Search results for: failure base rates

Authors: Wisam Ismail, Brendan Wooler, Penelope McManus

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Introduction: The public perception of implants has been damaged in the wake of recent negative publicity and increasingly we are finding patients wanting to avoid them. Planned lipo-modelling to enhance the volume of a Latissimus dorsi flap is a viable alternative to silicone implants and maintains a Totally Autologous Technique (TAT). Here we demonstrate that when compared to an Implant Assisted Technique (IAT), a TAT offers patients many benefits that offset the requirement of more operations initially, with reduced short and long term complications, reduced symmetrisation surgery and reduced revision rates. Methods. Data was collected prospectively over 7 years. The minimum follows up was 3 years. The technique was generally standardized in the hand of one surgeon. All flaps were extended LD flaps (ELD). Lipo-modelling was performed using standard techniques. Outcome measures were unplanned secondary procedures, complication rates, and contralateral symmetrisation surgery rates. Key Results Were: Lower complication rates in the TAT group (18.5% vs. 33.3%), despite higher radiotherapy rates (TAT=49%, IAT=36.8%), TAT was associated with lower subsequent symmetrisation rates (30.6% vs. 50.9%), IAT had a relative risk of 3.1 for subsequent unplanned procedure, Autologous patients required an average of 1.76 sessions of lipo-modelling, Conclusions: Using lipo-modelling to enable totally autologous LD reconstruction offers significant advantages over an implant assisted technique. We have shown a lower subsequent unplanned procedure rate, lower revision surgery, and less contralateral symmetrisation surgery. We anticipate that a TAT will be supported by patient satisfaction surveys and long-term patient-reported cosmetic outcome data and intended to study this.

Keywords: breast, Latissimus dorsi, lipomodelling, reconstruction

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Authors: Nathalie Bolding, Marta Montero, Joaquim Cevallos, Juan F. Martin-Lazaro

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Background: Inhaled epoprostenol (iEPO) have been shown to improve PaO2:FiO2 (PF) in combination with bronchodilators (BD). However, there is not an available device to deliver these two therapies concomitantly. We describe a new method to provide this therapy successfully. Objective: To evaluate the response to continuous nebulization of iEPO and intermittent nebulization of Salbutamol/Ipratropium bromide in adults with severe respiratory failure through a double mesh nebulisation in tandem. Methods: This observational study included two mechanical ventilated adults under hourly ventilatory, gasometrical and clinical measurements during 48h. Both had severe respiratory failure treated with continuous iEPO (50 – 200 micrograms/h) and BD (Salbutamol 2.5 mg and Ipratropium bromide 500 mcg every 6 hours) through double mesh nebulisation (Aerogen solo®) placed in tandem in the dry side of the humidificator. The primary endpoints were the variables associated with a positive response to this tandem nebulised therapy (PaFiO2 index, ROX index). Secondary endpoints were laboratory (ABG) clinical and ventilatory variables. Statistical analysis (SPSS v29) included linear regression and ANOVA. Results: The patients included (n=2) survived, both extubated, one after ECMO therapy. Severe acute respiratory failure had a positive response rate to continuous iEPO and intermittent BD: PaFiO2 increased (7.40 to 30.91; P75: 27%) as well as ROX index (2.91 to 11.43; P75: 33%). There was a linear correlation of improvement between iEPO with PaFiO2 (ANOVA, r=0.393, p<0.002) and ROX (r=0.419, p<0.001). iEPO+BD therapy did not show any complications. Conclusion: Continuous and intermittent mesh tandem nebulisation can be effectively delivered with this method with a positive effect in ventilatory parameters without observed complications. Randomised studies will be able to provide reassurance in this new therapy.

Keywords: tandem, mesh, nebulisers, pulmonary, vasoldilators, bronchodilators, respiratory, failure

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Authors: Lei Zhang, Tingting Xu, Jun He, Zhenyu Yan

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Email marketing is one of the most important segments of online marketing. It has been proved to be the most effective way to acquire and retain customers. The email content is vital to customers. Different customers may have different familiarity with a product, so a successful marketing strategy must personalize email content based on individual customers’ product affinity. In this study, we build our personalized email marketing strategy with three types of emails: nurture, promotion, and conversion. Each type of email has a different influence on customers. We investigate this difference by analyzing customers’ open rates, click rates and opt-out rates. Feature importance from response models is also analyzed. The goal of the marketing strategy is to improve the click rate on conversion-type emails. To build the personalized strategy, we formulate the problem as a reinforcement learning problem and adopt a Q-learning algorithm with variations. The simulation results show that our model-based strategy outperforms the current marketer’s strategy.

Keywords: email marketing, email content, reinforcement learning, machine learning, Q-learning

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Authors: Afnan Ahmad, Shahid Ali, Mujahid Khan

