Search results for: emergency reconstruction

Authors: Neil Singla, Derek Muse, Karen DiDonato, Pamela Palmer

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Introduction: Pain is the most common reason people visit emergency rooms. Studies indicate however, that Emergency Department (ED) physicians often do not provide adequate analgesia to their patients as a result of gender and age bias, opiophobia and insufficient knowledge of and formal training in acute pain management. Novel classes of analgesics have recently been introduced, but many patients suffer from acute pain in settings where the availability of intravenous (IV) access may be limited, so there remains a clinical need for rapid-acting, potent analgesics that do not require an invasive route of delivery. A sublingual sufentanil tablet (SST), dispensed using a single-dose applicator, is in development for treatment of moderate-to-severe acute pain in a medically-supervised setting. Objective: The primary objective of this study was to demonstrate the repeat-dose efficacy, safety and tolerability of sufentanil 20 mcg and 30 mcg sublingual tablets compared to placebo for the management of acute pain as determined by the time-weighted sum of pain intensity differences (SPID) to baseline over the 12-hour study period (SPID12). Key secondary efficacy variables included SPID over the first hour (SPID1), Total pain relief over the 12-hour study period (TOTPAR12), time to perceived pain relief (PR) and time to meaningful PR. Safety variables consisted of adverse events (AE), vital signs, oxygen saturation and early termination. Methods: In this Phase 2, double-blind, dose-finding study, an equal number of male and female patients were randomly assigned in a 2:2:1 ratio to SST 20 mcg, SS 30 mcg or placebo, respectively, following bunionectomy. Study drug was dosed as needed, but not more frequently than hourly. Rescue medication was available as needed. The primary endpoint was the Summed Pain Intensity Difference to baseline over 12h (SPIDI2). Safety was assessed by continuous oxygen saturation monitoring and adverse event reporting. Results: 101 patients (51 Male/50 Female) were randomized, 100 received study treatment (intent-to-treat [ITT] population), and 91 completed the study. Reasons for early discontinuation were lack of efficacy (6), adverse events (2) and drug-dosing error (1). Mean age was 42.5 years. For the ITT population, SST 30 mcg was superior to placebo (p=0.003) for the SPID12. SPID12 scores in the active groups were superior for both male (ANOVA overall p-value =0.038) and female (ANOVA overall p-value=0.005) patients. Statistically significant differences in favour of sublingual sufentanil were also observed between the SST 30mcg and placebo group for SPID1(p<0.001), TOTPAR12(p=0.002), time to perceived PR (p=0.023) and time to meaningful PR (p=0.010). Nausea, vomiting and somnolence were more frequent in the sufentanil groups but there were no significant differences between treatment arms for the proportion of patients who prematurely terminated due to AE or inadequate analgesia. Conclusions: Sufentanil tablets dispensed sublingually using a single-dose applicator is in development for treatment of patients with moderate-to-severe acute pain in a medically-supervised setting where immediate IV access is limited. When administered sublingually, sufentanil’s pharmacokinetic profile and non-invasive delivery makes it a useful alternative to IM or IV dosing.

Keywords: acute pain, pain management, sublingual, sufentanil

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Authors: Rubin Dan, Xingcai Wang, Ziyang Chen

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A chaotic time series noise reduction method based on the fusion of the local projection method, wavelet transform, and particle swarm algorithm (referred to as the LW-PSO method) is proposed to address the problem of false recognition due to noise in the recognition process of chaotic time series containing noise. The method first uses phase space reconstruction to recover the original dynamical system characteristics and removes the noise subspace by selecting the neighborhood radius; then it uses wavelet transform to remove D1-D3 high-frequency components to maximize the retention of signal information while least-squares optimization is performed by the particle swarm algorithm. The Lorenz system containing 30% Gaussian white noise is simulated and verified, and the phase space, SNR value, RMSE value, and K value of the 0-1 test method before and after noise reduction of the Schreiber method, local projection method, wavelet transform method, and LW-PSO method are compared and analyzed, which proves that the LW-PSO method has a better noise reduction effect compared with the other three common methods. The method is also applied to the classical system to evaluate the noise reduction effect of the four methods and the original system identification effect, which further verifies the superiority of the LW-PSO method. Finally, it is applied to the Chengdu rainfall chaotic sequence for research, and the results prove that the LW-PSO method can effectively reduce the noise and improve the chaos recognition rate.

Keywords: Schreiber noise reduction, wavelet transform, particle swarm optimization, 0-1 test method, chaotic sequence denoising

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Authors: Cathryn Robinson, Bernard McKenna, David Rooney

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This paper argues that the application of values-based leadership increasingly challenges leaders in rules-based organisations, particularly in bureaucratic organisations such as the military, public service, police, and emergency services. Leaders are grappling to reconcile how to enact values-based leadership and decision-making when they are bound by rules, policies, and procedures. This interpretive study used a multi-faceted vignette (critical incident) as the basis of an interview with air force officers at three levels: executive, senior, and junior. In this way, practice is forced to intersect with discourse. The findings revealed a shared set of discourse themes (legal; rules; safety and risk; operational practice/theatre discourses), but also clear dialectical tensions. These tensions were evident in executive officers and senior leaders emphasizing rules and information themes, whereas junior officers emphasized decision making, collateral, and situation. These findings reveal discourse and practice incommensurability that could have grave implications in the conduct of war.

