Search results for: oral history theatre

Authors: Abdulrahman A. Bahaddad, Mohammed Beshir

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The objective of this paper is to demonstrate and describe eight different types of power generation technologies and to understand the history and future trends of each technology. In addition, a comparative analysis between these technologies will be presented with respect to their cost analysis and associated performance.

Keywords: conventional power generation, economic analysis, environmental impact, renewable energy power generation

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Authors: Khaled Alabduljabbar

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Background: Benign, isolated, recurrent sixth nerve palsy is very rare in children. Here we report a case of recurrent abducens nerve palsy with no obvious etiology. It is a diagnosis of exclusion. A recurrent benign form of 6th nerve palsy, a rarer still palsy, has been described in the literature, and it is of most likely secondary to inflammatory causes, e.g, following viral and bacterial infections. Purpose: To present a case of 14 months old girl with recurrent attacks of isolated left sixth cranial nerve palsy following upper respiratory tract infection. Observation: The patient presented to opthalmology clinic with sudden onset of inward deviation (esotropia) of the left eye with a compensatory left face turn one week following signs of upper respiratory tract infection. Ophthalmological examination revealed large angle esotropia of the left eye in primary position, with complete limitation of abduction of the left eye, no palpebral fissure changes, and abnormal position of the head (left face turn). Visual acuity was normal, and no significant refractive error on cycloplegic refraction for her age. Fundus examination was normal with no evidence of papilledema. There was no relative afferent pupillary defect (RAPD) and no anisocoria. Past medical history and family history were unremarkable, with no history of convulsion attacks or head trauma. Additional workout include CBC. Erythrocyte sedimentation rate, Urgent magnetic resonance imaging (MRI), and angiography of the brain were performed and demonstrated the absence of intracranial and orbital lesions. Referral to pediatric neurologist was also done and concluded no significant finding. The patient showed improvement of the left sixth cranial nerve palsy and left face turn over a period of two months. Seven months since the first attack, she experienced a recurrent attack of left eye esotropia with left face turn concurrent with URTI. The rest of eye examination was again unremarkable. CT scan and MRI scan of brain and orbit were performed and showed only signs of sinusitis with no intracranial pathology. The palsy resolved spontaneously within two months. A third episode of left 6th nerve palsy occurred 6 months later, whichrecovered over one month. Examination and neuroimagingwere unremarkable. A diagnosis of benign recurrent left 6th cranial nerve palsy was made. Conclusion: Benign sixth cranial nerve palsy is always a diagnosis of exclusion given the more serious and life-threatening alternative causes. It seems to have a good prognosis with only supportive measures. The likelihood of benign 6th cranial nerve palsy to resolve completely and spontaneously is high. Observation for at least 6 months without intervention is advisable.

Keywords: 6th nerve pasy, abducens nerve pasy, recurrent nerve palsy, cranial nerve palsy

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Authors: Lakmali Anthony, Bushra Oathman, Anshini Jain, Raaj Chandra

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Introduction: Abscesses are traditionally treated by incision and drainage with the packing of the residual abscess cavity until healing. This method requires regular visits from community nurses for continuous wound packing upon discharge from the hospital and causes considerable patient discomfort. Whether abscess cavity packing offers any advantage over non-packing has not yet been adequately studied to the best of our knowledge. This study aims to determine if there are differences in clinical outcomes of time to healing, fistula formation and recurrence of abscess between abscess cavity packing vs. non-packing groups. Methods: This study was a single-center, single-blind, randomized controlled trial where patients were randomized into packing and non-packing arms. All patients over 18 years presenting to Eastern Health with an abscess requiring incision and drainage in the theatre were invited to participate. Those with underlying conditions that cause recurrent abscesses were excluded. Data were collected from December 2018 to April 2020. Results: There were 63 patients who had abscesses treated with incision and drainage that were enrolled in the study, 52 of which were suitable for analysis. Demographic characteristics were similar in both groups. The packing group had a significantly longer time to heal compared to the non-packing group. Rates of fistula formation and recurrence of abscess were low and there were no statistically significant differences between groups. The packing group had more patients with delayed healing (defined as >60 days) and required more follow-up visits compared to the non-packing group. Conclusion: This pilot study indicates that abscesses can not only be managed safely with incision and drainage alone without the need for continuous abscess cavity packing but also that non-packing may offer clinical benefits to patients with earlier healing of abscesses compared to continuous cavity packing.

Keywords: abscess packing, subcutaneous, perianal, pilonidal

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Authors: Jelena R. Pejović, Nina N. Serdar

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This paper presents an analysis of the “Performance-Based” seismic design method, in order to overcome the perceived disadvantages and limitations of the existing seismic design approach based on force, in engineering practice. Bearing in mind, the specificity of the earthquake as a load and the fact that the seismic resistance of the structures solely depends on its behaviour in the nonlinear field, traditional seismic design approach based on force and linear analysis is not adequate. “Performance-Based” seismic design method is based on nonlinear analysis and can be used in everyday engineering practice. This paper presents the application of this method to eight-story high reinforced concrete building with combined structural system (reinforced concrete frame structural system in one direction and reinforced concrete ductile wall system in other direction). The nonlinear time-history analysis is performed on the spatial model of the structure using program Perform 3D, where the structure is exposed to forty real earthquake records. For considered building, large number of results were obtained. It was concluded that using this method we could, with a high degree of reliability, evaluate structural behavior under earthquake. It is obtained significant differences in the response of structures to various earthquake records. Also analysis showed that frame structural system had not performed well at the effect of earthquake records on soil like sand and gravel, while a ductile wall system had a satisfactory behavior on different types of soils.

