Search results for: secondary compression index
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 7271

Search results for: secondary compression index

2171 The Impact of Diabetes Mellitus on Skin and Soft Tissue Infections

Authors: Stephanie Cheng, Benjamin Poh, Vivyan Tay, Sachin Mathur

Abstract:

Aim: Diabetes mellitus (DM) is a worldwide pandemic affecting 500 million people. It is known to be associated with increased susceptibility to soft tissue infections (STI). Despite being a major public health burden, the literature relating the effects of DM and the presentation, severity and healing of STIs in general surgical patients remain limited. Methods: We conducted a retrospective review of all patients admitted with STI in a tertiary teaching hospital over a 12-month period. Patient demographics and surgical outcomes were collected and analyzed. Results: During the study period, 1059 patients were admitted for STIs, of which 936 (88%) required surgical intervention. Diabetic patients were presented with a higher body-mass index (BMI) (28 vs 26), larger abscess size (24 vs 14 cm²) and a longer length of stay (LOS)(4.4 days vs 2.9 days). They also underwent a higher proportion of wide debridement as well as application of negative pressure wound therapy (NPWT) (42% vs 35%). More diabetic patients underwent subsequent re-operation within the same sitting (8 vs 4). There were no differences in re-admission rates within 30 days nor subsequent abscess formation in those followed for 6 months. Conclusion: The incidence of STIs among DM patients represents a significant disease burden; surgeons should consider intensive patient counseling and partnering with primary care providers in order to help reduce the incidence of future STI admissions based on lifestyle modification and glucose control.

Keywords: general surgery, emergency general surgery, acute care surgery, soft tissue infections, diabetes mellitus

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2170 Facilitating Active Reading Strategies through Caps Chart to Foster Elementary EFL Learners’ Reading Skills and Reading Competency

Authors: Michelle Bulawan, Mei-Hua Chen

Abstract:

Reading comprehension is crucial for acquiring information, analyzing critically, and achieving academic proficiency. However, there is a lack of growth in reading comprehension skills beyond fourth grade. The developmental shift from "learning to read" to "reading to learn" occurs around this stage. Factual knowledge and diverse views in articles enhance reading comprehension abilities. Nevertheless, some face difficulties due to evolving textual requirements, such as expanding vocabulary and using longer, more complex terminology. Most research on reading strategies has been conducted at the tertiary and secondary levels, while few have focused on the elementary levels. Furthermore, the use of character, ask, problem, solution (CAPS) charts in teaching reading has also been hardly explored. Thus, the researcher decided to explore the facilitation of active reading strategies through the CAPS chart and address the following research questions: a) What differences existed in elementary EFL learners' reading competency among those who engaged in active reading strategies and those who did not? b) What are the learners’ metacognitive skills of those who engage in active reading strategies and those who do not, and what are their effects on their reading competency? c) For those participants who engage in active reading activities, what are their perceptions about incorporating active reading activities into their English classroom learning? Two groups of elementary EFL learners, each with 18 students of the same level of English proficiency, participated in this study. Group A served as the control group, while Group B served as the experimental group. Two teachers also participated in this research; one of them was the researcher who handled the experimental group. The treatment lasts for one whole semester or seventeen weeks. In addition to the CAPS chart, the researcher also used the metacognitive awareness of reading strategy inventory (MARSI) and a ten-item, five-point Likert scale survey.

Keywords: active reading, EFL learners, metacognitive skills, reading competency, student’s perception

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2169 Synthesis and Characterization of CNPs Coated Carbon Nanorods for Cd2+ Ion Adsorption from Industrial Waste Water and Reusable for Latent Fingerprint Detection

Authors: Bienvenu Gael Fouda Mbanga

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This study reports a new approach of preparation of carbon nanoparticles coated cerium oxide nanorods (CNPs/CeONRs) nanocomposite and reusing the spent adsorbent of Cd2+- CNPs/CeONRs nanocomposite for latent fingerprint detection (LFP) after removing Cd2+ ions from aqueous solution. CNPs/CeONRs nanocomposite was prepared by using CNPs and CeONRs with adsorption processes. The prepared nanocomposite was then characterized by using UV-visible spectroscopy (UV-visible), Fourier transforms infrared spectroscopy (FTIR), X-ray diffraction pattern (XRD), scanning electron microscope (SEM), Transmission electron microscopy (TEM), Energy-dispersive X-ray spectroscopy (EDS), Zeta potential, X-ray photoelectron spectroscopy (XPS). The average size of the CNPs was 7.84nm. The synthesized CNPs/CeONRs nanocomposite has proven to be a good adsorbent for Cd2+ removal from water with optimum pH 8, dosage 0. 5 g / L. The results were best described by the Langmuir model, which indicated a linear fit (R2 = 0.8539-0.9969). The adsorption capacity of CNPs/CeONRs nanocomposite showed the best removal of Cd2+ ions with qm = (32.28-59.92 mg/g), when compared to previous reports. This adsorption followed pseudo-second order kinetics and intra particle diffusion processes. ∆G and ∆H values indicated spontaneity at high temperature (40oC) and the endothermic nature of the adsorption process. CNPs/CeONRs nanocomposite therefore showed potential as an effective adsorbent. Furthermore, the metal loaded on the adsorbent Cd2+- CNPs/CeONRs has proven to be sensitive and selective for LFP detection on various porous substrates. Hence Cd2+-CNPs/CeONRs nanocomposite can be reused as a good fingerprint labelling agent in LFP detection so as to avoid secondary environmental pollution by disposal of the spent adsorbent.