Keywords: critical incident, discourse analysis, rules-based, values-based

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Authors: Manjie Li, Xiangju Cheng, Yongcan Chen

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With rapid development of industrialization and urbanization, water environmental deterioration is widespread in majority of urban rivers, which seriously affects city image and life satisfaction of residents. As an emergency measure to improve water quality, clean water diversion is introduced for water environmental management. Lubao River and Southwest River, two urban rivers in typical plain tidal river network, are identified as technically and economically feasible for the application of clean water diversion. One-dimensional hydrodynamic-water quality model is developed to simulate temporal and spatial variations of water level and water quality, with satisfactory accuracy. The mathematical model after calibration is applied to investigate hydrodynamic and water quality variations in rivers as well as determine the optimum operation scheme of water diversion. Assessment system is developed for evaluation of positive and negative effects of water diversion, demonstrating the effectiveness of clean water diversion and the necessity of pollution reduction.

Keywords: assessment system, clean water diversion, hydrodynamic-water quality model, tidal river network, urban rivers, water environment improvement

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Authors: Mohamed Ouazene

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The insulating properties of the polymers are widely used in electrical engineering for the production of insulators and various supports, as well as for the insulation of electric cables for medium and high voltage, etc. These polymeric materials have significant advantages both technically and economically. However, although the insulation with polymeric materials has advantages, there are also certain disadvantages such as the influence of the heat which can have a detrimental effect on these materials. Polyvinyl chloride (PVC) is one of the polymers used in a plasticized state in the cable insulation to medium and high voltage. The studied material is polyvinyl chloride (PVC 4000 M) from the Algerian national oil company whose formula is: Industrial PVC 4000 M is in the form of white powder. The test sample is a pastille of 1 mm thick and 1 cm in diameter. The consequences of increasing the temperature of a polymer are modifications; some of them are reversible and others irreversible [1]. The reversible changes do not affect the chemical composition of the polymer, or its structure. They are characterized by transitions and relaxations. The glass transition temperature is an important feature of a polymer. Physical aging of PVC is to maintain the material for a longer or shorter time to its glass transition temperature. The aim of this paper is to study this phenomenon by the method of thermally stimulated depolarization currents. Relaxations within the polymer have been recorded in the form of current peaks. We have found that the intensity decreases for more residence time in the polymer along its glass transition temperature. Furthermore, it is inferred from this work that the phenomenon of physical aging can have important consequences on the properties of the polymer. It leads to a more compact rearrangement of the material and a reconstruction or reinforcement of structural connections.

Keywords: depolarization currents, glass transition temperature, physical aging, polyvinyl chloride (PVC)

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Authors: Linyu Wang, Liguo Qiao, Jianhong Xiang, Hao Xu

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In semantic communication, the existing joint Source Channel coding (JSCC) wireless communication system without pilot has unstable transmission performance and can not effectively capture the global information and location information of images. In this paper, a pilot-free image transmission system of joint source channel based on multi-level semantic information (Multi-level JSCC) is proposed. The transmitter of the system is composed of two networks. The feature extraction network is used to extract the high-level semantic features of the image, compress the information transmitted by the image, and improve the bandwidth utilization. Feature retention network is used to preserve low-level semantic features and image details to improve communication quality. The receiver also is composed of two networks. The received high-level semantic features are fused with the low-level semantic features after feature enhancement network in the same dimension, and then the image dimension is restored through feature recovery network, and the image location information is effectively used for image reconstruction. This paper verifies that the proposed multi-level JSCC algorithm can effectively transmit and recover image information in both AWGN channel and Rayleigh fading channel, and the peak signal-to-noise ratio (PSNR) is improved by 1~2dB compared with other algorithms under the same simulation conditions.

Keywords: deep learning, JSCC, pilot-free picture transmission, multilevel semantic information, robustness

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Authors: Mohammadreza Ashouri, Majid Bayatian

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Analysis of fire data is a way for the implementation of any plan to improve the level of safety in cities. Such an analysis is able to reveal signs of changes in a given period and can be used as a measure of safety. The information of about 66,341 fires (from 2002 to 2012) released by Tehran Safety Services and Fire-Fighting Organization and data on the population and the number of households provided by Tehran Municipality and the Statistical Yearbook of Iran were extracted. Using the data, the fire changes, the rate of injuries, and mortality rate were determined and analyzed. The rate of injuries and mortality rate of fires per one million population of Tehran were 59.58% and 86.12%, respectively. During the study period, the number of fires and fire stations increased by 104.38% and 102.63%, respectively. Most fires (9.21%) happened in the 4th District of Tehran. The results showed that the recorded fire data have not been systematically planned for fire prevention since one of the ways to reduce injuries caused by fires is to develop a systematic plan for necessary actions in emergency situations. To determine a reliable source for fire prevention, the stages, definitions of working processes and the cause and effect chains should be considered. Therefore, a comprehensive statistical system should be developed for reported and recorded fire data.

