Search results for: self-inflicted major trauma

Authors: Funmilayo Abiola Opadoja, Samuel Olukayode Awotona

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Nursing services costing has been a major interest to nurses for a long period of time. Determination of nursing costing is germane in order to show the effectiveness of nursing practice in an improved and affordable health care delivery system. This has been a major concern of managers that have the mind of quality and affordable health services. The treatment or intervention should be considered as ‘product’ of nursing care and should provide an explainable term for billing. The study was non-experimental, descriptive and went about eliciting the views of nurses on costing nursing care at two public hospitals namely: University College Hospital and Adeoyo Maternity Teaching Hospital. The questionnaire was the instrument used in eliciting nurse’s response. It was administered randomly on 300 selected respondents across various wards within the hospitals. The data was collected and analysed using SPSS20.0 to generate frequency, and cross-tabulations to explore the statistical relationship between variables. The result shows that 89.2% of the respondents viewed costing of nursing care as an important issued to be looked into. The study concluded that nursing care costing is germane to enhancing the status and imagery of the nurses, it is essential because it would enhance the performance of nurses in discharging their duties. There is need to have a procedural manual agreed on by nursing practitioner on costing of each care given.

Keywords: costing, health care delivery system, intervention, nursing care, practitioner

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Authors: Hansraj Bookun, Angela Tan, Rachel Xuan, Linheng Zhao, Kejia Wang, Animesh Singla, David Kim, Christopher Loupos

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Introduction: Incisional wound complications in vascular surgery patients represent a significant clinical and econometric burden of morbidity and mortality. The objective of this study was to trial the feasibility of applying the Prevena negative pressure incision management system as a routine dressing in patients who had undergone arterial surgery. Conventionally, Prevena has been applied to groin incisions, but this study features applications on multiple wound sites such as the thigh or major amputation stumps. Method: This was a cross-sectional observational, single-centre case series of 12 patients who had undergone major vascular surgery. Their wounds were managed with the Prevena system being applied either intra-operatively or on the first post-operative day. Demographic and operative details were collated as well as the length of stay and complication rates. Results: There were 9 males (75%) with mean age of 66 years and the comorbid burden was as follows: ischaemic heart disease (92%), diabetes (42%), hypertension (100%), stage 4 or greater kidney impairment (17%) and current or ex-smoking (83%). The main indications were acute ischaemia (33%), claudication (25%), and gangrene (17%). There were single instances of an occluded popliteal artery aneurysm, diabetic foot infection, and rest pain. The majority of patients (50%) had hybrid operations with iliofemoral endarterectomies, patch arterioplasties, and further peripheral endovascular treatment. There were 4 complex arterial bypass operations and 2 major amputations. The mean length of stay was 17 ± 10 days, with a range of 4 to 35 days. A single complication, in the form of a lymphocoele, was encountered in the context of an iliofemoral endarterectomy and patch arterioplasty. This was managed conservatively. There were no deaths. Discussion: The Prevena wound management system shows that in conjunction with safe vascular surgery, absolute wound complication rates remain low and that it remains a valuable adjunct in the treatment of vasculopaths.

Keywords: wound care, negative pressure, vascular surgery, closed incision

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Authors: Hammad Khan, Wookeun Bae

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Major concerns regarding nitritation of low-strength ammonium wastewaters include low ammonium loading rates (usually below 0.2 kg/m3-d) and uncertainty about long-term stability of the process. The purpose of this study was to test a sequencing batch reactor (SBR) filled with cell-immobilized polyethylene glycol (PEG) pellets to see if it could achieve efficient and stable nitritation under various environmental conditions. SBR was fed with synthetic ammonium wastewater of 30±2 mg-N/L and pH: 8±0.05, maintaining the dissolved oxygen concentration of 1.7±0.2 mg/L and the temperature at 30±1oC. The reaction was easily converted to partial nitrification mode within a month by feeding relatively high ammonium substrate (~100 mg-N/L) in the beginning. We observed stable nitritation over 300 days with high ammonium loading rates (as high as ~1.1 kg-N/m3-d), nitrite accumulation rates (mostly over 97%) and ammonium removal rate (mostly over 95%). DO was a major limiting substrate when the DO concentration was below ~4 mg/L and the NH4+-N concentration was above 5 mg/L, giving almost linear increase in the ammonium oxidation rate with the bulk DO increase. Low temperatures mainly affected the reaction rate, which could be compensated for by increasing the pellet volume (i.e. biomass). Our results demonstrated that an SBR filled with small cell-immobilized PEG pellets could achieve very efficient and stable nitritation of a low-strength ammonium wastewater.

Keywords: ammonium loading rate (ALR), cell-immobilization, long-term nitritation, sequencing batch reactor (SBR), sewage treatment

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Authors: Mohamed Hamed Mohamed Ahmed Alameer

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Population studies, essentially deals with the size, growth, and distribution of the population in a given area. Size, growth, and distribution are determined by three major factors, which are fertility mortality, and migration. Of these factors, fertility- as a number of live births a woman has actually had- is a potent socio-demographic force in vital process of population growth. So, fertility is a major component of population growth. It is one of the main determinants of population growth and has crucial role in population dynamic, because it measures the rate at which a population increased. In fact the levels of fertility are vary widely among nations, countries, geographic regions, ethnic, socio- economic groups, and religious groups. Fertility differential by religion have been empirically documented in a large numbers of countries. For instance, many researchers in developing and developed countries investigated the differential of fertility among Muslims and Non- Muslims. Most of them have found that fertility of Muslims is higher than fertility of non Muslims. And Muslims have a tendency for large families comparing to non- Muslims population. On the basis of this; Islam by it itself could play an important role in shaping attitudes and values of fertility, such as: sustainability of human kind, developmental reasons, religious Motivations, socioeconomic Motivations, and Psychological Motivation. Therefore, this paper investigates socio-economic values of fertility in Islam and compare it to Malthusian and neo Malthusian functionalists and conflict perspectives.