Keywords: ductile wall, frame system, nonlinear time-history analysis, performance-based methodology, RC building

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Authors: Harmeet Pal Singh Dhooria, Deepinder Chinna, UPS Sidhu, Alok Jain

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Serious infections caused by gram-negative bacteria are a significant cause of mortality and morbidity in the hospital setting. In acute care facilities like in intensive care units (ICUs), the intensity of antimicrobial use together with a population highly susceptible to infection, creates an environment, which facilitates both emergence and transmission of Extended Spectrum -lactamase (ESBL) producing Enterobacteriaceae species. The study was conducted in the Medical Intensive Care Unit (MICU) and the Pulmonary Critical Care Unit (PCCU) of the Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Out of a total of 1108 samples of urine, blood and respiratory tract secretions received for culture and sensitivity analysis from Medical Intensive Care Unit and Pulmonary Critical Care Unit, a total of 170 isolates of Enterobacteriaceae species were obtained which were then included in our study. Out of these 170 isolates, confirmed ESBL production was seen in 116 (68.24%) cases. E.coli was the most common species isolated (56.47%) followed by Klebsiella (32.94%), Enterobacter (5.88%), Citrobacter (3.53%), Enterobacter (0.59%) and Morganella (0.59%) among the total isolates. The rate of ESBL production was more in Klebsiella (78.57%) as compared to E.coli (60.42%). ESBL producers were found to be significantly more common in patients with prior history of hospitalization, antibiotic use, and prolonged ICU stay. Also significantly increased the prevalence of ESBL related infections was observed in patients with a history of catheterization or central line insertion but not in patients with the history of intubation. Patients who had an underlying malignancy had significantly higher prevalence of ESBL related infections as compared to other co-morbid illnesses. A slightly significant difference in the rate of mortality/LAMA was observed in the ESBL producer versus the non-ESBL producer group. The rate of mortality/LAMA was significantly higher in the ESBL related UTI but not in the ESBL related respiratory tract and bloodstream infections. ESBL producing isolates had significantly higher rates of resistance to Cefepime and Piperacillin/Tazobactum, and to non β-lactum antibiotics like Amikacin and Ciprofloxacin. The level of resistance to Imipenem was lower as compared to other antibiotics. However, it was noted that ESBL producing isolates had higher levels of resistance to Imipenem as compared to non-ESBL producing isolates. Conclusion- The prevalence of ESBL producing organisms was found to be very high (68.24%) among Enterobacteriaceae isolates in our ICU setting as among other ICU care settings around the world.

Keywords: enterobacteriaceae, extended spectrum B-lactamase (ESBL), ICU, antibiotic resistance

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Authors: Osama M. Ahmed, Walaa G. Hozayen, Haidy Tamer Abo Sree

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The effect of doxorubicin (4 mg/kg b.w.week) without or with oral administration of ethanolic purslane (Portulaca oleracea) shoot (leaves and stems) extract (50 mg/kg b.w.day) or ethanolic purslane seeds extract (50 mg/kg b.w.day) co-treatments for 6 weeks was evaluated in adult male rats. There was an increase in serum levels of ALT, AST, ALP, GGT and total bilirubin. In addition, hepatic glutathine, glutathione transferase, peroxidase, SOD, CAT activities were decreased while lipid peroxidation in the liver was increased. Co-administration of ethanolic purslane and seed extracts successfully improved the adverse changes in the liver functions with an increase in antioxidants activities and reduction of lipid peroxidation.

Keywords: antioxidants, doxorubicin, hepatotoxicity, purslane

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Authors: Hacer Kobya Bulut, Ilknur Kahriman, Birsel C. Demirbag

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Introduction and Purpose: The lives of children with cancer are affected by long term hospitalizations in a negative way due to complications arising from diagnosis or treatment. However, the children's parents are known to have difficulties in meeting their children’s needs and providing home care after cancer treatment or during remission process. Supporting these children and their parents by giving a planned discharge training starting from the hospital and home care leads to reducing hospital applications, hospitalizations, hospital costs, shortening the length of hospital stay and increasing the satisfaction of the children with cancer and their families. This study was conducted to investigate the status of children and their parents' unplanned application to hospital and re-hospitalization. Methods: The study was carried out with 65 children with hematological malignancy in 0-17 age group and their families in a hematology clinic and polyclinic of a university hospital in Trabzon. Data were collected with survey methodology between August-November, 2015 through face to face interview using numbers, percentage and chi-square test in the evaluation. Findings: Most of the children were leukemia (90.8%) and 49.2% had been ill over 13 months. Few of the parents (32.3%) stated that they had received discharge and home care training (24.6%) but most of them (69.2%) found themselves enough in providing home care. Very few parents (6.2%) received home care training after their children being discharged and the majority of parents (61.5%) faced difficulties in home care and had no one to call around them. The parents expressed that in providing care to their children with hematological malignance, they faced difficulty in feeding them (74.6%), explaining their disease (50.0%), giving their oral medication (47.5%), providing hygiene (43.5%) and providing oral care (39.3%). The question ‘What are the emergency situations in which you have to bring your children to a doctor immediately?' was replied as fever (89.2%), severe nausea and vomiting (87.7%), hemorrhage (86.2%) and pain (81.5%). The study showed that 50.8% of the children had unplanned applications to hospitals and 33.8% of them identified as unplanned hospitalization and the first causes of this were fever and pain. The study showed that the frequency of applications (%78.8) and hospitalizations (%81.8) was higher for boys and a statistically significant difference was found between gender and unplanned applications (X=4.779; p=0.02). Applications (48.5%) and hospitalizations (40.9%) were found lower for the parents who had received hospital discharge training, and a significant difference was determined between receiving training and unplanned hospitalizations (X=8.021; p=0.00). Similarly, applications (30.3%) and hospitalizations (40.9%) was found lower for the ones who had received home care training, and a significant difference was determined between receiving home care training and unplanned hospitalizations (X=4.758; p=0.02). Conclusion: It was found out that caregivers of children with cancer did not receive training related to home care and complications about treatment after discharging from hospital, so they faced difficulties in providing home care and this led to an increase in unplanned hospital applications and hospitalizations.

