Search results for: physical therapy intervention
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 9317

Search results for: physical therapy intervention

4187 The Right of Taiwanese Individuals with Mental Illnesses to Participate in Medical Decision-Making

Authors: Ying-Lun Tseng Chiu-Ying Chen

Abstract:

Taiwan's Mental Health Act was amended at the end of 2022; they added regulations regarding refusing compulsory treatment by patients with mental illnesses. In addition, not only by an examination committee, the judge must also assess the patient's need for compulsory treatment. Additionally, the maximum of compulsory hospitalization has been reduced from an unlimited period to a maximum of 60 days. They aim to promote the healthcare autonomy of individuals with mental illnesses in Taiwan and prevent their silenced voice in medical decision-making while they still possess rationality. Furthermore, they plan to use community support and social care networks to replace the current practice of compulsory treatment in Taiwan. This study uses qualitative research methodology, utilizing interview guidelines to inquire about the experiences of Taiwanese who have undergone compulsory hospitalization, compulsory community treatment, and compulsory medical care. The interviews aimed to explore their feelings when they were subjected to compulsory medical intervention, the inside of their illness, their opinions after treatments, and whether alternative medical interventions proposed by them were considered. Additionally, participants also asked about their personal life history and their support networks in their lives. We collected 12 Taiwanese who had experienced compulsory medical interventions and were interviewed 14 times. The findings indicated that participants still possessed rationality during the onset of their illness. However, when they have other treatments to replace compulsory medical, they sometimes diverge from those of the doctors and their families. Finally, doctors prefer their professional judgment and patients' families' option. Therefore, Taiwanese mental health patients' power of decision-making still needs to improve. Because this research uses qualitative research, so difficult to find participants, and the sample size rate was smaller than Taiwan's population, it may have biases in the analysis. So, Taiwan still has significant progress in enhancing the decision-making rights of participants in the study.

Keywords: medical decision making, compulsory treatment, medical ethics, mental health act

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4186 Comparative Analysis of Technologies for Production of Granular NPKS-Fertilizers

Authors: Andrey Norov

Abstract:

Based on a comparison of technologies for the production of granular nitrate-containing and nitrate-free NPKS-fertilizers, this paper considers the effect of process parameters on the economic feasibility of production, on physical & chemical, and structural & mechanical properties and quality of final products (caking, static strength of granules, hygroscopicity, etc.), as well as on thermal stability of fertilizers, eco-friendly production, and other aspects. This comparative analysis allows to select the optimal technology for specific conditions and requirements. Additionally, the report considers flexible, a unique technology for the production of granular NPKS-fertilizers containing sulfur and calcium, suggested by Samoilov Research Institute for Mineral Fertilizers JSC “NIUIF” - the oldest industry-oriented institute in Russia. This technology is implemented at one of the Russian plants where combined drum is used for granulation and drying.

Keywords: caking, granule static strength, granulating-drying drum, NPKS-fertilizers

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4185 Dam Break Model Using Navier-Stokes Equation

Authors: Alireza Lohrasbi, Alireza Lavaei, Mohammadali M. Shahlaei

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The liquid flow and the free surface shape during the initial stage of dam breaking are investigated. A numerical scheme is developed to predict the wave of an unsteady, incompressible viscous flow with free surface. The method involves a two dimensional finite element (2D), in a vertical plan. The Naiver-Stokes equations for conservation of momentum and mass for Newtonian fluids, continuity equation, and full nonlinear kinematic free-surface equation were used as the governing equations. The mapping developed to solve highly deformed free surface problems common in waves formed during wave propagation, transforms the run up model from the physical domain to a computational domain with Arbitrary Lagrangian Eulerian (ALE) finite element modeling technique.

Keywords: dam break, Naiver-Stokes equations, free-surface flows, Arbitrary Lagrangian-Eulerian

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4184 Thermo-Aeraulic Studies of a Multizone Building Influence of the Compactness Index

Authors: S. M. A. Bekkouche, T. Benouaz, M. K. Cherier, M. Hamdani, M. R. Yaiche, N. Benamrane

Abstract:

Most codes of building energy simulation neglect the humidity or well represent it with a very simplified method. It is for this reason that we have developed a new approach to the description and modeling of multizone buildings in Saharan climate. The thermal nodal method was used to apprehend thermoaeraulic behavior of air subjected to varied solicitations. In this contribution, analyzing the building geometry introduced the concept of index compactness as "quotient of external walls area and volume of the building". Physical phenomena that we have described in this paper, allow to build the model of the coupled thermoaeraulic behavior. The comparison shows that the found results are to some extent satisfactory. The result proves that temperature and specific humidity depending on compactness and geometric shape. Proper use of compactness index and building geometry parameters will noticeably minimize building energy.

Keywords: multizone model, nodal method, compactness index, specific humidity, temperature

Procedia PDF Downloads 399
4183 Optimization of Copper-Water Negative Inclination Heat Pipe with Internal Composite Wick Structure

Authors: I. Brandys, M. Levy, K. Harush, Y. Haim, M. Korngold

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Theoretical optimization of a copper-water negative inclination heat pipe with internal composite wick structure has been performed, regarding a new introduced parameter: the ratio between the coarse mesh wraps and the fine mesh wraps of the composite wick. Since in many cases, the design of a heat pipe matches specific thermal requirements and physical limitations, this work demonstrates the optimization of a 1 m length, 8 mm internal diameter heat pipe without an adiabatic section, at a negative inclination angle of -10º. The optimization is based on a new introduced parameter, LR: the ratio between the coarse mesh wraps and the fine mesh wraps.

