Search results for: brain drain

Authors: Jalil ur Rehman, Ramesh C, Tailor, Isa Khan, Jahanzeeb Ashraf, Muhammad Afzal, Geofferry S. Ibbott

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The purpose of this analysis is to estimate secondary cancer risks after VMAT compared to other modalities of head and neck radiotherapy (IMRT, 3DCRT). Computer tomography (CT) scans of Radiological Physics Center (RPC) head and neck phantom were acquired with CT scanner and exported via DICOM to the treatment planning system (TPS). Treatment planning was done using four arc (182-178 and 180-184, clockwise and anticlockwise) for volumetric modulated arc therapy (VMAT) , Nine fields (200, 240, 280, 320,0,40,80,120 and 160), which has been commonly used at MD Anderson Cancer Center Houston for intensity modulated radiation therapy (IMRT) and four fields for three dimensional radiation therapy (3DCRT) were used. True beam linear accelerator of 6MV photon energy was used for dose delivery, and dose calculation was done with CC convolution algorithm with prescription dose of 6.6 Gy. Primary Target Volume (PTV) coverage, mean and maximal doses, DVHs and volumes receiving more than 2 Gy and 3.8 Gy of OARs were calculated and compared. Absolute point dose and planar dose were measured with thermoluminescent dosimeters (TLDs) and GafChromic EBT2 film, respectively. Quality Assurance of VMAT and IMRT were performed by using ArcCHECK method with gamma index criteria of 3%/3mm dose difference to distance to agreement (DD/DTA). PTV coverage was found 90.80 %, 95.80 % and 95.82 % for 3DCRT, IMRT and VMAT respectively. VMAT delivered the lowest maximal doses to esophagus (2.3 Gy), brain (4.0 Gy) and thyroid (2.3 Gy) compared to all other studied techniques. In comparison, maximal doses for 3DCRT were found higher than VMAT for all studied OARs. Whereas, IMRT delivered maximal higher doses 26%, 5% and 26% for esophagus, normal brain and thyroid, respectively, compared to VMAT. It was noted that esophagus volume receiving more than 2 Gy was 3.6 % for VMAT, 23.6 % for IMRT and up to 100 % for 3DCRT. Good agreement was observed between measured doses and those calculated with TPS. The averages relative standard errors (RSE) of three deliveries within eight TLD capsule locations were, 0.9%, 0.8% and 0.6% for 3DCRT, IMRT and VMAT, respectively. The gamma analysis for all plans met the ±5%/3 mm criteria (over 90% passed) and results of QA were greater than 98%. The calculations for maximal doses and volumes of OARs suggest that the estimated risk of secondary cancer induction after VMAT is considerably lower than IMRT and 3DCRT.

Keywords: RPC, 3DCRT, IMRT, VMAT, EBT2 film, TLD

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Authors: Prateek Rastogi, Jenash Acharya

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Histopathology examination has been a boon to forensic experts all around the world since its implication in autopsy cases. Whenever a case of sudden death is encountered, forensic experts clandestinely focus on cardiovascular, respiratory, gastrointestinal or cranio-cerebral causes. After ruling out poisoning or trauma, they are left with the only option available, histopathology examination. Besides preserving thoracic and abdominal organs, brain tissues are very less frequently subjected for the analysis. Based on provisional diagnosis documented on hospital treatment record files, one hemisphere of grossly unremarkable cerebrum was confirmatively diagnosed by histopathology examination to be a case of cerebral toxoplasmosis.

Keywords: cerebral toxoplasmosis, sudden death, health information, histopathology

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Authors: M. L. Burnwal, P. Raychowdhury

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Earthquake leads to adverse effects on buildings resting on soft soils. Mitigating the response of shallow foundations on soft soil with different methods reduces settlement and provides foundation stability. Few methods such as the rocking foundation (used in Performance-based design), deep foundation, prefabricated drain, grouting, and Vibro-compaction are used to control the pore pressure and enhance the strength of the loose soils. One of the problems with these methods is that the settlement is uncontrollable, leading to differential settlement of the footings, further leading to the collapse of buildings. The present study investigates the utility of geosynthetics as a potential improvement of the subsoil to reduce the earthquake-induced settlement of structures. A steel moment-resisting frame building resting on loose liquefiable dry soil, subjected to Uttarkashi 1991 and Chamba 1995 earthquakes, is used for the soil-structure interaction (SSI) analysis. The continuum model can simultaneously simulate structure, soil, interfaces, and geogrids in the OpenSees framework. Soil is modeled with PressureDependentMultiYield (PDMY) material models with Quad element that provides stress-strain at gauss points and is calibrated to predict the behavior of Ganga sand. The model analyzed with a tied degree of freedom contact reveals that the system responses align with the shake table experimental results. An attempt is made to study the responses of footing structure and geosynthetics with unreinforced and reinforced bases with varying parameters. The result shows that geogrid reinforces shallow foundation effectively reduces the settlement by 60%.

Keywords: settlement, shallow foundation, SSI, continuum FEM

Procedia PDF Downloads 194

Authors: Ana Bermudez de Castro Muela, Xiomara Santos Salas, Silvia Cayon Somacarrera

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The aim of this review is to explain what is the intracranial hypotension and its main causes, and also to approach to the diagnostic management in the different clinical situations, understanding radiological findings, and physiopathological substrate. An approach to the diagnostic management is presented: what are the guidelines to follow, the different tests available, and the typical findings. We review the myelo-CT and myelo-RM studies in patients with suspected CSF fistula or hypotension of unknown cause during the last 10 years in three centers. Signs of intracranial hypotension (subdural hygromas/hematomas, pachymeningeal enhancement, venous sinus engorgement, pituitary hyperemia, and lowering of the brain) that are evident in baseline CT and MRI are also sought. The intracranial hypotension is defined as a lower opening pressure of 6 cmH₂O. It is a relatively rare disorder with an annual incidence of 5 per 100.000, with a female to male ratio 2:1. The clinical features it’s an orthostatic headache, which is defined as development or aggravation of headache when patients move from a supine to an upright position and disappear or typically relieve after lay down. The etiology is a decrease in the amount of cerebrospinal fluid (CSF), usually by loss of it, either spontaneous or secondary (post-traumatic, post-surgical, systemic disease, post-lumbar puncture etc.) and rhinorrhea and/or otorrhea may exist. The pathophysiological mechanisms of hypotension and CSF hypertension are interrelated, as a situation of hypertension may lead to hypotension secondary to spontaneous CSF leakage. The diagnostic management of intracranial hypotension in our center includes, in the case of being spontaneous and without rhinorrhea and/or otorrhea and according to necessity, a range of available tests, which will be performed from less to more complex: cerebral CT, cerebral MRI and spine without contrast and CT/MRI with intrathecal contrast. If we are in a situation of intracranial hypotension with the presence of rhinorrhea/otorrhea, a sample can be obtained for the detection of b2-transferrin, which is found in the CSF physiologically, as well as sinus CT and cerebral MRI including constructive interference steady state (CISS) sequences. If necessary, cisternography studies are performed to locate the exact point of leakage. It is important to emphasize the significance of myelo-CT / MRI to establish the diagnosis and location of CSF leak, which is indispensable for therapeutic planning (whether surgical or not) in patients with more than one lesion or doubts in the baseline tests.

