Search results for: logistic center
Commenced in January 2007
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Edition: International
Paper Count: 2813

Search results for: logistic center

623 Concussion: Clinical and Vocational Outcomes from Sport Related Mild Traumatic Brain Injury

Authors: Jack Nash, Chris Simpson, Holly Hurn, Ronel Terblanche, Alan Mistlin

Abstract:

There is an increasing incidence of mild traumatic brain injury (mTBI) cases throughout sport and with this, a growing interest from governing bodies to ensure these are managed appropriately and player welfare is prioritised. The Berlin consensus statement on concussion in sport recommends a multidisciplinary approach when managing those patients who do not have full resolution of mTBI symptoms. There are as of yet no standardised guideline to follow in the treatment of complex cases mTBI in athletes. The aim of this project was to analyse the outcomes, both clinical and vocational, of all patients admitted to the mild Traumatic Brain Injury (mTBI) service at the UK’s Defence Military Rehabilitation Centre Headley Court between 1st June 2008 and 1st February 2017, as a result of a sport induced injury, and evaluate potential predictive indicators of outcome. Patients were identified from a database maintained by the mTBI service. Clinical and occupational outcomes were ascertained from medical and occupational employment records, recorded prospectively, at time of discharge from the mTBI service. Outcomes were graded based on the vocational independence scale (VIS) and clinical documentation at discharge. Predictive indicators including referral time, age at time of injury, previous mental health diagnosis and a financial claim in place at time of entry to service were assessed using logistic regression. 45 Patients were treated for sport-related mTBI during this time frame. Clinically 96% of patients had full resolution of their mTBI symptoms after input from the mTBI service. 51% of patients returned to work at their previous vocational level, 4% had ongoing mTBI symptoms, 22% had ongoing physical rehabilitation needs, 11% required mental health input and 11% required further vestibular rehabilitation. Neither age, time to referral, pre-existing mental health condition nor compensation seeking had a significant impact on either vocational or clinical outcome in this population. The vast majority of patients reviewed in the mTBI clinic had persistent symptoms which could not be managed in primary care. A consultant-led, multidisciplinary approach to the diagnosis and management of mTBI has resulted in excellent clinical outcomes in these complex cases. High levels of symptom resolution suggest that this referral and treatment pathway is successful and is a model which could be replicated in other organisations with consultant led input. Further understanding of both predictive and individual factors would allow clinicians to focus treatments on those who are most likely to develop long-term complications following mTBI. A consultant-led, multidisciplinary service ensures a large number of patients will have complete resolution of mTBI symptoms after sport-related mTBI. Further research is now required to ascertain the key predictive indicators of outcome following sport-related mTBI.

Keywords: brain injury, concussion, neurology, rehabilitation, sports injury

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622 Multi-Stage Optimization of Local Environmental Quality by Comprehensive Computer Simulated Person as Sensor for Air Conditioning Control

Authors: Sung-Jun Yoo, Kazuhide Ito

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In this study, a comprehensive computer simulated person (CSP) that integrates computational human model (virtual manikin) and respiratory tract model (virtual airway), was applied for estimation of indoor environmental quality. Moreover, an inclusive prediction method was established by integrating computational fluid dynamics (CFD) analysis with advanced CSP which is combined with physiologically-based pharmacokinetic (PBPK) model, unsteady thermoregulation model for analysis targeting micro-climate around human body and respiratory area with high accuracy. This comprehensive method can estimate not only the contaminant inhalation but also constant interaction in the contaminant transfer between indoor spaces, i.e., a target area for indoor air quality (IAQ) assessment, and respiratory zone for health risk assessment. This study focused on the usage of the CSP as an air/thermal quality sensor in indoors, which means the application of comprehensive model for assessment of IAQ and thermal environmental quality. Demonstrative analysis was performed in order to examine the applicability of the comprehensive model to the heating, ventilation, air conditioning (HVAC) control scheme. CSP was located at the center of the simple model room which has dimension of 3m×3m×3m. Formaldehyde which is generated from floor material was assumed as a target contaminant, and flow field, sensible/latent heat and contaminant transfer analysis in indoor space were conducted by using CFD simulation coupled with CSP. In this analysis, thermal comfort was evaluated by thermoregulatory analysis, and respiratory exposure risks represented by adsorption flux/concentration at airway wall surface were estimated by PBPK-CFD hybrid analysis. These Analysis results concerning IAQ and thermal comfort will be fed back to the HVAC control and could be used to find a suitable ventilation rate and energy requirement for air conditioning system.

