Search results for: hospital setting

Authors: N. J. Nawarathna, N. R. Kmarasinghe, D. Chandrasekara, B. M. R. S. Balasooriya, R. A. A. Shaminda, R. J. K. Senevirathne

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Introduction: Thyroid malignancy associated with hyperthyroidism is considered rare. Retrospective studies have shown the incidence of thyroid malignancy in hyperthyroid patients to be low (0.7-8.5%). To assess the clinical relevance of this association, thyroid status in a cohort of patients with thyroid malignancy were analyzed. Method: Thyroid malignancies diagnosed histologically in 56 patients, over a 18 month period beginning from April 2013, in a single surgical unit at Teaching Hospital Kandy were included. Preoperative patient details and progression of thyroid status were asessed with Thyroid Stimulating Hormone, free Thyroxin and free Triiodothyronine levels. Results: Amongst 56 patients Papillary carcinoma was diagnosed in 44(78.6%), follicular carcinomas in 7(12.5%) and 5(8.9%) with medullary and anaplastic carcinomas. 12(21.4%) were males and 44(78.6%) were females. 20(35.7%) were less than 40years, 29(51.8%) were between 40 to 59years and 7(12.5%) were above 59years. Cross tabulation of Type of carcinoma with Gender revealed likelihood ratio of 6.908, Significance p = 0.032. Biochemically 12(21.4%) were hyperthyroid. Out of them 5(41.7%) had primary hyperthyroidism and 7(58.3%) had secondary hyperthyroidism. Mean age of euthyroid patients was 43.77years (SD 10.574) and hyperthyroid patients was 53.25years(SD 16.057). Independent Samples Test t is -2.446, two tailed significance p =0.018. When cross tabulate thyroid status with Age group Likelihood Ratio was 9.640, Significance p = 0.008. Conclusion: Papillary carcinoma is seen more among females. Among the patients with thyroid carcinomas, those with biochemically proven hyperthyroidism were more among the older age group than those who were euthyroid. Hence careful evaluation of elderly hyperthyroid patients to select the most suitable therapeutic approach is justified.

Keywords: age, hyperthyroidism, thyroid malignancy, thyroid status

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Authors: Mohd Afif Md Nasir, Faizal Amin Nur Yunus, Jamaluddin Hashim, Abd Samad Hassan Basari, A. Halim Sahelan

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The aim of this study is to identify the suitability of Virtual Learning Environment (VLE) in welding simulator application towards Computer-Based Training (CBT) in developing skills upon new students at the Advanced Technology Training Center (ADTEC), Batu Pahat, Johor, Malaysia and GIATMARA, Batu Pahat, Johor, Malaysia. The purpose of the study is to create a computer-based skills development approach in welding technology among new students in ADTEC and GIATMARA, as well as cultivating the elements of general skills among them. This study is also important in elevating the number of individual knowledge workers (K-workers) working in manufacturing industry in order to achieve a national vision which is to be an industrial nation in the year of 2020. The design of the study is a survey type of research which uses questionnaires as the instruments and 136 students from ADTEC and GIATMARA were interviewed. Descriptive analysis is used to identify the frequency and mean values. The findings of the study shows that the welding technology skills have developed in the students as a result of the application of VLE simulator at a high level and the respondents agreed that the skills could be embedded through the application of the VLE simulator. In summary, the VLE simulator is suitable in welding skills development training in terms of exposing new students with the relevant characteristics of welding skills and at the same time spurring the students’ interest towards learning more about the skills.

Keywords: computer-based training (CBT), knowledge workers (K-workers), virtual learning environment, welding simulator, welding technology

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Authors: A. Bruce Janati, Muhammad Umair Khan, Naif Alghassab, Ibrahim Alzeir, Assem Mahmoud, M. Sammour

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Rationale: Lennox-Gastaut syndrome(LGS) is an electro-clinical syndrome composed of the triad of mental retardation, multiple seizure types, and the characteristic generalized slow spike-wave complexes in the EEG. In this article, we report on two patients with LGS whose brain MRI showed dysgenesis of corpus callosum(CC). We review the literature and stress the role of CC in the genesis of secondary bilateral synchrony(SBS). Method: This was a clinical study conducted at King Khalid Hospital. Results: The EEG was consistent with LGS in patient 1 and unilateral slow spike-wave complexes in patient 2. The MRI showed hypoplasia of the splenium of CC in patient 1, and global hypoplasia of CC combined with Joubert syndrome in patient 2. Conclusion: Based on the data, we proffer the following hypotheses: 1-Hypoplasia of CC interferes with functional integrity of this structure. 2-The genu of CC plays a pivotal role in the genesis of secondary bilateral synchrony. 3-Electrodecremental seizures in LGS emanate from pacemakers generated in the brain stem, in particular the mesencephalon projecting abnormal signals to the cortex via thalamic nuclei. 4-Unilateral slow spike-wave complexes in the context of mental retardation and multiple seizure types may represent a variant of LGS, justifying neuroimaging studies.

