Search results for: four common ethics/virtues

Authors: Wen Hsin Hsu, Pin Lin

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Objective: Thirst discomfort is the most common yet often overlooked symptom in patients in the intensive care unit (ICU), with an incidence rate of 69.8%. If not properly cared for, it can easily lead to irritability, affect sleep quality, and increase the incidence of delirium, thereby extending the length of hospital stay. Research points out that the sensation of coldness is an effective strategy to alleviate thirst. Using a combined care approach for thirst can prolong the sensation of coldness in the mouth and reduce thirst discomfort. Therefore, it needs to be further analyzed and its effectiveness reviewed. Methods: This study uses systematic literature review and meta-analysis methodologies and searched databases including PubMed, MEDLINE, EMBASE, Cochrane, CINAHL, and two Chinese databases (CEPS and CJTD) based on keywords. JBI was used to appraise the quality of the literature. RevMen 5.4 software package was used, and Fix Effect Model was applied for data analysis. We selected experimental articles, including those in English and Chinese, that met the inclusion and exclusion criteria. Three research articles were included in total, with a sample size of 416 people. Two were randomized controlled trials, and one was a quasi-experimental design. Results: The results show that the combined care for thirst, which includes ice water spray or oral swab wipes, menthol mouthwash, and lip balm, can significantly relieve thirst intensity MD=-1.36 (3 studies, 95% CI (-1.77, -0.95), p <0.001) and thirst distress MD=-0.71 (2 studies, 95% CI (-1.32, -0.10), p =0.02). Therefore, it is recommended that medical staff identify high-risk groups for thirst early on. Implications for Practice: For patients who cannot eat orally, providing combined care for thirst can increase oral comfort and improve the quality of care.

Keywords: thirst bundle care, intensive care units, meta-analysis, ice water spray, menthol

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Authors: Mustafa Eruyar, Ersoy Pehlivan, Fatih Kafalı, Fatih Gundogan

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All megacities are not only under the pressure of common urbanization and growth problems but also dealing with different challenges according to their specific circumstances. However, the majority of cities focuses mainly on popular smart city projects, which are usually driven by strong private sector, regardless of their characteristics, each city needs to develop customized projects within a tailor-made smart city roadmap to be able to solve its own challenges. Smart city manifest, helps citizens to feel the action better than good reading smart city vision statements, which consists of five elements; namely purpose, values, mission, vision, and strategy. This study designs a methodology for smart city roadmap based on a top-down approach, breaking down of smart city manifest to feasible projects for a systematic smart city transformation. This methodology was implemented in Istanbul smart city transformation program which includes smart city literature review, current state analysis, roadmap, and architecture projects, respectively. Istanbul smart city roadmap project followed an extensive literature review of certain leading smart cities around the world and benchmarking of the city’s current state using well known smart city indices. In the project, needs of citizens and service providers of the city were identified via stakeholder, persona and social media analysis. The project aimed to develop smart city projects targeting fulfilling related needs by implementing a gap analysis between current state and foreseen plans. As a result, in 11 smart city domains and enablers; 24 strategic objectives, 50 programs, and 101 projects were developed with the support of 183 smart city stakeholder entities and based on 125 citizen persona profiles and last one-year social media analysis. In conclusion, the followed methodology helps cities to identify and prioritize their needs and plan for long-term sustainable development, despite limited resources.

Keywords: needs-based, manifest, roadmap, smart city, top-down approach

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Authors: Hamida Memon, Muhammad Sanan

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A 34-year-old male with no prior health issues presented with a wound in his left leg exhibiting active pus discharge, intense inflammation, pain radiating from the buttocks to the knee, foot drop, and skin darkening. Four years prior, he sustained an untreated dislocation of the hip joint and acetabulum from a road traffic accident. Initial nerve conduction studies (NCS) and electromyography (EMG) revealed severe axonotomesis of the left sciatic nerve and reduced compound muscle action potential in the left common peroneal nerve. Despite normal venous flow, edema and cellulitis were noted. Follow-up NCS/EMG in 2022 showed improvement, but in 2023, the patient experienced recurrent infection and underwent surgical intervention with tissue culture. Postoperative care included antibiotics and pain management. NCS/EMG in 2024 indicated decreased nerve amplitudes and conduction velocities, consistent with moderate axonotmesis and ongoing recovery, alongside incidental right S1 radiculopathy. General lab tests and abdominal imaging were normal. The patient was treated with Pregabalin and Neurobion for neuropathic pain and nerve support and is currently under observation by a tertiary sector hospital for treatment. This case underscores the critical importance of prompt treatment for hip dislocations to prevent long-term complications such as neuropathy and avascular necrosis. Delays in treatment significantly increase the risk of severe outcomes, highlighting the need for timely intervention. Overall, the case illustrates the challenges of managing complex nerve injuries and the importance of comprehensive care for optimal recovery.

Keywords: sciatic nerve neuropathy, hip dislocation, acetabular fracture, radiculopathy

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Authors: Shoba Bandi-Rao

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The lack of college readiness is one of the major contributors to low graduation rates at community colleges, especially among educationally and financially disadvantaged students. About 45% of underprepared high school graduates are required to complete ‘remedial’ reading/writing courses before they can begin taking college-level courses. Mobile apps present ‘bite-size’ learning materials that can be useful for practicing certain literacy skills, such as vocabulary learning. The convenience of mobile phones is ideal for a majority of students at community colleges who hold full or part-time jobs. Mobile apps allow students to learn during small ‘chunks’ of time available to them outside of the class—during subway commute, between classes, etc. Learning with mobile apps is a relatively new area in research, and their effectiveness for learning new words has been inconclusive. Using Mishra & Koehler’s TPCK theoretical framework, this study explored the effectiveness of the mobile app (Quizlet) for learning one hundred common college-level words in ‘remedial’ writing class over one semester. Each week, before coming to class, students studied a list of 10-15 words presented in context within sentences. Students came across these words in the article they read in class making their learning more meaningful. A pre and post-test measured the number of words students knew, learned and remembered. Statistical analysis shows that students performed better by 41% on the post-test indicating that the mobile app was helpful for learning words. Students also completed a short survey each week that sought to determine the amount of time students spent on the vocabulary app. A positive correlation was found between the amount of time spent on the mobile app and the number of words learned. The goal of this research is to capitalize on the convenience of smartphones to (1) better prepare them for college-level course work, and (2) contribute to current literature on mobile learning.

