Search results for: post-concussion symptoms scale

Authors: Johnson C. Y. Pang, Bo Pengb, Kara K. L. Reevesc, Allan C. L. Fud

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Objective: Dry needling (DN) has long been used as a treatment method for various musculoskeletal pain conditions. However, the evidence level of the studies was low due to the limitations of the methodology. Lack of randomization and inappropriate blinding are potentially the main sources of bias. A method that can differentiate clinical results due to the targeted experimental procedure from its placebo effect is needed to enhance the validity of the trial. Therefore, this study aimed to validate the method as a placebo ultrasound(US)-guided DN for patients with knee osteoarthritis (KOA). Design: This is a randomized controlled trial (RCT). Ninety subjects (25 males and 65 females) aged between 51 and 80 (61.26±5.57) with radiological KOA were recruited and randomly assigned into three groups with a computer program. Group 1 (G1) received real US-guided DN, Group 2 (G2) received placebo US-guided DN, and Group 3 (G3) was the control group. Both G1 and G2 subjects received the same procedure of US-guided DN, except the US monitor was turned off in G2, blinding the G2 subjects to the incorporation of faux US guidance. This arrangement created the placebo effect intended to permit comparison of their results to those who received actual US-guided DN. Outcome measures, including the visual analog scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of pain, symptoms and quality of life (QOL), were analyzed by repeated-measures analysis of covariance (ANCOVA) for time effects and group effects. The data regarding the perception of receiving real US-guided DN or placebo US-guided DN were analyzed by the chi-squared test. The missing data were analyzed with the intention-to-treat (ITT) approach if more than 5% of the data were missing. Results: The placebo US-guided DN (G2) subjects had the same perceptions as the use of real US guidance in the advancement of DN (p<0.128). G1 had significantly higher pain reduction (VAS and KOOS-pain) than G2 and G3 at 8 weeks (both p<0.05) only. There was no significant difference between G2 and G3 at 8 weeks (both p>0.05). Conclusion: The method with the US monitor turned off during the application of DN is credible for blinding the participants and allowing researchers to incorporate faux US guidance. The validated placebo US-guided DN technique can aid in investigations of the effects of US-guided DN with short-term effects of pain reduction for patients with KOA. Acknowledgment: This work was supported by the Caritas Institute of Higher Education [grant number IDG200101].

Keywords: reliability, jumping, 3D motion analysis, anterior crucial ligament reconstruction

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Authors: Rory Brown, Jessica Daniels, Babatunde Oremule, William Tsang, Sadie Khwaja

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Introduction: Dentures are common and are an intervention for both physical and psychological symptoms associated with tooth loss. However, the humble denture can cause morbidity and mortality if swallowed or aspirated. Numerous case reports document complications including hollow viscus perforation, fistula formation and airway compromise. The purpose of this review was to examine the literature documenting cases of swallowed or aspirated dentures over the past ten years to investigate factors that contribute to developing complications. Methods: A Medline literature search was performed to identify cases of denture ingestion or aspiration for over ten years. Data was collected to include patient, appliance and temporal factors that may contribute to developing complications including hollow viscus perforation, fistula formation, abscess, bowel obstruction, necrosis, hemorrhage and airway obstruction. The data was analyzed using observational and inferential statistics in the form of Chi-Squared and Pearson correlation tests. Results: Eighty-five cases of ingested or aspirated dentures were identified from 77 articles published between 1/10/2009 and 31/10/2019. Fourteen articles were excluded because they did not provide sufficient information on individual cases. Complications were documented in 37.6% of patients, and 2 cases resulted in death. There was no significant difference in complication risk based on patient age, hooked appliance, level of impaction, or radiolucency. However, symptoms of greater than 1-day duration are associated with an increased risk of complication (p=0.005). Increased time from ingestion or aspiration to removal is associated with an increased risk of complications, and the p-value remains significant up to and including day 4 (p=0.017). Conclusions: With denture use predicted to rise complications from the denture, ingestion and aspiration may become more frequent. We have demonstrated that increased symptom duration significantly increases the risk of developing complications. Additionally, we established the risk of developing complications is significantly reduced if the denture is removed with four days of aspiration or ingestion. By actively intervening early when presented with a case of swallowed or aspirated dentures, we may be able to reduce the morbidity associated with this unassuming device.

Keywords: aspiration, denture, ingestion, endoscopic foreign, body removal, foreign body impaction

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Authors: Xiping Guo, Jing Li

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The microstructure of an Si-Al-Y co-deposition coating prepared on an Nb-Si based ultra high temperature alloy by pack cementation process at 1250°C for eight hours was studied. The results showed that the coating was composed of a (Nb,X)Si₂ (X represents Ti, Cr and Hf elements) outer layer, a (Ti,Nb)₅Si₄ middle layer and an Al, Cr-rich inner layer. For comparison, the oxidation behaviors of the coating at 800, 1050 and 1350°C were investigated respectively. Linear oxidation kinetics was found with the parabolic rate constants of 5.29×10⁻², 9×10⁻²and 5.81 mg² cm⁻⁴ h⁻¹, respectively. Catastrophic pesting oxidation has not been found at 800°C even for 100 h. The surface of the scale was covered by compact glassy SiO₂ film. The coating was able to effectively protect the Nb-Si based alloy from oxidation at 1350°C for at least 100 h. The formation process of the scale was testified following an epitaxial growth mechanism. The mechanism responsible for the oxidation behavior of the Si-Al-Y co-deposition coating at 800, 1050 and 1350°C was proposed.