Keywords: EEG, Lennox-Gastaut syndrome, corpus callosum , MRI

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Authors: Abdelrahman Abdelrahman, Lawrence Nip, Seun Ikotun, Iman Satar, Anur Miah

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Introduction: Incision and drainage of an abscess is a common procedure performed by the general surgeon. Pus swabs are often obtained routinely for MC&S.Our study aimed to investigate whether swabs taken at our local institution had any impact on the overall management plan for uncomplicated abscesses. Methods: We retrospectively assessed all patients presenting to University Hospital Lewisham with an abscess between October 2020 – April 2021. Exclusion criteria were recurrent abscesses, patients admitted with sepsis, known inflammatory bowel disease, immunocompromised, and those managed non-operatively. Results: We identified 131 patients who met the inclusion criteria. Two thirds were performed in theatre under general anaesthetic and the other one third under local. 63% of patients had a pus swab collected. Of these, 96% were not followed up by the requesting doctor, and there was no further patient contact. In the other 4%, the organisms cultured were flagged as atypical such as MRSA. In these cases, microbiology advice was that if the patient was clinically well and adequate drainage was achieved, then no furtherantibiotics were required. All patients were discharged before any microbiology results had come back with no subsequent change in the management plan. Average cost of pus swab = £10.10 – potentially cost saving of £1656.4 annually. Conclusion: Our study reveals that the majority of pus swabs taken from uncomplicated abscessesare not followed up by requesting doctor with no impact on the overall management plan. We, therefore, do not recommend the routine use of pus swabs for uncomplicated abscesses.

Keywords: pus swabs, uncomplated abscess, Pus MCS, follow up of uncomplicated abscess

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Authors: Aravella Flores, Jose Rafael E. Sotelo, Luis Romulus Phillippe R. Javier, Josh Christian V. Nunez

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This study focuses on analyzing the performance of Grade 12 STEM students of De La Salle University - Integrated School that has completed the Disaster Readiness and Risk Reduction course in handling fire hazards through Minecraft Java Edition. This platform is suitable because fire DRRR is challenging to learn in a practical setting as well as questionable with regard to supplementing the successful implementation of textbook knowledge into actual practice. The purpose of this study is to acknowledge whether Minecraft can be a suitable environment to familiarize oneself to fire DRRR. The objectives are achieved through utilizing Minecraft in simulating fire scenarios which allows the participants to freely act upon and practice fire DRRR. The experiment was divided into the grounding and validation phase, where researchers observed the performance of the participants in the simulation. A pre-simulation and post-simulation survey was given to acknowledge the change in participants’ perception of being able to utilize fire DRRR procedures and their vulnerabilities. The paired t-test was utilized, showing significant differences in the pre-simulation and post-simulation survey scores, thus, insinuating improved judgment of DRRR, lessening their vulnerabilities in the possibility of encountering a fire hazard. This research poses a model for future research which can gather more participants and dwell on more complex codes outside just command blocks and into the code lines of Minecraft itself.

Keywords: minecraft, DRRR, fire, disaster, simulation

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Authors: Branimir Skoric

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Over the past two decades, number of international travels rose significantly in the United Kingdom and Worldwide in the shape of business travels and holiday travels as well. The fact that elderly people travel a lot, more than ever before increased the needs for medical evacuations (repatriations) back home if they fell ill abroad or had any kind of accident. This paper concerns medical evacuations of patients on the way back home to the United Kingdom (United Kingdom Residents) and their specific medical needs during short-haul or long-haul commercial scheduled flight and ground transportation to the final destination regardless whether it was hospital or usual place of residence. Particular medical need during medical evacuations is oxygen supply and it can be supplied via portable oxygen concentrator, pulse flow oxygenator or continuous free flow oxygenator depending on the main diagnosis and patient’s comorbidities. In this retrospective study, patients were divided into two groups. One group was consisted of patients suffering from cardio-respiratory diagnoses as primary illness. Another Group consisted of patients suffering from noncardiac illnesses who have other problems including any kind of physical injury. Needs for oxygen and type of supply were carefully considered in regards of duration of the flight, standard airline cabin pressure and results described in this retrospective study.

Keywords: commercial flight, elderly travellers, medical evacuations, oxygen

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Authors: Sara Bilal, Abdi Omar Shuriye, Raihan Othman

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Numerical Methods is a course that can be conducted using workshops and group discussion. This study has been implemented on undergraduate students of level two at the Faculty of Engineering, International Islamic University Malaysia. The Numerical Method course has been delivered to two Sections 1 and 2 with 44 and 22 students in each section, respectively. Systematic steps have been followed to apply the student centered learning approach in teaching Numerical Method course. Initially, the instructor has chosen the topic which was Euler’s Method to solve Ordinary Differential Equations (ODE) to be learned. The students were then divided into groups with five members in each group. Initial instructions have been given to the group members to prepare their subtopics before meeting members from other groups to discuss the subtopics in an expert group inside the classroom. For the time assigned for the classroom discussion, the setting of the classroom was rearranged to accommodate the student centered learning approach. Teacher strength was by monitoring the process of learning inside and outside the class. The students have been assessed during the migrating to the expert groups, recording of a video explanation outside the classroom and during the final examination. Euler’s Method to solve the ODE was set as part of Question 3(b) in the final exam. It is observed that none of the students from both sections obtained a zero grade in Q3(b), compared to Q3(a) and Q3(c). Also, for Section 1(44 students), 29 students obtained the full mark of 7/7, while only 10 obtained 7/7 for Q3(a) and no students obtained 6/6 for Q3(c). Finally, we can recommend that the Numerical Method course be moved toward more student-centered Learning classrooms where the students will be engaged in group discussion rather than having a teacher one man show.

