Search results for: general elections

Authors: Igna Brajević Gizdić, Gorka Vuletić

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Introduction: Addiction is a chronic brain relapsing disorder. Opioid Substitution Therapy (OST) using buprenorphine as a medical treatment option shows as a promising option for achieving and maintaining abstinence in opioid-addicted patients. This research aimed to determine and evaluate the quality of life (QoL) in opiate-addicted patients after five years of buprenorphine therapy. Method: The total sample included 44 buprenorphine-maintained opiate addicts in outpatient treatment. The participants were administered the QoL questionnaire (WHOQOL-BREF) at two-time points (T1 and T2) with an interval of at least five years. WHOQOL-BREF contains a total of 26 questions. The first two questions, related to overall QoL and general health status, and the remaining questions (3–26), which represented four domains—physical, psychological, social, and environmental health—were evaluated separately. Results: The results indicated no significant differences in overall self-assessed QoL nor in individual domains after five years (T2) of abstinence with OST buprenorphine- maintenance. Conclusion: These findings indicated no improvement in QoL of buprenorphine-maintenance opiate addicts in outpatient treatment. However, this might be due to the smaller sample size and participants' overall high scores in QoL at T1. This study suggests the importance of expectations when considering the QoL and general health of buprenorphine-maintenance opiate addicts in outpatient treatment.

Keywords: abstinence, addicts, buprenorphine, opioid substitution therapy, quality of life

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Authors: Emil Danehorn, Ulla Peterson, Marie Oscarsson, Goldina Smirthwaite, Katarina Swahnberg

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Swedish students who choose to study abroad are common, but there has been limited research on exchange students. There are indications that some Swedish exchange students have been exposed to violence, but it is not known if they, already before their semester abroad, are more exposed to violence than students who remain on campus. Our aim was to investigate potential differences in exposure to physical, sexual, and emotional violence between prospective exchange students and campus students and between male and female students in general, as well as to determine any associations between mental health and exposure to violence among students in the total sample. Method: Comparative cross-sectional design using an online survey containing the NorVold Abuse Questionnaire and the General Health Questionnaire 12. A total of 565 participants took part in the study. Results: Prospective exchange students were less exposed to emotional violence compared to campus students. About one-half of all the participating female students had been exposed to sexual violence and about one-third of all the male students had been exposed to physical violence. The results also indicated that exposure to more than one form of violence was associated with poor mental health for students as a group. Conclusion: Prospective exchange students as a group do not report more exposure to physical and sexual violence than campus students but do report less exposure to emotional violence. However, the overall frequency of exposure to violence among the students was high. This highlights the need for proactive efforts for everyone, not least for exchange students who will be staying in a new environment unknown to them.

Keywords: sexual violence, physical violence, emotional violence, exchange students, mental health

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Authors: Ian M. Grey, Bryan Roche, Anna Dillon, Justin Thomas, Sarah Cassidy, Dylan Colbert, Ian Stewart

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This paper presents findings from a study conducted in two schools in Abu Dhabi. The hypothesis is that teaching young children to derive various relations between stimuli leads to increases in full-scale IQ scores of typically developing children. In the experimental group, sixteen 6-7-year-old children were exposed over six weeks to an intensive training intervention designed specifically for their age group. This training intervention, presented on a tablet, aimed to improve their understanding of the relations Same, Opposite, Different, contextual control over the concept of Sameness and Difference, and purely arbitrary derived relational responding for Sameness and Difference. In the control group, sixteen 6-7-year-old children interacted with KIBO robotics over six weeks. KIBO purports to improve cognitive skills through engagement with STEAM activities. Increases in full-scale IQ were recorded for most children in the experimental group, while no increases in full-scale IQ were recorded for the control group. These findings support the hypothesis that relational skills underlie many aspects of general cognitive ability.

Keywords: early childhood, derived relational responding, intelligence, relational frame theory, relational skills

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Authors: Ntokozo C. Mthembu

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The notion of sustainable chemistry has become significant in the discourse for a global post-colonial era, including South Africa, especially when it comes to access to the general health system and related policies in relation to disease or ease of human life. In view of the stubborn vestiges of coloniality in the daily lives of indigenous African people in general, the fundamentals of present Western medical and traditional medicine systems and related policies in the democratic era were examined in this study. The situation of traditional healers in relation to current policy was also reviewed. The advent of democracy in South Africa brought about a variety of development opportunities and limitations, particularly with respect to indigenous African knowledge systems such as traditional medicine. There were high hopes that the limitations of previous narrow cultural perspectives would be rectified in the democratic era through development interventions, but some sections of society, such as traditional healers, remain marginalised. The Afrocentric perspective was explored in dissecting government interventions related to traditional medicine. This article highlights that multiple medical systems should be adopted and that health policies should be aligned in order to guarantee mutual respect and to address the remnants of colonialism in South Africa, Africa and the broader global community.

Keywords: traditional healing system, healers, pluralist healthcare system, post-colonial era

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Authors: Andres Portocarrero Bonifaz, Caterina Sandra Camarena Rodriguez, Ricardo Palma Esparza, Nicolas Antonio Romero Carlos

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Reference levels for common X-rays procedures have been set in many protocols. In Peru, during quality control tests, the dose tolerance is set by these international recommendations. Nevertheless, further studies can be made to assess the national reality and relate dose levels with different parameters such as kV, mA/mAs, exposure time, type of processing (digital, digitalized or conventional), etc. In this paper three radiologic procedures were taken into account for study, general X-rays (fixed and mobile), intraoral X-rays (fixed, mobile and portable) and mammography. For this purpose, an Unfors Xi detector was used; the dose was measured at a focus - detector distance which varied depending on the procedure, and was corrected afterward to find the surface entry dose. The data used in this paper was gathered over a period of over 3 years (2015-2018). In addition, each X-ray machine was taken into consideration only once. The results hope to achieve a new standard which reflects the local practice, and address the issues of the ‘Bonn Call for Action’ in Peru. For this purpose, the 75% percentile of the dose of each radiologic procedure was calculated. In future quality control services, those machines with dose values higher than the selected threshold should be informed that they surpass the reference dose levels established in comparison other radiological centers in the country.

