Search results for: hospital room/wards

Authors: Afolabi Joseph Fasoranti

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Tuberculosis (TB) is an infectious disease caused by mycobacterium tuberculosis. Tuberculosis is a major public health problem in Nigeria, being one of the ten leading causes of hospital admissions and a leading cause of death in adults, especially among the economically productive age group. This paper critically examined the importance of health education towards the eradication and prevention of tuberculosis in Nigeria. It was reviewed and discussed under the following subheadings; Global burden of tuberculosis in Nigeria, concept, definition and etiology of tuberculosis, Signs and symptoms of tuberculosis, diagnosis of tuberculosis, causative agent, modes of infection and incubation period, risk factors of pulmonary tuberculosis Dots and stop TB programmes in Nigeria Treatment and prevention of tuberculosis TB treatment strategies, Dealing with treatment problems in Nigeria Stigmatization against Tuberculosis Patients Health education as a tool for achieving free tuberculosis country. Emphasis for Tb control has been placed on the development of improved vaccines, diagnostic and treatment courses but less on health education and awareness. Although the need for these tools is indisputable, the obstacle facing the spread of TB go beyond technological. The findings of this study may stimulate health system policy makers, Government and non- governmental organizations, donor agencies and other stakeholders in planning and designing health education intervention programs on the control and eradication of tuberculosis. It therefore recommended that Government should implement health education as part of the DOTs, this will thus empower the tuberculosis patients on ways to live healthy, lifestyle, in doing this, they will recover fast and prevent them from spreading the disease.

Keywords: tuberculosis, health education, panacea, Nigeria, prevention

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Authors: Ashley R. Logsdon, Becky F. Antle, Cynthia M. Kamer

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This study examines the cost and benefits of a family treatment drug court in an urban county in a southeastern state. Additionally, this cost analysis will provide a detailed description of the type and cost of activities to produce the services provided to child welfare families. This study utilized return-on-investment analysis, which uses child welfare practices, disaggregates them into separate activities and estimates costs for these activities including child-level placement data for total cost of care for the child. Direct and indirect costs were considered as well as saving calculations what costs would be associated with child welfare outcomes both short and long term. The costs included were general program costs (salaries, drug screens, transportation, childcare, parent education, program evaluation, visitation, incentives) or personnel costs for other team members (judges, court administrators, child welfare workers, child welfare supervisors, and community mental health provider). The savings that were used in the study were length of time in out of home care, Medicaid costs, substance exposed births, emergency room utilization and jail/probation costs. This study documents an overall savings of between $168,993.30 and $837,993.30. The total savings per family divided by the 40 families who have participated in the program was between $4,224.83 to $20,949.83 per family. The results of this cost benefit analysis are consistent with prior research documenting savings associated with out of home care and jail/probation; however, there are also unique contributions of this study to the literature on cost effectiveness of family treatment drug courts. We will present recommendations for further utilization of family treatment drug courts and how to expand the current model.

Keywords: child welfare, cost analysis, family drug court, family treatment drug court

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Authors: Lolwa Alansari, Hanen Mrabet, Kholoud Khaled, Abdelhamid Azhaghdani, Sufia Athar, Aska Kaima, Zaineb Mhamdia, Zubaria Altaf, Almunzer Zakaria, Tamara Alshadafat

