Search results for: delayed diagnosis and poor outcome

Authors: Angelis P. Barlampas

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Purpose: A 29 years old woman presented in the emergency department with psychiatric symptoms. The psychiatrist ordered a computed tomography scan as part of a general examination. Material and methods: The CT showed bilateral enlarged choroid plexus structures mimicking papillomata and situated in the trigones of the lateral ventricles. The left choroid plexus was heavily calcified, but the right one has no any obvious calcifications. Results: It is well kown that any brain mass can present with behavioral changes and even psychiatric symptomatology. Papillomata of the ventricular system have been described to cause psychotic episodes. According to literature, choroid plexus papillomas are seldom neuroepithelial intraventricular tumors, which are benign and categorized as WHO grade 1 tumors. They are more common in the pediatric population, but they can occur in the adults, too1. In addition, the distinction between choroid plexus papilloma and carcinoma is very difficult and impossible by imagine alone. It can only be implied with more advanced imaging, such as arterial spin labeling and MRI. The final diagnosis is, of course, after surgical excision. The usual location in adults is the fourth ventricle, but in children, it is the lateral ventricles. Their imaging appearance is that of a solid vascular tumor, which enhances intensely after the intravenous administration of contrast material. One out of fourth tumors presents speckled calcifications1. In our case, there are symmetrically sized masses at the trigones, and there are no calcifications in one of them, whereas the other one is grossly calcified. Also, there is no obvious hydrocephalus or any other evidence of increased intracranial pressure. General conclusions: When there is a new psychiatric patient, someone must undergo any possible examination, and of course, a brain CT study should be done to exclude any rare organic causes that may be responsible for the disease.

Keywords: phycosis, intraventricular masses, CT, brain calcifications

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Authors: B. Kenny

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

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

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Authors: Erdem Elibol, Musa Cadırcı, Nedim Tutkun

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Recently, colloidal quantum dots (CQDs) have drawn increasing attention due to their unique size tunability, which makes them potential candidates for numerous applications including photovoltaic, LEDs, and imaging. However, the main challenge to exploit CQDs properly is that there has not been an effective method to produce them with highly crystalline form and narrow size dispersion. Hot injection method is one of the widely used techniques to produce high-quality nanoparticles. In this method, the key parameter is to reduce the time for injection of the precursors into each other, which yields fast and constant nucleation rate and hence to highly monodisperse QDs. In conventional hot injection method, the injection of precursors is carried out using standard lab syringes with long needles. However, this technique is relatively slow and thus will result in poor optical properties in QDs. In this work, highly luminescent CdTe QDs were synthesised by transferring hot precursors into each other using cannula method. Unlike regular syringe technique, with the help of high pressure difference between two precursors’ flasks and wide cross-section of cannula, the hot cannulation process is too short which yields narrow size distribution and high quantum yield of CdTe QDs. Here QDs with full width half maximum (FWHM) of 28 nm was achieved. In addition, the photoluminescence quantum yield of our samples was measured to be about 21 ± 0.9 which is at least twice the previous record values for CdTe QDs wherein syringe was used to transfer precursors.

Keywords: CdTe, hot injection method, luminescent, quantum dots

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Authors: Yingjin Cui, Xue Bai, Serena Reese

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Student engagement and student interest during class instruction are important conditions for active learning. Engagement, which has an important relationship with learning motivation, influences students' levels of persistence in overcoming challenges. Lack of student engagement and absence from face-to-face lectures and tutorials, in turn, can lead to poor academic performance. However, keeping students motivated and engaged in the learning process in different instructional modes poses a significant challenge; students can easily become discouraged from attending lectures and tutorials across both online and face-to-face settings. Many factors impact students’ engagement in the learning process. If you want to keep students focused on learning, you have to invite them into the process of helping themselves by providing an active learning environment. Active learning is an excellent technique for enhancing student engagement and participation in the learning process because it provides means to motivate the student to engage themselves in the learning process through reflection, analyzing, applying, and synthesizing the material they learn during class. In this study, we discussed how to create an active learning class (both face-to-face and synchronous online) through engagement activities, including reflection, collaboration, screen messages, open poll, tournament, and transferring editing roles. These activities will provide an uncommon interactive learning environment that can result in improved learning outcomes. To evaluate the effectiveness of those engagement activities in the learning process, an experimental group and a control group will be explored in the study.

Keywords: active learning, academic performance, engagement activities, learning motivation

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Authors: Tirtha Raj Dhakal, Brian Davidson, Bob Farquharson

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Institutional design is an important aspect in efficient water resource management. In Nepal, the water supply in both farmers’- and agency-managed irrigation systems has become sub-standard because of the weak institutional framework. This study characterizes both forms of the schemes and links existing institution and governance of the schemes with its performance with reference to cost recovery, maintenance of the schemes and water distribution throughout the schemes. For this, two types of surveys were conducted. A management survey of ten farmers’-managed and five agency-managed schemes of Chitwan valley and its periphery was done. Also, a farm survey comprising 25 farmers from each of head, middle and tail regions of both schemes; Narayani Lift Irrigation Project (agency-managed) and Khageri Irrigation System (farmers’-managed) of Chitwan Valley as a case study was conducted. The results showed that cost recovery of agency-managed schemes in 2015 was less than two percent whereas service fee collection rate in farmers’-managed schemes was nearly 2/3rd that triggered poor maintenance of the schemes and unequal distribution of water throughout the schemes. Also, the institution on practice is unable to create any incentives for farmers for economical use of water as well as willingness to pay for its use. This, thus, compels the need of refined institutional framework which has been suggested in this paper aiming to improve the cost recovery and better water distribution throughout the irrigation schemes.

