Search results for: operation control

Authors: Maher J. Tadros

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This research was conducted to study the effect of different salinity concentrations on the plant water relation and forage quality on two multipurpose forest trees species seedlings Leucaena leucocephala (Lam.) de wit and Acacia saligna (Labill.). Five different salinity concentrations mixture between sodium chloride and calcium chloride (v/v, 1:1) were applied. The control (Distilled Water), 2000, 4000, 6000, and 8000 ppm were used to water the seedlings for 3 months. The research results presented showed a marked variation among the two species in response to salinity. The Leucaena was able to withstand the highest level of salinity compared to Acacia all over the studied parameters except in the relative water content. Although all the morphological characteristics studied for the two species showed a marked decrease under the different salinity concentrations, except the shoot/root ratio that showed a trend of increase. The water stress measure the leaf water potential was more negative with as the relative water content increase under that saline conditions compared to the control. The forage quality represented by the crude protein and nitrogen content were low at 6000 ppm compared to the 8000 ppm in L. Leucocephala that increased compared that level in A. saligna. Also the results showed that growing both Leucaena and Acacia provide a good source of forage when that grow under saline condition which will be of great benefits to the agricultural sector especially in the arid and semiarid areas were these species can provide forage with high quality forage all year around when grown under irrigation with saline. This research recommended such species to be utilized and grown for forages under saline conditions.

Keywords: plant water relations, growth performance, salinity stress, protein content, forage quality, multipurpose trees

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Authors: Shahinaz El-Shourbagy El-Shourbagy, Ahmed M. E Ossman Ossman, Ashraf El-Mohamady El-Mohamady

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Objective: To investigate if there is a role of sildenafil citrate (Viagra) in the treatment of infertile couples for idiopathic cause. Design: An observational study. Setting: Infertility outpatient clinic of Tanta University Hospital Egypt. Patient(s): 50 unexplained infertility women {endometrial thickness (EM) and the mean resistance index (RI)} compared to 50 fertile control group attended for check-up in the same period and receiving no treatment. Intervention(s): unexplained infertility women were given 25 mg of sildenafil citrate suppositories four times per day for seven days starting from the 5th day of the menstrual cycle for three cycles. Main Outcome Measures: EM and RI of endometrial spiral artery were assessed by transvaginal color-pulsed Doppler ultrasound in unexplained infertility women before and after sildenafil citrate treatment and compared with control. The conception rate and pregnancy outcome were recorded in the two groups. Result(s): Women with unexplained infertility had significantly thinner endometrium and a higher spiral artery resistance index, meaning lower peri-implantation blood flow than the fertile controls. Sildenafil citrate treated women showed a statistically significant increase in endometrial thickness (p < 0.001) and a significant decrease in the mean spiral artery resistance index (p < 0.001) giving a better conception rate. Conclusion: Sildenafil citrate suppositories treatment enhance the endometrial blood flow through decreasing spiral artery resistance index 'RI' and consequently improve endometrial growth and receptivity in cases of unexplained infertility thus giving a better conception rate.

Keywords: Unexplained infertility, endometrial blood flow, endome¬trial receptivity, color-pulsed Doppler ultrasound; RI (resis¬tance index, Sildenafil citrate (Viagra)

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Authors: Arezoo Fallahi

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Background and purpose: Non-alcoholic fatty liver is one of the most common liver disorders, which, as the most important cause of death from liver disease, has unpleasant consequences and complications. The aim of this study was to investigate the effect of an educational intervention based on a health belief model to prevent non-alcoholic fatty liver among women. Materials and Methods: This experimental study was performed among 110 women referring to comprehensive health service centers in Malayer City, west of Iran, in 2023. Using the available sampling method, 110 Participants were divided into experimental and control groups. The data collection tool included demographic characteristics and a questionnaire based on the health belief model. In The experimental group, three one-hour training sessions were conducted in the form of pamphlets, lectures and group discussions. Data were analyzed using SPSS software version 21, by correlation tests, paired t-tests independent t-tests. Results: The mean age of participants was 38.07±6.28 years, and Most of the participants were middle-aged, married, housewives with academic education, middle-income and overweight. After the educational intervention, the mean scores of the constructs include perceived sensitivity (p=0.01), perceived severity (p=0.01), perceived benefits (p=0.01), guidance for internal (p=0.01) and external action (p=0.01), and perceived self-efficacy (p=0.01) in the experimental group were significantly higher than the control group. The score of perceived barriers in the experimental group decreased after training. The perceived obstacles score in the test group decreased after the training (15.2 ± 3.9 v.s 11.2 ± 3.3, (p<0.01). Conclusion: The findings of the study showed that the design and implementation of educational programs based on the constructs of the health belief model can be effective in preventing women from developing higher levels of non-alcoholic fatty liver.

Keywords: health, education, believe, behaviour

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Authors: J. Vinay , Kusumbati Besra, Niharika Pattnaik, Shivaram Prasad Singh, Manjusha Dixit

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Gallbladder cancer (GBC) is rare but highly malignant cancer; its prevalence is more in certain geographical regions and ethnic groups, which include the Northern and Eastern states of India. Previous studies in India have reported genetic predisposition as one of the risk factors in GBC pathogenesis. Although the matrix metalloproteinase-14 (MMP14) is a well-known modulator of the tumor microenvironment and tumorigenesis and TCGA data also suggests its upregulation yet, its role in the genetic predisposition for GBC is completely unknown. We elucidated the role of MMP14 promoter variants as genetic risk factors and their implications in expression modulation. We screened MMP14 promoter variants association with GBC using Sanger’s sequencing in approximately 300 GBC and 300 control subjects and 26 GBC tissue samples of Indian ethnicity. The immunohistochemistry was used to check the MMP14 protein expression in GBC tissue samples. The role of promoter variants on expression levels was elucidated using a luciferase reporter assay. The variants rs1004030 (p-value = 0.0001) and rs1003349 (p-value = 0.0008) were significantly associated with gallbladder cancer. The luciferase assay in two different cell lines, HEK-293 (p = 0.0006) and TGBC1TKB (p = 0.0036) showed a significant increase in relative luciferase activity in the presence of risk alleles for both the single nucleotide polymorphisms (SNPs). Similarly, genotype-phenotype correlation in patients samples confirmed that the presence of risk alleles at rs1004030 and rs1003349 increased MMP14 expression. Overall, this study unravels the genetic association of MMP14 promoter variants with gallbladder cancer, which may contribute to pathogenesis by increasing its expression.