Keywords: heat pipe, inclination, optimization, ratio

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4182 Key Affecting Factors for Social Sustainability through Urban Green Space Planning

Authors: Raziyeh Teimouri, Sadasivam Karuppannan, Alpana Sivam, Ning Gu

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Urban Green Space (UGS) is one of the most critical components of urban systems to create sustainable cities. UGS has valuable social benefits that closely correlate with people's life quality. Studying social sustainability factors that can be achieved by green spaces is required for optimal UGS planning to increase urban social sustainability. This paper aims to identify key factors that enhance urban social sustainability through UGS planning. To reach the goal of the study international experts’ survey has been conducted. According to the results of the survey analysis, factors of proper distribution, links to public transportation, walkable access, sense of place, social interactions, public education, safety and security, walkability and cyclability, physical activity and recreational facilities, suitability for all ages, disabled people, women, and children are among the key factors that should consider in UGS planning programs to promote urban social sustainability.

Keywords: UGS, planning, social sustainability, key factors

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4181 Effect of Depressurization Rate in Batch Foaming of Porous Microcellular Polycarbonate on Microstructure Development

Authors: Indrajeet Singh, Abhishek Gandhi, Smita Mohanty, S. K. Nayak

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In this article, a focused study has been performed to comprehend the influence of change in depressurization rate on microcellular polycarbonate foamed morphological attributes. The depressurization rate considered in this study were 0.5, 0.05, 0.01 and 0.005 MPa/sec and the physical blowing agent utilized was carbon dioxide owing to its high solubility in polycarbonate at room temperature. The study was performed on two distinct saturation pressures, i.e., 3 MPa and 6 MPa to understand if saturation pressure has any effects on it. It is reported that with increase in depressurization rate, a higher amount of thermodynamic instability was induced which resulted in generation of larger number of smaller sized cells. This article puts forward an understanding of how depressurization rate control could be well exploited during the batch foaming process to develop high quality microcellular foamed products with exceedingly well controlled cell size.

Keywords: depressurization, porous polymer, foaming, microcellular

Procedia PDF Downloads 247
4180 The Whale Optimization Algorithm and Its Implementation in MATLAB

Authors: S. Adhirai, R. P. Mahapatra, Paramjit Singh

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Optimization is an important tool in making decisions and in analysing physical systems. In mathematical terms, an optimization problem is the problem of finding the best solution from among the set of all feasible solutions. The paper discusses the Whale Optimization Algorithm (WOA), and its applications in different fields. The algorithm is tested using MATLAB because of its unique and powerful features. The benchmark functions used in WOA algorithm are grouped as: unimodal (F1-F7), multimodal (F8-F13), and fixed-dimension multimodal (F14-F23). Out of these benchmark functions, we show the experimental results for F7, F11, and F19 for different number of iterations. The search space and objective space for the selected function are drawn, and finally, the best solution as well as the best optimal value of the objective function found by WOA is presented. The algorithmic results demonstrate that the WOA performs better than the state-of-the-art meta-heuristic and conventional algorithms.

Keywords: optimization, optimal value, objective function, optimization problems, meta-heuristic optimization algorithms, Whale Optimization Algorithm, implementation, MATLAB

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4179 Numerical Solution of Two-Dimensional Solute Transport System Using Operational Matrices

Authors: Shubham Jaiswal

Abstract:

In this study, the numerical solution of two-dimensional solute transport system in a homogeneous porous medium of finite-length is obtained. The considered transport system have the terms accounting for advection, dispersion and first-order decay with first-type boundary conditions. Initially, the aquifer is considered solute free and a constant input-concentration is considered at inlet boundary. The solution is describing the solute concentration in rectangular inflow-region of the homogeneous porous media. The numerical solution is derived using a powerful method viz., spectral collocation method. The numerical computation and graphical presentations exhibit that the method is effective and reliable during solution of the physical model with complicated boundary conditions even in the presence of reaction term.

Keywords: two-dimensional solute transport system, spectral collocation method, Chebyshev polynomials, Chebyshev differentiation matrix

Procedia PDF Downloads 218
4178 Case Report: Mandibular Area Abscesses in Calves

Authors: Dovilė Bačėninaitė, Karina Džermeikaitė, Justinas Kirvela, Ramūnas Antanaitis

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Bacteria are often present in the mouth of cattle. Some of them can cause abscesses. Starting with severe swelling of the mouth, muscle spasm, or locked jaw, it can lead to inability to open its mouth, move the neck, cause pain while eating. While the calf is unable to eat properly, it becomes more susceptible to infectious diseases, lower weight gain can be observed. Abscesses can be considered as a continuum of oral disease, whereby early stages of the lumpy jaw could proceed from gingivitis to periodontal disease. In the event of tissue damage, bacteria can enter the bloodstream, even cause sepsis. The most common lesions occur when animals eat sharp grass, coarse fodder, sharp, piercing foreign bodies (this is especially common for calves when they are trying to eat inedible objects). A crossbred Holstein calf presented with a history of proliferative outgrowth in the mandibular region. On clinical examination, needle aspiration, mandibular swelling revealed sticky, white curd-like fluid containing. Pus bacteriology revealed gram-negative cocci. They were sensitive to amoxicillin, cephalexin, enrofloxacin, ceftiofur. Blood morphology was in physiological ranges. The calf was treated surgically. The growth was excised, the puss drained and the wound was flushed with potassium permanganate solution (0,01%). A week after clinical surgery examination was performed. The swelling was decreased. Superficial bacterial infections are often associated with poor hygiene, which should be improved before treatment is commenced. Clipping away dirty hair and gently washing affected areas of skin daily with solutions such as povidone-iodine, potassium permanganate is effective. Appropriate antibiotic therapy, based on sensitivity testing, may be used where there is evidence of systemic illness.