Keywords: teacher centered learning, student centered learning, mathematic, numerical methods

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Authors: Muneeb Nasir, Misbah Masood, Farrukh Rashid, Abubabakar Shahid

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Introduction: Neo-adjuvant chemotherapy is a potent option for triple negative breast cancer (TNBC) as these tumours lack a clearly defined therapeutic target. Several recent studies lend support that pathological complete remission (pCR) is associated with improved disease free survival (DFS) and overall survival (OS) and could be used as surrogate marker for DFS and OS in breast cancer patients. Methods: We have used a four-drug protocol in T3 and T4 TNBC patients either N+ or N- in the neo-adjuvant setting. The 15 patients enrolled in this study had a median age of 45 years. 12 patients went on to complete four planned cycles of B-CAT protocol. The chemotherapy regimen included inj. Bevacizumab 5mg/kg D1, inj. Adriamycin 50mg/m2 D1 and Docetaxel 65mg/m2 on D1. Inj. Cisplatin 60mg/m2 on D2. All patients received GCF support from D4 to D9 of each cycle. Results: Radiological assessment using ultrasound and PET-CT revealed a high percentage of responses. Radiological CR was documented in half of the patients (6/12) after four cycles. Remaining patients went on to receive 2 more cycles before undergoing radical surgery. pCR was documented in 7/12 patients and 3 more had a good partial response. The regimen was toxic and grade ¾ neutropenia was seen in 58% of patients. Four episodes of febrile neutropenia were reported and managed. Non-hematatological toxicities were common with mucositis, diarrhea, asthenia and neuropathy topping the list. Conclusion: B-CAT is a very active combination with very high pCR rates in TNBC. Toxicities though frequent, were manageable on outpatient basis. This protocol warrants further investigation.

Keywords: B-CAT:bevacizumab, cisplatin, adriamycin, taxotere, CR: complete response, pCR: pathological complete response, TNBC: triple negative breast cancer

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Authors: Jiahui Song

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There have been decades of research into the action potential block in nerves. To our best knowledge electrical voltages can reversibly block the conduction of action potentials across whole animal nerves. Blocking biological electrical signaling pathways can have a variety of applications in muscular and sensory incapacitation and clinical research, including urethral pressure reduction and relieving chronic pain relief from a peripheral nerve injury. The cessation ability has been used in muscle activation and fatigue reduction. Ultrashort, high-intensity electric pulses modulate the membrane conductivity to block nerve conduction through the electroporation process. Nanopore formation on the membrane surface would increase the local membrane conductivity and effectively "short-out" the trans-membrane potential of a nerve that inhibits action potential propagation. This block would be similar in concept to stopping the propagation of an air-pressure wave down a "leaky" pipe. This research focuses on a distributed electrical model with an additional time-dependent membrane conductance to calculate the poration induced by the ultrashort, high-intensity electric pulses. The changes in membrane conductivity are used to predict changes in action potential transmission. A "strength-duration (SD)" curve is generated for action potential blockage and would be used as a design guide for benchmarking safety thresholds or setting the pulse voltage and/or durations necessary for neuro-muscular incapacitation.

Keywords: action potential, ultrashort, high-intensity, nerve, strength-duration

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Authors: Maria Malliarou, Efrossini Lyraraki, Pavlos Sarafis, Theodosios Paralikas, Styliani Kotrotsiou, Evangelia Kotrotsiou, Mairy Gouva

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Women with breast cancer have to adapt to physical malformations, side effects of chemotherapy, emotional insecurity, and changes in social roles. Inability to recognize the co-morbidity of psychiatric conditions can have an aggravating effect on patient compliance in therapeutic interventions, resulting in treatment delays and an impact on overall survival. The purpose of this study was to identify the quality of life of breast cancer patients undergoing external radiation therapy and to correlate it with depression and anxiety. Patients were asked to respond to an anonymous questionnaire with general demographic and clinical questions, followed by the EORTCQLQ-C30 questionnaire for assessing the quality of life of patients with breast cancer. Hospital Anxiety and Depression Scale (HADS) as well as the Depression, Anxiety and Stress Scale (DASS-21) was also administered. The statistical analysis of the data was done in IBM SPSS. Results indicated that the incidence of anxiety and depression in breast cancer patients is high both in HADS (37.5 % with mild to moderate depression and 62.5 % with significant to severe depression) and DASS - 21 (39.2 % mild to moderate depression and 60.8 % significant to severe) scales. The correlation of anxiety and depression with life quality was negative for HADS (r = -, 810, p = .000) as well as for DASS-21 (r = -, 682, p = .000). The psychological impact of breast cancer on patients is important. Its correlation with the quality of life may lead to better tolerance to treatment and better effectiveness of the therapeutic approach.

Keywords: anxiety, breast cancer, depression, quality of life

Procedia PDF Downloads 269

Authors: Marwa Al-Subhi, Eiman Al-Ajmi, Mallak Al-Maamari, Humood Al-Dhuhli, Srinivasa Rao

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The orbit and its contents are affected by various pathologies and craniofacial anomalies. Sound knowledge of the normal orbital dimensions is clinically essential for successful surgical outcomes and also in the field of forensic anthropology. Racial, ethnic, and regional variations in the orbital dimensions have been reported. This study sought to determine the orbital dimensions of Omani subjects who had been referred for computed tomography (CT) images at a tertiary care hospital. A total of 273 patients’ CT images were evaluated retrospectively by using an electronic medical records database. The orbital dimensions were recorded using both axial and sagittal planes of CT images. The mean orbital index (OI) was found to be 83.25±4.83 and the prevalent orbital type was categorized as mesoseme. The mean orbital index was 83.34±5.05 and 83.16±4.57 in males and females, respectively, with their difference being statistically not significant (p=0.76). A statistically significant association was observed between the right and left orbits with regard to horizontal distance (p<0.05) and vertical distance (p<0.01) of orbit and OI (p<0.05). No significant difference between the OI and age groups was observed in both males and females. The mean interorbital distance and interzygomatic distance were found to be 19.45±1.52 mm and 95.59±4.08 mm, respectively. Both of these parameters were significantly higher in males (p<0.05). Results of the present study provide reference values of orbital dimensions in Omani subjects. The prevalent orbital type of Omani subjects is mesoseme, which is a hallmark of the white race.

