Search results for: case manager

Authors: Santosh Tummidi, Pragati Sathe, Kanchan Kothari, Prachi Gholap, Mona Agnihotri, Gwendolyn Fernandes, Leena Naik, Rachana Chaturvedi

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Introduction: EUS-Guided Fine Needle Aspiration/Brush (EUS-FNA/Brush) has become increasingly popular for the diagnosis and staging of gastrointestinal and peri-gastrointestinal lesions. Objective: To evaluate the diagnostic accuracy and spectrum of lesions in gastrointestinal EUS-FNA. Material and Methods: A total of 124 EUS-FNA during the period from Aug 2015-Nov 2016 were studied. Results: Age ranged from 13-80 years with a slight female predominance. CBD was the most common site with 47 cases amongst which were 9 adenocarcinoma, and 7 cases were suspicious for malignancy. Pancreatic EUS-FNA showed 5 adenocarcinoma, 2 SPEN, 1 case each of neuroendocrine tumor, anaplastic carcinoma and NHL. Amongst oesophageal lesions, 3 cases were suspicious for malignancy, and 4 were inflammatory, 4 showed SCC, 1case each adenocarcinoma and leiomyoma. Stomach- 1 case each of adenocarcinoma, granulomatous inflammation, and GIST. Periportal lymph nodes were the commonest nodes, and there were 11 necrotising granulomatous inflammations, 3 metastatic adenocarcinoma, 2 cases of atypical cells and 1 case of NHL. 17 cases were unsatisfactory, 41 cases had histopathology follow up with 85% cases being concordant. Conclusion: EUS-FNA is reliable, sensitive and specific. It can be utilized for better management of intra-abdominal lesions.

Keywords: EUS-FNA, brush, cytology, histopathology

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Authors: Chen-Ya Juan

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Problem-Based Learning uses vague questions to guide student thinking and enhance their self-learning and collaboration. Most teachers implement PBL in a physical classroom, where teachers can monitor and evaluate students’ learning progress and guide them to search resources for answers. However, the prevalence of the Covid-19 in the world had changed from physical teaching to distance teaching. This instruction used many cases and applied Problem-Based Learning combined on the distance teaching via the internet for college students. This study involved an experimental group with PBL and a control group without PBL. The teacher divided all students in PBL class into eight groups, and 7~8 students in each group. The teacher assigned different cases for each group of the PBL class. Three stages of instruction were developed, including background knowledge of Learning, case analysis, and solving problems for each case. This study used a quantitative research method, a two-sample t-test, to find a significant difference in groups with PBL and without PBL. Findings indicated that PBL incased the average score of special education knowledge. The average score was improved by 20.46% in the PBL group and 15.4% without PBL. Results didn’t show significant differences (0.589>0.05) in special education professional knowledge. However, the feedback of the PBL students implied learning more about the application, problem-solving skills, and critical thinking. PBL students were more likely to apply professional knowledge on the actual case, find questions, resources, and answers. Most of them understood the importance of collaboration, working as a team, and communicating with other team members. The suggestions of this study included that (a) different web-based teaching instruments influenced student’s Learning; (b) it is difficult to monitor online PBL progress; (c) online PBL should be implemented flexible and multi-oriented; (d) although PBL did not show a significant difference on the group with PBL and without PBL, it did increase student’s problem-solving skills and critical thinking.

Keywords: problem-based learning, college students, distance learning, case analysis, problem-solving

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Authors: Shi-xia Xu, Zai-wen Zhang, Ru-xue Chen, Shan Zhou, Xiang-feng Tang

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Objective: The clinical influence of HLA-DPB1 mismatches on clinical outcome of HSCT is less clear. This is the first meta-analysis to study the HLA-DPB1 matching statues on clinical outcomes after unrelated donor HSCT. Methods: We searched the CIBMTR, Cochrane Central Register of Controlled Trials (CENTRAL) and related databases (1995.01–2017.06) for all relevant articles. Comparative studies were used to investigate the HLA-DPB1 loci mismatches on clinical outcomes after unrelated donor HSCT, such as the disease-free survival (DFS), overall survival, GVHD, relapse, and transplant-related mortality (TRM). We performed meta-analysis using Review Manager 5.2 software and funnel plot to assess the bias. Results: At first, 1246 articles were retrieved, and 18 studies totaling 26368 patients analyzed. Pooled comparisons of studies found that the HLA-DPB1 mismatched group had a lower rate of DFS than the DPB1-matched group, and lower OS in non-T cell depleted transplantation. The DPB1 mismatched group has a higher incidence of aGVHD and more severe ( ≥ III degree) aGvHD, lower rate of relapse and higher TRM. Moreover, compared with 1-antigen mismatch, 2-antigen mismatched led to a higher risk of TRM and lower relapse rate. Conclusions: This meta-analysis indicated HLA-DPB1 has important influence on survival and transplant-related complications during unrelated donor HSCT and HLA-DPB1 donor selection strategies have been proposed based on a personalized algorithm.

