Search results for: severe trauma

Authors: Ersumo Tessema, Bogale Girmaye Tamrat, Mohammed Burka

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Background: Hyperthyroidism is a common thyroid disorder especially in women and characterized by increased thyroid hormone synthesis and secretion. The disorder manifests predominantly as Graves’ disease in iodine-sufficient areas and has increasing prevalence in iodine-deficient countries in patients with nodular thyroid disease and following iodine fortification. In Ethiopia, the magnitude of the disorder is unknown and, in Africa, due to scarcity of resources, its management remains suboptimal. Objective: The aim of this study was to analyze the pattern and management of patients with hyperthyroidism at the United Vision Medical Services Center, Addis Ababa between August 30, 2013, and February 1, 2018. Patients and methods: The study was a retrospective analysis of medical records of all patients with hyperthyroidism at the United Vision Private Medical Services Center, Addis Ababa. A questionnaire was filled out; the collected data entered into a computer and statistically analyzed using the SPSS package. The results were tabulated and discussed with literature review. Results: A total of 589 patients were included in this study. The median age was 40 years, and the male to female ratio was 1.0:7.9. Most patients (93%) presented with goiter and the associated features of toxic goiter except weight loss, sweating and tachycardia were uncommon. Majority of patients presented more than two years after the onset of their presenting symptoms. The most common physical finding (91%), as well as diagnosis, was toxic nodular goiter. The most frequent (83%) derangement in the thyroid function tests was a low thyroid-stimulating hormone, and the most commonly (94%) used antithyroid drug was a propylthiouracil. The most common (96%) surgical procedure in 213 patients was a near-total thyroidectomy with a postoperative course without incident in 92% of all the patients. Conclusion: The incidence and prevalence of hyperthyroidism are apparently on the increase in Addis Ababa, which may be related to the existing severe iodine-deficiency and or the salt iodation program (iodine-induced hyperthyroidism). Hyperthyroidism predominantly affects women and, in surgical services, toxic nodular goiter is more common than diffuse goiter, and the treatment of choice in experienced hands is a near-total thyroidectomy.

Keywords: Ethiopia, grave’s disease, hyperthyroidism, toxic nodular goiter

Procedia PDF Downloads 172

Authors: Mohammad Borhani, Ahmad Jamshidzaei, Mehdi Koohsari

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The study of climate has captivated human interest throughout history. In response to this fascination, individuals historically organized their daily activities in alignment with prevailing climatic conditions and seasonal variations. Understanding the elements and specific climatic parameters of each region, such as precipitation, which directly impacts human life, is essential because, in recent years, there has been a significant increase in heavy rainfall in various parts of the world attributed to the effects of climate change. Climate prediction models suggest a future scenario characterized by an increase in severe precipitation events and related floods on a global scale. This is a result of human-induced greenhouse gas emissions causing changes in the natural precipitation patterns. The Intergovernmental Panel on Climate Change reported global warming in 2001. The average global temperature has shown an increasing trend since 1861. In the 20th century, this increase has been between (0/2 ± 0/6) °C. The present study focused on examining the trend of monthly, seasonal, and annual precipitation in Sistan and Baluchestan provinces. The study employed data obtained from 13 precipitation measurement stations managed by the Iran Water Resources Management Company, encompassing daily precipitation records spanning the period from 1997 to 2016. The results indicated that the total monthly precipitation at the studied stations in Sistan and Baluchestan province follows a sinusoidal trend. The highest intense precipitation was observed in January, February, and March, while the lowest occurred in September, October, and then November. The investigation of the trend of seasonal precipitation in this province showed that precipitation follows an upward trend in the autumn season, reaching its peak in winter, and then shows a decreasing trend in spring and summer. Also, the examination of average precipitation indicated that the highest yearly precipitation occurred in 1997 and then in 2004, while the lowest annual precipitation took place between 1999 and 2001. The analysis of the annual precipitation trend demonstrates a decrease in precipitation from 1997 to 2016 in Sistan and Baluchestan province.

Keywords: climate change, extreme precipitation, greenhouse gas, trend analysis

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Authors: Rubina Jahan, Mohammad Zayeed Bin Alam, Razia Sultana, Md Faroque Miah

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Mental health remains a significant global public health challenge, profoundly affecting millions worldwide. In Bangladesh, the situation is dire, with the National Mental Health Survey 2018-19 indicating that 19% of adults suffer from any kind of mental disorders, including severe mental disorder of around 2%. Despite these high prevalence rates, there is a substantial treatment gap in low- and middle-income countries, including Bangladesh, where up to 92% of individuals with mental illnesses do not receive adequate care. This gap is exacerbated by social barriers such as stigma, discrimination, social exclusion, poverty, homelessness, and human rights violations. To address these challenges, the SAJIDA Foundation launched the Proshanti in November 2022. Proshanti is a community based supportive housing intervention designed to provide cost-effective, sustainable, long-term care for individuals with chronic mental illnesses. It aims to rehabilitate participants by improving their mental health, quality of life, and equipping them with skills necessary for independent living and social mobility. Currently, Proshanti operates seven houses in Manikganj and Habiganj districts of Bangladesh, accommodating up to 40 individuals. Over a two-year period, individuals have received personalized support from trained personal assistants and care coordinators, regular health checkups, and opportunities for vocational training and community engagement. In this presentation, we will present the outcome of such intervention on individual’s functionality, quality of life and psychological health generated from 24 months of journey. Additionally, a qualitative approach will be employed to understand the facilitators and barriers of program implementation. The Proshanti program represents a promising model for addressing the significant mental health treatment gap in Bangladesh at the community level. Our findings will provide crucial insights into the program's feasibility, effectiveness, and the factors influencing its implementation, potentially guiding future mental health interventions in similar contexts.

Keywords: mental health, community based supportive housing, treatment gap, bangladesh

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Authors: Manoj Kumar Reddy Pulim, Lakshmi Muthukrishnan, Geetha Jayapathy, Radhika Raman

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Introduction: In the past two decades, noninvasive positive pressure ventilation (NIPPV) emerged as one of the most important advances in the management of both acute and chronic respiratory failure in children. In the acute setting, it is an alternative to intubation with a goal to preserve normal physiologic functions, decrease airway injury, and prevent respiratory tract infections. There is a need to determine the clinical profile and parameters which point towards the need for NIV in the pediatric emergency setting. Objectives: i) To study the clinical profile of children who required non invasive ventilation and invasive ventilation, ii) To study the clinical parameters common to children who required non invasive ventilation. Methods: All children between one month to 18 years, who were intubated in the pediatric emergency department and those for whom decision to commence Non Invasive Ventilation was made in Emergency Room were included in the study. Children were transferred to the Paediatric Intensive Care Unit and started on Non Invasive Ventilation as per our hospital policy and followed up in the Paediatric Intensive Care Unit. Clinical profile of all children which included age, gender, diagnosis and indication for intubation were documented. Clinical parameters such as respiratory rate, heart rate, saturation, grunting were documented. Parameters obtained were subject to statistical analysis. Observations: Airway disease (Bronchiolitis 25%, Viral induced wheeze 22%) was a common diagnosis in 32 children who required Non Invasive Ventilation. Neuromuscular disorder was the common diagnosis in 27 children (78%) who were Intubated. 17 children commenced on Non Invasive Ventilation who later needed invasive ventilation had Neuromuscular disease. High frequency nasal cannula was used in 32, and mask ventilation in 17 children. Clinical parameters common to the Non Invasive Ventilation group were age < 1 year (17), tachycardia n = 7 (22%), tachypnea n = 23 (72%) and severe respiratory distress n = 9 (28%), grunt n = 7 (22%), SPO2 (80% to 90%) n = 16. Children in the Non Invasive Ventilation + INTUBATION group were > 3 years (9), had tachycardia 7 (41%), tachypnea 9(53%) with a male predominance n = 9. In statistical comparison among 3 groups,'p' value was significant for pH, saturation, and use of Ionotrope. Conclusion: Invasive ventilation can be avoided in the paediatric Emergency Department in children with airway disease, by commencing Non Invasive Ventilation early. Intubation in the pediatric emergency department has a higher association with neuromuscular disorders.