Keywords: islam, fertility, socioeconomic values, social sciences

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Authors: Fina O. Faithpraise, Effiong O. Obisung, Azele E. Peter, Chris R. Chatwin

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This study investigates and identifies consumer attitude as a major influence that results in non-technical losses in the Nigerian electricity supply sector. This discovery is revealed by the combination of quantitative and qualitative research to complete a survey. The dataset employed is a simple random sampling of households using electricity (public power supply), and the number of units chosen is based on statistical power analysis. The units were subdivided into two categories (household with and without electrical meters). The hypothesis formulated was tested and analyzed using a chi-square statistical method. The results obtained shows that the critical value for the household with electrical prepared meter (EPM) was (9.488 < 427.4) and those without electrical prepared meter (EPMn) was (9.488 < 436.1) with a p-value of 0.01%. The analysis demonstrated so far established the real-time position, which shows that the wrong attitude towards handling the electricity supplied (not turning off light bulbs and electrical appliances when not in use within the rooms and outdoors within 12 hours of the day) characterized the non-technical losses in the power sector. Therefore the adoption of efficient lighting attitudes in individual households as recommended by the researcher is greatly encouraged. The results from this study should serve as a model for energy efficiency and use for the improvement of electricity consumption as well as a stable economy.

Keywords: attitudinal change, household, non-technical losses, prepared meter

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Authors: M. P. Raju, P. D. Safai, P. S. P. Rao, P. C. S. Devara, C. V. Naidu

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In order to study the Physical and chemical characteristics of aerosols, samples of Total Suspended Particulates (TSP) were collected using a high volume sampler at Pune, a semi-urban location in SW India during March 2009 to February 2010. TSP samples were analyzed for water soluble components like F, Cl, NO3, SO4, NH4, Na, K, Ca, and Mg and acid soluble components like Al, Zn, Fe and Cu using Ion-Chromatograph and Atomic Absorption Spectrometer. Analysis of the data revealed that the monthly mean TSP concentrations varied between 471.3 µg/m3 and 30.5 µg/m3 with an annual mean value of 159.8 µg/m3. TSP concentrations were found to be less during post-monsoon and winter (October through February), compared to those in summer and monsoon (March through September). Anthropogenic activities like vehicular emissions and dust particles originated from urban activities were the major sources for TSP. TSP showed good correlation with all the major ionic components, especially with SO4 (R= 0.62) and NO3 (R= 0.67) indicating the impact of anthropogenic sources over the aerosols at Pune. However, the overall aerosol nature was alkaline (Ave pH = 6.17) mainly due to the neutralizing effects of Ca and NH4. SO4 contributed more (58.8%) to the total acidity as compared to NO3 (41.1%) where as, Ca contributed more (66.5%) to the total alkalinity than NH4 (33.5%). Seasonality of acid soluble component Al, Fe and Cu showed remarkable increase, indicating the dominance of soil source over the man-made activities. Overall study on TSP indicated that aerosols at Pune were mainly affected by the local sources.

Keywords: chemical composition, acidic and neutralization potential, radiative forcing, urban station

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Authors: Mizan Ahmed, Srikanth Venkatesan

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Geological and tectonic framework indicates that Bangladesh is one of the most seismically active regions in the world. The Bengal Basin is at the junction of three major interacting plates: the Indian, Eurasian, and Burma Plates. Besides there are many active faults within the region, e.g. the large Dauki fault in the north. The country has experienced a number of destructive earthquakes due to the movement of these active faults. Current seismic provisions of Bangladesh are mostly based on earthquake data prior to the 1990. Given the record of earthquakes post 1990, there is a need to revisit the design provisions of the code. This paper compares the base shear demand of three major cities in Bangladesh: Dhaka (the capital city), Sylhet, and Chittagong for earthquake scenarios of magnitudes 7.0MW, 7.5MW, 8.0MW and 8.5MW using a stochastic model. In particular, the stochastic model allows the flexibility to input region specific parameters such as shear wave velocity profile (that were developed from Global Crustal Model CRUST2.0) and include the effects of attenuation as individual components. Effects of soil amplification were analysed using the Extended Component Attenuation Model (ECAM). Results show that the estimated base shear demand is higher in comparison with code provisions leading to the suggestion of additional seismic design consideration in the study regions.

