Search results for: hypercapnic respiratory failure

Authors: S. P. Pradhan, Amulya Ratna Roul

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A number of landslides are occurring during the rainy season along Rayagada-Koraput Railway track for past three years. The track was constructed about 20 years ago. However, the protection measures are not able to control the recurring slope failures now. It leads to a loss to Indian Railway and its passengers ultimately leading to wastage of time and money. The slopes along Rayagada-Koraput track include both rock and soil slopes. The rock types include mainly Khondalite and Charnockite whereas soil slopes are mainly composed of laterite ranging from less weathered to highly weathered laterite. The field studies were carried out in one of the critical slope. Field study was followed by the kinematic analysis to assess the type of failure. Slake Durability test, Uniaxial Compression test, specific gravity test and triaxial test were done on rock samples to calculate and assess properties such as weathering index, unconfined compressive strength, density, cohesion, and friction angle. Following all the laboratory tests, rock mass rating was calculated. Further, from Kinematic analysis and Rock Mass Ratingbasic, Slope Mass Rating was proposed for each slope. The properties obtained were used to do the slope stability simulations using finite element method based modelling. After all the results, suitable protection measures, to prevent the loss due to slope failure, were suggested using the relation between Slope Mass Rating and protection measures.

Keywords: landslides, slope stability, rock mass rating, slope mass rating, numerical simulation

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Authors: Sudhir Kumar Singh, Debashish Chakravarty

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Slope stability analysis is an important aspect in the field of geotechnical engineering. It is also important from safety, and economic point of view as any slope failure leads to loss of valuable lives and damage to property worth millions. This paper aims at mitigating the risk of slope failure by studying the effect of different joint sets on the stability of mine pit slopes under the influence of various external factors, namely degree of saturation, rainfall intensity, and seismic coefficients. Supervised machine learning approach has been utilized for making accurate and reliable predictions regarding the stability of slopes based on the value of Factor of Safety. Numerous cases have been studied for analyzing the stability of slopes using the popular Finite Element Method, and the data thus obtained has been used as training data for the supervised machine learning models. The input data has been trained on different supervised machine learning models, namely Random Forest, Decision Tree, Support vector Machine, and XGBoost. Distinct test data that is not present in training data has been used for measuring the performance and accuracy of different models. Although all models have performed well on the test dataset but Random Forest stands out from others due to its high accuracy of greater than 95%, thus helping us by providing a valuable tool at our disposition which is neither computationally expensive nor time consuming and in good accordance with the numerical analysis result.

Keywords: finite element method, geotechnical engineering, machine learning, slope stability

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

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Introduction: Complex endovascular aortic aneursymal repairs with fenestrated and branched endografts require customised devices to exclude the pathology while reducing morbidity and mortality, which was historically associated with open repair of complex aneurysms. Such endovascular procedures have predominantly been performed in a large volume dedicated tertiary centres. We present here our nine year multidisciplinary experience with this technology in an Australian tertiary centre. Method: This was a cross-sectional, single-centre observational study of 670 patients who had undergone complex endovascular aortic aneurysmal repairs with conventional endografts, fenestrated endografts, and iliac-branched devices from January 2010 to July 2019. Descriptive statistics were used to characterise our sample with regards to demographic and perioperative variables. Homogeneity of the sample was tested using multivariant regression, which did not identify any statistically significant confounding variables. Results: 670 patients of mean age 74, were included (592 males) and the comorbid burden was as follows: ischemic heart disease (55%), diabetes (18%), hypertension (90%), stage four or greater kidney impairment (8%) and current or ex-smoking (78%). The main indications for surgery were elective aneurysms (86%), symptomatic aneurysms (5%), and rupture aneurysms (5%). 106 patients (16%) underwent fenestrated or branched endograft repairs. The mean length of stay was 7.6 days. 2 patients experienced reactionary bleeds, 11 patients had access wound complications (6 lymph fistulae, 5 haematoms), 11 patients had cardiac complications (5 arrhythmias, 3 acute myocadial infarctions, 3 exacerbation of congestive cardiac failure), 10 patients had respiratory complications, 8 patients had renal impairment, 4 patients had gastrointestinal complications, 2 patients suffered from paraplegia, 1 major stroke, 1 minor stroke, and 1 acute brain syndrome. There were 4 vascular occlusions requiring further arterial surgery, 4 type I endoleaks, 4 type II endoleaks, 3 episodes of thromboembolism, and 2 patients who required further arterial operations in the setting of patient vessels. There were 9 unplanned returns to the theatre. Discussion: Our numbers of 10 years suggest that we are not a dedicated high volume centre focusing on aortic repairs. However, we have achieved significantly low complication rates. This can be attributed to our multidisciplinary approach with the intraoperative involvement of skilled interventional radiologists and vascular surgeons as well as postoperative protocols with particular attention to spinal cord protection. Additionally, we have a ratified perioperative pathway that involves multidisciplinary team discussions of patient-related factors and lesion-centered characteristics, which allows for holistic, patient-centered care.

Keywords: aneurysm, aortic, endovascular, fenestrated

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Authors: Alaa Allakany, Koji Okamura

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Multicast technology is an efficient and scalable technology for data distribution in order to optimize network resources. However, in the IP network, the responsibility for management of multicast groups is distributed among network routers, which causes some limitations such as delays in processing group events, high bandwidth consumption and redundant tree calculation. Software Defined Networking (SDN) represented by OpenFlow presented as a solution for many problems, in SDN the control plane and data plane are separated by shifting the control and management to a remote centralized controller, and the routers are used as a forwarder only. In this paper we will proposed fast switching mechanism for solving the problem of link failure in multicast tree based on Tabu Search heuristic algorithm and modifying the functions of OpenFlow switch to fasts switch to the pack up sub tree rather than sending to the controller. In this work we will implement multicasting OpenFlow controller, this centralized controller is a core part in our multicasting approach, which is responsible for 1- constructing the multicast tree, 2- handling the multicast group events and multicast state maintenance. And finally modifying OpenFlow switch functions for fasts switch to pack up paths. Forwarders, forward the multicast packet based on multicast routing entries which were generated by the centralized controller. Tabu search will be used as heuristic algorithm for construction near optimum multicast tree and maintain multicast tree to still near optimum in case of join or leave any members from multicast group (group events).

Keywords: multicast tree, software define networks, tabu search, OpenFlow

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Authors: Vivek Bhat, Rohini Kelkar, Sanjay Biswas

