Search results for: patient state index

Authors: Samaneh Abolli, Mahdi Ahmadi Nasab, Kamyar Yaghmaeian, Mahmood Alimohammadi

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The quality of drinking water, in addition to the presence of physicochemical parameters, depends on the type and geographical location of water sources. In this study, groundwater quality was investigated by sampling total dissolved solids (TDS), electrical conductivity (EC), total hardness (TH), Cl, Ca²⁺, and Mg²⁺ parameters in 13 sites, and 40 water samples were sent to the laboratory. Electrometric, titration, and spectrophotometer methods were used. In the next step, the water quality index (WQI) was used to investigate the impact and weight of each parameter in the groundwater. The results showed that only the mean of magnesium ion (40.88 mg/l) was lower than the guidelines of World Health Organization (WHO). Interpreting the WQI based on the WHO guidelines showed that the statuses of 21, 11, and 7 samples were very poor, poor, and average quality, respectively, and one sample had excellent quality. Among the studied parameters, the means of EC (2,087.49 mS/cm) and Cl (1,015.87 mg/l) exceeded the global and national limits. Classifying water quality of TH was very hard (87.5%), hard (7.5%), and moderate (5%), respectively. Based on the geographical distribution, the drinking water index in sites 4 and 11 did not have acceptable quality. Chloride ion was identified as the responsible pollutant and the most important ion for raising the index. The outputs of statistical tests and Spearman correlation had significant and direct correlation (p < 0.05, r > 0.7) between TDS, EC, and chloride, EC and chloride, as well as TH, Ca²⁺, and Mg²⁺.

Keywords: water quality index, groundwater, chloride, GIS, Garmsar

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Authors: Abdelkrim Alfalah, Lahcen Ouarbya, John Howroyd

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This paper investigates and compares the performance of four existing distances and similarity measures between partitions. The partition measures considered are Rand Index (RI), Adjusted Rand Index (ARI), Variation of Information (VI), and Normalised Variation of Information (NVI). This work investigates the ability of these partition measures to capture three predefined intuitions: the variation within randomly generated partitions, the sensitivity to small perturbations, and finally the independence from the dataset scale. It has been shown that the Adjusted Rand Index performed well overall, with regards to these three intuitions.

Keywords: clustering, comparing partitions, similarity measure, partition distance, partition metric, similarity between partitions, clustering comparison.

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Authors: L. Korpinen, T. Kava, I. Salmi

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This study aimed to describe the operating model of obstructive sleep apnea. Due to the large number of patients, the role of nurses in the diagnosis and treatment of sleep apnea was important. Pulmonary physicians met only a minority of the patients. The sleep apnea study in 2018 included about 800 patients, of which about 28% were normal and 180 patients were classified as severe (apnea-hypopnea index [AHI] over 30). The operating model has proven to be workable and appropriate. The patients understand well that they may not be referred to a pulmonary doctor. However, specialized medical follow-up on professional drivers continues every year.

Keywords: sleep, apnea patient, operating model, hospital

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Authors: Guanhua Zhou, Zhongqi Ma

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Submerged aquatic vegetation (SAV) in wetlands can absorb nitrogen and phosphorus effectively to prevent the eutrophication of water. It is feasible to monitor the distribution of SAV through remote sensing, but for the reason of weak vegetation signals affected by water body, traditional terrestrial vegetation indices are not applicable. This paper aims at constructing SAV index to enhance the vegetation signals and distinguish SAV from water body. The methodology is as follows: (1) select the bands sensitive to the vegetation parameters based on global sensitivity analysis of SAV canopy radiative transfer model; (2) take the soil line concept as reference, analyze the distribution of SAV and water reflectance simulated by SAV canopy model and semi-analytical water model in the two-dimensional space built by different sensitive bands; (3)select the band combinations which have better separation performance between SAV and water, and use them to build the SAVI indices in the form of normalized difference vegetation index(NDVI); (4)analyze the sensitivity of indices to the water and vegetation parameters, choose the one more sensitive to vegetation parameters. It is proved that index formed of the bands with central wavelengths in 705nm and 842nm has high sensitivity to chlorophyll content in leaves while it is less affected by water constituents. The model simulation shows a general negative, little correlation of SAV index with increasing water depth. Moreover, the index enhances capabilities in separating SAV from water compared to NDVI. The SAV index is expected to have potential in parameter inversion of wetland remote sensing.