Keywords: clinical parameters, indications, non invasive ventilation, paediatric emergency room

Procedia PDF Downloads 333

Authors: Jessica M. Black

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Although much of natural and social science research aims to enhance human flourishing and address social problems, the training within the two fields is significantly different across theory, methodology, and implementation of results. Social scientists are trained in social, psychological, and to the extent that it is relevant to their discipline, spiritual development, theory, and accompanying methodologies. They tend not to receive training or learn about accompanying methodology related to interrogating human development and social problems from a biological perspective. On the other hand, those in the natural sciences, and for the purpose of this work, human biological sciences specifically – biology, neuroscience, genetics, epigenetics, and physiology – are often trained first to consider cellular development and related methodologies, and may not have opportunity to receive formal training in many of the foundational principles that guide human development, such as systems theory or person-in-environment framework, methodology related to tapping both proximal and distal psycho-social-spiritual influences on human development, and foundational principles of equity, justice and inclusion in research design. There is a need for disciplines heretofore siloed to know one another, to receive streamlined, easy to access training in theory and methods from one another and to learn how to build interdisciplinary teams that can speak and act upon a shared research language. Team science is more essential than ever, as are transdisciplinary approaches to training and research design. This study explores the use of a methodological toolbox that natural and social scientists can use by employing a decision-making tree regarding project aims, costs, and participants, among other important study variables. The decision tree begins with a decision about whether the researcher wants to learn more about social sciences approaches or biological approaches to study design. The toolbox and platform are flexible, such that users could also choose among modules, for instance, reviewing epigenetics or community-based participatory research even if those are aspects already a part of their home field. To start, both natural and social scientists would receive training on systems science, team science, transdisciplinary approaches, and translational science. Next, social scientists would receive training on grounding biological theory and the following methodological approaches and tools: physiology, (epi)genetics, non-invasive neuroimaging, invasive neuroimaging, endocrinology, and the gut-brain connection. Natural scientists would receive training on grounding social science theory, and measurement including variables, assessment and surveys on human development as related to the developing person (e.g., temperament and identity), microsystems (e.g., systems that directly interact with the person such as family and peers), mesosystems (e.g., systems that interact with one another but do not directly interact with the individual person, such as parent and teacher relationships with one another), exosystems (e.g., spaces and settings that may come back to affect the individual person, such as a parent’s work environment, but within which the individual does not directly interact, macrosystems (e.g., wider culture and policy), and the chronosystem (e.g., historical time, such as the generational impact of trauma). Participants will be able to engage with the toolbox and one another to foster increased transdisciplinary work

Keywords: methodology, natural science, social science, transdisciplinary

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Authors: Mir Ahmad Lashteh Neshaei, Hamed Afsoos Biria, Ata Ghabraei, Mir Abdolhamid Mehrdad

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Awareness of effective land using issues in coastal area including protection of natural ecosystems and coastal environment due to the increasing of human life along the coast is of great importance. There are numerous valuable structures and heritages which are located in defence sites and waterfront area. Marine structures such as groins, sea walls and detached breakwaters are constructed in coast to improve the coast stability against bed erosion due to changing wave and climate pattern. Marine mechanisms and interaction with the shore protection structures need to be intensively studied. Groins are one of the most prominent structures that are used in shore protection to create a safe environment for coastal area by maintaining the land against progressive coastal erosion. The main structural function of a groin is to control the long shore current and littoral sediment transport. This structure can be submerged and provide the necessary beach protection without negative environmental impact. However, for submerged structures adopted for beach protection, the shoreline response to these structures is not well understood at present. Nowadays, modelling and computer simulation are used to assess beach morphology in the vicinity of marine structures to reduce their environmental impact. The objective of this study is to predict the beach morphology in the vicinity of submerged groins and comparison with non-submerged groins with focus on a part of the coast located in Dahane sar Sefidrood, Guilan province, Iran where serious coast erosion has occurred recently. The simulations were obtained using a one-line model which can be used as a first approximation of shoreline prediction in the vicinity of groins. The results of the proposed model are compared with field measurements to determine the shape of the coast. Finally, the results of the present study show that using submerged groins can have a good efficiency to control the beach erosion without causing severe environmental impact to the coast. The important outcome from this study can be employed in optimum designing of defence sites in the coastal cities to improve their efficiency in terms of re-using the heritage lands.

Keywords: submerged structures, groin, shore protective structures, coastal cities

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Authors: David W. Hill, Linda W. Glass, Jakob L. Vingren

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Maximal accumulated oxygen deficit (MAOD), the gold standard measure of anaerobic capacity, is the difference between the oxygen cost of exhaustive severe intensity exercise and the accumulated oxygen consumption (O2; mL·kg–1). In theory, MAOD can be estimated as the sum of independent estimates of the phosphocreatine and glycolysis contributions, which we refer to as PCr+glycolysis. Purpose: The purpose was to test the hypothesis that PCr+glycolysis provides a valid measure of anaerobic capacity in cycling and running. Methods: The participants were 27 women (mean ± SD, age 22 ±1 y, height 165 ± 7 cm, weight 63.4 ± 9.7 kg) and 25 men (age 22 ± 1 y, height 179 ± 6 cm, weight 80.8 ± 14.8 kg). They performed two exhaustive cycling and running tests, at speeds and work rates that were tolerable for ~5 min. The rate of oxygen consumption (VO2; mL·kg–1·min–1) was measured in warmups, in the tests, and during 7 min of recovery. Fingerprick blood samples obtained after exercise were analysed to determine peak blood lactate concentration (PeakLac). The VO2 response in exercise was fitted to a model, with a fast ‘primary’ phase followed by a delayed ‘slow’ component, from which was calculated the accumulated O2 and the excess O2 attributable to the slow component. The VO2 response in recovery was fitted to a model with a fast phase and slow component, sharing a common time delay. Oxygen demand (in mL·kg–1·min–1) was determined by extrapolation from steady-state VO2 in warmups; the total oxygen cost (in mL·kg–1) was determined by multiplying this demand by time to exhaustion and adding the excess O2; then, MAOD was calculated as total oxygen cost minus accumulated O2. The phosphocreatine contribution (area under the fast phase of the post-exercise VO2) and the glycolytic contribution (converted from PeakLac) were summed to give PCr+glycolysis. There was not an interaction effect involving sex, so values for anaerobic capacity were examined using a two-way ANOVA, with repeated measures across method (PCr+glycolysis vs MAOD) and mode (cycling vs running). Results: There was a significant effect only for exercise mode. There was no difference between MAOD and PCr+glycolysis: values were 59 ± 6 mL·kg–1 and 61 ± 8 mL·kg–1 in cycling and 78 ± 7 mL·kg–1 and 75 ± 8 mL·kg–1 in running. Discussion: PCr+glycolysis is a valid measure of anaerobic capacity in cycling and running, and it is as valid for women as for men.

Keywords: alactic, anaerobic, cycling, ergometer, glycolysis, lactic, lactate, oxygen deficit, phosphocreatine, running, treadmill

Procedia PDF Downloads 133

Authors: Kenneth A. Rostowsky, Alexander S. Maher, Nahian F. Chowdhury, Andrei Irimia