Keywords: calf, abscess, lumpy jaw, pus, Streptococcus, Staphylococcus, Actinobacillus, infection

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4177 Mouthing Patterns in Indian Sign Language

Authors: Neha Kulshreshtha

Abstract:

This paper examines the patterns of 'Mouthing', a non-manual marker, and its distribution in Indian Sign Language (ISL). Linguistic research in Indian Sign Language is an emerging field where much is needed to be done. The little research which has happened focuses on the structure of ISL in terms of physical or manual markers, therefore a study of mouthing patterns would give an insight into the distribution of this particular non-manual marker. Data has been collected with the help of native ISL users through various techniques in which natural signs can be captured, for example, storytelling, informal conversations etc. The aim of the study is to find out the various situations where mouthing is used. Sometimes, the mouthing is not actually the articulation of the word as spoken in the local languages. The paper aims to find out whether the mouthing patterns in ISL are influenced by any local language or they are independent of any influence from the local language or both. Mouthing patterns have been studied in many sign languages and an investigation into ISL will reveal whether it falls in pattern with the other sign languages.

Keywords: Indian sign language, mouthing, non-manual marker, spoken language influence

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4176 Patients' Out-Of-Pocket Expenses-Effectiveness Analysis of Presurgical Teledermatology

Authors: Felipa De Mello-Sampayo

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Background: The aim of this study is to undertake, from a patient perspective, an economic analysis of presurgical teledermatology, comparing it with a conventional referral system. Store-and-forward teledermatology allows surgical planning, saving both time and number of visits involving travel, thereby reducing patients’ out-of-pocket expenses, i.e., costs that patients incur when traveling to and from health providers for treatment, visits’ fees, and the opportunity cost of time spent in visits. Method: Patients’ out-of-pocket expenses-effectiveness of presurgical teledermatology were analyzed in the setting of a public hospital during two years. The mean delay in surgery was used to measure effectiveness. The teledermatology network covering the area served by the Hospital Garcia da Horta (HGO), Portugal, linked the primary care centers of 24 health districts with the hospital’s dermatology department. The patients’ opportunity cost of visits, travel costs, and visits’ fee of each presurgical modality (teledermatology and conventional referral), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated from initial primary care visit until surgical intervention. Two groups of patients: those with squamous cell carcinoma and those with basal cell carcinoma were distinguished in order to compare the effectiveness according to the dermatoses. Results: From a patient perspective, the conventional system was 2.15 times more expensive than presurgical teledermatology. Teledermatology had an incremental out-of-pocket expenses-effectiveness ratio of €1.22 per patient and per day of delay avoided. This saving was greater in patients with squamous cell carcinoma than in patients with basal cell carcinoma. Conclusion: From a patient economic perspective, teledermatology used for presurgical planning and preparation is the dominant strategy in terms of out-of-pocket expenses-effectiveness than the conventional referral system, especially for patients with severe dermatoses.

Keywords: economic analysis, out-of-pocket expenses, opportunity cost, teledermatology, waiting time

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4175 Prevalence and Risk Factors of Musculoskeletal Disorders among School Teachers in Mangalore: A Cross Sectional Study

Authors: Junaid Hamid Bhat

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Background: Musculoskeletal disorders are one of the main causes of occupational illness. Mechanisms and the factors like repetitive work, physical effort and posture, endangering the risk of musculoskeletal disorders would now appear to have been properly identified. Teacher’s exposure to work-related musculoskeletal disorders appears to be insufficiently described in the literature. Little research has investigated the prevalence and risk factors of musculoskeletal disorders in teaching profession. Very few studies are available in this regard and there are no studies evident in India. Purpose: To determine the prevalence of musculoskeletal disorders and to identify and measure the association of such risk factors responsible for developing musculoskeletal disorders among school teachers. Methodology: An observational cross sectional study was carried out. 500 school teachers from primary, middle, high and secondary schools were selected, based on eligibility criteria. A signed consent was obtained and a self-administered, validated questionnaire was used. Descriptive statistics was used to compute the statistical mean and standard deviation, frequency and percentage to estimate the prevalence of musculoskeletal disorders among school teachers. The data analysis was done by using SPSS version 16.0. Results: Results indicated higher pain prevalence (99.6%) among school teachers during the past 12 months. Neck pain (66.1%), low back pain (61.8%) and knee pain (32.0%) were the most prevalent musculoskeletal complaints of the subjects. Prevalence of shoulder pain was also found to be high among school teachers (25.9%). 52.0% subjects reported pain as disabling in nature, causing sleep disturbance (44.8%) and pain was found to be associated with work (87.5%). A significant association was found between musculoskeletal disorders and sick leaves/absenteeism. Conclusion: Work-related musculoskeletal disorders particularly neck pain, low back pain, and knee pain, is highly prevalent and risk factors are responsible for the development of same in school teachers. There is little awareness of musculoskeletal disorders among school teachers, due to work load and prolonged/static postures. Further research should concentrate on specific risk factors like repetitive movements, psychological stress, and ergonomic factors and should be carried out all over the country and the school teachers should be studied carefully over a period of time. Also, an ergonomic investigation is needed to decrease the work-related musculoskeletal disorder problems. Implication: Recall bias and self-reporting can be considered as limitations. Also, cause and effect inferences cannot be ascertained. Based on these results, it is important to disseminate general recommendations for prevention of work-related musculoskeletal disorders with regards to the suitability of furniture, equipment and work tools, environmental conditions, work organization and rest time to school teachers. School teachers in the early stage of their careers should try to adapt the ergonomically favorable position whilst performing their work for a safe and healthy life later. Employers should be educated on practical aspects of prevention to reduce musculoskeletal disorders, since changes in workplace and work organization and physical/recreational activities are required.

