Search results for: multiple trauma

Authors: Sterlyn Poueriet Gil

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Through the years, the construction of cultural identity in the Dominican Republic has been subject to multiple unfavorable conditions fostered by the elites. These conditions have led to the loss of a pattern that lasts over time; leaving this as a result of inconsistency and the diversity of elements that at first are theses and antitheses and gives form to the complexity of what we can call: "the culture of a people that tries to reinvent itself in each social-historical moment". Religion is one of those cultural elements that does not escape the will of the elites. In the country, there are multiple religious groups that, in one way or another, represent what the people are, their ancestral customs, their philosophy, and even their strengths as groups of a certain social environment. However, these have always been marginalized and discriminated against by the country's official religion and their respective denominations. The objective of this research was to verify to what extent interreligious discrimination was real, moving from the assumption to scientific evidence through the application of research techniques such as the survey, fieldwork, and qualitative analysis of the collected evidence, the supremacy of the dominant religion condemns its rites and in many cases the person himself. In many communities, freedom of worship is reserved for traditional groups, having cases in the country where the manifestations of rites such as the "gagá" and the "prillé" have been prohibited, considering them as diabolical and primitive practices; this seeks to deny the roots of a people marked by poverty and social conflicts but remains firm in the will to be.

Keywords: cultural identity, freedom of worship, gagá, popular demonstrations

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Authors: Katie Jerram, Jacqui Nevols, Rebecca Howes, Hayley Richardson, Debbie Suso, Thomas Batten, Reny Mathai

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Pyomyositis is an uncommon acute purulent skeletal muscle infection, usually caused by Staphylococcus aureus, occurring either spontaneously or following local trauma. Immunocompromise is a risk factor. It presents with pyrexia, pain, and tenderness of the affected muscle, which may have a firm ‘woody’ feel. Management usually involves surgery and prolonged courses of antibiotics, but alongside these active treatments, palliation of symptoms such as pain is also a priority. A short case series of diabetic inpatients under the care of the Renal Medicine team with pyomyositis is presented, demonstrating that Hospital Palliative Care Teams may be well placed to provide symptom management advice by working jointly with the patient’s medical or surgical team. A review of the literature on the management of pain in pyomyositis is also presented, and there was no clear consensus on the best strategy. It may be that a combination of analgesics and adjuncts is the most effective strategy, perhaps combined with the holistic approach used within palliative care.

Keywords: pyomyositis, pain, palliation, analgesia

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Authors: Ojoniyi Oluwafeyekikunmi Okiki

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Notwithstanding advances in disturbing wound care and control, infections remain a main motive of mortality, morbidity, and financial disruption in tens of millions of wound sufferers around the sector. Animal models have become popular gear for analyzing a big selection of outside worrying wound infections and trying out new antimicrobial techniques. This evaluation covers experimental infections in animal models of surgical wounds, pores and skin abrasions, burns, lacerations, excisional wounds, and open fractures. Animal modes of external stressful wound infections stated via extraordinary investigators vary in animal species used, microorganism traces, the quantity of microorganisms carried out, the dimensions of the wounds, and, for burn infections, the period of time the heated object or liquid is in contact with the skin. As antibiotic resistance continues to grow, new antimicrobial procedures are urgently needed. Those have to be examined using popular protocols for infections in external stressful wounds in animal models.

Keywords: surgical wounds, animals, wound infections, burns, wound models, colony-forming gadgets, lacerated wounds

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Authors: Lajeesh Jabbar, Shibu T. Varghese

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Being under pain is a very distressing factor that it prolongs the healing of any kind of trauma and add to the post traumatic stressful state. Alleviating the pain from acute traumatic conditions like fracture, degloving injury etc will help in faster recovery and also decrease the incidence of post traumatic stress disorder. Most of the emergency departments in INDIA are using IV opioid analgesics to relieve the patient from pain in cases of acute traumatic injuries. None of the Emergency Departments practice regional blocks in the country. In this study, we are comparing the efficacy of Regional Blocks in relieving the pain in lower limb fractures versus the use of IV analgesics for the same in the emergency department. The site of study is Malabar Institute Of Medical Sciences in Calicut in Kerala in India and is a place which receives approximately 10-20 traumatic fracture cases per day. The fracture sites used for the study purpose are femur fracture and phalangeal fractures.

Keywords: regional blocks, IV analgesia, acute traumatic pain, femur fractures, phalanx fractures

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Authors: F. Sangiorgio, J. Silfwerbrand, G. Mancini

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Geometric and mechanical properties all influence the resistance of RC structures and may, in certain combination of property values, increase the risk of a brittle failure of the whole system. This paper presents a statistical and probabilistic investigation on the resistance of RC beams designed according to Eurocodes 2 and 8, and subjected to multiple failure modes, under both the natural variation of material properties and the uncertainty associated with cross-section and transverse reinforcement geometry. A full probabilistic model based on JCSS Probabilistic Model Code is derived. Different beams are studied through material nonlinear analysis via Monte Carlo simulations. The resistance model is consistent with Eurocode 2. Both a multivariate statistical evaluation and the data clustering analysis of outcomes are then performed. Results show that the ultimate load behaviour of RC beams subjected to flexural and shear failure modes seems to be mainly influenced by the combination of the mechanical properties of both longitudinal reinforcement and stirrups, and the tensile strength of concrete, of which the latter appears to affect the overall response of the system in a nonlinear way. The model uncertainty of the resistance model used in the analysis plays undoubtedly an important role in interpreting results.