Keywords: fire statistics, fire analysis, accident prevention, Tehran

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Authors: Yasuyuki Takahashi, Hirotaka Shimada, Takao Kanzaki

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A Dual-detector SPECT system is widely by use of myocardial SPECT studies. With 180-degree (180°) acquisition, reconstructed images are distorted in the posterior wall of myocardium due to the lack of sufficient data of posterior projection. We hypothesized that quality of myocardial SPECT images can be improved by the addition of data acquisition of only a few posterior projections to ordinary 180° acquisition. The proposed acquisition method (180° plus acquisition methods) uses the dual-detector SPECT system with a pair of detector arranged in 90° perpendicular. Sampling angle was 5°, and the acquisition range was 180° from 45° right anterior oblique to 45° left posterior oblique. After the acquisition of 180°, the detector moved to additional acquisition position of reverse side once for 2 projections, twice for 4 projections, or 3 times for 6 projections. Since these acquisition methods cannot be done in the present system, actual data acquisition was done by 360° with a sampling angle of 5°, and projection data corresponding to above acquisition position were extracted for reconstruction. We underwent the phantom studies and a clinical study. SPECT images were compared by profile curve analysis and also quantitatively by contrast ratio. The distortion was improved by 180° plus method. Profile curve analysis showed increased of cardiac cavity. Analysis with contrast ratio revealed that SPECT images of the phantoms and the clinical study were improved from 180° acquisition by the present methods. The difference in the contrast was not clearly recognized between 180° plus 2 projections, 180° plus 4 projections, and 180° plus 6 projections. 180° plus 2 projections method may be feasible for myocardial SPECT because distortion of the image and the contrast were improved.

Keywords: 180° plus acquisition method, a few posterior projections, dual-detector SPECT system, myocardial SPECT

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Authors: Jessie Fazel, Kristen Smith

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Human trafficking is a multi-billion-dollar criminal industry that affects 24.9 million people around the world. There are several different types of trafficking, the most common being sex trafficking, labor trafficking, and domestic servitude. Survival sex is common in the pediatric population, as they engage in sex for food, a place to sleep, or other basic needs. Statistics show that health care workers are at a unique advantage to help identify victims and get them the help they need, as 88% of trafficked victims encounter a health care worker while being trafficked. Unfortunately, victims don’t usually self-identify that they are being trafficked and the situations they face can vary dramatically. It is imperative to remember that traditional red flags are not always present in the pediatric population. Risk factors and red flags with their history and physical exam are one of the best indicators that health care providers need to be vigilant in looking at. There are numerous barriers for disclosure in the healthcare setting. Periods of time before and after disclosure are often emotionally difficult and could be dangerous for the victim. It is extremely important to have a plan in place for intervention if the victim does disclose trafficking. A trauma informed approach to medical and mental health interventions, that focus on safety, are vital in this population. This is happening where you live and you can make a difference in their lives.

Keywords: human trafficking, public health, emergency medicine, sexual health

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Authors: Sabah Mohammed, Jinan Fiaidhi, Darien Sawyer

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Describing clinical cases according to a clinical charting standard that enforces interoperability and enables connected care services can save lives in the event of a medical emergency or provide efficient and effective interventions for the benefit of the patients through the integration of bedside and bench side clinical research. This article presented a multi-tenant extension to the problem-oriented medical record that we have prototyped previously upon using the GraphQL Application Programming Interface to represent the notion of a problem list. Our implemented extension enables physicians and patients to collaboratively describe the patient case via using multi chatbots to collaboratively describe the patient case using the SOAP charting standard. Our extension also connects the described SOAP patient case with the HL7 FHIR (Health Interoperability Resources) medical record for connecting the patient case to the bench data.

Keywords: problem-oriented medical record, graphQL, chatbots, SOAP

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Authors: Welawat Tienpratarn, Chaiyaporn Yuksen, Kasamon Aramvanitch, Karn Suttapanit, Yahya Mankong, Nussareen Yaemluksanalert, Sansanee Meesawad

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Introduction : Application of a rigid cervical collar may interfere with the laryngeal view, and potentially lead to failed endotracheal intubation (ETI). This study aimed to compare intubation success rates while performing inline stabilization with and without cervical hard collar. Methods : This randomized prospective comparative study included paramedics working in the Department of Emergency Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand to compare the success rates of endotracheal intubation on manikin using inline stabilization with and without cervical hard collar. Results : 125 participants were evaluated; 63 in the rigid cervical collar and 62 in the non-cervical hard collar group. The rate of successful intubation was significantly higher using manual stabilization without cervical hard collar (61 (96.8%) vs. 55 (88.7%); p=0.048). The time required to successfully perform intubation was also shorter, with manual stabilization only (14.1 ±20.9 vs. 18.9±29.0; p = 0.081). Conclusion : It seems that, removal of the rigid cervical collar during ETI in patients with suspected traumatic spine injury could increase the intubation success rate.