Keywords: Nb-Si based ultra high temperature alloy, oxidation resistance, pack cementation, silicide coating, Al and Y modified

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Authors: Rimma Dzhusupova, Jan Bosch, Helena Holmström Olsson

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Artificial Intelligence (AI) in the Engineering, Procurement, and Construction (EPC) industry has not yet a proven track record in large-scale projects. Since AI solutions for industrial applications became available only recently, deployment experience and lessons learned are still to be built up. Nevertheless, AI has become an attractive technology for organizations looking to automate repetitive tasks to reduce manual work. Meanwhile, the current AI market has started offering various solutions and services. The contribution of this research is that we explore in detail the challenges and obstacles faced in developing and deploying AI in a large-scale project in the EPC industry based on real-life use cases performed in an EPC company. Those identified challenges are not linked to a specific technology or a company's know-how and, therefore, are universal. The findings in this paper aim to provide feedback to academia to reduce the gap between research and practice experience. They also help reveal the hidden stones when implementing AI solutions in the industry.

Keywords: artificial intelligence, machine learning, deep learning, innovation, engineering, procurement and construction industry, AI in the EPC industry

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Authors: Hiba Mezaache

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The study aims to assess the financial and social efficiency of microfinance institutions in india for the period 2015-2019 by using two models of economies of scale and choosing the output direction of the data envelope analysis (DEA) method and using the MIX MARKET database. The study concluded that microfinance institutions focus on achieving financial efficiency beyond their focus on achieving social efficiency to ensure their continuity in the market. Convergence in the efficiency ratios that have been achieved, but the optimum ratios have been achieved under the changing economies of scale; Efficiency is affected by the depth of reaching low-income groups, as serving this group raises costs and risks. The importance of lending to women in rural areas and raising their awareness to ensure their financial and social empowerment; Make improvements in operating expenses, asset management, and loan personnel control in order to maximize output.

Keywords: microfinance, financial efficiency, social efficiency, mix market, microfinance institutions

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Authors: Ming-Hong Chen

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In the study, the mechanical and financial feasibility for the compressed air energy storage (CAES) system in the porous media reservoir in Taiwan is evaluated. In 2035, Taiwan aims to install 16.7 GW of wind power and 40 GW of photovoltaic (PV) capacity. However, renewable energy sources often generate more electricity than needed, particularly during winter. Consequently, Taiwan requires long-term, large-scale energy storage systems to ensure the security and stability of its power grid. Currently, the primary large-scale energy storage options are Pumped Hydro Storage (PHS) and Compressed Air Energy Storage (CAES). Taiwan has not ventured into CAES-related technologies due to geological and cost constraints. However, with the imperative of achieving net-zero carbon emissions by 2050, there's a substantial need for the development of a considerable amount of renewable energy. PHS has matured, boasting an overall installed capacity of 4.68 GW. CAES, presenting a similar scale and power generation duration to PHS, is now under consideration. Taiwan's geological composition, being a porous medium unlike salt caves, introduces flow field resistance affecting gas injection and extraction. This study employs a program analysis model to establish the system performance analysis capabilities of CAES. The finite volume model is then used to assess the impact of porous media, and the findings are fed back into the system performance analysis for correction. Subsequently, the financial implications are calculated and compared with existing literature. For Taiwan, the strategic development of CAES technology is crucial, not only for meeting energy needs but also for decentralizing energy allocation, a feature of great significance in regions lacking alternative natural resources.

Keywords: compressed-air energy storage, efficiency, porous media, financial feasibility

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Authors: Shaokun Ge, Bart Merci, Fubao Zhou, Gao Liu, Ya Ni

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This study investigates the thermal response of main cables and suspenders in suspension bridges subjected to vehicle fires, integrating large-scale gasoline pool fire experiments with numerical simulations. Focusing on a suspension bridge in China, the research examines the impact of wind speed, pool size, and lane position on flame dynamics and temperature distribution along the cables. The results indicate that higher wind speeds and larger pool sizes markedly increase the mass burning rate, causing flame deflection and non-uniform temperature distribution along the cables. Under a wind speed of 1.56 m/s, maximum temperatures reached approximately 960 ℃ near the base in emergency lane fires and 909 ℃ at 1.6 m height for slow lane fires, underscoring the heightened thermal risk from emergency lane fires. The study recommends a zoning strategy for cable fire protection, suggesting a 0-12.8 m protection zone with a target temperature of 1000 ℃ and a 12.8-20.8 m zone with a target temperature of 700 ℃, both with a 90-minute fire resistance. This approach, based on precise temperature distribution data from experimental and simulation results, provides a vital reference for the fire protection design of suspension bridge cables. Understanding cable temperature response during vehicle fires is crucial for developing fire protection systems, as it dictates necessary structural protection, fire resistance duration, and maximum temperatures for mitigation. Challenges of controlling environmental wind in large-scale fire tests are also addressed, along with a call for further research on fire behavior mechanisms and structural temperature response in cable-supported bridges under varying wind conditions. Conclusively, the proposed zoning strategy enhances the theoretical understanding of near-field temperature response in bridge fires, contributing significantly to the field by supporting the design of passive fire protection systems for bridge cables, safeguarding their integrity under extreme fire conditions.