Keywords: global sensitivity analysis, radiative transfer model, submerged aquatic vegetation, vegetation indices

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Authors: Man Bahadur Shahu

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The secularism is a controversial, debatable and misinterpreted issue since its endorsement in the 2007 constitution in Nepal. The unprecedented acts have been seen favoring and disfavoring against the secularism within the public domain—which creates the fallacies and suspicions in the rationalization and modernization process. This paper highlights three important points: first, the secularization suddenly ruptures the silence and institutional decline of religion within the state. Second, state effort on secularism simultaneously fosters the state neutrality and state separation from religious institutions that amplify the recognition of all religious groups through the equal treatment in their festivity, rituals, and practices. Third, no state would completely secular because of their deep-rooted mindset and disposition with their own religious faiths and beliefs that largely enhance intergroup conflict, dispute, riot and turbulence in post-secular period in the name of proselytizing and conversion.

Keywords: conflict, proselytizing, religion, secular

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Authors: A. K. Srivastva

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Body weight is considered as an important factor in health and fitness. It is an index of one's health. Considering significance of body weight and its wider application in various fields in general and sports in particular, it is made a point of enquiry in the present study. The purpose of the study to observe over all weight pattern of Indian youths in the age group of 15 through 20 years. Total 7500 samples pooled from ten Indian states ranging in their age 15 to 20 years were examined in six age categories. Conclusion: 1. The period between 15 to 20 year of age is a growing period and that body weight is gained during this period. 2. Statewise difference is observed in body-weight during the period, which is significant. 3. PRG indicated by higher rate of weight gain varies from state to state. 4. Sportsman possess comparatively higer level of body-weight than other student of same age group. 5. Tribal youths show comparatively better status in their weight gain than the untrained uraban dwellers.

Keywords: PRG (period of rapid growth), HG (heterogeneous group), WP (weight pattern), MBW (mean body weight)

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Authors: Anirudh Sharma

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Introduction: The Covid-19 pandemic necessitated a change in the manner outpatient fracture clinics are conducted due to the need to reduce footfall in hospital. While studies regarding virtual fracture clinics have shown these to be useful and effective, they focus exclusively on remote consultations. However, our service was bespoke to the patient – either a face-to-face or telephone consultation depending on patient need – a ‘hybrid virtual clinic (HVC).’ We report patient satisfaction and outcomes with this novel service. Methods: Patients booked onto our fracture clinics during the first 2 weeks of national lockdown were retrospectively contacted to assess the mode of consultations (virtual, face-to-face, or hybrid), patient experience, and outcome. Patient experience was assessed using the net promoter (NPS), customer effort (CES) and customer satisfaction scores (CSS), and their likelihood of using the HVC in the absence of a pandemic. Patient outcomes were assessed using the components of the EQ5D score. Results: Of 269 possible patients, 140 patients responded to the questionnaire. Of these, 66.4% had ‘hybrid’ consultations, 27.1% had only virtual consultations, and 6.4% had only face-to-face consultations. The mean overall NPS, CES, and CSS (on a scale of 1-10) were 7.27, 7.25, and 7.37, respectively. The mean likelihood of patients using the HVC in the absence of a pandemic was 6.5/10. Patients who had ‘hybrid’ consultations showed better effort scores and greater overall satisfaction than those with virtual consultations only and also reported superior EQ5D outcomes (mean 79.27 vs. 72.7). Patients who did not require surgery reported increased satisfaction (mean 7.51 vs. 7.08) and were more likely to use the HVC in the absence of a pandemic. Conclusion: Our study indicates that a bespoke HVC has good overall patient satisfaction and outcomes and is a better format of fracture clinic service than virtual consultations alone. It may be the preferred mode for fracture clinics in similar situations in the future. Further analysis needs to be conducted in order to explore the impact on resources and clinician experience of HVC in order to appreciate this new paradigm shift.

Keywords: hybrid virtual clinic, coronavirus, COVID-19, fracture clinic, remote consultation

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Authors: Abdel-Aziz M. Mohamed

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This research proposes a methodology to estimate the customer order lead time in the supply chain based on the process capability index. The cases when the process output is normally distributed and when it is not are considered. The relationships between the system capability indices in both service and manufacturing applications, delivery system reliability and the percentages of orders delivered after their promised due dates are presented. The proposed method can be used to examine the current process capability to deliver the orders before the promised lead-time. If the system was found to be incapable, the method can be used to help revise the current lead-time to a proper value according to the service reliability level selected by the management. Numerical examples and a case study describing the lead time estimation methodology and testing the system capability of delivering the orders before their promised due date are illustrated.

