Search results for: occupational injury

Authors: Felipe Osorio Ospina, Maria Adelaida Mejia Arango, Esteban Onésimo Vallejo Agudelo, Victoria Lucía Dávila Osorio, Natalia Vargas Grisales, Lina María Martínez Sanchez, Camilo Andrés Agudelo Vélez, Ángela Maria Londoño García, Isabel Cristina Ortiz Trujillo

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Excessive exposure to ultraviolet radiation, has shown to be a risk factor for photodamage, alteration of the immune mechanisms to recognize malignant cells and cutaneous pro-inflamatorios states and skin cancers. Objective: To identify the time of exposure to ultraviolet radiation for the production of chromosomal damage in human lymphocytes. Methodology: We conducted an in vitro study serial, in which samples were taken from the heparinized blood of healthy people, who do not submit exposure to agents that could induce chromosomal alterations. The samples were cultured in RPMI-1640 medium containing 10% fetal bovine serum, penicillin, and streptomycin antibiotic. Subsequently, they were grouped and exposed to ultraviolet light for 1 to 20 seconds. At the end of the treatments, cytology samples were prepared, and it was colored with Giemsa (5%). Reading was carried out in an optical microscope and 100 metaphases analysed by treatment for posting chromosomal alterations. Each treatment was conducted at three separate times and each became two replicas. Results: We only presented chromosomal alterations in lymphocytes exposed to UV for groups 1 to 3 seconds (p < 0.05). Conclusions: Exposure to ultraviolet radiation generates visible damage in chromosomes from human lymphocytes observed in light microscopy, the highest rates of injury was observed between two and three seconds, and above this value, the reduction in the number of mitotic cells was evident.

Keywords: chromosome breakpoints, lymphocytes, photodamage, ultraviolet rays

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Authors: Francisco Toledo-Castillo, Pilar Peiró-Torres, María Josefa Sospedra-Baeza, Sergio Hidalgo-Fuentes

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The communication presented is about tasks that are been developed in the research project “safeRoute”, “Information safety system for professional road driving” (IPT-2012-110-370000). This R&D project was proposed by the consortium formed by Fagor Electronica la SEU 3 and the University of Valencia to the Ministry of Economy and Competitiveness, which approved it inside the INNPACTO subprogramme grants. Through this type of calls, the Ministry promote the innovative capacity of the Spanish companies and turn on the mechanism for competing internationally. With this kind of calls, private investments for technological and industrial development join their R & D resources with public entities to implement innovative project that could have an international exposure. Thus INNPACTO subprogramme promotes the creation of research projects with public-private partnerships that create exploitable final products. The “safeRoute” Project pretends develop a tool to help to make more safety the travels of commercial transport vehicles of goods and passengers. To achieve its objectives, the project is focused in three main lines of research: vehicle safety, the safety of the roads that they are using, and the safety which drivers do their job, their behaviour while they are driving. To improve safety, the project gives information about these three factors to all people that are involved in the safety of the professional transport. These three factors have influence to the occurrence of traffic accidents, thanks to the information provided and treated about these factors, we can achieve a significant reduction in occupational accidents in the transport sector. SafeRoute provide information about routes, vehicles, and driver behaviours, and in this manner pretends provide to transport companies a tool which could result in a safer driving results and could reduce their costs related to traffic accidents of their vehicles, in that way, this tool could help them to be more competitive, and give a more reliable service. This paper will focus mainly on the information about routes that drivers use to travel in their professional work, and how the researchers of this project have catalogued and evaluated these routes, and finally how that information will be provided to users.

Keywords: driver support systems, professional drivers, road safety, safeRoute

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Authors: Matthew T. McCarthy, Sarah Janse, Natalie M. Pizzimenti, Anthony K. Savino, Brian Crosser, Sean C. Rose

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Concussion is diagnosed clinically using a comprehensive history and exam, supported by ancillary testing. Frequently, symptom checklists are used as part of the evaluation of concussion. Existing symptom scales are based on a subjective Likert scale, without relation of symptoms to clinical or functional impairment. This is a retrospective review of 133 patients under age 30 seen in an outpatient neurology practice within 30 days of a probable or definite concussion. Each patient completed 2 symptom checklists at the initial visit – the SCAT-3 symptom evaluation (22 symptoms, 0-6 scale) and a scale based on the degree of clinical impairment for each symptom (22 symptoms, 0-3 scale related to functional impact of the symptom). Final clearance date was determined by the treating physician. 60.9% of patients were male with mean age 15.7 years (SD 2.3). Mean time from concussion to first visit was 6.9 days (SD 6.2), and 101 patients had definite concussions (75.9%), while 32 were diagnosed as probable (24.1%). 94 patients had a known clearance date (70.7%) with mean clearance time of 20.6 days (SD 18.6) and median clearance time of 19 days (95% CI 16-21). Mean total symptom score was 27.2 (SD 22.9) on the SCAT-3 and 14.7 (SD 11.9) for the functional impairment scale. Pearson’s correlation between the two scales was 0.98 (p < 0.001). After adjusting for patient and injury characteristics, an equivalent increase in score on each scale was associated with longer time to clearance (SCAT-3 hazard ratio 0.885, 95%CI 0.835-0.938, p < 0.001; functional impairment scale hazard ratio 0.851, 95%CI 0.802-0.902, p < 0.001). A concussion symptom scale based on degree of functional impairment correlates strongly with the SCAT-3 scale and demonstrates a similar association with time to clearance. By assessing the degree of impact on clinical functioning, this symptom scale reflects a more intuitive approach to rating symptoms and can be used in the management of concussion.