Keywords: bridge fire, temperature response, large-scale experiment, numerical simulations, fire protection

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Authors: Huei Jiun Chen, Hui Mei Huan

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Introduction: Pain is an unpleasant experience for hospitalized patients that impacts both their physical and mental well-being. It is important to select appropriate pain assessment tools to ensure effective pain management. Therefore, it is suggested to use Verbal Rating Scale (VRS) instead for better assessment. The Wong-Baker FACES Pain Rating Scale(WBS) is a widely used pain assessment tool in Taiwan to help individuals communicate the intensity of their pain. However, in clinical practice, even when using various assessment tools to evaluate pain, Numeric Rating Scale-11 (NRS-11) is still commonly utilized to quantify the intensity of pain. The correlation between NRS and other pain assessment tools has not been extensively explored in Taiwan. Additionally, the influence of gender and education level on pain assessment among elderly individuals has not been extensively studied in Taiwan. The aim of this study is to investigate the correlation between pain assessment scales (NRS-11, VRS, WBS) in assessing pain intensity among elderly inpatients. The secondary objective of this study is to examine how gender and education level influence pain assessment among individuals, as well as to explore their preferences regarding pain assessment tools. Method: In this study, a questionnaire survey and purposive sampling were employed to recruit participants from a medical center located in central Taiwan. Participants were requested to assess their pain intensity in the past 24 hours using NRS-11, VRS, and WBS. Additionally, the study investigated their preferences for pain assessment tools. Result: A total of 252 participants were included in this study, with a mean age of 71.1 years (SD=6.2). Of these participants, 135 were male (53.6%), and 44.4% had a primary level or below education. Participants were asked to use NRS-11, VRS, and WBS to assess their current, maximum, and minimum pain intensity experienced in the past 24 hours. The findings indicated a significant correlation (p< .01) among all three pain assessment tools. No significant differences were observed in gender across the three pain assessment scales. For severe pain, there were significant differences in self-rated pain scales among the elderly participants with different education levels (F=3.08, p< .01; X²=17.25, X²=17.21, p< .01), but there were no significant differences observed for mild pain. Regarding preferences for pain assessment tools, 158 participants (62.7%) favored VRS, followed by WBS; gender and education level had no influence on their preferences. Conclusion: Most elderly participants prefer using VRS (Verbal Rating Scale) to self-reported their pain. The reason for this preference may be attributed to the verbal nature of VRS, as it is simple and easy to understand. Furthermore, it could be associated with the level of education among the elderly participants. The pain assessment using VRS demonstrated a significant correlation with NRS-11 and WBS, and gender was not found to have any influence on these assessment. Further research is needed to explore the effect of different education levels on self-reported pain intensity among elderly people in Taiwan.

Keywords: pain assessment, elderly, gender, education

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Authors: Vincent Otieno, Alfred Agwanda, Anne Khasakhala

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Among the neo-Malthusian adherents, it is believed that rapid population growth strain countries’ capacity and performance. Fertility have however decelerated in most of the countries in the recent past. Scholars have concentrated on wide range of factors associated with fertility majorly at the national scale with some opining that analysis of trends and differentials in the various fertility parameters have been discussed extensively. However, others believe that considerably less attention has been paid to the fertility preference- a pathway through which various variables act on fertility. The Sub-Saharan African countries’ disparities amid almost similarities in policies is a cause of concern to demographers. One would point at the meager synergies that have been focused on the fertility preference as well, especially at the macro scale. Using Bongaarts reformulation of Easterlin and Crimmins (1985) conceptual scheme, the understanding of the current transition based on the fertility preference in general would help to provide explanations to the observed latest dynamics. This study therefore is an attempt to explain the current fertility transition through women’s fertility preference. Results reveal that indeed fertility transition is on course in most of the sub-Saharan countries with huge disparities in fertility preferences and its implementation indices.

Keywords: fertility preference, the degree of implementation index, sub-Saharan Africa, transition

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Authors: Fatemeh Yousefi, Narges Fallah, Mohsen Kian, Mehrzad Pakzadeh

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The petrochemical complex releases wastewater, which is rich in organic pollutants and could not be treated easily. Treatment of the wastewater from a petrochemical industry has been investigated using a submerged membrane bioreactor (MBR). For this purpose, a pilot-scale submerged MBR with a flat-sheet ultrafiltration membrane was used for treatment of petrochemical wastewater according to Bandar Imam Petrochemical complex (BIPC) Aromatic plant. The testing system ran continuously (24-h) over 6 months. Trials on different membrane fluxes and hydraulic retention time (HRT) were conducted and the performance evaluation of the system was done. During the 167 days operation of the MBR at hydraulic retention time (HRT) of 18, 12, 6, and 3 and at an infinite sludge retention time (SRT), the MBR effluent quality consistently met the requirement for discharge to the environment. A fluxes of 6.51 and 13.02 L m-2 h-1 (LMH) was sustainable and HRT of 6 and 12 h corresponding to these fluxes were applicable. Membrane permeability could be fully recovered after cleaning. In addition, there was no foaming issue in the process. It was concluded that it was feasible to treat the wastewater using submersed MBR technology.

Keywords: membrane bioreactor (MBR), petrochemical wastewater, COD removal, biological treatment

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Authors: Ayoub Daoudi, Javad Eslami, Anne-Lise Beaucour, Martin Vigroux, Albert Noumowé

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As a fact, many cultural heritage masonry buildings have undergone violent fires during their history. In order to investigate the high temperature behaviour of stone masonry, six French limestones were heated to 600 °C at a rate of 9 °C/min. The main focus is the comparison between the high temperature behaviour of stones at the material and at the structural scale. In order to evaluate the risk of spalling, the tests have been carried out on the stone blocks (12x30x30 cm) instrumented with thermocouples and subjected to an unidirectional heating on one face. Thereafter, visual assessments and non-destructive measurements (dynamic elastic modulus) performed on blocks demonstrate a different behaviour from what was observed at the material scale. Finally, a series of thermo-mechanical computations, using finite element method, allowed us to highlight the difference between the behaviour of stones at material and block scales.

