Search results for: pediatric septic shock

Authors: Maryam Khazaei Pool, Lori Lewis

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This is a summary of articles based on higher order B-splines methods and the variation of B-spline methods such as Quadratic B-spline Finite Elements Method, Exponential Cubic B-Spline Method, Septic B-spline Technique, Quintic B-spline Galerkin Method, and B-spline Galerkin Method based on the Quadratic B-spline Galerkin method (QBGM) and Cubic B-spline Galerkin method (CBGM). In this paper, we study the B-spline methods and variations of B-spline techniques to find a numerical solution to the Burgers’ equation. A set of fundamental definitions, including Burgers equation, spline functions, and B-spline functions, are provided. For each method, the main technique is discussed as well as the discretization and stability analysis. A summary of the numerical results is provided, and the efficiency of each method presented is discussed. A general conclusion is provided where we look at a comparison between the computational results of all the presented schemes. We describe the effectiveness and advantages of these methods.

Keywords: Burgers’ equation, Septic B-spline, modified cubic B-spline differential quadrature method, exponential cubic B-spline technique, B-spline Galerkin method, quintic B-spline Galerkin method

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Authors: Nivaldo Ferreira do Nascimento, Matheus Pereira-Santos, Nycolas Levy-Pereira, José Augusto Senhorini, George Shigueki Yasui, Laura Satiko Okada Nakaghi

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Tetraploid individuals, which could produce diploid gametes, can be used for production of 100% triploid fish. Therefore, the aim of this study was to develop a tetraploidization protocol for A. altiparanae. We tested the effect of heat shock (40 °C; 2 min) at 16, 18, 20, 22, 24 and 26 minutes post fertilization (mpf). Untreated eggs were used as control. After hatching, ploidy status of the larvae was checked by flow cytometry. No difference were observed for the hatching rate between all treatments (P = 0.5974). However, we observed an increase in the larval abnormality in the heat shock treatments, in special at 22 (82.17 ± 6.66%) 24 (78.31 ±7.28%) and 26 mpf (79.01 ± 7.85%) in comparison with the control group (12.87 ± 4.46%). No tetraploid was observed at 16 and 18 mpf. The higher number of tetraploid individuals (52/55) was observed at 26 mpf. Our results showed that high percentages of tetraploids are obtained by heat shock (40°C; 2min) at 26 mpf, which could enable the mass production of triploid individuals in A. altiparanae.

Keywords: chromosome manipulation, polyploidy, flow cytometry, tetraploidization

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Authors: Hanan Bin Nakhi, Asaad M. Albadrawi, Maged Al Shahat, ‎Entesar Mandani

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Background:‎ Kawasaki disease (KD) is one of the most common vasculitis of childhood. ‎It is considered the leading cause of acquired heart disease in children. The ‎peak age of occurrence is 6 to 24 months, with 80% of affected children being ‎less than 5 years old. There are only a few reports of KD in infants younger ‎than 6 months. Infants had a higher incidence of atypical KD and of coronary ‎artery complications. This case report from Kuwait will reinforce considering ‎atypical KD in case of sepsis like condition with negative cultures and ‎unresponding to systemic antibiotics. Early diagnosis allows early treatment ‎with intravenous immune globulin (IVIG) and so decreases the incidence of ‎cardiac aneurysm.‎ Case Report:‎ A 2 month old female infant, product of full term normal delivery to ‎consanguineous parents, presented with fever and poor feeding. She was ‎admitted and treated as urinary tract infection as her urine routine revealed ‎pyurea. The baby continued to have persistent fever and hypoactivity inspite ‎of using intravenous antibiotics. Latter, she developed non purulent ‎conjunctivitis, skin mottling, oedema of the face / lower limb and was treated ‎in intensive care unit as a case of septic shock. In spite of her partial general ‎improvement, she continued to look unwell, hypoactive and had persistent ‎fever. Septic work up, metabolic, and immunologic screen were negative. KD ‎was suspected when the baby developed polymorphic erythematous rash and ‎noticed to have peeling of skin at perianal area and periangular area of the ‎fingers of the hand and feet. IVIG was given in dose of 2 gm/kg/day in single ‎dose and aspirin 100 mg/kg/day in four divided doses. The girl showed marked ‎clinical improvement. The fever subsided dramatically and the level acute ‎phase reactant markedly decreased but the platelets count increased to ‎‎1600000/mm3. Echo cardiography showed mild dilatation of mid right ‎coronary artery. Aspirin was continued in a dose of 5 mg/kg/d till repeating ‎cardiac echo. ‎Conclusion:‎ A high index of suspicion of KD must be maintained in young infants with ‎prolonged unexplained fever. Accepted criteria should be less restrictive to ‎allow early diagnosis of a typical KD in infants less than 6 months of age. ‎Timely appropriate treatment with IVIG is essential to avoid severe coronary ‎sequels.‎

Keywords: Kawasaki disease, atypical Kawasaki disease, infantile Kawasaki disease, hypo activity‎ ‎

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Authors: Naima Nur, Safa Islam, Saeema Islam, Md. Faridul Alam

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Background: The worldwide increase in pediatric presumptive tuberculosis (TB) is the most life-threatening challenge in effectively controlling TB. The objective of this study was to determine the proportion of presumptive TB and the factors associated with it. Methods: A cross-sectional study was conducted between March and November 2013 at ICDDR-Bangladesh. Two hundred twelve pulmonary and extra-pulmonary specimens were collected from 84 suspected pediatric patients diagnosed with TB based on their clinical symptoms/radiological findings. Presumptive TB and confirmed TB were considered presumptive TB and non-presumptive TB and were isolated by smear-microscopy, culture, and GeneXpert. Logistic regression was used to analyze associations between outcome and predictor variables. Results: The proportion of presumptive TB was 85.7%, and 14.3% of non-presumptive TB. In presumptive TB, vaccine scars, family TB history, and school-going children were 16.6%, 33.3%, and 56.9%, respectively. In contrast, vaccine scars and family TB history were 8.3%, and school-going children were 58.3% in non-presumptive TB. Significant factors did not appear in the logistic regression analysis. Conclusion: Despite the high proportion of presumptive TB, there was no statistically significant between presumptive TB and non-presumptive TB.

