Search results for: common mesenteric vein

Authors: Sukryool Kang, James McConnaughey, Robin Doroshow, Raj Shekhar

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Still’s murmur, a vibratory heart murmur, is the most common normal innocent murmur of childhood. Many children with this murmur are unnecessarily referred for cardiology consultation and testing, which exacts a high cost financially and emotionally on the patients and their parents. Pediatricians to date are not successful at distinguishing Still’s murmur from murmurs of true heart disease. In this paper, we present a new algorithmic approach to distinguish Still’s murmur from pathological murmurs in children. We propose two distinct features, spectral width and signal power, which describe the sharpness of the spectrum and the signal intensity of the murmur, respectively. Seventy pediatric heart sound recordings of 41 Still’s and 29 pathological murmurs were used to develop and evaluate our algorithm that achieved a true positive rate of 97% and false positive rate of 0%. This approach would meet clinical standards in recognizing Still’s murmur.

Keywords: AR modeling, auscultation, heart murmurs, Still's murmur

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Authors: Nicolas Zufferey

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Ant algorithms are well-known metaheuristics which have been widely used since two decades. In most of the literature, an ant is a constructive heuristic able to build a solution from scratch. However, other types of ant algorithms have recently emerged: the discussion is thus not limited by the common framework of the constructive ant algorithms. Generally, at each generation of an ant algorithm, each ant builds a solution step by step by adding an element to it. Each choice is based on the greedy force (also called the visibility, the short term profit or the heuristic information) and the trail system (central memory which collects historical information of the search process). Usually, all the ants of the population have the same characteristics and behaviors. In contrast in this paper, a new type of ant metaheuristic is proposed, namely SMART (for Solution Methods with Ants Running by Types). It relies on the use of different population of ants, where each population has its own personality.

Keywords: ant algorithms, evolutionary procedures, metaheuristics, optimization, population-based methods

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Authors: Rebin Kamal Hama Gharib

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This research paper aims to identify the common and current problems and challenges faced by refugees and internally displaced persons (IDPs) in Iraq. The objective of this research is to highlight the urgent need for policy measures and support to address these issues. The research methodology includes a review of academic literature, government reports, and data collected by international organizations such as the United Nations High Commissioner for Refugees (UNHCR) and the International Organization for Migration (IOM). The main contribution of this research is to provide a comprehensive overview of the challenges faced by refugees and IDPs in Iraq, including their legal status, access to basic services, economic opportunities, and social integration.

Keywords: efugees, internally displaced persons, Iraq, challenges, policy measures

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Authors: Bilal Orfali

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It is common practice in modern times to read mystical poetry and apply it to our mundane lives and loves. Sufis in the early period did the opposite. Their mystical hymns often spun out of the courtly poetic ghazal, panegyric, and wine songs. This paper highlights the relation of the Arabic courtly poetic canon to early Sufism. Sufi akhbār and poetry evoke past poets and their poetic heritage. They tend to quote or refer to eminent poets whose poetry must have been widely circulated and memorized. However, Sufism places this readily recognizable poetry in a new context that deliberately changes the past. It is a process of a metaphorization in which the reality of the pre-Islamic, Umayyad, and Abbasid models now acts as a device or metaphor for the Sufi poetics.

Keywords: Sufism, Arabic poetry, literature, Islamic literature, Abbasid

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Authors: Kyungbong Kim

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This study proposed to compare and analyse the five stages of cultivating the Yogâcāra path and the spiritual journey in the Ten Ox-Herding Pictures. To achieve this, the study investigated the core concepts and practice methods of the two approaches and analysed their relations from the literature reviewed. The results showed that the end goal of the two approaches is the same, the attainment of Buddhahood, with the two having common characteristics including the practice of being aware of the impermanent and non-self, and the fulfilling benefit of sentient beings. The results suggest that our Buddhist practice system needs to sincerely consider the realistic ways by which one can help people in agony in contemporary society, not by emphasizing on the enlightenment through a specific practice way for all people, but by tailored practice methods based on each one's faculties in understanding Buddhism.