Keywords: work related musculoskeletal disorders, school teachers, risk factors funding, medical and health sciences

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4174 Who Killed Kalief? Examining the Effects of Solitary Confinement on Juvenile Detainees in the United States

Authors: Esther Baldwin

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It is well settled that the use of solitary confinement can cause psychological and physical harm to detainees. For juveniles, who are more susceptible to irreparable harm due to their underdeveloped psyches, the risks are exacerbated. Despite these risks, across the United States juvenile detainees are regularly held in isolation for prolonged periods of time. This essay will examine the broad impact of solitary confinement on juvenile detainees while giving particular focus to the story of Kalief Browder, a juvenile awaiting trial on Rikers Island in New York for a period of three years, nearly two years of which were spent in solitary confinement. Although sadly, his story is not uncommon, Kalief’s story offers a unique perspective in that it provides first-hand insight on the effects of solitary confinement on juveniles. It is our hope that by sharing his story, we will demand better detention practices and policies for juveniles under correctional control in the United States.

Keywords: criminal justice system, juveniles, Kalief browder, solitary confinement

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4173 Comparison of Conjunctival Autograft versus Amniotic Membrane Transplantation for Pterygium Surgery

Authors: Luksanaporn Krungkraipetch

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Currently, surgery is the only known effective treatment for pterygium. In certain groups, the probability of recurrence after basic sclera excision is very significant. Tissue grafting is substantially more time-consuming and challenging than keeping the sclera uncovered, but it reduces the chance of recurrence. Conjunctival autograft surgery is older than amniotic membrane graft surgery. The purpose of this study was to compare pterygium surgery with conjunctival autograft against an amniotic membrane transplant. In the study, a randomized controlled trial was used. Four cases were ruled out (two for failing to meet inclusion criteria and the other for refusing to participate). Group I (n = 40) received the intervention, whereas Group II (n = 40) served as the control. Both descriptive and inferential statistical approaches were used, including data analysis and data analysis statistics. The descriptive statistics analysis covered basic pterygium surgery information as well as the risk of recurrent pterygium. As an inferential statistic, the chi-square was used. A p-value of 0.05 is statistically significant. The findings of this investigation were the majority of patients in Group I were female (70.0%), aged 41–60 years, had no underlying disease (95.0%), and had nasal pterygium (97.5%). The majority of Group II patients were female (60.0%), aged 41–60 years, had no underlying disease (97.5%) and had nasal pterygium (97.5%). Group I had no recurrence of pterygium after surgery, but Group II had a 7.5% recurrence rate. Typically, the recurrence time is twelve months. The majority of pterygium recurrences occur in females (83.3%), between the ages of 41 and 60 (66.7%), with no underlying disease. The recurrence period is typically six months (60%) and a nasal pterygium site (83.3%). Pterygium recurrence after surgery is associated with nasal location (p =.002). 16.7% of pterygium surgeries result in complications; one woman with nasal pterygium underwent autograft surgery six months later. The presence of granulation tissue at the surgical site is a mild complication. A pterygium surgery recurrence rate comparison of conjunctival autograft and amniotic membrane transplantation revealed that conjunctival autograft had a higher recurrence rate than amniotic membrane transplantation (p =.013).

Keywords: pterygium, pterygium surgery, conjunctival autograft, amniotic membrane transplantation

Procedia PDF Downloads 53
4172 Assessment of Predictive Confounders for the Prevalence of Breast Cancer among Iraqi Population: A Retrospective Study from Baghdad, Iraq

Authors: Nadia H. Mohammed, Anmar Al-Taie, Fadia H. Al-Sultany

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Although breast cancer prevalence continues to increase, mortality has been decreasing as a result of early detection and improvement in adjuvant systemic therapy. Nevertheless, this disease required further efforts to understand and identify the associated potential risk factors that could play a role in the prevalence of this malignancy among Iraqi women. The objective of this study was to assess the perception of certain predictive risk factors on the prevalence of breast cancer types among a sample of Iraqi women diagnosed with breast cancer. This was a retrospective observational study carried out at National Cancer Research Center in College of Medicine, Baghdad University from November 2017 to January 2018. Data of 100 patients with breast cancer whose biopsies examined in the National Cancer Research Center were included in this study. Data were collected to structure a detailed assessment regarding the patients’ demographic, medical and cancer records. The majority of study participants (94%) suffered from ductal breast cancer with mean age 49.57 years. Among those women, 48.9% were obese with body mass index (BMI) 35 kg/m2. 68.1% of them had positive family history of breast cancer and 66% had low parity. 40.4% had stage II ductal breast cancer followed by 25.5% with stage III. It was found that 59.6% and 68.1% had positive oestrogen receptor sensitivity and positive human epidermal growth factor (HER2/neu) receptor sensitivity respectively. In regard to the impact of prediction of certain variables on the incidence of ductal breast cancer, positive family history of breast cancer (P < 0.0001), low parity (P< 0.0001), stage I and II breast cancer (P = 0.02) and positive HER2/neu status (P < 0.0001) were significant predictive factors among the study participants. The results from this study provide relevant evidence for a significant positive and potential association between certain risk factors and the prevalence of breast cancer among Iraqi women.