Keywords: Cd2+-CNPs/CeONRs nanocomposite, cadmium adsorption, isotherm, kinetics, thermodynamics, reusable for latent fingerprint detection

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2168 Virulence Phenotypes Among Multi-Drug Resistant Uropathogenic Bacteria

Authors: V. V. Lakshmi, Y. V. S. Annapurna

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Urinary tract infection (UTI) is one of the most common infectious diseases seen in the community. Susceptible individuals experience multiple episodes, and progress to acute pyelonephritis or uro-sepsis or develop asymptomatic bacteriuria (ABU). Ability to cause extraintestinal infections depends on several virulence factors required for survival at extraintestinal sites. Presence of virulence phenotypes enhances the pathogenicity of these otherwise commensal organisms and thus augments its ability to cause extraintestinal infections, the most frequent in urinary tract infections(UTI). The present study focuses on detection of the virulence characters exhibited by the uropathogenic organism and most common factors exhibited in the local pathogens. A total of 700 isolates of E.coli and Klebsiella spp were included in the study. These were isolated from patients from local hospitals reported to be suffering with UTI over a period of three years. Isolation and identification was done based on Gram character and IMVIC reactions. Antibiotic sensitivity profile was carried out by disc diffusion method and multi drug resistant strains with MAR index of 0.7 were further selected.. Virulence features examined included their ability to produce exopolysaccharides, protease- gelatinase production, hemolysin production, haemagglutination and hydrophobicity test. Exopolysaccharide production was most predominant virulence feature among the isolates when checked by congo red method. The biofilms production examined by microtitre plates using ELISA reader confirmed that this is the major factor contributing to virulencity of the pathogens followed by hemolysin production

Keywords: Escherichia coli, Klebsiella sp, Uropathogens, Virulence features.

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2167 Binding Mechanism of Synthesized 5β-Dihydrocortisol and 5β-Dihydrocortisol Acetate with Human Serum Albumin to Understand Their Role in Breast Cancer

Authors: Monika Kallubai, Shreya Dubey, Rajagopal Subramanyam

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Our study is all about the biological interactions of synthesized 5β-dihydrocortisol (Dhc) and 5β-dihydrocortisol acetate (DhcA) molecules with carrier protein Human Serum Albumin (HSA). The cytotoxic study was performed on breast cancer cell line (MCF-7) normal human embryonic kidney cell line (HEK293), the IC50 values for MCF-7 cells were 28 and 25 µM, respectively, whereas no toxicity in terms of cell viability was observed with HEK293 cell line. The further experiment proved that Dhc and DhcA induced 35.6% and 37.7% early apoptotic cells and 2.5%, 2.9% late apoptotic cells respectively. Morphological observation of cell death through TUNEL assay revealed that Dhc and DhcA induced apoptosis in MCF-7 cells. The complexes of HSA–Dhc and HSA–DhcA were observed as static quenching, and the binding constants (K) was 4.7±0.03×104 M-1 and 3.9±0.05×104 M-1, and their binding free energies were found to be -6.4 and -6.16 kcal/mol, respectively. The displacement studies confirmed that lidocaine 1.4±0.05×104 M-1 replaced Dhc, and phenylbutazone 1.5±0.05×104 M-1 replaced by DhcA, which explains domain I and domain II are the binding sites for Dhc and DhcA. Further, CD results revealed that the secondary structure of HSA was altered in the presence of Dhc and DhcA. Furthermore, the atomic force microscopy and transmission electron microscopy showed that the dimensions like height and molecular sizes of the HSA–Dhc and HSA–DhcA complex were larger compared to HSA alone. Detailed analysis through molecular dynamics simulations also supported the greater stability of HSA–Dhc and HSA–DhcA complexes, and root-mean-square-fluctuation interpreted the binding site of Dhc as domain IB and domain IIA for DhcA. This information is valuable for the further development of steroid derivatives with improved pharmacological significance as novel anti-cancer drugs.

Keywords: apoptosis, dihydrocortisol, fluorescence quenching, protein conformations

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2166 Profiling of Mother Child Behaviors during Free Play: A South Indian Scenario

Authors: Jayashree S. Bhat, Megha Mohan

Abstract:

Play is any activity spontaneously chosen, inherently motivated, and personally directed. There is a wide range of literature and research supporting the concept of play in promoting healthy development in young children. Modern children are experiencing nurture that has more structure and adult involvement than previous generations and free, unstructured, and child directed play is under peril. Play behaviors serve as a reflection of a child’s cultural and ethnic background and can be an index of a child’s development. The influence and impact of culture in children’s play is diverse. The culturally variable dimensions of play includes the choice of objects, the involvement of specific play partners, the amount of child initiations of social pretend play with caregivers along with its the components, and sequences and specific themes involved during play. India is a country well known for its cultural diversity. In this study, a cross sectional study design with convenient sampling was adopted. The mother child free play interaction was video clipped at their residence among typically developing children between 12 to 24 months in an urban city from South India. It was ascertained that all the children were first born and mothers were unemployed belonging to middle socioeconomic status. The video clippings were coded and analysed using SPSS software version 17. The results revealed interesting behaviors demonstrated by the mother as well as the child during the play interaction. The results high light the need for focusing on the play behaviors of children during their developmental assessment, especially so for children with challenges.

Keywords: culture, free play, interaction, typically developing

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2165 Determining the Effect of Tdcs in Pain and Quality of Life in Patients with Fibromyalgia

Authors: Farid Rezaei, Zahra Reza Soltani, Behrouz Tavana, Afsaneh Dadarkhah, Masoume Bahrami Asl, S. Alireza Mirghasemi

Abstract:

Introduction: Fibromyalgia is a syndrome comprised of a group of symptoms. The primary symptom of fibromyalgia is pain propagation is associated by Secondary symptoms include fatigue, cognitive disorders, sleep disorders and hypersensitivity to painful stimuli. Recent studies have shown that there is a direct relationship between fibromyalgia and certain changes in brain activity. Aim: The aim of this study is determining the effect of tDCS in pain and quality of life in patients with fibromyalgia. Method: 68 patients with fibromyalgia who had inclusion criterias were randomly divided into two groups of case and control. Groups were matched in terms of gender, age, education, duration of pain and PMS. Patient groups treated with tDCS device manufacture by Enraf company made in Netherlands (M1 anodal stimulation, 2 mA constant current, 20 minutes, for 10 sessions (3 days a week)). Also the protocol was done for control group, in sham mode of tDCS device that had no current, for 10 sessions of 20 minutes. Before treatment, immediately after the end of 10 sessions treatment (short-term) and 10 week later (long-term effect), pain intensity questionnaires (VAS) and quality of life in fibromyalgia patients questionnaire was completed by the patient. Results: Pain intensity were significantly lower in the treatment group than the sham group 2 weeks and 10 weeks after treatment than before treatment (P < 0.001). Although the quality of life of patients 2 weeks after treatment showed no significant change, but ten weeks after treatment were more than sham group (P < 0.0001). Conclusion: Our results suggest that tDCS is a safe and effective in treating fibromyalgia patients and an important effect in reducing pain and increasing quality of their life.