Keywords: gallbladder cancer, matrix metalloproteinase-14, single nucleotide polymorphism, case control study, genetic association study

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Authors: Linda Blümel, Bettina Bert, Jan Brosda, Heidrun Fink, Melanie Hamann

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Age-related cognitive decline can eventually lead to dementia, the most common mental illness in elderly people and an immense challenge for patients, their families and caregivers. Cholinesterase inhibitors constitute the most commonly used antidementia prescription medication. The standardized Ginkgo biloba leaf extract EGb 761® is approved for treating age-associated cognitive impairment and has been shown to improve the quality of life in patients suffering from mild dementia. A clinical trial with 96 Alzheimer´s disease patients indicated that the combined treatment with donepezil and EGb 761® had fewer side effects than donepezil alone. In an animal model of cognitive aging, we compared the effect of combined treatment with EGb 761® or donepezil monotherapy and vehicle. We compared the effect of chronic treatment (15 days of pretreatment) with donepezil (1.5 mg/kg p. o.), EGb 761® (100 mg/kg p. o.), or the combination of the two drugs, or vehicle in 18 – 20 month old male OFA rats. Learning and memory performance were assessed by Morris water maze testing, motor behavior in an open field paradigm. In addition to chronic treatment, the substances were administered orally 30 minutes before testing. Compared to the first day and to the control group, only the combination group showed a significant reduction in latency to reach the hidden platform on the second day of testing. Moreover, from the second day of testing onwards, the donepezil, the EGb 761® and the combination group required less time to reach the hidden platform compared to the first day. The control group did not reach the same latency reduction until day three. There were no effects on motor behavior. These results suggest a superiority of the combined treatment of donepezil with EGb 761® compared to monotherapy.

Keywords: age-related cognitive decline, dementia, ginkgo biloba leaf extract EGb 761®, learning and memory, old rats

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Authors: Tahira Hussain, Ilhom Rahamkulov, Muhammad Aasim, Ugur Pirlak, Emre Aksoy, Mehmet Emin Caliskan, Allah Bakhsh

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RNA interference (RNAi) has proved its usefulness in functional genomic research on insects recently and is considered potential strategy in crop improvement for the control of insect pests. The different insect pests incur significant losses to potato yield worldwide, Colorado Potato Beetle (CPB) being most notorious one. The present study focuses to knock down highly specific 20-hydroxyecdysone hormone-receptor complex interaction by using RNAi approach to silence Ecdysone receptor (EcR) gene of CPB in transgenic potato plants expressing dsRNA of EcR gene. The partial cDNA of Ecdysone receptor gene of CPB was amplified using specific primers in sense and anti-sense orientation and cloned in pRNAi-GG vector flanked by an intronic sequence (pdk). Leaf and internodal explants of Lady Olympia, Agria and Granola cultivars of potato were infected with Agrobacterium strain LBA4404 harboring plasmid pRNAi-CPB, pRNAi-GFP (used as control). Neomycin phosphotransferase (nptII) gene was used as a plant selectable marker at a concentration of 100 mg L⁻¹. The primary transformants obtained have shown proper integration of T-DNA in plant genome by standard molecular analysis like polymerase chain reaction (PCR), real-time PCR, Sothern blot. The transgenic plants developed out of these cultivars are being evaluated for their efficacy against larvae as well adults of CPB. The transgenic lines are expected to inhibit expression of EcR protein gene, hindering their molting process, hence leading to increased potato yield.

Keywords: plant mediated RNAi, molecular strategy, ecdysone receptor, insect metamorphosis

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Authors: Krishan P. Sharma, T. P. Sharma

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Wireless sensor nodes are resource constrained battery powered devices usually deployed in hostile and ill-disposed areas to cooperatively monitor physical or environmental conditions. Due to their limited power supply, the major challenge for researchers is to utilize their battery power for enhancing the lifetime of whole network. Communication and sensing are two major sources of energy consumption in sensor networks. In this paper, we propose a deployment strategy for enhancing the average lifetime of a sensor network by effectively utilizing communication and sensing energy to provide full coverage. The proposed scheme is based on the fact that due to heavy relaying load, sensor nodes near to the sink drain energy at much faster rate than other nodes in the network and consequently die much earlier. To cover this imbalance, proposed scheme finds optimal communication and sensing ranges according to effective load at each node and uses a non-uniform deployment strategy where there is a comparatively high density of nodes near to the sink. Probable relaying load factor at particular node is calculated and accordingly optimal communication distance and sensing range for each sensor node is adjusted. Thus, sensor nodes are placed at locations that optimize energy during network operation. Formal mathematical analysis for calculating optimized locations is reported in present work.

Keywords: load factor, network lifetime, non-uniform deployment, sensing range

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Authors: M. Naimi, M. B. Khaled

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The present study consisted of an applied test in meat system to assess the effectiveness of three bio agents bacteriocinproducing strains: Lm24: Lactobacillus sakei, Lm14and Lm25: Pediococcus spp. Two tests were carried out: The ex-situ test was intended for three batches added with crude bacteriocin solutions at 12.48 AU/ml for Lm25 and 8.4 AU/ml for Lm14 and Lm24. However, the in situ one consisted of four batches; three of them inoculated with one bacteriocinogenic Lm25, Lm14, Lm24, respectively. The fourth one was used in mixture: Lm14+m24 at approximately of 107 CFU/ml. The two used tests were done in the presence of the pathogen St. aureus ATCC 6538, as a test strain at 103 CFU/ml. Another batch served as a positive or a negative control was used too. The incubation was performed at 7°C. Total viable counts, staphylococci and lactic acid bacteria, at the beginning and at selected times with interval of three days were enumerated. Physicochemical determinations (except for in situ test): pH, dry mater, sugars, fat and total protein, at the beginning and at end of the experiment, were done, according to the international norms. Our results confirmed the ex situ effectiveness. Furthermore, the batches affected negatively the total microbial load over the incubation days, and showed a significant regression in staphylococcal load at day seven, for Lm14, Lm24, and Lm25 of 0.73, 2.11, and 2.4 log units. It should be noticed that, at the last day of culture, staphylococcal load was nil for the three batches. In the in situ test, the cultures displayed less inhibitory attitude and recorded a decrease in staphylococcal load, for Lm14, Lm24, Lm25, Lm14+m24 of 0.73, 0.20, 0.86, 0.032 log units. Therefore, physicochemical analysis for Lm14, Lm24, Lm25, Lm14+m24 showed an increase in pH from 5.50 to 5.77, 6.18, 5.96, 7.22, a decrease in dry mater from 7.30% to 7.05%, 6.87%, 6.32%, 6.00%.This result reflects the decrease in fat ranging from 1.53% to 1.49%, 1.07%, 0.99%, 0.87%; and total protein from 6.18% to 5.25%, 5.56%, 5.37%, 5.5%. This study suggests that the use of selected strains as Lm25 could lead to the best results and would help in preserving and extending the shelf life of lamb meat.

Keywords: biocontrol, in situ, ex situ, meat system, St. aureus, Lactobacillus sakei, Pediococcus spp.

