Search results for: infant head trauma

Authors: Maria Ahmad, Alexandra Valetopoulou, Michael D. Christian

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Background: London’s Air Ambulance (LAA) provides advanced pre-hospital trauma care across London, bringing specialist resources and expert trauma teams to patients. Since its inception 32 years ago, LAA has treated over 40,000 pre-hospital patients and significantly contributed to pre-hospital patient care in London. To the authors’ best knowledge, this is the first analysis to quantify the magnitude of the publication impact of LAA on the international field of pre-hospital medicine. Method: We searched the Scopus, Web of Science, Google Scholar and PubMed databases to identify LAA focused articles. These were defined as articles on the topic of pre-hospital medicine which either utilised data from LAA, or focused on LAA patients, or were authored by LAA clinicians. A bibliometric analysis was conducted and the impact of each eligible article was classified as either: high (article directly influenced the change or creation of clinical guidelines); medium (the article was referenced in clinical guidelines or had >20 Google Scholar citations or >10 PubMed citations); or low impact (article had <20 Google Scholar citations or <10 PubMed citations). Results: The literature search yielded 1,120 articles in total. 198 articles met our inclusion criteria, and their full text was analysed to determine the level of impact. 19 articles were classified as high-impact, 76 as medium-impact, and 103 as low-impact. 20 of the 76 medium-impact articles were referenced in clinical guidelines but had not prompted changes to the guidelines. Conclusion: To our knowledge, this review is the first to quantify the significant publication impact of LAA within the field of pre-hospital medicine over the last 32 years. LAA publications have focused on and driven clinical innovations in trauma care, particularly in pre-hospital anaesthesia, haemorrhage control, and major incidents, with many impacting national and international guidelines. We recommend a greater emphasis on multidisciplinary pre-hospital collaboration in publications in future research and quality improvement projects across all pre-hospital services.

Keywords: air ambulance, pre-hospital medicine, London’s Air Ambulance, London HEMS

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Authors: Ticijana Prijon, Branko Ermenc

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Background: Blunt aortic trauma (BAT) includes various morphological changes that occur during deceleration, acceleration and/or body compression in traffic accidents. The various forms of BAT, from limited laceration of the intima to complete transection of the aorta, depends on the force acting on the vessel wall and the tolerance of the aorta to injury. The force depends on the change in velocity, the dynamics of the accident and of the seating position in the car. Tolerance to aortic injury depends on the anatomy, histological structure and pathomorphological alterations due to aging or disease of the aortic wall.An overview of the literature and medical documentation reveals that different terms are used to describe certain forms of BAT, which can lead to misinterpretation of findings or diagnoses. We therefore, propose a classification that would enable uniform systematic screening of all forms of BAT. We have classified BAT into three morphologycal types: TYPE I (intramural), TYPE II (transmural) and TYPE III (multiple) aortic ruptures with appropriate subtypes. Methods: All car accident casualties examined at the Institute of Forensic Medicine from 2001 to 2009 were included in this retrospective study. Autopsy reports were used to determine the occurrence of each morphological type of BAT in deceased drivers, front seat passengers and other passengers in cars and to define the morphology of BAT in relation to the accident dynamics and the age of the fatalities. Results: A total of 391 fatalities in car accidents were included in the study. TYPE I, TYPE II and TYPE III BAT were observed in 10,9%, 55,6% and 33,5%, respectively. The incidence of BAT in drivers, front seat and other passengers was 36,7%, 43,1% and 28,6%, respectively. In frontal collisions, the incidence of BAT was 32,7%, in lateral collisions 54,2%, and in other traffic accidents 29,3%. The average age of fatalities with BAT was 42,8 years and of those without BAT 39,1 years. Conclusion: Identification and early recognition of the risk factors of BAT following a traffic accident is crucial for successful treatment of patients with BAT. Front seat passengers over 50 years of age who have been injured in a lateral collision are the most at risk of BAT.

Keywords: aorta, blunt trauma, car accidents, morphology, risk factors

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Authors: Monalisha Ghosh, Asit Mohanty

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The lack of sanitation increases living costs, decreases spend on education and nutrition, lowers income earning potential, and threatens safety and welfare. This is especially true for rural India. Only 32% of rural households have their own toilets and that less than half of Indian households have a toilet at home. Of the estimated billion people in the world who defecate in the open, more than half reside in rural India. It is empirically established that poor sanitation leads to high infant mortality rate and low income generation in rural India. In India, 1,600 children die every day before reaching their fifth birthday and 24% of girls drop out of school as the lack of basic sanitation. Above all, lack of sanitation is not a symptom of poverty but a major contributing factor. According to census 2011, 67.3% of the rural households in the country still did not have access to sanitation facilities. India’s sanitation deficit leads to losses worth roughly 6% of its gross domestic product (GDP) according to World Bank estimates by raising the disease burden in the country. The dropout rate for girl child is thirty percent in schools in rural areas because of lack of sanitation facilities for girl students. The productivity loss per skilled labors during a year is calculated at Rs.44, 160 in Odisha. The performance of the state of Odisha has not been satisfactory in improving sanitation facilities. The biggest challenge is triggering behavior change in vast section of rural population regarding need to use toilets. Another major challenge is funding and implementation for improvement of sanitation facility. In an environment of constrained economic resources, Public Private Partnership in form of performance based management or maintenance contract will be all the more relevant to improve the sanitation status in rural sector.