Keywords: CFD simulation, computer simulated person, HVAC control, indoor environmental quality

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621 Transcriptome Analysis of Saffron (crocus sativus L.) Stigma Focusing on Identification Genes Involved in the Biosynthesis of Crocin

Authors: Parvaneh Mahmoudi, Ahmad Moeni, Seyed Mojtaba Khayam Nekoei, Mohsen Mardi, Mehrshad Zeinolabedini, Ghasem Hosseini Salekdeh

Abstract:

Saffron (Crocus sativus L.) is one of the most important spice and medicinal plants. The three-branch style of C. sativus flowers are the most important economic part of the plant and known as saffron, which has several medicinal properties. Despite the economic and biological significance of this plant, knowledge about its molecular characteristics is very limited. In the present study, we, for the first time, constructed a comprehensive dataset for C. sativus stigma through de novo transcriptome sequencing. We performed de novo transcriptome sequencing of C. sativus stigma using the Illumina paired-end sequencing technology. A total of 52075128 reads were generated and assembled into 118075 unigenes, with an average length of 629 bp and an N50 of 951 bp. A total of 66171unigenes were identified, among them, 66171 (56%) were annotated in the non-redundant National Center for Biotechnology Information (NCBI) database, 30938 (26%) were annotated in the Swiss-Prot database, 10273 (8.7%) unigenes were mapped to 141 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway database, while 52560 (44%) and 40756 (34%) unigenes were assigned to Gen Ontology (GO) categories and Eukaryotic Orthologous Groups of proteins (KOG), respectively. In addition, 65 candidate genes involved in three stages of crocin biosynthesis were identified. Finally, transcriptome sequencing of saffron stigma was used to identify 6779 potential microsatellites (SSRs) molecular markers. High-throughput de novo transcriptome sequencing provided a valuable resource of transcript sequences of C. sativus in public databases. In addition, most of candidate genes potentially involved in crocin biosynthesis were identified which could be further utilized in functional genomics studies. Furthermore, numerous obtained SSRs might contribute to address open questions about the origin of this amphiploid spices with probable little genetic diversity.

Keywords: saffron, transcriptome, NGS, bioinformatic

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620 Comparison between Open and Closed System for Dewatering with Geotextile: Field and Comparative Study

Authors: Matheus Müller, Delma Vidal

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The present paper aims to expose two techniques of dewatering for sludge, analyzing its operations and dewatering processes, aiming at improving the conditions of disposal of residues with high liquid content. It describes the field tests performed on two geotextile systems, a closed geotextile tube and an open geotextile drying bed, both of which are submitted to two filling cycles. The sludge used in the filling cycles for the field trials is from the water treatment plant of the Technological Center of Aeronautics – CTA, in São José dos Campos, Brazil. Data about volume and height abatement due to the dewatering and consolidation were collected per time, until it was observed constancy. With the laboratory analysis of the sludge allied to the data collected in the field, it was possible to perform a critical comparative study between the observed and the scientific literature, in this way, this paper expresses the data obtained and compares them with the bibliography. The tests were carried out on three fronts: field tests, including the filling cycles of the systems with the sludge from CTA, taking measurements of filling time per cycle and maximum filling height per cycle, heights against the abatement by dewatering of the systems over time; tests carried out in the laboratory, including the characterization of the sludge and removal of material samples from the systems to ascertain the solids content within the systems per time and; comparing the data obtained in the field and laboratory tests with the scientific literature. Through the study, it was possible to perceive that the process of densification of the material inside a closed system, such as the geotextile tube, occurs faster than the observed in the drying bed system. This process of accelerated densification can be brought about by the pumping pressure of the sludge in its filling and by the confinement of the residue through the permeable geotextile membrane (allowing water to pass through), accelerating the process of densification and dewatering by its own weight after the filling with sludge.

Keywords: consolidation, dewatering, geotextile drying bed, geotextile tube

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619 Assessment of the Possible Effects of Biological Control Agents of Lantana camara and Chromolaena odorata in Davao City, Mindanao, Philippines

Authors: Cristine P. Canlas, Crislene Mae L. Gever, Patricia Bea R. Rosialda, Ma. Nina Regina M. Quibod, Perry Archival C. Buenavente, Normandy M. Barbecho, Cynthia Adeline A. Layusa, Michael Day

Abstract:

Invasive plants have an impact on global biodiversity and ecosystem function, and their management is a complex and formidable task. Two of these invasive plant species, Lantana camara and Chromolaena odorata, are found in the Philippines. Lantana camara has the ability to suppress the growth of and outcompete neighboring plants. Chromolaena odorata causes serious agricultural and economical damage and causes fire hazards during dry season. In addition, both species has been reported to poison livestock. One of the known global management strategies to control invasive plants is the introduction of biological control agents. These natural enemies of the invasive plants reduce population density and impacts of the invasive plants, resulting in the balance of the nature in their invasion. Through secondary data sources, interviews, and field validation (e.g. microhabitat searches, sweep netting, opportunistic sampling, photo-documentation), we investigated whether the biocontrol agents previously released by the Philippine Coconut Authority (PCA) in their Davao Research Center to control these invasive plants are still present and are affecting their respective host weeds. We confirm the presence of the biocontrol agent of L. camara, Uroplata girardi, which was introduced in 1985, and Cecidochares connexa, a biocontrol agent of C. odorata released in 2003. Four other biocontrol agents were found to affect L. camara. Signs of damage (e.g. stem galls in C. odorata, and leaf mines in L. camara) signify that these biocontrol agents have successfully established outside of their release site in Davao. Further investigating the extent of the spread of these biocontrol agents in the Philippines and their damage to the two weeds will contribute to the management of invasive plant species in the country.

