Search results for: short wave infrared region

Authors: Zengda Li

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The tectonic evolution of the Beishan orogen, which forms part of the Central Asian Orogenic Belt, remains debated. This study reports the identification of three Triassic granitic plutons representing two distinct stages of magmatism in southern Beishan orogen. Zircon U–Pb dating constrains the early stage as 238–237 Ma and the late stage as 229–227 Ma. The granitoids belong to high-K calc-alkaline and shoshonitic series and exhibit alkalic-calcic and calc-alkalic features, and are weakly peraluminous rocks. Most of these granitoids are highly fractionated I-type and A-type granites. They have relatively high Isr values (0.7049–0.7086) and weak negative εNd(t) values of −1.5 to −2.1, with young Nd model ages of 1.04–0.91 Ga, indicating a crustal contribution. They also show markedly positive zircon εHf(t) values (+3.4 to +11.8) and two-stage Hf model ages of 1.06–0.69 Ga, indicating a mixture of mantle and crustal components. The lithospheric mantle beneath this region incorporating older subducted materials was metasomatized by fluids or melts. Partial melting of the metasomatized lithospheric mantle resulted in underplated magmas, which provided the heat and material input to generate the granitoids. The Middle Triassic granitic plutons show moderate negative Eu anomalies, enrichment of LILEs and depletion in Nb, Ta, and Ti suggesting partial melting of crustal components in response to the underplated mantle-derived magmas, probably linked to lithospheric delamination and asthenospheric upwelling. The Late Triassic granitic plutons show characteristics of post-orogenic granite with strong negative anomalies of Eu, Ba, Nb, Sr, P, and Ti, indicating fractional crystallization and crustal contamination during the emplacement process.

Keywords: Triassic, magmatism, geochronology, petrogenesis, Beishan orogen

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Authors: Dib Imane, Chettah Wahid, Khedidja Abdelhamid

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The plain of Gadaïne - Ain Yaghout, located in the wilaya of Batna (Eastern Algeria), experiences intensive human activities, particularly in agricultural practices which are accompanied by an increasing use of chemical fertilizers and manure. These activities lead to a degradation of the quality of water resources. In order to protect the quality of groundwater in this plain and formulate effective strategies to mitigate or avoid any contamination of groundwater, a risk assessment using the European method known as “COSTE Action 620” was applied to the mio-. plio-quaternary aquifer of this plain. Risk assessment requires the identification of existing dangers and their potential impact on groundwater by using a system of evaluation and weighting. In addition, it also requires the integration of the hydrogeological factors that influence the movement of contaminants by means of the intrinsic vulnerability maps of groundwater, which were produced according to the modified DRASTIC method. The overall danger on the plain ranges from very low to high. Farms containing stables, houses detached from the public sewer system, and sometimes manure piles were assigned a weighting factor expressing the highest degree of harmfulness; this created a medium to high danger index. Large areas for agricultural practice and grazing are characterized, successively, by low to very low danger. Therefore, the risks present at the study site are classified according to a range from medium to very high-risk intensity. These classes successively represent 3%, 49%, and 0.2% of the surface of the plain. Cultivated land and farms present a high to very high level of risk successively. In addition, with the exception of the salt mine, which presents a very high level of risk, the gas stations and cemeteries, as well as the railway line, represent a high level of risk.

Keywords: semi-arid, quality of water resources, risk assessment, vulnerability, contaminants

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Authors: Farah Naja, Nahla Hwalla, Leila Itani, Shirine Baalbaki, Abla Sibai, Lara Nasreddine

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Purpose: To propose an index for assessing adherence to a Middle-Eastern version of the Mediterranean diet as represented by the traditional Lebanese Mediterranean diet (LMD), to evaluate the association between the LMD and selected European Mediterranean diets (EMD); to examine socio-demographic and lifestyle correlates of adherence to Mediterranean diet (MD) among Lebanese adults. Methods: Using nationally representative dietary intake data of Lebanese adults, an index to measure adherence to the LMD was derived. The choice of food groups used for calculating the LMD score was based on results of previous factor analyses conducted on the same dataset. These food groups included fruits, vegetables, legumes, olive oil, burghol, dairy products, starchy vegetables, dried fruits, and eggs. Using Pearson’s correlation and scores tertiles distributions agreement, the derived LMD index was compared to previously published EMD indexes from Greece, Spain, Italy, France, and EPIC. Results: Fruits, vegetables and olive oil were common denominators to all MD scores. Food groups, specific to the LMD, included burghol and dried fruits. The LMD score significantly correlated with the EMD scores, while being closest to the Italian (r=0.57) and farthest from the French (r=0.21). Percent agreement between scores’ tertile distributions and Kappa statistics confirmed these findings. Multivariate linear regression showed that older age, higher educational, female gender, and healthy lifestyle characteristics were associated with increased adherence to all MD studied. Conclusion: A novel LMD index was proposed to characterize Mediterranean diet in Lebanon, complementing international efforts to characterize the MD and its association with disease risk.

Keywords: mediterranean diet, adherence, Middle-East, Lebanon, Europe

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Authors: Suneeta Gireesh Panicker

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Aim: Aminopeptidase P (APP) is an enzyme that has specificity for proline, can specifically cleave Xaa-Proline peptides and is a metallo-aminopeptidase. The bonds nearby to the imino acid proline are tough to cleave by many peptidases, but APP can specifically break peptide bonds engaged with proline. Membrane-bound form and a cytosolic form are the two forms in which this enzyme exists. The exact physiological function of APP remains unclear and hence the present work attempts to determine it. Methods: In the present study, the expression pattern of cytosolic Aminopeptidase P (DAP) was determined in all the embryonic stages and larval stages of wild-type Drosophila by using polyclonal monospecific antibodies. To show the presence of DAP RNA in embryonic and larval stages, RNA in situ hybridization was performed. DAP promoter-LacZ fusion reporter gene vector was used to construct transgenic embryos to study the regulation pattern of DAP. To study the DAP expression profile, a transgenic fly consisting of a DAP promoter with β-gal and GFP reporter genes in front of it was constructed. Results: DAP protein expression was observed in neuroectodermal cells, posterior midgut primordium, proctodeum, ventral neuroblast and primordial stomatogastric nervous system. It was observed in the ventral cord and midgut in stage 12. The completely developed embryos showed the intense occurrence of it in the ventral cord and gut region. The eye-antennal disc, wing disc and leg disc also showed the presence of DAP protein. LacZ expression in transgenic embryos also showed the same pattern. Conclusion: Similar to various known multiple-functional proteins, DAP could be one with different functions at different stages and in different cells. Data presented here designates DAP functions in the early embryonic and imaginal dics differentiation and development, suggesting that it may be required for the metabolism of proteins like neuropeptides and tachykinins.

