Search results for: vascular emergency

Authors: Stephanie Cheng, Benjamin Poh, Vivyan Tay, Sachin Mathur

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Aim: Diabetes mellitus (DM) is a worldwide pandemic affecting 500 million people. It is known to be associated with increased susceptibility to soft tissue infections (STI). Despite being a major public health burden, the literature relating the effects of DM and the presentation, severity and healing of STIs in general surgical patients remain limited. Methods: We conducted a retrospective review of all patients admitted with STI in a tertiary teaching hospital over a 12-month period. Patient demographics and surgical outcomes were collected and analyzed. Results: During the study period, 1059 patients were admitted for STIs, of which 936 (88%) required surgical intervention. Diabetic patients were presented with a higher body-mass index (BMI) (28 vs 26), larger abscess size (24 vs 14 cm²) and a longer length of stay (LOS)(4.4 days vs 2.9 days). They also underwent a higher proportion of wide debridement as well as application of negative pressure wound therapy (NPWT) (42% vs 35%). More diabetic patients underwent subsequent re-operation within the same sitting (8 vs 4). There were no differences in re-admission rates within 30 days nor subsequent abscess formation in those followed for 6 months. Conclusion: The incidence of STIs among DM patients represents a significant disease burden; surgeons should consider intensive patient counseling and partnering with primary care providers in order to help reduce the incidence of future STI admissions based on lifestyle modification and glucose control.

Keywords: general surgery, emergency general surgery, acute care surgery, soft tissue infections, diabetes mellitus

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Authors: Dalal Alghawas, Jetty Lee, Kaisa Poutanen, Hani El-Nezami

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Oat β-glucan a water soluble non starch linear polysaccharide has been approved as a cholesterol lowering agent by various food safety administrations and is commonly used to reduce the risk of heart disease. The molecular weight of oat β-glucan can vary depending on the extraction and fractionation methods. It is not clear whether the molecular weight has a significant impact at reducing the acceleration of atherosclerosis. The aim of this study was to investigate three different oat β-glucan fractionations on the development of atherosclerosis in vivo. With special focus on plaque stability and the intestinal barrier function. To test this, ApoE-/- female mice were fed a high fat diet supplemented with oat bran, high molecular weight (HMW) oat β-glucan fractionate and low molecular weight (LMW) oat β-glucan fractionate for 16 weeks. Atherosclerosis risk markers were measured in the plasma, heart and aortic tree. Plaque size was measured in the aortic root and aortic tree. ICAM-1, VCAM-1, E-Selectin, P-Selectin, protein levels were assessed from the aortic tree to determine plaque stability at 16 weeks. The expression of p22phox at the aortic root was evaluated to study the NADPH oxidase complex involved in nitric oxide bioavailability and vascular elasticity. The tight junction proteins E-cadherin and beta-catenin from western blot analyses were analysed as an intestinal barrier function test. Plasma LPS, intestinal D-lactate levels and hepatic FMO gene expression were carried out to confirm whether the compromised intestinal barrier lead to endotoxemia. The oat bran and HMW oat β-glucan diet groups were more effective than the LMW β-glucan diet group at reducing the plaque size and showed marked improvements in plaque stability. The intestinal barrier was compromised for all the experimental groups however the endotoxemia levels were higher in the LMW β-glucan diet group. The oat bran and HMW oat β-glucan diet groups were more effective at attenuating the development of atherosclerosis. Reasons for this could be due to the LMW oat β-glucan diet group’s low viscosity in the gut and the inability to block the reabsorption of cholesterol. Furthermore the low viscosity may allow more bacterial endotoxin translocation through the impaired intestinal barrier. In future food technologists should carefully consider how to incorporate LMW oat β-glucan as a health promoting food.

Keywords: Atherosclerosis, beta glucan, endotoxemia, intestinal barrier function

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Authors: Ageliki I. Katsarou, Andriana C. Kaliora, Antonia Chiou, Apostolos Papalois, Nick Kalogeropoulos, Nikolaos K. Andrikopoulos

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Chronic inflammation plays a pivotal role in CVD development, while phytochemicals have been shown to reduce CVD risk. Several studies have correlated olive oil consumption with CVD prevention and CVD risk reduction. However, the effect of individual olive oil macro- or micro-constituents and possible synergisms among them needs to be further elucidated. Herein, extra virgin olive oil (EVOO) lipidic and polar phenolics fractions were evaluated for their effect on inflammatory markers in cholesterol-fed rats. Oils combining different characteristics as to their polar phenolic content and lipid profile were used. Male Wistar rats were fed for 9 weeks on either a high-cholesterol diet (HCD) or a HCD supplemented with oils, either commercially available, i.e. EVOO, sunflower oil (SO), or modified as to their polar phenol content, i.e. phenolics deprived-EVOO (EVOOd), SO enriched with the EVOO phenolics (SOe). Post-intervention, aorta and blood samples were collected. HCD induced dyslipidemia, manifested by serum total cholesterol and low-density lipoprotein cholesterol elevation. Additionally, HCD resulted in higher adhesion molecules’ levels in rat aorta. In the case of E-selectin, this increase was attenuated by HCD supplementation with EVOO and EVOOd, while no alterations were observed in SO and SOe groups. No differences were observed between pairs of commercial and modified oils, indicating that oleates may be the components responsible for aorta E-selectin levels lowering. The same was true for vascular adhesion molecule-1 (VCAM-1); augmentation in cholesterol-fed animals was attenuated by EVOO and EVOOd diets, highlighting oleates effect. In addition, VCAM-1 levels were higher in SO group compared to the respective SOe, indicating that in the presence of phenolic compounds linoleic acid have become less prone to oxidation. Intercellular adhesion molecule-1 (ICAM-1) levels were higher in cholesterol-fed rats, however not affected by any of the oils supplemented during the intervention. Overall, EVOO was found superior in regulating adhesion molecule levels in rat aorta compared to SO. EVOO and EVOOd exhibited analogous effects on all adhesion molecules assessed, indicating that EVOO major constituents (oleates) improve E-selectin and VCAM-1 levels in rat aorta, independently from phenolics presence. Further research is needed to elucidate the effect of phenolics and oleates in other tissues.