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This research presents the parametric study of an existing earth fill dam located at Latamber, Karak city, Pakistan. The study consists of carrying out seepage analysis, slope stability analysis, and Earthquake analysis of the dam for the existing dam geometry and do the same for modified geometry. Dams are massive as well as expensive hydraulic structure, therefore it needs proper attention. Additionally, this dam falls under zone 2B region of Pakistan, which is an earthquake-prone area and where ground accelerations range from 0.16g to 0.24g peak. So it should be deal with great care, as the failure of any dam can cause irreparable losses. Similarly, seepage as well as slope failure can also cause damages which can lead to failure of the dam. Therefore, keeping in view of the importance of dam construction and associated costs, our main focus is to carry out parametric study of newly constructed dam. GeoStudio software is used for this analysis in the study in which Seep/W is used for seepage analysis, Slope/w is used for Slope stability analysis and Quake/w is used for earthquake analysis. Based on the geometrical, hydrological and geotechnical data, Seepage and slope stability analysis of different proposed geometries of the dam are carried out along with the Seismic analysis. A rigorous analysis was carried out in 2-D limit equilibrium using finite element analysis. The seismic study began with the static analysis, continuing by the dynamic response analysis. The seismic analyses permitted evaluation of the overall patterns of the Latamber dam behavior in terms of displacements, stress, strain, and acceleration fields. Similarly, the seepage analysis allows evaluation of seepage through the foundation and embankment of the dam, while slope stability analysis estimates the factor of safety of the upstream and downstream of the dam. The results of the analysis demonstrate that among multiple geometries, Latamber dam is secure against seepage piping failure and slope stability (upstream and downstream) failure. Moreover, the dam is safe against any dynamic loading and no liquefaction has been observed while changing its geometry in permissible limits.

Keywords: earth-fill dam, finite element, liquefaction, seepage analysis

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Authors: Hilda Kundai Chikwanda, Lawrence Thabo Mokhadi

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The study aimed to review the factors that lead the freight railway suppliers base in South Africa (SA) to apply the Lean and Six Sigma (L&SS) methodologies. A thorough review of the factors that lead organisations, in the different industries, to implement these methodologies was done. L&SS applications were found to be prominent in the automotive industry. In particular, the railway industry in SA and the region were reviewed in terms of challenges in capturing the freight logistics market and growing market share. Qualitative methods have been used to collect primary data and descriptive statistics was used to calculate, describe, and summarize collected research data. The results show that external factors have a greater influence on the implementation of L&SS. The study drew inferences between freight railway supplier base and the application of Lean and Six Sigma (L&SS) methodologies in the SA context. It identified challenges that leads the SA freight railway to lose market share to road freight users. It further observes and recommends that L&SS methodologies are the ideal strategy required to implement a turnaround in the trajectory of freight railways as a competitive freight transport solution.

Keywords: production, methodology, manufacturing, lean, six sigma

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Authors: Marija Vitanova, Aleksandra Bogdanovic, Kemal Edip, Viktor Hristovski, Vlado Micov

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Bridges represent critical structures in lifeline systems. They provide reliable modes of transportation, so their failure can seriously obstruct relief and rehabilitation work. Earthquake ground motions can cause significant damages in bridges, so during the strong earthquakes, they can easily collapse. The base isolation technique has been quite effective in seismic response mitigation of the bridges in reducing the piers base shear. The effect of soil structure interaction on the dynamic responses of seismically isolated three span girder bridge with viscous dampers is investigated. Viscous dampers are installed in the mid span of the bridge to control bearing displacement. The soil surrounding the foundation of piers has been analyzed by applying different soil densities in order to consider the soil stiffness. The soil medium has been assumed as a four layered infill as dense and loose medium. The boundaries in the soil medium are considered as infinite elements in order to absorb the radiating waves. The formulation of infinite elements is the same as for the finite elements in addition to the mapping of the domain. Based on the iso-parametric concept, the infinite element in global coordinate is mapped onto an element in local coordinate system. In the formulation of the infinite element, only the positive direction extends to infinity thus allowing the waves to propagate outside of the soil medium. Dynamic analyses for two levels of earthquake intensity are performed in time domain using direct integration method. In order to specify the effects of the SSI, the responses of the isolated and controlled isolated bridges are compared. It is observed that the soil surrounding the piers has significant effects on the bearing displacement of the isolated RC bridges. In addition, it is observed that the seismic responses of isolated RC bridge reduced significantly with the installation of the viscous dampers.

Keywords: viscous dampers, reinforced concrete girder bridges, seismic response, SSI

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Authors: Abdelghani Chahmi

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This article examines the detection and localization of faults in electrical systems, particularly those using asynchronous machines. First, the process of failure will be characterized, relevant symptoms will be defined and based on those processes and symptoms, a model of those malfunctions will be obtained. Second, the development of the diagnosis of the machine will be shown. As studies of malfunctions in electrical systems could only rely on a small amount of experimental data, it has been essential to provide ourselves with simulation tools which allowed us to characterize the faulty behavior. Fault detection uses signal processing techniques in known operating phases.

Keywords: induction motor, modeling, bearing damage, airgap eccentricity, torque variation

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Authors: Malory Beaujolais

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Chlordecone is an organochlorine pesticide with a bishomocubane structure which led to high stability in organic matter. Microbial fuel cell is a type of electrochemical system that can convert organic matters into electricity thanks to electroactive bacteria. This technique has been used with mangrove swamp from Martinique to try to reduce chlordecone rates. Those experiments led to characterize the behavior of the electroactive biofilm formed at the cathode, without added redox mediator. The designed bioelectrochemical system seems to provide the necessary conditions for chlordecone degradation.