Keywords: rural sanitation, infant mortality rate, income, granger causality, pooled OLS method test public private partnership

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Authors: Heidi Ahonen

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Since antiquity, many cultures have seemingly known the power of low frequencies, incorporating them in healing practices through drumming, singing, humming, etc. Many music therapists recognize there is something in music that is transformative enough to make a difference in people’s lives. This paper summarizes the key findings of several low-frequency research with various client populations conducted by the author. Utilizing low-frequency sound (30 or 40 Hz) may have diverse therapeutic impacts: (1) Calming effect – decreased agitation (autism, brain injury, AD, dementia) (2) Muscle relaxation (CP & spasticity & pain/after surgery patients, MS, fibromyalgia) (3) Relaxation/stress release (anxiety, stress, PTSD, trauma, insomnia) (4) Muscular/motor functioning/ decrease of tremor (CP, MS, Parkinson) (5) Increase in alertness, cognitive awareness & short-term memory function (brain injury, severe global developmental delay, AD) (6) Increased focus (AD, PTSD, trauma). The paper will conclude by presenting ideas informing the clinical practice. Future studies need to investigate what frequencies are effective for particular client populations and why, what theories can explain the effect, and finally, something that has been long debated - is it auditive or kinaesthetic stimulation or the combination of both that is effective?

Keywords: low frequency, 40 Hz, sound, neuro disability

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Authors: Nathaniel C. Villanueva, Ian K. H. Chun, Alyssa S. Fujiwara, Emily R. Leibovitch, Brennan E. Yamamoto, Loren G. Yamamoto

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Introduction: In previous studies of high school sports, over 15% of concussions were attributed to contact with the playing surface. While artificial turf fields are increasing in popularity due to lower maintenance costs, artificial turf has been associated with more ankle and knee injuries, with inconclusive data on concussions. In this study, natural grass and artificial football fields were compared in terms of deceleration on fall impact. Methods: Accelerometers were placed on the forehead, apex of the head, and right ear of a Century Body Opponent Bag (BOB) manikin. A Riddell HITS football helmet was secured onto the head of the manikin over the accelerometers. This manikin was dropped onto natural grass (n = 10) and artificial turf (n = 9) high school football fields. The manikin was dropped from a stationary position at a height of 60 cm onto its front, back, and left side. Each of these drops was conducted 10 times at the 40-yard line, 20-yard line, and endzone. The net deceleration on impact was calculated as a net vector from each of the three accelerometers’ x, y, and z vectors from the three different locations on the manikin’s head (9 vector measurements per drop). Results: Mean values for the multiple drops were calculated for each accelerometer and drop type for each field. All accelerometers in forward and backward falls and one accelerometer in side falls showed significantly greater impact force on synthetic turf compared to the natural grass surfaces. Conclusion: Impact force was higher on synthetic fields for all drop types for at least one of the accelerometer locations. These findings suggest that concussion risk might be higher for athletes playing on artificial turf fields.

Keywords: concussion, football, biomechanics, sports

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Authors: Elizabeth Laguaite, Alexandria Purdy

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Heart transplant recipients face psycho-physiological stressors, including pain, lengthy hospitalizations, delirium, and existential crises. They pose an increased risk for Post Traumatic Stress Disorder (PTSD) and can be a predictor of poorer mental and physical Health-Related Quality of Life (HRQOL) outcomes and increased mortality. There is limited research on the prevention of Post Traumatic Stress Symptoms (PTSS) in transplant patients. This case report focuses on a collaborative Music and Art Therapy intervention used to improve outcomes for HMH transplant recipient John (Alias). John, a 58-year-old man with congestive heart failure, was admitted to HMH in February of 2021 with cardiogenic shock, cannulated with an Intra-aortic Balloon Pump, Impella 5.5, and Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) as a bridge to heart and kidney transplant. He was listed as status 1 for transplant. Music Therapy and Art Therapy (MT and AT) were ordered by the physician for mood regulation, trauma processing and anxiety management. During MT/AT sessions, John reported a history of anxiety and depression exacerbated by medical acuity, shortness of breath, and lengthy hospitalizations. He expressed difficulty sleeping, pain, and existential questions. Initially seen individually by MT/AT, it was determined he could benefit from a collaborative approach due to similar thematic content within sessions. A Life Review intervention was developed by MT/AT. The purpose was for him to creatively express, reflect and process his medical narrative, including the identification of positive and negative events leading up to admission at HMH, the journey to transplant, and his hope for the future. Through this intervention, he created artworks that symbolized each event and paired them with songs, two of which were composed with the MT during treatment. As of September 2023, John has not been readmitted to the hospital and expressed that this treatment is what “got him through transplant”. MT and AT can provide opportunities for a patient to reminisce through creative expression, leading to a shift in the personal meaning of these experiences, promoting resolution, and ameliorating associated trauma. The closer to trauma it is processed, the less likely to develop PTSD. This collaborative MT/AT approach could improve long-term outcomes by reducing mortality and readmission rates for transplant patients.

Keywords: art therapy, music therapy, critical care, PTSD, trauma, transplant

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Authors: Harald Haas, Andrea Plaschke

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Many of the contemporary major conflicts on this earth could not be solved so far, they either are perpetuated, or they are reflated again and again. Efforts of purely political conflict management or -resolution aim merely at the symptoms of conflict, not its roots. These roots are, in almost every case, also psychological ones. Thus, this contribution aims to shed light on the roots of one of the best known and longest-lasting conflicts: the Palestinian-Israeli one. Methodologies used were the compilation of existing scientific resources, field research in Palestine and Israel, as well as tests conducted with the Adult Attachment Projective in Palestine and Israel. Findings show that the majority of Palestinian, as well as Israeli test participants, show a disorganised attachment pattern which, in connection with the assumption of collective traumatization, seem to be a major obstacle to a lasting and peaceful conflict-resolution between these two peoples. There appears to be no short-term solution for this conflict, especially not within the range of usual Western legislative periods. Both sides ought to be provided with a kind of 'safe haven' over a long period of time, accompanied by a framework of various arrangements of coping with trauma, building lasting and secure relationships, as well as raising and educating present and future generations of Palestinians and Israelis for peace and co-operation with each other.