Keywords: extra virgin olive oil, cholesterol-fed rats, polar phenolics, adhesion molecules

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Authors: Hyeon-Kyo Lim, Tong-Il Jang, Yong-Hee Lee

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For the past several decades, not a few researchers have warned that even a trivial human error may result in unexpected accidents, especially in Nuclear Power Plants. To prevent accidents in Nuclear Power Plants, it is quite indispensable to make any factors under the effective control that may raise the possibility of human errors for accident prevention. This study aimed to develop a risk management program, especially in the sense that guaranteeing Fitness-for-Duty (FFD) of human beings working in Nuclear Power Plants. Throughout a literal survey, it was found that work stress and fatigue are major psychophysical factors requiring sophisticated management. A set of major management factors related to work stress and fatigue was through repetitive literal surveys and classified into several categories. To maintain the fitness of human workers, a 4-level – individual worker, team, staff within plants, and external professional - approach was adopted for FFD management program. Moreover, the program was arranged to envelop the whole employment cycle from selection and screening of workers, job allocation, and job rotation. Also, a managerial care program was introduced for employee assistance based on the concept of Employee Assistance Program (EAP). The developed program was reviewed with repetition by ex-operators in nuclear power plants, and assessed in the affirmative. As a whole, responses implied additional treatment to guarantee high performance of human workers not only in normal operations but also in emergency situations. Consequently, the program is under administrative modification for practical application.

Keywords: fitness-for-duty (FFD), human error, work stress, fatigue, Employee-Assistance-Program (EAP)

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Authors: Muhammad Kamran Hanif Khan, Fahad Mushtaq

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Globally, the death rate from cardiovascular disease has risen over the past 20 years, but especially in low and middle-income countries (LMICS), reports the World Health Organization (WHO). Around 17.5 million deaths, or 31% of all deaths worldwide in 2012, were attributed to CVD, 80% of which occurred in low- and middle-income nations, and eighty five percent of all worldwide disability is attributable to cardiovascular disease. This study assessed the dietary habit and Cardiovascular Risk factors among the patients of coronary artery disease against matched controls. The research was a case-control study. Sample size for this case-control study was 410 CAD cases and 410 healthy controls. The case-control ratio was 1:1. Patients diagnosed with coronary artery disease were recruited from the outpatient departments and emergency rooms of four hospitals in Pakistan. The ages of people who were diagnosed with coronary artery disease were not significantly different from (mean 57.97 7.39 years) the healthy controls (mean 57.12 6.73 years). In order to determine the relationship between food consumption and the two binary outcomes, logistic regression analysis was carried out. Chicken (0.340 (0.245-0.47), p-value 0.0001), beef (0.38 (0.254-0.56), p-value 0.0001), eggs (0.297 (0.208-0.426), p-value 0.0001), and junk food (0.249 (0.167-0.372), p-value 0.0001)) were protective, while yogurt consumption more than twice weekly was risk. Conclusion: In conclusion, poor dietary habits are closely linked to the risk of CAD. Investigations based on dietary trends offer vital and practical knowledge about societal patterns.

Keywords: dietary habbits, cardiovasculardisease, CVD risk factors, hypercholesterolemia

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Authors: Maariyah Irfan

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Intro: Current cardiovascular (CV) care faces challenges such as low budgets and high hospital admission rates. This review aims to evaluate Big Data in CV healthcare management through the use of wearable devices in atrial fibrillation (AF) detection. AF may present intermittently, thus it is difficult for a healthcare professional to capture and diagnose a symptomatic rhythm. Methods: The iRhythm ZioPatch, AliveCor portable electrocardiogram (ECG), and Apple Watch were chosen for review due to their involvement in controlled clinical trials, and their integration with smartphones. The cost-effectiveness and AF detection of these devices were compared against the 12-lead ambulatory ECG (Holter monitor) that the NHS currently employs for the detection of AF. Results: The Zio patch was found to detect more arrhythmic events than the Holter monitor over a 2-week period. When patients presented to the emergency department with palpitations, AliveCor portable ECGs detected 6-fold more symptomatic events compared to the standard care group over 3-months. Based off preliminary results from the Apple Heart Study, only 0.5% of participants received irregular pulse notifications from the Apple Watch. Discussion: The Zio Patch and AliveCor devices have promising potential to be implemented into the standard duty of care offered by the NHS as they compare well to current routine measures. Nonetheless, companies must address the discrepancy between their target population and current consumers as those that could benefit the most from the innovation may be left out due to cost and access.

Keywords: atrial fibrillation, big data, cardiovascular healthcare management, wearable devices

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Authors: Rosiris Maturo Domingues, Patricia Luissa Masmo, Cibele Cavalheiro Neves, Juliana Dalla Martha Rodriguez

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This article reports the experience of the pedagogical consultants responsible for the curriculum development of Senac São Paulo courses when facing the emergency need to maintain the pedagogical process in their schools in the face of the Covid-19 pandemic. The urgent adjustment to distance education resulted in the improvement of the process and the adoption of new teaching and learning strategies mediated by technologies. The processes for preparing and providing guidelines for professional education courses were also readjusted. Thus, a bank of teaching-learning strategies linked to digital resources was developed, categorized, and identified by their didactic-pedagogical potential, having as an intersection didactic planning based on learning objectives based on Bloom's taxonomy (revised), given its convergence with the competency approach adopted by Senac. Methodologically, a relationship was established between connectivity and digital networks and digital evolution in school environments, culminating in new paradigms and processes of educational communication and new trends in teaching and learning. As a result, teachers adhered to the use of digital tools in their practices, transposing face-to-face classroom methodologies and practices to online media, whose criticism was the use of ICTs in an instrumental way, reducing methodologies and practices to teaching only transmissive. There was recognition of the insertion of technology as a facilitator of the educational process in a non-palliative way and the development of a web curriculum, now and fully, carried out in contexts of ubiquity.

