Search results for: heart failure reversal therapy

Authors: Roya Vakili, Lekaa Elhajjmoussa, Barzin Omidi-Shal, Kim Blake

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Objective: The purpose of this case report is to highlight the successful treatment of a patient with Coloboma, Heart defect, Atresia choanae, Retarded growth and development, Genital hypoplasia, Ear anomalies/deafness, (CHARGE syndrome) using a vagal nerve stimulator (VNS). Background: This is the first documented case report, to the authors' best knowledge, for a patient with CHARGE syndrome, epilepsy, autism, and postural orthostatic tachycardia syndrome (POTS) that was successfully treated with an implanted VNS therapeutic device. Methodology: The study is a case report. Results: This is the case of a 24-year-old female patient with CHARGE syndrome (non-random association of anomalies Coloboma, Heart defect, Atresia choanae, Retarded growth and development, Genital hypoplasia, Ear anomalies/deafness) and several other comorbidities including refractory epilepsy, Patent Ductus Arteriosus (PDA) and POTS who had significant improvement of her symptoms after VNS implantation. She was a VNS candidate given her longstanding history of drug-resistant epilepsy and current disposition secondary to CHARGE syndrome. Prior to VNS implantation, she experienced three generalized seizures a year and daily POTS-related symptoms. She was having frequent lightheadedness and syncope spells due to a rapid heart rate and low blood pressure. The VNS device was set to detect a rapid heart rate and send appropriate stimulation anytime the heart rate exceeded 20% of the patient’s normal baseline. The VNS device demonstrated frequent elevated heart rates and concurrent VNS release every 8 minutes in addition to the programmed events. Following VNS installation, the patient became more active, alert, and communicative and was able to verbally communicate with words she was unable to say prior. Her GI symptoms also improved, as she was able to tolerate food better orally in addition to her G and J tube, likely another result of the vagal nerve stimulation. Additionally, the patient’s seizures and POTS-related cardiac events appeared to be well controlled. She had prolonged electroencephalogram (EEG) testing, showing no significant change in epileptiform activity. Improvements in the patient’s disposition are believed to be secondary to parasympathetic stimulation, adequate heart rate control, and GI stimulation, in addition to behavioral changes and other benefits via her implanted VNS. Conclusion: VNS showed promising results in improving the patient's quality of life and managing her diverse symptoms, including dysautonomia, POTs, gastrointestinal mobility, cognitive functioning as well seizure control.

Keywords: autism, POTs, CHARGE, VNS

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Authors: Omer Yeni

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Ground strata failure or fall-of-ground is one of the underground mines' most prominent catastrophic risks. Mining companies use various methods/technics to prevent and critically control the associated risks. Some of those are safety by design, excavation methods, ground support, training, and competency, which all require quality control and assurance activities to confirm their efficiencies and performances and identify improvement opportunities through monitoring. However, many mining companies use quality control (QC) methods without quality assurance (QA), and they call it QA/QC together as a habit. From a simple definition, QC is a method of detecting defects, and QA is a method of preventing defects. Testing the final products at the end of the production line is not the way of proper QA/QC application but testing every component before assembly and the final product once completed. The installed ground support elements are some final products mining companies use to prevent ground strata failure. Testing the final product (i.e., rock bolt pull testing, shotcrete strength test, etc.) with QC methods only while those areas are already accessible; is not like testing an airplane full of passengers right after the production line or testing a car after the sale. Can only QC methods be called QA/QC? Can QA/QC activities be numerically scored for each critical control implemented to assess ground strata failure potential? Can numerical scores be used to identify Geotechnical Risk Rating (GRR) to determine the ground strata failure risk and its probability? This paper sets out to provide a specific QA/QC methodology to manage and confirm efficiencies and performances of the implemented critical controls and a numerical approach through the Geotechnical Risk Rating (GRR) process to assess ground strata failure risk to determine the gaps where proactive action is required to evaluate the probability of ground strata failures in underground mines.

Keywords: fall of ground, ground strata failure, QA/QC, underground

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Authors: S. Altmeyer, B. Hof, F. Marques, J. M. Lopez

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We present numerical simulations concerning the reversal of spiraling vortices in short highly counter-rotating cylinders. Increasing the differential cylinder rotation results in global flow-inversion is which develops various different and complex flow dynamics of several quasi-periodic solutions that differ in their number of vortex cells in the bulk. The dynamics change from being dominated of the inner cylinder boundary layer with ’passive’ only responding outer one to be dominated by the outer cylinder boundary layer with only responding inner one. Solutions exist on either two or three tori invariant manifolds whereby they appear as symmetric or asymmetric states. We find for either moderate and high inner cylinder rotation speed the quasiperiodic flow to consist of only two vortex cells but differ as the vortices has opposite spiraling direction. These both flows live on 2-tori but differ in number of symmetries. While for the quasi-periodic flow (q^a_2) at lower rotation speed a pair of symmetrically related 2-tori T2 exists the quasi-periodic flow (q^s_2) at higher rotation speeds is symmetric living on a single 2-torus T2. In addition these both flows differ due to their dominant azimuthal m modes. The first is dominated by m=1 whereas for the latter m=3 contribution is largest. The 2-tori states are separated by a further quasi-periodic flow (q^a_3) living on pair of symmetrically related 3-tori T3. This flow offers a ’periodical’ competition between a two and three vortex cell states in the bulk. This flow is also an m=1 solution as for the quasiperiodic flows living on the pair of symmetrically-related 2-tori states. Moreover we find hysteresis resulting in coexisting regions of different quasiperiodic flows q^s_2 and q^a_3 with increasing and decreasing the differential rotation.