Keywords: cancer, children, unplanned application, unplanned hospitalization

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Authors: Weldegerima Gebremedhin Hagos

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Background: The Coronavirus disease of 2019 (COVID-19) is a catastrophic emerging global health threat caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 has a wide range of complications and sequels. It is devastating in developing countries, causing serious health and socioeconomic crises as a result of the increasingly overburdened healthcare system. Ethiopia reported the first case of SARS-CoV-2 on 13th March 2020, with community transmission ensuing by mid-May. The aim of this study was conducted to determine the prevalence of SARS-CoV-2 infection in Tigray, Ethiopia. Methods: Facility-based correctional study designs were used on a total of 380 study participants from March 2023 up to May 2023 in two general hospitals and one comprehensive specialized hospital in Tigray, Ethiopia. A pre-structured questionnaire was used to assess information regarding the socio-demographic, clinical data and other risk factors. A nasal swap was taken by trained health professionals, and the laboratory analysis was done by RT-PCR (quant studio 7-flex, applied biosystems) in Tigrai Health Research Institute and Mekelle University Medical Microbiology Research Laboratory. Result: The mean age of the study participants was 31 (SD+/-3.5) years, with 65% being male and 35% female. The overall seropositivity of sars-cov-2 among the study participants was 5.5%. The prevalence was higher in males (6.2%) than females which were (4.7%). Sars-cov-2 infection was significantly associated with a history of lack of vaccination (p-value 0.002). There was no significant association between seropositivity and demographic factors (P > 0.05). Conclusion: The seroprevalence of SARS-CoV-2 among the study participants is high. Those study participants with a previous history of vaccination have a low probability of developing COVID-19 infection. A low SARS-CoV-2 infection rate was recorded in those who frequently use masks.

Keywords: prevalence, SARS-CoV-2, infection, risk factors

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Authors: Kylie Mueller, Nijole Bernaitis, Shailendra Anoopkumar-Dukie

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Background: Vitamin K antagonists particularly warfarin is the most frequently used oral medication for deep vein thrombosis (DVT) treatment and prophylaxis. Time in therapeutic range (TITR) of the international normalised ratio (INR) is widely accepted as a measure to assess the quality of warfarin therapy. Multiple factors can affect warfarin control and the subsequent adverse outcomes including thromboembolic and bleeding events. Predictor models have been developed to assess potential contributing factors and measure the individual risk of these adverse events. These predictive models have been validated in atrial fibrillation (AF) patients, however, there is a lack of literature on whether these can be successfully applied to other warfarin users including DVT patients. Therefore, the aim of the study was to assess the ability of these risk models (HAS BLED and CHADS2) to predict haemorrhagic and ischaemic incidences in DVT patients treated with warfarin. Methods: A retrospective analysis of DVT patients receiving warfarin management by a private pathology clinic was conducted. Data was collected from November 2007 to September 2014 and included demographics, medical and drug history, INR targets and test results. Patients receiving continuous warfarin therapy with an INR reference range between 2.0 and 3.0 were included in the study with mean TITR calculated using the Rosendaal method. Bleeding and thromboembolic events were recorded and reported as incidences per patient. The haemorrhagic risk model HAS BLED and ischaemic risk model CHADS2 were applied to the data. Patients were then stratified into either the low, moderate, or high-risk categories. The analysis was conducted to determine if a correlation existed between risk assessment tool and patient outcomes. Data was analysed using GraphPad Instat Version 3 with a p value of <0.05 considered to be statistically significant. Patient characteristics were reported as mean and standard deviation for continuous data and categorical data reported as number and percentage. Results: Of the 533 patients included in the study, there were 268 (50.2%) female and 265 (49.8%) male patients with a mean age of 62.5 years (±16.4). The overall mean TITR was 78.3% (±12.7) with an overall haemorrhagic incidence of 0.41 events per patient. For the HAS BLED model, there was a haemorrhagic incidence of 0.08, 0.53, and 0.54 per patient in the low, moderate and high-risk categories respectively showing a statistically significant increase in incidence with increasing risk category. The CHADS2 model showed an increase in ischaemic events according to risk category with no ischaemic events in the low category, and an ischaemic incidence of 0.03 in the moderate category and 0.47 high-risk categories. Conclusion: An increasing haemorrhagic incidence correlated to an increase in the HAS BLED risk score in DVT patients treated with warfarin. Furthermore, a greater incidence of ischaemic events occurred in patients with an increase in CHADS2 category. In an Australian population of DVT patients, the HAS BLED and CHADS2 accurately predicts incidences of haemorrhage and ischaemic events respectively.

Keywords: anticoagulant agent, deep vein thrombosis, risk assessment, warfarin

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Authors: Behnoush Moghiminia, Jesus Anaya Diaz

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The current study attempts to present the relationship between the structure development and Patkaneh as one of the Iranian geometric patterns and parametric algorithms by introducing two practical methods. While having a structural function, Patkaneh is also used as an ornamental element. It can be helpful in the scientific and practical review of Patkaneh. The current study aims to use Patkaneh as a parametric form generator based on the algorithm. The current paper attempts to express how can a more complete algorithm of this covering be obtained based on the parametric study and analysis of a sample of a Patkaneh and also investigate the relationship between the development of the geometrical pattern of Patkaneh as a structural-decorative element of Iranian architecture and digital design. In this regard, to achieve the research purposes, researchers investigated the oldest type of Patkaneh in the architecture history of Iran, such as the Northern Entrance Patkaneh of Oshtorjan Jame’ Mosque. An accurate investigation was done on the history of the background to answer the questions. Then, by investigating the structural behavior of Patkaneh, the decorative or structural-decorative role of Patkaneh was investigated to eliminate the ambiguity. Then, the geometrical structure of Patkaneh was analyzed by introducing two practical methods. The first method is based on the constituent units of Patkaneh (Square and diamond) and investigating the interactive relationships between them in 2D and 3D. This method is appropriate for cases where there are rational and regular geometrical relationships. The second method is based on the separation of the floors and the investigation of their interrelation. It is practical when the constituent units are not geometrically regular and have numerous diversity. Finally, the parametric form algorithm of these methods was codified.

Keywords: geometric properties, parametric design, Patkaneh, structural analysis

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Authors: Tahera Begum, Sabina Yeasmin, Jalal Uddin

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Ten slums of ten wards of Chittagong city corporation of Bangladesh were conveniently selected to know about modern contraceptive use by the slum dwellers. Total 300 family heads or their wives were interviewed with a questionnaire in February 2014. Family size was 4.62. Among 300 families 248 eligible couples were found. 57% eligible couples use different modern contraceptive measures. Remaining 43% eligible couples do not use modern contraceptive measures. Among the users 58% use oral pill, 30% injectables, 8% use condom, 3% were found with ligation and only 1% with vasectomy. Contraceptive prevalence rate has been increased and pattern as changed. A discussion is made with literature review.

