Search results for: climatic risk management

Authors: Jawaad Saleem, Hannah Wright, Peter Sommerville, Adrian Hopper

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Introduction: Inpatient falls are the most commonly reported patient safety incidents, and carry a significant burden on resources, morbidity, and mortality. Ensuring adequate post falls management of patients by staff is therefore paramount to maintaining patient safety especially in out of hours and resource stretched settings. Aims: This quality improvement project aims to improve the current practice of falls management at Guys St Thomas Hospital, London as compared to our 2016 Quality Improvement Project findings. Furthermore, it looks to increase current junior doctors confidence in managing falls and their use of new guidance protocols. Methods: Multifaceted Interventions implemented included: the development of new trust wide guidelines detailing management pathways for patients post falls, available for intranet access. Furthermore, the production of 2000 lanyard cards distributed amongst junior doctors and staff which summarised these guidelines. Additionally, a ‘safety signal’ email was sent from the Trust chief medical officer to all staff raising awareness of falls and the guidelines. Formal falls teaching was also implemented for new doctors at induction. Using an established incident database, 189 consecutive falls in 2017were retrospectively analysed electronically to assess and compared to the variables measured in 2016 post interventions. A separate serious incident database was used to analyse 50 falls from May 2015 to March 2018 to ascertain the statistical significance of the impact of our interventions on serious incidents. A similar questionnaire for the 2017 cohort of foundation year one (FY1) doctors was performed and compared to 2016 results. Results: Questionnaire data demonstrated improved awareness and utility of guidelines and increased confidence as well as an increase in training. 97% of FY1 trainees felt that the interventions had increased their awareness of the impact of falls on patients in the trust. Data from the incident database demonstrated the time to review patients post fall had decreased from an average of 130 to 86 minutes. Improvement was also demonstrated in the reduced time to order and schedule X-ray and CT imaging, 3 and 5 hours respectively. Data from the serious incident database show that ‘the time from fall until harm was detected’ was statistically significantly lower (P = 0.044) post intervention. We also showed the incidence of significant delays in detecting harm ( > 10 hours) reduced post intervention. Conclusions: Our interventions have helped to significantly reduce the average time to assess, order and schedule appropriate imaging post falls. Delays of over ten hours to detect serious injuries after falls were commonplace; since the intervention, their frequency has markedly reduced. We suggest this will lead to identifying patient harm sooner, reduced clinical incidents relating to falls and thus improve overall patient safety. Our interventions have also helped increase clinical staff confidence, management, and awareness of falls in the trust. Next steps include expanding teaching sessions, improving multidisciplinary team involvement to aid this improvement.

Keywords: patient safety, quality improvement, serious incidents, falls, clinical care

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

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

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

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Authors: Lian Tong, Yan Ye, Qiong Yan

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Background: Children with attention-deficit/hyperactivity disorder (ADHD) often experience sleep problems, but the comorbidity mechanism has not been sufficiently studied. This study aimed to determine the comorbidity of ADHD and sleep problems as well as the moderating effects of bedtime activities and depression/anxiety symptoms on the relationship between ADHD and sleep problems. Methods: We recruited 934 primary students from third to fifth grade and their parents by stratified random sampling from three primary schools in Shanghai, China. This study used parent-reported versions of the ADHD Rating Scale-IV, Children’s Sleep Habits Questionnaire, and Achenbach Child Behavior Checklist. We used hierarchical linear regression analysis to clarify the moderating effects of bedtime activities and depression/anxiety symptoms. Results: We found that children with more ADHD symptoms had shorter sleep durations and more sleep problems on weekdays. Screen time before bedtime strengthened the relationship between ADHD and sleep-disordered breathing. Children with more screen time were more likely to have sleep onset delay, while those with less screen time had more sleep onset problems with increasing ADHD symptoms. The high bedtime eating group experienced more night waking with increasing ADHD symptoms compared with the low bedtime eating group. Anxiety/depression exacerbated total sleep problems and further interacted with ADHD symptoms to predict sleep length and sleep duration problems. Conclusions: Bedtime activities and emotional problems had important moderating effects on the relationship between ADHD and sleep problems. These findings indicate that appropriate bedtime management and emotional management may reduce sleep problems and improve sleep duration for children with ADHD symptoms.

Keywords: ADHD, sleep problems, anxiety/depression, bedtime activities, children

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Authors: Jiajia Peng, Jianqing Qiu, Jianjun Ren, Yu Zhao

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Background: We aimed to compare clinical and survival differences between B-cell (B-NHL) and NKT-cell non-Hodgkin lymphomas (NKT-NHL) located in the nasal cavity, nasopharynx and paranasal sinuses, which are always categorized as one sinonasal type. Methods: Patients diagnosed with primary B-NHL and NKT-NHL in the nasal cavity, nasopharynx, and paranasal sinuses from the SEER database were included. We identified these patients based on histological types and anatomical sites and subsequently conducted univariate and multivariate Cox regression and Kaplan–Meier analyses to examine cancer-special survival (CSS) outcomes. Results: Overall, most B-NHL cases originated from the nasopharynx, while the majority of NKT-NHL cases occurred in the nasal cavity. Notably, the CSS outcomes improved significantly in all sinonasal B-NHL cases over time, whereas no such improvement trend was observed in each sinonasal NKT-NHL type. Additionally, increasing age was linked with an elevated risk of death in B-NHL, particularly in the nasal cavity (HR:3.37), rather than in NKT-NHL. Compared with B-NHL, the adverse effect of the higher stage on CSS was more evident in NKT-NHL, particularly in its nasopharynx site (HR: 5.12). Furthermore, radiotherapy was beneficial for survival in patients with sinonasal B-NHL and NKT-NHL, except in those with NKT-NHL in the nasopharynx site. However, chemotherapy has only been beneficial for CSS in patients with B-NHL in paranasal sinuses (HR: 0.42) since 2010, rather than in other types of B-NHL or NKT-NHL. Conclusions: Although B-NHL and NKT-NHL in the nasal cavity, nasopharynx and paranasal sinuses have similar anatomical locations, their clinic demographics and prognoses are largely different and should be treated and studied as distinct diseases.