Keywords: transition, bifurcation, torus, symmetries

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Authors: Fu-Pei Hsiao, Fung-Chung Tu, Chien-Kuo Chiu

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In this work, to develop a method for detailed assesses of post-earthquake seismic performance for RC buildings in Taiwan, experimental data for several column specimens with various failure modes (flexural failure, flexural-shear failure, and shear failure) are used to derive reduction factors of seismic capacity for specified damage states. According to the damage states of RC columns and their corresponding seismic reduction factors suggested by experimental data, this work applies the detailed seismic performance assessment method to identify the seismic capacity of earthquake-damaged RC buildings. Additionally, a post-earthquake emergent assessment procedure is proposed that can provide the data needed for decision about earthquake-damaged buildings in a region with high seismic hazard. Finally, three actual earthquake-damaged school buildings in Taiwan are used as a case study to demonstrate application of the proposed assessment method.

Keywords: seismic assessment, seismic reduction factor, residual seismic ratio, post-earthquake, reinforced concrete, building

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Authors: Daniel Thompson, Muhammad Peerbux, Sophie Cerutti, Hansraj Bookun

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Introduction: Dialysis access is a key component of the care of patients with end stage renal failure. In our institution, a combined service of vascular surgeons and nephrologists are responsible for the creation and maintenance of arteriovenous fisultas (AVF), tenckhoff cathethers and Hickman/permcath lines. This poster investigates the last 10 years of dialysis access surgery conducted at St. Vincent’s Hospital Melbourne. Method: A cross-sectional retrospective analysis was conducted of patients of St. Vincent’s Hospital Melbourne (Victoria, Australia) utilising data collection from the Australasian Vascular Audit (Australian and New Zealand Society for Vascular Surgery). Descriptive demographic analysis was carried out as well as operation type, length of hospital stays, postoperative deaths and need for reoperation. Results: 2085 patients with renal failure were operated on between the years of 2011 and 2020. 1315 were male (63.1%) and 770 were female (36.9%). The mean age was 58 (SD 13.8). 92% of patients scored three or greater on the American Society of Anesthiologiests classification system. Almost half had a history of ischaemic heart disease (48.4%), more than half had a history of diabetes (64%), and a majority had hypertension (88.4%). 1784 patients had a creatinine over 150mmol/L (85.6%), the rest were on dialysis (14.4%). The most common access procedure was AVF creation, with 474 autologous AVFs and 64 prosthetic AVFs. There were 263 Tenckhoff insertions. We performed 160 cadeveric renal transplants. The most common location for AVF formation was brachiocephalic (43.88%) followed by radiocephalic (36.7%) and brachiobasilic (16.67%). Fistulas that required re-intervention were most commonly angioplastied (n=163), followed by thrombectomy (n=136). There were 107 local fistula repairs. Average length of stay was 7.6 days, (SD 12). There were 106 unplanned returns to theatre, most commonly for fistula creation, insertion of tenckhoff or permacath removal (71.7%). There were 8 deaths in the immediately postoperative period. Discussion: Access to dialysis is vital for patients with end stage kidney disease, and requires a multidisciplinary approach from both nephrologists, vascular surgeons, and allied health practitioners. Our service provides a variety of dialysis access methods, predominately fistula creation and tenckhoff insertion. Patients with renal failure are heavily comorbid, and prolonged hospital admission following surgery is a source of significant healthcare expenditure. AVFs require careful monitoring and maintenance for ongoing utility, and our data reflects a multitude of operations required to maintain usable access. The requirement for dialysis is growing worldwide and our data demonstrates a local experience in access, with preferred methods, common complications and the associated surgical interventions.

Keywords: dialysis, fistula, nephrology, vascular surgery

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Authors: Alireza Monzavi Chaleshtari, Mahnaz Aliakbari Dehkordi, Amin Asadi Hieh, Majid Kazemnezhad

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This research was conducted with the aim of determining the effectiveness of sexual cognitive behavioral therapy on psychological performance and openness to experience in women. The type of research was experimental in the form of pre-test-post-test. The statistical population of this research was made up of all working and married women with membership in the researcher's Instagram social network who had problems in marital-sexual relationships (N=900). From the statistical community, which includes working and married women who are members of the researcher's Instagram social network who have problems in marital-sexual relationships, there are 30 people including two groups (15 people in the experimental group and 15 people in the control group) as available sampling and selected randomly. They were placed in two experimental and control groups. The anxiety, stress, and depression scale (DASS) and the Costa and McCree personality questionnaire were used to collect data, and the cognitive behavioral therapy protocol of Dr. Mehrnaz Ali Akbari was used for the treatment sessions. To analyze the data, the covariance test was used in the SPSS22 software environment. The results showed that sexual cognitive behavioral therapy has a positive and significant effect on psychological performance and openness to experience in women. Conclusion: It can be concluded that interventions such as cognitive-behavioral sex can be used to treat marital problems.