Keywords: fibromyalgia, tDCS, quality of life, VAS score

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2164 Heavy Metal Contamination of Mining-Impacted Mangrove Sediments and Its Correlation with Vegetation and Sediment Attributes

Authors: Jumel Christian P. Nicha, Severino G. Salmo III

Abstract:

This study investigated the concentration of heavy metals (HM) in mangrove sediments of Lake Uacon, Zambales, Philippines. The relationship among the studied HM (Cr, Ni, Pb, Cu, Cd, Fe) and the mangrove vegetation and sediment characteristics were assessed. Fourteen sampling plots were designated across the lake (10 vegetated and 4 un-vegetated) based on distance from the mining effluents. In each plot, three sediment cores were collected at 20 cm depth. Among the dominant mangrove species recorded were (in order of dominance): Sonneratia alba, Rhizophora stylosa, Avicennia marina, Excoecaria agallocha and Bruguiera gymnorrhiza. Sediment samples were digested with aqua regia, and the HM concentrations were quantified using Atomic Absorption Spectroscopy (AAS). Results showed that HM concentrations were higher in the vegetated plots as compared to the un-vegetated sites. Vegetated sites had high Ni (mean: 881.71 mg/kg) and Cr (mean: 776.36 mg/kg) that exceeded the threshold values (cf. by the United States Environmental Protection Agency; USEPA). Fe, Pb, Cu and Cd had a mean concentration of 2597.92 mg/kg, 40.94 mg/kg, 36.81 mg/kg and 2.22 mg/kg respectively. Vegetation variables were not significantly correlated with HM concentration. However, the HM concentration was significantly correlated with sediment variables particularly pH, redox, particle size, nitrogen, phosphorus, moisture and organic matter contents. The Pollution Load Index (PLI) indicated moderate to high pollution in the lake. Risk assessment and management should be designed in order to mitigate the ecological risk posed by HM. The need of a regular monitoring scheme for lake and mangrove rehabilitation programs and management should be designed.

Keywords: heavy metals, mangrove vegetation, mining, Philippines, sediment

Procedia PDF Downloads 149
2163 Comparative Study of the Effects of Process Parameters on the Yield of Oil from Melon Seed (Cococynthis citrullus) and Coconut Fruit (Cocos nucifera)

Authors: Ndidi F. Amulu, Patrick E. Amulu, Gordian O. Mbah, Callistus N. Ude

Abstract:

Comparative analysis of the properties of melon seed, coconut fruit and their oil yield were evaluated in this work using standard analytical technique AOAC. The results of the analysis carried out revealed that the moisture contents of the samples studied are 11.15% (melon) and 7.59% (coconut). The crude lipid content are 46.10% (melon) and 55.15% (coconut).The treatment combinations used (leaching time, leaching temperature and solute: solvent ratio) showed significant difference (p < 0.05) in yield between the samples, with melon oil seed flour having a higher percentage range of oil yield (41.30 – 52.90%) and coconut (36.25 – 49.83%). The physical characterization of the extracted oil was also carried out. The values gotten for refractive index are 1.487 (melon seed oil) and 1.361 (coconut oil) and viscosities are 0.008 (melon seed oil) and 0.002 (coconut oil). The chemical analysis of the extracted oils shows acid value of 1.00mg NaOH/g oil (melon oil), 10.050mg NaOH/g oil (coconut oil) and saponification value of 187.00mg/KOH (melon oil) and 183.26mg/KOH (coconut oil). The iodine value of the melon oil gave 75.00mg I2/g and 81.00mg I2/g for coconut oil. A standard statistical package Minitab version 16.0 was used in the regression analysis and analysis of variance (ANOVA). The statistical software mentioned above was also used to optimize the leaching process. Both samples gave high oil yield at the same optimal conditions. The optimal conditions to obtain highest oil yield ≥ 52% (melon seed) and ≥ 48% (coconut seed) are solute - solvent ratio of 40g/ml, leaching time of 2hours and leaching temperature of 50oC. The two samples studied have potential of yielding oil with melon seed giving the higher yield.

Keywords: Coconut, Melon, Optimization, Processing

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2162 Powder Assisted Sheet Forming to Fabricate Ti Capsule Magnetic Hyperthermia Implant

Authors: Keigo Nishitani, Kohei Mizuta Mizuta, Kazuyoshi Kurita, Yukinori Taniguchi

Abstract:

To establish mass production process of Ti capsule which has Fe powder inside as magnetic hyperthermia implant, we assumed that Ti thin sheet can be drawn into a φ1.0 mm die hole through the medium of Fe Powder and becomes outer shell of capsule. This study discusses mechanism of powder assisted deep drawing process by both of numerical simulation and experiment. Ti thin sheet blank was placed on die, and was covered by Fe powder layer without pressurizing. Then upper punch was indented on the Fe powder layer, and the blank can be drawn into die cavity as pressurized powder particles were extruded into die cavity from behind of the drawn blank. Distinct Element Method (DEM) has been used to demonstrate the process. To identify bonding parameters on Fe particles which are cohesion, tensile bond stress and inter particle friction angle, axial and diametrical compression failure test of Fe powder compact was conducted. Several density ratios of powder compacts in range of 0.70 - 0.85 were investigated and relationship between mean stress and equivalent stress was calculated with consideration of critical state line which rules failure criterion in consolidation of Fe powder. Since variation of bonding parameters with density ratio has been experimentally identified, and good agreement has been recognized between several failure tests and its simulation, demonstration of powder assisted sheet forming by using DEM becomes applicable. Results of simulation indicated that indent/drawing length of Ti thin sheet is promoted by smaller Fe particle size, larger indent punch diameter, lower friction coefficient between die surface and Ti sheet and certain degrees of die inlet taper angle. In the deep drawing test, we have made die-set with φ2.4 mm punch and φ1.0 mm die bore diameter. Pure Ti sheet with 100 μm thickness, annealed at 650 deg. C has been tested. After indentation, indented/drawn capsule has been observed by microscope, and its length was measured to discuss the feasibility of this capsulation process. Longer drawing length exists on progressive loading pass comparing with the case of single stroke loading. It is expected that progressive loading has an advantage of which extrusion of powder particle into die cavity with Ti sheet is promoted since powder particle layer can be rebuilt while the punch is withdrawn from the layer in each loading steps. This capsulation phenomenon is qualitatively demonstrated by DEM simulation. Finally, we have fabricated Ti capsule which has Fe powder inside for magnetic hyperthermia cancer care treatment. It is concluded that suggested method is possible to use the manufacturing of Ti capsule implant for magnetic hyperthermia cancer care.