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The clinical significance of cerebral microbleeds (CMBs) due to mild traumatic brain injury (mTBI) remains unclear. Here we use magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) and connectomic analysis to investigate the statistical association between mTBI-related CMBs, post-TBI changes to the human connectome and neurological/cognitive deficits. This study was undertaken in agreement with US federal law (45 CFR 46) and was approved by the Institutional Review Board (IRB) of the University of Southern California (USC). Two groups, one consisting of 26 (13 females) mTBI victims and another comprising 26 (13 females) healthy control (HC) volunteers were recruited through IRB-approved procedures. The acute Glasgow Coma Scale (GCS) score was available for each mTBI victim (mean µ = 13.2; standard deviation σ = 0.4). Each HC volunteer was assigned a GCS of 15 to indicate the absence of head trauma at the time of enrollment in our study. Volunteers in the HC and mTBI groups were matched according to their sex and age (HC: µ = 67.2 years, σ = 5.62 years; mTBI: µ = 66.8 years, σ = 5.93 years). MRI [including T1- and T2-weighted volumes, gradient recalled echo (GRE)/susceptibility weighted imaging (SWI)] and gradient echo (GE) DWI volumes were acquired using the same MRI scanner type (Trio TIM, Siemens Corp.). Skull-stripping and eddy current correction were implemented. DWI volumes were processed in TrackVis (http://trackvis.org) and 3D Slicer (http://www.slicer.org). Tensors were fit to DWI data to perform DTI, and tractography streamlines were then reconstructed using deterministic tractography. A voxel classifier was used to identify image features as CMB candidates using Microbleed Anatomic Rating Scale (MARS) guidelines. For each peri-lesional DTI streamline bundle, the null hypothesis was formulated as the statement that there was no neurological or cognitive deficit associated with between-scan differences in the mean FA of DTI streamlines within each bundle. The statistical significance of each hypothesis test was calculated at the α = 0.05 level, subject to the family-wise error rate (FWER) correction for multiple comparisons. Results: In HC volunteers, the along-track analysis failed to identify statistically significant differences in the mean FA of DTI streamline bundles. In the mTBI group, significant differences in the mean FA of peri-lesional streamline bundles were found in 21 out of 26 volunteers. In those volunteers where significant differences had been found, these differences were associated with an average of ~47% of all identified CMBs (σ = 21%). In 12 out of the 21 volunteers exhibiting significant FA changes, cognitive functions (memory acquisition and retrieval, top-down control of attention, planning, judgment, cognitive aspects of decision-making) were found to have deteriorated over the six months following injury (r = -0.32, p < 0.001). Our preliminary results suggest that acute post-TBI CMBs may be associated with cognitive decline in some mTBI patients. Future research should attempt to identify mTBI patients at high risk for cognitive sequelae.

Keywords: traumatic brain injury, magnetic resonance imaging, diffusion tensor imaging, connectomics

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Authors: Aura Maria Lopera Echavarria, Angela Maria Lema Perez, Daniela Medrano David, Pedronel Araque Marin, Marta Elena Londoño Lopez

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Bone regeneration is the process by which the formation of new bone is stimulated. Bone fractures can originate at any time due to trauma, infections, tumors, congenital malformations or skeletal diseases. Currently there are different strategies to treat bone defects that in some cases, regeneration does not occur on its own. That is why they are treated with bone substitutes, which provide a necessary environment for the cells to synthesize new bone. The Demineralized Bone Matrix (DBM) is widely used as a bone implant due to its good properties, such as osteoinduction and bioactivity. However, the use of DBM is limited, because its presentation is powder, which is difficult to implant with precision and is susceptible to migrating to other sites through blood flow. That is why the DBM is commonly incorporated into a variety of vehicles or carriers. The objective of this project is to evaluate the bioactive and confinement properties of a bone substitute based on demineralized bone matrix (DBM). Also, structural and morphological properties were evaluated. Bone substitute was obtained from EIA Biomaterials Laboratory of EIA University and the DBM was facilitated by Tissue Bank Foundation. Morphological and structural properties were evaluated by scanning electron microscopy (SEM), X-ray diffraction (DRX) and Fourier transform infrared spectroscopy with total attenuated reflection (FTIR-ATR). Water absorption capacity and degradation were also evaluated during three months. The cytotoxicity was evaluated by the MTT test. The bioactivity of the bone substitute was evaluated through immersion of the samples in simulated body fluid during four weeks. Confinement tests were performed on tibial fragments of a human donor with bone defects of determined size, to ensure that the substitute remains in the defect despite the continuous flow of fluid. According of the knowledge of the authors, the methodology for evaluating samples in a confined environment has not been evaluated before in real human bones. The morphology of the samples showed irregular surface and presented some porosity. DRX confirmed a semi-crystalline structure. The FTIR-ATR determined the organic and inorganic phase of the sample. The degradation and absorption measurements stablished a loss of 3% and 150% in one month respectively. The MTT showed that the system is not cytotoxic. Apatite clusters formed from the first week were visualized by SEM and confirmed by EDS. These calcium phosphates are necessary to stimulate bone regeneration and thanks to the porosity of the developed material, osteinduction and osteoconduction are possible. The results of the in vitro evaluation of the confinement of the material showed that the migration of the bone filling to other sites is negligible, although the samples were subjected to the passage of simulated body fluid. The bone substitute, putty type, showed stability, is bioactive, non-cytotoxic and has handling properties for specialists at the time of implantation. The obtained system allows to maintain the osteoinductive properties of DBM and it can fill completely fractures in any way; however, it does not provide a structural support, that is, it should only be used to treat fractures without requiring a mechanical load.

Keywords: bone regeneration, cytotoxicity, demineralized bone matrix, hydrogel

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Authors: Sadaf H. Khan, Jyoti Kumar

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Sick Building Syndrome (SBS) is a situation in which inhabitants of a building develop illness symptoms or get infected with a chronic disease as a result of the building in which they reside or work. Certain symptoms tend to get more severe as an individual spends more time in the building; however, they generally improve with time or even disappear when they leave that space. Though ‘Design of Built-Spaces’ is a crucial factor in regulating these symptoms but it still needs to be identified further as to what specific design features of a ‘Built-Space’ trigger sick building syndrome (SBS). Much of the research work present to date is focused on the physiological or physical sickness caused due to inappropriate built-space design. In this paper, the psychological aspects of sick building syndrome (SBS) will be investigated across the adult population, more specifically graduate students in India trying to settle in back to their previous physical work environments, i.e., campus, classrooms, hostels, after a very long hold which lasted more than a year due to lockdowns during Covid-19 crisis all over the world. The study will follow an analytical approach and the data will be collected through self-reported online surveys. The purpose of this study is to enquire causal agents, diagnosable symptoms and remedial design of built spaces which can enhance the productive level of built environments and better facilitate the inhabitants by improving their psychological wellbeing, which is the most uprising concern. The fact that SBS symptoms can be studied only within the initial few weeks as an occupant starts interacting with a built-environment and leaves as the occupant leaves that space or zone, the post-lockdown incoming of students back to their respective campuses provides an opportunity to clearly draw multiple conclusions of the relationship that exist between the Design of Built-Spaces and Psychological Sickness Syndrome associated with it. The study will be one of a kind approach for understanding and formulating methods to improve psychological wellbeing within a built-setting by better identifying factors associated with these psychological symptoms, including anxiety, mental fatigue, reduced attention span and reduced memory span as refined symptoms of SBS discussed in 1987 by Molhave within his study.

Keywords: built-environment psychology, built-space design, healthcare architecture, psychological wellbeing

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Authors: Alsulami H., Alghamdi N., Alasker A., Almohen N., Shome D.

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Most conventional chemotherapeutic agents which are used for the treatment of cancers not only eradicate cancer cells but also affect normal hematopoietic Stem cells (HSCs) that leads to severe pancytopenia during treatment. Therefore, a need exists for novel approaches to treat cancer without or with minimum effect on normal HSCs. Parthenolide (PTL), a herbal product occurring naturally in the plant Feverfew, is a potential new chemotherapeutic agent for the treatment of many cancers such as acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL). In this study we investigated the effect of different PTL concentrations on the viability of normal HSCs and also on the ability of these cells to form colonies after they have been treated with PTL in vitro. Methods: In this study, 24 samples of bone marrow and cord blood were collected with consent, and mononuclear cells were separated using density gradient separation. These cells were then exposed to various concentrations of PTL for 24 hours. Cell viability after culture was determined using 7ADD in a flow cytometry test. Additionally, the impact of PTL on hematopoietic stem cells (HSCs) was evaluated using a colony forming unit assay (CFU). Furthermore, the levels of NFҝB expression were assessed by using a PE-labelled anti-pNFκBP65 antibody. Results: this study showed that there was no statistically significant difference in the percentage of cell death between untreated and PTL treated cells with 5 μM PTL (p = 0.7), 10 μM PTL (p = 0.4) and 25 μM (p = 0.09) respectively. However, at higher doses, PTL caused significant increase in the percentage of cell death. These results were significant when compared to untreated control (p < 0.001). The response of cord blood cells (n=4) on the other hand was slightly different from that for bone marrow cells in that the percentage of cell death was significant at 100 μM PTL. Therefore, cord blood cells seemed more resistant than bone marrow cells. Discussion &Conclusion: At concentrations ≤25 μM PTL has a minimum or no effect on HSCs in vitro. Cord blood HSCs are more resistant to PTL compared to bone marrow HSCs. This could be due to the higher percentage of T-lymphocytes, which are resistant to PTL, in CB samples (85% in CB vs. 56% in BM. Additionally, CB samples contained a higher proportion of CD34+ cells, with 14.5% of brightly CD34+ cells compared to only 1% in normal BM. These bright CD34+ cells in CB were mostly negative for early-stage stem cell maturation antigens, making them young and resilient to oxidative stress and high concentrations of PTL.