Keywords: sexual cognitive behavioral therapy, psychological function, openness to experience, women

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Authors: B. Paygozar, S.A. Dizaji, A.C. Kandemir

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In this study, the effects of the modified adhesive including different concentrations of Nano-silica are surveyed on the bonding strength of the adhesive scarf joints. The nanoparticles are added in two different concentrations, to an epoxy-based two-component structural adhesive, Araldite 2011, to survey the influences of the nanoparticle weight percentage on the failure load of the joints compared to that of the joints manufactured by the neat adhesive. The effects of being exposure to a moist ambience on the joint strength are also investigated for the joints produced of both neat and modified adhesives. For this purpose, an ageing process was carried out on the joints of both neat and improved kinds with variable immersion periods (20, 40 and 60 days). All the specimens were tested under a quasi-static tensile loading of 2 mm/min speed so as to find the quantities of the failure loads. Outcomes indicate that the failure loads of the joints with modified adhesives are measurably higher than that of the joint with neat adhesive, even while being put for a while under a moist condition. Another result points out that humidity lessens the bonding strength of all the joints of both types as the exposure time increases, which can be attributed to the change in the failure mode.

Keywords: bonding strength, humidity, nano-silica, scarf joint

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Authors: Vardan Melkonyan, Arman Azizyan, Astghik Boyajyan

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Virtual reality (VR) exposure therapy is a form of cognitive-behavioral therapy that uses immersive virtual environments to expose individuals to the feared stimuli or situations that trigger their phobia. VR exposure therapy has become an increasingly popular treatment for phobias, including fear of heights, public speaking, and flying, due to its ability to provide a controlled and safe environment for individuals to confront their fears while also allowing therapists to tailor the virtual exposure to the specific needs and goals of each individual. It is also a cost-effective and accessible treatment option, as it can be delivered remotely and does not require the use of drugs. Overall, VR exposure therapy has the potential to be a valuable tool for therapists in the treatment of phobias. But current methods may be improved by incorporating advanced technology such as photorealistic VR environments, tactile feedback suits, and responsive systems. The aim of this study was to identify the most effective approach for enhancing VR exposure therapy for the treatment of phobias. Photorealistic VR environments and stimuli can greatly enhance the effectiveness of VR exposure therapy for the treatment of phobias. By creating immersive, realistic virtual environments that closely mimic the real-life situations that trigger phobia responses, patients are able to more fully engage in the therapeutic process and confront their fears in a controlled and safe manner. This can help to reduce the severity of phobia symptoms and increase treatment outcomes. The use of tactile feedback suits and responsive systems can further enhance the VR exposure therapy experience by adding a physical element to the virtual environment. These suits, which can mimic the sensations of touch, pressure, and movement, allow patients to fully immerse themselves in the virtual world and feel as if they are physically present in the situation. This can help to increase the realism of the virtual environment and make it more effective in reducing phobia symptoms. Additionally, responsive systems can be used to trigger specific events or responses within the virtual environment based on the patient's actions, providing a more interactive and personalized treatment experience. A comprehensive literature review was conducted, including studies on VR exposure therapy for phobias and the use of advanced technology to enhance the therapy. Results indicate that incorporating these enhancements may significantly increase the effectiveness of VR exposure therapy for phobias. Further research is needed to fully understand the potential of these enhancements and to determine the optimal combination and implementation.

Keywords: virtual reality, mental health, phobias, fears, treatment, photorealistic, immersive, phobia

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Authors: Chaoyi Sun, Congxin Chen, Yun Zheng, Kaizong Xia, Wei Zhang

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Crest loads are often encountered in hydropower, highway, open-pit and other engineering rock slopes. Toppling failure is one of the most common deformation failure types of anti-dip bedding rock slopes. Analysis on such failure of anti-dip bedding rock slopes subjected to crest loads has an important influence on engineering practice. Based on the step-by-step analysis approach proposed by Goodman and Bray, a geo-mechanical model was developed, and the related analysis approach was proposed for the toppling failure of anti-dip bedding rock slopes subjected to crest loads. Using the transfer coefficient method, a formulation was derived for calculating the residual thrust of slope toe and the support force required to meet the requirements of the slope stability under crest loads, which provided a scientific reference to design and support for such slopes. Through slope examples, the influence of crest loads on the residual thrust and sliding ratio coefficient was investigated for cases of different block widths and slope cut angles. The results show that there exists a critical block width for such slope. The influence of crest loads on the residual thrust is non-negligible when the block thickness is smaller than the critical value. Moreover, the influence of crest loads on the slope stability increases with the slope cut angle and the sliding ratio coefficient of anti-dip bedding rock slopes increases with the crest loads. Finally, the theoretical solutions and numerical simulations using Universal Distinct Element Code (UDEC) were compared, in which the consistent results show the applicability of both approaches.

Keywords: anti-dip bedding rock slope, crest loads, stability analysis, toppling failure

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Authors: Abdelmounaim Zanaz, Sylvie Yotte, Fazia Fouchal, Alaa Chateauneuf

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This paper presents a methodology for probabilistic assessment of bearing capacity and prediction of failure mechanism of masonry vaults at the ultimate state with consideration of the natural variability of Young’s modulus of stones. First, the computation model is explained. The failure mode is the most reported mode, i.e. the four-hinge mechanism. Based on this assumption, the study of a vault composed of 16 segments is presented. The Young’s modulus of the segments is considered as random variable defined by a mean value and a coefficient of variation CV. A relationship linking the vault bearing capacity to the modulus variation of voussoirs is proposed. The failure mechanisms, in addition to that observed in the deterministic case, are identified for each CV value as well as their probability of occurrence. The results show that the mechanism observed in the deterministic case has decreasing probability of occurrence in terms of CV, while the number of other mechanisms and their probability of occurrence increase with the coefficient of variation of Young’s modulus. This means that if a significant change in the Young modulus of the segments is proven, taken it into account in computations becomes mandatory, both for determining the vault bearing capacity and for predicting its failure mechanism.