Keywords: cost recovery, governance, institution, schemes' performance

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Authors: N. J. Shanono, J. G. Ndiritu

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The poor performance of water resource systems (WRS) has been reportedly linked to not only climate variability and the water demand dynamics but also human behaviour-driven unlawful activities. Some of these unlawful activities that have been adversely affecting water sector include unauthorized water abstractions, water wastage behaviour, refusal of water re‐use measures, excessive operational losses, discharging untreated or improperly treated wastewater, over‐application of chemicals by agricultural users and fraudulent WRS operation. Despite advances in WRS planning, operation, and analysis incorporating such undesirable human activities to quantitatively assess their impact on WRS performance remain elusive. This study was then inspired by the need to develop a methodological framework for WRS performance assessment that integrates the impact of human behaviour with WRS performance assessment analysis. We, therefore, proposed a conceptual framework for assessing the impact of human behaviour on WRS performance using the concept of socio-hydrology. The framework identifies and couples four major sources of WRS-related values (water values, water systems, water managers, and water users) using three missing links between human and water in the management of WRS (interactions, outcomes, and feedbacks). The framework is to serve as a database for choosing relevant social and hydrological variables and to understand the intrinsic relations between the selected variables to study a specific human-water problem in the context of WRS management.

Keywords: conceptual framework, human behaviour; socio-hydrology; water resource systems

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Authors: Oladimeji Israel Ajayi

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Agricultural development has long been identified as a cornerstone for wealth creation and economic growth, particularly in emerging economies like Nigeria. This study examines the relationship between agricultural development and wealth creation in Nigeria, emphasizing the sector's potential in reducing poverty, creating employment, and boosting economic stability. Nigeria, endowed with fertile land and a favorable climate, has a significant agricultural base that, if fully leveraged, can transition the economy from oil dependency to a diversified and sustainable growth model. However, challenges such as limited access to credit, poor infrastructure, outdated farming techniques, and climate variability hinder optimal productivity. This research employs a mixed-methods approach, analyzing data from the Nigerian National Bureau of Statistics and the Food and Agriculture Organization to understand how investments in agriculture influence wealth indicators such as GDP growth, employment rates, and rural income levels. The findings reveal a strong positive correlation between agricultural investment and wealth creation, suggesting that strategic policies focusing on mechanization, credit accessibility, and sustainable practices could significantly boost agricultural productivity and contribute to wealth distribution in Nigeria. This study contributes to policy discourse by highlighting agriculture’s role as a transformative tool for economic resilience and sustainable wealth creation in Nigeria.

Keywords: agricultural development, poverty reduction, wealth creation, prosperity

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Authors: Smriti Gour, Neelam Pandey

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The objective of this study was to describe and analyse the mutual relationship between the coping mechanisms used by the families of a child with Autism Spectrum Disorder (ASD) and family dynamics and the effect sibling interactions have on the dynamics and coping mechanisms in an urban setup. In-depth interviews were conducted for 25 families, with 4 members each in the Delhi NCR area in India. The families who were interviewed had a younger child who had received a diagnosis of ASD between the ages of 5-12. The in-depth questionnaires contained open-ended questions and the interviews were conducted separately for the mother, father and the typically developing sibling. The key findings of the study suggested that lack of communication was a common factor in most families (n=19) leading to other difficulties like stress and relationship dysfunction. It also fostered a fallacious perception of the relationship dynamics in the family in most of the interviewed families and changed depending on the family member being interviewed. In families where the typically developing elder sibling had a good relationship with the autistic child, the family dynamics were found to be more stable, and the overall family well-being was better maintained. The coping mechanisms employed by the families were also more positive and tended to work better if the typically developing sibling maintained a positive and interactive relationship with the parents and the autistic child. The type of coping mechanisms had a major impact on the relationship between the parents and in dictating the dynamics of the family of the child with ASD. Spirituality, professional help, family support and household help emerged to be the most effective coping mechanisms for the families, with spirituality emerging to be the most positive and effective coping mechanism in the families interviewed.

Keywords: autism spectrum disorder, coping mechanism, family dynamics, parental relationships, siblings

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Authors: Geetanjali Sharma

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Guillain Barre’ syndrome (GBS) is an auto-immune mediated demyelination poly-radiculo-neuropathy. Clinical features include progressive symmetrical ascending muscle weakness of more than two limbs, areflexia with or without sensory, autonomic and brainstem abnormalities, the purpose of this study was to determine subclinical neurological changes of CNS with GBS and to establish the presence of central demyelination in GBS. The study was prospective and conducted in the Department of Physiology, Pt. B. D. Sharma Post-graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India to find out early central demyelination in clinically diagnosed patients of GBS. These patients were referred from the department of Medicine of our Institute to our department for electro-diagnostic evaluation. The study group comprised of 40 subjects (20 clinically diagnosed GBS patients and 20 healthy individuals as controls) aged between 6-65 years. Brain Stem evoked Potential (BAEP) were done in both groups using RMS EMG EP mark II machine. BAEP parameters included the latencies of waves I to IV, inter peak latencies I-III, III-IV & I-V. Statistically significant increase in absolute peak and inter peak latencies in the GBS group as compared with control group was noted. Results of evoked potential reflect impairment of auditory pathways probably due to focal demyelination in Schwann cell derived myelin sheaths that cover the extramedullary portion of auditory nerves. Early detection of the sub-clinical abnormalities is important as timely intervention reduces morbidity.