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Authors: Maryam Risla Shahul Hameed, Tharsiga Yogarajah, Fritzy Mathew, Tayyaba Syed, Shalin Shaunak

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Aim: Auditing the adherence of Trauma and Orthopaedics Operative notes to the RCS Good Surgical Practice Guidelines. Method: Clinical audit conducted on 150 operative notes over a period of 2 months April- May 2023, including emergency and elective surgeries performed in Ashford and St. Peter’s Hospital. The RCS Good Practice Surgical Guidelines for an ideal operative note were used to compare.Results: Date of the procedure and signature of the surgeon were mentioned in all the notes by default in the electronic template being used. Title of the operation performed and whether elective or emergency were mentioned by 92% and 45%, respectively. Name of theatre anaesthetist and operating surgeons were mentioned by 73% and 93% respectively. Time of surgery mentioned by 26%. Operative findings and operative diagnosis mentioned by 83% and 53% respectively. Incision and complications of surgery mentioned in 80% and 53%, respectively. Details of tissue added/ altered/ removed mentioned by 46%. Information on prosthesis or implant used is mentioned by 54%. Details of closure and anticipated blood loss mentioned in 91% and 45% respectively. Antibiotic prophylaxis was mentioned by 63%, out of which only 23% mentioned the name and duration of the antibiotic. VTE prophylaxis was mentioned by 84%, out of which only 23% and 29% mentioned the name and duration of the prophylaxis, respectively. Conclusion: There is more for improvement in the operative notes for better continuity of care between the operating surgeons and other doctors in the wards taking care of the patients post operatively. We recommend to follow a standardized guidelines by all the nationwide and a standard template to be followed by all.

Keywords: surgery, notes, RCS, guidelines

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Authors: Natália Maria Rego

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ALeibnizn-algebraGis aK-vector space endowed whit a n-linearbracket operation [-,…-] : GG … G→ Gsatisfying the fundamental identity, which can be expressed saying that the right multiplication map Ry2, …, ᵧₙ: Gn→ G, Rᵧ₂, …, ᵧₙn(ˣ¹, …, ₓₙ) = [[ˣ¹, …, ₓₙ], ᵧ₂, …, ᵧₙ], is a derivation. This structure, together with its skew-symmetric version, named as Lie n-algebra or Filippov algebra, arose in the setting of Nambumechanics, an n-ary generalization of the Hamiltonian mechanics. Thefirst goal of this work is to provide a characterization of various classes of central extensions of Leibniz n-algebras in terms of homological properties. Namely, Commutator extension, Quasi-commutator extension, Stem extension, and Stem cover. These kind of central extensions are characterized by means of the character of the map *(E): nHL1(G) → M provided by the five-term exact sequence in homology with trivial coefficients of Leibniz n-algebras associated to an extension E : 0 → M → K → G → 0. For a free presentation 0 →R→ F →G→ 0of a Leibniz n-algebra G,the term M(G) = (R[F,…n.., F])/[R, F,..n-1..,F] is called the Schur multiplier of G, which is a Baer invariant, i.e., it does not depend on the chosen free presentation, and it is isomorphic to the first Leibniz n-algebras homology with trivial coefficients of G. A central extension of Leibniz n-algebras is a short exact sequenceE : 0 →M→K→G→ 0such that [M, K,.. ⁿ⁻¹.., K]=0. It is said to be a stem extension if M⊆[G, .. n.., G]. Additionally, if the induced map M(K) → M(G) is the zero map, then the stem extension Eis said to be a stem cover. The second aim of this work is to analyze the interplay between stem covers of Leibniz n-algebras and the Schur multiplier. Concretely, in the case of finite-dimensional Leibniz n-algebras, we show the existence of coverings, and we prove that all stem covers with finite-dimensional Schur multiplier are isoclinic. Additionally, we characterize stem covers of perfect Leibniz n-algebras.

Keywords: leibniz n-algebras, central extensions, Schur multiplier, stem cover

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Authors: Javier Delgado-Gonzaga, Wilfrido Rivera, David Juárez-Romero

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Cooling and water purification are processes that have contributed to the economic and social development of the modern world. However, these processes require a significant amount of energy globally. Nowadays, absorption heat pumps have been studied with great interest since they are capable of producing cooling and/or purifying water from low-temperature energy sources such as industrial waste heat or renewable energy. In addition, absorption heat pumps require negligible amounts of electricity for their operation and generally use working fluids that do not represent a risk to the environment. The objective of this work is to evaluate a system that integrates an absorption heat transformer and an absorption cooling system to produce fresh water and cooling from a low-temperature heat source. Both cycles operate with the working pair LiBr-H2O. The integration is possible through the interaction of the LiBr-H2O solution streams between both cycles and also by recycling heat from the absorption heat transformer to the absorption cooling system. Mathematical models were developed to compare the performance of four different configurations. The results showed that the configuration in which the hottest streams of LiBr-H2O solution preheated the coldest streams in the economizers of both cycles was one that achieved the best performance. The interaction of the solution currents and the heat recycling analyzed in this work serves as a record of the possibilities of integration between absorption cycles for cogeneration.

Keywords: absorption heat transformer, absorption cooling system, water desalination, integrated system

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Authors: Mahmoud S. Zaghloul, Mohammed M. Khalaf, Wael N. Thabet, Haidy N. Asham

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Background. Hypertrophic scarring is a difficult problem for burn patients, and scar management is an essential aspect of outpatient burn therapy. Post-burn pathologic scars involve functional and aesthetic limitations that have a dramatic influence on the patient’s quality of life. The aim was to investigate the use of extracorporeal shock wave therapy (ESWT), which targets the fibroblasts in scar tissue, as an effective modality for scar treatment in burn patients. Subjects and methods: forty patients with post-burn scars were assigned randomly into two equal groups; their ages ranged from 20-45 years. The study group received ESWT and traditional physical therapy program (deep friction massage, stretching exercises). The control group received traditional physical therapy program (deep friction massage, stretching exercises). All groups received two sessions per week for six successful weeks. The data were collected before and after the same period of treatment for both groups. Evaluation procedures were carried out to measure scar thickness using ultrasonography and Vancouver Scar Scale (VSS) was completed before and after treatment. Results: Post-treatment results showed that there was a significant improvement difference in scar thickness in both groups in favor of the study group. Percentage of improvement in scar thickness in the study group was 42.55%, while it was 12.15% in the control group. There was also a significant improvement difference between results obtained using VSS in both groups in favor of the study group. Conclusion: ESWT is effective in management of pathologic post burn scars.