Keywords: masonry, mechanism, probability, variability, vault

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Authors: Arben Murtezani, Shefqet Mrasori, Vančo Spirov, Bukurije Rama, Oliver Dimitrovski, Visar Bunjaku

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Overview: Temporomandibular disorders (TMDs) are chronic musculoskeletal pain conditions. Clinical indicators of discomfort are related to the use of the joint stiffness during first motions after extended rest and restricted joint range of motion can cause substantial pain and disability. There is little evidence that physical therapy methods of management cause long-lasting reduction in signs and symptoms. Exercise programs premeditated to improve physical fitness have beneficial effects on chronic pain and disability of the musculoskeletal system. Objective: The aim of this study was to assess the effectiveness of physical therapy interventions in the management of temporomandibular disorders. Materials and Methods: A prospective comparative study with a 2-month follow-up period was conducted between April 2016 and June 2016 at the Physical Medicine and Rehabilitation Clinic in Prishtina. Forty six patients with TMDs, (more than three months duration of symptoms) were randomized into two groups: the TENS therapy group (n=24) and combination of active exercise and manual therapy group (n=22). The TENS therapy group patients were treated with twelve sessions of TENS. The treatment period of both groups was 3 weeks at an outpatient clinic. Following main outcome measures were evaluated: (1) pain at rest (2) pain at stress (3) impairment (4) mouth opening at base-line, before and after treatment and at 3 month follow-up. Results: Significant reduction in pain was observed in both treatment groups. In the TENS group 73% (16/22) achieved at least 80% improvement from baseline in TMJ pain at 2 months compared with 54% (13/24) in the exercise group (difference of 19%; 95% confidence interval 220 to 30%). Active and passive maximum mouth opening has been greater in the TENS group (p < 0.05). Conclusion: Exercise therapy in combination with TENS seems to be useful in the treatment of temporomandibular disorders.

Keywords: temporomandibular joint disorders, TENS, manual therapy, exercise

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Authors: Somayeh Negahdari, Mohsen Ghanbarzadeh, Masoud Nikbakht, Heshmatolah Tavakol

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Asthma, obesity and overweight are the main factors causing change within the heart and respiratory airways. Asthma symptoms are normally observed during exercising. Epidemiological studies have indicated asthma symptoms occurring due to certain lifestyle habits; for example, a sedentary lifestyle. In this study, eight weeks of aerobic exercises resulted in a positive effect overall in overweight women experiencing mild chronic asthma. The quasi-experimental applied research has been done based on experimental and control groups. The experimental group (seven patients) and control group (n = 7) were graded before and after the test. According to the Borg dyspnea and fatigue Perception Index, the training intensity has determined. Participants in the study performed a sub-maximal aerobic activity schedule (45% to 80% of maximum heart rate) for two months, while the control group (n = 7) stayed away from aerobic exercise. Data evaluation and analysis of covariance compared both the pre-test and post-test with paired t-test at significance level of P≤ 0.05. After eight weeks of exercise, the results of the experimental group show a significant decrease in resting heart rate, systolic blood pressure, minute ventilation, while a significant increase in maximal oxygen uptake and tolerance activity (P ≤ 0.05). In the control group, there was no significant difference in these parameters ((P ≤ 0.05). The results indicate the aerobic activity can strengthen the respiratory muscles, while other physiological factors could result in breathing and heart recovery. Aerobic activity also resulted in favorable changes in cardiovascular parameters, and exercise tolerance of overweight women with chronic asthma.

Keywords: asthma, respiratory cardiac index, exercise tolerance, aerobic, overweight

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Authors: Haider Al-Zubaidy, Xiao-Ling Zhao, Riadh Al-Mahaidi

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In recent years, the technique adhesively-bonded fibre reinforced polymer (FRP) composites has found its way into civil engineering applications and it has attracted a widespread attention as a viable alternative strategy for the retrofitting of civil infrastructure such as bridges and buildings. When adopting this method, adhesive has a significant role and controls the general performance and degree of enhancement of the strengthened and/or upgraded structures. This is because the ultimate member strength is highly affected by the failure mode which is considerably dependent on the utilised adhesive. This paper concerns with experimental investigations on the effect of the adhesive used on the bond between CFRP patch and steel plate under medium impact tensile loading. Experiment were conducted using double strap joints and these samples were prepared using two different types of adhesives, Araldite 420 and MBrace saturant. Drop mass rig was used to carry out dynamic tests at impact speeds of 3.35, 4.43 and m/s while quasi-static tests were implemented at 2mm/min using Instrone machine. In this test program, ultimate load-carrying capacity and failure modes were examined for all loading speeds. For both static and dynamic tests, the adhesive type has a significant effect on ultimate joint strength. It was found that the double strap joints prepared using Araldite 420 showed higher strength than those prepared utilising MBrace saturant adhesive. Failure mechanism for joints prepared using Araldite 420 is completely different from those samples prepared utilising MBrace saturant. CFRP failure is the most common failure pattern for joints with Araldite 420, whereas the dominant failure for joints with MBrace saturant adhesive is adhesive failure.

