Search results for: common injuries

Authors: Camarena Rodriguez C. S., Portocarrero Bonifaz A., Palma Esparza R., Romero Carlos N. A.

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Adobe is a construction material that fulfills the same function as a conventional brick. Widely used since ancient times, it is present in an appreciable percentage of buildings in Latin America. Adobe is a mixture of clay and sand. The interest in the study of the properties of this material arises due to its presence in the infrastructure of hospital´s radiological services, located in places with low economic resources, for the attenuation of radiation. Some materials such as lead and concrete are the most used for shielding and are widely studied in the literature. The present study will determine the mass attenuation coefficient of Adobe. The minimum required thicknesses for the primary and secondary barriers will be estimated for the shielding of radiological facilities where conventional and dental X-rays are performed. For the experimental procedure, an X-ray source emitted direct radiation towards different thicknesses of an Adobe barrier, and a detector was placed on the other side. For this purpose, an UNFORS Xi solid state detector was used, which collected information on the difference of radiation intensity. The initial parameters of the exposure started at 45 kV; and then the tube tension was varied in increments of 5 kV, reaching a maximum of 125 kV. The X-Ray tube was positioned at a distance of 0.5 m from the surface of the Adobe bricks, and the collimation of the radiation beam was set for an area of 0.15 m x 0.15 m. Finally, mathematical methods were applied to determine the mass attenuation coefficient for different energy ranges. In conclusion, the mass attenuation coefficient for Adobe was determined and the approximate thicknesses of the most common Adobe barriers in the hospital buildings were calculated for their later application in the radiological protection.

Keywords: Adobe, attenuation coefficient, radiological protection, shielding, x-rays

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Authors: André Rui Coelho Fernandes, Mariana Rufino, Divakar Hamal, Amr Sousa, Emma Fossett, Kamalpreet Cheema

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Aim: A single patella tendon rupture is relatively uncommon, but a simultaneous bilateral event is a rare occurrence and has been scarcely reviewed in the literature. This review was carried out to analyse the existing literature on this event, with the aim of proposing a standardised approach to the diagnosis and management of this injury. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three independent reviewers conducted searches in PubMed, OvidSP for Medline and Embase, as well as Cochrane Library using the same search strategy. From a total of 183 studies, 45 were included, i.e. 90 patellas. Results: 46 patellas had a Type 1 Rupture equating to 51%, with Type 3 being the least common, with only 7 patellas sustaining this injury. The mean Insall-Salvio ratio for each knee was 1.62 (R) and 1.60 (L) Direct Primary Repair was the most common surgical technique compared to Tendon Reconstruction, with End to End and Transosseous techniques split almost equally. Brace immobilisation was preferred over cast, with a mean start to weight-bearing of 3.23 weeks post-op. Conclusions: Bilateral patellar tendon rupture is a rare injury that should be considered in patients with knee extensor mechanism disruption. The key limitation of this study was the low number of patients encompassed by the eligible literature. There is space for a higher level of evidence study, specifically regarding surgical treatment choice and methods, as well as post-operative management, which could potentially improve the outcomes in the management of this injury.

Keywords: trauma and orthopaedic surgery, bilateral patella, tendon rupture, trauma

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Authors: S. Shafiee Ardestani, A. Najafi, N. Valizadeh, E. Payani, H. Karimian

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Objectives: Treatment of mild traumatic brain injury in emergency ward patients with any type of traumatic intracranial hemorrhage is flexible. The aim of this study is to assess the clinical outcomes of mild traumatic brain injury patients who had acute traumatic intracranial hemorrhage on initial emergency ward neuroimaging. Materials-Methods: From March 2011 to November 2012 in a retrospective cohort study we enrolled emergency ward patients with mild traumatic brain injury with Glasgow Coma Scale (GCS) scores of 14 or 15 and who had stable vital signs. Patients who had any type of intracranial hemorrhage on first head CT and repeat head CT within 24 hours were included. Patients with initial GCS < 14, injury > 24 hours old, pregnancy, concomitant non-minor injuries, and coagulopathy were excluded. Primary endpoints were neurosurgical procedures and/or death and for discharged patients, return to the emergency ward during one week. Results: Among 755 patients who were referred to the emergency ward and underwent two head CTs during first 24 hours, 302 (40%) were included. The median interval between CT scans was 6 hours (ranging 4 to 8 hours). Consequently, 135 (45%) patients had subarachnoid hemorrhage, 124 (41%) patients had subdural hemorrhage, 15 (5%) patients had epidural hemorrhage, 28 (9%) patients had cerebral contusions, and 54 (18%) patients had intra-parenchymal hemorrhage. Six of 302 patients died within 15 days of injury. 200 patients (66%) have been discharged from the emergency ward, 25 (12%) of whom returned to the emergency ward after one week. Conclusion: Discharge of the head trauma patients after a repeat head CT and brief period of observation in the emergency ward lead to early discharge of mild traumatic brain injury patients with traumatic ICH without adverse events.

Keywords: clinical outcomes, emergency ward, mild traumatic intracranial hemorrhage, Glasgow Coma Scale (GCS)

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Authors: Laila Seada, Ashraf Ibrahim, Amjad Al Shammari

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Background and Objectives: Breast carcinoma is the most common cancer of females in Hail region, accounting for 31% of all diagnosed cancer cases followed by thyroid carcinoma (25%) and colorectal carcinoma (13%). Methods: In the present retrospective study, all cases of breast lesions received at the histopathology department in King Khalid Hospital, Hail, during the period from May 2011 to April 2016 have been retrieved from department files. For all cases, a trucut biopsy, lumpectomy, or modified radical mastectomy was available for histopathologic diagnosis, while 105/140 (75%) had, as well, preoperative fine needle aspirates (FNA). Results: 49 cases out of 140 (35%) breast lesions were carcinomas: 44/49 (89.75%) was invasive ductal, 2/49(4.1%) invasive lobular carcinomas, 1/49(2.05%) intracystic low grade papillary carcinoma and 2/49 (4.1%) ductal carcinoma in situ (DCIS). Mean age for malignant cases was 45.06 (+/-10.58): 32.6% were below the age of 40 and 30.6 below 50 years, 18.3% below 60 and 16.3% below 70 years. For the benign group, mean age was 32.52 (+/10.5) years. Benign lesions were in order of frequency: 34 fibroadenomas, 14 fibrocystic disease, 12 chronic mastitis, five granulomatous mastitis, three intraductal papillomas, and three benign phyllodes tumor. Tubular adenoma, lipoma, skin nevus, pilomatrixoma, and breast reduction specimens constituted the remaining specimens. Conclusion: Breast lesions are common in our series and invasive carcinoma accounts for more than 1/3^rd of the lumps, with 63.2% incidence in pre-menopausal ladies, below the age of 50 years. FNA as a non-invasive procedure, proved to be an effective tool in diagnosing both benign and malignant/suspicious breast lumps and should continue to be used as a first assessment line of palpable breast masses.