Keywords: modelling, Monte Carlo simulations, probabilistic models, data clustering, reinforced concrete members, structural design

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Authors: Savannah Rugg, Carlo Moreno, Pushpa Soti, Alexis Racelis

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Situated in deep South Texas, the Lower Rio Grande Valley (LRGV) is considered one the most productive agricultural regions in the southern US. With the highest concentration of organic farms in the state (Hidalgo county), the LRGV has a strong potential to be leaders in sustainable agriculture. Finding management practices that comply with organic certification and increase the health of the agroecosytem and the farmers working the land is increasingly pertinent. Cover cropping, or the intentional planting of non-cash crop vegetation, can serve multiple functions in an agroecosystem by decreasing environmental pollutants that originate from the agroecosystem, reducing inputs needed for crop production, and potentially decreasing on-farm costs for farmers—overall increasing the sustainability of the farm. Use of cover crops on otherwise fallow lands have shown to enhance ecosystem services such as: attracting native beneficial insects (pollinators), increase nutrient availability in topsoil, prevent nutrient leaching, increase soil organic matter, and reduces soil erosion. In this study, four cover crops (Lablab, Sudan Grass, Sunn Hemp, and Pearl Millet) were analyzed in the subtropical region of south Texas to see how their multiple functions enhance ecosystem services. The four cover crops were assessed to see their potential to harbor native insects, their potential to increase soil nitrogen, to increase soil organic matter, and to suppress weeds. The preliminary results suggest that these subtropical varieties of cover crops have potential to enhance ecosystem services on agricultural land in the RGV by increasing soil organic matter (in all varieties), increasing nitrogen in topsoil (Lablab, Sunn Hemp), and reducing weeds (Sudan Grass).

Keywords: cover crops, ecosystem services, subtropical agriculture, sustainable agriculture

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Authors: Riina I. Bray, Yifan Wang, Nikolas Argiropoulos, Stephanie Robins, John Molot, Kelly Tragash, Lynn M. Marshall, Margaret E. Sears, Marie-Andrée Pigeon, Michel Gaudet, Pierre Auger, Emily Bélanger, Rohini Peris

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Multiple chemical sensitivity (MCS) is a chronic medical condition characterized by intolerances to chemical substances. Since the arrival of the COVID-19 pandemic and associated health measures, people experiencing MCS (PEMCS) are at a heightened risk of environmental exposures associated with cleaners, disinfectants, and sanitizers. Little attention has been paid to the well-being of PEMCS in the context of the COVID-19 pandemic. Objective: This study assesses the lived experiences of Canadian adults with MCS in relation to their living environment, access to healthcare, and levels of perceived social support before and during the pandemic. Methods: A total of 119 PEMCS completed an online questionnaire. McNemar Chi-Squared and Wilcoxon Signed Rank tests were used to evaluate if there were statistically significant changes in participants’ perception of their living environment, access to healthcare, and levels of social support before and after March 11, 2020. Results: Both positive and negative outcomes were noted. Participants reported an increase in exposure to disinfectants/sanitizers that entered their living environment (p<.001). There was a reported decrease in access to a family doctor during the pandemic (p<0.001). Although PEMCS experienced increased social isolation (p<0.001), they also reported an increase in understanding from family (p<0.029) and a decrease in stigma for wearing personal protective equipment (p<0.001). Conclusion: PEMCS reported experiencing: increased exposure to disinfectants or sanitizers, a loss of social support, and barriers in accessing healthcare during the pandemic. However, COVID-19 provided an opportunity to normalize the living conditions of PEMCS, such as wearing masks and social isolation. These findings can guide decision-makers on the importance of implementing nontoxic alternatives for cleaning and disinfection, as well as improving accommodation measures for PEMCS.

Keywords: covid-19, multiple chemical sensitivity, MCS, quality of life, social isolation, physical environment, healthcare

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Authors: P. Jayaram, Prasoon Prasannan, N. K. Deepak, P. P. Pradyumnan

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Indium and Zirconium co doped zinc oxide (InZrZnO) thin films are prepared by chemical spray pyrolysis method on pre-heated quartz substrates. The films are subjected to vacuum annealing at 400ᵒC for three hours in an appropriate air (10-5mbar) ambience after deposition. X-ray diffraction, Scanning electron microscopy, energy dispersive spectra and photoluminescence are used to characterize the films. Temperature dependent electrical measurements are conducted on the films and the films exhibit exceptional conductivity at higher temperatures. XRD analysis shows that all the films prepared in this work have hexagonal wurtzite structure. The average crystallite sizes of the films were calculated using Scherrer’s formula, and uniform deformation model (UDM) of Williamson-Hall method is used to establish the micro-strain values. The dislocation density is determined from the Williamson and Smallman’s formula. Intense, broad and strongly coupled multiple photoluminescence were observed from photoluminescence spectra. PL indicated relatively high concentration defective oxygen and Zn vacancies in the film composition. Strongly coupled ultraviolet near blue emissions authenticate that the dopants are capable of inducing modulated free excitonic (FX), donor accepter pair (DAP) and longitudinal optical phonon emissions in thin films.