Keywords: brainstem, demyelination, evoked potential, Guillain Barre’

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Authors: Sharareh Hekmat, Michelle Lane

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Pregnancy during adolescence affects both the growth and development of mother and baby, particularly in low socioeconomic and food insecure areas. This mixed methods study is aimed at discovering a need for a community-based probiotic yogurt program to assist pregnant women in the Mukuru slum Nairobi, Kenya. Surveys were conducted with pregnant women (14-25 years old, n=43), which included questionnaires on dietary intake, food access, and health/quality of life perception. The frequency and means procedure was used to analyze maternal characteristics, Women’s Dietary Diversity Score (WDDS) and Household Hunger Scale. 24-hour recalls were analyzed via ESHA Food Processor, and median nutrient intakes were reported as a percent of recommendations. An environmental scan was conducted to assess food availability, accessibility, and quality. WDDS reflected a low-moderate diet variation (3.86 food groups out of 9, SD ± 1.3) among the women. The 24-hour recall suggested an inadequate intake of many nutrients, most significantly B12, potassium and calcium. 86% of women reported little to no household hunger. However, the environmental scan revealed low quality and poor sanitation of food. This study provides evidence that a probiotic program would be desirable, and contribute to the nutritional status of women in the Mukuru community.

Keywords: dietary diversity, pregnant women, probiotics, urban slum, Kenya

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Authors: Jasmin Glock

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Media plays a significant role in terms of shaping and influencing people’s perception of various themes, including disability. Although recent examples indicate progressive attitudes in society, programs across genres continue to portray disability in a negative and stereotypical way. Such a one-sided or stereotypical portrayal of disabled people can further reinforce their marginalized position by turning them into the other. The common trope of the blind or visually impaired woman, for example, marks the character as particularly vulnerable. These stereotypes are easily absorbed and left unquestioned, especially by younger audiences. As a result, the presentation of disability as problematic or painful can instill a subconscious fear of disability in viewers at a very young age. Now the question arises, how can disability be portrayed to children in a more positive way? This paper focuses on the portrayal of physical disability in children’s programming. Using disabled characters from Nickelodeon’s Avatar: The Last Airbender and Avatar: The Legend of Korra, the paper will show that the chosen animated characters have the potential to challenge and subvert disability-based bias and to contribute to the normalization of disability on screen. Analyzing blind protagonist Toph Beifong, recurring support character and wheelchair user Teo, and villain Ming Hua who has prosthetic limbs, this paper aims at highlighting that these disabled characters are far more than mere stereotyped tokens. Instead, they are crucial to the outcome of the story. They are strong and confident while still being allowed to express their insecurities in certain situations. The paper also focuses on how these characters can make disability issues relatable to disabled and non-disabled young audiences alike and how they can thereby contribute to the reduction of prejudice. Finally, they will serve as an example of what inclusive, nuanced, and even empowering disability representation in animated television series can look like.

Keywords: Children, disability, representation, television

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Authors: Leonardo C. Pacheco-Londoño, Nataly J Galan-Freyle, Lisandro Pacheco-Lugo, Antonio Acosta-Hoyos, Elkin Navarro, Gustavo Aroca-Martinez, Karin Rondón-Payares, Alberto C. Espinosa-Garavito, Samuel P. Hernández-Rivera

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At the Life Science Research Center at Simon Bolivar University, a primary focus is the diagnosis of various diseases, and the use of gold nanoparticles (Au-NPs) in diverse biomedical applications is continually expanding. In the present study, Au-NPs were employed as substrates for Surface-Enhanced Raman Spectroscopy (SERS) aimed at diagnosing kidney diseases arising from Lupus Nephritis (LN), preeclampsia (PC), and Hypertension (H). Discrimination models were developed for distinguishing patients with and without kidney diseases based on the SERS signals from urine samples by partial least squares-discriminant analysis (PLS-DA). A comparative study of the Raman signals across the three conditions was conducted, leading to the identification of potential metabolite signals. Model performance was assessed through cross-validation and external validation, determining parameters like sensitivity and specificity. Additionally, a secondary analysis was performed using machine learning (ML) models, wherein different ML algorithms were evaluated for their efficiency. Models’ validation was carried out using cross-validation and external validation, and other parameters were determined, such as sensitivity and specificity; the models showed average values of 0.9 for both parameters. Additionally, it is not possible to highlight this collaborative effort involved two university research centers and two healthcare institutions, ensuring ethical treatment and informed consent of patient samples.

Keywords: SERS, Raman, PLS-DA, kidney diseases

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Authors: Irfan Ahmad Afip

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This main research objective is to accurately identify the possibility for a Leptospirosis outbreak severity of a certain area based on its input features into a multivariate regression model. The research question is the possibility of an outbreak in a specific area being influenced by this feature, such as social demographics and hydrometeorological extremes. If the occurrence of an outbreak is being subjected to these features, then the epidemic severity for an area will be different depending on its environmental setting because the features will influence the possibility and severity of an outbreak. Specifically, this research objective was three-fold, namely: (a) to identify the relevant multivariate features and visualize the patterns data, (b) to develop a multivariate regression model based from the selected features and determine the possibility for Leptospirosis outbreak in an area, and (c) to compare the predictive ability of multivariate regression model and machine learning algorithms. Several secondary data features were collected locations in the state of Negeri Sembilan, Malaysia, based on the possibility it would be relevant to determine the outbreak severity in the area. The relevant features then will become an input in a multivariate regression model; a linear regression model is a simple and quick solution for creating prognostic capabilities. A multivariate regression model has proven more precise prognostic capabilities than univariate models. The expected outcome from this research is to establish a correlation between the features of social demographic and hydrometeorological with Leptospirosis bacteria; it will also become a contributor for understanding the underlying relationship between the pathogen and the ecosystem. The relationship established can be beneficial for the health department or urban planner to inspect and prepare for future outcomes in event detection and system health monitoring.