Keywords: age incidence, breast carcinoma, fine needle aspiration, hail region

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Authors: Azhar Ulhaq, Zubair Yameen, Almas Anjum

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Frequency behaviour of self-excited induction generator (SEIG) wind turbines during control mode transition from grid connected to islanded mode is studied in detail. A robust control scheme for frequency regulation based on combined action of STATCOM, energy storage system (ESS) and pitch angle control for wind powered microgrid (MG) is proposed. Suggested STATCOM controller comprises a 3-phase voltage source converter (VSC) that contains insulated gate bipolar transistors (IGBTs) based pulse width modulation (PWM) inverters along with a capacitor bank. Energy storage system control consists of current controlled voltage source converter and battery bank. Both of them acting simultaneously after detection of island compensates for reactive and active power demands, thus regulating frequency at point of common coupling (PCC) and also improves load stability. STATCOM integrates at point of common coupling and ESS is connected to microgrids main bus. Results reveal that proposed control not only stabilizes frequency during transition duration but also minimizes sudden frequency imbalance caused by load variation or wind intermittencies in islanded operation. System is investigated with and without suggested control scheme. The efficacy of proposed strategy has been verified by simulation in MATLAB/Simulink.

Keywords: energy storage system, island, wind, STATCOM, self-excited induction generator, SEIG, transient

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Authors: Asanga Gunawansa, Shenella Fonseka

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On-demand bonds, also known as unconditional bonds, are commonplace in the construction industry as a means of safeguarding the employer from any potential non-performance by a contractor. On-demand bonds may be obtained from commercial banks, and they serve as an undertaking by the issuing bank to honour payment on demand without questioning and/or considering any dispute between the employer and the contractor in relation to the underlying contract. Thus, whether or not a breach had occurred under the underlying contract, which triggers the demand for encashment by the employer, is not a question the bank needs to be concerned with. As a result, an unconditional bond allows the beneficiary to claim the money almost without any condition. Thus, an unconditional bond is as good as cash-in-hand. In the past, establishing fraud on the part of the employer, of which the bank had knowledge, was the only ground on which a bank could dishonour a claim made under an on-demand bond. However, recent jurisprudence in common law countries shows that courts are beginning to consider unconscionable conduct on the part of the employer in claiming under an on-demand bond as a ground that contractors could rely on the prevent the banks from honouring such claims. This has created uncertainty in connection with on-demand bonds and their liquidity. This paper analyzes recent judicial decisions in four common law jurisdictions, namely, England, Singapore, Hong Kong, and Sri Lanka, to identify the scope of using the concept of “unconscionability” as a ground for preventing unreasonable claims for encashment of on-demand bonds. The objective of this paper is to argue that on-demand bonds have lost their effectiveness as “cash-in-hand” and that this is, in fact, an advantage and not an impediment to international commerce, as the purpose of such bonds should not be to provide for illegal and unconscionable conduct by the beneficiaries.

Keywords: fraud, performance guarantees, on-demand bonds, unconscionability

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Authors: Joo-Hack Lee, Jin-Seung Choi, Dong-Won Kang, Jeong-Woo Seo, Ju-Young Kim, Dae-Hyeok Kim, Seung-Tae Yang, Gye-Rae Tack

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For cycling, the analysis of the pedal force is one of the important factors in the study of exercise ability assessment and overuse injuries. In past studies, a two-axis measurement sensor was used at the sagittal plane to measure the force only in the anterior, posterior, and vertical directions and to analyze the loss of force and the injury on the frontal plane due to the forces in the right and left directions. In this study, which is a basic study on diverse analyses of the pedal force that consider the forces on the sagittal plane and the frontal plane, a three-axis pedal force measurement sensor was developed to measure the anterior-posterior (Fx), medio-lateral (Fz), and vertical (Fy) forces. The sensor was fabricated with a size and shape similar to those of the general flat pedal, and had a 550g weight that allowed smooth pedaling. Its measurement range was ±1000 N for Fx and Fz and ±2000 N for Fy, and its non-linearity, hysteresis, and repeatability were approximately 0.5%. The data were sampled at 1000 Hz using a signal collector. To use the developed sensor, the pedaling efficiency (index of efficiency, IE) and the range of left and right (medio-lateral, ML) forces were measured with two seat heights (low and high). The results of the measurement showed that the IE was higher and the force range in the ML direction was lower with the high position than with the low position. The developed measurement sensor and its application results will be useful in understanding and explaining the complicated pedaling technique, and will enable diverse kinematic analyses of the pedal force on the sagittal plane and the frontal plane.

Keywords: cycling, pedal force, index of effectiveness, measuring

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Authors: Roien Qiam, Shoshi Mizokami

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Parking demand in the Central Business District (CBD) has enlarged with the increase of the number of private vehicles due to rapid economic growth, lack of an efficient public transport and traffic management system. This has resulted in low mobility, poor accessibility, serious congestion, high rates of traffic accident fatalities and injuries and air pollution, mainly because people have to drive slowly around to find a vacant spot. With parking pricing and enforcement policy, considerable advancement could be found, and on-street parking spaces could be managed efficiently and effectively. To evaluate parking demand and making parking policy, it is required to understand the current parking condition and driver’s behavior, understand how drivers choose their parking type and location as well as their behavior toward finding a vacant parking spot under parking charges and search times. This study illustrates the result from an observational, revealed and stated preference surveys and experiment. Attained data shows that there is a gap between supply and demand in parking and it has maximized. For the modeling of the parking decision, a choice model was constructed based on discrete choice modeling theory and multinomial logit model estimated by using SP survey data; the model represents the choice of an alternative among different alternatives which are priced on-street, off-street, and illegal parking. Individuals choose a parking type based on their preference concerning parking charges, searching times, access times and waiting times. The parking assignment model was obtained directly from behavioral model and is used in parking simulation. The study concludes with an evaluation of parking policy.

