Search results for: clinically relevant

Authors: Andrew White, Abigail Lowe, Kory Watkins, Hamed Akhlaghi, Nicole Winter

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The timing and appropriateness of diagnostic imaging are critical to the evaluation and management of traumatic injuries. Within the subclass of trauma patients, the prevalence of c-spine injury is less than 4%. However, the incidence of delayed diagnosis within this cohort has been documented as up to 20%, with inadequate radiological examination most cited issue. In order to assess those in which c-spine injury cannot be fully excluded based on clinical examination alone and, therefore, should undergo diagnostic imaging, a set of criteria is used to provide clinical guidance. The NEXUS (National Emergency X-Radiography Utilisation Study) criteria is a validated clinical decision-making tool used to facilitate selective c-spine radiography. The criteria allow clinicians to determine whether cervical spine imaging can be safely avoided in appropriate patients. The NEXUS criteria are widely used within the Emergency Department setting given their ease of use and relatively straightforward application and are used in the Victorian State Trauma System’s guidelines. This audit utilized retrospective data collection to examine the concordance of c-spine imaging in trauma patients to that of the NEXUS criteria and assess compliance with state guidance on diagnostic imaging in trauma. Of the 183 patients that presented with trauma to the head, neck, or face (244 excluded due to incorrect triage), 98 did not undergo imaging of the c-spine. Out of those 98, 44% fulfilled at least one of the NEXUS criteria, meaning the c-spine could not be clinically cleared as per the current guidelines. The criterion most met was intoxication, comprising 42% (18 of 43), with midline spinal tenderness (or absence of documentation of this) the second most common with 23% (10 of 43). Intoxication being the most met criteria is significant but not unexpected given the cohort of patients seen at St Vincent’s and within many emergency departments in general. Given these patients will always meet NEXUS criteria, an element of clinical judgment is likely needed, or concurrent use of the Canadian C-Spine Rules to exclude the need for imaging. Midline tenderness as a met criterion was often in the context of poor or absent documentation relating to this, emphasizing the importance of clear and accurate assessments. The distracting injury was identified in 7 out of the 43 patients; however, only one of these patients exhibited a thoracic injury (T11 compression fracture), with the remainder comprising injuries to the extremities – some studies suggest that C-spine imaging may not be required in the evaluable blunt trauma patient despite distracting injuries in any body regions that do not involve the upper chest. This emphasises the need for standardised definitions for distracting injury, at least at a departmental/regional level. The data highlights the currently poor application of the NEXUS guidelines, with likely common themes throughout emergency departments, highlighting the need for further education regarding implementation and potential refinement/clarification of criteria. Of note, there appeared to be no significant differences between levels of experience with respect to inappropriately clearing the c-spine clinically with respect to the guidelines.

Keywords: imaging, guidelines, emergency medicine, audit

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Authors: Abdelrazzag Elmajdoub

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The present study was designed to investigate the bio-equivalence of doxycycline in Dolistin® and Colidox® at a dose rate of 10 mg doxycycline/kg of body weight in 48 clinically normal broiler chickens. After oral administration, plasma levels of doxycycline peaked after 2 hours post-dosing without significant differences between the two products and it could be detected therapeutically and exceeded the minimum inhibitory concentration (MIC) for most micro-organisms sensitive to doxycycline for 12 hours. The disposition kinetics of doxycycline in the two products following oral administration revealed that the maximum plasma concentrations (Cmax.) were 22.65 and 21.80 µg/ml and attained at (Tmax.) 2.10 and 2.20 hours, respectively. Doxycycline in both of the products was eliminated with half- lives (t0.5α) equal to 7.70 and 6.93 hours, respectively. The mean systemic bio availabilities of doxycycline in both of the products after oral administration in chickens were 80.60 and 79.70%, respectively. It was concluded that doxycycline in the form of Dolistin® and Colidox® needs a dose equivalent to 20 mg doxycycline/kg of body weight a day is better to keep the plasma concentration higher than the MIC.

Keywords: tetracyclines, doxycycline, bioavailability, broilers, chickens

Procedia PDF Downloads 507

Authors: Li Ma, Meishuang Ma, Mengying Huang

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The quality of construction projects reflects the credit and responsibilities of construction contractors for the owners and the whole society. Because the construction contractors master more relevant information about the entrusted engineering project under construction while the owners are in unfavorable position of gaining information, asymmetric information may lead the contractors act against the owners in order to pursue their own interests. Building a powerful motivation mechanism is the key to guarantee investor economic interests and the life and property of users in construction projects. Based on principal-agent theory and game theory, the authors develop relevant mathematical models to analyze and compare the contractor’s utility functions under different combinations of contracts’ explicit incentive mechanism and reputation’s implicit incentive mechanism aiming at finding out the conditions for incentive validity. The research concludes that the most rational motivation way is to combine the explicit and implicit incentive effects of both contracts and reputation mechanism, and puts forth some measures for problems on account of China’s current situation.