Keywords: geographical information system, hydrometeorological, leptospirosis, multivariate regression

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Authors: Muhammad Younis Laghari

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Global climate change has had many effects on the aquatic environment, and the major issue is pollution. Along with the other pollutants, there are a significant number of human microbial pathogens that pollute the water bodies. Another concern about the water quality is that the major aquatic resources bring water-borne pathogens and other related diseases. These resources include industrial effluent, untreated domestic sewage, acid mine drainage, etc. However, these water discharges through various routes may have treatment to eliminate the pathogenic microbes. Therefore, it is essential to control the leakage from sewer systems, residential discharge, and agricultural run-off. These pathogenic microbes have been implicated in the lives of water health (fishes), which is harmful and causes diseases. Mostly, the mortality of aquatic species results because of catastrophic floods due to poor water waste treatment and sanitation that introduce pathogenic bacteria into rivers. Pathogens survive in rivers and remain poorly known but essential to control water-borne diseases. The presence of bacteria in watercourses is diverse and constitutes a complicated subject. Many species are autochthonous and play an important role in aquatic ecosystems, while many others arise from untreated or poorly treated waste from industrial and domestic sources. Further, more investigation is required to know the induction of water-borne pathogens in various water resources and the potential impacts of water resource development on pathogen contamination.

Keywords: microbial pathogens, contamination, water resources, river water body

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Authors: Kasi Jockeil-Ojike

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The study of signage and wayfinding design guidelines is to provide consistent, coherent, and comprehensive guidelines for all type of signage design that may be applied to guide persons from the freeway into campus, and to specific building. As the world becomes more complex and the population increases, people increasingly rely on signage and wayfinding systems to navigate their way in built environment such as university campus. This paper will demonstrate and discuss signage and wayfinding, and the importance of visual literacy in university campuses. It discusses the process of wayfinding and signage, how poor signage and wayfinding systems affect people when navigating, and why wayfinding is more than just signage. Hence, this paper tries to examine the design guideline that primarily addresses the signage and wayfinding system that improves visual literacy within University of Port Harcourt multi-campuses. In doing this, the paper explore the environmental graphic design senori-emotional values and communicative information theories that takes the subjectivity of the observer in account. By making these connections, the paper will also determine what University of Port Harcourt need to focus on to be counted in the global trends, using developed visual communication guidelines based on previous studies or concept from professional. In conclusion, information about why physical structures (buildings and waypaths) on University of Port Harcourt multiple campuses need to be branded in self-communicative manner using signage and wayfinding design as integral part of its physical planning policy is recommended.

Keywords: campus-signage, movement, visual-literacy, wayfinding-guidelines

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Authors: Esther Gumboh

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The police play a critical role in society and are an integral aspect of the rule of law. Equally, respect for human rights is an integral part of professional policing. In view of the vast powers that the police enjoy and the attendant risk of abuse and resulting human rights violations, the need for police accountability and civilian police oversight is internationally and regionally recognised. Policing oversight springs from the duty to investigate human rights violations. Those implicated in perpetrating or covering up violations must be disciplined or prosecuted to ensure effective accountability. Police accountability is particularly important in Malawi given the dark history of policing in the country during the 30-year dictatorial era under President Kamuzu Banda. Described as one of the most repressive regimes in Africa, the Banda administration was characterised by gross state-sponsored violence, repressive policing and human rights violations. Indeed, the police were involved in various forms of human rights abuse including arbitrary arrests and unlawful detentions, torture, and excessive use of force in conducting arrests and public order policing. This situation flourished within a culture of police impunity bolstered in part by the absence of clear oversight mechanisms for police accountability. In turn, there was immense public mistrust of the police. Unsurprisingly, the criminal justice system was one of the priority areas for reform when Malawi adopted its first democratic Constitution in 1994. Section 153 of the Constitution envisions a police service that is, for all intents and purposes, there to provide for the protection of public safety and the rights of persons in Malawi according to the prescriptions of the Constitution and any other law. This position reflects the view that the duty to protect and promote human rights is not incompatible with effective policing. Despite this, the police continue to engage in questionable behaviour in public order policing, excessive use of force, deaths in police custody, ill-treatment, torture and other forms of abuse including sexual abuse. Perpetrators of abuses are occasionally punished, but investigations are often delayed, abandoned, or remain inconclusive. Police accountability remains largely elusive. Commendably, the law does subject the police to significant oversight both internally and externally. However, until 2010, Malawi lacked a wholly independent civilian oversight mechanism specifically mandated to monitor the activities of the Malawi Police Service and held it accountable. This void has since been filled by the Independent Complaints Commission established under the Police Act. This is a positive development that reiterates Malawi’s commitment to the investigation of human rights violations by the police and to ending police impunity. This contribution examines the legal framework for this Commission to project the effectiveness of the Commission. While the framework looks promising on various fronts, there are potential challenges that lie ahead. Malawi must pre-emptively deal with these challenges carefully if the Commission is to have any practical significance in transforming police accountability in the country. Drawing on lessons from other jurisdictions like South Africa, the paper makes recommendations for legislative reform to strengthen the Commission’s framework.