Keywords: aminopeptidase P, in situ hybridization, transgenic fly, embryonic stages

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Authors: M. Joris, O. Agirdag

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For over two decades, calls for citizenship education (CE) have been rising to the top of educational policy agendas in Europe. The main motive for the current treatment of CE as a key topic is a sense of crisis: social and political threats that go beyond the reach of nations and require action at the international and European level. On the one hand, this context has triggered abundant attention to the promotion of citizenship through education. On the other hand, the ubiquity of citizenship and education in policy language is paired with a self-evident manner of using the concepts: the more we call for citizenship in and through education, the less the concepts seem to be made explicit or be defined. Research and reflection on the normativity of the concepts of citizenship and CE in Europe are scarce. Departing from the idea that policies are always normative, this study, therefore, investigates the normativity of the current concepts of citizenship and education, in ’key’ European CE policy texts. The study consists of a content analysis of these texts, based on a normative framework developed around the different dimensions of citizenship as status, identity, virtues and agency. The framework also describes the purposes of education and its learning processes, content and practices, based on the assumption that good education always includes, next to qualification and socialisation, a purpose of emancipation: of helping young people become autonomous and independent subjects. The analysis shows how contemporary European citizenship is conceptualised around the dimension of competences. This focus on competences is also visible in the normative framing of education and its relationship to citizenship in the texts: CE should help young people learn how to become good citizens by acquiring a toolkit of competences, consisting of knowledge, skills, values and attitudes that can be predetermined, measured and evaluated. This ideal of citizenship-as-competence entails a focus on the educational purposes of socialisation and qualification. Current policy texts thus seem to leave out the educational purpose of emancipating young people, allowing them to take on citizenship as something to which they can determine their own relation and position. It is, however, this purpose of CE that seems increasingly important in our current context. Young people are stepping out of school and onto the streets by the thousands in Belgium and throughout Europe, protesting for more and better environmental policies. They are making use of existing modes of citizenship, exactly to indicate to policymakers how these are falling short and are claiming their right and entitlement to a future that established practices of politics are putting at risk. The importance of citizenship education might then lie, now more than ever, not in the fact that it would prepare young people for competent citizenship, but in offering them a possibility, an emancipatory experience of being able to do something new. It seems that this is what we might want to expect from the school if we want it to educate our truly future citizens.

Keywords: citizenship education, normativity, policy, purposes of education

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Authors: Yibeltal T. Bayou, Yohana S. Mashalla, Gloria Thupayagale-Tshweneagae

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Background: According to the World Health Organization, caesarean section delivery rates of more than 10-15% caesarean section deliveries in any specific geographic region in the world are not justifiable. The aim of the study was to describe the level and analyse determinants of caesarean section delivery in Addis Ababa. Methods: Data was collected in Addis Ababa using a structured questionnaire administered to 901 women aged 15-49 years through a stratified two-stage cluster sampling technique. Binary logistic regression model was employed to identify predictors of caesarean section delivery. Results: Among the 835 women who delivered their last birth at healthcare facilities, 19.2% of them gave birth by caesarean section. About 9.0% of the caesarean section births were due to mother’s request or service provider’s influence without any medical indication. The caesarean section delivery rate was much higher than the recommended rate particularly among the non-slum residents (27.2%); clients of private healthcare facilities (41.1%); currently married women (20.6%); women with secondary (22.2%) and tertiary (33.6%) level of education; and women belonging to the highest wealth quintile household (28.2%). The majority (65.8%) of the caesarean section clients were not informed about the consequences of caesarean section delivery by service providers. The logistic regression model shows that older age (30-49), secondary and above education, non-slum residence, high-risk pregnancy and receiving adequate antenatal care were significantly positively associated with caesarean section delivery. Conclusion: Despite the unreserved effort towards achieving MDG 5 through safe skilled delivery assistance among others, the high caesarean section rate beyond the recommend limit, and the finding that caesarean sections done without medical indications were also alarming. The government and city administration should take appropriate measures before the problems become setbacks in healthcare provision. Further investigations should focus on the effect of caesarean section delivery on maternal and child health outcomes in the study area.

Keywords: Addis Ababa, caesarean section, mode of delivery, slum residence

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Authors: Alexandra Shipley

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Background: Undergraduate paediatric teaching must overcome two major challenges: 1) balancing patient safety with active student engagement and 2) exposing students to a comprehensive range of pathologies within a relatively short clinical placement. Whilst lectures and shadowing on paediatric wards constitute the mainstay of learning, Simulation and Virtual Reality (VR) are emerging as effective teaching tools, which - immune to the unpredictability and seasonal variation of hospital presentations - could expose students to the entire syllabus more reliably, efficiently, and independently. We aim to evaluate the potential utility of Simulation and VR in addressing gaps within the traditional paediatric curriculum from the perspective of medical students. Summary of Work: Exposure to and perceived utility of various learning opportunities within the Paediatric and Emergency Medicine courses were assessed through a questionnaire completed by 5th year medical students (n=23). Summary of Results: Students reported limited exposure to several common acute paediatric presentations, such as bronchiolitis (41%), croup (32%) or pneumonia (14%), and to clinical emergencies, including cardiac/respiratory arrests or trauma calls (27%). Across all conditions, average self-reported confidence in assessment and management to the level expected of an FY1 is greater amongst those who observed at least one case (e.g. 7.6/10 compared with 3.6/10 for croup). Students rated exposure through Simulation or VR to be of similar utility to witnessing a clinical scenario on the ward. In free text responses, students unanimously favoured being ‘challenged’ through ‘hands-on’ patient interaction over passive shadowing, where it is ‘easy to zone out.’ In recognition of the fact that such independence is only appropriate in certain clinical situations, many students reported wanting more Simulation and VR teaching. Importantly, students raised the necessity of ‘proper debriefs’ after these sessions to maximise educational value. Discussion and Conclusion: Our questionnaire elicited several student-perceived challenges in paediatric education, including incomplete exposure to common pathologies and limited opportunities for active involvement in patient care. Indeed, these experiences seem to be important predictors of confidence. Quantitative and qualitative feedback suggests that VR and Simulation satisfy students’ self-reported appetite for independent engagement with authentic clinical scenarios. Take-aways: Our findings endorse further development of VR and Simulation as high-yield adjuncts to paediatric education.

Keywords: paediatric emergency education, simulation, virtual reality, medical education

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Authors: Qin Zhu

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Under the background of accelerating the construction of Beautiful and Livable Park City in Chengdu, the Tianfu greenway system, as an important support system for the construction of parks in the whole region, its accessibility is one of the key indicators to measure the effectiveness of the greenway construction. In recent years, cycling has become an important transportation mode for residents to go to the greenways because of its low-carbon, healthy and convenient characteristics, and the study of greenway accessibility under cycling mode can provide reference suggestions for the optimization and improvement of greenways. Taking Jincheng Greenway in Chengdu City as an example, the Baidu Map Application Programming Interface (API) and questionnaire survey was used to improve the two-step floating catchment area (2SFCA) method from the three dimensions of search threshold, supply side and demand side, to calculate the cycling accessibility of the greenway and to explore the spatial matching relationship with the population density, the number of entrances and the comprehensive attractiveness. The results show that: 1) the distribution of greenway accessibility in Jincheng shows a pattern of "high in the south and low in the north, high in the west and low in the east", 2) the spatial match between greenway accessibility and population density of the residential area is imbalanced, and there is a significant positive correlation between accessibility and the number of selectable greenway access points in residential areas, as well as the overall attractiveness of greenways, with a high degree of match. On this basis, it is proposed to give priority to the mismatch area to alleviate the contradiction between supply and demand, optimize the greenway access points to improve the traffic connection, enhance the comprehensive quality of the greenway and strengthen the service capacity, to further improve the cycling accessibility of the Jincheng Greenway and improve the spatial allocation of greenway resources.