Keywords: construction contractors, contract, reputation, incentive mechanism

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Authors: D. Kumar, S. Kumar, A. G. Memon, R. A. Memon, K. Harijan

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A considerable amount of energy is usually lost due to compression of insulation in Heating, ventilation, and air conditioning (HVAC) duct. In this paper, the economic impact of compression of insulation is estimated. Relevant mathematical models were used to estimate the optimal thickness at the points of compression. Furthermore, the payback period is calculated for the optimal thickness at the critical parts of supply air duct (SAD) and return air duct (RAD) considering natural gas (NG) and liquefied petroleum gas (LPG) as fuels for chillier operation. The mathematical model is developed using preliminary data obtained for an HVAC system of a pharmaceutical company. The higher heat gain and cooling loss, due to compression of thermal insulation, is estimated using relevant heat transfer equations. The results reveal that maximum energy savings (ES) in SAD is 34.5 and 40%, while in RAD is 22.9% and 29% for NG and LPG, respectively. Moreover, the minimum payback period (PP) for SAD is 2 and 1.6years, while in RAD is 4.3 and 2.7years for NG and LPG, respectively. The optimum insulation thickness (OIT) corresponding to maximum ES and minimum PP is estimated to be 35 and 42mm for SAD, while 30 and 38mm for RAD in case of NG and LPG, respectively.

Keywords: optimum insulation thickness, life cycle cost analysis, payback period, HVAC system

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Authors: Gizem Ertürk, Nursena Dinç

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The Aegean area has always been an important transit point for migration; however, the establishment of the European Union gave further impetus to the migration phenomenon and increased the significance of the area within this context. The migration waves have been more visible in the area in recent decades, and particularly after the “2015 Migration Crisis,” this issue has been subject to further securitization in the EU. In this conjuncture, the Frontex, which is an agency set up by the EU in 2005 for the purpose of managing and coordinating the border control efforts, has become more functional in the relevant area, but at the same time, have some questionable actions within the context of human rights. This paper problematizes the rationality behind the existence and practices of such a structure and attempts to make a political and legal analysis of the security practices of the European Union against migration within a framework based on the biopolitics approaches of Michel Foucault and Giorgio Agamben. The dataset of this paper, which focuses on the agency in question by taking it as a case, is formed by making use of the existing literature on the EU’s security policies, the relevant official texts of the Union and Frontex reports on migration practices in and around the Aegean Sea.

Keywords: migration, biopolitics, Frontex, security, European union, securitization

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Authors: Sara Grazhdani, Alma Cili, Arben Ivanaj

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Immune Thrombocytopenic Purpura is an autoimmune disease characterized by the destruction of platelets by immune mediators, their deficient production in the red bone marrow and increased splenic sequestration, leading to the appearance of thrombocytopenia and increased risk of hemorrhage. Treatment is indicated in patients with low platelet counts (<30 x 10 9 /L) who present clinically with hemorrhagic events or are at increased risk for hemorrhage. The goal of the treatment remains (I) prevention of hemorrhagic events and deaths resulting from them, (II) reaching an adequate level of the number of platelets, (III) treatment of patients with as few toxic effects as possible. Corticosteroid therapy remains the first choice in the treatment of patients with Primary Immune Thrombocytopenic Purpura. Rituximab (Mabthera) remains the first choice in the second line in the treatment of patients with Immune Thrombocytopenic Purpura, refractory to the use of cortisones.

Keywords: ITP, rituximab, prednisolone, relapse

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Authors: V. Polenta, S. D. Garvey, D. Chronopoulos, A. C. Long, H. P. Morvan

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A parametric study on circular thin-walled pipes subjected to pure bending is performed. Both straight and curved pipes are considered. Ratio D/t, initial pipe curvature and internal pressure are the parameters varying in the analyses. The study is mainly FEA-based. It is found that negative curvatures (opposite to bending moment) considerably increase stiffness and buckling limit of the pipe when no internal pressure is acting and, similarly, positive curvatures decrease the stiffness and buckling limit. For internal pressurised pipes the effects of initial pipe curvature are less relevant. Results show that this phenomenon is in relationship with the cross-section deformation due to bending moment, which undergoes relevant ovalisation for no pressurised pipes and little ovalisation for pressurised pipes.

Keywords: buckling, curved pipes, internal pressure, ovalisation, pure bending, thin-walled pipes

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Authors: Ferjani Hanen, El Arem Amira, Boussema Ayed Imen, Bacha Hassen

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Tacrolimus (TAC), a calcineurin inhibitor, is clinically used as an immunosuppressive agent in the transplant recipient, but its use associated-hepatotoxicity. Mycophenolate mofetil (MMF), an anti-metabolite, is a potent immunosuppressive drug. MMF is not hepatotoxic and is the most common adjunctive immunosuppressant for TAC. The effects of TAC and MMF combination in the liver is still not well understood. This work aimed to investigate their combined effect against in liver in rats Wistar after 24 h. The oral median lethal doses (LD50) of TAC and MMF alone were evaluated in rats are 240 mg/kg and 500 mg/kg respectively. Oral administration of the MMF at 50 mg/kg to male Wistar intoxicated with TAC at 60 mg/kg, demonstrated a significant protective effect by lowering the levels of hepatic markers enzymes (AST, ALT) in the serum rat. MMF attenuated oxidative stress by restoring the activities of SOD, CAT and by reducing the malondialdehyde (MDA) and protein carbonyl levels liver. This study provided evidence that MMF protects rat liver from TAC-induced injury and suggests a most combination use for organ transplantation.

Keywords: tacrolimus, mycophenolate mofetil, combination, liver, rat

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Authors: Fatemeh Valizadeh Gamchi, Edward L. Boone

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This research focuses on Lyme disease, a widespread infectious condition in the United States caused by the bacterium Borrelia burgdorferi sensu stricto. It is critical to identify environmental and economic elements that are contributing to the spread of the disease. This study examined data from Virginia to identify a subset of explanatory variables significant for Lyme disease case numbers. To identify relevant variables and avoid overfitting, linear poisson, and regularization regression methods such as a ridge, lasso, and elastic net penalty were employed. Cross-validation was performed to acquire tuning parameters. The methods proposed can automatically identify relevant disease count covariates. The efficacy of the techniques was assessed using four criteria on three simulated datasets. Finally, using the Virginia Department of Health’s Lyme disease data set, the study successfully identified key factors, and the results were consistent with previous studies.

