Search results for: Taiwanese legal cases

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

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

Keywords: MRI, breast, clinical, cancer

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Authors: A. Bertašienė

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

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

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

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

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

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Authors: Chala Elhassen

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City planning and urban management seem more complex our days compared to past times. The interaction of many factors both endogenous and exogenous made more difficult the urban fact. The city has changed status with the demographic bulge. It passed the primary status meeting limited requirements to a multidisciplinary status marked by the diversity of needs. These increase with the increase in population and living standard. Our era is marked by urbanization, complex phenomenon that develops both in industrialized countries in those of the third world. Human concentrations increasingly have significant multiplier effects on the social and economic structure of a region or a country. On the whole, the issue of urban planning revolved around questions related firstly to the understanding of the phenomena of urbanization; and also in search of the most appropriate ways to ensure control, the efficiency and consistency of the urbanization process. Urban planning remains an ambiguous area that mixes scientific contributions, technical, artistic, administrative and legal in varying proportions. What is the founder of specificity is that it always presupposes the existence of a will to act, itself supported by a thorough knowledge of will.

Keywords: urbanization, urban planning, management, industrialized countries

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Authors: Gregor Kosec

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

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

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Authors: Temosho Promise Chuene, T. Chitura

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Background: Foot and mouth disease is a real challenge in South Africa. The disease is a serious threat to the viability of livestock farming initiatives and affects local and international livestock trade. In Limpopo Province, the Kruger National Park and other game reserves are home to the African buffalo (Syncerus caffer), a notorious reservoir of the picornavirus, which causes foot and mouth disease. Out of the virus’s seven (7) distinct serotypes, Southern African Territories (SAT) 1, 2, and 3 are commonly endemic in South Africa. The broad objective of the study was to establish the trend of foot and mouth disease in Limpopo Province over a seven-year period (2014-2020), as well as the adoption and comprehensive reporting of the measures that are taken to contain disease outbreaks in the study area. Methods: The study used secondary data from the World Organization for Animal Health (WOAH) on reported cases of foot and mouth disease in South Africa. Descriptive analysis (frequencies and percentages) and Analysis of variance (ANOVA) were used to present and analyse the data. Result: The year 2020 had the highest prevalence of foot and mouth disease (3.72%), while 2016 had the lowest prevalence (0.05%). Serotype SAT 2 was the most endemic, followed by SAT 1. Findings from the study demonstrated the seasonal nature of foot and mouth disease in the study area, as most disease cases were reported in the summer seasons. Slaughter of diseased and at-risk animals was the only documented disease control strategy, and information was missing for some of the years. Conclusion: The study identified serious underreporting of the adopted control strategies following disease outbreaks. Adoption of comprehensive disease control strategies coupled with thorough reporting can help to reduce outbreaks of foot and mouth disease and prevent losses to the livestock farming sector of South Africa and Limpopo Province in particular.

Keywords: livestock farming, African buffalo, prevalence, serotype, slaughter

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Authors: Shahla Rostamirad

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Purpose: Giardiasis is a widespread infection in humans caused by Giardia lamblia. The prevalence of this parasite among children in Isfahan of Iran is unknown. This study intended to estimate Giardia lamblia infection prevalence and identify possible associated risk factors in a healthy pediatric population living in the Isfahan, a metropolitan city of Iran. Methods: Between September 2010 and March 2012, 1448 stool sample from children with clinical manifestation that refer to clinical lab in Isfahan city for stool examination were collected and analyzed. About 1218 samples were positive for parasitic disease. All of samples were examined and diagnosed by direct examination and formalin-ether concentration of stools. Results: A total of 1218 positive cases were analyzed in this study. The findings showed that 92.5% of patients were infected by protozoa and 7.5 percent with helminth infection. The highest and lowest rate of infection belongs to Giardia lamblia and Entamoeba histolytica with 75% and 1.1%, respectively. Other infection cases were included of Blastocystys hominis 9.9%, E. coli 6.5%, H. nana 1.3%, Enterobious vermicolaris 4% and Ascaris lumbricoides 2.2% percent. The population studied revealed a gender distribution of 53.2% male and 46.8% female. Age distribution was 57.3% between 0-5 years and 42.7% between 6-15 years.The prevalence was higher among children aged 0-5 years (57.8%), than among older children (42.2%). Conclusion: The prevalence of protozoan parasite, especially Giardiasis, in children residing in the region of Isfahan is high. Several risk factors were associated with this prevalence and highlight the importance of parents' education and sanitation conditions in the children's well being. The association between Giardia lamblia and H. pylori seems an important issue deserving further investigation in order to promote prevention or treatment strategies. Other risk factor include presence of Helicobacter pylori infection, living in houses with own drainage system and reported household, pet contact, especially with cat and dog.

Keywords: Giardia duodenalis, prevalence, risk factors, children, Isfahan, Iran

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Authors: Nowrozy Jahan, Sharifah Syed Hassan, Daniel Reidpath