Keywords: accessibility, Baidu maps API, cycling, greenway, 2SFCA

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Authors: My Hachem Aouragh, Hind Ragragui, Abdellah El-Hmaidi, Ali Essahlaoui, Abdelhadi El Ouali

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This study investigates soil erosion susceptibility in the Oued Mikkes watershed, located in the Meknes-Fez region of northern Morocco, utilizing advanced techniques such as deep learning algorithms and remote sensing integrated within Geographic Information Systems (GIS). Spanning approximately 1,920 km², the watershed is characterized by a semi-arid Mediterranean climate with irregular rainfall and limited water resources. The waterways within the watershed, especially the Oued Mikkes, are vital for agricultural irrigation and potable water supply. The research assesses the extent of erosion risk upstream of the Sidi Chahed dam while developing a spatial model of soil loss. Several important factors, including topography, land use/land cover, and climate, were analyzed, with data on slope, NDVI, and rainfall erosivity processed using deep learning models (DLNN, CNN, RNN). The results demonstrated excellent predictive performance, with AUC values of 0.92, 0.90, and 0.88 for DLNN, CNN, and RNN, respectively. The resulting susceptibility maps provide critical insights for soil management and conservation strategies, identifying regions at high risk for erosion across 24% of the study area. The most high-risk areas are concentrated on steep slopes, particularly near the Ifrane district and the surrounding mountains, while low-risk areas are located in flatter regions with less rugged topography. The combined use of remote sensing and deep learning offers a powerful tool for accurate erosion risk assessment and resource management in the Mikkes watershed, highlighting the implications of soil erosion on dam siltation and operational efficiency.

Keywords: soil erosion, GIS, remote sensing, deep learning, Mikkes Watershed, Morocco

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Authors: Zarina Othman, Bakri Mat, Aini Fatihah Roslam

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The Burmese ethnic known as Rohingya is one of the world’s most persecuted ethnic minorities on earth. They have been massacred, discriminated, humiliated, gang-raped, trafficked, abused and neglected. More than one million Rohingyas have been displaced internally and overseas. Currently, Rohingya asylum seekers can be found in India, Bangladesh, Thailand, Malaysia, and Indonesia. This forced migration is unacceptable since the Rohingya are stateless although they have been part of Myanmar for more than one century. Why the Rohingyas crisis is important to be analyse from human security perspectives? Understanding the human security of the Rohingya is important because the crisis may have implication on the regional stability in South and South-East Asia. The objectives of the research are to provide an explanation to the current human security situation in Myanmar, to analyse the regional implication of the Rohingya’s crisis and to recommend the workable solution that may help to reduce the tension. To analyze and demonstrate the case, the research has adopted the BAGHUS or Bangi Human Security Approach, a Southeast Asian human security model, designed to protect the weakest and the vital core of human life across national borders. Based on a qualitative research, and a review of literature from secondary sources of books, reports and academic journals, the research has conducted interviews with 1) Rohingya respondents in Cox’s Baza in February 2017; 2) experts and scholars in the field in Bangladesh, Myanmar and Malaysia. Preliminary findings suggest that conflicts lead to displacement and migration across borders, human insecurity is an issue where the implementation of human rights is too slow to take place even in sovereign state like Myanmar. The political and economic interests of many extraregional powers have further contributed to the current crisis. Human security perspectives is suggested as the workable solution for stability and peace in the region.

Keywords: human security, migration, Myanmar, regional security, Rohingya

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Authors: Jakia Rajoana

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The aim of this paper is to examine the role of women entrepreneurs in bringing about sustainable rural tourism (SRT) development in Sundarbans area of Bangladesh. Theoretically, it draws upon empowerment and entrepreneurial marketing concepts. Women entrepreneurship development and lack of empowered women as role models is an important issue for developing economies in South Asia. Despite the substantial role women play in rural economy of Sundarbans, their contribution remains overlooked as enterprises led by them are run on an informal basis and their business acumen is not taken seriously both by their families and society at large. Studies on SRT fail to engage in sufficient depth with the term applied in this paper as ‘invisible women on the margins’ who run their enterprises with no formal training or societal/familial support. Moreover, the link between their (non) tourism enterprise and their empowerment remains under-theorized. Thus empirically, this research seeks to fill a significant gap by focusing on a considerably under-researched Sundarbans region. Methodologically, this study follows a qualitative research design using visual ethnographic approach. Participant observation, semi-structured interviews, and documentation are the primary data collection instruments in three coastal communities – Munshigonj, Burigoalini and Gabura – in the Sundarbans area. By focusing on the narratives of these under-investigated women, this work aims to provide in-depth and nuanced insights into salient issues on marginal communities experience from rural women’s perspectives. Initial findings illustrate that the Sundarbans women have low income due to no or little education. In addition, socio-cultural and religious factors also restrict the scope of their extensive contribution to workplace. In addition, physical and social violence which is a common occurrence for these women inhibits their agency and contributes to their disempowerment.

Keywords: gender, empowerment, entrepreneurial marketing, sustainable rural tourism, Sundarbans

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Authors: Bauta J., Raynaud C., Vaca-Medina G., Simon V., Roully A., Vandenbossche V.

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Sargassum is a brown algae, originally found in the Sargasso Sea, located in the Caribbean region and the Gulf of Mexico. The flow of Sargassum is becoming a critical environmental problem all over the Caribbean islands particularly. In Guadeloupe alone, around 80,000 tons of seaweed are stranded during the season. Since the appearance of the first waves of Sargassum algae, several measures have been taken to collect them to keep the beaches clean. Nevertheless, 90% of the collected algae are currently stored without recovery. The lack of research initiative demands a more in-depth exploration of Sargassum algae chemistry, targeted towards added value applications and their development. In this context, the aim of the study was to develop a biorefinery process to valorize Sargassum as a source of bioactive natural substances and as raw material to produce biomaterials simultaneously. The technology used was the twin-screw extrusion, which allows to achieve continuously in the same machine different unit fractionation operations. After the identification of the molecules of interest in Sargassum algae, different operating conditions of thermo-mechanical treatment were applied in a twin-screw extruder. The nature of the solvent, the configuration of the extruder, the screw profile, and the temperature profile were studied in order to fractionate the algal biomass and to allow the recovery of a bioactive liquid fraction of interest and a solid residue suitable for the production of biomaterials. Each bioactive liquid fraction was characterized and strategic ways of adding value were proposed. In parallel, the possibility of using the solid residue to produce biomaterials was studied by setting up Dynamic Vapour Sorption (DVS) and basic Pressure-Volume-Temperature (PVT) analyses. The solid residue was molded by compression cooking. The obtained materials were finally characterized mechanically. The results obtained were very comforting and gave some perspectives to find an interesting valorization for the Sargassum algae.