Keywords: Ductal Breast Cancer, Hormone Sensitivity, Iraq, Risk Factors

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4171 PYURF and ZED9 Have a Prominent Role in Association with Molecular Pathways in Bortezomib in Myeloma Cells in Acute Myeloid Leukemia

Authors: Atena Sadat Hosseini, Mohammadhossein Habibi

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Acute myeloid leukemia (AML) is the most typically diagnosed leukemia. In older adults, AML imposes a dismal outcome. AML originates with a dominant mutation, then adds collaborative, transformative mutations leading to myeloid transformation and clinical/biological heterogeneity. Several chemotherapeutic drugs are used for this cancer. These drugs are naturally associated with several side effects, and finding a more accurate molecular mechanism of these drugs can have a significant impact on the selection and better candidate of drugs for treatment. In this study, we evaluated bortezomibin myeloma cells using bioinformatics analysis and evaluation of RNA-Seq data. Then investigated the molecular pathways proteins- proteins interactions associated with this chemotherapy drug. A total of 658upregulated genes and 548 downregulated genes were sorted.AUF1 (hnRNP D0) binds and destabilizes mRNA, degradation of GLI2 by the proteasome, the role of GTSE1 in G2/M progression after G2 checkpoint, TCF dependent signaling in response to WNT demonstrated in upregulated genes. Besides insulin resistance, AKT phosphorylates targets in the nucleus, cytosine methylation, Longevity regulating pathway, and Signal Transduction of S1P Receptor were related to low expression genes. With respect to this results, HIST2H2AA3, RP11-96O20.4, ZED9, PRDX1, and DOK2, according to node degrees and betweenness elements candidates from upregulated genes. in the opposite side, PYURF, NRSN1, FGF23, UPK3BL, and STAG3 were a prominent role in downregulated genes. Sum up, Using in silico analysis in the present study, we conducted a precise study ofbortezomib molecular mechanisms in myeloma cells. so that we could take further evaluation to discovermolecular cancer therapy. Naturally, more additional experimental and clinical procedures are needed in this survey.

Keywords: myeloma cells, acute myeloid leukemia, bioinformatics analysis, bortezomib

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4170 A Numerical Computational Method of MRI Static Magnetic Field for an Ergonomic Facility Design Guidelines

Authors: Sherine Farrag

Abstract:

Magnetic resonance imaging (MRI) presents safety hazards, with the general physical environment. The principal hazard of the MRI is the presence of static magnetic fields. Proper architectural design of MRI’s room ensure environment and health care staff safety. This research paper presents an easy approach for numerical computation of fringe static magnetic fields. Iso-gauss line of different MR intensities (0.3, 0.5, 1, 1.5 Tesla) was mapped and a polynomial function of the 7th degree was generated and tested. Matlab script was successfully applied for MRI SMF mapping. This method can be valid for any kind of commercial scanner because it requires only the knowledge of the MR scanner room map with iso-gauss lines. Results help to develop guidelines to guide healthcare architects to design of a safer Magnetic resonance imaging suite.

Keywords: designing MRI suite, MRI safety, radiology occupational exposure, static magnetic fields

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4169 The Impact of CYP2C9 Gene Polymorphisms on Warfarin Dosing

Authors: Weaam Aldeeban, Majd Aljamali, Lama A. Youssef

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Background & Objective: Warfarin is considered a problematic drug due to its narrow therapeutic window and wide inter-individual response variations, which are attributed to demographic, environmental, and genetic factors, particularly single nucleotide polymorphism (SNPs) in the genes encoding VKORC1 and CYP2C9 involved in warfarin's mechanism of action and metabolism, respectively. CYP2C9*2rs1799853 and CYP2C9*3rs1057910 alleles are linked to reduced enzyme activity, as carriers of either or both alleles are classified as moderate or slow metabolizers, and therefore exhibit higher sensitivity of warfarin compared with wild type (CYP2C9*1*1). Our study aimed to assess the frequency of *1, *2, and *3 alleles in the CYP2C9 gene in a cohort of Syrian patients receiving a maintenance dose of warfarin for different indications, the impact of genotypes on warfarin dosing, and the frequency of adverse effects (i.e., bleedings). Subjects & Methods: This retrospective cohort study encompassed 94 patients treated with warfarin. Patients’ genotypes were identified by sequencing the polymerase chain reaction (PCR) specific products of the gene encoding CYP2C9, and the effects on warfarin therapeutic outcomes were investigated. Results: Sequencing revealed that 43.6% of the study population has the *2 and/or *3 SNPs. The mean weekly maintenance dose of warfarin was 37.42 ± 15.5 mg for patients with the wild-type allele (CYP2C9*1*1), whereas patients with one or both variants (*2 and/or *3) demanded a significantly lower dose (28.59 ±11.58 mg) of warfarin, (P= 0.015). A higher percentage (40.7%) of patients with allele *2 and/or *3 experienced hemorrhagic accidents compared with only 17.9% of patients with the wild type *1*1, (P = 0.04). Conclusions: Our study proves an association between *2 and *3 genotypes and higher sensitivity to warfarin and a tendency to bleed, which necessitates lowering the dose. These findings emphasize the significance of CYP2C9 genotyping prior to commencing warfarin therapy in order to achieve optimal and faster dose control and to ensure effectiveness and safety.

