Search results for: forensic cases

Authors: Surachart Koyadun

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Introduction: Plasmodium knowlesi (P. knowlesi) malaria is a zoonotic disease that is classified as type 5 of human malaria. Commonly found in macaques (Macaca fascicularis) and (Macaca nemestrina), P. knowlesi is capable of resulting in both uncomplicated and severe malaria in humans. Situation of P. knowlesi malaria in Phang-Nga province for the past 3 years from 2020 – 2022 revealed no case report in 2020, however, a total of 14 cases had been reported in 2021 - 2022. This research aimed to 1) study the epidemiology of P. knowlesi, 2) examine the clinical manifestations of P. knowlesi patients, 3) analyze the ecology and entomology of P. knowlesi, and 4) analyze the diagnosis and treatment of P. knowlesi. Method: This research was a retrospective descriptive study/case report. The study was conducted in 14 patients with P. knowlesi malaria between 2021 and 2022 in 4 districts of Phang-Nga Province, Thailand including Thapput, Kapong, Takuapa and Khuraburi. Results: The study subjects of P. knowlesi malaria were all males. Most of them were working age groups as farmers and worked in forest or plantation areas. All had no history of blood transfusions. Most of the patients did not use mosquito nets and had a history of camping in the forest prior to the onset of fever. An analysis of all 14 sources of infection unveiled the area is home to macaques, and that area has detected Anopheles mosquito, which is the carrier of the disease. Majority of them got sick in the dry season of Thailand (December-April). The main symptoms brought to the hospital were fever, chills, headache, body aches. Laboratory findings on the first day of diagnosis were as follows: The white blood cell count was found within the normal range. In the proportion of white blood cells, eosinophils were found to be slightly higher than normal. Slight anemia was found on early examination. The platelet count was found to be below normal in all cases. Severely low platelet count (2,000 cells/mm3) was found in severe cases with multiple complications. No patient was found dead but 85.7% of complications were found, with acute renal failure being the most common. Patients with delayed diagnosis and treatment of malaria (inaccurate diagnosis or late access to the hospital) had the highest severity and complications than those who had seen the doctor since the first 3-4 days of illness or the screening of symptoms and risk history by the malaria clinic staff at vector-borne disease control unit. Conclusion and Recommendation: P. knowlesi malaria is an emerging infectious disease transmitted from animals to humans. There are challenges in epidemiology, entomology, ecology for effective surveillance, prevention and control. Early diagnosis and treatment would reduce complications and prevent death.

Keywords: malaria, plasmodium knowlesi, epidemiology, ecology, entomology, diagnosis, treatment

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Authors: Jiping Cai, Ningzhi Wangyang, Jun Shao

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Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality that leads to structural and functional damage in several parts of the brain, such as cranial nerves, optic nerve tract or other circuitry involved in vision and occipital lobe, depending on its location and severity. As a result, the function associated with vision processing and perception are significantly affected and cause blurred vision, double vision, decreased peripheral vision and blindness. Here two cases complaining of monocular vision loss (actually temporal hemianopia) due to traumatic chiasmal syndrome after frontal head injury were reported, and were compared the findings with individual case reports published in the literature. Reported cases of traumatic chiasmal syndrome appear to share some common features, such as injury to the frontal bone and fracture of the anterior skull base. The degree of bitemporal hemianopia and visual loss acuity have a variable presentation and was not necessarily related to the severity of the craniocerebral trauma. Chiasmal injury may occur even in the absence bony chip impingement. Isolated bitemporal hemianopia is rare and clinical improvement usually may not occur. Mechanisms of damage to the optic chiasm after trauma include direct tearing, contusion haemorrhage and contusion necrosis, and secondary mechanisms such as cell death, inflammation, edema, neurogenesis impairment and axonal damage associated with TBI. Beside visual field test, MRI evaluation of optic pathways seems to the strong objective evidence to demonstrate the impairment of the integrity of visual systems following TBI. Therefore, traumatic chiasmal syndrome should be considered as a differential diagnosis by both neurosurgeons and ophthalmologists in patients presenting with visual impairment, especially bitemporal hemianopia after head injury causing frontal and anterior skull base fracture.

Keywords: bitemporal hemianopia, brain injury, optic chiasma, traumatic chiasmal syndrome.

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Authors: Nazira B. Bekenova, Lydia A. Mukovozova, Andrej M. Grjibovski, Alma Z. Tokayeva, Yerbol M. Smail, Nurlan E. Aukenov

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Erysipelas is an infectious disease with socio-economic significance and prone to prolonged recurrent course (30%). Contribution of genetic factors, in particular the gene polymorphism of cytokines, can be essential in disease etiology and pathogenesis. Interleukin – 17 A are produced by T helpers of 17 type and plays a key role in development of local inflammation process. Local inflammatory process is a dominant in the clinic of erysipelas. Established that the skin and mucosas are primary areas of migration (homing) Th17-cell and their cytokines are stimulate the barrier function of the epithelium. We studied associations between gene polymorphism of IL-17A (C737T) rs 8193036 and IL-17A level in patients with erysipelas Kazakh population. Altogether, 90 cases with erysipelas and 90 healthy controls from an ethnic Kazakh population comprised the sample. Cases were identified at Clinical Infectious Diseases Hospital of Semey (Kazakhstan). The IL-17A (rs8193036) polymorphism was analyzed by a real time polymerase chain reaction. Plasma levels of IL-17 A were assessed by immuneenzyme analysis method using ‘Vector-Best’ test-system (Russia). Differences in levels of IL-17 A between CC, TT, CT groups were studied using Kruskal — Wallis test. Pairwise comparisons were performed using Mann-Whitney tests with Bonferroni correction (New significance level was set to 0.025). We found, that in patients with erysipelas with CC genotype the level of IL-17 A was higher (p= 0, 010) compared to the carriers of CT genotype. When compared the level of IL – 17 A between the patients with TT genotype and patients with CC genotype, also between the patients with CT genotype and patients with TT genotype statistically significant differences are not revealed (p = 0.374 and p = 0.043, respectively). Comparisons of IL-17 A plasma levels between the CC and CT genotypes, between the CC and TT genotypes, and between the TT and CT in healthy patients did not reveal significant differences (p = 0, 291). Therefore, we are determined the associations of gene polymorphism of IL-17 A (C737T) with its level in patients erysipelas carriers CC genotype.