Keywords: general X-rays, intraoral X-rays, mammography, reference dose levels

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Authors: Liaquat Ali, Khurshid Natasha

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Low resource countries are not usually equipped with the organizational tools to implement health care for chronic diseases, and thus, providing effective diabetes care in such countries is a challenging task. Diabetic Association of Bangladesh (BADAS in Bengali acronym) has created a stimulating example to meet this challenge. Starting its journey in 1956 with 39 patients in a small tin shed clinic BADAS, and its affiliated associations now operate 90 hospitals and health centres all over the country. Together, these facilities provide integrated health care to about 1.5 million registered diabetic patients which constitute about 20% of the estimated diabetic population in the country. BADAS has also become a pioneer in health manpower generation in Bangladesh. Along with its affiliates, it now runs 3 Medical Colleges (to generate graduate physicians), 2 Nursing Institutes, and 2 Postgraduate Institutes which conduct 25 postgraduate courses (under the University of Dhaka) in various basic, clinical and public health disciplines. BADAS gives great emphasis on research, which encompasses basic, clinical as well as public health areas. BADAS is an ideal example of public-private partnership in health as most of its infrastructure has been created through government support but it is almost self-reliant in managing its revenue budget which approached approximately 40 million US dollar during 2010. BADAS raises resources by providing high-quality services to the people, both diabetic and non-diabetic. At the same time, BADAS has developed a cross financing model, to support diabetic patients in general and poor diabetic patients (identified through a social welfare network) in particular, through redistribution of the resources. Along with financial sustainability BADAS ensure organizational sustainability through a process of decentralization, community ownership, and democratic management. Presently a large scale pilot project (named as a Health Care Development Project or HCDP) is under implementation under BADAS umbrella with an objective to transform the diabetes care model to a health care model in general. It is expected to create further evidence on providing sustainable (with social safety net) health care delivery for diabetes, and other chronic illnesses as an integral part of general health care delivery in a resource constrained setting.

Keywords: Bangladesh, self sustain, health care, constrain

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Authors: Vladyslav Povoroznyuk, Oksana Ivanyk, Nataliia Dzerovych

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In the diagnostics of osteoporosis, the gold standard is considered to be bone mineral density; however, X-ray densitometry is not an accurate indicator of osteoporotic fracture risk under all circumstances. In this regard, the search for new methods that could determine the indicators not only of the mineral density, but of the bone tissue quality, is a logical step for diagnostic optimization. One of these methods is the evaluation of trabecular bone quality. The aim of this study was to examine the quality and mineral density of spine bone tissue, femoral neck, and body composition of women depending on the duration of the postmenopausal period, to determine the correlation of body fat with indicators of bone mineral density and quality. The study examined 179 women in premenopausal and postmenopausal periods. The patients were divided into the following groups: Women in the premenopausal period and women in the postmenopausal period at various stages (early, middle, late postmenopause). A general examination and study of the above parameters were conducted with General Electric X-ray densitometer. The results show that bone quality and mineral density probably deteriorate with advancing of postmenopausal period. Total fat and lean mass ratio is not likely to change with age. In the middle and late postmenopausal periods, the bone tissue mineral density of the spine and femoral neck increases along with total fat mass.

Keywords: osteoporosis, bone tissue mineral density, bone quality, fat mass, lean mass, postmenopausal osteoporosis

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Authors: Abdelrahman Abdelrahman, Lawrence Nip, Seun Ikotun, Iman Satar, Anur Miah

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Introduction: Incision and drainage of an abscess is a common procedure performed by the general surgeon. Pus swabs are often obtained routinely for MC&S.Our study aimed to investigate whether swabs taken at our local institution had any impact on the overall management plan for uncomplicated abscesses. Methods: We retrospectively assessed all patients presenting to University Hospital Lewisham with an abscess between October 2020 – April 2021. Exclusion criteria were recurrent abscesses, patients admitted with sepsis, known inflammatory bowel disease, immunocompromised, and those managed non-operatively. Results: We identified 131 patients who met the inclusion criteria. Two thirds were performed in theatre under general anaesthetic and the other one third under local. 63% of patients had a pus swab collected. Of these, 96% were not followed up by the requesting doctor, and there was no further patient contact. In the other 4%, the organisms cultured were flagged as atypical such as MRSA. In these cases, microbiology advice was that if the patient was clinically well and adequate drainage was achieved, then no furtherantibiotics were required. All patients were discharged before any microbiology results had come back with no subsequent change in the management plan. Average cost of pus swab = £10.10 – potentially cost saving of £1656.4 annually. Conclusion: Our study reveals that the majority of pus swabs taken from uncomplicated abscessesare not followed up by requesting doctor with no impact on the overall management plan. We, therefore, do not recommend the routine use of pus swabs for uncomplicated abscesses.

Keywords: pus swabs, uncomplated abscess, Pus MCS, follow up of uncomplicated abscess

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Authors: Po-Chun Lee, Li-Lin Liang, Ching-Yuan Huang

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Purpose: Research on electronic word-of-mouth (eWOM)& online review has been widely used in service industry management research in recent years. The SERVQUAL scale is the most commonly used method to measure service quality. Therefore, the purpose of this research is to combine electronic word of mouth & online review with the SERVQUAL scale. To explore the comparative study of positive and negative electronic word-of-mouth reviews of a certain armed force general hospital in Taiwan. Data sources: This research obtained online word-of-mouth comment data on google maps from a military hospital in Taiwan in the past ten years through Internet data mining technology. Research methods: This study uses the semantic content analysis method to classify word-of-mouth reviews according to the revised PZB SERVQUAL scale. Then carry out statistical analysis. Results of data synthesis: The results of this study disclosed that the negative reviews of this military hospital in Taiwan have been increasing year by year. Under the COVID-19 epidemic, positive word-of-mouth has a downward trend. Among the five determiners of SERVQUAL of PZB, positive word-of-mouth reviews performed best in “Assurance,” with a positive review rate of 58.89%, Followed by 43.33% of “Responsiveness.” In negative word-of-mouth reviews, “Assurance” performed the worst, with a positive rate of 70.99%, followed by responsive 29.01%. Conclusions: The important conclusions of this study disclosed that the total number of electronic word-of-mouth reviews of the military hospital has revealed positive growth in recent years, and the positive word-of-mouth growth has revealed negative growth after the epidemic of COVID-19, while the negative word-of-mouth has grown substantially. Regardless of the positive and negative comments, what patients care most about is “Assurance” of the professional attitude and skills of the medical staff, which needs to be strengthened most urgently. In addition, good “Reliability” will help build positive word-of-mouth. However, poor “Responsiveness” can easily lead to the spread of negative word-of-mouth. This study suggests that the hospital should focus on these few service-oriented quality management and audits.