Keywords: lead-time estimation, process capability index, delivery system reliability, statistical analysis, service achievement index, service quality

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Authors: Parwinder Singh, Ashok Kumar

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Aim: The aim of the study was to investigate the relationship between selected Anthropometric and physical fitness variables of Junior Free Style Wrestlers. Method: one hundred fifty (N = 150) male Junior Free Style Wrestlers were selected as subjects, and they were categorized into five groups according to their weight categories; each group was comprised of 30 wrestlers. Body Mass Index can be considered according to the World Health Organization. Body fat percentage was assessed by using Durnin and Womersley equation, and Bodyweight was checked with a weighing machine. Cardiovascular endurance was checked by the Havard Step test of junior freestyle wrestlers. Results: A statistically positive significant correlation was found between Body Weight and Body Mass Index, skinfold thickness, and Percentage Body Fat. Fitness index was observed as negatively significant relationship related with Body Weight, Percent Body Fat, and Body Mass Index. Conclusion: It is concluded that freestyle wrestling is a weight classified sport and physical fitness is the most important factor in freestyle wrestling; therefore, the correlation of the fitness index of the wrestlers with body composition is important. The results of the present study also demonstrated the effect of Age, Body Height, Body Weight, Body Mass Index, and percentage body fat of the aerobic fitness of junior freestyle wrestlers.

Keywords: aerobic fitness, anthropometry, fat percentage, free style wrestling, skinfold, strength

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Authors: K. A. Ghazaryan, T. H. Derdzyan

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For assessment of the soils pollution level of the open mine and tailing dump of surrounding territories of Akhtala ore processing combine by heavy metals in 2013 collected soil samples and analyzed for different heavy metals, such as Cu, Zn, Pb, Ni and Cd. The main soil type in the study sites was the mountain cambisol. To classify soil pollution level contamination indices like Contamination factors (Cf), Degree of contamination (Cd), Pollution load index (PLI) and Geoaccumulation index (I-geo) are calculated. The distribution pattern of trace metals in the soil profile according to I geo, Cf and Cd values shows that the soil is very polluted. And also the PLI values for the 19 sites were >1, which indicates deterioration of site quality.

Keywords: soils pollution, heavy metal, geoaccumulation index, pollution load index, contamination factor

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Authors: Abrar R. Al-Hasan

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Despite the widespread use of social media by consumers and marketers, empirical research investigating their economic value in the healthcare industry still lags. This study explores the impact of the use of social media marketing efforts on a hospital's brand equity and, ultimately, consumer response. Using social media data from Twitter and Facebook, along with an online and offline survey methodology, data is analyzed using logistic regression models. A random sample of (728) residents of the Kuwaiti population is used. The results of this study found that social media marketing efforts (SMME) in terms of use and validation lead to higher hospital brand equity and in turn, patient loyalty and patient visit. The study highlights the impact of SMME on hospital brand equity and patient response. Healthcare organizations should guide their marketing efforts to better manage this new way of marketing and communicating with patients to enhance their consumer loyalty and financial performance.

Keywords: brand equity, healthcare marketing, patient visit, social media, SMME

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Authors: Suren Chilingaryan

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We study two models describing a single two-level system coupled to two boson field modes in either a parallel or orthogonal setup. Both models may be feasible for experimental realization through Raman adiabatic driving in cavity QED. We study their ground state configurations; that is, we find the quantum precursors of the corresponding semi-classical phase transitions. We found that the ground state configurations of both models present the same critical coupling as the quantum Rabi model. Around this critical coupling, the ground state goes from the so-called normal configuration with no excitation, the qubit in the ground state and the fields in the quantum vacuum state, to a ground state with excitations, the qubit in a superposition of ground and excited state, while the fields are not in the vacuum anymore, for the first model. The second model shows a more complex ground state configuration landscape where we find the normal configuration mentioned above, two single-mode configurations, where just one of the fields and the qubit are excited, and a dual-mode configuration, where both fields and the qubit are excited.

Keywords: quantum optics, quantum phase transition, cavity QED, circuit QED

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Authors: Sylvanus N. Wosu

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Research shows that factors, such as low motivation, preparation, resources, emotional and social integration, and fears of risk-taking, are the most common barriers to access, matriculation, and retention into science, technology, engineering, and mathematics (STEM) disciplines for underrepresented (URM) students. These factors have been shown to impact students’ attraction and success in STEM fields. Standardized tests such as the SAT and ACT often used as predictor of success, are not always true predictors of success for African and Hispanic American students. Without an adequate academic support environment, even a high SAT score does not guarantee academic success in science and engineering. This paper proposes a model for Academic Coaching for building success and inclusive excellence in STEM education. Academic coaching is framed as a process of motivating students to be independent learners through relational mentorship, facilitating learning supports inside and outside of the classroom or school environment, and developing problem-solving skills and success attitudes that lead to higher performance in the specific subjects. The model is formulated based on best strategies and practices for enriching Academic Performance Impact skills and motivating students’ interests in STEM. A scaled model for measuring the Academic Performance Impact (API) index and STEM is discussed. The study correlates API with state standardized test and shows that the average impact of those skills can be predicted by the Academic Performance Impact (API) index or Academic Preparedness Index.