Keywords: metal powder compaction, metal forming, distinct element method, cancer care, magnetic hyperthermia

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2161 The Effect of Exercise, Reflexology and Chrome on Metabolic Syndrome

Authors: F. Arslan, S.D. Guven, A. Özcan, H. Vatansev, Ö. Taşgin

Abstract:

Weight, hypertension and dyslipidemia control and increased physical activity are required for the treatment of metabolic syndrome (METS). The purpose of this study was to investigate the effect of core exercise, reflexology and intake chrome picolinate on METS. This study comprised a twelve-week randomized controlled trial. A total of 25 university workers with metabolic risk factors participated in this study voluntarily. They were randomly divided into three groups: Those undertaking a core exercise program (n=7), reflexology intervention group (n=8) and intake chrome group (n=10). The subjects took part in a core exercise program for one hour per day, three days a week and a reflexology interfered for thirty minutes per day, one days a week and chrome group took chrome picolinate every day in week for twelve weeks. The components of metabolic syndrome were analyzed before and after the completion of all the intervention. There were significant differences at pre-prandial blood glucose in the core exercise group and at systolic blood pressure in chrome group after the twelve week interventions (p < 0.005). While High Density Lipoprotein (HDL) excluding the components of METS decreased after the interventions on the all groups; levels of HDL and the other components of METS decreased in reflexology group. There was a clear response to the twelve-week interventions in terms of METS control. Besides, the reflexology intervention should not be applied to individuals with low HDL levels and core exercise and intake chrome picolinate suggested to improve the components of METS.

Keywords: blood pressure, body mass index, exercise, METS, pre-prandial blood glucose

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2160 Effect of Burdock Root Extract Concentration on Physiochemical Property of Coated Jasmine Rice by Using Top-Spay Fluidized Bed Coating Technique

Authors: Donludee Jaisut, Norihisa Kato, Thanutchaporn Kumrungsee, Kiyoshi Kawai, Somkiat Prachayawarakorn, Patchalee Tungtrakul

Abstract:

Jasmine Rice is a principle food of Thai people. However, glycemic index of jasmine rice is in high level, risk of type II diabetes after consuming. Burdock root is a good source of non-starch polysaccharides such as inulin. Inulin acts as prebiotic and helps reduce blood-sugar level. The purpose of this research was to reduce digestion rate of jasmine rice by coating burdock root extract on rice surface, using top-spay fluidized bed coating technique. Coating experiments were performed by spraying burdock root solution onto Jasmine rice kernels (Khao Dawk Mali-105; KDML), which had an initial moisture content of 11.6% wet basis, suspended in the fluidized bed. The experimental conditions were: solution spray rates of 31.7 mL/min, atomization pressure of 1.5 bar, spray time of 10 min, time of drying after spraying of 30 s, superficial air velocity of 3.2 m/s and drying temperatures of 60°C. The coated rice quality was evaluated in terms of the moisture content, texture, whiteness and digestion rate. The results showed that initial and final moisture contents of samples were the same in concentration 8% (v/v) and 10% (v/v). The texture was insignificantly changed from that of uncoated sample. The whiteness values were varied on concentration of burdock root extract. Coated samples were slower digested.

Keywords: burdock root, digestion, drying, rice

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2159 A Review of the Handling and Disposal of Botulinum Toxin in a Maxillofacial Unit

Authors: Ashana Gupta

Abstract:

Aim: In the UK, Botulinum Toxin (botox) is authorised for treating chronic myofascial pain secondary to masseter muscle hypertrophy (Fedorowicz et al. 2013). This audit aimed to ensure the Maxillofacial Unit is meeting the trust guidelines for the safe storage and disposal of botox. Method: The trust upholds a strict policy for botox handling. The audit was designed to optimise several elements including Staff awareness of regulations around botox handling A questionnaire was designed to test knowledge of advised storage temperatures, reporting of adverse events, disposal procedures and regulatory authorities. Steps taken to safely delivertoxin and eliminate unused toxin. A checklist was completed. These include marks for storagetemperature, identification checks, disposal of sharps, deactivation of toxin, and disposal. Results: All staff correctly stated storage requirements for toxin. 75% staff (n=8) were unsure about reporting and regulations. Whilst all staff knew how to dispose of vials, 0% staff showed awareness for the crucial step of deactivating toxin. All checklists (n=20) scored 100% for adequate storage, ID checks, and toxin disposal. However, there were no steps taken to deactivate toxin in any cases. Staff training took place with revision to clinical protocols. In line with Trust guidelines, an additional clinical step has been introduced including use of 0.5% sodium hypochlorite to deactivate botox. Conclusion: Deactivation is crucial to ensure residual toxin is not misused. There are cases of stolen botox within South-Tees Hospital (Woodcock, 2014). This audit was successful in increasing compliance to safe handling and disposal of botox by 100% and ensured our hospitalmeets Trust guidance.

Keywords: botulinum toxin, aesthetics, handling, disposal

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2158 The Effects of Teacher Efficacy, Instructional Leadership and Professional Learning Communities on Student Achievement in Literacy and Numeracy: A Look at Primary Schools within Sibu Division

Authors: Jarrod Sio Jyh Lih

Abstract:

This paper discusses the factors contributing to student achievement in literacy and numeracy in primary schools within Sibu division. The study involved 694 level 1 primary schoolteachers. Using descriptive statistics, the study observed high levels of practice for teacher efficacy, instructional leadership and professional learning communities (PLCs). The differences between gender, teaching experience and academic qualification were analyzed using the t-test and one-way analysis of variance (ANOVA). The study reported significant differences in respondent perceptions based on teaching experience vis-à-vis teacher efficacy. Here, the post hoc Tukey test revealed that efficaciousness grows with experience. A correlation test observed positive and significant correlations between all independent variables. Binary logistic regression was applied to predict the independent variables’ influence on student achievement. The findings revealed that a dimension of instructional leadership – ‘monitoring student progress’ - emerged as the best predictor of student achievement for literacy and numeracy. The result indicated the students were more than 4 times more likely to achieve the national key performance index for both literacy and numeracy when student progress was monitored. In conclusion, ‘monitoring student progress’ had a positive influence on students’ achievement for literacy and numeracy, hence making it a possible course of action for school heads. However, more comprehensive studies are needed to ascertain its consistency within the context of Malaysia.

