses were studied to explore the effect of their care quality improvement. The results showed that the pressure index, relaxation index, attention, and fatigue index of the elderly had statistically significant differences in two months. It can be seen that elderly people who have been treated to prevent and delay disability care courses can significantly improve their care quality if they continue to receive intensive training to prevent and delay disability through remote mode. This telecare is applied to the elderly program that has been used to prevent and delay disability care courses. It is worth continuing to promote, and it is recommended that follow-up studies be conducted in a longer-term manner to explore long-term benefits. It can solve the current insufficiency of long-term care resources, but the demand is urgent.

Keywords: telecare, bluetooth brainwave equipment, prevention and delay of disability, the elderly, care quality

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Authors: Ethan James

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Over one billion people worldwide suffer from some level of vision loss or blindness as a result of progressive retinal diseases. Many patients, particularly in developing areas, are incorrectly diagnosed or undiagnosed whatsoever due to unconventional diagnostic tools and screening methods. Artificial intelligence (AI) based on deep learning (DL) convolutional neural networks (CNN) have recently gained a high interest in ophthalmology for its computer-imaging diagnosis, disease prognosis, and risk assessment. Optical coherence tomography (OCT) is a popular imaging technique used to capture high-resolution cross-sections of retinas. In ophthalmology, DL has been applied to fundus photographs, optical coherence tomography, and visual fields, achieving robust classification performance in the detection of various retinal diseases including macular degeneration, diabetic retinopathy, and retinitis pigmentosa. However, there is no complete diagnostic model to analyze these retinal images that provide a diagnostic accuracy above 90%. Thus, the purpose of this project was to develop an AI model that utilizes machine learning techniques to automatically diagnose specific retinal diseases from OCT scans. The algorithm consists of neural network architecture that was trained from a dataset of over 20,000 real-world OCT images to train the robust model to utilize residual neural networks with cyclic pooling. This DL model can ultimately aid ophthalmologists in diagnosing patients with these retinal diseases more quickly and more accurately, therefore facilitating earlier treatment, which results in improved post-treatment outcomes.

Keywords: artificial intelligence, deep learning, imaging, medical devices, ophthalmic devices, ophthalmology, retina

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Authors: Safa Abdussalam

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Adolescence is a period of storm and stress. It is a transitional period. Adolescents undergo a lot of changes physically, emotionally and mentally during adolescence. Physical changes include puberty, sexual maturation, changes in height, weight, hormonal changes, changes in body image, changes in brain and in sexuality. Changes also occur in their cognition. According to Piaget’s theory, adolescent enter formal operational stage and engage in hypothetical-deductive reasoning. Main characteristic of adolescent cognition is adolescent egocentrism: imaginary audience and personal fable. One of the most common struggle majority of adolescents face is the conflict between parent and adolescent. They often complain that parents do not understand them/their situation. Common topics of conflict include identity crisis, issues with personal freedom and issues over personal preferences. Conflict resolution refers to solving conflicts in a healthy way. There is a lack of resources in dealing with such conflicts creatively. To deal with parent-adolescent conflict, a conflict resolution board game is designed. The board game consists of tokens, dice, 10 conflict situation cards and two conflict resolution sheets. Purpose of using a board game is to help adolescents understand the conflict situations and resolutions in a fun, creative and interactive way. It can be used for self-help or even therapists can use it in their clinical practice. The study aims to assess the effectiveness of the board game in dealing with the conflict. Experimental design will be used. Samples include 15 adolescents belonging to age group 10-19. Samples will be divided into two groups: Experimental group and control group. A pre-test and post-test will be conducted. The board game will be demonstrated to the experimental group. Results will be obtained after statistical analysis. Board games are a great way to be used with children and adolescents.