Keywords: human leukocyte antigen, DPB1, transplant, meta-analysis, outcome

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Authors: Michelangelo Liban, Debbie Liquete

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A case of a 93-year-old Filipina who experienced a sudden onset of left-sided hemichorea hemiballismus after falling from a standing height due to dizziness and then sought consult at the Emergency Room. She was not known to have diabetes mellitus nor experienced any symptoms of diabetes aside from its rare neurological manifestation of hemichorea-hemiballismus prior to this consult. On further workup, her baseline laboratory tests at the Emergency Room Department showed a CBG of 340mg/dL, an HbA1c of 15%, no ketones were detected in her urine but a hyperdensity with a Hounsfeld unit of 38 on CT, and hyperintensity on T1 weighted MRI on her right striatum with an incidental finding of a subdural hematoma measured as a 0.7cm hyperdensity on her right temporoparietal area with no midline shift. She was then treated with Clonazepam 2mg ¼ tab twice a day before bedtime and insulin 70/30 16 units in the morning and eight units in the evening, which provided good glycemic control maintained at 140-180 mg/dL, complete cessation of the left-sided hemichorea hemiballismus was also observed. The subdural hematoma was deemed non-surgical, and she refused admission into our institution; hence observation on an outpatient basis was done. This is a case of a rare neurological manifestation of diabetes mellitus but with good treatment response to anti-chorea medications combined with diabetes medications.

Keywords: hemichorea, hemiballismus, striatopathy, diabetes

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Authors: Hamidreza Jahani, Zahra Salehzadeh, Ehsan Amini, Mohsen Tohidifar

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Calvarial Hyperostosis Syndrome (CHS) is a benign bone disease of the skull. It is a non-neoplastic and proliferative bone disease, and the main feature of the disease is progressive and asymmetrical bone involvement. CHS is mostly reported in young male and female bullmastiff dogs and less frequently in other breeds. The etiology of CHS is unknown. This is the first case report of CHS in Iran. A 3-month-old male Persian Mastiff was presented with chief complaints of multiple episodes of seizure, pacing, bizarre behavior, delayed growth, head pressing, and difficulty in opening the mouth. Central blindness and open fontanelles were observed in clinical examination. No abnormality was found in the complete blood count and routine blood biochemical tests. CT scan findings include cortical thickening of frontal and parietal bones and enlargement of the left retropharyngeal lymph node. For treatment, oral clindamycin for two weeks, prednisolone and phenobarbital for one month, respectively, were administrated, and the case showed improvement after a week and recovered after one month.

Keywords: calvarial hyperostosis, Persian Mastiff, frontal bone, seizure

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Authors: Ravindra Gohane, S. V. Deshmukh

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The coal acts as a fuel on a very large scale. Coal forms the basis of any thermal power plant. Different types of coal are available for utilization. The moisture content, volatile nature and ash content determines the type of the coal. Out of these moisture plays a very important part as it is present naturally within the coal and is added while handling the coal and is termed as wet coal. The problems of wet coal are many and more particularly during rainy season such as generation loss, jamming of crusher, reduction in calorific value, transportation of coal etc. Efforts are made to resolve the problems arising out of wet coal worldwide. This paper highlights the issue of resolving the problem due to wet coal with the help of a case study involving installation of V-type wiper on the conveyer belt.

Keywords: coal handling plant, wet coal, v-type, generation

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Authors: Islam Abouelhamd

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Rives have long been recognized as one of the most important natural resources, They are important to ensure human health, civilization, and sustainable development, and the importance of rivers as the focal point of cities was established from the early times of civilization and will remain so. Urban design of Riverfront has been an issue of wide concern and extensive discussion since the 1970s, however, Cities seek a riverfront that is a place of public enjoyment, They want a Riverfront where there is ample visual and physical public access to both the water and the land, they want a place that contributes to the quality of life in all of its aspects; economic, social, and cultural, on another hand, Successful urban design of Riverfront requires an understanding of development processes, dimensions of urban design and an appreciation of the distinctiveness of Riverfront locations. A close association between cities and river is inherently over the history of civilization, and in fact, many urban cities in Egypt are located close to Nile River areas. Always trying to use the land closer to the river to take advantage of the benefits it provides, And in spite of the significant role played by the littoral fronts in the life of the city, the riverfronts have remained generally in Egypt and especially in Asyut city neglected. According to the knowledge gained from the literature review, review of case studies and the historical researches of Asyut Riverfront, this research aims to identify the urban transformations of Asyut riverfront and expect the Opportunities and Challenges which will play an important part of the future urban design issues and researches will prepare, especially in the case study area (northern areas of Asyut riverfront). After that, the case study data, historical framework and International experiences were collected and analyzed to Produce Primary indicators of the expectations of the riverfront urban design process inside the case study area, In addition to preparing the conclusions of the theoretical framework and recommendations for the paper.