Keywords: conflict-management, trauma, political psychology, attachment theory

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Authors: Sadra Abbasi

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The complex connection between psychological stress and the onset of different diseases has been an ongoing issue in the mental health field for a long time. Multiple studies have demonstrated that long-term stress can greatly heighten the likelihood of developing health issues like heart disease, cancer, arthritis, and severe depression. Recent research in cognitive science has provided insight into the intricate processes involved in posttraumatic stress disorder (PTSD), suggesting that distinct memory systems are accountable for both vivid reliving and normal autobiographical memories of traumatic incidents, as proposed by dual representation theory. This theory has important consequences for our comprehension of the neural mechanisms involved in fear and behavior related to threats, highlighting the amygdala-hippocampus-medial prefrontal cortex circuit as a crucial component in this process. This particular circuit, extensively researched in behavioral neuroscience, is essential for regulating the body's reactions to stress and trauma. This review will examine how incorporating a modern neuroscience viewpoint into an integrative case formulation offers a current way to comprehend the intricate connections among psychological stress, trauma, and disease.

Keywords: social, cognitive, stress, neuroscience, behavior, PTSD

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Authors: Nnaemeka Enemchukwu

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In modern-day Nigeria, the spirit of Biafra, the defunct secessionist state of former Eastern Nigeria, endures. While some attempt to downplay the historical factors that led to its creation, this paper aims to demonstrate that the 1966 pogroms in Nigeria, which claimed the lives of over 30,000 Igbo people, shattered their faith in the nation's ability to provide security and acceptance. This loss of faith led to a mass exodus from various regions of the country back to their homeland in Eastern Nigeria. Utilizing primary sources such as interviews and archival reports, and secondary sources like books, journals, and websites, this paper will argue that the trauma and terror of the 1966 massacres were the primary drivers of secessionist sentiment and self-determination among the Igbo people, ultimately leading to the declaration of Biafra. By drawing parallels with other historical incidents across the globe, this paper will establish the theoretical connection between shocking events, identity questioning among traumatized groups, and the subsequent rise of nationalistic sentiments seeking to ensure group preservation. To achieve its objective, this paper will employ descriptive, narrative, and chronological methods of analysis to present and discuss its findings.

Keywords: Igbo, pogrom, shock, trauma, nationalism, Biafra

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Authors: Judith Correa-Gomez, Cristina Garcia-De la Pena, Veronica Avila-Rodriguez, David R. Aguillon-Gutierrez

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Kemp's ridley (Lepidochelys kempii) is the smallest species of sea turtle. It nests on the beaches of the Gulf of Mexico during summer. To date, there is no information about congenital anomalies in this species, which could be an important factor to be considered as a survival threat. The aim of this study was to determine congenital anomalies in dead embryos and hatchlings of Kemp's ridley sea turtle during 2020 nesting season. Fieldwork was conducted at the 'Campamento Tortugero Barra Norte', on the shores of Tuxpan, Veracruz, Mexico. A total of 95 nests were evaluated, from which 223 dead embryos and hatchlings were collected. Anomalies were detected by detailed physical examinations. Photographs of each anomaly were taken. From the 223 dead turtles, 213 (95%) showed a congenital anomaly. A total of 53 types of congenital anomalies were found: 22 types on the head region, 21 on the carapace region, 6 on the flipper region, and 4 regarding the entire body. The most prevalent anomaly in the head region was the presence of prefrontal supernumerary scales (42%, 93 occurrences). On the carapace region, the most common anomaly was the presence of supernumerary gular scales (59%, 131 occurrences). The two most common anomalies on the flipper region were amelia in fore flippers and rear bifurcation of flippers (0.9%, 2 occurrences each). The most common anomaly involving the entire body was hypomelanism (35%, 79 occurrences). These results agree with the recent studies on congenital malformations on sea turtles, being the head and the carapace regions the ones with the highest number of congenital anomalies. It is unknown whether the reported anomalies can be related to the death of these individuals. However, it is necessary to develop embryological studies in this species. To our best knowledge, this is the first worldwide report on Kemp’s ridley sea turtle anomalies.

Keywords: Amelia, hypomelanism, morphology, supernumerary scales

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Authors: Stephanie Elizabeth Talder

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Art therapy is a field that is growing exponentially with new groundbreaking discoveries that allow for embodying trauma and mental healing. Applied theatre and performance is a continuously growing and developing field that can help people who are struggling to work through traumatic experiences plaguing their life. By using performance, there is an ability to target sensitive topics in a manner that does not lead to re-traumatization. The use of theatre as a healing agent has been going on for centuries, with clear applications beginning in Greek theatre and tragedy. When working with complex mental illness, issues such as PTSD, anxiety, and depression can be managed and worked through. A central component of drama therapy is the connection to community and self. The ability to connect mind-body to stories as well as to other people allows for healing to occur. There is the opportunity for healing through emotional catharsis and community building. Applied theatre in connection to the medical field can allow for there to be a meaningful impact made on mental health. Though there is still a significant amount of progress to be made within the stigmatization of mental health problems, bringing in a varying option that allows for there to be movement and community building possesses a strong ability to impact people in a positive way.

Keywords: applied theatre, drama therapy, art therapy, performance, theatre

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Authors: Smriti Pahwa, Karishma Vats, Aditi Macwan, Jija Dutt, Sumukhi Vaid

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Age approporiate complementary feeding has been stressed upon for sound young child nutrition and appropriate growth. National Infant and Young Child Feeding guidelines, policies and programs indicate cognizance of the issue taken by the country’s government, policy makers and technical experts. However, it is important that ordinary people, the caregivers of young children too understand the importance of appropriate feeding. For this, an interface might be required where ordinary people could participate in assessing the gaps in IYCF as a first step to take subsequent action. In this context an attempt was made to extrapolate a citizen led learning level survey that has been involving around 25000 ordinary citizens to reach out to 600,000 children annually for over a decade in India. Based on this philosophy of involving ordinary people in simple assessments to produce understandable actionable evidence, a rapid diet assessment tool was developed and collected from caregivers of 90 < 3year children from two urban clusters in Ahmedabad and Baroda, Gujarat. Target sample for pilot was selected after cluster census. Around half the mothers reported that they had not yet introduced water or other fluids to their < 6 month babies. However, about a third were already feeding them food other than mother’s milk. Although complementary feeding was initiated in almost all (95%) children more than 6 months old, frequency was suboptimal in 60%; in 80% cases no measure was taken to either improve energy or nutrient density; only 33% were fed protective foods; Green Leafy Vegetables consumption was negligible (1.4%). Anganwadi food was not consumed. By engaging ordinary people to generate evidence and understand the gaps, such assessments have the potential to be used to generate useful evidence for action at scale as well as locally.