Keywords: warfarin, CYP2C9, polymorphisms, Syrian, hemorrhage

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4168 Bronchoscopy and Genexpert in the Diagnosis of Pulmonary Tuberculosis in the Indian Private Health Sector: A Short Case Series

Authors: J. J. Mathew

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Pulmonary tuberculosis is highly prevalent in the Indian subcontinent. Most cases of pulmonary tuberculosis are diagnosed with sputum examinations and the vast majority of these are undertaken by the government run establishments. However, mycobacterial cultures are not routinely done, unless drug resistance is detected based on clinical response. Modern diagnostic tests like bronchoscopy and Genexpert are not routinely employed in the government institutions for the diagnosis of pulmonary tuberculosis, but have been accepted widely by good private institutions. The utility of these investigations in the private sector is not yet well recognized. This retrospective study aims to assess the usefulness of bronchoscopy and Genexpert in the diagnosis of pulmonary tuberculosis in quaternary care private hospital in India. 30 patients with respiratory symptoms raising the possibility of tuberculosis based on clinical and radiological features, but without any significant sputum production, were subject to bronchoscopy and BAL samples taken for microbiological studies, including Genexpert. 6 out of the 30 patients were found to be Genexpert positive and none of them showed Rifampicin resistance. All the 6 cases had upper zone predominant disease. One of the 6 cases of tuberculosis had another co-existent bacterial infection according to the routine culture studies. 6 other cases were proven to be due to other bacterial infections alone, 2 had a malignant diagnosis and the remaining cases were thought to be non-infective pathologies. The Genexpert results were made available within 48 hours in the 6 positive cases. All of them were commenced on standard anti-tuberculous regimen with excellent clinical response. The other infective cases were also managed successfully based on the drug susceptibilities. The study has shown the usefulness of these investigations as early intervention enabled diagnosis facilitating treatment and prevention of any clinical deterioration. The study lends support to early bronchoscopy and Genexpert testing in suspected cases of pulmonary tuberculosis without significant sputum production, in a high prevalence country which normally relies on sputum examination for the diagnosis of pulmonary tuberculosis.

Keywords: pulmonary, tuberculosis, bronchoscopy, genexpert

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4167 Prevalence and Potential Risk Factors Associated with Skin Affection in Donkeys

Authors: Mohamed Z. Sayed-Ahmed, Ahmed M. Ahdy, Emad E. Younis, Sabry A. El-Khodary

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Little research information is available on the prevalence of diseases of donkeys in Egypt. Across sectional study was undertaken between March 2009 and February 2010 to verify the prevalence of skin affection of donkeys. A total of 1134 donkeys in northern Egypt were investigated. A questionnaire was constructed to verify the number of infected contact animals as well as the associated factors. Physical examination was carried out, and the distribution of skin lesions was recorded. Skin scraping and biopsy were obtained to perform bacteriological, mycological, and histopathological examinations. Thirty-five (3.09%) out of 1134 noticed donkeys had skin affections including mange (18/35), dermatophytosis (6/35), bacterial dermatitis (6/35) urticaria (2/35) and allergic dermatitis (3/35). The present results indicate that mange and dermatophytosis are the prevalent skin diseases in donkeys. Contact with other animal species of contaminated environment may contribute to the occurrence of the diseases.

Keywords: donkeys, Egypt, prevalence, skin affection

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4166 Nakunan: An Exploratory Study on Filipino Mothers' Experience of Miscarriage

Authors: Micaella L. Gonzales, Joanne C. Alonzo, Nizza E. Regalado, Rosary L. Valenzuela

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Culture functions as a lens through which individuals experience universal phenomena. This study explored Filipino mothers’ experience of miscarriage, or having been ‘nakunan’ - a colloquial term for fetal death. In addition, this study also aims to establish an understanding of the concept in Filipino society. Semi-structured in-depth interviews were conducted with 13 Filipino women who had experienced miscarriage. Following thematic analysis, there emerged several themes within certain aspects (i.e. physical, psychological, inter-relational) of a woman’s life closely intertwined the experience, further reiterating the multidimensionality of the experience. Results show that Filipino values of family-centeredness and religiosity played a big part in women’s experiences. Family-centeredness was seen interwoven in the women’s self-concept and interrelations with others following her miscarriage, and religiosity came into play in the women’s personal definitions, perceived causes, and coping with what had happened to them.

Keywords: bereavement, fetal death, Filipino mothers, miscarriage

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4165 The Importance of Introducing New Academic Programs in ‎Egyptian National Cancer ‎Institute

Authors: Mohammed S. Mohammed, Asmaa M. S. Mohammed

Abstract:

Background: To achieve the quality of cancer care, the oncologic academic programs should be continuously developed with establishing new ones. We highlighted three disciplines, Clinical nutrition, medical biophysics and radiobiology and Psycho-oncology programs; without a doubt, the Egyptian National Cancer Institute, in ‎the accreditation era, will be establishing them ‎ due to their importance in improving the skills of cancer practitioners. Methods: The first suggested program in Clinical Nutrition that is dealing with the assessment of the patient's well-being before, during and after treatment to avoid the defects in the metabolism resulting from the cancer disease and its treatment by giving the supplements in the patient's diet. The second program is Medical Biophysics and Radiobiology, which there's no denying that it ‎is ‎provided ‎in Cairo University as a good program in the faculty of science but lacks the clinical ‎practice. Hence, it is probably better to establish this program in our institute to ‎improve the ‎practitioner skills and introduce a tailored radiation therapy regimen for every patient according to ‎their characteristic profile.‎ While patients are receiving their treatment, the risk of post-traumatic stress disorder arises, so the importance of the third program, Psycho-Oncology, is clearly obtained. This program is concerned with the psychological, social, behavioral, and ethical aspects of cancer. The area of multi-disciplinary interest has boundaries with the major specialties in oncology: the clinical disciplines (surgery, medicine, pediatrics, and radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology. Results: It is a prospective academic plan which is compatible with the institutional vision and its strategic plan. Conclusion: In this context, evaluating and understanding the suggested academic programs has become a mandatory part of cancer care. And it is essential to be provided by the NCI.