Keywords: cerebrospinal fluid, neuroradiology brain, magnetic resonance imaging, fistula

Procedia PDF Downloads 127

Authors: Yifan Gao

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Owing to the high breakdown field, high saturation drift velocity, 2DEG with high density and mobility and so on, AlGaN/GaN HEMTs have been widely used in high-frequency and high-power applications. To acquire a higher power often means higher breakdown voltage and higher drain current. Surface leakage current is usually the key issue affecting the breakdown voltage and power performance. In this work, we have performed in-situ N₂/NH₃ pretreatment before the passivation to suppress the surface leakage and achieve device performance enhancement. The AlGaN/GaN HEMT used in this work was grown on a 3-in. SiC substrate, whose epitaxial structure consists of a 3.5-nm GaN cap layer, a 25-nm Al₀.₂₅GaN barrier layer, a 1-nm AlN layer, a 400-nm i-GaN layer and a buffer layer. In order to analyze the mechanism for the N-based pretreatment, the details are measured by XPS analysis. It is found that the intensity of Ga-O bonds is decreasing and the intensity of Ga-N bonds is increasing, which means with the supplement of N, the dangling bonds on the surface are indeed reduced with the forming of Ga-N bonds, reducing the surface states. The surface states have a great influence on the leakage current, and improved surface states represent a better off-state of the device. After the N-based pretreatment, the breakdown voltage of the device with Lₛ𝒹=6 μm increased from 93V to 170V, which increased by 82.8%. Moreover, for HEMTs with Lₛ𝒹 of 6-μm, we can obtain a peak output power (Pout) of 12.79W/mm, power added efficiency (PAE) of 49.84% and a linear gain of 20.2 dB at 60V under 3.6GHz. Comparing the result with the reference 6-μm device, Pout is increased by 16.5%. Meanwhile, PAE and the linear gain also have a slight increase. The experimental results indicate that using N₂/NH₃ pretreatment before passivation is an attractive approach to achieving power performance enhancement.

Keywords: AlGaN/GaN HEMT, N-based pretreatment, output power, passivation

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Authors: Vaibhavi Birle

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Posterior reversible encephalopathy syndrome is a rare clinic-radiological syndrome associated with acute changes in blood pressure during pregnancy. It is characterized symptomatically by headache, seizures, altered mental status, and visual blurring with radiological changes of white matter (vasogenic oedema) affecting the posterior occipital and parietal lobes of the brain. It is being increasingly recognized due to increased institutional deliveries and advances in imaging particularly magnetic resonance imaging (MRI). In spite of the increasing diagnosis the prediction of PRES and patient factors affecting susceptibility is still not clear. Hence, we conducted the retrospective study to analyse the factors associated with PRES at our tertiary centre.

Keywords: pres syndrome, eclampsia, maternal outcome, fetal outcome

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Authors: Marie-Eve Joret, Marijn Van Vliet, Flavio Camarrone, Marc M. Van Hulle

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Event-related potentials (ERPs) provide evidence that the human brain can process and understand music at a pre-attentive level. Music-specific ERPs include the Early Right Anterior Negativity (ERAN) and a late Negativity (N5). This study aims to further investigate this issue using two types of syntactic manipulations in music: mild violations, containing no out-of-key tones and strong violations, containing out-of-key tones. We will examine whether both manipulations will elicit the same ERPs.

Keywords: ERAN ERPs, Music, N5, P3, ERPs, Music, N5 component, P3 component

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Authors: Jamal Radaideh

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Al-Asfar Lake is located about 14 km east of Al-Ahsa and is one of the most important wetland lakes in the Al Ahsa/Eastern Province of Saudi Arabia. Al-Ahsa is may be the largest oasis in the world, having an area of 20,000 hectares, in addition, it is of the largest and oldest agricultural centers in the region. The surplus farm irrigation water beside additional water supplied by treated wastewater from Al-Hofuf sewage station is collected by a drainage network and discharged into Al-Asfar Lake. The lake has good wetlands, sand dunes as well as large expanses of open and shallow water. Salt tolerant vegetation is present in some of the shallow areas around the lake, and huge stands of Phragmites reeds occur around the lake. The lake presents an important habitat for wildlife and birds, something not expected to find in a large desert. Although high evaporation rates in the range of 3250 mm are common, the water remains in the evaporation lakes during all seasons of the year is used to supply cattle with drinking water and for aquifer recharge. Investigations showed that high concentrations of nitrogen (N), phosphorus (P), biological oxygen demand (BOD), chemical oxygen demand (COD) and salinity discharge to Al Asfar Lake from the D2 drain exist. It is expected that the majority of BOD, COD and N originates from wastewater discharge and leachate from surplus irrigation water which also contribute to the majority of P and salinity. The significant content of nutrients and biological oxygen demand reduces available oxygen in the water. The present project aimed to improve the water quality of the lake using constructed wetland trains which will be built around the lake. Phragmites reeds, which already occur around the lake, will be used.