Keywords: civilian policing oversight, Malawi, police, police accountability, policing, policing oversight

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Authors: Olupemi E. Oludare

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This paper discusses the thematic structure of Yoruba popular music of Southwest Nigeria. It examines the use of themes and variations in early and contemporary Juju music. The work is an outcome of a research developed by the author in his doctoral studies at the University of Lagos, Nigeria, with the aim of analyzing the thematic and motivic developments in Yoruba popular genres. Observations, interviews, live recordings and CDs were used as methods for eliciting information. Field recordings and CDs of selected musical samples were also transcribed and notated. The research established the prevalent use of string of themes by Juju musicians as a compositional technique in moving from one musical section to another, as they communicate the verbal messages in their song. These themes consisting of the popular ‘call and response’ form found in most African music, analogous to the western ‘subject and answer’ style of the fugue or sonata form, although without the tonic–dominant relations. Due to the short and repetitive form of African melodies and rhythms, a theme is restated as a variation, where its rhythmic and melodic motifs are stylistically developed and repeated, but still retaining its recognizable core musical structure. The findings of this study showed that Juju musicians generally often employ a thematic plan where new themes are used to arrange the songs into sections, and each theme is developed into variations in order to further expand the music, eliminate monotony, and create musical aesthetics, serving as hallmark of its musical identity. The study established the musical and extra-musical attributes of the genre, while recommending further research towards analyzing the various compositional techniques employed in African popular genres.

Keywords: compositional techniques, popular music, theme and variation, thematic development

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Authors: Eman G. Alayad, Mazen G. Aleyad, Mohammed Alshahrani, Ibrahim Alnaami

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Introduction: Cerebral venous thrombosis (CVT) is a rare type of cerebrovascular disease that can occur at any age. Patients with CVT commonly present with headache, focal neurological deficit, decreased level of consciousness and seizures. Many etiologic risk factors have been reported for CVT, high altitude and oral contraceptive pill some of them. Case Presentation: A 37-year-old woman living in Abha city in the southeastern area of Saudi Arabia. (about 10,000 feet-3000 m) over the sea. complaining acute onset of severe diffuse headache and generalized tonic clonic convulsions. Followed by loss of consciousness. She was on contraceptive pills for the last 3 years. No significant Medical or surgical history. Brain CT revealed subarachnoid hemorrhage, with MRI findings showing thrombosis in transvers sinus. There was no vascular malformations such as aneurysm, arteriovenous malformation (AVM), or dural arteriovenous fistula. A CVT with subarachnoid hemorrhage was our final diagnosis based on clinical presentation and radiographic findings. Discussion: Patients with CVT had evidence of cortical SAH by 10 of 233, others found 3% of SAH was caused by CVT, indicating that the presence of cortical SAH without involvement of the basal cisterns may provide an early sign of underlying CVT. However, what is more interesting in this case, is the relationship of high altitude with CVT and SAH, which previously undescribed. Conclusion: High-altitude climbing per se was described as a risk factor for the development of CVT, though its occurrence was probably rare. Whether it is primary in etiology due to high altitude induced hypercoagulable state of unknown origin or due to cerebrovascular disturbances there is a need for further investigation especially at this unusual presentation of subarachnoid hemorrhage.

Keywords: cerebral venous thrombosis, high-altitude, subarachnoid hemorrhage, stroke

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Authors: Dwi Endarti, Susi a Kristina, Rizki Noorizzati, Akbar E Nugraha, Fera Maharani, Kika a Putri, Asninda H Azizah, Sausanzahra Angganisaputri, Yunisa Yustikarini

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Cost utility analysis is the most recommended pharmacoeconomic method since it allows widely comparison of cost-effectiveness results from different interventions. The method uses outcome of quality-adjusted life year (QALY) or disability-adjusted life year (DALY). Measurement of QALY requires the data of utility dan life years gained. Utility is measured with the instrument for quality of life measurement such as EQ-5D. Recently, the EQ-5D is available in two versions which are EQ-5D-3L and EQ-5D-5L. This study aimed to compare the EQ-5D-3L and EQ-5D-5L to examine the most suitable version for Indonesian population. This study was an observational study employing cross sectional approach. Data of quality of life measured with EQ-5D-3L and EQ-5D-5L were collected from several groups of population which were respondent with chronic diseases, respondent with acute diseases, and respondent from general population (without illness) in Yogyakarta Municipality, Indonesia. Convenience samples of hypertension patients (83), diabetes mellitus patients (80), and osteoarthritis patients (47), acute respiratory tract infection (81), cephalgia (43), dyspepsia (42), and respondent from general population (293) were recruited in this study. Responses on the 3L and 5L versions of EQ-5D were compared by examining the psychometric properties including agreement, internal consistency, ceiling effect, and convergent validity. Based on psychometric properties tests of EQ-5D-3L dan EQ-5D-5L, EQ-5D-5L tended to have better psychometric properties compared to EQ-5D-3L. Future studies for health related quality of life (HRQOL) measurements for pharmacoeconomic studies in Indonesia should apply EQ-5D-5L.