Keywords: PL, SEM, TCOs, thin films, XRD

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Authors: Bipasha Sen, Aditya Agarwal

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Multilingual automatic speech recognition (ASR) system is a single entity capable of transcribing multiple languages sharing a common phone space. Performance of such a system is highly dependent on the compatibility of the languages. State of the art speech recognition systems are built using sequential architectures based on recurrent neural networks (RNN) limiting the computational parallelization in training. This poses a significant challenge in terms of time taken to bootstrap and validate the compatibility of multiple languages for building a robust multilingual system. Complex architectural choices based on self-attention networks are made to improve the parallelization thereby reducing the training time. In this work, we propose Reed, a simple system based on 1D convolutions which uses very short context to improve the training time. To improve the performance of our system, we use raw time-domain speech signals directly as input. This enables the convolutional layers to learn feature representations rather than relying on handcrafted features such as MFCC. We report improvement on training and inference times by atleast a factor of 4x and 7.4x respectively with comparable WERs against standard RNN based baseline systems on SpeechOcean's multilingual low resource dataset.

Keywords: convolutional neural networks, language compatibility, low resource languages, multilingual automatic speech recognition

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Authors: Gerges Samaan Henin Abdalla

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Ultra-secured methods of banking services have been introduced to the customer, such as online banking. Banks have begun to consider electronic banking (e-banking) as a way to replace some traditional branch functions by using the Internet as a distribution channel. Some consumers have at least one account at multiple banks and access these accounts through online banking. To check their current net worth, clients need to log into each of their accounts, get detailed information, and work toward consolidation. Not only is it time consuming, but it is also a repeatable activity with a certain frequency. To solve this problem, the concept of account aggregation was added as a solution. Account consolidation in e-banking as a form of electronic banking appears to build a stronger relationship with customers. An account linking service is generally referred to as a service that allows customers to manage their bank accounts held at different institutions via a common online banking platform that places a high priority on security and data protection. Consumers have at least one account at multiple banks and access these accounts through online banking. To check their current net worth, clients need to log into each of their accounts, get detailed information, and work toward consolidation. The article provides an overview of the account aggregation approach in e-banking as a new service in the area of e-banking.

Keywords: compatibility, complexity, mobile banking, observation, risk banking technology, Internet banks, modernization of banks, banks, account aggregation, security, enterprise development

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Authors: Ya-Ping Chang

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Starting from the early stages of pregnancy, parents begin to form hopes and dreams about the future of their child. They will think about the appearance and personality of their child and may even develop many expectations. The patient in this study experienced a successful pregnancy following multiple attempts at artificial insemination. However, due to arrested embryonic development, and based on the physician’s evaluation, a caesarean section was performed at week 25. However, the baby suffered from infections and subsequently died from multiple organ failures. This study collected and analyzed objective and subjective data through observation, interviews, recording, and interactions with the patient. The following nursing issues of the patient were identified: anxiety, anticipatory grief, and adjustment disorder. The psychology of caring as proposed in Watson’s theory was applied to address these nursing issues. Comprehensive and continuous care was provided to the patient on the basis of mutual trust and individual nursing guidelines in order to alleviate the patient’s anxiety, help her to cope with grief, and prepare her for the eventual death of her child. The author helped the patient to say goodbye to her child and accept the child’s death calmly, such that she had no regrets about the experience. This nursing experience may serve as a reference to nurses managing similar cases in the future.

Keywords: dying baby, mother, grief, Watson’s theory

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Authors: Meng-Fei Cheng, Wei Fneg

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New Taiwan high school standards emphasize employing scientific models and modeling practices in physics learning. However, to our knowledge. Few studies address how scientific models and modeling are approached in current science teaching, and they do not examine the views of scientific models portrayed in the textbooks. To explore the views of scientific models and modeling in textbooks, this study investigated the atomic unit in different textbook versions as an example and provided suggestions for modeling curriculum. This study adopted a quantitative analysis of qualitative data in the atomic units of four mainstream version of Taiwan high school physics textbooks. The models were further analyzed using five dimensions of the views of scientific models (nature of models, multiple models, purpose of the models, testing models, and changing models); each dimension had three levels (low, medium, high). Descriptive statistics were employed to compare the frequency of describing the five dimensions of the views of scientific models in the atomic unit to understand the emphasis of the views and to compare the frequency of the eight scientific models’ use to investigate the atomic model that was used most often in the textbooks. Descriptive statistics were further utilized to investigate the average levels of the five dimensions of the views of scientific models to examine whether the textbooks views were close to the scientific view. The average level of the five dimensions of the eight atomic models were also compared to examine whether the views of the eight atomic models were close to the scientific views. The results revealed the following three major findings from the atomic unit. (1) Among the five dimensions of the views of scientific models, the most portrayed dimension was the 'purpose of models,' and the least portrayed dimension was 'multiple models.' The most diverse view was the 'purpose of models,' and the most sophisticated scientific view was the 'nature of models.' The least sophisticated scientific view was 'multiple models.' (2) Among the eight atomic models, the most mentioned model was the atomic nucleus model, and the least mentioned model was the three states of matter. (3) Among the correlations between the five dimensions, the dimension of 'testing models' was highly related to the dimension of 'changing models.' In short, this study examined the views of scientific models based on the atomic units of physics textbooks to identify the emphasized and disregarded views in the textbooks. The findings suggest how future textbooks and curriculum can provide a thorough view of scientific models to enhance students' model-based learning.