Keywords: invasive alien species, biological control agent, entomology, worst weeds

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618 Regional Variation of Cancer Incidence in Nepal

Authors: Rudra Prasad Khanal

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Introduction: Non-communicable disease, such as cancer, has spread all over the world for some last decades. However, every nation has experienced a burden from the development of technology. In the context of Nepal, 10 to 15 thousand new cancer incidences are being registered in different hospitals for treatment. Since the date of starting nuclear medicine at Bir Hospital in 1998, cancer patients have been getting treatment regularly. According to the data of the population-based cancer registry, approximately 60% of the population having a middle-class income is being affected by cancer in Nepal. Methods and Materials: The study is aimed to find out the particular place where the population density of new cancer incidence is highest in Nepal and to inform the concerned regulatory body that is working on cancer screening and early detection for the proper treatment from the beginning. In order to identify the areas with the highest population density of new cancer incidence, all the data of cancer patients were collected from five different renowned hospitals and also from the population-based cancer registry center and then analyzed the data. The history of cancer patients was studied from 2003 to 2020, but here the data are analyzed from 2015 to 2020 only to find the latest trend in cancer incidence. Results: In the five major hospitals in Nepal, the total new cancer incidence was 61783 from 2015 to 2020. Out of those, 34617 were female, and 27176 were male. This research shows that female cancer patients were more every year. In the male, lung cancer patients more than cancer of other organs, but in females, the number of breast cancer patients was greatest. The age-adjusted mortality rate for males in Kathmandu valley was 36.3, and for females was 27.0 per 100,000 population. The cancer incidence and mortality rate were slightly lesser in other districts of Nepal. This rate increased with the increase in the age of people. Over 60 years, cancer incidence and mortality rates have been found to increase rapidly. Conclusion: This research supports conducting the program of cancer screening and early detection at Kathmandu valley with high priority and then Morang, Rukum, SSDM, etc., to control cancer.

Keywords: cancer incidence, research scholar, Tribhuvan University, Bhaktapur Cancer Hospital, Nepal

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617 Application of Hydrological Engineering Centre – River Analysis System (HEC-RAS) to Estuarine Hydraulics

Authors: Julia Zimmerman, Gaurav Savant

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This study aims to evaluate the efficacy of the U.S. Army Corp of Engineers’ River Analysis System (HEC-RAS) application to modeling the hydraulics of estuaries. HEC-RAS has been broadly used for a variety of riverine applications. However, it has not been widely applied to the study of circulation in estuaries. This report details the model development and validation of a combined 1D/2D unsteady flow hydraulic model using HEC-RAS for estuaries and they are associated with tidally influenced rivers. Two estuaries, Galveston Bay and Delaware Bay, were used as case studies. Galveston Bay, a bar-built, vertically mixed estuary, was modeled for the 2005 calendar year. Delaware Bay, a drowned river valley estuary, was modeled from October 22, 2019, to November 5, 2019. Water surface elevation was used to validate both models by comparing simulation results to NOAA’s Center for Operational Oceanographic Products and Services (CO-OPS) gauge data. Simulations were run using the Diffusion Wave Equations (DW), the Shallow Water Equations, Eulerian-Lagrangian Method (SWE-ELM), and the Shallow Water Equations Eulerian Method (SWE-EM) and compared for both accuracy and computational resources required. In general, the Diffusion Wave Equations results were found to be comparable to the two Shallow Water equations sets while requiring less computational power. The 1D/2D combined approach was valid for study areas within the 2D flow area, with the 1D flow serving mainly as an inflow boundary condition. Within the Delaware Bay estuary, the HEC-RAS DW model ran in 22 minutes and had an average R² value of 0.94 within the 2-D mesh. The Galveston Bay HEC-RAS DW ran in 6 hours and 47 minutes and had an average R² value of 0.83 within the 2-D mesh. The longer run time and lower R² for Galveston Bay can be attributed to the increased length of the time frame modeled and the greater complexity of the estuarine system. The models did not accurately capture tidal effects within the 1D flow area.

Keywords: Delaware bay, estuarine hydraulics, Galveston bay, HEC-RAS, one-dimensional modeling, two-dimensional modeling

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616 An Experience on Urban Regeneration: A Case Study of Isfahan, Iran