Keywords: extracorporeal shock wave therapy, post-burn scars, ultrasonography, Vancouver scar scale

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Authors: S. Hammoudeh, S. Ghuloum, A. Abdelhakam, A. AlMujalli, M. Opler, Y. Hani, A. Yehya, S. Mari, R. Elsherbiny, Z. Mahfoud, H. Al-Amin

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Introduction: Suicidal ideation and attempts are very common in patients with schizophrenia and still contributes to the high mortality in this population. The InterSePT Scale for Suicidal Thinking (ISST) is a validated tool used to assess suicidal ideation in patients with schizophrenia. This research aims to validate the Arabic version of the ISST among the Arabs residing in Qatar. Methods: Patients diagnosed with schizophrenia were recruited from the department of Psychiatry, Rumailah Hospital, Doha, Qatar. Healthy controls were recruited from the primary health care centers in Doha, Qatar. The validation procedures including professional and expert translation, pilot survey and back translation of the ISST were implemented. Diagnosis of schizophrenia was confirmed using the validated Arabic version of Mini International Neuropsychiatric Interview (MINI 6, module K) for schizophrenia. The gold standard was the module B on suicidality from MINI 6 also. This module was administered by a rater who was blinded to the results of ISST. Results: Our sample (n=199) was composed of 98 patients diagnosed with schizophrenia (age 36.03 ± 9.88 years; M/F is 2/1) and 101 healthy participants (age 35.01 ± 8.23 years; M/F is 1/2). Among patients with schizophrenia: 26.5% were married, 17.3% had a college degree, 28.6% were employed, 9% had committed suicide once, and 4.4% had more than 4 suicide attempts. Among the control group: 77.2% were married, 57.4% had a college degree, and 99% were employed. The mean score on the ISST was 2.36 ± 3.97 vs. 0.47 ± 1.44 for the schizophrenia and control groups, respectively. The overall Cronbach’s alpha was 0.91. Conclusions: This is the first study in the Arab world to validate the ISST in an Arabic-based population. The psychometric properties indicate that the Arabic version of the ISST is a valid tool to assess the severity of suicidal ideation in Arabic speaking patients diagnosed with schizophrenia.

Keywords: mental health, Qatar, schizophrenia, suicide

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Authors: A. A. Saki, Y. Karimi, H. J. Najafabadi, P. Zamani, Z. Mostafaie

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The restaurant residuals reasons such as competition between human and animal consumption of cereals, increasing environmental pollution and the high cost of production of livestock products is important. Therefore, in this restaurant residuals have a high nutritional value (protein and high energy) that it is possible can replace some of the poultry diets are especially Japanese quail. Today, the challenges of processing and consumption of these lesions occurring in modern industry would be confronting. Increasing costs, pressures, and problems associated with waste excretion, the need for re-evaluation and utilization of waste to livestock and poultry feed fortifies. This study aimed to investigate the effects of different levels of restaurant residuals on performance of 300 layer Japanese quails. This experiment included 5 treatments, 4 replicates, and 15 quails in each from 10 to 18 weeks age in a completely randomized design (CRD). The treatments consist of basal diet including corn and soybean meal (without residual restaurants), and treatments 2, 3, 4 and 5, includes a basal diet containing 5, 10, 15 and 20% of restaurant residuals, respectively. There were no significant effect of restaurant residuals levels on body weight (BW), feed conversion ratio (FCR), percentage of egg production (EP), egg mass (EM) between treatments (P > 0/05). However, feed intake (FI) of 5% restaurant residual was significantly higher than 20% treatment (P < 0/05). Egg weight (EW) was also higher by receiving 20% restaurant residuals compared with 10% in this respect (P < 0/05). Yolk weight (YW) of treatments containing 10 and 20% of the residual restaurant were significantly higher than control (P < 0/05). Eggs white weight (EWW) of 20 and 5% restaurants residual treatments were significantly increased compared by 10% (P < 0/05). Furthermore, EW, egg weight to shell surface area and egg surface area in 20% treatment were significantly higher than control and 10% treatment (P < 0/05). The overall results of this study have shown that restaurant residuals for laying quail diets in levels of 10 and 15 percent could be replaced with a part of the quail ration without any adverse effect.

Keywords: by-product, laying quail, performance, restaurant residuals

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Authors: Scholastic Nangila Adeli, Francisca Mbutitia Ngithi

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Stigma is commonly associated with mental health patients and may act as a barrier to individuals who may seek or engage in treatment services. Stigmatization among university students is common whether they know someone with a mental health problem, or have a good knowledge and experience of mental health issues. The objective of this study was to establish the various barriers that prevent university students who have mental health challenges from seeking treatment and care. The study was a descriptive in nature where 320 respondents helped to establish the barriers to treatment or participation in mental health care among university students. A questionnaire was used to help establish the barriers and attitude towards mental illness among the respondents. Results from this study revealed that mental illnesses are common among university students and they are manifested in different forms like; anxiety and panic attacks, mood and eating disorders, Impulse control leading to gambling, alcohol and drug addictions, anger and depression leading to loneliness. Mental stigma (both social and self) was the major barrier with 62% of the respondents stating that social stigma was worse than self-stigma. This is because of the social discrimination towards the victim of mental challenges. On issues of attitude, 71% of the respondents said that they can never admit that they have a mental issue and would rather secretly seek clinical or psychological help for fear of being discriminated or excluded by peers. This view is informed by the societal belief that people with mental health challenges were dangerous (associating them with criminal behavior) and hard to socialize with or help. From the findings of this study, it is concluded that mental health problems are real among university students in Kenya and it is important for the university environment to minimize or eradicate stigma within the social circles. Stigma can be minimized or eradicated by creating awareness among university students and fostering social inclusion so that the students who have mental health challenges can experience a sense of belonging and acceptance hence build their self-esteem.

Keywords: disorders, impulse control, mental health problems, stigma

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Authors: Aleksandra Dragojlov

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Since the election of Aleksandar Vučić and the Progressives, Serbia has witnessed a slow decline in media freedom, which has been worse than in the 1990s. Although the government adopted a package of three laws in August 2014 to bring the media landscape up to European standards, the implementation of the laws has been limited and marginal, with the progressives engaging in fake compliance. The adoption of the new media strategy for 2020-2025 in 2020 has not led to genuine domestic reform and compliance with EU conditionality. In fact, the EU Commission and journalists’ associations in Serbia have criticised the decline in Serbia’s media freedom citing continued attacks on journalists and indirect political and economic control through advertising and project co-financing, which continue to be features of the Serbian media landscape. In the absence of clear and credible EU conditionality, the decline of media freedom is in the eye of the beholder, where the gap between public engagements with Serbian politicians and the critical stance of progress reports regarding the degradation of the media have enabled Serbian elites to exploit this ambiguity to continue their strategy of fake compliance vis-a-vis rule of law. This study used a mixed methods approach combining both primary and secondary sources with those semi-structured interviews via Zoom, email, and in person with EU and Serbian officials and journalists. Our findings add to the studies where the lack of clear and credible conditionality has allowed Serbia politicians to exploit them in a manner that would suit their own interests, finding new means to retain their control over the media. We argued and concluded that it is this discrepancy between public engagements with Serbia and the progress reports in the area of freedom of expression that has not led to genuine domestic media reforms in Serbia and instead allowed Serbian elites to engage in a strategy of fake and even non-compliance towards media freedom conditionality.