Keywords: orbit, orbital index, mesoseme, ethnicity, variation

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Authors: Nazmul Haque, Syeda Tasnuva Maria

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Sheehan's Syndrome (SS), also known as postpartum hypopituitarism, is a rare but potentially serious condition resulting from ischemic necrosis of the pituitary gland, often occurring during or after childbirth. This syndrome is characterized by hypopituitarism, leading to deficiencies in various hormones produced by the pituitary gland. The primary cause is typically severe postpartum hemorrhage, leading to inadequate blood supply and subsequent necrosis of the pituitary tissue. This chronic hypopituitarism sometimes plays the role of premature atherosclerosis, which may lead to cardiovascular disease. This abstract provides a comprehensive overview of Sheehan's Syndrome with ischaemic heart disease, encompassing its pathophysiology, clinical manifestations, and current management strategies. The disorder presents a wide spectrum of symptoms, including chest pain, fatigue, amenorrhea, lactation failure, hypothyroidism, and adrenal insufficiency. Timely diagnosis is crucial, as delayed recognition can lead to complications and long-term health consequences. We herein report a patient complaining of chronic fatigue symptoms, aggressiveness, chest pain, and breathlessness with repeated LOC that were diagnosed with SS with IHD. The patient was treated with antiplatelet, antianginal, steroids, and hormone replacement with marked improvement in his overall condition.

Keywords: ischaemic heart disease, Sheehan's syndrome, post-partum haemorrhage, pituitary gland

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Authors: Mohammed Khamis Albalushi

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Background: Somatic symptoms disorders are usually comorbid with depressive disorders despite the fact that there is little evidence for effective treatment for it. Repetitive transcranial magnetic stimulation (rTMS) has been approved by the FDA for mildly resistant depression. From this point, we hypothesized that rTMS delivered over the prefrontal cortex (PFC) may be useful in somatic symptoms disorder. Therefore, in our case report, we want to shed light on the potential effectiveness of rTMS in somatic symptoms disorder. Case Report: A 65-year-old Omani female with multiple medical comorbidities on multiple medications. She presented complaining of multiple somatic complaints in the last 2 years after visiting multiple clinics and underwent several specialists’ examinations, investigations and procedures for somatic treatments; all of them were normal. Then patient was seen by a different psychiatric clinic; multiple anti-depressant and adjuvant anti-psychotic medications were tried, patient still did not improve. The patient was admitted to the hospital for observation and management. Initially, she was preoccupied with her somatic complaint and kept on Fluoxetine and Olanzapine along with that, topiramate was added, but still with minimal improvement. Then rTMS was added to her management plan following Intermittent theta burst (iTBS) rTMS protocol. After completing all sessions of rTMS, the patient was recovering from all her symptoms, and no complaints were reported from her. Conclusion: Our case highlights the importance of investigating more thoroughly in rTMS as a treatment option for Persistent Somatic symptoms Disorder.

Keywords: rTMS, somatic symptoms disorder, resistive cases, TMS

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Authors: Yuguang Gao, Qiang Yang, Yanpeng Zhang, Mingtao Deng

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To enhance the safety, quality and efficiency of healthcare services provided by surgical doctors, we propose a comprehensive approach to the performance evaluation of individual doctors by incorporating insights from performance data as well as views of different stakeholders in the hospital. Exploratory factor analysis was first performed on collective multidimensional performance data of surgical doctors, where key factors were extracted that encompass assessment of professional experience and service performance. A two-level indicator system was then constructed, for which we developed a weighted interval-valued spherical fuzzy analytic hierarchy process to analyze the relative importance of the indicators while handling subjectivity and disparity in the decision-making of multiple parties involved. Our analytical results reveal that, for the key factors identified as instrumental for evaluating surgical doctors’ performance, the overall importance of clinical workload and complexity of service are valued more than capacity of service and professional experience, while the efficiency of resource consumption ranks comparatively the lowest in importance. We also provide a retrospective case study to illustrate the effectiveness and robustness of our quantitative evaluation model by assigning meaningful performance ratings to individual doctors based on the weights developed through our approach.

Keywords: analytic hierarchy processes, factor analysis, fuzzy logic, performance evaluation

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Authors: Victor Milanes, Martha Hubertz

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In the wake of COVID-19, all aspects of life have been estranged, and humanity has been forced to shift toward a more technologically integrated mode of operation. Essential work such as Healthcare, business, and public policy are a few notable industries that were initially dependent upon face-to-face modality but have completely reimagined their operation style. Unique to these fields, education was particularly strained because academics, teachers, and professors alike were obligated to shift their curriculums online over the course of a few weeks while also maintaining the expectation that they were educating their students to a similar level accomplished pre-pandemic. This was notable as research indicates two key concepts: Students prefer face-to-face modality, and due to the disruption in academic continuity/style, there was a negative impact on student's overall education and performance. With these two principles in mind, this study aims to inquire what online strategies could be best employed by teachers to educate their students, as well as what strategies could be adopted in a multimodal setting if deemed necessary by the instructor or outside convoluting factors (Such as the case of COVID-19, or a personal matter that demands the teacher's attention away from the classroom). Strategies and methods will be cross-analyzed via a ranking system derived from various recognized teaching assessments, in which engagement, retention, flexibility, interest, and performance are specifically accounted for. We expect to see an emphasis on positive social pressure as a dominant factor in the improved propensity for education, as well as a preference for visual aids across platforms, as research indicates most individuals are visual learners.