Keywords: CBD, parking demand forecast, parking policy, parking choice model

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Authors: Tatyana Suvorkina

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It is indisputable that the problem of the origin of Manichaeism is very complex. Manichaeism is characterized as a syncretic religion, which was influenced by many teachings, but it is difficult to define one which can be called fundamental. The aim of this paper is an attempt to regard Jewish apocalyptic tradition as one of the most defining source of formation of Manichaean systems. To realize this aim a comparison of the Manichean texts and the Jewish apocryphal literature is made. Consideration is given first to the Coptic Manichaean treatise Kephalaia, The Cologne Mani Codex and to books of Enoch. Under the article it is not denied that Manichaeism was influenced by different doctrines and, passed through centuries, it could adapt and strengthen this influence at an even deeper level. But the fact that the Judeo-Christian environment where Mani grew up and where the first sprouts of his teaching were formed had impact on future prophet seems obvious. Nevertheless, attempts to analyze the system of Mani within the Jewish tradition are quite rare, although such studies were carried out for Gnosticism. But Manichaeism, despite the Gnostic features it contains, is not 'one of the Gnostics' to place it under this term among the rest. Frequently, gnostic currents are pointed out as the main sources for the formation of Mani’s teachings. But it seems possible that Mani's interest in Gnosticism was motivated by the fact that he considered it as something close to that interpretation of Hebrew texts, which he aspired to undertake. The question of understanding the Manichaean system is connected not only with Manichaeism but also with other dualistic teachings, which were recognized by contemporaries as Manichaean. It is seen that polemics between Manicheans and Hellenized Christianity separated from Judaism and continued to separate with every century, were polemics between adherents of initially two different worldviews who had, however, a common source. Therefore an analysis of the controversy in the context of interpretations of this common source by disputing parties is seen very important for further study.

Keywords: dualism, Jewish apocalypticism, Manichaeism, syncretism

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Authors: Donna L. Roberts

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The theory of archetypes contends that themes based on universal foundational images reside in and are transmitted generationally through the collective unconscious, which is referenced throughout an individual’s experience in order to make sense of that experience. There is then, a profoundly visceral and instinctive agreement on the gestalt of these universal themes and how they apply to the human condition throughout space and time. The inherent nature of projective tests, such as the Rorschach Inkblot, necessitates that the stimulus is ambiguous and thus elicits responses that reflect the unconscious inner psyche of the respondent. As the development of the Rorschach inkblots was relatively random and serendipitous - i.e., the inkblots were not engineered to elicit a specifically defined response - it would stand to reason that without a collective unconscious, every individual would interpret the inkblots in an individualized and unique way. Yet this is not the case. Instead, common themes appear in the images of the inkblots and their interpretation that reflect this deeper iconic understanding. This study analyzed the ten Rorschach inkblots in terms of Jungian archetypes, both with respect to the form of images on each plate and the commonly observed themes in responses. Examples of the archetypes were compared to each of the inkblots, with subsequent descriptions matched to the standard responses. The findings yielded clear and distinct instances of the universal symbolism intrinsic in the inkblot images as well as ubiquitous throughout the responses. This project illustrates the influence of the theories of psychologist Carl Gustav Jung on the interpretation of the ambiguous stimuli. It further serves to demonstrate the merit of Jungian psychology as a valuable tool with which to understand the nature of projective tests in general, Rorschach’s work specifically, and ultimately the broader implications for our collective unconscious and common humanity.

Keywords: archetypes, inkblots, projective tests, Rorschach

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Authors: Yu-Wei Chu, Marie Aja-Herrera, Denis Antoine, Mengjie Di

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The purpose of this paper is to explore the innovative perspective of the local traditional culture of garments from different continents. The relationship between the local culture, the indigenous traditional technique of textile manufacture, and modern womenswear will be investigated. This will include exploring and discussing traditional techniques to create textiles reflecting different cultures and relevant handicrafts, including the history of these different peoples and regions. However, along with the improvement of technology, the diversity of culture is usually unified into a single aesthetic element, which makes fashion lack traditional cultural layers. Local cultural awareness has been gradually emerging in womenswear in recent years with the strong sweep of globalization. The possible loss of traditional art and crafts became an awareness for different cultures, who realized the necessity to protect and preserve their individual uniqueness. Modern womenswear is one of the largest markets in the fashion and apparel marketplace. Therefore, the commonalities of traditional textiles and garments for modern womenswear will be researched. Localized traditional fabrics have some elements, such as weaving techniques and other related crafts, in common with more modern manufacturing methods. In addition, the common point of traditional clothing is the use of draping, construction, and fabric manipulation. This paper aims to explore these factors, as discussed above, and also apply, in an innovative and creative manner, some of these traditional arts and crafts to modern womenswear. The combination of textile manipulation and different construction techniques can support the development of innovative womenswear to include a diversity of aesthetics. The main contribution of the paper is to find out the solution to bring local culture into the formal womenswear market with modern aesthetics to realize the ideal of traditional culture reconstruction.

Keywords: traditional culture, modern womenswear, diversity, aesthetics

Procedia PDF Downloads 113

Authors: Haftu Hailu Berhe, Hailekiros Sibhato Gebremichael, Kinfe Tsegay Beyene, Haileselassie Mehari

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The purpose of the study is to develop and validate integrated literature-based JIT, TQM, TPM, SCM and LSS framework through a combination of the PDCA cycle and DMAIC methodology. The study adopted a mixed research approach. Accordingly, the qualitative study employed to develop the framework is based on identifying the uniqueness and common practices of JIT, TQM, TPM, SCM and LSS initiatives, the existing practice of the integration, identifying the existing gaps in the framework and practices, developing new integrated JIT, TQM, TPM, SCM and LSS practice framework. Previous very few studies of the uniqueness and common practices of the five initiatives are preserved. Whereas the quantitative study working to validate the framework is based on empirical analysis of the self-administered questionnaire using a statistical package for social science. A combination of the PDCA cycle and DMAIC methodology stand integrated CI framework is developed. The proposed framework is constructed as a project-based framework with five detailed implementation phases. Besides, the empirical analysis demonstrated that the proposed framework is valuable if adopted and implemented correctly. So far, there is no study proposed & validated the integrated CI framework within the scope of the study. Therefore, this is the earliest study that proposed and validated the framework for manufacturing industries. The proposed framework is applicable to manufacturing industries and can assist in achieving competitive advantages when the manufacturing industries, institutions and government offer unconditional efforts in implementing the full contents of the framework.