Keywords: mobile learning, vocabulary learning, literacy skills, Quizlet

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Authors: Miguel A. Jimenez Barros, Elyn L. Solano Charris, Luis E. Ramirez, Lauren Castro Bolano, Carlos Torres Barreto, Juliana Morales Cubillo

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This project sought to mitigate the high levels of water consumption in industrial processes in accordance with the water-rationing plan promoted at national and international level due to the water consumption projections published by the United Nations. Water consumption has three main uses, municipal (common use), agricultural and industrial where the latter consumes a minimum percentage (around 20% of the total consumption). Awareness on world water scarcity, a Colombian company responsible for generation of massive consumption products, decided to implement politics and techniques for water treatment, recycling, and reuse. The project consisted in a business technology program that permits a better use of wastewater caused by production operations. This approach reduces the potable water consumption, generates better conditions of water in the sewage dumps, generates a positive environmental impact for the region, and is a reference model in national and international levels. In order to achieve the objective, a process flow diagram was used in order to define the industrial processes that required potable water. This strategy allowed the industry to determine a water reuse plan at the operational level without affecting the requirements associated with the manufacturing process and even more, to support the activities developed in administrative buildings. Afterwards, the company made an evaluation and selection of the chemical and biological processes required for water reuse, in compliance with the Colombian Law. The implementation of the business technology program optimized the water use and recirculation rate up to 70%, accomplishing an important reduction of the regional environmental impact.

Keywords: bio-reactor, potable water, reverse osmosis, water treatment

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Authors: Athanasia Eirini Zarkadi, Despoina Balli, Olga Elpis Kolokitha

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Objective: Impacted maxillary canines are a frequent condition and a common reason for patients seeking orthodontic treatment. Their simultaneous presence with dental anomalies raises a question about their possible connection. The aim of this study was to investigate the association of maxillary impacted canines with dental anomalies. Materials and Methods: Files of 874 patients from an orthodontic private practice in Greece were evaluated for the presence of maxillary impacted canines. From this sample, a group of 97 patients (39 males and 58 females) with at least one impacted maxillary canine were selected and consisted of the study group (canine impaction group) of this study. This group was compared to a control group of 97 patients (42 males and 55 females) that was created by random selection from the initial sample without maxillary canine impaction. The impaction diagnosis was made from the panoramic radiographs and confirmed from the surgery. The association between maxillary canine impaction and dental anomalies was examined with the chi-square test. A classification tree was created to further investigate the relations between impaction and dental anomalies. The reproducibility of diagnoses was assessed by re-examining the records of 25 patients two weeks after the first examination. Results: The found associated anomalies were cone-shaped upper lateral incisors and infraocclusion of deciduous molars. There is a significant increase in the prevalence of 12,4% of distal displacement of the unerupted mandibular second premolar in the canine impaction group compared to the control group that was 7,2%. The classification tree showed that the presence of a cone-shaped maxillary lateral incisor gave rise to the probability of an impacted canine to 83,3%. Conclusions: The presence of cone-shaped maxillary lateral incisors and infraocclusion of deciduous molars can be considered valuable early risk indicators for maxillary canine impaction.

Keywords: cone-shaped maxillary lateral incisors, dental anomalies, impacted canines, infraoccluded deciduous molars

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Authors: Acha Mildred Endam

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Gentrification brings changes in socio-economic and environmental aspects in cities. This is a concern for local governments and urban residents, as rapid urbanization poses a challenge to SDGs 11 and 13. This paper aims to: (1) examine the dominant gentrification actions that counteract the drive towards green urbanism; (2) evaluate policy actions and institutions created to promote green urbanism; (3) explore the constraints that hinder development proponents from achieving the goal of green urbanism. A mixed research design (survey and exploratory) was used, along with snowball sampling techniques, to administer the questionnaire. Structured interviews and focus group discussions were also conducted to assess the efforts and success rate of planning and development proponents in achieving green urbanism. Secondary data provided the basis for a literature review on activities that promote brown cities, which hinder green urbanism. The results of the study revealed that gentrification in Bamenda is mainly focused on upgrading infrastructure within the city centre. This transition is accompanied by unsustainable architectural developments, sprawl into peri-urban ecosystems, and climate-incompatible developments. Efforts to achieve green urbanization in Bamenda are insignificant. Socio-economic and policy actions of residents do not reflect a move towards sustainable cities, which is a common theme in most development agendas. This undermines the ecology, health, and general well-being of its inhabitants, increasing vulnerability. The study suggests that there is a need to learn from the few green cities in Africa and adopt a holistic approach towards green urbanization. This approach should include green transportation, preservation of green spaces, and retrofitting brown buildings to green buildings, through synergies, motivation and subsidization through green governance.

Keywords: environmental sustainability, green urbanism, green governace, retrofitting

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Authors: Fariha Akhter Chowdhury, Sabrina Mahboob, Anamika Saha, Afrin Jahan, Mohammad Nurul Islam

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Urinary tract infection (UTI) is frequently experienced by the female population where the prevalence increases with aging. Escherichia coli, one of the most common UTI causing organisms, retains glutathione defense mechanism that aids the organism to withstand the harsh physiological environment of urinary tract, host oxidative immune response and even to affect antibiotic-mediated cell death and the emergence of resistance. In this study, we aimed to investigate the glutathione reductase activity of uropathogenic E. coli (UPEC) by observing the reduced glutathione (GSH) level alteration under stressful condition. Urine samples of 58 patients with UTI were collected. Upon isolation and identification, 88% of the samples presented E. coli as UTI causing organism among which randomly selected isolates (n=9), obtained from urine samples of female patients, were considered for this study. E. coli isolates were grown under normal and stressful conditions where H₂O₂ was used as the stress-inducing agent. GSH level estimation of the isolates in both conditions was carried out based on the colorimetric measurement of 5,5'-dithio-bis (2-nitrobenzoic acid) (DTNB) and GSH reaction product using microplate reader assay. The GSH level of isolated E. coli sampled from adult patients decreased under stress compared to normal condition (p = 0.011). On the other hand, GSH production increased markedly in samples that were collected from elderly subjects (p = 0.024). A significant partial correlation between age and change of GSH level was found as well (p = 0.007). This study may help to reveal ways for better understanding of E. coli pathogenesis of UTI prevalence in elderly patients.