Keywords: presumptive tuberculosis, confirmed tuberculosis, patient's characteristics, diagnosis

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Authors: Xiaoxin Ye, Guoyi Tang

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The effect of electropulsing ultrasonic shock (EUS) on the surface hardening and microstructure of Ti6Al4V alloy was studied. It was found that electropulsing improved the microhardness dramatically both in the influential depth and maximum value, compared with the only ultrasonic-shocked sample. It’s indicated that refined surface layer with nanocrystalline and improved microhardness were obtained on account of surface severe plastic deformation, dynamic recrystallization (DRX) and phase change, which was implemented at relative low temperature and high strain rate/capacity due to the coupling of the thermal and athermal effects of EUS. It’s different from conventional experiments and theory. It’s discussed that the positive contributions of EPT in the thermodynamics and kinetics of microstructure and properties change were attributed to the reduction of nucleation energy barrier and acceleration of atomic diffusion. Therefore, it’s supposed that EUS is an energy-saving and high-efficiency method of surface treatment technique with the help of high-energy electropulses, which is promising in cost reduction of the surface engineering and energy management.

Keywords: titanium alloys, electropulsing, ultrasonic shock, microhardness, nanocrystalline

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Authors: Ahmed Assem Abd El Rahim

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Background: Mechanical low back pain is serious physical and social health problem. Purpose: To examine impact of shock wave therapy versus intermittent mechanical traction on mechanical LBP, and disabilities. Subjects: 60 mechanical LBP male studied cases years old 20-35 years were assigned randomly into 3 groups, Picked up from Sohag university orthopedic hospital outpatient clinic. Methods: (Study Group) A: 20 studied cases underwent shock wave therapy plus conventional physical therapy. (Study Group) B: twenty studied cases underwent intermittent mechanical traction plus conventional physical therapy. (Control Group) C: 20 patients underwent conventional physical therapy alone. Three sessions were applied weekly for four weeks. Pain was quantified using McGill Pain Questionnaire, Roland Morris Disability Questionnaire was used for measuring disability, and the ROM was evaluated by (BROM) device pre- & post-therapy. Results: Groups (A, B & C) found a reduction in pain & disability & rise in their in flexion and extension ROM after end of 4 weeks of program. Mean values of pain scale after therapy were 15.3, 9.47, and 23.07 in groups A, B, & C. mean values of Disability scale after therapy were 8.44, 4.87, 11.8in groups A, B & C. mean values of ROM of flexion were 25.53, 29.06, & 23.9 in groups A, B & C. mean values of ROM of extension were 11.73, 15.53 & 9.85 in groups A, B & C. studied cases who received intermittent mechanical traction & conventional physical therapy (group B), found reduction in pain & disability & improvement in ROM of flexion & extension value (P<0.001) after therapy program. Conclusion: Shock wave therapy and intermittent mechanical traction, as well as conventional physical treatment, can be beneficial in studied cases with mechanical LBP.

Keywords: mechanical low back pain, shock wave, mechanical, low back pain

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Authors: Michał Lidner, Zbigniew SzcześNiak

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The ability to estimate blast load overpressure properly plays an important role in safety design of buildings. The issue of studying of blast loading on structural elements has been explored for many years. However, in many literature reports shock wave overpressure is estimated with simplified triangular or exponential distribution in time. This indicates some errors when comparing real and numerical reaction of elements. Nonetheless, it is possible to further improve setting similar to the real blast load overpressure function versus time. The paper presents a method of numerical analysis of the phenomenon of the air shock wave propagation. It uses Finite Volume Method and takes into account energy losses due to a heat transfer with respect to an adiabatic process rule. A system of three equations (conservation of mass, momentum and energy) describes the flow of a volume of gaseous medium in the area remote from building compartments, which can inhibit the movement of gas. For validation three cases of a shock wave flow were analyzed: a free field explosion, an explosion inside a steel insusceptible tube (the 1D case) and an explosion inside insusceptible cube (the 3D case). The results of numerical analysis were compared with the literature reports. Values of impulse, pressure, and its duration were studied. Finally, an overall good convergence of numerical results with experiments was achieved. Also the most important parameters were well reflected. Additionally analyses of dynamic response of one of considered structural element were made.

Keywords: adiabatic process, air shock wave, explosive, finite volume method

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Authors: Teng Li, Kamran Mohseni

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This paper presents an inviscid regularization technique that is capable of regularizing the shocks and sharp interfaces simultaneously in the shock-interface interaction simulations. The direct numerical simulation of flows involving shocks has been investigated for many years and a lot of numerical methods were developed to capture the shocks. However, most of these methods rely on the numerical dissipation to regularize the shocks. Moreover, in high Reynolds number flows, the nonlinear terms in hyperbolic Partial Differential Equations (PDE) dominates, constantly generating small scale features. This makes direct numerical simulation of shocks even harder. The same difficulty happens in two-phase flow with sharp interfaces where the nonlinear terms in the governing equations keep sharpening the interfaces to discontinuities. The main idea of the proposed technique is to average out the small scales that is below the resolution (observable scale) of the computational grid by filtering the convective velocity in the nonlinear terms in the governing PDE. This technique is named “observable method” and it results in a set of hyperbolic equations called observable equations, namely, observable Navier-Stokes or Euler equations. The observable method has been applied to the flow simulations involving shocks, turbulence, and two-phase flows, and the results are promising. In the current paper, the observable method is examined on the performance of regularizing shocks and interfaces at the same time in shock-interface interaction problems. Bubble-shock interactions and Richtmyer-Meshkov instability are particularly chosen to be studied. Observable Euler equations will be numerically solved with pseudo-spectral discretization in space and third order Total Variation Diminishing (TVD) Runge Kutta method in time. Results are presented and compared with existing publications. The interface acceleration and deformation and shock reflection are particularly examined.