Keywords: B-cell non-Hodgkin lymphomas, NKT-cell non-Hodgkin lymphomas, nasal cavity lymphomas, nasal sinuses lymphomas, nasopharynx lymphomas

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Authors: Lamiaa Shehata

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The current (COVID-19) pandemic is one of the international crises, and a lot of efforts have been directed toward the improvement of efficient vaccines, however vaccine hesitancy is one of the universal menaces that make the fulfillment of society immunity very hard. The World Health Organization acknowledges vaccine hesitancy as the society’s maximum risk to people's health protection, especially in little and moderate-revenue nations. Social media is strong in observing audience behaviors and evaluating the circulation, which would supply useful data for strategy makers. It has a significant function in spreading facts during the pandemic, it could assist to boost protective manners. The objective of this study is to determine the effects of social media exposure on vaccine hesitancy. Data were collected using a survey in a form of a structured questionnaire conducted during December 2021- January 2022 using convenient sampling techniques (680) in Egypt and the United Arab Emirates. The results revealed that there was a significant relationship between the high exposure to social media and the refusal of the Covid19 vaccine also, the percentage of the refusal of the vaccine is higher in Egypt, however, UAE forced people to take the vaccine. Furthermore, public attitudes toward COVID-19 vaccination vary from gender and region. In conclusion, policymakers must adjust their policies through the use of social media to immediate actions to vaccine-related news to support vaccination approval.

Keywords: COVID-19, hesitancy, social media, vaccine

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Authors: Fatema Salman, Ridha Hammam, Fatima Khairallah, Fatima Aradi, Nafeesa Abdulla, Mohammed Alsafar

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Purpose: This study aims at measuring the extent of nurses’ knowledge and attitudes toward the use of physical restraints in different hospital wards at Salmaniya Medical Complex (SMC). Background: The habitual use of physical restraint is a widespread practice among nurses working in the clinical settings. Restraints inflict many deleterious consequences on patients physically and psychologically which in turn increases their morbidity and mortality risk and jeopardizes care quality. Nurses’ knowledge and attitudes toward physical restraints are crucial determinants of the persistence of this practice. Literature review: the evidence of lack of knowledge among nurses regarding the use of physical restraints is overwhelming in various clinical settings, especially in two main areas which are the negative consequences and the available alternatives to physical restraints. Studies explored nurses’ attitudes toward physical restraints yielded inconsistent findings. Equally comparable, some studies found that nurses hold positive attitudes toward the use of physical restraints while some others reported just the opposite. Methods: Self-administered knowledge and attitudes scales to 106 nurses working in the SMC. Findings: nurses hold the moderate level of knowledge about restraints (M=58%) with weak negative attitudes (M = -20%) toward using it. Significant moderately-strong negative correlation (r= -0.57, r2= 0.32, p= 0.000) was uncovered between nurses knowledge and their attitudes which provided an empirical explanation of this phenomenon (use of physical restraints). Recommendations: Induction of awareness program that especially focuses on the negative consequences and encourages the use of alternatives is an evident need. This effort necessarily should be adjoined with policy and procedure adjustments.

Keywords: attitudes, knowledge, nurses, restraints

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Authors: Azeez Yusuf, Alan Casey

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Silver nanoparticles (AgNP) are one of the most widely investigated metallic nanoparticles due to their promising antibacterial activities. In recent years, AgNP research has shifted beyond antimicrobial use to potential applications in the medical arena. This shift coupled with the extensive commercial applications of AgNP will further increase human exposure, and the subsequent risk of adverse effects that may result from repeated exposures and inefficient delivery meaning research into improved AgNP delivery is of paramount importance. In this study, AgNP were encapsulated in a natural bio-surfactant, dipalmitoylphosphatyidyl choline (DPPC), in an attempt to enhance the intracellular delivery and simultaneously mediate the associated cytotoxicity of the AgNP. It was noted that as a result of the encapsulation, liposomal-AgNP (Lipo-AgNP) at 0.625 μg/ml induced significant cell death in THP1 cell lines a notably lower dose than that of the uncoated AgNP induced cytotoxicity. The induced cytotoxicity was shown to result in an increased level of DNA fragmentation resulting in a cell cycle interruption at the S phase of the cell cycle. It was shown that the predominate form of cell death upon exposure to both uncoated and Lipo-AgNP was apoptosis, however, a ROS-independent activation of the executioner caspases 3/7 occurred when exposed to the Lipo-AgNP. These findings showed that encapsulation of AgNP enhances AgNP cytotoxicity and mediates an ROS-independent induction of apoptosis.