Keywords: integrated continuous improvement framework, just in time, total quality management, total productive maintenance, supply chain management, lean six sigma

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Authors: Hsiao-Lin Fang

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The Patient Self-Determination Act is based on the belief that each life is unique. The act regards each patient as an autonomous entity and explicitly protects the patient’s rights to know and make decisions and choices while ensuring that the patient’s wish for a peaceful end is granted. Even when the patient is unconscious and unable to express himself/herself, the patient’s self-determination and its exercise are still protected under the law. The act also ensures that healthcare professionals (HCPs) have a specific set of rules to follow and complete legal protection when their patients are unable to express themselves clearly. This report is about a 55-year-old female patient who weighed 110 kg and was diagnosed with acute type A aortic dissection. The case was that the patient suddenly felt backache and nausea during sleep before daybreak and was therefore transferred to this hospital from the original one. After the doctor explained the patient’s conditions, it was concluded that surgery was necessary. However, the patient’s family was immediately against the surgery after having heard its possible complications. Nevertheless, the patient was still willing to receive the surgery. Being at odds with her family, the patient decided to sign the surgery agreement herself and agreed to receive the two surgical procedures: (1) ascending aorta replacement and (2) innominate artery debranching. After the surgery, the patient did not regain consciousness and therefore received computed tomography scanning of the brain, which revealed false lumen involving proximal left common carotid artery, left subclavian artery and innominate artery, and severe compression of the true lumen with total/subtotal occlusion in the left common carotid artery. On the following day, the doctor discussed two further surgical procedures: (1) endografting for descending aorta and (2) endografting for left common carotid artery and subclavian artery with the family. However, as the patient’s postoperative recovery of consciousness only reached the level of stupor and her family had no intention of subsequent healthcare for the patient, the family made the joint decision three days later to have the endotracheal tube removed from the patient and let her die a natural death. Suggestion: An advance directive (AD) can be created beforehand. Once the patient is in a special clinical state (e.g., terminal illness, permanent vegetative state, etc.), the AD can determine whether to sustain the patient’s life through ‘medical intervention’ or to respect the patient’s rights to choose a peaceful end and receive palliative care. Through the expression of self-determination, it is possible to respect the patient’s medical practice autonomy and protect the patient’s dignity and right to a peaceful end, thereby respecting and supporting the patient’s decision. This also allows the three sides: the patient, the family and the medical team to understand the patient’s true wish in the process of advance care planning (ACP) and thereby promote harmony in the HCP-patient relationship.

Keywords: intensive care unit patient, cardiovascular surgery, self-determination, advance directive

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Authors: Mohammad Reza Zamanian

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The construction industry has always been recognized as one of the most dangerous available industries, and the statistics of accidents and injuries resulting from it say that the safety category needs more attention and the arrival of up-to-date technologies in this field. Building information modeling (BIM) is one of the relatively new and applicable technologies in Iran, that the necessity of using it is increasingly evident. The main purposes of this research are to evaluate the feasibility of using this technology in the safety sector of construction projects and to evaluate the effectiveness and operationality of its various applications in this sector. These applications were collected and categorized after reviewing past studies and researches then a questionnaire based on Delphi method criteria was presented to 30 experts who were thoroughly familiar with modeling software and safety guidelines. After receiving and exporting the answers to SPSS software, the validity and reliability of the questionnaire were assessed to evaluate the measuring tools. Fuzzy logic is a good way to analyze data because of its flexibility in dealing with ambiguity and uncertainty issues, and the implementation of the Delphi method in the fuzzy environment overcomes the uncertainties in decision making. Therefore, this method was used for data analysis, and the results indicate the usefulness and effectiveness of BIM in projects and improvement of safety status at different stages of construction. Finally, the applications and the sections discussed were ranked in order of priority for efficiency and effectiveness. Safety planning is considered as the most influential part of the safety of BIM among the four sectors discussed, and planning for the installation of protective fences and barriers to prevent falls and site layout planning with a safety approach based on a 3D model are the most important applications of BIM among the 18 applications to improve the safety of construction projects.

Keywords: building information modeling, safety of construction projects, Delphi method, fuzzy logic

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Authors: Ali Asgary, Haopeng Zhou, Ghassem Tofighi

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Use of virtual (VR), augmented reality (AR), and extended reality technologies for training and education has increased in recent years as more hardware and software tools have become available and accessible to larger groups of users. Similarly, the applications of these technologies in earthquake related training and education are on the rise. Several studies have reported promising results for the use of VR and AR for evacuation behaviour and training under earthquake situations. They simulate the impacts that earthquake has on buildings, buildings’ contents, and how building occupants and users can find safe spots or open paths to outside. Considering that considerable number of earthquake injuries and fatalities are linked to the behaviour, our goal is to use these technologies to reduce the impacts of building contents on people. Building on our artificial intelligence (AI) based indoor earthquake risk assessment application that enables users to use their mobile device to assess the risks associated with building contents during earthquakes, we develop a virtual reality application to demonstrate the behavior of different building contents during earthquakes, their associate moving, spreading, falling, and collapsing risks, and their risk mitigation methods. We integrate realistic seismic models, building contents behavior with and without risk mitigation measures in virtual reality environment. The application can be used for training of architects, interior design experts, and building users to enhance indoor safety of the buildings that can sustain earthquakes. This paper describes and demonstrates the application development background, structure, components, and usage.

Keywords: virtual reality, earthquake damage, building content, indoor risks, earthquake risk mitigation, interior design, unity game engine, oculus

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Authors: Gordon Weight, Hermione Tsoi, Patrick Cutinha, Sanjay Rajpal

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Aim: Greenlight-laser prostatectomy (GLLP) is becoming a popular treatment option for bladder outlet obstruction and lower urinary tract symptoms (LUTS). In this retrospective study, we aim to explore the patient selection, perioperative morbidity, and functional outcomes of GLLP. Methods: Patients who underwent GLLP at a UK tertiary centre between June 2018 and November 2021 were included in this study. Retrospective data covering patient demographics, perioperative parameters and postoperative outcomes were collected using the electronic records systems. Results: 305 patients were included in this study with a mean age of 73 (range 30-90) years. The most common indication (62.6%) for the procedure was patient’s wish to be free from long-term catheters (LTC) or intermittent catheterisation (ISC), followed by failed medical therapy for LUTS (36.4%). 84.6% of patients had an ASA ≥2, and 32.1% took anticoagulant or antiplatelet therapy. Inpatient stays were minimal, with the majority (68.2%) of patients were performed as day case, and only 10.5% of patients requiring more than a single night admission. The 3-month readmission rate was 10.8%, with the most common causes being haematuria and urinary-tract infection. The successful TWOC rate at follow up was 91.2%. Amongst the 19 patients who failed TWOC, 14 had LTC prior to the procedure and 4 had been performing ISC. Conclusions: Our study shows that GLLP is a safe and effective day case treatment and can be suitable for elderly and comorbid patients. Patients requiring LTC or ISC pre-operatively should be counselled carefully about the risk of not being catheter-free post procedure.

