Search results for: delayed diagnosis and poor outcome

Authors: Kamel Abd Elaziz Mohamed, Ahmed Yehia Mousa, Ahmed Samir ElSawy, Adel Mohamed Saleem

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Introduction: Critically ill patients frequently require tracheostomy to simplify long term air way management. While tracheostomy indications have remained unchanged, the timing of elective tracheostomy for the ventilated patient has been questioned. Aim of the work: This study was performed to compare the differences between early and late percutaneous dilatational tracheostomy (PDT) regarding, mechanical ventilation duration (MVD), length of ICU stay, length of hospital stay, incidence of ventilator associated pneumonia and hospital outcome. Patients and methods: Forty patients who met the inclusion criteria were randomly divided into early PDT who had the tracheostomy within the first 10 days of mechanical ventilation (MV) and the late PDT who had the tracheostomy after 10 days of MV. On admission, demographic data and Acute Physiology and Chronic ill Health II and GCS were collected. The duration of mechanical ventilation, ICU length of stay (LOS) and hospital LOS were all calculated. Results: Total of 40 patients were randomized to either early PDT (n= 20) or late PDT (n= 20). There were no significant differences between both groups regarding demographic data or the scores: APACHE II (22.75± 7 vs 24.35 ± 8) and GCS (6.10 ±2 vs 7.10 ± 2.71). An early PDT showed fewer complications vs late procedure, however it was insignificant. There were significant differences between the two groups regarding mean (MVD) which was shorter in early PDT than the late PDT group (32.2± 10.5) vs (20.6 ± 13 days; p= 0.004). Mean ICU stay was shorter in early PDT than late PDT (21 .0± 513.4) vs (40.15 ±12.7 days; p 6 0.001). Mean hospital stay was shorter in early PDT than late PDT (34.60± 18.37) vs (55.60± 25.73 days; p=0.005). Patients with early PDT suffered less sepsis and VAP than late PDT, there was no difference regarding the mortality rate between the two groups. Conclusion: Early PDT is recommended for patients who require prolonged tracheal intubation in the ICU as outcomes like the duration of mechanical ventilation length of ICU stay and hospital stay were significantly shorter in early tracheostomy.

Keywords: intensive care unit, early PDT, late PDT, intubation

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Authors: Hossein Bakhtiari, Mathias Cehlin, Jan Akander

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Envelopes with low thermal performance is a common characteristic in many European historic buildings which leads to higher energy demand for heating and cooling as well as insufficient thermal comfort for the occupants. This paper presents the results of a study on the thermal comfort in the City Hall (Rådhuset) in Gävle, Sweden. This historic building is currently used as an office building. It is equipped with two relatively modern mechanical heat recovery ventilation systems with displacement ventilation supply devices in the offices. The district heating network heats the building via pre-heat supply air and radiators. Summer cooling comes from an electric heat pump that rejects heat into the exhaust ventilation air. A building management system controls HVAC equipment (heating, ventilation and air conditioning). The methodology is based on on-site measurements, data logging on the management system and evaluating the occupants’ perception of a summer and a winter period indoor environment using a standardized questionnaire. The main aim of the study is to investigate whether or not it is enough to have modernized HVAC systems to get adequate thermal comfort in a historic building with poor envelope performance used as an office building in Nordic climate conditions.

Keywords: historic buildings, on-site measurements, standardized questionnaire, thermal comfort

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Authors: Rajandeep Kaur, Rajeev Gupta

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Background: Chronic myeloid leukemia (CML) is the most common leukaemia in India. The annual incidence of chronic myeloid leukemia in India was originally reported to be 0.8 to 2.2 per 1,00,000 population. CML is a clonal disorder that is usually easily diagnosed because the leukemic cells of more than 95% of patients have a distinctive cytogenetic abnormality, the Philadelphia chromosome (Ph1). The approval of tyrosine kinase inhibitors (TKIs), which target BCR-ABL1 kinase activity, has significantly reduced the mortality rate associated with chronic myeloid leukemia (CML) and revolutionized treatment. Material and Methods: 80 diagnosed cases of CML were taken. Investigations were done. Bone marrow and molecular studies were also done and with EUTOS, patients were stratified into low and high-risk groups and then treatment with Imatinib was given to all patients and the molecular response was evaluated at 6 months and 12 months follow up with BCR-ABL by RT-PCR quantitative assay. Results: In the study population, out of 80 patients in the study population, 40 were females and 40 were males, with M: F is 1:1. Out of total 80 patients’ maximum patients (54) were in 31-60 years age group. Our study showed a most common symptom of presentation is abdominal discomfort followed by fever. Out of the total 80 patients, 25 (31.3%) patients had high EUTOS scores and 55 (68.8%) patients had low EUTOS scores. On 6 months follow up 36.3% of patients had Complete Molecular Response, 16.3% of patients had Major Molecular Response and 47.5% of patients had No Molecular Response but on 12 months follow up 71.3% of patients had Complete Molecular Response, 16.25% of patients had Major Molecular Response and 12.5% patients had No Molecular Response. Conclusion: In this study, we found a significant correlation between EUTOS score and Molecular response at 6 months and 12 months follow up after Imatinib therapy.

Keywords: chronic myeloid leukemia, European treatment and outcome study score, hematological response, molecular response, tyrosine kinase inhibitor

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Authors: Takashi Kaburagi, Masashi Takenaka, Yosuke Kurihara, Takashi Matsumoto

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Major depressive disorder (MDD) is one of the most common mental illnesses today. It is believed to be caused by a combination of several factors, including stress. Stress can be quantitatively evaluated using the State-Trait Anxiety Inventory (STAI), one of the best indices to evaluate anxiety. Although STAI scores are widely used in applications ranging from clinical diagnosis to basic research, the scores are calculated based on a self-reported questionnaire. An objective evaluation is required because the subject may intentionally change his/her answers if multiple tests are carried out. In this article, we present a modified index called the “multi-channel Laterality Index at Rest (mc-LIR)” by recording the brain activity from a wider area of the frontal lobe using multi-channel functional near-infrared spectroscopy (fNIRS). The presented index aims to measure multiple positions near the F_pz defined by the international 10-20 system positioning. Using 24 subjects, the dependencies on the number of measuring points used to calculate the mc-LIR and its correlation coefficients with the STAI scores are reported. Furthermore, a simple linear regression was performed to estimate the STAI scores from mc-LIR. The cross-validation error is also reported. The experimental results show that using multiple positions near the Fpz will improve the correlation coefficients and estimation than those using only two positions.