Keywords: atomic models, textbooks, science education, scientific model

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Authors: Bowen Ding, Yihao Kuang

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In recent years, large-scale pre-trained language models have achieved state-of-the-art performance on a variety of natural language processing tasks. The word vectors produced by these language models can be viewed as dense encoded presentations of natural language that in text form. However, it is unknown how much linguistic information is encoded and how. In this paper, we construct several corresponding probing tasks for multiple linguistic information to clarify the encoding capabilities of different language models and performed a visual display. We firstly obtain word presentations in vector form from different language models, including BERT, ELMo, RoBERTa and GPT. Classifiers with a small scale of parameters and unsupervised tasks are then applied on these word vectors to discriminate their capability to encode corresponding linguistic information. The constructed probe tasks contain both semantic and syntactic aspects. The semantic aspect includes the ability of the model to understand semantic entities such as numbers, time, and characters, and the grammatical aspect includes the ability of the language model to understand grammatical structures such as dependency relationships and reference relationships. We also compare encoding capabilities of different layers in the same language model to infer how linguistic information is encoded in the model.

Keywords: language models, probing task, text presentation, linguistic information

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Authors: Auwal Mustapha Imam

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The aim of the energy management system is to monitor and control utilization, access, optimize and manage energy availability. This can be realized through real-time analyses and energy sources and loads data control in a predictive way. Smart-home monitoring and control provide convenience and cost savings by controlling appliances, lights, thermostats and other loads. There may be different categories of loads in the various homes, and the homeowner may wish to control access to solar-generated energy to protect the storage from draining completely. Controlling the power system operation by managing the converter output power and controlling how it feeds the appliances will satisfy the residential load demand. The Internet of Things (IoT) provides an attractive technological platform to connect the two and make home automation and domestic energy utilization easier and more attractive. This paper presents the use of IoT-based control topology to monitor and control power distribution and consumption by DC loads connected to single-input multiple outputs (SIMO) DC-DC converter, thereby reducing leakages, enhancing performance and reducing human efforts. A SIMO converter was first developed and integrated with the IoT/Raspberry Pi control topology, which enables the user to monitor and control power scheduling and load forecasting via an Android app.

Keywords: flyback, converter, DC-DC, photovoltaic, SIMO

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Authors: M'Hamed Boulakroune, Mouloud Challal, Hassiba Louazene, Saida Fentiz

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This paper presents a new ultra wideband (UWB) microstrip bandpass filter (BPF) at microwave frequencies. The first one is based on multiple-mode resonator (MMR) and rectangular-shaped defected ground structure (DGS). This filter, which is compact size of 25.2 x 3.8 mm2, provides in the pass band an insertion loss of 0.57 dB and a return loss greater than 12 dB. The second structure is a tunable bandpass filters using planar patch resonators based on diode varactor. This filter is formed by a triple mode circular patch resonator with two pairs of slots, in which the varactors are connected. Indeed, this filter is initially centered at 2.4 GHz, the center frequency of the tunable patch filter could be tuned up to 1.8 GHz simultaneously with the bandwidth, reaching high tuning ranges. Lossless simulations were compared to those considering the substrate dielectric, conductor losses, and the equivalent electrical circuit model of the tuning element in order to assess their effects. Within these variations, simulation results showed insertion loss better than 2 dB and return loss better than 10 dB over the passband. The proposed filters presents good performances and the simulation results are in satisfactory agreement with the experimentation ones reported elsewhere.

Keywords: defected ground structure, diode varactor, microstrip bandpass filter, multiple-mode resonator

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Authors: Lizhou Chen, Abdelhamid Belgaid, Assem Elsayed, Xiaoming Yang

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Compression index is essential in foundation settlement calculation. The traditional method for determining compression index is consolidation test which is expensive and time consuming. Many researchers have used regression methods to develop empirical equations for predicting compression index from soil properties. Based on a large number of compression index data collected from consolidation tests, the accuracy of some popularly empirical equations were assessed. It was found that primary compression index is significantly overestimated in some equations while it is underestimated in others. The sensitivity analyses of soil parameters including water content, liquid limit and void ratio were performed. The results indicate that the compression index obtained from void ratio is most accurate. The ANOVA (analysis of variance) demonstrates that the equations with multiple soil parameters cannot provide better predictions than the equations with single soil parameter. In other words, it is not necessary to develop the relationships between compression index and multiple soil parameters. Meanwhile, it was noted that secondary compression index is approximately 0.7-5.0% of primary compression index with an average of 2.0%. In the end, the proposed prediction equations using power regression technique were provided that can provide more accurate predictions than those from existing equations.