Keywords: conraceptive, Bangladesh, family, pill

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Authors: M. Benjamin Stacey

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Energy efficiency has been increasingly recognized as a high value resource through state policies that require utility companies to implement efficiency programs. While policymakers have recognized the statewide economic, environmental, and health related value to residents who rely on this grid supplied resource, varying interests in energy efficiency between socioeconomic groups stands undifferentiated in most state legislation. Instead, the benefits are oftentimes assumed to be distributed equitably across these groups. Despite this fact, these policies are frequently sited by advocacy groups, regulatory bodies and utility companies for their ability to address the negative financial, health and other social impacts of energy poverty in low income communities. Yet, while most states like Michigan require programs that target low income consumers, oftentimes no requirements exist for the equitable investment and energy savings for low income consumers, nor does it stipulate minimal spending levels on low income programs. To further understand the impact of the absence of these factors in legislation, this study examines the distribution of program funds and energy efficiency savings to answer a fundamental energy justice concern; Are there disparities in the investment and benefits of energy efficiency programs between socioeconomic groups? This study compiles data covering the history of Michigan’s Energy Efficiency policy implementation from 2010-2016, analyzing the energy efficiency portfolios of Michigan’s two main energy providers. To make accurate comparisons between these two energy providers' investments and energy savings in low and non-low income programs, the socioeconomic variation for each utility coverage area was captured and accounted for using GIS and US Census data. Interestingly, this study found that both providers invested more equitably in natural gas efficiency programs, however, together these providers invested roughly three times less per household in low income electricity efficiency programs, which resulted in ten times less electricity savings per household. This study also compares variation in commission approved utility plans and actual spending and savings results, with varying patterns pointing to differing portfolio management strategies between companies. This study reveals that for the history of the implementation of Michigan’s Energy Efficiency Policy, that the 35% of Michigan’s population who qualify as low income have received substantially disproportionate funding and energy savings because of the policy. This study provides an overview of results from a social perspective, raises concerns about the impact on energy poverty and equity between consumer groups and is an applicable tool for law makers, regulatory agencies, utility portfolio managers, and advocacy groups concerned with addressing issues related to energy poverty.

Keywords: energy efficiency, energy justice, low income, state policy

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Authors: Hatice Guzel, Imran Oral, Huseyin Isler

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In this study, elastic constants, Young’s modulus, Poisson’s ratios, and shear moduli of orthotropic composite materials, consisting of E-glass/epoxy and carbon/epoxy, were calculated by ultrasonic velocities which were measured using ultrasonic pulse-echo method. 35 MHz computer controlled analyzer, 60 MHz digital oscilloscope, 5 MHz longitudinal probe, and 2,25 MHz transverse probe were used for the measurements of ultrasound velocities, the measurements were performed at ambient temperature. It was understood from the data obtained in this study that, measured ultrasound velocities and the calculated elasticity coefficients were depending on the fiber orientations.

Keywords: composite materials, elastic constants, orthotropic materials, ultrasound

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Authors: Heroda Gebru, Berhanu Seyoum, Melake Damena, Gezahegn Tesfaye

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Background: In Ethiopia there is a population policy aimed at reducing fertility and increasing contraceptive prevalence. Objective: To assess the fertility preference and contraceptive use status of married women who were living in Dire Dawa administrative city. Methods: Cross sectional study which included a sample size of 421 married women of reproductive age were performed. Data was collected using structured questionnaire during house to house survey and semi-structured questionnaire during in-depth interview. Data was processed and analyzed using SPSS version 16 computer software. Univariate, bi variate and multi variate analysis was employed. Results: A total of 421 married women of reproductive age group were interviewed having a response rate of 100 percent. More than half (58.2%) of the respondent have desire of more children. While 41.8% want no more children. Regarding contraceptive use 52.5% of the respondents were using contraceptive at the time of survey. Fertility preference and contraceptive use were significantly associated with age of the respondent, history of child death, number of living children, religion and age at first birth. Conclusions: Those women with younger age group, who had no child death history and women with lesser number of surviving children were more likely desire additional children. Women with older age at first birth and protestant in religion were more likely practiced contraceptive use. Strong information and education regarding contraceptive for younger age group should be provided, advocacy at level of religious leader is important, comprehensive family planning counselling and education should be available for the community, husbands, and religious leaders and the aim for increasing contraceptive use should focus on the practical aspect.

Keywords: fertility preference, contraceptive use, univariate analysis, family planning

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Authors: Alex Knighton, Roba Khundkar, Michael Dunn

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Neo-colonialism is defined as the use of economic, political, cultural, or other pressures to control or influence other countries, especially former dependencies, and concerns have been raised about its presence in surgical missions. Surgical missions aim to rectify the huge disparity in surgical access worldwide, but their ethics must be carefully considered. This is especially in light of colonial history which affects international relations and global health today, to ensure that colonial attitudes are not influencing efforts to promote equity. This review examines the history of colonial global health, demonstrating that global health initiatives have consistently been used to benefit those providing them, and then asks whether elements of colonialism are still pervasive in surgical missions today. Data was collected from the literature using specified search terms and snowball searching, as well as from international expert web-based conferences on global surgery ethics. A thematic analysis was then conducted on this data, resulting in the identification of six themes which are identifiable in both past and present global health initiatives. These six themes are power, lack of understanding or respect, feelings of superiority, exploitation, enabling of dependency, and acceptance of poorer standards of care. An ethical analysis follows, concluding that the concerns of power and neo-colonialism in global surgery would be addressed by adopting a framework of procedural justice that promotes a refined governance process in which stakeholders are able to propose and reject decisions that affect them. The paper argues that adopting this model would address concerns of the power disparity in the field directly, as well as promoting an ethical framework to enable the other concerns of power disparity and neo-colonialism identified in the present analysis to be addressed.