Keywords: Escherichia coli, glutathione reductase activity, oxidative stress, reduced glutathione (GSH), urinary tract infection (UTI)

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Authors: Hanna Teklu Gebregziabher

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Background: A variety of techniques for medical termination of second-trimester pregnancy can be used, but there is no consensus about which is the best. Even though most evidence suggests the combined use of intracervical Foley catheter and vaginal misoprostol is safe, effective, and acceptable method for termination of second-trimester pregnancy, which is comparable to mifepristone-misoprostol combination regimen with lower cost and no additional maternal risks. The use of mifepristone and misoprostol alone with no other procedure is still the most common procedure in different institutions for 2nd-trimester pregnancy. Methods: A cross-sectional comparative prospective study design is employed on women who were admitted for 2nd-trimester medical abortion and medical abortion failed or if there was no change in cervical status after 24 hours of 1st dose of misoprostol. The study was conducted at St. Paulose Hospital Millennium Medical College. A sample of 44 participants in each arm was necessary to give a two-tailed test, a type 1 error of 5%, 80% statistical power, and a 1:1 ratio among groups. Thus, a total of 94 cases, 47 from each arm, were recruited. Data was entered and cleaned by using Epi-info and analyzed using SPSS version 29.0 statistical software and was presented in descriptive and tabular forms. Different variables were cross-tabulated and compared for significant differences and statistical analysis using the chi-square test and independent t-test, to conclude. Result: There was a significant difference between the two groups on induction to expulsion time and number of doses used. The mean ± SD of induction to expulsion time for those used misoprostol alone was 48.09 ± 11.86 and those who used trans-cervical catheter sequentially with misoprostol were 36.7 ±6.772. Conclusion: The use of a trans-cervical Foley catheter in conjunction with misoprostol in a sequential manner is a more effective, safe, and easily accessible procedure. In addition, the cost of utilizing the catheter is less compared to the cost of misoprostol and is readily available. As a good substitute, we advised using Trans-cervical Catether even for medical abortions performed in the second trimester.

Keywords: second trimester, medical abortion, catheter, misoprostol

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Authors: Wahab Ali Shah, Junjia He

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Transferring electrical power without any wiring has been a dream since late 19^th century. There were some advances in this area as to know more about microwave systems. However, this subject has recently become very attractive due to their practiScal systems. There are low power applications such as charging the batteries of contactless tooth brushes or implanted devices, and higher power applications such as charging the batteries of electrical automobiles or buses. In the first group of applications operating frequencies are in microwave range while the frequency is lower in high power applications. In the latter, the concept is also called inductive power transfer. The aim of the paper is to have an overview of the inductive power transfer for electrical vehicles with a special concentration on coil design and power converter simulation for static charging. Coil design is very important for an efficient and safe power transfer. Coil design is one of the most critical tasks. Power converters are used in both side of the system. The converter on the primary side is used to generate a high frequency voltage to excite the primary coil. The purpose of the converter in the secondary is to rectify the voltage transferred from the primary to charge the battery. In this paper, an inductive power transfer system is studied. Inductive power transfer is a promising technology with several possible applications. Operation principles of these systems are explained, and components of the system are described. Finally, a single phase 2 kW system was simulated and results were presented. The work presented in this paper is just an introduction to the concept. A reformed compensation network based on traditional inductor-capacitor-inductor (LCL) topology is proposed to realize robust reaction to large coupling variation that is common in dynamic wireless charging application. In the future, this type compensation should be studied. Also, comparison of different compensation topologies should be done for the same power level.

Keywords: coil design, contactless charging, electrical automobiles, inductive power transfer, operating frequency

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Authors: Hui-Chi Huang, Su-Ju Yang, Ching-Wei Lin, Jui-Yao Tsai, Liang-Yiang

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Background: The most common serious complication following acute stroke is pneumonia. It has been associated with the increased morbidity, mortality, and medical cost after acute stroke in elderly patients. Purpose: The aim of this retrospective study was to investigate the relationship between stroke patients, risk factors of pneumonia, and one-year survival rates in a group of patients, in a tertiary referal center in Northern Taiwan. Methods: From January 2012 to December 2013, a total of 1730 consecutively administered stroke patients were recruited. The Survival analysis and multivariate regression analyses were used to examine the predictors for the one-year survival in stroke patients of a stroke registry database from northern Taiwan. Results: The risk of stroke mortality increased with age≧ 75 (OR=2.305, p < .0001), cancer (OR=3.221, p=<.0001), stayed in intensive care unit (ICU) (OR=2.28, p <.0006), dysphagia (OR=5.026, p<.0001), without speech therapy(OR=0.192, p < .0001),serum albumin < 2.5(OR=0.322, p=.0053) , eGFR > 60(OR=0.438, p <. 0001), admission NIHSS >11(OR=1.631, p=.0196), length of hospitalization (d) > 30(OR=0.608, p=.0227), and stroke subtype (OR=0.506, p=.0032). After adjustment of confounders, pneumonia was not significantly associated with the risk of mortality. However, it is most likely to develop in patients who are age ≧ 75, dyslipidemia , coronary artery disease , albumin < 2.5 , eGFR <60 , ventilator use , stay in ICU , dysphagia, without speech therapy , urinary tract infection , Atrial fibrillation , Admission NIHSS > 11, length of hospitalization > 30(d) , stroke severity (mRS=3-5) ,stroke Conclusion: In this study, different from previous research findings, we found that elderly age, severe neurological deficit and rehabilitation therapy were significantly associated with Post-stroke Pneumonia. However, specific preventive strategies are needed to target the high risk groups to improve their long-term outcomes after acute stroke. These findings could open new avenues in the management of stroke patients.