Keywords: technologies, education, teaching-learning strategies, Bloom taxonomy

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Authors: Salizar Mohamed Ludin, Mohd Khairul Hasyimi Firdaus, Paul Arbon

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Purpose: This paper aims to develop Malaysian Government and community-level critical thinking, planning and action for improving community disaster resilience by reporting Phase 1, Part 1 of a larger community disaster resilience measurement study about adapting the Torrens Resilience Institute Australian Community Disaster Resilience Scorecard to the Malaysian context. Methodology: Pparticipatory action research encouraged key people involved in managing the six most affected areas in the 2014 flooding of Kelantan in Malaysia’s north-east to participate in discussions about adapting and self-testing the Australian Community Disaster Resilience Scorecard to measure and improve their communities’ disaster resilience. Findings: Communities need to strengthen their disaster resilience through better communication, cross-community cooperation, maximizing opportunities to compare their plans, actions and reactions with those reported in research publications, and aligning their community disaster management with reported best practice internationally while acknowledging the need to adapt such practice to local contexts. Research implications: There is a need for a Malaysia-wide, simple-to-use, standardized disaster resilience scorecard to improve the quality, quantity and capability of healthcare and emergency services’ preparedness, and to facilitate urgent reallocation of aid. Value: This study is the first of its kind in Malaysia. The resulting community disaster resilience guideline based on participants’ feedback about the Kelantan floods and scorecard self-testing has the potential for further adaptation to suit contexts across Malaysia, as well as demonstrating how the scorecard can be adapted for international use.

Keywords: community disaster resilience, CDR Scorecard, participatory action research, flooding, Malaysia

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Authors: Aleme Mekuria, Samuel Mathewos

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Background: Teenage pregnancy has long been a worldwide social, economic and educational concern for the developed, developing and underdeveloped countries. Studies on adolescent sexuality and pregnancy are very limited in our country. Therefore, this study aims at assessing the prevalence of teenage pregnancy and its determinants among school adolescents of Arba Minch town. Methods: Institution- based, cross-sectional study was conducted from 20-30 March 2014. Systematic sampling technique was used to select a total of 578 students from four schools of the town. Data were collected by trained data collectors using a pre-tested, self-administered structured questionnaire. The analysis was made using the software SPSS version 20.0 statistical packages. Multivariate logistic regression was used to identify the predictors of teenage pregnancy. Results: The prevalence of teenage pregnancy among school adolescents of Arba Minch town was 7.7%. Being grade11(AOR=4.6;95%CI:1.4,9.3) and grade12 student (AOR=5.8;95% CI:1.3,14.4), not knowing the correct time to take emergency contraceptives(AOR=3.3;95%CI:1.4,7.4), substance use(AOR=3.1;95%CI:1.1,8.8), living with either of biological parents (AOR=3.3;95%CI:1.1,8.7) and poor parent-daughter interaction (AOR=3.1;95%CI:1.1,8.7) were found to be significant predictors of teenage pregnancy. Conclusion: This study revealed a high level of teenage pregnancy among school adolescents of Arba Minch town. A significant number of adolescent female school students were at risk of facing the challenges of teenage pregnancy in the study area. School-based reproductive health education and strong parent-daughter relationships should be strengthened.

Keywords: adolescent, Arba minch, risk factors, school, southern Ethiopia, teenage pregnancy

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Authors: Matheesha Herath, Ned Kinnear, Bridget Heijkoop, Eliza Bramwell, Alannah Frazetto, Amy Noll, Prajay Patel, Derek Hennessey, Greg Otto, Christopher Dobbins, Tarik Sammour, James Moore

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Background: Important incidental pathology requiring further action is commonly found during appendicectomy, macro- and microscopically. It is unknown whether the acute surgical unit (ASU) model affects the management and disclosure of these findings. Methods: An ASU model was introduced at our institution on 01/08/2012. In this retrospective cohort study, all patients undergoing appendicectomy 2.5 years before (traditional group) or after (ASU group) this date were compared. The primary outcomes were rates of appropriate management of the incidental findings and communication of the findings to the patient and to their general practitioner (GP). Results: 1,214 patients underwent emergency appendicectomy; 465 in the traditional group and 749 in the ASU group. 80 (6.6%) patients (25 and 55 in each respective period) had important incidental findings. There were 24 patients with benign polyps, 15 with neuro-endocrine tumour, 11 with endometriosis, 8 with pelvic inflammatory disease, 8 Enterobius vermicularis infection, 7 with low grade mucinous cystadenoma, 3 with inflammatory bowel disease, 2 with diverticulitis, 2 with tubo-ovarian mass, 1 with secondary appendiceal malignancy and none with primary appendiceal adenocarcinoma. One patient had dual pathologies. There was no difference between the traditional and ASU group with regards to communication of the findings to the patient (p=0.44) and their GP (p=0.27), and there was no difference in the rates of appropriate management (p=0.21). Conclusions: The introduction of an ASU model did not change rates of surgeon-to-patient and surgeon-to-GP communication nor affect rates of appropriate management of important incidental pathology during an appendectomy.

Keywords: acute care surgery, appendicitis, appendicectomy, incidental

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Authors: Zerihun Ketema Tadesse, Dabbu Suman Reddy

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Brain-Computer Interfaces (BCIs) give the possibility for disabled people to communicate and control devices. This work aims at developing steady-state visual evoked potential (SSVEP)-based BCI for patients with limb disabilities. In hospitals, devices like nurse emergency call devices, lights, and TV sets are what patients use most frequently, but these devices are operated manually or using the remote control. Thus, disabled patients are not able to operate these devices by themselves. Hence, SSVEP-based BCI system that can allow disabled patients to control nurse calling device and other devices is proposed in this work. Portable LED visual stimulator that flickers at specific frequencies of 7Hz, 8Hz, 9Hz and 10Hz were developed as part of this project. Disabled patients can stare at specific flickering LED of visual stimulator and Emotiv EPOC used to acquire EEG signal in a non-invasive way. The acquired EEG signal can be processed to generate various control signals depending upon the amplitude and duration of signal components. MATLAB software is used for signal processing and analysis and also for command generation. Arduino is used as a hardware interface device to receive and transmit command signals to the experimental setup. Therefore, this study is focused on the design and development of Steady-state visually evoked potential (SSVEP)-based BCI for limb disabled patients, which helps them to operate and control devices in the hospital room/wards.