Keywords: citizen led, grass root engagement, IYCF (Infant and Young Child Feeding), rapid diet assessment, under nutrition

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Authors: Hannah Gutmann, Rick Richardson, Richard Bryant

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Intrusive memories following a traumatic event are not uncommon. However, in some individuals, these memories become maladaptive and lead to prolonged stress reactions. A seminal model of PTSD explains that aberrant processing during trauma may lead to prolonged stress reactions and intrusive memories. This model explains that elevated arousal at the time of the trauma promotes data driven processing, leading to fragmented and intrusive memories. This study investigated the role of elevated arousal on the development of intrusive memories. We measured salivary markers of arousal and investigated what impact this had on data driven processing, memory fragmentation, and subsequently, the development of intrusive memories. We assessed 100 healthy participants to understand their processing style, arousal, and experience of intrusive memories. Participants were randomised to a control or experimental condition, the latter of which was designed to increase their arousal. Based on current theory, participants in the experimental condition were expected to engage in more data driven processing and experience more intrusive memories than participants in the control condition. This research aims to shed light on the mechanisms underlying the development of intrusive memories to illustrate ways in which therapeutic approaches for PTSD may be augmented for greater efficacy.

Keywords: stress, cortisol, SAA, PTSD, intrusive memories

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Authors: Ruben Peralta, Sam Thomas, Nazia Hirani, Ayman El-Menyar, Hassan Al-Thani, Mohammed Al-Thani, Mohammed Al-Hajjaj, Rafael Consunji

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Moderate to severe work-related injuries [WRI's] are a leading cause of trauma admission in Qatar but information on risk factors for their incidence are lacking. This study aims to document and analyze the predictive characteristics for WRI to inform the creation of targeted interventions to improve worker safety in Qatar. This study was conducted as part of the NPRP grant # 7 - 1120 - 3 - 288, titled "A Unified Registry for Occupational Injury Prevention in Qatar”. 266 workers were interviewed using a standard questionnaire, during ‘World Day for Safety and Health at Work’, a Ministry of Public Health event, none refused interview. Nurses and doctors from the Hamad Trauma Center conducted the interviews. Questions were translated into the worker’s native language when it was deemed necessary. Standard information on epidemiologic characteristics and incidence of work-related injury were collected and compared between nationalities and those injured versus those not injured. 262 males and 4 females were interviewed. 17 [6.4%] reported a WRI in the last 24 months. More than half of the injured worked in construction [59%] followed by water supply [11.8%]. Factors significantly associated with recent injury were: Working for a company with > 500 employees and speaking Hindi. Protective characteristics included: Being from the Philippines or Sri Lanka, speaking Arabic, working in healthcare, an office or trading and company size between 100-500 employees. Years of schooling and working in Qatar were not predictive factor for WRI. The findings from this survey should guide future research that will better define worker populations at an increased risk for WRI and inform recruiters and sending countries. A focus on worker language skills, interventions in the construction industry and occupational safety in large companies is needed.

Keywords: occupational injury, prevention, safety, trauma, work related injury

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Authors: Alisha Fisher

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Sex trafficking is a worldwide crisis that requires trauma-informed and survivor-centered media attention to accurate disseminate information. Much of the previous literature on sex trafficking tends to focus on the frequency of incidents, intervention, and support strategies for survivors, with few of them looking to how the media is conducting their reporting on sex trafficking cases to the public. Utilizing data of reports from the media of cases of sex trafficking in the two Canadian provinces with the highest cases of sex trafficking, Ontario and Nova Scotia, the authors sought to analyze the similarities and differences of how sex trafficking cases were being reported. A total of twenty articles were examined, with ten based within the province of Ontario and the remaining ten from the province of Nova Scotia. The authors coded in two processes, first, who the article was about, and second, the framing and content inclusion. The results suggest that there is high usage and reliance of voices and images of authority, with male people of color being shown as the perpetrators and white women being shown as the survivors. These findings can aid in the expansion of trauma-informed, survivor-centered media literacy of reports of sex trafficking to provide accurate insights and further developing robust methods to intersectional approaches to reporting cases of sex trafficking.

Keywords: sex trafficking, media coverage, Canada sex trafficking, content analysis

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Authors: Musadiq Idris, Sajjad Ali, Syed A. Khaliq, Umer Farooq

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Postmortem record of 217 captive ungulates including Black-buck (n=31), Chinkara (n=20), Hog deer (n=116), Spotted deer (n=35), Red Deer n=(04), and Rusa deer (n=11) submitted to the Veterinary Research Institute, Lahore, Pakistan was analyzed to determine the primary cause of mortality in these animals. The submissions included temporal distribution from Government wildlife captive farms, zoo, and private ownerships, over a three year period (2007-2009). The most common cause of death was found to be trauma (20.27%), followed by parasitic diseases (15.67%), bacterial diseases (11.98%), stillbirths (9.21%), snakebites (2.76%), gut affections (2.30%), neoplasia (1.38%) and starvation (0.92%). The exact cause of death could not be determined in 77 of 217 animals. Pneumonia (8.29%) and tuberculosis (3.69%) were the most common bacterial diseases. Analyses for parasitic infestation revealed tapeworms to be highest (11.05%), followed by roundworms (8.29%) and hemoparasitism (5.07%) (babesiosis and theileriosis). The mortality rate in young ungulates was lower as compared to adults (32.26% and 67.74%). Gender wise data presented higher mortality in females (55.30%) compared to males (44.70%). In conclusion, highest mortality factor in captive ungulates was trauma, followed by parasitic and bacterial infestations/infections of tapeworms and pneumonia, respectively. Furthermore, necropsies provided substantial information on etiology of death and other related epidemiological aspects.