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Introduction: The Obstetrics and Gynecology Emergency Department at Alwakra Hospital has faced significant challenges, which have been further worsened by the impact of the COVID-19 pandemic. These challenges involve issues such as overcrowding, extended wait times, and a notable surge in demand for emergency care services. Moreover, prolonged waiting times have emerged as a primary factor contributing to situations where patients leave without receiving attention, known as left without being seen (LWBS), and unexpectedly abscond. Addressing the issue of insufficient patient mobility in the obstetrics and gynecology emergency department has brought about substantial improvements in patient care, healthcare administration, and overall departmental efficiency. These changes have not only alleviated overcrowding but have also elevated the quality of emergency care, resulting in higher patient satisfaction, better outcomes, and operational rewards. Methodology: The COVID-19 pandemic has served as a catalyst for substantial transformations in the obstetrics and gynecology emergency, aligning seamlessly with the strategic direction of Hamad Medical Corporation (HMC). The fundamental aim of this initiative is to revolutionize the operational efficiency of the OB-GYN ED. To accomplish this mission, a range of transformations has been initiated, focusing on essential areas such as digitizing systems, optimizing resource allocation, enhancing budget efficiency, and reducing overall costs. The project utilized the Plan-Do-Study-Act (PDSA) model, involving a diverse team collecting baseline data and introducing throughput improvements. Post-implementation data and feedback were analysed, leading to the integration of effective interventions into standard procedures. These interventions included optimized space utilization, real-time communication, bedside registration, technology integration, pre-triage screening, enhanced communication and patient education, consultant presence, and a culture of continuous improvement. These strategies significantly reduced waiting times, enhancing both patient care and operational efficiency. Results: Results demonstrated a substantial reduction in overall average waiting time, dropping from 35 to approximately 14 minutes by August 2023. The wait times for priority 1 cases have been reduced from 22 to 0 minutes, and for priority 2 cases, the wait times have been reduced from 32 to approximately 13.6 minutes. The proportion of patients spending less than 8 hours in the OB ED observation beds rose from 74% in January 2022 to over 98% in 2023. Notably, there was a remarkable decrease in LWBS and absconded patient rates from 2020 to 2023. Conclusion: The project initiated a profound change in the department's operational environment. Efficiency became deeply embedded in the unit's culture, promoting teamwork among staff that went beyond the project's original focus and had a positive influence on operations in other departments. This effectiveness not only made processes more efficient but also resulted in significant cost reductions for the hospital. These cost savings were achieved by reducing wait times, which in turn led to fewer prolonged patient stays and reduced the need for additional treatments. These continuous improvement initiatives have now become an integral part of the Obstetrics and Gynecology Division's standard operating procedures, ensuring that the positive changes brought about by the project persist and evolve over time.

Keywords: overcrowding, waiting time, person centered care, quality initiatives

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Authors: Ibrahim Hakeem

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Biosolids are stabilised sewage sludge produced from wastewater treatment processes. Biosolids contain valuable plant nutrient which facilitates their beneficial reuse in agricultural land. However, the increasing levels of legacy and emerging contaminants such as heavy metals (HMs), PFAS, microplastics, pharmaceuticals, microbial pathogens etc., are restraining the direct land application of biosolids. Pyrolysis of biosolids can effectively degrade microbial and organic contaminants; however, HMs remain a persistent problem with biosolids and their pyrolysis-derived biochar. In this work, we demonstrated the integrated processing of biosolids involving the acid pre-treatment for HMs removal and selective reduction of ash-forming elements followed by the bench-scale pyrolysis of the treated biosolids to produce quality biochar and bio-oil enriched with valuable platform chemicals. The pre-treatment of biosolids using 3% v/v H₂SO₄ at room conditions for 30 min reduced the ash content from 30 wt% in raw biosolids to 15 wt% in the treated sample while removing about 80% of limiting HMs without degrading the organic matter. The preservation of nutrients and reduction of HMs concentration and mobility via the developed hydrometallurgical process improved the grade of the treated biosolids for beneficial land reuse. The co-removal of ash-forming elements from biosolids positively enhanced the fluidised bed pyrolysis of the acid-treated biosolids at 700 ℃. Organic matter devolatilisation was improved by 40%, and the produced biochar had higher surface area (107 m²/g), heating value (15 MJ/kg), fixed carbon (35 wt%), organic carbon retention (66% dry-ash free) compared to the raw biosolids biochar with surface area (56 m²/g), heating value (9 MJ/kg), fixed carbon (20 wt%) and organic carbon retention (50%). Pre-treatment also improved microporous structure development of the biochar and substantially decreased the HMs concentration and bioavailability by at least 50% relative to the raw biosolids biochar. The integrated process is a viable approach to enhancing value recovery from biosolids.