Keywords: checklist, concussion, neurology, scale, sports, symptoms

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Authors: Mohammad Taghi Karimi, Maryam Hasan Zahraee

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Background: Low back pain (LBP) is a common health and socioeconomic problem, especially the chronic one. The joint contact force is an important parameter during walking which increases the incidence of injury and degenerative joint disease. To our best knowledge, there are not enough evidences in literature on the muscular forces and joint contact forces in subjects with low back pain. Purpose: The main hypothesis associated with this research was that joint contact force of L4/L5 of non-specific chronic low back pain subjects was the same as that of normal. Therefore, the aim of this study was to determine the joint contact force difference between non-specific chronic low back pain and normal subjects. Method: This was an experimental-comparative study. 20 normal subjects and 20 non-specific chronic low back pain patients were recruited in this study. Qualysis motion analysis system and a Kistler force plate were used to collect the motions and the force applied on the leg, respectively. OpenSimm software used to determine joint contact force and muscle forces in this study. Some parameters such as force applied on the legs (pelvis), kinematic of hip and pelvic, peaks of muscles, force of trunk musculature and joint contact force of L5/S1 were used for further analysis. Differences between mean values of all data were measured using two-sample t-test among the subjects. Results: The force produced by Semitendinosus, Biceps Femoris, and Adductor muscles were significantly different between low back pain and normal subjects. Moreover, the mean value of breaking component of the force of the knee joint increased significantly in low back pain subjects, besides a significant decrease in mean value of the vertical component of joint reaction force compared to the normal ones. Conclusions: The forces produced by the trunk and pelvic muscles, and joint contact forces differ significantly between low back pain and normal subjects. It seems that those with non-specific chronic low back pain use trunk muscles more than normal subjects to stabilize the pelvic during walking.

Keywords: low back pain, joint contact force, kinetic, muscle force

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Authors: Sijing Xiong, Ran Su, Lit-Hsin Loo, Daniele Zink

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The kidney is a major target for toxic effects of drugs, industrial and environmental chemicals and other compounds. Typically, nephrotoxicity is detected late during drug development, and regulatory animal models could not solve this problem. Validated or accepted in silico or in vitro methods for the prediction of nephrotoxicity are not available. We have established the first and currently only pre-validated in vitro models for the accurate prediction of nephrotoxicity in humans and the first predictive platforms based on renal cells derived from human pluripotent stem cells. In order to further improve the efficiency of our predictive models, we recently developed a high content screening (HCS) platform. This platform employed automated imaging in combination with automated quantitative phenotypic profiling and machine learning methods. 129 image-based phenotypic features were analyzed with respect to their predictive performance in combination with 44 compounds with different chemical structures that included drugs, environmental and industrial chemicals and herbal and fungal compounds. The nephrotoxicity of these compounds in humans is well characterized. A combination of chromatin and cytoskeletal features resulted in high predictivity with respect to nephrotoxicity in humans. Test balanced accuracies of 82% or 89% were obtained with human primary or immortalized renal proximal tubular cells, respectively. Furthermore, our results revealed that a DNA damage response is commonly induced by different PTC-toxicants with diverse chemical structures and injury mechanisms. Together, the results show that the automated HCS platform allows efficient and accurate nephrotoxicity prediction for compounds with diverse chemical structures.

Keywords: high content screening, in vitro models, nephrotoxicity, toxicity prediction

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Authors: Muogbo Chukwudi Peter, Gbabo Agidi

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Influence of different turmeric rhizome sizes and machine operational speed on the field capacity and efficiency of a developed prototype tractor-drawn turmeric planter was studied. This was done with a view to ascertaining how the field capacity and field efficiency were affected by the turmeric rhizome lengths and tractor operational speed. The turmeric rhizome planter consists of trapezoidal hopper, grooved cylindrical metering devise, rectangular frame, ground wheels made of mild steel, furrow opener, chain/sprocket drive system, three linkage point seed delivery tube and press wheel. The experiment was randomized in a factorial design of three levels of rhizome lengths (30, 45 and 60 mm) and operational speeds of 8, 10, and 12 kmh-1. About 3 kg cleaned turmeric rhizomes were introduced into each hopper of the planter and were planted 30 m2 of experimental plot. During the field evaluation of the planter, the effective field capacity, field efficiency, missing index, multiple index and percentage rhizome bruise were evaluated. 30.08% was recorded for maximum percentage bruise on the rhizome. The mean effective field capacity ranged between 0.63 – 0.96hah-1 at operational speeds of 8 and 12kmh-1 respectively and 45 mm rhizome length. The result also shows that the mean efficiency was obtained to be 65.8%. The percentage rhizome bruise decreases with increase in operational speed. The highest and lowest percentage turmeric rhizome miss index of 35% were recorded for turmeric rhizome length of 30 mm at a speed of 10 kmhr-1 and 8 kmhr-1, respectively. The potential implications of the experimental result is to determine the optimal machine process conditions for higher field capacity and gross reduction in mechanical injury (bruise) of planted turmeric rhizomes.

Keywords: rhizome sizes, operational speed, field capacity. field efficiency, turmeric rhizome, planter

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Authors: Duvert A. Puentes T., Javier A. Maldonado E., Ivan Quintero., Diego F. Villegas

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Mechanical Computation is a great tool to study the performance of complex models. An example of it is the study of the human body structure. This paper took advantage of different types of software to make a 3D model of the glenohumeral joint and apply a finite element analysis. The main objective was to study the change in the biomechanical properties of the joint when it presents an injury. Specifically, a BANKART lesion, which consists in the detachment of the anteroinferior labrum from the glenoid. Stress and strain distribution of the soft tissues were the focus of this study. First, a 3D model was made of a joint without any pathology, as a control sample, using segmentation software for the bones with the support of medical imagery and a cadaveric model to represent the soft tissue. The joint was built to simulate a compression and external rotation test using CAD to prepare the model in the adequate position. When the healthy model was finished, it was submitted to a finite element analysis and the results were validated with experimental model data. With the validated model, it was sensitized to obtain the best mesh measurement. Finally, the geometry of the 3D model was changed to imitate a BANKART lesion. Then, the contact zone of the glenoid with the labrum was slightly separated simulating a tissue detachment. With this new geometry, the finite element analysis was applied again, and the results were compared with the control sample created initially. With the data gathered, this study can be used to improve understanding of the labrum tears. Nevertheless, it is important to remember that the computational analysis are approximations and the initial data was taken from an in vitro assay.