Authors: Sedigheh Kalantari, Yaping Huang

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The historic area of cities has experienced different phases of transformation. The beginning of the twentieth century, modernism, and modern development changed the integrated pattern of change and the historic urban quarter were regarded as subject comprehensive redevelopment. In this respect, historic area of Iranian cities have not been safe from these changes and affected by widespread evolutions; in particular after Islamic Revolution eras (1978) cities have traveled through an evolution in conservation and development policies and practices. Moreover, moving toward a specific approach and specific attention paid to the regeneration of the historical urban centers in Iran has started since the 1990s. This reveals the great importance attached to the historical centers of cities. This paper is an approach to examine an experience on urban regeneration in Iran through a case study. The study relies on multiple source of evidence. The use of multiple sources of evidence can help substantially improve the validity and reliability of the research. The empirical core of this research, therefore, rests in the process of urban revitalization of the old square in Isfahan. Isfahan is one of the oldest city of Persia. The historic area of city encompasses a large number of valuable buildings and monuments. One of the cultural and historical region of Isfahan is Atiq Square (Old Square). It has been the backbone node of the city that in course of time has being ignored more and more and transformed negatively. The complex had suffered from insufficiencies especially with respect to social and spatial aspects. Therefore, reorganization of that complex as the main and most important urban center of Isfahan became an inevitable issue; So this paper except from reminding the value of such historic-cultural heritage and review of its transformation, focused on an experience of urban revitalization project in this heritage site. The outcome of this research shows that situated in different socio-economic political and historical contexts and in face of different urban regeneration issues, Iran have displayed significant differences in the way of urban regeneration.

Keywords: historic area, Iran, urban regeneration, revitalization

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615 Maternal Risk Factors Associated with Low Birth Weight Neonates in Pokhara, Nepal: A Hospital Based Case Control Study

Authors: Dipendra Kumar Yadav, Nabaraj Paudel, Anjana Yadav

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Background: Low Birth weight (LBW) is defined as the weight at birth less than 2500 grams, irrespective of the period of their gestation. LBW is an important indicator of general health status of population and is considered as the single most important predictors of infant mortality especially of deaths within the first month of life that is birth weight determines the chances of newborn survival. Objective of this study was to identify the maternal risk factors associated with low birth weight neonates. Materials and Methods: A hospital based case-control study was conducted in maternity ward of Manipal Teaching Hospital, Pokhara, Nepal from 23 September 2014 to 12 November 2014. During study period 59 cases were obtained and twice number of control group were selected with frequency matching of the mother`s age with ± 3 years and total controls were 118. Interview schedule was used for data collection along with record review. Data were entered in Epi-data program and analysis was done with help of SPSS software program. Results: From bivariate logistic regression analysis, eighteen variables were found significantly associated with LBW and these were place of residence, family monthly income, education, previous still birth, previous LBW, history of STD, history of vaginal bleeding, anemia, ANC visits, less than four ANC visits, de-worming status, counseling during pregnancy, CVD, physical workload, stress, extra meal during pregnancy, smoking and alcohol consumption status. However after adjusting confounding variables, only six variables were found significantly associated with LBW. Mothers who had family monthly income up to ten thousand rupees were 4.83 times more likely to deliver LBW with CI (1.5-40.645) and p value 0.014 compared to mothers whose family income NRs.20,001-60,000. Mothers who had previous still birth were 2.01 times more likely to deliver LBW with CI (0.69-5.87) and p value 0.02 compared to mothers who did not has previous still birth. Mothers who had previous LBW were 5.472 times more likely to deliver LBW with CI (1.2-24.93) and p value 0.028 compared to mothers who did not has previous LBW. Mothers who had anemia during pregnancy were 3.36 times more likely to deliver LBW with CI (0.77-14.57) and p value 0.014 compared to mothers who did not has anemia. Mothers who delivered female newborn were 2.96 times more likely to have LBW with 95% CI (1.27-7.28) and p value 0.01 compared to mothers who deliver male newborn. Mothers who did not get extra meal during pregnancy were 6.04 times more likely to deliver LBW with CI (1.11-32.7) and p value 0.037 compared to mothers who getting the extra meal during pregnancy. Mothers who consumed alcohol during pregnancy were 4.83 times more likely to deliver LBW with CI (1.57-14.83) and p value 0.006 compared to mothers who did not consumed alcohol during pregnancy. Conclusions: To reduce low birth weight baby through economic empowerment of family and individual women. Prevention and control of anemia during pregnancy is one of the another strategy to control the LBW baby and mothers should take full dose of iron supplements with screening of haemoglobin level. Extra nutritional food should be provided to women during pregnancy. Health promotion program will be focused on avoidance of alcohol and strengthen of health services that leads increasing use of maternity services.

Keywords: low birth weight, case-control, risk factors, hospital based study

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614 Traumatic Spinal Cord Injury; Incidence, Prognosis and the Time-Course of Clinical Outcomes: A 12 Year Review from a Tertiary Hospital in Korea