Keywords: medical ethics, global surgery, global health, neocolonialism, surgical missions

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Authors: Shang Yee Chong

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Perioperative pain is a complex mechanism activated by various nociceptive, neuropathic, and inflammatory pathways. Opioids have long been a mainstay for analgesia in this period, even as we are continuously moving towards a multimodal model to improve pain control while minimising side effects. Dexmedetomidine, a potent alpha-2 agonist, is a useful sedative and hypnotic agent. Its use in the intensive care unit has been well described, and it is increasingly an adjunct intraoperatively for its opioid sparing effects and to decrease pain scores. We describe a case of a general surgical patient in whom minimal opioids was required with dexmedetomidine use. The patient was a 61-year-old Indian gentleman with a history of hyperlipidaemia and type 2 diabetes mellitus, presenting with rectal adenocarcinoma detected on colonoscopy. He was scheduled for a robotic ultra-low anterior resection. The patient was induced with intravenous fentanyl 75mcg, propofol 160mg and atracurium 40mg. He was intubated conventionally and mechanically ventilated. Anaesthesia was maintained with inhalational desflurane and anaesthetic depth was measured with the Masimo EEG Sedline brain function monitor. An initial intravenous dexmedetomidine dose (bolus) of 1ug/kg for 10 minutes was given prior to anaesthetic induction and thereafter, an infusion of 0.2-0.4ug/kg/hr to the end of surgery. In addition, a bolus dose of intravenous lignocaine 1.5mg/kg followed by an infusion at 1mg/kg/hr throughout the surgery was administered. A total of 10mmol of magnesium sulphate and intravenous paracetamol 1000mg were also given for analgesia. There were no significant episodes of bradycardia or hypotension. A total of intravenous phenylephrine 650mcg was given throughout to maintain the patient’s mean arterial pressure within 10-15mmHg of baseline. The surgical time lasted for 5 hours and 40minutes. Postoperatively the patient was reversed and extubated successfully. He was alert and comfortable and pain scores were minimal in the immediate post op period in the postoperative recovery unit. Time to first analgesia was 4 hours postoperatively – with paracetamol 1g administered. This was given at 6 hourly intervals strictly for 5 days post surgery, along with celecoxib 200mg BD as prescribed by the surgeon regardless of pain scores. Oral oxycodone was prescribed as a rescue analgesic for pain scores > 3/10, but the patient did not require any dose. Neither was there nausea or vomiting. The patient was discharged on postoperative day 5. This case has reinforced the use of dexmedetomidine as an adjunct in general surgery cases, highlighting its excellent opioid-sparing effects. In the entire patient’s hospital stay, the only dose of opioid he received was 75mcg of fentanyl at the time of anaesthetic induction. The patient suffered no opioid adverse effects such as nausea, vomiting or postoperative ileus, and pain scores varied from 0-2/10. However, intravenous lignocaine infusion was also used in this instance, which would have helped improve pain scores. Paracetamol, lignocaine, and dexmedetomidine is thus an effective, opioid-sparing combination of multi-modal analgesia for major abdominal surgery cases.

Keywords: analgesia, dexmedetomidine, general surgery, opioid sparing

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Authors: Vidhi Chandra, Arshpreet Singh Grewal

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A five-year-old male child born from non-consanguineous marriage, who presented with complaints of growth retardation and no appreciable increase in the penile size since birth and he was posted for de-gloving of penis with dissection of corpora under anaesthesia. After thorough preoperative evaluation it was revealed that patient had peculiar facial dysmorphism that of Robinow Syndrome, high arched palate, Mallampati grade III, mesomelic limbs, scoliotic spine and short stature. All routine investigation were within normal limit, electrocardiography (ECG) and 2D-Echocardiography (ECHO) were normal. In antero-posterior roentgenogram chest showed butterfly and hemivertebrae at multiple levels. The patient was considered to be ASA II. On the day of surgery after ensuring fasting of 6 hours, patient was taken in operation theatre, all standard ASA monitoring was done with ECG, non-invasive blood pressure, peripheral oxygen saturation (SpO2) and body temperature. The patient was pre-oxygenated with 100% oxygen with anatomical face mask. General anaesthesia was induced with Sevoflurane 1-8%, and airway was secured with an appropriate size supraglottic airway and anaesthesia was maintained with nitrous oxide and oxygen in 1:1 ratio along with sevoflurane 2%. An ultrasound guided caudal block was given owing to the skeletal deformities making it difficult even under USG guidance. Post operatively patient was given supportive care with proper hydration, antibiotics, anti-inflammatory and analgesics. He was discharged the next day and followed up weekly for a month. DISCUSSION Robinow syndrome is genetically inherited as autosomal dominant, autosomal recessive or heterogenous disorder involving tyrosine kinase ROR2 gene located on chromosome 9. It has low incidence with no preponderance for any gender. Though intelligence is normal but developmental delay and mental retardation occurs in 20%cases

Keywords: Robinow Syndrome, dwarfism, paediatric, anaesthesia

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Authors: Irene Yi

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Machine learning, natural language processing, and neural network models of language are becoming more and more prevalent in the fields of technology and linguistics today. Training data for machines are at best, large corpora of human literature and at worst, a reflection of the ugliness in society. Machines have been trained on millions of human books, only to find that in the course of human history, derogatory and sexist adjectives are used significantly more frequently when describing females in history and literature than when describing males. This is extremely problematic, both as training data, and as the outcome of natural language processing. As machines start to handle more responsibilities, it is crucial to ensure that they do not take with them historical sexist and misogynistic notions. This paper gathers data and algorithms from neural network models of language having to deal with syntax, semantics, sociolinguistics, and text classification. Results are significant in showing the existing intentional and unintentional misogynistic notions used to train machines, as well as in developing better technologies that take into account the semantics and syntax of text to be more mindful and reflect gender equality. Further, this paper deals with the idea of non-binary gender pronouns and how machines can process these pronouns correctly, given its semantic and syntactic context. This paper also delves into the implications of gendered grammar and its effect, cross-linguistically, on natural language processing. Languages such as French or Spanish not only have rigid gendered grammar rules, but also historically patriarchal societies. The progression of society comes hand in hand with not only its language, but how machines process those natural languages. These ideas are all extremely vital to the development of natural language models in technology, and they must be taken into account immediately.

