Search results for: oblique incidence

Authors: Matthew Cameron, Stephen Yang, Latifa Al Kharusi, Adam Gosselin, Anissa Chirico, Pouya Gholipour Baradari

Abstract:

Background: Iron supplementation has been evaluated in several randomized controlled trials (RCTs) for the potential to increase baseline hemoglobin and decrease the incidence of red blood cell (RBC) transfusion during cardiac surgery. This study's main objective was to evaluate the evidence for iron administration in cardiac surgery patients for its effect on the incidence of perioperative RBC transfusion. Methods: This systematic review protocol was registered with PROSPERO (CRD42020161927) on Dec. 19th, 2019, and was prepared as per the PRISMA guidelines. MEDLINE, EMBASE, CENTRAL, Web of Science databases, and Google Scholar were searched for RCTs evaluating perioperative iron administration in adult patients undergoing cardiac surgery. Each abstract was independently reviewed by two reviewers using predefined eligibility criteria. The primary outcome was perioperative RBC transfusion, with secondary outcomes of the number of RBC units transfused, change in ferritin level, reticulocyte count, hemoglobin, and adverse events, after iron administration. The risk of bias was assessed with the Cochrane Collaboration Risk of Bias Tool, and the primary and secondary outcomes were analyzed with a random-effects model. Results: Out of 1556 citations reviewed, five studies (n = 554 patients) met the inclusion criteria. The use of iron demonstrated no difference in transfusion incidence (RR 0.86; 95% CI 0.65 to 1.13). There was a low heterogeneity between studies (I²=0%). The trial sequential analysis suggested an optimal information size of 1132 participants, which the accrued information size did not reach. Conclusion: The current literature does not support the routine use of iron supplementation before cardiac surgery; however, insufficient data is available to draw a definite conclusion. A critical knowledge gap has been identified, and more robust RCTs are required on this topic.

Keywords: cardiac surgery, iron, iron supplementation, perioperative medicine, meta-analysis, systematic review, randomized controlled trial

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Authors: Francis N. Okpaleke

Abstract:

The threat of Fulani herder militancy in Nigeria has led to a volatile security situation characterized by communal strife, arms proliferation, rural banditry, and insurgency. The exigency of this situation resonates in the eco-survivalist theory of farmer-herder conflict which holds that the herder deems the farmers’ unwarranted incursions into his grazing terrain as an effrontery that must reprised and a call to war. In spite of the rising incidence of Fulani militancy in Nigeria, only little is known concerning the phenomenon. The bulk of prevailing ideas on the subject has been largely and unnecessarily journalistic and anecdotal, lacking in intellectual depth, fecundity and rigour. The issue has remained scarcely documented by way of organized research. There is therefore a need for a systematic investigation that would leverage scholarly and policy insights on the subject which is the purpose of this study. The study will therefore, seek to examine the nexus between nomadic pastoralism and the incidence of herder-farmer conflicts in Nigeria with particular reference to the central region of the country. By means of qualitative descriptive analysis predicated on the theory of eco-violence, the paper explores the contemporary historical and structural drivers of this conflict, its relationship with the dynamics of climate change in Nigeria and its implication of human security in Nigeria. The paper also proffers theoretical and policy recommendations to mitigate the onto ward conflict.

Keywords: eco-survivalism, conflict, pastoralism, nomads

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Authors: Tejasvi Parupudi, Mochen Li, Lakshya Mittal, Ignacio G. Camarillo, Raji Sundararajan

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With breast cancer becoming a global pandemic, it is very important to assess a woman’s risk profile accurately in a timely manner. Providing an estimate of the risk of developing breast cancer to a woman gives her an opportunity to consider options to decrease this risk. Women at low risk may be suggested yearly screenings whereas women with a high risk of developing breast cancer would be candidates for aggressive surveillance. Fortunately, there is a set of risk factors that are used to predict the probability of a woman being diagnosed with breast cancer in the future. Studying risk factors and understanding how they correlate to cancer is important for early diagnosis, prevention and reducing mortality rates. The effect of crucial risk factors among black and white women was compared in this study. The various risk factors analyzed include breast density, age, cancer in a first-degree relative, menopausal status, body mass index (BMI) and prior breast cancer diagnosis, etc. Breast density, age at first full-term birth and BMI were utilized in this study as important risk factors for the comparison of incidence rates between women of black and white races in the USA. Understanding the differences could lead to the development of solutions to reduce disparity in mortality rates among black women by improving overall access to care.

Keywords: big data, breast cancer, risk factors, incidence rates, mortality, race

Procedia PDF Downloads 257

Authors: Nabiha Bouafia, Asma Ben Cheikh, Asma Ammar, Olfa Ezzi, Mohamed Mahjoub, Khaoula Meddeb, Imed Chouchene, Hamadi Boussarsar, Mansour Njah