Keywords: technological integration, multimodal teaching, education, student engagement

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Authors: Sonam Kelzang

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Background: Penetrating injuries as a result of traditional sports (Archery and Khuru) are commonly seen in Bhutan. To our knowledge, there is no study carried out looking into the data of penetrating injuries due to traditional sports. Aim: This is a retrospective analysis of cases of penetrating injuries as a result of traditional sports admitted to JDWNRH over the last 3 years to draw an inference on the pattern of injury and associated morbidity and mortality. Method: Data on penetrating injuries related to traditional sports (Archery and Khuru) were collected and reviewed over the period of 3 years. Assault cases were excluded. For each year we analysed age, sex, parts of the body affected, agent of injury and whether admission was required or not. Results: Out of the total 44 victims of penetrating injury by traditional sports (Archery and Khuru) between 2013 and 2015 (average of 15 cases of penetrating injuries per year). Eighty-five percent were male and 15% were female. Their age ranged from 4 yrs to 62 years. Sixty-one percent of the victims were in the working age group of 19-58 years; 30% of the victims were referred from various district hospitals; 38% of the victims needed admission; 42 % of the victims suffered injury to the head; and 54% of the injuries were caused by Khuru. Conclusion: Penetrating injuries due to traditional sports admitted to JDWNRH, Thimphu, remained same over the three years period despite safety regulations in place. Although there were no deaths during the last three years, morbidity still remains high.

Keywords: archery, Bhutan, Khuru, darts

Procedia PDF Downloads 167

Authors: Nambiar Ritu, Ali Ban, Munawar Farida, Israell Imelda, T. Farouk Eman Rasheeda, Jangalgi Renuka, S. Boma Nellie

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Aim: To define the ultrasonographic endometrial thickness (USG ET) cutoff for evacuation of retained pieces of conception (ERPC). Background: Studies of conservative management of 1st trimester miscarriage have questioned the need for post miscarriage curettage. Therapeutic decision making with transvaginal scan post miscarriage endometrial thickness in patients clinically thought to be incomplete miscarriage is often not clear. Method: Retrospective analysis of all 1ST trimester ERPC at Al Rahba Hospital from June 2012 to July 2013 was done. Total of 164 patients underwent ERPC. All cases were reviewed for pre-operative USG ET and post ERPC histopathological examination. TVS was done to evaluate the maximum ET of the uterine cavity along the long axis of the uterus and features of retained products was noted. All cases without preoperative USG ET measurement were excluded from the study, therefore only 62 out of 164 cases were included in the study. The patients were divided into three groups: o Group A: have retained products within endometrial cavity. o Group B: endometrial thickness equal or more than 20 mm. o Group C: endometrial thickness equal or less than 19.9 mm. o Post ERPC product was sent for HPE and the results were compared. Transvaginal sonographic findings can be used as a deciding factor in the management of patients with 1st trimester miscarriage who need ERPC. Our proposed cutoff in clinically stable patients requiring ERPC is more than 20 mm.

Keywords: ERPC, histopathological examination, long axis of the uterus, USG ET

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Authors: Renee Moten

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Introduction: Knee pain becomes chronic because the therapy used focuses only on the symptoms of knee pain and not the causes of knee pain. Preventing knee injuries is not in the toolbox of the traditional practitioner. This research was done to show that we must reduce the inflammation (holistically), reduce the swelling and regain flexibility before considering any type of exercise. This method of performing the correct exercise stops the bowing of the knee, corrects the walking gait, and starts to relieve knee, hip, back, and shoulder pain. Method: The holistic method that is used to heal knees is called the Knee Pain Recipe. It’s a six step system that only uses alternative medicine methods to reduce, relieve and restore knee joint mobility. The system is low cost, with no hospital bills, no physical therapy, and no painkillers that can cause damage to the kidneys and liver. This method has been tested on 200 women with knee, back, hip, and shoulder pain. Results: All 200 women reduce their knee pain by 50%, some by as much as 90%. Learning about ankle and foot flexibility, along with understanding the kinetic chain, helps improve the walking gait, which takes the pressure off the knee, hip and back. The knee pain recipe also has helped to reduce the need for a cortisone injection, stem cell procedures, to take painkillers, and surgeries. What has also been noted in the research was that if the women's knees were too far gone, the Knee Pain Recipe helped prepare the women for knee replacement surgery. Conclusion: It is believed that the Knee Pain Recipe, when performed by men and women from around the world, will give them a holistic alternative to drugs, injections, and surgeries.

Keywords: knee, surgery, healing, holistic

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Authors: Rosmini Yanti, Safira Aviolita, Marsetio

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Indonesia has several straits that are very important as a shipping lane, including the Sunda Strait and the Lombok Strait, which are the part of the Indonesian Archipelagic Sea Lane (IASL). An increase in traffic on the Marine Archipelago makes the task of monitoring sea routes increasingly difficult. Indonesia has proposed the establishment of a Traffic Separation Scheme (TSS) in the Sunda Strait and the Lombok Strait and the country now has the right to be able to conceptualize the TSS as well as the obligation to regulate it. Indonesia has the right to maintain national safety and sovereignty. In setting the TSS, Indonesia needs to issue national regulations that are in accordance with international law and the general provisions of the IMO (International Maritime Organization) can then be used as guidelines for maritime safety and security in the Sunda Strait and the Lombok Strait. The research method used is a qualitative method with the concept of linguistic and visual data collection. The source of the data is the analysis of documents and regulations. The results show that the determination of TSS was justified by International Law, in accordance with article 22, article 41, and article 53 of the United Nations Convention on the Law of the Sea (UNCLOS) 1982. The determination of TSS by the Indonesian government would be in accordance with COLREG (International Convention on Preventing Collisions at Sea) 10, which has been designed to follow IASL. Thus, TSS can provide a function as a safety and monitoring medium to minimize ship accidents or collisions, including the warship and aircraft of other countries that cross the IASL.