Keywords: compression index, clay, settlement, consolidation, secondary compression index, soil parameter

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Authors: A. Mech

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Repetitive transcranial magnetic stimulation has proven to be a valuable treatment option for patients who have failed to respond to multiple courses of antidepressant medication. In fact, the American Psychiatric Association recommends TMS after one failed treatment course of antidepressant medication. Genetic testing has proven valuable for pharmacokinetic variables, which, if understood, could lead to more efficient dosing of psychotropic medications to improve outcomes. Pharmacodynamic testing can identify biomarkers, which, if addressed, can improve patients' outcomes in antidepressant therapy. Monotherapy treatment of major depressive disorder with methylated B vitamin treatment has been shown to be safe and effective in patients with MTHFR polymorphisms without waiting for multiple trials of failed medication treatment for depression. Such treatment has demonstrated remission rates similar to antidepressant clinical trials. Combining pharmacodynamics testing with repetitive TMS treatment with NeuroStar has shown promising potential for enhancing remission rates and durability of treatment. In this study, a retrospective chart review (ongoing) of patients who obtained repetitive TMS treatment enhanced by dietary supplementation guided by Pharmacodynamic testing, displayed a greater remission rate (90%) than patients treated with only NeuroStar TMS (62%).

Keywords: improved remission rate, major depressive disorder, pharmacodynamic testing, rTMS outcomes

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Authors: S. MacDougall-Davis, S. Wysling, R. Willmore

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Background: The application of good non-technical skills, also known as crew resource management (CRM), is central to the delivery of safe, effective healthcare. The authors have been running remote trauma courses for over 10 years, primarily focussing on developing participants’ CRM in time-critical, high-stress clinical situations. The course has undergone an iterative process over the past 10 years. We employ a number of experiential learning techniques for improving CRM, including small group workshops, military command tasks, high fidelity simulations with reflective debriefs, and a ‘flipped classroom’, where participants are asked to create their own simulations and assess and debrief their colleagues’ CRM. We created a randomised simulation study to assess the impact of our course on UK medical students’ CRM, both at an individual and a teams level. Methods: Sixteen students took part. Four clinical scenarios were devised, designed to be of similar urgency and complexity. Professional moulage effects and experienced clinical actors were used to increase fidelity and to further simulate high-stress environments. Participants were block randomised into teams of 4; each team was randomly assigned to one pre-course simulation. They then underwent our 5 day remote trauma CRM course. Post-course, students were re-randomised into four new teams; each was randomly assigned to a post-course simulation. All simulations were videoed. The footage was reviewed by two independent CRM-trained assessors, who were blinded to the before/after the status of the simulations. Assessors used the internationally validated team emergency assessment measure (TEAM) to evaluate key areas of team performance, as well as a global outcome rating. Prior to the study, assessors had scored two unrelated scenarios using the same assessment tool, demonstrating 89% concordance. Participants also completed pre- and post-course questionnaires. Likert scales were used to rate individuals’ perceived NTS ability and their confidence to work in a team in time-critical, high-stress situations. Results: Following participation in the course, a significant improvement in CRM was observed in all areas of team performance. Furthermore, the global outcome rating for team performance was markedly improved (40-70%; mean 55%), thus demonstrating an impact at Level 4 of Kirkpatrick’s hierarchy. At an individual level, participants’ self-perceived CRM improved markedly after the course (35-70% absolute improvement; mean 55%), as did their confidence to work in a team in high-stress situations. Conclusion: Our study demonstrates that with a short, cost-effective course, using easily reproducible teaching sessions, it is possible to significantly improve participants’ CRM skills, both at an individual and, perhaps more importantly, at a teams level. The successful functioning of multi-disciplinary teams is vital in a healthcare setting, particularly in high-stress, time-critical situations. Good CRM is of paramount importance in these scenarios. The authors believe that these concepts should be introduced from the earliest stages of medical education, thus promoting a culture of effective CRM and embedding an early appreciation of the importance of these skills in enabling safe and effective healthcare.

Keywords: crew resource management, non-technical skills, training, simulation

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Authors: Rashmi Malik, Videep Mishra

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The practice of generative design has become a transformative approach for an efficient way of generating multiple iterations for any design project. The conventional way of modeling the game elements is very time-consuming and requires skilled artists to design. A 3D modeling tool like 3D S Max, Blender, etc., is used traditionally to create the game library, which will take its stipulated time to model. The study is focused on using the generative design tool to increase the efficiency in game development at the stage of prop and environment generation. This will involve procedural level and customized regulated or randomized assets generation. The paper will present the system design approach using generative tools like Grasshopper (visual scripting) and other scripting tools to automate the process of game library modeling. The script will enable the generation of multiple products from the single script, thus creating a system that lets designers /artists customize props and environments. The main goal is to measure the efficacy of the automated system generated to create a wide variety of game elements, further reducing the need for manual content creation and integrating it into the workflow of AAA and Indie Games.

Keywords: iterative game design, generative design, gaming asset automation, generative game design

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Authors: Augustina Konadu Larbi-Ampofo, Ekemini Umoinwek