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Background: Hospital acquired infections (HAI) cause significant morbidity, mortality, length of stay and hospital costs, especially in the intensive care unit (ICU), because of the debilitated immune systems of their patients and exposure to invasive devices. The aims of this study were to determine the rate and the risk factors of HAI in an ICU of a university hospital in Tunisia. Materials/Methods: A prospective study was conducted in the 8-bed adult medical ICU of a University Hospital (Sousse Tunisia) during 14 months from September 15th, 2015 to November 15th, 2016. Patients admitted for more than 48h were included. Their surveillance was stopped after the discharge from ICU or death. HAIs were defined according to standard Centers for Disease Control and Prevention criteria. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: During the study, 192 patients had admitted for more than 48 hours. Their mean age was 59.3± 18.20 years and 57.1% were male. Acute respiratory failure was the main reason of admission (72%). The mean SAPS II score calculated at admission was 32.5 ± 14 (range: 6 - 78). The exposure to the mechanical ventilation (MV) and the central venous catheter were observed in 169 (88 %) and 144 (75 %) patients, respectively. Seventy-three patients (38.02%) developed 94 HAIs. The incidence density of HAIs was 41.53 per 1000 patient day. Mortality rate in patients with HAIs was 65.8 %( n= 48). Regarding the type of infection, Ventilator Associated Pneumoniae (VAP) and central venous catheter Associated Infections (CVC AI) were the most frequent with Incidence density: 14.88/1000 days of MV for VAP and 20.02/1000 CVC days for CVC AI. There were 5 Peripheral Venous Catheter Associated Infections, 2 urinary tract infections, and 21 other HAIs. Gram-negative bacteria were the most common germs identified in HAIs: Multidrug resistant Acinetobacter Baumanii (45%) and Klebsiella pneumoniae (10.96%) were the most frequently isolated. Univariate analysis showed that transfer from another hospital department (p= 0.001), intubation (p < 10-4), tracheostomy (p < 10-4), age (p=0.028), grade of acute respiratory failure (p=0.01), duration of sedation (p < 10-4), number of CVC (p < 10-4), length of mechanical ventilation (p < 10-4) and length of stay (p < 10-4), were associated to high risk of HAIS in ICU. Multivariate analysis reveals that independent risk factors for HAIs are: transfer from another hospital department: OR=13.44, IC 95% [3.9, 44.2], p < 10-4, duration of sedation: OR= 1.18, IC 95% [1.049, 1.325], p=0.006, high number of CVC: OR=2.78, IC 95% [1.73, 4.487], p < 10-4, and length of stay in ICU: OR= 1.14, IC 95% [1.066,1.22], p < 10-4. Conclusion: Prevention of nosocomial infections in ICUs is a priority of health care systems all around the world. Yet, their control requires an understanding of epidemiological data collected in these units.

Keywords: healthcare associated infections, incidence, intensive care unit, risk factors

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Authors: Naser Shagerdi Esmaeli, Mohsen Hamidpour

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Purposes: The activation of coagulation in patients with cancer contributes significantly to morbidity and mortality rates and may play a fundamental role in the host response to growing tumor’s. Patients with cancer are clearly at high risk for the development of venous thromboembolism (VTE), particularly during chemotherapy and surgery. This situation is aggravated by the use of venous access catheters and possibly growth factors. Methods: Data derived from large, randomized, controlled trials have been used to determine the true incidence of this complication of cancer and its treatment. The incidence based on the analyses of these randomized controlled trials varies from 1% for limited stage patients with breast cancer treated with tamoxifen to 60% for patients with any type of cancer who are subjected to orthopedic surgery and do not receive prophylactic therapy. Results: In view of the morbidity and mortality attributable to VTE in cancer, widespread utilization of prophylactic anticoagulation therapy, which has proven safe and effective in a variety of situations, should be considered. While migratory thrombophlebitis is a clear indicator of an underlying neoplasm, the risk of cancer in patients with the more typical form of VTE has been the subject of intense debate over recent years. Conclusion: Some investigators have suggested that the relative risk of being diagnosed with occult cancer within six months of an episode of VTE (particularly recurrent VTE) could be up to 10-fold. However, the cost-effectiveness of aggressive screening for cancer in patients with VTE has not yet been defined adequately.

Keywords: venous thromboembolism, malignancy, cancer, tumor, heparin

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Authors: Khaliun Nyambayar, Nomindari Azzaya, Batkhuyag Purevjav

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Pharmacovigilance was officially introduced in Mongolia in 2003, in accordance with the Health Minister Order 183 for the registry of adverse drug reactions (ADR), approved in 2006 and was reviewed in 2010. This study was designed to evaluate the incidence and common types of adverse drug reactions among hospitalized children, the frequency of adverse drug reaction reported by health care providers, and the follow-up processes resulting from adverse drug reactions. A retrospective study of paediatric patients who experienced an adverse drug reaction from 2015 to 2019, extracted from the “yellow” card at the State Research Center for Maternal and Child Health, (city). A total of 417 adverse drug reactions were reported with an overall incidence was 80 (21.5%). Adverse reactions resulting from the use of antibiotics (particularly gentamycin, cephalosporins, and vancomycin) were usually mild. ADR’s were reported by physicians and nurses (93.8%), pharmacists (6.25%). Although documentation of physician notification occurred for 93% of adverse drug reactions, only 29% of cases were documented in the patient's medical chart, 13% included follow-up education for individuals involved, and 10% were updated in the allergy profile of the hospital computer system. Measures to improve the detection and reporting of adverse drug reactions by all health care professionals should be improved, to enhance our understanding of the nature and impact of these reactions in children.

Keywords: adverse drug reaction, pediatric, yellow card, Mongolia

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Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

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Introduction: To improve early detection and mortality rate of In- Hospital Cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditions and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90mmHg, respiratory rate <8 or > 28 breaths per minute, O2 saturation < 90%, acute change in conscious state, acute chest pain or worried about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in In-Hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in In-Hospital cardiac arrest and overall hospital mortality rate. We conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed Chi -square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010 ,139 calls in 2011 and 245 calls in 2012.The number of ERT calls per 1000 admissions in year 2009-10 was 7.69, 5.61 in 2011 and 9.38 in 2013. The number of Code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, But we have not found difference in overall hospital mortality rate.