Keywords: frontal lobe, functional near-infrared spectroscopy, state-trait anxiety inventory score, stress

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Authors: Zanib Nafees, Amir Razaghizad, Ibtisam Mahmoud, Abhinav Sharma, Renzo Cecere

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More than one million surgeries are performed each year in Canada, resulting in more than 100,000 associated serious adverse events (SAEs) per year. These are defined as unintended injuries or complications that adversely affect the well-being of patients. In recent years, there has been a proliferation of digital health interventions that have the potential to assist, monitor, and educate patients—facilitating self-care following post-operative discharge. Among digital health, interventions are interactive-voice response technologies (IVRs), which have been shown to be highly effective in certain medical settings. Although numerous IVR-based interventions have been developed, their effectiveness and utility remain unclear, notably in post-operative settings. To the best of our knowledge, no systematic or scoping reviews have evaluated this topic to date. Thus, the objective of this scoping review protocol is to systematically map and explore the literature and evidence describing and examining IVR tools, implementation, evaluation, outcome, and experience for post-operative patients. The focus will be primarily on the evaluation of baseline performance status, clinical assessment, treatment outcomes, and patient management, including self-management and self-monitoring. The objective of this scoping review is to assess the extent of the literature to direct future research efforts by identifying gaps and limitations in the literature and to highlight relevant determinants of positive outcomes in the emerging field of IVR monitoring for health outcomes in post-operative patients.

Keywords: digital healthcare technologies, post-surgery, interactive voice technology, interactive voice response

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Authors: I. Sani, F. Bello, I. M. Fakai, A. Abdulhamid

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Abelmoschus esculentus L. fruit is very common especially in northern part of Nigeria, but people are ignorant of its medicinal and pharmacological benefits. Preliminary phytochemical screening, antioxidant potential and mineral composition of the dried form of this fruit were determined. The Phytochemical screening was conducted using standard methods. Antioxidant potential screening was carried out using Ferric Reducing Antioxidant Power Assay (FRAP) method, while, the mineral compositions were analyzed using an atomic absorption spectrophotometer by wet digest method. The result of the qualitative phytochemical screening revealed that the fruits contain saponins, flavonoids, tannins, steroids, and terpenoids, while, anthraquinone, alkaloids, phenols, glycosides, and phlobatannins were not detected. The quantitative analysis revealed that the fruits contain saponnins (380 ± 0.020 mg/g), flavonoids (240±0.01 mg/g), and tannins (21.71 ± 0.66 mg/ml). The antioxidant potential was determined to be 54.1 ± 0.19%. The mineral composition revealed that 100 g of the fruits contains 97.52 ± 1.04 mg of magnesium (Mg), 94.53 ± 3.21 mg of calcium (Ca), 77.10 ± 0.79 mg of iron (Fe), 47.14 ± 0.41 mg of zinc (Zn), 43.96 ± 1.49 mg of potassium (K), 42.02 ± 1.09 mg of sodium (Na), 0.47 ± 0.08 mg of copper (Cu) and 0.10 ± 0.02 mg of lead (Pb). These results showed that the Abelmoschus esculentus L. fruit is a good source of antioxidants, and contains an appreciable amount of phytochemicals, therefore, it has some pharmacological attributes. On the other side, the fruit can serve as a nutritional supplement for Mg, Ca, Fe, Zn, K, and Na, but a poor source of Cu, and contains no significant amount of Pb.

Keywords: Abelmoschus esculentus Fruits, antioxidant potential, mineral composition, phytochemical screening

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Authors: Marzieh Imani

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Antoni Gaudi and Santiago Calatrava have reputation for designing bio-inspired creative and technical buildings. Even though they have followed different independent approaches towards design, the source of bio-inspiration seems to be common. Taking a closer look at their projects reveals that Calatrava has been influenced by Gaudi in terms of interpreting nature and applying natural principles into the design process. This research firstly discusses the dialogue between Biomimicry and architecture. This review also explores human/nature discourse during the history by focusing on how nature revealed itself to the fine arts. This is explained by introducing naturalism and romantic style in architecture as the outcome of designers’ inclination towards nature. Reviewing the literature, theoretical background and practical illustration of nature have been included. The most dominant practical aspects of imitating nature are form and function. Nature has been reflected in architectural science resulted in shaping different architectural styles such as organic, green, sustainable, bionic, and biomorphic. By defining a set of common aspects of Gaudi and Calatrava‘s design approach and by considering biomimetic design categories (organism, ecosystem, and behaviour as the main division and form, function, process, material, and construction as subdivisions), Gaudi’s and Calatrava’s project have been analysed. This analysis explores if their design approaches are equivalent or different. Based on this analysis, Gaudi’s architecture can be recognised as biomorphic while Calatrava’s projects are literally biomimetic. Referring to these architects, this review suggests a new set of principles by which a bio-inspired project can be determined either biomorphic or biomimetic.

Keywords: biomimicry, Calatrava, Gaudi, nature

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Authors: Basan Shrestha

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The relationship between the household size and the poverty is not well understood. Malthus followers advocate that the increasing population add pressure to the dwindling resource base due to increasing demand that would lead to poverty. Others claim that bigger households are richer due to availability of household labour for income generation activities. Facts from Nepal were analyzed to examine the relationship between the household size and poverty rate. The analysis of data from 3,968 Village Development Committee (VDC)/ municipality (MP) located in 75 districts of all five development regions revealed that the average household size had moderate positive correlation with the poverty rate (Karl Pearson's correlation coefficient=0.44). In a regression analysis, the household size determined 20% of the variation in the poverty rate. Higher positive correlation was observed in eastern Nepal (Karl Pearson's correlation coefficient=0.66). The regression analysis showed that the household size determined 43% of the variation in the poverty rate in east. The relation was poor in far-west. It could be because higher incidence of poverty was there irrespective of household size. Overall, the facts revealed that the bigger households were relatively poorer. With the increasing level of awareness and interventions for family planning, it is anticipated that the household size will decrease leading to the decreased poverty rate. In addition, the government needs to devise a mechanism to create employment opportunities for the household labour force to reduce poverty.