Keywords: biomechanics, computational model, finite elements, glenohumeral joint, bankart lesion, labrum

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Authors: Ragi Poyyara, V. Vivek, Ashish Khaparde

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The Product Development Process (PDP) in the technology group plays a very important role in the launch of any product. While a manufacturing process encourages the use of certain measures to reduce Health, Safety and Environmental (HSE) risks on the shop floor, the PDP concentrates on the use of Geometric Dimensioning and Tolerancing (GD&T) to develop a flawless design. Furthermore, PDP distributes and coordinates activities between different departments such as marketing, purchasing, and manufacturing. However, it is seldom realized that PDP makes a significant contribution to developing a product that reduces HSE risks by encouraging the Technology group to use effective GD&T. The GD&T is a precise communication tool that uses a set of symbols, rules, and definitions to mathematically define parts to be manufactured. It is a quality assurance method widely used in the oil and gas sector. Traditionally it is used to ensure the interchangeability of a part without affecting its form, fit, and function. Parts that do not meet these requirements are rejected during quality audits. This paper discusses how the Technology group integrates this quality assurance tool into the PDP and how the tool plays a major role in helping the HSE department in its goal towards eliminating HSE incidents. The PDP involves a thorough risk assessment and establishes a method to address those risks during the design stage. An illustration shows how GD&T helped reduce safety risks by ergonomically improving assembling operations. A brief discussion explains how tolerances provided on a part help prevent finger injury. This tool has equipped Technology to produce fixtures, which are used daily in operations as well as manufacturing. By applying GD&T to create good fits, HSE risks are mitigated for operating personnel. Both customers and service providers benefit from reduced safety risks.

Keywords: HSE risks, product development process, geometric dimensioning and tolerances, mechanical engineering

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Authors: Eric Beyegue, Boris Azantza, Judith Laure Ngondi, Julius E. Oben

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Background: Dietary supplement may potentially help to fight obesity and other metabolic disorders such as adipogenesis, insulin resistance, and inflammation. The present study aimed to test whether supplementation with African walnuts (Aw) could have an effect on adipogenesis and others dysfunctions associated with obesity in rats. Methods: Wistar rats were fed with standard diet (SD) or high-fat high-sucrose diet (HFS) and HFS with supplemented (HFS-Aw) for eight weeks. Results: HFS diet-induced body weight gain and increased fat mass compared to SD. In addition HFS-fed rats developed fasting hyperglycaemia and insulinaemia as well as insulin resistance. Aw supplementation in HFS rats had a protective effect against adipose tissues weigh gain but slightly against body weight gain and major study related disorders. This could be mainly due to decreased food intake dependently of effect in food intake in central nervous system, which decreased in HFS rats supplemented with African walnut compared to the HFS-diet group. Interestingly, African walnut supplementation induced a slight decrease of fasting glycaemia, insulinaemia and Nitric Oxide which could partially explain its minor protective effect against diet-induced insulin resistance. Additionally a decrease in hepatic TG and transaminases levels suggesting a protective effect against liver injury. Conclusion: Taken together these data suggested that supplementation of African walnut could be used to prevent adipose weight gain and related disorders on the other hand, minimally reduced insulin resistance.

Keywords: African walnut, dietary fiber, insulin resistance, oxidative stress

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Authors: Niloofar Nazeri, Mohammad Ali Derakhshan, Reza Faridi Majidi, Hossein Ghanbari

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Injury of peripheral nervous system (PNS) can lead to loss of sensation or movement. To date, one of the challenges for surgeons is repairing large gaps in PNS. To solve this problem, nerve conduits have been developed. Conduits produced by means of electrospinning can mimic extracellular matrix and provide enough surface for further functionalization. In this research, a conductive bilayer nerve conduit with poly caprolactone (PCL), poly (lactic acid co glycolic acid) (PLGA) and MWCNT for promoting peripheral nerve regeneration was fabricated. The conduit was made of longitudinally aligned PLGA nanofibrous sheets in the lumen to promote nerve regeneration and randomly oriented PCL nanofibers on the outer surface for mechanical support. The intra-luminal guidance channel was made out of conductive aligned nanofibrous rolled sheets which are coated with laminin via dopamine. Different properties of electrospun scaffolds were investigated by using contact angle, mechanical strength, degradation time, scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS). The SEM analysis was shown that size range of nanofibrous mat were about 600-750 nm and MWCNTs deposited between nanofibers. The XPS result was shown that laminin attached to the nanofibers surface successfully. The contact-angle and tensile tests analysis revealed that scaffolds have good hydrophilicity and enough mechanical strength. In vitro studies demonstrated that this conductive surface was able to enhance the attachment and proliferation of PC12 and Schwann cells. We concluded that this bilayer composite conduit has good potential for nerve regeneration.

Keywords: conductive, conduit, laminin, MWCNT

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Authors: Osama Zayed

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Aim of the work: The aim of this study is to assess the predictors of pelvic vascular injuries in patients with pelvic fractures from major blunt trauma. Methods: This study was conducted as a tool-assessment study. Forty six patients with pelvic fractures from major blunt trauma will be recruited to the study arriving to department of emergency, Suez Canal University Hospital. Data were collected from questionnaire including; personal data of the studied patients and full medical history, clinical examinations, outcome measures (The Physiological and Operative Severity Score for enumeration of Mortality and morbidity (POSSUM), laboratory and imaging studies. Patients underwent surgical interventions or further investigations based on the conventional standards for interventions. All patients were followed up during conservative, operative and post-operative periods in the hospital for interpretation the predictive scores of vascular injuries. Results: Significant predictors of vascular injuries according to computed tomography (CT) scan include age, male gender, lower Glasgow coma (GCS) scores, occurrence of hypotension, mortality rate, higher physical POSSUM scores, presence of ultrasound collection, type of management, higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) POSSUM scores, presence of abdominal injuries, and poor outcome. Conclusions: There was higher frequency of males than females in the studied patients. There were high probability of morbidity and low probability of mortality among patients. Our study demonstrates that POSSUM score can be used as a predictor of vascular injury in pelvis fracture patients.

Keywords: predictors, pelvic vascular injuries, pelvic fractures, major blunt trauma, POSSUM

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Authors: Mitchell Stanton

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Background: Endovascular management is well established as a mainstay treatment option for cerebral aneurysms. It is also well established that immediate post procedural imaging can be difficult to interpret due to the presence of contrast material. However, through the use of Dual-Energy computed tomography, it has become possible to differentiate contrast extravasation and intracranial haemorrhage. This case illustrates the importance of this technology following endovascular treatment of an unruptured cerebral aneurysm. Case Presentation: A 79-year-old female was found to have an unruptured large intracavernous ICA fusiform aneurysm on CT Brain Angiogram after presenting with acute ophthalmoplegia. This ophthalmoplegia was caused by mass effect from the aneurysm and subsequently the aneurysm was treated with an endovascular flow diverting stent. CT brain was performed post operatively due to a reduced level of consciousness and this showed diffuse subarachnoid hyperdensity of the left hemisphere. The use of Dual-Energy CT allowed accurate differentiation and illustrated diffuse contrast material extravasation, allowing patient to continue on dual-antiplatelets and therapeutic anticoagulation to reduce the risk of ischaemic injury post endovascular stent. Conclusion: Endovascular treatment options for management of intracranial aneurysms are constantly evolving. The use of Dual-Energy CT therefore has an integral role in accurately diagnosing any post-operative complications. Specifically, differentiating between subarachnoid haemorrhage and contrast extravasation is vital in these patients due to the significant consequences to their ongoing management in regards to continuation or cessation of antiplatelets or anticoagulation. With increasing access to this technology, its use should become standard practice in the post-operative investigation of these patients undergoing endovascular treatment.