Keywords: age, epidemiology, gender, mortality, ungulates

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Authors: Ksenia Siadkowska, Tytus Tulwin, Rafał Sochaczewski

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Selecting appropriate materials is presently a complex task as material databases cover tens of thousands of different types of materials. Product designing proceeds in numerous stages and in most of them there are open questions with not only one correct solution but better and worse ones. This paper overviews the Diesel engine body construction materials mentioned in the literature and discusses a certain practical method to select materials for a cylinder head and a Diesel engine block as a prototype. The engine body, depending on its purpose, is most frequently iron or aluminum. If it is important to optimize parts to achieve low weight, aluminum alloys are usually applied, especially in the automotive and aviation industries. In the latter case, weight is even more important so new types of magnesium alloys which are even lighter than aluminum ones are developed and used. However, magnesium alloys are, for example, more flammable and not enough strong so, for safety reasons, this type of material is not used solely in engine bodies. Acknowledgement: This work has been realized in the cooperation with The Construction Office of WSK "PZL-KALISZ" S.A." and is part of Grant Agreement No. POIR.01.02.00-00-0002/15 financed by the Polish National Centre for Research and Development.

Keywords: aluminum alloy, cylinder head, Diesel engine, materials selection

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Authors: Nikhat Iqbal Tamboli

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INTRODUCTION: road traffic accidents (RTAs) are one of the leading and common causes of ocular injuries especially in developing countries like India which are preventable with certain measures and so it is of public health importance. AIM: To study incidence and clinical presentation of ocular morbidity in road traffic accidents. METHOD: Prospective cross-sectional study was conducted on 360 patients reported in department of ophthalmology. Detailed ocular examination and relevant investigations done. RESULTS: Incidence of ocular injuries is 23%. male:female ratio is 4.5:1.Cases having Sub conjunctival haemorrhage [74].eccymosis[217]. lid lcerations [164]orbital fracture[12] corneal tear [7]corneal abrasion[2] sclera tear[6] hyphaema[4] traumatic mydriasis [7]traumatic cataract [2]vitreous haemorrhage [1]traumatic optic neuropathy[1].Maximum cases in age group 20-40 years, with two wheeler vehicles 94.7% .Under influence of alcohol 13.3%. CONCLUSION: Younger age group with male preponderance is involved in ocular trauma due to road traffic accidents .maximum cases reported are with anterior segment injuries. Alcohol and two wheeler vehicles are common risk factors. Injuries involving cornea had bad prognosis and involving retina had worst prognosis.

Keywords: ocular morbidity, eye trauma, RTA, eye injury

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Authors: Cecilia Moreira, Rita Paiva, Daniela Macedo, Leonor Ribeiro, Isabel Fernandes, Luis Costa

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Background: Head and neck paragangliomas are a rare group of tumors with a large spectrum of clinical manifestations. The approach to evaluate and treat these lesions has evolved over the last years. Surgery was the standard for the approach of these patients, but nowadays new techniques of imaging and radiation therapy changed that paradigm. Despite advances in treating, the growth potential and clinical outcome of individual cases remain largely unpredictable. Objectives: Characterization of our institutional experience with clinical management of these tumors. Methods: This was a cross-sectional study of patients followed in our institution between 01 January and 31 December 2017 with paragangliomas of the head and neck and cranial base. Data on tumor location, catecholamine levels, and specific imaging modalities employed in diagnostic workup, treatment modality, tumor control and recurrence, complications of treatment and hereditary status were collected and summarized. Results: A total of four female patients were followed between 01 January and 31 December 2017 in our institution. The mean age of our cohort was 53 (± 16.1) years. The primary locations were at the level of the tympanic jug (n=2, 50%) and carotid body (n=2, 50%), and only one of the tumors of the carotid body presented pulmonary metastasis at the time of diagnosis. None of the lesions were catecholamine-secreting. Two patients underwent genetic testing, with no mutations identified. The initial clinical presentation was variable highlighting the decrease of visual acuity and headache as symptoms present in all patients. In one of the cases, loss of all teeth of the lower jaw was the presenting symptomatology. Observation with serial imaging, surgical extirpation, radiation, and stereotactic radiosurgery were employed as treatment approaches according to anatomical location and resectability of lesions. As post-therapeutic sequels the persistence of tinnitus and disabling pain stands out, presenting one of the patients neuralgia of the glossopharyngeal. Currently, all patients are under regular surveillance with a median follow up of 10 months. Conclusion: Ultimately, clinical management of these tumors remains challenging owing to heterogeneity in clinical presentation, the existence of multiple treatment alternatives, and potential to cause serious detriment to critical functions and consequently interference with the quality of life of the patients.

Keywords: clinical outcomes, head and neck, management, paragangliomas

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Authors: Tamer Shehata

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Recently, nanotechnology acquired a great interest in the field of pharmaceutical production. Several pharmaceutical equipment were introduced into the research field for production of nanoparticles, among them, BÜCHI’ fourth generation nano-spray dryer B-90. B-90 is specialized with single step of production and drying of nano and microparticles. Currently, our research group is investigating several pharmaceutical formulations utilizing BÜCHI Nano-Spray Dryer B-90 technology. One of our projects is the formulation and evaluation of metformin hydrochloride mucoadhesive microparticles for treatment of type 2-diabetis. Several polymers were investigated, among them, gelatin and sodium alginate. The previous polymers are natural polymers with mucoadhesive properties. Preformulation studies such as atomization head mesh size, flow rate, head temperature, polymer solution viscosity and surface tension were performed. Postformulation characters such as particle size, flowability, surface scan and dissolution profile were evaluated. Finally, the pharmacological activity of certain selected formula was evaluated in streptozotocin-induced diabetic rats. B-90’spray head was 7 µm hole heated to 120 with air flow rate 3.5 mL/min. The viscosity of the solution was less than 11.5 cP with surface tension less than 70.1 dyne/cm. Successfully, discrete, non-aggregated particles and free flowing powders with particle size was less than 2000 nm were obtained. Gelatin and Sodium alginate combination in ratio 1:3 were successfully sustained the in vitro release profile of the drug. Hypoglycemic evaluation of the previous formula showed a significant reduction of blood glucose level over 24 h. In conclusion, mucoadhesive metformin hydrochloride microparticles obtained from B-90 could offer a convenient dosage form with enhanced hypoglycemic activity.