Keywords: lyme disease, Poisson generalized linear model, ridge regression, lasso regression, elastic net regression

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Authors: Martin Kittel, Alexander Roth

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The continuous integration of variable renewable energy sources (VRE) in the power sector is required for decarbonizing the European economy. Power sectors become increasingly exposed to weather variability, as the availability of VRE, i.e., mainly wind and solar photovoltaic, is not persistent. Extreme events, e.g., long-lasting periods of scarce VRE availability (‘VRE droughts’), challenge the reliability of supply. Properly accounting for the severity of VRE droughts is crucial for designing a resilient renewable European power sector. Energy system modeling is used to identify such a design. Our analysis reveals the sensitivity of the optimal design of the European power sector towards VRE droughts. We analyze how VRE droughts impact optimal power sector investments, especially in generation and flexibility capacity. We draw upon work that systematically identifies VRE drought patterns in Europe in terms of frequency, duration, and seasonality, as well as the cross-regional and cross-technological correlation of most extreme drought periods. Based on their analysis, the authors provide a selection of relevant historical weather years representing different grades of VRE drought severity. These weather years will serve as input for the capacity expansion model for the European power sector used in this analysis (DIETER). We additionally conduct robustness checks varying policy-relevant assumptions on capacity expansion limits, interconnections, and level of sector coupling. Preliminary results illustrate how an imprudent selection of weather years may cause underestimating the severity of VRE droughts, flawing modeling insights concerning the need for flexibility. Sub-optimal European power sector designs vulnerable to extreme weather can result. Using relevant weather years that appropriately represent extreme weather events, our analysis identifies a resilient design of the European power sector. Although the scope of this work is limited to the European power sector, we are confident that our insights apply to other regions of the world with similar weather patterns. Many energy system studies still rely on one or a limited number of sometimes arbitrarily chosen weather years. We argue that the deliberate selection of relevant weather years is imperative for robust modeling results.

Keywords: energy systems, numerical optimization, variable renewable energy sources, energy drought, flexibility

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Authors: Ibrahim I. Elshahawy

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The objective of the present study was to investigate the effect of green tea extract on serum oxidant and antioxidant profile, liver and kidney function. 40 Friesian calves are included in this study and allocated into two groups: Group I (n=20) clinically healthy calves showing no clinical abnormalities, not receiving any treatment and served as control; group II (n=20) received green tea extract (GTE) for 30 days. Non-significant changes in blood urea nitrogen (BUN) were detected between groups, on contrary, serum creatinine and activities of liver enzymes aspartate transaminase (AST) and alanine transaminase (ALT) were significantly different between two groups. There were significant increases in the mean values of serum antioxidative parameters (total antioxidant capacity, catalase, superoxide dismutase, reduced glutathione and glutathione peroxidase) in group II. Whereas, the activity of lipid peroxidase significantly decreased in GTE treated calves when compared to control.

Keywords: green tea extract, antioxidants, oxidants, calves

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Authors: Annika Barzen

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In this article, the collection and analysis of drawings are implemented and discussed as a methodological approach to reconstruct children's perspective on horse-assisted interventions. For this purpose, drawings of three children (8-10 years old) were included in the research process in order to clarify the question of what insights can be derived from the drawings about the child's perspective on the intervention. The children were asked to draw a picture of themselves at the horse stable. Practical implementation considerations are disclosed. The developed analysis steps consider the work of two art historians (Erwin Panofsky and Max Imdahl) to capture the visual sense and to interpret the children's drawings. Relevant topics about the children's perspective can be inferred from the drawings. In the drawings, the following topics are important for the children: Overcoming challenges and fears in handling the horse, support from an adult in handling the horse and feeling self-confident and competent to act after completing tasks with the horse. The drawings show the main topics which are relevant for the children and can be used as a basis for conversation. All in all, the child's drawing offers a useful addition to other survey methods in order to gain further insights into the experiences of children in a horse-assisted setting.

Keywords: children's perspective, interpret children's drawings, equine-assisted-intervention, methodical analysis

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Authors: Meline Mesropyan

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At the beginning of the 20th century, Japan served as a transit point for Armenian refugees fleeing the 1915 Genocide. However, research on Armenian refugees in Japan is sparse, and the Armenian Diaspora has never taken root in Japan. Consequently, Japan has not been considered a relevant research site for studying Armenian refugees. The primary objective of this study is to shed light on the number of Armenian refugees who passed through Japan between 1915 and 1930. Quantitative analyses will be conducted based on newly uncovered Japanese archival documents. Subsequently, the Japanese data will be compared to American immigration data to estimate the potential number of refugees in Japan during that period. This under-researched area is relevant to both the Armenian Diaspora and refugee studies in Japan. By clarifying the number of refugees, this study aims to enhance understanding of Japan's treatment of refugees and the extent of humanitarian efforts conducted by organizations and individuals in Japan, contributing to the broader field of historical refugee studies.