Keywords: Al Asfar lake, constructed wetland, water quality, water treatment

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Authors: Shereen Ismail Fawaz, Shin-Ichi Izumi, Nouran Mohamed Salah, Heba G. Saber, Ibrahim Mohamed Roushdi

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Background: Multiple sclerosis (MS) is a chronic, inflammatory, mainly demyelinating disease of the central nervous system, more common in young adults. Cerebellar involvement is one of the most disabling lesions in MS and is usually a sign of disease progression. It plays a major role in the planning, initiation, and organization of movement via its influence on the motor cortex and corticospinal outputs. Therefore, it contributes to controlling movement, motor adaptation, and motor learning, in addition to its vast connections with other major pathways controlling balance, such as the cerebellopropriospinal pathways and cerebellovestibular pathways. Hence, trying to stimulate the cerebellum by facilitatory protocols will add to our motor control and balance function. Non-invasive brain stimulation, both repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), has recently emerged as effective neuromodulators to influence motor and nonmotor functions of the brain. Anodal tDCS has been shown to improve motor skill learning and motor performance beyond the training period. Similarly, rTMS, when used at high frequency (>5 Hz), has a facilitatory effect on the motor cortex. Objective: Our aim was to determine the effect of high-frequency rTMS over the cerebellum in improving balance and functional ambulation of multiple sclerosis patients with Ataxia. Patients and methods: This was a randomized single-blinded placebo-controlled prospective trial on 40 patients. The active group (N=20) received real rTMS sessions, and the control group (N=20) received Sham rTMS using a placebo program designed for this treatment. Both groups received 12 sessions of high-frequency rTMS over the cerebellum, followed by an intensive exercise training program. Sessions were given three times per week for four weeks. The active group protocol had a frequency of 10 Hz rTMS over the cerebellar vermis, work period 5S, number of trains 25, and intertrain interval 25s. The total number of pulses was 1250 pulses per session. The control group received Sham rTMS using a placebo program designed for this treatment. Both groups of patients received an intensive exercise program, which included generalized strengthening exercises, endurance and aerobic training, trunk abdominal exercises, generalized balance training exercises, and task-oriented training such as Boxing. As a primary outcome measure the Modified ICARS was used. Static Posturography was done with: Patients were tested both with open and closed eyes. Secondary outcome measures included the expanded Disability Status Scale (EDSS) and 8 Meter walk test (8MWT). Results: The active group showed significant improvements in all the functional scales, modified ICARS, EDSS, and 8-meter walk test, in addition to significant differences in static Posturography with open eyes, while the control group did not show such differences. Conclusion: Cerebellar high-frequency rTMS could be effective in the functional improvement of balance in MS patients with ataxia.

Keywords: brain neuromodulation, high frequency rTMS, cerebellar stimulation, multiple sclerosis, balance rehabilitation

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Authors: M. Dasgupta, S. Banerjee

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Content Based Image Retrieval (CBIR) coupled with Case Based Reasoning (CBR) is a paradigm that is becoming increasingly popular in the diagnosis and therapy planning of medical ailments utilizing the digital content of medical images. This paper presents a survey of some of the promising approaches used in the detection of abnormalities in retina images as well in mammographic screening and detection of regions of interest in MRI scans of the brain. We also describe our proposed algorithm to detect hard exudates in fundus images of the retina of Diabetic Retinopathy patients.

Keywords: case based reasoning, exudates, retina image, similarity based retrieval

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Authors: Kartik Gupta, Virendra Kumar, Sanjeev Sinha, N. Jagannathan

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Introduction: A significant number of patients having human immunodeficiency virus (HIV) infection show a neurocognitive decline (NCD) ranging from minor cognitive impairment to severe dementia. The possible causes of NCD in HIV-infected patients include brain injury by HIV before cART, neurotoxic viral proteins and metabolic abnormalities. In the present study, we compared the level of NCD in asymptomatic HIV-infected patients with changes in brain metabolites measured by using magnetic resonance spectroscopy (MRS). Methods: 43 HIV-positive patients (30 males and 13 females) coming to ART center of the hospital and HIV-seronegative healthy subjects were recruited for the study. All the participants completed MRI and MRS examination, detailed clinical assessments and a battery of neuropsychological tests. All the MR investigations were carried out at 3.0T MRI scanner (Ingenia/Achieva, Philips, Netherlands). MRI examination protocol included the acquisition of T2-weighted imaging in axial, coronal and sagittal planes, T1-weighted, FLAIR, and DWI images in the axial plane. Patients who showed any apparent lesion on MRI were excluded from the study. T2-weighted images in three orthogonal planes were used to localize the voxel in left frontal lobe white matter (FWM) and left basal ganglia (BG) for single voxel MRS. Single voxel MRS spectra were acquired with a point resolved spectroscopy (PRESS) localization pulse sequence at an echo time (TE) of 35 ms and a repetition time (TR) of 2000 ms with 64 or 128 scans. Automated preprocessing and determination of absolute concentrations of metabolites were estimated using LCModel by water scaling method and the Cramer-Rao lower bounds for all metabolites analyzed in the study were below 15\%. Levels of total N-acetyl aspartate (tNAA), total choline (tCho), glutamate + glutamine (Glx), total creatine (tCr), were measured. Cognition was tested using a battery of tests validated for Indian population. The cognitive domains tested were the memory, attention-information processing, abstraction-executive, simple and complex perceptual motor skills. Z-scores normalized according to age, sex and education standard were used to calculate dysfunction in these individual domains. The NCD was defined as dysfunction with Z-score ≤ 2 in at least two domains. One-way ANOVA was used to compare the difference in brain metabolites between the patients and healthy subjects. Results: NCD was found in 23 (53%) patients. There was no significant difference in age, CD4 count and viral load between the two groups. Maximum impairment was found in the domains of memory and simple motor skills i.e., 19/43 (44%). The prevalence of deficit in attention-information processing, complex perceptual motor skills and abstraction-executive function was 37%, 35%, 33% respectively. Subjects with NCD had a higher level of Glutamate in the Frontal region (8.03 ± 2.30 v/s. 10.26 ± 5.24, p-value 0.001). Conclusion: Among newly diagnosed, ART-naïve retroviral disease patients from India, cognitive decline was found in 53\% patients using tests validated for this population. Those with neurocognitive decline had a significantly higher level of Glutamate in the left frontal region. There was no significant difference in age, CD4 count and viral load at initiation of ART between the two groups.

Keywords: HIV, neurocognitive decline, neurometabolites, magnetic resonance spectroscopy

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Authors: Masahiro Takimoto

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The present study explored how the metaphor awareness-raising approach affects the involvement of the right hemisphere in developing EFL learners’ knowledge regarding the different degrees of politeness embedded within different request expressions. The present study was motivated by theoretical considerations regarding the conceptual projection and the metaphorical idea of politeness is distance, as proposed; this study applied these considerations to develop Japanese learners’ knowledge regarding the different politeness degrees and to explore the connection between the metaphorical concept projection and right-hemisphere dominance. Japanese EFL learners do not know certain language strategies (e.g., English requests can be mitigated with biclausal downgraders, including the if-clause with past-tense modal verbs) and have difficulty adjusting the politeness degrees attached to request expressions according to situations. The present study used a pre/post-test design to reaffirm the efficacy of the cognitive technique and its connection to right-hemisphere involvement by mouth asymmetry technique. Mouth asymmetry measurement has been utilized because speech articulation, normally controlled mainly by one side of the brain, causes muscles on the opposite side of the mouth to move more during speech production. The present research did not administer the delayed post-test because it emphasized determining whether metaphor awareness-raising approaches for developing EFL learners’ pragmatic proficiency entailed right-hemisphere activation. Each test contained an acceptability judgment test (AJT) along with a speaking test in the post-test. The study results show that the metaphor awareness-raising group performed significantly better than the control group with regard to acceptability judgment and speaking tests post-test. These data revealed that the metaphor awareness-raising approach could promote L2 learning because it aided input enhancement and concept projection; through these aspects, the participants were able to comprehend an abstract concept: the degree of politeness in terms of the spatial concept of distance. Accordingly, the proximal-distal metaphor enabled the study participants to connect the newly spatio-visualized concept of distance to the different politeness degrees attached to different request expressions; furthermore, they could recall them with the left side of the mouth being wider than the right. This supported certain findings from previous studies that indicated the possible involvement of the brain's right hemisphere in metaphor processing.