Keywords: ntubation, Intratracheal, Spinal Injuries, Multiple trauma

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Authors: Zhang Pinliang, Chen Chuan, Song Guangming, Wu Qiang, Gong Zizheng, Li Ming

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The active removal of space debris and asteroid defense are important issues in human space activities. Both of them need a detumbling process, for almost all space debris and asteroid are in a rotating state, and it`s hard and dangerous to capture or remove a target with a relatively high tumbling rate. So it`s necessary to find a method to reduce the angular rate first. The laser ablation method is an efficient way to tackle this detumbling problem, for it`s a contactless technique and can work at a safe distance. In existing research, a laser rotational control strategy based on the estimation of the instantaneous angular velocity of the target has been presented. But their calculation of control torque produced by a laser, which is very important in detumbling operation, is not accurate enough, for the method they used is only suitable for the plane or regularly shaped target, and they did not consider the influence of irregular shape and the size of the spot. In this paper, based on the triangulation reconstruction of the target surface, we propose a new method to calculate the impulse of the irregularly shaped target under both the covered irradiation and spot irradiation of the laser and verify its accuracy by theoretical formula calculation and impulse measurement experiment. Then we use it to study the process of detumbling cylinder and asteroid by laser. The result shows that the new method is universally practical and has high precision; it will take more than 13.9 hours to stop the rotation of Bennu with 1E+05kJ laser pulse energy; the speed of the detumbling process depends on the distance between the spot and the centroid of the target, which can be found an optimal value in every particular case.

Keywords: detumbling, laser ablation drive, space target, space debris remove

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Authors: Peter Thissen

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In this work, we report about the influence of the chemical potential of water on the carbonation reaction of wollastonite (CaSiO3) as model surface of cement and concrete. Total energy calculations based on density functional theory (DFT) combined with kinetic barrier predictions based on nudge elastic band (NEB) method show that the exposure of the water-free wollastonite surface to CO2 results in a barrier-less carbonation. CO2 reacts with the surface oxygen and forms carbonate (CO32-) complexes together with a major reconstruction of the surface. The reaction comes to a standstill after one carbonate monolayer has been formed. In case one water monolayer is covering the wollastonite surface, the carbonation is no more barrier-less, yet ending in a localized monolayer. Covered with multilayers of water, the thermodynamic ground state of the wollastonite completely changes due to a metal-proton exchange reaction (MPER, also called early stage hydration) and Ca2+ ions are partially removed from solid phase into the H2O/wollastonite interface. Mobile Ca2+ react again with CO2 and form carbonate complexes, ending in a delocalized layer. By means of high resolution time-of-flight secondary-ion mass-spectroscopy images (ToF-SIMS), we confirm that hydration can lead to a partially delocalization of Ca2+ ions on wollastonite surfaces. Finally, we evaluate the impact of our model surface results by means of Low Energy Ion Scattering (LEIS) spectroscopy combined with careful discussion about the competing reactions of carbonation vs. hydration.

Keywords: Calcium-silicate, carbonation, hydration, metal-proton exchange reaction

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Authors: C. Busuioc, G. Voicu, S. I. Jinga

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The field of tissue engineering brings new challenges in terms of proposing original solutions for ongoing medical issues, improving the biological performances of existing clinical systems and speeding the healing process for a faster recovery and a more comfortable life as patient. In this context, we propose the obtaining of 3D porous scaffolds of mineral nature, dedicated to bone repairing and regeneration purposes or employed as bioactive filler for bone cements. Thus, bacterial cellulose - calcium phosphates composite materials have been synthesized by successive immersing of the polymeric membranes in the precursor solution containing Ca2+ and [PO4]3- ions. The mineral phase deposited on the surface of biocellulose fibers was varied as amount through the number of immersing cycles. The intermediary composites were subjected to thermal treatments at different temperatures in order to remove the organic part and provide the formation of a self-sustained 3D architecture. The resulting phase composition consists of common phosphates, while the morphology largely depends on the preparation parameters. Thus, the aspect of the 3D mineral scaffolds can be tuned from a loose microstructure composed of large grains connected via monocrystalline nanorods to a trabecular pattern crossed by parallel internal channels, just like the natural bone. The bioactivity and biocompatibility of the obtained materials have been also assessed, with encouraging results in the clinical use direction. In conclusion, the compositional, structural, morphological and biological characterizations sustain the suitability of the reported biostructures for integration in hard tissue engineering applications.

Keywords: bacterial cellulose, bone reconstruction, calcium phosphates, mineral scaffolds

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Authors: Olivier Mulisya, Guelord Barasima, Henry Mark Lugobe, Philémon Matumo, Bienfait Mumbere Vahwere, Hilaire Mutuka, Zawadi Léocadie, Wesley Lumika

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Abdominal pregnancy is defined as pregnancy anywhere within the peritoneal cavity, exclusive of tubal, ovarian, or broad ligament locations. It is a rare form of ectopic pregnancy with high morbidity and mortality for both the mother and the fetus. Diagnosis can be frequently missed in most poor-resource settings because of poor antenatal coverage, low socioeconomic status in most of the patients as well as lack of adequate medical resources. Clinical diagnosis can be very difficult and an ultrasound scan is very helpful during the early stages of gestation but can also be disappointing in the later stages. We report a case of a 25-year-old woman with severe abdominal pain not amended with any medication. A clinical picture of shock lead to an emergency laparotomy which confirmed the diagnosis of abdominal pregnancy. The ministry of health in developing countries should make an effort to make routine early ultrasounds accessible to pregnant women, and obstetricians should keep in mind the possibility of ectopic pregnancy, irrespective of the gestational age.