Keywords: compressible flow simulation, inviscid regularization, Richtmyer-Meshkov instability, shock-bubble interactions.

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Authors: Manoj Kumar, Sujata Mohanty, D. N. Rao, Arul Selvi, Sanjeev K. Bhoi

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Background: Hematopoietic progenitor cells (HPC) mobilized from bone marrow to peripheral blood has been observed in severe trauma and hemorrhagic shock patients. Granulocyte-colony stimulating factor (G-CSF) is a potent stimulator that mobilized HPC from bone marrow to peripheral blood. Objective: Our aim of the study was to investigate the serum G-CSF levels and correlate with HPC and outcome. Methods: Peripheral blood sample from 50 hemorrhagic shock patients was collected on arrival for determination of G-CSF and peripheral blood HPC (PBHPC) and compared with healthy control (n=15). Determination of serum levels of G-CSF by sandwich ELISA and PBHPC by Sysmex XE-2100. Data were categorized by age, sex, Injury Severity Score (ISS), and laboratory data was prospectively collected. Data are expressed as mean±SD and median (min, max). Results: Significantly increased the serum level of G-CSF (264.8 vs. 79.1 pg/ml) and peripheral blood HPC (0.1 vs. 0.01 %) in the T/HS patients when compared with control group. Conclusions: Our studies suggest serum G-CSF elevated in T/HS patients. The elevated in G-CSF was also associated with mobilization of HPC from BM to peripheral blood HPC. Increased the levels of G-CSF in T/HS may play a significant role in the alteration of the hematopoietic compartment.

Keywords: granulocyte colony stimulating factor, G-CSF, hematopoietic progenitor cells, HPC, trauma hemorrhagic shock, T/HS, outcome

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Authors: Farah Syazwani Hilmy Zaki

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Background: Compared to adult cardiopulmonary resuscitation (CPR), high-quality research and evidence on pediatric CPR remain relatively scarce. This knowledge gap hinders the development of optimal guidelines and best practices for resuscitating children. Objectives: To explore pediatric intensive care unit (PICU) CPR current practices in PICU of Institut Jantung Negara (IJN) Malaysia. Method: The research employed a qualitative approach, utilising case study research design. The data collection process involved in-depth interviews and reviewing the Resuscitation Feedback Form. Purposive sampling was used to select two cases consisting of 14 participants. The study participants comprised a cardiologist, one anaesthetist, and twelve nurses. The data collected were transcribed and entered into NVivo software to facilitate theme development. Subsequently, thematic analysis was conducted to analyse the data. Findings: The study yielded key findings regarding the enhancement of PICU CPR practices. These findings are categorised into four themes, namely routine procedures, resuscitation techniques, team dynamics, and individual contributions. Establishment of cohesive team is crucial in facilitating the effectiveness of resuscitation. According to participants, lack of confidence, skills and knowledge presents significant obstacles to effective PICU CPR. Conclusion: The findings of this study indicate that the participants express satisfaction with the current practices of PICU CPR. However, the research also highlights the need for enhancements in various areas, including routine procedures, resuscitation techniques, as well as team and individual factors. Furthermore, it was suggested that additional training be conducted on the resuscitation process to enhance the preparedness of the medical team.

Keywords: cardiopulmonary resuscitation, feedback, nurses, pediatric intensive care unit

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Authors: Hendra Wibowo, Suprayitno Wardoyo, Dhama Shinta

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Introduction: Pediatric pulmonary tuberculosis (TB) incidence was increasing, with many undetected cases. In complicated TB, treatment should consist of returning pulmonary function, preventing further complications, and eliminating bacteria. Complicated TB management was still controversial, and surgery was one of the treatments that should be evaluated in accordance with its role in the treatment of complicated TB. Method: This study was an evidence-based case report. The database used for the literature search were Cochrane, Medline, Proquest, and ScienceDirect. Keywords for the search were ‘primary pulmonary tuberculosis’, ‘surgery’, ‘lung resection’, and ‘children’. Inclusion criteria were studies in English or Indonesian, with children under 18 years old as subject, and full-text articles available. The assessment was done according to Oxford Centre for evidence-based medicine 2011. Results: Six cohort studies were analyzed. Surgery was indicated for patients with complicated TB that were unresponsive towards treatment. It should be noted that the experiments were done before the standard WHO antituberculosis therapy was applied; thus, the result may be different from the current application. Conclusion: Currently, there was no guideline on pulmonary resection. However, surgery yielded better mortality and morbidity in children with complicated pulmonary TB.

Keywords: pediatric, pulmonary, surgery, therapy, tuberculosis

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Authors: Reza Farahmand Rad, Farnad Imani, Azadeh Emami, Reza Salehi, Ali Reza Ghavamy, Ali Nima Shariat

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Background: One of the methods of pain control after pediatric surgical procedures is regional techniques, including caudal block, despite their limitations. Objectives: In this study, the pain score and complications of caudal tramadol were evaluated in pediatrics following lower abdom- inal surgery. Methods: In this study, 46 children aged 3 to 10 years were allocated into two equal groups (R and TR) for performing caudal anal- gesia after lower abdominal surgery. The injectate contained 0.2% ropivacaine 1 mL/kg in the R group (control group) and tramadol (2 mg/kg) and ropivacaine in the TR group. The pain score, duration of pain relief, amount of paracetamol consumption, hemody- namic alterations, and possible complications at specific times (1, 2, and 6 hours) were evaluated in both groups. Results: No considerable difference was observed in the pain score between the groups in the first and second hours (P > 0.05). However, in the sixth hour, the TR group had a significantly lower pain score than the R group (P < 0.05). Compared to the R group, the TR group had a longer period of analgesia and lower consumption of analgesic drugs (P < 0.05). Heart rate and blood pressure differences were not significant between the two groups (P > 0.05). Similarly, the duration of operation and recovery time were not remarkably different between the two groups (P > 0.05). Complications had no apparent differences between these two groups, as well (P > 0.05). Conclusions: In this study, the addition of tramadol to caudal ropivacaine in pediatric lower abdominal surgery promoted pain relief without complications.