Keywords: erysipelas, interleukin – 17 A, Kazakh, polymorphism

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Authors: Rahul Ranjan

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Using gender as a category to cull out historical analysis, feminist scholars have produced plethora of literature on the sexual symbolics and carnal practices of modern European empires. At a symbolic level, the penetration and conquest of faraway lands was charged with sexual significance and intrigue. The white male’s domination and possession of dark and fertile lands in Africa, Asia and the Americas offered, in Anne McClintock’s words, ‘a fantastic magic lantern of the mind onto which Europe projected its forbidden sexual desires and fears’. The politics of rape were also symbolically a question significant to the politics of empire. To the colonized subject, rape was a fearsome factor, a language that spoke of violent and voracious nature of imperial exploitation. The colonized often looked at rape as an act which colonizers used as tool of oppression. The rape as act of violence got encoded into the legal structure under the helm of Lord Macaulay in the so called ‘Age of Reform’ in 1860 under IPC (Indian penal code). Initially Lord Macaulay formed Indian Law Commission in 1837 in which he drafted a bill and defined the ‘crime of rape as sexual intercourse by a man to a woman against her will and without her consent , except in cases involving girls under nine years of age where consent was immaterial’. The modern English law of rape formulated under the colonial era introduced twofold issues to the forefront. On the one hand it deployed ‘technical experts’ who wrote textbooks of medical jurisprudence that were used as credential citation to make case more ‘objective’, while on the other hand the presumptions about barbaric subjects, the colonized women’s body that was docile which is prone to adultery reflected in cases. The untrustworthiness of native witness also remained an imperative for British jurists to put extra emphasis making ‘objective’ and ‘presumptuous’. This sort of formulation put women down on the pedestrian of justice because it disadvantaged her doubly through British legality and their thinking about the rape. The Imperial morality that acted as vanguards of women’s chastity coincided language of science propagated in the post-enlightenment which not only annulled non-conformist ideas but also made itself a hegemonic language, was often used as a tool and language in encoding of law. The medico-legal understanding of rape in the colonial India has its clear imprints in the post-colonial legality. The onus on the part of rape’s victim was dictated for the longest time and still continues does by widely referred idea that ‘there should signs, marks of resistance on the body of the victim’ otherwise it is likely to be considered consensual. Having said so, this paper looks at the textual continuity that had prolonged the colonial construct of women’s body and the self.

Keywords: body, politics, textual construct, phallocentric

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Authors: R. K. Dubey

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Bianchi type cosmological models have been studied on the basis of Lyra’s geometry. Exact solution has been obtained by considering a time dependent displacement field for constant deceleration parameter and varying cosmological term of the universe. The physical behavior of the different models has been examined for different cases.

Keywords: Bianchi type-I cosmological model, variable gravitational coupling, cosmological constant term, Lyra's model

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Authors: Innocensia John, Henrik Egelyng, Razack Lokina

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As the world`s population is constantly growing, food security has become a thorny trending issue. The impact has particularly been felt more in Africa as most of the people depend on food Agriculture products. Geographical Indications can aid in transforming the Tanzania agriculture-dependent economy through tapping the unique attributes of their quality products like soil, taste color etc. Consumers worldwide demand more uniquer products featuring a ´connect´ with the land use systems producing particular qualities. Tanzania has demonstrated the capacity to tap into the organic world market and has untapped potential for harvesting market value from geographical indications. This paper presents preliminary results from VALOR — a research project investigating conditions under which Tanzanian origin food producers can add value by incorporating territory specific cultural, environmental and social qualities into marketing, production and processing of unique local, niche and specialty products. Cases are investigated of the prospects for Tanzania to leapfrog perhaps into exports of geographical indications products, and certainly into allowing smallholders to create employment and build monetary value, while stewarding local food cultures and natural environments and resources, and increasing the diversity of supply of natural and unique quality products and so contribute to enhanced food security. Rice from Kyela, coffee and Sugar from Kilimanjaro, are some of the product cases investigated and provides for the in-depth case study, as ´landscape´ products incorporating ´taste of place´. Framework conditions for producers creating or capturing market value as stewards of cultural and landscape values and environments and institutional requirements for such creation or capturing to happen, including presence of export opportunities, are discussed.

Keywords: food origins, food security, protected geographical indications, case study analysis

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Authors: A. Askerov, Y. Teterin, P. Yartcev, S. Novikov

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Introduction: Acute pancreatitis (AP) is a socially significant problem for public health and continues to be one of the most common causes of hospitalization of patients with pathology of the gastrointestinal tract. It is characterized by high mortality rates, which reaches 62-65% in infected pancreatic necrosis. Aims & Methods: The study group included 63 patients who underwent transluminal drainage (TLD) fluid collection (FC). All patients were performed transabdominal ultrasound, computer tomography of the abdominal cavity and retroperitoneal organs and endoscopic ultrasound (EUS) of the pancreatobiliary zone. The EUS was used as a final diagnostic method to determine the characteristics of FC. The indications for TLD were: the distance between the wall of the hollow organ and the FC was not more than 1 cm, the absence of large vessels on the puncture trajectory (more than 3 mm), and the size of the formation was more than 5 cm. When a homogeneous cavity with clear, even contours was detected, a plastic stent with rounded ends (“double pig tail”) was installed. The indication for the installation of a fully covered self-expanding stent was the detection of nonhomogeneous anechoic FC with hyperechoic inclusions and cloudy purulent contents. In patients with necrotic forms after drainage of the purulent cavity, a cystonasal drainage with a diameter of 7Fr was installed in its lumen under X-ray control to sanitize the cavity with a 0.05% aqueous solution of chlorhexidine. Endoscopic necrectomy was performed every 24-48 hours. The plastic stent was removed in 6 month, the fully covered self-expanding stent - in 1 month after the patient was discharged from the hospital. Results: Endoscopic TLD was performed in 63 patients. The FC corresponding to interstitial edematous pancreatitis was detected in 39 (62%) patients who underwent TLD with the installation of a plastic stent with rounded ends. In 24 (38%) patients with necrotic forms of FC, a fully covered self-expanding stent was placed. Communication with the ductal system of the pancreas was found in 5 (7.9%) patients. They underwent pancreaticoduodenal stenting. A complicated postoperative period was noted in 4 (6.3%) cases and was manifested by bleeding from the zone of pancreatogenic destruction. In 2 (3.1%) cases, this required angiography and endovascular embolization a. gastroduodenalis, in 1 (1.6%) case, endoscopic hemostasis was performed by filling the cavity with 4 ml of Hemoblock hemostatic solution. The combination of both methods was used in 1 (1.6%) patient. There was no evidence of recurrent bleeding in these patients. Lethal outcome occurred in 4 patients (6.3%). In 3 (4.7%) patients, the cause of death was multiple organ failure, in 1 (1.6%) - severe nosocomial pneumonia that developed on the 32nd day after drainage. Conclusions: 1. EUS is not only the most important method for diagnosing FC in AP, but also allows you to determine further tactics for their intraluminal drainage.2. Endoscopic intraluminal drainage of fluid zones in 45.8% of cases is the final minimally invasive method of surgical treatment of large-focal pancreatic necrosis. Disclosure: Nothing to disclose.