Keywords: biosolids, pyrolysis, biochar, heavy metals

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Authors: Frederick Anlimah, Vinod Gopaldasani, Catherine MacPhail, Brian Davies

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The construction industry, particularly tunnel construction, exposes workers to respirable crystalline silica (RCS), which can cause incurable illnesses such as silicosis and lung cancer. Despite various control measures, exposures remain inadequately controlled. This research aimed to identify the barriers and challenges hindering the implementation of effective controls and the adoption of safe work practices to protect workers from RCS exposure in tunnelling. A mixed-method approach was employed for this research. Tunnel construction workers were observed, surveyed and interviewed to gauge their knowledge and attitudes and understand their challenges in reducing RCS exposure. The preliminary analysis of the data reveals a diverse array of sociotechnical factors interacting to influence RCS exposure. It is noteworthy that participants consistently emphasised the project as the most exemplary one they have been involved in, although there is room for improvement. While there is a commendable level of knowledge about RCS exposure and control in tunnelling, there is a striking lack of perceived satisfaction regarding dust control. Several factors were identified as interacting to prevent the effective management of dust. These include perceived time pressure, absence of on-tool dust controls, low risk perceptions among workers, and inadequate enforcement of controls. Moreover, participants highlighted communication and heat-related challenges as hindrances to the continuous wear of respirators. This research highlights the need for a paradigm shift in tunnel construction to address the barriers associated with RCS exposure reduction. It emphasises the importance of collaboration among various stakeholders, advocating for more effective controls and enforcement strategies and enhanced worker education through knowledge sharing.

Keywords: respirable crystalline silica, dust control, worker practices, exposure prevention, silicosis

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Authors: Karen G. Bastidas Gomez, Hugo R. Zea Ramirez, Manuel F. Ribeiro Pereira, Cesar A. Sierra Avila, Juan A. Clavijo Morales

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The contamination of water sources with heavy metals such as mercury has been an environmental problem; it has generated a high impact on the environment and human health. In countries such as Colombia, mercury contamination due to mining has reached levels much higher than the world average. This work proposes the use of fique fibers as adsorbent in mercury removal. The evaluation of the material was carried out under five different conditions (raw, pretreated by organosolv, functionalized by TEMPO oxidation, fiber functionalized plus MOF-199 and fiber functionalized plus MOF-199-SH). All the materials were characterized using FTIR, SEM, EDX, XRD, and TGA. Regarding the mercury removal, it was done under room pressure and temperature, also pH = 7 for all materials presentations, followed by Atomic Absorption Spectroscopy. The high cellulose content in fique is the main particularity of this lignocellulosic biomass since the degree of oxidation depends on the number of hydroxyl groups on the surface capable of oxidizing into carboxylic acids, a functional group capable of increasing ion exchange with mercury in solution. It was also expected that the impregnation of the MOF would increase the mercury removal; however, it was found that the functionalized fique achieved a greater percentage of removal, resulting in 81.33% of removal, 44% for the fique with the MOF-199 and 72% for the MOF-199-SH with. The pretreated fiber and raw also showed 74% and 56%, respectively, which indicates that fique does not require considerable modifications in its structure to achieve good performances. Even so, the functionalized fiber increases the percentage of removal considerably compared to the pretreated fique, which suggests that the functionalization process is a feasible procedure to apply with the purpose of improving the removal percentage. In addition, this is a procedure that follows a green approach since the reagents involved have low environmental impact, and the contribution to the remediation of natural resources is high.

Keywords: biomass, nanotechnology, science materials, wastewater treatment

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Authors: Mannar R. Maurya, Bhawna Uprety, Fernando Avecilla, Pedro Adão, J. Costa Pessoa