Keywords: adolescent, adolescence, parent-child conflict, conflict resolution

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Authors: Verd Shomrom, Gilat Trabelsi

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The goal of the study was to examine the effects of Computerized Cognitive Training (CCT) with and without cognitive mediation on Executive Function (EF) (planning and self- regulation) and on psychological resiliency among adolescents with Attention Deficits Hyperactive Disorder (ADHD) with or without Learning Disabilities (LD). Adolescents diagnosed with Attention Deficit Disorder and / or Learning Disabilities have multidimensional impairments that result from neurological damage. This work explored the possibility of influencing cognitive aspects in the field of Executive Functions (specifically: patterns of planning and self-regulation) among adolescents with a diagnosis of Attention Deficit Disorder and / or Learning Disabilities who study for a 10-12 grades. 46 adolescents with ADHD and/or with LD were randomly applied to experimental and control groups. All the participants were tested (BRC- research version, Resiliency quaternaries) before and after the intervention: mediated/ non-mediated Computerized Cognitive Training (MINDRI). The results indicated significant effects of cognitive modification in the experimental group, between pre and post Phases, in comparison to control group, especially in self- regulation (BRC- research version, Resiliency quaternaries), and on process analysis of Computerized Cognitive Training (MINDRI). The main conclusion was that even short- term mediation synchronized with CCT could greatly enhance the performance of executive functions demands. Theoretical implications for the positive effects of MLE in combination with CCT indicate the ability for cognitive change. The practical implication is the awareness and understanding of efficient intervention processes to enhance EF, learning awareness, resiliency and self-esteem of adolescents in their academic and daily routine.

Keywords: attention deficits hyperactive disorder, computerized cognitive training, executive function, mediated learning experience, learning disabilities

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Authors: Qingsong Xiong, Cheng Yuan, Qingzhao Kong, Haibei Xiong

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Deep-learning-driven approaches based on vibration responses have attracted larger attention in rapid structural condition assessment while obtaining sufficient measured training data with corresponding labels is relevantly costly and even inaccessible in practical engineering. This study proposes an integrated label propagation network for structural condition assessment, which is able to diffuse the labels from continuously-generating measurements by intact structure to those of missing labels of damage scenarios. The integrated network is embedded with damage-sensitive features extraction by deep autoencoder and pseudo-labels propagation by optimized fuzzy clustering, the architecture and mechanism which are elaborated. With a sophisticated network design and specified strategies for improving performance, the present network achieves to extends the superiority of self-supervised representation learning, unsupervised fuzzy clustering and supervised classification algorithms into an integration aiming at assessing damage conditions. Both numerical simulations and full-scale laboratory shaking table tests of a two-story building structure were conducted to validate its capability of detecting post-earthquake damage. The identifying accuracy of a present network was 0.95 in numerical validations and an average 0.86 in laboratory case studies, respectively. It should be noted that the whole training procedure of all involved models in the network stringently doesn’t rely upon any labeled data of damage scenarios but only several samples of intact structure, which indicates a significant superiority in model adaptability and feasible applicability in practice.

Keywords: autoencoder, condition assessment, fuzzy clustering, label propagation

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Authors: Aditi Jain

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Aim: To compare the canal transportation, centering ability and remaining dentin thickness of OneShape and WaveOne system using CBCT. Objective: To identify rotary system which respects original canal anatomy. Materials and Methods: Forty extracted human single-rooted premolars were used in the present study. Pre-instrumentation scans of all teeth were taken, canal curvatures were calculated, and the samples were randomly divided into two groups with twenty samples in each group, where Group 1 included WaveOne system and Group 2 Protaper rotary system. Post-instrumentation scans were performed, and the two scans were compared to determine canal transportation, centering ability and remaining dentin thickness at 1, 3, and 5 mm from the root apex. Results: Using Student’s unpaired t test results were as follows; for canal transportation Group 1 showed statistical significant difference at 3mm, 6mm and non-significant difference was obtained at 9mm but for Group 2 non-statistical significant difference was obtained at 3mm, 6mm, and 9mm. For centering ability and remaining dentin thickness Group 1 showed non-statistical significant difference at 3mm and 9mm, while statistical significant difference at 6mm was obtained. When comparison of remaining dentin thickness was done at three levels using two groups WaveOne and ProTaper. There was non-statistical significant difference between two groups. Conclusion: WaveOne single reciprocation file respects original canal anatomy better than ProTaper. WaveOne depicted the best centering ability.