Keywords: efficacy, instructional, literacy, numeracy

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2157 Worldwide Prosperity Through Democracy: A Cross-country Examination of the Impact of Democratization on Human Development from 1990

Authors: Martin Plener

Abstract:

Developmental and democratization research has a long tradition of focusing on the relationship between democratization and economic development. However, recent studies have shown that economic development is not adequate to measure the actual living conditions of civilian people. In consequence, it is unclear if a democratization process helps to improve people’s quality of life. This work addresses this issue by investigating the influence of democratization on the Human Development Index (HDI) created by the United Nations. The main objective is to study the relationship between democracy and human development and whether democratization positively impacts the living conditions of the population over time. The main mechanism which supports a positive impact is that democratic structures promote participation and political involvement of people from all social classes resulting in a better articulation of interests and thus accountability to the government. To study this issue, a panel regression with Fixed-Effects is conducted. By that, it is examined if democracy has a positive impact on the HDI (Hypothesis 1) and secondly if the same effect weakens in more developed democracies compared to less developed democracies (Hypothesis 2). The results do not reveal a direct positive relationship between the democratization of a country and its development of the HDI, not supporting H1 which denies the first hypothesis. In contrast to the assumption of H2, the effect of democratization on human development seems to be negatively correlated in countries in which democracy is barely developed. Therefore, both hypotheses must be discarded. The results indicate rather a positive correlation between economic development on human development. Therefore, the impact of democracy on the well-being of countries’ citizens needs to be reinvestigated in order to create a better understanding of how improved human development can be achieved.

Keywords: democracy, human development, modernization theory, HDI, TSCS

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2156 Disarmament and Rehabilitation of Women Maoists: A Case Study of Chhattisgarh, India

Authors: Pinal Patel

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The study defines the problems and issues of women in Maoist groups, also referred as ‘Naxalites’, in Chhattisgarh, India. It analyses the causes and consequences of increasing number of women joining Maoists groups and measures taken by the central and state government to retreat them. The main aspect of the study is, how to counter the challenges to resolve the issues and restore normalcy in the life of women Maoists to resettle them in mainstream once they become physically inactive and wish to become part of the society. The rationale behind this study is that women Maoists once inactive, has no place either with Maoist camps/rebel groups or particularly in society. The problems faced by the women Maoists, in society as well as in Maoists camps, can be studied through social, economic, cultural, political and humanitarian aspects. The methodology of the study is dependent on primary sources of information which includes a research survey in majorly affected areas, statistical analysis. Secondary sources of information are helpful for understanding the background of the problem. Government’s strategy of rewarding with cash and providing resettlement and rehabilitation benefits including houses and jobs to ex-women Maoists and their families is a well formulated and feasible policy and effectively implemented by the concerned authorities. But, the survey results show that the policy has not been able to have impacts as it was intended. Because inactive and physically disabled women are still left deserted in deep forests to die and police or authorities are not able to reach them and bring them back. The difficult terrain and dense forest areas are major hurdles to reach to Maoists camps. Moreover, to make people aware of government’s surrendering and rehabilitation schemes and policies as communication networks are very poor due to the lack of development in the state.

Keywords: maoists, women, government, policy

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2155 Comparative Study of Mechanical and Physiological Gait Efficiency Following Anterior Cruciate Ligament Reconstruction

Authors: Radwa E. Sweif, Amira A. A. Abdallah

Abstract:

Background: Evaluation of gait efficiency is used to examine energy consumption especially in patients with movement disorders. Hypothesis/Purpose: This study compared the physiological and mechanical measures of gait efficiency between patients with ACL reconstruction (ACLR) and healthy controls and correlated among these measures. Methods: Seventeen patients with ACLR and sixteen healthy controls with mean ± SD age 23.06±4.76 vs 24.85±6.47 years, height 173.93±6.54 vs 175.64±7.37cm, and weight 74.25±12.1 vs 76.52±10.14 kg, respectively, participated in the study. The patients were operated on six months prior to testing. They should have completed their accelerated rehabilitation program during this period. A 3D motion analysis system was used for collecting the mechanical measures (Biomechanical Efficiency Quotient (BEQ), the maximum degree of knee internal rotation during stance phase and speed of walking). The physiological measures (Physiological Cost Index (PCI) and Rate of Perceived Exertion (RPE)) were collected after performing the 6- minute walking test. Results: MANOVA showed that the maximum degree of knee internal rotation, PCI, and RPE increased and the speed decreased significantly (p<0.05) in the patients compared with the controls with no significant difference for the BEQ. Finally, there were significant (p<0.05) positive correlations between each of the PCI & RPE and each of the BEQ, speed of walking and the maximum degree of knee internal rotation in each group. Conclusion: It was concluded that there are alterations in both mechanical and physiological measures of gait efficiency in patients with ACLR after being rehabilitated, clarifying the need for performing additional endurance as well as knee stability training programs. Moreover, the positive correlations indicate that using either of the mechanical or physiological measures for evaluating gait efficiency is acceptable.

Keywords: ACL reconstruction, mechanical, physiological, gait efficiency

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2154 Established Novel Approach for Chemical Oxygen Demand Concentrations Measurement Based Mach-Zehner Interferometer Sensor

Authors: Su Sin Chong, Abdul Aziz Abdul Raman, Sulaiman Wadi Harun, Hamzah Arof

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Chemical Oxygen Demand (COD) plays a vital role determination of an appropriate strategy for wastewater treatment including the control of the quality of an effluent. In this study, a new sensing method was introduced for the first time and developed to investigate chemical oxygen demand (COD) using a Mach-Zehner Interferometer (MZI)-based dye sensor. The sensor is constructed by bridging two single mode fibres (SMF1 and SMF2) with a short section (~20 mm) of multimode fibre (MMF) and was formed by tapering the MMF to generate evanescent field which is sensitive to perturbation of sensing medium. When the COD concentration increase takes effect will induce changes in output intensity and effective refractive index between the microfiber and the sensing medium. The adequacy of decisions based on COD values relies on the quality of the measurements. Therefore, the dual output response can be applied to the analytical procedure enhance measurement quality. This work presents a detailed assessment of the determination of COD values in synthetic wastewaters. Detailed models of the measurement performance, including sensitivity, reversibility, stability, and uncertainty were successfully validated by proficiency tests where supported on sound and objective criteria. Comparison of the standard method with the new proposed method was also conducted. This proposed sensor is compact, reliable and feasible to investigate the COD value.