Keywords: stroke, risk, pneumonia, survival

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Authors: Saiada Fuadi Fancy, Fahim Ahmed, Shofiq Ahmed, Raquib Ahsan

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The worldwide use of reinforced concrete construction stems from the wide availability of reinforcing steel as well as concrete ingredients. However, concrete construction requires a certain level of technology, expertise, and workmanship, particularly, in the field during construction. As a supporting technology for a concrete column or wall construction, kicker is cast as part of the slab or foundation to provide a convenient starting point for a wall or column ensuring integrity at this important junction. For that reason, a comprehensive study was carried out here to investigate the behavior of reinforced concrete frame with different kicker parameters. To achieve this objective, six half-scale specimens of portal reinforced concrete frame with kickers and one portal frame without kicker were constructed according to common practice in the industry and subjected to cyclic incremental horizontal loading with sustained gravity load. In this study, the experimental data, obtained in four deflections controlled cycle, were used to evaluate the behavior of kickers. Load-displacement characteristics were obtained; maximum loads and deflections were measured and assessed. Finally, the test results of frames constructed with three different types of kicker thickness were compared with the kickerless frame. Similar crack patterns were observed for all the specimens. From this investigation, specimens with kicker thickness 3″ were shown better results than specimens with kicker thickness 1.5″, which was specified by maximum load, stiffness, initiation of first crack and residual displacement. Despite of better performance, it could not be firmly concluded that 4.5″ kicker thickness is the most appropriate one. Because, during the test of that specimen, separation of dial gauge was needed. Finally, comparing with kickerless specimen, it was observed that performance of kickerless specimen was relatively better than kicker specimens.

Keywords: crack, cyclic, kicker, load-displacement

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Authors: Kathleen Canul

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Bullying is on the rise according to several recent studies. Workplace bullying has garnered less attention than other forms yet incidence rates range from 35-45%. The consequences of being bullied at work are broad, ranging from physiological to psychological to occupational. As the bullying progresses, employees begin to exhibit physical and psychological symptoms. Blood pressure rises, along with other cardiac related concerns. For men, covert coping with job unfairness was associated with a four-fold risk of heart attack and death. Gastrointestinal distress, headaches, muscle tension, sleep disorders and exhaustion are also common. Workplace bullying appears to contribute to the risk of subsequent psychotropic medication, as well. Emotionally, anxiety and depression increase along with lowered self-esteem and problems concentrating on the duties of the job. In an attempt to cope, individuals may succumb to unhealthy practices involving food, alcohol and other drugs. Patterns of bullying vary by gender, race, and ethnicity, as well as sexual orientation, with women, ethnic minorities and LGBTQ employees reporting higher rates of bullying in the workplace. Not only is this an issue of inequity on the job, but also a problem of health disparities as there are few mental health professionals confident and competent in dealing with workplace bullying issues, and the lack of culturally competent clinicians exacerbates this inequality in receiving adequate care. Alone, the topic of workplace bullying is not unique; however, the diverse experiences of underrepresented groups who disproportionately are affected on the job and suffer untreated, health related concerns represent a significant and emerging problem requiring attention. Conference participants who have experienced, witnessed or help those bullied on the job would benefit most from this review of the literature on the consequences of bullying experienced by diverse and underrepresented groups in the workplace.

Keywords: bullying, ethnic minorities, health disparities, workplace conflict

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Authors: I GD Yudha Partama, A. Kanno, Y. Akamatsu, R. Inui, M. Goto, M. Sekine

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The aerial photogrammetry of shallow water bottoms has the potential to be an efficient high-resolution survey technique for shallow water topography, thanks to the advent of convenient UAV and automatic image processing techniques Structure-from-Motion (SfM) and Multi-View Stereo (MVS)). However, it suffers from the systematic overestimation of the bottom elevation, due to the light refraction at the air-water interface. In this study, we present an empirical method to correct for the effect of refraction after the usual SfM-MVS processing, using common software. The presented method utilizes the empirical relation between the measured true depth and the estimated apparent depth to generate an empirical correction factor. Furthermore, this correction factor was utilized to convert the apparent water depth into a refraction-corrected (real-scale) water depth. To examine its effectiveness, we applied the method to two river sites, and compared the RMS errors in the corrected bottom elevations with those obtained by three existing methods. The result shows that the presented method is more effective than the two existing methods: The method without applying correction factor and the method utilizes the refractive index of water (1.34) as correction factor. In comparison with the remaining existing method, which used the additive terms (offset) after calculating correction factor, the presented method performs well in Site 2 and worse in Site 1. However, we found this linear regression method to be unstable when the training data used for calibration are limited. It also suffers from a large negative bias in the correction factor when the apparent water depth estimated is affected by noise, according to our numerical experiment. Overall, the good accuracy of refraction correction method depends on various factors such as the locations, image acquisition, and GPS measurement conditions. The most effective method can be selected by using statistical selection (e.g. leave-one-out cross validation).

Keywords: bottom elevation, MVS, river, SfM

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Authors: Ting Shen, Spyros Konstantopoulos

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During the past three decades, class size effects have been a focal debate in education. The idea of having smaller class is enormously popular among parents, teachers and policy makers. The rationale of its popularity is that small classroom could provide a better learning environment in which there would be more teacher-pupil interaction and more individualized instruction. This early stage benefits would also have a long-term positive effect. It is a common belief that reducing class size may result in increases in student achievement. However, the empirical evidence about class-size effects from experimental or quasi-experimental studies has been mixed overall. This study sheds more light on whether class size reduction impacts reading achievement in eight European countries: Bulgaria, Germany, Hungary, Italy, Lithuania, Romania, Slovakia, and Slovenia. We examine class size effects on reading achievement using national probability samples of fourth graders. All eight European countries had participated in the Progress in International Reading Literacy Study (PIRLS) in 2001, 2006 and 2011. Methodologically, the quasi-experimental method of instrumental variables (IV) has been utilized to facilitate causal inference of class size effects. Overall, the results indicate that class size effects on reading achievement are not significant across countries and years. However, class size effects are evident in Romania where reducing class size increases reading achievement. In contrast, in Germany, increasing class size seems to increase reading achievement. In future work, it would be valuable to evaluate differential class size effects for minority or economically disadvantaged student groups or low- and high-achievers. Replication studies with different samples and in various settings would also be informative. Future research should continue examining class size effects in different age groups and countries using rich international databases.