Keywords: stem cell, parthenolide, NFKB, CLL

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Authors: Gurjeet Khurana, Surender Singh, Poonam Arora, Praveendra K. Sachan

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Introduction: Post-operative quality of recovery is the key outcome in the perspective of anesthesiologist. It is directly related to patient satisfaction. This is unsurprising, considering most aspects of a poor quality recovery after surgery will impair satisfaction with care. This study was thus undertaken to evaluate effects of Dexamethasone and Lignocaine on Quality of Recovery using QoR- 40 questionnaire and compare their effects. Material and methods: After obtaining the ethical committee approval and written informed consent, 67 patients of 18-60 years, ASA grade I and II scheduled for elective laparoscopic cholecystectomy were randomly allocated into two groups. Group I of 34 patients received 2mg/kg lignocaine diluted to 10ml with normal saline. Group 2 of 33 patients received 0.1 mg/kg I/V Dexamethasone diluted to 10ml with normal saline. QoR-40 was assessed on pre-operative day, and again QoR-40 was assessed at 24 hr post-operative day-1. Postoperative pain scores, nausea and vomiting and shoulder pain were secondary outcomes. Results: The Global QoR-40 was more than 180 at 24 hr in both the groups. The Dexamethasone group had higher Global QoR-40 than lignocaine group 187.94 v/s 182.85. Amongst dimensions of QoR-40 Dexamethasone had statistically better physical comfort, physical independence, and pain relief as compared to Lignocaine. Positive items had excellent responses in Dexamethasone group. Headache, backache and sore throat were also less severe in Dexamethasone group as compared to Lignocaine group. Dexamethasone group had lower VAS compared to lignocaine group. Similarly, there was less fentanyl consumption in dexamethasone group (364.08 ± 127.31) in postoperative period when compared to the lignocaine group (412.31 ± 147.8). Group receiving dexamethasone had 36% increase in appetite compared to lignocaine group (17.6%), which facilitated early oral feeding. Frequency of PONV was less in group-2 at different time interval as compared to group 1. Total episode of PONV were 18 in group 1 and 7 in group 2. Statistically significant difference was seen among two groups (p value= 0.007). Use of antiemetic was more in group 1 as compared to group 2 at all the times, though it was not statistically significant at different time intervals. Antiemetics were administered to 18 patients in group 1 as compared to 5 patients in group 2 postoperatively. Statistically significant difference (p value= 0.011) was seen in total antiemetic consumption. Conclusion: Our study demonstrated that pre-operative administration of a single dose of dexamethasone enhanced the quality of recovery after laparoscopic cholecystectomy as compared to Lignocaine bolus dose.

Keywords: dexamethasone, lignocaine, QoR-40 questionnaire, quality of recovery

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Authors: Adi Levy

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Military and security personnel defections during nonviolent resistance (NVR) campaigns are recognized as an effective way of undermining the regime’s power, but they also may generate moral dilemmas that contradict the moral standing of NVR tactics. NVR campaigns have been primarily praised for their adherence to moral and legal norms, yet some of NVR tactics raise serious ethical concerns. This paper focuses on NVR tactics that seek to promote defections and disobedience within military and security personnel to sustain their campaign. Academic literature regarding NVR tactics indicates that compared to violent forms of resistance, defections are more likely to occur when security forces confront nonviolent activists. Indeed, defections play a strategically fundamental role in nonviolent campaigns, particularly against authoritarian regimes, as it enables activists to undermine the regime’s central pillars of support. This study examines the events of the Arab Spring and discusses the ethical problems that arise in nonviolent activists’ promotion of defections and disobedience. The cases of Syria and Egypt suggest that the strategic promotion of defections and disobedience was significantly effective in sustaining the campaign. Yet, while such defections enhance nonviolent activists’ resilience, how they are promoted can be morally contentious and the consequences can be dire. Defections are encouraged by social, moral and emotional appeals that use the power disparities between unarmed civilians and powerful regimes to affect soldiers and security personnel’s process of decision-making. In what is commonly referred to as dilemma action, nonviolent activists deliberately entangle security forces in a moral dilemma that compels them to follow a moral code to protect unarmed civilians. In this way, activists sustain their struggle and even gain protection. Nonviolent activists are likely to be completely defeated when confronted with armed forces. Therefore they rely on the military and security personnel’s moral conscious of convincing them to refrain from using force against them. While this is effective, it also leaves soldiers and security forces exposed to the implications and punishments that might follow their disobedience or defection. As long as they remain nonviolent, activists enjoy civilian immunity despite using morally contentious tactics. But the severe implications brought upon defectors. As a result, demand a deep examination of this tactic’s moral permissibility and a discussion that assesses culpability for the moral implications of its application.

Keywords: culpability, defections, nonviolence, permissibility

Procedia PDF Downloads 111

Authors: Ethel E. Phiri, Lionel Hartzenberg, Percy Chimwamuromba, Emmanuel Nepolo, Jens Kossmann, James R. Lloyd

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Orphan crops are underresearched and underutilized food plant species that have not been categorized as major food crops, but have the potential to be economically and agronomically significant. They have been documented to have the ability to tolerate extreme environmental conditions. However, limited research has been conducted to uncover their potential as food crop species. The New Partnership for Africa’s Development (NEPAD) has classified Marama bean, Tylosema esculentum, as an orphan crop. The plant is one of the 101 African orphan crops that must have their genomes sequenced, assembled, and annotated in the foreseeable future. Marama bean is a perennial leguminous plant that primarily grows in poor, arid soils in southern Africa. The plants produce large tubers that can weigh as much as 200kg. While the foliage provides fodder, the tuber is carbohydrate rich and is a staple food source for rural communities in Namibia. Also, the edible seeds are protein- and oil-rich. Marama Bean plants respond rapidly to increased temperatures and severe water scarcity without extreme consequences. Advances in molecular biology and biotechnology have made it possible to effectively transfer technologies between model- and major crops to orphan crops. In this research, the aim was to assemble the first transcriptomic analysis of Marama Bean RNA-sequence data. Many model plant species have had their genomes sequenced and their transcriptomes assembled. Therefore the availability of transcriptome data for a non-model crop plant species will allow for gene identification and comparisons between various species. The data has been sequenced using the Ilumina Hiseq 2500 sequencing platform. Data analysis is underway. In essence, this research will eventually evaluate the potential use of Marama Bean as a crop species to improve its value in agronomy. data for a non-model crop plant species will allow for gene identification and comparisons between various species. The data has been sequenced using the Ilumina Hiseq 2500 sequencing platform. Data analysis is underway. In essence, this researc will eventually evaluate the potential use of Marama bean as a crop species to improve its value in agronomy.