Keywords: ShapeOne, WaveOne, transportation, centering ability, dentin thickness, CBCT (Cone Beam Computed Tomography)

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Authors: Adela Penesova, Zofia Radikova, Boris Bajer, Andrea Havranova, Miroslav Vlcek

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Background: The aim of our study was to compare the effect of intensified lifestyle intervention on insulin resistance (HOMA-IR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and Fibroblast growth factor (FGF) 21 after 8 weeks of lifestyle intervention. Methods: A group of 43 obese patients (13M/30F; 43.0±12.4 years; BMI (body mass index) 31.2±6.3 kg/m2 participated in a weight loss interventional program (NCT02325804) following an 8-week hypocaloric diet (-30% energy expenditure) and physical activity 150 minutes/week. Insulin sensitivity was evaluated according to the homeostasis model assessment of insulin resistance (HOMA-IR) and insulin sensitivity indices according to Matsuda and Cederholm were calculated (ISImat and ISIced). Plasma ALT, AST, Fetuin-A, FGF 21, and physical fitness were measured. Results: The average reduction of body weight was 6.8±4.9 kg (0-15 kg; p=0.0006), accompanied with a significant reduction of body fat amount of fat mass (p=0.03), and waist circumference (p=0.02). Insulin sensitivity has been improved (IR HOMA 2.71±3.90 vs 1.24±0.83; p=0.01; ISIMat 6.64±4.38 vs 8.93±5.36 p ≤ 0.001). Total, LDL cholesterol, and triglycerides decreased (p=0.05, p=0.04, p=0.04, respectively). Physical fitness significantly improved after intervention (as measure VO2 max (maximal oxygen uptake) (p ≤ 0.001). ALT decreased significantly (0.44±0.26 vs post 0.33±0.18 ukat/l, p=0.004); however, AST not (pre 0.40±0.15 vs 0.35±0.09 ukat/l, p=0.07). Hepatokine Fetuin-A significantly decreased after intervention (43.1±10.8 vs 32.6±8.6 ng/ml, p < 0.001); however, FGF 21 levels tended to decrease (146±152 vs 132±164 pg/ml, p=0.07). Conclusion: 8-weeks of diet and physical activity intervention program in obese otherwise healthy subjects led to an improvement of insulin resistance parameters and liver marker profiles, as well as increased physical fitness. This study was supported by grants APVV 15-0228; VEGA 2/0161/16.

Keywords: obesity, diet, exercice, insulin sensitivity

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Authors: Nkereke Essien

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The study seeks to analyze tone in the Educated Nigerian accent of English (ENAE) using the three tones: Low (L), High (H) and Low-High (LH). The aim is to find out whether there are any differences or similarities in the performance of the experimental group and the control. To achieve this, twenty educated Nigerian speakers of English who are educated in the language were selected by a Stratified Random Sampling (SRS) technique from two federal universities in Nigeria. They were given a passage to read and their intonation patterns were compared with that of a native speaker (control). The data were analyzed using Pierrehumbert’s (1980) intonation system of analysis. Three different approaches were employed in the analysis of the intonation Phrase (IP) as used by Pierrehumbert: perceptual, statistical and acoustic. We first analyzed our data from the passage and utterances using Willcoxon Matched Pairs Signs Ranks Test to establish the differences between the performance of the experimental group and the control. Then, the one-way Analysis of variance (ANOVA) statistical and Tukey-Krammar Post Hoc Tests were used to test for any significant difference in the performances of the twenty subjects. The acoustic data were presented to corroborate both the perceptual and statistical findings. Finally, the tonal patterns of the selected subjects in the three categories - A, B, C, were compared with those of the control. Our findings revealed that the tonal pattern of the Educated Nigerian Accent of English (ENAE) is significantly different from the tonal pattern of the Standard British Accent of English (SBAE) as represented by the control. A high preference for unidirectional tones, especially, the high tones was observed in the performance of the experimental group. Also, high tones do not necessarily correspond to stressed syllables and low tones to unstressed syllables.