Keywords: household size, poverty rate, nepal, regional development

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Authors: Vignesh Ratnaraj, Jaewon Chang

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Background: Frailty is associated with poorer outcomes in cardiac surgery, but the heterogeneity in frailty assessment tools makes it difficult to ascertain its true impact in cardiac surgery. Slow gait speed is a simple, validated, and reliable marker of frailty. We performed a systematic review and meta-analysis to examine the effect of slow gait speed on postoperative cardiac surgical patients. Methods: PubMED, MEDLINE, and EMBASE databases were searched from January 2000 to August 2021 for studies comparing slow gait speed and “normal” gait speed. The primary outcome was in-hospital mortality. Secondary outcomes were composite mortality and major morbidity, AKI, stroke, deep sternal wound infection, prolonged ventilation, discharge to a healthcare facility, and ICU length of stay. Results: There were seven eligible studies with 36,697 patients. Slow gait speed was associated with an increased likelihood of in-hospital mortality (risk ratio [RR]: 2.32; 95% confidence interval [CI]: 1.87–2.87). Additionally, they were more likely to suffer from composite mortality and major morbidity (RR: 1.52; 95% CI: 1.38–1.66), AKI (RR: 2.81; 95% CI: 1.44–5.49), deep sternal wound infection (RR: 1.77; 95% CI: 1.59–1.98), prolonged ventilation >24 h (RR: 1.97; 95% CI: 1.48–2.63), reoperation (RR: 1.38; 95% CI: 1.05–1.82), institutional discharge (RR: 2.08; 95% CI: 1.61–2.69), and longer ICU length of stay (MD: 21.69; 95% CI: 17.32–26.05). Conclusion: Slow gait speed is associated with poorer outcomes in cardiac surgery. Frail patients are twofold more likely to die during hospital admission than non-frail counterparts and are at an increased risk of developing various perioperative complications.

Keywords: cardiac surgery, gait speed, recovery, frailty

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Authors: I. Hua Chu, Hsiang-Chi Yu, Hsuan Su

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Purpose: To examine the associations between self-determined motivation and physical activity in patients with coronary heart disease (CHD) in a longitudinal study. Methods: Patients with CHD were recruited for this study. Their motivations for exercise were measured by the Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2). Physical activity was assessed using the 7-day physical activity recall questionnaire. Duration and energy expenditure of moderate to vigorous physical activity (MVPA) were used in data analysis. All outcome measures were assessed at baseline and 12 months follow up. Data were analyzed using Pearson correlation analysis and regression analysis. Results: The results of the 45 participants (mean age 60.24 yr; 90.2% male) revealed that there were significant negative correlations between amotivation at baseline and duration (r=-.295, p=.049) and energy expenditure (r=-.300, p=.045) of MVPA at 12 months. In contrast, there were significant positive correlations between calculated relative autonomy index (RAI) at baseline and duration (r=.377, p=.011) and energy expenditure (r=.382, p=.010) of MVPA at 12 months. There was no significant correlation between other subscales of the BREQ-2 and duration or energy expenditure of MVPA. Regression analyses revealed that RAI was a significant predictor of duration (p=.011) and energy expenditure (p=.010) of MVPA at 12 months follow-up. Conclusions: These results suggest that the relative degree of self-determined motivation could predict long-term MVPA behaviors in CHD patients. Physical activity interventions are recommended to target enhancing one’s identified and intrinsic motivation to increase the likelihood of physical activity participation in this population.

Keywords: self-determined motivation, physical activity, coronary heart disease, relative autonomy index (RAI)

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Authors: Drutika Upadhyay

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Rape is one of the most heinous crimes committed against the body of a woman violating her privacy and dignity. The Right to Privacy and the Right to Live with Dignity constitute the very essence of the Right to Life and Personal Liberty, a Fundamental Right guaranteed under Article 21 of the Indian Constitution. The study is conducted with the primary objective of analyzing the efficacy of rape laws in India. The study begins by explaining the origin, meaning, and kinds of rape recognised under Indian jurisprudence. Further, it explains various statutory and penal provisions relating to rape and the loopholes in such provisions. It focuses on the procedure followed during investigation and trial and also aims at developing an understanding of the rights of the victim and the sentence in cases of rape. The study also throws some light upon the amendments made to the criminal law and the recommendations of the Law Commission of India to meet the demands of the changing criminal justice delivery system. The outcome of the study suggests that the laws relating to rape have proved to be a major failure owing to the lack of proper implementation. Also, the lack of education among the masses leads to gender biasness, which is the ultimate cause for the commission of such crime. At last, the author concludes that the present criminal law system of the country contains various lacunae that need to be filled in so as to make the criminal justice system more stringent. Further, the scope of the definition of ‘rape’ needs to be widened in order to include such other acts of non-consensual and sexual nature that are currently not included in the definition. The author has adopted a non-doctrinal and analytical approach and relied upon the secondary sources of data for the purpose of the study. The scope of the study is limited to the crime committed against women.

Keywords: amendment, criminal law, fundamental right, personal liberty, privacy, rape

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Authors: Boyu Li

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Mixed matrix membranes (MMMs), as a separation technology, can improve CO₂ recycling efficiency and reduce the environmental impacts associated with huge emissions. Nevertheless, many challenges must be overcome to design excellent selectivity and permeability performance MMMs. Herein, this work demonstrates the design of nano-scale GNPs (Cu-BDC@PEG) with strong compatibility and high free friction volume (FFV) is an effective way to construct non-interfacial voids MMMs with a desirable combination of selectivity and permeability. Notably, the FFV boosted thanks to the chain length and shape of the GNPs. With this, the permeability and selectivity of Cu-BDC@PEG/PVDF MMMs had also been significantly improved. As such, compatible Cu-BDC@PEG proves very efficient for resolving challenges of MMMs with poor compatibility on the basis of the interfacial defect. Poly (Ethylene Glycol) (PEG) with oxygen groups can be finely coordinated with Cu-MOFs to disperse Cu-BDC@PEG homogenously and form hydrogen bonds with matrix to achieve continuous phase. The resultant MMMs exhibited a simultaneous enhancement of gas permeability (853.1 Barrer) and ideal CO₂/N selectivity (41.7), which has surpassed Robenson's upper bound. Moreover, Cu-BDC@PEG/PVDF has a high-temperature resistance and a long time sustainably. This attractive separation performance of Cu-BDC@PEG/PVDF offered an exciting platform for the development of composite membranes for sustainable CO₂ separations.