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The reaction of the tripodal tetradentate dibasic ligand 6,6'–(2–(pyridin–2–yl)ethylazanediyl)bis(methylene)bis(2,4–di–tert–butylphenol), H2L1 I, with [VIVO(acac)2] in CH3CN gives the VVO–complex, [VVO(acac)(L1)] 1. Crystallization of 1 in CH3CN at ~0 ºC, gives dark blue crystals of 1, while at room temperature it affords dark green crystals of [{VVO(L1)}2µ–O] 3. Upon prolonged treatment of 1 in MeOH [VVO(OMe)(MeOH)(L1)] 2 is obtained. All three complexes are analyzed by single–crystal X–ray diffraction, depicting distorted octahedral geometry around vanadium. In the reaction of H2L1 with VIVOSO4 partial hydrolysis of the tripodal ligand results in elimination of the pyridyl fragment of L1 and the formation of H[VVO2(L2)] 4, containing the ONO tridentate ligand 6,6'–azanediylbis(methylene)bis(2,4–di–tert–butylphenol), H2L2 II. Compound 4, which was not fully characterized, undergoes dimerization in acetone yielding the hydroxido–bridged [{VVO(L2)}2µ–(HO)2] 5, having distorted octahedral geometry around each vanadium. In contrast, from a solution of 4 in acetonitrile, the dinuclear compound [{VVO(L2)}2µ–O] 6 is obtained, with trigonal bipyramidal geometry around each vanadium. The methoxido complex 2 is successfully employed as a functional catechol–oxidase mimic in the oxidation of catechol to o–quinone under air. The process is confirmed to follow a Michaelis–Menten type kinetics with respect to catechol, the Vmax and KM values obtained being 7.66×10–6 M min -1 and 0.0557 M, respectively, and the turnover frequency is 0.0541 min–1. Complex 2 is also used as a catalyst precursor for the oxidative bromination of thymol in aqueous medium. The selectivity shows quite interesting trends, namely when not using excess of primary oxidizing agent, H2O2 the para mono–brominated product corresponds to ~93 % of the products and no dibromo derivative is formed.

Keywords: oxidovanadium (V) complexes, tripodal ligand, crystal structure, catechol oxidase mimetic activity

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Authors: Lung-Lung Hu

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Ronald Dworkin offered a legal theory of ‘chain enterprise’ that all the judges in legal history altogether create a ‘law’ aiming a specific purpose. Those judges are like co-writers of a chain-story who not only create freely but also are constrained by the story made by the judges before them. The law created by Chinese traditional judges is another case, they, compared with the judges mentioned by Ronald Dworkin, have relatively narrower space of making a legal sentence according to their own discretions because the statutes in Chinese traditional law at the very beginning have been designed as panel code that leaves small room to judge’s discretion. Furthermore, because law is a representative of the authority of the government, i.e. the emperor, any misjudges and misuses deviated from the law will be considered as a challenge to the supreme power. However, different from judges as the defenders of law, Chinese litigation masters who want to win legal cases have to be offenders challenging the verdict that does not favor his or his client’s interest. Besides, litigation master as an illegal or non-authorized profession does not belong to any legal system, therefore, they are relatively freer to ‘create’ the law. According to Stanley Fish’s articles that question Ronald Dworkin and Owen Fiss’ ideas about law, he construes that, since law is made of language, law is open to interpretations that cannot be constrained by any rules or any particular legal purposes. Stanley Fish’s idea can also be applied on the analysis about the stories of Chinese litigation masters in traditional Chinese literature. These Chinese litigation masters’ legal opinions in the so-called chain enterprise are like an unexpected episode that tries to revise the fixed story told by law. Although they are not welcome to the officials and also to the society, their existence is still a phenomenon representing another version of justice different from the official’s and can be seen as a de-structural power to the government. Hence, in this present paper the language and strategy applied by Chinese litigation masters in Chinese legal stories will be analysed to see how they refute made legal judgments and challenge the official standard of justice.

Keywords: Chinese legal stories, interdisciplinary, litigation master, post-structuralism

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Authors: Zana Llonçari Osmani, Nita Llonçari