Keywords: quality of medical service, electronic word-of-mouth, armed forces general hospital

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Authors: Shuang Luo, Er-Xiang Song

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Many problems in geotechnical engineering, such as foundation deformation, groundwater seepage, seismic wave propagation and geothermal transfer problems, may involve analysis in the ground which can be seen as extending to infinity. To that end, consideration has to be given regarding how to deal with the unbounded domain to be analyzed by using numerical methods, such as finite element method (FEM), finite difference method (FDM) or finite volume method (FVM). A simple artificial boundary approach derived from the analytical solutions for transient radial seepage problems, is introduced. It should be noted, however, that the analytical solutions used to derive the artificial boundary are particular solutions under certain boundary conditions, such as constant hydraulic head at the origin or constant pumping rate of the well. When dealing with unbounded domains with unsteady boundary conditions, a more sophisticated artificial boundary approach to deal with the infinity of the domain is presented. By applying Laplace transforms and introducing some specially defined auxiliary variables, the global artificial boundary conditions (ABCs) are simplified to local ones so that the computational efficiency is enhanced significantly. The introduced two local ABCs are implemented in a finite element computer program so that various seepage problems can be calculated. The two approaches are first verified by the computation of a one-dimensional radial flow problem, and then tentatively applied to more general two-dimensional cylindrical problems and plane problems. Numerical calculations show that the local ABCs can not only give good results for one-dimensional axisymmetric transient flow, but also applicable for more general problems, such as axisymmetric two-dimensional cylindrical problems, and even more general planar two-dimensional flow problems for well doublet and well groups. An important advantage of the latter local boundary is its applicability for seepage under rapidly changing unsteady boundary conditions, and even the computational results on the truncated boundary are usually quite satisfactory. In this aspect, it is superior over the former local boundary. Simulation of relatively long operational time demonstrates to certain extents the numerical stability of the local boundary. The solutions of the two local ABCs are compared with each other and with those obtained by using large element mesh, which proves the satisfactory performance and obvious superiority over the large mesh model.

Keywords: transient seepage, unbounded domain, artificial boundary condition, numerical simulation

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Authors: Jenny Ringblom, Marie Proczkowska, Laura Korhonen, Ingrid Wåhlin

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Background: Emergence delirium is a well-known behaviour of perceptual disturbances that may occur after general anaesthesia in children. Children with emergence delirium are often confused; they cry, are involuntarily physically active and are almost impossible to console. The prevalence varies considerably between about 13% and 53%. Research has mainly focused on how different medication accents affect the incidence of emergence delirium, but less is known about parents’ experiences of emergence delirium during the recovery process. Aim: The aim of this study was to describe parents’ experiences and reflections during their child's emergence delirium behaviour when recovering from anaesthesia. Method: The study has a qualitative design, and the data has been analyzed using thematic analysis. A total of 16 parents were interviewed at two county hospitals in Sweden. Results: When the parents reunited with their child at the recovering unit, they felt as if they were encountering an incomprehensible scenario. When watching their child demonstrating emergence delirium, they experienced fear and insecurity and had feelings of powerlessness and guilt. Information and previous experience turned out to offer relief and being seen by the healthcare staff when they, in their vulnerability, failed to reach or console their child gave hope and energy. Conclusion: Emergence delirium must be extensively considered in children undergoing general anaesthesia. Healthcare staff needs to be aware of the parental difficulties it may cause. There is also important to know what parents experience as relieving, such as receiving information and when staff members are being available, responsive and supportive during the wake-up period.

Keywords: emergence delirium, experiences, pediatrics, parents, postoperative care

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Authors: Martin Leroux, Sylvain Brisebois

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Eating a meal is among the Activities of Daily Living, but it takes a lot of time and effort for people with physical or functional limitations. Dedicated technologies are cumbersome and not portable, while general-purpose assistive robots such as wheelchair-based manipulators are too hard to control for elaborate continuous motion like eating. Eating with such devices has not previously been automated, since there existed no description of a feeding motion for uncontrolled environments. In this paper, we introduce a feeding mode for assistive manipulators, including a mathematical description of trajectories for motions that are difficult to perform manually such as gathering and scooping food at a defined/desired pace. We implement these trajectories in a sequence of movements for a semi-automated feeding mode which can be controlled with a very simple 3-button interface, allowing the user to have control over the feeding pace. Finally, we demonstrate the feeding mode with a JACO robotic arm and compare the eating speed, measured in bites per minute of three eating methods: a healthy person eating unaided, a person with upper limb limitations or disability using JACO with manual control, and a person with limitations using JACO with the feeding mode. We found that the feeding mode allows eating about 5 bites per minute, which should be sufficient to eat a meal under 30min.

Keywords: assistive robotics, automated feeding, elderly care, trajectory design, human-robot interaction

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Authors: Pratibha Srivastava, Chithra V. J., Sudhakar S., Nitin K. D.

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A closed-loop system comprises of a controller, a response system, and an actuating system. The controller, which is the system under test for us, excites the actuators based on feedback from the sensors in a periodic manner. The sensors should provide the feedback to the System Under Test (SUT) within a deterministic time post excitation of the actuators. Any delay or miss in the generation of response or acquisition of excitation pulses may lead to control loop controller computation errors, which can be catastrophic in certain cases. Such systems categorised as hard real-time systems that need special strategies. The real-time operating systems available in the market may be the best solutions for such kind of simulations, but they pose limitations like the availability of the X Windows system, graphical interfaces, other user tools. In this paper, we present strategies that can be used on a general purpose operating system (Bare Linux Kernel) to achieve a deterministic deadline and hence have the added advantages of a GPOS with real-time features. Techniques shall be discussed how to make the time-critical application run with the highest priority in an uninterrupted manner, reduced network latency for distributed architecture, real-time data acquisition, data storage, and retrieval, user interactions, etc.