Keywords: gendered grammar, misogynistic language, natural language processing, neural networks

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Authors: Ágota Ladó

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Miercurea Ciuc is a town in the historical region of Szeklerland in Transylvania, Romania, with a predominantly Hungarian population (its name in Hungarian being Csíkszereda) having an urban landscape and environment that has been shaped dramatically by different perceptions of urbanization during the history. The town has been part of Hungary and the Austro-Hungarian Empire before the First World War. It even got an important role, becoming in 1876 the seat and administrative center of the historical Csík county. This marks the beginning of the first urbanization process: new administrative buildings, railways, a railway station, a hospital, a Redoute and new schools have been built, new streets have been opened. However, not only the public facilities have changed: the center of the town with its private houses has also transformed, new, modern decorative and lifestyle elements have appeared. One of the streets from the town center, Kossuth street, has been featured on many postcards of the time; even a novel has mentioned it as a symbol of modern urbanization. Right after the First World War, the town became part of Romania and aside from a short interruption (between 1940 and 1944), it is still part of it. The beginning of the second major urbanization process – exactly one hundred years later - is marked by the visit of the communist leader Nicolae Ceaușescu in Miercurea Ciuc on the 6th of October 1976. In the upcoming years, he decided and started to demolish the old Kossuth street and to construct a new avenue with tall blocks of flats according to the principles of socialist urbanization. No other Transylvanian settlement has gone through such systematic abolition of its historical center and urban history during the Communist era. Not only the urban landscape has been affected. The collective memory and contemporary identity of the locals are also violated by this recent transformation of the town: important spaces, buildings, venues of activities and events simply cannot be localized, thus understood - by the younger generations.

Keywords: communist era, historical urban landscape, urban identity, urbanization

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Authors: Farida Habib, Haya Alfozan, Eman Miligi, Najla Alotaibi

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Background: Women’s satisfaction with maternity services, especially care during labor and birth, has become highly significant to healthcare providers, administrators, and policymakers. Purpose: The aims of this study were to assess maternal satisfaction regarding the quality of care during labor and to compare the level of maternal satisfaction between women who delivered by physicians and those delivered by midwives. Methodology: A descriptive, cross-sectional, correlational design was used. A convenient sample of 180 low-risk cases of immediate postpartum women who delivered at King Abdul-Aziz medical city was recruited. Women whose babies were diagnosed with serious health problems were excluded from the study. Data were collected using a self-administered questionnaire. The validity and reliability of the questionnaire were ensured. The questionnaire included three parts, namely: demographics data, medical history, and obstetrical history, and the last part is the satisfaction assessment tool. Ethical confederations were ensured. Maternal satisfaction during labor was classified in terms of health care, health workers' communication, and the environment. Results: Regarding health care, women were highly satisfied with care received from nurse (M = 4.21 + 0.88), medical care received (M = 4.17 + 0.79), and comfort techniques (M = 4.04 + 0.91). Regarding health workers' communication, women were highly satisfied with the provider to treat with dignity and respect (M = 4.03 + 0.91) and orientation to the toilet, bathroom, washing area (M = 4.00 + 0.93). Regarding the environment, women were highly satisfied with the experience of their baby's birth (M = 4.18 + 0.98) and supplies with drugs and supplies (M = 4.09 + 0.97). There was no statistically significant difference in maternal satisfaction between women who delivered by physicians and those delivered by midwives. Conclusion: Women were generally satisfied with their labor and delivery experience. There was no difference in maternal satisfaction on the labor process between women who delivered by physicians and those delivered by midwives.

Keywords: maternity, satisfaction, labor, delivery

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Authors: Samaneh Pouyanfar, Michael Oliff

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The industry of home appliances may beone of theindustries which has the highest competition, and actually what can guarantee the survival of this industry is discovering the superior services. A trend to provide quality products and services plays an important role in this industry because discovering the services is counted as a vital affair for Manufacturing Organizations’ survival and profitability. Given the importance of the topic, this paper attempts to investigate the relative priority of the factors influencing the customer satisfaction in gaining the competitive advantage in Pars-Khazar Company. In sum, 96 executives of Pars-Khazar Company where investigated in a census. For this purpose, after reviewing the research literature and performing deep interviews between pundits and experts active in the industry, the research questionnaire was made based on variables affecting customer satisfaction and components determining business competitive advantage. Determining the content validity took place by judgement of the experts. The reliability of each structure was measured based on Cronbach’s alpha coefficient. Since the value of Cronbach's alpha was higher than 0.7 for each structure, internal consistency of statements was high and the reliability of the questionnaire was acceptable. The data analysis was also done with Kulmgrf-asmyrnf test and Friedman test using SPSS software. The results showed that in dimension of factors affecting customer satisfaction, the History of trade name (brand), Familiarity with the product brand, Brand reputation and Safety have the highest value of priority respectively, and the variable of firm growth has the highest value of priority among the components determining the performance of competitive advantage.

Keywords: customer satisfaction, competitive advantage, brand history, safety, growth

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Authors: S. H. Jang

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Posterior reversible encephalopathy syndrome (PRES) is characterized by acute neurologic symptoms (visual loss, headache, altered mentality and seizures) and by typical imaging findings (bilateral subcortical and cortical edema with predominatly posterior distribution). Nephrotic syndrome is a syndrome comprising signs of proteinuria, hypoalbuminemia, and edema. It is well known that hypertension predispose patient with nephrotic syndrome to PRES. A 45-year old male was referred for suddenly developed vertigo, disequilibrium. He had previous history of nephrotic syndrome. His medical history included diabetes controlled with medication. He was hospitalized because of generalized edema a few days ago. His vital signs were stable. On neurologic examination, his mental state was alert. Horizontal nystagmus to right side on return to primary position was observed. He showed good grade motor weakness and ataxia in right upper and lower limbs without other sensory abnormality. Brain MRI showed increased signal intensity in FLAIR image, decreased signal intensity in T1 image and focal enhanced lesion in T1 contrast image at whole midbrain, pons and cerebellar peduncle symmetrically, which was compatible with vasogenic edema. Laboratory findings showed severe proteinuria and hypoalbuminemia. He was given intravenous dexamethasone and diuretics to reduce vasogenic edema and raise the intra-vascular osmotic pressure. Nystagmus, motor weakness and limb ataxia improved gradually over 2 weeks; He recovered without any neurologic symptom and sign. Follow-up MRI showed decreased vasogenic edema fairly. We report a case of brain stem PRES in normotensive, nephrotic syndrome patient.