Keywords: acute pancreatitis, fluid collection, endoscopy surgery, necrectomy, transluminal drainage

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Authors: Jack Nash, Chris Simpson, Holly Hurn, Ronel Terblanche, Alan Mistlin

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There is an increasing incidence of mild traumatic brain injury (mTBI) cases throughout sport and with this, a growing interest from governing bodies to ensure these are managed appropriately and player welfare is prioritised. The Berlin consensus statement on concussion in sport recommends a multidisciplinary approach when managing those patients who do not have full resolution of mTBI symptoms. There are as of yet no standardised guideline to follow in the treatment of complex cases mTBI in athletes. The aim of this project was to analyse the outcomes, both clinical and vocational, of all patients admitted to the mild Traumatic Brain Injury (mTBI) service at the UK’s Defence Military Rehabilitation Centre Headley Court between 1st June 2008 and 1st February 2017, as a result of a sport induced injury, and evaluate potential predictive indicators of outcome. Patients were identified from a database maintained by the mTBI service. Clinical and occupational outcomes were ascertained from medical and occupational employment records, recorded prospectively, at time of discharge from the mTBI service. Outcomes were graded based on the vocational independence scale (VIS) and clinical documentation at discharge. Predictive indicators including referral time, age at time of injury, previous mental health diagnosis and a financial claim in place at time of entry to service were assessed using logistic regression. 45 Patients were treated for sport-related mTBI during this time frame. Clinically 96% of patients had full resolution of their mTBI symptoms after input from the mTBI service. 51% of patients returned to work at their previous vocational level, 4% had ongoing mTBI symptoms, 22% had ongoing physical rehabilitation needs, 11% required mental health input and 11% required further vestibular rehabilitation. Neither age, time to referral, pre-existing mental health condition nor compensation seeking had a significant impact on either vocational or clinical outcome in this population. The vast majority of patients reviewed in the mTBI clinic had persistent symptoms which could not be managed in primary care. A consultant-led, multidisciplinary approach to the diagnosis and management of mTBI has resulted in excellent clinical outcomes in these complex cases. High levels of symptom resolution suggest that this referral and treatment pathway is successful and is a model which could be replicated in other organisations with consultant led input. Further understanding of both predictive and individual factors would allow clinicians to focus treatments on those who are most likely to develop long-term complications following mTBI. A consultant-led, multidisciplinary service ensures a large number of patients will have complete resolution of mTBI symptoms after sport-related mTBI. Further research is now required to ascertain the key predictive indicators of outcome following sport-related mTBI.

Keywords: brain injury, concussion, neurology, rehabilitation, sports injury

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Authors: Katarzyna Lubecka, Kirsty Flower, Megan Beetch, Lucinda Kurzava, Hannah Buvala, Samer Gawrieh, Suthat Liangpunsakul, Tracy Gonzalez, George McCabe, Naga Chalasani, James M. Flanagan, Barbara Stefanska

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Hepatocellular carcinoma (HCC), the most prevalent type of primary liver cancer, is the second leading cause of cancer death worldwide. Late onset of clinical symptoms in HCC results in late diagnosis and poor disease outcome. Approximately 85% of individuals with HCC have underlying liver cirrhosis. However, not all cirrhotic patients develop cancer. Reliable early detection biomarkers that can distinguish cirrhotic patients who will develop cancer from those who will not are urgently needed and could increase the cure rate from 5% to 80%. We used Illumina-450K microarray to test whether blood DNA, an easily accessible source of DNA, bear site-specific changes in DNA methylation in response to HCC before diagnosis with conventional tools (pre-diagnostic). Top 11 differentially methylated sites were selected for validation by pyrosequencing. The diagnostic potential of the 11 pyrosequenced probes was tested in blood samples from a prospective cohort of cirrhotic patients. We identified 971 differentially methylated CpG sites in pre-diagnostic HCC cases as compared with healthy controls (P < 0.05, paired Wilcoxon test, ICC ≥ 0.5). Nearly 76% of differentially methylated CpG sites showed lower levels of methylation in cases vs. controls (P = 2.973E-11, Wilcoxon test). Classification of the CpG sites according to their location relative to CpG islands and transcription start site revealed that those hypomethylated loci are located in regulatory regions important for gene transcription such as CpG island shores, promoters, and 5’UTR at higher frequency than hypermethylated sites. Among 735 CpG sites hypomethylated in cases vs. controls, 482 sites were assigned to gene coding regions whereas 236 hypermethylated sites corresponded to 160 genes. Bioinformatics analysis using GO, KEGG and DAVID knowledgebase indicate that differentially methylated CpG sites are located in genes associated with functions that are essential for gene transcription, cell adhesion, cell migration, and regulation of signal transduction pathways. Taking into account the magnitude of the difference, statistical significance, location, and consistency across the majority of matched pairs case-control, we selected 11 CpG loci corresponding to 10 genes for further validation by pyrosequencing. We established that methylation of CpG sites within 5 out of those 10 genes distinguish cirrhotic patients who subsequently developed HCC from those who stayed cancer free (cirrhotic controls), demonstrating potential as biomarkers of early detection in populations at risk. The best predictive value was detected for CpGs located within BARD1 (AUC=0.70, asymptotic significance ˂0.01). Using an additive logistic regression model, we further showed that 9 CpG loci within those 5 genes, that were covered in pyrosequenced probes, constitute a panel with high diagnostic accuracy (AUC=0.887; 95% CI:0.80-0.98). The panel was able to distinguish pre-diagnostic cases from cirrhotic controls free of cancer with 88% sensitivity at 70% specificity. Using blood as a minimally invasive material and pyrosequencing as a straightforward quantitative method, the established biomarker panel has high potential to be developed into a routine clinical test after validation in larger cohorts. This study was supported by Showalter Trust, American Cancer Society (IRG#14-190-56), and Purdue Center for Cancer Research (P30 CA023168) granted to BS.

Keywords: biomarker, DNA methylation, early detection, hepatocellular carcinoma

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Authors: Shivam Dwivedi, Saumya Kapoor

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The Israeli Supreme Court in Public Committee against Torture in Israel v. Government of Israel observed the presence of non-state actors in cross-border terrorist activities thereby making the role of non-state actors in terrorism the center of discussion under the scope of International Humanitarian Law. Non-state actors and their role in a conflict have also been traversed upon by the Tadic case decided by the International Criminal Tribunal for the former Yugoslavia. However, there still are lacunae in International Humanitarian Law when it comes to determining the nature of a conflict, especially when non-state groups act within the ambit of various states, for example, Taliban in Afghanistan or the groups operating in Ukraine and Georgia. Thus, the objective of writing this paper would be to observe the ways by which non-state actors particularly terrorist organizations could be brought under the ambit of Additional Protocol I. Additional Protocol I is a 1977 amendment protocol to the Geneva Conventions relating to the protection of victims of international conflicts which basically outlaws indiscriminate attacks on civilian populations, forbids conscription of children and preserves various other human rights during the war. In general, the Additional Protocol I reaffirms the provisions of the original four Geneva Conventions. Since provisions of Additional Protocol I apply only to cases pertaining to International Armed Conflicts, the answer to the problem should lie in including the scope for ‘transnational armed conflict’ in the already existing definition of ‘International Armed Conflict’ within Common Article 2 of the Geneva Conventions. This would broaden the applicability of the provisions in cases of non-state groups and render an international character to the conflict. Also, the non-state groups operating or appearing to operate should be determined by the test laid down in the Nicaragua case by the International Court of Justice and not under the Tadic case decided by the International Criminal Tribunal for Former Yugoslavia in order to provide a comprehensive system to deal with such groups. The result of the above proposal, therefore, would enhance the scope of the application of International Humanitarian Law to non-state groups and individuals.