Keywords: 101 African orphan crops, RNA-Seq, Tylosema esculentum, underutilised crop plants

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Authors: Kittitara Chunlakittiphan, Patompong Satapornpong

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Introduction: The variation of genetics affects how our body responds to pharmaceuticals elucidates the correlation between long-term use of medical cannabis and adverse drug reactions (ADRs). Medical cannabis is regarded as the treatment for chronic pain, cancer pain, acute pain, psychological disorders, multiple sclerosis and migraine management. However, previous studies have shown that delta-9-Tetrahydrocannabinol (THC), an ingredient found in cannabis, was the cause of ADRs in CB1 receptors found in humans. Previous research suggests that distributions of the cannabinoid type 1 (CB1) receptor gene and pharmacogenetic markers, which vary amongst different populations, might affect incidences of ADRs. Although there is an evident need to investigate the level of the CB1 receptor gene (rs806365), studies on the distribution of CB1-pharmacogenetics markers in Thai patients are limited. Objective: Therefore, the aim of this study is to investigate the distribution of the rs806365 polymorphism in Thai patients who have been treated with medical cannabis. Materials and Methods: We enrolled 31 Thai patients with THC-induced ADRs and 34 THC-tolerant controls to take part in this study. All patients with THC-induced ADRs were accessed through a review of medical records by physicians. EDTA blood of 3ml was collected to obtain the CNR1 gene (rs806365) and genotyping of this gene was conducted using the real-time PCR ViiA7 (ABI, Foster City, CA, USA) following the manufacturer’s instruction. Results: The sample consisted of 65 patients (40/61.54%) were females and (25/38.46%) were males, with an age range of 19-87 years, who have been treated with medical cannabis. In this study, the most common THC-induced ADRs were dry mouth and/or dry throat, tachycardia, nausea, and arrhythmia. Across the whole sample, we found that 52.31% of Thai patients carried a heterozygous variant (rs806365, CT allele). Moreover, the number of rs806365 (CC, homozygous variant) carriers totaled seventeen people (26.15%) amongst the subjects of Thai patients treated with medical cannabis. Furthermore, 17 out of 22 patients (77.27%) who experienced severe ADRs: Tachycardia and/or arrhythmia, carried an abnormal rs806365 gene (CT and CC alleles). Conclusions: The results propose that the rs806365 gene is widely distributed amongst the Thai population and there is a link between this gene and vulnerability to developing THC-induced ADRs after being treated with medical cannabis. Therefore, it is necessary to screen for the rs806365 gene before using medical cannabis to treat a patient.

Keywords: rs806365, THC-induced adverse drug reactions, CB1 receptor, Thai population

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Authors: Andrea Zielke-Nadkarni

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Pain management is a question of quality of life and an indicator for nursing quality. Chronic pain which is predominant in oncology and palliative nursing situations is perceived today as a multifactorial, individual emotional experience with specific characteristics including the sociocultural dimension when dealing with migrant patients. This dimension of chronic pain is of major importance in professional nursing of migrant patients in hospices or palliative care units. Objectives of the study are: 1. To find out more about the sociocultural views on pain and nursing care, on customs and nursing practices connected with pain of both Turkish Muslim and German Christian women, 2. To improve individual and family oriented nursing practice with view to sociocultural needs of patients in severe pain in palliative care. In a qualitative-explorative comparative study 4 groups of women, Turkish Muslims immigrants (4 from the first generation, 5 from the second generation) and German Christian women of two generations (5 of each age group) of the same age groups as the Turkish women and with similar educational backgrounds were interviewed (semistructured ethnographic interviews using Spradley, 1979) on their perceptions and experiences of pain and nursing care within their families. For both target groups the presentation will demonstrate the following results in detail: Utterance of pain as well as “private” and “public” pain vary within different societies and cultures. Permitted forms of pain utterance are learned in childhood and determine attitudes and expectations in adulthood. Language, especially when metaphors and symbols are used, plays a major role for misunderstandings. The sociocultural context of illness may include specific beliefs that are important to the patients and yet seem more than far-fetched from a biomedical perspective. Pain can be an influential factor in family relationships where respect or hierarchies do not allow the direct utterance of individual needs. Specific resources are often, although not exclusively, linked to religious convictions and are significantly helpful in reducing pain. The discussion will evaluate the results of the study with view to the relevant literature and present nursing interventions and instruments beyond medication that are helpful when dealing with patients from various socio-cultural backgrounds in painful end-oflife situations.

Keywords: pain management, migrants, sociocultural context, palliative care

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Authors: Jakob Krause

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Past Financial Crisis has shown that contemporary risk management models provide an unjustified sense of security and fail miserably in situations in which they are needed the most. In this paper, we start from the assumption that risk is a notion that changes over time and therefore past data points only have limited explanatory power for the current situation. Our objective is to derive the optimal amount of representative information by optimizing between the two adverse forces of estimator convergence, incentivizing us to use as much data as possible, and the aforementioned non-representativeness doing the opposite. In this endeavor, the cornerstone assumption of having access to identically distributed random variables is weakened and substituted by the assumption that the law of the data generating process changes over time. Hence, in this paper, we give a quantitative theory on how to perform statistical analysis in non-ergodic systems. As an application, we discuss the impact of a paragraph in the last iteration of proposals by the Basel Committee on Banking Regulation. We start from the premise that the severity of assumptions should correspond to the robustness of the system they describe. Hence, in the formal description of physical systems, the level of assumptions can be much higher. It follows that every concept that is carried over from the natural sciences to economics must be checked for its plausibility in the new surroundings. Most of the probability theory has been developed for the analysis of physical systems and is based on the independent and identically distributed (i.i.d.) assumption. In Economics both parts of the i.i.d. assumption are inappropriate. However, only dependence has, so far, been weakened to a sufficient degree. In this paper, an appropriate class of non-stationary processes is used, and their law is tied to a formal object measuring representativeness. Subsequently, that data set is identified that on average minimizes the estimation error stemming from both, insufficient and non-representative, data. Applications are far reaching in a variety of fields. In the paper itself, we apply the results in order to analyze a paragraph in the Basel 3 framework on banking regulation with severe implications on financial stability. Beyond the realm of finance, other potential applications include the reproducibility crisis in the social sciences (but not in the natural sciences) and modeling limited understanding and learning behavior in economics.

Keywords: banking regulation, non-ergodicity, risk management, semimartingale modeling

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Authors: Basma Hassabo, Sarah Ahmed, Aisha Hameed

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Aims and Objectives: To determine the incidence of maternal mortality amongst pregnant women with sickle cell disease (SCD) in the United Kingdom and to determine exact cause of death in these women. Background: SCD is caused by the ‘sickle’ gene and is characterized by episodes of severe bone pain and other complications like acute chest syndrome, chronic pulmonary hypertension, stroke, retinopathy, chronic renal failure, hepato-splenic crises, avascular bone necrosis, sepsis and leg ulcers. SCD is a continual cause of maternal mortality and fetal complications, and it comprises 1.5% of all Direct and Indirect deaths in the UK. Sepsis following premature rupture of membranes with ascending infection, post-partum infection and pre-labour overwhelming septic shock is one of its leading causes of death. Over the last fifty years of maternal mortality reports in UK, between 1 to 4 pregnant women died in each triennium. Material and Method: This is a retrospective study that involves pregnant women who died from SCD complications in the UK between 1952-2012. Data were collected from the UK Confidential Enquiries into Maternal Death and its causes between 1952–2012. Prior to 1985, exact cause of death in this cohort was not recorded. Results: 33 deaths reported between 1964 and 1984. 17 deaths were reported due to sickle cell disease between 1985 and 2012. Five women in this group died of sickle cell crisis, one woman had liver sequestration crisis, two women died of venous thromboembolism, two had myocardial fibrosis and three died of sepsis. Remaining women died of amniotic fluid embolism, SUDEP, myocardial ischemia and intracranial haemorrhage. Conclusion: The leading causes of death in sickle cell sick pregnant women are sickle cell crises, sepsis, venous thrombosis and thromboembolism. Prenatal care for women with SCD should be managed by a multidisciplinary team that includes an obstetrician, nutritionist, primary care physician, and haematologist. In every sick Sickle Cell woman Sickle Cell crises should be on the top of the list of differential diagnosis. Aggressive treatment of complications with low threshold to commence broad-spectrum antibiotics and LMWH contribute to better outcomes.