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In recent decades, Malaysia has become a dengue hyper-endemic country with the co-circulation of the four-dengue virus (DENV) serotypes. The number of symptomatic dengue cases is maintaining an increasing trend since 1995 and sharply increased in 2014. The four DENV serotypes have been co-circulating since 2000, and this pattern of cyclical dominance of sub-types contributed to the development of frequent major dengue epidemics in Malaysia. Since 2012, different Malaysian state was dominated by different serotypes. The study aims to estimate the burden of asymptomatic dengue in a healthy adult population which may act as a potential source of further symptomatic dengue infection. It also aims to identify the predominant DENV serotypes which are circulating at the community level. A longitudinal prospective community-based study was conducted in the Segamat district of Johor State, southern part of Malaysia where the number of reported dengue cases has steadily increased over the last three years (2013-2015). More specifically, the study was conducted in and around of Kampung Abdullah of Sungai Segamat sub-district which was identified as a hot spot area over the period of 2013-2015. This community-based study has been conducted by Southeast Asia Community Observatory (SEACO), an ISO-certified research platform in collaboration of the Ministry of Health Malaysia and Monash University Malaysia. It was conducted from May 2015 to May 2016. In this study, 277 apparently looking healthy respondents joined who were followed up as a cohort for four times during the one-year study period. Blood was collected to detect the serological marker of dengue at each round of follow-up. Among 277, 184 respondents (66%) joined all four rounds. Half of the study respondents were at the age-group of 45-64 years, slightly more than half of the respondents (59%) were female, and the most (69%) of them were Malay; only 35% lived in urban areas. During the baseline, the study found a very high prevalence of exposure to dengue virus; 89% of the study respondents had serological evidence of previous asymptomatic dengue infection; the majority of them did not know about it as they did not develop any symptom of dengue fever; only 13% knew as they developed symptoms. At the end of the one-year study period, 19% of respondents developed recent secondary dengue infection which was also identified by the serological marker as they did not develop any symptom (asymptomatic cases). The asymptomatic dengue incidence was higher during the rainy season compared to the dry season. All four dengue serotypes were identified in the serum of the infected respondents; among them, DENV-2 was the most prominent. Further genetic analysis is going on to identify the association of HLA-B*46 and HLA-DRB1*08 with dengue resistance. This study provides evidence for the policymakers to be aware of asymptomatic dengue infection, to develop a useful tool for raising awareness about asymptomatic dengue infection among the general population, to monitor the community participation to strengthen the individual and community level dengue prevention and control measures when neither there is vaccine nor particular treatment for dengue.

Keywords: asymptomatic, dengue, health adults, prospective study

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Authors: Sharon Kun-Amornpong

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In this paper, ASEAN financial integration will be discussed from the perspective of the rule of law. The methodology of the paper is comparative regionalism. It will compare the role of the rule of law in ASEAN financial integration with that of the European Union with particular focuses on, for example, institutions and values. The paper argues that in the realm of financial integration, the rule of law is one of the most important factors that could help strengthen and promote financial integration in ASEAN. This is despite the fact that the ‘ASEAN Way’ emphasises non-interference and utilises a consensus-based cooperation rather than formal institutions. Nevertheless, the rule of law for ASEAN financial integration should be situated in its own historical, cultural, and political contexts. In addition, in the case of ASEAN, the rule of law cannot take root if it does not come from the demand of the people in this region. For instance, a reform or creation of legal institutions should not be imposed by international financial institutions. The paper will conclude that law has a normative force. It could shape expectation of market participants and promote deeper financial integration if norms that the law generates have become a significant norm in the society or industry.

Keywords: Association of Southeast Asian Nations, ASEAN, comparative regionalism, financial integration, the rule of law

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Authors: Riaz Ahmed Mangrio

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Reduplication in Urdu-Hindi affects all major word categories, particles, and even nonsensical words. It conveys a variety of meanings, including distribution, emphasis, iteration, adjectival and adverbial. This study will primarily discuss reduplicative structures of nonsensical words in Urdu-Hindi and then briefly look at some examples from other Indo-Aryan languages to introduce the debate regarding the same structures in them. The goal of this study is to present counter-evidence against Keane (2005: 241), who claims “the base in the cases of lexical and phrasal echo reduplication is always independently meaningful”. However, Urdu-Hindi reduplication derives meaningful compounds from nonsensical words e.g. gũ mgũ (A) ‘silent and confused’ and d̪əb d̪əb-a (N) ‘one’s fear over others’. This needs a comprehensive examination to see whether and how the various structures form patterns of a base-reduplicant relationship or, rather, they are merely sub lexical items joining together to form a word pattern of any grammatical category in content words. Another interesting theoretical question arises within the Optimality framework: in an OT analysis, is it necessary to identify one of the two constituents as the base and the other as reduplicant? Or is it best to consider this a pattern, but then how does this fit in with an OT analysis? This may be an even more interesting theoretical question. Looking for the solution to such questions can serve to make an important contribution. In the case at hand, each of the two constituents is an independent nonsensical word, but their echo reduplication is nonetheless meaningful. This casts significant doubt upon Keane’s (2005: 241) observation of some examples from Hindi and Tamil reduplication that “the base in cases of lexical and phrasal echo reduplication is always independently meaningful”. The debate on the point becomes further interesting when the triplication of nonsensical words in Urdu-Hindi e.g. aẽ baẽ ʃaẽ (N) ‘useless talk’ is also seen, which is equally important to discuss. The example is challenging to Harrison’s (1973) claim that only the monosyllabic verbs in their progressive forms reduplicate twice to result in triplication, which is not the case with the example presented. The study will consist of a thorough descriptive analysis of the data for the purpose of documentation, and then there will be OT analysis.

Keywords: reduplication, urdu-hindi, nonsensical, optimality theory

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Authors: Rahul Pal

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In India, construction industry plays a vital role in the development of infrastructures. It is one of the most hazardous industries. Construction workers are a group that is particularly vulnerable to health risks because they have few legal protection. India has the world’s highest accident rate among construction workers. This study aimed to investigate the prevalence of occupation injury among construction workers and to find out the factors responsible for such injuries. Methodology: A cross-sectional study using a semi-structured questionnaire among 305 construction workers in Bhubaneswar city. In this study, it was found that the overall prevalence of injury was 43.28% in the previous one year period. Majority of the construction workers were less experience in the construction work. Factors responsible for injuries are fall of the object followed by striking, and majority of the workers reported their injuries to have occurred in the summer season. And most of the construction workers are not using personal protective equipment (PPE). Conclusion: Given the occupational injuries, the majority of the construction workers are injured in this study; there is a need to address this issue to ensure necessary step for the safety and well-being of construction workers.