Keywords: real time data acquisition, real time kernel preemption, scheduling, network latency

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Authors: Achim Kampker, Kai Kreiskoether, Johannes Wagner, Sarah Fluchs

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The growing speed of innovation in related industries requires the automotive industry to adapt and increase release frequencies of new vehicle derivatives which implies a significant reduction of investments per vehicle and ramp-up times. Emerging markets in various parts of the world augment the currently dominating established main automotive markets. Local content requirements such as import tariffs on final products impede the accessibility of these micro markets, which is why in the future market exploitation will not be driven by pure sales activities anymore but rather by setting up local assembly units. The aim of this paper is to provide an overview of the concept of decentralized assembly and to discuss and critically assess some currently researched and crucial approaches in production technology. In order to determine the scope in which complementary mobile assembly can be profitable for manufacturers, a general cost model is set up and each cost driver is assessed with respect to varying levels of decentralization. One main result of the paper is that the presented approaches offer huge cost-saving potentials and are thus critical for future production strategies. Nevertheless, they still need to be further exploited in order for decentralized assembly to be profitable for companies. The optimal level of decentralization must, however, be specifically determined in each case and cannot be defined in general.

Keywords: automotive assembly, e-mobility, production technology, release capability, small series assembly

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Authors: Jenee Gooden, Kevin Vasquez-monterroso, Lady Paula Dejesus, Sandra Wainwright, Daniel Kim, Mackenzie Walker

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Introduction: Pyoderma gangrenosum (PG) is a rare, rapidly progressive, neutrophilic ulcerative colitis condition with an incidence of 3 to 10 cases per year ¹ ². Due to the similar appearance, PG is often misdiagnosed as a diabetic ulcer in diabetic patients. Though they may clinically appear similar in appearance, the treatment protocol and diagnostic criteria differ. Also, end-stage renal disease (ESRD) is often a condition seen in diabetic patients, which can have a significant impact on wound healing due to the wide range of uremic toxins³. This case study demonstrates a multidisciplinary team and multimodal treatment approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine for an uncontrolled diabetic with pyoderma gangrenosum of a significant circumferential wound, covering almost the entire right lower extremity. Methods:56 y.o male presents with multiple PG ulcerations, including the chest, right posterior lower extremity and sacrum. All ulcerations were previously managed by the same wound care specialist. His chief complaint was worsening PG ulcerations accompanied by a fever of 103 °F . This case study focuses on the wound to his RLE. Past medical history significant for diabetes mellitus type 2 with hemoglobin A1c of 10% and end stage renal disease (ESRD) on hemodialysis. A multidisciplinary team approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine was successfully used to perform right lower extremity limb salvage. The patient was managed by rheumatology for the continuation of prior medication, as well as the mutual agreement with wound care for the addition of dapsone. A coronary CT angiogram was performed by interventional cardiology, but no significant disease was noted, and no further vascular workup was necessary. Multiple surgical sharp wide excisional debridements with application of allografts and split thickness skin grafts for the circumferential ulceration that encompassed almost the entire right lower extremity were performed by both podiatric surgery and general surgery. Wound cultures and soft tissue biopsies were performed, and infectious disease managed antibiotic therapy. Hyperbaric oxygen therapy and wound vac therapy by wound care were also completed as adjunct management. Results: Prevention of leg amputation by limb salvage of the RLE was accomplished by a multidisciplinary team approach, with the wound size decreasing over a total of 29 weeks from 600 cm² to 12.0 x 3.5 x 0.2 cm. Our multidisciplinary team included podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine. Discussion: Wound healing, in general, can have its challenges, and those challenges are only magnified when accompanied by multiple systemic illnesses. Though the negative impact of diabetes on wound healing is well known, the compound impact of being a diabetic with ESRD and having pyoderma gangrenosum is not. This case demonstrates the necessity for a multidisciplinary team approach with a wide array of treatment modalities to optimize wound healing and perform limb salvage with prevention of lower extremity amputation.

Keywords: diabetes, podiatry, pyoderma gangrenosum, end stage renal disease

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Authors: Moez Yeddes

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The property of opacity is widely used in the formal verification of security in computer systems and protocols. Opacity is a general language-theoretic scheme of many security properties of systems. Opacity is parametrized with framework in which several security properties of a system can be expressed. A secret behaviour of a system is opaque if a passive attacker can never deduce its occurrence from the system observation. Instead of considering the case of static observability where the set of observable events is fixed off-line or dynamic observability where the set of observable events changes over time depending on the history of the trace, we introduce Orwellian partial observability where unobservable events are not revealed provided that downgrading events never occurs in the future of the trace. Orwellian partial observability is needed to model intransitive information flow. This Orwellian observability is knwon as ipurge function. We show in previous work how to verify opacity for regular secret is opaque for a regular language L w.r.t. an Orwellian projection is PSPACE-complete while it has been proved undecidable even for a regular language L w.r.t. a general Orwellian observation function. In this paper, we address two problems of opacification of a regular secret ϕ for a regular language L w.r.t. an Orwellian projection: Given L and a secret ϕ ∈ L, the first problem consist to compute some minimal regular super-language M of L, if it exists, such that ϕ is opaque for M and the second consists to compute the supremal sub-language M′ of L such that ϕ is opaque for M′. We derive both language-theoretic characterizations and algorithms to solve these two dual problems.