Keywords: metal organic framework, CO₂ separation, mixed matrix membrane, polymer

Procedia PDF Downloads 117

Authors: Haruna Seidu, Francis Wilson Owusu, Michael Mensah, Felix Boakye, James Korang, Safia Ibrahim

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Over the years, wooden furniture produced in Ghana had no means of testing their products against standards. It was therefore difficult for such furniture producers to know whether their products conform to international standards. The setting up of the ISO 17025 compliant laboratory has become a reference and accessing point for determining the quality of the furniture they produce. The objective of the study includes the determination of mechanical safety, durability, strength, and stability of wooden furniture produced in Ghana. Twelve wooden furniture manufacturers were randomly selected to design furniture (chairs and tables) for testing. 9 out of the 12 produced chairs, and three provided tables. Standard testing methods were used in this experiment, including GS EN 581-1, GS EN 581-2, and GS EN 581-3. The test results analysis indicates 55.6% of the chairs tested passed all applicable tests. 66.7% of tables tested passed all the applicable tests. The percentage pass and failure of the 12 furniture were 58.3% and 41.7% respectively. In conclusion, chair manufacturers had good designs that withstand the standard testing of strength and durability; most failures occurred largely as a result of poor stability designs adopted for the construction of the chairs and tables. It was observed that the manufacturers did not use the software in designing their furniture.

Keywords: durability, international standards, mechanical safety, wooden furniture design

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Authors: Roseanne Sharon Borromeo, Mariana Carvalho, Mariia Karizhenskaia

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Healthcare providers need to comprehend cultural diversity for optimal patient-centered care, especially near the end of life. Although a universal method for navigating cultural differences would be ideal, culture’s high complexity makes this strategy impossible. Adding cultural humility, a process of self-reflection to understand personal and systemic biases and humbly acknowledging oneself as a learner when it comes to understanding another's experience leads to a meaningful process in palliative care generating respectful, honest, and trustworthy relationships. This study is a systematic review of the literature on cultural humility in palliative care research and best practices. Race, religion, language, values, and beliefs can affect an individual’s access to palliative care, underscoring the importance of culture in palliative care. Cultural influences affect end-of-life care perceptions, impacting bereavement rituals, decision-making, and attitudes toward death. Cultural factors affecting the delivery of care identified in a scoping review of Canadian literature include cultural competency, cultural sensitivity, and cultural accessibility. As the different parts of the world become exponentially diverse and multicultural, healthcare providers have been encouraged to give culturally competent care at the bedside. Therefore, many organizations have made cultural competence training required to expose professionals to the special needs and vulnerability of diverse populations. Cultural competence is easily standardized, taught, and implemented; however, this theoretically finite form of knowledge can dangerously lead to false assumptions or stereotyping, generating poor communication, loss of bonds and trust, and poor healthcare provider-patient relationship. In contrast, Cultural humility is a dynamic process that includes self-reflection, personal critique, and growth, allowing healthcare providers to respond to these differences with an open mind, curiosity, and awareness that one is never truly a “cultural” expert and requires life-long learning to overcome common biases and ingrained societal influences. Cultural humility concepts include self-awareness and power imbalances. While being culturally competent requires being skilled and knowledgeable in one’s culture, being culturally humble involves the sometimes-uncomfortable position of healthcare providers as students of the patient. Incorporating cultural humility emphasizes the need to approach end-of-life care with openness and responsiveness to various cultural perspectives. Thus, healthcare workers need to embrace lifelong learning in individual beliefs and values on suffering, death, and dying. There have been different approaches to this as well. Some adopt strategies for cultural humility, addressing conflicts and challenges through relational and health system approaches. In practice and research, clinicians and researchers must embrace cultural humility to advance palliative care practices, using qualitative methods to capture culturally nuanced experiences. Cultural diversity significantly impacts patient-centered care, particularly in end-of-life contexts. Cultural factors also shape end-of-life perceptions, impacting rituals, decision-making, and attitudes toward death. Cultural humility encourages openness and acknowledges the limitations of expertise in one’s culture. A consistent self-awareness and a desire to understand patients’ beliefs drive the practice of cultural humility. This dynamic process requires practitioners to learn continuously, fostering empathy and understanding. Cultural humility enhances palliative care, ensuring it resonates genuinely across cultural backgrounds and enriches patient-provider interactions.

Keywords: cultural competency, cultural diversity, cultural humility, palliative care, self-awareness

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Authors: Mohammad Najmol Haque, Takeshi Maki, Jun Sasaki

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Headed stud shear connections are widely used in the junction or embedded zone of hybrid girder to achieve whole composite action with continuity that can sustain steel-concrete interfacial tensile and shear forces. In Japan, Japan Road Association (JRA) specifications are used for hybrid girder design that utilizes very low level of stud capacity than those of American Institute of Steel Construction (AISC) specifications, Japan Society of Civil Engineers (JSCE) specifications and EURO code. As low design shear strength is considered in design of connections, the time dependent shear behavior due to sustained external loading is not considered, even not fully studied. In this study, a finite element approach was used to evaluate the time dependent shear behavior for headed studs used as connections at the junction. This study clarified, how the sustained loading distinctively impacted on changing the interfacial shear of connections with time which was sensitive to lodging history, positions of flanges, neighboring studs, position of prestress bar and reinforcing bar, concrete strength, etc. and also identified a shear influence area. Stud strength was also confirmed through pushout tests. The outcome obtained from the study may provide an important basis and reference data in designing connections of hybrid girders with enhanced stud capacity with due consideration of their long-term shear behavior.