Keywords: tramadol, ropivacaine, caudal block, pediatric, lower abdominal surgery, postoperative pain

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Authors: Rami Faraj, Cezary Graczykowski, Błażej Popławski, Grzegorz Mikułowski, Rafał Wiszowaty

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Progress in the field of sensors, electronics and computing results in more and more often applications of adaptive techniques for dynamic response mitigation. When it comes to systems excited with mechanical impacts, the control system has to take into account the significant limitations of actuators responsible for system adaptation. The paper provides a comprehensive discussion of the problem of appropriate design and implementation of adaptation techniques and mechanisms. Two case studies are presented in order to compare completely different adaptation schemes. The first example concerns a double-chamber pneumatic shock absorber with a fast piezo-electric valve and parameters corresponding to the suspension of a small unmanned aerial vehicle, whereas the second considered system is a safety air cushion applied for evacuation of people from heights during a fire. For both systems, it is possible to ensure adaptive performance, but a realization of the system’s adaptation is completely different. The reason for this is technical limitations corresponding to specific types of shock-absorbing devices and their parameters. Impact mitigation using a pneumatic shock absorber corresponds to much higher pressures and small mass flow rates, which can be achieved with minimal change of valve opening. In turn, mass flow rates in safety air cushions relate to gas release areas counted in thousands of sq. cm. Because of these facts, both shock-absorbing systems are controlled based on completely different approaches. Pneumatic shock-absorber takes advantage of real-time control with valve opening recalculated at least every millisecond. In contrast, safety air cushion is controlled using the semi-passive technique, where adaptation is provided using prediction of the entire impact mitigation process. Similarities of both approaches, including applied models, algorithms and equipment, are discussed. The entire study is supported by numerical simulations and experimental tests, which prove the effectiveness of both adaptive impact mitigation techniques.

Keywords: adaptive control, adaptive system, impact mitigation, pneumatic system, shock-absorber

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Authors: C. Recommandé, J. C. Blind, A. Clavel, R. Gourichon, V. Le Gal

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Simulations are developed in this paper with usual DSGE model equations. The model is based on simplified version of Smets-Wouters equations in use at European Central Bank which implies 10 macro-economic variables: consumption, investment, wages, inflation, capital stock, interest rates, production, capital accumulation, labour and credit rate, and allows take into consideration the banking system. Throughout the simulations, this model will be used to evaluate the impact of rate shocks recounting the actions of the European Central Bank during 2008.

Keywords: CC-LM, Central Bank, DSGE, liquidity shock, non-standard intervention

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Authors: Kazumasa Kitazono, Hiroshi Fukuoka, Nao Kuniyoshi, Minoru Yaga, Eri Ueno, Naoaki Fukuda, Toshio Takiya

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The unsteady supersonic jet formed by a shock tube with a small high-pressure chamber was used as a simple alternative model for pulsed laser ablation. Understanding the vortex ring formed by the shock wave is crucial in clarifying the behavior of unsteady supersonic jet discharged from an elliptical cell. Therefore, this study investigated the behavior of vortex rings and a jet. The experiment and numerical calculation were conducted using the schlieren method and by solving the axisymmetric two-dimensional compressible Navier–Stokes equations, respectively. In both, the calculation and the experiment, laser ablation is conducted for a certain duration, followed by discharge through the exit. Moreover, a parametric study was performed to demonstrate the effect of pressure ratio on the interaction among vortex rings and the supersonic jet. The interaction between the supersonic jet and the vortex rings increased the velocity of the supersonic jet up to the magnitude of the velocity at the center of the vortex rings. The interaction between the vortex rings increased the velocity at the center of the vortex ring.

Keywords: computational fluid dynamics, shock-wave, unsteady jet, vortex ring

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Authors: Nourhan G. Sahly, Ahmed Moustafa, Mohamed S. Zaghloul, Tamer Z. Salem

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The gut microbiome plays important roles in the human body that includes but not limited to digestion, immunity, homeostasis and response to some drugs such as chemotherapy and immunotherapy. Its role has also been linked to radiotherapy and associated gastrointestinal injuries, where the microbial dysbiosis could be the driving force for dose determination or the complete suspension of the treatment protocol. Linking the gut microbiota alterations to different cancer treatment protocols is not easy especially in humans. However, enormous effort was exerted to understand this complex relationship. In the current study, we described the gut microbiota dysbiosis in pediatric sarcoma patients, in the pelvic region, with regards to radiotherapy and antibiotics. Fecal samples were collected as a source of microbial DNA for which the gene encoding for V3-V5 regions of 16S rRNA was sequenced. Two of the three patients understudy had experienced an increase in alpha diversity post exposure to 50.4 Gy. Although phylum Firmicutes overall relative abundance has generally decreased, six of its taxa increased in all patients. Our results may indicate the possibility of radiosensitivity or enrichment of the antibiotic resistance of the elevated taxa. Further studies are needed to describe the extent of radiosensitivity with regards to antibiotic resistance.