Keywords: abdominal pregnancy, live new bron, ultrasound imaging, abdominal pain

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Authors: Chanya Thanomlikhit, Pataraporn Kheawwan

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Transition from student to staff nurse can be difficult for nurses beginning their nursing profession. Objective: The purpose of this study was to explore the transition experiences during the first year of practice among new nurses in Thailand. Methods: A descriptive design using a survey questionnaire was used. One hundred seventy-eight new graduate nurses from one tertiary hospital in Thailand participated in this study. Data were collected using paper-and-pencil format of the Revised Casey-Fink Graduate Nurse Experience Survey. Results: Participants reported three types of difficulties they were experiencing during the first year of practice including role expectation, lack of confidence, and workload. New nurses reported uncomfortable to perform high risk skills such as code/emergency, ventilator care, EKG, and chest tube care. Organizing, prioritizing and communication were rated as difficult tasks during 12-month transition period. New nurses satisfied the benefit package they received from the institution, however, salary was lowest satisfied. Conclusion: Results inform transition program development for new nurses. Initiative of systems that support for the graduate nurse during the first year of practice is suggested.

Keywords: new graduate nurse, transition, nurse residency program, clinical education

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Authors: Lakmali Anthony, Madeline Gillies

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Purpose: Decreasing mortality has led to increased focus on patient-reported outcomes such as quality of life (QoL) in breast cancer. Breast cancer patients often have decreased QoL even after treatment is complete. This systematic review of the literature aims to identify psychosocial factors associated with decreased QoL in post-treatment breast cancer patients. Methodology: This systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The search was conducted in MEDLINE, EMBASE, and PsychINFO using MeSH headings. The two authors screened studies for relevance and extracted data. Results: Seventeen studies were identified, including 3,150 total participants (mean = 197) with a mean age of 51.9 years. There was substantial heterogeneity in measures of QoL. The most common was the European Organisation for Research and Treatment of Cancer QLQ-C30 (n=7, 41.1%). Most studies (n=12, 70.5%) found that emotional distress correlated with poor QoL, while 3 found no significant association. The most common measure of emotional distress was the Hospital Anxiety and Depression Scale (n=12, 70.5%). Other psychosocial factors associated with QoL were unmet needs, problematic social support, and negative affect. Clinicopathologic determinants included mastectomy without reconstruction, stage IV disease, and adjuvant chemotherapy. Conclusion: This systematic review provides a summary of the psychosocial determinants of poor QoL in post-treatment breast cancer patients, as well as the most commonly reported measures of these. An understanding of these potentially modifiable determinants of poor outcome is pivotal to the provision of quality, patient-centred care in surgical oncology.

Keywords: breast cancer, quality of life, psychosocial determinants, cancer surgery

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Authors: Talha A. Al-Dubai, Rashad A. Bantan, Ramadan H. Abu-Zied, Brian G. Jones, Aaid G. Al-Zubieri

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Contemporary foraminiferal samples sediments were collected from the intertidal sabkha of Al-Kharrar Lagoon, Saudi Arabia, to study the vertical distribution of Foraminifera and, based on a modern training set, their potential to develop a predictor of former sea-level changes in the area. Based on hierarchical cluster analysis, the intertidal sabkha is divided into three vertical zones (A, B & C) represented by three foraminiferal assemblages, where agglutinated species occupied Zone A and calcareous species occupied the other two zones. In Zone A (high intertidal), Agglutinella compressa, Clavulina angularis and C. multicamerata are dominant species with a minor presence of Peneroplis planatus, Coscinospira hemprichii, Sorites orbiculus, Quinqueloculina lamarckiana, Q. seminula, Ammonia convexa and A. tepida. In contrast, in Zone B (middle intertidal) the most abundant species are P. planatus, C. hemprichii, S. orbiculus, Q. lamarckiana, Q. seminula and Q. laevigata, while Zone C (low intertidal) is characterised by C. hemprichii, Q. costata, S. orbiculus, P. planatus, A. convexa, A. tepida, Spiroloculina communis and S. costigera. A transfer function for sea-level reconstruction was developed using a modern dataset of 75 contemporary sediment samples and 99 species collected from several transects across the sabkha. The model provided an error of 0.12m, suggesting that intertidal foraminifers are able to predict the past sea-level changes with high precision in Al-Kharrar Lagoon, and thus the future prediction of those changes in the area.

Keywords: Lagoonal foraminifers, intertidal sabkha, vertical zonation, transfer function, sea level

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Authors: Yaya Gao, Bing Zhong, Yafeng Liu, Fei Chen

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Aim: The purpose of this study was to explore the difference between acellular dermal matrix (ADM) combined with anterolateral thigh (ALT) flap and ALT flap alone. Methods: HSCC patients were treated and divided into group A (ALT) and group B (ALT+ADM) between January 2014 and December 2018. We compared and analyzed the intraoperative information and postoperative outcomes of the patients. Results: There were 21 and 17 patients in group A and group B, respectively. The operation time, blood loss, defect size and anastomotic vessel selection showed no significant difference between two groups. The postoperative complications, including wound bleeding (n=0 vs. 1, p=0.459), wound dehiscence (n=0 vs. 1, p=0.459), wound infection (n=5vs.3, p=0.709), pharyngeal fistula (n=5vs.4, p=1.000) and hypoproteinemia (n=11 vs. 12, p=0.326) were comparable between the groups. Dysphagia at 6 months (number of liquid diets=0vs. 0; number of partial tube feedings=1vs. 1; number of total tube feedings=1vs. 0, p=0.655) also showed no significant differences. However, significant differences was observed in dysphagia at 12 months (number of liquid diets=0vs. 0; number of partial tube feedings=3 vs. 1; number of total tube feedings=10vs. 1, p=0.006). Conclusion: For HSCC patients, the use of the ALT flap combined ADM, compared to ALT treatment, showed better swallowing function at 12 months. The ALT flap combined ADM may serve as a safe and feasible alternative for selected HSCC patients.