Keywords: bioelectrochemistry, bioremediation, chlordecone, mangrove swamp

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Authors: Sonia Anand Knowlton

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There are some cases where we as a society feel deeply uncomfortable with the use of Artificial Intelligence (AI) tools in the judicial decision-making process, and justifiably so. A perfect example is COMPAS, an algorithmic model that predicts recidivism rates of offenders to assist in the determination of their bail conditions. COMPAS turned out to be extremely racist: it massively overpredicted recidivism rates of Black offenders and underpredicted recidivism rates of white offenders. At the same time, there are certain uses of AI in the judicial decision-making process that many would feel more comfortable with and even support. Take, for example, a “super-breathalyzer,” an (albeit imaginary) tool that uses AI to deliver highly detailed information about the subject of the breathalyzer test to the legal decision-makers analyzing their drunk-driving case. This article evaluates the point at which a judge’s use of AI tools begins to undermine the public’s trust in the administration of justice. It argues that the answer to this question depends on whether the AI tool is in a role in which it must perform a moral evaluation of a human being.

Keywords: artificial intelligence, judicial reasoning, morality, technology, algorithm

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Authors: A. K. M. Badrul Alam, Yoshiaki Fujii, Nahid Hasan Dipu, Shakil Ahmed Razo

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Shale rockmasses often include silt layers, impacting slope stability in construction and mining. Analyzing their interaction is crucial for long-term stability. A study used an elastoplastic model, incorporating the stress transfer method and Coulomb's criterion, to assess a shale rock mass with silt layers. It computed stress distribution, assessed failure potential, and identified vulnerable regions where nodal forces were calculated for a comprehensive analysis. A shale rock mass ranging from 14.75 to 16.75 meters thick, with silt layers varying from 0.36 to 0.5 meters, was considered in the model. It examined four silt layer conditions: horizontal (SiHL), vertical (SiVL), inclined against slope (SiIincAGS), and along slope (SilincALO). Mechanical parameters like uniaxial compressive strength (UCS), tensile strength (TS), Young’s modulus (E), Poisson’s ratio, and density were adjusted for varied scenarios: UCS (0.5 to 5 MPa), TS (0.1 to 1 MPa), and E (6 to 60 MPa). In elastic analysis of shale rock masses, stress distributions vary based on layer properties. When shale and silt layers have the same elasticity modulus (E), stress concentrates at corners. If the silt layer has a lower E than shale, marginal changes in maximum stress (σmax) occur for SilHL. A decrease in σmax is evident at SilVL. Slight variations in σmax are observed for SilincAGS and SilincALO. In the elastoplastic analysis, the overall decrease of 20%, 40%, 60%, 80%, and 90% was considered. For SilHL:(i) Same E, UCS, and TS for silt layer and shale, UCS/TS ratio 5: strength decrease led to shear (S), tension then shear (T then S) failure; noticeable failure at 60% decrease, significant at 80%, collapse at 90%. (ii) Lower E for silt layer, same strength as shale: No significant differences. (iii) Lower E and UCS, silt layer strength 1/10: No significant differences. For SilVL: (i) Same E, UCS, and TS for silt layer and shale, UCS/TS ratio 5: Similar effects as SilHL. (ii) Lower E for silt layer, same strength as shale: Slip occurred. (iii) Lower E and UCS, silt layer strength 1/10: Bitension failure also observed with larger slip. For SilincAGS: (i) Same E, UCS, and TS for silt layer and shale, UCS/TS ratio 5: Effects similar to SilHL. (ii) Lower E for silt layer, same strength as shale: Slip occurred. (iii) Lower E and UCS, silt layer strength 1/10: Tension failure also observed with larger slip. For SilincALO: (i) Same E, UCS, and TS for silt layer and shale, UCS/TS ratio 5: Similar to SilHL with tension failure. (ii) Lower E for silt layer, same strength as shale: No significant differences; failure diverged. (iii) Lower E and UCS, silt layer strength 1/10: Bitension failure also observed with larger slip; failure diverged. Toppling failure was observed for lower E cases of SilVL and SilincAGS. The presence of silt interlayers in shale greatly impacts slope stability. Designing slopes requires careful consideration of both the silt and shale's mechanical properties. The temporal degradation of strength in these layers is a major concern. Thus, slope design must comprehensively analyze the immediate and long-term mechanical behavior of interlayer silt and shale to effectively mitigate instability.

Keywords: shale rock masses, silt layers, slope stability, elasto-plastic model, temporal degradation

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Authors: Silumpa Suboonsan, Suwat Pattaramalai

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In this paper, the performance of internet usage by using Vertical Handover (VHO) between cellular network and wireless local area network (WLAN) on Silom line Bangkok Mass Transit System (BTS) is evaluated. In the evaluation model, there is the WLAN on every BTS station and there are cellular base stations along the BTS path. The maximum data rates for cellular network are 7.2, 14.4, 42, and 100Mbps and for WLAN are 54, 150, and 300Mbps. The simulation are based on users using internet, watching VDOs and browsing web pages, on the BTS train from first station to the last station (full time usage) and on the BTS train for traveling some number of stations (random time). The results shows that VHO system has throughput a lot more than using only cellular network when the data rate of WLAN is more than one of cellular network. Lastly, the number of watching HD VDO and Full HD VDO is higher on VHO system on both regular time and rush hour of BTS travelling.