Authors: Jeounghee Kim

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Objective: To describe the incidence of complication, according to the stage of Traumatic Spinal Cord Injury (TSCI) which was treated at Asan Medical Center (AMC), Korea. Hereafter, it should be developed in nursing management protocol of traumatic SCI. Methods. Retrospectively reviewed hospital records about the patients who were admitted AMC Patients with traumatic spinal cord injury until January 2005 and December 2016 were analyzed (n=97). AMC is a single institution of 2,700 beds where patients with trauma and severe trauma can be treated. Patients who were admitted to the emergency room due to spinal cord injury and who underwent intensive care unit, general ward, and rehabilitation ward. To identify long-term complications, we excluded patients who were operated on to other hospitals after surgery. Complications such as respiratory(pneumonia, atelectasis, pulmonary embolism, and others), cardiovascular (hypotension), urinary (autonomic dysreflexia, urinary tract infection (UTI), neurogenic bladder, and others), and skin systems (pressure ulcers) from the time of admission were examined through medical records and images. Results: SCI was graded according to ASIA scale. The initial grade was checked at admission. (grade A 55(56.7%), grade B 14(14.4)%, grade C 11(11.3%), grade D 15(15.5%), and grade E 2(2.1%). The grade was rechecked when the patient was discharged after treatment. (grade A 43(44.3%), grade B 15(15.5%), grade C 12(12.4%), grade D 21(21.6%), and grade E 6(6.2%). The most common complication after SCI was UTI 24cases (mean 36.5day), sore 24cases (40.5day), and Pneumonia which was 23 cases after 10days averagely. The other complications after SCI were neuropathic pain 19 cases, surgical site infection 4 cases. 53.6% of patient who had SCI were educated about intermittent catheterization at discharge from hospital. The mean hospital stay of all SCI patients was 61days. Conclusion: The Complications after traumatic SCI were developed at various stages from acute phase to chronic phase. Nurses need to understand fully the time-course of complication in traumatic SCI to provide evidence-based practice.

Keywords: spinal cord injury, complication, nursing, rehabilitation

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613 Acupuncture in the Treatment of Parkinson's Disease-Related Fatigue: A Pilot Randomized, Controlled Study

Authors: Keng H. Kong, Louis C. Tan, Wing L. Aw, Kay Y. Tay

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Background: Fatigue is a common problem in patients with Parkinson's disease, with reported prevalence of up to 70%. Fatigue can be disabling and has adverse effects on patients' quality of life. There is currently no satisfactory treatment of fatigue. Acupuncture is effective in the treatment of fatigue, especially that related to cancer. Its role in Parkinson's disease-related fatigue is uncertain. Aims: To evaluate the clinical efficacy of acupuncture treatment in Parkinson's disease-related fatigue. Hypothesis: We hypothesize that acupuncture is effective in alleviating Parkinson's disease-related fatigue. Design: A single center, randomized, controlled study with two parallel arms. Participants: Forty participants with idiopathic Parkinson's disease will be enrolled. Interventions: Participants will be randomized to receive verum (real) acupuncture or placebo acupuncture. The retractable non-invasive sham needle will be used in the placebo group. The intervention will be administered twice a week for five weeks. Main outcome measures: The primary outcome will be the change in general fatigue score of the multidimensional fatigue inventory at week 5. Secondary outcome measures include other subscales of the multidimensional fatigue inventory, movement disorders society-unified Parkinson's disease rating scale, Parkinson's disease questionnaire-39 and geriatric depression scale. All outcome measures will be assessed at baseline (week 0), completion of intervention (week 5) and 4 weeks after completion of intervention (week 9). Results: To date, 23 participants have been recruited and nine have completed the study. The mean age is 63.5±14.2 years, mean duration of Parkinson’s disease is 6.4±1.8 years and mean MDS-UPDRS score is 8.3±2.8. The mean general fatigue score of the multidimensional fatigue inventory is 13.5±4.6. No significant adverse event related to acupuncture is noted. Potential significance: If the results are as expected, this study will provide preliminary scientific evidence for the efficacy of acupuncture in Parkinson's Disease-related fatigue, and opens the door for a larger multicentre trial to be performed. In the longer term, it may lead to the integration of acupuncture in the care of patients with Parkinson's disease.

Keywords: acupuncture, fatigue, Parkinson's disease, trial

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612 Field Prognostic Factors on Discharge Prediction of Traumatic Brain Injuries

Authors: Mohammad Javad Behzadnia, Amir Bahador Boroumand

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Introduction: Limited facility situations require allocating the most available resources for most casualties. Accordingly, Traumatic Brain Injury (TBI) is the one that may need to transport the patient as soon as possible. In a mass casualty event, deciding when the facilities are restricted is hard. The Extended Glasgow Outcome Score (GOSE) has been introduced to assess the global outcome after brain injuries. Therefore, we aimed to evaluate the prognostic factors associated with GOSE. Materials and Methods: In a multicenter cross-sectional study conducted on 144 patients with TBI admitted to trauma emergency centers. All the patients with isolated TBI who were mentally and physically healthy before the trauma entered the study. The patient’s information was evaluated, including demographic characteristics, duration of hospital stays, mechanical ventilation on admission laboratory measurements, and on-admission vital signs. We recorded the patients’ TBI-related symptoms and brain computed tomography (CT) scan findings. Results: GOSE assessments showed an increasing trend by the comparison of on-discharge (7.47 ± 1.30), within a month (7.51 ± 1.30), and within three months (7.58 ± 1.21) evaluations (P < 0.001). On discharge, GOSE was positively correlated with Glasgow Coma Scale (GCS) (r = 0.729, P < 0.001) and motor GCS (r = 0.812, P < 0.001), and inversely with age (r = −0.261, P = 0.002), hospitalization period (r = −0.678, P < 0.001), pulse rate (r = −0.256, P = 0.002) and white blood cell (WBC). Among imaging signs and trauma-related symptoms in univariate analysis, intracranial hemorrhage (ICH), interventricular hemorrhage (IVH) (P = 0.006), subarachnoid hemorrhage (SAH) (P = 0.06; marginally at P < 0.1), subdural hemorrhage (SDH) (P = 0.032), and epidural hemorrhage (EDH) (P = 0.037) were significantly associated with GOSE at discharge in multivariable analysis. Conclusion: Our study showed some predictive factors that could help to decide which casualty should transport earlier to a trauma center. According to the current study findings, GCS, pulse rate, WBC, and among imaging signs and trauma-related symptoms, ICH, IVH, SAH, SDH, and EDH are significant independent predictors of GOSE at discharge in TBI patients.