Keywords: urology, endourology, prostate, bladder outlet obstruction, laser

Procedia PDF Downloads 64

Authors: Iman Shawky, Mohamed Elsayed

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Every hotel works in the hospitality market tends to have its own merit and character in its products marketing in order to maintain both its brand's identity and image among guests. According to the growth of global competition in the hospitality industry; the concept of competitive advantage is becoming increasingly important in hotels' marketing world as it examines reasons for outweighing hotels in their dimensions of strategic and marketing plans. In fact, Egypt is the land of appeared and submerged secrets as a result of its ancient civilization ongoing explorations. Although underwater antiquities represent ambiguous treasures, they have auspicious future in it, particularly in Alexandria. The study aims at examining to what extent underwater antiquities represent a competitive advantage of four and five-star hotels in Alexandria. For achieving this aim, an exploratory study conducted by currying out the investigation and comparison of the closest and most popular landmarks mentioned on both hotels' official websites and on common used reservations' websites. In addition to that, two different questionnaire forms designed; one for both revenue and sales and marketing hotels' managers while the other for their guests. The results indicate that both official hotels' websites and the most common used reservations' websites totally ignore mentioning underwater antiquities as attractive landmarks surrounding Alexandria hotels. Furthermore, most managers expect that underwater antiquities can furnish distinguished competitive advantage to their hotels. Also, they can help exceeding guests' expectations during their accommodation as long as they included on both official hotels' and reservations' websites as the most surrounding famous landmarks. Moreover, most managers foresee that high awareness of underwater antiquities can enhance the guests' accommodation frequencies and improve the financial performance of their hotels.

Keywords: competitive advantage, financial performance, hotels' websites, underwater antiquities

Procedia PDF Downloads 164

Authors: Elizabeth Russo, Angelica Terepka

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The present paper reviews literature examining trends among suicide, suicidal ideation, and mental illness rates in ethnic and racial minority student-athletes. While the rates of suicide amongst student athlete populations is lower than rates of suicide seen in the general student populations, there is a discrepancy amongst rates of suicide in student athletes; specifically, those identifying with racial and ethnic minority backgrounds endorse higher rates of suicidal ideation. The samples from the existing literature consisted of White, Black, Hispanic/Latinx, Asian/ Pacific Islander, Multiracial, and Native American student-athletes. Studies suggest that ethnic and racial minority students are more susceptible to suicide, depression, and other mental health concerns compared to their white counterparts. Across the literature, White student athletes appeared to have more social and academic support from fellow classmates, university administration and professors, and staff within their athletic departments. Student athletes who did not identify as White endorsed higher rates of loneliness, felt ethnically and racially underrepresented within their athletic department, and endorsed lack of appropriate medical treatment for injuries by athletic department medical staff. Additionally, non-White student athletes receive less peer support and must balance additional stressors such as discrimination in contrast to their White/non-Latinx peers. Recommendations for athletic departments and mental health providers supporting student athletes who identify as racial and ethnic minorities are discussed.

Keywords: racial and ethnic minority, suicide, student-athlete, suicidal ideation

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Authors: Antarip Bhattacharya, Dhritiman Maitra

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Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia due to autonomous production of parathormone (PTH) and the third most common endocrine disorder. Upto 2% of postmenopausal women could have this condition. Primary hyperparathyroidism is characterized by hypercalcemia with a high or insufficiently suppressed level of parathyroid hormone and is caused by a solitary parathyroid adenoma in 85-90% of patients. PHPT may also be caused by parathyroid hyperplasia (involving multiple glands) or parathyroid carcinoma. Associated morbidities and sequelae include decreased bone mineral density, fractures, kidney stones, hypertension, cardiac comorbidities and psychiatric disorder which entail huge costs for treatment. In the year 2021, by virtue of running a Breast and Endocrine Surgery clinic in a Tier 1 city at a tertiary care hospital, the opportunity to be associated with patients of hyperparathyroidism came our way. Here, we shall describe the spectrum of clinical presentations and customisation of treatment for parathyroid diseases with reference to the above patients. A retrospective analysis of the data of all patients presenting with symptoms of parathyroid diseases was made and classified according to the cause. 13 patients had presented with symptoms of hyperparathyroidism and each case presented with unique symptoms and necessitated detailed evaluation. The treatment or surgery offered to each patient was tailored to his/her individual disease and led to favourable outcomes. Diseases affecting parathyroid are not as rare as we believe. Each case merits detailed clinical evaluation, investigations and tailoring of suitable treatment with regard to medical management and extent of surgery. Intra-operative frozen section/iOPTH monitoring are really useful adjuncts for intra-operative decision making.

Keywords: hyperparathyroidism, parathyroid adenoma, parathyroid surgery, PTH

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Authors: Chia-Feng Chen, Wan-Yi Lin, Chia-En Liu

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Background: There are approximately 600 newborns that stay four weeks in our postpartum agency every year. As we all know, newborn’s skin is 40-60% thinner than adult skin, newborn skin has a higher trans epidermal water loss, so many postpartum agencies use massage oil every day, no matter which seasons. In fact, neonatal miliaria or prickly heat is the most common condition from two to three -week- old newborns. According to research, about 80 percent of two to three -week- old baby are diagnosed with prickly heat because nurses apply massage oil to their faces every day. In China, we can use honeysuckle to wipe the newborn's face for treatment. Purpose: the purpose of the study is to discuss that using massage oil will be induced neonatal miliaria among two or three-week-old newborns and the aim of the study is to assess the protocol of miliaria condition with the face. Methods: a quasi-experimental design was used to evaluated the result between massage oil and non massage oil. A total of 22 participants were recruited randomly and analyzed from August to September in the south of China and collected for about 2 week long. The 22 participants were randomly selected and live in the stable air condition belong, 24 to 26℃. Results: the 64% of participants were diagnosed with miliaria using massage oil, the 2/8 of participants were diagnosed with miliaria no using massage oil. The pearson correction was0.67. The result of 22 participants, including massage oil, and diagnosed with miliaris. Besides, in our study, 9 of participants with miliaria for 3 to 6 days on the face, were treatment with honey-suckle wipe 3days through pediatric doctor suggestion. The effect of honey-suckle were useful in improving miliaria and decreasing the anxiety of parents. Conclusions: Miliaria is a common condition in newborns, especially in summer. The authors postulate that the massage oil did not find suitable for newborn in summer, and the study provides evidence that honey-suckle effectively control miliaria on using massage oil of participants.