Keywords: clinical nutrition, psycho-oncology, medical biophysics and radiobiology, medical education

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4164 Development of Gold Nanoparticles-Antibody System for the Selective Photothermal Destruction of Multidrug Resistant Bacteria

Authors: Teodora Mocan, Lucian Mocan, Cornel Iancu, Flaviu A. Tabaran, Bartos Dana, Matea Cristian

Abstract:

Antimicrobial resistance, which threatens the efficacy of the existing antibiotics represents a worldwide public health issue. At the current time, vancomycin is the only responsive treatment although has significant cytotoxicity, is partially effective and it is poorly retained by infected tissues. From a clinical point of view, attractive alternative approaches for treating such Meticillin-Resistant Staphylococcus Aureus (MRSA) strains would be using agents that cause physical damage to the bacteria. Modular nanopharmaceuticals systems are being designed to address all of these multifunctional capabilities for the ideal bacterial treatment, with the ability to mix and match appropriate functions. Here we present a novel method of selective laser photothermal ablation of MRSA bacteria mediated by gold nanoparticles bound to PBP antibody against PBP protein located on the MRSA surface.

Keywords: MRSA, laser, nanoparticle, antibody

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4163 Effectiveness of Gamified Virtual Physiotherapy Patients with Shoulder Problems

Authors: A. Barratt, M. H. Granat, S. Buttress, B. Roy

Abstract:

Introduction: Physiotherapy is an essential part of the treatment of patients with shoulder problems. The focus of treatment is usually centred on addressing specific physiotherapy goals, ultimately resulting in the improvement in pain and function. This study investigates if computerised physiotherapy using gamification principles are as effective as standard physiotherapy. Methods: Physiotherapy exergames were created using a combination of commercially available hardware, the Microsoft Kinect, and bespoke software. The exergames used were validated by mapping physiotherapy goals of physiotherapy which included; strength, range of movement, control, speed, and activation of the kinetic chain. A multicenter, randomised prospective controlled trial investigated the use of exergames on patients with Shoulder Impingement Syndrome who had undergone Arthroscopic Subacromial Decompression surgery. The intervention group was provided with the automated sensor-based technology, allowing them to perform exergames and track their rehabilitation progress. The control group was treated with standard physiotherapy protocols. Outcomes from different domains were used to compare the groups. An important metric was the assessment of shoulder range of movement pre- and post-operatively. The range of movement data included abduction, forward flexion and external rotation which were measured by the software, pre-operatively, 6 weeks and 12 weeks post-operatively. Results: Both groups show significant improvement from pre-operative to 12 weeks in elevation in forward flexion and abduction planes. Results for abduction showed an improvement for the interventional group (p < 0.015) as well as the test group (p < 0.003). Forward flexion improvement was interventional group (p < 0.0201) with the control group (p < 0.004). There was however no significant difference between the groups at 12 weeks for abduction (p < 0.118067) , forward flexion (p < 0.189755) or external rotation (p < 0.346967). Conclusion: Exergames may be used as an alternative to standard physiotherapy regimes; however, further analysis is required focusing on patient engagement.

Keywords: shoulder, physiotherapy, exergames, gamification

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4162 Experimental and Numerical Analysis of a Historical Bell Tower

Authors: Milorad Pavlovic, Sebastiano Trevisani, Antonella Cecchi

Abstract:

In this paper, a procedure for the evaluation of seismic behavior of slender masonry structures (towers, bell towers, chimneys, minarets, etc.) is presented. The presented procedure is based on a full three-dimensional modal analyses and frequency measurements. As well-known, masonry is a composite material formed by bricks, or stone blocks, and mortar arranged more or less regularly and adopted for many centuries as structural material. Dynamic actions may represent the major risk of collapse of brickworks, and despite the progress achieved so far in science and mechanics; the assessment of their seismic performance remains a challenging task. Then, reliable physical and numerical models are worthy of recommendation. In this paper, attention is paid to the historical bell tower of the Basilica of Santa Maria Gloriosa dei Frari - usually called Frari - one of the greatest churches in Venice, Italy.

Keywords: bell tower, FEM, masonry, modal analysis, non-destructive testing

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4161 Repercussions of Ritual Dances to Personal Adjustment: A Perspicacious Study Among School Children

Authors: Abdul Rahiman Kannam Kulam

Abstract:

Reflecting the concepts of the development of the whole child, it is claimed that, purposeful engagement in physical activities or exercise involved ritual dances has the potential to engender in young people, the purpose of the present study was to analyze school children and their personal adjustment based on Ritual dance participation. For the purpose, two thousand and three hundred school children of Kerala were analyzed. AISS manual of A.K.P Sinha and R.P Singh was used to collect the data for adjustments. The adjustment qualities classifies as excellent, good, average, unsatisfactory and very unsatisfactory. The total performance denotes the state of adjustment based on the classifications. Findings of the study were subjected to percentages and ‘t’ ratio. The study enlightened that, the emotional, social and overall adjustments are better than non-athletes. But the study elucidated that, there is no difference in educational adjustment of school athletes and non athletes among school children.