Keywords: construction, construction workers, occupational injuries, personal protective equipment

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Authors: Donna Erika E. De Jesus

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Introduction: Cardiac arrest occurs when abrupt cessation of cardiac function results in loss of effective circulation and complete cardiovascular collapse. For every minute of cardiac arrest without early intervention (cardiopulmonary resuscitation [CPR], defibrillation), chances of survival drop by 7-10%. It is crucial that CPR be initiated within 4-6 minutes to avoid brain death. Most out-of-hospital cardiac arrests (OHCA) occur in a residential setting where access to trained personnel and equipment is not readily available, resulting in poor victim outcomes. Methods: This is a descriptive study done from August to November 2021 using a prospective cohort design. Participants of the study include adult patients aged 18 years and above brought to the emergency room who suffered from out-of-hospital cardiac arrest. Out of the total 102 cases of OHCA, 63 participants were included in the study. Descriptive statistics were used to summarize the demographic and clinical characteristics of the patients. Results: 43 were male patients, comprising the majority at 73.02%. Hypertension was identified as the top co-morbidity, followed by diabetes mellitus, heart failure, and chronic kidney disease (CKD). Medical causes of arrest were identified in 96.83% of the cases. 90.48% of cardiac arrests occurred at home. Only 26 patients (41.27%) received pre-hospital intervention prior to ER arrival, which comprised only hands-only CPR. Twenty-three of which were performed by individuals with background knowledge of CPR. 60.32% were brought via self-conduction, the remainder by ambulances, which were noted to have no available equipment necessary to provide proper resuscitation. The average travel time from dispatch to ER arrival is 20 minutes. Conclusion: Overall survival of OHCA in our local setting remains dismal, as a return of spontaneous circulation was not achieved in any of the patients. The small number of patients having pre-hospital CPR indicates the need for emphasis on training and community education.

Keywords: out-of-hospital cardiac arrest, cardiopulmonary resuscitation, basic life support, emergency medical services

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Authors: Marzieh Nojomi, Azadeh Mottaghi, Arghavan Haj-Sheykholeslami, Narjes Khalili, Arash Tehrani Banihashemi

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Background and objectives: Domestic violence is a global problem with severe consequences throughout the life of the victims. Iran’s Ministry of Health has launched an intimate partner violence (IPV) prevention program, integrated in the primary health care services since 2016. The present study is a part of this national program’s evaluation. In this section, we aimed to examine spousal abuse victims’ knowledge and attitude towards domestic violence before and after receivingthese services. Methods: To assess the knowledge and attitudes of victims, a questionnaire designed by Ahmadzadand colleagues in 2013 was used. This questionnaire includes 15 questions regarding knowledge in the fields of definition, epidemiology, and effects on children, outcomes, and prevention of domestic violence. To assess the attitudes, this questionnaire has 10 questions regarding the attitudes toward the causes, effects, and legal or protective support services of domestic violence. To assess the satisfaction and the effect of the program on prevention or reduction of spousal violence episodes, two more questions were also added. Since domestic violence prevalence differs in different parts of the country, we chose nine areas with the highest, the lowest, and moderate prevalence of IPVfor the study. The link to final electronic version of the questionnaire was sent to the randomly selected public rural or urban health centers in the nine chosen areas. Since the study had to be completed in one month, we used newly identified victims as pre-intervention group and people who had at least received one related service from the program (like psychiatric consultation, education about safety measures, supporting organizations and etc.) during the previous year, as our post- intervention group. Results: A hundred and ninety-two newly identified IPV victims and 267 victims who had at least received one related program service during the previous year entered the study. All of the victims were female. Basic characteristics of the two groups, including age, education, occupation, addiction, spouses’ age, spouses’ addiction, duration of the current marriage, and number of children, were not statistically different. In knowledge questions, post- intervention group had statistically better scores in the fields of domestic violence outcomes and its effects on children; however, in the remaining areas, the scores of both groups were similar. The only significant difference in the attitude across the two groups was in the field of legal or protective support services. From the 267 women who had ever received a service from the program, 91.8% were satisfied with the services, and 74% reported a decrease in the number of violent episodes. Conclusion: National IPV prevention program integrated in the primary health care services in Iran is effective in improving the knowledge of victims about domestic violence outcomes and its effects on children. Improving the attitude and knowledge of domestic violence victims about its causes and preventive measures needs more effective interventions. This program can reduce the number of IPV episodes between the spouses, and satisfaction among the service users is high.

Keywords: intimate partner violence, assessment, health services, efficacy

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Authors: Hycham Aboutaleb, Bruno Monsuez

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Current systems' complexity has reached a degree that requires addressing conception and design issues while taking into account environmental, operational, social, legal, and financial aspects. Therefore, one of the main challenges is the way complex systems are specified and designed. The exponentially growing effort, cost, and time investment of complex systems in modeling phase emphasize the need for a paradigm, a framework, and an environment to handle the system model complexity. For that, it is necessary to understand the expectations of the human user of the model and his limits. This paper presents a generic framework for designing complex systems, highlights the requirements a system model needs to fulfill to meet human user expectations, and suggests a graph-based formalism for modeling complex systems. Finally, a set of transformations are defined to handle the model complexity.