Keywords: seaweeds, twin-screw extrusion, fractionation, bioactive compounds, biomaterials, biomass

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Authors: Julia R. Beulig, Stefan Ohla, Detlev Belder

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In contrast to off-line analytical methods, lab-on-a-chip technology delivers direct information about the observed reaction. Therefore, microfluidic devices make an important scientific contribution, e.g. in the field of synthetic chemistry. Herein, the rapid generation of analytical data can be applied for the optimization of chemical reactions. These microfluidic devices enable a fast change of reaction conditions as well as a resource saving method of operation. In the presented work, we focus on the investigation of multiphase regimes, more specifically on a biphasic microfluidic droplet systems. Here, every single droplet is a reaction container with customized conditions. The biggest challenge is the rapid qualitative and quantitative readout of information as most detection techniques for droplet systems are non-specific, time-consuming or too slow. An exception is the electrospray mass spectrometry (ESI-MS). The combination of a reaction screening platform with a rapid and specific detection method is an important step in droplet-based microfluidics. In this work, we present a novel approach for synthesis optimization on the nanoliter scale with direct ESI-MS detection. The development of a droplet-based microfluidic device, which enables the modification of different parameters while simultaneously monitoring the effect on the reaction within a single run, is shown. By common soft- and photolithographic techniques a polydimethylsiloxane (PDMS) microfluidic chip with different functionalities is developed. As an interface for the MS detection, we use a steel capillary for ESI and improve the spray stability with a Teflon siphon tubing, which is inserted underneath the steel capillary. By optimizing the flow rates, it is possible to screen parameters of various reactions, this is exemplarity shown by a Domino Knoevenagel Hetero-Diels-Alder reaction. Different starting materials, catalyst concentrations and solvent compositions are investigated. Due to the high repetition rate of the droplet production, each set of reaction condition is examined hundreds of times. As a result, of the investigation, we receive possible reagents, the ideal water-methanol ratio of the solvent and the most effective catalyst concentration. The developed system can help to determine important information about the optimal parameters of a reaction within a short time. With this novel tool, we make an important step on the field of combining droplet-based microfluidics with organic reaction screening.

Keywords: droplet, mass spectrometry, microfluidics, organic reaction, screening

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Authors: A. Camões, M. Ferreira Dias, M. Amorim

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In recent years, the social economy is increasingly seen as a viable means to address social problems. Social enterprises, as well as public projects and initiatives targeted to meet social purposes, offer organizational models that assume heterogeneity, flexibility and adaptability to the ‘real world and real problems’. Despite the growing popularity of social initiatives, decision makers still face a paucity in what concerns the available models and tools to adequately assess its sustainability, and its impacts, notably the nature of its contribution to economic growth. This study was carried out at the local level, by analyzing the social impact initiatives and projects promoted by the Municipality of Albergaria-a-Velha (Câmara Municipal de Albergaria-a-Velha -CMA), a municipality of 25,000 inhabitants in the central region of Portugal. This work focuses on the challenges related to the qualifications and employability of citizens, which stands out as one of the key concerns in the Portuguese economy, particularly expressive in the context of small-scale cities and inland territories. The study offers a characterization of the Municipality, its socio-economic structure and challenges, followed by an exploratory analysis of multiple sourced data, collected from the CMA's documental sources as well as from privileged informants. The purpose is to conduct detailed analysis of the CMA's social projects, aimed at characterizing its potential impact for the model of qualifications and employability of the citizens of the Municipality. The study encompasses a discussion of the socio-economic profile of the municipality, notably its asymmetries, the analysis of the social projects and initiatives, as well as of data derived from inquiry actors involved in the implementation of the social projects and its beneficiaries. Finally, the results obtained with the Better Life Index will be included. This study makes it possible to ascertain if what is implicit in the literature goes to the encounter of what one experiences in reality.

Keywords: measurement, municipalities, social economy, social impact

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Authors: Clémence Royer, Stéphane Mazouffre

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Nowadays, electric propulsion systems play a crucial role in space exploration missions due to their high specific impulse and long operational life. The Hall thrusters are one of the most mature EP technologies. It is a gridless ion thruster that has proved reliable and high-performance for decades in various space missions. Operation of HT relies on electron emissions through a cathode placed outside a hollow dielectric channel that includes an anode at the back. Negatively charged particles are trapped in a magnetic field and efficiently slow down. By collisions, the electron cloud ionizes xenon atoms. A large electric field is generated in the axial direction due to the low electron transverse mobility in the region of a strong magnetic field. Positive particles are pulled out of the chamber at high velocity and are neutralized directly at the exhaust area. This phenomenon leads to the acceleration of the spacecraft system at a high specific impulse. While HT’s architecture and operating principle are relatively simple, the physics behind thrust is complex and still partly unknown. Current and voltage oscillations, as well as electron properties, have been captured over a 30 mn time period after ignition. The observed low-frequency oscillations exhibited specific frequency ranges, amplitudes, and stability patterns. Correlations between the oscillations and plasma characteristics we analyzed. The impact of these instabilities on thruster performance, including thrust efficiency, has been evaluated as well. Moreover, strategies for mitigating and controlling these instabilities have been developed, such as filtering. In this contribution, in addition to presenting a summary of the results obtained in the transient regime, we will present and discuss recent advances in Hall thruster plasma discharge filtering and control.

Keywords: electric propulsion, Hall Thruster, plasma diagnostics, low-frequency oscillations

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Authors: Rakesh C. Mathad, G. Y. Lokesh, Basavegowda

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In agriculture using quality seeds of improved varieties is very important to ensure higher productivity thereby food security and sustainability. To ensure good productivity, seeds should have characters as described by the breeder. To know whether the characters as described by the breeder are expressing in a variety such as genuineness or genetic purity, field grow out test (GOT) is done. In pigeon pea which is long durational crop, conducting a GOT may take very long time and expensive also. Since in pigeon pea flower character is a most distinguishing character from the contaminants, conducting a field grow out test require 120-130 days or till flower emergence, which may increase cost of storage and seed production. This will also delay the distribution of seed inventory to the pigeon pea growing areas. In this view during 2014-15 with financial support of Govt. of Karnataka, India, a project to develop a molecular genetic test for newly developed variety of pigeon pea cv.TS3R was commissioned at Seed Unit, UAS, Raichur. A molecular test was developed with the help SSR markers to identify pure variety from possible off types in newly released pigeon pea variety TS3R. In the investigation, 44 primer pairs were screened to identify the specific marker associated with this variety. Pigeon pea cv. TS3R could be clearly identified by using the primer CCM 293 based on the banding pattern resolved on gel electrophoresis and PCR reactions. However some of the markers like AHSSR 46, CCM 82 and CCM 57 can be used to test other popular varieties in the region like Asha, GRG-811 and Maruti respectively. Further to develop this in to a lab test, the seed sample size was standardized to 200 seeds and a grow out matrix was developed. This matrix was used to sample 12 days old leaves to extract DNA. The lab test results were validated with actual field GOT test results and found variations within the acceptable limit of 1%. This molecular method can now be employed to test the genetic purity in pigeon pea cv TS3R which reduces the time and can be a cheaper alternative method for field GOT.