Keywords: Geneva Conventions, International Armed Conflict, International Humanitarian Law, non-state actors

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Authors: Muner M. B. Mohamed, Vipin Varghese, Dustin Chalmers, Khalid M. G. Mohammed, Juan Carlos Q. Velez

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Background: Urinary waxy casts (uWxC) are traditionally described in textbooks as indicative of chronic renal parenchymal disease. However, data supporting this contention is lacking. uWxC can be seen in the context of various renal syndromes, including acute kidney injury, chronic kidney disease, rapidly progressive glomerulonephritis (GN), and nephrotic syndrome. Thus, we investigated the correlation between the identification of uWxC and renal pathological findings. Methods: We prospectively collected data of patients seen in nephrology consultation with a urine specimen subjected to the microscopic examination of the urinary sediment (MicrExUrSed) over a 3-year period. Within this cohort, we identified cases in which a kidney biopsy was concomitantly performed. We assessed the association of uWxC with glomerular or tubular pathology and with chronicity [interstitial fibrosis and tubular atrophy (IFTA) and glomerular obsolescence (GO)]. Results: Among 683 patients with MicrExUrSed,103 (15%) underwent kidney biopsy and were included. The mean age was 55 years, 51% women, 50% white, and 38% self-identified black. Median serum creatinine was 3.2 (0-7-15.6) mg/dL and not significantly different between those with and without uWxC (4.7 vs 3.8 mg/dL, p=0.13). uWxC was identified in 35 (34%) cases. A glomerulopathy was diagnosed in 79 (77%). Among those with uWxC (n=35), a glomerulopathy was more likely to be found with concomitant acute tubular injury (ATI) than without ATI (57% vs. 23%, p=0.0006), whereas among those without uWxC, glomerulopathies were found with or without concomitant ATI with similar frequency (41% vs. 34%, p=0.48). Overall (n=103), more patients with uWxC had ≥ 20% IFTA compared to those without uWxC (74% vs 51%, p=0.03). Among those with glomerulopathy (n=79), more patients with uWxC had ≥ 20% IFTA compared to those without uWxC (89% vs. 56%, p=0.004). uWxC did not correlate with GO. Conclusion: Identification of uWxC denotes a greater likelihood of finding evidence of ATI superimposed with a glomerulopathy rather than finding an isolated glomerular lesion. uWxC is associated with a greater probability of finding ≥ 20% IFTA in a kidney biopsy specimen, particularly in those with a glomerular pathology. This observation may help clinicians weigh on the suitability of a kidney biopsy when chronicity or coexistence of ATI is in question.

Keywords: waxy cast, kidney biopsy, acute tubular injury, glomerulopathy

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Authors: Smruti Mahapatra, Dipankar Biswas, Richard Um, Michael Meggyesy, Riccardo Serra, Noah Gorelick, Steven Marra, Amir Manbachi, Mark G. Luciano

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Intracranial pressure (ICP) is profoundly regulated by the effects of cardiac pulsation and the volume of the incoming blood. Furthermore, these effects on ICP are incremented by the presence of a rigid skull that does not allow for changes in total volume during the cardiac cycle. These factors play a pivotal role in cerebrospinal fluid (CSF) dynamics and distribution, with consequences that are not well understood to this date and that may have a deep effect on the Central Nervous System (CNS) functioning. We designed this study with two specific aims: (a) To study how pulsatility influences local CSF flow, and (b) To study how modulating intracranial pressure affects drug distribution throughout the SAS globally. In order to achieve these aims, we built an elaborate in-vitro model of the SAS closely mimicking the dimensions and flow rates of physiological systems. To modulate intracranial pressure, we used an intracranially implanted, cardiac-gated, volume-oscillating balloon (CADENCE device). Commercially available dye was used to visualize changes in CSF flow. We first implemented two control cases, seeing how the tracer behaves in the presence of pulsations from the brain phantom and the balloon individually. After establishing the controls, we tested 2 cases, having the brain and the balloon pulsate together in sync and out of sync. We then analyzed the distribution area using image processing software. The in-sync case produced a significant increase, 5x times, in the tracer distribution area relative to the out-of-sync case. Assuming that the tracer fluid would mimic blood flow movement, a drug introduced in the SAS with such a system in place would enhance drug distribution and increase the bioavailability of therapeutic drugs to a wider spectrum of brain tissue.

Keywords: blood-brain barrier, cardiac-gated, cerebrospinal fluid, drug delivery, neurosurgery

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Authors: Mohammad Karam, Abdulmalik Alsaif, Abdulrahman Al-Naseem, Amrit Hayre, Abdurrahman Al Jabbouri, Ahmad Aldubaikhi, Narvair Kahlar, Salem Al-Mutairi

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Purpose: To compare the outcomes of mycophenolate mofetil (MMF) versus methotrexate (MTX) in non-infectious ocular inflammatory disease (NIOID). Methods: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and an electronic search was conducted to identify all comparative studies of MMF versus MTX in NIOID. Treatment results and side effects were primary outcome measures. Secondary outcome measures included visual acuity and resolution of macular oedema. Fixed and random-effects models were used for the analysis. Results: Four studies enrolling 905 patients were identified. There was no significant difference between MMF and MTX groups in overall treatment success (Odds Ratio [OR] = 0.97, P = 0.96) and failure (OR = 0.86, P = 0.85) of NIOID. Although treatment success of uveitis showed no significant difference for anterior and intermediate uveitis cases (OR = 2.33, P = 0.14), MTX showed a significantly improved effect in cases involving posterior uveitis and panuveitis (OR = 0.41, P = 0.003). However, the median dose required for treatment success was lower for MTX whereas MMF was associated with a faster median time to treatment success. Further to this, MMF showed a reduced rate of side effects when compared to MTX, but MTX failed to reach statistical significance, most notably for liver enzyme elevation (OR = 0.65, P = 0.16), fatigue (OR = 0.84, P = 0.49) and headache (OR = 0.81, P = 0.37). For secondary outcomes, no significant difference was noted in visual acuity and resolution of macular edema. Conclusions: MMF is comparable to MTX in the treatment of NIOID as there was no significant difference in the outcome of treatment success and side effect profiles.

Keywords: Mycophenolate mofetil, methotrexate, non-infectious ocular inflammation, uveitis, scleritis

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Authors: Naglaa A. Abd Elkader, Haithem A. Farghali

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The present study carried out on fifteen clinical cases of different species of dogs which admitted to surgical clinic of veterinary medicine with different symptoms (Acute vomiting, hematemesis and anorexia). There was diagnostic march which including plain radiograph and endoscopic examination. Treatment was including surgical interference and endoscopic retrieval followed by medicinal treatment. This study was aimed the detection of different foreign bodies by the most suitable method according to the type of the foreign bodies.