Keywords: aneurysm, computed tomography, contrast extravasation, dual-energy CT, endovascular, subarachnoid haemorrhage

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Authors: Ryan Houser

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Introduction: Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. As the COVID-19 pandemic continues, few studies have evaluated bioterrorism preparedness of Emergency Medical Services, even in the accelerating environment of biothreats. Methods: This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack and identify factors that predict preparedness and willingness among Nebraska EMS (Emergency Medical Services ) providers. The survey was available for one month in 2021, during which 190 EMS providers responded to the survey. Results: Only 56.8% of providers were able to recognize an illness or injury as potentially resulting from exposure to a CBRN agent. The provider Clinical Competency levels range from a low of 13.6% (ability to initiate patient care within his/her professional scope of practice and arrange for prompt referral appropriate to the identified condition(s)) to a high of 74% (the ability to respond to an emergency within the emergency management system of his/her practice, institution and community). Only 10% of the respondents are both willing and able to effectively function in a bioterror environment. Discussion: In order to effectively prepare for and respond to a bioterrorist attack, all levels of the healthcare system need to have the clinical skills, knowledge, and abilities necessary to treat patients exposed. Policy changes and increased focus on training and drills are needed to ensure a prepared EMS system which is crucial to a resilient state. EMS entities need to be aware of the extent of their available workforce so that the country can be prepared for the increasing threat of bioterrorism or other novel emerging infectious disease outbreaks. A resilient nation relies on a prepared set of EMS providers who are willing to respond to biological terrorism events.

Keywords: bioterrorism, prehospital, EMS, disaster, emergency, medicine, preparedness, policy

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Authors: Alessio Giovannelli, Claudia Cocozza, Enrico Marchi, Valerio Giorgio Muzzini, Eleftherios Touloupakis, Raffaella Margherita Zampieri

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In Mediterranean countries, forest fires are recurrent events that need to be considered as a central component of regional and global forest management strategies and biodiversity restoration programmes. The response of tree function to fire damage can vary widely, also taking into account species, season, age of the tree, etc. Trees that survive fire may have different levels of physiological functionality, which may result in reduced growth or increased susceptibility to delayed mortality. An approach to assessing irreversible physiological injury in trees could help to inform management decisions at burned sites for biodiversity restoration, environmental safety and understanding of ecosystem functional adaptations. Physiological proxies for latent tree mortality, such as cambial cell death, reduced or absent starch and soluble sugar content in C sinks, and ethanol accumulation in the phloem, are considered proxies for cell death. However, their determination requires time-consuming laboratory protocols, making the approach unfeasible as a practical option in the field, but recent findings have shown that biosensors could be usefully applied to overcome these limitations. The study will focus on the development of amperometric biosensors capable of detecting a few target molecules in the phloem and xylem (such as ethanol and glucose) that have recently been identified as proxies for latent tree mortality. The results of a specific experiment on a stand of Pinus pinaster subjected to prescribed fire are reported.

Keywords: enzymes, glucose, ethanol, prescribed fires

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Authors: Fernanda Ludmilla Rossi Rocha, Thamiris Cavazzani Vegro, Silvia Helena Henriques Camelo, Carmen Silvia Gabriel, Andrea Bernardes

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Introduction: Organizations are cultural, symbolic and imaginary systems composed by values and norms. These values and norms represent the organizational culture, which determines the behavior of the workers, guides the work practices and impacts the quality of care and the safety culture of health services worldwide. Objective: To analyze the organizational culture of a public and a private hospital in Brazil. Method: Descriptive study with quantitative approach developed in a public and in a private hospital of Brazil. Sample was composed by 281 nursing workers, of which 73 nurses and 208 nursing auxiliaries and technicians. The data collection instrument comprised the Brazilian Instrument for Assessing Organizational Culture. Data were collected from March to December 2013. Results: At the public hospital, the results showed an average score of 2.85 for the values concerning cooperative professionalism (CP); 3.02 for values related to hierarchical rigidity and the centralization of power (HR); 2.23 for individualistic professionalism and competition at work (IP); 2.22 for values related to satisfaction, well-being and motivation of workers (SW); 3.47 for external integration (EI); 2.03 for rewarding and training practices (RT); 2.75 for practices related to the promotion of interpersonal relationships (IR) About the private hospital, the results showed an average score of 3.24 for the CP; 2.83 for HR; 2.69 for IP; 2.71 for SW; 3.73 for EI; 2.56 for RT; 2.83 for IR at the hospital. Discussion: The analysis of organizational values of the studied hospitals shows that workers find the existence of hierarchical rigidity and the centralization of power in the institutions; believed there was cooperation at workplace, though they perceived individualism and competition; believed that values associated with the workers’ well-being, satisfaction and motivation were seldom acknowledged by the hospital; believed in the adoption of strategic planning actions within the institution, but considered interpersonal relationship promotion, continuous education and the rewarding of workers to be little valued by the institution. Conclusion: This work context can lead to professional dissatisfaction, compromising the quality of care and contributing to the occurrence of occupational diseases.