Keywords: emergency response team, ERT, cardiac arrest, emergency medicine

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Authors: Hyuk-Hoon Kim, Young Gi Min

Abstract:

Background: Acute poisoning is the common cause of morbidity and mortality. Characteristics of acute poisoning differ between countries. While other countries operate the database system for poisoning, Korea has not collected the database for acute poisoning. Distribution of incidence of acute poisoning depending on the types of materials have also not studied in Korea. Our aims are to evaluate the etiologic and demographic characteristics of acute poisoning cases and to obtain up-to-date information on acute poisonings. Method: We retrospectively recorded cases of acute poisoning from eight emergency departments of second level or university hospitals from different cities in Gyeonggi province in Korea from April 2006 and March 2015. The distributions of incidence of acute poisoning depending on the types of materials are mapped by geographic information system. Result: A total of 3,449 poisoned cases were analyzed. Mean estimated age of patients was 39.56 ± 22.40 years. Mean male to female ratio of patients was 1:1.4. Mean proportion of intentional poisoning was 57.9%. Common materials are benzodiazepine (16.6%), carbon monoxide (10.5%), pesticide (8.1%) and zolpidem (7.1%) Common route of exposure is ingestion (79.5%) and followed by inhalation (16.5%). Common treatment methods are gastric lavage (20%) and activated charcoal (30%). Most cases had uneventful recovery; 61.4% were treated as outpatients and 0.1% of the poisoning resulted in death in ER. Conclusion: Even though the cases enrolled in our study is not the overall cases of acute poisoning in Korea, our study could be the basis of countermeasures for analysis and prevention of acute poisoning in Korea.

Keywords: acute poisoning, emergency department, epidemiology, Korea

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Authors: Jirapat Suriyachaisawat, Ekkit Surakarn

Abstract:

Introduction: To improve early detection and mortality rate of in-hospital cardiac arrest, Emergency Response Team (ERT) system was planned and implemented since June 2009 to detect pre-arrest conditons and for any concerns. The ERT consisted of on duty physicians and nurses from emergency department. ERT calling criteria consisted of acute change of HR < 40 or > 130 beats per minute, systolic blood pressure < 90 mmHg, respiratory rate <8 or >28 breaths per minute, O2 saturation <90%, acute change in conscious state, acute chest pain or worry about the patients. From the data on ERT system implementation in our hospital in early phase (during June 2009-2011), there was no statistic significance in difference in in-hospital cardiac arrest incidence and overall hospital mortality rate. Since the introduction of the ERT service in our hospital, we have conducted continuous educational campaign to improve awareness in an attempt to increase use of the service. Methods: To investigate outcome of ERT system in in-hospital cardiac arrest and overall hospital mortality rate, we conducted a prospective, controlled before-and after examination of the long term effect of a ERT system on the incidence of cardiac arrest. We performed chi-square analysis to find statistic significance. Results: Of a total 623 ERT cases from June 2009 until December 2012, there were 72 calls in 2009, 196 calls in 2010, 139 calls in 2011 and 245 calls in 2012. The number of ERT calls per 1000 admissions in year 2009-10 was 7.69; 5.61 in 2011 and 9.38 in 2013. The number of code blue calls per 1000 admissions decreased significantly from 2.28 to 0.99 per 1000 admissions (P value < 0.001). The incidence of cardiac arrest decreased progressively from 1.19 to 0.34 per 1000 admissions and significant in difference in year 2012 (P value < 0.001 ). The overall hospital mortality rate decreased by 8 % from 15.43 to 14.43 per 1000 admissions (P value 0.095). Conclusions: ERT system implementation was associated with progressive reduction in cardiac arrests over three year period, especially statistic significant in difference in 4th year after implementation. We also found an inverse association between number of ERT use and the risk of occurrence of cardiac arrests, but we have not found difference in overall hospital mortality rate.

Keywords: cardiac arrest, outcome, in-hospital, ERT

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Authors: Noora Al-Shanfari, M. Mazharul Islam

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The cumulative incidence function (CIF) is a fundamental approach for analyzing survival data in the presence of competing risks, which estimates the marginal probability for each competing event. Parametric modeling of CIF has the advantage of fitting various shapes of CIF and estimates the impact of covariates with maximum efficiency. To calculate the total CIF's covariate influence using a parametric model., it is essential to parametrize the baseline of the CIF. As the CIF is an improper function by nature, it is necessary to utilize an improper distribution when applying parametric models. The Gompertz distribution, which is an improper distribution, is limited in its applicability as it only accounts for monotone hazard shapes. The generalized Gompertz distribution, however, can adapt to a wider range of hazard shapes, including unimodal, bathtub, and monotonic increasing or decreasing hazard shapes. In this paper, the generalized Gompertz distribution is used to parametrize the baseline of the CIF, and the parameters of the proposed model are estimated using the maximum likelihood approach. The proposed model is compared with the existing Gompertz model using the Akaike information criterion. Appropriate statistical test procedures and model-fitting criteria will be used to test the adequacy of the model. Both models are applied to the ‘colon’ dataset, which is available in the “biostat3” package in R.

Keywords: competing risks, cumulative incidence function, improper distribution, parametric modeling, survival analysis

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Authors: Sajjad Ur Rahman, Muhammad Tahir, Mukarram Bashir, Jawad, Aoun Muhammad, Muhammad Zohaib, Hannan Khan, Seemal Javaid, Mariam Azam

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The efficiency of natural metabolites obtained from partially fermented soya hulls and wheat bran using Saccharomyces cerevisiae (DL-22 S/N) ensures a potential impact on the total milk yield and quality of milk production. On attaining a moderate number of Saccharomyces cerevisiae cells around 1×10⁹ CFU/ml, the concentrate was further elevated under in-vivo conditions to study the quality of milk production in lactating buffalo. Ten lactating buffalos of the Nili Ravi breed having the same physical factors were given 12 gm of microbial metabolites daily, along with the palleted feed having 22 % proteins. Another group of 10 lactating animals with the same characteristics was maintained without metabolites. The body score, overall health, incidence of mastitis, milk fat, milk proteins, ash and solid not fat (SNF) were elevated on a weekly basis up to thirty days of trial. It was recorded that the average total increase in quality milk production was 0.9 liter/h/d, whereas SNF in the milk was enhanced to 0.71, and fats were decreased to 0.09 %. Moreover, during all periods of the trial, the overall non-specific immunity of buffalo was increased, as indicated by less than 0.2 % of mastitis incidence compared to 1.8% in the untreated buffalos.