Keywords: vertical handover, WLAN, cellular, silom line BTS

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Authors: Jin-Qu Chen, Jie Liu, Yong Yin, Zi-Qi Ju, Yu-Yao Wu

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Increase in travel fare and station’s failure will have huge impact on passengers’ travel. The Urban Rail Transit (URT) station’s accessibility reliability under increasing travel fare and station failure are analyzed in this paper. Firstly, the passenger’s travel path is resumed based on stochastic user equilibrium and Automatic Fare Collection (AFC) data. Secondly, calculating station’s importance by combining LeaderRank algorithm and Ratio of Station Affected Passenger Volume (RSAPV), and then the station’s accessibility evaluation indicators are proposed based on the analysis of passenger’s travel characteristic. Thirdly, station’s accessibility under different scenarios are measured and rate of accessibility change is proposed as station’s accessibility reliability indicator. Finally, the accessibility of Hangzhou metro stations is analyzed by the formulated models. The result shows that Jinjiang station and Liangzhu station are the most important and convenient station in the Hangzhou metro, respectively. Station failure and increase in travel fare and station failure have huge impact on station’s accessibility, except for increase in travel fare. Stations in Hangzhou metro Line 1 have relatively worse accessibility reliability and Fengqi Road station’s accessibility reliability is weakest. For Hangzhou metro operational department, constructing new metro line around Line 1 and protecting Line 1’s station preferentially can effective improve the accessibility reliability of Hangzhou metro.

Keywords: automatic fare collection data, AFC, station’s accessibility reliability, stochastic user equilibrium, urban rail transit, URT

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Authors: Ioana Dallinger, Vincent P. Magnini

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Due to the many moving parts and high human component, mistakes and failures sometimes occur during transactions in service environments. Because a certain portion of such failures is unavoidable, many service providers constantly look for guidance regarding optimal ways by which they should manage failures and recoveries. Through the use of a scenario-based experiment, the findings of this study run counter to the empowerment approach (i.e. that frontline employees should be empowered to resolve failure situations on their own doing). Specifically, this study finds that customers’ perceptions of distributive, procedural, and interactional justice are significantly higher [p-values < .05] when a manager delivers an apology as opposed to the frontline provider. Moreover, customers’ satisfaction with the recovery and commitment to the firm are also significantly stronger [p-values < .05] when a manager apologizes. Interestingly, this study also empirically tests the effects of combined apologies of both the manager and employee and finds that the combined approach yields better results for customers’ interactional justice perceptions and for their satisfaction with recovery, but not for their distributive or procedural justice perceptions or consequent commitment to the firm. This study can serve a springboard for further research. For example, perceptions and attitudes regarding employee empowerment vary based upon country culture. Furthermore, there are likely a number of factors that can moderate the cause and effect relationship between a failure recovery and customers’ post-recovery perceptions [e.g. the severity of the failure].

Keywords: apology, empowerment, service failure recovery, service recovery

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Authors: Norbert Simon, Rodeano Roslee, Abdul Ghani Rafek, Goh Thian Lai, Azimah Hussein, Lee Khai Ern

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The 54 km stretch of Ranau-Tambunan (RTM) road in Sabah is subjected to slope failures almost every year. This study is focusing on identifying section of roads that are susceptible to failure based on temporal landslide density and lineament density analyses. In addition to the analyses, the rock slopes in several sections of the road were assessed using the geological strength index (GSI) technique. The analysis involved 148 landslides that were obtained in 1978, 1994, 2009 and 2011. The landslides were digitized as points and the point density was calculated based on every 1km2 of the road. The lineaments of the area was interpreted from Landsat 7 15m panchromatic band. The lineament density was later calculated based on every 1km2 of the area using similar technique with the slope failure density calculation. The landslide and lineament densities were classified into three different classes that indicate the level of susceptibility (low, moderate, high). Subsequently, the two density maps were overlap to produce the final susceptibility map. The combination of both high susceptibility classes from these maps signifies the high potential of slope failure in those locations in the future. The final susceptibility map indicates that there are 22 sections of the road that are highly susceptible. Seven rock slopes were assessed along the RTM road using the GSI technique. It was found from the assessment that rock slopes along this road are highly fractured, weathered and can be classified into fair to poor categories. The poor condition of the rock slope can be attributed to the high lineament density that presence in the study area. Six of the rock slopes are located in the high susceptibility zones. A detailed investigation on the 22 high susceptibility sections of the RTM road should be conducted due to their higher susceptibility to failure, in order to prevent untoward incident to road users in the future.

Keywords: GSI, landslide, landslide density, landslide susceptibility, lineament density

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Authors: Athar Mahmood, Asad Ali

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Management considerations including harvesting time and nitrogen application considerably influence the biomass yield, quality and biogas production. Therefore, a field study was conducted to determine the effect of various harvesting times and nitrogen rates on the biomass yield, quality and biogas yield of maize crop. This experiment was consisted of various harvesting times i.e., harvesting after 45, 55 and 65 days of sowing (DAS) and nitrogen rates i.e., 0, 100, 150 and 200 kg ha-1 respectively. The data indicated that maximum plant height, leaf area, dry matter (DM) yield, protein, acid detergent fiber, neutral detergent fiber, crude fiber contents and biogas yield were recorded 65 days after sowing while lowest was recorded 45 days after sowing. In contrary to that significantly higher chlorophyll contents were observed at 45 DAS. In case of nitrogen rates maximum plant height, leaf area, and DM yield, protein contents, ash contents, acid detergent fiber, neutral detergent fiber, crude fiber contents and chlorophyll contents were determined with nitrogen at the rate of 200 kg ha-1, while minimum was observed when no N was applied. Therefore, harvesting 65 DAS and N application @ 200 kg ha-1 can be suitable for getting the higher biomass and biogas production.