Keywords: hypopharyngeal squamous cell carcinoma, anterolateral thigh free flap, acellular dermal matrix, reconstruction, dysphagia

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Authors: Jiri Barta

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At the present time, awareness, education, computer simulation and information systems protection are very serious and relevant topics. The article deals with perspectives and possibilities of implementation of emergence or natural hazard threats into the system which is developed for communication among members of crisis management staffs. The Czech Hydro-Meteorological Institute with its System of Integrated Warning Service resents the largest usable base of information. National information systems are connected to foreign systems, especially to flooding emergency systems of neighboring countries, systems of European Union and international organizations where the Czech Republic is a member. Use of outputs of particular information systems and computer simulations on a single communication interface of information system for communication among members of crisis management staff and setting the site interoperability in the net will lead to time savings in decision-making processes in solving extraordinary events and crisis situations. Faster managing of an extraordinary event or a crisis situation will bring positive effects and minimize the impact of negative effects on the environment.

Keywords: computer simulation, communication, continuity, critical infrastructure, information systems, safety

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Authors: Walid Tawfik

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The interaction of high intensity ultrashort laser pulses with plasma generates many significant applications, including soft x-ray lasers, time-resolved laser induced plasma spectroscopy LIPS, and laser-driven accelerators. The development in producing of femtosecond down to ten femtosecond optical pulses has facilitates scientists with a vital tool in a variety of ultrashort phenomena, such as high field physics, femtochemistry and high harmonic generation HHG. In this research, we generate a two-octave-wide ultrashort supercontinuum pulses with an optical spectrum extending from 3.5 eV (ultraviolet) to 1.3 eV (near-infrared) using a capillary fiber filled with neon gas. These pulses are formed according to nonlinear self-phase modulation in the neon gas as a nonlinear medium. The investigations of the created pulses were made using spectral phase interferometry for direct electric-field reconstruction (SPIDER). A complete description of the output pulses was considered. The observed characterization of the produced pulses includes the beam profile, the pulse width, and the spectral bandwidth. After reaching optimization conditions, the intensity of the reconstructed pulse autocorrelation function was applied for the shorts pulse duration to achieve transform limited ultrashort pulses with durations below 6-fs energies up to 600μJ. Moreover, the effect of neon pressure variation on the pulse width was examined. The nonlinear self-phase modulation realized to be increased with the pressure of the neon gas. The observed results may lead to an advanced method to control and monitor ultrashort transit interaction in femtochemistry.

Keywords: supercontinuum, ultrafast, SPIDER, ultra-broadband

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Authors: Aliaksei Patsekha, Michael Hohenberger, Harald Raupenstrauch

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An effective emergency response to accidents with chemical, biological, radiological, nuclear, or explosive materials (CBRNE) that represent highly dynamic situations needs immediate actions within limited time, information and resources. The aim of the study is to provide the foundation for division of unsafe area into risk zones according to the impact of hazardous parameters (heat radiation, thermal dose, overpressure, chemical concentrations). A decision on the boundary values for three risk zones is based on the vulnerability analysis that covered a variety of accident scenarios containing the release of a toxic or flammable substance which either evaporates, ignites and/or explodes. Critical values are selected for the boundary definition of the Red, Orange and Yellow risk zones upon the examination of harmful effects that are likely to cause injuries of varying severity to people and different levels of damage to structures. The obtained results provide the basis for creating a comprehensive real-time risk map for a decision support at CBRNE operations.

Keywords: boundary values, CBRNE threats, decision making process, hazardous effects, vulnerability analysis, risk zones

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Authors: Okhee Woo

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Purpose: The aim of this study is to evaluate 2-year cumulative effective radiation dose and cumulative organ dose on regular follow-up computed tomography (CT) scans in patients with breast cancer and to establish personalized low-dose CT protocol. Methods and Materials: A retrospective study was performed on the patients with breast cancer who were diagnosed and managed consistently on the basis of routine breast cancer follow-up protocol between 2012-01 and 2016-06. Based on ICRP (International Commission on Radiological Protection) 103, the cumulative effective radiation doses of each patient for 2-year follow-up were analyzed using the commercial radiation management software (Radimetrics, Bayer healthcare). The personalized effective doses on each organ were analyzed in detail by the software-providing Monte Carlo simulation. Results: A total of 3822 CT scans on 490 patients was evaluated (age: 52.32±10.69). The mean scan number for each patient was 7.8±4.54. Each patient was exposed 95.54±63.24 mSv of radiation for 2 years. The cumulative CT radiation dose was significantly higher in patients with lymph node metastasis (p = 0.00). The HER-2 positive patients were more exposed to radiation compared to estrogen or progesterone receptor positive patient (p = 0.00). There was no difference in the cumulative effective radiation dose with different age groups. Conclusion: To acknowledge how much radiation exposed to a patient is a starting point of management of radiation exposure for patients with long-term CT follow-up. The precise and personalized protocol, as well as iterative reconstruction, may reduce hazard from unnecessary radiation exposure.