Keywords: class size, reading achievement, instrumental variables, PIRLS

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Authors: Warda Jabeen, Romaisa Shamim Khan, Osama Shakeel, Ahmed Faraz Bhatti, Raza Hussain

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Background: The worldwide incidence of cutaneous melanoma (CM) has been on the rise over the past few decades. Primary prevention and early treatment remain the focus of management to reduce the burden of disease. This entails identification of risk factors to prompt early diagnosis. In Pakistan, there is a scarcity of clinico-pathological data relating to cutaneous malignant melanoma. Objective: The purpose of this study was to analyze the epidemiological and clinical characteristics of patients presenting with cutaneous malignant melanoma in Pakistan, and to compare the results with other studies. Method: Shaukat Khanum Memorial Cancer Hospital and Research Centre is currently the only dedicated cancer hospital in the country, accepting patients from all over Pakistan. Majority of the patients, however, belong to the northern half of the country. From the recorded data of the hospital, all cutaneous melanoma cases were identified and evaluated. Results: Between 1997 and 2017, a total of 169 cutaneous melanoma patients were registered at Shaukat Khanum. Mean age was 47.5 years. The highest incidence of melanoma was seen in the age group 40-59 years (n=69, 40.8%). Most commonly reported clinical subtype was unspecified melanoma (n=154, 91%). Amongst those in which T stage was reported, the most frequently observed T-stage at presentation was T4 (n=23, 13.6%). With regards to body distribution, in our study CM was seen most commonly in the lower limb including the hip. The yearly incidence of melanoma has increased/remained stable from 2007 to 2017. Conclusion: cutaneous malignant melanoma is a fairly common disease in Pakistan. Patients tend to present at a more advanced stage as compared to patients in developed countries. Identification of risk factors and tumor characteristics is therefore of paramount importance to deal with these patients.

Keywords: epidemiology of cutaneous malignant melanoma, cutaneous malignant melanoma, Pakistan, skin cancer

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Authors: Hailu Kebede Bekele

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Construction delays are suitable where project events occur at a certain time expected due to causes related to the client, consultant, and contractor. Delay is the major cause of the cost overrun that leads to the poor efficiency of the project. The cost difference between completion and the originally estimated is known as cost overrun. The common ways of cost overruns are not simple issues that can be neglected, but more attention should be given to prevent the organization from being devastated to be failed, and financial expenses to be extended. The reasons that may raised in different studies show that the problem may arise in construction projects due to errors in budgeting, lack of favorable weather conditions, inefficient machinery, and the availability of extravagance. The study is focused on the pace of mega projects that can have a significant change in the cost overrun calculation.15 mega projects are identified to study the problem of the cost overrun in the site. The contractor, consultant, and client are the principal stakeholders in the mega projects. 20 people from each sector were selected to participate in the investigation of the current mega construction project. The main objective of the study on the construction cost overrun is to prioritize the major causes of the cost overrun problem. The methodology that was employed in the construction cost overrun is the qualitative methodology that mostly rates the causes of construction project cost overrun. Interviews, open-ended and closed-ended questions group discussions, and rating qualitative methods are the best methodologies to study construction projects overrun. The result shows that design mistakes, lack of labor, payment delay, old equipment and scheduling, weather conditions, lack of skilled labor, payment delays, transportation, inflation, and order variations, market price fluctuation, and people's thoughts and philosophies, the prior cause of the cost overrun that fail the project performance. The institute shall follow the scheduled activities to bring a positive forward in the project life.

Keywords: cost overrun, delay, mega projects, design

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Authors: P. Mukhopadhyay, N. C. Dey

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Occupational health hazard is a very common term in every emerging country. Along with the unorganized sector, most organized sectors including government industries are suffering from this affliction. In addition to workload, the seasonal changes also have some impacts on working environment. With this focus in mind, one hundred male industrial workers, who are directly involved to the task of Periodic Overhauling (POH) in a fabricating workshop in the public domain are selected for this research work. They have been studied during work periods throughout different seasons in a year. For each and every season, the participants working heart rate (WHR) is measured and compared with the standards given by different national and internationally recognized agencies i.e., World Health Organization (WHO) and American Conference of Governmental Industrial Hygienists (ACGIH) etc. The different environmental parameters i.e. dry bulb temperature (DBT), wet bulb temperature (WBT), globe temperature (GT), natural wet bulb temperature (NWB), relative humidity (RH), wet bulb globe temperature (WBGT), air velocity (AV), effective temperature (ET) are recorded throughout the seasons to critically observe the effect of seasonal changes on the WHR of the workers. The effect of changes in environment to the WHR of the workers is very much surprising. It is found that the percentages of workers who belong to the ‘very heavy’ workload category are 83.33%, 66.66% and 16.66% in the summer, rainy and winter seasons, respectively. Ongoing undertaking of this type of job profile forces the worker towards occupational disorders causing absenteeism. This occurrence results in lower production rates, and on the other hand, costs due to medical claims also weaken the industry’s economic condition. In this circumstance, the authors are trying to focus on some remedial measures from the ergonomic angle by proposing a new work/ rest regimen and introducing engineering controls along with management controls which may help the worker, and consequently, the management also.

Keywords: workload, working heart rate, occupational health hazard, industrial worker

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Authors: F. Gallop, C. Ward, M. Zaky, M. Vaghela, R. Sabaratnam

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Nitrous oxide (N₂O) has been used in anaesthesia for over 150 years owing to advantageous physical and pharmacological properties. However, with a global warming potential of 310, we have an urgent responsibility to reduce its usage and emission. Anecdotal evidence in our hospital trust suggests minimal N₂O usage, yet our theatres receive a staggering supply. This warranted further investigation. We used a data collection tool to prospectively capture quantitative and qualitative data regarding N₂O cases during one week: this recorded demographics, N₂O indications, clinical management, and total N₂O consumption in litres. In addition, N₂O usage in dental sedation suites and paediatric theatres was separately quantified. Pipeline supply data was acquired from British Oxygen Company accounts. We captured 490 cases. 4% (n=19) used N₂O, 63% (n=12) of these in dental theatres. Common N₂0 indications were induction speed (37%) and rapidly increasing anaesthesia depth (32%). In adult cases, N₂O was always used intraoperatively rather than solely at induction. 74% (n=14) of anaesthetists reported environmental concern over using N₂O. The week’s total N₂O usage was 8109 litres, amounting to 421,668 litres annually. However, the annual N₂O pipeline supply is 2,997,000 litres; an enormous 1.8 million Kg of CO₂. Our results supportively demonstrate that the N₂O pipeline supply greatly exceeds its clinical use. Acknowledging clinical areas not audited, the discrepancy between supply and usage suggests approximately 2.5 million litres of yearly wastage. We consequently recommend terminating the N₂O pipeline supply in minimally used areas, eliminating 1.5 million Kg of CO₂ emissions. High usage clinical areas could consider portable N₂O cylinders as an alternative. In Sweden, N₂O destruction technology is routinely used to minimise CO₂ emissions. Our results support National Health System investment in similar infrastructure.