Keywords: civilization, sustainable development, riverfront, urban transformations

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Authors: Amanda Maitland

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This preliminary study has examined ways in which social media may help cause stalker murder by individuals with personality disorders and a strong sense of sexual propriety. A public display on social media by the intended victim was felt to be a trigger that instigated interpersonal violence. To identify behavioural paradigms, case studies of intimate partner murders were explored using news media sources and documentaries. In all of the case studies, social media interaction and social media postings occurred shortly before the murder. The evidence suggested a preponderance of correlations between the social media postings, stalking behaviours, personality disorders, and the murder of an intimate partner. In addition to this, a profile for of Facebook/social media murder was gleaned from the paradigms of behavior found in the case studies. The evidence showed a complex relationship between severe violence, stalking, borderline personality, and intimate partner violence was identified through the study. The struggle clients have in dealing with the: public, ambiguous and unrelenting nature of social media postings was also observed. The murderers anguish and rage appeared to be further intensified by attitudes of sexual propriety and entitlement. These attitudes were evident in all the case studies. The study concluded with further research on how the public can protect themselves from entering situations where social media postings might trigger a violent response. Further to this, psychological approaches were identified that might support client’s with personality disorders to cope with perceived provocative and distressing data on the internet. Thus, the findings of this study will be of interest to: therapists, psychologists, nurses, criminologists and social workers.

Keywords: social media, borderline personality, murder, cyberstalking, intimate partner violence, sexual propriety, Facebook

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Authors: Mohammed Sabri Ali Akresh

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The modern technologies and developments in computer and Global Positioning System (GPS) as well as Geographic Information System (GIS) and total station TS. This paper presents a new proposal for coordinates system by a harmonic equations “United projections”, which have five projections (Mercator, Lambert, Russell, Lagrange, and compound of projection) in one zone coordinate system width 14 degrees, also it has one degree for overlap between zones, as well as two standards parallels for zone from 10 S to 45 S. Also this paper presents two cases; first case is to compare distances between a new coordinate system and UTM, second case creating local coordinate system for the city of Sydney to measure the distances directly from rectangular coordinates using projection of Mercator, Lambert and UTM.

Keywords: harmonic equations, coordinate system, projections, algorithms, parallels

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Authors: Risna Wijayanti, Sumiati, Hanif Iswari

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This study aims to analyze the role of financial risk attitude as a mediation between financial knowledge and business growth. The ability of human resources in managing capital (financial literacy) can be a major milestone for a company's business to grow and build its competitive advantage. This study analyzed the important role of financial risk attitude in bringing about financial knowledge on corporate growth. There have been many discussions arguing that financial knowledge is one of the main abilities of corporate managers in determining the success of managing a company. However, a contrary argument of other scholars also enlightened that financial knowledge did not have a significant influence on corporate growth. This study used literatures' review to analyze whether there is another variable that can mediate the effect of financial knowledge toward corporate growth. Research mapping was conducted to analyze the concept of risk tolerance. This concept was related to people's risk aversion effects when making a decision under risk and the role of financial knowledge on changes in financial income. Understanding and managing risks and investments are complicated, in particular for corporate managers, who are always demanded to maintain their corporate growth. Substantial financial knowledge is extremely needed to identify and take accurate information for corporate financial decision-making. By reviewing several literature, this study hypothesized that financial knowledge of corporate managers would be meaningless without manager's courage to bear risks for taking favorable business opportunities. Therefore, the level of risk aversion from corporate managers will determine corporate action, which is a reflection of corporate-level investment behavior leading to attain corporate success or failure for achieving the company's expected growth rate.