Keywords: attenuation, earthquake, ground motion, Stochastic, seismic hazard

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Authors: Girija Jha

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This paper investigates the need of cotton to integrate sustainability. The methodology used in the paper is to do secondary research to find out the various environmental implications of cotton as textile material across its life cycle and try to look at ways and possibilities of minimizing its ecological footprint. Cotton is called ‘The Fabric of Our Lives’. History is replete with examples where this fabric used to be more than a fabric of lives. It used to be a miracle fabric, a symbol India’s pride and social Movement of Swaraj, Gandhijee’s clarion call to self reliance. Cotton is grown in more than 90 countries across the globe on 2.5 percent of the world's arable land in countries like China, India, United States, etc. accounting for almost three fourth of global production. But cotton as a raw material has come under the scanner of sustainability experts because of myriad reasons a few have been discussed here. It may take more than 20,000 liters of water to produce 1kg of cotton. Cotton harvest is primarily done from irrigated land which leads to Salinization and depletion of local water reservoirs, e.g., Drying up of Aral Sea. Cotton is cultivated on 2.4% of total world’s crop land but accounts for 24% usage of insecticide and shares the blame of 11% usage of pesticides leading to health hazards and having an alarmingly dangerous impact on the ecosystem. One of the possible solutions to these problems as proposed was GM, Genetically Modified cotton crop. However, use of GM cotton is still debatable and has many ethical issues. The practice of mass production and increasing consumerism and especially fast fashion has been major culprits to disrupt this delicate balance. Disposable fashion or fast fashion is on the rise and cotton being one of the major choices adds on to the problem. Denims – made of cotton and have a strong fashion statement and the washes being an integral part of their creation they share a lot of blame. These are just a few problems listed. Today Sustainability is the need of the hour and it is inevitable to incorporate have major changes in the way we cultivate and process cotton to make it a sustainable choice. The answer lies in adopting minimalism and boycotting fast fashion, in using Khadi, in saying no to washed denims and using selvedge denims or using better methods of finishing the washed out fabric so that the environment does not bleed blue. Truly, the answer lies in integrating state of art technology with age old sustainable practices so that the synergy of the two may help us come out of the vicious circle.

Keywords: cotton, sustainability, denim, Khadi

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Authors: Amichai Ben ari, Daniella Margalit

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Medical procedures, such as surgery, may have traumatic significance for some children. This study examines the relationship between maltreatment in children and the development Pediatric Medical Traumatic Stress (PMTS). To this end, differences in the level of distress of children after surgery were examined between two groups: children who were maltreated ("children at risk") and children from the control group ("children who are not at risk"). The study involved 230 parents of children who came to the hospital to undergo surgery. Parents filled out demographic questionnaires to measure socioeconomic variables and psychological questionnaires to measure the distress of the child and parent before surgery. After 6 months from the time of surgery, the parents again filled in the questionnaire measuring the child's distress. The results of the study showed that the level of distress experienced by children at risk after surgery was significantly higher relative to children who are not at risk. It was also found that the level of distress experienced by parents of children at risk in relation to their child’s surgery is significantly higher compared to parents of children who are not at risk. Finally, it was found that the variables: (1) pre-morbid psychological functioning of the child. (2) Parental and family functioning in daily life. (3) Exposure of the child to traumatic events. (4) Support factors for the family. Are variables that predict the development of PMTS in children after surgery, but only for children at risk and not for children who are not at risk. The significance of the findings in relation to the need to identify at-risk populations in the hospitals and the policies derived from them were discussed, and several directions were raised for further research.

Keywords: children at risk, pediatric medical traumatic stress (PMTS), PTSD, medical procedures

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Authors: Bahlous Afef, Bouzid Kahena, Bardkis Ahlem, Mrad Mehdi, Kalai Eya, Sonia Bahri, Abdelmoula Jaouida

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Diabetic nephropathy is the first cause of chronic renal failure and hemodialysis use in several countries including Tunisia. The role of hypertension (HT) as major risk factor for nephropathy is undeniable. The aim of our study was to determine the relationship between blood pressure and nephropathy in a population of diabetic type 2 recently discovered. Materials and methods: We conducted a prospective study focused on 60 patients with type 2 diabetes recently discovered (<5 years). Each patient have benefited from: -a full clinical examination with measurement of blood pressure - exploring a blood-glucose control and renal function -urinary exploration with the determination of proteinuria microalbuminumie of 24 hours with a immunoturbidimetric method using Architect (ABBOTT CI 8200). Results and discussion: Hypertension was present in 46.7% of cases. Twenty patients, 35% of the study population showed nephropathy. Four of these patients (6.66% of cases) had proteinuria, while 16 (26.6% of patients) had microalbuminuria (> 30mg/24 hours). Systolic blood pressure was significantly (p < 0.05) associated with the presence of nephropathy (139 +19.44) vs. for the group with normal renal function (128.65 +15.12 mmHg). Conclusion: The etiology of diabetic nephropathy is multifactorial. However, systolic blood pressure and glycemic control remains the major risk factors. Better glycemic control and treatment of hypertension allowed preventing and slowing the progression of diabetic nephropathy.

Keywords: hypertension, nephropathy, hemodialysis, diabetes

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Authors: Samuel O. Alamu, Seong W. Lee, Blaise Kalmia, Marc J. Louise Caballes, Xuejun Qian

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The application of combustion technologies for thermal conversion of biomass and solid wastes to energy has been a major solution to the effective handling of wastes over a long period of time. Lab-scale biomass combustion systems have been observed to be economically viable and socially acceptable, but major concerns are the environmental impacts of the process and deviation of temperature distribution within the combustion chamber. Both high and low combustion chamber temperature may affect the overall combustion efficiency and gaseous emissions. Therefore, there is an urgent need to develop a control system which measures the deviations of chamber temperature from set target values, sends these deviations (which generates disturbances in the system) in the form of feedback signal (as input), and control operating conditions for correcting the errors. In this research study, major components of the feedback control system were determined, assembled, and tested. In addition, control algorithms were developed to actuate operating conditions (e.g., air velocity, fuel feeding rate) using ladder logic functions embedded in the Programmable Logic Controller (PLC). The developed control algorithm having chamber temperature as a feedback signal is integrated into the lab-scale swirling fluidized bed combustor (SFBC) to investigate the temperature distribution at different heights of the combustion chamber based on various operating conditions. The air blower rates and the fuel feeding rates obtained from automatic control operations were correlated with manual inputs. There was no observable difference in the correlated results, thus indicating that the written PLC program functions were adequate in designing the experimental study of the lab-scale SFBC. The experimental results were analyzed to study the effect of air velocity operating at 222-273 ft/min and fuel feeding rate of 60-90 rpm on the chamber temperature. The developed temperature-based feedback control system was shown to be adequate in controlling the airflow and the fuel feeding rate for the overall biomass combustion process as it helps to minimize the steady-state error.