Keywords: higraph-based, formalism, system engineering paradigm, modeling requirements, graph-based transformations

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Authors: John Ahluwalia

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As an affluent first-world nation, Canada took swift and comprehensive action during the outbreak of the SARS-CoV-2 (COVID-19) pandemic compared to other countries in the same socio-economic cohort. The United States has stumbled to overcome obstacles most developed nations have faced, which has led to significantly more per capita cases and deaths. The initial outbreaks of COVID-19 occurred in the US and Canada within days of each other and posed similar potentially catastrophic threats to public health, the economy, and governmental stability. On a macro level, events that take place in the US have a direct impact on Canada. For example, both countries tend to enter and exit economic recessions at approximately the same time, they are each other’s largest trading partners, and their currencies are inexorably linked. Why is it that Canada has not shared the same fate as the US (and many other nations) that have realized much worse outcomes relative to the COVID-19 pandemic? Variables intrinsic to Canada’s national infrastructure have been instrumental in the country’s efforts to flatten the curve of COVID-19 cases and deaths. Canada’s coordinated multi-level governmental effort has allowed it to create and enforce policies related to COVID-19 at both the national and provincial levels. Canada’s policy of universal healthcare is another variable. Health care and public health measures are enforced on a provincial level, and it is within each province’s jurisdiction to dictate standards for public safety based on scientific evidence. Rather than introducing confusion and the possibility of competition for resources such as PPE and vaccines, Canada’s multi-level chain of government authority has provided consistent policies supporting national public health and local delivery of medical care. This paper will demonstrate that the coordinated efforts on provincial and federal levels have been the linchpin in Canada’s relative success in containing the deadly spread of the COVID-19 virus.

Keywords: COVID-19, Canada, GIS, temporal analysis, ESRI

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Authors: Afsane Amiri

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Electric Vehicle (EV) technology is expected to take a major share in the light-vehicle market in the coming decades. Charging of EVs will put an extra burden on the distribution grid and in some cases adjustments will need to be made. In this paper a review of different plug-in and vehicle to grid (V2G) capable vehicles are given along with their power electronics topologies. The economic implication of charging the vehicle or sending power back to the utility is described in brief.

Keywords: energy storage system, battery unit, cost, optimal sizing, plug-in electric vehicles (PEVs), smart grid

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Authors: Lauren Beth Birney

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BOP-CCERS is a consortium of scientists, K-16 New York City students, faculty, academicians, teachers, stakeholders, STEM Industry professionals, CBO’s, NPO’s, citizen scientists, and local businesses working in partnership to restore New York Harbor’s oyster populations while at the same time providing clean water in New York Harbor. BOP-CCERS gives students an opportunity to learn hands-on about environmental stewardship as well as environmental law and policy by giving students real responsibility. The purpose of this REU will allow for the BOP CCERS Project to further broaden its parameters into the focus of environmental law and policy where further change can be affected. Creating opportunities for undergraduates to work collaboratively with graduate students in law and policy and envision themselves in STEM careers in the field of law continues to be of importance in this project. More importantly, creating opportunities for underrepresented students to pursue careers in STEM Education has been a goal of the project over the last ten years. By raising the level of student interest in community-based citizen science integrated into environmental law and policy, a more diversified workforce will be fostered through the momentum of this dynamic program. The continuing climate crisis facing our planet calls for 21st-century skill development that includes learning and innovation skills derived from critical thinking, which will help REU students address the issues of climate change facing our planet. The demand for a climate-friendly workforce will continue to be met through this community-based citizen science effort. Environmental laws and policies play a crucial role in protecting humans, animals, resources, and habitats. Without these laws, there would be no regulations concerning pollution or contamination of our waterways. Environmental law serves as a mechanism to protect the land, air, water, and soil of our planet. To protect the environment, it is crucial that future policymakers and legal experts both understand and value the importance of environmental protection. The Environmental Law and Policy REU provides students with the opportunity to learn, through hands-on work, the skills, and knowledge needed to help foster a legal workforce centered around environmental protection while participating alongside the BOP CCERS researchers in order to gain research experience. Broadening this area to law and policy will further increase these opportunities and permit students to ultimately affect and influence larger-scale change on a global level while further diversifying the STEM workforce. Students’ findings will be shared at the annual STEM Institute at Pace University in August 2022. Basic research methodologies include qualitative and quantitative analysis performed by the research team. Early findings indicate that providing students with an opportunity to experience, explore and participate in environmental science programs such as these enhances their interests in pursuing STEM careers in Law and Policy, with the focus being on providing opportunities for underserved, marginalized, and underrepresented populations.

Keywords: environmental restoration science, citizen science, environmental law and policy, STEM education

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Authors: Sushma Tejwani, Shoruba Dinakaran, Kushal Kacha, K. Bhujang Shetty