Keywords: media freedom, EU conditionality, Serbia, fake compliance, EU integration, Chapter 23, justice and fundamental rights

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Authors: Vivek Rangarajan, Kim G. Klarke

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With overpopulation threatening the world’s ability to feed itself, food production and protection has become a major issue, especially in developing countries. Almost one-third of the food produced for human consumption, around 1.3 billion tonnes, is either wasted or lost annually. Postharvest decay in particular constitutes a major cause of crop loss with about 20% of fruits and vegetables produced lost during postharvest storage, mainly due to fungal disease. Some of the major phytopathogenic fungi affecting postharvest fruit crops in South Africa include Aspergillus, Botrytis, Penicillium, Alternaria and Sclerotinia spp. To date control of fungal phytopathogens has primarily been dependent on synthetic chemical fungicides, but these chemicals pose a significant threat to the environment, mainly due to their xenobiotic properties and tendency to generate resistance in the phytopathogens. Here, an environmentally benign alternative approach to control postharvest fungal phytopathogens in perishable fruit crops has been presented, namely the application of a bio-fungicide in the form of lipopeptide molecules. Lipopeptides are biosurfactants produced by Bacillus spp. which have been established as green, nontoxic and biodegradable molecules with antimicrobial properties. However, since the Bacillus are capable of producing a large number of lipopeptide homologues with differing efficacies against distinct target organisms, the lipopeptide production conditions and strategy are critical to produce the maximum lipopeptide concentration with homologue ratios to specification for optimum bio-fungicide efficacy. Process conditions, and their impact on Bacillus lipopeptide production, were evaluated in fully instrumented laboratory scale bioreactors under well-regulated controlled and defined environments. Factors such as the oxygen availability and trace element and nitrate concentrations had profound influences on lipopeptide yield, productivity and selectivity. Lipopeptide yield and homologue selectivity were enhanced in cultures where the oxygen in the sparge gas was increased from 21 to 30 mole%. The addition of trace elements, particularly Fe2+, increased the total concentration of lipopeptides and a nitrate concentration equivalent to 8 g/L ammonium nitrate resulted in optimum lipopeptide yield and homologue selectivity. Efficacy studies of the culture supernatant containing the crude lipopeptide mixture were conducted using phytopathogens isolated from fruit in the field, identified using genetic sequencing. The supernatant exhibited antifungal activity against all the test-isolates, namely Lewia, Botrytis, Penicillium, Alternaria and Sclerotinia spp., even in this crude form. Thus the lipopeptide product efficacy has been confirmed to control the main diseases, even in the basic crude form. Future studies will be directed towards purification of the lipopeptide product and enhancement of efficacy.

Keywords: antifungal efficacy, biocontrol, lipopeptide production, perishable crops

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Authors: Danny Alexander R. Moreno, Gustavo L. Sartorello, Yuli Andrea P. Bermudez, Richard R. Lobo, Ives Claudio S. Bueno, Augusto H. Gameiro

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Meat production is a significant sector for Brazil's economy; however, the agricultural segment has suffered censure regarding the negative impacts on the environment, which consequently results in climate change. Therefore, it is essential the implementation of nutritional strategies that can improve the environmental performance of livestock. This research aimed to estimate the environmental impact and profitability of the use of yerba mate extract (Ilex paraguariensis) as an additive in the feeding of feedlot lamb. Thirty-six castrated male lambs (average weight of 23.90 ± 3.67 kg and average age of 75 days) were randomly assigned to four experimental diets with different levels of inclusion of yerba mate extract (0, 1, 2, and 4 %) based on dry matter. The animals were confined for fifty-three days and fed with 60:40 corn silage to concentrate ratio. As an indicator of environmental impact, the carbon footprint (CF) was measured as kg of CO₂ equivalent (CO₂-eq) per kg of body weight produced (BWP). The greenhouse gas (GHG) emissions such as methane (CH₄) generated from enteric fermentation, were calculated using the sulfur hexafluoride gas tracer (SF₆) technique; while the CH₄, nitrous oxide (N₂O - emissions generated by feces and urine), and carbon dioxide (CO₂ - emissions generated by concentrate and silage processing) were estimated using the Intergovernmental Panel on Climate Change (IPCC) methodology. To estimate profitability, the gross margin was used, which is the total revenue minus the total cost; the latter is composed of the purchase of animals and food. The boundaries of this study considered only the lamb fattening system. The enteric CH₄ emission from the lamb was the largest source of on-farm GHG emissions (47%-50%), followed by CH₄ and N₂O emissions from manure (10%-20%) and CO₂ emission from the concentrate, silage, and fossil energy (17%-5%). The treatment that generated the least environmental impact was the group with 4% of yerba mate extract (YME), which showed a 3% reduction in total GHG emissions in relation to the control (1462.5 and 1505.5 kg CO₂-eq, respectively). However, the scenario with 1% YME showed an increase in emissions of 7% compared to the control group. In relation to CF, the treatment with 4% YME had the lowest value (4.1 kg CO₂-eq/kg LW) compared with the other groups. Nevertheless, although the 4% YME inclusion scenario showed the lowest CF, the gross margin decreased by 36% compared to the control group (0% YME), due to the cost of YME as a food additive. The results showed that the extract has the potential for use in reducing GHG. However, the cost of implementing this input as a mitigation strategy increased the production cost. Therefore, it is important to develop political strategies that help reduce the acquisition costs of input that contribute to the search for the environmental and economic benefit of the livestock sector.

Keywords: meat production, natural additives, profitability, sheep

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Authors: Hossain A., Miah S., Ray P. K.

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Introduction: Single channel and tri-channel applicators are used in the traditional treatment of cervical cancer. Total reference air kerma (TRAK) and treatment outcomes in high-dose-rate brachytherapy for cervical cancer using single-channel and tri-channel applicators were the main objectives of this retrospective study. Material and Methods: Patients in the radiotherapy division who received brachytherapy, chemotherapy, and external radiotherapy (EBRT) using single and tri-channel applicators were the subjects of a retrospective cohort study from 2016 to 2020. All brachytherapy parameters, including TRAK, were calculated in accordance with the international protocol. The Kaplan Meier method was used to analyze survival rates using a log-rank test. Results and Discussions: Based on treatment times of 15.34 (10-20) days and 21.35 (6.5-28) days, the TRAK for the tri-channel applicator was 0.52 cGy.m² and for the single-channel applicator was 0.34 cGy.m². Based on TRAK, the rectum, bladder, and tumor had respective Pearson correlations of 0.082, 0.009, and 0.032. The 1-specificity and sensitivity were 0.70 and 0.30, respectively. At that time, AUC was 0.71. The log-rank test showed that tri-channel applicators had a survival rate of 95% and single-channel applicators had a survival rate of 85% (p=0.565). Conclusions: The relationship between TRAK and treatment duration and Pearson correlation for the tumor, rectum, and bladder suggests that TRAK should be taken into account for the proper operation of single channel and tri-channel applicators.