Keywords: massage oil, miliaria, newborn, honey suckle

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Authors: Zainab Alghali Elsaid Muhammed

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Background : IBS is a gastrointestinal disorder characterized by a variety of symptoms that occur concurrently. It is very common and is associated with high levels of psychiatric comorbidities, all of which have a negative impact on the patient's quality of life. Abdominal pain, diarrhea, constipation, excess gas, and bloating are common symptoms of IBS. Objectives : The purpose of this study is to determine the prevalence of IBS among medical students and intern doctors in Sudan, as well as the risk factors associated with it. Study design: This cross-sectional study was carried out in Sudan from April to July 2022. All participants completed a six-part online questionnaire. The ROME IV criteria questionnaire was used to make an IBS diagnosis. Participants completed the hospital anxiety and depression questionnaire in order to be diagnosed with anxiety and depression. Results : 600 participants filled out the questionnaire. The overall prevalence of IBS was found to be 42%, with females being the most affected. Intern doctors had higher IBS rates (30.0%) than medical students, but this was not statistically significant. Single status (p =0.079), good GPAs (p =0.00), had significant associations with IBS occurrence. Other significantly associated habits were sleeping less than 8 hours (p =0.013), two cups or less of coffee per day (p = 0.109), No smoking (p =0.001), and No exercise (p =0.00, IBS participants were also found to have a significant relationship with abnormal anxiety (p =0.00) and borderline depression (p=0.0156). Conclusion : The high prevalence of IBS in this study suggests that medical students and interns are unable to recognize their symptoms. The main IBS predictors in this study were suffering from anxiety or depression, having an insufficient income, sleeping less than 8 hours per day, working/ studying more than 8 hours per day, and not performing any type of exercise.

Keywords: irritable bowel syndrome, sudan, HADS, rome IV, medical students

Procedia PDF Downloads 99

Authors: Syed Dawood M. Taimur

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Background: Peripheral arterial disease (PAD) is under diagnosed in primary care practices, yet the extent of unrecognized PAD in patients with coronary artery disease (CAD) is unknown. Objective: To assess the prevalence of previously unrecognized PAD in patients undergoing coronary angiogram and to determine the relationship between the presence of PAD and severity of CAD. Material & Methods: This five years retrospective study was conducted at an invasive lab of the department of Cardiology, Ibrahim Cardiac Hospital & Research Institute from January 2010 to December 2014. Total 77 patients were included in this study. Study variables were age, sex, risk factors like hypertension, diabetes mellitus, dyslipidaemia, smoking habit and positive family history for ischemic heart disease, coronary artery and peripheral artery profile. Results: Mean age was 56.83±13.64 years, Male mean age was 53.98±15.08 years and female mean age was 54.5±1.73years. Hypertension was detected in 55.8%, diabetes in 87%, dyslipidaemia in 81.8%, smoking habits in 79.2% and 58.4% had a positive family history. After catheterization 88.3% had peripheral arterial disease and 71.4% had coronary artery disease. Out of 77 patients, 52 had both coronary and peripheral arterial disease which was statistically significant (p < .014). Coronary angiogram revealed 28.6% (22) patients had triple vessel disease, 23.3% (18) had single vessel disease, 19.5% (15) had double vessel disease and 28.6% (22) were normal coronary arteries. The peripheral angiogram revealed 54.5% had superficial femoral artery disease, 26% had anterior tibial artery disease, 27.3% had posterior tibial artery disease, 20.8% had common iliac artery disease, 15.6% had common femoral artery disease and 2.6% had renal artery disease. Conclusion: There is a strong and definite correlation between coronary and peripheral arterial disease. We found that cardiovascular risk factors were in fact risk factors for both PAD and CAD.

Keywords: coronary artery disease (CAD), peripheral artery disease(PVD), risk, factors, correlation, cathetarization

Procedia PDF Downloads 420

Authors: M. Chukhryaeva, R. Skhalyakho, J. Kagazegeva, E. Pocheshkhova, L. Yepiskopossyan, O. Balanovsky, E. Balanovska

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The Middle East is crossroad of different populations at different times. The Kurds are of particular interest in this region. Historical sources suggested that the origin of the Kurds is associated with Medes. Therefore, it was especially interesting to compare gene pool of Kurds with other supposed descendants of Medes-Tats. Yezidis are ethno confessional group of Kurds. Yezidism as a confessional teaching was formed in the XI-XIII centuries in Iraq. Yezidism has caused reproductively isolation of Yezidis from neighboring populations for centuries. Also, isolation helps to retain Yezidian caste system. It is unknown how the history of Yezidis affected its genу pool because it has never been the object of researching. We have examined the Y-chromosome variation in Yezidis and Kurdish males to understand their gene pool. We collected DNA samples from 90 Yezidi males and 24 Kurdish males together with their pedigrees. We performed Y-STR analysis of 17 loci in the samples collected (Yfiler system from Applied Biosystems) and analysis of 42 Y-SNPs by real-time PCR. We compared our data with published data from other Kurdish groups and from European, Caucasian, and West Asian populations. We found that gene pool of Yezidis contains haplogroups common in the Middle East (J-M172(xM67,M12)- 24%, E-M35(xM78)- 9%) and in South Western Asia (R-M124- 8%) and variant with wide distribution area - R-M198(xM458- 9%). The gene pool of Kurdish has higher genetic diversity than Yezidis. Their dominants haplogroups are R-M198- 20,3 %, E-M35- 9%, J-M172- 9%. Multidimensional scaling also shows that the Kurds and Yezidis are part of the same frontier Asian cluster, which, in addition, included Armenians, Iranians, Turks, and Greeks. At the same time, the peoples of the Caucasus and Europe form isolated clusters that do not overlap with the Asian clusters. It is noteworthy that Kurds from our study gravitate towards Tats, which indicates that most likely these two populations are descendants of ancient Medes population. Multidimensional scaling also reveals similarity between gene pool of Yezidis, Kurds with Armenians and Iranians. The analysis of Yezidis pedigrees and their STR variability did not reveal a reliable connection between genetic diversity and caste system. This indicates that the Yezidis caste system is a social division and not a biological one. Thus, we showed that, despite many years of isolation, the gene pool of Yezidis retained a common layer with the gene pool of Kurds, these populations have common spectrum of haplogroups, but Yezidis have lower genetic diversity than Kurds. This study received primary support from the RSF grant No. 16-36-00122 to MC and grant No. 16-06-00364 to EP.