Keywords: limestones, hight temperature behaviour, damage, thermo-mechanical modeling, material and blocks scales, color change

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Authors: Baha Vural Kök, Mehmet Yilmaz, Mustafa Akpolat, Cihat Sav

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Various types of additives are used frequently in order to improve the rheological and mechanical properties of bituminous mixtures. Small devices instead of full scale machines are used for bitumen modification in the laboratory. These laboratory scale devices vary in terms of their properties such as mixing rate, mixing blade and the amount of binder. In this study, the effect of mixing rate and time during the bitumen modification processes on conventional and rheological properties of pure and crumb rubber modified binder were investigated. Penetration, softening point, rotational viscosity (RV) and dynamic shear rheometer (DSR) tests were applied to pure and CR modified bitumen. It was concluded that the penetration and softening point test did not show the efficiency of CR obtained by different mixing conditions. Besides, oxidation that occurred during the preparation processes plays a great part in the improvement effects of the modified binder.

Keywords: bitumen, crumb rubber, modification, rheological properties

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Authors: Sheeba Farhan

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This study is conducted to explore the predictive relationship of perceived stress and self-esteem with social support of students and to explore the factors, which contribute to develop or enhance the level of stress in students of private universities in Karachi-Pakistan. After literature review following hypotheses were formulated; 1)social support would predict perceived stress of students of business administration of private organizations of Higher education, 2) social support would predict the self-esteem of students of private organizations of Higher education, 3) there will be a relationship of perceived stress and self-esteem of students of private organizations of Higher education, 4) there will be a relationship of self esteem and social support of students of private organizations of Higher education. Sample of the study is comprise of 100 students of private organizations of Higher education in Karachi- Pakistan (i.e. males= 50 & females= 50). The age range of participants is 18-26 years. The measures, used in the study are: Demographic information form, a semi structured interview form, Rosenberg self esteem scale (Rosenberg, 1965) and perceived stress scale (Cohen, Kamarck, and Mermelstein, 1983) and multidimensional scale of perceived social support (Zimet, 1988) Descriptive statistics is used for getting a better statistical view of characteristics of sample. Regression analysis is used to explore the predictive relationship of study related stress and self esteem with academic achievement of students of private organizations of Higher education. Percentages and ratios were calculated to explore the level of perceived stress with respect to Socio-demographic characteristics in students of private organizations of Higher education. Finding shows that social support is significantly associated with the higher level of self-esteem among students of graduation but insignificantly associated with stress that has been experienced by them. These results are correlated with a wide variety of studies in which social support has proposed to be a predictor of well being for the students.

Keywords: private universities of Karachi-Pakistan, Self-esteem, social support, stress

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Authors: Haruo Okabayashi

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Human biological signals (pulse wave and brain wave, etc.) have a rhythm which shows fluctuations. This study investigates the relationship between fluctuations of biological signals which are shown by a finger plethysmogram (i.e., finger pulse wave) in conversation and anthropophobic tendency, and identifies whether the fluctuation could be an index of mental health. 32 college students participated in the experiment. The finger plethysmogram of each subject was measured in the following conversation situations: Fun memory talking/listening situation and regrettable memory talking/ listening situation for three minutes each. Lyspect 3.5 was used to collect the data of the finger plethysmogram. Since Lyspect calculates the Lyapunov spectrum, it is possible to obtain the largest Lyapunov exponent (LLE). LLE is an indicator of the fluctuation and shows the degree to which a measure is going away from close proximity to the track in a dynamical system. Before the finger plethysmogram experiment, each participant took the psychological test questionnaire “Anthropophobic Scale.” The scale measures the social phobia trend close to the consciousness of social phobia. It is revealed that there is a remarkable relationship between the fluctuation of the finger plethysmography and anthropophobic tendency scale in talking about a regrettable story in conversation: The participants (N=15) who have a low anthropophobic tendency show significantly more fluctuation of finger pulse waves than the participants (N=17) who have a high anthropophobic tendency (F (1, 31) =5.66, p<0.05). That is, the participants who have a low anthropophobic tendency make conversation flexibly using large fluctuation of biological signal; on the other hand, the participants who have a high anthropophobic tendency constrain a conversation because of small fluctuation. Therefore, fluctuation is not an error but an important drive to make better relationships with others and go towards the development of interaction. In considering mental health, the fluctuation of biological signals would be an important indicator.

Keywords: anthropophobic tendency, finger plethymogram, fluctuation of biological signal, LLE

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Authors: Jaskarn Singh Sidhu

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The present study investigated the relationship of Empathy and Narcissism among university sports persons. Sample-The sample of the study consists of a total of 248 sportspersons and non-sports persons. Tools- To evaluate empathy, a 16-scale questionnaire was used and to evaluate narcissism, NPI-16 questionnaire was used. Statically-Two-Way Analysis of Variance used to analyse the data collected to establish the relationship. Results- In empathy male champion players shows more empathy than female counterparts the results also reveals that non champion females showed more empathy than non-champion male sports persons. In totality champion shows more empathy than non- champions. Results of Narcissism revealed that male champion sports persons were high on Narcissism scale then female counterparts. Non -champion males also indicate high narcissism then non champion female sports persons indicating female were less self -oriented then male sports persons. Conclusion- From the results it was concluded that no significant difference exists among sports persons in empathy and narcissism with reference to gender and sports performance.