Keywords: metaphor awareness-raising, right hemisphere, L2 politeness, mouth asymmetry

Procedia PDF Downloads 154

Authors: Parag Katira, Frederika Rentzeperis, Zuzanna Nowicka, Giada Fiandaca, Thomas Veith, Jack Farinhas, Noemi Andor

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Resource limitations shape the outcome of competitions between genetically heterogeneous pre-malignant cells. One example of such heterogeneity is in the ploidy (DNA content) of pre-malignant cells. A whole-genome duplication (WGD) transforms a diploid cell into a tetraploid one and has been detected in 28-56% of human cancers. If a tetraploid subclone expands, it consistently does so early in tumor evolution, when cell density is still low, and competition for nutrients is comparatively weak – an observation confirmed for several tumor types. WGD+ cells need more resources to synthesize increasing amounts of DNA, RNA, and proteins. To quantify resource limitations and how they relate to ploidy, we performed a PAN cancer analysis of WGD, PET/CT, and MRI scans. Segmentation of >20 different organs from >900 PET/CT scans were performed with MOOSE. We observed a strong correlation between organ-wide population-average estimates of Oxygen and the average ploidy of cancers growing in the respective organ (Pearson R = 0.66; P= 0.001). In-vitro experiments using near-diploid and near-tetraploid lineages derived from a breast cancer cell line supported the hypothesis that DNA content influences Glucose- and Oxygen-dependent proliferation-, death- and migration rates. To model how subpopulations with variable DNA content compete in the resource-limited environment of the human brain, we developed a stochastic state-space model of the brain (S3MB). The model discretizes the brain into voxels, whereby the state of each voxel is defined by 8+ variables that are updated over time: stiffness, Oxygen, phosphate, glucose, vasculature, dead cells, migrating cells and proliferating cells of various DNA content, and treat conditions such as radiotherapy and chemotherapy. Well-established Fokker-Planck partial differential equations govern the distribution of resources and cells across voxels. We applied S3MB on sequencing and imaging data obtained from a primary GBM patient. We performed whole genome sequencing (WGS) of four surgical specimens collected during the 1ˢᵗ and 2ⁿᵈ surgeries of the GBM and used HATCHET to quantify its clonal composition and how it changes between the two surgeries. HATCHET identified two aneuploid subpopulations of ploidy 1.98 and 2.29, respectively. The low-ploidy clone was dominant at the time of the first surgery and became even more dominant upon recurrence. MRI images were available before and after each surgery and registered to MNI space. The S3MB domain was initiated from 4mm³ voxels of the MNI space. T1 post and T2 flair scan acquired after the 1ˢᵗ surgery informed tumor cell densities per voxel. Magnetic Resonance Elastography scans and PET/CT scans informed stiffness and Glucose access per voxel. We performed a parameter search to recapitulate the GBM’s tumor cell density and ploidy composition before the 2ⁿᵈ surgery. Results suggest that the high-ploidy subpopulation had a higher Glucose-dependent proliferation rate (0.70 vs. 0.49), but a lower Glucose-dependent death rate (0.47 vs. 1.42). These differences resulted in spatial differences in the distribution of the two subpopulations. Our results contribute to a better understanding of how genomics and microenvironments interact to shape cell fate decisions and could help pave the way to therapeutic strategies that mimic prognostically favorable environments.

Keywords: tumor evolution, intra-tumor heterogeneity, whole-genome doubling, mathematical modeling

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Authors: Przemysław Adamczyk, Mirosław Wyczesany, Aleksandra Domagalik, Artur Daren, Kamil Cepuch, Piotr Błądziński, Tadeusz Marek, Andrzej Cechnicki

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The present study aimed at evaluation of neural correlates of humor comprehension impairments observed in schizophrenia. To investigate the nature of this deficit in schizophrenia and to localize cortical areas involved in humor processing we used functional magnetic resonance imaging (fMRI). The study included chronic schizophrenia outpatients (SCH; n=20), and sex, age and education level matched healthy controls (n=20). The task consisted of 60 stories (setup) of which 20 had funny, 20 nonsensical and 20 neutral (not funny) punchlines. After the punchlines were presented, the participants were asked to indicate whether the story was comprehensible (yes/no) and how funny it was (1-9 Likert-type scale). fMRI was performed on a 3T scanner (Magnetom Skyra, Siemens) using 32-channel head coil. Three contrasts in accordance with the three stages of humor processing were analyzed in both groups: abstract vs neutral stories - incongruity detection; funny vs abstract - incongruity resolution; funny vs neutral - elaboration. Additionally, parametric modulation analysis was performed using both subjective ratings separately in order to further differentiate the areas involved in incongruity resolution processing. Statistical analysis for behavioral data used U Mann-Whitney test and Bonferroni’s correction, fMRI data analysis utilized whole-brain voxel-wise t-tests with 10-voxel extent threshold and with Family Wise Error (FWE) correction at alpha = 0.05, or uncorrected at alpha = 0.001. Between group comparisons revealed that the SCH subjects had attenuated activation in: the right superior temporal gyrus in case of irresolvable incongruity processing of nonsensical puns (nonsensical > neutral); the left medial frontal gyrus in case of incongruity resolution processing of funny puns (funny > nonsensical) and the interhemispheric ACC in case of elaboration of funny puns (funny > neutral). Additionally, the SCH group revealed weaker activation during funniness ratings in the left ventro-medial prefrontal cortex, the medial frontal gyrus, the angular and the supramarginal gyrus, and the right temporal pole. In comprehension ratings the SCH group showed suppressed activity in the left superior and medial frontal gyri. Interestingly, these differences were accompanied by protraction of time in both types of rating responses in the SCH group, a lower level of comprehension for funny punchlines and a higher funniness for absurd punchlines. Presented results indicate that, in comparison to healthy controls, schizophrenia is characterized by difficulties in humor processing revealed by longer reaction times, impairments of understanding jokes and finding nonsensical punchlines more funny. This is accompanied by attenuated brain activations, especially in the left fronto-parietal and the right temporal cortices. Disturbances of the humor processing seem to be impaired at the all three stages of the humor comprehension process, from incongruity detection, through its resolution to elaboration. The neural correlates revealed diminished neural activity of the schizophrenia brain, as compared with the control group. The study was supported by the National Science Centre, Poland (grant no 2014/13/B/HS6/03091).