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Introduction: Cancer patients are at increased risk of bacterial infections. This may due to the disease process itself, the effect of chemotherapeutic drugs or invasive procedures such as catheterization. A wide variety of bacteria including some emerging pathogens are increasingly being reported from these patients. The incidence of multidrug-resistant organisms particularly in the Gram negative group is also increasing, with higher resistance rates seen to cephalosporins, β-lactam/β-lactam inhibitor combinations, and the carbapenems. This study documents the bacteriological spectrum of infections and their resistance patterns in cancer patients. Methods: This study includes all bacterial isolates recovered from infections cancer patients over a period of 18 months. Samples included Blood cultures, Pus/wound swabs, urine, tissue biopsies, body fluids, catheter tips and respiratory specimens such as sputum and bronchoalveolar lavage (BAL). All samples were processed in the microbiology laboratory as per standard laboratory protocols. Organisms were identified to species level and antimicrobial susceptibility testing was performed manually by the disc diffusion technique or in the Vitek-2 (Biomereux, France) instrument. Interpretations were as per Clinical laboratory Standards Institute (CLSI) guidelines. Results: A total of 1150 bacterial isolates were cultured from 884 test samples during the study period. Of these 227 were Gram-positive and 923 were Gram-negative organisms. Staphylococcus aureus (99 isolates) was the commonest Gram-positive isolate followed by Enterococcus (79) and Gr A Streptococcus (30). Among the Gram negatives, E. coli (304), Pseudomonas aeruginosa (201) and Klebsiella pneumoniae (190) were the most common. Of the Staphylococcus aureus isolates 27.2% were methicillin resistant. Only 5.06% enterococci were vancomycin resistant. High rates of resistance to cefotaxime and ciprofloxacin were seen amongst E. coli (84.8% & 83.55%) and Klebsiella pneumoniae (71 & 62.1%) respectively. Resistance to carbapenems (meropenem) was high at 70% in Acinetobacter spp.; however all isolates were sensitive to colistin. Among the aminoglycosides, amikacin retained good efficacy against Escherichia coli (82.9%) and Pseudomonas aeruginosa (78.1%). Occasional isolates of emerging pathogens such as Chryseobacterium indologens, Roseomonas, and Achromobacter xyloxidans were also recovered. Conclusion: The common infections in cancer patients include respiratory, wound, tract infections and sepsis. The commonest isolates include Staphylococcus aureus, Enterococci, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. There is a high level of resistance to the commonly used antibiotics among Gram-negative organisms.

Keywords: bacteria, resistance, infection, cancer

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Authors: Rajwanlop Kumpoopong, Sukit Yindeesuk, Pornchai Silarom

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Modeling cracks in concrete is complicated by its strain-softening behavior which requires the use of sophisticated energy criteria of fracture mechanics to assure stable and convergent solutions in the finite-element (FE) analysis particularly for relatively large structures. However, for small-scale structures such as beams and slabs, a simpler approach relies on retaining some shear stiffness in the cracking plane has been adopted in literature to model the strain-softening behavior of concrete under monotonically increased loading. According to the shear retaining approach, each element is assumed to be an isotropic material prior to cracking of concrete. Once an element is cracked, the isotropic element is replaced with an orthotropic element in which the new orthotropic stiffness matrix is formulated with respect to the crack orientation. The shear transfer factor of 0.5 is used in parallel to the crack plane. The shear retaining approach is adopted in this research to model cracks in RC bridge deck with some modifications to take into account the effect of repetitive moving truck wheel loads as they cause fatigue cracking of concrete. First modification is the introduction of fatigue tests of concrete and reinforcing steel and the Palmgren-Miner linear criterion of cumulative damage in the conventional FE analysis. For a certain loading, the number of cycles to failure of each concrete or RC element can be calculated from the fatigue or S-N curves of concrete and reinforcing steel. The elements with the minimum number of cycles to failure are the failed elements. For the elements that do not fail, the damage is accumulated according to Palmgren-Miner linear criterion of cumulative damage. The stiffness of the failed element is modified and the procedure is repeated until the deck slab fails. The total number of load cycles to failure of the deck slab can then be obtained from which the S-N curve of the deck slab can be simulated. Second modification is the modification in shear transfer factor. Moving loading causes continuous rubbing of crack interfaces which greatly reduces shear transfer mechanism. It is therefore conservatively assumed in this study that the analysis is conducted with shear transfer factor of zero for the case of moving loading. A customized FE program has been developed using the MATLAB software to accomodate such modifications. The developed procedure has been validated with the fatigue test of the 1/6.6-scale AASHTO bridge deck under the applications of both fixed-point repetitive loading and moving loading presented in the literature. Results are in good agreement both experimental vs. simulated S-N curves and observed vs. simulated crack patterns. Significant contribution of the developed procedure is a series of S-N relations which can now be simulated at any desired levels of cracking in addition to the experimentally derived S-N relation at the failure of the deck slab. This permits the systematic investigation of crack propagation or deterioration of RC bridge deck which is appeared to be useful information for highway agencies to prolong the life of their bridge decks.

Keywords: bridge deck, cracking, deterioration, fatigue, finite-element, moving truck, reinforced concrete

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Authors: Rideci Farias, Haroldo Paranhos

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The present work deals with the use of drainage geo-composite as a deep drainage and geogrid element to reinforce the base of the body of the landfill destined to the road pavement on geological faults in the stretch of the TO-342 Highway, between the cities of Miracema and Miranorte, in the State of Tocantins / TO, Brazil, which for many years was the main link between TO-010 and BR-153, after the city of Palmas, also in the state of Tocantins / TO, Brazil. For this application, geotechnical and geological studies were carried out by means of SPT percussion drilling, drilling and rotary drilling, to understand the problem, identifying the type of faults, filling material and the definition of the water table. According to the geological and geotechnical studies carried out, the area where the route was defined, passes through a zone of longitudinal fault to the runway, with strong breaking / fracturing, with presence of voids, intense alteration and with advanced argilization of the rock and with the filling up parts of the faults by organic and compressible soils leachate from other horizons. This geology presents as a geotechnical aggravating agent a medium of high hydraulic load and very low resistance to penetration. For more than 20 years, the region presented constant excessive deformations in the upper layers of the pavement, which after routine services of regularization, reconformation, re-compaction of the layers and application of the asphalt coating. The faults were quickly propagated to the surface of the asphalt pavement, generating a longitudinal shear, forming steps (unevenness), close to 40 cm, causing numerous accidents and discomfort to the drivers, since the geometric positioning was in a horizontal curve. Several projects were presented to the region's highway department to solve the problem. Due to the need for partial closure of the runway, the short time for execution, the use of geosynthetics was proposed and the most adequate solution for the problem was taken into account the movement of existing geological faults and the position of the water level in relation to several Layers of pavement and failure. In order to avoid any flow of water in the body of the landfill and in the filling material of the faults, a drainage curtain solution was used, carried out at 4.0 meters depth, with drainage geo-composite and as reinforcement element and inhibitor of the possible A geogrid of 200 kN / m of resistance was inserted at the base of the reconstituted landfill. Recent evaluations, after 13 years of application of the solution, show the efficiency of the technique used, supported by the geotechnical studies carried out in the area.

Keywords: geosynthetics, geocomposite, geogrid, road, recovery, geological failure

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Authors: Ariyan S. Araghi, Guy C. Jackson, Stephen J. Bonsor

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Materials & Methods: A systematic literature search was undertaken using pre-determined inclusion and exclusion criteria. This review followed the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) statement. Several databases were used to search for randomised control trials and longitudinal cohort studies, which were published less than thirty years ago. A total of 54 studies met the predefined inclusion criteria. Four studies reviewed the success, survival, and failure characteristics of zirconia framework resin retained bridges, whilst two reviewed non-precious metal resin retained bridges. Results: The analysis of the studies revealed an overall survival rate of 95.9% for zirconia-based restorations compared to 90.7% for non-precious metal frameworks. Non-precious metal resin retained bridges displayed a higher overall failure rate of 11.9% compared to 4.6% for zirconia-based restorations in the analysed papers. The most frequent complications were wing debonding for the non-precious metal wing group, whereas substructure fracture and veneering ceramic fracture were more prevalent for the zirconia arm of the study. Conclusion: Both types of resin retained bridges provide effective medium to long-term survival. Zirconia-based frameworks will provide marginally increased success and survival and greatly improved aesthetics. However, catastrophic failure is more likely with zirconia-based restorations. Non-precious metal is time tested but performs worse than its zirconia counterpart with regards to longevity; it does not exhibit the same framework fractures as zirconia. Cement choice and attention to the adhesive bonding systems used appear to be paramount to restoration longevity with both restoration subtypes. Furthermore, improved longevity can be seen when air particle abrasion is incorporated into the adhesive protocol. Within the limitations of this study, it has been determined that zirconia-based resin retained bridges can be effectively used in anterior cantilever bridges. Clinical Significance: Zirconia-based resin retained bridges have been demonstrating promising results in terms of improved success and survival characteristics, together with improved aesthetics when compared to non-precious metal winged resin retained bridges. Their popularity is increasing in the age of digital dentistry as many restorations are manufactured using such technology. It is essential that clinicians understand the limitations of each material type and principles of adhesion to ensure restoration longevity.