Keywords: stomach, endoscopy, foreign bodies, dogs

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Authors: Kejal Khatri, Vishnu Narayan Mishra

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We compute the degree of approximation of functions\tilde{f}\in H_w, a new Banach space using (T.E^1) summability means of conjugate Fourier series. In this paper, we extend the results of Singh and Mahajan which in turn generalizes the result of Lal and Yadav. Some corollaries have also been deduced from our main theorem and particular cases.

Keywords: conjugate Fourier series, degree of approximation, Hölder metric, matrix summability, product summability

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Authors: Giulia Bonaldo, Alberto Vaccheri, Ottavio D'Annibali, Domenico Motola

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The Human Papilloma Virus (HPV) was shown to be the cause of different types of carcinomas, first of all of the cervical intraepithelial neoplasia. Since the early 80s to today, thanks first to the preventive screening campaigns (pap-test) and following to the introduction of HPV vaccines on the market; the number of new cases of cervical cancer has decreased significantly. The HPV vaccines currently approved are three: Cervarix® (HPV2 - virus type: 16 and 18), Gardasil® (HPV4 - 6, 11, 16, 18) and Gardasil 9® (HPV9 - 6, 11, 16, 18, 31, 33, 45, 52, 58), which all protect against the two high-risk HPVs (6, 11) that are mainly involved in cervical cancers. Despite the remarkable effectiveness of these vaccines has been demonstrated, in the recent years, there have been many complaints about their risk-benefit profile due to Adverse Events Following Immunization (AEFI). The purpose of this study is to provide a support about the ongoing discussion on the safety profile of HPV vaccines based on real life data deriving from spontaneous reports of suspected AEFIs collected in the Vaccine Adverse Events Reporting System (VAERS). VAERS is a freely-available national vaccine safety surveillance database of AEFI, co-administered by the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA). We collected all the reports between January 2007 to December 2017 related to the HPV vaccines with a brand name (HPV2, HPV4, HPV9) or without (HPVX). A disproportionality analysis using Reporting Odds Ratio (ROR) with 95% confidence interval and p value ≤ 0.05 was performed. Over the 10-year period, 54889 reports of AEFI related to HPV vaccines reported in VAERS, corresponding to 224863 vaccine-event pairs, were retrieved. The highest number of reports was related to Gardasil (n = 42244), followed by Gardasil 9 (7212) and Cervarix (3904). The brand name of the HPV vaccine was not reported in 1529 cases. The two events more frequently reported and statistically significant for each vaccine were: dizziness (n = 5053) ROR = 1.28 (CI95% 1.24 – 1.31) and syncope (4808) ROR = 1.21 (1.17 – 1.25) for Gardasil. For Gardasil 9, injection site pain (305) ROR = 1.40 (1.25 – 1.57) and injection site erythema (297) ROR = 1.88 (1.67 – 2.10) and for Cervarix, headache (672) ROR = 1.14 (1.06 – 1.23) and loss of consciousness (528) ROR = 1.71 (1.57 – 1.87). In total, we collected 406 reports of death and 2461 cases of permanent disability in the ten-year period. The events consisting of incorrect vaccine storage or incorrect administration were not considered. The AEFI analysis showed that the most frequently reported events are non-serious and listed in the corresponding SmPCs. In addition to these, potential safety signals arose regarding less frequent and severe AEFIs that would deserve further investigation. This already happened with the referral of the European Medicines Agency (EMA) for the adverse events POTS (Postural Orthostatic Tachycardia Syndrome) and CRPS (Complex Regional Pain Syndrome) associated with anti-papillomavirus vaccines.

Keywords: adverse drug reactions, pharmacovigilance, safety, vaccines

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Authors: Danica Maljkovic, Igor Balen, Bojana Dalbelo Basic

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Following the regulation of EU Directive on Energy Efficiency, specifically Article 9, individual metering in district heating systems has to be introduced by the end of 2016. These directions have been implemented in member state’s legal framework, Croatia is one of these states. The directive allows installation of both heat metering devices and heat cost allocators. Mainly due to bad communication and PR, the general public false image was created that the heat cost allocators are devices that save energy. Although this notion is wrong, the aim of this work is to develop a model that would precisely express the influence of installation heat cost allocators on potential energy savings in each unit within multifamily buildings. At the same time, in recent years, a science of machine learning has gain larger application in various fields, as it is proven to give good results in cases where large amounts of data are to be processed with an aim to recognize a pattern and correlation of each of the relevant parameter as well as in the cases where the problem is too complex for a human intelligence to solve. A special method of machine learning, decision tree method, has proven an accuracy of over 92% in prediction general building consumption. In this paper, a machine learning algorithms will be used to isolate the sole impact of installation of heat cost allocators on a single building in multifamily houses connected to district heating systems. Special emphasises will be given regression analysis, logistic regression, support vector machines, decision trees and random forest method.

Keywords: district heating, heat cost allocator, energy efficiency, machine learning, decision tree model, regression analysis, logistic regression, support vector machines, decision trees and random forest method

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Authors: Siddharatha Sharma

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With the advent of technology and machines, the role of biometrics in society is taking an important place for secured living. Security issues are the major concern in today’s world and continue to grow in intensity and complexity. Biometrics based recognition, which involves precise measurement of the characteristics of living beings, is not a new method. Fingerprints are being used for several years by law enforcement and forensic agencies to identify the culprits and apprehend them. Biometrics is based on four basic principles i.e. (i) uniqueness, (ii) accuracy, (iii) permanency and (iv) peculiarity. In today’s world fingerprints are the most popular and unique biometrics method claiming a social benefit in the government sponsored programs. A remarkable example of the same is UIDAI (Unique Identification Authority of India) in India. In case of fingerprint biometrics the matching accuracy is very high. It has been observed empirically that even the identical twins also do not have similar prints. With the passage of time there has been an immense progress in the techniques of sensing computational speed, operating environment and the storage capabilities and it has become more user convenient. Only a small fraction of the population may be unsuitable for automatic identification because of genetic factors, aging, environmental or occupational reasons for example workers who have cuts and bruises on their hands which keep fingerprints changing. Fingerprints are limited to human beings only because of the presence of volar skin with corrugated ridges which are unique to this species. Fingerprint biometrics has proved to be a high level authentication system for identification of the human beings. Though it has limitations, for example it may be inefficient and ineffective if ridges of finger(s) or palm are moist authentication becomes difficult. This paper would focus on uniqueness of fingerprints to the human beings in comparison to other living beings and review the advancement in emerging technologies and their limitations.