Keywords: SSVEP-BCI, Limb Disabled Patients, LED Visual Stimulator, EEG signal, control devices, hospital room/wards

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Authors: Allaeddine Athmani, Abdelhacine Gouasmia, Tiago Ferreira, Romeu Vicente

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Seismic vulnerability assessment of masonry buildings is a fundamental issue even for moderate to low seismic hazard regions. This fact is even more important when dealing with old structures such as those located in Annaba city (Algeria), which the majority of dates back to the French colonial era from 1830. This category of buildings is in high risk due to their highly degradation state, heterogeneous materials and intrusive modifications to structural and non-structural elements. Furthermore, they are usually shelter a dense population, which is exposed to such risk. In order to undertake a suitable seismic risk mitigation strategies and reinforcement process for such structures, it is essential to estimate their seismic resistance capacity at a large scale. In this sense, two seismic vulnerability index methods and damage estimation have been adapted and applied to a pilot-scale building area located in the moderate seismic hazard region of Annaba city: The first one based on the EMS-98 building typologies, and the second one derived from the Italian GNDT approach. To perform this task, the authors took the advantage of an existing data survey previously performed for other purposes. The results obtained from the application of the two methods were integrated and compared using a geographic information system tool (GIS), with the ultimate goal of supporting the city council of Annaba for the implementation of risk mitigation and emergency planning strategies.

Keywords: Annaba city, EMS98 concept, GNDT method, old city center, seismic vulnerability index, unreinforced masonry buildings

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Authors: Ida Fatimawati Adi Badiozaman, Augustus Raymond Segar

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The Covid-19 pandemic transformed teaching contexts at an unprecedented level. Although studies have focused mainly on its impact on students, little is known about how emergency online teaching affects faculty members in higher education. Given that the pandemic has robbed teachers of opportunities for adequate preparation, it is vital to understand how teaching competencies were perceived in the crisis-response transition to online teaching and learning (OTL). Therefore, the study explores how academics perceive their readiness for OTL and what competencies were perceived to be central. Therefore, through a mixed-methods design, the study first explores through a survey how academics perceive their readiness for OTL and what competencies were perceived to be central. Emerging trends from the quantitative data of 330 academics (three public and three private Higher learning institutions) led to the formulation of interview guides for the subsequent qualitative phase. The authors use critical sensemaking (CSM) to analyse interviews with twenty-two teachers (n = 22) (three public; three private HEs) toward understanding the interconnected layers of influences they draw from as they make sense of their teaching competence. The sensemaking process reframed competence and readiness in that agentic competency emerged as crucial in shaping resilience and adaptability during the transition to OTL. The findings also highlight professional learningcriticalto teacher competence: course design, communication, time management, technological competence, and identity (re)construction. The findings highlight opportunities for strategic orientation to change during crisis. Implications for pedagogy and policy are discussed.

Keywords: online teaching, pedagogical competence, agentic competence, agency, technological competence

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Authors: Olivier Chaigneau, Damianos Oikonomidis, Marie-Cecile Delmas

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GAMBAS (Galileo Advanced features for the Maritime domain: Breakthrough Applications for Safety and security) is a project funded by the European Space Program Agency (EUSPA) aiming at identifying the search-and-rescue and ship security alert system needs for maritime users (including operators and fishing stakeholders) and developing operational concepts to answer these needs. The general objective of the GAMBAS project is to support the deployment of Galileo exclusive features in the maritime domain in order to improve safety and security at sea, detection of illegal activities and associated surveillance means, resilience to natural and human-induced emergency situations, and develop, integrate, demonstrate, standardize and disseminate these new associated capabilities. The project aims to demonstrate: improvement of the SAR (Search And Rescue) and SSAS (Ship Security Alert System) detection and response to maritime distress through the integration of new features into the beacon for SSAS in terms of cost optimization, user-friendly aspects, integration of Galileo and OS NMA (Open Service Navigation Message Authentication) reception for improved authenticated localization performance and reliability, and at sea triggering capabilities, optimization of the responsiveness of RCCs (Rescue Co-ordination Centre) towards the distress situations affecting vessels, the adaptation of the MCCs (Mission Control Center) and MEOLUT (Medium Earth Orbit Local User Terminal) to the data distribution of SSAS alerts.

Keywords: Galileo new advanced features, maritime, safety, security

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Authors: Inkyong Yi

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Acute kidney injury (AKI) in trauma patients is known to be associated with multiple factors, especially shock and consequent inadequate renal perfusion, yet its clinical presentation is little known in severe trauma patients. Our aim was to investigate the clinical presentation of acute kidney injury and its outcome in severe trauma patients at a level I trauma center. A total of 93 consecutive adult trauma patients with an injury severity score (ISS) of more than 15 were analyzed retrospectively from our Level I trauma center data base. Patients with direct renal injury were excluded. Patients were dichotomized into two groups, according to the presence of AKI. Various clinical parameters were compared between two groups, with Student’s T test and Mann-Whitney’s U test. The AKI group was further dichotomized into patients who recovered within seven days, and those who required more than 7days for recovery or those who did not recover at all. Various clinical parameters associated with outcome were further analyzed. Patients with AKI (n=33, 35%) presented with significantly higher age (61.4±17.3 vs. 45.4±17.3, p < 0.0001), incidence of comorbidities (hypertension; 51.5% vs. 13.3%, OR 6.906 95%CI 2.515-18.967, diabetes; 27.3% vs. 6.7%, OR 5.250, 95%CI 1.472-18.722), odds of head and neck trauma (69.7% vs. 41.7%, OR 3.220, 95%CI 1.306-7.942) and presence of shock during emergency room care (66.7% vs 21.7% OR 7.231, 95%CI, 2.798-18.687). Among AKI patients, patients who recovered within 1 week showed lower peak lactate (4.7mmol/L, 95%CI 2.9-6.5 vs 7.3mmol/L, 95%CI 5.0-9.6, p < 0.0287), lesser units of transfusion during first 24 hours (pRBC; 20.4unit, 95%CI 12.5-28.3 vs. 58.9unit, 95%CI 39.4-78.5, p=0.0003, FFP; 16.6unit, 95%CI 6.8-26.4 vs. 56.1unit, 95%CI 26.9-85.2, p=0.0027). In severe trauma patients, patients with AKI showed different clinical presentations and worse outcomes. Initial presence of shock and higher DIC profiles may be important risk factors for AKI in severe trauma patients. In patients with AKI, peak lactate level and amounts of transfusion are related to recovery.