Keywords: resin retained bridge, fixed partial denture, zirconia bridge, adhesive bridge

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Authors: Soniya Nityanand, Ekta Minocha, Manali Jain, Rohit Anthony Sinha, Chandra Prakash Chaturvedi

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Amniotic fluid stem cells (AFSC) have been shown to contribute towards the amelioration of Acute Renal Failure (ARF), but the mechanisms underlying the renoprotective effect are largely unknown. Therefore, the main goal of the current study was to evaluate the therapeutic efficacy of AFSC in a cisplatin-induced rat model of ARF and to investigate the underlying mechanisms responsible for its renoprotective effect. To study the therapeutic efficacy of AFSC, ARF was induced in Wistar rats by an intra-peritoneal injection of cisplatin, and five days after administration, the rats were randomized into two groups and injected with either AFSC or normal saline intravenously. On day 8 and 12 after cisplatin injection, i.e., day 3 and day7 post-therapy respectively, the blood biochemical parameters, histopathological changes, apoptosis and expression of pro-apoptotic, anti-apoptotic and autophagy-related proteins in renal tissues were studied in both groups of rats. Administration of AFSC in ARF rats resulted in improvement of renal function and attenuation of renal damage as reflected by significant decrease in blood urea nitrogen, serum creatinine levels, tubular cell apoptosis as assessed by Bax/Bcl2 ratio, and expression of the pro-apoptotic proteins viz. PUMA, Bax, cleaved caspase-3 and cleaved caspase-9 as compared to saline-treated group. Furthermore, in the AFSC-treated group as compared to saline-treated group, there was a significant increase in the activation of autophagy as evident by increased expression of LC3-II, ATG5, ATG7, Beclin1 and phospho-AMPK levels with a concomitant decrease in phospho-p70S6K and p62 expression levels. To further confirm whether the protective effects of AFSC on cisplatin-induced apoptosis were dependent on autophagy, chloroquine, an autophagy inhibitor was administered by the intra-peritoneal route. Chloroquine administration led to significant reduction in the anti-apoptotic effects of the AFSC therapy and further deterioration in the renal structure and function caused by cisplatin. Collectively, our results put forth that AFSC ameliorates cisplatin-induced ARF through induction of autophagy and inhibition of apoptosis. Furthermore, the protective effects of AFSC were blunted by chloroquine, highlighting that activation of autophagy is an important mechanism of action for the protective role of AFSC in cisplatin-induced renal injury.

Keywords: amniotic fluid stem cells, acute renal failure, autophagy, cisplatin

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Authors: P. V. S. Mascarenhas, B. C. P. Albuquerque, D. J. F. Campos, L. L. Almeida, V. R. Domingues, L. C. S. M. Ozelim

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Retaining slope structures are increasingly considered in geotechnical engineering projects due to extensive urban cities growth. These kinds of engineering constructions may present instabilities over the time and may require reinforcement or even rebuilding of the structure. In this context, statistical analysis is an important tool for decision making regarding retaining structures. This study approaches the failure probability of the construction of a retaining wall over the debris of an old and collapsed one. The new solution’s extension length will be of approximately 350 m and will be located over the margins of the Lake Paranoá, Brasilia, in the capital of Brazil. The building process must also account for the utilization of the ruins as a caisson. A series of in situ and laboratory experiments defined local soil strength parameters. A Standard Penetration Test (SPT) defined the in situ soil stratigraphy. Also, the parameters obtained were verified using soil data from a collection of masters and doctoral works from the University of Brasília, which is similar to the local soil. Initial studies show that the concrete wall is the proper solution for this case, taking into account the technical, economic and deterministic analysis. On the other hand, in order to better analyze the statistical significance of the factor-of-safety factors obtained, a Monte Carlo analysis was performed for the concrete wall and two more initial solutions. A comparison between the statistical and risk results generated for the different solutions indicated that a Gabion solution would better fit the financial and technical feasibility of the project.

Keywords: economical analysis, probability of failure, retaining walls, statistical analysis

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Authors: Vadim A. Kuznetsov, Anna M. Soldatova, Tatyana N. Enina, Elena A. Gorbatenko, Dmitrii V. Krinochkin

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The aim of the study was to evaluate potential parameters related with super-response to CRT. Methods: 60 CRT patients (mean age 54.3 ± 9.8 years; 80% men) with congestive heart failure (CHF) II-IV NYHA functional class, left ventricular ejection fraction < 35% were enrolled. At baseline, 1 month, 3 months and each 6 months after implantation clinical, electrocardiographic and echocardiographic parameters, NT-proBNP level were evaluated. According to the best decrease of left ventricular end-systolic volume (LVESV) (mean follow-up period 33.7 ± 15.1 months) patients were classified as super-responders (SR) (n=28; reduction in LVESV ≥ 30%) and non-SR (n=32; reduction in LVESV < 30%). Results: At baseline groups differed in age (58.1 ± 5.8 years in SR vs 50.8 ± 11.4 years in non-SR; p=0.003), gender (female gender 32.1% vs 9.4% respectively; p=0.028), width of QRS complex (157.6 ± 40.6 ms in SR vs 137.6 ± 33.9 ms in non-SR; p=0.044). Percentage of LBBB was equal between groups (75% in SR vs 59.4% in non-SR; p=0.274). All parameters of mechanical dyssynchrony were higher in SR, but only difference in left ventricular pre-ejection period (LVPEP) was statistically significant (153.0 ± 35.9 ms vs. 129.3 ± 28.7 ms p=0.032). NT-proBNP level was lower in SR (1581 ± 1369 pg/ml vs 3024 ± 2431 pg/ml; p=0.006). The survival rates were 100% in SR and 90.6% in non-SR (log-rank test P=0.002). Multiple logistic regression analysis showed that LVPEP (HR 1.024; 95% CI 1.004–1.044; P = 0.017), baseline NT-proBNP level (HR 0.628; 95% CI 0.414–0.953; P=0.029) and age at baseline (HR 1.094; 95% CI 1.009-1.168; P=0.30) were independent predictors for CRT super-response. ROC curve analysis demonstrated sensitivity 71.9% and specificity 82.1% (AUC=0.827; p < 0.001) of this model in prediction of super-response to CRT. Conclusion: Super-response to CRT is associated with better survival in long-term period. Presence of LBBB was not associated with super-response. LVPEP, NT-proBNP level, and age at baseline can be used as independent predictors of CRT super-response.