Keywords: transformation of consciousness to wisdom, enlightenment, the five stages of cultivating the Yogacāra path, the Ten Ox-Herding Pictures, transformation of the basis

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Authors: Xiaohua Jing

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Efficient extraction for separation of V and Cr in the leaching/aqueous solution is essential to the reuse of V and Cr in the V-Cr slag. Trioctylamine, a common tertiary amine extractant, with some good characters (e.g., weak base, insoluble in water and good stability) different from N1923, was investigated in this paper. The separation factor of Cr and V can be reached to 230.71 when initial pH of the aqueous solution is 0.5, so trioctylamine can be used for extracting Cr from the leaching/aqueous solution contained V and Cr. The highest extraction percentages of Cr and V were 98.73% and 90.22% when the initial pH values were 0.5 and 1.5, respectively. Via FT-IR spectra of loaded organic phase and trioctylamine, the hydrogen bond association mechanism of extracting V and Cr was investigated, which was the same with the way of extracting the two metals with primary amine N1923.

Keywords: selective extraction, trioctylamine, V and Cr, separation factor, hydrogen bond association

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Authors: Chek Kim Loi

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The study attempts to undertake an error analysis of prepositions employed in the written work of Form 4 Malay ESL (English as a Second Language) students in Malaysia. The error analysis is undertaken using Richards’s (1974) framework of intralingual and interlingual errors and Bennett’s (1975) framework in identifying prepositional concepts found in the sample. The study first identifies common prepositional errors in the written texts of 150 student participants. It then measures the relative intensities of these errors and finds out the possible causes for the occurrences of these errors. In this study, one significant finding is that among the nine concepts of prepositions examined, the participant students tended to make errors in the use of prepositions of time and place. The present study has pedagogical implications in teaching English prepositions to Malay ESL students.

Keywords: error, interlingual, intralingual, preposition

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Authors: Mehrdad Nouri Khajavi, Gollamhassan Payganeh, Mohsen Fallah Tafti

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Fault diagnosis is an important aspect of maintaining rotating machinery health and increasing productivity. Many researches has been done in this regards. Many faults such as unbalance, misalignment, looseness, bearing faults, etc. have been considered and diagnosed with different techniques. Most of the researches in fault diagnosis of rotating machinery deal with single fault. Where as in reality faults usually occur simultaneously and it is, therefore, necessary to recognize them at the same time. In this research, two of the most common faults namely unbalance and misalignment have been considered simultaneously with different intensity and then identified and classified with the use of Multi-Layer Perception Neural Network (MLPNN). Processed Vibration signals are used as the input to the MLPNN, and the class of mixed unbalancy, and misalignment is the output of the NN.

Keywords: unbalance, parallel misalignment, combined faults, vibration signals

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Authors: Mohammed Farag, Mina Attari, S. Andrew Gadsden, Saeid R. Habibi

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Battery state of charge (SOC) estimation is an important parameter as it measures the total amount of electrical energy stored at a current time. The SOC percentage acts as a fuel gauge if it is compared with a conventional vehicle. Estimating the SOC is, therefore, essential for monitoring the amount of useful life remaining in the battery system. This paper looks at the implementation of three nonlinear estimation strategies for Li-Ion battery SOC estimation. One of the most common behavioral battery models is the one state hysteresis (OSH) model. The extended Kalman filter (EKF), the smooth variable structure filter (SVSF), and the time-varying smoothing boundary layer SVSF are applied on this model, and the results are compared.

Keywords: state of charge estimation, battery modeling, one-state hysteresis, filtering and estimation

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Authors: Tzu-Jung Huang, Hsun-Jung Cho, Chien-Chia Liäm Huang

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To improve the level of service (LoS) of urban arterial systems containing a series of signalized intersections, a proper design of offsets for all intersections associated is of great importance. The MAXBAND model has been the most common approach for this purpose. In this paper, we propose a MAXBAND model with phase constraints so that the lengths of the phases in a cycle are variable. In other words, the length of a cycle is also variable in our setting. We conduct experiments on a real-world traffic network, having several major paths, in Taiwan for numerical evaluations. Actual traffic data were collected through on-site experiments. Numerical evidences suggest that the improvements are around 32%, on average, in terms of total delay of the entire network.