Keywords: Armenian genocide, Armenian refugees, Japanese statistics, number of refugees

Procedia PDF Downloads 57

Authors: Rahma Adinda Sartika

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The use of technology in learning mathematics has received a positive response from both students and teachers, so many researchers have conducted research on this theme. Based on the findings carried out in this study, 807 documents relevant to this theme have been published in Scopus from 1995-2024. After going through the stages of identification, screening, eligibility, and including, the documents that meet the criteria are 227 documents. These documents are then analyzed using the bibliometric method so that it can be seen that the most published documents in the Scopus database occurred in 2020, with 38 documents, and the lowest was from 1996 to 2000 and 2004 to 2007, namely, no documents published. The highest number of citations is in documents published in 2018, with a total of 349 citations, so the h-index is higher than the others. The country that published the most documents relevant to this theme is Indonesia with a total of 91 documents. The second largest is the United States, with a total of 28 published documents, and the third largest is China, with a total of 15 documents. Indonesia and the United States have the most working relationships between countries compared to other countries. The focus of research related to this theme is 1) mathematics learning, 2) learning systems, 3) engineering education, 4) technology and 5) mathematical concepts.

Keywords: technology, bibliometric, mathematics learning, mathematical concepts

Procedia PDF Downloads 61

Authors: S. Zolghadri, M. Naderi, H. Yousefnia, A. Ramazani, A. R. Jalilian

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The aim of this work was to evaluate the values of absorbed dose of 68Ga-DOTATOC in numerous human organs. 68Ga-DOTATOC was prepared with the radiochemical purity of higher than 98% and by specific activity of 39.6 MBq/nmol. The complex demonstrated great stability at room temperature and in human serum at 37° C at least 2 h after preparation. Significant uptake was observed in somatostatin receptor-positive tissues such as pancreas and adrenal. The absorbed dose received by human organs was evaluated based on biodistribution studies in Syrian rats by the radiation absorbed dose assessment resource (RADAR) method. Maximum absorbed dose was obtained in the pancreas, kidneys, and adrenal with 0.105, 0.074, and 0.010 mGy/MBq, respectively. The effective absorbed dose was 0.026 mSv/MBq for 68Ga-DOTATOC. The results showed that 68Ga-DOTATOC can be considered as a safe and effective agent for clinically PET imaging applications.

Keywords: effective absorbed dose, Ga-68, octreotide, MIRD

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Authors: Fakhrosadat Sajjadian

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In the USA, about 5% of women diagnosed with breast cancer annually are affected by Inflammatory Breast Cancer (IBC), which is a highly aggressive type of Locally Advanced Breast Cancer (LABC). It is a type of LABC that is clinically and pathologically different, known for its rapid growth, invasiveness, and ability to promote the growth of blood vessels. Almost all women are found to have lymph nodes affected upon diagnosis, while around 36% show obvious distant metastases. Even with the latest improvements in multimodality therapies, the outlook for patients with IBC remains bleak, as the average disease-free survival time is less than 2.5 years. Recent research on the genetic factors responsible for the IBC phenotype has resulted in the discovery of genes that play a role in the advancement of this illness. The development of primary human cell lines and animal models has assisted in this research. These advancements offer new possibilities for future actions in identifying and treating IBC.

Keywords: breast cancer, inflammation, diagnosis, IBC, LABC

Procedia PDF Downloads 43

Authors: Ika Jorum

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The aim of this collaborative project was to develop library support that contributes in a long-term way to a technical university’s work on increased equality in education. The background was an assessment made by the Higher Education Authority that showed the need for improvement regarding equality in several programs at the university. The university’s Vice President for equality and Vice President for sustainability announced funds for projects that supported the improvement of equality in education. The library was granted funding for a one-year project that aimed both to support teachers in order to embed equality in education and to support the library staff and improve the organization’s own work. The part of the project that was directed to teachers was performed as activities in different areas and forms, such as acquisition and collections, teaching, exhibitions and book discussions. Besides the activities and support that was offered to teachers, the education team had journal clubs in order to develop and embed equality in their own teaching. The part that was directed to library staff and management was performed as workshops in collaboration with Equality Office in order to identify areas where the library could make improvements on work with equality and inclusion. The expectation was that the activities would be well attended since the project team had got indications that the content would be relevant. The outcome of this project was that some activities turned out to be more attended than others and what is expected to be found relevant, for example, a workshop on information searching from a gender and equality perspective for teachers, might still not attract participants. On the other hand, Ph.D. students and students participated in the book discussions and wanted them to continue after the project had ended. Results will be shared both on what was successful and what was challenging. Some reflections will be given on what can be done to attract participants to activities in the area of gender equality that is most likely relevant for the expected attendants and how results from a project on gender equality can be integrated into an organization’s daily work.

Keywords: equality, higher education, critical information literacy, collaboration

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Authors: Danilo F. Rodrigues, Hérida Regina N. Salgado