Keywords: archipelago state, maritime law, maritime security, traffic separation scheme

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Authors: Majid Khan

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Introduction: In this era of microsurgery, free flap holds a remarkable spot in reconstructive surgery. A free flap is well suited for composite defects as it provides sufficient and well-vascularized tissue for coverage. We report our experience with the use of the free flaps for the reconstruction of composite defects. Methods: This is a retrospective case series (chart review) of patients who underwent reconstruction of composite defects with a free flap at Aga Khan University Hospital, Karachi (Pakistan) from January 01, 2015, to December 31, 2019. Data were collected for patient demographics, size of the defect, size of flap, recipient vessels, postoperative complications, and outcome of the free flap. Results: Over this period, 532 free flaps are included in this study. The overall success rate is 95.5%. The mean age of the patient was 44.86 years. In 532 procedures, there were 448 defects from tumor ablation of head and neck cancer. The most frequent free flap was the anterolateral thigh flap in 232 procedures. In this study, the risk factor hypertension (p=0.004) was found significant for wound dehiscence, preop radiation/chemotherapy (p=0.003), and malnutrition (p=0.005) were found significant for fistula formation. Malnutrition (p=0.02) and use of vein grafts (p=0.025) were significant factors for flap failure. Conclusion: Free tissue transfer is a reliable option for the reconstruction of large and composite defects. Hypertension, malnutrition, and preoperative radiotherapy can cause significant morbidity.

Keywords: free flap, free flap failure, risk factors for flap failure, free flap outcome

Procedia PDF Downloads 119

Authors: Michael Kho Lim

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This paper examines the status of the film industry as an industry in the Philippines—where or how it is classified in the Philippine industrial classification system and how this positioning gives the film industry an identity (or not) and affects (film) policy development and impacts the larger national economy. It is important to look at how the national government recognises Philippine cinema officially, as this will have a direct and indirect impact on the industry in terms of its representation, conduct of business, international relations, and most especially its implications on policy development and implementation. Therefore, it is imperative that the ‘identity’ of Philippine cinema be clearly established and defined in the overall industrial landscape. Having a clear understanding of Philippine cinema’s industry status provides a better view of the bigger picture and helps us determine cinema’s position in the national agenda in terms of priority setting, future direction and how the state perceives and thereby values the film industry as an industry. This will then serve as a frame of reference that will anchor the succeeding discussion. Once the Philippine film industry status is identified, the paper will then clarify how cultural policy is defined, understood, and applied in the Philippines in relation to Philippine cinema by reviewing and analyzing existing policy documents and pending bills in the Philippine Congress and Senate. Lastly, the paper delves into the roles that (national) cultural institutions and industry organisations play as primary drivers or support mechanisms and how they become platforms (or not) for the upliftment of the independent film sector and towards the sustainability of the film industry. The paper concludes by arguing that the role of the government and how government officials perceive and treats culture is far more important than cultural policy itself, as these policies emanate from them.

Keywords: cultural and creative industries, cultural policy, film industry, Philippine cinema

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Authors: Hsin-Yi Lo, Huang-Ju Jiun, Yu-Chiao Chu

Abstract:

Hemodynamic monitoring is an important in the intensive care unit. Advances in medical technology in recent years, more diversification of intensive care equipment, there are many kinds of instruments available for monitoring of hemodynamics, Edwards Lifesciences Hemodynamic Monitoring (FloTrac) is one of them. The recent medical safety incidents in parameters were changed, nurses have not to notify doctor in time, therefore, it is hoped to analyze the current problems and find effective improvement strategies. In August 2021, the survey found that only 74.0% of FloTrac correctness of operation, reasons include lack of education, the operation manual is difficulty read, lack of audit mechanism, nurse doesn't know those numerical changes need to notify doctor, work busy omission, unfamiliar with operation and have many nursing records then omissions. Improvement methods include planning professional nurse education, formulate the secret arts of FloTrac, enacting an audit mechanism, establish FloTrac action learning, make「follow the sun」care map, hold simulated training and establish monitoring data automatically upload nursing records. After improvement, FloTrac correctness of operation increased to 98.8%. The results are good, implement to the ICU of the hospital.

Keywords: hemodynamic monitoring, edwards lifesciences hemodynamic monitoring, multiple strategies, intensive care

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Authors: Oum Elkhir Mahmoudi, Nebiha Ben Haj Ali

Abstract:

Micropaleontological, sedimentological and statistical studies were carried out on the late Paleoceneearly Eocene succession of Sra Ouertaine and Dyr El Kef in Northern open phosphatic Basin of Tunisia. Based on the abundance and stratigraphic distribution of planktic foraminiferal species, five planktic zones have been recognized from the base to the top of the phosphatic layers. The El Acarinina sibaiyaensis Zone, the E2 Pseudohastigerina wilcoxensis Zone, the E3 Morozovella marginodentata Zone, the E4 Morozovella formosa Zones and the E5 Morozovella subbotinae Zone. The placement of Paleocene-Eocene boundary (PETM) is just below the base of the phosphatic interval. The ETM-2 event may be detectable in the analyzed biotic record of Sra Ouertaine. Based on benthic assemblages, abundances, cluster and multivariate statistical analyses, two biofacies were recognized for each section. The recognized ecozones are typical of warm and shallow water inner neritic setting (dominance of epifaunal fauna Anomalinoides, Dentalina and Cibicidoides associated with Frondicularia phosphatica, Trochamminoides globigeriniformis and Eponides elevatus). The paleoenvironment is eutrophic (presence of several bolivinitids and verneuilinids). For the Dyr El Kef section and P5 and E2 of Sra Ouertaine section, our records indicate that paleoenvironment is influenced by coastal upwelling without oxygen-deficiency, the paleodepth is estimated to be around 50 m. The paleoecosystem is diversified and balanced with a general tendency to stressed condition. While the upper part of Sra Ouertaine section is more eutrophic, influenced by coastal upwelling with oxygen-deficiency, the paleodepth is estimated to be less than 50 m and the ecosystem is unsettled.