Keywords: anaesthesia, environment, medical gases, nitrous oxide, sustainability

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Authors: Dagmawit Tewahido

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Purpose: This qualitative study was conducted to explore social norms around adolescent girls’ marriage practices in West Hararghe, Ethiopia, where early marriage is prohibited by law. Methods: Twenty Focus Group Discussions were conducted with Married and Unmarried adolescent girls, adolescent boys and parents of girls using locally developed vignettes. A total of 32 in-depth interviews were conducted with married and unmarried adolescent girls, husbands of adolescent girls and mothers-in-law. Key informant interviews were conducted with 36 district officials. Data analysis was assisted by Open Code computer software. The Social Norms Analysis Plot (SNAP) framework developed by CARE guided the development and analysis of vignettes. A thematic data analysis approach was utilized to summarize the data. Results: Early marriage is seen as a positive phenomenon in our study context, and girls who are not married by the perceived ideal age of 15 are socially sanctioned. They are particularly influenced by their peers to marry. Marrying early is considered a chance given by God and a symbol of good luck. The two common types of marriage are decided: 1) by adolescent girl and boy themselves without seeking parental permission (’Jalaa-deemaa’- meaning ‘to go along’), and 2) by just informing girl’s parents (‘Cabsaa’- meaning ‘to break the culture’). Relatives and marriage brokers also arrange early marriages. Girls usually accept the first marriage proposal regardless of their age. Parents generally tend not to oppose marriage arrangements chosen by their daughters. Conclusions: In the study context social norms encourage early marriage despite the existence of a law prohibiting marriage before the age of eighteen years. Early marriage commonly happens through consensual arrangements between adolescent girls and boys. Interventions to reduce early marriage need to consider the influence of Reference Groups on the decision makers for marriages, especially girls’ own peers.

Keywords: adolescent girls, social norms, early marriage, Ethiopia

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Authors: Antonio Pizzarello, Oris Friesen

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Networks, such as the electric power grid, must demonstrate exemplary performance and integrity. Integrity depends on the quality of both the system design model and the deployed software. Integrity of the deployed software is key, for both the original versions and the many that occur throughout numerous maintenance activity. Current software engineering technology and practice do not produce adequate integrity. Distributed systems utilize networks where each node is an independent computer system. The connections between them is realized via a network that is normally redundantly connected to guarantee the presence of a path between two nodes in the case of failure of some branch. Furthermore, at each node, there is software which may fail. Self-stabilizing protocols are usually present that recognize failure in the network and perform a repair action that will bring the node back to a correct state. These protocols first introduced by E. W. Dijkstra are currently present in almost all Ethernets. Super stabilization protocols capable of reacting to a change in the network topology due to the removal or addition of a branch in the network are less common but are theoretically defined and available. This paper describes how to use the Software Integrity Assessment (SIA) methodology to analyze self-stabilizing software. SIA is based on the UNITY formalism for parallel and distributed programming, which allows the analysis of code for verifying the progress property p leads-to q that describes the progress of all computations starting in a state satisfying p to a state satisfying q via the execution of one or more system modules. As opposed to demonstrably inadequate test and evaluation methods SIA allows the analysis and verification of any network self-stabilizing software as well as any other software that is designed to recover from failure without external intervention of maintenance personnel. The model to be analyzed is obtained by automatic translation of the system code to a transition system that is based on the use of the weakest precondition.

Keywords: network, power grid, self-stabilization, software integrity assessment, UNITY, weakest precondition

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Authors: Esraa Elaraby, Dania Abu Zahra, Ghidaa Maswadah, Osama Amira, Mohamed Alshoura, Nihar Dash

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Background: Human being uses salon for a variety of purposes, from trimming of hair and shaving to a range of beauty treatments such as manicure and pedicure. Salon activities involve use of several instruments including scissors, scalpels and razors, materials such as soaps, solutions, creams and gels on human skin and body. Besides, salon customers also use chair, bed and many other common shared utensils and appliances. These salons related activities create a suitable environment for the transmission of several diseases and pathogens including hepatitis B and C, scabies, tuberculosis, staphylococcus and MRSA etc. The transmission of these pathogens can be prevented by maintenance of adequate hygiene and standard preventive measures. Aim: To assess the customer’s level of knowledge about salon-acquired infections and practices taken to prevent their transmission. Methods: A cross-sectional study was conducted among 500 participants across the Emirates. Moreover, self-administered questionnaires (in English and Arabic) were distributed through convenience sampling methods between February and April 2017. Results: The study included 500 participants of which 250 were females. The mean age of the study population was 33 years (SD=4.77). The participants were from several nationalities including 325 Arabs (Non-GCC) (66.2%), 108 Non-Arabs (22%), and 59 Arabs (GCC) (11.8%). The majority of the participants 421 (84.4%) had required knowledge about salon-associated infections with a mean knowledge score of 6/10 (60%). However, when it comes down to preventive practices, only 73 of the 500 participants (14.6%) did carry their own equipment. Thus, there was insufficient correlation between the level of knowledge and preventive practices (p=0.139) of salon-associated infections. Conclusion: People’s knowledge about the salon-associated infections among UAE residents was good, but only a small number practically took the required preventative measures towards this issue. Therefore, a public awareness program is recommended to enhance the deficiencies in knowledge and practices to prevent salon-acquired infections among the users. Up to our knowledge, this is the first study of this kind in the UAE targeting the salon customers about this important issue.

Keywords: awareness, knowledge, practices, salon-associated infections

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Authors: Aynura Valiyeva, Basil John Thomas

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Intra-firm communication is critical for building synergy amongst internal business units of a firm, where employees from various functional departments and ranks incorporate their decision-making, understanding of organizational objectives, as well as common norms and culture for better organizational effectiveness. This study builds on and assesses a framework of the causes and consequences of effective communication in business interactions between customer and supplier firms, and the path for efficient communication within a firm. The proposed study’s structural equation modeling (SEM) analysis based on 352 sample responses collected from firm representatives at different job positions ranging from marketing to logistics operations, reveals that, in the frame of reference of intra-organizational communication, organization characteristics and shared values, top management support and style of leadership, as well as information technology, are all significantly related to communication effectiveness. Furthermore, the frequency and variety of interactions enhance the outcome of communication, that improves a company’s performance. The results reveal that cultural factors are significantly related to communication effectiveness, as well as the shared beliefs and goals. In terms of organizational factors, leadership style, top management support and information technology are significant determinants of effective communication. Among the contextual factors, interaction frequency and diversity are found to be priority factors. This study also tests the relationship between supplier and supplier firm performance in the context of communication effectiveness, and finds that they are closely related, when trust and commitment is built between business partners. When firms do business in other multicultural contexts, language and shared values with destination country must be considered significant elements of communication process.