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Introduction: The emergence of resistant microorganisms to a large number of clinically approved antimicrobials has been increasing, which restrict the options for the treatment of bacterial infections. As a strategy, drugs with high antimicrobial activities are in evidence. Stands out a class of antimicrobial, the cephalosporins, having as fourth generation cefepime (CEF) a semi-synthetic product which has activity against various Gram-positive bacteria (e.g. oxacillin resistant Staphylococcus aureus) and Gram-negative (e.g. Pseudomonas aeruginosa) aerobic. There are few studies in the literature regarding the development of microbiological methodologies for the analysis of this antimicrobial, so researches in this area are highly relevant to optimize the analysis of this drug in the industry and ensure the quality of the marketed product. The development of microbiological methods for the analysis of antimicrobials has gained strength in recent years and has been highlighted in relation to physicochemical methods, especially because they make possible to determine the bioactivity of the drug against a microorganism. In this context, the aim of this work was the development and validation of a microbiological method for quantitative analysis of CEF in powder lyophilized for injectable solution by turbidimetric assay. Method: For performing the method, Staphylococcus aureus ATCC 6538 IAL 2082 was used as the test microorganism and the culture medium chosen was the Casoy broth. The test was performed using temperature control (35.0 °C ± 2.0 °C) and incubated for 4 hours in shaker. The readings of the results were made at a wavelength of 530 nm through a spectrophotometer. The turbidimetric microbiological method was validated by determining the following parameters: linearity, precision (repeatability and intermediate precision), accuracy and robustness, according to ICH guidelines. Results and discussion: Among the parameters evaluated for method validation, the linearity showed results suitable for both statistical analyses as the correlation coefficients (r) that went 0.9990 for CEF reference standard and 0.9997 for CEF sample. The precision presented the following values 1.86% (intraday), 0.84% (interday) and 0.71% (between analyst). The accuracy of the method has been proven through the recovery test where the mean value obtained was 99.92%. The robustness was verified by the parameters changing volume of culture medium, brand of culture medium, incubation time in shaker and wavelength. The potency of CEF present in the samples of lyophilized powder for injectable solution was 102.46%. Conclusion: The turbidimetric microbiological method proposed for quantification of CEF in lyophilized powder for solution for injectable showed being fast, linear, precise, accurate and robust, being in accordance with all the requirements, which can be used in routine analysis of quality control in the pharmaceutical industry as an option for microbiological analysis.

Keywords: cefepime hydrochloride, quality control, turbidimetric assay, validation

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Authors: G. Infante Dennis, S. Balinas Elvira, C. Valencia Yolanda, Cunanan

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This paper examined the feed-backs, concerns, and insights of the teachers, supervisors, and teacher-trainers on the nature and qualities of the K-12 grade 8 design, content, approaches, and materials. Specifically, it sought to achieve the following objectives: 1) to describe the critical nature and qualities of the design, content, teaching-learning-and-evaluation approaches, and the materials to be utilized in the implementation of the grade 8 curriculum; 2) to extract the possible challenges relevant to the implementation of the design, content, teaching-learning-and-evaluation approaches, and the materials of the grade 8 curriculum in terms of the linguistic and technical competence of the teachers, readiness to implement, willingness to implement, and capability to make relevant adaptations; 3) to present essential demands on the successful and meaningful implementation of the grade 8 curriculum in terms of teacher-related factors, school-related factors, and student-related concerns.

Keywords: curriculum reforms, K-12, teacher-training, language teaching, learning

Procedia PDF Downloads 255

Authors: E. Abdi

Abstract:

The purpose of this theoretical literature review is to study the relevant academic literature on lack of cardiorespiratory fitness and its effects on children. The total of thirty eight relevant documents were identified and considered for this review which nineteen of those were original research articles published in peer reviewed journals. The other nineteen articles were statistical documents. This document is structured to examine 4 effects in deficiency of cardiorespiratory fitness in school aged children: (a) obesity, (b) inadequate fitness level, (c) unhealthy life style, and (d) academics. The categories provide a theoretical framework for future studies. The results are broken down into 6 sections: (a) academics,( b) healthy life style, (c) low cost, (d) obesity, (e) Relative Age Effect (RAE), and (f) race/poverty. The study discusses that regular physical fitness assists children and adolescents to develop healthy physical activity behaviors which can be sustained throughout adult life. Conclusion suggests that advocacy for increasing physical activity and decreasing sedentary behaviors at school and home are necessary.

Keywords: cardiorespiratory, endurance, physical activity, physical fitness

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Authors: Beverly Wang

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Background: Rosai-Dorfman disease (RDD), aka sinus histiocytosis with massive lymphadenopathy, is a rare, idiopathic histiocytic proliferative disorder. Although RDD can be seen involving the head and neck lymph nodes, rarely it can affect other extranodal sites. It present 3 unique cases of RDD affecting the nasal cavity, paranasal sinuses, and ear canal. The initial clinical presentation on two cases mimicked a malignant neoplasm. The 3rd case of RDD co-existed with a cholesteatoma of the ear canal. The clinical presentation, histology and immunohistochemical stains, and radiographic findings are discussed. Design: An overview of 3 cases of RDD affected sinonasal cavity and ear canal from UCI Medical Center was conducted. Case 1: A 61 year old male complaining of breathing difficulty presented with bilateral polypoid sinonasal masses and severe nasal obstruction. The masses elevated the nasal floor, and involved the anterior nasal septum to lateral wall. It was endoscopically excised. At intraoperative consultation, frozen section reported a pleomorphic spindle cell neoplasm with scattered large atypical spindle cells, resembling a high grade sarcoma. Case 2: A 46 year old male presented with recurrent bilateral maxillary chronic sinusitis with mass formation, clinically suspicious for malignant lymphoma. Excisional tissue sample showed large irregular spindled histiocytes with abundant granular and vacuolated cytoplasm. Case 3: A 36 year old female with a history of asthma initially presented with left-sided chronic otalgia, occasional nausea, vertigo, and fluctuating pain exacerbated by head movement and temperature changes. CT scan revealed an external auditory canal mass extending to the middle ear, coexisting with a small cholesteatoma. Results: The morphology of all cases revealed large atypical spindled histiocytes resembling fibrohistiocytic or myofibroblastic proliferative neoplasms. Scattered emperipolesis was seen. All 3 cases were confirmed as extranodal sinus RDD, confirmed by immunohistochemistry. The large atypical cells were positive for S100, CD68, and CD163. No evidence for malignancy was identified. Case 3 showed concurrent RDD co-existing with a cholesteatoma. Conclusion: Due to its rarity and variable clinical presentations, the diagnosis of RDD is seldom clinically considered. Extranodal sinus RDD morphologically can be pitfall as mimicker of spindly neoplasm, especially at intraoperative consultation. It can create diagnostic and therapeutic challenges. Correlation of radiological findings with histologic features will help to reach the diagnosis.