Keywords: communication skills, functional magnetic resonance imaging, humor, schizophrenia

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Authors: Tesnim Charrad, Kaouther Nouira, Ahmed Ferchichi

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In order to reduce the number of deaths due to heart problems, we propose the use of Hierarchical Temporal Memory Algorithm (HTM) which is a real time anomaly detection algorithm. HTM is a cortical learning algorithm based on neocortex used for anomaly detection. In other words, it is based on a conceptual theory of how the human brain can work. It is powerful in predicting unusual patterns, anomaly detection and classification. In this paper, HTM have been implemented and tested on ECG datasets in order to detect cardiac anomalies. Experiments showed good performance in terms of specificity, sensitivity and execution time.

Keywords: cardiac anomalies, ECG, HTM, real time anomaly detection

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Authors: Bahaa Eldin A. Fouda, Khaled N. Yossef, Mohamed Elhosseny, Ahmed Lotfy, Mohamed Salama, Mohamed Sobh

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Developmental neurotoxicity (DNT) entails the toxic effects imparted by various chemicals on the brain during the early childhood period. As human brains are vulnerable during this period, various chemicals would have their maximum effects on brains during early childhood. Some toxicants have been confirmed to induce developmental toxic effects on CNS e.g. lead, however; most of the agents cannot be identified with certainty due the defective nature of predictive toxicology models used. A novel alternative method that can overcome most of the limitations of conventional techniques is the use of 3D neurospheres system. This in-vitro system can recapitulate most of the changes during the period of brain development making it an ideal model for predicting neurotoxic effects. In the present study, we verified the possible DNT of epoxomicin which is a naturally occurring selective proteasome inhibitor with anti-inflammatory activity. Rat neural progenitor cells were isolated from rat embryos (E14) extracted from placental tissue. The cortices were aseptically dissected out from the brains of the fetuses and the tissues were triturated by repeated passage through a fire-polished constricted Pasteur pipette. The dispersed tissues were allowed to settle for 3 min. The supernatant was, then, transferred to a fresh tube and centrifuged at 1,000 g for 5 min. The pellet was placed in Hank’s balanced salt solution cultured as free-floating neurospheres in proliferation medium. Two doses of epoxomicin (1µM and 10µM) were used in cultured neuropsheres for a period of 14 days. For proliferation analysis, spheres were cultured in proliferation medium. After 0, 4, 5, 11, and 14 days, sphere size was determined by software analyses. The diameter of each neurosphere was measured and exported to excel file further to statistical analysis. For viability analysis, trypsin-EDTA solution were added to neurospheres for 3 min to dissociate them into single cells suspension, then viability evaluated by the Trypan Blue exclusion test. Epoxomicin was found to affect proliferation and viability of neuropsheres, these effects were positively correlated to doses and progress of time. This study confirms the DNT effects of epoxomicin on 3D neurospheres model. The effects on proliferation suggest possible gross morphologic changes while the decrease in viability propose possible focal lesion on exposure to epoxomicin during early childhood.

Keywords: neural progentor cells, epoxomicin, neurosphere, medical and health sciences

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Authors: Peter Pfeifer, Julian Pfeifer, Niko Pfeifer

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Information processing is the focus of brain and cognition research. This work has a different perspective; it starts with behaviors. The detailed analysis of behaviors leads to the discovery that a significant proportion of them are based on only five basic drives. These basic drives are combinable, and the combinations result in the diversity of human behavior and thinking. The key elements are drive memories. They collect memories of drive-related situations and feelings. They contain variations of basic drives in numerous areas of life and build combinations with different meanings depending on the area. Human thinking could be explained with variations on these nested combinations of basic drives.

Keywords: cognition, psycholinguistics, psychology, psychophysiology of cognition

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Authors: Wi-Sun Ryu, Eun-Kee Bae

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Prior studies have shown that patients with right hemispheric stroke are likely to seek medical service compared with those with left hemispheric stroke. However, the underlying mechanism for this phenomenon is unknown. In the present study, we generated lesion probability maps in a patient with right and left middle cerebral artery infarct and statistically compared. We found that precentral gyrus-Brodmann area 44, a language area in the left hemisphere - involvement was significantly higher in patients with left hemispheric stroke. This finding suggests that a language dysfunction was more noticeable, thereby taking more patients to hospitals.

Keywords: cerebral infarct, brain MRI, statistical parametric mapping, middle cerebral infarct

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Authors: Vasudha Govil, Prashant Kumar, Ishwar Singh, Kiranpreet Kaur

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Traumatic brain injury leads to elevated intracranial pressure. Intraocular pressure (IOP) may also be affected by intracranial pressure. Increased venous pressure in the cavernous sinus is transmitted to the episcleral veins, resulting in an increase in IOP. All drugs used in anesthesia induction can change IOP. Irritation of the gag reflex after usage of the endotracheal tube can also increase IOP; therefore, the administration of anesthetic drugs, which make the lowest change in IOP, is important, while cardiovascular depression must also be avoided. Thiopentone decreases IOP by 40%, whereas etomidate decreases IOP by 30-60% for up to 5 minutes. Hundred patients (age 18-55 years) who underwent emergency craniotomy for TBI are selected for the study. Patients are randomly assigned to two groups of 50 patients each accord¬ing to the drugs used for induction: group T was given thiopentone sodium (5mg kg-1) and group E was given etomi¬date (0.3mg kg-1). Preanaesthesia intraocular pressure (IOP) was measured using Schiotz tonometer. Induction of anesthesia was achieved with etomidate (0.3mg kg-1) or thiopentone (5mg kg-1) along with fentanyl (2 mcg kg-1). Intravenous rocuronium (0.9mg kg-1) was given to facilitate intubation. Intraocular pressure was measured after 1 minute of induction agent administration and 5 minutes after intubation. Maintainance of anesthesia was done with isoflurane in 50% nitrous oxide with fresh gas flow of 5 litres. At the end of the surgery, the residual neuromuscular block was reversed and the patient was shifted to ward/ICU. Patients in both groups were comparable in terms of demographic profile. There was no significant difference between the groups for the hemody¬namic and respiratory variables prior to thiopentone or etomidate administration. Intraocular pressure in thiopentone group in left eye and right eye before induction was 14.97±3.94 mmHg and 14.72±3.75 mmHg respectively and for etomidate group was 15.28±3.69 mmHg and 15.54±4.46 mmHg respectively. After induction IOP decreased significantly in both the eyes (p<0.001) in both the groups. After 5 min of intubation IOP was significantly less than the baseline in both the eyes but it was more than the IOP after induction with the drug. It was found that there was no statistically significant difference in IOP between the two groups at any point of time. Both the drugs caused a significant decrease in IOP after induction and after 5 minutes of endotracheal intubation. The mechanism of decrease in IOP by intravenous induction agents is debatable. Systemic hypotension after the induction of anaesthesia has been shown to cause a decrease in intra-ocular pressure. A decrease in the tone of the extra-ocular muscles can also result in a decrease in intra-ocular pressure. We observed that it is appropriate to use etomidate as an induction agent when elevation of intra-ocular pressure is undesirable owing to the cardiovascular stability it confers in the patients.