Keywords: security policies, opacity, formal verification, orwellian observation

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Authors: Peri Harish Kumar, Sai Sharan Dwarka, Tajbinder Singh Bains, Suneet John Joseph, Chaitanya Kiran, Sambhu Dutta, Sarah Makram, Mohamed Sayed Zaazouee, Alaa Ahmed Elshanbary

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Objective: To identify cancer and non-cancer causes of death in hepatocellular carcinoma (HCC) patients over different time periods after diagnosis and to compare the mortality risk of each cause in HCC patients with the general population. Methods: In this retrospective cohort study, data of 67,637 HCC patients from 1975 to 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. We investigated the association between different causes of death and the following variables: age, race, tumor stage at diagnosis, and treatment (surgery, chemotherapy, and radiotherapy); each according to the periods of <1 year, 1-5 years, 5-10 years, and >10 years following the diagnosis. Standardized mortality ratios (SMRs) and their 95% confidence intervals (CIs) were calculated for cancer and non-cancer deaths in each of the mentioned periods following diagnosis. Results: Data of 67,637 patients, of whom 50,571 patients died during the follow-up period, were analyzed. Most deaths were due to HCC itself (35,535, 70.3%), followed by other cancers (3,983, 7.9%). Common causes of non-cancer mortality included infectious and parasitic diseases including HIV (2,823 patients, SMR=105.68, 95% CI: 101.82-109.65), chronic liver disease (2,719 patients, SMR=76.56, 95% CI: 73.71,79.5), and heart diseases (1,265 patients, SMR=2.26, 95% CI: 2.14-2.39), with higher mortality risk in HCC patients than in the general population. Conclusion: Cancers stand for most deaths in patients with HCC. Besides, infectious, and parasitic diseases including HIV represent the commonest non-cancer cause of mortality.

Keywords: hepatocellular carcinoma, seer, causes of death, mortality

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Authors: Yi-Hsuan Gloria Lo

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The educational objective of vocational high schools (VHSs) is to equip VHS students with practical skills and knowledge that can be applied in the job-related market. However, with the increasing number of technological universities over the past two decades, the majority of VHS students have chosen to receive higher education rather than enter the job market. VHS English education has been confronting a dilemma: Should an English for specific purposes (ESP) approach, which aligns with the educational goal of VHS education, be taken or should an English for general purposes (EGP) approach, which prepares VHS students for advanced studies in universities, be followed? While ESP theorists proposed that that ESP can be taught to secondary learners, little was known about VHS students’ perspective on this ESP-versus-EGP dilemma. Scant research has investigated different facets of students’ needs (necessities, wants, and lacks) for both ESP and EGP in terms of the four language skills and the factors that contribute to any differences. To address the gap in the literature, 100 VHS students responded to statements related to their necessities, wants, and lacks in learning ESP and EGP on a 6-point Likert scale. Six VHS students were interviewed to tap into the reasons for different facets of the needs for learning EGP and ESP. The statistical analysis indicates that at this stage of learning English, VHS subjects believed that EGP was more necessary than ESP; EGP was more desirable than ESP. However, they reported that they were more lacking in ESP than in EGP learning. Regarding EGP, the results show that the VHS subjects rated speaking as their most necessary skill, speaking as the most desirable skill, and writing as the most lacking skill. A significant difference was found between perceived learning necessities and lacks and between perceived wants and lacks. No statistical difference was found between necessities and wants. In the aspect of ESP, the results indicate that the VHS subjects marked reading as their most necessary skill, speaking as the most desirable skill, and writing as the most lacking skill. A significant difference exists between their perceived necessities and lacks and between their wants and lacks. However, there is no statistically significant difference between their perceived lacks and wants. Despite the lack of a significant difference between learning necessities and wants, the qualitative interview data reveal that the reasons for their perceived necessities and wants were different. The findings of the study confirm previous research that demonstrates that ‘needs’ is a multiple and conflicting construct. What VHS students felt most lacking was not necessarily what they believed they should learn or would like to learn. Although no statistical difference was found, different reasons were attributed to their perceived necessities and wants. Both theoretical and practical implications have been drawn and discussed for ESP research in general and teaching ESP in VHSs in particular.

Keywords: vocational high schools (VHSs), English for General Purposes (EGP), English for Specific Purposes (ESP), needs analysis

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Authors: Layal Mansour

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The aim of this paper is to identify whether oil price volatility or geopolitical risks can predict future financial stress periods or economic recessions in Kuwait. We construct the first Financial Stress Index for Kuwait (FSIK) that includes informative vulnerable indicators of the main financial sectors: the banking sector, the equities market, and the foreign exchange market. The study covers the period from 2000 to 2020, so it includes the two recent most devastating world economic crises with oil price fluctuation: the Covid-19 pandemic crisis and Ukraine-Russia War. All data are taken by the central bank of Kuwait, the World Bank, IMF, DataStream, and from Federal Reserve System St Louis. The variables are computed as the percentage growth rate, then standardized and aggregated into one index using the variance equal weights method, the most frequently used in the literature. The graphical FSIK analysis provides detailed information (by dates) to policymakers on how internal financial stability depends on internal policy and events such as government elections or resignation. It also shows how monetary authorities or internal policymakers’ decisions to relieve personal loans or increase/decrease the public budget trigger internal financial instability. The empirical analysis under vector autoregression (VAR) models shows the dynamic causal relationship between the oil price fluctuation and the Kuwaiti economy, which relies heavily on the oil price. Similarly, using vector autoregression (VAR) models to assess the impact of the global geopolitical risks on Kuwaiti financial stability, results reveal whether Kuwait is confronted with or sheltered from geopolitical risks. The Financial Stress Index serves as a guide for macroprudential regulators in order to understand the weakness of the overall Kuwaiti financial market and economy regardless of the Kuwaiti dinar strength and exchange rate stability. It helps policymakers predict future stress periods and, thus, address alternative cushions to confront future possible financial threats.

Keywords: Kuwait, financial stress index, causality test, VAR, oil price, geopolitical risks

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Authors: Siphat Lim

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This study used Autoregressive Distributed Lag (ARDL) approach to cointegration. In the long-run the general price level and exchange rate have a positively significant effect on domestic output. The estimated result further revealed that fiscal stimulus help stimulate domestic output in the long-run, but not in the short-run, while monetary expansion help to stimulate output in both short-run and long-run. The result is complied with the theory which is the macroeconomic policies, fiscal and monetary policy; help to stimulate domestic output in the long-run. The estimated result of the Vector Error Correction Model (VECM) has indicated more clearly that the consumer price index has a positive effect on output with highly statistically significant. Increasing in the general price level would increase the competitiveness among producers than increase in the output. However, the exchange rate also has a positive effect and highly significant on the gross domestic product. The exchange rate depreciation might increase export since the purchasing power of foreigners has increased. More importantly, fiscal stimulus would help stimulate the domestic output in the long-run since the coefficient of government expenditure is positive. In addition, monetary expansion would also help stimulate the output and the result is highly significant. Thus, fiscal stimulus and monetary expansionary would help stimulate the domestic output in the long-run in Cambodia.