Keywords: computed tomography, breast cancer, effective radiation dose, cumulative organ dose

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Authors: Shibinu S, Mohamed Haseeb N

Abstract:

In times of crisis, the diaspora's role and the help it offers are seen to be vital in determining how many countries, particularly low- and middle-income nations that significantly rely on remittances, recover. Twenty-one lakh twenty thousand Keralites have emigrated abroad, with 81.2 percent of these outflows occurring in the Gulf Cooperative Council (GCC). Most of them are semi-skilled or low-skilled laborers employed in GCC nations. Additionally, a sizeable portion of migrants are employed in industrialized nations like the UK and the US. These nations have seen the development of a highly robust Indian Diaspora. India's development is largely dependent on the generosity of its diaspora, and the nation has benefited greatly from the substantial contributions made by several emigrant generations. Its strength was noticeable during the COVID-19 and Kerala floods. Millions of people were displaced, millions of properties were damaged, and many people died as a result of the 2018 Kerala floods. The Malayalee diaspora played a crucial role in the reconstruction of Kerala by providing support for the rescue efforts underway on the ground through their extensive worldwide network. During COVID-19, an analogous outreach was also noted, in which the diaspora assisted stranded migrants across the globe. Together with the work the diaspora has done for the state's development and recovery, there has also been a recent outpouring of assistance during the COVID-19 pandemic. The study focuses on the subtleties of diaspora philanthropic scholarship and how Kerala was able to recover from the COVID-19 pandemic and floods thanks to it. Semi-structured in-depth interviews with migrants, migrant organizations, and beneficiaries from the diaspora through snowball sampling to better understand the role that diaspora philanthropy plays in times of crisis.

Keywords: crises, diaspora, remittances, COVID-19, flood, economic development of Kerala

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Authors: Ju-Hong Lee, Yi-Lin Shieh

Abstract:

Two-dimensional (2-D) quadrature mirror filter (QMF) banks have been widely considered for high-quality coding of image and video data at low bit rates. Without implementing subband coding, a 2-D QMF bank is required to have an exactly linear-phase response without magnitude distortion, i.e., the perfect reconstruction (PR) characteristics. The design problem of 2-D QMF banks with the PR characteristics has been considered in the literature for many years. This paper presents a transformation approach for designing 2-D two-channel QMF banks. Under a suitable one-dimensional (1-D) to two-dimensional (2-D) transformation with a specified decimation/interpolation matrix, the analysis and synthesis filters of the QMF bank are composed of 1-D causal and stable digital allpass filters (DAFs) and possess the 2-D doubly complementary half-band (DC-HB) property. This facilitates the design problem of the two-channel QMF banks by finding the real coefficients of the 1-D recursive DAFs. The design problem is formulated based on the minimax phase approximation for the 1-D DAFs. A novel objective function is then derived to obtain an optimization for 1-D minimax phase approximation. As a result, the problem of minimizing the objective function can be simply solved by using the well-known weighted least-squares (WLS) algorithm in the minimax (L∞) optimal sense. The novelty of the proposed design method is that the design procedure is very simple and the designed 2-D QMF bank achieves perfect magnitude response and possesses satisfactory phase response. Simulation results show that the proposed design method provides much better design performance and much less design complexity as compared with the existing techniques.

Keywords: Quincunx QMF bank, doubly complementary filter, digital allpass filter, WLS algorithm

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

Abstract:

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

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

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Authors: Muhammad R. Ahmed, Mohammed Aseeri

Abstract:

Wireless Sensor Network (WSN) consists of low-cost and multi functional resources constrain nodes that communicate at short distances through wireless links. It is open media and underpinned by an application driven technology for information gathering and processing. It can be used for many different applications range from military implementation in the battlefield, environmental monitoring, health sector as well as emergency response of surveillance. With its nature and application scenario, security of WSN had drawn a great attention. It is known to be valuable to variety of attacks for the construction of nodes and distributed network infrastructure. In order to ensure its functionality especially in malicious environments, security mechanisms are essential. Malicious or internal attacker has gained prominence and poses the most challenging attacks to WSN. Many works have been done to secure WSN from internal attacks but most of it relay on either training data set or predefined threshold. Without a fixed security infrastructure a WSN needs to find the internal attacks is a challenge. In this paper we present an internal attack detection method based on maximum entropy model. The final experimental works showed that the proposed algorithm does work well at the designed level.

Keywords: internal attack, wireless sensor network, network security, entropy

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Authors: Şakir Bingöl, Bayram İslamoğlu, Ebubekir Furkan Tepeli, Fatih Mehmet Karakule, Fatih Küçük, Merve Sena Arpacık, Mustafa Taha Kabar, Muhammet Metin Molak, Osman Emre Turan, Ömer Faruk Yesir, Sıla İnanır

Abstract:

This study introduces an IoT-based real-time safety system for mining, addressing global safety challenges. The wearable device, seamlessly integrated into miners' jackets, employs LoRa technology for communication and offers real-time monitoring of vital health and environmental data. Unique features include an LCD panel for immediate information display and sound-based location tracking for emergency response. The methodology involves sensor integration, data transmission, and ethical testing. Validation confirms the system's effectiveness in diverse mining scenarios. The study calls for ongoing research to adapt the system to different mining contexts, emphasizing its potential to significantly enhance safety standards in the industry.