Keywords: acute kidney injury, lactate, transfusion, trauma

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Authors: Jean Berger, Nassirou Lo, Martin Noel

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Perfectly suited for natural or man-made emergency and disaster management situations such as flood, earthquakes, tornadoes, or tsunami, multi-target search path planning for a team of rescue agents is known to be computationally hard, and most techniques developed so far come short to successfully estimate optimality gap. A novel mixed-integer linear programming (MIP) formulation is proposed to optimally solve the multi-target multi-agent discrete search and rescue (SAR) path planning problem. Aimed at maximizing cumulative probability of successful target detection, it captures anticipated feedback information associated with possible observation outcomes resulting from projected path execution, while modeling agent discrete actions over all possible moving directions. Problem modeling further takes advantage of network representation to encompass decision variables, expedite compact constraint specification, and lead to substantial problem-solving speed-up. The proposed MIP approach uses CPLEX optimization machinery, efficiently computing near-optimal solutions for practical size problems, while giving a robust upper bound obtained from Lagrangean integrality constraint relaxation. Should eventually a target be positively detected during plan execution, a new problem instance would simply be reformulated from the current state, and then solved over the next decision cycle. A computational experiment shows the feasibility and the value of the proposed approach.

Keywords: search path planning, search and rescue, multi-agent, mixed-integer linear programming, optimization

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Authors: Maitri Dave

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Coronaviruses (CoV) is such infectious virus which has impacted globally in a more dangerous manner causing severe lung problems and leaving behind more serious diseases among the people. This pandemic has affected globally and created severe respiratory problems, and damaged the lungs. India has reported the first case of COVID-19 in January 2020. The first wave of COVID-19 took place from April to September of 2020. Soon after, a second peak is also noticed in the month of March 2021, which in turn becomes more dangerous due to a lack of supply of medical equipment. It created resource deficiency globally, specifically in India, where some necessary life-saving equipment like ventilators and oxygenators were not sufficient to cater to the demand-supply ratio effectively. Through carefully examining such a situation, India began to execute the process of vaccination in the month of January 2021 and successfully administered 25,46,71,259 doses of vaccines till now, which is only 15.5% of the total population while only 3.6% of the total population is fully vaccinated. India has authorized the British Oxford–AstraZeneca vaccine (Covishield), the Indian BBV152 (Covaxin) vaccine, and the Russian Sputnik V vaccine for emergency use. In the present study, we have collected all the data state wisely of both first and second wave and analyzed them using MS Excel Version 2019 and SPSS Statistics Version 26. Following the trends, we have predicted the characteristics of the upcoming third wave of COVID-19 and recommended some strategies, early actions, and measures that can be taken by the public health system in India to combat the third wave more effectively.

Keywords: COVID-19, vaccination, Covishiled, Coronavirus

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Authors: Maria Pavlova

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In our days, it is possible to put the camera on different vehicles like quadcopter, train, airplane and etc. The camera also can be the input sensor in many different systems. That means the object recognition like non separate part of monitoring control can be key part of the most intelligent systems. The aim of this paper is to focus of the object recognition process during vehicles movement. During the vehicle’s movement the camera takes pictures from the environment without storage in Data Base. In case the camera detects a special object (for example human or animal), the system saves the picture and sends it to the work station in real time. This functionality will be very useful in emergency or security situations where is necessary to find a specific object. In another application, the camera can be mounted on crossroad where do not have many people and if one or more persons come on the road, the traffic lights became the green and they can cross the road. In this papers is presented the system has solved the aforementioned problems. It is presented architecture of the object recognition system includes the camera, Raspberry platform, GPS system, neural network, software and Data Base. The camera in the system takes the pictures. The object recognition is done in real time using the OpenCV library and Raspberry microcontroller. An additional feature of this library is the ability to display the GPS coordinates of the captured objects position. The results from this processes will be sent to remote station. So, in this case, we can know the location of the specific object. By neural network, we can learn the module to solve the problems using incoming data and to be part in bigger intelligent system. The present paper focuses on the design and integration of the image recognition like a part of smart systems.

Keywords: camera, object recognition, OpenCV, Raspberry

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Authors: Naila Awan, Shahrukh Inam

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This study was conducted to highlight the role of basic health units in district Swabi, which provides primary health services to the people of district Swabi having four tehsils. Tehsil Swabi was selected purposively for the study. Three villages were purposively selected from district Swabi. A sum of 110 respondents was randomly selected for interview i.e., 27 from Botakaa, 39 from Gulatee, and 44 from Darra Cham, using proportion allocation sampling technique. A pretested and well-designed interview schedule was used to collect as per the objective and Chi square test was applied to find an association between the quality of medicines and health improvement. The output of the test shows that the government was doing its best and providing enough facilities to the individuals at the healthcare units, and they were utilizing them. These resources were easily accessible to the people of the community. Medicines provided by the government were of good quality and quantity. There were also school health sessions and community health sessions (SHS/CHS) to deliver useful information and awareness regarding health problems and diseases were conducted. The staff of the BHU was present at work time and was performing their duties. The respondents seemed satisfied with their behavior and the duty of the staff. However, there were no emergency resources existing at the BHU after the working hours of the medical staff. It is recommended that government should provide appropriate quantity and quality of medicines to the basic health units so that these healthcare units don’t have to face any shortages regarding medicines at the end of the month. In addition, laboratory and blood testing facilities need to be provided in the basic health units, and also the infrastructure should be made suitable, satisfactory, and more functional.