Keywords: mucoadhesive, microparticles, metformin hydrochloride, nano-spray dryer

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Authors: Jevonte Abioye, Dylan Savary

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The aim of this research is to present a disaggregated geostatistical analysis of the subnational provincial trends of child mortality variation in Zimbabwe from a child health policy perspective. Soon after gaining independence in 1980, the government embarked on efforts towards promoting equitable health care, namely through the provision of primary health care. Government intervention programmes brought hope and promise, but achieving equity in primary health care coverage was hindered by previous existing disparities in maternal health care disproportionately concentrated in urban settings to the detriment of rural communities. The article highlights policies and programs adopted by the government during the millennium development goals period between 1990-2015 as a response to the inequities that characterised the country’s maternal health care. A longitudinal comparative method for a spatial variation on child mortality rates across provinces is developed based on geostatistical analysis. Cross-sectional and time-series data was extracted from the World Health Organisation (WHO) global health observatory data repository, demographic health survey reports, and previous academic and technical publications. Results suggest that although health care policy was uniform across provinces, not all provinces received the same antenatal and perinatal services. Accordingly, provincial rates of child mortality growth between 1994 and 2015 varied significantly. Evidence on the trends of child mortality rates and maternal health policies in Zimbabwe can be valuable for public child health policy planning and public service delivery design both in Zimbabwe and across developing countries pursuing the sustainable development agenda.

Keywords: antenatal care, perinatal care, infant mortality rate, neonatal mortality rate, under-five mortality rate, millennium development goals, sustainable development agenda

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Authors: B. S. So, Y. H. Yoon, J. O. Jung, K. S. Bae

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Metal Injection Molding (MIM) is a technology that combines powder metallurgy and injection molding. Particularly, it is widely applied to the manufacture of precision mobile parts and automobile turbocharger parts because compact precision parts with complicated three-dimensional shapes that are difficult to machining are formed into a large number of finished products. The swing valve is a valve that adjusts the boost pressure of the turbocharger. Since the head portion is exposed to the harsh temperature condition of about 900 degrees in the gasoline GDI engine, it is necessary to use Inconel material with excellent heat resistance and abrasion resistance, resulting in high manufacturing cost. In this study, we developed a swing valve using a metal powder injection molding based hybrid material (Inconel 713C material with heat resistance is applied to the head part, and HK30 material with low price is applied to the rest of the body part). For this purpose, the process conditions of the metal injection molding were optimized to minimize the internal defects, and the effectiveness was confirmed by the fracture strength and fatigue test.

Keywords: hybrid metal injection molding, swing valve, turbocharger, double injection

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Authors: Cosette Maiky

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Background: In the context of the Syrian crisis, the past few years have witnessed an exponential growth in the number of refugee mental health studies, which have essentially focused either on the affected Syrian population and/or host communities. However, the Palestinian communities in the region did not receive sufficient that much of attention. Aim: The study aimed at identifying trends and patterns of mental health and and psychosocial conditions among Palestinian refugees in the context of the Syrian crisis, including the recognition of gaps in appropriate services. Methods: The research model comprised a systematic documentary review, a mapping of available contextual analyses, a quantitative survey, focus group discussions as well as key informant interviews (with relevant stakeholders and beneficiaries). Findings: Content analysis revealed multiple effects of transgenerational transmission of trauma among Palestinian refugees in the context of the Syrian crisis, which showed to be neither linear nor one-dimensional occurrence. In addition to highlights on exposure to traumatic events and psychological sequelae, the review outlines the most prevailing coping mechanisms and essential protective factors. Conclusion: Away from a trauma-centered or symptom-focused exercise, practitioners may take account of the present study to better focus research and intervention methodologies.

Keywords: Palestine refugees, Syria crisis, psychosocial, mental health

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Authors: Gubair Tarabeh, Ghadir Zriek, David Oppenheim, Avi Sagi-Schwartz, Nina Koren-Karie

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Introduction: Mind-Mindedness (MM) focuses on mothers' attunement to their infant's mental states as reflected in their speech to the infant. Appropriate MM comments are associated with attachment security in individualistic Western societies where parents value their children’s autonomy and independence, and may therefore be more likely to engage in mind-related discourse with their children that highlights individual thoughts, preferences, emotions, and motivations. Such discourse may begin in early infancy, even before infants are likely to understand the semantic meaning of parental speech. Parents in collectivistic societies, by contrast, are thought to emphasize conforming to social norms more than individual goals, and this may lead to parent-child discourse that emphasizes appropriate behavior and compliance with social norms rather than internal mental states of the self and the other. Therefore, the examination of maternal MM and its relationship with attachment in Arab collectivistic culture in Israel was of particular interest. Aims of the study: The goal of the study was to examine whether the associations between MM and attachment in the Arab culture in Israel are the same as in Western samples. An additional goal was to examine whether appropriate and non-attuned MM comments could, together, distinguish among mothers of children in the different attachment classifications. Material and Methods: 76 Arab mothers and their infants between the ages of 12 and 18 months were observed in the Strange Situation Procedure (49 secure (B), 11 ambivalent (C), 14 disorganized (D), and 2 avoidant (A) infants). MM was coded from an 8-minute free-play sequence. Results: Mothers of B infants used more appropriate and less non-attuned MM comments than mothers of D infants, with no significant differences with mothers of C infants. Also, mothers of B infants used less non-attuned MM comments than both mothers of D infants and mothers of C infants. In addition, Mothers of B infants were most likely to show the combination of high appropriate and low non-attuned MM comments; Mothers of D infants were most likely to show the combination of high non-attuned and low appropriate MM comments; and a non-significant trend indicated that mothers of C infants were most likely to show a combination of high appropriate and high non-attuned MM comments. Conclusion: Maternal MM was associated with attachment in the Arab culture in Israel with combinations of appropriate and non-attuned MM comments distinguishing between different attachment classifications.