Keywords: fiscal policy, monetary policy, ARDL, VECM

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Authors: Håkon Riiber

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This paper explores the extent to which Russian ‘Active Measures’ play a role in contemporary Russian foreign policy and in what way the legacy of the Soviet Union is still apparent in these practices. The analysis draws on a set of case studies from the 21st century to examine these aspects, showing which ‘Active Measures’ features are old and which are new in the post-Cold War era. The paper highlights that the topic has gained significant academic and political interest in recent years, largely due to the aggressive posture of the Russian Federation on the world stage, exemplified through interventions in Estonia, Georgia, and Ukraine and interference in several democratic elections in the West. However, the paper argues that the long-term impact of these measures may have unintended implications for Russia. While Russia is unlikely to stop using Active Measures, increased awareness of the exploitation of weaknesses, institutions, or other targets may lead to greater security measures and an ability to identify and defend against these activities. The paper contends that Soviet-style ‘Active Measures’ from the Cold War era have been modernized and are now utilized to create an advantageous atmosphere for further exploitation to support contemporary Russian foreign policy. It offers three key points to support this argument: the reenergized legacy of the Cold War era, the use of ‘Active Measures’ in a number of cases in the 21st century, and the applicability of AM to the Russian approach to foreign policy. The analysis reveals that while this is not a new Russian phenomenon, it is still oversimplified and inaccurately understood by the West, which may result in a decreased ability to defend against these activities and limit the unwarranted escalation of the ongoing security situation between the West and Russia. The paper concludes that the legacy of Soviet-era Active Measures continues to influence Russian foreign policy, and modern technological advances have only made them more applicable to the current political climate. Overall, this paper sheds light on the important issue of Russian ‘Active Measures’ and the role they play in contemporary Russian foreign policy. It emphasizes the need for increased awareness, understanding, and security measures to defend against these activities and prevent further escalation of the security situation between the West and Russia.

Keywords: Russian espionage, active measures, disinformation, Russian intelligence

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Authors: Ofelia Loani Elvir Lazo, Roya Yumul, Sevan Komshian, Ruby Wang, Jun Tang

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Background: Monitoring the anti-nociceptive drug effect is useful because a sudden and strong nociceptive stimulus may result in untoward autonomic responses and muscular reflex movements. Monitoring the anti-nociceptive effects of perioperative medications has long been desiredas a way to provide anesthesiologists information regarding a patient’s level of antinociception and preclude any untoward autonomic responses and reflexive muscular movements from painful stimuli intraoperatively.To this end, electroencephalogram (EEG) based tools includingBIS and qCON were designed to provide information about the depth of sedation whileqNOXwas produced to informon the degree of antinociception.The goal of this study was to compare the reliability of qCON/qNOX to BIS asspecific indicators of response to nociceptive stimulation. Methods: Sixty-two patients undergoing general anesthesia with LMA were included in this study. Institutional Review Board(IRB) approval was obtained, and informed consent was acquired prior to patient enrollment. Inclusion criteria included American Society of Anesthesiologists (ASA) class I-III, 18 to 80 years of age, and either gender. Exclusion criteria included the inability to consent. Withdrawal criteria included conversion to endotracheal tube and EEG malfunction. BIS and qCON/qNOX electrodes were simultaneously placed o62n all patientsprior to induction of anesthesia and were monitored throughout the case, along with other perioperative data, including patient response to noxious stimuli. All intraoperative decisions were made by the primary anesthesiologist without influence from qCON/qNOX. Student’s t-distribution, prediction probability (PK), and ANOVA were used to statistically compare the relative ability to detect nociceptive stimuli for each index. Twenty patients were included for the preliminary analysis. Results: A comparison of overall intraoperative BIS, qCON and qNOX indices demonstrated no significant difference between the three measures (N=62, p> 0.05). Meanwhile, index values for qNOX (62±18) were significantly higher than those for BIS (46±14) and qCON (54±19) immediately preceding patient responses to nociceptive stimulation in a preliminary analysis (N=20, * p= 0.0408). Notably, certain hemodynamic measurements demonstrated a significant increase in response to painful stimuli (MAP increased from74±13 mm Hg at baseline to 84± 18 mm Hg during noxious stimuli [p= 0.032] and HR from 76±12 BPM at baseline to 80±13BPM during noxious stimuli[p=0.078] respectively). Conclusion: In this observational study, BIS and qCON/qNOX provided comparable information on patients’ level of sedation throughout the course of an anesthetic. Meanwhile, increases in qNOX values demonstrated a superior correlation to an imminent response to stimulation relative to all other indices.

Keywords: antinociception, bispectral index (BIS), general anesthesia, laryngeal mask airway, qCON/qNOX

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Authors: Hadi Farahani, Mahsa Tahzibi, Laleh Golamrej Eliasi, Mohammad Torkashvand

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Iranian deafs are an under-researched population. The lack of research comes from the fact that if none, there are very few researchers capable of speaking sign language. The exclusion of this minority group from mainstream society often distorts the general understanding of prevalent issues of the deaf in Iran. The topic of this research was co-created through preliminary discussions with the Iranian deaf. Domestic violence then was picked up as an infrastructural issue impacting other dimensions of deaf lives such as work, education, and outside family relationships. For this purpose, we systematically searched the literature seeking a comprehensive questionnaire. We came across a 46-item standardized questionnaire measuring domestic violence in Iran. To adapt this questionnaire, we followed standard procedures reflected in another article. The inclusion criteria of the current research were married (had experienced living with a partner before) and +18-year-old deaf. Sampling was random and recruitment of the participants was through governmental or voluntary organizations for the deaf. 390 questionnaires then were analyzed through SPSS version 27. Analysis showed that the prevalence rate of domestic violence was 26% in general that emotional violence with 29% was the most prevalent type. Findings suggested that the more educated, and economically independent were the participants, the lower the probability of encountering domestic violence. Domestic violence within families where all members were deaf proved to be less usual than in families in which only the participant was deaf. Further interventional research is needed to assess how to empower the Iranian deaf regarding domestic violence.