Keywords: genuineness, grow-out matrix, molecular genetic purity, SSR markers

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Authors: Albert Herve Nkolo Mpoko

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The Foreign Direct Investment (FDI) landscape in Cameroon has garnered significant attention from both European and Asian nations due to perceived benefits such as capital infusion, technology transfer, and potential for economic expansion. However, it is noteworthy that South Africa's investment presence remains comparatively subdued in Cameroon, lagging behind that of Europe and Asia. Equally surprising is the limited footprint of Africa's economic powerhouse within other African economies. This study delved into four specific facets of South African investment in Cameroon. Initially, it focused on identifying South African companies operating within Cameroon. Subsequently, the analysis encompassed assessing the correlation between South African investment and poverty alleviation. Additionally, the study examined the nexus between South African investment and technological advancement, and underscored the significance of investment incentives in both countries Key findings of the research shed light on several crucial points. South Africa ought to reassess its economic engagement with Francophone Africa, particularly Cameroon. Despite existing policies aimed at fostering investment, there remains substantial ground to cover in this realm. The proliferation of South African enterprises in Cameroon holds the potential to ameliorate poverty and foster employment opportunities across both nations. The advent of South African firms in Cameroon can catalyse technological advancements within the region. Data collection involved surveying 100 executives from the respective administrations and conducting ten interviews. The gathered data underwent triangulation, wherein quantitative findings were juxtaposed with qualitative insights. In conclusion, the study underscores the underutilization of Cameroon by South Africa, emphasizing the untapped potential for mutual economic growth. Furthermore, it posits that the success of South Africa's multinational corporations abroad could serve as a pivotal pillar for sustaining its domestic economy.

Keywords: FDI, transfer of technology, South-South cooperation, mutual economic growth

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Authors: Mohammed Alruwaili‬

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Nowadays, renewable energy resources are playing an important role in replacing traditional energy resources such as fossil fuels by integrating solar energy with conventional energy. Concerns about the environment led to an intensive search for a renewable energy source. The Rapid growth of distributed energy resources will have prompted increasing interest in the integrated distributing network in the Kingdom of Saudi Arabia next few years, especially after the adoption of new laws and regulations in this regard. Photovoltaic energy is one of the promising renewable energy sources that has grown rapidly worldwide in the past few years and can be used to produce electrical energy through the photovoltaic process. The main objective of the research is to study the impact of PV in distribution networks based on real data and details. In this research, site survey and computer simulation will be dealt with using the well-known computer program software ETAB to simulate the input of electrical distribution lines with other variable inputs such as the levels of solar radiation and the field study that represent the prevailing conditions and conditions in Diriah, Riyadh region, Saudi Arabia. In addition, the impact of adding distributed generation units (DGs) to the distribution network, including solar photovoltaic (PV), will be studied and assessed for the impact of adding different power capacities. The result has been achieved with less power loss in the loop distribution network from the current condition by more than 69% increase in network power loss. However, the studied network contains 78 buses. It is hoped from this research that the efficiency, performance, quality and reliability by having an enhancement in power loss and voltage profile of the distribution networks in Riyadh City. Simulation results prove that the applied method can illustrate the positive impact of PV in loop distribution generation.

Keywords: renewable energy, smart grid, efficiency, distribution network

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Authors: Andrea S. Badillo-Perez, Alexis D. Mitchell, Sara M. Levens

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Overeating, and obesity have been associated with addictive behavior, primarily due to behaviors like reward-based eating, the tendency to overeat due to factors such as lack of control, preoccupation over food, and lack of satiation. Temporal discounting (TD), the ability to select future rewards over short term gains, and mindfulness, the process of maintaining present moment awareness, have been suggested to have significant, differential impacts on health-related behaviors. An individual’s health locus of control, the degree to which they feel that they have control over their health is also known to have an impact on health outcomes. The goal of this study was to investigate the relationship between health locus of control and reward-based eating, as well as the relation between TD and mindfulness in a sample (N = 126) of overweight or obese participants from larger health-focused study. Through the use of questionnaires (including the Five Facet Mindfulness Questionnaire (FFMQ), Reward-Based Eating Drive (RED), and Multidimensional Health Locus of Control (MHLOC)), anthropometric measurements, and a computerized TD task, a series of regressions tested the association between subscales of these measures. Results revealed differences in how the mindfulness subscales are associated with TD measures. Specifically the ‘Observing’ (beta =-.203) and ‘Describing’ (beta =.26) subscales were associated with lower TD rates and a longer subjective devaluation time-frame respectively. In contrast, the ‘Acting with Awareness’ subscale was associated with a shorter subjective devaluation timeframe (beta =-.23). These findings suggest that the reflective perspective initiated through the observing and describing components of mindfulness may facilitate delay of gratification, whereas the acting with awareness component of mindfulness, which focuses on the present moment, may make delay of gratification more challenging. Results also indicated that a higher degree of reward-based eating was associated with a higher degree of an external health locus of control based on the power of chance (beta =.10). However, an external locus of control based on the power of others had no significant association with reward-based eating. This finding implies that the belief that health is due to chance is associated with greater reward-based eating behavior, suggesting that interventions that focus on locus of control may be helpful. Overall, findings demonstrate that weight loss interventions may benefit from health locus of control and mindfulness exercises, but caution should be taken as the components of mindfulness appear to have different effects on increasing or decreasing delay of gratification.

Keywords: health locus of control, mindfulness, obesity, reward-based eating, temporal discounting

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Authors: Valerii Dashuk

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The usage of the confidence intervals in economics and econometrics is widespread. To be able to investigate a random variable more thoroughly, joint tests are applied. One of such examples is joint mean-variance test. A new approach for testing such hypotheses and constructing confidence sets is introduced. Exploring both the value of the random variable and its deviation with the help of this technique allows checking simultaneously the shift and the probability of that shift (i.e., portfolio risks). Another application is based on the normal distribution, which is fully defined by mean and variance, therefore could be tested using the introduced approach. This method is based on the difference of probability density functions. The starting point is two sets of normal distribution parameters that should be compared (whether they may be considered as identical with given significance level). Then the absolute difference in probabilities at each 'point' of the domain of these distributions is calculated. This measure is transformed to a function of cumulative distribution functions and compared to the critical values. Critical values table was designed from the simulations. The approach was compared with the other techniques for the univariate case. It differs qualitatively and quantitatively in easiness of implementation, computation speed, accuracy of the critical region (theoretical vs. real significance level). Stable results when working with outliers and non-normal distributions, as well as scaling possibilities, are also strong sides of the method. The main advantage of this approach is the possibility to extend it to infinite-dimension case, which was not possible in the most of the previous works. At the moment expansion to 2-dimensional state is done and it allows to test jointly up to 5 parameters. Therefore the derived technique is equivalent to classic tests in standard situations but gives more efficient alternatives in nonstandard problems and on big amounts of data.