Keywords: community health session, basic health units, outpatient department, tuberculosis

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Authors: Christopher Leung, Assad Zahid

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Mesenteric vasculitis can often mimic abdominal sepsis in a postoperative setting leading to a predicament where steroids could improve mesenteric vasculitis whilst worsening abdominal sepsis. Here this study presents a unique and rare case of perforated sigmoid diverticulitis secondary to systemic vasculitis. A 68-year-old gentleman presented with perforated sigmoid diverticulitis requiring an emergency Hartmann’s procedure. Early in his postoperative course, he had painful and asymmetrical neuropathy that, after a careful history and examination, revealed a patient with mono neuritis multiplex on a background history of longstanding rheumatoid arthritis. On day seven of his postoperative course, he had rising inflammatory markers and a CT abdomen and pelvis showing fluid around the mesentery. Whilst contamination from sigmoid perforation was somewhat congruent with these signs, a diagnosis of polyarteritis nodosa, a common cause of mononeuritis multiplex, is also possible, although involvement of the large bowel in polyarteritis nodosa is extremely rare. The histopathology from the initial Hartmann’s procedure was re-examined, showing medium vessel disease vasculitis. Given his lack of fevers, absence of abdominal pain, and worsening neurology, he was given a provisional diagnosis of polyarteritis nodosa and was treated successfully, not on IV antibiotics but on steroids. Large bowel involvement of polyarteritis nodosa is extremely rare and this is the first case of polyarteritis nodosa causing perforated diverticulitis. The learning point here is to obtain a good clinical picture of a patient to identify mesenteric vasculitis as compared to abdominal sepsis as the treatment of one worsens the other.

Keywords: abdominal sepsis, diverticulitis, mesenteric vasculitis, polyarteritis nodosa

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Authors: Sonny Dewi Judiasih

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Every person retains the right to marry and starts a family through a legitimized marriage. Indonesian Marriage Act has regulated the minimum age for boys to marry is 19 while the girls is 16, with an exception that the parents could ask for an exemption to the court or to the authorized official. Despite the age limit is set by the Marriage Act, however, with the influences from adat law and islamic law which allows younger persons to marry, the child marriage phenomenon is inevitable to happen in Indonesia. Child marriages in Indonesia have shown such alarming fact where 4.8 percentage of total marriage number come from persons with the age of 10 to 14 years old. The percentage was the result from a research conducted by the National Population and Family Planning Board (BKKBN). The result shows 41.9 percent of child marriages was contributed by girls who marry in the age of 15 to 19, which mostly comes from villagers. Other fact shows 50 percent of child marriages end in divorce with grounds varied from the mental health of the children, economic situation, and so on. With more children committed early marriages, more babies will be borned from indebted families. Subsequently, the government’s program to alleviate poverty will be short of expectations. Other risk for child marriages includes death of the mother and the child after giving birth. The people have challenged the legality of child marriages through judicial review filed to the Constitutional Court. The Court decided to reinforce the age limitation previously set by the Marriage Act by issuing judicial decision no: 30-74/PUU-Xii/2014. The Court stated that changes to the age limit must be in conform with cultural and traditional situation. Further, it stated child marriages are allowed to be arranged as an “emergency exit” if the parents filed such request to an exemption on the grounds of coercive situation and after the court or the authorized officials issued its approval.

Keywords: child, marriage, court, Indonesia

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Authors: Sophia Shi

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Acute kidney injury (AKI) is the sudden onset of kidney damage in which the kidneys cannot filter waste from the blood, requiring emergency hospitalization. AKI patient mortality rate is high in the ICU and is virtually impossible for doctors to predict because it is so unexpected. Currently, there is no hybrid model predicting AKI that takes advantage of two types of data. De-identified patient data from the MIMIC-III database and de-identified kidney images and corresponding patient records from the Beijing Hospital of the Ministry of Health were collected. Using data features including serum creatinine among others, two numeric models using MIMIC and Beijing Hospital data were built, and with the hospital ultrasounds, an image-only model was built. Convolutional neural networks (CNN) were used, VGG and Resnet for numeric data and Resnet for image data, and they were combined into a hybrid model by concatenating feature maps of both types of models to create a new input. This input enters another CNN block and then two fully connected layers, ending in a binary output after running through Softmax and additional code. The hybrid model successfully predicted AKI and the highest AUROC of the model was 0.953, achieving an accuracy of 90% and F1-score of 0.91. This model can be implemented into urgent clinical settings such as the ICU and aid doctors by assessing the risk of AKI shortly after the patient’s admission to the ICU, so that doctors can take preventative measures and diminish mortality risks and severe kidney damage.

Keywords: Acute kidney injury, Convolutional neural network, Hybrid deep learning, Patient record data, ResNet, Ultrasound kidney images, VGG

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Authors: Anjali Roy, Mirza S. Baig

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Atherosclerosis is a chronic inflammatory disease characterized by the formation of lipid rich plaque enriched with necrotic core, modified lipid accumulation, smooth muscle cells, endothelial cells, leucocytes and macrophages. Macrophage foam cells play a critical role in the occurrence and development of inflammatory atherosclerotic plaque. Foam cells are the fat-laden macrophages in the initial stage atherosclerotic lesion formation. Foam cells are an indication of plaque build-up, or atherosclerosis, which is commonly associated with increased risk of heart attack and stroke as a result of arterial narrowing and hardening. The mechanisms that drive atherosclerotic plaque progression remain largely unknown. Dissecting the molecular mechanism involved in process of macrophage foam cell formation will help to develop therapeutic interventions for atherosclerosis. To investigate the mechanism, we studied the role of nitric oxide synthase 1(NOS1)-mediated nitric oxide (NO) on low-density lipoprotein (LDL) uptake by bone marrow derived macrophages (BMDM). Using confocal microscopy, we found that incubation of macrophages with NOS1 inhibitor, TRIM (1-(2-Trifluoromethylphenyl) imidazole) or L-NAME (N omega-nitro-L-arginine methyl ester) prior to LDL treatment significantly reduces the LDL uptake by BMDM. Further, addition of NO donor (DEA NONOate) in NOS1 inhibitor treated macrophages recovers the LDL uptake. Our data strongly suggest that NOS1 derived NO regulates LDL uptake by macrophages and foam cell formation. Moreover, we also checked proinflammatory cytokine mRNA expression through real time PCR in BMDM treated with LDL and copper oxidized LDL (OxLDL) in presences and absences of inhibitor. Normal LDL does not evoke cytokine expression whereas OxLDL induced proinflammatory cytokine expression which significantly reduced in presences of NOS1 inhibitor. Rapid NOS-1-derived NO and its stable derivative formation act as signaling agents for inducible NOS-2 expression in endothelial cells, leading to endothelial vascular wall lining disruption and dysfunctioning. This study highlights the role of NOS1 as critical players of foam cell formation and would reveal much about the key molecular proteins involved in atherosclerosis. Thus, targeting NOS1 would be a useful strategy in reducing LDL uptake by macrophages at early stage of disease and hence dampening the atherosclerosis progression.