Keywords: gene pool, haplogroup, Kurds, SNP and STR markers, Yezidis

Procedia PDF Downloads 204

Authors: Shittu Bashirat, Shittu Mujeeb, Oluremi Adeolu, Orisadare Olayiwola, Jikeme Osameke, Bello Lateef

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Septicemia in neonates refers to generalized bacterial infection documented by positive blood culture in the first 28 days of life and is one of the leading causes of neonatal mortality in sub-Sahara Africa. Thrombocytopenia in newborns is a result of increased platelet consumption; sepsis was found to be the most common risk factor. The objective of the study was to determine if there are organism-specific platelet responses among the 2 groups of bacterial agents: Gram-positive and Gram-negative bacteria, and also to examine the association of platelet count and prothrombin time with neonatal septicemia. 232 blood samples were collected for this study. The blood culture was performed using Bactec 9050, an instrumented blood culture system. The platelet count and prothrombin time were performed using Abacus Junior 5 hematology analyzer and i-STAT 1 analyzer respectively. Of the 231 neonates hospitalized with clinical sepsis, blood culture reports were positive in 51 cases (21.4%). Klebsiella spp. (35.3%) and Staphylococcus aureus (27.5%) were the most common Gram-negative and Gram-positive isolates respectively. Thrombocytopenia was observed in 30 (58.8%) of the neonates with septicemia. Of the 9 (17.6%) patients with severe thrombocytopenia, seven (77.8%) had Klebsiella spp. septicemia. Out of the 21(63.6%) of thrombocytopenia produced by Gram-negative isolate, 17 (80.9) had increased prothrombin time. In conclusion, Gram-negative organisms showed the highest cases of severe thrombocytopenia and prolonged PT. This study has helped to establish a disturbance in hemostatic systems in neonates with septicemia. Further studies, however, may be required to assess other hemostasis parameters in order to understand their interaction with the infectious organisms in neonates.

Keywords: neonates, septicemia, thrombocytopenia, prolonged prothrombin time, platelet count

Procedia PDF Downloads 402

Authors: Jonah Kenei, Elisha Opiyo

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Electronic health records, as a repository of patient information, is nowadays the most commonly used technology to record, store and review patient clinical records and perform other clinical tasks. However, the accurate identification and retrieval of relevant information from clinical records is a difficult task due to the unstructured nature of clinical documents, characterized in particular by a lack of clear structure. Therefore, medical practice is facing a challenge thanks to the rapid growth of health information in electronic health records (EHRs), mostly in narrative text form. As a result, it's becoming important to effectively manage the growing amount of data for a single patient. As a result, there is currently a requirement to visualize electronic health records (EHRs) in a way that aids physicians in clinical tasks and medical decision-making. Leveraging text visualization techniques to unstructured clinical narrative texts is a new area of research that aims to provide better information extraction and retrieval to support clinical decision support in scenarios where data generated continues to grow. Clinical datasets in electronic health records (EHR) offer a lot of potential for training accurate statistical models to classify facets of information which can then be used to improve patient care and outcomes. However, in many clinical note datasets, the unstructured nature of clinical texts is a common problem. This paper examines the very issue of getting raw clinical texts and mapping them into meaningful structures that can support healthcare professionals utilizing narrative texts. Our work is the result of a collaborative design process that was aided by empirical data collected through formal usability testing.

Keywords: classification, electronic health records, narrative texts, visualization

Procedia PDF Downloads 116

Authors: Akber Oumer Abdurezak

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Road traffic accident is a major problem in Ethiopia, resulting in the deaths of many people and potential injuries and crash every year and loss of properties. According to the Federal Transport Authority, one of the main causes of traffic accident and crash in Ethiopia is over speeding. Implementation of different technologies is used to monitor the speed of vehicles in order to minimize accidents and crashes. This research aimed at designing a speed monitoring system to monitor the speed of travelling vehicles and movements, reporting illegal speeds or overspeeding vehicles to the concerned bodies. The implementation of the system is through a wireless sensor network. The proposed system can sense and detect the movement of vehicles, process, and analysis the data obtained from the sensor and the cloud system. The data is sent to the central controlling server. The system contains accelerometer and gyroscope sensors to sense and collect the data of the vehicle. Arduino to process the data and Global System for Mobile Communication (GSM) module for communication purposes to send the data to the concerned body. When the speed of the vehicle exceeds the allowable speed limit, the system sends a message to database as “over speeding”. Both accelerometer and gyroscope sensors are used to collect acceleration data. The acceleration data then convert to speed, and the corresponding speed is checked with the speed limit, and those above the speed limit are reported to the concerned authorities to avoid frequent accidents. The proposed system decreases the occurrence of accidents and crashes due to overspeeding and can be used as an eye opener for the implementation of other intelligent transport system technologies. This system can also integrate with other technologies like GPS and Google Maps to obtain better output.