Keywords: nursing management, organizational culture, quality of care, interpersonal relationships

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Authors: Thomas Vlasak, Tanja Dujlociv, Alfred Barth

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Shift work is an essential element of modern labor, ensuring ideal conditions of service for today’s economy and society. Despite the beneficial properties, its impact on the neurobehavioral performance of exposed subjects remains controversial. This meta-analysis aims to provide first summarizing the effects regarding the association between shift work exposure and different cognitive functions. A literature search was performed via the databases PubMed, PsyINFO, PsyARTICLES, MedLine, PsycNET and Scopus including eligible studies until December 2020 that compared shift workers with non-shift workers regarding neurobehavioral performance tests. A random-effects model was carried out using Hedge’s g as a meta-analytical effect size with a restricted likelihood estimator to summarize the mean differences between the exposure group and controls. The heterogeneity of effect sizes was addressed by a sensitivity analysis using funnel plots, egger’s tests, p-curve analysis, meta-regressions, and subgroup analysis. The meta-analysis included 18 studies resulting in a total sample of 18,802 participants and 37 effect sizes concerning six different neurobehavioral outcomes. The results showed significantly worse performance in shift workers compared to non-shift workers in the following cognitive functions with g (95% CI): processing speed 0.16 (0.02 - 0.30), working memory 0.28 (0.51 - 0.50), psychomotor vigilance 0.21 (0.05 - 0.37), cognitive control 0.86 (0.45 - 1.27) and visual attention 0.19 (0.11 - 0.26). Neither significant moderating effects of publication year or study quality nor significant subgroup differences regarding type of shift or type of profession were indicated for the cognitive outcomes. These are the first meta-analytical findings that associate shift work with decreased cognitive performance in processing speed, working memory, psychomotor vigilance, cognitive control, and visual attention. Further studies should focus on a more homogenous measurement of cognitive functions, a precise assessment of experience of shift work and occupation types which are underrepresented in the current literature (e.g., law enforcement). In occupations where shift work is fundamental (e.g., healthcare, industries, law enforcement), protective countermeasures should be promoted for workers.

Keywords: meta-analysis, neurobehavioral performance, occupational psychology, shift work

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Authors: Samar Mousa, Rebecca Shirley

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Injuries to the hand account for 20% of all emergency department attendances, with an estimated annual treatment cost of over £100 million in the UK. Functional impairments as a result of hand injuries often necessitate absence from employment, resulting in reduced productivity estimated to incur an additional £600m loss to the UK economy. Appropriate and early management is vital to preserve anatomy, prevent stiffness and allow function. The initial assessment and management of hand injuries are usually undertaken by junior staff, many of whom have little or no training or experience in splinting hand fractures. In our plastic surgery department at Stoke Mandeville hospital Buckinghamshire trust, we carried out an audit project to detect errors in hand splinting in the period between April 2022 and July 2022 and find out measures to support junior doctors, nurses and hand therapists in providing the best possible care for hand trauma patients. Our standards were The British Society for Surgery of the Hand (BSSH) standard of care in hand trauma, AO surgery reference and Stoke Mandeville hospital hand therapy mini protocol Feb 2022 During the period of 4 months, 5 cases were identified. Two cases of wrong splint choice, two cases of early removal of the splint and one tight splint that required change. In order to avoid those mistakes, a training program was given to junior doctors and nurses in collaboration with the hand therapy team regarding ways of splinting the hand in different injuries like fractures, tendons injuries, muscle injuries and ligamentous injuries. In addition to, a poster hung in the examination rooms and theatres to help junior doctors reach the correct decision.

Keywords: splinting, hand trauma, plastic surgery, tendon injury, hand fracrture

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Authors: Betül Ersoy, Deniz Özalp Kizilay, Gül Gümüşer, Fatma Taneli

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Introduction: Peak bone mass is reached in late adolescence in females. Age at menarche influences estrogen exposure, which plays a vital role in bone metabolism. The relationship between age at menarche and bone mineral density (BMD) is still controversial. In this study, we investigated the relationship between age at menarche, BMD, socioeconomic status (SES) and body composition in female university student. Participant and methods: A total of 138 healthy girls at late adolescence period (mean age 20.13±0.93 years, range 18-22) were included in this university school-based cross-sectional study in the urban area western region of Turkey. Participants have been randomly selected to reflect the university students studying in all faculties. We asked relevant questions about socioeconomic status and age at menarche to female university students. Students were grouped into three SES as lower, middle and higher according to the educational and occupational levels of their parents using Hollingshead index. Height and weight were measured. Body Mass Index (BMI) (kg/m2 ) was calculated. Dual energy X-ray absorptiometry (DXA) was performed using the Lunar DPX series, and BMD and body composition were evaluated. Results: The mean age of menarche of female university student included in the study was 13.09.±1.3 years. There was no significant difference between the three socioeconomic groups in terms of height, body weight, age at menarche, BMD [BMD (gr/cm2 ) (L2-L4) and BMD (gr/cm2 ) (total body)], and body composition (lean tissue, fat tissue, total fat, and body fat) (p>0.05). While no correlation was found between the age at menarche and any parameter (p>0.05), a positive significant correlation was found between lean tissue and BMD L2-L4 (r=0.286, p=0.01). When the relationships were evaluated separately according to socioeconomic status, there was a significant correlation between BMDL2-L4 (r: 0.431, p=0.005) and lean tissue in females with low SES, while this relationship disappeared in females with middle and high SES. Conclusion: Age at menarche did not change according to socioeconomic status, nor did BMD and body composition in female at late adolescents. No relationship was found between age at menarche and BMD and body composition determined by DEXA in female university student who were close to reaching peak bone mass. The results suggested that especially BMDL2-L4 might increase as lean tissue increases.

Keywords: bone, osteoposis, menarche, dexa

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Authors: Radwa Talaat Mohammed El-Shorbagy, Alaa El-Din Balbaa, Khaled Ayad, Waleed Red

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Introduction: Ankle sprain is a common lower limb injury that is complicated by high recurrence rate. The cause of recurrence is not clear; however, changes in motor control have been postulated. Objective: To determine the contribution of proximal hip strategy to dynamic balance control in patients with recurrent ankle sprain. Methods: Fifteen subjects with recurrent ankle sprain (group A) and fifteen healthy control subjects (group B) participated in this study. Abductor-adductors as well as flexor-extensor hip musculatures control was abolished by fatigue using the Biodex Isokinetic system. Dynamic balance was measured before and after fatigue by the Biodex Balance system Results: Repeated measures MANOVA was used to compare between and within group differences. In group A fatiguing of hip muscles (flexors-extensors and abductors-adductors) increased overall stability index (OASI), anteroposterior stability index (APSI) and mediolateral stability index (MLSI) significantly (p=0.00) whereas; in group B fatiguing of hip flexors-extensors increased significantly OASI and APSI only (p= 0.017, 0.010; respectively) while fatiguing of hip abductors-adductors has no significant effect on these variables. Moreover, patients with ankle sprain had significantly lower dynamic balance after hip muscles fatigue compared to the control group. Specifically, after hip flexor-extensor fatigue, the OASI, APSI and MLSI were increased significantly than those of the control values (p=0.002, 0.011, and 0.003, respectively) whereas fatiguing of hip abductors-adductors increased significantly in OASI and APSI only (p=0.012, 0.026, respectively). Conclusion: To maintain dynamic balance, patients with recurrent ankle sprain seem to relay more on the hip strategy.