Keywords: Tunisia, early Eocene, foraminifera, chronostratigraphy

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Authors: R. M. Noah, N. M. Nasir, M. R. Jais, M. S. S. Wahab, M. H. Abdullah, A. S. S. Raj

Abstract:

Infectious diseases are getting more difficult to treat due to the resistant strains of bacteria. Current generations of antibiotics are most likely ineffective against multi-drug resistant strains bacteria. Thus, there is an urgent need in search of natural antibiotics in particular from medicinal plants. One of the common medicinal plants, Melaleuca cajuputi, has been reported to possess antibacterial properties. The study was conducted to evaluate and justify the presence of antibacterial activity of Melaleuca cajuputi essential oil (EO) against the multi-drug resistant bacteria. Clinical isolates obtained from the teaching hospital were re-assessed to confirm the exact identity of the bacteria to be tested, namely methicillin-resistant staphylococcus aureus (MRSA), carbapenem-resistant enterobacteriaceae (CRE), and extended-spectrum beta-lactamases producer (ESBLs). A well diffusion method was done to observe the inhibition zones of the essential oil against the bacteria. Minimum inhibitory concentration (MIC) was determined using the microdilution method in 96-well flat microplate. The absorbance was measured using a microplate reader. Minimum bactericidal concentration (MBC) was performed using the agar medium method. The zones of inhibition produced by the EO against MRSA, CRE, and ESBL were comparable to that of generic antibiotics used, gentamicin and augmentin. The MIC and MBC results highlighted the antimicrobial efficacy of the EO. The outcome of this study indicated that the EO of Melaleuca cajuputi had antibacterial activity on the multi-drug resistant bacteria. This finding was eventually substantiated by electron microscopy work.

Keywords: melaleuca cajuputi, antibacterial, resistant bacteria, essential oil

Procedia PDF Downloads 126

Authors: Ali El Ksimi

Abstract:

In today's digital academic environment, secure authentication methods are essential for managing sensitive user data, including that of students and faculty. The rise in cyber threats and data breaches has exposed the vulnerabilities of traditional authentication systems used in universities. Passwords, often the first line of defense, are particularly susceptible to hacking, phishing, and brute-force attacks. While multi-factor authentication (MFA) provides an additional layer of security, it can still be compromised and often adds complexity and inconvenience for users. As universities seek more robust security measures, blockchain technology emerges as a promising solution. Renowned for its decentralization, immutability, and transparency, blockchain has the potential to transform how user management is conducted in academic institutions. In this article, we explore a system that leverages blockchain technology specifically for managing user accounts within a university setting. The system enables the secure creation and management of accounts for different roles, such as administrators, teachers, and students. Each user is authenticated through a decentralized application (DApp) that ensures their data is securely stored and managed on the blockchain. By eliminating single points of failure and utilizing cryptographic techniques, the system enhances the security and integrity of user management processes. We will delve into the technical architecture, security benefits, and implementation considerations of this approach. By integrating blockchain into user management, we aim to address the limitations of traditional systems and pave the way for the future of digital security in education.

Keywords: blockchain, university, authentication, decentralization, cybersecurity, user management, privacy

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Authors: Dina Tamazin, Nicoleta Tipi, Sahar Validi

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The oil refining industry plays vital role in the world economy. Oil refining companies operate in a more complex and dynamic environment than ever before. In addition, oil refining companies and the public are becoming more conscious of crude oil scarcity and climate changes. Hence, sustainability in the oil refining industry is becoming increasingly critical to the industry's long-term viability and to the environmental sustainability. Mainly, it is relevant to the measurement and evaluation of the company's sustainable performance to support the company in understanding their performance and its implication more objectively and establishing sustainability development plans. Consequently, the oil refining companies attempt to re-engineer their supply chain to meet the sustainable goals and standards. On the other hand, this research realized that previous research in oil refining sustainable supply chain performance measurements reveals that there is a lack of studies that consider the integration of sustainability in the supply chain performance measurement practices in the oil refining industry. Therefore, there is a need for research that provides performance guidance, which can be used to measure sustainability and assist in setting sustainable goals for oil refining supply chains. Accordingly, this paper aims to present a comprehensive oil refining sustainable supply chain performance measurement theoretical framework. In development of this theoretical framework, the main characteristics of oil refining industry have been identified. For this purpose, a thorough review of relevant literature on performance measurement models and sustainable supply chain performance measurement models has been conducted. The comprehensive oil refining sustainable supply chain performance measurement theoretical framework introduced in this paper aims to assist oil refining companies in measuring and evaluating their performance from a sustainability aspect to achieve sustainable operational excellence.

Keywords: oil refining industry, oil refining sustainable supply chain, performance measurement, sustainability

Procedia PDF Downloads 291

Authors: Glaucia Maricato

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Our research deals with specific use of DNA tests in Brazil – aimed at financial reparation for the institutionalized and otherwise scattered offspring of leprosy patients who, from the 1920s up through the 1980s, were subjected to compulsory internment in the 'hospital-colonies', specialized in the containment of Hansen’s disease. Through a social movement, the ex-patients themselves gained the right, in 2007, to financial compensations. At the moment, the movement is seeking reparation for the (now adult) children of these people as well. Many of these children grew up in orphanages, in adopted families, or do not have official documents to prove their family belonging. In 2011, a team of Brazilian geneticists had volunteered their services, applying DNA tests in order to ascertain the connection of certain individuals to an ex-internee of the leprosarium. We have accompanied the activities in four different ex-colonies in order to understand how the DNA test was being signified by those being tested, and how the test fit into already existent notions of family. Inspired in the writings of scholars such as Sheila Jasanoff and Helena Machado, we examine the possibility of a 'geneticization of family ties' when people are obliged to back their claim for human rights by producing legal proof based on blood tests. However, in like fashion to other ethnographic studies on this theme, we encountered among tested adults a number of creative strategies that allow for the co-existence of the idea of 'scientifically-based' blood ties alongside other more traditional ways of signifying kinship.