Keywords: financial knowledge, financial risk attitude, corporate growth, risk tolerance

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Authors: Mengjie Zhou

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Under the rapid promotion of digital logistics, the old consumption space in cities is undergoing profound transformation and reconstruction. This article systematically analyzes the impact of digital logistics on existing consumer spaces in cities and how these spaces can adapt to and lead this change through distinct ‘spatial production’ models. The digital transformation of the logistics industry has significantly improved logistics efficiency and service quality while also putting forward new requirements for the form and function of consumer space. In this process, the old consumption space in cities not only faces the trend of material consumption transforming into spiritual consumption but also needs to face profound changes in consumer behavior patterns. Taking Fengying Xili in Changsha as an empirical case, this article explores in detail how it successfully transformed from a traditional consumption space to a modern cultural consumption space by introducing new business formats, optimizing spatial layout, and improving service quality while preserving its historical heritage. This case not only provides valuable practical experience for the transformation of old urban consumption spaces but also demonstrates the feasibility and potential of the new model of ‘spatial production’.

Keywords: digital logistics, urban consumption space, space production, urban renewal

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Authors: Mohamed K. Metwally, Sherif H. El-Gohary, Kyung Min Byun, Seung Moo Han, Soo Yeol Lee, Min Hyoung Cho, Gon Khang, Jinsung Cho, Tae-Seong Kim

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Photoacoustic imaging (PAI) is a non-invasive and non-ionizing imaging modality that combines the absorption contrast of light with ultrasound resolution. Laser is used to deposit optical energy into a target (i.e., optical fluence). Consequently, the target temperature rises, and then thermal expansion occurs that leads to generating a PA signal. In general, most image reconstruction algorithms for PAI assume uniform fluence within an imaging object. However, it is known that optical fluence distribution within the object is non-uniform. This could affect the reconstruction of PA images. In this study, we have investigated the influence of optical fluence distribution on PA back-propagation imaging using finite element method. The uniform fluence was simulated as a triangular waveform within the object of interest. The non-uniform fluence distribution was estimated by solving light propagation within a tissue model via Monte Carlo method. The results show that the PA signal in the case of non-uniform fluence is wider than the uniform case by 23%. The frequency spectrum of the PA signal due to the non-uniform fluence has missed some high frequency components in comparison to the uniform case. Consequently, the reconstructed image with the non-uniform fluence exhibits a strong smoothing effect.

Keywords: finite element method, fluence distribution, Monte Carlo method, photoacoustic imaging

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Authors: Antoifi Abdoulhalik, Ashraf Ahmed

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Saltwater intrusion (SWI) in coastal aquifers has become a growing threat for many countries around the world. While various control measures have been suggested to mitigate SWI, the construction of subsurface physical barriers remains one of the most effective solutions for this problem. In this work, we used laboratory experiments and numerical simulations to investigate the effectiveness of subsurface dams in heterogeneous layered coastal aquifer with different layering patterns. Four different cases were investigated, including a homogeneous (case H), and three heterogeneous cases in which a low permeability (K) layer was set in the top part of the system (case LH), in the middle part of the system (case HLH) and the bottom part of the system (case HL). Automated image analysis technique was implemented to quantify the main SWI parameters under high spatial and temporal resolution. The method also provides transient salt concentration maps, allowing for the first time clear visualization of the spillage of saline water over the dam (advancing wedge condition) as well as the flushing of residual saline water from the freshwater area (receding wedge condition). The SEAWAT code was adopted for the numerical simulations. The results show that the presence of an overlying layer of low permeability enhanced the ability of the dam to retain the saline water. In such conditions, the rate of saline water spillage and inland extension may considerably be reduced. Conversely, the presence of an underlying low K layer led to a faster increase of saltwater volume on the seaward side of the wall, therefore considerably facilitating the spillage. The results showed that a complete removal of the residual saline water eventually occurred in all the investigated scenarios, with a rate of removal strongly affected by the hydraulic conductivity of the lower part of the aquifer. The data showed that the addition of the underlying low K layer in case HL caused the complete flushing to be almost twice longer than in the homogeneous scenario.

Keywords: heterogeneous coastal aquifers, laboratory experiments, physical barriers, seawater intrusion control

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Authors: Aurélie Cassiers

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In this presentation, an overview is given of the freedom of states to legislate concerning abortion. Today, access to safe and legal abortion is still a hot topic in many countries in the world. Abortion policies try to strike a balance between women’s rights to self-determination and private life on the one hand, and the protection of the life of unborn children on the other. Each country has different religious, cultural and political views on abortion, and therefore specific legislations. However, citizens may submit a complaint at international courts when they find their national legislation too restrictive. The study is discussed of the development of the ECtHR, UNCHR, and IACHR case law, regarding the question of the ‘right to abort’ and indirectly of the protection of the unborn children. Each relevant case is analyzed to answer the following questions: Is the unborn child protected, and if so, how? Why does the woman want to abort and how is her interest or right protected? How is a fair balance reached between the different interests? Is the state completely free to write policies that restrict abortion? What are the factors to determine the margin of appreciation of the state? In conclusion, does this specific court recognize a right to abort, and if so, under which conditions? To conclude, this presentation shows that each court has its own perspective on and perception of abortion, and its own criteria to determine whether the state is complying with international norms regarding individual liberty and protection of the children.