Keywords: ankle sprain, hip muscles fatigue, dynamic balance

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Authors: Fatemeh Rasooli, Behzad Simiari, Pooya Payandemehr, Amir Nejati, Maryam Bahreini, Atefeh Abdollahi

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Introduction: Pain is a complex physiological reaction to tissue injury. In the course of painful procedures such as nerve block, ice has been shown to be a feasible and inexpensive material to control pain. It delays nerve conduction, actives other senses and reduces inflammatory and painful responses. This study assessed the effect of ice in reducing pain caused by needling and infiltration during digital block. Patient satisfaction recorded as a secondary outcome. Methods: This study was designed as a non-blinded randomized clinical trial approved by Tehran University of Medical Sciences Ethical Committee. Informed consent was taken from all the participants who were then randomly divided into two groups. Digital block performed by standard approach in selected patients. Tubes of ice were prepared in gloves and were fragmented at a time of application for circling around the finger. Tubes were applied for 6 minutes before digital nerve block in the site of needling in the case group. Patients in the control group underwent digital nerve block with the conventional method without ice administration. Numeric Rating Scale (NRS) used for grading pain. 0 used for no pain and 10 for the worst pain that patient had experienced until now. Scores were analyzed by Wilcoxon Rank Sum test and compared in case and control groups. Results: 100 patients aged 16-50 years were enrolled. Mean NRS scores with and without ice were 1.5 mm (S.D ± 1.44) and 6.8 mm (S.D ± 1.40) for needling pain and for infiltration pain were 2.7mm ( S.D ±1.65) and 8.5mm ( S.D ± 1.47), respectively (p<0.001). Besides, patients’ satisfactions were significantly higher in the ice group (p<0.001). Conclusion: Application of ice for 6 minutes significantly reduced pain of needling and infiltration in digital nerve block; thus, it seems to be a feasible and inexpensive material which acts effectively to decrease pain and stress before the procedure.

Keywords: digital block, ice, needle, pain

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Authors: Deepak L. Waikar

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Unprecedented natural as well as human made disasters have been responsible for loss of hundreds of thousands of lives, injury & displacement of millions of people and damages in billions of dollars in various parts of the world. Scientists, experts, associations and united nation have been warning about colossal disregard for human safety and environment in exploiting natural resources for insatiable greed for economic growth and rising lavish life style of the rich. Usual blame game is routinely played at international forums & summits by vested interests in developing and developed nations, while billions of people continue to suffer in abject energy poverty. Energy security, on the other hand, is becoming illusive with the dominance of few players in the market, poor energy governance mechanisms, volatile prices and geopolitical conflicts in supply chain. Conflicting scenarios have been cited as one of the major barriers for transformation to a low carbon economy. Policy makers, researchers, academics, businesses, industries and communities have been evaluating sustainable alternatives, albeit at snail’s pace. This presentation focuses on technologies, energy governance, policies & practices, economics and public concerns about safe, prudent & sustainable harnessing of energy resources. Current trends and potential research & development projects in power & energy sectors which students can undertake will be discussed. Speaker will highlight on how youths can be engaged in meaningful, safe, enriching, inspiring and value added self-development programmes in our quest for sustainability in the midst of conflict between climate and energy security.

Keywords: clean energy, energy policy, energy security, sustainable energy

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Authors: Muhammad Solikhudin Nafi, Wahyu Afif Mufida, Mita Erna Wati, Fitri Setyani Rokim, M. Al-Rizqi Dharma Fauzi

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High dose activity without any pre-exercise will impact Delayed Onset Muscle Soreness (DOMS). DOMS known as delayed pain post-exercise and induce skeletal injury which will decrease athletes’ performances. From now on, post-exercise muscle damage can be detected by measuring skeletal troponin I (sTnI) concentration in serum using ELISA but this method needs more time and cost. To prevent decreased athletes performances, screening need to be done rapidly. We want to introduce our new prototype to detect DOMS acutely. Rapid detection tests are based on immunological reaction between skeletal troponin I antibodies and sTnI in human serum or whole blood. Chemical methods that are used in the manufacture of diagnostic test is lateral flow immunoassay. The material used is rat monoclonal antibody sTnI, colloidal gold, anti-mouse IgG, nitrocellulose membrane, conjugate pad, sample pad, wick and backing card. The procedure are made conjugate (colloidal gold and mAb sTnI) and insert into the conjugate pad, gives spray sTnI mAb and anti-mouse IgG into nitrocellulose membrane, and assemble RDT. RDT had been evaluated by measuring the sensitivity of positive human serum (n = 30) and negative human serum (n = 30). Overall sensitivity value was 93% and specificity value was 90%. ADCOR as the first rapid detection test qualitatively showed antigen-antibody reaction and showed good overall performances for screening of muscle damage. Furthermore, these finding still need more improvements to get best results.

Keywords: DOMS, sTnI, rapid detection test, ELISA

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Authors: Chia Yu Chen, Shu Fen Wu, Chen-Fuh Lam, I-Ling Tsai, Shu Jiuan Chen, Yen Ling Liu