Keywords: posterior reversible encephalopathy syndrome, MRI, nephrotic syndrome, vasogenic brain edema

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Authors: Aaron Walayat

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Protection of the environment in international law has been one of the most developed in the context of international humanitarian law. This paper examines the history of the protection of the environment in times of armed conflict, beginning with the traditional notion of restraint observed in antiquity towards the obligation to protect the environment, examining the treaties and agreements, both binding and non-binding which have contributed to environmental protection in war. The paper begins with a discussion of the ancient concept of restraint. This section examines the social norms in favor of protection of the environment as observed in the Bible, Greco-Roman mythology, and even more contemporary literature. The study of the traditional rejection of total war establishes the social foundation on which the current legal regime has stemmed. The paper then studies the principle of restraint as codified in international humanitarian law. It mainly examines Additional Protocol I of the Geneva Convention of 1949 and existing international law concerning civilian objects and the principles of international humanitarian law in the classification between civilian objects and military objectives. The paper then explores the environment’s classification as both a military objective and as a civilian object as well as explores arguments in favor of the classification of the whole environment as a civilian object. The paper will then discuss the current legal regime surrounding the protection of the environment, discussing some declarations and conventions including the 1868 Declaration of St. Petersburg, the 1907 Hague Convention No. IV, the Geneva Conventions, and the 1976 Environmental Modification Convention. The paper concludes with the outline noting the movement from codification of the principles of restraint into the various treaties, agreements, and declarations of the current regime of international humanitarian law. This paper provides an analysis of the history and significance of the relationship between international humanitarian law as a major contributor to the growing field of international environmental law.

Keywords: armed conflict, environment, legal regime, restraint

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Authors: Akbar Jamali

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Many scholars consider Hegel’s philosophy of art as the greatest theory of aesthetics since Aristotle’s Poetics. ‘Freedom’ distinguishes modern, especially German Idealism with Greek philosophy. Therefore, introducing and contemplating on Hegel’s Aesthetics as a whole, freedom as the essence of art, Hegel’s controversial claim on the end of art, and the relation of art and state is the main theme of this study. Hegel’s aesthetics is to be understood in his whole system. According to Hegel’s speculative philosophy, being is to be understood as self-determining Reason or Idea. The self-determining Reason actualizes and realizes himself in the course of history. Idea in the process of self-actualization becomes more and more rational. It first actualizes itself in matter, then in non-conscious life, finally in conscious and self-conscious life. Self-conscious life is the most rational stage of development of Idea in which the subject can think and imagine, use language and exercise freedom. Hegel calls this self-conscious life Spirit (Geist). Therefore, emergence of human being is an essential moment in the process of self-determination of Reason. It is not accidental rather a necessity. The essence of spirit is freedom. Since the history is the process of the self-actualization if spirit, humankind becomes more and more, free. Spirit in its ‘Absolute’ form manifests itself into three forms; Art, Religion and philosophy. Art is the first stage in which Spirit understands itself. In fact, Art is the expression of human spirit, which is comprehended by our senses. Beauty is defined as the sensuous expression of free Spirit. The purpose of art is, therefore, to express, enjoy and contemplate on our freedom. State belongs to the realm of Objective spirit, while Art along with Religion and philosophy belong to the realm of Absolute Spirit. Absolute spirit is superior to Objective Spirit; therefore, state must not interfere in the realm of art. Limitation on art by state directly violates freedom and prevents development of national spirit. Genuine art leads us to freedom and richness of (national) Spirit. Using Hegel’s philosophy of art, we can comprehend why totalitarian states try to limit art and, why artists are the enemy of totalitarian states. In this philosophical system, we contemplate on art as a way to freedom and emancipation.

Keywords: aesthetics, freedom, spirit, state

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Authors: Katri K. Cornelissen, Lise Gulli Brokjob, Kristofor McCarty, Jiri Gumancik, Martin J. Tovee, Piers L. Cornelissen

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Recent research has shown that body size estimation of healthy women is driven by independent attitudinal and perceptual components. The attitudinal component represents psychological concerns about body, coupled to low self-esteem and a tendency towards depressive symptomatology, leading to over-estimation of body size, independent of the Body Mass Index (BMI) someone actually has. The perceptual component is a normal bias known as contraction bias, which, for bodies is dependent on actual BMI. Women with a BMI less than the population norm tend to overestimate their size, while women with a BMI greater than the population norm tend to underestimate their size. Women whose BMI is close to the population mean are most accurate. This is indexed by a regression of estimated BMI on actual BMI with a slope less than one. It is well established that body dissatisfaction, i.e. an attitudinal distortion, leads to body size overestimation in eating disordered individuals. However, debate persists as to whether women with eating disorders may also suffer a perceptual body distortion. Therefore, the current study was set to ask whether women with eating disorders exhibit the normal contraction bias when they estimate their own body size. If they do not, this would suggest differences in the way that women with eating disorders process the perceptual aspects of body shape and size in comparison to healthy controls. 100 healthy controls and 33 women with a history of eating disorders were recruited. Critically, it was ensured that both groups of participants represented comparable and adequate ranges of actual BMI (e.g. ~18 to ~40). Of those with eating disorders, 19 had a history of anorexia nervosa, 6 bulimia nervosa, and 8 OSFED. 87.5% of the women with a history of eating disorders self-reported that they were either recovered or recovering, and 89.7% of them self-reported that they had had one or more instances of relapse. The mean time lapsed since first diagnosis was 5 years and on average participants had experienced two relapses. Participants were asked to fill number of psychometric measures (EDE-Q, BSQ, RSE, BDI) to establish the attitudinal component of their body image as well as their tendency to internalize socio-cultural body ideals. Additionally, participants completed a method of adjustment psychophysical task, using photorealistic avatars calibrated for BMI, in order to provide an estimate of their own body size and shape. The data from the healthy controls replicate previous findings, revealing independent contributions to body size estimation from both attitudinal and perceptual (i.e. contraction bias) body image components, as described above. For the eating disorder group, once the adequacy of their actual BMI ranges was established, a regression of estimated BMI on actual BMI had a slope greater than 1, significantly different to that from controls. This suggests that (some) eating disordered individuals process the perceptual aspects of body image differently from healthy controls. It therefore is necessary to develop interventions which are specific to the perceptual processing of body shape and size for the management of (some) individuals with eating disorders.

Keywords: body image distortion, perception, recovery, relapse, BMI, eating disorders

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Authors: Olusola Abiodun Arinde

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This research work was prompted by the very important role e-commerce plays in every organization, be it private or public. The underlying objective of this study is to have a critical appraisal of the extent to which e-commerce impacts on organizational effectiveness. This research was carried out using Zenith Bank Plc as a case study. Relevant data were collected through structured questionnaire, oral interview, journals, newspapers, and textbooks. The data collected were analyzed and hypotheses were tested. Based on the result of the hypotheses, it was observed that e-commerce is significant to every organization. Through e-commerce, fast services delivery would be guaranteed to customers, this would lead to higher productivity and profit for organizations. E-commerce should be managed in such a way that it does not alienate customers; it should also prevent enormous risks that are associated with e-commerce.