Keywords: silver nanoparticles, AgNP, cytotoxicity, encapsulation, liposome

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Authors: Zahid O. Alibrahim, Craig D. Williams, Clive L. Roberts

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The study area (Ecton mining area) is located in the southern part of the Peak District in Derbyshire, England. It is bounded by the River Manifold from the west. This area has been mined for a long period. As a result, huge amounts of potentially toxic metals were released into the surrounding area and are most likely to be a significant source of heavy metal contamination to the local soil, water and vegetation. In order to appraise the potential heavy metal pollution in this area, 37 topsoil samples (5-20 cm depth) were collected and analysed for their total content of Cu, Pb, Zn, Mn, Cr, Ni and V using ICP (Inductively Coupled Plasma) optical emission spectroscopy. Multivariate Geospatial analyses using the GIS technique were utilised to draw geochemical maps of the metals of interest over the study area. A few hotspot points, areas of elevated concentrations of metals, were specified, which are presumed to be the results of anthropogenic activities. In addition, the soil’s environmental quality was evaluated by calculating the Mullers’ Geoaccumulation index (I geo), which suggests that the degree of contamination of the investigated heavy metals has the following trend: Pb > Zn > Cu > Mn > Ni = Cr = V. Furthermore, the potential ecological risk, using the enrichment factor (EF), was also specified. On the basis of the calculated amount or the EF, the levels of pollution for the studied metals in the study area have the following order: Pb>Zn>Cu>Cr>V>Ni>Mn.

Keywords: enrichment factor, geoaccumulation index, GIS, heavy metals, multivariate analysis

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Authors: Migael van Zyl, Stefanie Visser, Awelani Phaswana

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The electricity landscape in South Africa is characterized by frequent occurrences of loadshedding, a measure implemented by Eskom to manage electricity generation shortages by curtailing demand. Loadshedding, classified into stages ranging from 1 to 8 based on severity, involves the systematic rotation of power cuts across municipalities according to predefined schedules. However, this practice introduces distortions in recorded electricity demand, posing challenges to accurate forecasting essential for budgeting, network planning, and generation scheduling. Addressing this challenge requires the development of a methodology to quantify the impact of loadshedding and integrate it back into metered electricity demand data. Fortunately, comprehensive records of loadshedding impacts are maintained in a database, enabling the alignment of Loadshedding effects with hourly demand data. This adjustment ensures that forecasts accurately reflect true demand patterns, independent of loadshedding's influence, thereby enhancing the reliability of electricity supply management in South Africa. This paper presents a methodology for determining the hourly impact of load scheduling and subsequently adjusting historical demand data to account for it. Furthermore, two forecasting models are developed: one utilizing the original dataset and the other using the adjusted data. A comparative analysis is conducted to evaluate forecast accuracy improvements resulting from the adjustment process. By implementing this methodology, stakeholders can make more informed decisions regarding electricity infrastructure investments, resource allocation, and operational planning, contributing to the overall stability and efficiency of South Africa's electricity supply system.

Keywords: electricity demand forecasting, load shedding, demand side management, data science

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Authors: Zsolt Szabolcsi

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Political communication in Hungary has undergone a significant change in the 2010s. One element of the transformation is the Flashnews. This media product was launched in March 2015 and since then 40-50 blocks are broadcasted, daily, on 5 channels. Flashnews blocks are condensed news sessions, containing the summary of political narratives. It starts with the introduction of the narrator, then, usually four news topics are presented and, finally, the narrator concludes the block. The block lasts only one minute and, therefore, it provides a blink session into the main narratives of political communication at the time. Beyond its rapid pace, what makes its avoidance difficult is that these blocks are always in the first position in the commercial break of a non-political media product. Although it is only one minute long, its significance is high. The content of the Flashnews reflects the main governmental narratives and, therefore, the Flashnews is part of the agenda-setting capacity of political communication. It reaches media consumers who have limited knowledge and interest in politics, and their use of media products is not politically related. For this audience, the Flashnews pops up in the same way as commercials. Due to its structure and appearance, the impact of Flashnews seems to be similar to commercials, imbedded into the break of media products. It activates existing knowledge constructs, builds up associational links and maintains their presence in a way that the recipient is not aware of the phenomenon. The research aims to examine the extent to which the Flashnews and the main news narratives are identical in their content. This aim is realized with the content analysis of the two news products by examining the Flashnews and the evening news during main sport events from 2016 to 2018. The initial hypothesis of the research is that Flashnews is a contribution to the news management technique for an effective articulation of political narratives in public service media channels.

Keywords: flashnews, political communication, political marketing, news management

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Authors: Bo-Bin Xiaoa, Chia-Yi Liua

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In the task of searching for anomalous radiation sources, personnel holding radiation detectors to search for radiation sources may be exposed to unnecessary radiation risk, and automated search using machines becomes a required project. The research uses various sophisticated algorithms, which are double Q learning, dueling network, and NoisyNet, of deep reinforcement learning to search for radiation sources. The simulation environment, which is a 10*10 grid and one shielding wall setting in it, improves the development of the AI model by training 1 million episodes. In each episode of training, the radiation source position, the radiation source intensity, agent position, shielding wall position, and shielding wall length are all set randomly. The three algorithms are applied to run AI model training in four environments where the training shielding wall is a full-shielding wall, a lead wall, a concrete wall, and a lead wall or a concrete wall appearing randomly. The 12 best performance AI models are selected by observing the reward value during the training period and are evaluated by comparing these AI models with the gradient search algorithm. The results show that the performance of the AI model, no matter which one algorithm, is far better than the gradient search algorithm. In addition, the simulation environment becomes more complex, the AI model which applied Double DQN combined Dueling and NosiyNet algorithm performs better.