Keywords: natural metabolites, quality milk, milk yield, microorganisms, fermentation, nonspecific immunity, better performing animals

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Authors: Mikiale Gebreslase Gebremariam, Chai Huaqi, Tesfay Gebretsdkan Gebremichael, Dawit Nega Bekele

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In recent years, brownfield redevelopment projects (BRPs) have contributed to the overarching paradigm of the United Nations 2030 agendas. In the present circumstance, most developed nations adopted BRPs, an efficacious urban policy tool. However, in developing and some advanced countries, BRPs are lacking due to limitations of awareness, policy tools, and financial capability for cleaning up brownfield sites. For example, the growth and development of Ethiopian cities were achieved at the cost of poor urban planning, including no community consultations and excessive urbanization for future growth. The demand for land resources is more and more urgent as the result of an intermigration to major cities and towns for socio-economic reasons and population growth. In the past, the development mode of spreading major cities has made horizontal urbanizations stretching outwards. Expansion in search of more land resources, while the outer cities are growing, the inner cities are polluted by environmental pollution. It is noteworthy that the rapid development of cities has not brought about an increase in people's happiness index. Thus, the proposed management framework for managing brownfields in Ethiopia as a lesson to the developing nation facing similar challenges and growth will add immense value in solving the problems and give insights into brownfield land utilization. Under the umbrella of the grey incidence decision-making model and with the consideration of multiple stakeholders and tight environmental and economic constraints, the proposed management framework integrates different criteria from economic, social, environmental, technical, and risk aspects into the grey incidence decision-making model and gives useful guidance to manage brownfields in Ethiopia. Furthermore, it will contribute to the future development of the social economy and the missions of the 2030 UN sustainable development goals.

Keywords: Brownfields, environmental sustainability, Ethiopia, grey-incidence decision-making, sustainable urban development

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Authors: Vignesh Ratnaraj, Daniel Marascia, Kelly Ruecker

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Purpose: Pulmonary embolism (PE) is a major cause of morbidity and mortality in trauma patients. Data suggests PE is occurring earlier in trauma patients, with attention being turned to possible de novo events. Here, we examine the incidence of early PE at a level 1 trauma center and examine the relationship with a chest injury. Method: A retrospective analysis was performed from a prospective trauma registry at a level 1 trauma center. All patients admitted from 1 January 2010 to 30 June 2019 diagnosed with PE following trauma were included. Early PE was considered a diagnosis within 72 hours of admission. The severity of the chest injury was determined by the Abbreviated Injury Score (AIS). Analysis of severe chest injury and incidence of early PE was performed using chi-square analysis. Sub-analysis on the timing of PE and PE location was also performed using chi-square analysis. Results: Chest injury was present in 125 of 184 patients diagnosed with PE. Early PE occurred in 28% (n=35) of patients with a chest injury, including 24.39% (n=10) with a severe chest injury. Neither chest injury nor severe chest injury determined the presence of early PE (p= > 0.05). Sub-analysis showed a trend toward central clots in early PE (37.14%, n=13) compared to late (27.78%, n=25); however, this was not found to be significant (p= > 0.05). Conclusion: PE occurs early in trauma patients, with almost one-third being diagnosed before 72 hours. This analysis does not support the paradigm that chest injury, nor severe chest injury, results in statistically significant higher rates of early PE. Interestingly, a trend toward early central PE was noted in those suffering chest trauma.

Keywords: trauma, PE, chest injury, anticoagulation

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Authors: Mohammad Ghandehari Motlagh

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Purpose: To evaluate validity of simplified Javal’s rule (Total Ast=Corneal Ast-0.50@9) in 147 pre-op cataract eyes. Methods: Due to change in lens tissue and structure in a cataract crystalline lens, we conceive the simplified javal’s rule may not be valid in cataract cases.In this cross-sectional study,147 pre-op cataract eyes without oblique astigmatism were enrolled in this study. Ocular biometry (with IOL master 500)and keratometry and refraction findings were recorded. Results: Mean age of our patients was 64.95 yrs/old (SD+_9.86) that confirms on senile cataract. Mean Axial length and average keratometry were respectively 23.86 and 44.62.Prevalence of systemic diseases diabet and high blood pressure were respectively 43 (29.25%) and 44 (29.93%)and shows importance of these diseases. The Corneal astigmatism axis is correlated with refractive astigmatism in cataract eyes (R=0.493). Simplified Javal’s rule is valid in cataract eyes (P<0.001). Conclusion: Simplified Javal’s rule is a valid formula in pre-op cataract eyes and can be used for keratometry results confirmation.

Keywords: javals rule, cataract, keratometry, ocular axial length

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Authors: Khalid Alhudaib

Abstract:

Potato is considered as one of the most important and potential vegetable crops in Saudi Arabia. Alfalfa mosaic virus (AMV), genus Alfamovirus, family Bromoviridae is among the broad spread of viruses in potato. During spring and fall growing seasons of potato in 2015 and 2016, several field visits were conducted in the four major growing areas of potato cultivation (Riyadh-Qaseem-Hail-Hard). The presence of AMV was detected in samples using ELISA, dot blot hybridization and/or RT-PCR. The highest occurrence of AMV was observed as 18.6% in Qaseem followed by Riyadh with 15.2% while; the lowest infection rates were recorded in Hard and Hail, 8.3 and 10.4%, respectively. The sequences of seven isolates of AMV obtained in this study were determined and the sequences were aligned with the other sequences available in the GenBank database. Analyses confirmed the low variability among AMV isolated in this study, which means that all AMV isolates may originate from the same source. Due to high incidence of AMV, other economic susceptible crops may become affected by high incidence of this virus in potato crops. This requires accurate examination of potato seed tubers to prevent the spread of the virus in Saudi Arabia. The obtained results indicated that the hybridization and ELISA are suitable techniques in the routine detection of AMV in a large number of samples while RT-PCR is more sensitive and essential for molecular characterization of AMV.