Keywords: accelerometer, IOT, GSM, gyroscope

Procedia PDF Downloads 74

Authors: Ming-Dong Wang, Abigail F. Ruby, Michelle E. Ross

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Methylphenidate is a first-line treatment drug for attention deficit hyperactivity disorder (ADHD), a common mental health disorder in children and adolescents. Over the last several decades, the rate of children and adolescents using ADHD medication has been increasing in many countries. A recent study found that the prevalence of ADHD medication use among children aged 3-18 years increased in 13 different world regions between 2001 and 2015, where the absolute increase ranged from 0.02 to 0.26% per year. The goal of this study was to examine the use of methylphenidate in Canadian children and its associated adverse reactions. Methylphenidate use information among young Canadians aged 0-14 years was extracted from IQVIA data on prescriptions dispensed by pharmacies between April 2014 and June 2020. The adverse reaction information associated with methylphenidate use was extracted from the Canada Vigilance database for the same time period. Methylphenidate use trends were analyzed based on sex, age group (0-4 years, 5-9 years, and 10-14 years), and geographical location (province). The common classes of adverse reactions associated with methylphenidate use were sorted, and the relative risks associated with methylphenidate use as compared with two second-line amphetamine medications for ADHD were estimated. This study revealed that among Canadians aged 0-14 years, every 100 people used about 25 prescriptions (or 23,000 mg) of methylphenidate per year during the study period, and the use increased with time. Boys used almost three times more methylphenidate than girls. The amount of drug used was inversely associated with age: Canadians aged 10-14 years used nearly three times as many drugs compared to those aged 5-9 years. Seasonal methylphenidate use patterns were apparent among young Canadians, but the seasonal trends differed among the three age groups. Methylphenidate use varied from region to region, and the highest methylphenidate use was observed in Quebec, where the use of methylphenidate was at least double that of any other province. During the study period, Health Canada received 304 adverse reaction reports associated with the use of methylphenidate for Canadians aged 0-14 years. The number of adverse reaction reports received for boys was 3.5 times higher than that for girls. The three most common adverse reaction classes were psychiatric disorders, nervous system disorders and injury, poisoning procedural complications. The number one commonly reported adverse reaction for boys was aggression (11.2%), while for girls, it was a tremor (9.6%). The safety profile in terms of adverse reaction classes associated with methylphenidate use was similar to that of the selected control products. Methylphenidate is a commonly used pharmaceutical product in young Canadians, particularly in the province of Quebec. Boys used approximately three times more of this product as compared to girls. Future investigation is needed to determine what factors are associated with the observed geographic variations in Canada.

Keywords: adverse reaction risk, methylphenidate, prescription trend, use variation

Procedia PDF Downloads 155

Authors: Wei-Chia Huang, Jane Wang

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Damage to nerves is considered one of the most irreversible injuries. The regeneration of nerves has always been an important topic in regenerative medicine. In general, damage to human tissue will naturally repair overtime. However, when the nerves are damaged, healed flesh wound cannot guarantee full restoration to its original function, as truncated nerves are often irreversible. Therefore, the development of treatment methods to successfully guide and accelerate the regeneration of nerves has been highly sought after. In order to induce nerve tissue growth, nerve conduits are commonly used to help reconnect broken nerve bundles to provide protection to the location of the fracture while guiding the growth of the nerve bundles. To prevent the protected tissue from becoming necrotic and to ensure the growth rate, the conduits used are often modified with microstructures or blended with neuron growth factors that may facilitate nerve regeneration. Electrical stimulation is another attempted treatment for medical rehabilitation. With appropriate range of voltages and stimulation frequencies, it has been demonstrated to promote cell proliferation and migration. Biodegradability are critical for medical devices like nerve conduits, while conductive polymers pose great potential toward the differentiation and growth of nerve cells. In this work, biodegradability and conductivity were combined into a novel biodegradable, photocurable, conductive polymer composite materials by embedding conductive nanoparticles in poly(glycerol sebacate) acrylate (PGSA) and 3D-printed into nerve conduits. Rat pheochromocytoma cells and rat neuronal Schwann cells were chosen for the in vitro tests of the conduits and had demonstrate selective growth upon culture in the conductive conduits with built-in microchannels and electrical stimulation.

Keywords: biodegradable polymer, 3d printing, neural regeneration, electrical stimulation

Procedia PDF Downloads 102

Authors: Suzanne Strauss, Leandi Steenkamp

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The Finnish symphonic metal band Nightwish is the brainchild of songwriter and lyricist TuomasHolopainen and the band recorded their first demonstration recording in 1996. The band has since produced nine full-length studio albums, the most recent being the 2020 album Human. :||: Nature., and has reached massive international success. The band is well known for songs about fantasy and escapism and employs many sonic, visual and branding tools and techniques to communicate these constructs to the audience. Among these, is the band’s creation of the so-called “Nightwish world and mythology” with a set of recurring characters and narratives which, in turn, creates a psychological anchor and safe space for Nightwish fans around the globe. Nature and the reverence of nature are central themes in Nightwish’s self-created mythology.Swiss psychologist Carl Jung’s theory of the collective unconscious identified a mysterious reservoir of psychological constructs common to all people, being derived from ancestral memory and experience, common to all humankind, and distinct from the individual’s personal unconscious. Furthermore, he defined archetypes as timeless collective patterns and images that springs forth from the collective unconscious. Archetypes can be actualized when they enter consciousness as images in interaction with the outside world. Archetypal patterns or images can manifest in different ways across world cultures, but follow common patterns, also known as archetypal themes and symbols. The Jungian approach to the psyche places great emphasis on nature, positing a direct link betweenthe concept of wholeness and responsible care for nature and the environment.In our proposed paper, we examine, by means of thematic content analysis, how Nightwish makes use of archetypal themes and symbols referring to nature and the environment in selected songs from their ninth full-length album Human. II Nature. Furthermore, we argue that the longing for and reverence of nature in selected Nightwish songs may serve as a type of “social intervention” and social critique on modern capitalist society. The type of social critique that the band offers is generally connoted intertextually and is not equally explicit in their songs. The band uses a unique combination of escapism, fantasy, and nature narratives to inspire a sense of wonder, enchantment, and magic in the listener. In this way, escapism, fantasy, and nature serve as postmodern frames of reference that aim to “re-enchant” the disenchanted and de-spiritualized. In this way, re-enchantment could also refer to spiritual and/or psychological healing and rebirth.

Keywords: archetypes, metal music, nature, Nightwish, social interventions

Procedia PDF Downloads 106

Authors: Yasin Akgül, Yusuf Polat, Emine Canbay, Ali Kılıç

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Electrospinning is the most common method to produce nanofibers. However, low production rate is still a big challenge for industrial applications of this method. In this study, morphology of nanofibers obtained from namely centrifugal spinning was investigated. Dominant process parameters acting on the fiber diameter and fiber orientation were discussed.

Keywords: centrifugal spinning, electrospinning, nanofiber, TPU nanofibers

Procedia PDF Downloads 444