Keywords: deaf, domestic violence, economic violence, emotional violence, physical violence, sexual violence

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Authors: Amanda Andrea Beatrix Brita, Dominic J. Buenaventura, Charmaine A. Seromines, Antonne Noel V. Chua, Ma. Luisa G. Badilles

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Online ranting, or the act of forcefully expressing your opinion towards other people over the Internet, has been an ongoing issue ever since the creation of the Internet. Due to the COVID-19 pandemic, the rise of active users has been observed to have increased during this time, thus increasing the number of people being engaged in online activities, which consequently affects the number of individuals who participate in online ranting. However, with all that is observed, what is usually not a topic being discussed about this event are the motivations that lead people to do online ranting. The study was undertaken to discover the level of aggression, Satisfaction, and online engagement in their environment. We utilized 2 researcher-made questionnaires that were validated by three experts, namely for the Satisfaction and engagement levels. We adapted Cyber-Aggression Typology Questionnaire (CATQ) for the level of aggression. Quota sampling was used in determining the respondents. A quota of 250 students was recommended. The results showed that the students in every institution have a deficient level of aggression, and the majority of the institution has a shallow level of Satisfaction when it comes to online ranting. Similar findings are presented in the level of engagement; 2 out of 3 of the institution students have shallow engagement in the general settings that expound students' engagement. Although the result shows deficient levels, there are still instances and possibilities that students may still engage in an online rant regarding various circumstances when triggered. Researchers assumed that there are restrictions on movements likely to show opinions online because of consequences.

Keywords: aggression, satisfaction, online rant engagement, online rant

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Authors: Haruna Abdu Usman, Bashir Usman Mohammed, Mohammed Umar Jamil

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Municipal solid waste management constitutes a serious problem bedeviling environmental protection agencies in many cities of developing countries. Most agencies do not collect the totality of the waste generated in their cities. This study presents the current solid waste management practices and problems in Bauchi metropolis, Bauchi state Nigeria. The general feature is characterized by inefficient, insufficient and irrational collection and improper disposal alternatives. The consequent environmental effects of these problems depict clogged city drains, uncollected heap of waste on road sides of residential areas, vacant plots and uncompleted buildings and highways. This contributes immensely to flooding in the city. The major challenges facing the state environmental protection agency includes; lack of collection and disposal points, technical and institutional arrangements, financial resources and general attitude of the serving public among others. The study suggested a comprehensive and integrated approach to the solid waste management which recognizes and incorporates the interventionist role of the state government, the private formal and informal waste management operators and the serving public.

Keywords: municipal solid waste, bauchi metropolitan area, environmental protection agency, solid waste management, waste disposal

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Authors: Ali Showail Ali Alasmari

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Introduction: Cataract is the loss of transparency of the lens inside the eye. It is the most common cause of visual loss and blindness worldwide. This study provides a systemic review of the recent findings on the association of vitamin D, and vitamin B12, and their possible role in preventing cataracts in senile (S) and diabetic mellitus (DM) patient groups. Objective: This study was intended to establish and investigate if there is any role between vitamin D and vitamin B12? Secondly, the connection between serum level of vitamin D and vitamin B12 in cataract incidence senile (s) vs. diabetic mellitus (DM) cataract patient groups. Furthermore, to evaluate and analyze cataract occurrence regarding vitamin D and vitamin B12 levels with other risk factors. Finally, to evaluate lens opacities pre and post treatment with vitamin D and vitaminB12 linked to age and visual acuity loss in both senile(S) and diabetic mellitus (DM) cataract patients’ groups. Methods: This study conducted at the ophthalmology clinic at Muhyail General Hospital. Select a prospective case-control to study the effect of vitamin D and Vit B12 on senile(S) cataracts that caused by age and diabetic mellitus (DM)cataract patients; then we compare these two groups. This study prospectively enrolled a total of 50 samples, 25 with senile cataract and 25 with diabetic cataract, from ophthalmology clinic at Muhyail General Hospital. Measuring 25-hydroxy vitamin D and vitamin B12 level concentrations in the assigned samples. Analyses were performed using SAS (statistical analysis software) program. Results: The most important finding in this study was that the senile(s) cataract patients’ group greatly benefited by the combination therapy of vitamin D, and Vitamin B12 reached (28.5±1.50 and 521.1±21.10) respectively; on the contrary, the diabetic cataract patient group hardly shows any significant improvement (21.5 ± 1.00 and 197.2 ± 7.20) respectively. This is because of the Metformin, the first line drug for treating diabetes, has been reported to potentially decrease vitamin B-12 status. This epigenetic modification was correlated with the diabetic mellitus (DM) cataract patients’ group not responding. Vitamin B12 deficiency also leads to an impairment of the conversion of methylmalonyl-CoA to succinyl-CoA, which has been associated with insulin resistance. There was no significant difference between the age, body mass index (BMI), the mean of Vit-D pre-treatments, and the mean values of Hemoglobin A1C of both senile (S) and diabetic mellitus (DM) cataract patient groups. On other hand, there was a highly significant difference between the mean values of glucose levels in both senile (S) and diabetic mellitus (DM) cataract patient groups. Conclusion: Here we conclude that diabetic mellitus (DM) cataract patient group hardly benefited from this combination therapy vitamin D and vitamin B12; on the other hand senile patient group (s) benefited a lot from the therapy.

Keywords: cataract patients, senile, diabetes mellitus, vitamin B12, vitamin D, Muhyail General Hospital, Saudi Arabia

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Authors: Ahmed Khalil

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Increased energy demands around the world have led to the raise in power production which has resulted with more greenhouse gas emissions through fossil sources. These fossil sources and emissions cause deterioration in echo-system. Therefore, renewable energy sources come to the scene as echo-friendly and clean energy sourcing, whereas the electrical devices and energy needs decrease in the timeline. Each of these renewable energy sources contribute to the reduction of greenhouse gases and mitigate environmental deterioration. However, there are also some general and source-specific challenges, which influence the choice of the investors. The most prominent general challenge that effects end-users’ comfort and reliability is usually determined as the intermittence which derives from the diversions of source conditions, due to nature dynamics and uncontrolled periodic changes. Research and development professionals strive to mitigate intermittence challenge through material improvement for each renewable source whereas hybrid source mix stand as a solution. This solution prevails well, when single renewable technologies are upgraded further. On the other hand, integration of energy efficient devices and systems, raise the affirmative effect of such solution in means of less energy requirement in sustainability composition or scenario. This paper provides a glimpse on the advantages of composing renewable source mix versus single usage, with contribution of sampled e-efficient systems and devices. Accordingly it demonstrates the extended benefits, through planning and predictive estimation stages of Ahmadi Town Projects in Kuwait.