Keywords: confidence set, cumulative distribution function, hypotheses testing, normal distribution, probability density function

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Authors: Muhammed Shahriar Haque

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As an offshoot of journalistic discourse, the documentary should be objective in nature without harbouring any preconceived notion to foster ulterior motifs. When it comes to a social issue like rape in South Asian countries, as media in recent times is inundated with this violent act in India, Pakistan, Myanmar, Bangladesh, how does one document it in terms of objectivity and subjectivity? The objective of this study is twofold: to document the history of documentaries, and to critically analyze South Asian rape/flesh trade-documentaries. The overall goal is to trace the (re/de)construction of objectivity-subjectivity in documentaries. This paper adopts a qualitative approach to documentarist discourse through the lens of critical discourse analysis (CDA). Data was gathered for 10 documentaries on the theme of rape and/or flesh trade from eight South Asian countries, predominantly the South Asian Association of Regional Cooperation (SAARC) region. The documentaries were primarily categorised by using three frameworks based on six modes, six subgenres, and four basic approaches of documentary. Subsequently, the findings were critiqued from CDA perspective. The outcome suggests that there a two schools of thoughts regarding documentaries. According to journalistic ethics, news and/or documentaries should be objective in orientation and focus on informing the audience and/common people. The empirical findings tend to challenge ethical parameters of objectivity. At times, it seems that journalistic discourse is discursively (re)constructed to give an augmented simulation of objectivity. Based on the findings it may be recommended that if documentaries steer away from empirical facts and indulge in poetic naivety, their credibility could be questioned. A research of this nature is significant as it raises questions with regard to ethical and moral conscience of documentary filmmakers. Furthermore, it looks at whether they uphold journalistic integrity or succumb to their bias, and thereby depict subjective views, which could be tainted with political and/or propagandist ulterior motifs.

Keywords: discursive (re/de)construction, documentaries, journalistic integrity, rape/flesh trade

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Authors: Xiaomin Zhong, Alexander Pate, Ya-Ting Yang, Ali Fahmi, Darren M. Ashcroft, Ben Goldacre, Brian Mackenna, Amir Mehrkar, Sebastian C. J. Bacon, Jon Massey, Louis Fisher, Peter Inglesby, Kieran Hand, Tjeerd van Staa, Victoria Palin

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Background: This study aimed to predict risks of potentially inappropriate antibiotic type and repeat prescribing and assess changes during COVID-19. Methods: With the approval of NHS England, we used the OpenSAFELY platform to access the TPP SystmOne electronic health record (EHR) system and selected patients prescribed antibiotics from 2019 to 2021. Multinomial logistic regression models predicted the patient’s probability of receiving an inappropriate antibiotic type or repeating the antibiotic course for each common infection. Findings: The population included 9.1 million patients with 29.2 million antibiotic prescriptions. 29.1% of prescriptions were identified as repeat prescribing. Those with same-day incident infection coded in the EHR had considerably lower rates of repeat prescribing (18.0%), and 8.6% had a potentially inappropriate type. No major changes in the rates of repeat antibiotic prescribing during COVID-19 were found. In the ten risk prediction models, good levels of calibration and moderate levels of discrimination were found. Important predictors included age, prior antibiotic prescribing, and region. Patients varied in their predicted risks. For sore throat, the range from 2.5 to 97.5th percentile was 2.7 to 23.5% (inappropriate type) and 6.0 to 27.2% (repeat prescription). For otitis externa, these numbers were 25.9 to 63.9% and 8.5 to 37.1%, respectively. Interpretation: Our study found no evidence of changes in the level of inappropriate or repeat antibiotic prescribing after the start of COVID-19. Repeat antibiotic prescribing was frequent and varied according to regional and patient characteristics. There is a need for treatment guidelines to be developed around antibiotic failure and clinicians provided with individualised patient information.

Keywords: antibiotics, infection, COVID-19 pandemic, antibiotic stewardship, primary care

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Authors: Racheli Magnezi, Inbal Gazit, Michal Rassin, Joseph Barr, Orna Tal

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An effective process for transmitting patient critical information is essential for patient safety and for improving communication among healthcare staff. Previous studies have discussed handover tools such as SBAR (Situation, Background, Assessment, Recommendation) or SOFI (Short Observational Framework for Inspection). Yet, these formats lack flexibility, and require special training. In addition, nurses and physicians have different procedures for handing over information. The objectives of this study were to establish a universal, structured tool for handover, for both physicians and nurses, based on parameters that were defined as ‘important’ and ‘appropriate’ by the medical team, and to implement this tool in various hospital departments, with flexibility for each ward. A questionnaire, based on established procedures and on the literature, was developed to assess attitudes towards the most important information for effective handover between shifts (Cronbach's alpha 0.78). It was distributed to 150 senior physicians and nurses in 62 departments. Among senior medical staff, 12 physicians and 66 nurses responded to the questionnaire (52% response rate). Based on the responses, a handover form suitable for all hospital departments was designed and implemented. Important information for all staff included: Patient demographics (full name and age); Health information (diagnosis or patient complaint, changes in hemodynamic status, new medical treatment or equipment required); and Social Information (suspicion of violence, mental or behavioral changes, and guardianship). Additional information relevant to each unit included treatment provided, laboratory or imaging required, and change in scheduled surgery in surgical departments. ICU required information on background illnesses, Pediatrics required information on diet and food provided and Obstetrics required the number of days after cesarean section. Based on the model described, a flexible tool was developed that enables handover of both common and unique information. In addition, it includes general logistic information that must be transmitted to the next shift, such as planned disruptions in service or operations, staff training, etc. Development of a simple, clear, comprehensive, universal, yet flexible tool designed for all medical staff for transmitting critical information between shifts was challenging. Physicians and nurses found it useful and it was widely implemented. Ongoing research is needed to examine the efficiency of this tool, and whether the enthusiasm that accompanied its initial use is maintained.