Keywords: atherosclerosis, NOS1, inflammation, oxidized LDL

Procedia PDF Downloads 127

Authors: Meng-Huan Wu, Wei-Er Wang, Tsu-Nai Wang, Wei-Jian Hsu, Vincent Chin-Hung Chen

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Objective: Studies have reported a strong link between asthma and bipolar disorder. We conducted a 17-year community-based large cohort study to examine the relationship between asthma, early smoking initiation, and bipolar disorder during adolescence and early adulthood. Methods: A total of 162,766 participants aged 11–16 years were categorized into asthma and non-asthma groups at baseline and compared within the observation period. Covariates during late childhood or adolescence included parental education, cigarette smoking by family members of participants, and participant’s gender, age, alcohol consumption, smoking, and exercise habits. Data for urbanicity, prednisone use, allergic comorbidity, and Charlson comorbidity index were acquired from the National Health Insurance Research Database. The Cox proportional-hazards model was used to evaluate the association between asthma and bipolar disorder. Results: Our findings revealed that asthma increased the risk of bipolar disorder after adjustment for key confounders in the Cox proportional hazard regression model (adjusted HR: 1.31, 95% CI: 1.12-1.53). Hospitalizations or visits to the emergency department for asthma exhibited a dose–response effect on bipolar disorder (adjusted HR: 1.59, 95% CI: 1.22-2.06). Patients with asthma with onset before 20 years of age who smoked during late childhood or adolescence had the greatest risk for bipolar disorder (adjusted HR: 3.10, 95% CI: 1.29-7.44). Conclusions: Patients newly diagnosed with asthma had a 1.3 times higher risk of developing bipolar disorder. Smoking during late childhood or adolescence increases the risk of developing bipolar disorder in patients with asthma.

Keywords: adolescence, asthma, smoking, bipolar disorder, early adulthood

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Authors: Avi Shrivastava

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Title 42, an emergency health decree, has forced the federal authorities to turn away asylum seekers and all other border crossers since last year. When Title 42 was first deployed in immigration detention centers, where many migrants are held when they arrive at the U.S.-Mexico border, the Trump administration embraced it as a strategy. Expulsions Policy and New Border Challenges will be examined in regard to Title 42 concerns. Humanitarian measures for refugees arriving at the US-Mexico border are the focus of this article. To a large extent, this article addresses the implications of the United States' use of Title 42 in expelling refugees and the possible ramifications of doing away with it. A secondary data collecting strategy was used to gather the information for this study, allowing researchers to examine a large number of previously collected data sets. Information about Title 42 may be found in a variety of places, such as scholarly publications, newspapers, books, and the internet. The inquiry employed qualitative and explanatory research approaches. The claim that 1.7 million individuals were forced to leave the country as a result of it was withdrawn. Since CBP and ICE were limited in their ability to process deportees, it employed a very random patchwork technique in selecting the expelled individuals. As a consequence, repeat offenders, particularly those who were single, got a reduced punishment. The government will be compelled to focus on long-overdue but vital border enhancements if expulsions are halted. Title 42 provisions may help expedite the processing of asylum and other types of humanitarian relief. The government is prepared for an increase in arrivals, but ending the program would lead to a return to arrival levels seen during the Title 42 period.

Keywords: migrants, refugees, title 42, medical, trump administration

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Authors: Peter Jin

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Ever since the recent resurgence of interest in political theorist Carl Schmitt’s work, much of the current analysis on Schmitt has fo-cused on evaluating Schmitt’s legacy by exposing contradictions in his rationale. Rather than condemn such contradictions, this paper instead seeks to analyze these contradictions in an effort to better understand the radical shift in Schmitt’s intellectual trajectory from an astute critic of liberal democracy to a fascist apologist towards the end of the Weimar period. An essential part of this change is his interest in what Schmitt called ‘the emergence of aesthetics.’ Schmitt diagnosed the underlying issue with the aesthetic in the political sphere to be its irrationalism, indifference, and indeci-siveness. For Schmitt, the latter two of these were especially prob-lematic for two of his key concepts: the ‘political’ and ‘the shared historical reality.’ Schmitt’s radical depiction of ‘the political’ as an existential opposition of allegiances that necessitated a state of emergency and a decisionist sovereign political struggle required an equally radical justification, or Schmitt’s call for ‘a shared his-torical reality’ not based in historical fact yet able to mobilize the masses. In this way, Schmitt clearly condemns the indifferent, indecisive aesthetic that runs against his decisionist, action-oriented political theory. Yet despite his firm stance against aestheticism, Schmitt himself used the evocative and irrational power of aesthet-icism as a tool to present his own ‘political myth’ that compelled believers to join in decisive unity against a common enemy. In short, Schmitt’s contradictions on aestheticism and his creation of a ‘political myth’ suggest that Schmitt’s underlying conflict with aestheticism was not as much of an issue of irrationality as it was a chronic preoccupation with coercing concrete action at the expense of rational deliberation.