Keywords: Alfamovirus, AMV, Alfalfa mosaic virus, PCR, potato

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Authors: Ibrahim A. Elshaer, Alaa M. Shaker

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Several previous empirical studies have operationalized service quality as either a multidimensional or unidimensional construct. While few earlier studies investigated some practices of the assumed dimensional structure of service quality, no study has been found to have tested the construct’s dimensionality using confirmatory factor analysis (CFA). To gain a better insight into the dimensional structure of service quality construct, this paper tests its dimensionality using three CFA models (higher order factor model, oblique factor model, and one factor model) on a set of data collected from 390 British tourists visited Egypt. The results of the three tests models indicate that service quality construct is multidimensional. This result helps resolving the problems that might arise from the lack of clarity concerning the dimensional structure of service quality, as without testing the dimensional structure of a measure, researchers cannot assume that the significant correlation is a result of factors measuring the same construct.

Keywords: service quality, dimensionality, confirmatory factor analysis, Egypt

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Authors: Ana Corberan-Vallet, Karen C. Florez, Ingrid C. Marino, Jose D. Bermudez

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In 2016, the Region of the Americas was declared free of measles, a viral disease that can cause severe health problems. However, since 2017, measles has reemerged in Venezuela and has subsequently reached neighboring countries. In 2018, twelve American countries reported confirmed cases of measles. Governmental and health authorities in Colombia, a country that shares the longest land boundary with Venezuela, are aware of the need for a strong response to restrict the expanse of the epidemic. In this work, we apply a Bayesian hierarchical Poisson model with an underlying cluster structure to describe disease incidence in Colombia. Concretely, the proposed methodology provides relative risk estimates at the department level and identifies clusters of disease, which facilitates the implementation of targeted public health interventions. Socio-demographic factors, such as the percentage of migrants, gross domestic product, and entry routes, are included in the model to better describe the incidence of disease. Since the model does not impose any spatial correlation at any level of the model hierarchy, it avoids the spatial confounding problem and provides a suitable framework to estimate the fixed-effect coefficients associated with spatially-structured covariates.

Keywords: Bayesian analysis, cluster identification, disease mapping, risk estimation

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Authors: Abedalbasit M. Abedalhafiz, Aman Kasawneh, Zyad Altahynah, Ahmad Okor

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The purpose of this study was to determine the construct validity of the morale sprit scale (MSS). Ninety faculty members from colleges of physical education at Jordanian universities were chosen to participate in this study. The design of this study was an ex-post facto. The MSS consists of (48) items that measure different dimensions of morale spirit among faculty members. Principle axis factoring with oblique rotation was utilized to uncover the underlying structure of the instrument. The findings revealed eight factor solution explaining (72.825%). Seven factors were accepted according to the conditions of accepting factors. The seven factors were named morale as reflection of faculty and department's administration, regulations and instructions, working environment and conditions, promotions and incentives and salaries, relations between the faculty member's, the trend toward the college and university, the trend toward self factors.

Keywords: Factorial validity, morale sprit, faculty members, Jordanian Universities

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Authors: Mostafa A. Amer, I. A. El-Samra, I. I. Abou-ElSeoud, S. M. El-Abd, N. K. Shawertamimi

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Tomato Fusarium wilt disease caused by Fusarium oxysporum f. sp. Lycopercisi (FOL) is considered one of the most destructive diseases in Egypt. Effect of some biotic inducers such as Bacillus megaterium var. phosphaticum, Glomus intraradices and Glomus macrocarpum at seven different mixed treatments, was tested for their ability to induce resistance in tomato plants against the disease. According to pathogenicity tests, all the tested isolates of FOL showed wilt symptoms on both of the tested cultivars; however, they considerably varied in percentages of disease incidence (DI) and disease severity (DS). Castle Rock was more susceptible than Peto 86, which was relatively resistant. Pretreatment of both cultivars, under greenhouse conditions, with the tested biotic inducers alone or in combination with each other's, significantly increased the induction of chitinase, β-1,3-glucanase, peroxidase, and polyphenoloxidase and reduced disease incidence and severity, compared with untreated noninoculated (C1) and untreated inoculated (C2) controls. Application of a combination of BMP, with GI and GM was the most effective in increasing the induction rated of the tested enzymes, compared with the other treatments. Induction of enzymes in most of the tested bioinducers treatments gradually increased, attaining maximum values after 48 or/and 72 hrs after challenging with FOL, then gradually declined. GI was the least effective bioinducer.

Keywords: F. oxysporum f. sp. lycopersici, defense enzymes, induced systemic resistance, ISR, B. megaterium var. phosphaticum, G. macrocarpum, G. intraradices