Keywords: cardiac resynchronisation therapy, superresponse, congestive heart failure, left bundle branch block

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Authors: Saiakhil Chilaka

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Understanding the demographic factors that influence mortality from respiratory diseases like COVID-19, pneumonia, and influenza is crucial for informing public health policy. This study utilizes multivariable regression models to assess the relationship between state, sex, and age group on deaths from these diseases using U.S. data from 2020 to 2023. The analysis reveals that age and sex play significant roles in mortality, while state-level variations are minimal. Although the model’s low R-squared values indicate that additional factors are at play, this paper discusses how these findings, in light of recent research, can inform future public health policy, resource allocation, and intervention strategies.

Keywords: COVID-19, multivariable regression, public policy, data science

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Authors: Pushp Lata Sankhwar

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INTRODUCTION: Maternal Hypothyroidism is the most frequent endocrine disorder in pregnancy and varies from 2.5% in the west to 11.0% in India. Maternal Hypothyroidism can have detrimental maternal effects like increased risk of preterm labor, PPROM leading to increased maternal morbidity and also on the neonate in the form of prematurity and its complications, prolonged hospital stay, neurological developmental problems, delayed milestones and mental retardation etc. Henceforth, the study was planned to evaluate the role of Hypothyroidism in preterm labor and its effect on neonates. AIMS AND OBJECTIVES: To Correlate Overt Hypothyroidism, Subclinical Hypothyroidism and Isolated Hypothyroxinemia With Preterm Labor and the neonatal outcome. Material and Methods: A case-control study of singleton pregnancy was performed over a year, in which a total of 500 patients presenting in the emergency with preterm labor were enrolled. The thyroid profile of these patients was sent at the time of admission, on the basis of which they were divided into Cases – Hypothyroidic mothers and Controls – Euthyroid mothers. The cases were further divided into subclinical, overt Hypothyroidism and isolated hypothyroxinemia. The neonatal outcome of these groups was also compared on the basis of the incidence and severity of neonatal morbidity, neonatal respiratory distress, the incidence of neonatal Hypothyroidism and early complications. The feto-maternal data was collected and analysed. RESULTS: In the study, a total of 500 antenatal patients with a history of preterm labor were enrolled, out of which 67 (13.8%) patients were found to be hypothyroid. The majority of the mothers had Subclinical Hypothyroidism (12.2%), followed by Overt Hypothyroidism seen in 1% of the mothers and isolated hypothyroxinemia in 0.6% of cases. The neonates of hypothyroid mothers had higher levels of cord blood TSH, and the mean cord blood TSH levels were highest in the case of neonates of mothers with Overt Hypothyroidism. The need for resuscitation of the neonates at the time of birth was higher in the case of neonates of hypothyroid mothers, especially with Subclinical Hypothyroidism. Also, it was found that the requirement of oxygen therapy in the form of oxygen by nasal prongs, oxygen by a hood, CPAP, CPAP along with surfactant therapy and mechanical ventilation along with surfactant therapy was significantly higher in the case of neonates of hypothyroid mothers. CONCLUSION: The results of our study imply that uncontrolled and untreated maternal Hypothyroidism may also lead to preterm delivery. The neonates of mothers with Hypothyroidism have higher cord blood TSH levels. The study also shows that there is an increased incidence and severity of respiratory distress in the neonates of hypothyroid mothers with untreated subclinical Hypothyroidism. Hence, we propose that routine screening for thyroid dysfunction in pregnant women should be done to prevent thyroid-related feto-maternal complications.

Keywords: high-risk pregnancy, thyroid, dysfunction, hypothyroidism, Preterm labor

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Authors: Sukhdev Singh, Baljinder Singh Bal, Amandeep Singh, Kanchan Thappa

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A nation's future almost certainly rests on the future of its children, and a nation's wellbeing can be greatly improved by providing for the right upbringing of its children. Participating in physical education and sports programmes is crucial for reaching one's full potential. As we are all aware, sports have recently become incredibly popular on a global scale. Sports are continually becoming more and more popular, and this positive trend is probably going to last for some time to come. Motor abilities will provide more accurate information on the developmental process of children. Motor fitness is a component of physical fitness that includes strength, speed, flexibility, and agility, and is related to enhanced performance and the development of motor skills. In recent years, there has been increased interest in the differences in child growth between urban and rural environments. Differences in student growth, body dimensions, body composition, and fitness levels due to urban and rural environmental disparities have come into focus in recent years. The main aim of this study is to know the differentials of motor fitness components among the school children of rural and urban areas of the Jammu region. Material and Methods: In total, sixty male subjects (mean ± SD; age, 16.475 ± 1.0124 yrs.; height, 172.8 ± 2.0153 cm; Weight, 59.75 ± 3.628 kg) from the Jammu region took part in the study. A minimum sample size of 40 subjects was obtained and was derived from Rural (N1=20) and Urban (N2=20) school-going children. Statistical Applications: The Statistical Package for the Social Sciences (SPSS) version 14.0 was used for all analyses. The differences in the mean of each group for the selected variable were tested for the significance of difference by an independent samples t-test. For testing the hypotheses, the level of significance was set at 0.05. Results: Results revealed that there were significant differences of leg explosive strength (p=0.0040*), dynamic balance (p=0.0056*), and Agility (p=0.0176*) among the School Children of the rural and urban areas of the Jammu region. However, Results further revealed that there were not significant differences of cardio respiratory endurance (p=0.8612), speed (p=0.2231), Low Back/Hamstring Flexibility (p=0.6478), and Two Hand Coordination. (p= 0.0953) among the School Children of the rural and urban areas of the Jammu region. Conclusion: The results of study showed that there is significance difference between Rural and Urban School children of the Jammu region with regards to a variable," leg explosive strength, dynamic balance, Agility” and the there is no significance difference between Rural and Urban School children of the Jammu region with regards variable “cardio-respiratory endurance, speed, Low Back/Hamstring Flexibility, Two Hand Coordination”.

Keywords: motor fitness, rural areas, school children, urban areas

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Authors: Dhyaalddin Bahaalddin Noori Zangana

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This study involves the behavior of reinforced sand under a square footing. A series of bearing capacity tests were performed on a small-scale laboratory model, which filled with a poorly-graded homogenous bed of sand, which was placed in a medium dense state using sand raining technique. The sand was reinforced with 40 mm wide household aluminum foil strips. The main studied parameters was to consider the effect of reinforcing strip length, with various linear density of reinforcement, number of reinforcement layers and depth of top layer of reinforcement below the footing, on load-settlement behavior, bearing capacity ratio and settlement reduction factor. The relation of load-settlement generally showed similar trend in all the tests. Failure was defined as settlement equal to 10% of the footing width. The recommended optimum reinforcing strip length, linear density of reinforcement, number of reinforcement layers and depth of top layer of reinforcing strips that give the maximum bearing capacity improvement and minimum settlement reduction factor were presented and discussed. Different bearing capacity ration versus length of the reinforcing strips and settlement reduction factor versus length of the reinforcing strips relations at failure were showed improvement of bearing capacity ratio by a factor of 3.82 and reduction of settlement reduction factor by a factor of 0.813. The optimum length of reinforcement was found to be 7.5 times the footing width.