Keywords: incidence, maternal mortality, sickle cell disease (SCD), uk

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Authors: Charisse H. Tay

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Background: Schizophrenia is a severe chronic mental disorder that can result in hallucinations, delusions, reduced social engagement, and lack of motivation. While antipsychotic medications often provide the basis for treatment, psychosocial strategies complement the benefit of medications and can result in meaningful improvements in symptoms and functioning. The aim of the study was to investigate psychosocial strategies used by internet self-help forum participants to effectively manage symptoms caused by schizophrenia. Internet self-help forums are a resource for medical and psychological problems and are commonly used to share information about experiences with symptom management. Method: Three international self-help internet forums on schizophrenia were identified using a search engine. 1,181 threads regarding non-pharmacological, psychosocial self-management of schizophrenia symptoms underwent screening, resulting in the final identification and coding of 91 threads and 191 posts from 134 unique forum users that contained details on psychosocial strategies endorsed personally by users that allowed them to effectively manage symptoms of schizophrenia, including positive symptoms (e.g., auditory/visual/tactile hallucinations, delusions, paranoia), negative symptoms (e.g.., avolition, apathy, anhedonia), symptoms of distress, and cognitive symptoms (e.g., memory loss). Results: Effective symptom management strategies personally endorsed by online forum users were psychological skills (e.g., re-focusing, mindfulness/meditation, reality checking; n = 94), engaging in activities (e.g., exercise, working/volunteering, hobbies; n = 84), social/familial support (n = 48), psychotherapy (n = 33), diet (n = 18), and religion/spirituality (n = 14). 44.4% of users reported using more than one strategy to manage their symptoms. The most common symptoms targeted and effectively managed, as specified by users, were positive symptoms (n = 113), negative symptoms (n = 17), distress (n = 8), and memory loss (n = 6). 10.5% of users reported more than one symptom effectively targeted. 70.2% of users with positive symptoms reported that psychological skills were effective for symptom relief. 88% of users with negative symptoms and 75% with distress symptoms reported that engaging in activities was effective. Discussion: Individuals with schizophrenia rely on a variety of different psychosocial methods to manage their symptoms. Different symptomology appears to be more effectively targeted by different types of psychosocial strategies. This may help to inform treatment strategy and tailored for individuals with schizophrenia.

Keywords: psychosocial treatment, qualitative methods, schizophrenia, symptom management

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Authors: Olarinde Olaniran, Oluyomi A. Sowemimo

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Toxoplasmosis is frequently misdiagnosed or underdiagnosed, and it is the third most common cause of hospitalization due to food-borne infection. Intra-uterine infection with Toxoplasma gondii due to active parasitaemia during pregnancy can cause severe and often fatal cerebral damage, abortion, and stillbirth of a fetus. The aim of the study was to investigate the prevalence of T. gondii infection in women of childbearing age in selected communities of Osun State with a view to determining the risk factors which predispose to the T. gondii infection. Five (5) ml of blood was collected by venopuncture into a plain blood collection tube by a medical laboratory scientist. Serum samples were separated by centrifuging the blood samples at 3000 rpm for 5 mins. The sera were collected with Eppendorf tubes and stored at -20°C analysis for the presence of IgG and IgM antibodies against T. gondii by commercially available enzyme-linked immunosorbent assay (ELISA) kit (Demeditec Diagnostics GmbH, Germany) conducted according to the manufacturer’s instructions. The optical densities of wells were measured by a photometer at a wavelength of 450 nm. Data collected were analysed using appropriate computer software. The overall seroprevalence of T. gondii among the women of child-bearing age in selected seven communities in Osun state was 76.3%. Out of 76.3% positive for Toxoplasma gondii infection, 70.0% were positive for anti- T. gondii IgG, and 32.3% were positive for IgM, and 26.7% for both IgG and IgM. The prevalence of T. gondii was lowest (58.9%) among women from Ile Ife, a peri-urban community, and highest (100%) in women residing in Alajue, a rural community. The prevalence of infection was significantly higher (P= 0.000) among Islamic women (87.5%) than in Christian women (70.8%). The highest prevalence (86.3%) was recorded in women with primary education, while the lowest (61.2%) was recorded in women with tertiary education (p =0.016). The highest prevalence (79.7%) was recorded in women that reside in rural areas, and the lowest (70.1%) was recorded in women that reside in peri-urban area (p=0.025). The prevalence of T. gondii infection was highest (81.4%) in women with one miscarriage, while the prevalence was lowest in women with no miscarriages (75.9%). The age of the women (p=0.042), Islamic religion (p=0.001), the residence of the women (p=0.001), and water source were all positively associated with T. gondii infection. The study concluded that there was a high seroprevalence of T. gondii recorded among women of child-bearing age in the study area. Hence, there is a need for health education and create awareness of the disease and its transmission to women of reproductive age group in general and pregnant women in particular to reduce the risk of T. gondii in pregnant women.

Keywords: seroepidemiology, Toxoplasma gondii, women, child-bearing, age, communities, Ile -Ife, Nigeria

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Authors: Habiba Nahzat, Karen Crow, Lisa Manuel, Maria Huijbregts

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Background and Rationale: The World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020. Shortly after, the Ontario provincial and Toronto municipal governments also released multiple directives that led to the mass closure of businesses both in the public and private sectors. Recent research has identified connections between Intimate Partner Violence (IPV) and COVID-19 related stressors - especially because of lockdown and social isolation measures. Psychological impacts of lengthy seclusion coupled with disconnection from extended family and diminished support services can take a toll on families at risk and may increase mental health issues and the prevalence of IPV. Research Question: Thus, the purpose of the study was to understand the perspective of the Violence Against Women (VAW) program staff on the impact of the COVID-19 pandemic; we especially wanted to understand staff views of restrictions on clients’ counseling experiences and the ability to access services in general. The study also aimed to examine VAW program staff experiences regarding remote work and explore how the pandemic restriction measures affected the ability of their program operations to support their clients and each other. Method: A cross-sectional, descriptive qualitative study was conducted with a purposive sample of 9 VAW program staff – eight VAW counselors and one VAW manager. Prior to data collection, program staff collaborated in the development of the study purpose, interview questions and methodology. Ethics approval was obtained from the sponsoring organization’s Research Ethics Board. In-depth individual interviews were conducted with study participants using a semi-structured interview questionnaire. Brief demographic information was also collected prior to the interview. Descriptive statistics were used to analyze quantitative data and qualitative data was analyzed by thematic content analysis. Results: Findings from this study indicate that the COVID-19 pandemic restrictions had an adverse impact on clients seeking VAW services based on VAW staff perspectives. Program staff reported a perceived increase in abuse among women, especially in emotional and financial abuse and experiences of isolation and trauma. Findings further highlight the challenges women experienced when trying to access services in general as well as counseling and legal services. This was perceived to be more prominent among newcomers and marginalized women. The study also revealed client and staff challenges when participating in virtual counseling, their innovations and clients’ creativity in accessing needed counseling and how staff over time adapted to providing virtual support during the pandemic. Conclusion and Next Steps: This study builds upon existing evidence on the impact of COVID-19 restrictions on VAW and may inform future research to better understand the association between the COVID-19 pandemic restrictions and VAW on a broader scale and to inform and support possible short-term and long-term changes in the client experience and counselling practice.

Keywords: COVID-19, pandemic, virtual, violence against women (VAW)

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Authors: Allaw Kamel, Bazzi Hasan

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Municipal solid waste (MSW) generation is among the most significant sources which threaten the global environmental health. Solid Waste Management has been an important environmental problem in developing countries because of the difficulties in finding sustainable solutions for solid wastes. Therefore, more efforts are needed to be implemented to overcome this problem. Lebanon has suffered a severe solid waste management problem in 2015, and a new landfill site was proposed to solve the existing problem. The study aims to identify and locate the most suitable area to construct a landfill taking into consideration the sustainable development to overcome the present situation and protect the future demands. Throughout the article, a landfill site selection methodology was discussed using Geographic Information System (GIS) and Multi Criteria Decision Analysis (MCDA). Several environmental, economic and social factors were taken as criterion for selection of a landfill. Soil, geology, and LUC (Land Use and Land Cover) indices with the Sustainable Development Index were main inputs to create the final map of Environmentally Sensitive Area (ESA) for landfill site. Different factors were determined to define each index. Input data of each factor was managed, visualized and analyzed using GIS. GIS was used as an important tool to identify suitable areas for landfill. Spatial Analysis (SA), Analysis and Management GIS tools were implemented to produce input maps capable of identifying suitable areas related to each index. Weight has been assigned to each factor in the same index, and the main weights were assigned to each index used. The combination of the different indices map generates the final output map of ESA. The output map was reclassified into three suitability classes of low, moderate, and high suitability. Results showed different locations suitable for the construction of a landfill. Results also reflected the importance of GIS and MCDA in helping decision makers finding a solution of solid wastes by a sanitary landfill.