Keywords: chemical oxygen demand, environmental sensing, Mach-Zehnder interferometer sensor, online monitoring

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2153 Associations and Interactions of Delivery Mode and Antibiotic Exposure with Infant Cortisol Level: A Correlational Study

Authors: Samarpreet Singh, Gerald Giesbrecht

Abstract:

Both c-section and antibiotic exposure are linked to gut microbiota imbalance in infants. Such disturbance is associated with the Hypothalamic-Pituitary-Adrenal (HPA) axis function. However, the literature only has contradicting evidence for the association between c-sections and the HPA axis. Therefore, this study aims to test if the mode of delivery and antibiotics exposure is associated with the HPA axis. Also, whether exposure to both interacts with the HPA-axis. It was hypothesized that associations and interactions would be observed. Secondary data analysis was used for this co-relational study. Data for the mode of delivery and antibiotics exposure variables were documented from hospital records or self-questionnaires. In addition, cortisol levels (Area under the curve with respect to increasing (AUCi) and Area under the curve with respect to ground (AUCg)) were based on saliva collected from three months old during the infant’s visit to the lab and after drawing blood. One-way and between-subject ANOVA analyses were run on data. No significant association between delivery mode and infant cortisol level was found, AUCi and AUCg, p > .05. Only the infant’s AUCg was found to be significantly higher if there were antibiotics exposure at delivery (p = .001) or their mothers were exposed during pregnancy (p < .05). Infants born by c-section and exposed to antibiotics at three months had higher AUCi than those born vaginally, p < .02. These results imply that antibiotic exposure before three months is associated with an infant’s stress response. The association might increase if antibiotic exposure occurs three months after a c-section birth. However, more robust and causal evidence in future studies is needed, given a variable group’s statistically weak sample size. Nevertheless, the results of this study still highlight the unintended consequences of antibiotic exposure during delivery and pregnancy.

Keywords: HPA-axis, antibiotics, c-section, gut-microbiota, development, stress

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2152 Analyzing the Influence of Hydrometeorlogical Extremes, Geological Setting, and Social Demographic on Public Health

Authors: Irfan Ahmad Afip

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

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

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2151 VR in the Middle School Classroom-An Experimental Study on Spatial Relations and Immersive Virtual Reality

Authors: Danielle Schneider, Ying Xie

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Middle school science, technology, engineering, and math (STEM) teachers experience an exceptional challenge in the expectation to incorporate curricula that builds strong spatial reasoning skills on rudimentary geometry concepts. Because spatial ability is so closely tied to STEM students’ success, researchers are tasked to determine effective instructional practices that create an authentic learning environment within the immersive virtual reality learning environment (IVRLE). This study looked to investigate the effect of the IVRLE on middle school STEM students’ spatial reasoning skills as a methodology to benefit the STEM middle school students’ spatial reasoning skills. This experimental study was comprised of thirty 7th-grade STEM students divided into a treatment group that was engaged in an immersive VR platform where they engaged in building an object in the virtual realm by applying spatial processing and visualizing its dimensions and a control group that built the identical object using a desktop computer-based, computer-aided design (CAD) program. Before and after the students participated in the respective “3D modeling” environment, their spatial reasoning abilities were assessed using the Middle Grades Mathematics Project Spatial Visualization Test (MGMP-SVT). Additionally, both groups created a physical 3D model as a secondary measure to measure the effectiveness of the IVRLE. The results of a one-way ANOVA in this study identified a negative effect on those in the IVRLE. These findings suggest that with middle school students, virtual reality (VR) proved an inadequate tool to benefit spatial relation skills as compared to desktop-based CAD.

Keywords: virtual reality, spatial reasoning, CAD, middle school STEM

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2150 Eco-Cities in Challenging Environments: Pollution As A Polylemma in The Uae

Authors: Shaima A. Al Mansoori

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Eco-cities have become part of the broader and universal discourse and embrace of sustainable communities. Given the ideals and ‘potential’ benefits of eco-cities for people, the environment and prosperity, hardly can an argument be made against the desirability of eco-cities. Yet, this paper posits that it is necessary for urban scholars, technocrats and policy makers to engage in discussions of the pragmatism of implementing the ideals of eco-cities, for example, from the political, budgetary, cultural and other dimensions. In the context of such discourse, this paper examines the feasibility of one of the cardinal principles and goals of eco-cities, which is the reduction or elimination of pollution through various creative and innovative initiatives, in the UAE. This paper contends and argues that, laudable and desirable as this goal is, it is a polylemma and, therefore, overly ambitious and practically unattainable in the UAE. The paper uses the mixed method research strategy, in which data is sourced from secondary and general sources through desktop research, from public records in governmental agencies, and from the conceptual academic and professional literature. Information from these sources will be used, first, to define and review pollution as a concept and multifaceted phenomenon with multidimensional impacts. Second, the paper will use society’s five goal clusters as a framework to identify key causes and impacts of pollution in the UAE. Third, the paper will identify and analyze specific public policies, programs and projects that make pollution in the UAE a polylemma. Fourth, the paper will argue that the phenomenal rates of population increase, urbanization, economic growth, consumerism and development in the UAE make pollution an inevitable product and burden that society must live with. This ‘reality’ makes the goal and desire of pollution-free cities pursuable but unattainable. The paper will conclude by identifying and advocating creative and innovative initiatives that can be taken by the various stakeholders in the country to reduce and mitigate pollution in the short- and long-term.

Keywords: goal clusters, pollution, polylemma, sustainable communities

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2149 Comparison of Clinical Profiles of Patients Seen in a Women and Children Protection Unit in a Local Government Hospital in Makati, Philippines Before and During the COVID-19 Pandemic Between January 2018 to February 2020 and March 2020 to December 2021

Authors: Margaret Denise P. Del Rosario, Geraldine Alcantara

Abstract:

Background: The declaration of the COVID-19 pandemic has impacted hospital visits of child abuse cases with less consults but more severe injuries. Objective: The study aims to identify the clinical profiles of patients seen in the hospital ng Makati Women and Children Protection Unit before and during the pandemic. Design: A cross-sectional analytic study design through review of records that underwent quantitative analysis. Results: 264 cases pre-pandemic and 208 cases during the pandemic were reviewed. Most reported cases were neglect comprising of 47% of the pre-pandemic cases and 68% of cases during the pandemic. Supervisory neglect was most commonly reported. An equal distribution between males and females were seen among victims and alleged perpetrators. The age group of both victims and alleged perpetrators during the pandemic was significantly younger compared to the pre-pandemic period. Children belonging to larger family groups were commonly encountered with most of them being the eldest amongst siblings. Alleged perpetrators were mostly secondary graduates for both time periods. A significant increase of cases during the pandemic occurred at home. More patients required hospitalization during the pandemic period with 37% compared to the 23% of admissions prior to the pandemic. Furthermore, a three-fold increase of injuries sustained during the pandemic required intensive care. Conclusion: The study reflects increased severity of injuries related to abuse during the pandemic compared to pre-pandemic times. A significant increase in injuries requiring intensive care were also seen despite less reported cases.