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Aim: It remains undetermined that whether increased work stress may affect the job satisfaction and career loyalty among nursing staffs in the operating room. The long-term goal of this study is to lengthen the professional life of operating room nurses by attenuating the work stress and enhancing their contentment in work. Method: This was a cross-sectional, descriptive study performed in a metropolitan teaching hospital in the southern Taiwan between May 2017 to July 2017. A structured self-administered questionnaire, modified from the Occupational Stress Indicator-2 (OSI-2) and Maslach Burnout Inventory (MBI) manual was collected from the operating room nurses. Chi-square test was used to analyze the categorical data and Pearson correlation was used to analyze the association between two numerical datasets (SPSS version 20.0). Results: The response rate was 80% (80/100) and a total of 73 (73%) completed forms were eventually proceeded for analysis. The average scores for work stress and job satisfaction of the operating room nurses were 145.96±32.91 and 47.38±6.07, respectively. The correlation coefficients of work stress versus job satisfaction and organizational identity were (r=-0.338, p=0.003 and r=-0.354, p=0.002), respectively. There were more nurses who took rotating shift quitted works from the operating room than those who took only dayshift (2＝5.176, p<0.05). Nurses who reported of having lower job satisfaction were associated with significantly higher turnover intention (t=3.714, p< 0.01). Following multivariate regression analysis, rotating shift and low job satisfaction were identified as the two independent predictors of intention to quit from working in the operating room. Conclusion: Our study clearly demonstrates that increased work stress significantly attenuates job satisfaction and organizational identity. Rotating shift is associated with higher work stress, lower job satisfaction, and higher turnover intention, which is consistent with the previous surveys carried out in the department of medical technology. Therefore, improvement of working quality in the operating rooms is essential to increase the retain intention of the well-trained nursing staffs. Further investigation into types of work shifts and other strategies of attenuating stress in workplace is currently undertaken in order to improve the job satisfaction and to decrease turnover intention in the operating room.

Keywords: rotating shift, work stress, job satisfaction, turnover intention

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Authors: Rehab F. Abdel-Rahman, Sally A. El Awdan, Rehab R. Hegazy, Dina F. Mansour, Hanan A. Ogaly, Marwan Abdelbaset

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Disorders of the cerebral circulation are the leading cause of numerous neurological and psychiatric illnesses. The transient middle cerebral artery occlusion model (MCAO) is considered to be a reliable and reproducible rodent model of cerebral ischemia. The purpose of the current study was to examine the neuroprotective effects of Crocus sativus (saffron) in a rat model of left middle cerebral artery MCAO. Male Wistar rats were anesthetized and subjected to 1 h of MCAO followed by 48 h reperfusion or sham surgery. One group of the ischemia operated animals was kept as left brain ischemia/reperfusion (I/R). Another 2 operated groups received saffron extract (100 or 200 mg/kg, i.p) four times (60 min before the surgery, during the surgery, and on days 1 and 2 after the occlusion). During the experiment, behavioral tests were performed. After 72 h the animals were euthanized and their left brain hemispheres were used in the biochemical, histopathological, and immunohistochemical studies. Saffron administration revealed an improvement in I/R-induced alteration of locomotor balance and coordination ability of rats. Moreover, saffron decreased the brain content of malondialdehyde, nitric oxide, brain natriuretic peptide and vascular endothelial growth factor with significant increase of reduced glutathione. Immunohistochemical evaluation of caspase-3 and Bax protein expression revealed reduction in I/R-enhanced apoptosis in saffron treated rats. In conclusion, saffron treatment decreases ischemic brain injury in association with inhibition of apoptotic and oxidative cell death in a dose dependent manner.

Keywords: caspase-3, cerebral ischemia, Crocus sativus, rats, vascular endothelial growth factor

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Authors: Luedech Girdwichai, Withaya Mekhum

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This research intended to develop the model of community management for sustainable utilization by investigating on 2 groups of population, the family heads and the community management team. The population of the former group consisted of family heads from 511 families in 12 areas to complete the questionnaires which were returned at 479 sets. The latter group consisted of the community management team of 12 areas with 1 representative from each area to give the interview. The questionnaires for the family heads consisted of 2 main parts; general information such as occupations, etc. in the form of checklist. The second part dealt with the data on self reliance community development based on 4P Framework, i.e., People (human resource) development, Place (area) development, Product (economic and income source) development, and Plan (community plan) development in the form of rating scales. Data in the 1st part were calculated to find frequency and percentage while those in the 2nd part were analyzed to find arithmetic mean and SD. Data from the 2nd group of population or the community management team were derived from focus group to find factors influencing successful management together with the in depth interview which were analyzed by descriptive statistics. The results showed that 479 family heads reported that the aspect on the implementation of community plan to self reliance community activities based on Sufficient Economy Philosophy and the 4P was at the average of 3.28 or moderate level. When considering in details, it was found that the 1st aspect was on the area development with the mean of 3.71 or high level followed by human resource development with the mean of 3.44 or moderate level, then, economic and source of income development with the mean of 3.09 or moderate level. The last aspect was community plan development with the mean of 2.89. The results from the small group discussion revealed some factors and guidelines for successful community management as follows: 1) on the People (human resource) development aspect, there was a project to support and develop community leaders. 2) On the aspect of Place (area) development, there was a development on conservative tourism areas. 3) On the aspect of Product (economic and source of income) development, the community leaders promoted the setting of occupational group, saving group, and product processing group. 4) On the aspect of Plan (community plan) development, there was a prioritization through public hearing.

Keywords: model of community management, sustainable utilization, family heads, community management team

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Authors: Asanka U. K. Godamunne

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Road traffic accidents (RTA) are a leading cause of death globally as well as in Sri Lanka and results in a large proportion of disability especially among young people. Ninety-percent of world’s road traffic deaths occur in low- and middle-income countries. The gross disparities in injury outcomes relate to immediate post-crash and hospital management. Emergency management, methods of patient transportation following road traffic accidents and safety measures are important factors to reduce mortality and morbidity. Studies in this area are limited in Sri Lanka. The main objective of this research was to assess the emergency management and proper method of transportation of road traffic accident victims. This offers the best way to explore the ways to reduce the mortality and morbidity and raise the public awareness. This study was conducted as a descriptive cross-sectional study. All the consecutive road traffic accident victims admitted to surgical wards at District General Hospital, Matale, Sri Lanka, over a period of three months were included in the study. Data from 387 victims were analyzed. The majority were in the 20-30 year age group. Seventy six percent of the patients were males. Motorcycles and trishaws were most affected. First-aid was given to only 2% of patients and it was given by non-medical persons. A significant proportion of patients (75%) were transported to the hospital by trishaws and only 1% transported by ambulance. About 86% of the patients were seated while transport and 14% were flat. Limbs and head were the most affected areas of the body. As per this study, immediate post-crash management and patient transportation were not satisfactory. There is a need to strengthen certain road safety laws and make sure people follow them.