Keywords: field, Glasgow outcome score, prediction, traumatic brain injury.

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611 Absolute Lymphocyte Count as Predictor of Pneumocystis Pneumonia in Patients With Unknown HIV Status at a Private Tertiary Hospital

Authors: Marja A. Bernardo, Coreena A. Bueser, Cybele Lara R. Abad, Raul V. Destura

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Pneumocystis jirovecii pneumonia (PCP) is the most common opportunistic infection among people with HIV. Early consideration of PCP should be made even in patients whose HIV status is unknown as delay in treatment may be fatal. The use of absolute lymphocyte count (ALC) has been suggested as an alternative predictor of PCP especially in resource limited settings where PCR testing is costly or delayed. Objective: To determine whether the absolute lymphocyte count (ALC) can be used as a screening tool to predict Pneumocystis pneumonia in patients with unknown HIV status admitted at a private tertiary hospital. Methods: A retrospective cross-sectional study was conducted at a private tertiary medical center. Inpatient medical records of patients aged 18 years old and above from January 2012 to May 2014, in whom a clinical diagnosis of Pneumocystis jirovecii pneumonia was made were reviewed for inclusion. Demographic data, clinical features, hospital course, PCP PCR and HIV results were recorded. Independent t-test and chi-square analysis was used to determine any statistical difference between PCP-positive and PCP-negative groups. Mann-Whitney U-test was used for comparison of hospital stay. Results: There were no statistically significant differences in baseline characteristics between PCP positive and negative groups. While both the percent lymphocyte count (0.14 ± 0.13 vs 0.21 ± 0.16) and ALC (1160 ± 528.67 vs 1493.70 ± 988.61) were lower for the PCP-positive group, only the percent lymphocyte count reached a statistically significant difference (p= 0.067 vs p= 0.042). Conclusion: A quick determination of the ALC may be useful as an additional parameter to help screen for and diagnose pneumocystis pneumonia. In our study, the ALC of patients with PCP appear to be lower than in patients without PCP. A low ALC (e.g. below 1200) may help with the decision regarding empiric treatment. However, it should be used in conjunction with the patient’s clinical presentation, as well as other diagnostic tests. Larger, prospective studies incorporating the ALC with other clinical predictors are necessary to optimally predict those who would benefit from empiric or expedited management for potential PCP.

Keywords: Pneumocystis carinii pneumonia, Absolute Lymphocyte Count, infection, PCP

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610 Recurrence of Pterygium after Surgery and the Effect of Surgical Technique on the Recurrence of Pterygium in Patients with Pterygium

Authors: Luksanaporn Krungkraipetch

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A pterygium is an eye surface lesion that begins in the limbal conjunctiva and progresses to the cornea. The lesion is more common in the nasal limbus than in the temporal, and it has a distinctive wing-like aspect. Indications for surgery, in decreasing order of significance, are grown over the corneal center, decreased vision due to corneal deformation, documented growth, sensations of discomfort, and aesthetic concerns. Recurrent pterygium results in the loss of time, the expense of therapy, and the potential for vision impairment. The objective of this study is to find out how often the recurrence of pterygium after surgery occurs, what effect the surgery technique has, and what causes them to come back in people with pterygium. Materials and Methods: Observational case control in retrospect: the study involves a retrospective analysis of 164 patient samples. Data analysis is descriptive statistics analysis, i.e., basic data details about pterygium surgery and the risk of recurrent pterygium. For factor analysis, the inferential statistics odds ratio (OR) and 95% confidence interval (CI) ANOVA are utilized. A p-value of 0.05 was deemed statistically important. Results: The majority of patients, according to the results, were female (60.4%). Twenty-four of the 164 (14.6%) patients who underwent surgery exhibited recurrent pterygium. The average age is 55.33 years old. Postoperative recurrence was reported in 19 cases (79.3%) of bare sclera techniques and five cases (20.8%) of conjunctival autograft techniques. The recurrence interval is 10.25 months, with the most common (54.17 percent) being 12 months. In 91.67 percent of cases, all follow-ups are successful. The most common recurrence level is 1 (25%). A surgical complication is a subconjunctival hemorrhage (33.33 percent). Comparing the surgeries done on people with recurrent pterygium didn't show anything important (F = 1.13, p = 0.339). Age significantly affected the recurrence of pterygium (95% CI, 6.79-63.56; OR = 20.78, P 0.001). Conclusion: This study discovered a 14.6% rate of pterygium recurrence after pterygium surgery. Across all surgeries and patients, the rate of recurrence was four times higher with the bare sclera method than with conjunctival autograft. The researchers advise selecting a more conventional surgical technique to avoid a recurrence.