Keywords: mining safety, internet of things, wearable technology, LoRa, RFID tracking, real-time safety system, safety alerts, safety measures

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Authors: Imran Altaf Wasil, Dinesh Ganvir

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Due to a scarcity of virgin aggregates, the use of reclaimed asphalt pavement (RAP) as a substitute for natural aggregates has gained popularity. Despite the fact that RAP is recycled in asphalt pavement, there is still excess RAP, and its use in concrete pavements has expanded in recent years. According to a survey, 98 percent of India's pavements are flexible. As a result, the maintenance and reconstruction of such pavements generate RAP, which can be reused in concrete pavements as well as surface course, base course, and sub-base of flexible pavements. Various studies on the properties of reclaimed asphalt pavement and its optimal requirements for usage in concrete has been conducted throughout the years. In this study a total of four different mixes were prepared by partially replacing natural aggregates by RAP in different proportions. It was found that with the increase in the replacement level of Natural aggregates by RAP the mechanical and durability properties got reduced. In order to increase the mechanical strength of mixes 40% Glass Granulated Blast Furnace Slag (GGBS) was used and it was found that with replacement of cement by 40% of GGBS, there was an enhancement in the mechanical and durability properties of RAP inclusive PQC mixes. The reason behind the improvement in the properties is due to the processing technique used in order to remove the contaminant layers present in the coarse RAP aggregates. The replacement level of Natural aggregate with RAP was done in proportions of 20%, 40% and 60% along with the partial replacement of cement by 40% GGBS. It was found that all the mixes surpassed the design target value of 40 MPa in compression and 4.5 MPa in flexure making it much more economical and feasible.

Keywords: reclaimed asphalt pavement, pavement quality concrete, glass granulated blast furnace slag, mechanical and durability properties

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Authors: Agnes Simone

Abstract:

A 52-year-old male with unknown psychiatric and medical history was brought to the Psychiatric Emergency Room by ambulance directly from jail. He had been detained for three weeks for possession of a firearm while intoxicated. On initial evaluation, the patient was unable to provide a reliable history. He presented with odd jerking movements of his extremities and catatonic features, including mutism and stupor. His vital signs were stable. Patient was transferred to the medical emergency department for work-up of altered mental status. Due to suspicion for opioid overdose, the patient was given naloxone (Narcan) with no improvement. Laboratory work-up included complete blood count, comprehensive metabolic panel, thyroid stimulating hormone, vitamin B12, folate, magnesium, rapid plasma reagin, HIV, blood alcohol level, aspirin, and Tylenol blood levels, urine drug screen, and urinalysis, which were all negative. CT head and chest X-Ray were also negative. With this negative work-up, the medical team concluded there was no organic etiology and requested inpatient psychiatric admission. Upon re-evaluation by psychiatry, it was evident that the patient continued to have an altered mental status. Of note, the medical team did not include substance withdrawal in the differential diagnosis due to stable vital signs and a negative urine drug screen. The psychiatry team decided to check California's prescription drug monitoring program (CURES) and discovered that the patient was prescribed benzodiazepine alprazolam (Xanax) 2mg BID, a sedative-hypnotic, and hydrocodone/acetaminophen 10mg/325mg (Norco) QID, an opioid. After a thorough chart review, his daughter's contact information was found, and she confirmed his benzodiazepine and opioid use, with recent escalation and misuse. It was determined that the patient was experiencing alprazolam withdrawal, given this collateral information, his current symptoms, negative urine drug screen, and recent abrupt discontinuation of medications while incarcerated. After admission to the medical unit and two doses of alprazolam 2mg, the patient's mental status, alertness, and orientation improved, but he had no memory of the events that led to his hospitalization. He was discharged with a limited supply of alprazolam and a close follow-up to arrange a taper. Accompanying this case report, a qualitative review of presentations with alprazolam withdrawal was completed. This case and the review highlights: (1) Alprazolam withdrawal can occur at low doses and within just one week of use. (2) Alprazolam withdrawal can present without any vital sign instability. (3) Alprazolam withdrawal does not respond to short-acting benzodiazepines but does respond to certain long-acting benzodiazepines due to its unique chemical structure. (4) Alprazolam withdrawal is distinct from and more severe than other benzodiazepine withdrawals. This case highlights (1) the importance of physician utilization of drug-monitoring programs. This case, in particular, relied on California's drug monitoring program. (2) The importance of obtaining collateral information, especially in cases in which the patient is unable to provide a reliable history. (3) The importance of including substance intoxication and withdrawal in the differential diagnosis even when there is a negative urine drug screen. Toxidrome of withdrawal can be delayed. (4) The importance of discussing addiction and withdrawal risks of medications with patients.

Keywords: addiction risk of benzodiazepines, alprazolam withdrawal, altered mental status, benzodiazepines, drug monitoring programs, sedative-hypnotics, substance use disorder

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