Keywords: double Q learning, dueling network, NoisyNet, source searching

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Authors: Desta Gebretekle Shiferaw, Balakrishna Kalluraya

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Triazoles are basic five-membered ring heterocycles with an unsaturated, six-delocalized electron ring system. Since the dawn of click chemistry, triazoles have represented a functional heterocyclic core that has been the foundation of medicinal chemistry. The compounds with 1,2,3-triazole rings can be used in several fields, including medicine, organic synthesis, polymer chemistry, fluorescent imaging, horticulture, and industries, to name a few. Besides that, they found it to have health applications in the prevention and reduction of the risk of diseases, such as anti-cancer, antimicrobial, antiviral, and anti-inflammatory properties. Here, we present the synthesis of twelve 1,2,3-triazolyl chalcone derivatives (4a–l), which were produced in high yields by coupling substituted aldehydes and triazolyl acetophenone (3a–d) in ethanol. The title products were characterized by physicochemical, infrared, nuclear magnetic resonance, and mass spectral methods. The in vitro tests were used to evaluate the antioxidant and antimicrobial activity of each of the prepared molecules. The preliminary assessment and 2,2-diphenyl-1-picrylhydrazyl activity of the title compounds showed significantly higher antibacterial activity and moderate-to-good antifungal and antioxidant activities compared to their standards. This work presents the synthesis of triazolyl chalcone derivatives and their biological activity. Based on the findings, these compounds could be used as lead compounds in antimicrobial and antioxidant research in the future.

Keywords: antibacterial activity, antifungal activity, antioxidant activity, chalcone, 1, 2, 3-triazole

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Authors: Valliyil Govindankutty

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Human civilizations across the globe stand testimony to water being one of the major interaction points with nature. The interactions with nature especially in drier areas revolve around water, be it harnessing, transporting, usage and management. Many ingenious ideas were born, nurtured and developed for harnessing, transporting, storing and distributing water through the areas in the drier parts of the world. Many methods of water extraction, collection and management could be found throughout the world, some of which are associated with efficient, sustained use of surface water, ground water and rain water. Karez is one such ingenious method of collection, transportation, storage and distribution of ground water. Most of the Karez systems in India were developed during reign of Muslim dynasties with ruling class descending from Persia or having influential connections and inviting expert engineers from there. Karez have strongly influenced the village socio-economic organisations due to multitude of uses they were brought into. These are masterpiece engineering structures to collect groundwater and direct it, through a subsurface gallery with a gradual slope, to surface canals that provide water to settlements and agricultural fields. This ingenious technology, karez was result of need for harnessing groundwater in arid areas like that of Bidar. The study views this traditional technology in historical perspective linked to sustainable utilization and management of groundwater and above all the immediate environment. The karez system is one of the best available demonstration of human ingenuity and adaptability to situations and locations of water scarcity. Bidar, capital of erstwhile Bahmani sultanate with a history of more than 700 years or more is one of the heritage cities of present Karnataka State. The unique water systems of Bidar along with other historic entities have been listed under World Heritage Watch List by World Monument Fund. The Historical or cultural landscape in Bidar is very closely associated to the natural resources of the region, Karez systems being one of the best examples. The Karez systems were the lifeline of Bidar’s historical period providing potable water, fulfilling domestic and irrigation needs, both within and outside the fort enclosures. These systems are still functional, but under great pressure and threat of rapid and unplanned urbanisation. The change in land use and fragmentation of land are already paving way for irreversible modification of the karez cultural and geographic landscape. The Paper discusses the significance of character defining elements of Naubad Karez Landscape, highlights the importance of conserving cultural heritage and presents a geographical approach to its revival.

Keywords: Karez, groundwater, traditional water harvesting, cultural heritage landscape, urban planning

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Authors: Pagadaplly Girish, P. V. Manohar

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Introduction: Management of distal femur fractures is challenging. Recently, treatment has evolved towards indirect reduction and minimally invasive techniques. Objectives: To assess the fracture union and functional outcome following open reduction and internal fixation of distal femur fractures with locking compression plate and to achieve restoration of the anatomical alignment of fracture fragments and stable internal fixation. Methodology: Patients with distal femur fracture treated by locking compression during Oct 2011 to April 2013 were assessed prospectively. Patients below 18 years and those with neuro-vascular deficits were excluded. Age, sex of the patient, type of fracture, mechanism of injury, type of implant used, operative time and postoperative complications were analysed. The Neer’s scale was used to assess the outcome of the patients. Results: The total number of patients was 30; 28 males and 2 females; mean age was 41.53 years. Road traffic accidents were the major causes of injury followed by falls. The average duration of hospital stay was 21.3 days. The overall complication rate note was 23.33%. The mean range of movement around the knee joint after 6 months of follow-up was 114.330. The average time for the radiological union was 14 weeks. Excellent to good results were noted in 26 patients (86.6%) and average to poor results were observed in 4 (13.33%) patients. Conclusions: The locking compression plate gives a rigid fixation for the fracture. It also provides a good purchase in osteoporotic bones. LCP is simple and a reliable implant appropriate for fixation of femoral fractures with promising results.