Keywords: square footing, relative density, linear density of reinforcement, bearing capacity ratio, load-settlement behaviour

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Authors: Khaled Alabduljabbar

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Background: Benign, isolated, recurrent sixth nerve palsy is very rare in children. Here we report a case of recurrent abducens nerve palsy with no obvious etiology. It is a diagnosis of exclusion. A recurrent benign form of 6th nerve palsy, a rarer still palsy, has been described in the literature, and it is of most likely secondary to inflammatory causes, e.g, following viral and bacterial infections. Purpose: To present a case of 14 months old girl with recurrent attacks of isolated left sixth cranial nerve palsy following upper respiratory tract infection. Observation: The patient presented to opthalmology clinic with sudden onset of inward deviation (esotropia) of the left eye with a compensatory left face turn one week following signs of upper respiratory tract infection. Ophthalmological examination revealed large angle esotropia of the left eye in primary position, with complete limitation of abduction of the left eye, no palpebral fissure changes, and abnormal position of the head (left face turn). Visual acuity was normal, and no significant refractive error on cycloplegic refraction for her age. Fundus examination was normal with no evidence of papilledema. There was no relative afferent pupillary defect (RAPD) and no anisocoria. Past medical history and family history were unremarkable, with no history of convulsion attacks or head trauma. Additional workout include CBC. Erythrocyte sedimentation rate, Urgent magnetic resonance imaging (MRI), and angiography of the brain were performed and demonstrated the absence of intracranial and orbital lesions. Referral to pediatric neurologist was also done and concluded no significant finding. The patient showed improvement of the left sixth cranial nerve palsy and left face turn over a period of two months. Seven months since the first attack, she experienced a recurrent attack of left eye esotropia with left face turn concurrent with URTI. The rest of eye examination was again unremarkable. CT scan and MRI scan of brain and orbit were performed and showed only signs of sinusitis with no intracranial pathology. The palsy resolved spontaneously within two months. A third episode of left 6th nerve palsy occurred 6 months later, whichrecovered over one month. Examination and neuroimagingwere unremarkable. A diagnosis of benign recurrent left 6th cranial nerve palsy was made. Conclusion: Benign sixth cranial nerve palsy is always a diagnosis of exclusion given the more serious and life-threatening alternative causes. It seems to have a good prognosis with only supportive measures. The likelihood of benign 6th cranial nerve palsy to resolve completely and spontaneously is high. Observation for at least 6 months without intervention is advisable.

Keywords: 6th nerve pasy, abducens nerve pasy, recurrent nerve palsy, cranial nerve palsy

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Authors: Sapan Bhatnagar, Danish Akhtar, Salman Ahmed, Asif Ekbal, Gufran Beig

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Particulates are the solid and liquid droplets present in the atmosphere, they have serious negative effects on human health and environment. PM10 and PM2.5 are so small that they can penetrate deep into our lungs through the respiratory system. Determination of the amount of particulates present in the atmosphere per cubic meter is necessary to monitor, regulate and model atmospheric particulate levels. Air Quality Index is an index tells us how clean or polluted our air is, and what associated health effects might be a concern for us. The AQI focuses on health affects you may experience within a few hours or days after breathing polluted air. The quality rating for each pollutant was calculated. The geometric mean of these quality ratings gives the Air Quality Index. The existing concentrations of pollutants were compared with ambient air quality standards.

Keywords: air quality index, particulate, respirable dust sampler, dust sampler

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Authors: Jie Liu, Jinqu Cheng, Qiyuan Peng, Yong Yin

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Urban rail transit (URT) plays a significant role in dealing with traffic congestion and environmental problems in cities. However, equipment failure and obstruction of links often lead to URT links’ capacities loss in daily operation. It affects the reliability and transport service quality of URT network seriously. In order to measure the influence of links’ capacities loss on reliability and transport service quality of URT network, passengers are divided into three categories in case of links’ capacities loss. Passengers in category 1 are less affected by the loss of links’ capacities. Their travel is reliable since their travel quality is not significantly reduced. Passengers in category 2 are affected by the loss of links’ capacities heavily. Their travel is not reliable since their travel quality is reduced seriously. However, passengers in category 2 still can travel on URT. Passengers in category 3 can not travel on URT because their travel paths’ passenger flow exceeds capacities. Their travel is not reliable. Thus, the proportion of passengers in category 1 whose travel is reliable is defined as reliability indicator of URT network. The transport service quality of URT network is related to passengers’ travel time, passengers’ transfer times and whether seats are available to passengers. The generalized travel cost is a comprehensive reflection of travel time, transfer times and travel comfort. Therefore, passengers’ average generalized travel cost is used as transport service quality indicator of URT network. The impact of links’ capacities loss on transport service quality of URT network is measured with passengers’ relative average generalized travel cost with and without links’ capacities loss. The proportion of the passengers affected by links and betweenness of links are used to determine the important links in URT network. The stochastic user equilibrium distribution model based on the improved logit model is used to determine passengers’ categories and calculate passengers’ generalized travel cost in case of links’ capacities loss, which is solved with method of successive weighted averages algorithm. The reliability and transport service quality indicators of URT network are calculated with the solution result. Taking Wuhan Metro as a case, the reliability and transport service quality of Wuhan metro network is measured with indicators and method proposed in this paper. The result shows that using the proportion of the passengers affected by links can identify important links effectively which have great influence on reliability and transport service quality of URT network; The important links are mostly connected to transfer stations and the passenger flow of important links is high; With the increase of number of failure links and the proportion of capacity loss, the reliability of the network keeps decreasing, the proportion of passengers in category 3 keeps increasing and the proportion of passengers in category 2 increases at first and then decreases; When the number of failure links and the proportion of capacity loss increased to a certain level, the decline of transport service quality is weakened.

Keywords: urban rail transit network, reliability, transport service quality, links’ capacities loss, important links

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Authors: Elena Kalcheva, Ahmad Taki, Yuri Hadi

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Urban regeneration often includes residential high-rises as a way of optimum use of land. However, high-rises are in many cases connected to placelessness, this is not due to some intrinsic characteristic of the typology, but more to a failure to provide meaningful places in connection to them. The reason to study the Isle of the Dogs regeneration is the successful process that led to vibrant area with strong identity and social sustainability. Therefore, the purpose of this research is to identify the gaps into the sound strategy for the development of the area and in its implementation which will make the place more sustainable. The paper addresses four research questions: are the residential high-rises supporting a proper physical form; is there deployed properly scaled mix of land uses and functions in connection with residential high-rises; are there possible quality activities in quality places near the residential high-rises; and is there a strong sense of place created with the residential high-rise buildings and their surroundings. The methodology relies on observational survey of the researched area together with structured questions, to evaluate the external qualities of the residential high-rises and their surroundings. Visual information can help identify the mistakes and the omissions of the provided project examples. It can provide insight on how can be improved imageability, legibility and human scale. In this connection, the paper argues that although the quality of the architecture of the high-rises is superb, there is a failure to create meaningful, high quality public realm in connection with them. As such, it does not function as well as the designers intended to do: the functional quality of the public realm is quite low. The implications of the study suggest that actions need to take place in order to improve and foster further regeneration of the area.