Keywords: champion, narcissism, empathy, non champion players

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Authors: Gomes C. C. Izabel, Lanzotti B. Rafaela, Orlandi S. Fabiana

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Chronic Kidney Disease is considered a serious public health problem. The exploitation of resilience has been guided by studies conducted in various contexts, especially in hemodialysis, since the impact of diagnosis and restrictions produced during the treatment process because, despite advances in treatment, remains the stigma of the disease and the feeling of pain, hopelessness, low self-esteem and disability. The objective was to evaluate the level of resilience of patients in chronic renal dialysis. This is a descriptive, correlational, cross and quantitative research. The sample consisted of 100 patients from a Renal Replacement Therapy Unit in the countryside of São Paulo. For data collection were used the characterization instrument of Participants and the Resilience Scale. There was a predominance of males (70.0%) were Caucasian (45.0%) and had completed elementary education (34.0%). The average score obtained through the Resilience Scale was 131.3 (± 20.06) points. The resiliency level submitted may be considered satisfactory. It is expected that this study will assist in the preparation of programs and actions in order to avoid possible situations of crises faced by chronic renal patients.

Keywords: hemodialysis units, renal dialysis, renal insufficiency chronic, resilience psychological

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Authors: Aspasia Simpsi

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The aim of this study was to translate into Greek and then validate the psychometric properties of the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF) (Pontes & Griffiths, 2015). This is the first short standardized psychometric tool to assess Internet Gaming Disorder (IGD) according to the DSM-V nine clinical criteria and among the most frequently examined. The translation of the test was done through the process of back-translation. To gain a better insight into the psychometric properties of this test, the questionnaire included demographic questions and the Greek version of the Internet Addiction Test (Young, 1998). The participants of the study were 241 adolescents aged between 12 to 18. They were nationally recruited in Greece through an online survey that was hosted on the platform of Qualtrics. Analysis revealed excellent reliability with Cronbach’s alpha coefficients α = .939 for IGDS9-SF and α = .940 for IAT. The use of Pearson product-moment correlation revealed a significant positive relationship between IGDS9-SF and IAT r (241) =.45, p < .001. Due to inconsistencies in terminology and tests in the field of IGD, what is recommended for future research is a consensus regarding IGD testing and research.

Keywords: internet gaming disorder, IGDS9-SF, psychometric properties, internet addiction

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Authors: Roaa Al Sharif, Salsabil Abo Al-Azayem, Nimah Alsomali, Wjoud Alsaeed, Nawal Alshammari, Abdulaziz Alwatban, Yaseen Alrabae, Razan Orfali, Faisal Alqarni, Ahmad Alrasheedi

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from various countries have revealed that nurses possess only a basic understanding of the GCS. Regarding this matter, limited knowledge is available about the situation in Saudi Arabia. Overall, the available research suggests that there is room for improvement in the knowledge of the GCS among nurses in Saudi Arabia. Further training and education programs may be beneficial in enhancing nurses' understanding and application of the GCS in clinical practice. Objective: To determine the level of knowledge and competence in assessing the GCS among staff nurses and to identify factors that might influence their knowledge at King Fahd Medical City in Riyadh, Saudi Arabia. Methods: A descriptive, cross-sectional survey involving 199 KFMC staff nurses was conducted. Nurses were provided with a structured questionnaire, and data were collected and analyzed using SPSS version 16, employing descriptive statistics and Chi-square tests. Results: The majority, 81.4% of nurses, had an average level of knowledge in assessing the Glasgow Coma Scale (GCS). The mean score for measuring the level of knowledge among staff nurses in GCS assessment was 8.8 ± 1.826. Overall, 13.6% of respondents demonstrated good knowledge of the GCS, scoring between 11 and 15 points, while only 5% of nurses exhibited poor knowledge of the GCS assessment. There was a significant correlation between knowledge and nurses' departments (χ2(2) = 19.184, p < 0.001). χ2(2) = 19.184," representing a Chi-square statistic with 2 degrees of freedom used to test the association between categorical variables in the data analysis. Conclusion: The findings indicate that knowledge of GCS assessment among staff nurses in a single center in Saudi Arabia is moderate. Therefore, there is a need for continuous education programs to enhance their competence in using this assessment.

Keywords: Glasgow Coma Scale, brain injury, nurses’ knowledge assessment, continuous education programs

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Authors: Ali Baker, Russel Krawitz

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This paper describes a rare occurrence where a potentially fatal complication of COVID-19 infection (MIS-A) was misdiagnosed as an acute abdomen. As most patients with this syndrome present with fever and gastrointestinal symptoms, they may inadvertently fall under the care of the surgical unit. However, unusual imaging findings and a poor response to anti-microbial therapy should prompt clinicians to suspect a non-surgical etiology. More than half of MIS-A patients require ICU admission and vasopressor support. Prompt referral to a physician is key, as the cornerstone of treatment is IVIG and corticosteroid therapy. A 32 year old woman presented with right sided abdominal pain and fevers. She had also contracted COVID-19 two months earlier. Abdominal examination revealed generalised right sided tenderness. The patient had raised inflammatory markers, but other blood tests were unremarkable. CT scan revealed extensive lymphadenopathy along the ileocolic chain. The patient proved to be a diagnostic dilemma. She was reviewed by several surgical consultants and discussed with several inpatient teams. Although IV antibiotics were commenced, the right sided abdominal pain, and fevers persisted. Pan-culture returned negative. A mild cholestatic derangement developed. On day 5, the patient underwent preparation for colonoscopy to assess for a potential intraluminal etiology. The following day, the patient developed sinus tachycardia and hypotension that was refractory to fluid resuscitation. That patient was transferred to ICU and required vasopressor support. Repeat CT showed peri-portal edema and a thickened gallbladder wall. On re-examination, the patient was Murphy’s sign positive. Biliary ultrasound was equivocal for cholecystitis. The patient was planned for diagnostic laparoscopy. The following morning, a marked rise in cardiac troponin was discovered, and a follow-up echocardiogram revealed moderate to severe global systolic dysfunction. The impression was post-COVID MIS with myocardial involvement. IVIG and Methylprednisolone infusions were commenced. The patient had a great response. Vasopressor support was weaned, and the patient was discharged from ICU. The patient continued to improve clinically with oral prednisolone, and was discharged on day 17. Although MIS following COVID-19 infection is well-described syndrome in children, only recently has it come to light that it can occur in adults. The exact incidence is unknown, but it is thought to be rare. A recent systematic review found only 221 cases of MIS-A, which could be included for analysis. Symptoms vary, but the most frequent include fever, gastrointestinal, and mucocutaneous. Many patients progress to multi-organ failure and require vasopressor support. 7% succumb to the illness. The pathophysiology of MIS is only partly understood. It shares similarities with Kawasaki disease, macrophage activation syndrome, and cytokine release syndrome. Importantly, by definition, the patient must have an absence of severe respiratory symptoms. It is thought to be due to a dysregulated immune response to the virus. Potential mechanisms include reduced levels of neutralising antibodies and autoreactive antibodies that promote inflammation. Further research into MIS-A is needed. Although rare, this potentially fatal syndrome should be considered in the unwell surgical patient who has recently contracted COVID-19 and poses a diagnostic dilemma.