Keywords: CFRP/steel double strap joints, adhesives of different ductility, dynamic tensile loading, bond between CFRP and steel

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Authors: Mohammedi Ferhate

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This work presents details of the study of the entire flow inside the facility where the exothermic chemical reaction process in the chemical laser cavity is analyzed. In our paper we will describe the principles of chemical lasers where flow reversal is produced by chemical reactions. We explain the device for converting chemical potential energy laser energy. We see that the phenomenon thus has an explosive trend. Finally, the feasibility and effectiveness of the proposed method is demonstrated by computer simulation

Keywords: genetic, lasers, nozzle, programming

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Authors: Richard Colwell, Thomas Englert

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In cryogenic liquefaction processes, brazed aluminum core heat exchangers are used to minimize surface area/volume of the exchanger. Aluminum alloy (5083-H321; UNS A95083) piping must transition to higher melting point 304L stainless steel piping outside of the heat exchanger kettle or cold box for safety reasons. Since aluminum alloys and austenitic stainless steel cannot be directly welded to together, a transition joint consisting of 5 layers of different metals explosively bonded are used. Failures of two of these joints resulted in process shut-down and loss of revenue. Failure analyses, FEA analysis, and mock-up testing were performed by multiple teams to gain a further understanding into the failure mechanisms involved.

Keywords: explosion bonding, intermetallic compound, thermal strain, titanium-nickel Interface

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Authors: Andrew Anis Fakhrey Mosaad

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Introduction: There are many different types of sleep disorders, each with serious implications for a person's health and a large financial burden on society. Method: This review offers a framework based on the International Classification of Sleep Disorders to aid in the diagnosis and treatment of sleep disorders. Differentiating between primary and secondary insomnia is covered, along with pharmacological and nonpharmacological therapy options. Common abnormalities of the circadian rhythm are mentioned along with their therapies, such as light therapy and chronotherapy. This article discusses the identification and management of periodic limb movement disorder and restless legs syndrome. The therapy of upper airway resistance syndrome and obstructive sleep apnea are the main topics of discussion. Conclusion: The range of narcolepsy symptoms and results, as well as diagnostic procedures and treatment, are discussed. The causes, outcomes, and treatments of many types of insomnias, such as sleep terrors, somnambulism, and rapid eye movement (REM) behavior sleep disorders, are discussed.

Keywords: diagnosis, treatment, sleep disorders, insomnia

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Authors: H. Akhloufi, M. Hulscher, J. M. Prins, I. H. Van Der Sijs, D. Melles, A. Verbon

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Background: A timely switch from intravenous to oral antibiotic therapy has many advantages, such as reduced incidence of IV-line related infections, a decreased hospital length of stay and less workload for healthcare professionals with equivalent patient safety. Additionally, numerous studies have demonstrated significant decreases in costs of a timely intravenous to oral antibiotic therapy switch, while maintaining efficacy and safety. However, a considerable variation in iv to oral antibiotic switch therapy criteria has been described in literature. Here, we report the development of a set of iv to oral switch criteria that are generally applicable in all hospitals. Material/methods: A RAND-modified Delphi procedure, which was composed of 3 rounds, was used. This Delphi procedure is a widely used structured process to develop consensus using multiple rounds of questionnaires within a qualified panel of selected experts. The international expert panel was multidisciplinary and composed out of clinical microbiologists, infectious disease consultants and clinical pharmacists. This panel of 19 experts appraised 6 major intravenous to oral antibiotic switch therapy criteria and operationalized these criteria using 41 measurable conditions extracted from the literature. The procedure to select a concise set of iv to oral switch criteria included 2 questionnaire rounds and a face-to-face meeting. Results: The procedure resulted in the selection of 16 measurable conditions, which operationalize 6 major intravenous to oral antibiotic switch therapy criteria. The following 6 major switch therapy criteria were selected: (1) Vital signs should be good or improving when bad. (2) Signs and symptoms related to the infection have to be resolved or improved. (3) The gastrointestinal tract has to be intact and functioning. (4) The oral route should not be compromised. (5) Absence of contra-indicated infections. (6) An oral variant of the antibiotic with good bioavailability has to exist. Conclusions: This systematic stepwise method which combined evidence and expert opinion resulted in a feasible set of 6 major intravenous to oral antibiotic switch therapy criteria operationalized by 16 measurable conditions. This set of early antibiotic iv to oral switch criteria can be used in daily practice in all adult hospital patients. Future use in audits and as rules in computer assisted decision support systems will lead to improvement of antimicrobial steward ship programs.

Keywords: antibiotic resistance, antibiotic stewardship, intravenous to oral, switch therapy

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Authors: A. S. Grewal, R. S. Sangwan, Dharambir, Vikas Dhanda

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The purpose of this paper is to develop and analyze two reliability models for a system of non-identical firearms – one is standard firearm (called as original unit) and the other is a country-made firearm (called as duplicate /substandard unit). There is a single server who comes immediately to do inspection and repair whenever needed. On the failure of standard firearm, the server inspects the operative country-made firearm to see whether the unit is capable of performing the desired function well or not. If country-made firearm is not capable to do so, the operation of the system is stopped and server starts repair of the standard firearms immediately. However, no inspection is done at the failure of the country-made firearm as the country-made firearm alone is capable of performing the given task well. In model I, priority to repair the standard firearm is given in case system fails completely and country-made firearm is already under repair, whereas in model II there is no such priority. The failure and repair times of each unit are assumed to be independent and uncorrelated random variables. The distributions of failure time of the units are taken as negative exponential while that of repair and inspection times are general. By using semi-Markov process and regenerative point technique some econo-reliability measures are obtained. Graphs are plotted to compare the MTSF (mean time to system failure), availability and profit of the models for a particular case.