Keywords: single-channel, tri-channel, high dose rate brachytherapy, cervical cancer

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Authors: Iyd Eqqab Maree, Habil Jurgen Bast

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Vibration control of machines and structures incorporating viscoelastic materials in suitable arrangement is an important aspect of investigation. The use of viscoelastic layers constrained between elastic layers is known to be effective for damping of flexural vibrations of structures over a wide range of frequencies. The energy dissipated in these arrangements is due to shear deformation in the viscoelastic layers, which occurs due to flexural vibration of the structures. Multilayered cantilever sandwich beam like structures can be used in aircrafts and other applications such as robot arms for effective vibration control. These members may experience parametric instability when subjected to time dependant forces. The theory of dynamic stability of elastic systems deals with the study of vibrations induced by pulsating loads that are parametric with respect to certain forms of deformation. The purpose of the present work is to investigate the dynamic stability of a three layered symmetric sandwich beam (Drone Aircraft wings ) subjected to an end periodic axial force . Equations of motion are derived using finite element method (MATLAB software). It is observed that with increase in core thickness parameter fundamental buckling load increases. The fundamental resonant frequency and second mode frequency parameter also increase with increase in core thickness parameter. Fundamental loss factor and second mode loss factor also increase with increase in core thickness parameter. Increase in core thickness parameter enhances the stability of the beam. With increase in core loss factor also the stability of the beam enhances. There is a very good agreement of the experimental results with the theoretical findings.

Keywords: steel cantilever beam, viscoelastic material core, loss factor, transition region, MATLAB R2011a

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Authors: A. Mohammed, A. Babatunde

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This study investigated the integrated removal of heavy metals, organic matter and nitrogen from landfill leachate using a novel laboratory scale constructed wetland system. The main objectives of this study were: (i) to assess the overall effectiveness of the constructed wetland system for treating landfill leachate; (ii) to examine the interactions and impact of key leachate constituents (heavy metals, organic matter and nitrogen) on the overall removal dynamics and efficiency. The constructed wetland system consisted of four stages operated in tidal flow and anoxic conditions. Results obtained from 215 days of operation have demonstrated extraordinary heavy metals removal up to 100%. Analysis of the physico- chemical data reveal that the controlling factors for metals removal were the anoxic condition and the use of the novel media (dewatered ferric sludge which is a by-product of drinking water treatment process) as the main substrate in the constructed wetland system. Results show that the use of the ferric sludge enhanced heavy metals removal and brought more flexibility to simultaneous nitrification and denitrification which occurs within the microbial flocs. Furthermore, COD and NH₄-N were effectively removed in the system and this coincided with enhanced aeration in the 2nd and 3rd stages of the constructed wetland system. Overall, the results demonstrated that the ferric dewatered sludge constructed wetland system would be an effective solution for integrated removal of pollutants from landfill leachates.

Keywords: constructed wetland, ferric dewatered sludge, heavy metals, landfill leachate

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Authors: A. O. Oluwajobi, O. A. Falusi, N. A. Zubbair, T. Owoeye, F. Ladejobi, M. C. Dangana, A. Abubakar

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The technology of mobile telephony has positively enhanced human life and reports on the bio safety of the radiation from their antennae have been contradictory, leading to serious litigations and violent protests by residents in several parts of the world. The crave for more information, as requested by WHO in order to resolve this issue, formed the basis for this study on the effect of the radiation from 900 MHz GSM antenna on the DNA of Hibiscus sabdariffa. Seeds of H. sabdariffa were raised in pots placed in three replicates at 100, 200, 300 and 400 metres from the GSM antennae in three selected test locations and a control where there was no GSM signal. Temperature (˚C) and the relative humidity (%) of study sites were measured for the period of study (24 weeks). Fresh young leaves were harvested from each plant at two, eight and twenty-four weeks after sowing and the DNA extracts were subjected to RAPD-PCR analyses. There were no significant differences between the weather conditions (temperature and relative humidity) in all the study locations. However, significant differences were observed in the intensities of radiations between the control (less than 0.02 V/m) and the test (0.40-1.01 V/m) locations. Data obtained showed that DNA of samples exposed to rays from GSM antenna had various levels of distortions, estimated at 91.67%. Distortions occurred in 58.33% of the samples between 2-8 weeks of exposure while 33.33% of the samples were distorted between 8-24 weeks exposure. Approximately 8.33% of the samples did not show distortions in DNA while 33.33% of the samples had their DNA damaged twice, both at 8 and at 24 weeks of exposure. The study showed that radiation from the 900 MHz GSM antenna is potent enough to cause distortions to DNA of H. sabdariffa even within 2-8 weeks of exposure. DNA damage was also independent of the distance from the antenna. These observations would qualify emissions from GSM mast as environmental hazard to the existence of plant biodiversities and all life forms in general. These results will trigger efforts to prevent further erosion of plant genetic resources which have been threatening food security and also the risks posed to living organisms, thereby making our environment very safe for our existence while we still continue to enjoy the benefits of the GSM technology.

Keywords: damage, DNA, GSM antenna, radiation

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Authors: Ankita Wadhawan, Parteek Kumar, Umesh Kumar

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Gesture is any body movement that expresses some attitude or any sentiment. Gestures as a sign language are used by deaf people for conveying messages which helps in eliminating the communication barrier between deaf people and normal persons. Nowadays, everybody is using mobile phone and computer as a very important gadget in their life. But there are some physically challenged people who are blind/deaf and the use of mobile phone or computer like device is very difficult for them. So, there is an immense need of a system which works on body gesture or sign language as input. In this research, Microsoft Kinect Sensor, SDK V2 and Hidden Markov Toolkit (HTK) are used to recognize the object, motion of object and human body joints through Touch less NUI (Natural User Interface) in real-time. The depth data collected from Microsoft Kinect has been used to recognize gestures of Indian Sign Language (ISL). The recorded clips are analyzed using depth, IR and skeletal data at different angles and positions. The proposed system has an average accuracy of 85%. The developed Touch less NUI provides an interface to recognize gestures and controls the cursor and click operation in computer just by waving hand gesture. This research will help deaf people to make use of mobile phones, computers and socialize among other persons in the society.