Keywords: acute-abdomen, MIS, COVID-19, ICU

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Authors: Usama Mohamed, Sam Booth, Aliysn J. Nedoma

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As part of the transition to electric vehicles, there has been a recent increase in demand for battery manufacturing. Cathodes typically account for approximately 50% of the total lithium-ion battery cell cost and are a pivotal factor in determining the viability of new industrial infrastructure. Cathodes which offer lower costs whilst maintaining or increasing performance, such as nickel-rich layered cathodes, have a significant competitive advantage when scaling up the manufacturing process. This project evaluates the techno-economic value proposition of an integrated industrial scale cathode active material (CAM) production process, closing the mass and energy balances, and optimizing the operation conditions using a sensitivity analysis. This is done by developing a process model of a co-precipitation synthesis route using Aspen Plus software and validated based on experimental data. The mechanism chemistry and equilibrium conditions were established based on previous literature and HSC-Chemistry software. This is then followed by integrating the energy streams, adding waste recovery and treatment processes, as well as testing the effect of key parameters (temperature, pH, reaction time, etc.) on CAM production yield and emissions. Finally, an economic analysis estimating the fixed and variable costs (including capital expenditure, labor costs, raw materials, etc.) to calculate the cost of CAM ($/kg and $/kWh), total plant cost ($) and net present value (NPV). This work sets the foundational blueprint for future research into sustainable industrial scale processes for CAM manufacturing.

Keywords: cathodes, industrial production, nickel-rich layered cathodes, process modelling, techno-economic analysis

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Authors: Yihao Kuang, Bowen Ding

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With the increasing scale and complexity of knowledge graph, modern knowledge graph contains more and more types of entity, relationship, and attribute information. Therefore, in recent years, it has been a trend for knowledge graph inference to use reinforcement learning to deal with large-scale, incomplete, and noisy knowledge graphs and improve the inference effect and interpretability. The Proximal Policy Optimization (PPO) algorithm utilizes a near-end strategy optimization approach. This allows for more extensive updates of policy parameters while constraining the update extent to maintain training stability. This characteristic enables PPOs to converge to improved strategies more rapidly, often demonstrating enhanced performance early in the training process. Furthermore, PPO has the advantage of offline learning, effectively utilizing historical experience data for training and enhancing sample utilization. This means that even with limited resources, PPOs can efficiently train for reinforcement learning tasks. Based on these characteristics, this paper aims to obtain a better and more efficient inference effect by introducing PPO into knowledge inference technology.

Keywords: reinforcement learning, PPO, knowledge inference

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Authors: Rukhsana Kausar, Nida Zafar

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The present research investigated socio-demographic predictors of divorce adjustment in Pakistani women. The sample comprised of 80 divorced women from different areas of Lahore. Self developed Socio-Demographic predictor scale and Divorce Adjustment Scale by (Fisher, 2001) was used for assessment. Analyses showed that working divorced women living with joint family system are more adjusted as compared to non-working divorced women living with joint family system. Women having one child are more adjusted as compared to women having more than one child. Findings highlight importance of presence of father for healthy development of adolescents. Adjustment of divorcee women was positively associated with income, social support from the family, having favorable attitudes toward marital dissolution prior to divorce, and being the partner who initiated the divorce. In addition, older women showed some evidence of poorer adjustment than did younger women. Findings highlight importance of support for divorce adjustment.

Keywords: socio-demographic, adjustment, women, divorce

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Authors: Elizabeth Grier, Meg Gemmill, Mary Martin, Leora Reiter, Herman Tang, Alexandra Donaldson, Isis Lunsky, Mia Wu

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Background: Individuals with Cerebral Palsy (CP) and/or IDD face numerous physical and mental health challenges, including difficulty accessing effective palliative care. The aim of this study is to assess the knowledge and comfort of healthcare providers in providing community-based palliative care for patients with Cerebral Palsy (CP) and severe to profound Intellectual and Developmental Disabilities (IDD). Methods: This study includes a mixed methods approach obtaining both quantitative and qualitative data. Quantitative data from palliative care practitioners was obtained through an online survey assessing comfort in symptom management, grief assessment, and goals of care discussion. This survey was distributed to physicians and allied health practitioners across Canada through the College of Family Physicians of Canada Member Interest Groups for Palliative Care and for IDD. Survey results guided the development of a semi-structured interview template, which was used to conduct a focus group on the same topic. Participants were four palliative care providers (3 physicians and one spiritual care practitioner). The focus group transcript is currently undergoing thematic analysis using NVivo 12 software. Results: 57 palliative care practitioners completed the survey. 87% of participants indicated they have provided palliative care services for persons with CP and/or IDD. Findings suggest practitioners are somewhat confident in identifying specific physical symptoms (dyspnea, pressure ulcers) but less confident in identifying physical/emotional pain, addressing grief, and prognosticating life expectancy in this population. 54% of responses indicated they had little/no training on palliating those with CP or IDD, and 45% somewhat or strongly disagree members of their profession can manage symptoms for this population. Focus group analysis is underway, and results will be available at the time of the poster presentation. Conclusion: Persons with CP and IDD are more likely to experience severe health inequities when accessing palliative care. Results of this study suggest further education is needed for palliative care professionals to address the barriers and challenges in providing palliative care to this patient population.