Keywords: abortion, international courts, unborn children, women rights

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Authors: Dativa Maria Aliddeki, Fred Monje, Godfrey Nsereko, Benon Kwesiga, Daniel Kadobera, Alex Riolexus Ario

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Background: Cholera is a severe gastrointestinal disease caused by Vibrio cholera. It has caused several pandemics. On 26 February 2018, a suspected cholera outbreak, with one death, occurred in School X in Hoima Municipality, western Uganda. We investigated to identify the scope and mode of transmission of the outbreak, and recommend evidence-based control measures. Methods: We defined a suspected case as onset of diarrhea, vomiting, or abdominal pain in a student or staff of School X or their family members during 14 February–10 March. A confirmed case was a suspected case with V. cholerae cultured from stool. We reviewed medical records at Hoima Hospital and searched for cases at School X. We conducted descriptive epidemiologic analysis and hypothesis-generating interviews of 15 case-patients. In a retrospective cohort study, we compared attack rates between exposed and unexposed persons. Results: We identified 15 cases among 75 students and staff of School X and their family members (attack rate=20%), with onset from 25-28 February. One patient died (case-fatality rate=6.6%). The epidemic curve indicated a point-source exposure. On 24 February, a student brought fried fish from her home in a fishing village, where a cholera outbreak was ongoing. Of the 21 persons who ate the fish, 57% developed cholera, compared with 5.6% of 54 persons who did not eat (RR=10; 95% CI=3.2-33). None of 4 persons who recooked the fish before eating, compared with 71% of 17 who did not recook it, developed cholera (RR=0.0, 95%CIFisher exact=0.0-0.95). Of 12 stool specimens cultured, 6 yielded V. cholerae. Conclusion: This cholera outbreak was caused by eating fried fish, which might have been contaminated with V. cholerae in a village with an ongoing outbreak. Lack of thorough cooking of the fish might have facilitated the outbreak. We recommended thoroughly cooking fish before consumption.

Keywords: cholera, disease outbreak, foodborne, global health security, Uganda

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Authors: Gauranga Das

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People in cities have prosperity but there is immense pollution, chaos in the mind, anxiety and turbulence. People in the villages experience pristine pure environment but they also experience poverty. There is a need to find out ways by which the cities and the villages can complement each other through their strengths and take care of each other’s weaknesses. In order to do this, the case study of Govardhan Ecovillage has been explored in this paper. All its environment, social and economic initiatives along with eco-tourism and wellness features are being analyzed. The analysis shows that Govardhan Ecovillage is successfully able to harmonize its different initiatives and provide a package which has created a win-win solution for the city people and also the villagers. Such kind of Eco-tourism initiatives should be supported and replicated in other places in the world to benefit everyone.

Keywords: sustainability, ecotourism, ecology, rural development, wellness, biodiversity

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Authors: J. O. Alvarez, L. Y. Rivera

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Physical activity can reduce symptomatology in children with autism spectrum disorder (ASD). The sport of soccer has been widely applied as a therapeutic method for ASD children. However, empirical results from soccer programs are not widely known. This paper presents the case study of Golitos, the only dedicated soccer program for children on the island of Puerto Rico, and analyzes its results in the reduction of ASD social and emotional symptoms. The paper shows evidence that suggests that program approach, content, and community-based elements can make a notable difference in the effectiveness of using soccer or sports as therapeutic methods for children with ASD.

Keywords: autism, soccer, program, community

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Authors: Adrian Sebastian, Chris Gillespie

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We describe a case of diffuse rectal involvement with cap polyposis, manifesting with a protein-losing colopathy and occurring in the setting of advanced mechanical pelvic floor dysfunction. A 59-year-old male with a 5-year history of persistent excessive flatulence, defecatory difficulties, and diarrhea. He had extensive cap polyposis of the entire rectum endoscopically. His symptoms progressed to severe fecal incontinence with mucus leakage, pelvic pain, weight loss, and hypoalbuminemia. Clinical examination exhibited severe perineal descent, a large rectocele, poor anal squeeze, and a poor defecatory technique. After a trial of nonoperative therapies addressing his defecatory dysfunction, and Helicobacter pylori eradication, surgical resection was offered due to severe symptoms with ongoing incontinence and protein loss with no other reasonable options. A robotic abdominoperineal resection with a permanent colostomy was performed, followed by an uncomplicated recovery. Our observation of coexisting mechanical pelvic floor changes in this patient lends weight to the concept of a prolapse-related phenomenon in the pathophysiology of this rare condition.