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Authors: Ammar Asma, Bouafia Nabiha, Ben Cheikh Asma, Ezzi Olfa, Mahjoub Mohamed, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Ventilator-associated pneumonia (VAP) is currently recognized as one of the most relevant causes of morbidity and mortality among intensive care unit (ICU) patients worldwide. Identifying modifiable risk factors for VAP could be helpful for future controlled interventional studies aiming at improving prevention of VAP. The purposes of this study were to determine the incidence and risk factors for VAP in in a Tunisian medical ICU. Materials / Methods: A retrospective case-control study design based on the prospective database collected over a 14-month period from September 15th, 2015 through November 15th, 2016 in an 8-bed medical ICU. Patients under ventilation for over 48 h were included. The number of cases was estimated by Epi-info Software with the power of statistical test equal to 90 %. Each case patient was successfully matched to two controls according to the length of mechanical ventilation (MV) before VAP for cases and the total length of MV in controls. VAP in the ICU was defined according to American Thoracic Society; Infectious Diseases Society of America guidelines. Early onset or late-onset VAP were defined whether the infectious process occurred within or after 96 h of ICU admission. Patients’ risk factors, causes of admission, comorbidities and respiratory specimens collected were reviewed. Univariate and multivariate analyses were performed to determine variables associated with VAP with a p-value < 0.05. Results: During the period study, a total of 169 patients under mechanical ventilation were considered, 34 patients (20.11%) developed at least one episode of VAP in the ICU. The incidence rate for VAP was 14.88/1000 ventilation days. Among these cases, 9 (26.5 %) were early-onset VAP and 25 (73.5 %) were late-onset VAP. It was a certain diagnosis in 66.7% of cases. Tracheal aspiration was positive in 80% of cases. Multi-drug resistant Acinerobacter baumanii was the most common species detected in cases; 67.64% (n=23). The rate of mortality out of cases was 88.23% (n= 30). In univariate analysis, the patients with VAP were statistically more likely to suffer from cardiovascular diseases (p=0.035) and prolonged duration of sedation (p=0.009) and tracheostomy (p=0.001), they also had a higher number of re-intubation (p=0.017) and a longer total time of intubation (p=0.012). Multivariate analysis showed that cardiovascular diseases (OR= 4.44; 95% IC= [1.3 - 14]; p=0.016), tracheostomy (OR= 4.2; 95% IC= [1.16 -15.12]; p= 0.028) and prolonged duration of sedation (OR=1.21; 95% IC= [1.07, 1.36]; p=0.002) were independent risk factors for the development of VAP. Conclusion: VAP constitutes a therapeutic challenge in an ICU setting, therefore; strategies that effectively prevent VAP are needed. An infection control-training program intended to all professional heath care in this unit insisting on bundles and elaboration of procedures are planned to reduce effectively incidence rate of VAP.

Keywords: case control study, intensive care unit, risk factors, ventilator associated pneumonia

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Authors: Abdul Wajid Ali

Abstract:

Supersonic flight promises speed, but the design of the air inlet faces an obstacle: shock waves. They prevent air flow in the mixed compression ports, which reduces engine performance. Our research investigates this using supersonic wind tunnels and schlieren imaging to reveal the complex dance between shock waves and airflow. The findings show clear patterns of shock wave formation influenced by internal/external pressure surfaces. We looked at the boundary layer, the slow-moving air near the inlet walls, and its interaction with shock waves. In addition, the study emphasizes the dependence of the shock wave behaviour on the Mach number, which highlights the need for adaptive models. This knowledge is key to optimizing the combined compression inputs, paving the way for more powerful and efficient supersonic vehicles. Future engineers can use this knowledge to improve existing designs and explore innovative configurations for next-generation ultrasonic applications.

Keywords: oblique shock formation, boundary layer interaction, schlieren images, double wedge surface

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Authors: Alexandra Serra, Nair Torrão, Rui G. Serôdio, José A. Lima

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The present study aimed to evaluate the incidence and the prevalence of domestic violence legitimatory beliefs, emotional regulation difficulties and, early maladaptive schemas regarding intimidate partner violence in a sample of 50 Portuguese inmates. As expected, results show high levels of legitimatory beliefs, significant difficulties of emotional regulation and a set of high levels of early maladaptive schemas that clearly compromise the inmates affective-cognitive functioning. The most prevalent set of maladaptive schemas are associated with depression, anxiety, hostility, reduced ability to empathize and, dependence on the approval of others, which, combined, may trigger aggressive responses towards the intimate’s partner. Being victimized in their childhood and having committing murder are not differentiating factors on the measures we analyzed, but alcohol consumption may be associated with an intensification of domestic violence legitimatory beliefs. In the discussion of our findings, we compare the pattern of the psychosocial measures we used with the equivalent results obtained with convicted individuals that attend a community compulsory program, specifically designed for domestic violence perpetrators. We also highlight the importance of implementing specialized interventions in prison settings focusing on an evidence-based-practice.

Keywords: domestic violence, intimate partner offenders, incidence and prevalence of legitimatory beliefs, Portuguese inmates

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Authors: Shekoufeh Behdad, Sahar Yadegari, Alireza Ghehrazad, Amirhossein Yadegari

Abstract:

Background: In this study, we compared the effect of intravenous dexamethasone with placebo on hemodynamic variables and hypotension in patients undergoing cesarean section under spinal anesthesia. Materials and methods: This double-blind, randomized clinical trial was conducted with the approval of the university ethics committee. Written informed consent was obtained from all participating patients. Before spinal anesthesia, patients were randomly assigned to receive either dexamethasone (8 mg IV) or placebo (normal saline). Hemodynamic variables, including systolic, diastolic, and mean arterial blood pressures, as well as heart rate, were measured before drug administration and every 3 minutes until the birth of the neonate and then every 5 minutes until the end of surgery. Side effects such as hypotension, bradycardia, nausea, and vomiting were assessed and recorded for all the patients. Results: There were no significant differences in mean systolic, diastolic, and mean arterial blood pressures before and after administration of the studied drugs in both groups (P.Value>0.05), but heart rate and the incidence of hypotension in the dexamethasone group were less than placebo significantly. Conclusions: Intravenous administration of 8 mg dexamethasone before spinal anesthesia in females undergoing cesarean section can reduce the incidence of post-spinal hypotension without causing serious side effects.