Keywords: finite element, hybrid girder, shear connections, sustained loading, time dependent behavior

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Authors: Maryam Ziaee

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This research proposes a new approach and provides an opportunity for manufacturing companies to produce large amounts of products that meet their prospective customers’ tastes, needs, and expectations and simultaneously enable manufacturers to increase their profit. Mass customization is the production of products or services to meet each individual customer’s desires to the greatest possible extent in high quantities and at reasonable prices. This process takes place at different levels such as the customization of goods’ design, assembly, sale, and delivery status, and classifies in several categories. The main focus of this study is on one class of mass customization, called optional customization, in which companies try to provide their customers with as many options as possible to customize their products. These options could range from the design phase to the manufacturing phase, or even methods of delivery. Mass customization values customers’ tastes, but it is only one side of clients’ satisfaction; on the other side is companies’ fast responsiveness delivery. It brings the concept of agility, which is the ability of a company to respond rapidly to changes in volatile markets in terms of volume and variety. Indeed, mass customization is not effectively feasible without integrating the concept of agility. To gain the customers’ satisfaction, the companies need to be quick in responding to their customers’ demands, thus highlighting the significance of agility. This research offers a different method that successfully integrates mass customization and fast production in manufacturing industries. This research is built upon the hypothesis that the success key to being agile in mass customization is to forecast demand, cooperate with suppliers, and control inventory. Therefore, the significance of the supply chain (SC) is more pertinent when it comes to this stage. Since SC behavior is dynamic and its behavior changes constantly, companies have to apply one of the predicting techniques to identify the changes associated with SC behavior to be able to respond properly to any unwelcome events. System dynamics utilized in this research is a simulation approach to provide a mathematical model among different variables to understand, control, and forecast SC behavior. The final stage is delayed differentiation, the production strategy considered in this research. In this approach, the main platform of products is produced and stocked and when the company receives an order from a customer, a specific customized feature is assigned to this platform and the customized products will be created. The main research question is to what extent applying system dynamics for the prediction of SC behavior improves the agility of mass customization. This research is built upon a qualitative approach to bring about richer, deeper, and more revealing results. The data is collected through interviews and is analyzed through NVivo software. This proposed model offers numerous benefits such as reduction in the number of product inventories and their storage costs, improvement in the resilience of companies’ responses to their clients’ needs and tastes, the increase of profits, and the optimization of productivity with the minimum level of lost sales.

Keywords: agility, manufacturing, resilience, supply chain

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Authors: Igor Michel Gachig, Samanta Tiague

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Baka ‘Pygmies’ is an indigenous community living in the rainforest region of Cameroon. This community is known to be poor and marginalized from the political, economic and social life, regardless of sedentarization and development efforts. In fact, the social exclusion of ‘Pygmy’ people prevents them from gaining basic citizen’s rights, among which access to education, land, healthcare, employment and justice. In this study, social interactions, behaviors, and perceptions were considered. An interview guide and focus group discussions were used to collect data. A sample size of 97 was used, with 60 Baka Pygmies and 37 Bantus from two Baka-Bantu settlements/villages of the south region of Cameroon. The data were classified in terms of homogenous, exhaustive and exclusive categories. This classification has enabled factors explaining social exclusion in the Baka community to be highlighted using content analysis. The study shows that (i) limited access to education, natural resources and care in modern healthcare organizations, and (ii) different views on the development expectations and integration approaches both highlight the social exclusion in the Baka ‘Pygmies’ community. Therefore, an effective and adequate social integration of ‘Pygmies’ based on cultural peculiarities and identity, as well as reduction of disparities and improvement of their access to education should be of major concern to the government and policy makers.

Keywords: development, indigenous people, integration, social exclusion

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Authors: Irma Gabriela Lopez-Moreno, Elva Perez-Luque, Herlinda Aguilar-Zavala

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Introduction: Type 2 Diabetes Mellitus (T2DM) is characterized by combination of insulin resistance and deterioration of insulin secretion. Sfrp5 is a protein that antagonizes Wnt5a proteins by preventing it from reaching its receptor and activating the Wnt/β-catenin signaling pathway, this pathway is one of the most important regulators of adipogenesis. Although metformin decreases glucose levels its mechanisms of action are not fully known but it has been implicated in the inhibition of the Wnt/β-catenin signaling pathway. Objective: The objective was evaluating the effects of metformin on serum levels of Sfrp5 in patients with T2DM treated and not treated with metformin. Methods: Two groups of patients were selected: one group of T2DM patients treated with metformin (n = 35) and another group of subjects with recent diagnosis of T2DM untreated (n = 35) with a mean age of 48 ± 9 years. In these subjects anthropometric measures were taken as weight, height, waist and hip circumference, were calculated the percentage of body fat, visceral fat and muscle mass. In addition, were measured glucose levels, lipid profile, adiponectin and Sfrp5. Results: Sfrp5 were higher in metformin-treated patients compared to the untreated group (19.9 vs 13.6 ng/mL p < 0.001), a negative correlation was found between Sfrp5 levels and total cholesterol levels (r= -0.25, p = 0.03) and percentage of visceral fat (r = -0.26, p = 0.03) and a positive correlation with HDL cholesterol levels (r = 0.31, p = 0.01) and adiponectin (r=0.65, p = < 0.001). Conclusions: The findings show that metformin consumption increased levels of Sfrp5, which may lead to a decrease in the activation of the WNT/β-catenin pathway impacting on adipogenesis.