Keywords: etomidate, intraocular pressure, thiopentone, traumatic

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Authors: Dewan Hasin Mahtab, Farzana Sadia

Abstract:

At present, wastewater treatment has become essential to maintain a constant supply of safe water as well as to protect the environment. Due to overpopulation and overconsumption, the water quality from various surface water sources is degrading every day. Being one of the megacities in the world, Dhaka City, is going through rapid industrialization and urbanization. The effluents from these industries and factories are mostly discharged directly into the rivers without any treatment. As such, the quality of water of Buriganga is being afflicted with a noisome problem of pollution. The water of the Buriganga River has become detrimental to humans, animals, and the environment. It has become crucial to conserve the environment so that we can save both ourselves and the environment. The first step towards it should be analyzing the wastewater to decide the further steps of the treatment process. Increased population and increased consumption both contribute to water pollution. Mohammadpur is a developing area of Dhaka City, and Kamrangirchar is one of the largest slum areas in Dhaka City. The total study area is 6.13 sq. Km of Dhaka city with a population of 4,73,310 people. Of them, 86.47% had their own latrine, 47% were directly connected to the drain, 55% had septic tanks, and 70.09% of them cleaned their septic tank once a year. The pH, Dissolved Oxygen, Chemical Oxygen Demand, Biochemical Oxygen Demand, Total Dissolved Solid, Total Suspended and total coliforms of wastewater from two samples of both Mohammadpur and Kamrangirchar was analyzed. The DO level from the water bodies of Kamrangirchar was found very low, making the water bodies inhabitable for aquatic plants and animals. The BOD and COD level was extremely high from samples collected from Mohammadpur. The total coliforms count was found too high during the wet season, making it a potential health concern in the wet season in these two areas.

Keywords: Dhaka, environmental conservation rule, sanitation, wastewater

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Authors: Fernando Ojedo, Alejandro Alvarez, Pedro Macizo

Abstract:

In the present study, we explored electrophysiological correlates of Arabic digits naming to determine semantic processing of numbers. Participants named Arabic digits grouped by category or intermixed with exemplars of other semantic categories while the N400 event-related potential was examined. Around 350-450 ms after the presentation of Arabic digits, brain waves were more positive in anterior regions and more negative in posterior regions when stimuli were grouped by category relative to the mixed condition. Contrary to what was found in other studies, electrophysiological results suggested that the production of numerals involved semantic mediation.

Keywords: Arabic digit naming, event-related potentials, semantic processing, number production

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Authors: Yung-Chih Kuo, I-Hsin Wang

Abstract:

Catanionic solid lipid nanoparticles (CASLNs) with surface wheat germ agglutinin (WGA) and lactoferrin (Lf) were formulated for entrapping and releasing etoposide (ETP), crossing the blood–brain barrier (BBB), and inhibiting the growth of glioblastoma multiforme (GBM). Microemulsified ETP-CASLNs were modified with WGA and Lf for permeating a cultured monolayer of human brain-microvascular endothelial cells (HBMECs) regulated by human astrocytes and for treating malignant U87MG cells. Experimental evidence revealed that an increase in the concentration of catanionic surfactant from 5 μM to 7.5 μM reduced the particle size. When the concentration of catanionic surfactant increased from 7.5 μM to 12.5 μM, the particle size increased, yielding a minimal diameter of WGA-Lf-ETP-CASLNs at 7.5 μM of catanionic surfactant. An increase in the weight percentage of BW from 25% to 75% enlarged WGA-Lf-ETP-CASLNs. In addition, an increase in the concentration of catanionic surfactant from 5 to 15 μM increased the absolute value of zeta potential of WGA-Lf-ETP-CASLNs. It was intriguing that the increment of the charge as a function of the concentration of catanionic surfactant was approximately linear. WGA-Lf-ETP-CASLNs revealed an integral structure with smooth particle contour, displayed a lighter exterior layer of catanionic surfactant, WGA, and Lf and showed a rigid interior region of solid lipids. A variation in the concentration of catanionic surfactant between 5 μM and 15 μM yielded a maximal encapsulation efficiency of ETP ata 7.5 μM of catanionic surfactant. An increase in the concentration of Lf/WGA decreased the grafting efficiency of Lf/WGA. Also, an increase in the weight percentage of ETP decreased its encapsulation efficiency. Moreover, the release rate of ETP from WGA-Lf-ETP-CASLNs reduced with increasing concentration of catanionic surfactant, and WGA-Lf-ETP-CASLNs at 12.5 μM of catanionic surfactant exhibited a feature of sustained release. The order in the viability of HBMECs was ETP-CASLNs ≅ Lf-ETP-CASLNs ≅ WGA-Lf-ETP-CASLNs > ETP. The variation in the transendothelial electrical resistance (TEER) and permeability of propidium iodide (PI) was negligible when the concentration of Lf increased. Furthermore, an increase in the concentration of WGA from 0.2 to 0.6 mg/mL insignificantly altered the TEER and permeability of PI. When the concentration of Lf increased from 2.5 to 7.5 μg/mL and the concentration of WGA increased from 2.5 to 5 μg/mL, the enhancement in the permeability of ETP was minor. However, 10 μg/mL of Lf promoted the permeability of ETP using Lf-ETP-CASLNs, and 5 and 10 μg/mL of WGA could considerably improve the permeability of ETP using WGA-Lf-ETP-CASLNs. The order in the efficacy of inhibiting U87MG cells was WGA-Lf-ETP-CASLNs > Lf-ETP-CASLNs > ETP-CASLNs > ETP. As a result, WGA-Lf-ETP-CASLNs reduced the TEER, enhanced the permeability of PI, induced a minor cytotoxicity to HBMECs, increased the permeability of ETP across the BBB, and improved the antiproliferative efficacy of U87MG cells. The grafting of WGA and Lf is crucial to control the medicinal property of ETP-CASLNs and WGA-Lf-ETP-CASLNs can be promising colloidal carriers in GBM management.