Keywords: palliative care, symptom management, health equity, community healthcare, intellectual and developmental disabilities

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Authors: Edwin Cartledge, Jack Clark, Mazaher Molaei-Chalchooghi

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The mixing in the crystallization step of active pharmaceutical ingredient manufacturers was studied via advanced modeling tools to enable a successful scale-up. A virtual representation of the vessel was created, and computational fluid dynamics were used to simulate multiphase flow and, thus, the mixing environment within this vessel. The study identified a significant dead zone in the vessel underneath the impeller and found that increasing the impeller speed and power did not improve the mixing. A series of sensitivity analyses found that to improve mixing, the vessel had to be redesigned, and found that optimal mixing could be obtained by adding two extra cylindrical baffles. The same two baffles from the simulated environment were then constructed and added to the process vessel. By identifying these potential issues before starting the manufacture and modifying the vessel to ensure good mixing, this study mitigated a failed crystallization and potential batch disposal, which could have resulted in a significant loss of high-value material.

Keywords: active pharmaceutical ingredient, baffles, computational fluid dynamics, mixing, modelling

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Authors: R. C. Tyagi

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Quasi-periodicity of frequency intervals observed in Shruti based Absolute Scale of Music has been used to graphically identify the Anchor notes ‘Vadi’ and ‘Samvadi’ which are nodal points for expansion, elaboration and iteration of the emotional theme represented by the characteristic tonic arrangement in Raga compositions. This analysis leads to defining the Tonic parameters in the octave including the key-note frequency, tonic intervals’ anchor notes and the on-set and range of quasi-periodicities as exponents of 2. Such uniformity of representation of characteristic data would facilitate computational analysis and synthesis of music compositions and also help develop noise suppression techniques. Criteria for tuning of strings for compatibility with placement of frets on finger boards is discussed. Natural Rhythmic cycles in music compositions are analytically shown to lie between 3 and 126 beats.

Keywords: absolute scale, anchor notes, computational analysis, frets, innovation, noise suppression, Quasi-periodicity, rhythmic cycle, tonic interval, Shruti

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Authors: Inas S. Khayal, Weiping Zhou, Jonathan Skinner

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Healthcare delivery systems around the world are in crisis. The need to improve health outcomes while decreasing healthcare costs have led to an imminent call to action to transform the healthcare delivery system. While Bioinformatics and Biomedical Engineering have primarily focused on biological level data and biomedical technology, there is clear evidence of the importance of the delivery of care on patient outcomes. Classic singular decomposition approaches from reductionist science are not capable of explaining complex systems. Approaches and methods from systems science and systems engineering are utilized to structure healthcare delivery system data. Specifically, systems architecture is used to develop a multi-scale and multi-dimensional characterization of the healthcare delivery system, defined here as the Healthcare Delivery System Knowledge Base. This paper is the first to contribute a new method of structuring and visualizing a multi-dimensional and multi-scale healthcare delivery system using systems architecture in order to better understand healthcare delivery.

Keywords: health informatics, systems thinking, systems architecture, healthcare delivery system, data analytics

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Authors: Elzbieta Sikorska-Simmons

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Dementia is a progressive terminal disease. Despite this recognition, research shows that most family caregivers do not know it, and it is unclear how this knowledge affects the quality of patient care. The aim of this qualitative study of 20 family caregivers for patients with advanced dementia is to examine how the caregiver's knowledge about dementia affects the quality of patient care in the context of healthcare decision-making, advanced care planning, and access to adequate support systems. Knowledge about dementia implies family caregivers' understanding of dementia trajectories, common symptoms/complications, and alternative treatment options (e.g., comfort feeding versus tube feeding). Data were collected in semi-structured interviews with 20 family caregivers. The interviews were conducted in person by the author and designed to elicit rich descriptions of family caregivers' experiences with healthcare decision-making and the management of common symptoms/complications of end-stage dementia as patient healthcare proxies. The study findings suggest that caregivers who recognize that dementia is a terminal disease are less likely to opt for life-extending treatments during the advanced stages. They are also more likely to seek palliative/hospice care, and consequently, they are better able to avoid unnecessary hospitalizations or medical procedures. For example, those who know that dementia is a terminal disease tend to opt for "comfort feeding" rather than "tube feeding" in managing the swallowing difficulties that accompany advanced dementia. In the context of advance care planning, family caregivers who know that dementia is a terminal disease tend to have more meaningful advance directives (e.g., Power of Attorney and Do Not Resuscitate orders). They are better prepared to anticipate common problems and pursue treatments that foster the best quality of patient life and care. Greater knowledge about advanced dementia helps them make more informed decisions that focus on enhancing the quality of patient life rather than just survival. In addition, those who know that dementia is a terminal disease are more likely to establish adequate support systems to help them cope with the complex demands of caregiving. For example, they are more likely to seek dementia-oriented primary care programs that offer house visits or respite services. Based on the study findings, knowledge about dementia as a terminal disease is critical in the optimal management of patient care needs and the establishment of adequate support systems. More research is needed to better understand what caregivers need to know to better prepare them for the complex demands of dementia caregiving.