Keywords: combined radiotherapy and chemotherapy, gut microbiome, pediatric cancer, radiosensitivity

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Authors: Ahmed Mantawy, James C. Anderson

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Numerous cases of earthquakes (main-shocks) that were followed by aftershocks have been recorded in California. In 1992 a pair of strong earthquakes occurred within three hours of each other in Southern California. The first shock occurred near the community of Landers and was assigned a magnitude of 7.3 then the second shock occurred near the city of Big Bear about 20 miles west of the initial shock and was assigned a magnitude of 6.2. In the same year, a series of three earthquakes occurred over two days in the Cape-Mendocino area of Northern California. The main-shock was assigned a magnitude of 7.0 while the second and the third shocks were both assigned a value of 6.6. This paper investigates the effect of a main-shock accompanied with aftershocks of significant intensity on reinforced concrete (RC) frame buildings to indicate nonlinear behavior using PERFORM-3D software. A 6-story building in San Bruno and a 20-story building in North Hollywood were selected for the study as both of them have RC moment resisting frame systems. The buildings are also instrumented at multiple floor levels as a part of the California Strong Motion Instrumentation Program (CSMIP). Both buildings have recorded responses during past events such as Loma-Prieta and Northridge earthquakes which were used in verifying the response parameters of the numerical models in PERFORM-3D. The verification of the numerical models shows good agreement between the calculated and the recorded response values. Then, different scenarios of a main-shock followed by a series of aftershocks from real cases in California were applied to the building models in order to investigate the structural behavior of the moment-resisting frame system. The behavior was evaluated in terms of the lateral floor displacements, the ductility demands, and the inelastic behavior at critical locations. The analysis results showed that permanent displacements may have happened due to the plastic deformation during the main-shock that can lead to higher displacements during after-shocks. Also, the inelastic response at plastic hinges during the main-shock can change the hysteretic behavior during the aftershocks. Higher ductility demands can also occur when buildings are subjected to trains of ground motions compared to the case of individual ground motions. A general conclusion is that the occurrence of aftershocks following an earthquake can lead to increased damage within the elements of an RC frame buildings. Current code provisions for seismic design do not consider the probability of significant aftershocks when designing a new building in zones of high seismic activity.

Keywords: reinforced concrete, existing buildings, aftershocks, damage accumulation

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Authors: Tobias Schramm, Günther Prokop

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Degraded vehicle shock absorbers represent a risk for road safety. The exact effect of degraded vehicle dampers on road safety is still the subject of research. This work is intended to contribute to estimating the effect of degraded twin-tube dampers of passenger cars on road safety. An axle model was built using a damper model to simulate different degradation levels. To parameterize the model, a realistic parameter space was estimated based on test rig measurements and database analyses, which is intended to represent the vehicle field in Germany. Within the parameter space, simulations of the axle model were carried out, which calculated the transmittable lateral forces of the various axle configurations as a function of vehicle speed, road surface, damper conditions and axle parameters. A degraded damper has the greatest effect on the transmittable lateral forces at high speeds and in poor road conditions. If a vehicle is traveling at a speed of 100 kph on a Class D road, a degraded damper reduces the transmissible lateral forces of an axle by 20 % on average. For individual parameter configurations, this value can rise to 50 %. The axle parameters that most influence the effect of a degraded damper are the vertical stiffness of the tire, the unsprung mass and the stabilizer stiffness of the axle.

Keywords: vehicle dynamics, vehicle simulation, vehicle component degradation, shock absorber model, shock absorber degradation

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Authors: Bliss Singhal

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Epilepsy is a prevalent neurological disorder affecting approximately 50 million individuals worldwide and 1.2 million Americans. There exist millions of pediatric patients with intractable epilepsy, a condition in which seizures fail to come under control. The occurrence of seizures can result in physical injury, disorientation, unconsciousness, and additional symptoms that could impede children's ability to participate in everyday tasks. Predicting seizures can help parents and healthcare providers take precautions, prevent risky situations, and mentally prepare children to minimize anxiety and nervousness associated with the uncertainty of a seizure. This research proposes a comprehensive framework to predict seizures in pediatric patients by evaluating machine learning algorithms on unimodal neuroimaging data consisting of electroencephalogram signals. The bandpass filtering and independent component analysis proved to be effective in reducing the noise and artifacts from the dataset. Various machine learning algorithms’ performance is evaluated on important metrics such as accuracy, precision, specificity, sensitivity, F1 score and MCC. The results show that the deep learning algorithms are more successful in predicting seizures than logistic Regression, and k nearest neighbors. The recurrent neural network (RNN) gave the highest precision and F1 Score, long short-term memory (LSTM) outperformed RNN in accuracy and convolutional neural network (CNN) resulted in the highest Specificity. This research has significant implications for healthcare providers in proactively managing seizure occurrence in pediatric patients, potentially transforming clinical practices, and improving pediatric care.

Keywords: intractable epilepsy, seizure, deep learning, prediction, electroencephalogram channels

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Authors: Hiromi Takafuji

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Flight attendant:FA is one of popular occupation, especially in Asian countries, and the decision to be hired is made after clearing a high multiplier. On the other hand, immediately after joining the company, they experience unique stress due to the fact that the organization requires them to perform security and customer service duties in a highly specialized and limited space and time. As a result, despite the high level of difficulty in joining the company, many new recruits retire early at a high rate. It is commonly said that 30% of new graduates leave the company within three years in Japan and speculated that Reality Shock:RS is one of the causes of this. RS is that newcomers experience refers to the stress caused by the difference between pre-employment expectations and post-employment reality. The purpose of this study was to elucidate the mechanism by which the expertise required of new FA and the expectation of expertise held by each of them cause reality shock, which affects motivation and the decision to leave. This study identified the professionalism required of new FA and the impact of that expectation for professionalism on RS through an exploratory study of the experiences and psychological processes of FA who left within three years. Semi-structured in-depth interviews were conducted with five FA who left a major Japanese airline at an early stage, and their experiences were categorized, integrated, and classified by qualitative content analysis. They were chosen under a number of controlled conditions. Then two major findings emerged: first, that pre-employment expectations defining RS were hierarchical, and second, that training amplified expectations of professionalism, which strongly influenced early turnover. From these, this study generated a model of RS generative process model of FA that expectations are hierarchical and influential. This could contribute to the prevention of mental health deterioration by reality shock among new FA.