Keywords: fingerprinting, biometrics, human beings, authentication

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Authors: Andrew Cummings, Rhianne Boag, Sarah Bryson, Gordon Turner

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Packages designed for transport of radioactive material must satisfy rigorous safety regulations specified by the International Atomic Energy Agency (IAEA). Higher Activity Waste (HAW) transport packages have to maintain containment of their contents during normal and accident conditions of transport (NCT and ACT). To ensure containment criteria is satisfied these packages are required to be leak-tight in all transport conditions to meet allowable activity release rates. Package design safety reports are the safety cases that provide the claims, evidence and arguments to demonstrate that packages meet the regulations and once approved by the competent authority (in the UK this is the Office for Nuclear Regulation) a licence to transport radioactive material is issued for the package(s). The standard approach to demonstrating containment in the RWM transport safety case is set out in BS EN ISO 12807. In this document a method for measuring a leak rate from the package is explained by way of a small interspace test volume situated between two O-ring seals on the underside of the package lid. The interspace volume is pressurised and a pressure drop measured. A small interspace test volume makes the method more sensitive enabling the measurement of smaller leak rates. By ascertaining the activity of the contents, identifying a releasable fraction of material and by treating that fraction of material as a gas, allowable leak rates for NCT and ACT are calculated. The adherence to basic safety principles in ISO12807 is very pessimistic and current practice in the demonstration of transport safety, which is accepted by the UK regulator. It is UK government policy that management of HAW will be through geological disposal. It is proposed that the intermediate level waste be transported to the geological disposal facility (GDF) in large cuboid packages. This poses a challenge for containment demonstration because such packages will have long seals and therefore large interspace test volumes. There is also uncertainty on the releasable fraction of material within the package ullage space. This is because the waste may be in many different forms which makes it difficult to define the fraction of material released by the waste package. Additionally because of the large interspace test volume, measuring the calculated leak rates may not be achievable. For this reason a justification for a lower releasable fraction of material is sought. This paper considers the use of aerosol processes to reduce the releasable fraction for both NCT and ACT. It reviews the basic coagulation and removal processes and applies the dynamic aerosol balance equation. The proposed solution includes only the most well understood physical processes namely; Brownian coagulation and gravitational settling. Other processes have been eliminated either on the basis that they would serve to reduce the release to the environment further (pessimistically in keeping with the essence of nuclear transport safety cases) or that they are not credible in the conditions of transport considered.

Keywords: aerosol processes, Brownian coagulation, gravitational settling, transport regulations

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Authors: Aminu Ololade Matilda

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Child abuse is a significant issue worldwide, affecting the socio-development and mental and physical health of young individuals. It is the maltreatment of a child by an adult or a child. This paper focuses on child abuse in Communities in Lagos State. The aim of this study is to investigate the extent of child abuse and its impact on the mood, social activities, self-worth, concentration, and academic performance of children in Communities in Lagos State. The primary research instrument used in this study was the interview (Forensic), which consisted of two sections. The first section gathered data on the details of the child and the forms and impacts of abuse experienced, while the second section focused on parental style. The study found that children who experienced various forms of abuse, such as emotional, neglect, physical, or sexual abuse, were hesitant to report it out of fear of threats or even death from the abuser. These abused children displayed withdrawn behaviour, depression, and low self-worth and underperformed academically compared to their peers who did not experience abuse. The findings align with socio-learning and intergenerational transmission of violence theories, which suggest that parents and caregivers who engage in child abuse often do so because they themselves experienced or witnessed abuse as children, thereby normalizing violence. The study highlights the prevalent issue of child abuse in Lagos State and emphasizes the need for advocacy programs and capacity building to raise awareness about child abuse and prevention. The distribution of the Child’s Rights Act in various sectors is also recommended to underscore the importance of protecting the rights of children. Additionally, the inclusion of courses on child abuse in the school curriculum is proposed to ensure children are educated on recognizing and reporting abuse.

Keywords: abuse, child, awareness, effects, emotional, neglect, physical, psychological, sexual, recognize, reporting, right

Procedia PDF Downloads 79

Authors: L. Mtibaa, N. Baccouchi, S. Hannechi, R. Abid, R. Battikh, B. Jemli

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Cryptococcosis is an opportunistic fungal infection which is commonly associated with an immune-compomised state, especially HIV infection. Rare cases of cryptococcosis have been reported in patients with multiple myeloma (MM), and they are all at a late stage of the disease. However, the inaugural character of cryptococcosis revealing the MM at an early stage has never been reported to our best knowledge. We presented here a case of neuromeningeal cryptococcosis in a patient without any apparent underlying conditions, who has revealed IgA-λ MM. Early detection and treatment of cryptococcosis are essential to reduce morbidity and for a better outcome.

Keywords: Cryptococcosis, Cryptococcus, hematologic, malignancy

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Authors: Malika El Kyal, Ahmed Machmoum

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We prove the superlinear convergence of asynchronous multi-splitting methods applied to differential equations. This study is based on the technique of nested sets. It permits to specify kind of the convergence in the asynchronous mode.The main characteristic of an asynchronous mode is that the local algorithm not have to wait at predetermined messages to become available. We allow some processors to communicate more frequently than others, and we allow the communication delays to be substantial and unpredictable. Note that synchronous algorithms in the computer science sense are particular cases of our formulation of asynchronous one.

Keywords: parallel methods, asynchronous mode, multisplitting, ODE

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Authors: Elizaveta Startseva, Elena Notina, Irina Bykova, Valentina Ulyumdzhieva, Natallia Zhabo

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With the various existing models of intercultural communication that contain a vast number of stages for foreign language acquisition, there is a need for conscious perception of the foreign culture. Such a process is associated with the emergence of linguistic conflict with the consistent students’ desire to solve the problem of the language differences, along with cultural discrepancies. The aim of this study is to present the modern ways and methods of removing psycholinguistic conflict through skills development in professional translation and intercultural communication. The study was conducted in groups of 1-4-year students of Medical Institute and Agro-Technological Institute RUDN university. In the course of training, students got knowledge in such disciplines as basic grammar and vocabulary of the English language, phonetics, lexicology, introduction to linguistics, theory of translation, annotating and referencing media texts and texts in specialty. The students learned to present their research work, participated in the University and exit conferences with their reports and presentations. Common strategies of removing linguistic and cultural conflict can be attributed to the development of such abilities of a language personality as a commitment to communication and cooperation, the formation of cultural awareness and empathy of other cultures of the individual, realistic self-esteem, emotional stability, tolerance, etc. The process of mastering a foreign language and culture of the target language leads to a reduplication of linguistic identity, which leads to successive formation of the so-called 'secondary linguistic personality.' In our study, we tried to approach the problem comprehensively, focusing on the translation gaps for technical and non-technical language still missing such a typology which could classify all of the lacunas on the same principle. When obtaining the background knowledge, students learn to overcome the difficulties posed by the national-specific and linguistic differences of cultures in contact, i.e., to eliminate the gaps (to fill in and compensate). Compensation gaps is a means of fixing it, the initial phase of elimination, followed in some cases and some not is filling semantic voids (plenus). The concept of plenus occurs in most cases of translation gaps, for example in the transcription and transliteration of (intercultural and exoticism), the replication (reproduction of the morphemic structure of words or idioms. In all the above cases the task of the translator is to ensure an identical response of the receptors of the original and translated texts, since any statement is created with the goal of obtaining communicative effect, and hence pragmatic potential is the most important part of its contents. The practical value of our work lies in improving the methodology of teaching English for specific purposes on the basis of psycholinguistic concept of the secondary language personality.