Keywords: non-identical firearms, inspection, priority to repair, semi-Markov process, regenerative point

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Authors: Hossein Ilanloo, Sedigheh Ahmadi, Kianoosh Zahrakar

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The present study aims at investigating the effectiveness of group counseling of mindfulness-based cognitive therapy on cognitive emotion regulation in high school students. The research design was quasi-experimental and pre-test-post-test type and a two-month follow-up with a control group. The statistical population of the study consisted of all-male high school students in Takestan city in the Academic Year 2020-2021. The sample comprised 30 high school male students selected through the convenience sampling method and randomly assigned to experimental (n=15) and control (n=15) groups. The experimental group then received ten sessions of 90-minute group counseling of mindfulness-based cognitive therapy, and the control group did not receive any intervention. In order to collect data, the author used the Cognitive Emotion Regulation Questionnaire (CERQ). The researcher also used multivariate analysis of covariance, repeated measures, LSD post hoc test, and SPSS-26 software for data analysis.

Keywords: mindfulness-based cognitive therapy, cognitive emotion regulation, students, high schools

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Authors: Wiesława Klimek-Piotrowska, Mateusz K. Hołda, Mateusz Koziej, Katarzyna Piątek, Jakub Hołda

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Introduction: The coronary sinus venous system (CSVS), which has always been overshadowed by the coronary arterial tree, has recently begun to attract more attention. Since it is a target for clinicians the knowledge of its anatomy is essential. Cardiac resynchronization therapy, catheter ablation of cardiac arrhythmias, defibrillation, perfusion therapy, mitral valve annuloplasty, targeted drug delivery, and retrograde cardioplegia administration are commonly used therapeutic methods involving the CSVS. The great variability in the course of coronary veins and tributaries makes the diagnostic and therapeutic processes difficult. Our aim was to investigate detailed anatomy of most common clinically used CSVS`s structures: the coronary sinus with its ostium, great cardiac vein, posterior vein of the left ventricle, middle cardiac vein and oblique vein of the left atrium. Methodology: This is a prospective study of 70 randomly selected autopsied hearts dissected from adult humans (Caucasian) aged 50.1±17.6 years old (24.3% females) with BMI=27.6±6.7 kg/m2. The morphology of the CSVS was assessed as well as its precise measurements were performed. Results: The coronary sinus (CS) with its ostium was present in all hearts. The mean CS ostium diameter was 9.9±2.5mm. Considered ostium was covered by its valve in 87.1% with mean valve height amounted 5.1±3.1mm. The mean percentage coverage of the CS ostium by the valve was 56%. The Vieussens valve was present in 71.4% and was unicuspid in 70%, bicuspid in 26% and tricuspid in 4% of hearts. The great cardiac vein was present in all cases. The oblique vein of the left atrium was observed in 84.3% of hearts with mean length amounted 20.2±9.3mm and mean ostium diameter 1.4±0.9mm. The average length of the CS (from the CS ostium to the Vieussens valve) was 31.1±9.5mm or (from the CS ostium to the ostium of the oblique vein of the left atrium) 28.9±10.1mm and both were correlated with the heart weight (r=0.47; p=0.00 and r=0.38; p=0.006 respectively). In 90.5% the ostium of the oblique vein of the left atrium was located proximally to the Vieussens valve, in remaining cases was distally. The middle cardiac vein was present in all hearts and its valve was noticed in more than half of all the cases (52.9%). The posterior vein of the left ventricle was observed in 91.4% of cases. Conclusions: The CSVS is vastly variable and none of basic hearts parameters is a good predictor of its morphology. The Vieussens valve could be a significant obstacle during CS cannulation. Caution should be exercised in this area to avoid coronary sinus perforation. Because of the higher incidence of the presence of the oblique vein of the left atrium than the Vieussens valve, the vein orifice is more useful in determining the CS length.

Keywords: cardiac resynchronization therapy, coronary sinus, Thebesian valve, Vieussens valve

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Authors: Abeer N. Alshukairi, Abdulrahman A. Alrajhi, Abdulfattah W. Alamri, Adel F. Alothman

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We described the nosocomial transmission of a pre-XDR or an MDR case of pulmonary tuberculosis in a HIV negative health care worker in an area endemic for MDR & XDR tuberculosis. With inadequate therapy and non-compliance, his strain developed acquired resistance and he presented with extra-pulmonary XDR tuberculosis in the form of multi-focal osteomyelitis and encysted pleural effusion. He was cured after 2 years of therapy with various anti-tuberculous drugs in addition to interferon gamma.

Keywords: osteomyelitis, treatment, XDR tuberculosis, successful treatment

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Authors: Rawa Delshada, Sanaa G. Hamab, Rastee D. Koyeec

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Eighty patients with suspected ischemic heart disease were enrolled in the present study. They were classified into two groups: patients with positive exercise stress test results (n=40) and control group with negative exercise stress test results (n=40). Serum concentration of troponin I, Heart-type Fatty Acid Binding Protein (H-FABP) and Ischemia Modified Albumin (IMA) were measured one hour after performing stress test. Enzyme Linked Immunosorbent Assay was used to measure both troponin I, H-FABP levels, while IMA levels were measured by albumin cobalt binding test. There was no statistically significant difference in the mean concentration of troponin I between two groups (0.75±0.55ng/ml) for patients with positive test result vs. (0.71±0.55ng/ml) for negative test result group with P>0.05. Contrary to our expectation, mean IMA level was slightly higher among control group (70.88±39.76U/ml) compared to (62.7±51.9U/ml) in positive test result group, but still with no statistically significant difference (P>0.05). Median H-FABP level was also higher among negative exercise stress testing group compared the positive one (2ng/ml vs. 1.9ng/ml respectively), but failed to reach statistically significant difference (P>0.05). When quartiles model used to explore the possible association between each study biomarkers with the others; serum H-FABP level was lowest (1.7ng/ml) in highest quartile of IMA and lowest H-FABP (1.8ng/ml) in highest quartile of troponin I but with no statistically significant association (P>0.05). Myocardial ischemia, more likely occurred after exercise stress test, is not capable of causing troponin I release. Furthermore, an increase in H-FABP and IMA levels after stress test are not reflecting myocardial ischemia. Moreover, the combination of troponin I, H-FABP and IMA after measuring their post exercise levels does not improve the diagnostic utility of exercise stress test enormously.