Keywords: child abuse, COVID-19, violence against children, WCPU, neglect

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2148 Strength Evaluation by Finite Element Analysis of Mesoscale Concrete Models Developed from CT Scan Images of Concrete Cube

Authors: Nirjhar Dhang, S. Vinay Kumar

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Concrete is a non-homogeneous mix of coarse aggregates, sand, cement, air-voids and interfacial transition zone (ITZ) around aggregates. Adoption of these complex structures and material properties in numerical simulation would lead us to better understanding and design of concrete. In this work, the mesoscale model of concrete has been prepared from X-ray computerized tomography (CT) image. These images are converted into computer model and numerically simulated using commercially available finite element software. The mesoscale models are simulated under the influence of compressive displacement. The effect of shape and distribution of aggregates, continuous and discrete ITZ thickness, voids, and variation of mortar strength has been investigated. The CT scan of concrete cube consists of series of two dimensional slices. Total 49 slices are obtained from a cube of 150mm and the interval of slices comes approximately 3mm. In CT scan images, the same cube can be CT scanned in a non-destructive manner and later the compression test can be carried out in a universal testing machine (UTM) for finding its strength. The image processing and extraction of mortar and aggregates from CT scan slices are performed by programming in Python. The digital colour image consists of red, green and blue (RGB) pixels. The conversion of RGB image to black and white image (BW) is carried out, and identification of mesoscale constituents is made by putting value between 0-255. The pixel matrix is created for modeling of mortar, aggregates, and ITZ. Pixels are normalized to 0-9 scale considering the relative strength. Here, zero is assigned to voids, 4-6 for mortar and 7-9 for aggregates. The value between 1-3 identifies boundary between aggregates and mortar. In the next step, triangular and quadrilateral elements for plane stress and plane strain models are generated depending on option given. Properties of materials, boundary conditions, and analysis scheme are specified in this module. The responses like displacement, stresses, and damages are evaluated by ABAQUS importing the input file. This simulation evaluates compressive strengths of 49 slices of the cube. The model is meshed with more than sixty thousand elements. The effect of shape and distribution of aggregates, inclusion of voids and variation of thickness of ITZ layer with relation to load carrying capacity, stress-strain response and strain localizations of concrete have been studied. The plane strain condition carried more load than plane stress condition due to confinement. The CT scan technique can be used to get slices from concrete cores taken from the actual structure, and the digital image processing can be used for finding the shape and contents of aggregates in concrete. This may be further compared with test results of concrete cores and can be used as an important tool for strength evaluation of concrete.

Keywords: concrete, image processing, plane strain, interfacial transition zone

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2147 Virulence Phenotypes among Multi Drug Resistant Uropathogenic E. Coli and Klebsiella SPP

Authors: V. V. Lakshmi, Y. V. S. Annapurna

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Urinary tract infection (UTI) is one of the most common infectious diseases seen in the community. Susceptible individuals experience multiple episodes, and progress to acute pyelonephritis or uro-sepsis or develop asymptomatic bacteriuria (ABU). Ability to cause extraintestinal infections depends on several virulence factors required for survival at extraintestinal sites. Presence of virulence phenotypes enhances the pathogenicity of these otherwise commensal organisms and thus augments its ability to cause extraintestinal infections, the most frequent in urinary tract infections(UTI). The present study focuses on detection of the virulence characters exhibited by the uropathogenic organism and most common factors exhibited in the local pathogens. A total of 700 isolates of E.coli and Klebsiella spp were included in the study.These were isolated from patients from local hospitals reported to be suffering with UTI over a period of three years. Isolation and identification was done based on Gram character and IMVIC reactions. Antibiotic sensitivity profile was carried out by disc diffusion method and multi drug resistant strains with MAR index of 0.7 were further selected. Virulence features examined included their ability to produce exopolysaccharides, protease- gelatinase production, hemolysin production, haemagglutination and hydrophobicity test. Exopolysaccharide production was most predominant virulence feature among the isolates when checked by congo red method. The biofilms production examined by microtitre plates using ELISA reader confirmed that this is the major factor contributing to virulencity of the pathogens followed by hemolysin production.

Keywords: Escherichia coli, Klebsiella spp, Uropathogens, virulence features

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2146 Extended Intuitionistic Fuzzy VIKOR Method in Group Decision Making: The Case of Vendor Selection Decision

Authors: Nastaran Hajiheydari, Mohammad Soltani Delgosha

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Vendor (supplier) selection is a group decision-making (GDM) process, in which, based on some predetermined criteria, the experts’ preferences are provided in order to rank and choose the most desirable suppliers. In the real business environment, our attitudes or our choices would be made in an uncertain and indecisive situation could not be expressed in a crisp framework. Intuitionistic fuzzy sets (IFSs) could handle such situations in the best way. VIKOR method was developed to solve multi-criteria decision-making (MCDM) problems. This method, which is used to determine the compromised feasible solution with respect to the conflicting criteria, introduces a multi-criteria ranking index based on the particular measure of 'closeness' to the 'ideal solution'. Until now, there has been a little investigation of VIKOR with IFS, therefore we extended the intuitionistic fuzzy (IF) VIKOR to solve vendor selection problem under IF GDM environment. The present study intends to develop an IF VIKOR method in a GDM situation. Therefore, a model is presented to calculate the criterion weights based on entropy measure. Then, the interval-valued intuitionistic fuzzy weighted geometric (IFWG) operator utilized to obtain the total decision matrix. In the next stage, an approach based on the positive idle intuitionistic fuzzy number (PIIFN) and negative idle intuitionistic fuzzy number (NIIFN) was developed. Finally, the application of the proposed method to solve a vendor selection problem illustrated.