Keywords: catanionic solid lipid nanoparticle, etoposide, glioblastoma multiforme, lactoferrin, wheat germ agglutinin

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Authors: Maryam Jaberi, Siavosh Shayan, Mojtaba Yamani

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Habble-Rud River basin (HR), up to 100 km length, one of the largest watersheds which drain into deserts to the north of Central Iran (Dasht-e Kavir). This stream is oblique with the NE-SW trending, flow in the southern range of central Alborz Mountains and the northern border of Central Iran. The end of the ~17 km suddenly change direction and with the southern trending to have a morphology which meanders passes through the Alborz Mountain ridge and flows into the Garmsar plain where it forms one of the largest alluvial fans in Iran, i.e. the vast Garmsar alluvial fan with an area of 476 km2. This study was carried out through morphometric analyses, longitudinal river profiles, and study of geomorpholic evidence such as fluvial terraces, gypsum-salt domes, seismic data, and satellite images. This study aimed to investigate the changes in the pattern of rivers in the southern part of the HR river basin. The southern part of HR river basin located at the southern foothills of the Central Alborz is characterized the thrust faults (Sorkheh-Kalut and Garmsar faults), folds,diapirs and arid climate. The activity of more than 10 salt domes that belong to the Oligocene-Miocene period has considerably influenced the pattern of streams in this region. Dissolution of these domes has not only reduced the quality of water and soil resources, but also has led to the formation of badlands and gullies.Our results indicated that the pattern of rivers in the southern part of HR river basin was influenced by discharge of the HR river in Quaternary, geological structure, subsidence of Central Iran and vertical uplift of Alborz mountain. These agents caused the formation meanders in the southern part of the HR River and evaluation of the seasonal rivers like Shoor-Darre and Garmabsar.

Keywords: geomorphologic evaluation, rivers pattern, Habble-Rud River basin, seasonal rivers

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Authors: Samson Mil'shtein, Dhawal Asthana, Benjamin Sullivan

Abstract:

The wide energy gap of GaN is the major parameter justifying the design and fabrication of high-power electronic components made of this material. However, the existence of a piezo-electrics in nature sheet charge at the AlGaN/GaN interface complicates the control of carrier injection into the intrinsic channel of GaN HEMTs (High Electron Mobility Transistors). As a result, most of the transistors created as R&D prototypes and all of the designs used for mass production are D-mode devices which introduce challenges in the design of integrated circuits. This research presents the design and modeling of an E-mode GaN HEMT with a very low turn-on voltage. The proposed device includes two critical elements allowing the transistor to achieve zero conductance across the channel when Vg = 0V. This is accomplished through the inclusion of an extremely thin, 2.5nm intrinsic Ga₀.₇₄Al₀.₂₆N spacer layer. The added spacer layer does not create piezoelectric strain but rather elastically follows the variations of the crystal structure of the adjacent GaN channel. The second important factor is the design of a gate metal with a high work function. The use of a metal gate with a work function (Ni in this research) greater than 5.3eV positioned on top of n-type doped (Nd=10¹⁷cm⁻³) Ga₀.₇₄Al₀.₂₆N creates the necessary built-in potential, which controls the injection of electrons into the intrinsic channel as the gate voltage is increased. The 5µm long transistor with a 0.18µm long gate and a channel width of 30µm operate at Vd=10V. At Vg =1V, the device reaches the maximum drain current of 0.6mA, which indicates a high current density. The presented device is operational at frequencies greater than 10GHz and exhibits a stable transconductance over the full range of operational gate voltages.

Keywords: compound semiconductors, device modeling, enhancement mode HEMT, gallium nitride

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Authors: Ruxandra Aursulesei, David O’Callaghan, Cian Ryan, Diarmaid O’Cualain, Viktor Varkarakis, Alina Sultana, Joseph Lemley

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Human errors caused by drowsiness are among the leading causes of road accidents. Neurobiological research gives information about the electrical signals emitted by neurons firing within the brain. Electrical signal frequencies can be determined by attaching bio-sensors to the head surface. By observing the electrical impulses and the rhythmic interaction of neurons with each other, we can predict the mental state of a person. In this paper, we aim to better understand intersubject and intrasubject variability in terms of electrophysiological patterns that occur at the onset of drowsiness and their evolution with the decreasing of vigilance. The purpose is to lay the foundations for an algorithm that detects the onset of drowsiness before the physical signs become apparent.

Keywords: electroencephalography, drowsiness, ADAS, annotations, clinician

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Authors: Geeta Gahlawat, Ashok Kumar Srivastava

Abstract:

In the present study, a simple drain and fill protocol strategy of repeated batch was adopted for enhancement in polyhydroxyalkanoates (PHAs) production using alcaligenes latus DSM 1124. Repeated batch strategy helped in increasing the longevity of otherwise decaying culture in the bioreactor by supplementing fresh substrates during each cycle of repeated-batch. The main advantages of repeated batch are its ease of operation, enhancement of culture stability towards contamination, minimization of pre-culture effects and maintenance of organism at high growth rates. The cultivation of A. latus was carried out in 7 L bioreactor containing 4 L optimized nutrient medium and a comparison with the batch mode fermentation was done to evaluate the performance of repeated batch in terms of PHAs accumulation and productivity. The statistically optimized medium recipe consisted of: 25 g/L Sucrose, 2.8 g/L (NH4)2SO4, 3.25 g/L KH2PO4, 3.25 g/L Na2HPO4, 0.2 g/L MgSO4, 1.5 mL/L trace element solution. In this strategy, 20% (v/v) of the culture broth was removed from the reactor and supplemented with an equal volume of fresh medium when sucrose concentration inside the reactor decreased below 8 g/L. The fermenter was operated for three repeated batch cycles and fresh nutrient feeding was done at 27 h, 48 h, and 60 h. Repeated batch operation resulted in a total biomass of 27.89 g/L and PHAs concentration 20.55 g/L at the end of 69 h which was a marked improvement as compared to batch cultivation (8.71 g/L biomass and 6.24 g/L PHAs). This strategy demonstrated 3.3 fold and 1.8 fold increase in PHAs concentration and volumetric productivity, respectively as compared to batch cultivation. Repeated batch cultivation strategy had also the benefit of avoiding non-productive time period required for cleaning, refilling and sterilization of bioreactor, thereby increasing the overall volumetric productivity and making the entire process cost-effective too.