Keywords: cesarean section, hypotension, spinal anesthesia, dexamethasone

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Authors: Yu-Shi Ye, Jia-Min Wu, Jhih-Ci Li

Abstract:

Background: Most orthopedic inpatients and primary caregivers are elderly, and patients are at high risk of falls. We set up a quality control team to analyze the root cause and found the following issues: 1. The nursing staff did not conduct cognitive assessments of patients and their primary caregivers to ensure that health education content was understood. 2. Nurses prefer to use spoken language in health education but lack the skills to use diverse teaching materials. 3. Newly recruited nurses have insufficient awareness of fall prevention. Methods: The study subjects were 16 nurses in the orthopedic ward of a teaching hospital in central Taiwan. We implemented the following strategies: 1. Developed a fall simulation teaching plan and conducted teaching courses and assessments in the morning meeting; 2. Designed and used a "fall prevention awareness card" to improve the prevention awareness of elderly patients; 3. All staff (including new staff) received experiential education training. Results: In 2021, 40% of patients in the orthopedic wards were aged 60-79 years (792/1979) with a high risk of falls. According to data collection, the incidence of falls in hospitalized patients was 0.04% (5/12651), which exceeded the threshold of 0.02% in our ward. After completing the on-the-job education training in October, the nursing staff expressed that they were more aware of the special situation of fall prevention. Through practical sharing and drills, combined with experiential teaching strategies, nurses can reconstruct the safety awareness of fall prevention and deepen their cognitive memory. Participants scored between 30 and 80 on the pretest (16 students, mean: 72.6) and between 90 and 100 on the post-test (16 students, mean: 92.6), resulting in a 73.8% improvement in overall scores. We have a total of 4 new employees who have all completed the first 3 months of compulsory PGY courses. From January to April 2022, the incidence of falls in hospitalized patients was 0.025% (1/3969). We have made good improvements and will continue to track the outcome. Discussion: In addition to enhancing the awareness of falls among nursing staff, how-to guide patients and primary caregivers to prevent falls is also the focus of improvement. The proper way of health education can be better understood through practical exercises and case sharing.

Keywords: experiential teaching strategies, fall prevention, cognitive card, elderly patients, orthopedic wards

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Authors: Y. Galerkin, E. Popova, K. Soldatova

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There is an evident trend to elevate pressure ratio of a single stage of a turbo compressors - axial compressors in particular. Whilst there was an opinion recently that a pressure ratio 1,9 was a reasonable limit, later appeared information on successful modeling tested of stages with pressure ratio up to 2,8. The Authors recon that lack of information on high pressure stages makes actual a study of rational choice of design parameters before high supersonic flow problems solving. The computer program of an engineering type was developed. Below is presented a sample of its application to study possible parameters of the impeller of the stage with pressure ratio π*=3,0. Influence of two main design parameters on expected efficiency, periphery blade speed and flow structure is demonstrated. The results had lead to choose a variant for further analysis and improvement by CFD methods.

Keywords: supersonic stage, impeller, efficiency, flow rate coefficient, work coefficient, loss coefficient, oblique shock, direct shock

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Authors: Jun Hong Lee

Abstract:

Background: Alzheimer`s disease (AD) I: creases with age and is characterized by the premature progressive loss of neuronal cell. In contrast, cancer cells have inappropriate cell proliferation and resistance to cell death. Objective: We evaluated the association between cancer and AD and also examined the specific types of cancer. Patients and Methods/Material and Methods: This retrospective, nationwide, longitudinal study used National Health Insurance Service – Senior cohort (NHIS-Senior) 2002-2013, which was released by the KNHIS in 2016, comprising 550,000 random subjects who were selected from over than 60. The study included a cohort of 4,408 patients who were first diagnoses as AD between 2003 and 2005. To match each dementia patient, 19,150 subjects were selected from the database by Propensity Score Matching. Results: We enrolled 4,790 patients for analysis in this cohort and the prevalence of AD was higher in female (19.29%) than in male (17.71%). A higher prevalence of AD was observed in the 70-84 year age group and in the higher income status group. A total of 540 cancers occurred within the observation interval. Overall cancer was less frequent in those with AD (12.25%) than in the control (18.46%), with HR 0.704 (95% Confidence Intervals (CIs)=0.0.64-0.775, p-Value < 0.0001). Conclusion: Our data showed a decreased incidence of overall cancers in patients with AD similar to previous studies. Patients with AD had a significantly decreased risk of colon & rectum, lung and stomach cancer. This finding lower than but consistent with Western countries. We need further investigation of genetic evidence linking AD to cancer.

Keywords: Alzheimer, cancer, nationwide, longitudinal study

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Authors: Emmanuel Anim

Abstract:

Ghana has been touted as an oasis of peace in Africa following her relatively peaceful democratic elections, proliferated number of the media, and freedom of speech. Besides, the former Gold Coast country is yet to experience any major incidence of terrorism. Nevertheless, the somewhat occasional simmering violence and conflicts arising from political, religious and chieftaincy skirmishes, largely at its northern part portrays that it is not immune to the political violence of terrorism. The predominantly-based qualitative research reveals that current conditions of socio-politico-economic, and religious issues in Ghana places the West African country on the possible sidelines of the phenomenon of terrorism, when its status quo is juxtaposed with the factors enumerated to have culminated in the rise of Boko Haram, and its accompanying insurgency in Nigeria. Arguing from the perspective of the theory of Social Movement, the analyses and discussions note that the current state of affairs in Ghana could foster domestic terrorism in the country. What is more, the research shows that Ghana faces threats from transnational terrorism given the tendency for elements in Ghana to sympathize and subscribe to the ideological dictates and appeals from Boko Haram and other terrorist organizations. As a consequence, the study recommends that adverse conditions of poverty, poor governance, unemployment, and rising levels of (Islamic) religious radicalization should be remedied by economic improvements, good governance, job creation, and de-radicalization programs by government officials to aid mitigate the incidence of terrorism in the country.