Keywords: distal femur fractures, locking compression plate, Neer’s criteria, neuro-vascular deficits

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Authors: Sarisha Devnath, Oluwatosin A. Ijabadeniyi

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In recent years milk contamination has become a major problem in households; due to the likely occurrence of bacteria, even after the milk has been processed. One such genus of bacteria causing unwanted growth is Bacillus. This research project looks at the presence of spore formers in processed milk from household refrigerators and the effect of pasteurization and high temperature on Bacillus spores activation. 24 samples each of UHT milk and pasteurised milk from 24 households were sampled for the presence of spore formers. While anaerobic spore formers were not found in any of the samples, the average aerobic spore formers in UHT milk and pasteurized milk however were 5.77 cfu/ml and 5.88 cfu/ml respectively. After sequencing, it was detected that the mixed culture contained Bacillus cereus, for both pasteurised and UHT milk samples. For the activation study, raw milk samples were collected and subjected to four different temperatures; 65˚C, 72˚C, 80˚C, 100˚C respectively. Samples were stored for 7 days at 5˚C and 10˚C and analysed daily. The average aerobic spore formers in raw milk for samples stored at 5˚C range between 4.67-6.00 cfu/ml while it ranges between 4.84-6.00 cfu/ml at 10˚C, signifying that the high temperatures could have resulted in germination of dominant spores. Statistical analysis conducted on these results indicated a significant difference between the numbers of colonies present at the different treatment temperatures the bacterium was exposed to. This work showed that household milk may constitute public health risk furthermore; pasteurization and higher temperatures may not be effective to remove aerobic spore formers because of Bacillus spores activation.

Keywords: sporeformers, bacillus, spores, activation, milk

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Authors: Sajida Saqira, Anthony Chariton, Grant C. Hose

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The Anthropocene has seen dramatic environmental changes which are affecting every ecosystem on earth. Freshwater ecosystems are particularly vulnerable as they are at risk from the many activities that go on and contaminants that are released in catchments. They are thus subject to many stressors simultaneously. Freshwater ecosystems respond to stress at all levels of biological organization, from subcellular to community structure and ecosystem functioning. The aim of this study was to examine the resistance and resilience of freshwater ecosystems to multiple stressors. Here we explored the individual and combined effects of copper as a chemical stressor and common carp (Cyprinus carpio) as a biological stressor on the health, functioning, and recovery of outdoor experimental pond ecosystems in a long-term, controlled, factorial experiment. Primary productivity, decomposition, and water and sediment quality were analysed at regular intervals for one year to understand the health and functioning of the ecosystems. Changes to benthic biota were quantified using DNA-based and traditional microscopy-based counts of invertebrates. Carp were added to the ponds to copper contaminated sediments (with controls) to explore the combined effects of copper and carp and removed after six months to explore the resilience and recovery of the system. The outcomes of this study will advance our understanding of the impacts of multiple stressors on freshwater ecosystems, and the resilience of these systems to copper and C. carpio, which are both globally significant stressors in freshwater systems.

Keywords: carp, copper, ecosystem health, freshwater ecosystem, multiple stressors

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Authors: Kriti Upadhyay, Ashraf Ali, Puja Sohal, Randeep Guleria

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Background: In Chronic Obstructive Pulmonary diseases (COPD) pathogenesis oxidative stress plays an important role. Hypoxia-Inducible factor (HIF-1α) is a dimeric protein complex which Functions as a master transcriptional regulator of the adaptive response to hypoxiaand is a risk factor that increases when oxidative stress triggers. The role ofHIF-1αin COPD due to smoking is lacking. Aim: This study aims to evaluate the role of HIF-1α in smoker COPD patients comparing its association with diseases severity. Method: In this cross-sectional study, we recruited 87 subjects, 57 were smokers with COPD,15 were smokers without COPD and other 15 were non-smoker healthy controls. The mean age was 54.6± 9.32 (cases 57.08±8.15; controls 50.0± 9.8). There were 62%smokers, 25% non-smokers,7% tobacco chewers and 6% ex-smokers. Enzyme-linked immune sorbent assay (ELISA) method was used for analyzing serum samples wherein HIF-1α was analyzed by Sandwich-ELISA. Results: In smoker COPD patients, a significantly higher HIF-1α level showed positive association with hypoxia, smoking status and severity of disease (p=0.03). The mean value of HIF-1α was not significantly different in smokers without COPD and healthy controls. Conclusion: It is found that HIF-1α level was increased in smoker COPD, but not in smokers without COPD. This suggests that development of COPD drive the HIF-1α pathway and it correlates with the severity of diseases.

Keywords: COPD, chronic obstructive pulmonary diseases, smokers, nonsmokers, hypoxia

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Authors: Chaiyaporn Yuksen

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Backgroud: Supraventricular tachycardia (SVT) is an abnormally fast atrial tachycardia characterized by narrow (≤ 120 ms) and constant QRS. Adenosine was the drug of choice; the first dose was 6 mg. It can be repeated with the second and third doses of 12 mg, with greater than 90% success. The study found that patients observed at 4 hours after normal sinus rhythm was no recurrence within 24 hours. The objective of this study was to investigate the factors that influence the recurrence of SVT after adenosine in the emergency department (ED). Method: The study was conducted retrospectively exploratory model, prognostic study at the Emergency Department (ED) in Faculty of Medicine, Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand. The study was conducted for ten years period between 2010 and 2020. The inclusion criteria were age > 15 years, visiting the ED with SVT, and treating with adenosine. Those patients were recorded with the recurrence SVT in ED. The multivariable logistic regression model developed the predictive model and prediction score for recurrence PSVT. Result: 264 patients met the study criteria. Of those, 24 patients (10%) had recurrence PSVT. Five independent factors were predictive of recurrence PSVT. There was age>65 years, heart rate (after adenosine) > 100 per min, structural heart disease, and dose of adenosine. The clinical risk score to predict recurrence PSVT is developed accuracy 74.41%. The score of >6 had the likelihood ratio of recurrence PSVT by 5.71 times Conclusion: The clinical predictive score of > 6 was associated with recurrence PSVT in ED.