Keywords: alcaligenes, biodegradation, polyhydroxyalkanoates, repeated batch

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Authors: M.Rüştü Karaman, İsmail İşeri, Kadir Saltalı, A.Reşit Brohi, Ayhan Horuz, Mümin Dizman

Abstract:

Considerable relations has recently been given to the environmental hazardous caused by agricultural chemicals such as excess fertilizers. In this study, a neural network approach was investigated in the prediction of potential nitrate pollution across different land-use patterns by using a feedforward multilayered computer model of artificial neural network (ANN) with proper training. Periodical concentrations of some anions, especially nitrate (NO3-), and cations were also detected in drainage waters collected from the drain pipes placed in irrigated tomato field, unirrigated wheat field, fallow and pasture lands. The soil samples were collected from the irrigated tomato field and unirrigated wheat field on a grid system with 20 m x 20 m intervals. Site specific nitrate concentrations in the soil samples were measured for ANN based simulation of nitrate leaching potential from the land profiles. In the application of ANN model, a multi layered feedforward was evaluated, and data sets regarding with training, validation and testing containing the measured soil nitrate values were estimated based on spatial variability. As a result of the testing values, while the optimal structures of 2-15-1 was obtained (R2= 0.96, P < 0.01) for unirrigated field, the optimal structures of 2-10-1 was obtained (R2= 0.96, P < 0.01) for irrigated field. The results showed that the ANN model could be successfully used in prediction of the potential leaching levels of nitrate, based on different land use patterns. However, for the most suitable results, the model should be calibrated by training according to different NN structures depending on site specific soil parameters and varied agricultural managements.

Keywords: artificial intelligence, ANN, drainage water, nitrate pollution

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Authors: Liliana Villavicencio, Yohn Garcia, Pallavi Singh, Luis Fernando Cruz, Wilfrido Moreno

Abstract:

Psychophysiological adaptive automation is a concept that combines human physiological data and computer algorithms to create personalized interfaces and experiences for users. This approach aims to enhance human learning by adapting to individual needs and preferences and optimizing the interaction between humans and machines. According to neurosciences, the working memory demand during the student learning process is modified when the student is learning a new subject or topic, managing and/or fulfilling a specific task goal. A sudden increase in working memory demand modifies the level of students’ attention, engagement, and cognitive load. The proposed psychophysiological adaptive automation system will adapt the task requirements to optimize cognitive load, the process output variable, by monitoring the student's brain activity. Cognitive load changes according to the student’s previous knowledge, the type of task, the difficulty level of the task, and the overall psychophysiological state of the student. Scaling the measured cognitive load as low, medium, or high; the system will assign a task difficulty level to the next task according to the ratio between the previous-task difficulty level and student stress. For instance, if a student becomes stressed or overwhelmed during a particular task, the system detects this through signal measurements such as brain waves, heart rate variability, or any other psychophysiological variables analyzed to adjust the task difficulty level. The control of engagement and stress are considered internal variables for the hypermedia system which selects between three different types of instructional material. This work assesses the feasibility of a fuzzy controller to track a student's physiological responses and adjust the learning content and pace accordingly. Using an industrial automation approach, the proposed fuzzy logic controller is based on linguistic rules that complement the instrumentation of the system to monitor and control the delivery of instructional material to the students. From the test results, it can be proved that the implemented fuzzy controller can satisfactorily regulate the delivery of academic content based on the working memory demand without compromising students’ health. This work has a potential application in the instructional design of virtual reality environments for training and education.

Keywords: fuzzy logic controller, hypermedia control system, personalized education, psychophysiological adaptive automation

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Authors: Kaouther Selmi, Alaeddine Sridi, Mohamed Bouallegue, Kais Bouallegue

Abstract:

Neurons are the fundamental units of the brain and the nervous system. The variable structure model of neurons consists of a system of differential equations with various parameters. By optimizing these parameters, we can create a unique model that describes the dynamic behavior of a single neuron. We introduce a neural network based on neurons with multiple dendrites employing an activation function with a variable structure. In this paper, we present a model for heart behavior. Finally, we showcase our successful simulation of the heart's ECG diagram using our Variable Structure Neuron Model (VSMN). This result could provide valuable insights into cardiology.

Keywords: neural networks, neuron, dendrites, heart behavior, ECG

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Authors: Benjamin J. Kuo, Silvia D. Vaca, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Lydia Nanjula, Christine Muhumuza, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

Abstract:

Background: Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The disparities in the injury incidence and outcome between LMICs and resource-rich settings have led to increased health outcomes research for TBIs and their associated risk factors in LMICs. While there have been increasing TBI studies in LMICs over the last decade, there is still a need for more robust prospective registries. In Uganda, a trauma registry implemented in 2004 at the Mulago National Referral Hospital (MNRH) showed that RTI is the major contributor (60%) of overall mortality in the casualty department. While the prior registry provides information on injury incidence and burden, it’s limited in scope and doesn’t follow patients longitudinally throughout their hospital stay nor does it focus specifically on TBIs. And although these retrospective analyses are helpful for benchmarking TBI outcomes, they make it hard to identify specific quality improvement initiatives. The relationship among epidemiology, patient risk factors, clinical care, and TBI outcomes are still relatively unknown at MNRH. Objective: The objectives of this study are to describe the processes of care and determine risk factors predictive of poor outcomes for TBI patients presenting to a single tertiary hospital in Uganda. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Research Electronic Data Capture (REDCap) was used to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. Results: 563 TBI patients were enrolled from 1 June – 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe TBI patients with GCS 3-5. Within each TBI severity category, mortality differed by management pathway. Variables predictive of mortality were TBI severity, more than one intracranial bleed, failure to receive surgery, high dependency unit admission, ventilator support outside of surgery, and hospital arrival delayed by more than 4 hours. Conclusions: The overall mortality rate of 9.6% in Uganda for TBI is high, and likely underestimates the true TBI mortality. Furthermore, the wide-ranging mortality (3-82%), high ICU fatality, and negative impact of care delays suggest shortcomings with the current triaging practices. Lack of surgical intervention when needed was highly predictive of mortality in TBI patients. Further research into the determinants of surgical interventions, quality of step-up care, and prolonged care delays are needed to better understand the complex interplay of variables that affect patient outcome. These insights guide the development of future interventions and resource allocation to improve patient outcomes.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, prospective registry, traumatic brain injury

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