Keywords: air flow, biomass combustion, feedback control signal, fuel feeding, ladder logic, programmable logic controller, temperature

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Authors: Le Nguyen Binh, Luong Xuan Binh, Le Van Tuan, Tran Binh Duong, Truong Nguyen Khanh Hung, Do Le Hoang Son, Pham Quang Vinh, Hoang Quoc Huy, Nguyen Bach, Nguyen Quoc Khanh Le, Jiunn Horng Kang

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Introduction: Traumatic hip dislocation is an emergency in young adult which can cause avascular necrosis of femoral head or osteoarthritis of hip joint. The reasons for these may be the loose body of bony or chondral fragments, which are difficult to be detected on CT scan or MRI. In those cases, Hip arthroscopy may be the method of choice for diagnosis and treatment of loose bodies in hip joint after traumatic dislocation. Methods: A case report is performed. A 55-year-old male patient was under hip arthroscopy to retrieve the loose body in the right hip joint. Results: The patient’s hip was reduced under anesthesia in the opeation room. Xray and CT scan post-reduction showed that his right hip was wide and a small fragment of femoral head (< 5mm) locking inside the joint. A hip arthroscopy was done to take the fragment out. Post-operation, the patient went under rehabilition. After 6 months, he can walk with full-weight bearing; no further dislocaion was noted, and the Harris score was 84 points. Conclusions: Although acute traumatic injury of hip joint is usually treated with open surgeries, these methods have many drawbacks, such as soft tissue destruction, blood-loss,….Despite its technical requirement, hip arthroscopy is less invasive and effective treatment. Therefore, it may be an alternative treatment for a traumatic hip injury and can be applied frequently in the near future.

Keywords: hip dislocation, hip arthroscopy, hip osteoarthritis, acute hip trauma

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Authors: Muhammad Feteha

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The socio-political Middle East scene has radically changed over the last decade, and one major contributor to this change was the Egyptian revolution of 2011. The massive impact of this revolution that originally started as a small protest in the Tahrir square has attracted more scholars to study the public space in Egypt, where it has become a necessity in order to understand and improve the socio-political conditions. The status of public space in Egypt has been deteriorating due to many reasons, including privatization and neglect. This paper studies one of the major problems of the contemporary public space in Cairo, which is the lack of identity. This takes place through a comparative analysis between selected case studies from both medieval and contemporary Cairo. The theoretical framework upon which the analysis is based views public space as a ‘container of social action’ and a ‘product of spatial practice’. Through the ‘deciphering of space’, differences in the socio-political role, symbolism, and identity of public spaces between both eras are shown. The paper aims to extract some lessons from public space in medieval Cairo, which was truly the ‘centerpiece of the public realm’ and a ‘fundamental expressions’ of the unique trans-dynastic architectural identity of Cairo. In addition, it suggests some strategies to revive the Cairene identity of public space instead of constructing new ones to be only ‘utilitarian spaces used for circulation’ and lack any identity.

Keywords: architectural identity, Cairene public space, Islamic architectural history, production of space

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Authors: Yiseyon Hosu, Joseph Akande

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Wheat is one of the most important staple food grains of human for centuries and is largely consumed in South Africa. It has a special place in the South African economy because of its significance in food security, trade, and industry. This paper modelled and forecast the production and consumption of wheat in South Africa in the time covid-19 and the ongoing Russia-Ukraine war by using annual time series data from 1940–2021 based on the ARIMA models. Both the averaging forecast and selected models forecast indicate that there is the possibility of an increase with respect to production. The minimum and maximum growth in production is projected to be between 3million and 10 million tons, respectively. However, the model also forecast a possibility of depression with respect to consumption in South Africa. Although Covid-19 and the war between Ukraine and Russia, two major producers and exporters of global wheat, are having an effect on the volatility of the prices currently, the wheat production in South African is expected to increase and meat the consumption demand and provided an opportunity for increase export with respect to domestic consumption. The forecasting of production and consumption behaviours of major crops play an important role towards food and nutrition security, these findings can assist policymakers and will provide them with insights into the production and pricing policy of wheat in South Africa.

Keywords: ARIMA, food security, price volatility, staple food, South Africa

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Authors: Pedro Ferraz-Gameiro

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Introduction: The Pellegrini-Stieda lesion is the result of post-traumatic calcification and/or ossification on the medial collateral ligament (MCL) of the knee. When this calcification is accompanied by gonalgia and limitation of knee flexion, it is called Pellegrini-Stieda syndrome. The pathogenesis is probably the calcification of a post-traumatic hematoma at least three weeks after the initial trauma or secondary to repetitive microtrauma. On anteroposterior radiographs, a Pellegrini-Stieda lesion is a linear vertical ossification or calcification of the proximal portion of the MCL and usually near the medial femoral condyle. Patients with Pellegrini-Stieda syndrome present knee pain associated with loss of range of motion. The treatment is usually conservative with analgesic and anti-inflammatory drugs, either systemic or intra-articular. Physical medicine and rehabilitation techniques associated with shock wave therapy can be a way of reduction of pain/inflammation. Patients who maintain instability with significant limitation of knee mobility may require surgical excision. Methods: Research was done using PubMed central using the terms Pellegrini-Stieda syndrome. Discussion/conclusion: Medical treatment is the rule, with initial rest, anti-inflammatory, and physiotherapy. If left untreated, this ossification can potentially form a significant bone mass, which can compromise the range of motion of the knee. Physical medicine and rehabilitation techniques associated with shock wave therapy are a way of reduction of pain/inflammation.