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Background: Hypercalcaemia is a common electrolyte imbalance that increases mortality if poorly controlled. Primary hyperparathyroidism often presents like this with a prevalence of 0.1-0.3%. Management due to an ectopic parathyroid adenoma in the mediastinum is challenging, especially in a patient with a pacemaker. Case Presentation: A 79-year-old woman with a history of a previous cardiac arrest, permanent pacemaker, ischaemic heart disease, bilateral renal calculi, rectal polyps, liver cirrhosis, and a family history of hyperthyroidism presented to the emergency department with acute back pain. Management and Outcome: The patient was diagnosed with primary hyperparathyroidism due to her elevated corrected calcium and parathyroid hormone levels. Parathyroid investigations consisting of an NM MIBI scan, SPECT-CT, 4D parathyroid scan, and an ultrasound scan of the neck and thorax confirmed an ectopic parathyroid adenoma in the mediastinum at the level of the aortic arch, along with benign thyroid nodules. The location of the adenoma warranted a thoracoscopic surgical approach; however, the presence of her pacemaker and other cardiovascular conditions predisposed her to a potentially poorer post-operative outcome. Discussion: Mediastinal ectopic parathyroid adenomas are rare and difficult to diagnose and treat, often needing a multimodal imaging approach for accurate localisation. Surgery is a definitive treatment; however, in this patient, long-term medical treatment with cinacalcet was the only next suitable treatment option. The difficulty with this is that cinacalcet tackles the biochemical markers of the disease entity and not the disease itself, leaving room for what happens next if there is refractory/uncontrolled hypercalcaemia in this patient with a pacemaker. Moreover, the coexistence of her multiple conditions raises the suspicion of an underlying multisystemic or multiple endocrine disorder, with multiple endocrine neoplasia coming to mind, necessitating further genetic or autoimmune investigations. Conclusion: Mediastinal ectopic parathyroid adenomas are rare, with diagnostic and management challenges.

Keywords: mediastinal ectopic parathyroid adenoma, hyperparathyroidism, SPECT/CT, nuclear medicine, multimodal imaging

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Authors: Chiung-Hui Chen

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With advancements in science and technology, the concept of the Internet of Things (IoT) has gradually developed. The development of the intelligent environment adds intelligence to objects in the living space by using the IoT. In the smart environment, when multiple users share the living space, if different service requirements from different users arise, then the context-aware system will have conflicting situations for making decisions about providing services. Therefore, the purpose of establishing a communication and negotiation mechanism among objects in the intelligent environment is to resolve those service conflicts among users. This study proposes developing a decision-making methodology that uses “Event Agents” as its core. When the sensor system receives information, it evaluates a user’s current events and conditions; analyses object, location, time, and environmental information; calculates the priority of the object; and provides the user services based on the event. Moreover, when the event is not single but overlaps with another, conflicts arise. This study adopts the “Multiple Events Correlation Matrix” in order to calculate the degree values of incidents and support values for each object. The matrix uses these values as the basis for making inferences for system service, and to further determine appropriate services when there is a conflict.

Keywords: internet of things, intelligent object, event agents, negotiation mechanism, degree of similarity

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Authors: Kenneth A. Rostowsky, Alexander S. Maher, Nahian F. Chowdhury, Andrei Irimia

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The clinical significance of cerebral microbleeds (CMBs) due to mild traumatic brain injury (mTBI) remains unclear. Here we use magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) and connectomic analysis to investigate the statistical association between mTBI-related CMBs, post-TBI changes to the human connectome and neurological/cognitive deficits. This study was undertaken in agreement with US federal law (45 CFR 46) and was approved by the Institutional Review Board (IRB) of the University of Southern California (USC). Two groups, one consisting of 26 (13 females) mTBI victims and another comprising 26 (13 females) healthy control (HC) volunteers were recruited through IRB-approved procedures. The acute Glasgow Coma Scale (GCS) score was available for each mTBI victim (mean µ = 13.2; standard deviation σ = 0.4). Each HC volunteer was assigned a GCS of 15 to indicate the absence of head trauma at the time of enrollment in our study. Volunteers in the HC and mTBI groups were matched according to their sex and age (HC: µ = 67.2 years, σ = 5.62 years; mTBI: µ = 66.8 years, σ = 5.93 years). MRI [including T1- and T2-weighted volumes, gradient recalled echo (GRE)/susceptibility weighted imaging (SWI)] and gradient echo (GE) DWI volumes were acquired using the same MRI scanner type (Trio TIM, Siemens Corp.). Skull-stripping and eddy current correction were implemented. DWI volumes were processed in TrackVis (http://trackvis.org) and 3D Slicer (http://www.slicer.org). Tensors were fit to DWI data to perform DTI, and tractography streamlines were then reconstructed using deterministic tractography. A voxel classifier was used to identify image features as CMB candidates using Microbleed Anatomic Rating Scale (MARS) guidelines. For each peri-lesional DTI streamline bundle, the null hypothesis was formulated as the statement that there was no neurological or cognitive deficit associated with between-scan differences in the mean FA of DTI streamlines within each bundle. The statistical significance of each hypothesis test was calculated at the α = 0.05 level, subject to the family-wise error rate (FWER) correction for multiple comparisons. Results: In HC volunteers, the along-track analysis failed to identify statistically significant differences in the mean FA of DTI streamline bundles. In the mTBI group, significant differences in the mean FA of peri-lesional streamline bundles were found in 21 out of 26 volunteers. In those volunteers where significant differences had been found, these differences were associated with an average of ~47% of all identified CMBs (σ = 21%). In 12 out of the 21 volunteers exhibiting significant FA changes, cognitive functions (memory acquisition and retrieval, top-down control of attention, planning, judgment, cognitive aspects of decision-making) were found to have deteriorated over the six months following injury (r = -0.32, p < 0.001). Our preliminary results suggest that acute post-TBI CMBs may be associated with cognitive decline in some mTBI patients. Future research should attempt to identify mTBI patients at high risk for cognitive sequelae.