Keywords: cardiac biomarkers, ischemic heart disease, troponin I, ischemia modified albumin, heart-type fatty acid binding protein, exercise stress testing

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Authors: Weigao. Wu, Stefano. Utili

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Based on the kinematic approach of limit analysis, a full set of upper bound solutions for the stability of homogeneous rock slopes subjected to tension cracks are obtained. The generalized Hoek-Brown failure criterion is employed to describe the non-linear strength envelope of rocks. In this paper, critical failure mechanisms are determined for cracks of known depth but unspecified location, cracks of known location but unknown depth, and cracks of unspecified location and depth. It is shown that there is a nearly up to 50% drop in terms of the stability factors for the rock slopes intersected by a tension crack compared with intact ones. Tables and charts of solutions in dimensionless forms are presented for ease of use by practitioners.

Keywords: Hoek-Brown failure criterion, limit analysis, rock slope, tension cracks

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Authors: Fadwa Chtioui

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Vital Pulp Therapy (VPT) is nowadays challenging the deep-rooted dogma of root canal treatment, being the only therapeutic option for permanent teeth diagnosed with irreversible pulpitis or carious pulp exposure. Histologic and clinical research has shown that compromised dental pulp can be treated without the full removal or excavation of all healthy pulp, and the outcome of the partial or full pulpotomy followed by a Tricalcium-Silicate-based dressing seems to show promising results in maintaining pulp vitality and preserving affected teeth in the long term. By reviewing recent advances in the techniques of VPT and their clinical effectiveness and safety in permanent teeth with irreversible Pulpitis, this work provides a new understanding of pulp pathophysiology and defense mechanisms and will reform dental practitioners' decision-making in treating irreversible pulpits from root canal therapy to vital pulp therapy by taking advantage of the biological effects of Tricalcium Silicate materials. Biography of presenting author: Fadwa Chitoui graduated from the school of Dental Medicine of Monastir, Tunisia, in 2015. After getting her DDS degree with honors, she earned her Postgraduate master's Degree in Endodontics and Restorative Dentistry from her Faculty. Since 2021, she has Started her own private and specialized practice based in the capital Tunis. She enjoys the sphere of associative life, worked with national and international associations, and got engaged in scientific dental research, whereby she tailored her passion for her field of specialty towards broadening her knowledge and ambitions, holding conferences and workshops nationally and internationally and publishing scientific articles in several journals.

Keywords: irreversible pulpitis, permanenet teeth, vital pulp therapy, pulpotomy

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Authors: M. Ezzat, Y. Zaghloul, T. Sorour, A. Hefny, M. Eid

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Ultimate capacity of large diameter bored piles is usually determined from pile loading tests as recommended by several international codes and foundation design standards. However, loading of this type of piles till achieving apparent failure is practically seldom. In this paper, numerical analyses are carried out to simulate load test of a large diameter bored pile performed at the location of Alzey highway bridge project (Germany). Test results of pile load settlement relationship till failure as well as results of the base and shaft resistances are available. Apparent failure was indicated in this test by the significant increase of the induced settlement during the last load increment applied on the pile head. Measurements of this pile load test are used to assess the quality of the numerical models investigated. Three different material soil models are implemented in the analyses: Mohr coulomb (MC), Soft soil (SS), and Modified Mohr coulomb (MMC). Very good agreement is obtained between the field measured settlement and the calculated settlement using the MMC model. Results of analysis showed also that the MMC constitutive model is superior to MC, and SS models in predicting the ultimate base and shaft resistances of the large diameter bored pile. After calibrating the numerical model, behavior of large diameter bored piles under axial loads is discussed and the formation of the plastic zone around the pile is explored. Results obtained showed that the plastic zone below the base of the pile at failure extended laterally to about four times the pile diameter and vertically to about three times the pile diameter.

Keywords: ultimate capacity, large diameter bored piles, plastic zone, failure, pile load test

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Authors: Reisy Tane

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Asthma is the common health problems in adolescents. Self-management is one way to improve health status in adolescent with asthma. Mobile technology has the potential to improve self-management in adolescents with asthma. Objective: the aim of this study to determine the effectiveness of using the mobile technology Asthma Action Plan to improve self management. Method: this study is Systematic review approach using PRISM template. The literature search started on first September 2017 by using electronic data Pro Quest and Google Scholars with keywords ‘Mobile AAP’ and ‘Adolescent Asthma’. Results and Conclusion: M-AAP is effective to improve adolescent self-management with asthma because it is easy to use and provide information appropriately. The improvement of self-management in teenagers will enhance the quality of life of adolescents with asthma. The recommendation of this study is the addition of parental control content in the application appropriate with Family Centered Care (FCC) philosophy on pediatric nursing. In addition, it is expected the development of applications for other chronic diseases such as diabetes mellitus and congestive heart failure.