Keywords: chemical composition, fiber contents, biogas, nitrogen, harvesting time

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Authors: Jiayue Yang

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Based on an analysis of China's database of certified disabled persons in 2021, this study reveals several key findings. Firstly, the proportion of certified mentally disabled persons among China's certified disabled population (Certification rate 1) shows a decreasing distribution from the East to the West and from the South to the North. Secondly, the spatial distribution of the number of mentally disabled persons per 1,000 people holding certificates (certification rate 2) shows a relatively scattered pattern, with significant variations observed between cities in the eastern region. However, on an overall scale, a south-north gradient can still be observed, with higher rates in the North and lower rates in the west, while the central region demonstrates higher rates compared to the western region. The variation in the rate of mentally handicapped certificates among regions is influenced not only by traditional culture and welfare level but also exhibits a certain correlation with the level of economic development.

Keywords: certified disabled persons, mentally disabled persons, spatial distribution, China

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Authors: M. A. Hassan, M. H. Sakinah, K. Kadirgama, D. Ramasamy, M. M. Noor, M. M. Rahman

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Tribological properties that include nanoparticles are an alternative to improve the tribological behaviour of lubricating oil, which has been investigated by many researchers for the past few decades. Various nanostructures can be used as additives for tribological improvement. However, this also depends on the characteristics of the nanoparticles. In this study, tribological investigation was performed to examine the effect of CuO nanoparticles on the tribological behaviour of Syntium 800 SL 10W−30. Three parameters used in the analysis using the wear tester (piston ring) were load, revolutions per minute (rpm), and concentration. The specifications of the nanoparticles, such as size, concentration, hardness, and shape, can affect the tribological behaviour of the lubricant. The friction and wear experiment was conducted using a tribo-tester and the Response Surface Methodology method was used to analyse any improvement of the performance. Therefore, two concentrations of 40 nm nanoparticles were used to conduct the experiments, namely, 0.005 wt % and 0.01 wt % and compared with base oil 0 wt % (control). A water bath sonicator was used to disperse the nanoparticles in base oil, while a tribo-tester was used to measure the coefficient of friction and wear rate. In addition, the thermal properties of the nanolubricant were also measured. The results have shown that the thermal conductivity of the nanolubricant was increased when compared with the base oil. Therefore, the results indicated that CuO nanoparticles had improved the tribological behaviour as well as the thermal properties of the nanolubricant oil.

Keywords: concentration, improvement, tribological, copper (II) oxide, nano lubricant

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Authors: Katherine Russell

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Background: Over recent decades the number of caesarean sections performed in the UK has continued to rise. The cause of the rising caesarean rate (CSR) is not well understood. However, one of the most heavily cited reasons is an increase in maternal request for caesarean section. Maternal request for caesarean section (CDMR) refers to a caesarean section performed on maternal request with no medical indication. The true rate of caesarean delivery on maternal request in the UK and its contribution to the caesarean section rate is not known. Methods: To elucidate current understanding of the cause of the rising caesarean section rate and the role of CDMR we conducted a systematic review of the literature. To determine the role of CDMR in the CSR at the PRH we conducted a retrospective observational study of the caesarean section rates and CDMR from 2009-2015. Results: We demonstrated a negative correlation between rates of elective sections and CDMR over the study period (-0.123). On average, there were more elective sections performed after 2011 (15.10% of all deliveries) than before 2011 (12.41% of all deliveries); this difference was statistically significant (p = < 0.001). There were more cases of CDMR after 2011 (1.39% of all deliveries) than before 2011 (0.85% of all deliveries). The difference in average rates of CDMR before and after 2011 was statistically significant (p ≤ 0.001). Conclusions: CDMR is only a minor contributor to the CSR at the PRH. However, it remains an important factor because it represents a target for the reduction of the CSR that is more manageable than other, more complex and ubiquitous causes of the rising CSR.

Keywords: cesarean section, maternal request for cesarean section, obstetrics, pre-natal health

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Authors: Xiaomin Zhong, Alexander Pate, Ya-Ting Yang, Ali Fahmi, Darren M. Ashcroft, Ben Goldacre, Brian Mackenna, Amir Mehrkar, Sebastian C. J. Bacon, Jon Massey, Louis Fisher, Peter Inglesby, Kieran Hand, Tjeerd van Staa, Victoria Palin

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Background: This study aimed to predict risks of potentially inappropriate antibiotic type and repeat prescribing and assess changes during COVID-19. Methods: With the approval of NHS England, we used the OpenSAFELY platform to access the TPP SystmOne electronic health record (EHR) system and selected patients prescribed antibiotics from 2019 to 2021. Multinomial logistic regression models predicted the patient’s probability of receiving an inappropriate antibiotic type or repeating the antibiotic course for each common infection. Findings: The population included 9.1 million patients with 29.2 million antibiotic prescriptions. 29.1% of prescriptions were identified as repeat prescribing. Those with same-day incident infection coded in the EHR had considerably lower rates of repeat prescribing (18.0%), and 8.6% had a potentially inappropriate type. No major changes in the rates of repeat antibiotic prescribing during COVID-19 were found. In the ten risk prediction models, good levels of calibration and moderate levels of discrimination were found. Important predictors included age, prior antibiotic prescribing, and region. Patients varied in their predicted risks. For sore throat, the range from 2.5 to 97.5th percentile was 2.7 to 23.5% (inappropriate type) and 6.0 to 27.2% (repeat prescription). For otitis externa, these numbers were 25.9 to 63.9% and 8.5 to 37.1%, respectively. Interpretation: Our study found no evidence of changes in the level of inappropriate or repeat antibiotic prescribing after the start of COVID-19. Repeat antibiotic prescribing was frequent and varied according to regional and patient characteristics. There is a need for treatment guidelines to be developed around antibiotic failure and clinicians provided with individualised patient information.