Keywords: arterial progression, MAXBAND, signal control, offset

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Authors: Jian-Jun Shu

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It is common knowledge that many physical problems (such as non-linear shallow-water waves and wave motion in plasmas) can be described by the Korteweg-de Vries (KdV) equation, which possesses certain special solutions, known as solitary waves or solitons. As a marriage of the KdV equation and the classical Burgers (KdVB) equation, the Korteweg-de Vries-Burgers (KdVB) equation is a mathematical model of waves on shallow water surfaces in the presence of viscous dissipation. Asymptotic analysis is a method of describing limiting behavior and is a key tool for exploring the differential equations which arise in the mathematical modeling of real-world phenomena. By using variable transformations, the asymptotic expansion of the KdVB equation is presented in this paper. The asymptotic expansion may provide a good gauge on the validation of the corresponding numerical scheme.

Keywords: asymptotic expansion, differential equation, Korteweg-de Vries-Burgers (KdVB) equation, soliton

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Authors: Najmehossadat Enjoo

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Beautification means all mindfully measurements to improve quality of urban environment which makes the city more suitable for its inhabitants' life. Purpose of beautification is to provide an environment in which all citizens take pleasure. Beautification aims at urban environment's quality improvement. In space among buildings and constructions some supplementary elements are required to furnish urban life; equipment like house furniture makes life possible in a space surrounded with stones, concrete, and glass. Such elements regulate the flow of movement, rest, recreation and stress in a city and exhilarate it. Urban furniture is the common term used for such facilities and capabilities. Nowadays, experience and application of urban elements have proved that to what extent using proper equipment and furniture can positively affect the citizens and users of urban environments.

Keywords: urban servitudes, urban design, urban furniture, visage of city

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Authors: Gil Soriano, Aubreyrose Casilang

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Soil-transmitted helminth infection remains to be one of the leading public health problem worldwide, which is common in the rural developing regions especially among children. This study aimed to detect the presence of soil transmitted helminths among children and its associated transmission factors. Descriptive cross sectional research was the design used in the study and questionnaires were administered. Stool samples were collected among the samples (n=108) and were analyzed using kato thick method. Results showed that 61 out of 108 respondents are infected by soil transmitted helminth infection with A. lumbricoides the highest, followed by hookworm and T. trichuria. Parent's educational attainment, hand washing practices, and water sources were found to be associated with presence of Soil Transmitted Helminth infection.

Keywords: associated risk factors, barangay, school children, soil transmitted helminth infection

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Authors: Peihao Huang, Chun Zhao

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Thin-film transistors(TFTs) have the advantages of low power consumption, short reaction time, and have high research value in the field of semiconductors, based on this reason, people have focused on gallium oxide-indium oxide thin-film transistors, a relatively common thin-film transistor, elaborated and analyzed his production process, "aqueous solution method", explained the purpose of each step of operation, and finally explored the influence of potassium ions doped in the channel layer on the electrical properties of the device, as well as the effect of oxygen vacancies on its switching ratio and memory, and summarized the conclusions.

Keywords: aqueous solution, oxygen vacancies, switch ratio, thin-film transistor(TFT)

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Authors: Haidy Weliam Megaly Gouda