Keywords: cap polyposis, pelvic dysfunction, fecal incontinence, case report

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Authors: Asghar Zamani, Mostafa Falahmorad

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Virtualization is established to combine and use the unique capabilities of employees to increase productivity and agility to provide services regardless of location. Adapting to fast and continuous change and getting maximum access to human resources are reasons why virtualization is happening. The distance problem is solved by information. Flexibility is the most important feature of virtualization, and information will be the main focus of virtualized companies. In this research, we used the Covid-19 opportunity window to assess the productivity of the companies that had been going through more virtualized management before the Covid-19 in comparison with those that just started planning on developing infrastructures on virtual management after the crises of pandemic occurred. The research process includes financial (profitability and customer satisfaction) and behavioral (organizational culture and reluctance to change) metrics assessment. In addition to financial and CRM KPIs, a questionnaire is devised to assess how manager and employees’ attitude has been changing towards the migration to virtualization. The sample companies and questions are selected by asking from experts in the IT industry of Iran. In this article, the conclusion is that companies open to virtualization based on accurate strategic planning or willing to pay to train their employees for virtualization before the pandemic are more agile in adapting to change and moving forward in recession. The prospective companies in this research, not only could compensate for the short period loss from the first shock of the Covid-19, but they could also foresee new needs of their customer sooner than other competitors, resulting in the need to employ new staff for executing the emerging demands. Findings were aligned with the literature review. Results can be a wake-up call for business owners especially in developing countries to be more resilient toward modern management styles instead of continuing with traditional ones.

Keywords: virtual management, virtual organization, competitive advantage, KPI, profit

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Authors: P. S. Dhananjaya Swamy, B. Chinnappa, G. B. Ramesh, Naveen P. Kumar

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Kodagu district is one of the most densely forested districts in the India as around sixty five per cent of geographical areas under tree cover. Nearly 53 per cent of the flora of Kodagu is endemic. The district is also a hotspot of endemic orchids found mainly in the Thadiandamol. Shade grown, eco-friendly coffee farms are perhaps a selected few places on this planet where nature runs wild. The Kodagu accounts for more than 8.8 per cent of floral diversity of Karnataka state. Estimation of unit cost of cultivation plays a vital role in determining the governmental program their market intervention policies. On an average, planters incurred around Rs. 17041 per acre. The extent of production risk was highest among small category of planters (66 %) compared to other two exhibiting production instability. The result shows that, the coffee productivity in medium plantations was 1051.2 kg per acre as against 758.5 and 789.2 kg in the case of small and large plantations. An annual net return per acre was highest in the case of medium planters (Rs. 26109.3) as against Rs. 20566.7 and Rs. 18572.7 in the case of small and large planters. Cost of production was lowest in the case of small planters (Rs. 18.9 per kg of output) followed by medium planters (Rs. 21.2 per kg of output) and large planters (Rs. 22.5 per kg of output). The productivity of coffee is less whenever it is grown under high shade and native tree cover; it is around 6 quintals per acre when compared with low shade conditions, which is around 8.9 quintals per acre, without a significant difference in the amount invested for growing coffee. Net gain was lower by Rs. 15.5 per kg for the planters growing under high shade and native trees cover when compared with low shade and exotic trees cover.

Keywords: coffee, cultivation, economics, Kodagu

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Authors: Dan Qu, Dezhi Sun, Benhang Li

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The removal of Nitenpyram from farmland runoff by an integrated eco-ditches and constructed wetland system was investigated in the case of different HRT. Experimental results show that the removal of COD, N and P was not influenced by the Nitenpyram. When the HRT was 2.5 d, 2 d, and 1 d, the Nitenpyram removal efficiency could reach 100%, 100% and 84%, respectively. The removal efficiency in the ecological ditches was about 38%-40% in the case of different HRT, while that in the constructed wetland was influenced by the HRT variation. The optimum HRT for Nitenpyram and pollutants removal was 2 d. The substrate zeolite with soil and hollow brick layer enabled higher Nitenpyram removal rates, probably due to the cooperative phenomenon of plant uptake and microbiological deterioration as well as the adsorption by the substrate.