Keywords: e-commerce, fast service, productivity, profit

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Authors: Jean Berger, Mohamed Barkaoui

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Discrete search path planning in time-constrained uncertain environment relying upon imperfect sensors is known to be hard, and current problem-solving techniques proposed so far to compute near real-time efficient path plans are mainly bounded to provide a few move solutions. A new information-theoretic –based open-loop decision model explicitly incorporating false alarm sensor readings, to solve a single agent military logistics search-and-delivery path planning problem with anticipated feedback is presented. The decision model consists in minimizing expected entropy considering anticipated possible observation outcomes over a given time horizon. The model captures uncertainty associated with observation events for all possible scenarios. Entropy represents a measure of uncertainty about the searched target location. Feedback information resulting from possible sensor observations outcomes along the projected path plan is exploited to update anticipated unit target occupancy beliefs. For the first time, a compact belief update formulation is generalized to explicitly include false positive observation events that may occur during plan execution. A novel genetic algorithm is then proposed to efficiently solve search path planning, providing near-optimal solutions for practical realistic problem instances. Given the run-time performance of the algorithm, natural extension to a closed-loop environment to progressively integrate real visit outcomes on a rolling time horizon can be easily envisioned. Computational results show the value of the approach in comparison to alternate heuristics.

Keywords: search path planning, false alarm, search-and-delivery, entropy, genetic algorithm

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Authors: Jose Ramon Sanabria Navarro, Yahilina Silveira Perez

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The Pan American Games are one of the best regional sports integration events for the Americas, thousands of athletes from different countries are integrated based on obtaining satisfactory sports results and bringing the glory of the national identity of the sport to their country. There are countries that despite the small number of inhabitants have obtained very satisfactory results such as Cuba. Objective: To analyze the impact of Cuba's sports results in the Pan American Games. The methodology was based on the postulates of the materialist dialectic since the investigated reality was studied from historicity, systematicity and in its systemic character. The population and sample consisted of 41 countries of the American continent, and the 15 events carried out to date were analyzed. The impact of Cuba is very relevant because it is the country that has the second place by country in terms of number of medals, is among the first in terms of medals per inhabitants and in general sense of all the indicators treated assumes the fourth place integral. What is the current status of Cuba's sports results in Pan American Games? Having as a general objective, analyze the impact of Cuba's sports results in the Pan American Games. The hypotheses that will lead this research have the following methodological and interaction order: H1: Cuba's performance in Pan American Sports Games positively impacts the amount of medals obtained. H2: The amount of medals from Cuba in Pan American Sports Games positively impacts the general podium for countries of these regional events. H3: The amount of medals obtained by Cuba in Pan American Sports Games positively impacts the number of inhabitants. H4: The amount of medals obtained by Cuba positively impacts the overall result of the countries. H5: Cuba's performance in the Panamerican Sports Games positively impacts the overall results of these regional events. In general, it is possible to demonstrate the impact of Cuba's sports performance in Pan American Games and the organizational sports structure that has allowed the country to obtain them is evidenced.

Keywords: Cuba, history of sport, sports games, regional events, sport

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Authors: Elisabeth Pedersen

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Representations and interpretations of womanhood and female sexualities bring forth various questions regarding gender norms, and the implications of these norms, which are permeating and repetitive within various societies. Literature is one form of media which provides the space to represent and interpret women, their bodies, and sexualities, and also reveals the power of language as an affective and affected force. As literature allows an opportunity to explore history and the representations of gender, power dynamics, and sexuality through historical contexts, this paper uses engaged theory through a comparative analysis of two work of literature, The Duchess of Malfi by John Wester, and The Sound and the Fury by William Faulkner. These novels span across space and time, which lends to the theory that repetitive tropes of womanhood and female sexuality in literature are influenced by and have an influence on the hegemonic social order throughout history. It analyzes how the representation of the dichotomy of male chivalry and honor, and female purity are disputed and questioned when a woman is portrayed as sexually emancipated, and explores the historical context in which these works were written to examine how socioeconomic events challenged the hegemonic social order. The analysis looks at how stereotypical ideals of womanhood and manhood have damaging implications on women, as the structure of society provides more privilege and power to men than to women, thus creating a double standard for men and women in regards to sexuality, sexual expression, and rights to sexual desire. This comparative analysis reveals how strict gender norms are permeating and have negative consequences. However, re-reading stories through a critical lens can provide an opportunity to challenge the repetitive tropes of female sexuality, and thus lead to the embrace of the complexity of female sexuality and expression.

Keywords: femininity, literature, representation, sexuality

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Authors: Renee Fabian, Jordan Davidson

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Current research on non-suicidal self-injury (NSSI) provides ample insights on best practices for caregivers and clinicians to address and reduce NSSI behavior among adolescents. However, the efficacy of evidenced-based NSSI interventions and their delivery from the perspective of adolescent patients does not receive significant attention, creating a gap between the efficacy of research-based NSSI interventions and adolescent perceptions of NSSI treatment and adolescent willingness to engage in NSSI interventions. To address the gap between practice and patient perspectives and inform more effective treatment outcomes, the current survey aims to identify major patient-reported adverse reactions to NSSI disclosures from caregivers, treating mental health clinicians, and medical professionals using a mixed methods survey of 2,500 people with a history of NSSI completed by editors at a consumer-facing health publication. Based on the analyzed results of the survey, a majority of adolescents with a history of NSSI found parents and caregivers ineffective at empathetically addressing NSSI, and a significant number of participants reported at least one treating mental health professional inadequately responded to NSSI behaviors, in addition to other findings of adverse reactions to NSSI disclosures that serve as a barrier to treatment. NSSI is a significant risk factor for future suicide attempts. Addressing patient-reported adverse reactions to NSSI disclosures in the adolescent population can remove barriers to the effectiveness of caregiver and clinician NSSI interventions and reduce the risk of NSSI-related harm and lower the risk of future suicide attempts or completions.

Keywords: adolescent self-injury, non-suicidal self-injury, patient perspectives, self-harm interventions

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