Keywords: asthma, mobile AAP, adolescent, self-management

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Authors: Kathryn L. Duncan, Charles A. Kuntz, Alessandra C. Santamaria, James O. Simcock

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Access to megavoltage radiation therapy for small animals is limited in many locations around the world. This can preclude the use of palliative radiation therapy for the treatment of appendicular osteosarcoma in dogs. The objective of this study was to retrospectively assess the adverse effects and survival times of dogs with appendicular osteosarcoma that were treated with hypofractionated orthovoltage radiation therapy and adjunctive carboplatin chemotherapy administered via a single subcutaneous infusion. Medical records were reviewed retrospectively to identify client-owned dogs with spontaneously occurring appendicular osteosarcoma that was treated with palliative orthovoltage radiation therapy and a single subcutaneous infusion of carboplatin. Data recorded included signalment, tumour location, results of diagnostic imaging, haematologic and serum biochemical analyses, adverse effects of radiation therapy and chemotherapy, and survival times. Kaplan-Meier survival analysis was performed, and log-rank analysis was used to determine the impact of specific patient variables on survival time. Twenty-three dogs were identified that met the inclusion criteria. Median survival time for dogs was 182 days. Eleven dogs had adverse haematologic effects, 3 had adverse gastrointestinal effects, 6 had adverse effects at the radiation site and 7 developed infections at the carboplatin infusion site. No statistically significant differences were identified in survival times based on sex, tumour location, development of infection, or pretreatment serum alkaline phosphatase. Median survival time and incidence of adverse effects were comparable to those previously reported in dogs undergoing palliative radiation therapy with megavoltage or cobalt radiation sources and conventional intravenous carboplatin chemotherapy. The use of orthovoltage palliative radiation therapy may be a reasonable alternative to megavoltage radiation in locations where access is limited.

Keywords: radiotherapy, veterinary oncology, chemotherapy, osteosarcoma

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Authors: Mikhail O. Eremin

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Present work is devoted to experimental study and numerical modelling of failure of rocks typical for Kuzbass coal basin (Russia). The main goal was to define strength and deformation characteristics of rocks on the base of uniaxial compression and three-point bending loadings and then to build a mathematical model of failure process for both types of loading. Depending on particular physical-mechanical characteristics typical rocks of Kuzbass coal basin (sandstones, siltstones, mudstones, etc. of different series – Kolchuginsk, Tarbagansk, Balohonsk) manifest brittle and quasi-brittle character of failure. The strength characteristics for both tension and compression are found. Other characteristics are also found from the experiment or taken from literature reviews. On the base of obtained characteristics and structure (obtained from microscopy) the mathematical and structural models are built and numerical modelling of failure under different types of loading is carried out. Effective characteristics obtained from modelling and character of failure correspond to experiment and thus, the mathematical model was verified. An Instron 1185 machine was used to carry out the experiments. Mathematical model includes fundamental conservation laws of solid mechanics – mass, impulse, energy. Each rock has a sufficiently anisotropic structure, however, each crystallite might be considered as isotropic and then a whole rock model has a quasi-isotropic structure. This idea gives an opportunity to use the Hooke’s law inside of each crystallite and thus explicitly accounting for the anisotropy of rocks and the stress-strain state at loading. Inelastic behavior is described in frameworks of two different models: von Mises yield criterion and modified Drucker-Prager yield criterion. The damage accumulation theory is also implemented in order to describe a failure process. Obtained effective characteristics of rocks are used then for modelling of rock mass evolution when mining is carried out both by an open-pit or underground opening.

Keywords: damage accumulation, Drucker-Prager yield criterion, failure, mathematical modelling, three-point bending, uniaxial compression

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Authors: Fatai Shola Afolabi

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The study identified and evaluates the causes of building failure and examined the effects of building failure with respect to cost in Lagos State, Nigeria. The method employed in the collection of data includes the administration of questionnaire to professionals in the construction industry and case studies for the sites. A purposive sampling technique was used for selecting the sites visited, and selecting the construction professionals. Descriptive statistical techniques such as frequency distribution and percentages and mean response analysis were used to analyze data. The study revealed that the major causes of building failures were bad design, faulty construction, over loading, non-possession of approved drawings, Possession of approved drawings but non-compliance, and the use of quarks. In the two case studies considered, the total direct loss to the building owners was thirty eight million three hundred and eight five thousand, seven hundred and twenty one naira (38,385,721) which is about One hundred and ninety four thousand, eighty hundred and fifty one dollars ($194,851) at one hundred and ninety seven naira to one US dollars, central bank Nigeria of exchange rate as at 14th March, 2015.

Keywords: building structures, building failure, building collapse, structural failure, cost, direct loss

Procedia PDF Downloads 244

Authors: Stephanie Elizabeth Talder

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Art therapy is a field that is growing exponentially with new groundbreaking discoveries that allow for embodying trauma and mental healing. Applied theatre and performance is a continuously growing and developing field that can help people who are struggling to work through traumatic experiences plaguing their life. By using performance, there is an ability to target sensitive topics in a manner that does not lead to re-traumatization. The use of theatre as a healing agent has been going on for centuries, with clear applications beginning in Greek theatre and tragedy. When working with complex mental illness, issues such as PTSD, anxiety, and depression can be managed and worked through. A central component of drama therapy is the connection to community and self. The ability to connect mind-body to stories as well as to other people allows for healing to occur. There is the opportunity for healing through emotional catharsis and community building. Applied theatre in connection to the medical field can allow for there to be a meaningful impact made on mental health. Though there is still a significant amount of progress to be made within the stigmatization of mental health problems, bringing in a varying option that allows for there to be movement and community building possesses a strong ability to impact people in a positive way.

Keywords: applied theatre, drama therapy, art therapy, performance, theatre

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