Keywords: diversity, equity, graduate education, inclusion, inclusive excellence, model

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Authors: Shih-Pin Chen, Shih-Syuan You

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This study proposes a regression model with flexible spreads for fuzzy input-output data to cope with the situation that the existing measures cannot reflect the actual estimation error. The main idea is that a dissemblance index (DI) is carefully identified and defined for precisely measuring the actual estimation error. Moreover, the graded mean integration (GMI) representation is adopted for determining more representative numeric regression coefficients. Notably, to comprehensively compare the performance of the proposed model with other ones, three different criteria are adopted. The results from commonly used test numerical examples and an application to Taiwan's business monitoring indicator illustrate that the proposed dissemblance index method not only produces valid fuzzy regression models for fuzzy input-output data, but also has satisfactory and stable performance in terms of the total estimation error based on these three criteria.

Keywords: dissemblance index, forecasting, fuzzy sets, linear regression

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Authors: S. A. Salau, I. F. Ayanda, I. Afe, M. O. Adesina, N. B. Nofiu

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Food insecurity is still a critical challenge among rural and urban households in Nigeria. The country’s food insecurity situation became more pronounced due to frequent conflict between pastoralist and crop farmers. Thus, this study assesses pastoralist-crop farmers’ conflict and food security of farming households in Kwara state, Nigeria. The specific objectives are to measure the food security status of the respondents, quantify pastoralist- crop farmers’ conflict, determine the effect of pastoralist- crop farmers conflict on food security and describe the effective coping strategies adopted by the respondents to reduce the effect of food insecurity. A combination of purposive and simple random sampling techniques will be used to select 250 farming households for the study. The analytical tools include descriptive statistics, Likert-scale, logistic regression, and food security index. Using the food security index approach, the percentage of households that were food secure and insecure will be known. Pastoralist- crop farmers’ conflict will be measured empirically by quantifying loses due to the conflict. The logistic regression will indicate if pastoralist- crop farmers’ conflict is a critical determinant of food security among farming households in the study area. The coping strategies employed by the respondents in cushioning the effects of food insecurity will also be revealed. Empirical studies on the effect of pastoralist- crop farmers’ conflict on food security are rare in the literature. This study will quantify conflict and reveal the direction as well as the extent of the relationship between conflict and food security. It could contribute to the identification and formulation of strategies for the minimization of conflict among pastoralist and crop farmers in an attempt to reduce food insecurity. Moreover, this study could serve as valuable reference material for future researches and open up new areas for further researches.

Keywords: agriculture, conflict, coping strategies, food security, logistic regression

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Authors: Manotar Tampubolon

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Indonesia is a country that upholds the law, human rights and religious freedom. The freedom that implied in various laws and constitution (Undang-undang 1945) is not necessarily applicable in practice of religious life. In one side, the state has a duty as protector and guarantor of freedom, on the other side, however, it turns into one of the actors of freedom violations of religion minority. State action that interferes freedom of religion is done in various ways both intentionally or negligently or not to perform its obligations in the enforcement of human rights (human rights due diligence). Besides the state, non-state actors such as religious organizations, individuals also become violators of the rights of religious freedom. This article will discuss two fundamental issues that interfere freedom of religion in Indonesia after democratic era. In addition, this article also discusses a comprehensive state policy that discriminates minority religions to manifest their faith.

Keywords: religious freedom, constitution, minority faith, state actor

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Authors: Faisal Alshammari, Abdulmajid Addali, Mosab Alrashed, Taihiret Alhashan

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The application of acoustic emission techniques is gaining popularity, as it can monitor the condition of gears and bearings and detect early symptoms of a defect in the form of pitting, wear, and flaking of surfaces. Early detection of these defects is essential as it helps to avoid major failures and the associated catastrophic consequences. Signal processing techniques are required for early defect detection – in this article, a time domain technique called the Energy Index (EI) is used. This article presents an investigation into the Energy Index’s effectiveness to detect early-stage defect initiation and deterioration, and compares it with the common r.m.s. index, Kurtosis, and the Kolmogorov-Smirnov statistical test. It is concluded that EI is a more effective technique for monitoring defect initiation and development than other statistical parameters.