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In Kosovo, public rhetoric and popular sentiment position the War of 1998-99 (the war) as central to the formation of contemporary Kosovo's national identity. This period was marked by the forced massive displacement of Kosovo Albanians, the destruction of entire settlements, the loss of family members, and the profound emotional trauma experienced by civilians, particularly those who actively participated in the war as members of the Kosovo Liberation Army (KLA). Amidst these profound experiences, the Prekaz Massacre (The Massacre) is widely regarded as the defining event that preceded the final struggles of 1999 and the long-awaited attainment of independence. This study aims to explore how different visitors perceive the dominant discourse at The Memorial, a site dedicated to commemorating the Prekaz Massacre, and to identify the factors that influence their perceptions. The research employs a comprehensive mixed-method approach, combining online surveys, critical discourse analysis of visitor impressions, and content analysis of media representations. The findings of the study highlight the significant role played by original material remains in shaping visitor perceptions of The Memorial in comparison to the curated symbols and figurative representations interspersed throughout the landscape. While the design elements and physical layout of the memorial undeniably hold significance in conveying the memoryscape, there are notable shortcomings in enhancing the overall visitor experience. Visitors are still primarily influenced by the tangible remnants of the war, suggesting that there is room for improvement in how design elements can more effectively contribute to the memorial's narrative and the collective memory of the Prekaz Massacre.

Keywords: critical discourse analysis, memorialisation, national discourse, public rhetoric, war tourism

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Authors: Ana Paula Mousinho, Ronaldo D. Mansano, Nelson Ordonez

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Carbon nanotubes are one of the main elements in nanotechnologies; their applications are in microelectronics, nano-electronics devices (photonics, spintronic), chemical sensors, structural material and currently in clean energy devices (supercapacitors and fuel cells). The use of magnetic particle decorated carbon nanotubes increases the applications in magnetic devices, magnetic memory, and magnetic oriented drug delivery. In this work, single-walled carbon nanotubes (CNTs) forest decorated with chromium were deposited at room temperature by high-density plasma chemical vapor deposition (HDPCVD) system. The CNTs forest was obtained using pure methane plasmas and chromium, as precursor material (seed) and for decorating the CNTs. Magnetron sputtering deposited the chromium on silicon wafers before the CNTs' growth. Scanning electron microscopy, atomic force microscopy, micro-Raman spectroscopy, and X-ray diffraction characterized the single-walled CNTs forest decorated with chromium. In general, the CNTs' spectra show a unique emission band, but due to the presence of the chromium, the spectra obtained in this work showed many bands that are related to the CNTs with different diameters. The CNTs obtained by the HDPCVD system are highly aligned and showed metallic features, and they can be used as photonic material, due to the unique structural and electrical properties. The results of this work proved the possibility of obtaining the controlled deposition of aligned single-walled CNTs forest films decorated with chromium by high-density plasma chemical vapor deposition system.

Keywords: CNTs forest, high density plasma deposition, high-aligned CNTs, nanomaterials

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Authors: Ganesh Nivrutti Akhade

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This paper attempts to develop a reliable and valid instrument of measuring Healthcare service quality in India, and also analyses the impact of demographic factor of respondent on healthcare service quality. In this research paper , extant literature survey, discussion with stakeholder of healthcare system such as patients, patients relative, administrators of hospitals, clinics, professionals and expert interviews were used to develop a attributes of healthcare service quality dimensions. A pilot study was conducted with a sample of 31 healthcare patients of private sector, public sector ,trust hospital ,primary health care centers and clinics was surveyed in the Nagpur Metropolitan Area. At the end fifteen dimensions—reliability, assurance, responsiveness, tangibility, empathy, affordability, respect, and caring, Attitude of staff, Technical competence, Appropriateness, Safety, continuity, Effectiveness, Availability, Financial support. This fifteen-dimensional model was validated through a content validity and construct validity. The proposed research model shows acceptable fit indices. Impact of these dimensions on the Overall Healthcare Service Quality and customer satisfaction are analyzed using multiple regression technique. Findings indicate that all dimensions carry significant impact on the Overall Healthcare Service Quality perceptions and customer satisfaction. However, availability and effectiveness dimensions carry the maximum impact on the Overall healthcare Service Quality .