Keywords: ecological ditch, vertical flow constructed wetland, hydraulic retention time, Nitenpyram

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Authors: Tianyi Qin

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Along with the acceleration of Chinese urbanization, the expansion, renovation and demolition of old buildings is on the stage together with the design and construction of new buildings every day in downtown of the old city area. The coordinative symbiosis between new and old buildings is an important problem which needs to be solved in the process of urban development. By studying and analyzing the case of Shanghai Citic Plaza and surroundings, this paper contributes to discussing the concept, value and problems to be solved of the coordination of new and old buildings, meanwhile, striking the balance between new and old buildings from the aspects of architectural form, space, function and local context. As a result, the strategy of the coordinative symbiosis between new and old buildings is summarized, which can offer some guiding principles to urban development from now on.

Keywords: coordinative symbiosis, new and old buildings, Shanghai Citic Plaza, strategy

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Authors: Steven Robinson, Adriana Dager, Param Patel

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Wandering spleen is a rare variant where there is abnormal development of the ligamentous peritoneal attachments of the spleen which normally anchor it in the left upper quadrant of the abdomen. Ligamentous abnormalities can be congenital, or acquired through pregnancy, injury, or iatrogenic causes. Absence or laxity of these ligaments allows migration of the spleen into ectopic portions of the abdomen, which is also associated with an elongated vascular pedicle. Incidence of wandering spleen is reported at less than 0.25% with a female to male ratio of approximately 6:1. The most common complication of a wandering spleen is torsion around its vascular pedicle which can lead to thrombosis and infarction. Torsion of a wandering spleen is a rare but important cause of an acute abdomen. Imaging, and specifically CT or ultrasound, is crucial in the diagnosis. We present a case of a torsed wandering spleen which was treated with splenectomy.

Keywords: Wandering Spleen, Torsion, Splenic Torsion, Spleen

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Authors: Mahdi Goharrokhi, Rasool Shiri, Eiraj Naser

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A depropanizer column of a particular refinery was redesigned in this work. That is, minimum reflux ratio, minimum number of trays, feed tray location and the hydraulic characteristics of the tower were calculated and compared with the actual values of the existing tower. To Design review of the tower, fundamental equations were used to develop software which its results were compared with two commercial software results. In each case PR EOS was used. Based on the total energy consumption in reboiler and condenser, feed tray location was also determined using case study definition for tower.

Keywords: column, hydraulic design, pressure drop, energy consumption

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Authors: Ginés Hernández-Cánovas, Mª Camino Ramón-Llorens, Johanna Koëter-Kant

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This paper uses a survey data-set of 837 Spanish SMEs to analyze the association between borrower discouragement and prior firm´s strategic decisions, while controlling for firm and owner characteristics. While existing literature has neglected factors limiting the demand for resources by an overreliance on arguments which attempt to explain the existence of discouraged borrowers solely in terms of lack of access to supply of credit. The objective of this paper is to show that factors limiting the demand for resources and, therefore, reducing the availability of funds, can be traced back to the firm manager´s decision. Our hypothesis is that managers that undertake strategic decisions seeking growth or improvement in their business performance participate more in the banking market than those showing contentment with their current business situation. Our results shows that SMEs that undertake an active role in research and development activities and that achieve improvements in the operating performance of their business are less likely to be discouraged from applying for a loan. Who needs credit and who applies for credit is important for firms, prospective lenders and policymakers interested in the financial health of these firms. Credit constrained firms are less likely to invest in R&D and to introduce new products, possibly harming long-term economic growth. Knowing how important borrower discouragement is in Europe, is important for judging the priority which should be attached to government policies aimed at reducing its effects. For example, policy makers could encourage the transparency about credit eligibility and conditions in order to reduce discouragement.

Keywords: discouragement, financial constraints, SMEs financing

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Authors: Darma Putra Sitepu, Dewi Larasati, Yohanes Wolter Hendrik George

Abstract:

Sepsis is a life-threatening medical emergency frequently observed in intensive care unit (ICU). Surviving Sepsis Campaign in 2018 has recommended the administration of early vasopressor in the first hour of sepsis or septic shock but has not yet included de-resuscitation protocol. De-resuscitation in acute management of septic shock is where patient received active removal of accumulated fluid. It has been proposed by some studies and ongoing clinical trials. Here we present a case with early vasopressor and de-resuscitation. Male, 27 years old presenting to the emergency room with shortness of breath, altered mental status, and widespread blisters on his body and lips started a few hours prior, after receiving non-steroidal anti-inflammatory drug through intravenous injection. Patient was hypotensive, tachycardic, and tachypneic at admission, diagnosed with Steven Johnson Syndrome with Septic Shock. Patient received fluid resuscitation, early vasopressor, and diuresis agent aimed to actively remove fluid after the initial phase of resuscitation. Patient was admitted to ICU and progressively recovering. At day-10, patient was stabilized and was transferred to general ward. Early vasopressor and de-resuscitation are beneficial for the patient.