Keywords: knee, Pellegrini-Stieda syndrome, rehabilitation, shock waves therapy

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Authors: Maryam Haghi, Ivan Contreras, Nadia Bhuiyan

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Chemotherapy is one of the most popular and effective cancer treatments offered to patients in outpatient oncology centers. In such clinics, patients first consult with an oncologist and the oncologist may prescribe a chemotherapy treatment plan for the patient based on the blood test results and the examination of the health status. Then, when the plan is determined, a set of chemotherapy and consultation appointments should be scheduled for the patient. In this work, a comprehensive mathematical formulation for planning and scheduling different types of chemotherapy patients over a planning horizon considering blood test, consultation, pharmacy and treatment stages has been proposed. To be more realistic and to provide an applicable model, this study is focused on a case study related to a major outpatient cancer treatment clinic in Montreal, Canada. Comparing the results of the proposed model with the current practice of the clinic under study shows significant improvements regarding different performance measures. These major improvements in the patients’ schedules reveal that using optimization techniques in planning and scheduling of patients in such highly demanded cancer treatment clinics is an essential step to provide a good coordination between different involved stages which ultimately increases the efficiency of the entire system and promotes the staff and patients' satisfaction.

Keywords: chemotherapy patients scheduling, integer programming, integrated scheduling, staff balancing

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Authors: Oludare Olupemi Ezekiel

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This research examines the rhythmic structure of Sakara music by tracing its roots and analyzing the various rhythmic patterns of this neo-traditional genre, as well as the contributions of the major exponents and contemporary practitioners, using these as a model for understanding and establishing African rhythms. Biography of the major exponents and contemporary practitioners, interviews and participant observational methods were used to elicit information. Samples of the genre which were chosen at random were transcribed, notated and analyzed for academic use and documentation. The research affirmed that rhythms such as the Hemiola, Cross-rhythm, Clave or Bell rhythm, Percussive, Speech and Melodic rhythm and other relevant rhythmic theories were prevalent and applicable to Sakara music, while making important contributions to musical scholarship through its analysis of the music. The analysis and discussions carried out in the research pointed towards a conclusion that the Yoruba musicians are guided by some preconceptions and sound musical considerations in making their rhythmic patterns, used as compositional techniques and not mere incidental occurrence. These rhythmic patterns, with its consequential socio-cultural connotations, enhance musical values and national identity in Nigeria. The study concludes by recommending that musicologists need to carry out more research into this and other neo-traditional genres in order to advance the globalisation of African music.

Keywords: compositional techniques, globalisation, identity, neo-traditional, rhythmic theory, Sakara music

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

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

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

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Authors: Kuo-Wei Hsu, Yen-Ting, Wu

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Recently, green marketing issues have emerged as the developing direction for local governments and social enterprises. At the same time, many social enterprises have considered how to effectively create a low-carbon and sustainable environment. Local government has a role to play in promoting low-carbon life styles and creating a green sustainable environment within this green marketing trend. Therefore, urban commercial centers have implemented relevant plans such as: Green Store, Green Action Shops, Green Restaurants and Green Hotels. The purpose of these plans to select the commercial center organizations have potential energy saving demonstration and environmental greenification. These organizations are willing to provide assistance counseling and become a green demonstration district, thereby promoting the major shopping district to take the initiative to enhance its green competitiveness. Finally, they create a new landscape for the commercial center. Studies on green marketing in commercial centers are seen as less attractive and only a few studies for commercial centers have focused on green marketing strategies. There is no empirical evidence for how commercial center managers evaluate a commercial center green marketing strategy. This research investigated the major commercial centers in Taichung City and found green marketing helps to enhance the connection between the urban commercial center value and society value, shape corporate image with social responsibility and create brand value, and therefore impact the increase of economic value.

Keywords: economic value added, green marketing, sustainable environment, urban commercial center.

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Authors: Horesh Reinman Netta

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Objectives: To examine the relationship between stressful life events and recurrent major depressive disorders Methods: Three groups of 50 subjects were assessed. One group had a recurrent major depressive disorder with melancholic features; the second group met the criteria for borderline personality disorder, and the third consisted of healthy controls. The Structured Clinical Interview for AXIS I DSM-IV Disorders sand the Structured Clinical Interview for AXIS II DSM-IV Disorders were used for diagnosis. The Israel Psychiatric Epidemiology Research Interview (IPERI) Life Event Scale and the Coddington Life Events Schedule (CLES) were used to measure life events which were confirmed with a confirmatory semi-structured interview. The Beck Depression Inventory and the Satisfaction from Life scales were also administered. Results : The total number of loss-related events in childhood and in the year preceding the first episode was significantly higher in the affective disorder group than in the two control groups. Total number of LE, uncontrolled and independent events were also more common in the depressed patients in the year preceding the first episode. No category of SLE was differentiated among any of the three groups during any period of time following the first depressive episode. Conclusions: SLE play an important role in the onset of affective disorders. There appear to be specific kinds of SLE occurring in childhood and in the year preceding a first episode that have particular significance. SLE may have a lesser role in the maintenance of this illness.