Keywords: healthcare, service quality, factor analysis (CFA), india, service quality dimensions

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Authors: H. N. S. Silva, S. N. Silva

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Introduction: The latest WHO data published in 2014 states that Sri Lanka has reached 2,773 of total deaths and over 14000 individuals’ sustained injuries due to RTAs each year. It was noticed in previous studies that policemen, three wheel drivers and also pedestrians were the first to respond to RTAs but the victim’s condition was aggravated due to unskilled attempts made by the responders while management of the victim’s wounds, moving and positioning of the victims and also mainly while transportation of the victims. Objective: To observe the practices of the urban public in Sri Lanka who are encountered with RTAs. Methods: A qualitative study was done to analyze public behavior seen on video recordings of scenes of accidents purposefully selected from social media, news websites, YouTube and Google. Results: The results showed that all individuals who tried to help during the RTA were middle aged men, who were mainly pedestrians, motorcyclists and policemen during that moment. Vast majority were very keen to actively help the victims to get to hospital as soon as possible and actively participated in providing 'aid'. But main problem was the first aid attempts were disorganized and uncoordinated. Even though all individuals knew how to control external bleeding, none of them was aware of spinal prevention techniques or management of limb injuries. Most of the transportation methods and transfer techniques used were inappropriate and more injury prone. Conclusions: The public actively engages in providing aid despite their inappropriate practices in giving first aid.

Keywords: encountered, pedestrians, road traffic accidents, urban public

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Authors: Rasheed F. G., Hassan H. A., Shehu F. A., Mukhtar M. M., Muhammad Y. Y., Ibrahim S. S., Shehu D., Abdulsalam K., N. Abdullahi

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A cross sectional randomized, descriptive cross sectional study was conducted on the frequency of GSTT1 null alleles in patients diagnosed with type-2-diabetes mellitus (T2DM). A total of 40 patients with T2DM and 10 non-diabetic controls were included in the study. GSTT1 null-alleles genotyping was carried out using multiplex PCR amplification to amplify GSTT1 gene (460bp) while using β-globulin (250bp) as an internal control. The results showed that 55% of T2DM patients had BMI within reference limits, 13% are overweight. Additionally, patients with T2DM were found to have significantly higher (p<0.05) serum levels of glucose, total cholesterol, triglyceride and low density lipoprotein. Furthermore, the presence of null genotype of GSTT1 (deletion in GSTT1) was observed in 28% of diabetic patients. Subjects with GSTT1 deletion have significantly higher (p<0.05) levels of serum glucose, low-density lipoprotein and total cholesterol when compared with individuals without deletion (diabetic and non-diabetic). This results suggests that the deletion of GSTT1 gene might serve as a predisposing factor in the development of T2DM and dyslipideamia

Keywords: diabetes, glutathione-S-transferase, lipid profile, PCR, polymorphism.

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Authors: Adriana Stefan, Cristina-Elisabeta Pelin, George Pelin, Maria Daniela Stelescu, Elena Manaila

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Elastomeric composites have been known for a long time, but, to our knowledge, space and the aeronautic community has been directing a special attention to them only in the last decade. The required properties of advanced elastomeric materials used in space applications (such as O-rings) are sealing, abrasion, low-temperature flexibility, the long-term compression set properties, impact resistance and low-temperature thermal stability in different environments, such as ionized radiations. Basically, the elastomeric nanocomposites are composed of a rubber matrix and a wide and varied range of nanofillers, added with the aim of improving the physico-mechanical and elasticity modulus properties of the materials as well as their stability in different environments. The paper presents a partial synthesis of the research regarding the use of silicon carbide in nanometric form and/or organophylized montmorillonite as fillers in butyl rubber matrix. The need of composite materials arose from the fact that stand-alone polymers are ineffective in providing all the superior properties required by different applications. These drawbacks can be diminished or even eliminated by incorporating a new range of additives into the organic matrix, fillers that have important roles in modifying properties of various polymers. A composite material can provide superior and unique mechanical and physical properties because it combines the most desirable properties of its constituents while suppressing their least desirable properties. The commercial importance of polymers and the continuous increase of their use results in the continuous demand for improvement in their properties to meet the necessary conditions. To study the performance of the elastomeric nanocomposites were mechanically tested, it will be tested the qualities of tensile at low temperatures and RT and the behavior at the compression at cryogenic to room temperatures and under different environments. The morphology of specimens will be investigated by optical and scanning electronic microscopy.