Keywords: high-rises, isle of the dogs, public realm, regeneration

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Authors: Jared Beard, Ali Baheri

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As autonomous systems become more prominent in society, ensuring their safe application becomes increasingly important. This is clearly demonstrated with autonomous cars traveling through a crowded city or robots traversing a warehouse with heavy equipment. Human environments can be complex, having high dimensional state and action spaces. This gives rise to two problems. One being that analytic solutions may not be possible. The other is that in simulation based approaches, searching the entirety of the problem space could be computationally intractable, ruling out formal methods. To overcome this, approximate solutions may seek to find failures or estimate their likelihood of occurrence. One such approach is adaptive stress testing (AST) which uses reinforcement learning to induce failures in the system. The premise of which is that a learned model can be used to help find new failure scenarios, making better use of simulations. In spite of these failures AST fails to find particularly sparse failures and can be inclined to find similar solutions to those found previously. To help overcome this, multi-fidelity learning can be used to alleviate this overuse of information. That is, information in lower fidelity can simulations can be used to build up samples less expensively, and more effectively cover the solution space to find a broader set of failures. Recent work in multi-fidelity learning has passed information bidirectionally using “knows what it knows” (KWIK) reinforcement learners to minimize the number of samples in high fidelity simulators (thereby reducing computation time and load). The contribution of this work, then, is development of the bidirectional multi-fidelity AST framework. Such an algorithm, uses multi-fidelity KWIK learners in an adversarial context to find failure modes. Thus far, a KWIK learner has been used to train an adversary in a grid world to prevent an agent from reaching its goal; thus demonstrating the utility of KWIK learners in an AST framework. The next step is implementation of the bidirectional multi-fidelity AST framework described. Testing will be conducted in a grid world containing an agent attempting to reach a goal position and adversary tasked with intercepting the agent as demonstrated previously. Fidelities will be modified by adjusting the size of a time-step, with higher-fidelity effectively allowing for more responsive closed loop feedback. Results will compare the single KWIK AST learner with the multi-fidelity algorithm with respect to number of samples, distinct failure modes found, and relative effect of learning after a number of trials.

Keywords: multi-fidelity reinforcement learning, multi-fidelity simulation, safety validation, falsification

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Authors: Ruoyang Tang, Jianguo Nie

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Lateral-torsional bracing members are critical to the stability of girder systems during the construction phase of steel-concrete composite bridges, and the interaction effect of multiple girders plays an essential role in the determination of buckling load. In this paper, an investigation is conducted on the lateral-torsional buckling behavior of the steel girder system which is composed of three or four I-shaped girders and braced by solid web crossbeams. The buckling load for such girder system is comprehensively analyzed and an analytical solution is developed for uniform pressure loading conditions. Furthermore, post-buckling analysis including initial geometric imperfections is performed and parametric studies in terms of bracing density, stiffness ratio as well as the number and spacing of girders are presented in order to find the optimal bracing plans for an arbitrary girder layout. The theoretical solution of critical load on account of local buckling mode shows good agreement with the numerical results in eigenvalue analysis. In addition, parametric analysis results show that both bracing density and stiffness ratio have a significant impact on the initial stiffness, global stability and failure mode of such girder system. Taking into consideration the effect of initial geometric imperfections, an increase in bracing density between adjacent girders can effectively improve the bearing capacity of the structure, and higher beam-girder stiffness ratio can result in a more ductile failure mode.

Keywords: bracing member, construction stage, lateral-torsional buckling, steel girder system

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Authors: Harmeet Pal Singh Dhooria, Deepinder Chinna, UPS Sidhu, Alok Jain

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Serious infections caused by gram-negative bacteria are a significant cause of mortality and morbidity in the hospital setting. In acute care facilities like in intensive care units (ICUs), the intensity of antimicrobial use together with a population highly susceptible to infection, creates an environment, which facilitates both emergence and transmission of Extended Spectrum -lactamase (ESBL) producing Enterobacteriaceae species. The study was conducted in the Medical Intensive Care Unit (MICU) and the Pulmonary Critical Care Unit (PCCU) of the Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Out of a total of 1108 samples of urine, blood and respiratory tract secretions received for culture and sensitivity analysis from Medical Intensive Care Unit and Pulmonary Critical Care Unit, a total of 170 isolates of Enterobacteriaceae species were obtained which were then included in our study. Out of these 170 isolates, confirmed ESBL production was seen in 116 (68.24%) cases. E.coli was the most common species isolated (56.47%) followed by Klebsiella (32.94%), Enterobacter (5.88%), Citrobacter (3.53%), Enterobacter (0.59%) and Morganella (0.59%) among the total isolates. The rate of ESBL production was more in Klebsiella (78.57%) as compared to E.coli (60.42%). ESBL producers were found to be significantly more common in patients with prior history of hospitalization, antibiotic use, and prolonged ICU stay. Also significantly increased the prevalence of ESBL related infections was observed in patients with a history of catheterization or central line insertion but not in patients with the history of intubation. Patients who had an underlying malignancy had significantly higher prevalence of ESBL related infections as compared to other co-morbid illnesses. A slightly significant difference in the rate of mortality/LAMA was observed in the ESBL producer versus the non-ESBL producer group. The rate of mortality/LAMA was significantly higher in the ESBL related UTI but not in the ESBL related respiratory tract and bloodstream infections. ESBL producing isolates had significantly higher rates of resistance to Cefepime and Piperacillin/Tazobactum, and to non β-lactum antibiotics like Amikacin and Ciprofloxacin. The level of resistance to Imipenem was lower as compared to other antibiotics. However, it was noted that ESBL producing isolates had higher levels of resistance to Imipenem as compared to non-ESBL producing isolates. Conclusion- The prevalence of ESBL producing organisms was found to be very high (68.24%) among Enterobacteriaceae isolates in our ICU setting as among other ICU care settings around the world.

Keywords: enterobacteriaceae, extended spectrum B-lactamase (ESBL), ICU, antibiotic resistance

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Authors: M. Bahari Mehrabani, Hua-Peng Chen

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Management and maintenance of coastal defence structures during the expected life cycle have become a real challenge for decision makers and engineers. Accurate evaluation of the current condition and future performance of flood defence structures is essential for effective practical maintenance strategies on the basis of available field inspection data. Moreover, as coastal defence structures age, it becomes more challenging to implement maintenance and management plans to avoid structural failure. Therefore, condition inspection data are essential for assessing damage and forecasting deterioration of ageing flood defence structures in order to keep the structures in an acceptable condition. The inspection data for flood defence structures are often collected using discrete visual condition rating schemes. In order to evaluate future condition of the structure, a probabilistic deterioration model needs to be utilised. However, existing deterioration models may not provide a reliable prediction of performance deterioration for a long period due to uncertainties. To tackle the limitation, a time-dependent condition-based model associated with a transition probability needs to be developed on the basis of condition grade scheme for flood defences. This paper presents a probabilistic method for predicting future performance deterioration of coastal flood defence structures based on condition grading inspection data and deterioration curves estimated by expert judgement. In condition-based deterioration modelling, the main task is to estimate transition probability matrices. The deterioration process of the structure related to the transition states is modelled according to Markov chain process, and a reliability-based approach is used to estimate the probability of structural failure. Visual inspection data according to the United Kingdom Condition Assessment Manual are used to obtain the initial condition grade curve of the coastal flood defences. The initial curves then modified in order to develop transition probabilities through non-linear regression based optimisation algorithms. The Monte Carlo simulations are then used to evaluate the future performance of the structure on the basis of the estimated transition probabilities. Finally, a case study is given to demonstrate the applicability of the proposed method under no-maintenance and medium-maintenance scenarios. Results show that the proposed method can provide an effective predictive model for various situations in terms of available condition grading data. The proposed model also provides useful information on time-dependent probability of failure in coastal flood defences.