Keywords: adiponectin, diabetes, metformin, Sfrp5

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Authors: R. O. Osaseri, A. R. Usiobaifo

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The power transformer which is responsible for the voltage transformation is of great relevance in the power system and oil-immerse transformer is widely used all over the world. A prompt and proper maintenance of the transformer is of utmost importance. The dissolved gasses content in power transformer, oil is of enormous importance in detecting incipient fault of the transformer. There is a need for accurate prediction of the incipient fault in transformer oil in order to facilitate the prompt maintenance and reducing the cost and error minimization. Study on fault prediction and diagnostic has been the center of many researchers and many previous works have been reported on the use of artificial intelligence to predict incipient failure of transformer faults. In this study machine learning technique was employed by using gradient decent algorithms and Support Vector Machine (SVM) in predicting incipient fault diagnosis of transformer. The method focuses on creating a system that improves its performance on previous result and historical data. The system design approach is basically in two phases; training and testing phase. The gradient decent algorithm is trained with a training dataset while the learned algorithm is applied to a set of new data. This two dataset is used to prove the accuracy of the proposed model. In this study a transformer fault diagnostic model based on Support Vector Machine (SVM) and gradient decent algorithms has been presented with a satisfactory diagnostic capability with high percentage in predicting incipient failure of transformer faults than existing diagnostic methods.

Keywords: diagnostic model, gradient decent, machine learning, support vector machine (SVM), transformer fault

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Authors: J. Martin, A. Nominé, T. Czerwiec, G. Henrion, T. Belmonte

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The plasma electrolytic oxidation (PEO) is a particular electrochemical process to produce protective oxide ceramic coatings on light-weight metals (Al, Mg, Ti). When applied to aluminum alloys, the resulting PEO coating exhibit improved wear and corrosion resistance because thick, hard, compact and adherent crystalline alumina layers can be achieved. Several investigations have been carried out to improve the efficiency of the PEO process and one particular way consists in tuning the suitable electrical regime. Despite the considerable interest in this process, there is still no clear understanding of the underlying discharge mechanisms that make possible metal oxidation up to hundreds of µm through the ceramic layer. A key parameter that governs the PEO process is the numerous short-lived micro-discharges (micro-plasma in liquid) that occur continuously over the processed surface when the high applied voltage exceeds the critical dielectric breakdown value of the growing ceramic layer. By using a bipolar pulsed current to supply the electrodes, we previously observed that micro-discharges are delayed with respect to the rising edge of the anodic current. Nevertheless, explanation of the origin of such phenomena is still not clear and needs more systematic investigations. The aim of the present communication is to identify the relationship that exists between this delay and the mechanisms responsible of the oxide growth. For this purpose, the delay of micro-discharges ignition is investigated as the function of various electrical parameters such as the current density (J), the current pulse frequency (F) and the anodic to cathodic charge quantity ratio (R = Qp/Qn) delivered to the electrodes. The PEO process was conducted on Al2214 aluminum alloy substrates in a solution containing potassium hydroxide [KOH] and sodium silicate diluted in deionized water. The light emitted from micro-discharges was detected by a photomultiplier and the micro-discharge parameters (number, size, life-time) were measured during the process by means of ultra-fast video imaging (125 kfr./s). SEM observations and roughness measurements were performed to characterize the morphology of the elaborated oxide coatings while XRD was carried out to evaluate the amount of corundum -Al203 phase. Results show that whatever the applied current waveform, the delay of micro-discharge appearance increases as the process goes on. Moreover, the delay is shorter when the current density J (A/dm2), the current pulse frequency F (Hz) and the ratio of charge quantity R are high. It also appears that shorter delays are associated to stronger micro-discharges (localized, long and large micro-discharges) which have a detrimental effect on the elaborated oxide layers (thin and porous). On the basis of the results, a model for the growth of the PEO oxide layers will be presented and discussed. Experimental results support that a mechanism of electrical charge accumulation at the oxide surface / electrolyte interface takes place until the dielectric breakdown occurs and thus until micro-discharges appear.

Keywords: aluminium, micro-discharges, oxidation mechanisms, plasma electrolytic oxidation

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Authors: Qasim Munye, Juned Islam, Haseeb Qureshi, Syed Jung

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Lung nodules are commonly identified in computed tomography (CT) scans by experienced radiologists at a relatively late stage. Early diagnosis can greatly increase survival. We propose using a pix2pix conditional generative adversarial network to generate realistic images simulating early-stage lung nodule growth. We have applied deep images prior to 2341 slices from 895 computed tomography (CT) scans from the Lung Image Database Consortium (LIDC) dataset to generate pseudo-healthy medical images. From these images, 819 were chosen to train a pix2pix network. We observed that for most of the images, the pix2pix network was able to generate images where the nodule increased in size and intensity across epochs. To evaluate the images, 400 generated images were chosen at random and shown to a medical student beside their corresponding original image. Of these 400 generated images, 384 were defined as satisfactory - meaning they resembled a nodule and were visually similar to the corresponding image. We believe that this generated dataset could be used as training data for neural networks to detect lung nodules at an early stage or to improve the accuracy of such networks. This is particularly significant as datasets containing the growth of early-stage nodules are scarce. This project shows that the combination of deep image prior and generative models could potentially open the door to creating larger datasets than currently possible and has the potential to increase the accuracy of medical classification tasks.

Keywords: medical technology, artificial intelligence, radiology, lung cancer

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Authors: Henry Wilde, Thiravat Hemachudha

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Human rabies deaths are underreported worldwide at 55,000 annual cases; more than of dengue and Japanese encephalitis. Almost half are children. A recent study from the Philippines of nearly 2,000 rabies deaths revealed that none of had received incomplete or no post exposure prophylaxis. Coming from a canine rabies endemic country, this is not unique. There are two major barriers to reducing human rabies deaths: 1) the large number of unvaccinated dogs and 2) post-exposure prophylaxis (PEP) that is not available, incomplete, not affordable, or not within reach for bite victims travel means. Only the first barrier, inadequate vaccination of dogs, is now being seriously addressed. It is also often not done effectively or sustainably. Rabies PEP has evolved as a complex, prolonged process, usually delegated to centers in larger cities. It is virtually unavailable in villages or small communities where most dog bites occur, victims are poor and usually unable to travel a long distance multiple times to receive PEP. Reseacrh that led to better understanding of the pathophysiology of rabies and immune responses to potent vaccines and immunoglobulin have allowed shortening and making PEP more evidence based. This knowledge needs to be adopted and applied so that PEP can be rendered safely and affordably where needed the most: by village health care workers who have long performed more complex services after appropriate training. Recent research makes this an important and long neglected goal that is now within our means to implement.