Keywords: acoustic emission, signal processing, kurtosis, Kolmogorov-Smirnov test

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Authors: Arvind Aggarwal

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We have developed a comprehensive global healthcare delivery System based on information technology. It has medical consultation system where a virtual consultant can give medical consultation to the patients and Doctors at the digital medical centre after reviewing the patient’s EMR file consisting of patient’s history, investigations in the voice, images and data format. The system has the surgical operation system too, where a remote robotic consultant can conduct surgery at the robotic surgical centre. The instant speech and text translation is incorporated in the software where the patient’s speech and text (language) can be translated into the consultant’s language and vice versa. A consultant of any specialty (surgeon or Physician) based in any country can provide instant health care consultation, to any patient in any country without loss of time. Robotic surgeons based in any country in a tertiary care hospital can perform remote robotic surgery, through patient friendly telemedicine and tele-surgical centres. The patient EMR, financial data and data of all the consultants and robotic surgeons shall be stored in cloud. It is a complete comprehensive business model with healthcare medical and surgical delivery system. The whole system is self-financing and can be implemented in any country. The entire system uses paperless, filmless techniques. This eliminates the use of all consumables thereby reduces substantial cost which is incurred by consumables. The consultants receive virtual patients, in the form of EMR, thus the consultant saves time and expense to travel to the hospital to see the patients. The consultant gets electronic file ready for reporting & diagnosis. Hence time spent on the physical examination of the patient is saved, the consultant can, therefore, spend quality time in studying the EMR/virtual patient and give his instant advice. The time consumed per patient is reduced and therefore can see more number of patients, the cost of the consultation per patients is therefore reduced. The additional productivity of the consultants can be channelized to serve rural patients devoid of doctors.

Keywords: e-health, telemedicine, telecare, IT-based healthcare

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Authors: Cheng-Yu Tsai, Wen-Te Liu, Chen-Chen Lo, Yin-Tzu Lin, Kang Lo

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Background: Driving fatigue related to inadequate or disordered sleep accounts for a major percentage of traffic accidents. Obstructive sleep apnea syndrome (OSAS) is a common respiratory disorder during sleep. However, the effects of OSAS severity on driving drowsiness remain unclear. Objective: The aim of this study is to investigate the relationship between OSAS severity and driving fatigue. Methodologies: The physical condition while driving was obtained from the questionnaires to classify the state of driving fatigue. OSAS severity was quantified as the polysomnography, and the mean hourly number of greater than 3% dips in oxygen saturation during examination in a hospital in New Taipei City (Taiwan). The severity of OSAS was diagnosed by the apnea and hypopnea index (AHI) with the American Academy of Sleep Medicine (AASM) guideline. The logistic regression model was used to examine the associations after adjusted age, gender, neck circumstance, waist circumstance, and body mass index (BMI). Results: There were 880 subjects recruited in this study, who had been done polysomnography for evaluating severity for OSAS as well as completed the driver condition questionnaire. 752 subjects were diagnosed with OSA, and 484 subjects had fatigue driving behavior in the past week. Patients diagnosed with OSAS had a 9.42-fold higher odds ratio (p < 0.01, 95% CI = 5.41 – 16.42) of driving drowsiness for cohorts with a normal degree. Conclusion: We observe the considerable correlation between OSAS and driving fatigue. For the purpose of promoting traffic safety, OSAS should be monitored and treated.

Keywords: obstructive sleep apnea syndrome, driving fatigue, polysomnography, apnea and hypopnea index

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Authors: E. Kharaishvili

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The paper shows the necessity of farm diversification in accordance with the current trends in agricultural sector of Georgia. The possibilities for the diversification and the corresponding economic policy are suggested. The causes that hinder diversification of farms are revealed, possibilities of diversification are suggested and the ability of increasing employment through diversification is proved. Index of harvest diversification is calculated based on the areas used for cereals and legumes, potatoes and vegetables and other food crops. Crop and livestock production indexes are analyzed, correlation between crop capacity index and value-added per one worker and one ha is studied. Based on the research farm diversification strategies and priorities of corresponding economic policy are presented. Based on the conclusions relevant recommendations are suggested.

Keywords: farm diversification, diversification index, agricultural development policy

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Authors: Thu Nguyen, Jane Daugherty-Luck

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Falx subdural hematoma is a life-threatening condition associated with high mortality. We present a patient case who had fallen with no head injury or loss of conspicuousness. She had tenderness along cervical and thoracic lumbar spine. CT head revealed falx subdural hematoma. The patient was managed medically. The pathophysiology of falx subdural hematoma is linked to laceration of bridging veins provoked by frontal or occipital impact. Posttraumatic subdural hematoma is commonly caused by inertia instead of facture or cerebral contusion resulting from direct impact. The theory is consistent with the lack of fracture in most cases in the literature. Our patient had neither contusion nor fracture.

Keywords: falx subdural hematoma, traumatic head injury, CT head scan, bridging veins, inertia

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Authors: Janiel David Melamed Visbal

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The Islamic State has become one of the most remarkable threats for international security through their religious extremism and their establishment of a new caliphate by force. The main objective of this organization is to obtain territorial expansions beyond the Middle East and eventually to consolidate an Islamic global order based on their extremist ideology. This paper will conduct an analysis regarding how, over the past year, many jihadist organizations worldwide have pledged their alliagance to the Islamic State, transforming it into the most important jihadist franchise globally.