Keywords: head and neck, extranodal, rosai-dorfman disease, mimicker, immunohistochemistry

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Authors: Suhayla Reda Al-Banai

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Problem Statement: Tooth whitening was used for over one hundred and fifty year. The question concerning the whiteness of teeth is a complex one since tooth whiteness will vary from individual to individual, dependent on age and culture, etc. Tooth whitening following treatment may be dependent on the type of whitening system used to whiten the teeth. There are a few side-effects to the process, and these include tooth sensitivity and gingival irritation. Some individuals may experience no pain or sensitivity following the procedure. Purpose: To systematically review the available published literature until 31st December 2021 to identify all relevant studies for inclusion and to determine whether there was any evidence demonstrating that the application of whitening procedures resulted in the tooth sensitivity. Aim: Systematically review the available published works of literature to identify all relevant studies for inclusion and to determine any evidence demonstrating that application of 10% & 15% carbamide peroxide in tooth whitening procedures resulted in tooth sensitivity. Material and Methods: Following a review of 70 relevant papers from searching both electronic databases (OVID MEDLINE and PUBMED) and hand searching of relevant written journals, 49 studies were identified, 42 papers were subsequently excluded, and 7 studies were finally accepted for inclusion. The extraction of data for inclusion was conducted by two reviewers. The main outcome measures were the methodology and assessment used by investigators to evaluate tooth sensitivity in tooth whitening studies. Results: The reported evaluation of tooth sensitivity during tooth whitening procedures was based on the subjective response of subjects rather than a recognized methodology for evaluating. One of the problems in evaluating was the lack of homogeneity in study design. Seven studies were included. The studies included essential features namely: randomized group, placebo controls, doubleblind and single-blind. Drop-out was obtained from two of included studies. Three of the included studies reported sensitivity at the baseline visit. Two of the included studies mentioned the exclusion criteria Conclusions: The results were inconclusive due to: Limited number of included studies, the study methodology, and evaluation of DS reported. Tooth whitening procedures adversely affect both hard and soft tissues in the oral cavity. Sideeffects are mild and transient in nature. Whitening solutions with greater than 10% carbamide peroxide causes more tooth sensitivity. Studies using nightguard vital bleaching with 10% carbamide peroxide reported two side effects tooth sensitivity and gingival irritation, although tooth sensitivity was more prevalent than gingival irritation

Keywords: dentine, sensitivity, bleaching, carbamide peroxde

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Authors: Lalrokima Chenkual

Abstract:

Legal provision and various guidelines issued by the National Disaster Management Authority in India strives for setting up of disaster management authority from the central government to the district level. Community-Based Disaster Risk Reduction practice is still relevant as the communities are the victim as well as the first responder in any incidents. The primary goal of Community Based Disaster Risk Reduction is to reduce vulnerability of the concerned community and strengthen its existing capacity to cope with disaster. By involving the community in the preparedness phase, it not only increases the likelihood of coordinated action by the communities to help in mitigating disasters and lessening the impact of disaster but also brings the community together to address the issue collectively. Community participation ensures local ownership, addresses local needs, and promotes volunteerism and mutual help to prevent and minimise damage. Community-Based Disaster Risk Reduction is very much relevant for Mizoram as the society is closed knit, population is very less, religion homogeneity i.e Christianity, very active and widespread community-based organization viz, Young Mizo Association, MHIP (Women Federation), MUP (Elders Clubs which are guided together by Mizo code of morals conduct termed as Tlawmngaihna.

Keywords: community, close-knit, first responder, Tlawmngaihna

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Authors: Ryotaro Ishikawa

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Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over. Inflated responsibility attitude and interpretation are central beliefs in a cognitive model of OCD. This study aimed to develop a Japanese version of the Responsibility Attitude Scale (RAS-J) and Responsibility Interpretation Questionnaire (RIQ-J). 98 participants (OCD group = 37; anxiety control group = 24; healthy control group = 37) completed the RAS-J, RIQ-J and other measures to assess the validity of the RAS-J and RIQ-J. As a result of analysis, both scales had adequate concurrent validity, demonstrated by significant correlations with other measures of OCD, anxiety, and depression. Group comparison data using ANOVA with Bonferroni method indicated that RAS-J and RIQ-J scores for the OCD group not only differed from the nonclinical group, but also from the clinically anxious comparison group. In conclusion, this study indicated that the developed RAS-J and RIQ-J effectively measure responsibility attitude and responsibility interpretation in the Japanese population.

Keywords: obsessive-compulsive disorder, responsibility, cognitive theory, anxiety disorder

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Authors: Wann-Ming Wey

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In today's popularity and progress of information technology, the big data set and its analysis are no longer a major conundrum. Now, we could not only use the relevant big data to analysis and emulate the possible status of urban development in the near future, but also provide more comprehensive and reasonable policy implementation basis for government units or decision-makers via the analysis and emulation results as mentioned above. In this research, we set Taipei City as the research scope, and use the relevant big data variables (e.g., population, facility utilization and related social policy ratings) and Analytic Network Process (ANP) approach to implement in-depth research and discussion for the possible reduction of land use in primary and secondary schools of Taipei City. In addition to enhance the prosperous urban activities for the urban public facility utilization, the final results of this research could help improve the efficiency of urban land use in the future. Furthermore, the assessment model and research framework established in this research also provide a good reference for schools or other public facilities land use and adaptive reuse strategies in the future.