Keywords: reality shock, flight attendant, early turnover, qualitative study

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Authors: C. Bala Prashanth Reddy, B. Abhinay, C. Sreekar, D. V. Shobhana Priscilla

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The project aims in designing an emergency pacemaker which is capable of giving shocks to a human heart which has stopped working suddenly. A pacemaker is a machine commonly used by cardiologists. This machine is used in order to shock a human’s heart back into usage. The way the heart works is that there are small cells called pacemakers sending electrical pulses to cardiac muscles that tell the heart when to pump blood. When these electrical pulses stop, the heart stops beating. When this happens, a pacemaker is used to shock the heart muscles and the pacemakers back into action. The way this is achieved is by rubbing the two panels of the pacemaker together to create an adequate electrical current, and then the heart gets back to the normal state. The project aims in designing a system which is capable of continuously displaying the heart beat and blood pressure of a person on LCD. The concerned doctor gets the heart beat and also the blood pressure details continuously through the GSM Modem in the form of SMS alerts. In case of abnormal condition, the doctor sends message format regarding the amount of electric shock needed. Automatically the microcontroller gives the input to the pacemaker which in turn gives the shock to the patient. Heart beat monitor and display system is a portable and a best replacement for the old model stethoscope which is less efficient. The heart beat rate is calculated manually using stethoscope where the probability of error is high because the heart beat rate lies in the range of 70 to 90 per minute whose occurrence is less than 1 sec, so this device can be considered as a very good alternative instead of a stethoscope.

Keywords: missing R wave, PWM, demand pacemaker, heart

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Authors: D. M. El-Tanbouly, R. M. Abdelsalam, A. S. Attia, M. T. Abdel-Aziz

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Lipopolysaccharide (LPS) endotoxin, a component of the outer membrane of Gram-negative bacteria, is involved in the pathogenesis of sepsis. LPS administration induces systemic inflammation that mimics many of the initial clinical features of sepsis and has deleterious effects on several organs including the liver and eventually leading to septic shock and death. The present study aimed to investigate the protective effect of magnesium, a well-known cofactor in many enzymatic reactions and a critical component of the antioxidant system, on hepatic damage associated with LPS induced- endotoxima in mice. Mg (20 and 40 mg/kg, po) was administered for 7 consecutive days. Systemic inflammation was induced one hour after the last dose of Mg by a single dose of LPS (2 mg/kg, ip) and three hours thereafter plasma was separated, animals were sacrificed and their livers were isolated. LPS-treated mice suffered from hepatic dysfunction revealed by histological observation, elevation in plasma transaminases activities, C-reactive protein content and caspase-3, a critical marker of apoptosis. Liver inflammation was evident by elevation in liver cytokines contents (TNF-α and IL-10) and myeloperoxidase (MPO) activity. Additionally, oxidative stress was manifested by increased liver lipoperoxidation, glutathione depletion, elevated total nitrate/nitrite (NOx) content and glutathione peroxidase (GPx) activity. Pretreatment with Mg largely mitigated these alternations through its anti-inflammatory and antioxidant potentials. Mg, therefore, could be regarded as an effective strategy for prevention of liver damage associated with septicemia.

Keywords: LPS, liver damage, magnesium, septicemia

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Authors: Minna K. Miller, Chantel. E. Canessa, Suzanna V. McRae, Susan Shumay, Alissa Collingridge

Abstract:

Primary care provides the first point of contact and access to health care services. For the pediatric population, the goal is to help healthy children stay healthy and to help those that are sick get better. Primary care facilitates regular well baby/child visits; health promotion and disease prevention; investigation, diagnosis and management of acute and chronic illnesses; health education; both consultation and collaboration with, and referral to other health care professionals. There is a protective association between regular well-child visit care and preventable hospitalization. Further, low adherence to well-child care and poor continuity of care are independently associated with increased risk of hospitalization. With a declining number of family physicians caring for children, and only a portion of pediatricians providing primary care services, it is becoming increasingly difficult for children and their families to access primary care. Nurse practitioners are in a unique position to improve access to primary care and improve health outcomes for children. Limited literature is available on the nurse practitioner role in primary care pediatrics. The purpose of this paper is to describe the development, implementation and evaluation of a Nurse Practitioner-led pediatric primary care clinic in a tertiary care setting. Utilizing the participatory, evidence-based, patient-focused process for advanced practice nursing (PEPPA framework), this paper highlights the results of the initial needs assessment/gap analysis, the new service delivery model, populations served, and outcome measures.

Keywords: access, health outcomes, nurse practitioner, pediatric primary care, PEPPA framework

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Authors: Hela Ghali, Oumayma Ben Amor, Salwa Khefacha, Mohamed Ben Rejeb, Sirine Frigui, Meriam Tourki Dhidah, Lamine Dhidah, Houyem Said Laatiri

Abstract:

Background: Blood exposure accidents are the most common problem in hospitals that threaten healthcare professionals with a high risk of infectious complications which weighs heavily on health systems worldwide. Paramedics are the highest risk group due to the nature of their daily activities. We aimed to determine knowledge and attitudes about the management of blood-exposure accidents among nurses and technicians in two pediatric departments. Materials/Methods: This is a cross-sectional descriptive study conducted on March 2017, carried out with the care staff of the pediatric ward of the Farhat Hached Teaching Hospital of Sousse and pediatric surgery of the Fattouma Bourguiba University Hospital in Monastir, using a pre- tested and self-administered questionnaire. Data entry and analysis were performed using Excel software. Results: The response rate was 85.1%. A female predominance (82.5%) was reported among respondents with a sex ratio of 0.21. 80% of the participants were under 35 years old. Seniority of less than 10 years was found in 77.5% of respondents. Only 22.5% knew the definition of a blood- exposure accident. 100% and 95% of participants reported the relative risk, respectively, to hepatitis and AIDS viruses. However, only 15% recognized the severity factors of a blood-exposure accident. Hygiene compliance was the most important dimension for almost the entire population for the prevention. On the other hand, only 12.5% knew the meaning of 'standard precautions' and ¼ considered them necessary for at-risk patients only. 40% reported being exposed at least once, among them, 87.5% used betadine, and 77.5% said that anti-infectious chemoprophylaxis is necessary regardless of the patient's serological status. However, 52.5% did not know the official reporting circuit of management of blood-exposure accident in their institutions. Conclusion: For better management of risks in hospitals and an improvement of the safety of the care, a reinforcement of the sensibilization of the caregivers with regard to the risks of blood exposure accident is necessary, while developing their knowledge to act in security.