Keywords: business performance, intra-firm communication, inter-firm communication, structural equation modeling

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Authors: Lubna Khondker

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Background: Melasma is a common pigmentary dermatosis, manifested by hyperpigmented macules or patches on the face, commonly occurring in females due to an acquired disorder in the melanogenesis process. Although several treatments are currently used, it remains a great challenge due to recurrence and refractory nature. It was recently reported that tranexamic acid (TA-plasmin inhibitor) is an effective treatment for melasma. Objective: This study aims to compare the efficacy and side effects of intralesional injection of Tranexamic acid with oral Tranexamic acid in the treatment of melasma. Methods: A clinical trial was done in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, for a period of 4 years. A total of 100 patients with melasma who did not respond to topical therapy were included in the study as group A and group B. Group A Patients were administered intralesional injection (10 mg/ml) of Tranexamic acid( TA) weekly for 6 weeks, and group B patients were treated with oral tranexamic acid 250 mg 12 hourly for 12 weeks after taking informed consent. The severity and extent of pigmentation were assessed by the modified melasma area severity index (MASI). The response to treatment was assessed by MASI at 4 weeks, 8 weeks, and 12 weeks after stopping treatment. Results: The study showed the MASI scores at the baseline, 4 weeks, 8 weeks, and 12 weeks in group A were 18.23±1.22, 6.14±3.26, 3.21±2.14 and 2.11±2.01 respectively, and in group B, 17.87±1.12, 11.21±6.25, 6.57±4.26 and 6.41±4.17 respectively. The mean MASI significantly reduced in group A compared to group B in the 4th, 8th, and 12th weeks. The present study showed that among group A patients, 56% rated excellent (>75% reduction) in outcome, 32% good (50-75% reduction), 8% moderate (25-50% reduction) and only 4% (<25% reduction) was unsatisfactory and among group B patients, 14% rated excellent in outcome, 28% good, 36% moderate and 22% was unsatisfactory. Overall improvement in our study in group A was 96% and in group B 78%. Side effects were negligible, and all the patients tolerated the treatment well. Conclusion: Based on our results, intralesional Tranexamic acid (10 mg/ml) is more effective and safer than oral Tranexamic acid in the treatment of melasma.

Keywords: intralesional tranexamic acid, melasma, oral tranexamic acid, MASI score

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Authors: David Whitehouse

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Some of the strengths of online teaching include flexibility, creativity, and comprehensiveness. A challenge can be motivation. How can an instructor repeating the same lessons over and over, day in and day out, year after year, maintain motivation? Enthusiasm? Does motivating the student and creating enthusiasm in class build the same things inside the instructor? The answers lie in the adoption of what I label EUQ—The Empathy and Understanding Quotient. In the online environment, students who are adults have many demands on their time: civilian careers, families (spouse, children, older parents), and sometimes even military service. Empathetic responses on the part of the instructor will lead to open and honest communication on the part of the student, which will lead to understanding on the part of the instructor and a rise in motivation in both parties. Understanding the demands can inform an instructor’s relationship with the student throughout the temporal parameters of classwork. In practicing EUQ, instructors can build motivation in their students and find internal motivation in an enhanced classroom dynamic. The presentation will look at what motivates a student to accomplish more than the minimum required and how that can lead to excellent results for an instructor’s own motivation. Through direct experience of having students give high marks on post-class surveys and via direct messaging, the presentation will focus on how applying EUQ in granting extra time, searching for intent while grading, communicating with students via Quick Notes, responses in Forums, comments in Assignments, and comments in grading areas - - - how applying these things infuses enthusiasm and energy in the instructor which drive creativity in teaching. Three primary ways of communicating with students will be given as examples. The positive response and negative response each for a Forum, an Assignment, and a Message will be explored. If there is time, participants will be invited to craft their own EUQ responses in a role playing exercise involving two common classroom scenarios—late work and plagiarism.

Keywords: education, instruction, motivation, online, teaching

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Authors: Hugo T. Jorge, Richard T. Simanke

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Lacan’s work addresses overarching issues concerning the scientific intelligibility of the subject in its philosophical sense. Even though his reflection is not, strictly speaking, philosophy of science, it contains many traits that are typical of this branch of philosophy. However, the relation between Lacan’s early thought and the philosophy of science of the time is often disregarded or only incompletely accounted for in Lacanian scholarship. French philosopher of science Emile Meyerson was often implicitly or explicitly referred to in Lacan’s works, yet few publications can be found on their relationship. The objective of this paper is to contribute to the analysis of this relationship, indicating some of its possible implications. For this, the convergence between Meyerson’s doctrine of science and Lacan’s works between 1936 and 1953 is discussed, as well as the conditions under which Lacan’s reception of Meyerson’s ideas take place. In conclusion, it is argued that this convergence allows for the clarification of important issues in Lacan’s early work, such as the concept of imago, his views on the nature of truth, and his thesis of the anthropomorphism of natural sciences. Meyerson’s argument for the permanence of common sense within science makes Lacan’s claims on the anthropomorphism of natural sciences more understandable. Similarly, Meyerson’s views on the epistemological shortfall of the Principle of Identity sheds some light on Lacan’s 1936 critique of associationistic concepts of engram and truth and may be at the origins of his antirealist and anti-idealist stances. Meyerson’s Principle of Identity is also related to some aspects of Lacan’s concept of imago. The imago understood as the unconscious condition for the identity in time of family figures in childhood, would be an excellent expression of the Principle of Identity. In this sense, the Principle of Identity may be linked to the concept of imaginary as developed by Lacan in the 1950s. However, Lacan considerably distorts Meyerson’s views in his 1936 critique of Freud’s concept of libido. Finally, a possible relationship between Lacan’s late concept of the real and Meyerson’s concept of the irrational is suggested.