Keywords: adaptive reuse, analytic network process, big data, land use strategy

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Authors: Shadi Alghaffari, Hong-Oanh Nguyen, Peggy Chen, Hossein Enshaei

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The main purpose of this study was to explore the role of organisational effectiveness (OE) in seaports. OE is an important managerial concept, one that is necessary for leaders and directors in any organisation to understand the output of their work. OE has been applied in many organisations; however, it is a vital concept in the port business. This paper examines various approaches and applications of the OE concept to business management, and describes benefits that are important and applicable to seaport management. This research reviews and classifies articles published in relevant journals and books between 1950 and 2016; from the general literature on OE to the narrower field of OE in seaports. Based on the extensive literature review, this study identifies and discusses several issues relevant to both practices and theories of this concept. The review concludes by presenting a gap in the literature, as it found only a limited amount of research that endeavours to clarify OE in the seaport sector. As a result of this gap, seaports suffer from a lack of empirical study and are largely neglected in this subject area. The implementation of OE in this research has led to the maritime sector interfacing with different disciplines in order to acquire the advantage of enhancing managerial knowledge and competing successfully in the international marketplace.

Keywords: literature review, maritime, organisational effectiveness, seaport management

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Authors: Venencia Albert, Arulselvi Subramanian, Hara Prasad Pati, Asok K. Mukhophadhyay

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Acute traumatic coagulopathy in an endogenous dysregulation of the intrinsic coagulation system in response to the injury, associated with three-fold risk of poor outcome, and is more amenable to corrective interventions, subsequent to early identification and management. Multiple definitions for stratification of the patients' risk for early acute coagulopathy have been proposed, with considerable variations in the defining criteria, including several trauma-scoring systems based on prehospital data. We aimed to develop a clinically relevant definition for acute coagulopathy of trauma based on conventional coagulation assays and to assess its efficacy in comparison to recently established prehospital prediction models. Methodology: Retrospective data of all trauma patients (n = 490) presented to our level I trauma center, in 2014, was extracted. Receiver operating characteristic curve analysis was done to establish cut-offs for conventional coagulation assays for identification of patients with acute traumatic coagulopathy was done. Prospectively data of (n = 100) adult trauma patients was collected and cohort was stratified by the established definition and classified as "coagulopathic" or "non-coagulopathic" and correlated with the Prediction of acute coagulopathy of trauma score and Trauma-Induced Coagulopathy Clinical Score for identifying trauma coagulopathy and subsequent risk for mortality. Results: Data of 490 trauma patients (average age 31.85±9.04; 86.7% males) was extracted. 53.3% had head injury, 26.6% had fractures, 7.5% had chest and abdominal injury. Acute traumatic coagulopathy was defined as international normalized ratio ≥ 1.19; prothrombin time ≥ 15.5 s; activated partial thromboplastin time ≥ 29 s. Of the 100 adult trauma patients (average age 36.5±14.2; 94% males), 63% had early coagulopathy based on our conventional coagulation assay definition. Overall prediction of acute coagulopathy of trauma score was 118.7±58.5 and trauma-induced coagulopathy clinical score was 3(0-8). Both the scores were higher in coagulopathic than non-coagulopathic patients (prediction of acute coagulopathy of trauma score 123.2±8.3 vs. 110.9±6.8, p-value = 0.31; trauma-induced coagulopathy clinical score 4(3-8) vs. 3(0-8), p-value = 0.89), but not statistically significant. Overall mortality was 41%. Mortality rate was significantly higher in coagulopathic than non-coagulopathic patients (75.5% vs. 54.2%, p-value = 0.04). High prediction of acute coagulopathy of trauma score also significantly associated with mortality (134.2±9.95 vs. 107.8±6.82, p-value = 0.02), whereas trauma-induced coagulopathy clinical score did not vary be survivors and non-survivors. Conclusion: Early coagulopathy was seen in 63% of trauma patients, which was significantly associated with mortality. Acute traumatic coagulopathy defined by conventional coagulation assays (international normalized ratio ≥ 1.19; prothrombin time ≥ 15.5 s; activated partial thromboplastin time ≥ 29 s) demonstrated good ability to identify coagulopathy and subsequent mortality, in comparison to the prehospital parameter-based scoring systems. Prediction of acute coagulopathy of trauma score may be more suited for predicting mortality rather than early coagulopathy. In emergency trauma situations, where immediate corrective measures need to be taken, complex multivariable scoring algorithms may cause delay, whereas coagulation parameters and conventional coagulation tests will give highly specific results.

Keywords: trauma, coagulopathy, prediction, model

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Authors: Ezzi Olfa, Bouafia Nabiha, Ammar Asma, Ben Cheikh Asma, Mahjoub Mohamed, Bannour Wadiaa, Achour Bechir, Khelif Abderrahim, Njah Mansour