Keywords: traumatic brain injury, magnetic resonance imaging, diffusion tensor imaging, connectomics

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Authors: Monica Puri Sikka, Subrato Ghosh Arunangshu Mukhopadhyay

Abstract:

Appropriate compression bandaging is important for compression therapeutic medical diseases. The high compression approach employed for treating venous leg ulcers should be used correctly so that sufficient (but not excessive) pressure is applied. Bandages used to treat venous disease by compression should achieve and sustain effective levels and gradients of pressure and minimise the risk of pressure trauma. To maintain graduated compression on the limb the bandage needs to be applied at same tension for each layer from ankle to the knee. In this paper the geometry for various bandaging procedures is used to wrap each layer of bandage by marking the relaxed length of the bandage. The relaxed length is calculated depending on the stretch, average circumference of the limb on which it is to be applied and the bandaging technique to be used. This paper aims at developing a scientific approach while applying the bandage to reduce the inter operator variability in applying same tension on each successive layer of bandage.

Keywords: bandaging, compression, inter operator variability, graduated, relaxed length, stretch

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Authors: Huma Naqeeb

Abstract:

Epidemiological studies have shown the robust link between breast cancer and dietary pattern. There has been no previous study conducted in Pakistan, which specifically focuses on dietary patterns among breast cancer women. This study aims to examine the association of breast cancer with dietary patterns among Pakistani women. This case-control research was carried in multiple tertiary care facilities. Newly diagnosed primary breast cancer patients were recruited as cases (n = 408); age matched controls (n = 408) were randomly selected from the general population. Data on required parameters were systematically collected using subjective and objective tools. Factor and Principal Component Analysis (PCA) techniques were used to extract women’s dietary patterns. Four dietary patterns were identified based on eigenvalue >1; (i) veg-ovo-fish, (ii) meat-fat-sweet, (iii) mix (milk and its products, and gourds vegetables) and (iv) lentils - spices. Results of the multiple regressions were displayed as adjusted odds ratio (Adj. OR) and their respective confidence intervals (95% CI). After adjusted for potential confounders, veg-ovo-fish dietary pattern was found to be robustly associated with a lower risk of breast cancer among women (Adj. OR: 0.68, 95%CI: (0.46-0.99, p<0.01). The study findings concluded that attachment to the diets majorly composed of fresh vegetables, and high quality protein sources may contribute in lowering the risk of breast cancer among women.

Keywords: breast cancer, dietary pattern, women, principal component analysis

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Authors: H.-H. Doh, J.-M. Yu, Y.-J. Kwon, J.-H. Shin, H.-W. Kim, S.-H. Nam, D.-H. Lee

Abstract:

This paper suggests a decision tree based approach for flexible job shop scheduling with multiple process plans, i. e. each job can be processed through alternative operations, each of which can be processed on alternative machines. The main decision variables are: (a) selecting operation/machine pair; and (b) sequencing the jobs assigned to each machine. As an extension of the priority scheduling approach that selects the best priority rule combination after many simulation runs, this study suggests a decision tree based approach in which a decision tree is used to select a priority rule combination adequate for a specific system state and hence the burdens required for developing simulation models and carrying out simulation runs can be eliminated. The decision tree based scheduling approach consists of construction and scheduling modules. In the construction module, a decision tree is constructed using a four-stage algorithm, and in the scheduling module, a priority rule combination is selected using the decision tree. To show the performance of the decision tree based approach suggested in this study, a case study was done on a flexible job shop with reconfigurable manufacturing cells and a conventional job shop, and the results are reported by comparing it with individual priority rule combinations for the objectives of minimizing total flow time and total tardiness.

Keywords: flexible job shop scheduling, decision tree, priority rules, case study

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Authors: Mazyar Yosofi, Olivier Kerbrat, Pascal Mognol

Abstract:

Life cycle assessment of additive manufacturing processes has evolved significantly since these past years. A lot of existing studies mainly focused on energy consumption. Nowadays, new methodologies of life cycle inventory acquisition came through the literature and help manufacturers to take into account all the input and output flows during the manufacturing step of the life cycle of products. Indeed, the environmental analysis of the phenomena that occur during the manufacturing step of additive manufacturing processes is going to be well known. Now it becomes possible to count and measure accurately all the inventory data during the manufacturing step. Optimization of the environmental performances of processes can now be considered. Environmental performance improvement can be made by varying process parameters. However, a lot of these parameters (such as manufacturing speed, the power of the energy source, quantity of support materials) affect directly the mechanical properties, surface finish and the dimensional accuracy of a functional part. This study aims to improve the environmental performance of an additive manufacturing process without deterioration of the part quality. For that purpose, the authors have developed a generic method that has been applied on multiple parts made by additive manufacturing processes. First, a complete analysis of the process parameters is made in order to identify which parameters affect only the environmental performances of the process. Then, multiple parts are manufactured by varying the identified parameters. The aim of the second step is to find the optimum value of the parameters that decrease significantly the environmental impact of the process and keep the part quality as desired. Finally, a comparison between the part made by initials parameters and changed parameters is made. In this study, the major finding claims by authors is to reduce the environmental impact of an additive manufacturing process while respecting the three quality criterion of parts, mechanical properties, dimensional accuracy and surface roughness. Now that additive manufacturing processes can be seen as mature from a technical point of view, environmental improvement of these processes can be considered while respecting the part properties. The first part of this study presents the methodology applied to multiple academic parts. Then, the validity of the methodology is demonstrated on functional parts.