Keywords: handover, nurses, hospital, critical information

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Authors: Tarali Kalita, Karabi Dutta

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The North Eastern Region of India, with diverse climatic conditions and a wide range of ecological habitats, makes an ideal natural abode for a good number of silk-producing insects. Cocoon is the economically important life stage from where silk of economic importance is obtained. In recent years, silk-based biomaterials have gained considerable attention, which is dependent on the structure and properties of the silkworm cocoons as well as silk yarn. The present investigation deals with the morphological study of cocoons, including cocoon color, cocoon size, shell weight and shell ratio of eleven different species of silk insects collected from different regions of North East India. The Scanning Electron Microscopic study and X-ray photoelectron spectroscopy were performed to know the arrangement of silk threads in cocoons and the atomic elemental analysis, respectively. Further, collected cocoons were degummed and reeled/spun on a reeling machine or spinning wheel to know the filament length, linear density and tensile strength by using Universal Testing Machine. The study showed significant variation in terms of cocoon color, cocoon shape, cocoon weight and filament packaging. XPS analysis revealed the presence of elements (Mass %) C, N, O, Si and Ca in varying amounts. The wild cocoons showed the presence of Calcium oxalate crystals which makes the cocoons hard and needs further treatment to reel. In the present investigation, the highest percentage of strain (%) and toughness (g/den) were observed in Antheraea assamensis, which implies that the muga silk is a more compact packing of molecules. It is expected that this study will be the basis for further biomimetic studies to design and manufacture artificial fiber composites with novel morphologies and associated material properties.

Keywords: cocoon characterization, north-east India, prospects, silk characterization

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Authors: Lillian Musila, Valerie Oundo, Daniel Erwin, Willie Sang

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Staphylococcus aureus infections are a major cause of nosocomial infections in Kenya. Methicillin resistant S. aureus (MRSA) infections are a significant burden to public health and are associated with considerable morbidity and mortality. At a hospital in Western Kenya two clusters of MRSA cases emerged within short periods of time. In this study we explored whether these clusters represented a nosocomial outbreak by characterizing the isolates using phenotypic and molecular assays and examining epidemiological data to identify possible transmission patterns. Specimens from the site of infection of the subjects were collected, cultured and S. aureus isolates identified phenotypically and confirmed by APIStaph™. MRSA were identified by cefoxitin disk screening per CLSI guidelines. MRSA were further characterized based on their antibiotic susceptibility patterns and spa gene typing. Characteristics of cases with MRSA isolates were compared with those with MSSA isolated around the same time period. Two cases of MRSA infection were identified in the two week period between 21 April and 4 May 2015. A further 2 MRSA isolates were identified on the same day on 7 September 2015. The antibiotic resistance patterns of the two MRSA isolates in the 1st cluster of cases were different suggesting that these were distinct isolates. One isolate had spa type t2029 and the other had a novel spa type. The 2 isolates were obtained from urine and an open skin wound. In the 2nd cluster of MRSA isolates, the antibiotic susceptibility patterns were similar but isolates had different spa types: one was t037 and the other a novel spa type different from the novel MRSA spa type in the first cluster. Both cases in the second cluster were admitted into the hospital but one infection was community- and the other hospital-acquired. Only one of the four MRSA cases was classified as an HAI from an infection acquired post-operatively. When compared to other S. aureus strains isolated within the same time period from the same hospital only one spa type t2029 was found in both MRSA and non-MRSA strains. None of the cases infected with MRSA in the two clusters shared any common epidemiological characteristic such as age, sex or known risk factors for MRSA such as prolonged hospitalization or institutionalization. These data suggest that the observed MRSA clusters were multi strain clusters and not an outbreak of a single strain. There was no clear relationship between the isolates by spa type suggesting that no transmission was occurring within the hospital between these cluster cases but rather that the majority of the MRSA strains were circulating in the community. There was high diversity of spa types among the MRSA strains with none of the isolates sharing spa types. Identification of disease clusters in space and time is critical for immediate infection control action and patient management. Spa gene typing is a rapid way of confirming or ruling out MRSA outbreaks so that costly interventions are applied only when necessary.

Keywords: cluster, Kenya, MRSA, spa typing

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Authors: Hamideh Nouri, Sattar Chavoshi Borujeni

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Grey infrastructure is an unavoidable part of urbanisation that is threatening the local microclimates. Sustainable urbanisation requires more green infrastructure in cities such as green roofs to minimise urbanisation impacts. The environmental, social and economic benefits of green roofs are widely deliberated. However, there is still a lack of assessment of the water management for green roofs. This paper aimed to assess the irrigation management of green roofs in a semi-arid region where blue water scarcity is one of the primary challenges in urban water management. To determine the appropriate water source and growing media for green roofs, an experiment was established at the University of South Australia, Australia. This study compared the performance of two growing media and three water sources on the drainage quality, medium weight and survival rate of potted Tussock grass (Poa labillardieral), an endemic plant to Australia and recommended for green roofs. Three irrigation sources were tap water, mixed of wastewater-stormwater, and rainwater. The growing media were natural sandy loam soil and Scoria - one of the most used commercial growing media for green roofs. The drainage quality of these media was tested by analysing leachate samples. Medium weight was measured before and after watering, and all pots were monitored for their survival rates. Results showed that although plant growing development was significantly higher in Scoria, the survival rate was lower. For all three water sources, EC and pH of the leachate were significantly lower from Scoria than the sandy loam soil. However, the mixed of wastewater-stormwater had the highest EC, and rainwater had the lowest EC. Results did not present a significant difference between pH of different water resources in the same media. Our experimental results found the scoria and rainwater as the best sources of medium and water for green roofs.

Keywords: green smart cities, urban water, green roofs, green walls, wastewater, stormwater

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Authors: Yu-Ching Lin, Meei-Ling Gau, Ghi-Hwei Kao, Hung-Chang Lee

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Objective: To compare the pushing experiences and birth outcomes of three different pushing positions during the second stage of labor. The three positions were: semi-recumbent, squatting, and squatting with the aid of ergonomically designed ankle supports. Methods: A randomized controlled trial was conducted at a regional teaching hospital in northern Taiwan. Data were collected from 168 primiparous women in their 38th to 42nd gestational week. None of the participants received epidural analgesia during labor and all were free of pregnancy and labor-related complications. Intervention: During labor, after full cervical dilation and when the fetal head had descended to at least the +1 station and had turned to the occiput anterior position, the experimental group was asked to push in the squatting position while wearing the ergonomically designed ankle supports; comparison group A was asked to push in the squatting position without the use of these supports; and comparison group B was asked to push in a standard semi-recumbent position. Measures: The participants completed a demographic and obstetrics datasheet, the Short Form McGill Pain Questionnaire (MPQ-SF), and the Labor Pushing Experience scale within 4-hours postpartum. Conclusion: In terms of delivery time, the duration between the start of pushing to crowning for the experimental group (squatting with ankle supports) averaged 25.52 minutes less (F =6.02, p< .05) than the time for comparison group B (semi-recumbent). Furthermore, the duration between the start of pushing to infant birth averaged 25.21 minutes less for the experimental group than for comparison group B (F =6.14, p< .05). Moreover, the experimental group had a lower average VAS pain score (5.05±3.22) than comparison group B and the average McGill pain score for the experimental group was lower than both comparison groups (F=18.12, p< .001). In summary, the participants in the group that delivered from a squatting position with ankle supports had better labor pushing experiences than their peers in the comparison groups. Results: In comparison to both unsupported squatting and semi-recumbent pushing, squatting with the aid of ergonomically designed ankle supports reduced pushing times, ameliorated labor pain, and improved the pushing experience. Clinical application and suggestion: The squatting with ankle-support intervention introduced in the present study may significantly reduce tiredness and difficulties in maintaining balance as well as increase pushing efficiency. Thus, this intervention may reduce the caring needs of women during the second stage of labor. This intervention may be introduced in midwifery education programs and in clinical practice as a method to improve the care of women during the second stage of labor.