Keywords: group decision making, intuitionistic fuzzy set, intuitionistic fuzzy entropy measure, vendor selection, VIKOR

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2145 Assessment of Osteocalcin and Homocysteine Levels in Saudi Female Patients with Type II Diabetes Mellitus

Authors: Walaa Mohammed Saeed

Abstract:

Studies suggest a crosstalk between bone and metabolism through Osteocalcin (OC), a bone-derived protein that plays an important role in regulating glucose and fat metabolism. Studies relate type II Diabetes Mellitus (DMII) with Homocysteine (Hcy) and cardiovascular diseases (CVD). This study investigates the relationship between levels of OC, Hcy, and DMII in 85 subjects of which 50 were diabetic female patients (29–65 years) and 35 healthy controls. OC and Hcy levels were measured in fasting blood samples using immunoassay analyzer. Fasting serum glucose, glycated hemoglobin, lipid profile, were estimated by automated Siemens Dimension XP auto-analyzer. A significant increase in the frequency of low OC levels (p < 0.001) and high Hcy levels (p < 0.001) was detected in diabetic patients compared to controls (chi-squared test). Using ANOVA test, patients were divided into tertiles based on plasma OC and Hcy levels; fasting serum glucose varied inversely with OC but directly with Hcy tertiles (p=0.049, p=0.033 respectively). Atherogenic Index of Plasma (AIP=Log TG/HDL) predicts that diabetic patients with 36% high and 15% intermediate cardiovascular risk had increased frequency of low OC levels compared to low-risk patients (p=0.047). Another group of diabetic patients with 39% high and 11% intermediate CVD risk had increased frequency of high Hcy levels (p=0.033). A significant negative correlation existed between OC and glucose (r = -0.318; p = 0.035) while correlation between glucose level and Hcy (r = 0.851 p=0.022) was positive. Hence, low serum OC levels and high Hcy levels were associated with impaired glucose metabolism that may increase cardiovascular risk in DMII.

Keywords: osteocalcin, homocysteine, type 2 diabetes, cardiovascular

Procedia PDF Downloads 137
2144 Trial of Resorbable versus Non-Resorbable Sutures for Traumatic Lacerations of the Face: A Demonstration of Maxillo-Facial Trainee Led Research

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

Abstract:

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

Keywords: laceration, suture, trauma, trial

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2143 Traffic Accident Risk Assessment on National Roads: A Case Study in East Aceh Regency

Authors: Muksalmina

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Transportation plays an important role in people's daily activities but is often marred by traffic accidents. In Indonesia, traffic accidents are the third leading cause of death after coronary heart disease and tuberculosis, according to the World Health Organization (2013). Several roads in East Aceh District are strategic access points for economic growth in the Aceh region. There were 446 traffic accidents in 2023, which is the highest case in the last five years. This study aims to analyze black spot locations on national roads in East Aceh District and evaluate road safety deficiencies in the area. The research methodology began by selecting the locations with the highest accident rates based on data from East Aceh Police from 2019-2023. Next, Average Daily Traffic (ADT) was measured by projecting population growth data. The analysis of road safety deficiencies included measurements of road geometrics, traffic signs and markings, and traffic volumes at black spot locations. The study results showed deficiencies in lane width, shoulder width, and inadequate road safety facilities at several locations. Recommendations for improvements include increasing lane and shoulder widths and adding signs and markings to improve safety. This study is expected to serve as a reference for the government and relevant stakeholders in improving traffic safety in East Aceh District.

Keywords: black spot, traffic accident, severity index, road safety

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2142 C-Spine Imaging in a Non-trauma Centre: Compliance with NEXUS Criteria Audit

Authors: Andrew White, Abigail Lowe, Kory Watkins, Hamed Akhlaghi, Nicole Winter

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The timing and appropriateness of diagnostic imaging are critical to the evaluation and management of traumatic injuries. Within the subclass of trauma patients, the prevalence of c-spine injury is less than 4%. However, the incidence of delayed diagnosis within this cohort has been documented as up to 20%, with inadequate radiological examination most cited issue. In order to assess those in which c-spine injury cannot be fully excluded based on clinical examination alone and, therefore, should undergo diagnostic imaging, a set of criteria is used to provide clinical guidance. The NEXUS (National Emergency X-Radiography Utilisation Study) criteria is a validated clinical decision-making tool used to facilitate selective c-spine radiography. The criteria allow clinicians to determine whether cervical spine imaging can be safely avoided in appropriate patients. The NEXUS criteria are widely used within the Emergency Department setting given their ease of use and relatively straightforward application and are used in the Victorian State Trauma System’s guidelines. This audit utilized retrospective data collection to examine the concordance of c-spine imaging in trauma patients to that of the NEXUS criteria and assess compliance with state guidance on diagnostic imaging in trauma. Of the 183 patients that presented with trauma to the head, neck, or face (244 excluded due to incorrect triage), 98 did not undergo imaging of the c-spine. Out of those 98, 44% fulfilled at least one of the NEXUS criteria, meaning the c-spine could not be clinically cleared as per the current guidelines. The criterion most met was intoxication, comprising 42% (18 of 43), with midline spinal tenderness (or absence of documentation of this) the second most common with 23% (10 of 43). Intoxication being the most met criteria is significant but not unexpected given the cohort of patients seen at St Vincent’s and within many emergency departments in general. Given these patients will always meet NEXUS criteria, an element of clinical judgment is likely needed, or concurrent use of the Canadian C-Spine Rules to exclude the need for imaging. Midline tenderness as a met criterion was often in the context of poor or absent documentation relating to this, emphasizing the importance of clear and accurate assessments. The distracting injury was identified in 7 out of the 43 patients; however, only one of these patients exhibited a thoracic injury (T11 compression fracture), with the remainder comprising injuries to the extremities – some studies suggest that C-spine imaging may not be required in the evaluable blunt trauma patient despite distracting injuries in any body regions that do not involve the upper chest. This emphasises the need for standardised definitions for distracting injury, at least at a departmental/regional level. The data highlights the currently poor application of the NEXUS guidelines, with likely common themes throughout emergency departments, highlighting the need for further education regarding implementation and potential refinement/clarification of criteria. Of note, there appeared to be no significant differences between levels of experience with respect to inappropriately clearing the c-spine clinically with respect to the guidelines.

Keywords: imaging, guidelines, emergency medicine, audit

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