Keywords: lacuna, language barrier, plenus, secondary language personality

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Authors: Satender Saraswat, Dharmendra Prasad Singh, Rajesh Kumar Verma, Swati Sarswat

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Background and Purpose: The predominant cause of candidiasis was Candida albicans which has shifted towards non-Candida albicans Candida (NCAC) (Candida species other than the C. albicans). NCAC, earlier considered non-pathogenic or minimally virulent, are now considered a primary cause of morbidity and mortality in immunocompromised. With the NCAC spp. gaining weightage in the clinical cases, this study was conducted to determine the prevalence of NCAC spp. in different clinical specimens and to assess a few of their virulence factors. Material and Methods: Routine samples for bacterial culture and sensitivity, showing colony characteristics like Candida on Blood Agar and microscopic features resembling Candida spp. were processed further. Candida isolates were tested for chlamydospore formation, biochemical tests including sugar fermentation and sugar assimilation tests, and growth at 42oC, colony colour on HiCrome™ Candida Differential Agar, HiCandida Identification Kit and VITEK-2 Compact. Virulence factors like adherence to buccal epithelial cells (ABEC), biofilm formation, hemolytic activity, and production of coagulase enzyme were also tested. Results: Mean age of the patients was 38.46 with a male-female ratio of 1.36:1. 137 Candida isolates were recovered. 45.3% isolates were isolated from urine, 19.7% from vaginal swabs and 13.9% from oropharyngeal swabs. 55 (40.1%) isolates of C. albicans and 82 (59.9%) of NCAC spp. were identified, with C. tropicalis (23.4%) in NCAC. C. albicans (3; 50%) was the commonest species in cases of candidemia. Haemolysin production (85.5%) and ABEC (78.2%) were the major virulence factors in C. albicans. C. tropicalis (59.4%) and C. dubliniensis (50%) showed maximum ABEC. Biofilm forming capacity was higher in C. tropicalis (78.1%) than C. albicans (67%). Conclusion: This study suggests varied prevalence and virulence based on geographical locations, even within a subcontinent. It clearly demarcates the emergence of NCAC and their predominance in different body fluids. Identification of Candida to species level should become a routine in all the laboratories.

Keywords: ABEC, NCAC, non-Candida albicans Candida, Vitek-2TM compact

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Authors: Dylan Elliott, Katya Pertsova

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Preposition errors are some of the most common errors created by L2 speakers. In addition, improving error correction and detection methods remains an open issue in the realm of Natural Language Processing (NLP). This research investigates whether the bidirectional encoder representations from the transformers model (BERT) have the potential to correct preposition errors accurately enough to be useful in error correction software. This research finds that BERT performs strongly when the scope of its error correction is limited to preposition choice. The researchers used an open-source BERT model and over three hundred thousand edited sentences from Wikipedia, tagged for part of speech, where only a preposition edit had occurred. To test BERT’s ability to detect errors, a technique known as multi-level masking was used to generate suggestions based on sentence context for every prepositional environment in the test data. These suggestions were compared with the original errors in the data and their known corrections to evaluate BERT’s performance. The suggestions were further analyzed to determine if BERT more often agreed with the judgements of the Wikipedia editors. Both the untrained and fined-tuned models were compared. Finetuning led to a greater rate of error-detection which significantly improved recall, but lowered precision due to an increase in false positives or falsely flagged errors. However, in most cases, these false positives were not errors in preposition usage but merely cases where more than one preposition was possible. Furthermore, when BERT correctly identified an error, the model largely agreed with the Wikipedia editors, suggesting that BERT’s ability to detect misused prepositions is better than previously believed. To evaluate to what extent BERT’s false positives were grammatical suggestions, we plan to do a further crowd-sourcing study to test the grammaticality of BERT’s suggested sentence corrections against native speakers’ judgments.

Keywords: BERT, grammatical error correction, preposition error detection, prepositions

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Authors: Shivalaxmi Arumugham

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Child sexual abuse (CSA) has taken several forms, particularly with the advent of internet technologies that provide pedophiles access to their targets anonymously at an affordable rate. To combat CSA which has far-reaching consequences on the physical and psychological health of the victims, a special act, the Protection of Children from Sexual Offences (POCSO) Act, was formulated amongst the existing laws. With its latest amendment criminalizing various online activities about child pornography also known as child sexual abuse materials in 2019, tremendous pressure is speculated on law enforcement to identify offenders online. Effective investigations of CSA cases help in not only to detect perpetrators but also in preventing the re-victimization of children. Understanding the vulnerability of the child population and that the offenders continue to develop stealthier strategies to operate, it is high time that traditional investigation, where the focus is on apprehending and prosecuting the offender, must make a paradigm shift to proactively investigate to prevent victimization at the first place. One of the proactive policing techniques involves understanding the psychology of the offenders and children and operating undercover to catch the criminals before a real child is victimized. With the fundamental descriptive approach to research, the article attempts to identify the multitude of issues associated with the investigation of child sexual abuse cases currently in practice in India. Then, the article contextualizes the various covert operations carried out by numerous law enforcement agencies across the globe. To provide this comprehensive overview, the paper examines various reports, websites, guidelines, protocols, judicial pronouncements, and research articles. Finally, the paper presents the challenges and ethical issues that are to be considered before getting into undercover operations either in the guise of a pedophile or as a child. The research hopes to contribute to the making of standard operating protocols for investigation officers and other relevant policymakers in this regard.

Keywords: child sexual abuse, cybercrime against children, covert police operations, investigation of CSA

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Authors: Janet Wing-Chong Wai, Alex Chiu-Wing Lee, Hailey Hoi-Ching Tsang, Jeffrey Chiu, Kwok-Wing Tang

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Background: Mammography has limited sensitivity and specificity though it is the primary imaging technique for detection of early breast cancer. Ultrasound imaging and contrast-enhanced MRI are useful adjunct tools to mammography. The advantage of breast MRI is high sensitivity for invasive breast cancer. Therefore, indications for and use of breast magnetic resonance imaging have increased over the past decade. Objectives: 1. Cases demonstration on different indications for breast MR imaging. 2. To review of the common artifacts and pitfalls in breast MR imaging. Materials and Methods: This is a retrospective study including all patients underwent dynamic contrast-enhanced breast MRI examination in our centre, performed from Jan 2011 to Dec 2017. The clinical data and radiological images were retrieved from the EPR (electronic patient record), RIS (Radiology Information System) and PACS (Picture Archiving and Communication System). Results and Discussion: Cases including (1) Screening of the contralateral breast in patient with a new breast malignancy (2) Breast augmentation with free injection of unknown foreign materials (3) Finding of axillary adenopathy with an unknown site of primary malignancy (4) Neo-adjuvant chemotherapy: before, during, and after chemotherapy to evaluate treatment response and extent of residual disease prior to operation. Relevant images will be included and illustrated in the presentation. As with other types of MR imaging, there are different artifacts and pitfalls that can potentially limit interpretation of the images. Because of the coils and software specific to breast MR imaging, there are some other technical considerations that are unique to MR imaging of breast regions. Case demonstration images will be available in presentation. Conclusion: Breast MR imaging is a highly sensitive and reasonably specific method for the detection of breast cancer. Adherent to appropriate clinical indications and technical optimization are crucial for achieving satisfactory images for interpretation.