Keywords: e-efficient systems, hybrid source, intermittence challenge, renewable energy

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Authors: Ssembatya Joseph Mary

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Introduction: Omphalocele, an abdominal wall defect, occurs in 1 out of 4,000 to 6,000 live births. It is characterized by visceral herniation of small and large intestines, liver, and sometimes spleen and gonads are involved. The viscera is always covered by a three-layered sac. The defect in the mesoderm is mainly due to the failure of lateral abdominal wall folds to unite. About 350,000 ventral hernia repairs are done annually in the united states of America. Surgical repair with a mesh is the gold standard surgical method. With conservative management of Omphalocele, children are eventually closed between the age of 1 and 5 years. Herein, we present a late manifestation of ventral hernia following Omphalocele in a female Ugandan. Case presentation: A 56-year-old female with no known chronic illnesses and normal perinatal history presented with an umbilical swelling since birth with no associated symptoms. She is a married woman to one husband and has five children, and all of them are in good general condition with no such symptoms. She had normal vitals with an umbilical defect measuring about 20cm from the xiphoid process and 10 cm from the symphysis pubis. Surgery was done (component separation) on the second inpatient day, and it was uneventful. The patient was discharged on the 4th postoperative day in good general condition with a dry and clean surgical site. Conclusion: Despite adequate literature about Omphalocele and clear management guidelines, there have been reported cases of adult presentation of ventral hernias secondary to Omphalocele.

Keywords: omphalocele, ventral hernia, uganda, late presentation

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Authors: Konysbek Aksaule

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The purpose of this work is to explore new and effective ways of teaching English to students who are studying a foreign language since the timeliness of the problem disclosed in this article is due to the high level of English proficiency that potential specialists must have due to high competition in the context of global globalization. The article presents an analysis of the feasibility and effectiveness of using an authentic feature film in teaching English to students. The methodological basis of the study includes an assessment of the level of students' proficiency in a foreign language, the stage of evaluating the film, and the method of selecting the film for certain categories of students. The study also contains a list of practical tasks that can be applied in the process of viewing and perception of an original feature film in a foreign language, and which are aimed at developing language skills such as speaking and listening. The results of this study proved that teaching English to students through watching an original film is one of the most effective methods because it improves speech perception, speech reproduction ability, and also expands the vocabulary of students and makes their speech fluent. In addition, learning English through watching foreign films has a huge impact on the cultural views and knowledge of students about the country of the language being studied and the world in general. Thus, this study demonstrates the high potential of using authentic feature film in English lessons for pedagogical science and methods of teaching English in general.

Keywords: university, education, students, foreign language, feature film

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Authors: Shang Yee Chong

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Perioperative pain is a complex mechanism activated by various nociceptive, neuropathic, and inflammatory pathways. Opioids have long been a mainstay for analgesia in this period, even as we are continuously moving towards a multimodal model to improve pain control while minimising side effects. Dexmedetomidine, a potent alpha-2 agonist, is a useful sedative and hypnotic agent. Its use in the intensive care unit has been well described, and it is increasingly an adjunct intraoperatively for its opioid sparing effects and to decrease pain scores. We describe a case of a general surgical patient in whom minimal opioids was required with dexmedetomidine use. The patient was a 61-year-old Indian gentleman with a history of hyperlipidaemia and type 2 diabetes mellitus, presenting with rectal adenocarcinoma detected on colonoscopy. He was scheduled for a robotic ultra-low anterior resection. The patient was induced with intravenous fentanyl 75mcg, propofol 160mg and atracurium 40mg. He was intubated conventionally and mechanically ventilated. Anaesthesia was maintained with inhalational desflurane and anaesthetic depth was measured with the Masimo EEG Sedline brain function monitor. An initial intravenous dexmedetomidine dose (bolus) of 1ug/kg for 10 minutes was given prior to anaesthetic induction and thereafter, an infusion of 0.2-0.4ug/kg/hr to the end of surgery. In addition, a bolus dose of intravenous lignocaine 1.5mg/kg followed by an infusion at 1mg/kg/hr throughout the surgery was administered. A total of 10mmol of magnesium sulphate and intravenous paracetamol 1000mg were also given for analgesia. There were no significant episodes of bradycardia or hypotension. A total of intravenous phenylephrine 650mcg was given throughout to maintain the patient’s mean arterial pressure within 10-15mmHg of baseline. The surgical time lasted for 5 hours and 40minutes. Postoperatively the patient was reversed and extubated successfully. He was alert and comfortable and pain scores were minimal in the immediate post op period in the postoperative recovery unit. Time to first analgesia was 4 hours postoperatively – with paracetamol 1g administered. This was given at 6 hourly intervals strictly for 5 days post surgery, along with celecoxib 200mg BD as prescribed by the surgeon regardless of pain scores. Oral oxycodone was prescribed as a rescue analgesic for pain scores > 3/10, but the patient did not require any dose. Neither was there nausea or vomiting. The patient was discharged on postoperative day 5. This case has reinforced the use of dexmedetomidine as an adjunct in general surgery cases, highlighting its excellent opioid-sparing effects. In the entire patient’s hospital stay, the only dose of opioid he received was 75mcg of fentanyl at the time of anaesthetic induction. The patient suffered no opioid adverse effects such as nausea, vomiting or postoperative ileus, and pain scores varied from 0-2/10. However, intravenous lignocaine infusion was also used in this instance, which would have helped improve pain scores. Paracetamol, lignocaine, and dexmedetomidine is thus an effective, opioid-sparing combination of multi-modal analgesia for major abdominal surgery cases.

Keywords: analgesia, dexmedetomidine, general surgery, opioid sparing

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