Keywords: second stage of labor, pushing, squatting with ankle supports, squatting

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Authors: Angelis P. Barlampas

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Purpose of Learning Objective: This case depicts the need for cooperation between the emergency department and the radiologist to achieve the best diagnostic result for the patient. The clinical picture must correlate well with the radiology report and when it does not, this is not necessarily someone’s fault. Careful interpretation and good knowledge of the limitations, advantages and disadvantages of each imaging procedure are essential for the final diagnostic goal. Methods or Background: A patient was brought to the emergency department by their relatives. He was suddenly confused and his mental status was altered. He hadn't any history of mental illness and was otherwise healthy. A computing tomography scan without contrast was done, but it was unremarkable. Because of high clinical suspicion of probable neurologic disease, he was admitted to the hospital. Results or Findings: Another T was done after 48 hours. It showed a hypodense region in both thalamic areas. Taking into account that the first CT was normal, but the initial clinical picture of the patient was alerting of something wrong, the repetitive CT exam is highly suggestive of a probable diagnosis of bilateral thalamic infractions. Differential diagnosis: Primary bilateral thalamic glioma, Wernicke encephalopathy, osmotic myelinolysis, Fabry disease, Wilson disease, Leigh disease, West Nile encephalitis, Greutzfeldt Jacob disease, top of the basilar syndrome, deep venous thrombosis, mild to moderate cerebral hypotension, posterior reversible encephalopathy syndrome, Neurofibromatosis type 1. Conclusion: As is the case of limitations for any imaging procedure, the same applies to CT. The acute ischemic attack can not depict on CT. A period of 24 to 48 hours has to elapse before any abnormality can be seen. So, despite the fact that there are no obvious findings of an ischemic episode, like paresis or imiparesis, one must be careful not to attribute the patient’s clinical signs to other conditions, such as toxic effects, metabolic disorders, psychiatric symptoms, etc. Further investigation with MRI or at least a repeated CT must be done.

Keywords: CNS, CT, thalamus, emergency department

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Authors: Bidisha Chatterjee, Sonal Grover, Rekha Gurung

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Postpartum dissection of the internal carotid artery is a relatively rare condition and is considered as an underlying aetiology in 5% to 25% of strokes under the age of 30 to 45 years. However, 86% of these cases recover completely and 14% have mild focal neurological symptoms. Prognosis is generally good with early intervention. The risk quoted for a repeat carotid artery dissection in subsequent pregnancies is less than 2%. 36-year Caucasian primipara presented on postnatal day one of forceps delivery with tachycardia. In the intrapartum period she had a history of prolonged rupture of membranes and developed intrapartum sepsis and was treated with antibiotics. Postpartum ECG showed septal inferior T wave inversion and a troponin level of 19. Subsequently Echocardiogram ruled out post-partum cardiomyopathy. Repeat ECG showed improvement of the previous changes and in the absence of symptoms no intervention was warranted. On day 4 post-delivery, she had developed symptoms of droopy right eyelid, pain around the right eye and itching in the right ear. On examination, she had developed right sided ptosis, unequal pupils (Rt miotic pupil). Cranial nerve examination, reflexes, sensory examination and muscle power was normal. Apart from migraine, there was no medical or family history of note. In view of Horner’s on the right, she had a CT Angiogram and subsequently MR/MRA and was diagnosed with dissection of the cervical portion of the right internal carotid artery. She was discharged on a course of Aspirin 75mg. By 6 week post-natal follow up patient had recovered significantly with occasional episodes of unequal pupils and tingling of right toes which resolved spontaneously. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy with an estimated annual incidence of 2.6–3 per 100,000 pregnancy hospitalizations. Aetiology remains unclear though trauma during straining at labour, underlying arterial disease and preeclampsia have been implicated. Hypercoagulable state during pregnancy and puerperium could also be an important factor. 60-90% cases present with severe headache and neck pain and generally precede neurological symptoms like ipsilateral Horner’s syndrome, retroorbital pain, tinnitus and cranial nerve palsy. Although rare, the consequences of delayed diagnosis and management can lead to severe and permanent neurological deficits. Patients with a strong index of suspicion should undergo an MRI or MRA of head and neck. Antithrombotic and antiplatelet therapy forms the mainstay of therapy with selected cases needing endovascular stenting. Long term prognosis is favourable with either complete resolution or minimal deficit if treatment is prompt. Patients should be counselled about the recurrence risk and possibility of stroke in future pregnancy. Coronary artery dissection is rare and treatable but needs early diagnosis and treatment. Post-partum headache and neck pain with neurological symptoms should prompt urgent imaging followed by antithrombotic and /or antiplatelet therapy. Most cases resolve completely or with minimal sequelae.

Keywords: postpartum, dissection of internal carotid artery, magnetic resonance angiogram, magnetic resonance imaging, antiplatelet, antithrombotic

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Authors: Adelson G. Guillarte, M. D., Noel J. Belonguel, Jarungchai Anton S. Vatanagul

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Patients with malignant middle cerebral infarction (MCA) (with massive brain swelling and herniation) were reported to have a mortality rate of 80% even with the appropriate conservative medical therapy. European Trials (DECIMAL, DESTINY I, and II, HAMLET) showed significant improvement in mortality and functional outcome with hemicraniectomy. No known published local studies in the region, thus a local study is vital. This is a single center, retrospective, descriptive, cross-sectional, chart review study which includes ≥18 year-old patients with malignant MCA infarction, who underwent hemicraniectomy, and those who were given conservative medical therapy alone, from January 2008 to December 2012 at Perpetual Succour Hospital. Excluded were patients whose charts are with insufficient data, prior MCA stroke, with concomitant intracerebral hemorrhage and with other serious medical conditions or terminal illnesses. Minimum of 32 populations were needed. Data were presented in mean, standard deviation, frequency and percentage distribution. Man n Whitney U test and Chi Square test were used. P-values lesser than 0.05 alpha were considered statistically significant. A total of 672 stroke patients were admitted. 34 patients pass the inclusion criteria. 9 underwent hemicraniectomy and 25 were treated by conservative medical therapy alone. Although not statistically significant (64% vs 33%, p=0.112) there were more patients noted improved in the conservative treatment group. Meanwhile, the Hemicraniectomy group have increased percentage of mortality (67%) (p=0.112). There was a decreasing trend in the average NIHSS score in both groups from admission to post-op 7 days (p=0.198, p=0.78). A bigger multicenter prospective study is recommended to control inherent biases and limitations of a retrospective and smaller study.

Keywords: cerebral infarct, hemicraniectomy, ischemic stroke, malignant middle cerebral artery (MCA) infarct

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