Keywords: attitudes, blood-exposure accident, knowledge, pediatric department

Procedia PDF Downloads 196

Authors: Izzatul Ulfana, Angga Pratomo Cahyadi, Rimayanti, Widjiati

Abstract:

Freezing oocyte could cause temperature stress. Temperature stress triggers cell damage. Insulin Transferrin Selenium (ITS) and Heat Shock Protein 70 (HSP70) had been used to prevent damage to the oocyte after freezing. ITS and HSP70 could cause the difference protective effect. The aim of this research was to obtain an effective cryoprotectant for freezing local goat oocyte in cumulus cells change. The research began by collecting the ovary from a local slaughterhouse in Indonesia, aspiration follicle, in vitro maturation and the freezing had been used vitrification method. Examination of the morphology cells by native staining method. Data on the calculation morphology oocyte analyzed by Kruskall-Wallis Test. After the Kruskall-Wallis Test which indicated significance, followed by Mann-Whitney Test to compare between treatment groups. As a result, cryoprotectant ITS has the best culumus cells after warming

Keywords: Insulin Transferrin Selenium, Heat Shock Protein 70, cryoprotectant, vitrification

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Authors: Inaam Khalaf, Nadin M. Abdel Razeq, Hamza Alduraidi, Suhaila Halasa, Omayyah S. Nassar, Eman Al-Horani, Jumana Shehadeh, Anna Talal

Abstract:

Background: Nursing researchers are responsible for generating knowledge that corresponds to national and global research priorities in order to promote, restore, and maintain the health of individuals and societies. The objectives of this scoping review of Jordanian literature are to assess the existing research on pediatric nursing in terms of evolution, authorship and collaborations, funding sources, methodologies, topics of research, and pediatric subjects' age groups so as to identify gaps in research. Methodology: A search was conducted using related keywords obtained from national and international databases. The reviewed literature included pediatric health articles published through December 2019 in English and Arabic, authored by nursing researchers. The investigators assessed the retrieved studies and extracted data using a data-mining checklist. Results: The review included 265 articles authored by Jordanian nursing researchers concerning children's health, published between 1987 and 2019; 95% were published between 2009 and 2019. The most commonly applied research methodology was the descriptive non-experimental method (76%). The main generic topics were health promotion and disease prevention (23%), chronic physical conditions (19%), mental health, behavioral disorders, and forensic issues (16%). Conclusion: The review findings identified a grave shortage of evidence concerning nursing care issues for children below five years of age, especially those between ages two and five years. The research priorities identified in this review resonate with those identified in international reports. Implications: Nursing researchers are encouraged to conduct more research targeting topics of national-level importance in collaboration with clinically involved nurses and international scholars.

Keywords: Jordan, scoping review, children health nursing, pediatric, adolescents

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Authors: Bahram Fathi, Karim Alizadeh, Azam Mohammadbagheri

Abstract:

The aim of this paper is to investigate the role of oil price shocks in explaining business cycles in Iran using a dynamic stochastic general equilibrium approach. This model incorporates both productivity and oil revenue shocks. The results indicate that productivity shocks are relatively more important to business cycles than oil shocks. The model with two shocks produces different values for volatility, but these values have the same ranking as that of the actual data for most variables. In addition, the actual data are close to the ratio of standard deviations to the output obtained from the model with two shocks. The results indicate that productivity shocks are relatively more important to business cycles than the oil shocks. The model with only a productivity shock produces the most similar figures in term of volatility magnitude to that of the actual data. Next, we use the Impulse Response Functions (IRF) to evaluate the capability of the model. The IRF shows no effect of an oil shock on the capital stocks and on labor hours, which is a feature of the model. When the log-linearized system of equations is solved numerically, investment and labor hours were not found to be functions of the oil shock. This research recommends using different techniques to compare the model’s robustness. One method by which to do this is to have all decision variables as a function of the oil shock by inducing the stationary to the model differently. Another method is to impose a bond adjustment cost. This study intends to fill that gap. To achieve this objective, we derive a DSGE model that allows for the world oil price and productivity shocks. Second, we calibrate the model to the Iran economy. Next, we compare the moments from the theoretical model with both single and multiple shocks with that obtained from the actual data to see the extent to which business cycles in Iran can be explained by total oil revenue shock. Then, we use an impulse response function to evaluate the role of world oil price shocks. Finally, I present implications of the findings and interpretations in accordance with economic theory.

Keywords: oil price, shocks, dynamic stochastic general equilibrium, Iran

Procedia PDF Downloads 439

Authors: Mariam G. Eshak, Ahmed Abbas, M. I. El-Sabry, M. M. Mashaly

Abstract:

This investigation was conducted to determine the physiological response and evaluate the expression of inflammatory and cell death genes and DNA damage induced by endotoxic shock in laying hens. Endotoxic shock was induced by a single intravenous injection of 107 Escherichia coli (E. coli,) colony/hen. In the present study, 240 forty-week-old laying hens (H&N) were randomly assigned into 2 groups with 3 replicates of 40 birds each. Hens were reared in battery cages with wire floors in an open-sided housing system under natural conditions. Housing and general management practices were similar for all groups. At 42-wk of age, 45 hens from the first group (15 replicate) were infected with E. coli, while the same number of hens from the second group was injected with saline and served as a control. Heat shock protein-70 (HSP-70) expression, plasma corticosterone concentration, body temperature, and the gene expression of bax, caspase-3 activity, P38, Interlukin-1β (Il-1β), and tumor necrosis factor alpha (TNF-α) genes and DNA damage in the brain and liver were measured. Hens treated with E. coli showed significant (P≤0.05) increase of body temperature by 1.2 ᴼC and plasma corticosterone by 3 folds compared to the controls. Further, hens injected with E.Coli showed markedly over-expression of HSP-70 and increase DNA damage in brain and liver. These results were synchronized with activating cell death program since our data showed significant (P≤0.05) high expression of bax and caspase-3 activity genes in the brain and liver. These results were related to remarkable over-inflammation gene expression of P38, IL-1β, and TNF-α in brain and liver. In conclusion, our results indicate that endotoxic shock induces inflammatory physiological response and triggers cell death program by promoting P38, IL-1β, and TNF-α gene expression in the brain and liver.