Keywords: aesthetics of the political, Carl Schmitt, political myth, Weimar democracy

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Authors: Lijuan Wang, Junsheng Huo, Jing Sun, Wenxian Li, Jian Huang, Lin Ling, Yiping Zhou, Chengyu Huang, Jifang Hu

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Backgrounds and Objective: This study aimed to evaluate the impact of highly nutrient-dense complementary food supplement-Yingyangbao, at the time of 3 months after Wenchuan earthquake, on the anemia of young children in a county in Sichuan province. Methods: The young children aged 6-23 months in the county were fed one sachet Yingyangbao per day. Yingyangbao were distributed for 15 months for free. The children entering 6 months age would be included. The length, weight and hemoglobin of the children aged 6-29 months were assessed at baseline (n=257) and Yingyangbao intervention for 6 (n=218) and 15 months (n=253) by cluster sampling. Growth status has not been described in the paper. The analysis was conducted based on 6-11, 12-17, 18-23 and 24-29 months. Results: It showed that the hemoglobin concentration in each group among the 4 groups increased by 4.9, 6.4, 8.0, 9.5 g/L after 6 months and 12.7, 11.4, 16.7, 15.7 g/L after 15 months compared to the baseline, respectively. The total anemia prevalence in each group was significantly lower after 6 and 15 months than the baseline (P<0.001), except the 6-11 months group after 6 months because of fewer Yingyangbao consumption. Total moderate anemia rate decreased from 18.3% to 5.5% after 6 months, and kept decreasing to 0.8% after another 9 months. The hemoglobin concentration was significantly correlated with the amount of Yingyangbao consumption(P<0.001) The anemia rate was significantly different based on the Yingyangbao compliance (P<0.001). Conclusion: It was concluded that Yingyangbao which contains quality protein, vitamins and micronutrients intervened 15 months could be effective for the improvement of anemia of young children. The study provides the support that the application of the complementary food supplements to reduce the anemia of young children in the emergency of natural disaster.

Keywords: young children, anemia, nutrition intervention, complementary food supplements, Yingyangbao

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Authors: Yu-Chuan Huang

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Introduction: There is a higher mortality rate for unplanned transfer to intensive care units. It also needs a longer length of stay and makes the intensive care unit beds cannot be effectively used. It affects the immediate medical treatment of critically ill patients, resulting in a drop in the quality of medical care. Purpose: The purpose of this study was using SOFA and APACHEII score to analyze the mortality rate of the cases transferred from ED to ICU. According to the score that should be provide an appropriate care as early as possible. Methods: This study was a descriptive experimental design. The sample size was estimated at 220 to reach a power of 0.8 for detecting a medium effect size of 0.30, with a 0.05 significance level, using G-power. Considering an estimated follow-up loss, the required sample size was estimated as 242 participants. Data were calculated by medical system of SOFA and APACHEII score that cases transferred from ED to ICU in 2016. Results: There were 233 participants meet the study. The medical records showed 33 participants’ mortality. Age and sex with QSOFA , SOFA and sex with APACHEII showed p>0.05. Age with APCHHII in ED and ICU showed r=0.150, 0,268 (p < 0.001**). The score with mortality risk showed: ED QSOFA is r=0.235 (p < 0.001**), exp(B)=1.685(p = 0.007); ICU SOFA 0.78 (p < 0.001**), exp(B)=1.205(p < 0.001). APACHII in ED and ICU showed r= 0.253, 0.286 (p < 0.001**), exp(B) = 1.041,1.073(p = 0.017,0.001). For SOFA, a cutoff score of above 15 points was identified as a predictor of the 95% mortality risk. Conclusions: The SOFA and APACHE II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hours of ICU admission. In conclusion, the SOFA and APACHII score is significantly associated with mortality and strongly predicting mortality. Early predictors of morbidity and mortality, which we can according the predicting score, and provide patients with a detail assessment and proper care, thereby reducing mortality and length of stay.

Keywords: SOFA, APACHEII, mortality, ICU

Procedia PDF Downloads 147

Authors: Shafait Hussain Ali

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Since its outbreak in China, the Covid_19 19 disease has been caused by the corona virus SARS N coyote 2. Italy was the first Western country to be severely affected, and the first country to take drastic measures to control the disease. In start of December 2019, the sudden outbreaks of the Coronary Virus Disease was caused by a new Corona 2 virus (SARS-CO2) of acute respiratory syndrome in china city Wuhan. The World Health Organization declared the epidemic a public health emergency of international concern on January 30, 2020,. On February 14, 2020, 49,053 laboratory-confirmed deaths and 1481 deaths have been reported worldwide. The threat of the disease has forced most of the governments to implement various control measures. Therefore it becomes necessary to analyze the Italian data very carefully, in particular to investigates and to find out the present condition and the number of infected persons in the form of positive cases, death, hospitalized or some other features of infected persons will clear in simple form. So used such a model that will clearly shows the real facts and figures and also understandable to every readable person which can get some real benefit after reading it. The model used must includes(total positive cases, current positive cases, hospitalized patients, death, recovered peoples frequency rates ) all features that explains and clear the wide range facts in very simple form and helpful to administration of that country.

Keywords: machine learning tools and techniques, rapid miner tool, Naive-Bayes algorithm, predictions

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Authors: Yeimis Milton, Palomino Pichihua

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The city, like living organisms, originates from codes, structured information in the form of rules that condition the physical form and performance of urban space. Usually, the so-called urban codes clash with the spontaneous nature of the city, with the urban Kháos that contextualizes the free creation (poiesis) of human collectives. This contradiction is especially evident in Latin America, which, like other developing regions, lacks adequate instruments to guide urban growth. Thus constructing a hybrid between the formal and informal city, categories that are difficult to separate one from the other. This is a comparative study focusing on the urban codes created to address the pandemic. The objective is to build an overview of these innovations in the region. The sample is made up of official norms published in pandemic, directly linked to urban planning and building control (urban form). The countries analyzed are Brazil, Mexico, Argentina, Peru, Colombia, and Chile. The study uncovers a shared interest in facing future urban problems, in contrast to the inconsistency of proposed legal instruments. Factors such as the lack of articulation, validity time, and ambiguity, among others, accentuate this problem. Likewise, it evidences that the political situation of each country has a significant influence on the development of these norms and the possibility of their long-term impact. In summary, the global emergency has produced opportunities to transform urban systems from their internal rules; however, there are very few successful examples in this field. Therefore, Latin American cities have the task of learning from this defeat in order to lay the foundations for a more resilient and sustainable urban future.

Keywords: pandemic, regulation, urban planning, latin America

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