Keywords: condition grading, flood defense, performance assessment, stochastic deterioration modelling

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Authors: Luciano Tarantino

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Gas gangrene is a rare, severe infection with a very high mortality rate caused by Clostridium species. The infection causes a non-suppurative localized producing gas lesion from which harmful toxins that impair the inflammatory response cause vessel damage and multiple organ failure. Gas gangrene of the liver is very rare and develops suddenly, often as a complication of abdominal surgery and liver transplantation. The present paper deals with a case of gas gangrene of the liver that occurred after percutaneous MW ablation of hepatocellular carcinoma, resulting in progressive liver necrosis and multi-organ failure in spite of specific antibiotics administration. The patient was successfully treated with percutaneous Radiofrequency ablation. Case report: Female, 76 years old, Child A class cirrhosis, treated with synchronous insertion of 3 MW antennae for large HCC (5.5 cm) in the VIII segment. 24 hours after treatment, the patient was asymptomatic and left the hospital . 2 days later, she complained of fever, weakness, abdominal swelling, and pain. Abdominal US detected a 2.3 cm in size gas-containing area, eccentric within the large (7 cm) ablated area. The patient was promptly hospitalized with the diagnosis of anaerobic liver abscess and started antibiotic therapy with Imipenem/cilastatine+metronidazole+teicoplanine. On the fourth day, the patient was moved to the ICU because of dyspnea, congestive heart failure, atrial fibrillation, right pleural effusion, ascites, and renal failure. Blood tests demonstrated severe leukopenia and neutropenia, anemia, increased creatinine and blood nitrogen, high-level FDP, and high INR. Blood cultures were negative. At US, unenhanced CT, and CEUS, a progressive enlargement of the infected liver lesion was observed. Percutaneous drainage was attempted, but only drops of non-suppurative brownish material could be obtained. Pleural and peritoneal drainages gave serosanguineous muddy fluid. The Surgeon and the Anesthesiologist excluded any indication of surgical resection because of the high perioperative mortality risk. Therefore, we asked for the informed consent of the patient and her relatives to treat the gangrenous liver lesion by percutaneous Ablation. Under conscious sedation, percutaneous RFA of GG was performed by double insertion of 3 cool-tip needles (Covidien LDT, USA ) into the infected area. The procedure was well tolerated by the patient. A dramatic improvement in the patient's condition was observed in the subsequent 24 hours and thereafter. Fever and dyspnea disappeared. Normalization of blood tests, including creatinine, was observed within 4 days. Heart performance improved, 10 days after the RFA the patient left the hospital and was followed-up with weekly as an outpatient for 2 months and every two months thereafter. At 18 months follow-up, the patient is well compensated (Child-Pugh class B7), without any peritoneal or pleural effusion and without any HCC recurrence at imaging (US every 3 months, CT every 6 months). Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients non-responder to antibiotics and when surgery and liver transplantation are not feasible. A fast and early indication is needed in case of rapid worsening of patient's conditions.

Keywords: liver tumor ablation, interventional ultrasound, liver infection, gas gangrene, radiofrequency ablation

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Authors: Taraneh Estedlal

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The objective of this study was to review in-vivo and in-vitro studies to compare the effectiveness of bulk-fill and conventional resin composites with regard to marginal adaptation, polymerization shrinkage, and other mechanical properties.PubMed and Scopus databases was investigated for in-vitro studies and randomized clinical trials comparing incidence of fractures, color stability, marginal adaptation, pain and discomfort, recurrent caries, occlusion, pulpal reaction, and proper proximal contacts of restorations made with conventional and bulk resins. The failure rate of conventional and flowable bulk-fill resin composites was not significantly different to sculptable bulk-fill resin composites. The objective of this study was to review in-vivo and in-vitro studies to compare the effectiveness of bulk-fill and conventional resin composites with regard to marginal adaptation, polymerization shrinkage, and other mechanical properties. PubMed and Scopus databases was investigated for in-vitro studies and randomized clinical trials comparing one of the pearlier mentioned properties between bulk-fill and control composites. Despite differences in physical and in-vitro properties, failure rate of conventional and flowable bulk-fill resin composites was not significantly different to sculptable bulk-fill resin composites.

Keywords: polymerization shrinkage, color stability, marginal adaptation, recurrent caries, occlusion, pulpal reaction

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Authors: Romeo Malik, Yashraj Tripathy, Anup Barai

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Transportation safety is a major concern for vehicle electrification on a large-scale. The failure cost of lithium-ion batteries is substantial and is significantly impacted by higher liability and replacement cost. With continuous advancement on the material front in terms of higher energy density, upgrading safety characteristics are becoming more crucial for broader integration of lithium-ion batteries. Understanding and impeding thermal runaway is the prime issue for battery safety researchers. In this study, a comprehensive comparison of thermal runaway mechanisms for two different cathode types, Li(Ni₀.₃Co₀.₃Mn₀.₃)O₂ and Li(Ni₀.₈Co₀.₁₅Al₀.₀₅)O₂ is explored. Both the chemistries were studied for different states of charge, and the various abuse scenarios that lead to thermal runaway is investigated. Abuse tests include mechanical abuse, electrical abuse, and thermal abuse. Batteries undergo thermal runaway due to a series of combustible reactions taking place internally; this is observed as multiple jets of flame reaching temperatures of the order of 1000ºC. The physicochemical characterisation was performed on cells, prior to and after abuse. Battery’s state of charge and chemistry have a significant effect on the flame temperature profiles which is otherwise quantified as heat released. Majority of the failures during transportation is due to these external short circuit. Finally, a mitigation approach is proposed to impede the thermal runaway hazard. Transporting lithium-ion batteries under low states of charge is proposed as a way forward. Batteries at low states of charge have demonstrated minimal heat release under thermal runaway reducing the risk of secondary hazards such as thermal runaway propagation.

Keywords: battery reliability, lithium-ion batteries, thermal runaway characterisation, tomography

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Authors: Maryam Nazari

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COVID-19 is a respiratory disease triggered by the novel coronavirus, SARS-CoV-2, that has reached pandemic status today. Acute inflammation and immune cells infiltration into lung injuries result in multi-organ failure. The presence of other non-communicable diseases (NCDs) with systemic inflammation derived from COVID-19 may exacerbate the patient's situation and increase the risk for adverse effects and mortality. This pandemic is a novel situation and the scientific community at this time is looking for vaccines or drugs to treat the pathology. One of the biggest challenges is focused on reducing inflammation without compromising the correct immune response of the patient. In this regard, addressing the nutritional factors should not be overlooked not only as a matter of avoiding the presence of NCDs with severe infections but also as an adjunctive way to modulate the inflammatory status of the patients. Despite the pivotal role of nutrition in modifying immune response, due to the novelty of the COVID-19 disease, information about the effects of specific dietary agents is limited in this area. From the macronutrients point of view, protein deficiency (quantity or quality) has negative effects on the number of functional immunoglobulins and gut-associated lymphoid tissue (GALT). High biological value proteins or some amino acids like arginine and glutamine are well known for their ability to augment the immune system. Among lipids, fish oil has the ability to inactivate enveloped viruses, suppress pro-inflammatory prostaglandin production and block platelet-activating factors and their receptors. In addition, protectin D1, which is an Omega-3 PUFAs derivation, is a novel antiviral drug. So it seems that these fatty acids can reduce the severity and/or improve recovery of patients with COVID-19. Carbohydrates with lower glycemic index and fibers are associated with lower levels of inflammatory cytokines (CRP, TNF-α, and IL-6). Short-Chain Fatty acids not only exert a direct anti-inflammatory effect but also provide appropriate gut microbial, which is important in gastrointestinal issues related to COVID-19. From the micronutrients point of view, Vitamins A, C, D, E, iron, magnesium, zinc, selenium and copper play a vital role in the maintenance of immune function. Inadequate status in these nutrients may result in decreased resistance against COVID-19 infection. There are specific bioactive compounds in the diet that interact with the ACE2 receptor, which is the gateway for SARS and SARS-CoV-2, and thus controls the viral infection. Regarding this, the potential benefits of probiotics, resveratrol (a polyphenol found in grape), oleoylethanolamide (derived from oleic acid), and natural peroxisome proliferator-activated receptor γ agonists in foodstuffs (like curcumin, pomegranate, hot pepper) are suggested. Yet, it should be pointed out that most of these results have been reported in animal models and further human studies are needed to be verified.