Keywords: attachment, maternal mind-mindedness, Arab culture, collectivistic culture

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Authors: Gudakesh Yadav

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Utter Pradesh, which is one of the largest states of India with unequal distribution of resources and different socioeconomic and cultural characteristics, level of different new born health care indicators varies a lot from one district to another district. State shared more than 21 percent of total live births of India; whereas, it accounts for 28 percent of total infant deaths of the country, with the 53 per thousand infant mortality rate. The present paper attempts to examine tempo-spatial changes in new born care practices during NFHS-1 to NFHS-3 and DLHS-2 to DLHS-3 in Uttar Pradesh and different regions. Descriptive statistics, rate-ratios, concentration index, multivariate and decomposition analysis has been used for the study. Findings of the study reveal that new born care practices have improved over the time in the state and across all the regions because of giving more emphasis on venerable groups like poor, rural, less educated mothers and scheduled caste & tribes but still it did not achieve the desired successes. Regional analysis of third rounds of DLHS shows that, coverage of intuitional delivery was the lowest in the central region. Performance of the southern region was the lowest in terms of initiation of breastfeeding, keeping baby warm and dry after the birth. The study calls for proper follow up of new born children to accelerate new born and child health care service and prioritises increasing antenatal check-ups and institutional delivery, which helps to improve level of other new born care services. At the policy level there is need to reach venerable groups like scheduled caste and tribes, poor and uneducated, and new mother especially in rural areas. High focused district should be allocated for better implementation of new born care promotion programme in low performing districts. Partnership with the private sector health professional is necessary to reach the every part of population.

Keywords: decomposition, inequality, initiation of breastfeeding, institutional delivery

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Authors: Chih-Wei Pai, Rong-Chang Jou

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Using A1 A2 police-reported accident data for years 2003–2010 in Taiwan, the paper examines anatomic injuries and crash characteristics specific to pedestrians in “facing traffic” and “back to traffic” crashes. There were 2768 and 7558 accidents involving pedestrians walking along with/against traffic respectively. Injuries sustained by pedestrians and crash characteristics in these two crash types were compared with those in other crash types (nearside crash, nearside dart-out crash, offside crash, offside dart-out crash). Main findings include that “back to traffic” crashes resulted in more severe injuries, and pedestrians in “back to traffic” crashes had increased head, neck, and spine injuries than those in other crash types; and there was an elevated risk of head injuries in unlit darkness and NBU (non-built-up) roadways. Several crash features (e.g. unlit darkness, overtaking maneuvers, phone use by pedestrians and drivers, intoxicated drivers) appear to be over-involved in “back to traffic” crashes. The implications of the research findings regarding pedestrian/driver education, enforcement, and remedial engineering design are discussed.

Keywords: pedestrian accident, crash characteristics, injury, facing traffic, back to traffic

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Authors: Vanessa Do, Lauren Smith, Leslie Carver

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It is widely known that individuals with autism spectrum disorder (ASD) may exhibit sensitivity to stimuli. Even at a young age, they tend to display stimuli-related discomfort in their behavior during play. Play serves a crucial role in a child’s early years as it helps support healthy brain development, socio-emotional skills, and adaptation to their environment There is research dedicated to studying infant preferences for toys, especially in regard to: gender preferences, the advantages of promoting play, and the caregiver’s role in their child’s play routines. However, there is a disproportionate amount of literature examining how play patterns may differ in children with sensory sensitivity, such as children diagnosed with ASD. Prior literature has studied and found supporting evidence that individuals with ASD have deficits in social communication and have increased presence of repetitive behaviors and/or restricted interests, which also display in early childhood play patterns. This study aims to examine potential differences in toy preference between infants with (FH+) and without (FH-) a familial history of ASD ages 6. 9, and 12 months old. More specifically, this study will address the question, “do FH+ infants tend to play more with toys that require less social engagement compared to FH- infants?” Infants and their caregivers were recruited and asked to engage in a free-play session in their homes that lasted approximately 5 minutes. The sessions were recorded and later coded offline for engagement behaviors categorized by toy; each toy that the infants interacted with was coded as belonging to one of 6 categories: sensory (designed to stimulate one or more senses such as light-up toys or musical toys) , construction (e.g., building blocks, rubber suction cups), vehicles (e.g., toy cars), instructional (require steps to accomplish a goal such as flip phones or books), imaginative (e.g., dolls, stuffed animals), and miscellaneous (toys that do not fit into these categories). Toy engagement was defined as the infant looking and touching the toy (ILT) or looking at the toy while their caregiver was holding it (IL-CT). Results reported include/will include the proportion of time the infant was actively engaged with the toy out of the total usable video time per subject — distractions observed during the session were excluded from analysis. Data collection is still ongoing; however, the prediction is that FH+ infants will have higher engagement with sensory and construction toys as they require the least amount of social effort. Furthermore, FH+ infants will have the least engagement with the imaginative toys as prior literature has supported the claim that individuals with ASD have a decreased likelihood to engage in play that requires pretend play and other social skills. Looking at what toys are more or less engaging to FH+ infants is important as it provides significant contributions to their healthy cognitive, social, and emotional development. As play is one of the first ways for a child to understand the complexities of the larger world, the findings of this study may help guide further research into encouraging play with toys that are more engaging and sensory-sensitive for children with ASD.