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Introduction and aim: It is not unusual to find patients with glaucomatous damage and normal intraocular pressure, and to label a patient as Normal tension glaucoma (NTG) majority of clinicians depend on office Intraocular pressures (IOP) recordings; hence, the concern is that whether we are missing the late night or early morning spikes in this group of patients. Also, ischemia to the optic nerve is one of the presumed causes of damage in these patients, however demonstrating the same has been a challenge. The aim of this study was to evaluate IOP variations and patterns in a series of patients with open angles, glaucomatous discs or fields but normal office IOP, and in addition to identify ischemic factors for true NTG patients. Materials & Methods: This was an observational cross- sectional study from a tertiary care centre. The patients that underwent full day DVT from Jan 2012 to April 2014 were studied. All patients underwent IOP measurement on Goldmann applanation tonometry every 3 hours for 24 hours along with a recording of the blood pressure (BP). Further patients with normal IOP throughout the 24- hour period were evaluated with a cardiologist for echocardiography and carotid Doppler. Results: There were 47 patients and a maximum number of patients studied was in the age group of 50-70 years. A biphasic IOP peak was noted for almost all the patients. Out of the 47 patients, 2 were excluded from analysis as they were on treatment.20 patients (42%) were diagnosed on DVT to have an IOP spike and were then diagnosed as open angle glaucoma and another 25 (55%) were diagnosed to have normal tension glaucoma and were subsequently advised a carotid Doppler and a cardiologists consult. Another interesting finding was that 9 patients had a nocturnal dip in their BP and 3 were found to have carotid artery stenosis. Conclusion: A continuous 24-hour monitoring of the IOP and BP is a very useful albeit mildly cumbersome tool which provides a wealth of information in cases of glaucoma presenting with normal office pressures. It is of great value in differentiating between normal tension glaucoma patients & open angle glaucoma patients. It also helps in timely diagnosis & possible intervention due to referral to a cardiologist in cases of carotid artery stenosis.

Keywords: carotid artery disease in NTG, diurnal variation of IOP, ischemia in glaucoma, normal tension glaucoma

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Authors: A. Keshavarz

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A physical model for guiding the wave in photorefractive media is studied. Propagation of cos-Gaussian beam as the special cases of sinusoidal-Gaussian beams in photorefractive crystal is simulated numerically by the Crank-Nicolson method in one dimension. Results show that the beam profile deforms as the energy transfers from the center to the tails under propagation. This simulation approach is of significant interest for application in optical telecommunication. The results are presented graphically and discussed.

Keywords: beam propagation, cos-Gaussian beam, numerical simulation, photorefractive crystal

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Authors: Ayse Gul Bilen

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Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants that are used clinically for the treatment of anxiety disorders, obsessive-compulsive disorder (OCD), panic disorders and eating disorders. The first SSRI, fluoxetine (sold under the brand names Prozac and Sarafem among others), had an adverse effect profile better than any other available antidepressant when it was introduced because of its selectivity for serotonin receptors. They have been considered almost free of side effects and have become widely prescribed, however questions about the safety and tolerability of SSRIs have emerged with their continued use. Most SSRI side effects are dose-related and can be attributed to serotonergic effects such as nausea. Continuous use might trigger adverse effects such as hyponatremia, tremor, nausea, weight gain, sleep disturbance and sexual dysfunction. Moderate toxicity can be safely observed in the hospital for 24 hours, and mild cases can be safely discharged (if asymptomatic) from the emergency department once cleared by Psychiatry in cases of intentional overdose and after 6 to 8 hours of observation. Although fluoxetine is relatively safe in terms of overdose, it might still be cardiotoxic and inhibit platelet secretion, aggregation, and plug formation. There have been reported clinical cases of seizures, cardiac conduction abnormalities, and even fatalities associated with fluoxetine ingestions. While the medical literature strongly suggests that most fluoxetine overdoses are benign, emergency physicians need to remain cognizant that intentional, high-dose fluoxetine ingestions may induce seizures and can even be fatal due to cardiac arrhythmia. Our case is a 35-year old female patient who was sent to ER with symptoms of confusion, amnesia and loss of orientation for time and location after being found wandering in the streets unconsciously by police forces that informed 112. Upon laboratory examination, no pathological symptom was found except sinus tachycardia in the EKG and high levels of aspartate transaminase (AST) and alanine transaminase (ALT). Diffusion MRI and computed tomography (CT) of the brain all looked normal. Upon physical and sexual examination, no signs of abuse or trauma were found. Test results for narcotics, stimulants and alcohol were negative as well. There was a presence of dysrhythmia which required admission to the intensive care unit (ICU). The patient gained back her conscience after 24 hours. It was discovered from her story afterward that she had been using fluoxetine due to post-traumatic stress disorder (PTSD) for 6 months and that she had attempted suicide after taking 3 boxes of fluoxetine due to the loss of a parent. She was then transferred to the psychiatric clinic. Our study aims to highlight the need to consider toxicologic drug use, in particular, the abuse of selective serotonin reuptake inhibitors (SSRIs), which have been widely prescribed due to presumed safety and tolerability, for diagnosis of patients applying to the emergency room (ER).

Keywords: abuse, amnesia, fluoxetine, intoxication, SSRI

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Authors: Rada Somkhuean, Sa-aat Niwitpong, Suparat Niwitpong

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This paper presents the generalized p-values for testing the difference between two future population means when the variances are unknown, in both cases for when the variances are equal and unequal. We also derive a closed form expression of the upper bound of the proposed generalized p-value.

Keywords: generalized p-value, two future population means, upper bound, variances

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Authors: Igor Perechuda, Wojciech Cieśliński

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The paper identifies the features of Polish sports clubs in the particular organizational forms: profit and nonprofit. Identification and description of these features is carried out in terms of financial efficiency of the given organizational form. Under the terms of the efficiency the research allows you to specify the advantages of particular organizational sports club form and the following limitations. Paper considers features of sports clubs in range of Polish conditions as legal regulations. The sources of the functioning efficiency of sports clubs may lie in the organizational forms in which they operate. Each of the available forms can be considered either a for-profit or nonprofit enterprise. Depending on this classification there are different capabilities of increasing organizational and financial efficiency of a given sports club. Authors start with general classification and difference between for-profit and non-profit sport clubs. Next identifies specific financial and organizational conditions of both organizational form and then show examples of mixed activity forms and their efficiency effect.