Keywords: dementia education, family caregiver, management of dementia, quality of care

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Authors: Santosh Kaware, Dnyandeo Patil, Moninder Modgil, Hemant Bhoir, Debendra Behera

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The Unified Field Theory has been an area of intensive research since many decades. This paper focuses on philosophy and metaphysics of unified field theory at Planck scale - and its relationship with super string theory and Quantum Vacuum Dynamic Physics. We examined the epistemology of questions such as - (1) what is the Unified Field of universe? (2) can it actually - (a) permeate the complete universe - or (b) be localized in bound regions of the universe - or, (c) extend into the extra dimensions? - -or (d) live only in extra dimensions? (3) What should be the emergent ontological properties of Unified field? (4) How the universe is manifesting through its Quantum Vacuum energies? (5) How is the space time metric coupled to the Unified field? We present a number of ansatz - which we outline below. It is proposed that the unified field possesses consciousness as well as a memory - a recording of past history - analogous to ‘Consistent Histories’ interpretation of quantum mechanics. We proposed Planck scale geometry of Unified Field with circle like topology and having 32 energy points on its periphery which are the connected to each other by 10 dimensional meta-strings which are sources for manifestation of different fundamentals forces and particles of universe through its Quantum Vacuum energies. It is also proposed that the sub energy levels of ‘Conscious Unified Field’ are used for the process of creation, preservation and rejuvenation of the universe over a period of time by means of negentropy. These epochs can be for the complete universe, or for localized regions such as galaxies or cluster of galaxies. It is proposed that Unified field operates through geometric patterns of its Quantum Vacuum energies - manifesting as various elementary particles by giving spins to zero point energy elements. Epistemological relationship between unified field theory and super-string theories is examined. Properties of ‘consciousness’ and 'memory' cascades from universe, into macroscopic objects - and further onto the elementary particles - via a fractal pattern. Other properties of fundamental particles - such as mass, charge, spin, iso-spin also spill out of such a cascade. The manifestations of the unified field can reach into the parallel universes or the ‘multi-verse’ and essentially have an existence independent of the space-time. It is proposed that mass, length, time scales of the unified theory are less than even the Planck scale - and can be called at a level which we call that of 'Super Quantum Gravity (SQG)'.

Keywords: super string theory, Planck scale geometry, negentropy, super quantum gravity

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Authors: Olga Tkacheva, Pavel Arkhipov, Alexey Rudenko, Yurii Zaikov

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The aluminum electrolysis process in the conventional cryolite-alumina electrolyte with cryolite ratio of 2.7 was carried out at an initial temperature of 970 °C and the anode current density of 0.5 A/cm² in a 15A lab-scale cell in order to study the formation of the side ledge during electrolysis and the alumina distribution between electrolyte and side ledge. The alumina contained 35.97% α-phase and 64.03% γ-phase with the particles size in the range of 10-120 μm. The cryolite ratio and the alumina concentration were determined in molten electrolyte during electrolysis and in frozen bath after electrolysis. The side ledge in the electrolysis cell was formed only by the 13^th hour of electrolysis. With a slight temperature decrease a significant increase in the side ledge thickness was observed. The basic components of the side ledge obtained by the XRD phase analysis were Na₃AlF₆, Na₅Al₃F₁₄, Al₂O₃, and NaF^.5CaF₂^.AlF₃. As in the industrial cell, the increased alumina concentration in the side ledge formed on the cell walls and at the ledge-electrolyte-aluminum three-phase boundary during aluminum electrolysis in the lab cell was found (FTP No 05.604.21.0239, IN RFMEFI60419X0239).

Keywords: alumina distribution, aluminum electrolyzer, cryolie-alumina electrolyte, side ledge

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Authors: Ayse Ozturk Samur, Gozde Inal Kiziltepe

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No matter what level of education it is, starting a school is an exciting process as it includes new experiences. In this process, child steps into a different environment and institution except from the family institution which he was born into and feels secure. That new environment is different from home; it is a social environment which has its own rules, and involves duties and responsibilities that should be fulfilled and new vital experiences. The children who have a positive attitude towards school and like school are more enthusiastic and eager to participate in classroom activities. Moreover, a close relationship with the teacher enables the child to have positive emotions and ideas about the teacher and school and helps children adapt to school easily. In this study, it is aimed to identify children’s perceptions of academic competence, attitudes towards school and ideas about their teachers. In accordance with the aim a mixed method that includes both qualitative and quantitative data collection methods are used. The study is supported with qualitative data after collecting quantitative data. The study group of the research consists of randomly chosen 250 children who are 60-72 month old and attending a preschool institution in a city center located West Anatolian region of Turkey. Quantitative data was collected using Feelings about School scale. The scale consists of 12 items and 4 dimensions; school, teacher, mathematic, and literacy. Reliability and validity study for the scale used in the study was conducted by the researchers with 318 children who were 60-72 months old. For content validity experts’ ideas were asked, for construct validity confirmatory factor analysis was utilized. Reliability of the scale was examined by calculating internal consistency coefficient (Cronbach alpha). At the end of the analyses it was found that FAS is a valid and reliable instrument to identify 60-72 month old children’ perception of their academic competency, attitude toward school and ideas about their teachers. For the qualitative dimension of the study, semi-structured interviews were done with 30 children aged 60-72 month. At the end of the study, it was identified that children’s’ perceptions of their academic competencies and attitudes towards school was medium-level and their ideas about their teachers were high. Based on the semi structured interviews done with children, it is identified that they have a positive perception of school and teacher. That means quantitatively gathered data is supported by qualitatively collected data.

Keywords: feelings, preschool education, school, teacher, thoughts

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