Keywords: autism engagement, children’s play, early development, free-play, infants, toy

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Authors: Mohammad Rostami, Mohammad Reza Forghani, Elahe Neshat, Fatemeh Yaghoobi

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An Ad Hoc network consists of wireless mobile equipment which connects to each other without any infrastructure, using connection equipment. The best way to form a hierarchical structure is clustering. Various methods of clustering can form more stable clusters according to nodes' mobility. In this research we propose an algorithm, which allocates some weight to nodes based on factors, i.e. link stability and power reduction rate. According to the allocated weight in the previous phase, the cellular learning automaton picks out in the second phase nodes which are candidates for being cluster head. In the third phase, learning automaton selects cluster head nodes, member nodes and forms the cluster. Thus, this automaton does the learning from the setting and can form optimized clusters in terms of power consumption and link stability. To simulate the proposed algorithm we have used omnet++4.2.2. Simulation results indicate that newly formed clusters have a longer lifetime than previous algorithms and decrease strongly network overload by reducing update rate.

Keywords: mobile Ad Hoc networks, clustering, learning automaton, cellular automaton, battery power

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Authors: Charlotte Bach, Albrecht Jahn, Mahnaz Motamedi, Maryam Karimi-Ghahfarokhi

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Background: Maternal and infant deaths are most prevalent in the first month after birth, emphasizing the critical need for quality healthcare services during this period. Immigrant women, who are more susceptible to adverse pregnancy outcomes, often face neglect in accessing proper healthcare. The lack of adequate postpartum care significantly contributes to mortality rates. Therefore, utilizing maternal health care services and implementing postpartum care is crucial in reducing maternal and child mortality. Aims: This study aims to evaluate the assessment of pre- and postnatal care among women with and without migration background. In addition, the study explores the impact of COVID-19 procedures on women's experiences during pregnancy, birth, and the postpartum period. Methods: This research employs a cross-sectional Mixed-Method design. Data collection was facilitated through structured questionnaires administered to participants, alongside the utilization of patient bases, including Maternity and child medical records. Following the assumption that the investigator aimed to gain comprehensive insights, qualitative sampling focused on individuals with substantial experiences related to COVID-19, regarded as rich cases. Results: our study highlighted the influence of educational level, marital status, and consensual partnerships on the likelihood of Cesarean deliveries. Regarding breastfeeding practices, migrant women exhibited higher rates of breastfeeding initiation and continuation. Contraception utilization revealed interesting patterns, with non-migrants displaying higher odds of contraceptive use. The qualitative component of our research adds depth to the exploration of women's experiences during the COVID-19 pandemic, revealing nuanced challenges related to anxiety, hospital restrictions, breastfeeding support, and postnatal ward routines. Conclusion: Dissimilarity among studies toward cesarean rate between migrants and non-migrants underscores the importance of targeted interventions considering the diverse needs of distinct population groups. It also acknowledges potential cultural, contextual, and healthcare system influences on the association between mode of delivery and infant feeding practices. Studies acknowledge the influence of contextual variables on contraceptive preferences among migrants and non-migrants, emphasizing the need for tailored healthcare policies. The findings contribute to existing research, highlighting the need for a nuanced understanding of the impact of birth preparation courses on maternal and infant outcomes. Furthermore, they emphasize the universality of certain maternity care experiences, regardless of pandemic contexts, reinforcing the importance of patient-centred approaches in healthcare delivery.

Keywords: migration background, pregnancy outcome, covid-19, postpartum

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Authors: S. K. Sharma, P. Kumar, Pratibha Singh

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Consumption of SNACK is growing its popularity every day in India and a broad range of these items are available in the market. The end user interest in ready-to-eat snack foods is constantly growing mainly due to their ease, ample accessibility, appearance, taste and texture. Food extrusion has been practiced for over fifty years. Its role was initially limited to mixing and forming cereal products. Although thermoplastic extrusion has been successful for starch products, extrusion of proteins has achieved only limited success. In this study, value-added extruded prawn product was prepared with prawn flavor powder and corn flour using a twin-screw extruder. Prawn flavor concentrates prepared from fresh prawn head (Solenocera indica). To prepare flavor concentrate prawn head washed with potable water and blended with 200ml 3% salt solution per 250gm head weight to make the slurry, which was further put in muslin cloth and boiled with salt and starch solution for 10 minutes, cooled to room temperature and filtered, starch added to the filtrate and made into powder in an electrically drier at 43-450c. The mixture was passed through the twin-screw extruder (co-rotating twin screw extruder - basic technology Pvt. Ltd., Kolkata) which was operated at a particular speed of rotation, die diameter, temperature, moisture, and fish powder concentration. Many trial runs were conducted to set up the process variables. The different extrudes produced after each trail were examined for the quality and characteristics. The effect of temperature, moisture, screw speed, protein, fat, ash and thiobarbituric acid (TBA) number and expansion ratio were studied. In all the four trials, moisture, temperature, speed and die diameter used was 20%, 100°C, 350 rpm and 4 mm, respectively. The ratio of prawn powder and cornstarch used in different trials ranged between 2:98 and 10:90. The storage characteristics of the final product were studied using three different types of packaging under nitrogen flushing, i.e. a- 12-pm polyester, 12-pm metalized polyester, 60-11m polyethylene (metalized polyester a), b- 12-11m metalized polyester, 37.5-11m polyethylene (metalized polyester b), c- 12-11m polyethylene, 9-11m aluminium foil, 37.5-11m polyethylene (aluminium foil). The organoleptic analysis was carried out on a 9-point hedonic scale. The study revealed that the fried product packed in aluminum foil under nitrogen flushing would remain acceptable for more than three months.

Keywords: extruded product, prawn flavor, twin-screw extruder, storage characteristics

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