Keywords: financial efficiency, for-profit, non-profit, sports club

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Authors: Ling Liyun

Abstract:

In the field of contemporary architecture, complex forms of architectural works continue to emerge in the world, along with some new terminology emerged: digital architecture, parametric design, algorithm generation, building information modeling, CNC construction and so on. Architects gradually mastered the new skills of mathematical logic in the form of exploration, virtual simulation, and the entire design and coordination in the construction process. Digital construction technology has a greater degree in controlling construction, and ensure its accuracy, creating a series of new construction techniques. As a result, the use of digital technology is an improvement and expansion of the practice of digital architecture design revolution. We worked by reading and analyzing information about the digital architecture development process, a large number of cases, as well as architectural design and construction as a whole process. Thus current developments were introduced and discussed in our paper, such as architectural discourse, design theory, digital design models and techniques, material selecting, as well as artificial intelligence space design. Our paper also pays attention to the representative three cases of digital design and construction experiment at great length in detail to expound high-informatization, high-reliability intelligence, and high-technique in constructing a humane space to cope with the rapid development of urbanization. We concluded that the opportunities and challenges of the shift existed in architectural paradigms, such as the cooperation methods, theories, models, technologies and techniques which were currently employed in digital design research and digital praxis. We also find out that the innovative use of space can gradually change the way people learn, talk, and control information. The past two decades, digital technology radically breaks the technology constraints of industrial technical products, digests the publicity on a particular architectural style (era doctrine). People should not adapt to the machine, but in turn, it’s better to make the machine work for users.

Keywords: artificial intelligence, collaboration, digital architecture, digital design theory, material selection, space construction

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Authors: Mustafa Gok, Sair Kahraman, Mustafa Fener

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In rock engineering applications, determining uniaxial compressive strength (UCS), Brazilian tensile strength (BTS), and basic index properties such as density, porosity, and water absorption is crucial for the design of both underground and surface structures. However, obtaining reliable samples for direct testing, especially from rocks that weather quickly and have low strength, is often challenging. In such cases, indirect methods provide a practical alternative to estimate the physical and mechanical properties of these rocks. In this study, tuff samples collected from the Cappadocia region (Nevşehir) in Turkey were subjected to indirect testing methods. Over 100 tests were conducted, using needle penetrometer index (NPI), point load strength index (PLI), and disc shear index (BPI) to estimate the uniaxial compressive strength (UCS), Brazilian tensile strength (BTS), density, and water absorption index of the tuffs. The relationships between the results of these indirect tests and the target physical properties were evaluated using simple and multiple regression analyses. The findings of this research reveal strong correlations between the indirect methods and the mechanical properties of the tuffs. Both uniaxial compressive strength and Brazilian tensile strength could be accurately predicted using NPI, PLI, and BPI values. The regression models developed in this study allow for rapid, cost-effective assessments of tuff strength in cases where direct testing is impractical. These results are particularly valuable for geological engineering applications, where time and resource constraints exist. This study highlights the significance of using indirect methods as reliable predictors of the mechanical behavior of weak rocks like tuffs. Further research is recommended to explore the application of these methods to other rock types with similar characteristics. Further research is required to compare the results with those of established direct test methods.

Keywords: brazilian tensile strength, disc shear strength, indirect methods, tuffs, uniaxial compressive strength

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Authors: D. Mulligan, D. Casey

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Introductory Statement: Delegation is when a registered nurse (RN) transfers a task or activity that is normally within their scope of practice to another person (delegatee). RN delegation is common practice with unregistered staff, e.g., student nurses and health care assistants (HCAs). As the role of the HCA is increasingly embedded as a direct care and support role, especially in long-term residential care for older adults, there is RN uncertainty as to their role as a delegator. The assignment is when a task is transferred to a person that is within the role specification of the delegatee. RNs in long-term care (LTC) for older people are increasingly working in teams where there are less RNs and more HCAs providing direct care to the residents. The RN is responsible and accountable for their decision to delegate and assign tasks to HCAs. In an interpretive, multiple case studies to explore how delegation of tasks by RNs to HCAs occurred in long-term care settings in Ireland the importance of the RN understanding their scope of practice emerged. Methodology: Focus group interviews and individual interviews were undertaken as part of a multiple case study. Both cases, anonymized as Case A and Case B, were within the public health service in Ireland. The case study sites were long-term care settings for older adults located in different social care divisions, and in different geographical areas. Four focus group interviews with staff nurses and three individual interviews with CNMs were undertaken. The interactive data analysis approach was the analytical framework used, with within-case and cross-case analysis. The theoretical lens of organizational role theory, applying the role episode model (REM), was used to understand, interpret, and explain the findings. Study Findings: RNs and CNMs understood the role of the nurse regulator and the scope of practice. RNs understood that the RN was accountable for the care and support provided to residents. However, RNs and CNM2s could not describe delegation in the context of their scope of practice. In both cases, the RNs did not have a standardized process for assessing HCA competence to undertake nursing tasks or interventions. RNs did not routinely supervise HCAs. Tasks were assigned and not delegated. There were differences between the cases in relation to understanding which nursing tasks required delegation. HCAs in Case A undertook clinical vital sign assessments and documentation. HCAs in Case B did not routinely undertake these activities. Delegation and assignment were influenced by the organizational factors, e.g., model of care, absence of delegation policies, inadequate RN education on delegation, and a lack of RN and HCA role clarity. Concluding Statement: Nurse staffing levels and skill mix in long-term care settings continue to change with more HCAs providing more direct care and support. With decreasing RN staffing levels RNs will be required to delegate and assign more direct care to HCAs. There is a requirement to distinguish between RN assignment and delegation at policy, regulation, and organizational levels.