Keywords: accent, intonation phrase (IP), tonal patterns, tone

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Authors: Yi Gu

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The Three-Body Problem by Cixin Liu has been a bestseller Chinese Sci-Fi novel for years since 2008. The book was translated into English by Ken Liu in 2014 and won the prestigious 2015 science fiction and fantasy writing Hugo Award, drawing greater attention from wider international communities. The story exposes the horrors of the Chinese Cultural Revolution in the 1960s, in an intriguing narrative for readers at home and abroad. However, without the access to the source text, western readers may not be aware that the original Chinese version of the book is rich in gender-bias. Some Chinese scholars have applied feminist translation theories to their analysis on this book before, based on isolated selected, cherry-picking examples. Thus this paper aims to obtain a more thorough picture of how translators can cope with gender discrimination and reshape the gendered discourse from the source text, by systematically investigating the lexical and syntactic patterns in the translation of Liu’s entire book of 400 pages. The source text and the translation were downloaded into digital files, automatically aligned at paragraph level and then manually post-edited. They were then compiled into a parallel corpus of 114,629 English words and 204,145 Chinese characters using Sketch Engine. Gender-discrimination markers such as the overuse of ‘girl’ to describe an adult woman were searched in the source text, and the alignment made it possible to identify the strategies adopted by the translator to mitigate gender discrimination. The results provide a framework for translators to address gender bias. The study also shows how corpus methods can be used to further research in feminist translation and critical discourse analysis.

Keywords: corpus, discourse analysis, feminist translation, science fiction translation

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Authors: Yolanda Havenga

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Being a competent nurse requires clinical, general, and moral competencies. Moral competence is a culmination of moral perceptions, moral judgment, moral behaviour, and moral identity. Moral identity is the values, images, and fundamental principles held in the collective minds and memories of nurses about what it means to be a ‘good nurse’. It is important to explore and describe South African nurses’ moral identities and excavate the post-colonial counter-narrative to nurses moral identities as a better understanding of these identities will enable means to positively address nurses’ moral behaviours. This study explored the moral identity of nurses within the South African context. A qualitative approach was followed triangulating with phenomenological and narrative designs with the same purposively sampled group of professional nurses. In-depth interviews were conducted until saturation of data occurred about the sampled nurses lived experiences of being a nurse in South Africa. They were probed about their core personal-, social-, and professional values. Data were analysed based on the steps used by Colaizzi. These nurses were then asked to write a narrative telling a personal story that portrayed a significant time in their professional career that defines their identity as a nurse. This data were analysed using a critical narrative approach and findings of the two sets of data were merged. Ethical approval was obtained and approval from all relevant gate keepers. In the findings, themes emerged related to personal, social and professional values, images and fundamental principles of being a nurse within the South African context. The findings of this study will inform a future national study including a representative sample of South African nurses.

Keywords: moral behaviour, moral identity, nurses, qualitative research

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Authors: B. Kenny

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The complications associated with transfusions are well documented, with the serious hazards of transfusion (SHOT) reporting system continuing to report deaths and serious morbidity due to the transfusion of allogenic blood. Many different sources including the TRICC trial, NHMRC and Cochrane recommending similar transfusion triggers/guidelines. Recent studies found the rate of infection (deep infection, wound infection, chest infection, urinary tract infection, and others) were purely a dose response relationship, increasing the Relative Risk by 3.44. It was also noted that each transfused patient stayed in hospital for one additional day. We hypothesise that providing an approved/standardised, guideline with a graphical summary of decision pathways for anaemic patients will reduce unnecessary transfusions. We retrospectively assessed patients undergoing primary knee or hip arthroplasties over a 4 year period, 1459 patients. Of these, 339 (23.24%) patients received allogenic blood transfusions and 858 units of blood were transfused, 9.14% of patients transfused had haemoglobin levels above 100 g/L, 7.67% of patients were transfused without knowing the haemoglobin level, 24 hours prior to transfusion initiation and 4.5% had possible transfusion reactions. Overall, 17% of allogenic transfusions topatients admitted to the Orthopaedic department within a 4 year period were outside NHMRC and Cochrane guidelines/recommendations. If our transfusion frequency is compared with that of other authors/hospitals, transfusion rates are consistently being high. We subsequently implemented a simple guideline for transfusion initiation. This guideline was then assessed. We found the transfusion rate post transfusion implementation to be significantly lower, without increase in patient morbidity or mortalitiy, p <0.001). Transfusion rates and patient outcome can be optimized by a simple graphical aid for decision making.