Keywords: modd dosorders, recurrent depression, stress, life events

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Authors: Aymen Arfaoui, Abdelkader Soumaya

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The Messalla-Ressas-Bou Kornine (MRB) and Hammamet Korbous (HK) major trending North-South fault zones provide a good opportunity to show the effects of the Eocene compressive phase in northern Tunisia. They acted as paleogeographical boundaries during the Mesozoic and belonged to a significant strike-slip corridor called the «North-South Axis,» extending from the Saharan platform at the South to the Gulf of Tunis at the North. Our study area is situated in a relay zone between two significant strike-slip faults (HK and MRB), separating the Atlas domain from the Pelagian Block. We used a multidisciplinary approach, including fieldwork, stress inversion, and geophysical profiles, to argue the shortening event that affected the study region. The MRB and HK contractional duplex is a privileged area for a local stress field and stress nucleation. The stress inversion of fault slip data reveals an Eocene compression with NW-SE trending SHmax, reactivating most of the ancient Mesozoic normal faults in the region. This shortening phase is represented in the MRB belt by an angular unconformity between the Upper Eocene over various Cretaceous strata. The stress inversion data reveal a compressive tectonic with an average NW-SE trending Shmax. The major N-S faults are reactivated under this shortening as sinistral oblique faults. The orientation of SHmax deviates from NW-SE to E-W near the preexisting deep faults of MRB and HK. This E-W stress direction generated the emerging overlap of Ressas-Messella and blind thrust faults in the Cretaceous deposits. The connection of the sub-meridian reverse faults in depth creates "flower structures" under an E-W local compressive stress. In addition, we detected a reorientation of the SHmax into an N-S direction in the central part of the MRB - HK contractional duplex, creating E-W reverse faults and overlapping zones. Finally, the Eocene compression constituted the first major tectonic phase which inverted the Mesozoic preexisting extensive fault system in Northern Tunisia.

Keywords: Tunisia, eocene compression, tectonic stress field, Bou Kornine-Ressas-Messella

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Authors: Shehu Usman Rano Aliyu

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Despite the significance of finance as a major trade lubricant, evidence in the literature alludes to its scarcity and increasing cost, especially in developing countries where small and medium-scale enterprises are worst affected. The creation of the African Continental Free Trade Area (AFCFTA) in 2018, an organ of the African Union (AU), was meant to serve as a beacon for deepening economic integration through the removal of trade barriers inhibiting intra-African trade and movement of persons, among others. Hence, this research explores the role Islamic trade finance (ITF) could play in spurring intra- and inter-African trade. The study involves six countries; Egypt, Kenya, Malaysia, Morocco, Nigeria, and Saudi Arabia, and employs survey research, a total of 430 sample data, and SmartPLS Structural Equation Modelling (SEM) techniques in its analyses. We find strong evidence that Shari’ah, legal and regulatory compliance issues of the ITF institutions rhythm with the internal, national, and international compliance requirements equally as the unique instruments applied in ITF. In addition, ITF was found to be largely driven by global economic and political stability, socially responsible finance, ethical and moral considerations, risk-sharing, and resilience of the global Islamic finance industry. Further, SMEs, Governments, and Importers are the major beneficiary sectors. By and large, AfCFTA’s protocols align with the principles of ITF and are therefore suited for the proliferation of Islamic finance in the continent. And, while AML/KYC and BASEL requirements, compliance to AAOIFI and IFSB standards, paucity of Shari'ah experts, threats to global security, and increasing global economic uncertainty pose as major impediments, the future of ITF would be shaped by a greater need for institutional and policy support, global economic cum political stability, robust regulatory framework, and digital technology/fintech. The study calls for the licensing of more ITF institutions in the continent, participation of multilateral institutions in ITF, and harmonization of Shariah standards.

Keywords: AfCFTA, islamic trade finance, murabaha, letter of credit, forwarding

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Authors: Mahwish Rabia, Najma Najam

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The present study was conducted to identify emotional and behavioral disturbances among earthquake survived children and the perceived coping strategies of affected children. In the present study, a sample of 50 children (6-16 years) belonging to badly affected areas (earthquake) was selected from different camps in Islamabad. Child Behavioral Checklist (CBCL) and Rotter Incomplete Sentence Blank (RISB) interpretations were used to assess variety of emotional and behavioral patterns, and Child Coping Strategies Checklist (CCSC) was used to assess the perceived coping strategies of affected children. Results showed that some of the frequent emotional/behavioral reactions exhibited by children like withdrawal, anxiety\depression, aggression and attention seeking behavior. Whereas gender-based comparisons indicated that female children showed more internalizing behavioral patterns (withdrawn, somatic complaints) as compared to male children who exhibited more externalizing emotions (aggression, delinquent behavior).Coping strategies in which male children tried to adopt Positive Cognitive Restructuring and for distracting attention they used distraction strategies of coping. It is concluded that significant negative emotional and behavioral reactions are exhibited by the earthquake affected children. Male children adopt coping strategies more as compared to female children. The study identifies the negative emotional and behavioral reactions towards trauma, which can be helpful for identifying the problematic area for counseling and therapeutic interventions for these children.