Keywords: additive manufacturing, environmental impact, environmental improvement, mechanical properties

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Authors: Ceyda Sensin

Abstract:

Chios Island in Greece hosts many refugees from the Middle East since the Turkey-EU Refugee Deal. Thus, it has become commonplace for non-governmental organizations (NGO) to provide help for refugees in various ways. The purpose of this research is to identify ways in which improvements can be made in the educational services offered to young adult refugees (age group 14-22) by the NGO’s. To meet this aim, an unstructured observational technique was used in this qualitative study. The data was collected as a participant observer in February 2018. According to the observations made in this study, it came out that international NGOs may utilize volunteering team members on an urgent basis since they are a free resource from all around the world. In this study, it was observed that the volunteering team members without any teaching qualifications or teaching experience have struggled with reaching refugee students with or without potential mental health problems from exposure to stress, turmoil and trauma. Therefore, this study highly recommends the use of more relevantly trained professionals, alongside the volunteer staff. Alternatively, the volunteer staffs need to have teacher training and periodical refresher training.

Keywords: ethnographic study, non-governmental organizations, refugees, qualitative research method

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Authors: María de los Ángeles Crespo López, Carmen García García

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The highly competitive nature of today's globalised marketplace requires that brands and stores develop effective commercial strategies to ensure their economic survival. Maintaining the loyalty of existing customers constitutes one key strategy that yields the best results. Although the relationship between consumers' self-congruity and their manifestations of loyalty towards a store has been investigated, the role of store personality in this relationship remains unclear. In this study, multiple parallel mediation analysis was used to examine the effect of Store Personality on the relationship between Self-Congruity of consumers and their Manifestations of Loyalty. For this purpose, 457 Spanish consumers of the Fnac store completed three self-report questionnaires assessing Store Personality, Self-Congruity, and Store Loyalty. The data were analyzed using the SPSS macro PROCESS. The results revealed that three dimensions of Store Personality, namely Exciting, Close and Competent Store, positively and significantly mediated the relationship between Self-Congruity and Manifestations of Loyalty. The indirect effect of Competent Store was the greatest. This means that a consumer with higher levels of Self-Congruity with the store will exhibit more Manifestations of Loyalty when the store is perceived as Exciting, Close or Competent. These findings suggest that more attention should be paid to the perceived personality of stores for the development of effective marketing strategies to maintain or increase consumers' manifestations of loyalty towards stores.

Keywords: multiple parallel mediation, PROCESS, self-congruence, store loyalty, store personality

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Authors: H. Al-Baghli, F. Al-Asfour

Abstract:

The current applied asphalt technology for Kuwait roads pavement infrastructure is the hot mix asphalt (HMA) pavement, including both pen grade and polymer modified bitumen (PMBs), that is produced and compacted at high temperature levels ranging from 150 to 180 °C. There are no current specifications for warm and cold mix asphalts in Kuwait’s Ministry of Public Works (MPW) asphalt standard and specifications. The process of the conventional HMA is energy intensive and directly responsible for the emission of greenhouse gases and other environmental hazards into the atmosphere leading to significant environmental impacts and raising health risk to labors at site. Warm mix asphalt (WMA) technology, a sustainable alternative preferred in multiple countries, has many environmental advantages because it requires lower production temperatures than HMA by 20 to 40 °C. The reduction of temperatures achieved by WMA originates from multiple technologies including foaming and chemical or organic additives that aim to reduce bitumen and improve mix workability. This paper presents a literature review of WMA technologies and techniques followed by an experimental study aiming to compare the results of produced WMA samples, using a water containing additive (foaming process), at different compaction temperatures with the HMA control volumetric properties mix designed in accordance to the new MPW’s specifications and guidelines.

Keywords: warm-mix asphalt, water-bearing additives, foaming-based process, chemical additives, organic additives

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Authors: Rabiaal Adawiyah Shazali, Corina Joseph

Abstract:

The disclosure of Intellectual Capital (IC) information is getting more vital in today’s era of a knowledge-based economy. Companies are advised by accounting bodies to enhance IC disclosure which complements the conventional financial disclosures. There are no accounting standards for Intellectual Capital Disclosure (ICD), therefore the disclosure is entirely voluntary. Hence, this study aims to investigate the extent of ICD and to examine the relationship between corporate governance and ICD in Malaysia. This study employed content analysis of 100 annual reports by the top 100 public listed companies in Malaysia during 2012. The uniqueness of this study lies on its underpinning theory used where it applies the institutional isomorphism theory to support the effect of the attributes of corporate governance towards ICD. In order to achieve the stated objective, multiple regression analysis were employed to conduct this study. From the descriptive statistics, it was concluded that public listed companies in Malaysia have increased their awareness towards the importance of ICD. Furthermore, results from the multiple regression analysis confirmed that corporate governance affects the company’s ICD where the frequency of audit committee meetings and the board size has positively influenced the level of ICD in companies. Findings from this study would provide an incentive for companies in Malaysia to enhance the disclosure of IC. In addition, this study would assist Bursa Malaysia and other regulatory bodies to come up with a proper guideline for the disclosure of IC.

Keywords: annual report, content analysis, corporate governance, intellectual capital disclosure

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