Keywords: transfusion, morbidity, mortality, neck of femur, fracture, arthroplasty, rehabilitation

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Authors: Anjali Suresh

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Kerala is well known for its unique settlement pattern; comprising the most part, a continuous spread of habitation. The notable urbanization trend in Kerala is urban spread rather than concentration which points out the increasing urbanization of peripheral areas of existing urban centers. This has thrown a challenge for the authorities to cater the needs of the urban population like to provide affordable housing and infrastructure facilities to sustain their livelihood; which is a matter of concern that needs policy attention in fixing the optimum FSI value. Based on recent reports (Post Disaster Need Analysis –PDNA) from the UN, addressing the unsafe situation of the carpet FAR/FSI practice in the state showcasing the varying geological & climatic conditions should also be the matter of concern. The FSI (Floor space index- the ratio of the built-up space on a plot to the area of the plot) value is certainly one of the key regulation factors in checking the land utilization for the varying occupancies desired for the overall development of a state with limitation in land availability when compared to its neighbors. The pattern of urbanization, physical conditions, topography, etc., varies within the state and can change remarkably over time which identifies that the practicing FSI norms in Kerala does not fulfils the intended function. Thus the FSI regulation is expected to change dynamically from location to location. So for determining the optimum value of FSI /FAR of a region in the state of Kerala, the government agencies should consider the optimum land utilization for the growing urbanization. On the other hand, shall keep in check the overutilization of the same in par with environmental and geographic nature. Therefore the study identifies parameters that should be considered for assigning FSI within the Kerala context, and through expert surveys; opinions arrive at a methodology for assigning an optimum FSI value of a region in the state of Kerala.

Keywords: floor space index, urbanization, density, civic pressure, optimization

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Authors: Kristina Karapetyan, Flora Tkhruni, Tsovinar Balabekyan, Arevik Israyelyan, Tatyana Khachatryan

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The ability of the lactic acid bacteria (LAB) to prevent and cure a variety of diseases, their protective role against infections and colonization of pathogenic microorganisms in the digestive tract, has lead to the coining of the term probiotics or pro-life. LAB inhibiting the growth of pathogenic and food spoilage microorganisms, maintaining the nutritive quality and improving the shelf life of foods. They have also been used as flavor and texture producers. Enterococcus strains have been used for treatment of diseases such as diarrhea or antibiotic associated diarrhea, inflammatory pathologies that affect colon such as irritable bowel syndrome, or immune regulation, diarrhea caused by antibiotic treatments. The obtaining and investigation of biological properties of proteinoceous antibiotics, on the basis of probiotic LAB shown, that bacteriocins, metabiotics, and peptides of LAB represent bactericides have a broad range of activity and are excellent candidates for development of new prophylactic and therapeutic substances to complement or replace conventional antibiotics. The genotyping by 16S rRNA sequencing for LAB were used. Cell free culture broth (CFC) broth was purified by the Gel filtration method on the Sephadex Superfine G 25 resin. Antimicrobial activity was determined by spot-on-lawn method and expressed in arbitrary units (AU/ml). The diversity of multidrug-resistance (MDR) of pathogenic strains to antibiotics, most widely used for treatment of human diseases in the Republics of Armenia and Nagorno Karabakh were examined. It was shown, that difference of resistance of pathogens to antibiotics depends on their isolation sources. The influences of partially purified antimicrobial preparations (AMP), obtained from the different strains of Enterococcus genus on the growth of MDR pathogenic bacteria were investigated. It was shown, that bacteriocin containing partially purified preparations, obtained from different strains of Enterococcus faecium and durans species, possess bactericidal or bacteriostatic activity against antibiotic resistant intestinal, spoilage and food-borne pathogens such as Listeria monocytogenes, Staphylococcus aureus, E. coli, and Salmonella. Endemic strains of LAB, isolated from Matsoni made from donkey, buffalo and goat milk, shown broad spectrum of activity against food spoiling microorganisms, moulds and fungi, such as Salmonella sp., Esherichia coli, Aspergillus and Penicillium species. Highest activity against MDR pathogens shown bacteria, isolated from goat milk products. High stability of the investigated strains of the genus Enerococcus, isolated from samples of matsun from different regions of Nagorno-Karabakh (NKR) to the antibiotics was shown. The obtained data show high stability of the investigated different strains of the genus Enerococcus. The high genetic diversity in Enterococcus group suggests adaptations for specific mutations in different environments. Thus, endemic strains of LAB are able to produce bacteriocins with high and different inhibitory activity against broad spectrum of microorganisms isolated from different sources and belong to different taxonomic group. Prospect of the use of certain antimicrobial preparations against pathogenic strains is obvious. These AMP can be applied for long term use against different etiology antibiotic resistant pathogens for prevention or treatment of infectional diseases as an alternative to antibiotics.