Keywords: clinical prediction score, SVT, recurrence, emergency department

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Authors: Vikrum Malhotra, Manpreet Kaur, Ayesha Ghotto

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Background: Cardiac registries such as ACC Percutaneous Coronary Intervention Registry require high quality data to be abstracted, including data elements such as nuclear cardiology, diagnostic coronary angiography, and PCI. Introduction: The audit tool created is used by data abstractors to provide data audits and assess the accuracy and inter-rater reliability of abstraction performed by the abstractors for a health system. This audit tool solution has been developed across 13 registries, including ACC/NCDR registries, PCI, STS, Get with the Guidelines. Methodology: The data audit tool was used to audit internal registry abstraction for all data elements, including stress test performed, type of stress test, data of stress test, results of stress test, risk/extent of ischemia, diagnostic catheterization detail, and PCI data elements for ACC/NCDR PCI registries. This is being used across 20 hospital systems internally and providing abstraction and audit services for them. Results: The data audit tool had inter-rater reliability and accuracy greater than 95% data accuracy and IRR score for the PCI registry in 50 PCI registry cases in 2021. Conclusion: The tool is being used internally for surgical societies and across hospital systems. The audit tool enables the abstractor to be assessed by an external abstractor and includes all of the data dictionary fields for each registry.

Keywords: abstraction, cardiac registry, cardiovascular registry, registry, data

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Authors: Hye Lin Yang, Clifton R. Emery

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Purpose: The purpose of this study is to examine the effects of intimate partner violence on child abuse, whether patriarchal attitude and informal social control moderate the relationship between intimate partner violence and child abuse. This study was conducted with data from The Seoul Families and Neighborhoods Study (SFNS). The SFNS is a representative random probability 3-stage cluster sample of 541 cohabiting couples in Seoul, South Korea collected in 2012. To verify research models, Random effect analysis were used. All analyses were performed using the Stata program. Results: Crucial findings are the following. First, intimate partner violence showed a significantly positive relationship with Child abuse. Second, there are significant moderating effects of informal social control on intimate partner violence - child abuse. Third, there are significant moderating effects of patriarchal attitude on intimate partner violence - child abuse. In other words, Patriarchal attitude is a significant risk factor of child abuse and informal social control is a significant Protection factor of child abuse. Based on results, the policy and practical implications for preventing child abuse, promoting informal social control were discussed.

Keywords: Intimate partner violence, child abuse, informal social control, patriarchal attitude

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Authors: Noel Busch-Armendariz, Caitlin Sulley

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Introduction: This study investigated the development of college experiences, COVID-19 pandemic experiences, alcohol use, and sexual violence. The longitudinal study includes 656 college students living in the same dormitory. Students' alcohol use and social network structure were investigated to better understand the relationship with sexual violence risk. Basic Methodologies: Over two years, students repeated five web-based surveys, including a pre-college survey and surveys during four consecutive semesters. Questions were added in the fourth wave to assess students’ experiences of the COVID-19 pandemic, administered from November-January 2021, including mental and behavioral health. Analyses include the impact of COVID on living arrangements, drinking behaviors, and daily life; experiences of COVID symptoms, testing, and diagnosis, responses to COVID such as social distancing, quarantining, not working, increased health care needs; experience of fear, worry, stigma, emotional well-being, loneliness, and mental health; experiences of financial loss, lack of basic supplies, receiving emotional and financial support, and comparison with academic disengagement. Concluding Statement: Findings and discussion will include strategies to strengthen mental and behavioral health programs and policies.

Keywords: COVID, mental health, substance abuse, college students, sexual misconducts

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Authors: Mohamamd Ayish

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This study addresses media diplomacy as an integral component of public diplomacy which emerged in the United States in the post-World War II era and found applications in other countries around the world. The study seeks to evolve a conceptual framework for understanding the practice of public diplomacy through social networks, often referred to as social engagement diplomacy. This form of diplomacy is considered far more ahead of the other two forms associated with both government controlled and independent media. The cases of the Voice of America Arabic Service and the 1977 CBS interviews with the late Egyptian President Anwar Sadat and Israeli Prime Minister Menachem Begin are cited in this study as reflecting the two traditional models. The new social engagement model sees public diplomacy as an act of communication that seeks to effect changes in target audiences through a process of persuasion shaped by discourse orientations and technological features. The proposed conceptual framework for social, diplomatic engagement draws on an open communication environment, an empowered audience, an interactive and symmetrical process of communication, multimedia-based flows of information, direct and credible feedback, distortion and high risk. The writer believes this study would be helpful in providing appropriate knowledge pertaining to our understanding of social diplomacy and furnishing concrete insights into how diplomats could harness virtual space to maximize their goals in the global environment.

Keywords: diplomacy, engagement, social, globalization

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Authors: M. Abou-Amouna, A. Radwan, L. Al-kuwari, A. Hammuda, K. Al-Khalifa

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There is growing concern over increasing incidences of road accidents and consequent loss of human life in Qatar. In light to the future planned event in Qatar, World Cup 2022; Qatar should put into consideration the future deaths caused by road accidents, and past trends should be considered to give a reasonable picture of what may happen in the future. Qatar roads should be arranged and paved in a way that accommodate high capacity of the population in that time, since then there will be a huge number of visitors from the world. Qatar should also consider the risk issues of road accidents raised in that period, and plan to maintain high level to safety strategies. According to the increase in the number of road accidents in Qatar from 1995 until 2012, an analysis of elements affecting and causing road accidents will be effectively studied. This paper aims to identify and criticize the factors that have high effect on causing road accidents in the state of Qatar, and predict the total number of road accidents in Qatar 2022. Alternative methods are discussed and the most applicable ones according to the previous researches are selected for further studies. The methods that satisfy the existing case in Qatar were the multiple linear regression model (MLR) and artificial neutral network (ANN). Those methods are analyzed and their findings are compared. We conclude that by using MLR the number of accidents in 2022 will become 355,226 accidents, and by using ANN 216,264 accidents. We conclude that MLR gave better results than ANN because the artificial neutral network doesn’t fit data with large range varieties.