Keywords: elastomeric nanocomposites, O-rings, space applications, mechanical properties

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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: 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: Kyung Min Kwom, Young Joo Lee

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Purpose: Up to 90% of pancreatic cancer patient suffer from neuropathic pain. In palliative care setting, pain control in a pancreatic cancer patient is one of the major goals. Ketamine is a NMDA receptor antagonist effective in neuropathic pain. Also, there have been studies about opioid sparing effect of ketamine. This study was held in palliative care unit among pancreatic cancer patients to find out the factors related to ketamine use and the opioid sparing effect. Methods: Medical records of pancreatic cancer patients admitted to St. Mary’s hospital palliative care unit from 2013.1 to 2014.12 were reviewed. Patients were divided into two categories according to ketamine use. Also, opioid use before and after ketamine use was compared in ketamine group. Results: Compared to non ketamine use group, patients in ketamine group required a higher dose of opioid. Total opioid dose, daily opioid dose, number of daily rescue medication, daily average rescue dose were statistically significantly higher in ketamine group. Opioid requirement was increased after ketamine administration. Conclusion: In this study, ketamine group required more opioid. Ketamine is frequently considered in patients with severe pain, requiring high amount of opioid. Also, ketamine did not have an opioid sparing effect. Future studies about palliative use of ketamine in a larger number of patients are required.

Keywords: ketamine, opioid sparing, palliative care, pancreatic cancer

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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: D. Jagath Kumari, K. Srinivasa Rao

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Reinforced concrete column is an important structural element in a building. Concrete usually performs well in building fires. However, when it is subjected to prolonged fire exposure or unusually high temperatures, and then it will suffer significant distress. Because concrete pre-fire compressive strength generally exceeds design requirements, therefore an average strength reduction can be tolerated. However high temperature reduces the compressive strength of concrete so much that the concrete retains no useful structural strength. Therefore the residual strength and its performance of structure can be assed by NDT testing. In this paper, rebound hammer test and the ultrasonic pulse velocity (UPV) are used to evaluate the residual compressive strength and material integrity of post-fire-curing concrete subjected to elevated temperatures. Also considering the large availability of fly ash in most of the countries, an attempt was made to study the effect of high volume fly ash concrete exposed to elevated temperatures. 32 RC column specimens were made with a M20 grade concrete mix. Out of 32 column specimens 16 column specimens were made with OPC concrete and other 16 column specimens were made with HVFA concrete. All specimens having similar cross-section details. Columns were exposed to fire for temperatures from 100oC to 800o C with increments of 100o C for duration of 3 hours. Then the specimens allowed cooling to room temperature by two methods natural air cooling method and immediate water quenching method. All the specimens were tested identically, for the compressive strengths and material integrity by rebound hammer and ultrasonic pulse velocity meter respectively for study. These two tests were carried out on preheating and post heating of the column specimens. The percentage variation of compressive strengths of RCC columns with the increase in temperature has been studied and compared the results for both OPC and HVFA concretes. Physical observations of the heated columns were observed.

Keywords: HVFA concrete, NDT testing, residual strength

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Authors: Hao Yang, Lei Chen, Ting Mei, Jianbang Zheng

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Currently, the uncooled PbSe photodetectors in the mid-infrared range (2-5μm) with sensitization technology extract more photoelectric response than traditional ones, and enable the room temperature (300K) photo-detection with high detectivity, which have attracted wide attentions in many fields. This technology generally contains the film fabrication with vapor phase deposition (VPD) and a sensitizing process with doping of oxygen and iodine. Many works presented in the recent years almost provide and high temperature activation method with oxygen/iodine vapor diffusion, which reveals that oxygen or iodine plays an important role in the sensitization of PbSe material. In this paper, we provide our latest experimental results and discussions in the stoichiometry of oxygen and iodine and its influence on the polycrystalline structure and photo-response. The experimental results revealed that crystal orientation was transformed from (200) to (420) by sensitization, and the responsivity of 5.42 A/W was gained by the optimal stoichiometry of oxygen and iodine with molecular density of I2 of ~1.51×1012 mm-3 and oxygen pressure of ~1Mpa. We verified that I2 plays a role in transporting oxygen into the lattice of crystal, which is actually not its major role. It is revealed that samples sensitized with iodine transform atomic proportion of Pb from 34.5% to 25.0% compared with samples without iodine from XPS data, which result in the proportion of about 1:1 between Pb and Se atoms by sublimation of PbI2 during sensitization process, and Pb/Se atomic proportion is controlled by I/O atomic proportion in the polycrystalline grains, which is very an important factor for improving responsivity of uncooled PbSe photodetector. Moreover, a novel sensitization and dopant activation method is proposed using oxygen ion implantation with low ion energy of < 500eV and beam current of ~120μA/cm2. These results may be helpful to understanding the sensitization mechanism of polycrystalline lead salt materials.