Keywords: antimicrobial biopreparation, endemic lactic acid bacteria, intra-species diversity, multidrug resistance of pathogens

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Authors: Semra Çörekçi̇

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In this study, a new source on Ottoman Self-narratives, Kulakzâde Mahmud Paşa’s Düşname (Dreambook), will be introduced to illustrate how dreams can provide a ground for historical analysis. The manuscript looks like a private notebook of an Ottoman official, Mahmud Pasha, who lived and operated in Rumelia in the early eighteenth century. It provides insight into the ordinary and daily concerns of a bureaucrat who had the knowledge and tools to record them in writing. On the one side of the notebook, Mahmud Pasha recorded his travels and appointments in 1730-1731. He wrote places that he reached and stayed every day. On the reverse side, the same author kept a record of his dreams and named that part of his notebook, Düşname. He recorded his dreams on a daily basis in writing and therefore they were well-preserved in a dream diary. This study aims at drawing the social, cultural and psychic life of an early modern Ottoman bureaucrat. It will uncover the ways and means whereby he interpreted his environment, as well as how he made meaning of his dreams considering the social milieu and historical context within which he lived. The first part will focus on 'official dreams' uncovering how his official life and ambitions coincide with his spiritual life. Related to this, connection between anxiety and dream narratives will be evaluated as dreams in which the mundane concerns of securing a post occupied the most central place in the construction of his narrative. A further point will be made by questioning Mahmud Pasha’s possible Sufi connections and his familiarity with the tradition of dream interpretation. Also, considering Mahmud Pasha’s inclusion of other’s dreams in his Düşnâme, the issue of dream-telling will be questioned in order to reveal how dreams were interconnected and how they created a space for social gathering.

Keywords: Ottoman self-narratives, dreams, diary, Ottoman cultural history

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Authors: Nita Nurlaila Kadarwaty

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Purpose: This study presents a rare case of bilateral Acute Primary Angle Closure Glaucoma (PACG). Method: A case report of a 64-year-old woman with a good outcome Acute PACG in both eyes who underwent phacotrabeculectomy surgery. Result: A 64-year-old woman complained of acute pain in both eyes, accompanied by decreased vision, photophobia, and seeing halos for three weeks. There was no history of trauma, steroid or other systemic drugs used, or intraocular surgery before. Ophthalmologic examination revealed a right eye (RE) visual acuity of 0.1, left eye (LE) 0.2. RE intraocular pressure (IOP) was 12 mmhg and LE: 36.4 mmHg in medication of timolol maleat ED and acetazolamide oral. Both eyes' anterior segments revealed mixed injection, corneal edema, shallow anterior chamber, posterior synechiae, mid-dilatation pupil with negative pupillary reflection, and cloudy lens without intumescent. There was a glaucomatous optic and closed iridocorneal angle on the gonioscopy. Initial treatments included oral acetazolamide and potassium aspartate 250 mg three times a day, timolol maleate ED 0.5% twice a day, and prednisolone acetate ED 1% four times a day. This patient underwent trabeculectomy, phacoemulsification, and implantation of IOL in both eyes. One week after the surgeries, both eyes showed decreased IOP and good visual improvement. Conclusion: Bilateral simultaneous Acute PACG is generally severe and results in a poor outcome. It causes rapidly progressive visual loss and is often irreversible. Phacotrabeculectomy has more benefits compared to only phacoemulsification for the intervention regarding the reduced IOP post-surgical.

Keywords: acute primary angle closure glaucoma, intraocular pressure, phacotrabeculectomy, glaucoma

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