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Dermatology is often a neglected specialty in low-resource settings despite the high morbidity associated with skin disease. This becomes even more significant when associated with HIV infection, as dermatological conditions are more common and aggressive in HIV-positive patients. African countries have the highest HIV infection rates, and skin conditions are frequently misdiagnosed and mismanaged because of a lack of dermatological training and educational material. The frequent lack of diagnostic tests in the African setting renders basic clinical skills all the more vital. This project aimed to improve the diagnosis and treatment of skin disease in the HIV population in a district hospital in Malawi. A basic dermatological clinical tool was developed and produced in collaboration with local staff and based on available literature and data collected from clinics. The aim was to improve diagnostic accuracy and provide guidance for the treatment of skin disease in HIV-positive patients. A literature search within Embassy, Medline and Google Scholar was performed and supplemented through data obtained from attending 5 Antiretroviral clinics. From the literature, conditions were selected for inclusion in the resource if they were described as specific, more prevalent, or extensive in the HIV population or have more adverse outcomes if they develop in HIV patients. Resource-appropriate treatment options were decided using Malawian Ministry of Health guidelines and textbooks specific to African dermatology. After the collection of data and discussion with local clinical and pharmacy staff, a list of 15 skin conditions was included, and a booklet was created using the simple layout of a picture, a diagnostic description of the disease and treatment options. Clinical photographs were collected from local clinics (with full consent of the patient) or from the book ‘Common Skin Diseases in Africa’ (permission granted if fully acknowledged and used in a not-for-profit capacity). This tool was evaluated by the local staff alongside an educational teaching session on skin disease. This project aimed to reduce uncertainty in diagnosis and provide guidance for appropriate treatment in HIV patients by gathering information into one practical and manageable resource. To further this project, we hope to review the effectiveness of the tool in practice.

Keywords: prevalence and pattern of skin diseases, impact on quality of life, rural Nepal, interventions, quality switched ruby laser, skin color river blindness, clinical signs, circularity index, grey level run length matrix, grey level co-occurrence matrix, local binary pattern, object detection, ring detection, shape identification

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Authors: Aydin Azizi, Ahmed Al. Azizi

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Mechanical seals are essential components in centrifugal pumps since they help in controlling leaking out of the liquid that is pumped under pressure. Unlike the common types of packaging, mechanical seals are highly efficient and they reduce leakage by a great extent. However, all multiphase mechanical seals leak and they are subject to failure. Some of the factors that have been recognized to their failure include excessive heating, open seal faces, as well as environment related factors that trigger failure of the materials used to manufacture seals. The proposed research study will explore the failure of multiphase mechanical seal in centrifugal pumps. The objective of the study includes how to reduce the failure in multiphase mechanical seals and to make them more efficient.

Keywords: mechanical seals, centrifugal pumps, multi phase failure, excessive heating

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Authors: E. H. N. Gashti, J. Razzaghi, K. Kujala

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In general, codes and regulations consider seismic loads only for completed structures of the bridges while, evaluation of incomplete structure of bridges, especially those constructed by free cantilever method, under these loads is also of great importance. Hence, this research tried to study the behavior of incomplete structure of common bridge type (box girder bridge), in construction phase under vertical seismic loads. Subsequently, the paper provided suitable guidelines and solutions to withstand this destructive phenomena. Research results proved that use of preventive methods can significantly reduce the stresses resulted from vertical seismic loads in box cross sections to an acceptable range recommended by design codes.

Keywords: box girder bridges, prestress loads, free cantilever method, seismic loads, construction phase

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

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

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

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Authors: M. Habab, C. Benachaiba, B. Mazari, H. Madi, C. Benoudjafer

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The use of Distributed Generation (DG) has been increasing in recent years to fill the gap between energy supply and demand. This paper presents the grid connected wind energy system with UPQC based on fuzzy controller to compensate for voltage and current disturbances. The proposed system can improve power quality at the point of installation on power distribution systems. Simulation results show the capability of the DG-UPQC intelligent system to compensate sags voltage and current harmonics at the Point of Common Coupling (PCC).

Keywords: shunt active filter, series active filter, UPQC, power quality, sags voltage, distributed generation, wind turbine

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Authors: R. A. Qawasma, F. M. Haddad, H. O. Salhab

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Hemodialysis is a life-preserving treatment for a number of patients with kidney failure. The standard procedure of hemodialysis is three times a week during the hemodialysis procedure, the patient usually suffering from many inconvenient, exhausting feeling and effect on the heart and cardiovascular system are the most common signs. This paper provides a solution to reduce the previous problems by designing a wearable artificial kidney (WAK) taking in consideration a minimization the size of the dialysis machine. The WAK system consists of two circuits: blood circuit and dialysate circuit. The blood from the patient is filtered in the dialyzer before returning back to the patient. Several parameters using an advanced microcontroller and array of sensors. WAK equipped with visible and audible alarm system to aware the patients if there is any problem.