Keywords: road safety, prediction, accident, model, Qatar

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Authors: Samar Mousa, Rebecca Shirley

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Injuries to the hand account for 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. Functional impairments as a result of hand injuries often necessitate absence from employment, resulting in reduced productivity estimated to incur an additional £600m loss to the UK economy. Appropriate and early management is vital to preserve anatomy, prevent stiffness and allow function. The initial assessment and management of hand injuries are usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In our plastic surgery department at Stoke Mandeville hospital Buckinghamshire trust, we carried out an audit project to detect errors in hand splinting in the period between April 2022 and July 2022 and find out measures to support junior doctors, nurses and hand therapists in providing the best possible care for hand trauma patients. Our standards were The British Society for Surgery of the Hand (BSSH) standard of care in hand trauma, AO surgery reference and Stoke Mandeville hospital hand therapy mini protocol Feb 2022 During the period of 4 months, 5 cases were identified. Two cases of wrong splint choice, two cases of early removal of the splint and one tight splint that required change. In order to avoid those mistakes, a training program was given to junior doctors and nurses in collaboration with the hand therapy team regarding ways of splinting the hand in different injuries like fractures, tendons injuries, muscle injuries and ligamentous injuries. In addition to, a poster hung in the examination rooms and theatres to help junior doctors reach the correct decision.

Keywords: splinting, hand trauma, plastic surgery, tendon injury, hand fracrture

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Authors: Salah Hassab Elnaby, Omnia Hamdy, Aziza Ahmed Hassan, Salwa Abdelkawi, Ibrahim Abdelhalim

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Laser corneal reshaping has been proposed as a successful treatment of many refraction disorders. However, some physical and chemical demonstrations of the laser effect upon interaction with the corneal tissue are still not fully explained. Therefore, different computational and mathematical models have been implemented to predict the depth of the ablated channel and calculate the ablation threshold and the local temperature rise. In the current paper, we present a modified model that aims to answer some of the open questions about the ablation threshold, the ablation rate, and the physical and chemical mechanisms of that action. The proposed model consists of three parts. The first part deals with possible photochemical reactions between the incident photons and various components of the cornea (collagen, water, etc.). Such photochemical reactions may end by photo-ablation or just the electronic excitation of molecules. Then a chemical reaction is responsible for the ablation threshold. Finally, another chemical reaction produces fragments that can be cleared out. The model takes into account all processes at the same time with different probabilities. Moreover, the effect of applying different laser wavelengths that have been studied before, namely the common excimer laser (193-nm) and the solid state lasers (213-nm & 266-nm), has been investigated. Despite the success and ubiquity of the ArF laser, the presented results reveal that a carefully designed 213-nm laser gives the same results with lower operational drawbacks. Moreover, the use of mode locked laser could also decrease the risk of heat generation and diffusion.

Keywords: UV lasers, mathematical model, corneal ablation, photochemical ablation

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Authors: Manita Pyakurel, Ram Chandra Silwal, Padam Simkhada, Edwin van Teijlingen, Bikesh Bajracharya, Sushila Sapkota, Tina Gorkhali, Salita Gurung

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Introduction: Gender-based violence (GBV) has been identified as a social and personal security concern for women with disabilities who are at increased risk for various types of abuse. This study aims to determine the prevalence rates of physical, psychological, and sexual violence among women and girls with disability in Nepal. Methods: This cross-sectional study was conducted in 28 municipalities, 14 districts, and 7 provinces representing all three ecological regions of Nepal from January to March 2021. Study respondents were girls and women with disabilities, aged between 15 and 59 years, at the study sites. Face-to-face semi-structured interviews were conducted among 1294 respondents using the KoBo toolbox application on a smartphone or tablet. Results: Among the total study population, 35.3% shared lifetime violence experience. Only 4.8% formally reported violence experienced. Among the violence experienced participants maximum (92.6%) of women and girls identified no change in violence before and after the COVID-19 pandemic. Women who were married had protective odds of 0.71 for violence experienced in their lifetime [aOR-0.71, CI (0.56-0.90)]. Conclusion: More than one-third experienced violence in their lifetime. Intimate partner violence was the most common violence experienced by women and girls with disability in Nepal. Sexual violence was the least type of violence experienced. The most common perpetrator of violence includes the mother or father-in-law. Most of the women and girls never reported violence.

Keywords: gender-based violence, prevalence, girls, women

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Authors: Ma Lanting, S. Eguilior, A. Hurtado, Juan F. Llamas Borrajo

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Horizontal hydraulic fracturing is a technology to increase natural gas flow and improve productivity in the low permeability formation. During this drilling operation tons of flowback and produced water which contains many organic compounds return to the surface with a potential risk of influencing the surrounding environment and human health. A mathematical model is urgently needed to represent organic compounds in water transportation process behavior and the concentration change with time throughout the hydraulic fracturing operation life cycle. A comprehensive model combined Organic Matter Transport Dynamic Model with Two-Compartment First-order Model Constant (TFRC) Model has been established to quantify the organic compounds concentration. This algorithm model is composed of two transportation parts based on time factor. For the fast part, the curve fitting technique is applied using flowback water data from the Marcellus shale gas site fracturing and the coefficients of determination (R2) from all analyzed compounds demonstrate a high experimental feasibility of this numerical model. Furthermore, along a decade of drilling the concentration ratio curves have been estimated by the slow part of this model. The result shows that the larger value of Koc in chemicals, the later maximum concentration in water will reach, as well as all the maximum concentrations percentage would reach up to 90% of initial concentration from shale formation within a long sufficient period.