Keywords: EQ-5D, Health Related Quality of Life, Indonesian Population, Psychometric Properties

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Authors: Vladyslav Povoroznyuk, Anna Musiienko, Nataliia Zaverukha, Roksolana Povoroznyuk

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Along with the global aging of population, the number of people with somatic diseases is increasing, including such interrelated pathologies as obesity, osteoarthritis (OA) and osteoporosis (OP). The objective of the study is to examine the connection between body mass index (BMI), OA and bone mineral density (BMD) of lumbar spine, femoral neck and trabecular bone score (TBS) in postmenopausal women with OA. We have observed 359 postmenopausal women (50-89 years old) and divided them into four groups by age: 50-59 yrs, 60-69 yrs, 70-79 yrs and over 80 years old. In addition, according to the American College of Rheumatology (ACR) Clinical classification criteria for knee and hip OA, we divided them into 2 groups: group I – 117 females with symptomatic OA (including 89 patients with knee OA, 28 patients with hip OA) and group II –242 women with a normal functional activity of large joints. Analysis of data was performed taking into account their BMI, classified by World Health Organization (WHO). Diagnosis of obesity was established when BMI was above 30 kg/m². In woman with obesity, a symptomatic OA was detected in 44 postmenopausal women (41.1%), a normal functional activity of large joints - in 63 women (58.9%). However, in women with normal BMI – 73 women, who account for 29.0% of cases, a symptomatic OA was detected. According to a chi-squared (χ2) test, a significantly higher level of BMI was detected in postmenopausal women with OA (χ2 = 5.05, p = 0.02). Women with a symptomatic OA had a significantly higher BMD of lumbar spine compared with women who had a normal functional activity of large joints. No significant differences of BMD of femoral necks or TBS were detected in either the group with OA or with a normal functional activity of large joints.

Keywords: bone mineral density, body mass index, obesity, overweight, postmenopausal women, osteoarthritis

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Authors: Alex Kiselyov, Suehyun Cho, Darrell Harrington; Florent Cros, Olin Palmer, John Caputo, Michael Kardosh, Eran Oren, William Loudon, Michael Shpigelmacher

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Despite the most aggressive surgical and adjuvant therapeutic strategies, treatment of both pediatric and adult brainstem tumors remains problematic. Novel strategies, including targeted biologics, immunotherapy, and specialized delivery systems such as convection-enhanced delivery (CED), have been proposed. While some of these novel treatments are entering phase I trials, the field is still in need of treatment(s) that exhibits dramatically enhanced potency with optimal therapeutic ratio. Bionaut Labs has developed a modular microrobotic platform for performing localized delivery of diverse therapeutics in vivo. Our biocompatible particles (Bionauts™) are externally propelled and visualized in real-time. Bionauts™ are specifically designed to enhance the effect of radiation therapy via anatomically precise delivery of a radiosensitizing agent, as exemplified by temozolomide (TMZ) and Avastin™ to the brainstem gliomas of diverse origin. The treatment protocol is designed to furnish a better therapeutic outcome due to the localized (vs systemic) delivery of the drug to the neoplastic lesion(s) for use as a synergistic combination of radiation and radiosensitizing agent. In addition, the procedure is minimally invasive and is expected to be appropriate for both adult and pediatric patients. Current progress, including platform optimization, selection of the lead radiosensitizer as well as in vivo safety studies of the Bionauts™ in large animals, specifically the spine and the brain of porcine and ovine models, will be discussed.

Keywords: Bionaut, brainstem, glioma, local delivery, micro-robot, radiosensitizer

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Authors: Mohammed T. Hayajneh

Abstract:

Machining of Metal Matrix Composites (MMCs) is very significant process and has been a main problem that draws many researchers to investigate the characteristics of MMCs during different machining process. The poor machining properties of hard particles reinforced MMCs make drilling process a rather interesting task. Unlike drilling of conventional materials, many problems can be seriously encountered during drilling of MMCs, such as tool wear and cutting forces. Cutting tool wear is a very significant concern in industries. Cutting tool wear not only influences the quality of the drilled hole, but also affects the cutting tool life. Prediction the cutting tool life during drilling is essential for optimizing the cutting conditions. However, the relationship between tool life and cutting conditions, tool geometrical factors and workpiece material properties has not yet been established by any machining theory. In this research work, fuzzy subtractive clustering system has been used to model the cutting tool life in drilling of Al₂O₃ particle reinforced aluminum alloy composite to investigate of the effect of cutting conditions on cutting tool life. This investigation can help in controlling and optimizing of cutting conditions when the process parameters are adjusted. The built model for prediction the tool life is identified by using drill diameter, cutting speed, and cutting feed rate as input data. The validity of the model was confirmed by the examinations under various cutting conditions. Experimental results have shown the efficiency of the model to predict cutting tool life.

Keywords: composite, fuzzy, tool life, wear

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Authors: Bhaskar M. Murai, Neeraj Banchor, Ishveen Chabbra, Madhusudhan Nadgir, S. Vidhya

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Sol-gel technology combined with electronics and biochemistry helps to overcome the problems caused by mosquitoes by developing a portable, low-cost device which enables controlled release of trapped compound inside it. It is a wet-chemical technique which is used primarily for fabrication of silicate gel which is usually allowed to dry as per requirement. The outcome is solid rock hard material which is porous and has lots of applications in different fields. Taking porosity as a key factor, allethrin a naturally occurring synthetic compound with molecular mass 302.40 was entrapped inside the sol-gel matrix as a dopant. Allethrin is commonly used as an insecticide and is a key ingredient in commercially available mosquitoes repellent in Asian and subtropical countries. It has low toxicity for humans and birds, and are used in many household insecticides such as RAID as well as mosquito coils. They are however highly toxic to fish and bees. Insects subject to its exposure become paralyzed (nervous system effect) before dying. They are also used as an ultra-low volume spray for outdoor mosquito control. Therefore, there is a need for controlled release of allethrin in the environment. For controlled release of allethrin from sol-gel matrix, its (allethrin) we utilized temperature based controlled evaporation through porous sol-gel. Different types of fabric like cotton, Terri-cotton, polyester, surgical cap, knee-cap etc are studied and the best with maximum absorption capacity is selected to hold the sol-gel matrix with maximum quantity. For sol-gel coating 2 x 2cm cloth pieces are dipped in sol-gel solution for 10 minutes and by calculating the weight difference we concluded that Terri cotton is best suitable for our project. An electronic circuit with heating plate is developed in to test the controlled release of compound. An oscillatory circuit is used to produce the required heat.