Keywords: pterygium, recurrence pterygium, pterygium surgery, excision pterygium

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609 Atherosclerosis Prevalence Within Populations of the Southeastern United States

Authors: Samuel P. Prahlow, Anthony Sciuva, Katherine Bombly, Emily Wilson, Shiv Dhiman, Savita Arya

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A prevalence cohort study of atherosclerotic lesions within cadavers was performed to better understand and characterize the prevalence of atherosclerosis among Georgia residents within body donors in the Philadelphia College of Osteopathic Medicine (PCOM) - Georgia body donor program. We procured specimens from cadavers used for medical students, physical therapy students, and biomedical science students cadaveric anatomical dissection at PCOM - South Georgia and PCOM - Georgia. Tissues were prepared using hematoxylin and eosin (H&E) stainas histological slides by Colquitt Regional Medical Center Laboratory Services. One section from each of the following arteries was taken after cadaveric dissection at the site of most calcification palpated grossly (if present): left anterior descending coronary artery, left internal carotid artery, abdominal aorta, splenic artery, and hepatic artery. All specimens were graded and categorized according to the American Heart Association’s Modified and Conventional Standards for Atherosclerotic Lesions using x4, x10, x40 microscopic magnification. Our study cohort included 22 cadavers, with 16 females and 6 males. The average age was 72.54, and the median age was 72, with a range of 52 to 90 years old. The cause of death determination listing vascular and/or cardiovascular causes was present on 6 of the 22 death certificates. 19 of 22 (86%) cadavers had at least a single artery grading > 5. Of the cadavers with at least a single artery graded at greater than 5, only 5 of 19 (26%) cadavers had a vascular or cardiovascular cause of death reported. Malignancy was listed as a cause of death on 7 (32%) death certificates. The average atherosclerosis grading of the common hepatic, splenic and left internal carotid arteries (2.15, 3.05, and 3.36 respectively) were lower than the left anterior descending artery and the abdominal aorta (5.16 and 5.86 respectively). This prevalence study characterizes atherosclerosis found in five medium and large systemic arteries within cadavers from the state of Georgia.

Keywords: pathology, atherosclerosis, histology, cardiovascular

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608 Exposure to Ionizing Radiation Resulting from the Chernobyl Fallout and Childhood Cardiac Arrhythmia: A Population Based Study

Authors: Geraldine Landon, Enora Clero, Jean-Rene Jourdain

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In 2005, the Institut de Radioprotection et de Sûreté Nucléaire (IRSN, France) launched a research program named EPICE (acronym for 'Evaluation of Pathologies potentially Induced by CaEsium') to collect scientific information on non-cancer effects possibly induced by chronic exposures to low doses of ionizing radiation with the view of addressing a question raised by several French NGOs related to health consequences of the Chernobyl nuclear accident in children. The implementation of the program was preceded by a pilot phase to ensure that the project would be feasible and determine the conditions for implementing an epidemiological study on a population of several thousand children. The EPICE program focused on childhood cardiac arrhythmias started in May 2009 for 4 years, in partnership with the Russian Bryansk Diagnostic Center. The purpose of this cross-sectional study was to determine the prevalence of cardiac arrhythmias in the Bryansk oblast (depending on the contamination of the territory and the caesium-137 whole-body burden) and to assess whether caesium-137 was or not a factor associated with the onset of cardiac arrhythmias. To address these questions, a study bringing together 18 152 children aged 2 to 18 years was initiated; each child received three medical examinations (ECG, echocardiography, and caesium-137 whole-body activity measurement) and some of them were given with a 24-hour Holter monitoring and blood tests. The findings of the study, currently submitted to an international journal justifying that no results can be given at this step, allow us to answer clearly to the issue of radiation-induced childhood arrhythmia, a subject that has been debated for many years. Our results will be certainly helpful for health professionals responsible for the monitoring of population exposed to the releases from the Fukushima Dai-ichi nuclear power plant and also useful for future comparative study in children exposed to ionizing radiation in other contexts, such as cancer radiation therapies.