Keywords: human rights, social movements, DNA tests, Hansen's disease

Procedia PDF Downloads 142

Authors: Jeonghyun Chang, Taegeun Lee, Heungsup Sung, Yoon-Seon Lee, Youn-Jung Kim, Mi-Na Kim

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Background: Safety device has been applied to improve safety and performance of blood culture practice. BD vacutainer® Safety-Lokᵀᴹ blood collection sets with pre-attached holder (Safety-Lok) (BD, USA) was evaluated in the emergency room (ER) of a tertiary care hospital. Methods: From April to June 2017, interns and nurses in ER were surveyed for blood culture practices with a questionnaire before and after 2 or 3 weeks of experience of Safety-Lok. All of them participated in exercise workshop for 1 hour combined with video education prior to the initial survey. The blood volume, positive and contamination rates of Safety-Lok-drawn (SD) blood cultures were compared to those of overall blood cultures. Results: Eighteen interns and 30 nurses were enrolled. As a result of the initial survey, interns had higher rates of needlestick incidence (27.8%), carriage of the blood-filled syringe with needle (88.9%) and lower rates of vacutainer use (38.9%) than nurses (13.3%, 53.3%, and 60.0%). Interns preferred to use safety devices (88.9%) rather than nurses (40.0%). The number of overall blood cultures and SD blood cultures was 9,053 and 555, respectively. While the overall blood volume of aerobic bottles was 2.6±2.1 mL, those of SD blood cultures were 5.0±3.0 mL in aerobic bottles and 6.0±3.0 mL in anaerobic bottles. Positive and contamination rates were 6.5% and 0.72% with SD blood cultures and 6.2% and 0.3% with overall blood cultures. Conclusions: The introduction of the safety device would encourage healthcare workers to collect adequate blood volume as well as lead to safer practices in the ER.

Keywords: blood culture, needlestick, safety device, volume

Procedia PDF Downloads 210

Authors: Mohammed Mamdouh Mohammed, Ali Zain Elabdeen Heikal, Hassan Mahdy, Sherif El-Badawy

Abstract:

The main purpose of this research is to assess the effectiveness of the Cold In-Place Recycling (CIR) technique in asphalt maintenance by analyzing performance outcomes. To achieve this, fifteen CIR mixtures were prepared using slow-setting emulsified asphalt as the recycling agent, with percentages ranging from 2% to 4% in 0.5% increments. Additionally, pure water was incorporated in percentages ranging from 2% to 4% in 1% increments, and Portland cement was added at a constant content of 1%. The components were mixed at room temperature and subsequently compacted using a gyratory compactor with 150 gyrations. Prior to testing, the samples underwent a two-stage treatment process: initially, they were placed in an oven at 60°C for 48 hours, followed by a 24-hour period of air curing. The Hamburg wheel tracking test was performed to evaluate the samples’ resistance to rutting. Additionally, the Indirect Tensile Strength (ITS) test and the Semi-Circular Beam (SCB) test were conducted to assess their resistance to cracking. Upon analyzing the test results, it was observed that the samples’ resistance to rutting decreased with higher asphalt and moisture content. In contrast, ITS and SCB tests revealed that the samples’ resistance to cracking initially increased with higher asphalt and moisture content, peaking at a certain point, and then decreased, forming a bell-curve pattern.

Keywords: cold in-place, indirect tensile strength, recycling, emulsified asphalt, semi-circular beam

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Authors: Xu Lan, Zainor Izat Zainal

Abstract:

Human intervention in Earth’s macro system has ushered in the age of the Anthropocene, prompting introspection among humans, the action agent. This epoch demands a reawakening of human conscience and inner motivation to mitigate the irreversible trend so as to shape the trajectory of the Anthropocene. Environmental virtue ethics claims that the fundamental cause of environmental crisis lies in humans themselves. Rather than focusing more on what humans should do, environmental virtue ethics seeks to specify environmental virtues to appeal to what kind of person a human should be. Renowned Pulitzer Prize-winning author Barbara Kingsolver illustrates her contentions about environmental ethics through the narrative of Codi and her sister Hallie’s environmental choices and actions in Animal Dreams (1990). This study adopts a textual analysis approach of the character traits exhibited by Codi and Hallie that are constitutive of making them environmentally virtuous, exploring how emotions and inner motivations drive actions. This paper is informed by Ronald Sandler’s (2007) virtues of sustainability, virtues of communion with nature, and virtues of environmental stewardship and activism. It aims to examine how Codi and Hallie’s character traits are built around these virtues. Furthermore, this study underscores the importance of internalizing principles and cultivating virtues for the environment and humans’ flourishing in the Anthropocene. As a tentative practice in applying environmental virtue ethics to examine environmental virtues for the Anthropocene, this study reveals Kingsolver’s endeavor of setting environmental virtue exemplars from fictional characters to inspire humans’ long-term and stable contribution to a better future.

Keywords: anthopocene, environmental ethics, environmental virtues, virtue ethics

Procedia PDF Downloads 41