Keywords: assignment, delegation, registered nurse, scope of practice

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

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Introduction: It is well known that patients with Head and Neck Cancer (HNC) are at increased risk of subsequent head and neck cancers due to various aetiologies. Aim: We sought to determine the factors contributing to an increased risk of subsequent HNC primaries, and also to evaluate whether Aboriginal patients are at increased risk. Methods: We performed a retrospective cohort analysis of 320 HNC patients from a single centre in Western Australia, identifying 80 Aboriginal patients and 240 non-Aboriginal patients matched on a 1:3 ratio by site, histology, rurality, and age. We collected patient data including smoking and alcohol consumption, tumour and treatment data, and data on subsequent HNC primaries. Results: A subsequent HNC primary was seen in 37 patients (11.6%) overall. There was no significant difference in the rate of second primary HNCs between Aboriginal patients (12.5%) and nonAboriginal patients (11.2%) (p=0.408). Subsequent HNCs, were strongly associated with smoking and alcohol consumption however, with 95% of patients with a second primary being ever-smokers, and 54% of patients with a second primary having a history of excessive alcohol consumption. In the 37 patients with multiple HNC primaries, there were a total of 57 HNCs, with 29 patients having two primaries, six patients having 3 HNC primaries, one patient with four, and one with six. 54 out of the 57 cancers were in ever smokers (94.7%). There were only two multiple HNC primaries in a never smoker, non-drinker, and these cases were of unknown etiology with HPV/p16 status unknown in both cases. In the whole study population, there were 32 HPV-positive HNCs, and 67 p16-positive HNCs, with only two 2 nd HNCs in a p16-positive case, giving a rate of 3% in the p16+ population, which is actually much lower than the rate of second primaries seen in the overall population (11.6%), and was highest in the p16-negative population (15.7%). This suggests that p16-positivity is not a strong risk factor for subsequent primaries, and in fact p16-negativity appeared to be associated with increased risk, however this data is limited by the large number of patients without documented p16 status (45.3% overall, 12% for oropharyngeal, and 59.6% for oral cavity primaries had unknown p16 status). Summary: Subsequent HNC primaries were strongly associated with smoking and alcohol excess. Second and later HNC primaries did not appear to occur at increased rates in Aboriginal patients compared with non-Aboriginal patients, and p16-positivity did not predict increased risk, however p16-negativity was associated with an increased risk of subsequent HNCs.

Keywords: head and neck cancer, multiple primaries, aboriginal, p16 status, smoking, alcohol

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Authors: Magdalena Rusady Goey, Gordon Strathdee, Neil Perkins

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Background: Acute lymphoblastic leukaemia (ALL) is the most frequent type of childhood malignancy, accounting for 25% of all cases. TWIST2, a basic helix-loop-helix transcription factor, has been implicated in ALL development. Prior studies found that TWIST2 undergoes epigenetic silencing in more than 50% cases of ALL through promoter hypermethylation and suggested that re-expression of TWIST2 may inhibit cell growth/survival of leukaemia cell lines. TWIST2 has also been implicated as a regulator of NF-kappaB activity, which is constitutively active in leukaemia. Here, we use a lentiviral transductions system to confirm the importance of TWIST2 in controlling leukaemia cell growth and to investigate whether this is achieved through altered regulation of NF-kappaB activity. Method: Re-expression of TWIST2 in leukaemia cell lines was achieved using lentiviral-based transduction. The lentiviral vector also expresses enhanced green fluorescent protein (eGFP), allowing transduced cells to be tracked using flow cytometry. Analysis of apoptosis and cell proliferation were done using annexinV and VPD450 staining, respectively. Result and Discussion: TWIST2-expressing cells were rapidly depleted from a mixed population in ALL cell lines (NALM6 and Reh), indicating that TWIST2 inhibited cell growth/survival of ALL cells. In contrast, myeloid cell lines (HL60 and K562) were comparatively insensitive to TWIST2 re-expression. Analysis of apoptosis and cell proliferation found no significant induction of apoptosis, but did find a rapid induction of proliferation arrest in TWIST2-expressing Reh and NALM6 cells. Initial experiment with NF-kappaB inhibitor demonstrated that inhibition of NF-kappaB has similar impact on cell proliferation in the ALL cell lines, suggesting that TWITST2 may induce cell proliferation arrest through inhibition of NF-kappaB. Conclusion: The results of this study suggest that epigenetic inactivation of TWIST2 in primary ALL leads to increased proliferation, potentially by altering the regulation of NF-kappaB.

Keywords: leukaemia, acute lymphoblastic leukaemia, NF-kappaB, TWIST2, lentivirus

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Authors: William Elnemer, Nauman Hussain, Samir Al-Ali, Henry Shu, Diane Ghanem, Babar Shafiq