Keywords: Boko Haram, Ghana, Nigeria, terrorism

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Authors: Mariam Azam, Sajjad Ur Rahman, Mukarram Bashir, Muhammad Tahir, Seemal Javaid, Jawad, Aoun Muhammad, Muhammad Zohaib, Hannan Khan

Abstract:

Products of microbial origin are of great importance as they have proved their value in healthcare and nutrition, use of these microbial metabolites acquired from partially fermented soya hulls and wheat bran along with Saccharomyces cerevisiae (DL-22 S/N) substantiates to be a great source for an increase in the total milk production and quality yield.1×109 CFU/ml cells of Saccharomyces cerevisiae (DL-22 S/N) were further grown under in-vivo conditions for the assessment of quality milk production. Two groups with twelve cows, each having the same physical characteristics (Group A and Group B), were under study, Group A was daily fed with 12gm of biological metabolites and 22% protein-pelleted feed. On the other hand, the animals of Group B were provided with no metabolites in their feed. In thirty days of trial, improvement in the overall health, body score, milk protein, milk fat, yield, incidence rate of mastitis, ash, and solid not fat (SNF) was observed. The collected data showed that the average quality milk production was elevated up to 0.45 liter/h/d. However, a reduction in the milk fats up to 0.45% and uplift in the SNF value up to 0.53% of cow milk was also observed. At the same time, the incidence rate of mastitis recorded for the animals under trial was reduced to half, and improved non specific immunity was reported.

Keywords: microbial metabolites, post-biotics, animal supplements, animal nutrition, proteins, animal production, fermentation

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Authors: Leili Iranirad, Mohammad Saleh Sadeghi, Seyed Fakhreddin Hejazi, Negar Vakili Razlighi

Abstract:

Objective: Contrast-induced nephropathy (CIN) or contrast-induced acute kidney injury (CI-AKI) is an unknown acute kidney injury (AKI) occurring after exposure to contrast media (CM). Contrast agents are most often used for diagnostic procedures or therapeutic angiographic interventions. Recently, Na/K citrate as a urine alkalinization has been evaluated for the prevention of CIN. We conducted this experiment to evaluate the efficiency of Na/K citrate on CIN in high-risk patients treated with cardiac catheterization. Methods: A prospective randomized clinical trial was conducted on 400 patients having moderate to high-risk factors for CIN treated with elective percutaneous coronary intervention (PCI) and were assigned randomly to the control group or the Na/K citrate group. The Na/K citrate group (n=200) received 5 g Na/K citrate solution, which was diluted in 200 mL water two h before and four hours after the first administration and intravenous hydration for two h prior to and six h after the procedure, while the control group (n=200) only received intravenous hydration. Serum creatinine (SCr) was calculated prior to the contrast exposure and after 48 h. CIN was described as a 25% increase in creatinine of serum (SCr) or >0.5 mg/dl 48 h after contrast administration. Results: CIN was observed in 33 patients (16.5%) in the control group and in 6 patients (3%) in the Na/K citrate group. A significant variation was recorded in the CIN incidence between the two groups 48 h after the radiocontrast agent administration (p < 0.001). Conclusion: Our results show that Na/K citrate is useful and substantially reduces the incidence of CIN.

Keywords: contrast media, citrate, PCI

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Authors: Ana L. M. Pavan, Guilherme Giacomini, Allan F. F. Alves, Marcela De Oliveira, Fernando A. B. Neto, Maria E. D. Rosa, Andre P. Trindade, Diana R. De Pina

Abstract:

Mammography is a worldwide image modality used to diagnose breast cancer, even in asymptomatic women. Due to its large availability, mammograms can be used to measure breast density and to predict cancer development. Women with increased mammographic density have a four- to sixfold increase in their risk of developing breast cancer. Therefore, studies have been made to accurately quantify mammographic breast density. In clinical routine, radiologists perform image evaluations through BIRADS (Breast Imaging Reporting and Data System) assessment. However, this method has inter and intraindividual variability. An automatic objective method to measure breast density could relieve radiologist’s workload by providing a first aid opinion. However, pectoral muscle is a high density tissue, with similar characteristics of fibroglandular tissues. It is consequently hard to automatically quantify mammographic breast density. Therefore, a pre-processing is needed to segment the pectoral muscle which may erroneously be quantified as fibroglandular tissue. The aim of this work was to develop an automatic algorithm to segment and extract pectoral muscle in digital mammograms. The database consisted of thirty medio-lateral oblique incidence digital mammography from São Paulo Medical School. This study was developed with ethical approval from the authors’ institutions and national review panels under protocol number 3720-2010. An algorithm was developed, in Matlab® platform, for the pre-processing of images. The algorithm uses image processing tools to automatically segment and extract the pectoral muscle of mammograms. Firstly, it was applied thresholding technique to remove non-biological information from image. Then, the Hough transform is applied, to find the limit of the pectoral muscle, followed by active contour method. Seed of active contour is applied in the limit of pectoral muscle found by Hough transform. An experienced radiologist also manually performed the pectoral muscle segmentation. Both methods, manual and automatic, were compared using the Jaccard index and Bland-Altman statistics. The comparison between manual and the developed automatic method presented a Jaccard similarity coefficient greater than 90% for all analyzed images, showing the efficiency and accuracy of segmentation of the proposed method. The Bland-Altman statistics compared both methods in relation to area (mm²) of segmented pectoral muscle. The statistic showed data within the 95% confidence interval, enhancing the accuracy of segmentation compared to the manual method. Thus, the method proved to be accurate and robust, segmenting rapidly and freely from intra and inter-observer variability. It is concluded that the proposed method may be used reliably to segment pectoral muscle in digital mammography in clinical routine. The segmentation of the pectoral muscle is very important for further quantifications of fibroglandular tissue volume present in the breast.

Keywords: active contour, fibroglandular tissue, hough transform, pectoral muscle

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