Keywords: rabies, post-exposure prophylaxis, availability, immunoglobulin

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Authors: Zhang Shuqi, Liu Dan

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For the problems in intelligent network anomaly traffic detection models, such as low detection accuracy caused by the lack of training samples, poor effect with small sample attack detection, a classification model enhancement method, F-ACGAN(Flow Auxiliary Classifier Generative Adversarial Network) which introduces generative adversarial network and adversarial training, is proposed to solve these problems. Generating adversarial data with category labels could enhance the training effect and improve classification accuracy and model robustness. FACGAN consists of three steps: feature preprocess, which includes data type conversion, dimensionality reduction and normalization, etc.; A generative adversarial network model with feature learning ability is designed, and the sample generation effect of the model is improved through adversarial iterations between generator and discriminator. The adversarial disturbance factor of the gradient direction of the classification model is added to improve the diversity and antagonism of generated data and to promote the model to learn from adversarial classification features. The experiment of constructing a classification model with the UNSW-NB15 dataset shows that with the enhancement of FACGAN on the basic model, the classification accuracy has improved by 8.09%, and the score of F1 has improved by 6.94%.

Keywords: data imbalance, GAN, ACGAN, anomaly detection, adversarial training, data augmentation

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Authors: Luiz Ernani Meira Jr., Antônio Prates Caldeira, Gilson Gabriel Viana Veloso, Jackson Andrade

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Background: In Brazil, primary health care (PHC) system has developed with multidisciplinary teams in facilities located in peripheral areas, as the entrance doors for all patients. So, professionals must be prepared to deal with patients with simple and complex problems. Objective: To evaluate the knowledge and the skills of physicians and nurses of PHC on cardiorespiratory arrest (CRA) and cardiopulmonary resuscitation (CPR) before and after training in Basic Life Support. Methods: This is a before-and-after study developed in a Simulation Laboratory in Montes Claros, Brazil. We included physicians and nurses randomly chosen from PHC services. Written tests on CRA and CPR were carried out and performances in a CPR simulation were evaluated, based on the American Heart Association recommendations. Training practices were performed using special manikins. Statistical analysis included Wilcoxon’s test to compare before and after scores. Results: Thirty-two professionals were included. Only 38% had previous courses and updates on emergency care. Most of professionals showed poor skills to attend to CRA in a simulated situation. Subjects showed an increased in knowledge and skills about CPR after training (p-value=0.003). Conclusion: Primary health care professionals must be continuously trained to assist urgencies and emergencies, like CRA.

Keywords: primary health care, professional training, cardiopulmonary resuscitation, cardiorespiratory, emergency

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Authors: Hasan Bulent Kantarci

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This paper examine how Zakat provide a fair income redistribution and struggle with poverty. To provide a fair income redistribution and struggle with poverty take place among the fundamental tasks of all countries. Each country seeks a solution for this problem according to their political, economical and administrative styles through applying various economic and financial policies. The same situation gets handled via zakat association in the Islam. Nowadays, we observe different versions of zakat in developed countries. The applications such as negative income tax denote merely a difference from the zakat being applied almost the same way under changed names. But the minimum values to donate the zakat (e.g. 85 gr. gold and 40 animals) get altered and various amounts are put into practice. It might be named as negative income tax instead of zakat, nonetheless, these applications are based on the Holy Koran and the hadith released 1400 years ago. Besides, considering the savage and slavery in the world at those times, we might easily recognize the true value of the zakat applied the first time then in Islamic system. Through zakat is enabled an income transfer by the government so that the poor could reach the minimum level of life standard. To whom the zakat would be donated was not left to people’s heart and encouraged to determine according to objective criteria. Since the zakat is obligatory, the transfer do not get forward by hand but via the government and get distributed, which requires a vast government organization. Through applying the zakat as it must be would achieve to reduce the poverty mostly and ensuring the fair income redistribution.

Keywords: Islamic finance, zakat, income redistribution, circle of poverty, negatif income tax

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Authors: Ratna Farida Soenarto, Anas Alatas, Made Ryan Kharmayani

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Background: Conventional ultrafiltration (CUF) system was shown to be helpful in reducing anti-inflammatory mediators for patients who underwent open heart surgery. Additionally, modified ultrafiltration (MUF) has been shown to reduce anti-inflammatory mediators further while reducing interstitial fluid volume at the same time. However, there has been minimal data concerning the efficacy of combining both ultrafiltration methods. This study aims to compare inflammation marker, vascular resistance, and cardiac index on CUF+MUF patients with CUF only patients undergoing open heart surgery. Method: This is a single blind randomized controlled trial on patients undergoing open heart surgery between June 2021 - October 2021 in CiptoMangunkusumo National Referral Hospital and Jakarta Heart Hospital. Patients wererandomized using block randomization into modified ultrafiltration following conventional ultrafiltration (CUF+MUF) and conventional ultrafiltration (CUF) only. Outcome assessed in this study were 24-hoursinterleukin-6 levels, systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), and cardiac index. Results: A total of 38patients were included (19 CUF+MUF and 19 CUF subjects). There was no difference in postoperative IL-6 level between groups (p > 0.05).No difference in PVR was observed between groups.Higher difference in SVR was observed in CUF+MUF group (-646 vs. -261dyn/s/cm-5, p < 0.05). Higher cardiac index was observed on CUF+MUF group (0.93 vs. 0.48, p < 0.05). Conclusion: Patients undergoing open heart surgery with modified ultrafiltration following conventional ultrafiltration had similar systemic inflammatory response and better cardiac response than those having conventional ultrafiltration.