Keywords: polycrystalline PbSe, sensitization, transport, stoichiometry

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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 255

Authors: Evgeny Obraztsov, Ilya Kremnev, Vitaly Sokolov, Maksim Gavrilov, Evgeny Tretyakov, Vladimir Kukhtevich, Vladimir Bezlepkin

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Over the last decade, a specific set of connected software tools and calculation codes has been gradually developed. It allows simulating I&C systems, thermal-hydraulic, neutron-physical and electrical processes in elements and systems at the Unit of NPP (initially with WWER (pressurized water reactor)). In 2012 it was called a complex simulation suite “Virtual Unit of NPP” (or CSS “VEB” for short). Proper application of this complex tool should result in a complex coupled mathematical computational model. And for a specific design of NPP, it is called the Virtual Power Unit (or VPU for short). VPU can be used for comprehensive modelling of a power unit operation, checking operator's functions on a virtual main control room, and modelling complicated scenarios for normal modes and accidents. In addition, CSS “VEB” contains a combination of thermal hydraulic codes: the best-estimate (two-liquid) calculation codes KORSAR and CORTES and a homogenous calculation code TPP. So to analyze a specific technological system one can build thermal-hydraulic simulation models with different detalization levels up to a nodalization scheme with real geometry. And the result at some points is similar to the notion “engineering/testing simulator” described by the European utility requirements (EUR) for LWR nuclear power plants. The paper is dedicated to description of the tools mentioned above and an example of the application of the engineering thermal-hydraulic simulator in analysis of the boron acid concentration in the primary coolant (changed by the make-up and boron control system).

Keywords: best-estimate code, complex simulation suite, engineering simulator, power plant, thermal hydraulic, VEB, virtual power unit

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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: K. M. R. Siriwardhana

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Sri Lanka is a developing country in South Asia which uses English as its second language. Today, most of the university students in Sri Lanka are eagerly exploring knowledge giving special consideration to English as their 2nd Language with the understanding that to climb up the career ladder, English is inevitable both in local and international contexts. However, still a considerable failing rate in English can also be seen among the Sri Lankan undergraduates Further, most of the Sri Lankan universities now practice English as their medium of instructions making English a credited Subject to brighten the future of the Sri Lankan students. Accordingly, in many universities an array of assessments are employed to evaluate undergraduates’ competence in English language. The main objective of this study was to ascertain the effective assessment methods to improve the 2nd language skills of the Sri Lankan university students which also create a more interest in them to learn English. Accordingly, hundred (100) undergraduates were selected as the research sample and the primary data was collected employing a semi structured questionnaire along with class room observations and semi structured interviews. Data was mainly analyzed descriptively employing graphical illustrations. According to the research findings, it was revealed that practical assessments such as oral tests, competitive drama and presentations are more effective in improving their language skills and preferred by the majority of students than written assignments and papers. Further, most of the students have scored better in practical assignments than in the written assignments. Hence, the study concludes that best and the benefited way of improving English language skills of Sri Lankan undergraduates is practical assessments as it gives them the opportunity to apply the language with much confidence and competence in actual situations. Further, the study recommends the language teachers to improve their own skills and creativity in practicing and employing such assessments as it will develop both second language teaching and learning skills. Ultimately, the university graduates will be able to secure their positions internationally as they are well capable in English, the lingua franca of the world.

Keywords: assessments, second language, Sri Lanka, undergraduates

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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

Procedia PDF Downloads 48

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: 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

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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

Procedia PDF Downloads 201