Keywords: sol-gel, allethrin, TEOS, biochemistry

Procedia PDF Downloads 375

Authors: Anirudh Sharma

Abstract:

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: Roshanak Farjad, Amirhossein Hosseini

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Fecal incontinence (FI) is a stressful condition for children and their parents that may affect the patient’s psychological well-being. Evaluating the patients’ psychological status may help physicians manage the disease effectively. This study aimed to assess the emotional and behavioral disturbances in children with FI who were referred to the pediatric gastroenterology clinic in Mofid Children’s Hospital from April 2021 to 2022. This cross-sectional study included children (over four years old) with chronic constipation and fecal incontinence. The diagnosis of chronic constipation and FI were made according to Rome-IV criteria. The Child Behavior Checklist (CBCL) evaluated patients’ emotional, behavioral, and social problems. One hundred one patients with a mean age of 7.96 years were enrolled in the study; 67.32% were males. According to CBCL, 12% (12 patients) indicated emotional and behavioral problems, with CBCL scores in the clinical or at-risk range. We detected anxious/depressed problems in five (4.95%), withdrawn/depressed problems in eight (7.92%), somatic complaints in seven (6.93%), social problems in eight (7.92%), thought problems in nine (8.91%), attention problems in seven (6.93%), rule-breaking behavior in two (1.98%), and aggressive behavior in nine (8.91%) patients. The risk of internalizing and externalizing disorders was reported in four (3.96%) and five (4.95%) patients. Also, eight (7.92%) and seven (6.93%) patients had clinical symptoms of internalizing and externalizing disorders, respectively. There was no significant relationship between patients’ age and gender with the CBCL scores in any subscales. However, there was a significant difference in the total score among the age groups (P = 0.04). The relatively high prevalence of emotional, behavioral, and social problems in our study corroborates the importance of psychological screening of children with FI during the treatment process.

Keywords: chronic constipation, child behavior checklist (CBCL), fecal incontinence, rome-IV criteria

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Authors: Dwitya Elvira, Eryati Darwin

Abstract:

Background: Graves’ disease (GD) is an autoimmune thyroid disease. Imbalance of Th1/Th2 cells and T-regulatory (Treg)/Th17 cells was thought to play pivotal role in the pathogenesis of GD. Treg FoxP3 produced TGF-β to maintain regulatory function, and Th17 cells produced IL-17 as cytokines that were thought in mediating several autoimmune diseases. The aim of this study is to assess the role of IL-17 and TGF-β in the pathogenesis of GD and to investigate its correlation with Thyroid Stimulating Hormone Receptor Antibody (TRAb) and Treg FoxP3 expression. Method: 30 GD patients and 27 age and sex-matched controls were enrolled in this study. Diagnosis of GD was based on clinical and biochemical of GD. Serum IL-17, TGF-β, TRAb, and FoxP3 were measured by enzyme-linked immunosorbent assay (ELISA). Data were analyzed by using SPSS 21.0 (SPSS Inc.). Spearman rank correlation test was used for assessment of correlation. The statistical significance was accepted as P<0.05. Result: There was no significant correlation between IL-17 and TGF-β serum with expression of FoxP3 level in GD, but there was significant correlation between TGF-β and TRAb serum level (P<0.05). Serum levels of IL-17 and TGF-β were found to be elevated in patient group compared to control, where mean values of IL-17 were 14.43±2.15 pg/mL and TGF-β were 10.44±3.19 pg/mL in patients group; and in control group, level of IL-17 were 7.1±1.45 pg/mL and TGF-β were 4.95±1.35 pg/mL. Conclusion: Serum Il-17 and TGF-β were elevated in GD patients that reflect the role of inflammatory and regulatory cytokines activation in pathogenesis of GD. There was significant correlation between TGF-β and TRAb, revealing that Treg cytokines may play a role in pathogenesis of GD.

Keywords: IL-17, TGF-B, FoxP3, TRAb, Graves’ disease

Procedia PDF Downloads 286

Authors: R. Botrugno, S Basyuni, G. Nugent, I. Jenkyn, A. Ferro, H. Bennett, C. Hjalmarsson, J. Chu, V. Santhanam

Abstract:

This trainee led randomised controlled trial (RCT) aims to assess various outcomes for resorbable versus non-resorbable sutures for traumatic lacerations to the face. Within this trial of resorbable versus non-resorbable sutures for traumatic lacerations of the face (TORNFace), patient recruitment was facilitated by trainees who were employed at an NHS University Teaching Hospital in the United Kingdom. The trainees received appropriate training prior to recruiting patients for the trial. This included the completion of a national research e-learning module and face-to-face training that was provided locally. The locally delivered training provided an understanding of the eligibility criteria for the trial and the consent process. Existing trainee skills were utilised involving clinical photography to record baseline data and delivering the intervention based on the treatment arm selected. Eligible patients who required primary closure of traumatic lacerations of the face were randomised into one of two treatment arms. These comprised of resorbable (vicryl rapide) or non-resorbable sutures (ethilon). Primarily the cosmetic outcome was assessed. Secondary outcomes included: complications rates, health care economics, and patient-reported outcomes. Remote follow-up of recruited patients utilised photographs of the facial laceration which had received the intervention. These took place at 1 week, 3 months and 6 months post-intervention. This study aims to demonstrate an example of trainee-led research within the specialty of oral and maxillofacial surgery. The available data for the randomised controlled trial will also be presented.