Keywords: open-heart, CUF, MUF, SVR, PVR, IL-6

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Authors: Thanakorn Thanawat, Nomjit Nualnetr

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Background and Purpose: In Thailand, rice farmers have the most prevalence of low back pain when compared with other manual workers. Exercises have been suggested to be a principal part of treatment programs for low back pain. However, the programs should be tailored to an individual’s readiness to change categorized by a behavioral approach. This study aimed to evaluate a difference between the responses of rice farmers with chronic low back pain who received an exercise program integrated with the transtheoretical model of behavior change (TTM) and those of the comparison group regarding severity of pain and trunk muscle endurance. Materials and Methods: An 8-week exercise program was conducted to rice farmers with chronic low back pain who were randomized to either the TTM (n=62, 52 woman and 10 men, mean age ± SD 45.0±5.4 years) or non-TTM (n=64, 53 woman and 11 men, mean age ± SD 44.7±5.4 years) groups. All participants were tested for their severity of pain and trunk (abdominal and back) muscle endurance at baseline (week 0) and immediately after termination of the program (week 8). Data were analysed by using descriptive statistics and student’s t-tests. The results revealed that both TTM and non-TTM groups could decrease their severity of pain and improve trunk muscle endurance after participating in the 8-week exercise program. When compared with the non-TTM group, however, the TTM showed a significantly greater increase in abdominal muscle endurance than did the non-TTM (P=0.004, 95% CI -12.4 to -2.3). Conclusions and Clinical Relevance: An exercise program integrated with the TTM could provide benefits to rice farmers with chronic low back pain. Future studies with a longitudinal design and more outcome measures such as physical performance and quality of life are suggested to reveal further benefits of the program.

Keywords: chronic low back pain, transtheoretical model, rice farmers, exercise program

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Authors: Keiko Naito, Y. Nakashima, S. Yamauchi, Y. Kunitani, Y. Ishigami, K. Numata, M. Mizobe, Y. Homma, J. Takahashi, T. Inoue, T. Shiga, H. Funakoshi

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Background: A presence of severe acidemia, defined as pH < 7.2, is common during endotracheal intubation for critically ill patients in the emergency department (ED). Severe acidemia is widely recognized as a predisposing factor for intubation failure. However, it is unclear that acidemic condition itself actually makes endotracheal intubation more difficult. We aimed to evaluate if a presence of severe acidemia before intubation is associated with the lower first attempt intubation success rate in the ED. Methods: This is a retrospective observational cohort study in the ED of an urban hospital in Japan. The collected data included patient demographics, such as age, sex, and body mass index, presence of one or more factors of modified LEMON criteria for predicting difficult intubation, reasons for intubation, blood gas levels, airway equipment, intubation by emergency physician or not, and the use of the rapid sequence intubation technique. Those with any of the following were excluded from the analysis: (1) no blood gas drawn before intubation, (2) cardiopulmonary arrest, and (3) under 18 years of age. The primary outcome was the first attempt intubation success rates between a severe acidemic patients (SA) group and a non-severe acidemic patients (NA) group. Logistic regression analysis was used to test the first attempt success rates for intubations between those two groups. Results: Over 5 years, a total of 486 intubations were performed; 105 in the SA group and 381 in the NA group. The univariate analysis showed that the first attempt intubation success rate was lower in the SA group than in the NA group (71.4% vs 83.5%, p < 0.01). The multivariate logistic regression analysis identified that severe acidemia was significantly associated with the first attempt intubation failure (OR 1.9, 95% CI 1.03-3.68, p = 0.04). Conclusions: A presence of severe acidemia before endotracheal intubation lowers the first attempt intubation success rate in the ED.

Keywords: acidemia, airway management, endotracheal intubation, first-attempt intubation success rate

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Authors: Muhammad Izzam Bin Mohd Khazar, Ruqayyah Binti Mohamad Ali, Nurul Atiqah Binti Yusri

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Value-based intermediation (VBI) has been introduced by Bank Negara Malaysia (BNM) as the next strategic direction and growth driver for Islamic banking institutions. The aim of VBI is to deliver the intended outcome of Shariah through practices, conducts, and offerings that generate positive and sustainable impact to the economy, community and environment which is aligned to Maqasid Shariah in preserving the common interest of society by preventing harm and maximizing benefit. Hence, upon its implementation, VBI will experiment the current Shariah compliance treatment and revolutionise new policies and systems that can meritoriously entrench and convey the objectives of Shariah. However, discussion revolving VBI in the light of Maqasid analysis is still scarce hence further research needs to be undertaken. The idea of implementation of VBI vision into quantifiable Maqasid Shariah measurement is yet to be explored due to the nature of Maqasid that is variable. The contemporary scholars also have different views on the implementation of VBI. This paper aims to discuss on the importance of Maqasid Shariah in the current Islamic finance transactions by providing Shariah index measurement in the application of VBI. This study also intends to explore basic Shariah guidelines and parameters based on the objectives of Shariah; preservation of the five pillars (religion, life, progeny, intellect and wealth) with further elaboration on preservation of wealth under five headings: rawaj (circulation and marketability); wuduh (transparency); hifz (preservation); thabat (durability and tranquillity); and ‘adl (equity and justice). In alignment with these headings, Islamic finance can be innovated for VBI implementation, particularly in Maybank Islamic being a significant leader in the IFI market.

Keywords: Islamic Financial Institutions, Maqasid Index, Maqasid Shariah, sustainability, value-based intermediation

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Authors: D. Bheenick, M. Young, M.Elmussareh, A.Ali

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Objective: Coronavirus disease 2019 (COVID-19) has had unprecedented effects on the healthcare system in the UK. The pandemic has impacted every service within secondary care, including urology. Our objective is to determine how COVID-19 has influenced acute urology admissions in a busy district general hospital in the UK. Patient and methods: Retrospective data of patients presenting acutely to the urology department was collected between 13th January to 22nd March 2020 (pre-lockdown period) and 23rd March to 31st May 2020 (lockdown period). The nature of referrals, types of admission encountered, and management required in accordance with the new set of protocols established during the lockdown period were analysed and compared to the same data prior to UK lockdown. Results: 1092 patients were included in the study. An overall reduction of 32.5% was seen in the total number of admissions. A marked decrease was seen in non-urological pathology as compared to other categories. Urolithiasis showed the highest proportional increase. Treatment varied proportionately to the diagnosis, with conservative management accounting for the most likely treatment during lockdown. However, the proportion of patients requiring interventions during the lockdown period increased overall. No comparative differences were observed during the two periods in terms of source of referral, length of stay and patient age. Conclusion: The admission rate showed a decrease, with no significant difference in the nature and timing of presentation. Our department was able to continue providing effective management to patients presenting acutely during the COVID-19 outbreak.

Keywords: COVID-19, lockdown, admissions, urology

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