Keywords: imaginary, Lacan, Meyerson, philosophy of science, real

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Authors: Rajkumar Ghosh

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Urban flooding is a common occurrence throughout Asia. Almost every city is vulnerable to urban floods in some fashion, and city people are particularly vulnerable. Pluvial and fluvial flooding are the most prominent causes of urban flooding in the Gomti Nagar region of Lucknow, Uttar Pradesh, India. The pluvial flooding is regarded to be less damaging because it is caused by heavy rainfall, Seasonal rainfall fluctuations, water flows off concrete infrastructures, blockages of the drainage system, and insufficient drainage capacity or low infiltration capacity. However, this study considers pluvial flooding in Lucknow to be a significant source of cumulative damage over time, and the risks of such events are increasing as a result of changes in ageing infrastructure, hazard exposure, rapid urbanization, massive water logging and global warming. As a result, urban flooding has emerged as a critical field of study. The popularity of analytical approaches to project the spatial extent of flood dangers has skyrocketed. To address future urban flood resilience, more effort is needed to enhance both hydrodynamic models and analytical tools to simulate risks under present and forecast conditions. Proper urban planning with drainage system and ample space for high infiltration capacity are required to reduce urban flooding. A better India with no urban flooding is a pipe dream that can be realized by putting household rooftop rainwater collection systems in every structure. According to the current study, domestic RTRWHs are strongly recommended as an alternative source of water, as well as to prevent surface runoff and urban floods in this region of Lucknow, urban areas of India.

Keywords: rooftop rainwater harvesting, urban flood, pluvial flooding, fluvial flooding

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Authors: Peifang Hsieh

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The prevention of child abuse has aroused serious concerns in Taiwan because of the disparity between the increasing amount of reported child abuse cases that doubled over the past decade and the scarcity of social workers. New Taipei city, with the most population in Taiwan and over 70% of its 4 million citizens are migrant families in which the needs of children can be easily neglected due to insufficient support from relatives and communities, sees urgency for a social support system, by preemptively identifying and outreaching high-risk families of child abuse, so as to offer timely assistance and preventive measure to safeguard the welfare of the children. Big data analysis is the inspiration. As it was clear that high-risk families of child abuse have certain characteristics in common, New Taipei city decides to consolidate detailed background information data from departments of social affairs, education, labor, and health (for example considering status of parents’ employment, health, and if they are imprisoned, fugitives or under substance abuse), to cross-reference for accurate and prompt identification of the high-risk families in need. 'The Service Center for High-Risk Families' (SCHF) was established to integrate data cross-departmentally. By utilizing the machine learning 'random forest method' to build a risk prediction model which can early detect families that may very likely to have child abuse occurrence, the SCHF marks high-risk families red, yellow, or green to indicate the urgency for intervention, so as to those families concerned can be provided timely services. The accuracy and recall rates of the above model were 80% and 65%. This prediction model can not only improve the child abuse prevention process by helping social workers differentiate the risk level of newly reported cases, which may further reduce their major workload significantly but also can be referenced for future policy-making.

Keywords: child abuse, high-risk families, big data analysis, risk prediction model

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Authors: Ayesha Siddiqua

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Background: Hypertension is a silent killer disease and a common risk factor for considerable morbidity and mortality. Its effects can be seen on the organs like Heart; Brain; Kidneys. In Saudi Arabia, hypertension affects a sizeable enough proportion of the population, with a prevalence of 27.9% in urban and 22.4 in rural population. Despite these features, the magnitude and epidemiological characteristics of this disease have been rarely studied in Saudi Arabia. To fill this gap, we conducted a survey in Abha to study the KAP of hypertension. KAP study shows what people know about certain things, their feelings and behavior towards the disease management. An improvement in the Knowledge and Attitudes towards disease management can reform the kinds of practices which are followed. Objectives: To assess the level of Knowledge, Attitude and Practice of patients who suffer from Hypertension. To improve the Quality of life of patients. Methods: A prospective cross-sectional survey was conducted on a sample size of 130 Hypertensive patients of both the genders enrolled by simple random sampling technique admitted in the Aseer Central Hospital of Abha during the period from October 2016 to December 2016. Results: Altogether 130 hypertensive patients were enrolled in this study with equal no. of Males and Females. Most of the respondents were aged between 18-40 years (45%). On assessing the KAP of the patients, we found that the Knowledge and Attitude score was good but the Practice scores were moderate in both the genders. Conclusion: Our study concludes that a significant proportion of hypertensive patients show less Practice towards the disease management which can lead to severe complications in time being and also result in damage of other vital organs. So there is a need of intense educational intervention for the patients which can be done by Patient counselling by the clinical pharmacist. Strategies to modify lifestyle which help in control of hypertension can include providing leaflets as well as direct educational programs.

Keywords: Attitude, hypertension, Knowledge, practices

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Authors: Shilpa Kumari, Ramakumar Jayachandran

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Machining of aluminium extrusion profiles in the automotive industry has gained much interest in the last decade, particularly due to the higher utilization of aluminum profiles and the weight reduction benefits it brings. Milling is the most common material removal process, where the rotary milling cutter is moved against a workpiece. The physical contact of the milling cutter to the workpiece increases the friction between them, thereby affecting the longevity of the milling tool and also the surface finish of the workpiece. To minimise this issue, the milling process uses cutting fluids or emulsions; however, the use of emulsion in the process has a negative impact on the environment ( such as consumption of water, oils and the used emulsion needs to be treated before disposal) and also on the personal ( may cause respiratory problems, exposure to microbial toxins generated by bacteria in the emulsions on prolonged use) working close to the process. Furthermore, the workpiece also needs to be cleaned after the milling process, which is not adding value to the process, and the cleaning also disperses mist of emulsion in the working environment. Hydro Extrusion is committed to improving the performance of sustainability from its operations, and with the negative impact of using emulsion in the milling process, a new innovative process- Dry Milling was developed to minimise the impact the cutting fluid brings. In this paper, the authors present one application of dry milling in the machining of tensile specimens in the laboratory. Dry milling is an innovative milling process without the use of any cooling/lubrication and has several advantages. Several million tensile tests are carried out in extrusion laboratories worldwide with the wet milling process. The machining of tensile specimens has a significant impact on the reliability of test results. The paper presents the results for different 6xxx alloys with different wall thicknesses of the specimens, which were machined by both dry and wet milling processes. For both different 6xxx alloys and different wall thicknesses, mechanical properties were similar for samples milled using dry and wet milling. Several tensile specimens were prepared using both dry and wet milling to compare the results, and the outcome showed the dry milling process does not affect the reliability of tensile test results.

Keywords: dry milling, tensile testing, wet milling, 6xxx alloy

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