Keywords: MRI, breast, clinical, cancer

Procedia PDF Downloads 239

Authors: A. Bertašienė

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Energy harvesting from any structure makes a challenge. Different structure of air/wind flows in industrial, environmental and residential applications emerge the real flow investigation in detail. Many of the application fields are hardly achievable to the detailed description due to the lack of up-to-date statistical data analysis. In situ measurements aim crucial investments thus the simulation methods come to implement structural analysis of the flows. Different configurations of testing environment give an overview how important is the simple structure of field in limited area on efficiency of the system operation and the energy output. Several configurations of modeled working sections in air flow test facility was implemented in CFD ANSYS environment to compare experimentally and numerically air flow development stages and forms that make effects on efficiency of devices and processes. Effective form and amount of these flows under different geometry cases define the manner of instruments/devices that measure fluid flow parameters for effective operation of any system and emission flows to define. Different fluid flow regimes were examined to show the impact of fluctuations on the development of the whole volume of the flow in specific environment. The obtained results rise the discussion on how these simulated flow fields are similar to real application ones. Experimental results have some discrepancies from simulation ones due to the models implemented to fluid flow analysis in initial stage, not developed one and due to the difficulties of models to cover transitional regimes. Recommendations are essential for energy harvesting systems in both, indoor and outdoor cases. Further investigations aim to be shifted to experimental analysis of flow under laboratory conditions using state-of-the-art techniques as flow visualization tool and later on to in situ situations that is complicated, cost and time consuming study.

Keywords: fluid flow, initial region, tube coefficient, distinct shape

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Authors: Dawid Jakimiuk, Krzysztof Mitura, Leszek Szpakowski, Sławomir Pilip, Daniel Celiński

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The Emergency Medical Teams (EMS) of the Ambulance Service in Siedlce serve the population living in the Mazowieckie Voivodeship (the area of eastern Poland with approximately 550,000 inhabitants). They provide health services at the pre-hospital stage to all life-threatening patients. The analysis covered the interventions of emergency medical teams in cases of suicide attempts that occurred in the years 2015-2018. The study was retrospective. The data was obtained on the basis of digital medical records of completed call-outs. When defining the disease entity, the International Statistical Classification of Diseases and Health Problems ICD-10 prepared by WHO was used. The relationship between selected disease entities and the area of EMT intervention, the patient's sex and age, and the time of occurrence of the event were investigated. Non-urban area was defined as the area inhabited by a population below 10,000 residents. Statistical analysis was performed using Pearson's Chi ^ 2 test and presenting the percentage of cases in the study group. Of all the suicide attempts, drug abuse cases were the most frequent, including: X60 (Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics); X61 (Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonian and psychotropic drugs, not elsewhere classified); X62 (Intentional self-poisoning by and exposure to narcotics and psycholeptics [hallucinogens], not elsewhere classified); X63 (Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system); X64 (Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substance) oraz X70 (Intentional self-harm by hanging, strangulation and suffocation). In total, they accounted for 69.4% of all interventions to suicide attempts in the studied period. Statistical analysis shows significant differences (χ2 = 39.30239, p <0.0001, n = 561) between the area of EMT intervention and the type of suicide attempt. In non-urban areas, a higher percentage of X70 diagnoses was recorded (55.67%), while in urban areas, X60-X64 (72.53%). In non-urban areas, a higher proportion of patients attempting suicide was observed compared to patients living in urban areas. For X70 and X60 - X64 in total, the incidence rates in non-urban areas were 80.8% and 56%, respectively. Significant differences were found (χ2 = 119.3304, p <0.0001, n = 561) depending on the method of attempting suicide in relation to the patient's sex. The percentage of women diagnosed with X60-X64 versus X70 was 87.50%, which was the largest number of patients (n = 154) as compared to men. In the case of X70 in relation to X60-X64, the percentage of men was 62.08%, which was the largest number of patients (n = 239) as compared to women (n = 22). In the case of X70, the percentage of men compared to women was as high as 92%. Significant differences were observed (χ2 = 14.94848, p <0.01058) between the hour of EMT intervention and the type of suicide attempt. The highest percentage of X70 occurred between 04:01 - 08:00 (64.44%), while X60-X64 between 00:01 - 04:00 (70.45%). The largest number of cases of all tested suicide attempts was recorded between 16:01 - 20:00 for X70 (n = 62), X60 - X64 (n = 82), respectively. The highest percentage of patients undertaking all suicide attempts studied at work was observed in the age range of 18-30 (31.5%), while the lowest was in the age group over 60 years of age. (11%). There was no significant correlation between the day of the week or individual months of the year and the type of suicide attempt - respectively (χ2 = 6.281729, p <0.39238, n = 561) and (χ2 = 3.348913, p <0.9857, n = 561). There were also no significant differences in the incidence of suicide attempts for each year in the study period (χ2 = 3.348913, p <0.9857 n = 561). The obtained results suggest the necessity to undertake preventive measures in order to minimize the number of suicide attempts. Such activities should be directed especially at young patients living in non-urban areas.

Keywords: emergency med, emergency medical team, attempted suicide, pre-hospital

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Authors: Gregor Kosec

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Simple and robust numerical approach for solving flow problems is presented, where involved physical fields are represented through the local approximation functions, i.e., the considered field is approximated over a local support domain. The approximation functions are then used to evaluate the partial differential operators. The type of approximation, the size of support domain, and the type and number of basis function can be general. The solution procedure is formulated completely through local computational operations. Besides local numerical method also the pressure velocity is performed locally with retaining the correct temporal transient. The complete locality of the introduced numerical scheme has several beneficial effects. One of the most attractive is the simplicity since it could be understood as a generalized Finite Differences Method, however, much more powerful. Presented methodology offers many possibilities for treating challenging cases, e.g. nodal adaptivity to address regions with sharp discontinuities or p-adaptivity to treat obscure anomalies in physical field. The stability versus computation complexity and accuracy can be regulated by changing number of support nodes, etc. All these features can be controlled on the fly during the simulation. The presented methodology is relatively simple to understand and implement, which makes it potentially powerful tool for engineering simulations. Besides simplicity and straightforward implementation, there are many opportunities to fully exploit modern computer architectures through different parallel computing strategies. The performance of the method is presented on the lid driven cavity problem, backward facing step problem, de Vahl Davis natural convection test, extended also to low Prandtl fluid and Darcy porous flow. Results are presented in terms of velocity profiles, convergence plots, and stability analyses. Results of all cases are also compared against published data.

Keywords: fluid flow, meshless, low Pr problem, natural convection

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