Keywords: Covid-19, inflammation, nutrition, dietary agents

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Authors: Paul Saah, Charles Mbohwa, Nelson Sizwe Madonsela

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The capacity to deliver projects on schedule, within budget, and to the pleasure of the client depends on effective communication, which is the lifeblood of project-based businesses. In order to pinpoint areas for development and shed light on the crucial role that communication plays in project success, the aim of this study is to evaluate the efficacy of communication practises and processes inside project-based organisations. In order to analyse concepts and get a greater grasp of their theoretical basis, this study's methodology combines a careful review of the relevant literature with a conceptual analysis of the subject. Data from a varied sample of project-based businesses spanning all industries and sizes were collected via document analysis. The relationship between communication practises, and processes were investigated in connection to key performance measures such as project outcomes, client satisfaction, and team dynamics. According to the study's findings, project-based businesses that adopt effective communication practises, and procedures experience a reduction in unfavourable experiences, stronger integration, and coordination, clarity of purpose, and practises that can hasten problem resolution. However, failing to adopt effective communication practises and procedures in project-based company result in counter issues, including project derailment from the schedule, failure to meet goals, inefficient use of existing resources, and failure to meet organisational goals. Therefore, optimising their communication practises, and procedures are crucial for sustainable growth and competitive advantage as project-based enterprises continue to play a crucial part in today's dynamic business scene.

Keywords: effective communication, project-based firms, communication practices, project success, communication strategies

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Authors: Fiona Jensen, Barb Goodwin, Nancy Kleiman, Rhonda Usunier

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Background: Clinical simulation is now a common component in many health profession curricula in preparation for clinical practice. In the Rady Faculty of Health Sciences (RFHS) college leads in simulation and interprofessional (IP) education, planned an eight hour simulated hospital day shift, where seventy students from six health professions across two campuses, learned with each other in a safe, realistic environment. Learning about interprofessional collaboration, an expected competency for many health professions upon graduation, was a primary focus of the simulation event. Method: Faculty representatives from the Colleges of Nursing, Medicine, Pharmacy and Rehabilitation Sciences (Physical Therapy, Occupation Therapy, Respiratory Therapy) and Pharmacy worked together to plan the IP event in a simulation facility in the College of Nursing. Each college provided a faculty mentor to guide the same profession students. Students were placed in interprofessional teams consisting of a nurse, physician, pharmacist, and then sharing respiratory, occupational, and physical therapists across the team depending on the needs of the patients. Eight patient scenarios were role played by health profession students, who had been provided with their patient’s story shortly before the event. Each team was guided by a facilitator. Results and Outcomes: On the morning of the event, all students gathered in a large group to meet mentors and facilitators and have a brief overview of the six competencies for effective collaboration and the session objectives. The students assuming their same profession roles were provided with their patient’s chart at the beginning of the shift, met with their team, and then completed professional specific assessments. Shortly into the shift, IP team rounds began, facilitated by the team facilitator. During the shift, each patient role-played a spontaneous health incident, which required collaboration between the IP team members for assessment and management. The afternoon concluded with team rounds, a collaborative management plan, and a facilitated de-brief. Conclusions: During the de-brief sessions, students responded to set questions related to the session learning objectives and expressed many positive learning moments. We believe that we have a sustainable simulation IP collaborative learning opportunity, which can be embedded into curricula, and has the capacity to grow to include more health profession faculties and students. Opportunities are being explored in the RFHS at the administrative level, to offer this event more frequently in the academic year to reach more students. In addition, a formally structured event evaluation tool would provide important feedback and inform the qualitative feedback to event organizers and the colleges about the significance of the simulation event to student learning.

Keywords: simulation, collaboration, teams, interprofessional

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Authors: Redie Kidane Ghebrehawariat, Betiel Habte Hadgu, Filmon Berhane Kahsay, Rim Berhane Fisehaye, Samuel Haile Kahsay, Saron Yemane Yosief, Selemawit Mosazghi Gilazghi

Abstract:

A cross-sectional study was conducted from 22 February to 9 April 2022 on small, medium, and large holder dairy farms to determine the bovine mastitis prevalence and associated risk factors in the Anseba region, Eritrea. A total of 34 dairy farms and 193 dairy cows were randomly selected. Dairy cows were physically examined for any change on the udder and milk; a California mastitis test was performed to check sub-clinical mastitis; a closed-ended semi-structured questionnaire composed of 28 variables/risk factors (21 management risk factors and 7 animal-level risk factors) was used to determine the risk factors responsible for clinical and sub-clinical mastitis in the dairy cows. The overall cow-level prevalence of mastitis was 147 (76.2%). The animal level prevalence rate of clinical and sub-clinical mastitis was found to be 22 (11.4%) and 125 (64.8%), respectively, while herd level prevalence both for clinical and subclinical mastitis was found to be 14 (41.2%) and 26 (76.5%) respectively. Based on the already set P-value, which is <0.05, a number of risk factors were found to have a significant relationship with the occurrence of clinical and sub-clinical mastitis. Generally, animal risk factors such as animal age, parity, injury on the udder or teat, and previous history of mastitis presence of injury on the udder and lactation stage were risk factors with a significant relationship with the occurrence of clinical and sub-clinical mastitis. On the other hand, management risk factors with a significant relationship to the occurrence of clinical and sub-clinical mastitis were herd size, failure to milk mastitic cow, at last, educational level, floor type, failure to use a towel, using one towel for more than one cow and failure to practice mastitis test. From a total of 772 quarters, 280 (36.3%) were found positive for sub-clinical mastitis using the California mastitis test; of these, 70 (9%) were weakly positive, 90 (11.7%) were distinct positive, and 120 (15.5%) were strongly positive. Furthermore, 13 (1.7%) quarters were blocked. Quarter level prevalence was right front 80 (41.5%), left front 64 (33.3%), right hind 69 (35.8%) and left hind 67 (34.7%). The study has shown that mastitis is a major problem for dairy farms and the findings suggested that mastitis is one of the limiting factors in increasing milk production. Subclinical mastitis was found to be a devastating problem, and it occurred in all three breeds of lactating dairy cattle. Therefore, farmers should work hard to avoid the above-mentioned risk factors to minimize the infection of their dairy cattle by mastitis and thereby increase their profit. On the other hand, the Ministry of Agriculture, through the extension unit, should work in close contact with the farmers to increase awareness of the economic importance of the disease and associated risk factors.

Keywords: mastitis, prevalence, dairy cattle, Anseba, Eritrea

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