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Background: In hematology/oncology, health care improvement has allowed increasingly aggressive management in diagnostic and therapeutic procedures. Nevertheless, these intensified procedures have been associated with higher risk of healthcare associated infections (HAIs). We undertook this study to estimate the burden of HAIs in the cancer patients in an onco -hematology unit in a Tunisian university hospital. Materials/Methods: A prospective, observational study, based on active surveillance for a period of 06 months from Mars through September 2016, was undertaken in the department of onco-hematology in a university hospital in Tunisia. Patients, who stayed in the unit for ≥ 48 h, were followed until hospital discharge. The Centers for Disease Control and Prevention criteria (CDC) for site-specific infections were used as standard definitions for HAIs. Results: One hundred fifty patients were included in the study. The gender distribution was 33.3% for girls and 66.6% boys. They have a mean age of 23.12 years (SD = 18.36 years). The main patient’s diagnosis is: Acute Lymphoblastic Leukemia (ALL): 48.7 %( n=73). The mean length of stay was 21 days +/- 18 days. Almost 8% of patients had an implantable port (n= 12), 34.9 % (n=52) had a lumber puncture and 42.7 % (n= 64) had a medullary puncture. Chemotherapy was instituted in 88% of patients (n=132). Eighty (53.3%) patients had neutropenia at admission. The incidence rate of HAIs was 32.66 % per patient; the incidence density was 15.73 per 1000 patient-days in the unit. Mortality rate was 9.3% (n= 14), and 50% of cases of death were caused by HAIs. The most frequent episodes of infection were: infection of skin and superficial mucosa (5.3%), pulmonary aspergillosis (4.6%), Healthcare associated pneumonia (HAP) (4%), Central venous catheter associated infection (4%), digestive infection (5%), and primary bloodstream infection (2.6%). Finally, fever of unknown origin (FUO) incidence rate was 14%. In case of skin and superficial infection (n= 8), 4 episodes were documented, and organisms implicated were Escherichia.coli, Geotricum capitatum and Proteus mirabilis. For pulmonary aspergillosis, 6 cases were diagnosed clinically and radiologically, and one was proved by positive aspergillus antigen in bronchial aspiration. Only one patient died due this infection. In HAP (6 cases), four episodes were diagnosed clinically and radiologically. No bacterial etiology was established in these cases. Two patients died due to HAP. For primary bloodstream infection (4 cases), implicated germs were Enterobacter cloacae, Geotricum capitatum, klebsiella pneumoniae, and Streptococcus pneumoniae. Conclusion: This type of prospective study is an indispensable tool for internal quality control. It is necessary to evaluate preventive measures and design control guides and strategies aimed to reduce the HAI’s rate and the morbidity and mortality associated with infection in a hematology/oncology unit.

Keywords: cohort prospective studies, healthcare associated infections, hematology oncology department, incidence

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Authors: Harihara Prakash Ramanathan, Daksha Mishra, Ankita Dhaduk

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Relevance: This qualitative study will educate the clinician in putting into practice the advanced method of movement science in restoring the function. Purpose: The purpose of this study is to compare the effectiveness of Active Release Technique and myofascial release technique on range of motion, neck function and pain in patients with upper trapezius spasm. Methods/Analysis: The study was approved by the institutional Human Research and Ethics committee. This study included sixty patients of age group between 20 to 55 years with upper trapezius spasm. Patients were randomly divided into two groups receiving Active Release Technique (Group A) and Myofascial Release Technique (Group B). The patients were treated for 1 week and three outcome measures ROM, pain and functional level were measured using Goniometer, Visual analog scale(VAS), Neck disability Index Questionnaire(NDI) respectively. Paired Sample 't' test was used to compare the differences of pre and post intervention values of Cervical Range of motion, Neck disability Index, Visual analog scale of Group A and Group B. Independent't' test was used to compare the differences between two groups in terms of improvement in cervical range of motion, decrease in visual analogue scale(VAS), decrease in Neck disability index score. Results: Both the groups showed statistically significant improvements in cervical ROM, reduction in pain and in NDI scores. However, mean change in Cervical flexion, cervical extension, right side flexion, left side flexion, right side rotation, left side rotation, pain, neck disability level showed statistically significant improvement (P < 0. 05)) in the patients who received Active Release Technique as compared to Myofascial release technique. Discussion and conclusions: In present study, the average improvement immediately post intervention is significantly greater as compared to before treatment but there is even more improvement after seven sessions as compared to single session. Hence, this proves that several sessions of Manual techniques are necessary to produce clinically relevant results. Active release technique help to reduce the pain threshold by removing adhesion and promote normal tissue extensibility. The act of tensioning and compressing the affected tissue both with digital contact and through the active movement performed by the patient can be a plausible mechanism for tissue healing in this study. This study concluded that both Active Release Technique (ART) and Myofascial release technique (MFR) are equally effective in managing upper trapezius muscle spasm, but more improvement can be achieved by Active Release Technique (ART). Impact and Implications: Active Release Technique can be adopted as mainstay of treatment approach in treating trapezius spasm for faster relief and improving the functional status.

Keywords: trapezius spasm, myofascial release, active release technique, pain

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Authors: Mokgata Matjie, Sibo Mayime

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The 4IR brought with it an inevitable need for change in all organisations, regardless of sector. As a member of the global community, South African organisations are bound to experience the 4IR pressure, and the need to digitize becomes unavoidable. The South African government sector has various departments, of which one of them is the land administration solely responsible for the registration, management, and maintenance of the property registry of South Africa. For the past many years, the registration of deeds was done manually, ranging from 7-10 days, with lots and loads of paperwork handled manually by conveyancers and Registry Clerks. Some information might get lost during the registration period, thus delaying the whole process. This conceptual paper proposes ways to digitalize the land administration office by consulting all relevant literature and ultimately developing a theoretical change management framework for all public sector organisations in South Africa. Change is inevitable, but careful consideration is necessary in terms of consulting all relevant stakeholders for their buy-in and successful implementation of digitalization. The developed framework will serve as a theoretical basis for the empirical research envisaged as a PhD study.

Keywords: stakeholders, engagement, change management, land administration, digitalisation, South African public sector

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