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Introduction: The incidence of infection in open tibial shaft injuries varies depending on the severity of the injury, with rates ranging from 1.8% for Gustilo-Anderson type I to 42.9% for type IIIB fractures. The timely administration of antibiotics upon presentation to the emergency department (ED) is an essential component of fracture management, and evidence indicates that prompt delivery of antibiotics is associated with improved outcomes. The objective of this study is to identify factors that contribute to the expedient administration of antibiotics. Methods: This is a retrospective study of open tibial shaft fractures at an academic Level I trauma center. Current Procedural Terminology (CPT) codes identified all patients treated for open tibial shaft fractures between 2015 and 2021. Open fractures were identified by reviewing ED and provider notes, and with ballistic fractures were considered open. Chart reviews were performed to extract demographics, fracture characteristics, postoperative outcomes, time to operative room, time to antibiotic order, and delivery. Univariate statistical analysis compared patients who received early antibiotics (EA), which were delivered within one hour of ED presentation, and those who received late antibiotics (LA), which were delivered outside of one hour of ED presentation. A multivariate analysis was performed to investigate patient, fracture, and transport/ED characteristics contributing to faster delivery of antibiotics. The multivariate analysis included the dependent variables: ballistic fracture, activation of Delta Trauma, Gustilo-Andersen (Type III vs. Type I and II), AO-OTA Classification (Type C vs. Type A and B), arrival between 7 am and 11 pm, and arrival via Emergency Medical Services (EMS) or walk-in. Results: Seventy ED patients with open tibial shaft fractures were identified. Of these, 39 patients (55.7%) received EA, while 31 patients (44.3%) received LA. Univariate analysis shows that the arrival via EMS as opposed to walk-in (97.4% vs. 74.2%, respectively, p = 0.01) and activation of Delta Trauma (89.7% vs. 51.6%, respectively, p < 0.001) was significantly higher in the EA group vs. the LA group. Additionally, EA cases had significantly shorter intervals between the antibiotic order and delivery when compared to LA cases (0.02 hours vs. 0.35 hours, p = 0.007). No other significant differences were found in terms of postoperative outcomes or fracture characteristics. Multivariate analysis shows that a Delta Trauma Response, arrival via EMS, and presentation between 7 am and 11 pm were independent predictors of a shorter time to antibiotic administration (Odds Ratio = 11.9, 30.7, and 5.4, p = 0.001, 0.016, and 0.013, respectively). Discussion: Earlier antibiotic delivery is associated with arrival to the ED between 7 am and 11 pm, arrival via EMS, and a coordinated Delta Trauma activation. Our findings indicate that in cases where administering antibiotics is critical to achieving positive outcomes, it is advisable to employ a coordinated Delta Trauma response. Hospital personnel should be attentive to the rapid administration of antibiotics to patients with open fractures who arrive via walk-in or during late-night hours.

Keywords: antibiotics, emergency department, fracture management, open tibial shaft fractures, orthopaedic surgery, time to or, trauma fractures

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Authors: Viviana Letelier, Ester Tarela, Bianca Lopez, Pedro Muñoz, Giacomo Moriconi

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The environmental impact has become a global concern during the last decades. Several alternatives have been proposed and studied to minimize this impact in different areas. The reuse of aggregates from old concretes to manufacture new ones not only can reduce this impact but is also a way to optimize the resource management. The effect of the origin of the reused aggregates from two different origin materials in recycled concrete pavement is studied here. Using the dosing applied by a pavement company, coarse aggregates in the 6.3-25 mm fraction are replaced by recycled aggregates with two different origins: old concrete pavements with similar origin strength to the one of the control concrete, and precast concrete pipes with smaller strengths than the one of the control concrete. The replacement percentages tested are 30%, 40% and 50% in both cases. The compressive strength tests are performed after 7, 14, 28 and 90 curing days, the flexural strength tests and the elasticity modulus tests after 28 and 90 curing days. Results show that the influence of the quality of the origin concrete in the mechanical properties of recycled concretes is not despicable. Concretes with up to a 50% of recycled aggregates from the concrete pavement have similar compressive strengths to the ones of the control concrete and slightly smaller flexural strengths that, however, in all cases exceed the minimum of 5MPa after 28 curing days stablished by the Chilean regulation for pavement concretes. On the other hand, concretes with recycled aggregates from precast concrete pipes show significantly lower compressive strengths after 28 curing days. The differences with the compressive strength of the control concrete increase with the percentage of replacement, reaching a 13% reduction when 50% of the aggregates are replaced. The flexural strength also suffers significant reductions that increase with the percentage of replacement, only obeying the Chilean regulation when 30% of the aggregates are recycled after 28 curing days. Nevertheless, after 90 curing days, all series obey the regulation requirements. Results show, not only the importance of the quality of the origin concrete, but also the significance of the curing days, that may allow the use of less quality recycled material without important strength losses.

Keywords: flexural strength of recycled concrete., mechanical properties of recycled concrete, recycled aggregates, recycled concrete pavements

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Authors: Si Jack Chong, Chew Theng Yap, Wan Loong James Mok

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Introduction: Regional burn centres face the spectra of introduced multi-drug resistant organisms (MDRO) from transfer patients resident in MDRO endemic countries. MDRO can cause severe nosocomial infection, which in massive burn patients, will lead to greater morbidity and mortality and strain the institution financially. We aim to highlight 4 key measures that have effectively prevented transmission of imported MDRO. Methods: A case of Candida auris (C. auris) from a massive burn patient transferred from an MDRO endemic country is used to illustrate the measures. C. auris is a globally emerging multi-drug resistant fungal pathogen causing nosocomial transmission. Results: Infection control measures used to mitigate the risk of outbreak from transfer cases are: (1) Multidisciplinary team approach involving Infection Control and Infectious Disease specialists early to ensure appropriate antibiotics use and implementation of barrier measures, (2) aseptic procedures for dressing change with strict isolation and donning of personal protective equipment in the ward, (3) early screening of massive burn patient from MDRO endemic region, (4) hydrogen peroxide vaporization terminal cleaning for operating theatres and rooms. Conclusion: The prevalence of air travel and international transfer to regional burn centres will need effective infection control measures to reduce the risk of transmission from imported massive burn patients. In our centre, we have effectively implemented 4 measures which have reduced the risks of local contamination. We share a recent case report to illustrate successful management of a potential MDRO outbreak resulting from transfer of massive burn patient resident in an MDRO endemic area.

Keywords: burns, burn unit, cross infection, infection control

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