Keywords: model, shale gas, concentration, organic compounds

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Authors: Qiongpeng Dan, Xiyao Li, Qiong Zhang, Yongzhen Peng

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The nutrients removal from wastewater is of great significance for global wastewater recycling and sustainable reuse. Traditional nitrogen and phosphorus removal processes are very dependent on the input of aeration and carbon sources, which makes it difficult to meet the low-carbon goal of energy saving and emission reduction. This study reported a proof-of-concept demonstration of integrating anammox and enhanced biological phosphorus removal (EBPR) by flocs management in a single-stage hybrid bioreactor (biofilms and flocs) for simultaneous nitrogen and phosphorus removal (SNPR). Excellent removal efficiencies of nitrogen (97.7±1.3%) and phosphorus (97.4±0.7%) were obtained in low C/N ratio (3.0±0.5) municipal wastewater treatment. Interestingly, with the loss of flocs, anammox bacteria (Ca. Brocadia) was highly enriched in biofilms, with relative and absolute abundances reaching up to 12.5% and 8.3×1010 copies/g dry sludge, respectively. The anammox contribution to nitrogen removal also rose from 32.6±9.8% to 53.4±4.2%. Endogenous denitrification by flocs was proven to be the main contributor to both nitrite and nitrate reduction, and flocs loss significantly promoted nitrite flow towards anammox, facilitating AnAOB enrichment. Moreover, controlling the floc's solid retention time at around 8 days could maintain a low poly-phosphorus level of 0.02±0.001 mg P/mg VSS in the flocs, effectively addressing the additional phosphorus removal burden imposed by the enrichment of phosphorus-accumulating organisms in biofilms. This study provides an update on developing a simple and feasible strategy for integrating anammox and EBPR for SNPR in mainstream municipal wastewater.

Keywords: anammox process, enhanced biological phosphorus removal, municipal wastewater, sustainable nutrients removal

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Authors: Aleksandr Nagay, Gulnoz Khamidullayeva

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It is known that an unbalanced intake of salt (NaCI), lifestyle and genetic predisposition to pathology is a key component of the risk and the development of essential hypertension (EH). Purpose: To study the relationship between salt-sensitivity and blood pressure (BP) on systolic (SBP) and diastolic (DBP) blood pressure, depending on the C825T polymorphism of GNB3 in individuals of Uzbek nationality with EH. Method: studied 148 healthy and 148 patients with EH with I-II degree (WHO/ISH, 2003) with disease duration 6,5±1,3 years. Investigation of the gene GNB3 was produced by PCR-RFLP method. Determination of salt-sensitivity was performed by the method of R. Henkin. Results: For a comparative analysis of BP, the groups with carriage of CТ and TT genotypes were combined. The analysis showed that carriers of CC genotype and low salt-sensitivity were determined by higher levels of SBP compared with carriers of CT and TT genotypes, and low salt-sensitivity of SBP: 166,2±4,3 against 158,2±9,1 mm Hg (p=0,000). A similar analysis on the values of DBP also showed significantly higher values of blood pressure in carriers of CC genotype DBP: 105,8±10,6 vs. 100,5±7,2 mm Hg, respectively (p=0,001). The average values of SBP and DBP in groups with carriers of CC genotype at medium or high salt-sensitivity in comparison with carriers of CT or TT genotype did not differ statistically SBP: 165,0±0,1 vs. 160,0±8,6 mm Hg (p=0,275) and DBP: 100,1±0,1 vs. 101,6±7,6 mm Hg (p=0,687), respectively. Conclusion: It is revealed that in patients with EH CC genotype of the gene GNB3 given salt-sensitivity has a negative effect on blood pressure profile. Since patients with EH with the CC genotype of GNB3 gene with low-salt taste sensitivity is determined by a higher level of blood pressure, both on SBP and DBP.

Keywords: salt sensitivity, essential hypertension EH, blood pressure BP, genetic predisposition

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Authors: Vladyslav Povoroznyuk, Oksana Ivanyk, Nataliia Dzerovych

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In the diagnostics of osteoporosis, the gold standard is considered to be bone mineral density; however, X-ray densitometry is not an accurate indicator of osteoporotic fracture risk under all circumstances. In this regard, the search for new methods that could determine the indicators not only of the mineral density, but of the bone tissue quality, is a logical step for diagnostic optimization. One of these methods is the evaluation of trabecular bone quality. The aim of this study was to examine the quality and mineral density of spine bone tissue, femoral neck, and body composition of women depending on the duration of the postmenopausal period, to determine the correlation of body fat with indicators of bone mineral density and quality. The study examined 179 women in premenopausal and postmenopausal periods. The patients were divided into the following groups: Women in the premenopausal period and women in the postmenopausal period at various stages (early, middle, late postmenopause). A general examination and study of the above parameters were conducted with General Electric X-ray densitometer. The results show that bone quality and mineral density probably deteriorate with advancing of postmenopausal period. Total fat and lean mass ratio is not likely to change with age. In the middle and late postmenopausal periods, the bone tissue mineral density of the spine and femoral neck increases along with total fat mass.

Keywords: osteoporosis, bone tissue mineral density, bone quality, fat mass, lean mass, postmenopausal osteoporosis

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