Keywords: laceration, suture, trauma, trial

Procedia PDF Downloads 137

Authors: Latifa Hamoudi-Belarbi, L'Hadi Nouri, Khaled Belkacemi

Abstract:

The effect of three methods of drying (traditional drying, freeze-drying and spray-drying) on the survival of concentrated cultures of Geotrichum fragrans and Wickerhamomyces anomalus was studied. The survival of yeast cultures was initially compared immediately after freeze-drying using HES 12%(w/v)+Sucrose 7% (w/v) as protectant, traditional drying in dry rice cakes and finally spray-drying with whey proteins. The survival of G. fragrans and W. anomalus was studied during 4 months of storage at 4°C and 25°C, in the darkness, under vacuum and at 0% relative humidity. The results demonstrated that high survival was obtained using traditional method of preservation in rice cakes (60% for G. fragrans and 65% for W. anomalus) and freeze-drying in (68% for G. fragrans and 74% for W. anomalus). However, poor survival was obtained by spray-drying method in whey protein with 20% for G. fragrans and 29% for W. anomalus. During storage at 25°C, yeast cultures of G. fragrans and W. anomalus preserved by traditional and freeze-drying methods showed no significant loss of viable cells up to 3 months of storage. Spray-dried yeast cultures had the greatest loss of viable count during the 4 months of storage at 25°C. During storage at 4°C, preservation of yeasts cultures using traditional method of preservation provided better survival than freeze-drying. This study demonstrated the effectiveness of the traditional method to preserve yeasts cultures compared to the high cost methods like freeze-drying and spray-drying.

Keywords: freeze-drying, traditional drying, spray drying, yeasts

Procedia PDF Downloads 490

Authors: Debarati Bhaumik, Diptish Dey

Abstract:

Multilevel models, increasingly deployed in industries such as insurance, food production, and entertainment within functions such as marketing and supply chain management, need to be transparent and ethical. Applications usually result in binary classification within groups or hierarchies based on a set of input features. Using open-source datasets, we demonstrate that popular explainability methods, such as SHAP and LIME, consistently underperform inaccuracy when interpreting these models. They fail to predict the order of feature importance, the magnitudes, and occasionally even the nature of the feature contribution (negative versus positive contribution to the outcome). Besides accuracy, the computational intractability of SHAP for binomial classification is a cause of concern. For transparent and ethical applications of these hierarchical statistical models, sound audit frameworks need to be developed. In this paper, we propose an audit framework for technical assessment of multilevel regression models focusing on three aspects: (i) model assumptions & statistical properties, (ii) model transparency using different explainability methods, and (iii) discrimination assessment. To this end, we undertake a quantitative approach and compare intrinsic model methods with SHAP and LIME. The framework comprises a shortlist of KPIs, such as PoCE (Percentage of Correct Explanations) and MDG (Mean Discriminatory Gap) per feature, for each of these three aspects. A traffic light risk assessment method is furthermore coupled to these KPIs. The audit framework will assist regulatory bodies in performing conformity assessments of AI systems using multilevel binomial classification models at businesses. It will also benefit businesses deploying multilevel models to be future-proof and aligned with the European Commission’s proposed Regulation on Artificial Intelligence.

Keywords: audit, multilevel model, model transparency, model explainability, discrimination, ethics

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Authors: Zainab Alghali Elsaid Muhammed

Abstract:

Background : IBS is a gastrointestinal disorder characterized by a variety of symptoms that occur concurrently. It is very common and is associated with high levels of psychiatric comorbidities, all of which have a negative impact on the patient's quality of life. Abdominal pain, diarrhea, constipation, excess gas, and bloating are common symptoms of IBS. Objectives : The purpose of this study is to determine the prevalence of IBS among medical students and intern doctors in Sudan, as well as the risk factors associated with it. Study design: This cross-sectional study was carried out in Sudan from April to July 2022. All participants completed a six-part online questionnaire. The ROME IV criteria questionnaire was used to make an IBS diagnosis. Participants completed the hospital anxiety and depression questionnaire in order to be diagnosed with anxiety and depression. Results : 600 participants filled out the questionnaire. The overall prevalence of IBS was found to be 42%, with females being the most affected. Intern doctors had higher IBS rates (30.0%) than medical students, but this was not statistically significant. Single status (p =0.079), good GPAs (p =0.00), had significant associations with IBS occurrence. Other significantly associated habits were sleeping less than 8 hours (p =0.013), two cups or less of coffee per day (p = 0.109), No smoking (p =0.001), and No exercise (p =0.00, IBS participants were also found to have a significant relationship with abnormal anxiety (p =0.00) and borderline depression (p=0.0156). Conclusion : The high prevalence of IBS in this study suggests that medical students and interns are unable to recognize their symptoms. The main IBS predictors in this study were suffering from anxiety or depression, having an insufficient income, sleeping less than 8 hours per day, working/ studying more than 8 hours per day, and not performing any type of exercise.

Keywords: irritable bowel syndrome, sudan, HADS, rome IV, medical students

Procedia PDF Downloads 101