Keywords: behavioural disturbances, emotional disturbances, coping strategies, earthquake, children

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Authors: Prince Suka Neekia Momta, Rita Iheoma Achonyeulo

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Ant Tracking seismic attribute applied over 4-seconds seismic volume revealed structural features triggered by clay diapirism, growth fault development, rapid deltaic sedimentation and intense drilling. The attribute was extracted on vertical seismic sections and time slices. Mega tectonic structures such as growth faults and clay diapirs are visible on vertical sections with obscured minor lineaments or fractures. Fractures are distinctively visible on time slices yielding recognizable patterns corroborating established geologic models. This model seismic attribute enabled the understanding of fluid flow characteristics and production responses. Three structural patterns recognized in the field include: major growth faults, minor faults or lineaments and network of fractures. Three growth faults mapped on seismic section form major deformation bands delimiting the area into three blocks or depocenters. The growth faults trend E-W, dip down-to-south in the basin direction, and cut across the study area. The faults initiating from about 2000ms extended up to 500ms, and tend to progress parallel and opposite to the growth direction of an upsurging diapiric structure. The diapiric structures form the major deformational bands originating from great depths (below 2000ms) and rising to about 1200ms where series of sedimentary layers onlapped and pinchout stratigraphically against the diapir. Several other secondary faults or lineaments that form parallel streaks to one another also accompanied the growth faults. The fracture networks have no particular trend but form a network surrounding the well area. Faults identified in the study area have potentials for structural hydrocarbon traps whereas the presence of fractures created a fractured-reservoir condition that enhanced rapid fluid flow especially water. High aquifer flow potential aided by possible fracture permeability resulted in rapid decline in oil rate. Through the application of Ant Tracking attribute, it is possible to obtain detailed interpretation of structures that can have direct influence on oil and gas production.

Keywords: seismic, attributes, production, structural

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Authors: Surachai Ampawasuvan, Supornchai Utainarumol

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Most of fuel station’ customers, who drive on the major arterial road wants to use the stations to fill fuel to their vehicle during their journey to destinations. According to the survey of traffic volume of the vehicle using fuel stations by video cameras, automatic counting tools, or questionnaires, it was found that most users prefer to use fuel stations on holiday rather than on working day. They also prefer to use fuel stations in the morning rather than in the evening. When comparing the ratio of the distribution pattern of traffic volume of the vehicle using fuel stations by video cameras, automatic counting tools, there is no significant difference. However, when comparing the ratio of peak hour (peak hour rate) of the results from questionnaires at 13 to 14 percent with the results obtained by using the methods of the Institute of Transportation Engineering (ITE), it is found that the value is similar. However, it is different from a survey by video camera and automatic traffic counting at 6 to 7 percent of about half. So, this study suggests that in order to forecast trip generation of vehicle using fuel stations on major arterial road which is mostly characterized by Though Traffic, it is recommended to use the value of half of peak hour rate, which would make the forecast for trips generation to be more precise and accurate and compatible to surrounding environment.

Keywords: peak rate, trips generation, fuel station, arterial road

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Authors: Raheel Shakoor Siddiqui, Calvin Mathias, Manikandar Srinivas Cheruvu, Bobin Varghese

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A 58 year old gentleman presented to accident and emergency at the district general hospital with worsening shortness of breath and a non-productive cough over a period of five days. He was initially admitted under the medical team for suspicion of SARS-CoV-2 (COVID-19) pneumonitis. Subsequently, upon deterioration of observations and a positive COVID-19 PCR, he was taken to intensive care for invasive mechanical ventilation. He required frequent proning, inotropic support and was intubated for thirty-three days. After successful extubation, he developed myopathy with a limited range of motion to his right knee and right shoulder. Plain film imaging of these limbs demonstrated an unusual formation of heterotopic ossification without any precipitating trauma or surgery. Current literature demonstrates limited case series portraying heterotopic ossification post-COVID-19. There has been negligible evidence of heterotopic ossification in the ipsilateral knee and shoulder post-prolonged immobility secondary to a critical illness. Physiotherapy and rehabilitation are post-intensive care can be prolonged due to the formation of heterotopic ossification around joints. Prolonged hospital stays may lead to a higher risk of developing infections of the chest, urine and pressure sores. This raises the question of whether a severe systemic inflammatory immune response from the SARS-CoV-2 virus results in histopathological processes leading to the formation of heterotopic ossification not previously seen, requiring prolonged physiotherapy.

Keywords: orthopaedics, rehabilitation, physiotherapy, heterotopic ossification, COVID-19

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Authors: Rupinder Kaur, Parmjit S. Panesar, Ram S. Singh

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Whey is the lactose rich by-product of the dairy industry, having good amount of nutrient reservoir. Most abundant nutrients are lactose, soluble proteins, lipids and mineral salts. Disposing of whey by most of milk plants which do not have proper pre-treatment system is the major issue. As a result of which, there can be significant loss of potential food and energy source. Thus, whey has been explored as the substrate for the synthesis of different value added products such as enzymes. β-galactosidase is one of the important enzymes and has become the major focus of research due to its ability to catalyze both hydrolytic as well as transgalactosylation reaction simultaneously. The enzyme is widely used in dairy industry as it catalyzes the transformation of lactose to glucose and galactose, making it suitable for the lactose intolerant people. The enzyme is intracellular in both bacteria and yeast, whereas for molds, it has an extracellular location. The present work was carried to utilize the whey for the production of β-galactosidase enzyme using both yeast and fungal cultures. The yeast isolate Kluyveromyces marxianus WIG2 and various fungal strains have been used in the present study. Different disruption techniques have also been investigated for the extraction of the enzyme produced intracellularly from yeast cells. Among the different methods tested for the disruption of yeast cells, SDS-chloroform showed the maximum β-galactosidase activity. In case of the tested fungal cultures, Aureobasidium pullulans NCIM 1050, was observed to be the maximum extracellular enzyme producer.