Keywords: Islamic state, franchise, jihad, Islamic fundamentalism, caliphate

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Authors: Richa Jaiswal, Vidisha Sharma, Amulya Rattan, Sushma Sagar, Subodh Kumar, Amit Gupta, Biplab Mishra, Maneesh Singhal

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Background: Adequate nutritional support and daily patient monitoring have an independent therapeutic role in the successful management of high output fistulae and early recovery after abdominal trauma. Case presentation: An 18-year-old girl was brought to AIIMS emergency with alleged history of fall of a heavy weight (electric motor) over abdomen. She was evaluated as per Advanced Trauma Life Support(ATLS) protocols and diagnosed to have significant abdominal trauma. After stabilization, she was referred to Trauma center. Abdomen was guarded and focused assessment with sonography for trauma(FAST) was found positive. Complete duodenojejunal(DJ) junction transection was found at laparotomy, and end-to-end repair was done. However, patient was re-explored in view of biliary peritonitis on post-operative day3, and anastomotic leak was found with sloughing of duodenal end. Resection of non-viable segments was done followed by side-to-side anastomosis. Unfortunately, the anastomosis leaked again, this time due to a post-anastomotic kink, diagnosed on dye study. Due to hostile abdomen, the patient was planned for supportive care, with plan of build-up and delayed definitive surgery. Percutaneous transheptic biliary drainage (PTBD) and STSG were required in the course as well. Nutrition: In intensive care unit (ICU), major goals of nutritional therapy were to improve wound healing, optimize nutrition, minimize enteral feed associated complications, reduce biliary fistula output, and prepare the patient for definitive surgeries. Feeding jejunostomy (FJ) was started from day 4 at the rate of 30ml/h along with total parenteral nutrition (TPN) and intra-venous (IV) micronutrients support. Due to high bile output, bile refeed started from day 13.After 23 days of ICU stay, patient was transferred to general ward with body mass index (BMI)<11kg/m2 and serum albumin –1.5gm%. Patient was received in the ward in catabolic phase with high risk of refeeding syndrome. Patient was kept on FJ bolus feed at the rate of 30–50 ml/h. After 3–4 days, while maintaining patient diet book log it was observed that patient use to refuse feed at night and started becoming less responsive with every passing day. After few minutes of conversation with the patient for a couple of days, she complained about enteral feed discharge in urine, mild pain and sign of dumping syndrome. Dye study was done, which ruled out any enterovesical fistula and conservative management were planned. At this time, decision was taken for continuous slow rate feeding through commercial feeding pump at the rate of 2–3ml/min. Drastic improvement was observed from the second day in gastro-intestinal symptoms and general condition of the patient. Nutritional composition of feed, TPN and diet ranged between 800 and 2100 kcal and 50–95 g protein. After STSG, TPN was stopped. Periodic diet counselling was given to improve oral intake. At the time of discharge, serum albumin level was 2.1g%, weight – 38.6, BMI – 15.19 kg/m2. Patient got discharge on an oral diet. Conclusion: Successful management of post-traumatic proximal high output fistulae is a challenging task, due to impaired nutrient absorption and enteral feed associated complications. Strategic- and goal-based nutrition support can salvage such critically ill patients, as demonstrated in the present case.

Keywords: nutritional monitoring, nutritional support, duodenal fistula, abdominal trauma

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Authors: Yuhan Wu, CTB (Kees) Ahaus, Martina Buljac-Samardzic

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Patient aggression and violence is a complex occupational hazards for physicians working in hospitals, and it can have multiple severe negative effects for physicians and hospitals. Although there is a range of interventions in the healthcare sector applied in various countries, China lacks a comprehensive set of interventions at the hospital level in this area. Therefore, due to cultural differences, this study investigates whether international interventions are important and feasible in the Chinese cultural context by conducting a Delphi study. Based on a literature search, a list of 47 hospital interventions to prevent and manage patient aggression and violence was constructed, including 8 categories: hospital environment design, access and entrance, staffing and work practice, training and education, leadership and culture, support, during/after-the-event actions, and hospital policy. The list of interventions will be refined, extended and brought back during a three-round Delphi study. The panel consists of 17 Chinese experts, including physicians experiencing patient aggression and violence, hospital management team members, scientists working in this research area, and policymakers in the healthcare sector. In each round, experts will receive the possible interventions with the instruction to indicate the importance and feasibility of each intervention for preventing and managing patient violence and aggression in Chinese hospitals. Experts will be asked about the importance and feasibility of interventions for patient violence and aggression at the same time. This study will exclude or include interventions based on the score of importance. More specifically, an intervention will be included after each round if >80% of the experts judged it as important or very important and excluded if >50% judged an intervention as not or moderately important. The three-round Delphi study will provide a list of included interventions and assess which of the 8 categories of interventions are considered as important. It is expected that this study can bring new ideas and inspiration to Chinese hospitals in the prevention and management of patient aggression and violence.