Keywords: sepsis, shock, de-resuscitation, vasopressor, fluid, case report

Procedia PDF Downloads 145

Authors: Pavel Adámek

Abstract:

This study examines perception of environmental approach in small and medium-sized enterprises (SMEs) – the process by which firms integrate environmental concern into business. Based on a review of the literature, the paper synthesizes focus on environmental issues with the reflection in a case study in the Czech Republic. Two themes of corporate environmentalism are discussed – corporate environmental orientation and corporate stances toward environmental concerns. It provides theoretical material on greening organizational culture that is helpful in understanding the response of contemporary business to environmental problems. We integrate theoretical predictions with empirical findings confronted with reality. Scales to measure these themes are tested in a survey of managers in 229 Czech firms. We used the process of in-depth questioning. The research question was derived and answered in the context of the corresponding literature and conducted research. A case study showed us that environmental approach is variety different (depending on the size of the firm) in SMEs sector. The results of the empirical mapping demonstrate Czech company’s approach to environment and define the problem areas and pinpoint the main limitation in the expansion of environmental aspects. We contribute to the debate for recognition of the particular role of environmental issues in business reality.

Keywords: corporate environmentalism, Czech Republic, empirical mapping, environmental performance

Procedia PDF Downloads 350

Authors: Zohreh Soltani, Seyedmohammadhossein Hosseinian

Abstract:

Reduction of energy consumption in built infrastructure, through the installation of energy-efficient technologies, is a major approach to achieving sustainability. In practice, the viability of energy efficiency projects strongly depends on the cost reimbursement and profitability. These projects are subject to failure if the actual cost savings do not reimburse the project cost in a timely manner. In such cases, refinancing could be a solution to benefit from the long-term returns of the project if implemented wisely. However, very little is still known about the effect of refinancing options on financial performance of energy efficiency projects. To fill this gap, the present study investigates the financial behavior of energy efficiency projects with focus on refinancing options, such as Leveraged Loans. A System Dynamics (SD) model is introduced, and the model application is presented using an actual case-study data. The case study results indicate that while high-interest start-ups make using Leveraged Loan inevitable, refinancing can rescue the project and bring about profitability. This paper also presents some managerial implications of refinancing energy efficiency projects based on the case-study analysis. Results of this study help implementing financially viable energy efficiency projects, so the community could benefit from their environmental advantages widely.

Keywords: energy efficiency projects, leveraged loan, refinancing, sustainability

Procedia PDF Downloads 385

Authors: Wid Kattan, Rahaf Albarraq

Abstract:

Background: Tokophobia is a pathological fear of pregnancy that can lead to the avoidance of childbirth. It is classified as primary or secondary. This report describes a patient with tokophobia, as well as her presentation, risk factors, comorbidities, and treatment. Case Presentation: A 43-year-old Saudi woman experienced tokophobia upon becoming pregnant for the fifth time. She was assessed in two clinical interviews by a consultant psychiatrist specializing in women’s mental health. In addition, she completed several questionnaires for assessment of different aspects of her mental health: overall depression, perinatal depression, generalized anxiety, maternal functioning, and fear of childbirth (FOC). Several risk factors and comorbidities that may have contributed to the development of tokophobia in this patient were discussed, including traumatic experiences in previous deliveries, the unplanned nature of the pregnancy, perinatal depression, and pronounced symptoms of anxiety. A collaborative decision to perform a C-section was made, in line with obstetric guidelines and good mental health practice. Full symptomatic recovery was achieved immediately after delivery. Conclusions: We hope to increase clinical awareness of the assessment and management of tokophobia, which is a relatively new concept and, as yet, understudied.

Keywords: tokophobia, fear of childbirth, mental health, anxiety, case report, depression, fear of delivery, psychiatry, cesarean section, perinatal depression

Procedia PDF Downloads 134

Authors: W. S. Hsu, Y. Chiang, H. C. Chen, J. R. Wang, S. W. Chen, J. H. Yang, C. Shih

Abstract:

Not only radiation materials, but also the normal chemical material stored in the power plant can cause a risk to the residents. In this research, the ALOHA code was used to perform the concentration analysis under the CO₂ storage burst or leakage conditions for Kuosheng nuclear power plant (NPP). The Final Safety Analysis Report (FSAR) and data were used in this study. Additionally, the analysis results of ALOHA code were compared with the R.G. 1.78 failure criteria in order to confirm the control room habitability. The comparison results show that the ALOHA result for burst case was 0.923 g/m³ which was below the criteria. However, the ALOHA results for leakage case was 11.3 g/m³.

Keywords: BWR, ALOHA, habitability, Kuosheng

Procedia PDF Downloads 341