Keywords: gesture recognition, Indian sign language, Microsoft Kinect, natural user interface, sign language

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Authors: Shu-Lien Chou, Chung-Feng Liu

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Self-health management of chronic illnesses plays an important part in chronic illness treatments. However, various kinds of health information (health education materials) which government or healthcare institutions provide for patients may not achieve the expected outcome. One of the critical reasons affecting patients’ use intention could be patients’ perceived Information overload regarding the health information. This study proposed an extended model of Theory of Planned Behavior, which integrating perceived information overload as another construct to explore patients’ use intention of the health information for self-health management. The independent variables are attitude, subject norm, perceived behavior control and perceived information overload while the dependent variable is behavior intention to use the health information. The cross-sectional study used a structured questionnaire for data collection, focusing on the chronic patients with coronary artery disease (CAD), who are the potential users of the health information, in a medical center in Taiwan. Data were analyzed using descriptive statistics of the basic information distribution of the questionnaire respondents, and the Partial Least Squares (PLS) structural equation model to study the reliability and construct validity for testing our hypotheses. A total of 110 patients were enrolled in this study and 106 valid questionnaires were collected. The PLS analysis result indicates that the patients’ perceived information overload of health information contributes the most critical factor influencing the behavioral intention. Subjective norm and perceived behavioral control of TPB constructs had significant effects on patients’ intentions to use health information also, whereas the attitude construct did not. This study demonstrated a comprehensive framework, which extending perceived information overload into TPB model to predict patients’ behavioral intention of using heath information. We expect that the results of this study will provide useful insights for studying health information from the perspectives of academia, governments, and healthcare providers.

Keywords: chronic patients, health information, information overload, theory of planned behavior

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Authors: B. Petrović, L. Rutonjski, M. Baucal, M. Teodorović, O. Čudić, B. Basarić

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Purpose/Objective: Radiotherapy treatment planning requires use of CT simulator, in order to acquire CT images. The overall performance of CT simulator determines the quality of radiotherapy treatment plan, and at the end, the outcome of treatment for every single patient. Therefore, it is strongly advised by international recommendations, to set up a quality control procedures for every machine involved in radiotherapy treatment planning process, including the CT scanner/ simulator. The overall process requires number of tests, which are used on daily, weekly, monthly or yearly basis, depending on the feature tested. Materials/Methods: Two phantoms were used: a dedicated phantom CIRS 062QA, and a QA phantom obtained with the CT simulator. The examined CT simulator was Siemens Somatom Definition as Open, dedicated for radiation therapy treatment planning. The CT simulator has a built in software, which enables fast and simple evaluation of CT QA parameters, using the phantom provided with the CT simulator. On the other hand, recommendations contain additional test, which were done with the CIRS phantom. Also, legislation on ionizing radiation protection requires CT testing in defined periods of time. Taking into account the requirements of law, built in tests of a CT simulator, and international recommendations, the intitutional QC programme for CT imulator is defined, and implemented. Results: The CT simulator parameters evaluated through the study were following: CT number accuracy, field uniformity, complete CT to ED conversion curve, spatial and contrast resolution, image noise, slice thickness, and patient table stability.The following limits are established and implemented: CT number accuracy limits are +/- 5 HU of the value at the comissioning. Field uniformity: +/- 10 HU in selected ROIs. Complete CT to ED curve for each tube voltage must comply with the curve obtained at comissioning, with deviations of not more than 5%. Spatial and contrast resultion tests must comply with the tests obtained at comissioning, otherwise machine requires service. Result of image noise test must fall within the limit of 20% difference of the base value. Slice thickness must meet manufacturer specifications, and patient stability with longitudinal transfer of loaded table must not differ of more than 2mm vertical deviation. Conclusion: The implemented QA tests gave overall basic understanding of CT simulator functionality and its clinical effectiveness in radiation treatment planning. The legal requirement to the clinic is to set up it’s own QA programme, with minimum testing, but it remains user’s decision whether additional testing, as recommended by international organizations, will be implemented, so to improve the overall quality of radiation treatment planning procedure, as the CT image quality used for radiation treatment planning, influences the delineation of a tumor and calculation accuracy of treatment planning system, and finally delivery of radiation treatment to a patient.

Keywords: CT simulator, radiotherapy, quality control, QA programme

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Authors: Amauri Josafat Gomez Aguilar, Jean Pierre Kenné

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This research presents the development of a self-sustainable manufacturing system from a circular economy perspective, structured by a multi-stage serial production system consisting of a series of machines under deterioration in charge of producing a single product and a reverse remanufacturing system constituted by the same productive systems of the first scheme and different tooling, fed by-products collected at the end of their life cycle, and non-conforming elements of the first productive scheme. Since the advanced production manufacturing system is unable to satisfy the customer's quality expectations completely, we propose the development of a mixed integer linear mathematical model focused on the optimal search and assignment of quality stations and preventive maintenance operation to the machines over a time horizon, intending to segregate the correct number of non-conforming parts for reuse in the remanufacturing system and thereby minimizing production, quality, maintenance, and customer non-conformance penalties. Numerical experiments are performed to analyze the solutions found by the model under different scenarios. The results showed that the correct implementation of a closed manufacturing system and allocation of quality inspection and preventive maintenance operations generate better levels of customer satisfaction and an efficient manufacturing system.

Keywords: closed loop, mixed integer linear programming, preventive maintenance, quality inspection

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Authors: Menouar Hanafi

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The original function of the process of platforming is to develop heavy naphtha (HSRN), coming from the atmospheric unit of distillation with a weak octane number (NO=44), to obtain a mixture of fuels â number octane raised by catalytically supporting specific groups of chemical reactions. The installation is divided into two sections: Section hydrobon. Section platforming. The rafinat coming from the bottom of column 12C2 to feed the section platforming, is divided into two parts whose flows are controlled and mixed with gas rich in hydrogen. Bottom of the column, we obtain stabilized reformat which is aspired by there pump to ensure the heating of the column whereas a part is sent towards storage after being cooled by the air cooler and the condenser. In catalytic catalyst of reforming, there is voluntarily associated a hydrogenating function-dehydrogenating, brought by platinum deposited, with an acid function brought by the alumina support (Al 2 0 3). The mechanism of action of this bifunctional catalyst depends on the severity of the operation, of the quality of the load and the type of catalyst. The catalyst used in the catalytic process of reforming is a very elaborate bifunctional catalyst whose performances are constantly improved thanks to the experimental research supported on an increasingly large comprehension of the phenomena. The American company Universel 0i1 petroleum (UOP) marketed several series of bimetallic catalysts such as R16, R20, R30, and R62 consisted Platinum/Rhenium on an acid support consisted the alumina added with a halogenous compound (chlorine).