Keywords: emergency management, patient transportation, road traffic accident victims, Sri Lanka

Procedia PDF Downloads 249

Authors: Siti Rajaah Binti Sayed Sultan

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Managing the code blue event is stressful for nurses, the patient, and the patient's families. The rapid response from the first and second responders in the code blue event will improve patient outcomes and prevent tissue hypoxia that leads to brain injury and other organ failures. Providing 1 minute for the cardiac massage and 2 minutes for defibrillation will significantly improve patient outcomes. As we know, the American Heart Association came out with guidelines for managing cardiac arrest patients. The hospital must provide competent staff to manage this situation. It can be achieved when the staff is well equipped with the skill, attitude, and knowledge to manage this situation with well-planned strategies, i.e., clear guidelines for managing the code blue event, competent staff, and functional equipment. The code blue simulation (CBS) was chosen in the training program for code blue management because it can mimic real scenarios. Having the code blue simulation module will allow the staff to appreciate what they will face during the code blue event, especially since it rarely happens in that area. This CBS module training will help the staff familiarize themselves with the activities that happened during actual events and be able to operate the equipment accordingly. Being challenged and independent in managing the code blue in the early phase gives the patient a better outcome. The CBS module will help the assessor and the hospital management team with the proper tools and guidelines for managing the code blue drill accordingly. As we know, prompt action will benefit the patient and their family. It also indirectly increases the confidence and job satisfaction among the nurses, increasing the standard of care, reducing the complication and hospital burden, and enhancing cost-effective care.

Keywords: code blue simulation module, development of code blue simulation module, code blue response time, code blue drill, cardiorespiratory arrest, managing code blue

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Authors: Pardis Abolghasemi, Benyamin Hatamsaz

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Background: Diabetic nephropathy is a serious health problem described by specific kidney structure and functional disturbance. Renoprotective effects of the stem cells secretase have been shown in many kidney diseases. The aim is to evaluate the capability of human Wharton’s jelly mesenchymal stem cells conditioned media (hWJMSCs-CM) to alleviate DN in streptozotocin (STZ)-induced diabetes. Methods: Diabetic nephropathy was induced by injection of STZ (60 mg/kg, IP) in twenty rats. Conditioned media was extracted from hWJMSCs at third passages. At week 8, diabetic rats were divided into two groups: treated (hWJMSCs-CM, 500 μl/rat for three weeks, IP) and not treated (DN). In the 11th week, three groups (control, DN and DN+hWJMSCs-CM) were kept in metabolic cages and urine was collected for 24h. Blood pressure (BP) and heart rate (HR) were continuously recorded. The serum samples were maintained for measuring BUN, Cr and angiotensin-converting enzyme (ACE) activity. The left kidney was kept at -80°C for ACE activity assessment. The right kidney and pancreas were used for histopathologic evaluation. Result: Diabetic nephropathy was detected by microalbuminuria and increased albumin/creatinine ratio, as well as the pancreas and renal structural disturbance. Glomerular filtration rate, BP and HR increased in the DN group. The ACE activity was elevated in the serum and kidneys of the DN group. Administration of hWJMSCs-CM modulated the renal functional and structural disturbance and decreased the ACE activity. Conclusion: Conditioned media was extracted from hWJMSCs may have a Renoprotective effect in diabetic nephropathy. This may happen through regulation of ACE activity and renin-angiotensin system inhibition.

Keywords: diabetic nephropathy, mesenchymal stem cells, immunomodulation, anti-inflammation

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Authors: Salwa M. Almomen, Mona A. Almaghrabi, Saja M. Alhabardi, Adel A. Alrwisan

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Background: Hepatotoxicity is a major reason for medication withdrawal from the markets. Unfortunately, serious adverse hepatic effects can occur after marketing with limited indicators during clinical development. Therefore, finding possible predictors for hepatotoxicity might guide the monitoring program of various stakeholders. Methods: We examined the clinical review documents for drugs approved in the US from 2011 to 2016 to evaluate their hepatic safety profile. Predictors: we assessed whether these medications meet Hy’s Law with hepatotoxicity grade ≥ 3, labeled hepatic adverse effects at approval, or accelerated approval status. Outcome: post-marketing regulatory action related to hepatotoxicity, including product withdrawal or updates to warning, precaution, or adverse effects sections. Statistical analysis: drugs were included in the analysis from the time of approval until the end of 2019 or the first post-marketing regulatory action related to hepatotoxicity, whichever occurred first. The hazard ratio (HR) was estimated using Cox-regression analysis. Results: We included 192 medications in the study. We classified 48 drugs as having grade ≥ 3 hepatotoxicities, 43 had accelerated approval status, and 74 had labeled information about hepatotoxicity prior to marketing. The adjusted HRs for post-marketing regulatory action for products with grade ≥ 3 hepatotoxicity was 0.61 (95% confidence interval [CI], 0.17-2.23), 0.92 (95%CI, 0.29-2.93) for a drug approved via accelerated approval program, and was 0.91 (95%CI, 0.33-2.56) for drugs with labeled hepatotoxicity information at approval time. Conclusion: This study does not provide conclusive evidence on the association between post-marketing regulatory action and grade ≥ 3 hepatotoxicity, accelerated approval status, or availability of labeled information at approval due to sampling size and channeling bias.

Keywords: accelerated approvals, hepatic adverse effects, drug-induced liver injury, hepatotoxicity predictors, post-marketing withdrawal

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Authors: Hsin-Yi Lo, Chia-Yu Hsu

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This article is the nursing experience of a multiple trauma case using Swanson's theory of caring, the nursing period is from May 31 to June 4, 2021, collect data through observation, written talks, interviews, listening, direct care and physical assessment, established cases with health problems such as acute pain, impaired tissue integrity, and anxiety. Nursing process including, evaluate the pain index with the pain assessment scale, assist in acupoint massage, use a corset to fix the wound, and give the patient listening to favorite radio programs to divert attention and relieve pain problems; promote wound healing and avoid infection by assessing wound condition and exudation, changing dressings with aseptic technique, and providing appropriate dressings; encourage patients to express their feelings, provide companionship, and assist in self-care and participation in treatment plans, to enable the case to overcome the anxiety caused by being admitted to the intensive care unit for the first time and not knowing about the disease, and assist the case to overcome the injury caused by the accident and return to normal life. There is no video equipment in the intensive care unit during the nursing period. In response to the problem that family visits cannot be opened during the epidemic, it is a limitation this time. It is recommended that the hospital take this into consideration in the future. In the post-epidemic era, it can reduce the risk of various infections for patients and family members. Traveling between home and hospital, improving the quality of high-quality and technological care.

Keywords: swanson's theory of caring, multiple trauma, anxiety, nursing experience

Procedia PDF Downloads 81