Keywords: artificial kidney, home dialysis, renal failure, wearable kidney

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Authors: Raghul Vignesh Kumar, M. Vadivel

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With the recent years many industries and companies have turned their attention in realizing how going 'green' can benefit public relations, lower cost, and reduce global emissions from industrial manufacturing. Green Computing has become an originative way on how technology and ecology converge together. It is a growing import subject that creates an urgent need to train next generation computer scientists or practitioners to think ‘green’. However, green computing has not yet been well taught in computer science or computer engineering courses as a subject. In this modern IT world it’s impossible for an organization or common man to work without hardware like servers, desktop, IT devices, smartphones etc. But it is also important to consider the harmful impact of those devices and steps to achieve energy saving and environmental protection. This paper presents the magnitude of green computing and steps to be followed to go green.

Keywords: green computing, carbon-dioxide, greenhouse gas, energy saving, environmental protection agency

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Authors: Kim Kennedy, Daren Gibson, Stephanie Flukes, Chandra Diwakarla, Lisa Spalding, Leanne Pilkington, Andrew Redfern

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Introduction: Head and neck cancer and treatments are known for their profound effect on nutrition and tube feeding is a common requirement to maintain nutrition. Aim: We aimed to evaluate the frequency of tube feeding in Aboriginal and non-Aboriginal patients, and to examine the relapse and survival outcomes in patients who require enteral tube feeding. Methods: We performed a retrospective cohort analysis of 320 head and neck cancer patients from a single centre in Western Australia, identifying 80 Aboriginal patients and 240 non-Aboriginal patients matched on a 1:3 ratio by site, histology, rurality, and age. Data collected included patient demographics, tumour features, treatment details, and cancer and survival outcomes. Results: Aboriginal and non-Aboriginal patients required feeding tubes at similar rates (42.5% vs 46.2% respectively), however Aboriginal patients were far more likely to fail to return to oral nutrition, with 26.3% requiring long-term tube feeding versus only 15% of non-Aboriginal patients. In the overall study population, 27.5% required short-term tube feeding, 17.8% required long-term enteral tube nutrition, and 45.3% of patients did not have a feeding tube at any point. Relapse was more common in patients who required tube feeding, with relapses in 42.1% of the patients requiring long-term tube feeding, 31.8% in those requiring a short-term tube, versus 18.9% in the ‘no tube’ group. Survival outcomes for patients who required a long-term tube were also significantly poorer when compared to patients who only required a short-term tube, or not at all. Long-term tube-requiring patients were half as likely to survive (29.8%) compared to patients requiring a short-term tube (62.5%) or no tube at all (63.5%). Patients requiring a long-term tube were twice as likely to die with active disease (59.6%) as patients with no tube (28%), or a short term tube (33%). This may suggest an increased relapse risk in patients who require long-term feeding, due to consequences of malnutrition on cancer and treatment outcomes, although may simply reflect that patients with recurrent disease were more likely to have longer-term swallowing dysfunction due to recurrent disease and salvage treatments. Interestingly long-term tube patients were also more likely to die with no active disease (10.5%) (compared with short-term tube requiring patients (4.6%), or patients with no tube (8%)), which is likely reflective of the increased mortality associated with long-term aspiration and malnutrition issues. Conclusions: Requirement for tube feeding was associated with a higher rate of cancer relapse, and in particular, long-term tube feeding was associated with a higher likelihood of dying from head and neck cancer, but also a higher risk of dying from other causes without cancer relapse. This data reflects the complex effect of head and neck cancer and its treatments on swallowing and nutrition, and ultimately, the effects of malnutrition, swallowing dysfunction, and aspiration on overall cancer and survival outcomes. Tube feeding was seen at similar rates in Aboriginal and non-Aboriginal patient, however failure to return to oral intake with a requirement for a long-term feeding tube was seen far more commonly in the Aboriginal population.