Keywords: antibiotics, infection, COVID-19 pandemic, antibiotic stewardship, primary care

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Authors: Taylor Harris

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Gustilo-anderson grade III tibial fractures are exquisitely difficult injuries to manage as they require extensive soft tissue repair in addition to fracture fixation. These injuries are best managed collaboratively by Orthopedic and Plastic surgeons. While utilizing an Orthoplastics approach has decreased the rates of adverse outcomes in these injuries, there is a large amount of variation in exactly how an Orthoplastics team approaches complex cases such as these. It is sometimes recommended that definitive bone fixation and soft tissue coverage be completed simultaneously in a single-stage manner, but there is a paucity of large scale studies to provide evidence to support this recommendation. It is the aim of this study to report the outcomes of a single-stage "fix-and-flap" approach through a systematic review of the available literature. Hopefully, this better informs an evidence-based Orthoplastics approach to managing open tibial fractures. Systematic review of the literature was performed. Medline and Google Scholar were used and all studies published since 2000, in English were included. 103 studies were initially evaluated for inclusion. Reference lists of all included studies were also examined for potentially eligible studies. Gustilo grade III tibial shaft fractures in adults that were managed with a single-stage Orthoplastics approach were identified and evaluated with regard to outcomes of interest. Exclusion criteria included studies with patients <16 years old, case studies, systemic reviews, meta-analyses. Primary outcomes of interest were the rates of deep infections and rates of limb salvage. Secondary outcomes of interest included time to bone union, rates of non-union, and rates of re-operation. 15 studies were eligible. 11 of these studies reported rates of deep infection as an outcome, with rates ranging from 0.98%-20%. The pooled rate between studies was 7.34%. 7 studies reported rates of limb salvage with a range of 96.25%-100%. The pooled rate of the associated studies was 97.8%. 6 reported rates of non-union with a range of 0%-14%, a pooled rate of 6.6%. 6 reported time to bone union with a range of 24 to 40.3 weeks and a pooled average time of 34.2 weeks, and 4 reported rates of reoperation ranging from 7%-55%, with a pooled rate of 31.1%. A few studies that compared a single stage to a multi stage approach side-by-side unanimously favored the single stage approach. Outcomes of Gustilo grade III open tibial fractures utilizing an Orthoplastics approach that is specifically done in a single-stage produce low rates of adverse outcomes. Large scale studies of Orthoplastic collaboration that were not completed in strictly a single stage, or were completed in multiple stages, have not reported as favorable outcomes. We recommend that not only should Orthopedic surgeons and Plastic surgeons collaborate in the management of severe open tibial fracture, but they should plan to undergo definitive fixation and coverage in a single-stage for improved outcomes.

Keywords: orthoplastic, gustilo grade iii, single-stage, trauma, systematic review

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Authors: Saad Bin Saeed, Fayzan Ahmed, Shahbaz Ahmed, Amjad Hussain

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The aim of this study is to evaluate dynamic log files (Dynalogs) at different dose rates by dose-volume histograms (DVH) and used as a (QA) procedure of IMRT. Seven patients of phase one head and neck cancer with similar OAR`s are selected randomly. Reference plans of dose rate 300 and 600 MU/Min with prescribed dose of 50Gy in 25 fractions for each patient is made. Dynalogs produced by delivery of reference plans processed by in-house MATLAB program which produces new field files contain actual positions of multi-leaf collimators (MLC`s) instead of planned positions in reference plans. Copies of reference plans are used to import new field files generated by MATLAB program and renamed as Dyn.plan. After dose calculations of Dyn.plans for different dose rates, DVH, and multiple linear regression tools are used to evaluate reference and Dyn.plans. The results indicate good agreement of correlation between different dose rate plans. The maximum dose difference among PTV and OAR`s are found to be less than 5% and 9% respectively. The study indicates the potential of dynalogs to be used as patient-specific QA of IMRT at different dose rate.

Keywords: IMRT, dynalogs, dose rate, DVH

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Authors: M. A. Munteanu, A. M. Lungu, A. I. Chivescu, V. Teodorescu, E. Tufanoiu, C. Nicolae, T. I. Nanea

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Introduction: Sodium-glucose co-transporter 2 inhibitors (SGLT2i), which were first developed as antidiabetic medications, have demonstrated numerous positive benefits on the cardiovascular system, especially in the prevention of heart failure (HF). HF is a challenging, multifaceted disease that needs all-encompassing therapy. It should not be viewed as a limited form of heart illness but rather as a systemic disease that leads to multiple organ failure and death. SGLT2i is an extremely effective tool for treating HF by using its pleiotropic effects. In addition to its use in patients with diabetes mellitus who are at high cardiovascular risk or who have already experienced a cardiovascular event, SGLT2i administration has been shown to have positive effects on a variety of HF manifestations and stages, regardless of the patient's presence of diabetes mellitus. Material and Methods: According to the guide, 110 patients (83 males and 27 females) with heart failure with mildly reduced ejection fraction (HFmrEF), with T2D and neoplasia, were enrolled in the prospective study. The structural and functional state of the left ventricle myocardium and ejection fraction was assessed through echocardiography. Patients were randomized to receive once-daily dapagliflozin 10 mg. Results: Patients with HFmrEF were divided into 3 subgroups according to age. 7% (8) patients aged < 45 years, 35% (28) patients aged between 46-59 years, and 58% (74) patients aged> 60 years. The most prevalent comorbidities were hypertension (43.1%), coronary heart disease (40%), and obesity (33.2%). Study drug discontinuation and serious adverse events were not frequent in the subgroups, in either men or women, until now. Conclusions: SGLT-2 inhibitors are a novel class of antidiabetic agents that have demonstrated positive efficacy and safety outcomes in the setting of HFmrEF. Until now, in our study, dapagliflozin was safe and well-tolerated irrespective of sex.