Keywords: sustainable development, landfill, municipal solid waste (MSW), geographic information system (GIS), multi criteria decision analysis (MCDA), environmentally sensitive area (ESA)

Procedia PDF Downloads 148

Authors: Lei Zhao, Yi Song, Tim Dunne, Jiaxiang (Jason) Ren, Wenhan Yue, Lei Yang, Li Wen, Yu Liu

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Fasting dissolving magnesium (DM) alloy technology has contributed significantly to the “Shale Revolution” in oil and gas industry. This application requires DM downhole tools dissolving initially at a slow rate, rapidly accelerating to a high rate after certain period of operation time (typically 8 h to 2 days), a contradicting requirement that can hardly be addressed by traditional Mg alloying or processing itself. Premature disintegration has been broadly reported in downhole DM tool from field trials. To address this issue, “temporary” thin polymers of various formulations are currently coated onto DM surface to delay its initial dissolving. Due to conveying parts, harsh downhole condition, and high dissolving rate of the base material, the current delay coatings relying on pure polymers are found to perform well only at low temperature (typical < 100 ℃) and parts without sharp edges or corners, as severe geometries prevent high quality thin film coatings from forming effectively. In this study, a coating technology combining Plasma Electrolytic Oxide (PEO) coatings with advanced thin film deposition has been developed, which can delay DM complex parts (with sharp corners) in corrosive fluid at 150 ℃ for over 2 days. Synergistic effects between porous hard PEO coating and chemical inert elastic-polymer sealing leads to its delaying dissolution improvement, and strong chemical/physical bonding between these two layers has been found to play essential role. Microstructure of this advanced coating and compatibility between PEO and various polymer selections has been thoroughly investigated and a model is also proposed to explain its delaying performance. This study could not only benefit oil and gas industry to unplug their High Temperature High Pressure (HTHP) unconventional resources inaccessible before, but also potentially provides a technical route for other industries (e.g., bio-medical, automobile, aerospace) where primer anti-corrosive protection on light Mg alloy is highly demanded.

Keywords: dissolvable magnesium, coating, plasma electrolytic oxide, sealer

Procedia PDF Downloads 105

Authors: Maari Sugawara

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This arts-based research is about "self-torture": the interplay of seemingly opposing elements of pain, pleasure, submission, and power. It asserts that "self-torture" can be considered a nontrivial mediation between the aesthetic and the sociopolitical. It explores what the author calls queered self-torture; "self-torture" marked by an ambivalence that allows the oppressed to resist, and their counter-valorization occasionally functions as therapeutic solutions to the problems they highlight and condense. The research goal is to deconstruct normative self-torture and propose queered self-torture as a fertile ground for considering the complexities of desire that allow the oppressed to practice freedom. While “self-torture” manifests in many societies, this research focuses on cultural and national identity in post-WWII Japan using this lens of self-torture, as masochism functions as the very basis for Japanese cultural and national identity to ensure self-preservation. This masochism is defined as an impulse to realize a sense of pride and construct an identity through the acceptance of subordination, shame, and humiliation in the face of an all-powerful Other; the dominant Euro-America. It could be argued that this self-torture is a result of Japanese cultural annihilation and the trauma of the nation's defeat to the US. This is the definition of "self-torturous thresholds," the author’s post-WWII Japan psycho-historical diagnosis; when this threshold is crossed, the oppressed begin to torture themselves; the oppressors no longer need to do anything to maintain their power. The oppressed are already oppressing themselves. The term "oppressed" here refers to Japanese individuals and residents of Japan who are subjected to oppressive “white” heteropatriarchal supremacist structures and values that serve colonialist interests. There are three stages in "self-torturous thresholds": (1) the oppressors no longer need to oppress because the oppressed voluntarily commit to self-torture; (2) the oppressed find pleasure in self-torture; and (3) the oppressed achieve queered self-torture, to achieve alternative futures. Using the conceptualization of "self-torture," this research examines and critiques pleasure, desire, capital, and power in postwar Japan, which enables the discussion of the data-colonizing “Moonshot Research and Development program”. If the oppressed want to divest from the habits of normative self-torture, which shape what is possible in both our present and future, we need methods to feel and know that the alternative results of self-torture are possible. Phase three will be enacted using Sarah Ahmed's queer methodology to reorient national and cultural identity away from heteronormativity. Through theoretical analysis, textual analysis, archival research, ethnographic interviews, and digital art projects, including experimental documentary as a method to capture the realities of the individuals who are practicing self-torture, this research seeks to reveal how self-torture may become not just a vehicle of pleasure but also a mode of critiquing power and achieving freedom. It seeks to encourage the imaginings of queer Japanese futures, where the marginalized survive Japan’s natural and man-made disasters and Japan’s Imperialist past and present rather than submitting to the country’s continued violence.

Keywords: arts-based research, Japanese studies, interdisciplinary arts, queer studies, cultural studies, popular culture, BDSM, sadomasochism, sexuality, VR, AR, digital art, visual arts, speculative fiction

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Authors: Huei Jiun Chen, Hui Mei Huan

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

Keywords: pain assessment, elderly, gender, education

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Authors: Thiago Ribeiro de Alencar, Jacyro Gramulia Junior, Patricia Teixeira Leite

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The area of the electricity sector that deals with energy needs by the hydroelectric in a coordinated manner is called Operation Planning of Hydrothermal Power Systems (OPHPS). The purpose of this is to find a political operative to provide electrical power to the system in a given period, with reliability and minimal cost. Therefore, it is necessary to determine an optimal schedule of generation for each hydroelectric, each range, so that the system meets the demand reliably, avoiding rationing in years of severe drought, and that minimizes the expected cost of operation during the planning, defining an appropriate strategy for thermal complementation. Several optimization algorithms specifically applied to this problem have been developed and are used. Although providing solutions to various problems encountered, these algorithms have some weaknesses, difficulties in convergence, simplification of the original formulation of the problem, or owing to the complexity of the objective function. An alternative to these challenges is the development of techniques for simulation optimization and more sophisticated and reliable, it can assist the planning of the operation. Thus, this paper presents the development of a computational tool, namely Hydro-IA for solving optimization problem identified and to provide the User an easy handling. Adopted as intelligent optimization technique is Genetic Algorithm (GA) and programming language is Java. First made the modeling of the chromosomes, then implemented the function assessment of the problem and the operators involved, and finally the drafting of the graphical interfaces for access to the User. The results with the Genetic Algorithms were compared with the optimization technique nonlinear programming (NLP). Tests were conducted with seven hydroelectric plants interconnected hydraulically with historical stream flow from 1953 to 1955. The results of comparison between the GA and NLP techniques shows that the cost of operating the GA becomes increasingly smaller than the NLP when the number of hydroelectric plants interconnected increases. The program has managed to relate a coherent performance in problem resolution without the need for simplification of the calculations together with the ease of manipulating the parameters of simulation and visualization of output results.