Keywords: head and neck cancer, enteral tube feeding, malnutrition, survival, relapse, aboriginal patients

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Authors: Paul B Stone, Subhashini Ganapathy, Mary E. Fendley, Layla Akilan

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As notifications become more common through mobile devices, it is important to understand the impact of wearable devices on the improved user experience of man-machine interfaces. This study examined the use of a wearable device for a real-time system using a computer-simulated petrochemical system. The key research question was to determine how using the information provided by the wearable device can improve human performance through measures of situational awareness and decision making. Results indicate that there was a reduction in response time when using the watch, and there was no difference in situational awareness. Perception of using the watch was positive, with 83% of users finding value in using the watch and receiving haptic feedback.

Keywords: computer applications, haptic feedback, petrochemical systems, situational awareness, wearable technology

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Authors: Ewelina Nowak, Anna Wisla-Swider

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Deoxyribonucleic acid (DNA) is a biomolecule which exhibits an electro-optic properties. These features are related with structure of double-stranded helix. Modification of DNA with ionic liquids allows intensify these properties. The aim of our study was synthesis of ionic liquids that are used the formation of DNA-surfactant complexes in order to obtain new materials with potential application for nonlinear optics. Complexes were achieved through the ion exchange reactions of carbazole-based and imidazole-based ionic liquids with H+ ions from salmon DNA. To examination the properties of obtained complexes DNA-ionic liquids there were investigated using circular dichroism (CD), UV-Vis spectra and infrared spectroscopy (IR). Additionally, the resulting DNA-surfactant complexes were characterized in terms of solubility in common organic solvents and water.

Keywords: deoxyribonucleic acid, biomolecule, carbazole, imidazole, ionic liquids, ion exchange reactions

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Authors: Tugba Ayas Onol

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The paper revisits Jean-François Lyotard’s interpretation of the Kantian Sublime as a tool for understanding politics after modernity. In 1985 Lyotard announces the end of rational politics based on consensus and claims that new strategies are urged to recognize the political imperatives of marginalized groups. The charm of the sublime as a reflective judgment is grounded on the fact that the judgment of sublime is free from any notion of consensus or common sense in particular. Lyotard interprets this feature of the sublime as a respect for heterogeneity and for him aesthetic judgments can be a model for understanding justice in postmodern times, in which it seems hard to follow a single universal law among different phrase regimes. More importantly, the Kantian sublime speaks to what Lyotard addresses as the incommensurability of phase genres. The present paper shall try to evaluate Lyotard’s employment of the Kantian notion of the sublime in relation to its possible political import.

Keywords: Kant, Lyotard, sublime, politics

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Authors: Krishna Prasad Regmi, Jun-Bo Tu, Cheng-Qun Hou, Li-Feng Li

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Maxillofacial trauma in a pediatric group of patients is particularly challenging, as these patients have significant differences from adults as far as the facial skeleton is concerned. Mandibular condylar fractures are common presentations to hospitals across the globe and remain the most important cause of temporomandibular joint (TMJ) ankylosis. The etiology and epidemiology of pediatric trauma involving the diacapitular condylar fractures (DFs) have been reported in a large series of patients. Nevertheless, little is known about treatment protocols for DFs in children. Accordingly, the treatment modalities for the management of pediatric fractures also differ. We suggest following the PDA and intracapsular ABC classification of condylar fracture to increase the overall postoperative satisfaction level that bypasses the change of subjective feelings of patients’ from preoperative to the postoperative condition. At the same time, use of 3-D technology and surgical navigation may also increase treatment accuracy.

Keywords: maxillofacial trauma, diacapitular fracture, condylar fracture, PDA classification

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Authors: Manel Youssef, Lotfi Belkacem

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This paper employs multivariate long memory GARCH models to simultaneously estimate mean and conditional variance spillover effects between oil prices and different financial markets. Since different financial assets are traded based on these market sector returns, it’s important for financial market participants to understand the volatility transmission mechanism over time and across these series in order to make optimal portfolio allocation decisions. We examine weekly returns from January 1, 2003 to November 30, 2012 and find evidence of significant transmission of shocks and volatilities between oil prices and some of the examined financial markets. The findings support the idea of cross-market hedging and sharing of common information by investors.