Keywords: β-galactosidase, fungus, yeast, whey

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Authors: Hsin-Lien Lin, Ju-Hui Fu

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Dendritic cells (DCs) are the major professional antigen-presenting cells for the development of optimal T-cell immunity. DCs can be used as pharmacological targets to screen novel biological modifiers for the treatment of harmful immune responses, such as transplantation rejection. Dryopteris crassirhizoma Nakai (Aspiadaceae) is used for traditional herbal medicine in the region of East Asia. The root of this fern plant has been listed for treating inflammatory diseases. Dryocrassin is the tetrameric phlorophenone component derived from Dryopteris. Here, we tested the immunomodulatory potential of dryocrassin on lipopolysaccharide (LPS)-stimulated activation of mouse bone marrow-derived DCs in vitro and in skin allograft transplantation in vivo. Results demonstrated that dryocrassin reduced the secretion of tumor necrosis factor-α, interleukin-6, and interleukin-12p70 by LPS-stimulated DCs. The expression of LPS-induced major histocompatibility complex class II, CD40, and CD86 on DCs was also blocked by dryocrassin. Moreover, LPS-stimulated DC-elicited allogeneic T-cell proliferation was lessened by dryocrassin. In addition, dryocrassin inhibited LPS-induced activation of IϰB kinase, JNK/p38 mitogen-activated protein kinase, as well as the translocation of NF-ϰB. Treatment with dryocrassin obviously diminished 2,4-dinitro-1-fluorobenzene- induced delayed-type hypersensitivity and prolonged skin allograft survival. Dryocrassin may be one of the potent immunosuppressive agents for transplant rejection through the destruction of DC maturation and function.

Keywords: dryocrassin, dendritic cells, immunosuppression, skin allograft

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Authors: S. Yeo, M. Mathur

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Introduction: Obesity, defined as a Body Mass Index (BMI) of more than or equal to 30kg/m, is associated with an increased risk of complications during pregnancy and delivery. During labour, obese mothers often require greater intervention and have higher rates of caesarean section. Despite a low overall rate of serious complications following caesarean section, a high BMI predisposes to a higher risk of postoperative complications. Our study, therefore, aimed to investigate the impact of antenatal obesity on adverse outcomes following caesarean section, particularly wound-related infections. Materials and Methods: A retrospective cohort study of all caesarean deliveries during the first quarter of a chosen year was undertaken in our hospital, which is a tertiary referral centre with > 12,000 deliveries per year. Patients’ health records and data from our hospital’s electronic labour and delivery database were reviewed. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS), and odds ratios plus adjusted odd ratios were calculated with 95% confidence intervals (CI). Results: A total of 1829 deliveries were reviewed during our study period. Of these, 180 (9.8%) patients were obese. The rate of caesarean delivery was 48.9% in obese patients versus 28.1% in non-obese patients. Post-operatively, 17% of obese patients experienced wound infection versus 0.2% of non-obese patients. Obese patients were also more likely to experience major postpartum haemorrhage (4.6% vs. 0.2%) and postpartum pyrexia (18.2% vs. 5.0%) in comparison to non-obese patients. Conclusions: Obesity is a significant risk factor in the development of postoperative complications following caesarean section. Wound infection remains a major concern for obese patients undergoing major surgery and results in extensive morbidity during the postnatal period. Postpartum infection can prolong recovery and affect maternal mental health, leading to reduced perinatal bonding with long-term implications on breastfeeding and parenting confidence. This study supports the need for the development of standardized protocols specifically for obese patients undergoing caesarean section. Multidisciplinary team care, in conjunction with anaesthesia, family physicians, and plastic surgery counterparts, early on in the antenatal journey, may be beneficial where wound complications are anticipated and to minimize the burden of postoperative infection in obese mothers.

Keywords: pregnancy, obesity, caesarean, infection

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Authors: Souhir Chelly, Chahida Harizi, Aicha Hechaichi, Sihem Aissaoui, Leila Ben Ayed, Maha Bergaoui, Mohamed Kouni Chahed

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Introduction: The International Classification of Primary Care (ICPC) is part of the morbidity classification system. It had 17 chapters, and each is coded by an alphanumeric code: the letter corresponds to the chapter, the number to a paragraph in the chapter. The objective of this study is to show the utility of this classification in the coding of the reasons for demand for care in Primary health care (PHC), its advantages and limits. Methods: This is a cross-sectional descriptive study conducted in 4 PHC in Ariana district. Data on the demand for care during 2 days in the same week were collected. The coding of the information was done according to the CISP. The data was entered and analyzed by the EPI Info 7 software. Results: A total of 523 demands for care were investigated. The patients who came for the consultation are predominantly female (62.72%). Most of the consultants are young with an average age of 35 ± 26 years. In the ICPC, there are 7 rubrics: 'infections' is the most common reason with 49.9%, 'other diagnoses' with 40.2%, 'symptoms and complaints' with 5.5%, 'trauma' with 2.1%, 'procedures' with 2.1% and 'neoplasm' with 0.3%. The main advantage of the ICPC is the fact of being a standardized tool. It is very suitable for classification of the reasons for demand for care in PHC according to their specificity, capacity to be used in a computerized medical file of the PHC. Its current limitations are related to the difficulty of classification of some reasons for demand for care. Conclusion: The ICPC has been developed to provide healthcare with a coding reference that takes into account their specificity. The CIM is in its 10th revision; it would gain from revision to revision to be more efficient to be generalized and used by the teams of PHC.

Keywords: international classification of primary care, medical file, primary health care, Tunisia

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