Keywords: diabetes mellitus type 2, Sodium-glucose co-transporters-2 inhibitors, heart failure, neoplasia

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Authors: K. Sandjak, B. Tiliouine

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This article presents the main results of three-dimensional (3-D) numerical investigation of asphalt pavement structures behaviour using a coupled Finite Element-Mapped Infinite Element (FE-MIE) model. The validation and numerical performance of this model are assessed by confronting critical pavement responses with Burmister’s solution and FEM simulation results for multi-layered elastic structures. The coupled model is then efficiently utilised to perform 3-D simulations of a typical asphalt pavement structure in order to investigate the impact of two tire configurations (conventional dual and new generation wide-base tires) on critical pavement response parameters. The numerical results obtained show the effectiveness and the accuracy of the coupled (FE-MIE) model. In addition, the simulation results indicate that, compared with conventional dual tire assembly, single wide base tire caused slightly greater fatigue asphalt cracking and subgrade rutting potentials and can thus be utilised in view of its potential to provide numerous mechanical, economic, and environmental benefits.

Keywords: 3-D numerical investigation, asphalt pavements, dual and wide base tires, Infinite elements

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Authors: Muhammad Naveed Iftikhar, Farah Khalid

Abstract:

Global best practices as ordained by international organizations comprise a broader top-down approach to development problems, without taking into account country-specific factors. The political economy of each country is extremely different and the failure of several attempts of international organizations to implement global best practice models in developing countries each with its unique set of variables, goes on to show that this is not the most efficient solution to development problems. This paper is a humble attempt at shedding light on some specific examples of failures of the global best practices. Pakistan has its unique set of problems and unless those are added to the broader equation of development, country-specific reform and growth will continue to pose a challenge to reform programs initiated by international organizations. The three case studies presented in this paper are just a few prominent examples of failure of the global best practice, top-down, universalistic approach to development as ordained by international organizations. Development and reform can only be achieved if local dynamics are given their due importance. The modus operandi of international organizations needs to be tailored according to each country’s unique politico-economic environment.

Keywords: best practice, development, context

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Authors: Sunmyeng Kim

Abstract:

IEEE 802.11a/b/g standards provide multiple transmission rates, which can be changed dynamically according to the channel condition.Cooperative communications we reintroduced to improve the overallperformance of wireless LANs with the help of relay nodes with higher transmission rates. The cooperative communications are based on the fact that the transmission is much faster when sending data packets to a destination node through a relay node with higher transmission rate, rather than sending data directly to the destination node at low transmission rate. To apply the cooperative communications in wireless LAN, several MAC protocols have been proposed. Some of them can result in collisions among relay nodes in a dense network. In order to solve this problem, we propose a new protocol. Relay nodes are grouped based on their transmission rates. And then, relay nodes only in the highest group try to get channel access. Performance evaluation is conducted using simulation, and shows that the proposed protocol significantly outperforms the previous protocol in terms of throughput and collision probability.

Keywords: cooperative communications, MAC protocol, relay node, WLAN

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Authors: Hadeer E. Eliwa, Naglaa S. Bazan, Ebtissam A. Darweesh, Nagwa A. Sabri

Abstract:

Background: Generic substitution of brand ivabradine prescriptions can reduce drug expenditures and improve adherence. However, the distrust of generic medicines by practitioners and patients due to doubts regarding their quality and fear of counterfeiting compromise the acceptance of this practice. Aim: The goal of this study is to compare the therapeutic equivalence of brand product versus the generic product of ivabradine in adult patients with chronic heart failure with reduced ejection fraction (≤ 40%) (HFrEF). Methodology: Thirty-two Egyptian patients with chronic heart failure with reduced ejection fraction (HFrEF) were treated with branded ivabradine (Procrolan ©) and generic (Bradipect ©) during 24 (2x12) weeks. Primary outcomes were resting heart rate (HR), NYHA FC, Quality of life (QoL) using Minnesota Living with Heart Failure (MLWHF) and EF. Secondary outcomes were the number of hospitalizations for worsening HFrEF and adverse effects. The washout period was not allowed. Findings: At the 12th week, the reduction in HR was comparable in the two groups (90.13±7.11 to 69±11.41 vs 96.13±17.58 to 67.31±8.68 bpm in brand and generic groups, respectively). Also, the increase in EF was comparable in the two groups (27.44 ±4.59 to 33.38±5.62 vs 32±5.96 to 39.31±8.95 in brand and generic groups, respectively). The improvement in NYHA FC was comparable in both groups (87.5% in brand group vs 93.8% in the generic group). The mean value of the QOL improved from 31.63±15.8 to 19.6±14.7 vs 35.68±17.63 to 22.9±15.1 for the brand and generic groups, respectively. Similarly, at end of 24 weeks, no significant changes were observed from data observed at 12th week regarding HR, EF, QoL and NYHA FC. Only minor side effects, mainly phosphenes, and a comparable number of hospitalizations were observed in both groups. Conclusion: The study revealed no statistically significant differences in the therapeutic effect and safety between generic and branded ivabradine. We assume that practitioners can safely interchange between them for economic reasons.