Keywords: patient aggression and violence, hospital interventions, feasibility, importance

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Authors: Hilary P. Stevenson, Alexander J. Hayek, Amie Dereczyk

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In this case report, we provide an example of an asymptomatic COVID-19 positive patient who presented with new-onset psychosis with severe paranoid delusions. He was seen in our ED after ingesting isopropyl alcohol which he reported was an attempt to escape presumed attackers, which at the time was logical to the patient. The patient’s family had COVID-19 symptoms that corresponded to those typically observed from the Omicron variant. The patient was treated successfully, within ten days, with Risperdal twice-daily dosing resulting in the resolution of the patient’s delusions and improved insight regarding the events that led to his hospitalization. In this work, we examine possible contributing factors to new-onset psychosis in the context of COVID-19, a phenomenon that is becoming increasingly notable in the literature. One area of importance is the already established inflammatory hypothesis of psychosis in which defects in the innate immune system, which result in its overactivation, may play a role in a typical first-episode psychosis, in addition to subsequent episodes. Given that COVID-19 is known to cause derangements in the innate immune system, such as cytokine storm reactions, this link may be critical in further understanding the etiologies of new-onset COVID-19 psychosis and its risk factors. Also included in this work is a brief review of antipsychotic interventions that have been described in the literature to date for the first episode of COVID-19-related psychosis. This will explore the potential of some antipsychotics to innately diminish the production of pro-inflammatory cytokines, further enhancing their usefulness in COVID-19 first-episode psychosis patients.

Keywords: COVID-19, first break psychosis, inflammatory hypothesis of psychosis, Risperdal

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Authors: M. Reza Roshandel, Tannaz Aghaei Badr, Batoul Khoundabi, Sara C. Lewis, Soroush Rais-Bahrami, John Sfakianos, Reza Mehrazin, Ash K. Tewari

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Introduction: Prostate biopsy is the most reliable diagnostic method for choosing the appropriate management of prostate cancer. However, discrepancies between Gleason grade groups (GG) of different biopsies remain a significant concern. This study aims to assess the association of the radiological factors with GG discrepancies in patients with index Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions, using radical prostatectomy (RP) specimens as the most accurate and informative pathology. Methods: This single-institutional retrospective study was performed on a total of 2289 consecutive prostate cancer patients with combined targeted and systematic prostate biopsy followed by radical prostatectomy (RP). The database was explored for patients with the index PI-RADS 3 lesions version 2 and 2.1. Cancers with PI-RADS 4 or 5 scoring were excluded from the study. Patient characteristics and radiologic features were analyzed by multivariable logistic regression. Number-density of lesions was defined as the number of lesions per prostatic volume. Results: Of the 151 prostate cancer cases with PI-RADS 3 index lesions, 27% and 17% had upgrades and downgrades at RP, respectively. Analysis of grade changes showed no significant associations between discrepancies and the number or the number density of PI-RADS 3 lesions. Moreover, the study showed no significant association of the GG changes with race, age, location of the lesions, or prostate volume. Conclusions: This study demonstrated that in PI-RADS 3 cancerous nodules, the chance of the pathology changes in the final pathology of RP specimens was low. Furthermore, having multiple PI-RADS 3 nodules did not change the conclusion, as the possibility of grade changes in patients with multiple nodules was similar to those with solitary lesions.

Keywords: prostate, adenocarcinoma, multiparametric MRI, Gleason score, robot-assisted surgery

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Authors: Rajish Shil, Amal Alduhoori, Vipin Thomachan, Jamal Teir, Radhakrishnan Renganathan

Abstract:

Background: Antiphospholipid antibody syndrome (APS) has a broad spectrum of thrombotic and non-thrombotic clinical manifestations. We present a case of APS presenting with seizure, stroke, and atrial mass. Case Description: A 38-year-old male presented with headache of 10 days duration and tonic-clonic seizure. The neurological examination was normal. Magnetic resonance imaging of brain showed small acute right cerebellar infarct. Magnetic resonance angiography of brain and neck showed a focal narrowing in the origin of the internal carotid artery bilaterally. Electroencephalogram was normal. He was started on aspirin, atorvastatin, and carbamazepine. Transthoracic and trans-esophageal echocardiography showed a pedunculated and lobular atrial mass, measuring 1 X 1.5 cm, which was freely mobile across mitral valve opening across the left ventricular inflow. Autoimmune screening showed positive Antiphospholipid antibodies in high titer (Cardiolipin IgG > 120 units/ml, B2 glycoprotein IgG 90 units/mL). Anti-nuclear antibody was negative. Erythrocyte sedimentation rate and C-reactive protein levels were normal. Platelet count was low (111 x 109/L). The patient underwent successful surgical removal of the mass, which looked like a thrombotic clot, and Histopathological analysis confirmed it as a fibrinous clot, with no evidence of tumor cells. The patient was started on full anticoagulation treatment and was followed up regularly in the clinic, where our patient did not have any further complications from the disease. Discussion: Our patient was diagnosed to have APS based on the features of high positive anticardiolipin antibody IgG and B2 glycoprotein IgG levels, Stroke, thrombocytopenia, and abnormal echo findings. Thrombotic vegetation can mimic an atrial myxoma on echo. Conclusion: APS can present with neurological and cardiac manifestations, and therefore a high index of suspicion is necessary for a diagnosis of the disease as it can affect both short and long term treatment plans and prognosis. Therefore, in patients presenting with neurological symptoms like seizures, weakness and radiological diagnosis of stroke in a young patient, where atrial masses could be thought to be the cause of stroke, they should be screened for any concomitant findings of thrombocytopenia and/or activated partial thromboplastin time prolongation, which should raise the suspicion of vasculitis, specifically APS to be the primary cause of the clinical presentation.

Keywords: antiphospholipid syndrome, seizures, atrial mass, stroke

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Authors: Mohamed Eladham Fadl M. E. Fadl

Abstract:

In Egypt, wastewater has been used for irrigation in areas with fresh water scarcity. However, continuous applications may cause potential risks. Thus, the current study aims at screening the impacts of long-term wastewater irrigation on soil pollution and human health due to the exposure of heavy metals. Soils of nine sites in Al-Qalyubiyah Governorate, Egypt were sampled and analyzed for different properties. Wastewater resulted in a build-up of metals in soils. The pollution index (PI) showed the order of Cd > Pb > Ni > Zn. The integrated pollution index of Nemerow’s (IPIN) exceeded the safe limit of 0.7. The enrichment factor (EF) surpassed 1.0 value proving anthropogenic effects. The geo-accumulation index (Igeo) indicated that Pb, Ni, and Zn-induced none to moderate pollution, while high threats were associated with Cd. The calculated hazard index proved a potential health risk for humans, particularly children. It is recommended to perform a treatment to the wastewater used in irrigation to avoid such threats.

Keywords: pollution, health risks, heavy metals, effluent, irrigation, GIS techniques

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Authors: Temitope O. Tokosi, Visvanathan Naicker

Abstract:

Patient health records contain sensitive information for which an electronic patient record (EPR) system can safely secure and transmit amongst clinicians for use in improving health delivery. Clinician’s use of the behaviour of these systems is under scrutiny to assess their attributes towards health technology. South Africa (SA) clinicians responded to a pilot study survey to assess their understanding of EPR, what attributes are important towards technology use and more importantly streamlining the survey for a larger study. Descriptive statistics using mean scores was used because of the small sample size of 11 clinicians who completed the survey. Nine (9) constructs comprising 62 items were used and a Cronbach alpha score of 0.883 was obtained. Limitations and discussions conclude the study.

Keywords: EPR, clinicians, pilot study, South Africa

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Authors: E. Feizi Ashtiani, S. Jamshidi, M.H Niksokhan, A. Feizi Ashtiani

Abstract:

Waste load allocation (WLA) policies may use multi-objective optimization methods to find the most appropriate and sustainable solutions. These usually intend to simultaneously minimize two criteria, total abatement costs (TC) and environmental violations (EV). If other criteria, such as inequity, need for minimization as well, it requires introducing more binary optimizations through different scenarios. In order to reduce the calculation steps, this study presents value index as an innovative decision making approach. Since the value index contains both the environmental violation and treatment costs, it can be maximized simultaneously with the equity index. It implies that the definition of different scenarios for environmental violations is no longer required. Furthermore, the solution is not necessarily the point with minimized total costs or environmental violations. This idea is testified for Haraz River, in north of Iran. Here, the dissolved oxygen (DO) level of river is simulated by Streeter-Phelps equation in MATLAB software. The WLA is determined for fish farms using multi-objective particle swarm optimization (MOPSO) in two scenarios. At first, the trade-off curves of TC-EV and TC-Inequity are plotted separately as the conventional approach. In the second, the Value-Equity curve is derived. The comparative results show that the solutions are in a similar range of inequity with lower total costs. This is due to the freedom of environmental violation attained in value index. As a result, the conventional approach can well be replaced by the value index particularly for problems optimizing these objectives. This reduces the process to achieve the best solutions and may find better classification for scenario definition. It is also concluded that decision makers are better to focus on value index and weighting its contents to find the most sustainable alternatives based on their requirements.

Keywords: waste load allocation (WLA), value index, multi objective particle swarm optimization (MOPSO), Haraz River, equity

Procedia PDF Downloads 402