Keywords: platforming, amelioration, octane number, catalyst

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Authors: Kalsoom Rani

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Tobacco contains nicotine, which causes addiction to many toxic chemicals. In the world, people consume it in the form of smoke, chew, and sniffing, smoke of it is composed of almost 7000 active chemicals, which are very harmful to human health as well as for eye health, inhalation of tobacco smoke and fumes can accelerate and cause many blinding eye diseases. Dry eye and smoking have not been covered extensively in researches; more studies are required to unveil the relationship between smoking and dry eye. This study was conducted to determine the quantity and quality of tears in smokers. 60 subjects participated in the study, which was divided into two groups on the basis of consumption of cigarettes per day with age matched non smokers of 15-50 years. All participants have gone through a study based questioner, eye examination, and diagnostic 'Dry Eye Tests' for evaporative tears evaluation and measurement of basal tear secretion. Subjects were included in the criteria of 10 cigarettes per day with a minimum duration of 1 year; passive smokers for control groups were excluded. The study was carried out in a Medina Teaching Hospital, Faisalabad, Pakistan, ophthalmology department for the duration of 8 months. Mean values for tear break up time (TBUT), was reported 10sec with SD of +3.74 in controlled group, 5sec with SD + 2.32 in smokers and 4sec SD +3.77 heavy smokers in right eye (RE) and left eye (LE) 10.35sec with SD of +3.88 in controlled 5sec with SD + 2.3 in smokers and much reduced TBUT in heavy smokers was 3.85sec SD+2.20. Smoking has a very strong association with TRUT with a significance of P=.00 both eyes. Mean Schirmer-I value of the subjects was reported 12.6mm with SD + 8.37 in RE and 12.59mm with SD + 8.96 LE. The mean Schirmer-II test value was reported in the right, and left eye with a mean value for control was 20.23mm with SD + 8.93, 20.75mm with SD + 8.84 respectively, and in Smokers 9.90mm with SD + 5.74, and 10.07mm with SD + 6.98, and in heavy smokers 7.7mm, SD + 3.22 and 6.9, SD + 3.50 mm, association with smoking showed p=.001 in RE and .003 in LE. Smoking has deteriorated effect on both evaporative tear and aqueous tear secretion and causing symptoms of dry eye burning, itching, redness, and watering with epithelial cell damage.

Keywords: tear break-up time, basal tear secretion, smokers, dry eye

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Authors: Athanasia Eirini Zarkadi, Despoina Balli, Olga Elpis Kolokitha

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Objective: Impacted maxillary canines are a frequent condition and a common reason for patients seeking orthodontic treatment. Their simultaneous presence with dental anomalies raises a question about their possible connection. The aim of this study was to investigate the association of maxillary impacted canines with dental anomalies. Materials and Methods: Files of 874 patients from an orthodontic private practice in Greece were evaluated for the presence of maxillary impacted canines. From this sample, a group of 97 patients (39 males and 58 females) with at least one impacted maxillary canine were selected and consisted of the study group (canine impaction group) of this study. This group was compared to a control group of 97 patients (42 males and 55 females) that was created by random selection from the initial sample without maxillary canine impaction. The impaction diagnosis was made from the panoramic radiographs and confirmed from the surgery. The association between maxillary canine impaction and dental anomalies was examined with the chi-square test. A classification tree was created to further investigate the relations between impaction and dental anomalies. The reproducibility of diagnoses was assessed by re-examining the records of 25 patients two weeks after the first examination. Results: The found associated anomalies were cone-shaped upper lateral incisors and infraocclusion of deciduous molars. There is a significant increase in the prevalence of 12,4% of distal displacement of the unerupted mandibular second premolar in the canine impaction group compared to the control group that was 7,2%. The classification tree showed that the presence of a cone-shaped maxillary lateral incisor gave rise to the probability of an impacted canine to 83,3%. Conclusions: The presence of cone-shaped maxillary lateral incisors and infraocclusion of deciduous molars can be considered valuable early risk indicators for maxillary canine impaction.

Keywords: cone-shaped maxillary lateral incisors, dental anomalies, impacted canines, infraoccluded deciduous molars

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Authors: Shreya Saxena, Felix Miller-Molloy, Phillipa Bowen, Greg Fellows, Elizabeth Bowen

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Background: Complex fluid balance abnormalities are well-established post-neurosurgery and traumatic brain injury (TBI). The triple-phase response requires fluid management strategies reactive to urine output and sodium homeostasis as patients shift between Diabetes Insipidus (DI) and Syndrome of Inappropriate ADH (SIADH). It was observed, at a tertiary paediatric center, a relatively high prevalence of the above complications within a cohort of paediatric post-neurosurgical and TBI patients. An audit of the clinical practice against set institutional guidelines was undertaken and analyzed to understand why this was occurring. Based on those results, new guidelines were developed with structured educational packages for the specialist teams involved. This was then reaudited, and the findings were compared. Methods: Two independent audits were conducted across two time periods, pre and post guideline change. Primary data was collected retrospectively, including both qualitative and quantitative data sets from the CQUIN neurosurgical database and electronic medical records. All paediatric patients post posterior fossa (PFT) or supratentorial surgery or with a TBI were included. A literature review of evidence-based practice, initial audit data, and stakeholder feedback was used to develop new clinical guidelines and nursing standard operation procedures. Compliance against these newly developed guidelines was re-assessed and a thematic, trend-based analysis of the two sets of results was conducted. Results: Audit-1 January2017-June2018, n=80; Audit-2 January2020-June2021, n=30 (reduced operative capacity due to COVID-19 pandemic). Overall, improvements in the monitoring of both fluid balance and electrolyte trends were demonstrated; 51% vs. 77% and 78% vs. 94%, respectively. The number of clear fluid management plans documented postoperatively also increased (odds ratio of 4), leading to earlier recognition and management of evolving fluid-balance abnormalities. The local paediatric endocrine team was involved in the care of all complex cases and notified sooner for those considered to be developing DI or SIADH (14% to 35%). However, significant Na fluctuations (>12mmol in 24 hours) remained similar – 5 vs six patients – found to be due to complex pituitary hypothalamic pathology – and the recommended adaptive fluid management strategy was still not always used. Qualitative data regarding useability and understanding of fluid-balance abnormalities and the revised guidelines were obtained from health professionals via surveys and discussion in the specialist teams providing care. The feedback highlighted the new guidelines provided a more consistent approach to the post-operative care of these patients and was a better platform for communication amongst the different specialist teams involved. The potential limitation to our study would be the small sample size on which to conduct formal analyses; however, this reflects the population that we were investigating, which we cannot control. Conclusion: The revised clinical guidelines, based on audited data, evidence-based literature review and stakeholder consultations, have demonstrated an improvement in understanding of the neuro-endocrine complications that are possible, as well as increased compliance to post-operative monitoring of fluid balance and electrolytes in this cohort of patients. Emphasis has been placed on preventative rather than treatment of DI and SIADH. Consequently, this has positively impacted patient safety for the center and highlighted the importance of educational awareness and multi-disciplinary team working.

Keywords: post-operative, fluid-balance management, neuro-endocrine complications, paediatric

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