Keywords: ritual dances, emotional adjustment, Poorakkali, Kolkkali, Margamkali

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4160 A CMOS-Integrated Hall Plate with High Sensitivity

Authors: Jin Sup Kim, Min Seo

Abstract:

An improved cross-shaped hall plate with high sensitivity is described in this paper. Among different geometries that have been simulated and measured using Helmholtz coil. The paper describes the physical hall plate design and implementation in a 0.18-µm CMOS technology. In this paper, the biasing is a constant voltage mode. In the voltage mode, magnetic field is converted into an output voltage. The output voltage is typically in the order of micro- to millivolt and therefore, it must be amplified before being transmitted to the outside world. The study, design and performance optimization of hall plate has been carried out with the COMSOL Multiphysics. It is used to estimate the voltage distribution in the hall plate with and without magnetic field and to optimize the geometry. The simulation uses the nominal bias current of 1mA. The applied magnetic field is in the range from 0 mT to 20 mT. Measured results of the one structure over the 10 available samples show for the best sensitivity of 2.5 %/T at 20mT.

Keywords: cross-shaped hall plate, sensitivity, CMOS technology, Helmholtz coil

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4159 The Inverse Problem in the Process of Heat and Moisture Transfer in Multilayer Walling

Authors: Bolatbek Rysbaiuly, Nazerke Rysbayeva, Aigerim Rysbayeva

Abstract:

Relevance: Energy saving elevated to public policy in almost all developed countries. One of the areas for energy efficiency is improving and tightening design standards. In the tie with the state standards, make high demands for thermal protection of buildings. Constructive arrangement of layers should ensure normal operation in which the humidity of materials of construction should not exceed a certain level. Elevated levels of moisture in the walls can be attributed to a defective condition, as moisture significantly reduces the physical, mechanical and thermal properties of materials. Absence at the design stage of modeling the processes occurring in the construction and predict the behavior of structures during their work in the real world leads to an increase in heat loss and premature aging structures. Method: To solve this problem, widely used method of mathematical modeling of heat and mass transfer in materials. The mathematical modeling of heat and mass transfer are taken into the equation interconnected layer [1]. In winter, the thermal and hydraulic conductivity characteristics of the materials are nonlinear and depends on the temperature and moisture in the material. In this case, the experimental method of determining the coefficient of the freezing or thawing of the material becomes much more difficult. Therefore, in this paper we propose an approximate method for calculating the thermal conductivity and moisture permeability characteristics of freezing or thawing material. Questions. Following the development of methods for solving the inverse problem of mathematical modeling allows us to answer questions that are closely related to the rational design of fences: Where the zone of condensation in the body of the multi-layer fencing; How and where to apply insulation rationally his place; Any constructive activities necessary to provide for the removal of moisture from the structure; What should be the temperature and humidity conditions for the normal operation of the premises enclosing structure; What is the longevity of the structure in terms of its components frost materials. Tasks: The proposed mathematical model to solve the following problems: To assess the condition of the thermo-physical designed structures at different operating conditions and select appropriate material layers; Calculate the temperature field in a structurally complex multilayer structures; When measuring temperature and moisture in the characteristic points to determine the thermal characteristics of the materials constituting the surveyed construction; Laboratory testing to significantly reduce test time, and eliminates the climatic chamber and expensive instrumentation experiments and research; Allows you to simulate real-life situations that arise in multilayer enclosing structures associated with freezing, thawing, drying and cooling of any layer of the building material.

Keywords: energy saving, inverse problem, heat transfer, multilayer walling

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4158 Central Retinal Venous Occlusion Associated O Bilateral Optic Nerve Infiltration Revealing Relapse Of An Acute Lymphoblastic Leukemia

Authors: Fendouli Ines, Zaafrane Nesrine, Mhamdi Hana, Knani Leila, Ghorbel Mohamed

Abstract:

Introduction: Ocular infiltration of leukemia can involve orbit, uveal tract, retina and optic nerve. It may result from direct ocular infiltration by leukemic cells or indirect ocular involvement resulting from secondary hematologic changes, opportunistic infections and complications of various modalities of therapy. We here in report a case of central venous retinal occlusion associated to optic nerve infiltration as presenting signs of a relapse of acute lymphoblastic leukemia. Case Report: A twelve-year-old male -patient of acute B lymphoblastic leukemia presented with headaches and bilateral blurred vision in the left ee. Ophthalmic examination showed a visual acuity reduced to counting fingers in the right eye and no light perception in the left eye. Funduscopy revealed a voluminous disc edema surrounded by retinal haemorrhages in the right eye, and venous tortusities, papillary edema, and hemorrages suggesting central retinal venous occlusion in the LE. Swept source optical coherence tomography revealed a serous retinal detachment in the RE and .hyperreflective inner layers with macular edema in the left eye. Cerebro-orbital MRI showed bilateral thickened left optic nerve. There were no radiological signs of true papillary edema due to intracranial hypertension secondary to central nervous system involvement. Myelogram and lumbar punction demonstrated blast infiltration and confirmed ocular relapse of the leukemia. Conclusion: Ocular involvement lymphoblastic acute leukemias decreased since the introduction of a systematic prophylactic treatment of central nervous system. Periodic ophthalmic examination is necessary to allow early diagnosis and treatment.

Keywords: acute leukemia, optic nerve, infiltration, relapse

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