Keywords: chicken, DNA damage, Escherichia coli, gene expression, inflammation

Procedia PDF Downloads 347

Authors: T. Mcgraw, F. N. Morin, N. Desai

Abstract:

Background: Antimicrobial resistance is a critical issue in global health care and a significant contributor to increased patient morbidity and mortality. Suspected urinary tract infection (UTI) is a key area of inappropriate antibiotic prescription in pediatrics. Management patterns of infectious diseases have been shown to vary by provider type within a single setting. The aim of this study was to assess compliance with national UTI management guidelines by nurse practitioners in a pediatric emergency department (ED). Methods: This was a post-hoc analysis of a retrospective cohort study to review and evaluate visits to a tertiary care freestanding pediatric emergency department. Patients were included if they were 60 days to 36 months old and discharged with a diagnosis of UTI or ‘rule-out UTI’ between July 2015 and July 2020. Primary outcome measure was proportion of visits seen by Nurse Practitioners (NP) which were associated with national guideline compliance in the diagnosis and treatment of suspected UTI. We performed descriptive statistics and comparative analyses to determine differences in practice patterns between NPs, and physicians. Results: A total of 636 charts were reviewed, of which 402 patients met inclusion criteria. 17 patients were treated by NPs, 385 were treated by either Pediatric Emergency Medicine physicians (PEM) or non-PEM physicians. Overall, the proportion of infants receiving guideline-compliant care was 25.9% (21.8-30.4%). Of those who were prescribed antibiotics, 79.6% (74.7-83.8%) received first line guideline recommended therapy and 58.9% (53.8-63.8%) received fully compliant therapy with respect to age, dose, duration, and frequency. In patients treated by NPs, 16/17 (94%(95% CI:73.0-99.0)) required antibiotics, 15/16 (93%(95% CI: 71.7-98.9)) were treated with first line agent (cephalexin), 8/16 (50%(95% CI:28-72)) were guideline compliant of dose and duration. 5/8 (63%(95% CI:30.6-86.3)) were noncompliant for dose being too high. There was no difference in receiving guideline compliant empiric antibiotic therapy between physicians and nurse practitioners (OR: 0.837 CI: 0.302-2.69). Conclusion: In this post-hoc analysis, guideline noncompliance by nurse practitioners is common in children tested and treated for UTIs in a pediatric emergency department. Care by a Nurse Practitioner was not associated with greater rate of noncompliance than care by a Pediatric Emergency Medicine physician. Future appropriately powered studies may focus on confirming these results.

Keywords: antibiotic stewardship, infectious disease, nurse practitioner, urinary tract infection

Procedia PDF Downloads 105

Authors: Lily Parm, Irma Nool, Liina Männiksaar, Mare Tupits, Ivi Prits, Merilin Kuhi, Valentina Raudsepp

Abstract:

Background: The results of previous clinical satisfaction surveys show that nursing students swhounderw entinternships in the pediatricwardhadthelowestsatisfactioncomparedtootherwards, but the quality of students' practicaltrainingexperienceisanimportant determinant in nursing education. The aim of theresearchwastodescribenursingstudents` assessment to the clinical learning environment and supervision in pediatric wards Method: Theresearchisquantitative. All studentswhohadpracticaltraining in the pediatric ward participated in the study (N = 39). FordatacollectionClinicalLearningEnvironment, Supervision, and NurseTeacher (CLES + T) evaluationscalewasused, wherethescalewasanswered on a 5-point Likert scale. In addition, 10 backgroundvariableswereused in the questionnaire. IBM SPSS Statistics 28.0 wasusedfordataanalysis. Descriptive statistics and Spearmanncorrelationanalysiswasusedtofindcorrelatinsbetweenbackgroundvariables and satisfaction with supervision.Permissiontoconductthestudy (No 695) hasbeenobtainedbytheEthicsCommittee of theInstituteforHealthDevelopment. Results: Of therespondents, 28 (71.8%) werefirst-year, 9 (23.1%) second-year and 2 (5.1%) fourth-yearstudents. Thelargestshare of the last practicaltrainigwas in nursing, with 27 (69.2%) respondents. Mainlythementorswerenursesfor 32 (82,1%) of students.Satisfactionwiththementoring (4.4 ± 0.83) and wardnursemanager`sleaderhiostyle (4.4 ± 0.7), ratedthehighest and therole of thenurseteacherwasratedthelowest (3,7 ± 0.83.In Spearmann'scorrelationanalysis, therewas a statisticallystrongcorrelationbetween a positiveattitudetowardsthesupervisor'ssupervision and receivingfeedbackfromthesupervisor (r =0.755; p <0.001), studentsatisfactionwithsupervision (r = 0.742; p <0.001), supervisionbased on cooperation (r = 0.77) and instructionbased on theprinciple of equalitythatpromotedlearning (r = 0.755; p <0.001). Conclusions: Theresults of theresearchshowedhighsatisfactionwiththesupervisionand therole of wardmanager. Stillbettercooperationisneededbetweenpracticalplacement and nursingschooltoenhancethestudents`satisfactionwithsupervision.

Keywords: CLES+T, clinical environment, nurse teacher, statisfaction, pediatric ward, mentorship

Procedia PDF Downloads 219