Keywords: energy, optimization, hydrothermal power systems, artificial intelligence and genetic algorithms

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Authors: Cherrie Mae S. Sia, Noel J. Belonguel, Jarungchai Anton S. Vatanagul

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Background: Parkinson’s disease (PD) is a chronic progressive, neurodegenerative disorder known for its motor symptoms such as bradykinesia, resting tremor, muscle rigidity, and postural instability. Patients with PD also experience non-motor symptoms (NMS) such as depression, fatigue, and sleep disturbances that are most of the time unrecognized by clinicians. This may be due to the lack of spontaneous reports from the patients or partly because of the lack of systematic questioning from the healthcare professional. There is limited data with regards to these NMS especially that of Filipino patients with PD. Objectives: This study aims to determine the non-motor symptoms of Filipino patients with Parkinson’s disease. Materials and Methods: This is a prospective, cohort study involving thirty-four patients of Filipino-descent diagnosed with PD in three out-patient clinics in Cebu City from April to September 2014. Each patient was interviewed using the Non-Motor Symptom Scale (NMSS). A Cebuano version of the NMSS was also provided for the non-English speaking patients. Interview time was approximately ten to fifteen minutes for each respondent. Results: Of the thirty-four patients with Parkinson’s disease, majority was noted to be males (N=19) and the disease was noted to be more prevalent in patients with a mean age of 62 (SD±9) years old. Hypertension (59%) and diabetes mellitus (29%) were the common co-morbidities in the study population. All patients presented more than one NMS, with insomnia (41.2%), poor memory (23.5%) and depression (14.7%) being the first non-motor symptoms to occur. Symptoms involving mood/cognition (mean=2.21), and attention/memory (mean=2.05) were noted to be the most frequent and of moderate severity. Based on the NMSS, the symptoms that were noted to be mild and often to occur were those that involved the mood/cognition (score=3.84), attention/memory (score=3.50), and sleep/fatigue (score=3.00) domains. Levodopa-Carbidopa, Ropinirole, and Pramipexole were the most frequently used medications in the study population. Conclusion: Non-motor symptoms (NMS) are common in patients with Parkinson’s disease (PD). They appear at the time of diagnosis of PD or even before the motor symptoms manifest. The earliest non-motor symptoms to occur are insomnia, poor memory, and depression. Those pertaining to mood/cognition and attention/memory are the most frequent NMS and they are of moderate severity. Identifying these NMS by doing a questionnaire-guided interview such as the Non-Motor Symptom Scale (NMSS) before they can become more severe and affect the patient’s quality of life is a must for every clinician caring for a PD patient. Early treatment and control of these NMS can then be given, hence, improving the patient’s outcome and prognosis.

Keywords: non motor symptoms, Parkinson's Disease, insomnia, depression

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Authors: Flora Tajiki

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Undoubtedly, the desire to experience the beauty of motherhood is a dream for every woman, and delays in achieving this can have significant psychological consequences. Endometriosis, which is the presence of endometrial tissue in organs other than the uterus, can cause infertility through adhesion and inflammation. The fallopian tubes play a crucial role in transferring the egg to the uterus; if adhesions are present, the chances of natural pregnancy decrease, while the likelihood of ectopic pregnancy and miscarriage increases. In cases of mild adhesions observed during hysterosalpingography or laparoscopy, the tubes may open, but in severe adhesions, this is usually not possible. The aim of this study is to assess the effectiveness of a healthy lifestyle combined with massage of the uterine and ovarian areas in relieving adhesions in the fallopian tubes and treating the complications of endometriosis. This case study focuses on a 33-year-old woman, who married at 20, and experienced a miscarriage five years ago that required curettage. Following this, a hysterosalpingography revealed blockages in both fallopian tubes. A laparoscopic examination also indicated endometriosis and specialists in infertility ruled out the possibility of natural pregnancy. Three years ago, she underwent an unsuccessful IVF procedure. Two years ago, she began a lifestyle modification program that included improving sleep patterns, eliminating sugar and preservatives, avoiding red meat and gluten, eating a balanced diet, walking, exercising, and incorporating beneficial foods like olive oil, almonds, and nutritious vegetables, along with abdominal massage using chamomile oil. She also took vitamin C and vitamin D supplements. After approximately twenty weeks of these methods, and given that infertility centers had indicated that surgery and repeated IVF were the only options for her to conceive, she became pregnant naturally and had a successful pregnancy and delivery. Endometriosis is one of the significant factors contributing to infertility and adhesions in the fallopian tubes and uterus, and unfortunately, it has no definitive cure and can recur even after surgery. The treatment of similar cases emphasizes lifestyle modifications, and this approach has proven to be both cost-effective and harmless. Therefore, it seems essential to focus on this treatment strategy.

Keywords: infertility, endometriosis, adhesions, fallopian tubes, healthy lifestyle, lifestyle modifications, abdominal massage, case study, natural pregnancy, ivf, psychological consequences, uterine health, complementary treatments, nutrition, women's health.

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Authors: Sumit Kanwar, Manisha Chand, Gregory Gilot

Abstract:

Background: Septic arthritis of the shoulder has infrequently been discussed. Focus on infection of the untouched shoulder has not heretofore been described. We present four patients with glenohumeral septic arthritis. Methods: Case 1: A 59 year old male with left shoulder pain in the anterior, posterior and superior aspects. Case 2: A 60 year old male with fever, chills, and generalized muscle aches. Case 3: A 70 year old male with right shoulder pain about the anterior and posterior aspects. Case 4: A 55 year old male with global right shoulder pain, swelling, and limited ROM. Results: In case 1, the left shoulder was affected. Physical examination, swelling was notable, there was global tenderness with a painful range of motion (ROM). The lab values indicated an erythrocyte sedimentation rate (ESR) of 96, and a C-reactive protein (CRP) of 304.30. Imaging studies were performed and MRI indicated a high suspicion for an abscess with osteomyelitis of the humeral head. Our second case’s left arm was affected. He had swelling, global tenderness and painful ROM. His ESR was 38, CRP was 14.9. X-ray showed severe arthritis. Case 3 differed with the right arm being affected. Again, global tenderness and painful ROM was observed. His ESR was 94, and CRP was 10.6. X-ray displayed an eroded glenoid space. Our fourth case’s right shoulder was affected. He had global tenderness and painful, limited ROM. ESR was 108 and CRP was 2.4. X-ray was non-significant. Discussion: Monoarticular septic arthritis of the virgin glenohumeral joint is seldom diagnosed in clinical practice. Common denominators include elevated ESR, painful, limited ROM, and involvement of the dominant arm. The male population is more frequently affected with an average age of 57. Septic arthritis is managed with incision and drainage or needle aspiration of synovial fluid supplemented with 3-6 weeks of intravenous antibiotics. Due to better irrigation and joint visualization, arthroscopy is preferred. Open surgical drainage may be indicated if the above methods fail. Conclusion: If a middle-aged male presents with vague anterior or posterior shoulder pain, elevated inflammatory markers and a low grade fever, an x-ray should be performed. If this displays degenerative joint disease, the complete further workup with advanced imaging, such as an MRI, CT scan, or an ultrasound. If these imaging modalities display anterior space joint effusion with soft tissue involvement, we can suspect septic arthritis of the untouched glenohumeral joint and surgery is indicated.

Keywords: glenohumeral joint, identification, infection, septic arthritis, shoulder

Procedia PDF Downloads 420

Authors: Siyang Wang, Yujin Hu, Xuelin Wang, Wenqian Zhang

Abstract:

Austenitic stainless steels are widely used in nuclear industry to manufacture critical components owing to their excellent corrosion resistance at high temperatures. Almost all the components used in nuclear power plants are produced by surface finishing (surface cold work) such as milling, grinding and so on. The change of surface states induced by machining has great influence on the corrosion behavior. In the present study, long time oxidation behavior of machined 316 austenitic stainless steel exposed to simulated pressure water reactor environment was investigated considering different surface states. Four surface finishes were produced by electro-polishing (P), grinding (G), and two milling (M and M1) processes respectively. Before oxidation, the surface Vickers micro-hardness, surface roughness of each type of sample was measured. Corrosion behavior of four types of sample was studied by using oxidation weight gain method for six oxidation periods. The oxidation time of each period was 120h, 216h, 336h, 504h, 672h and 1344h, respectively. SEM was used to observe the surface morphology of oxide film in several period. The results showed that oxide film on austenitic stainless steel has a duplex-layer structure. The inner oxide film is continuous and compact, while the outer layer is composed of oxide particles. The oxide particle consisted of large particles (nearly micron size) and small particles (dozens of nanometers to a few hundred nanometers). The formation of oxide particle could be significantly affected by the machined surface states. The large particle on cold worked samples (grinding and milling) appeared earlier than electro-polished one, and the milled sample has the largest particle size followed by ground one and electro-polished one. For machined samples, the large particles were almost distributed along the direction of machining marks. Severe exfoliation was observed on one milled surface (M) which had the most heavily cold worked layer, while rare local exfoliation occurred on the ground sample (G) and the other milled sample (M1). The electro-polished sample (P) entirely did not exfoliate.

Keywords: austenitic stainless steel, oxidation, machining, SEM

Procedia PDF Downloads 285