Keywords: oil prices, stock indices returns, oil volatility, contagion, DCC-multivariate (FI) GARCH

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Authors: Malab Sana Balouch, Meenakshi Nayar

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Hemispatial Neglect is a common disorder primarily associated with right hemispheric stroke, in the acute phase of which it can occur up to 82% of the time. Such individuals fail to acknowledge or respond to people and objects in their left field of vision due to deficits in attention and awareness. Persistent hemispatial neglect significantly impedes post-stroke recovery, leading to longer hospital stays post-stroke, increased functional dependency, longer-term disability in ADLs and increased risk of falls. Recently, evidence has emerged for the use of dopamine agonist Rotigotine in neglect. The aim of our Quality Improvement Project (QIP) is to evaluate and better the current protocols and practice in assessment, documentation and management of neglect and rotigotine use at the Neurorehabilitation unit at Charing Cross Hospital (CNRU). In addition, it brings light to rotigotine use in the management of hemispatial neglect and paves the way for future research in the field. Our QIP was based in the CNRU. All patients admitted to the CNRU suffering from a right-sided stroke from 2nd of February 2018 to the 2nd of February 2021 were included in the project. Each patient’s multidisciplinary team report and hospital notes were searched for information, including bio-data, fulfilment of the inclusion criteria (having hemispatial neglect) and data related to rotigotine use. This includes whether or not the drug was administered, any contraindications to drug in patients that did not receive it, and any therapeutic benefits(subjective or objective improvement in neglect) in those that did receive the rotigotine. Data was simultaneously entered into excel sheet and further statistical analysis was done on SPSS 20.0. Out of 80 patients suffering from right sided strokes, 72.5% were infarcts and 27.5% were hemorrhagic strokes, with vast majority of both types of strokes were in the middle cerebral artery territory (MCA). A total of 31 (38.8%) of our patients were noted to have hemispatial neglect, with the highest number of cases being associated with MCA strokes. Almost half of our patients with MCA strokes suffered from neglect. Neglect was more common in male patients. Out of the 31 patients suffering from visuospatial neglect, only 16% actually received rotigotine and 80% of them were noted to have an objective improvement in their neglect tests and 20% revealed subjective improvement. After thoroughly going through neglect-associated documentation, the following recommendations/plans were put in place for the future. We plan to liaise with the occupational therapy team at our rehab unit to set a battery of tests that would be done on all patients presenting with neglect and recommend clear documentation of outcomes of each neglect screen under it. Also to create two proformas; one for the therapy team to aid in systematic documentation of neglect screens done prior to and after rotigotine administration and a second proforma for the medical team with clear documentation of rotigotine use, its benefits and any contraindications if not administered.

Keywords: hemispatial Neglect, right hemispheric stroke, rotigotine, neglect, dopamine agonist

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Authors: Ju-Chun Chien

Abstract:

Rapid aging and depopulation could lead to serious problems, including workforce shortages and health expenditure costs. The current and predicted future LTC workforce shortages could be a real threat to Taiwan’s society. By means of comparison of data from 144 nursing aide trainees and 727 general public, the main purpose of the present study was to determine whether there were any notable differences between the two groups toward engaging in LTC services. Moreover, this study focused on recognizing the attributes of the general public who had the willingness to take LTC jobs but continue to ride the fence. A self-developed questionnaire was designed based on Ajzen’s Theory of Planned Behavior model. After conducting exploratory factor analysis (EFA) and reliability analysis, the questionnaire was a reliable and valid instrument for both nursing aide trainees and the general public. The main results were as follows: Firstly, nearly 70% of nursing aide trainees showed interest in LTC jobs. Most of them were middle-aged female (M = 46.85, SD = 9.31), had a high school diploma or lower, had unrelated work experience in healthcare, and were mostly unemployed. The most common reason for attending the LTC training program was to gain skills in a particular field. The second most common reason was to obtain the license. The third and fourth reasons were to be interested in caring for people and to increase income. The three major reasons that might push them to leave LTC jobs were physical exhaustion, payment is bad, and being looked down on. Secondly, the variables that best-predicted nursing aide trainees’ intention to engage in LTC services were having personal willingness, perceived behavior control, with high school diploma or lower, and supported from family and friends. Finally, only 11.80% of the general public reported having interest in LTC jobs (the disapproval rating was 50% for the general public). In comparison to nursing aide trainees who showed interest in LTC settings, 64.8% of the new workforce for LTC among the general public was male and had an associate degree, 54.8% had relevant healthcare experience, 67.1% was currently employed, and they were younger (M = 32.19, SD = 13.19) and unmarried (66.3%). Furthermore, the most commonly reason for the new workforce to engage in LTC jobs were to gain skills in a particular field. The second priority was to be interested in caring for people. The third and fourth most reasons were to give back to society and to increase income, respectively. The top five most commonly reasons for the new workforce to quitting LTC jobs were listed as follows: physical exhaustion, being looked down on, excessive working hours, payment is bad, and excessive job stress.

Keywords: long-term care services, nursing aide trainees, Taiwanese people, theory of planned behavior

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Authors: Birendra Kumar Bista, Rhitik Bista, Prafulla Koirala, Lokendra Mandal, Nikrsh Raj Shrestha, Vivek Kattel

Abstract:

Introduction: Poorly controlled diabetes is associated with cause and poor outcome of stroke. High blood sugar reduces cerebral blood flow, increases intracranial pressure, cerebral edema and neuronal death, especially among patients with poorly controlled diabetes.1 SGLT2 inhibitors are associated with 50% reduction in hemorrhagic stroke compared with placebo. SGLT2 inhibitors decrease cardiovascular events via reducing glucose, blood pressure, weight, arteriosclerosis, albuminuria and reduction of atrial fibrillation.2,3 No study has been documented in low income countries to see the role of post stroke SGLT2 inhibitors on diabetic patients at and after ICU admission. Aims: The aim of the study was to measure the 12 months outcome of diabetic patients with acute stroke admitted in ICU set up with naïve SGLT2 inhibitors add on therapy. Method: It was prospective cohort study carried out in a 250 bedded tertiary neurology care hospital at the province capital Biratnagar Nepal. Diabetic patient with acute stroke admitted in ICU from 1st January 2022 to 31st December 2022 who were not under SGLT2 inhibitors were included in the study. These patients were managed as per hospital protocol. Empagliflozin was added to the alternate enrolled patients. Empagliflozin was continued at the time of discharged and during follow up unless contraindicated. These patients were followed up for 12 months. Outcome measured were mortality, morbidity requiring readmission or hospital visit other than regular follow up, SGLT2 inhibitors related adverse events, neuropsychiatry comorbidity, functional status and biochemical parameters. Ethical permission was taken from hospital administration and ethical board. Results: Among 147 diabetic cases 68 were not treated with empagliflozin whereas 67 cases were started the SGLT2 inhibitors. HbA1c level and one year mortality was significantly low among patients on empaglifozin arm. Over a period of 12 months 427 acute stroke patients were admitted in the ICU. Out of them 44% were female, 61% hypertensive, 34% diabetic, 57% dyslipidemia, 26% smoker and with median age of 45 years. Among 427 cases 4% required neurosurgical interventions and 76% had hemorrhagic CVA. The most common reason for ICU admission was GCS<8 (51%). The median ICU stay was 5 days. ICU mortality was 21% whereas 1 year mortality was 41% with most common reason being pneumonia. Empaglifozin related adverse effect was seen in 11% most commonly lower urinary tract infection in 6%. Conclusion: Empagliflozin can safely be started among acute stroke with better Hba1C control and low mortality outcome compared to treatment without SGLT2 inhibitor.

Keywords: diabetes, ICU, mortality, SGLT2 inhibitors, stroke

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