Keywords: bradipect©, heart failure, ivabradine, Procrolan ©, therapeutic equivalence

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Authors: Ahmad Amiri, Hamed K. Arzani, S. N. Kazi, B. T. Chew

Abstract:

Since graphene nanoplatelet (GNP) is a promising material due to desirable thermal properties, this paper is related to the thermophysical and heat transfer performance of covalently functionalized GNP-based water/ethylene glycol nanofluid through an annular channel. After experimentally measuring thermophysical properties of prepared samples, a computational fluid dynamics study has been carried out to examine the heat transfer and pressure drop of well-dispersed and stabilized nanofluids. The effect of concentration of GNP and Reynolds number at constant wall temperature boundary condition under turbulent flow regime on convective heat transfer coefficient has been investigated. Based on the results, for different Reynolds numbers, the convective heat transfer coefficient of the prepared nanofluid is higher than that of the base fluid. Also, the enhancement of convective heat transfer coefficient and thermal conductivity increase with the increase of GNP concentration in base-fluid. Based on the results of this investigation, there is a significant enhancement on the heat transfer rate associated with loading well-dispersed GNP in base-fluid.

Keywords: nanofluid, turbulent flow, forced convection flow, graphene, annular, annulus

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Authors: Omar Ibrahim, Aly A. Gaafar, K. A. Ratib

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Two field experiments in micro plots were carried out during the winter seasons of 2012/2013 and 2013/2014, Soil Salinity Laboratory, Alexandria, Egypt, to study the effect of three levels of salicylic acid (SA) as a growth regulator (0, 50, 100 ppm) and three rates of nitrogen fertilizer (75, 100, 125 kg N/feddan) on growth and yield of a spring wheat (Giza 168). The experimental design was a split plot with the main plots in randomized complete block design (RCBD) and four replicates. The results indicated that increasing nitrogen fertilizer rates resulted in insignificant effect on both plant height (cm) and grain weight/spike only. However, a significant effect was observed in all the other studied characters due to the increase in nitrogen fertilizer. On the other hand, increasing salicylic acid rates resulted in insignificant effect in all the studied characters except for chlorophyll a, chlorophyll b, number of grain/spike, and grain yield (gm/ plot). The highest effects on grain yield in wheat were obtained by the rate of 125 kg/feddan of nitrogen fertilizer and 100 ppm of salicylic acid. In conclusion, the data indicated that a high grain yield could be obtained by adding 100 kg/feddan of nitrogen fertilizer and spraying of 50 ppm of salicylic acid with no significant difference with the highest rates. Finally, the interaction had no significant effect on all the studied characters.

Keywords: growth regulator, nitrogen fertilizer, spring wheat, salicylic acid

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Authors: Jeonghyun Chang, Taegeun Lee, Heungsup Sung, Yoon-Seon Lee, Youn-Jung Kim, Mi-Na Kim

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Background: Safety device has been applied to improve safety and performance of blood culture practice. BD vacutainer® Safety-Lokᵀᴹ blood collection sets with pre-attached holder (Safety-Lok) (BD, USA) was evaluated in the emergency room (ER) of a tertiary care hospital. Methods: From April to June 2017, interns and nurses in ER were surveyed for blood culture practices with a questionnaire before and after 2 or 3 weeks of experience of Safety-Lok. All of them participated in exercise workshop for 1 hour combined with video education prior to the initial survey. The blood volume, positive and contamination rates of Safety-Lok-drawn (SD) blood cultures were compared to those of overall blood cultures. Results: Eighteen interns and 30 nurses were enrolled. As a result of the initial survey, interns had higher rates of needlestick incidence (27.8%), carriage of the blood-filled syringe with needle (88.9%) and lower rates of vacutainer use (38.9%) than nurses (13.3%, 53.3%, and 60.0%). Interns preferred to use safety devices (88.9%) rather than nurses (40.0%). The number of overall blood cultures and SD blood cultures was 9,053 and 555, respectively. While the overall blood volume of aerobic bottles was 2.6±2.1 mL, those of SD blood cultures were 5.0±3.0 mL in aerobic bottles and 6.0±3.0 mL in anaerobic bottles. Positive and contamination rates were 6.5% and 0.72% with SD blood cultures and 6.2% and 0.3% with overall blood cultures. Conclusions: The introduction of the safety device would encourage healthcare workers to collect adequate blood volume as well as lead to safer practices in the ER.

Keywords: blood culture, needlestick, safety device, volume

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Authors: Sunghyun Kim, Hong-Gun Park

Abstract:

In the performance-based design (PBD), by using the nonlinear dynamic analysis (NDA), the actual performance of the structure is evaluated. Unlike frame structures, in the wall structures, base shear force which is resulted from the NDA, is greatly amplified than that from the elastic analysis. This shear amplifying effect causes repeated designs which make designer difficult to apply the PBD. Therefore, in this paper, factors which affect shear amplification were studied. For the 20-story wall model, the NDA was performed. From the analysis results, the base shear amplification factor was proposed.

Keywords: performance based design, shear amplification factor, nonlinear dynamic analysis, RC shear wall

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