Keywords: Caesium-137, cardiac arrhythmia, Chernobyl, children

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607 Analyzing the Sound of Space - The Glissando of the Planets and the Spiral Movement on the Sound of Earth, Saturn and Jupiter

Authors: L. Tonia, I. Daglis, W. Kurth

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The sound of the universe creates an affinity with the sounds of music. The analysis of the sound of space focuses on the existence of a tone material, the microstructure and macrostructure, and the form of the sound through the signals recorded during the flight of the spacecraft Van Allen Probes and Cassini’s mission. The sound becomes from the frequencies that belong to electromagnetic waves. Plasma Wave Science Instrument and Electric and Magnetic Field Instrument Suite and Integrated Science (EMFISIS) recorded the signals from space. A transformation of that signals to audio gave the opportunity to study and analyze the sound. Due to the fact that the musical tone pitch has a frequency and every electromagnetic wave produces a frequency too, the creation of a musical score, which appears as the sound of space, can give information about the form, the symmetry, and the harmony of the sound. The conversion of space radio emissions to audio provides a number of tone pitches corresponding to the original frequencies. Through the process of these sounds, we have the opportunity to present a music score that “composed” from space. In this score, we can see some basic features associated with the music form, the structure, the tone center of music material, the construction and deconstruction of the sound. The structure, which was built through a harmonic world, includes tone centers, major and minor scales, sequences of chords, and types of cadences. The form of the sound represents the symmetry of a spiral movement not only in micro-structural but also to macro-structural shape. Multiple glissando sounds in linear and polyphonic process of the sound, founded in magnetic fields around Earth, Saturn, and Jupiter, but also a spiral movement appeared on the spectrogram of the sound. Whistles, Auroral Kilometric Radiations, and Chorus emissions reveal movements similar to musical excerpts of works by contemporary composers like Sofia Gubaidulina, Iannis Xenakis, EinojuhamiRautavara.

Keywords: space sound analysis, spiral, space music, analysis

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606 Two Brazilian Medeas: The Cases of Mata Teu Pai and Medeia Negra

Authors: Jaqueline Bohn Donada

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The significance of Euripides’ Medea for contemporary literature is noticeable. Even if the bulk of Classical Reception studies does not tend to look carefully and consistently to the literature produced outside the Anglophone world, Brazilian literature offers abundant materials for such studies. Indeed, a certain Classical background can be observed in Brazilian literature at least since 1975 when Gota d’Água [The Final Straw, in English], a play that recreates the story of Medea and sets it in a favela in Rio de Janeiro. Also worthy of notice is Ivo Bender’s Trilogia Perversa [Perverse Trilogy, in English], a series of three historical plays set in Southern Brazil and based on Aeschylus’ Oresteia and on Euripides’ Iphigenia in Aulis published in the 1980s. Since then, a number of works directly inspired by the plays of Aeschylus, Sophocles and Euripides have been published, not to mention several adaptations of Homer’s two epic poems. This paper proposes a comparative analysis of two such works: Grace Passô’s 2017 play Mata teu Pai [Kill your father, in English] and Marcia Lima’s 2019 play Medeia Negra [Black Medea, in English] from the perspective of Classical Reception Studies in an intersection with feminist literary criticism. The paper intends to look at the endurance of Euripides’ character in contemporary Brazilian literature with a focus on how the character seems to have acquired special relevance to the treatment of pressing issues of the twenty-first century. Whereas Grace Passô’s play sets Medea at the center of a group of immigrant women, Marcia Limma has the character enact the dilemmas of incarcerated women in Brazil. The hypothesis that this research aims at testing is that both artists preserve the pathos of Euripides’s original character at the same time that they recreate his Medea in concrete circumstances of Brazilian contemporary social reality. At the end, the research aims at stating the significance of the Medea theme to contemporary Brazilian literature.

Keywords: Euripides, Medea, Grace Passô, Marcia Limma, Brazilian literature

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605 Role of Male Partners in Postpartum Family Planning

Authors: Stephen Rulisa, Aimee Nyiramahirwe

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Background: Strategies to increase the uptake of contraception services have been adopted in Rwanda, but the unmet need for family planning remains high. Women in the postpartum period are at higher risk for unintended pregnancy due to the silent conversion from lactational amenorrhea to reactivation of ovulatory cycles. The purpose of this study was to explore the role of male partners in the uptake of postpartum contraception. Methods: A prospective cross-sectional study was conducted among women who delivered at the University Teaching Hospital of Kigali for a period of 3 months with random sampling. A questionnaire was used to collect socio-demographic and antenatal data, information on male companionship, and intent to use postpartum contraception at admission. Participants were contacted six weeks later to collect data on contraceptive use. The outcome variables were uptake of postpartum contraception and types of contraceptives taken (long-acting vs. short-acting), controlling for male companionship during the antenatal period. A Chi-square test was used and a p-value ≤0.05 was considered significant. Results: A total of 209 women were recruited with a mean age of 30.8±5.2 years. The majority (60.9%) were multigravida, and 66.5% were multiparous. More than half (55%) had male partner companionship, 18.3% had companionship for four antenatal visits, and 28.2% had education on contraception with their male partner. Factors significantly associated with uptake of postpartum contraception were: age above 30 years, owning or heading a business, multigravidity, multiparity, antenatal care at a health center or district hospital, cesarean delivery, and previous utilization of contraception. Male companionship significantly increased the intent to use contraception, uptake of modern contraception in general, and uptake of long active contraceptives but did not predict the uptake of short-acting contraceptives. Conclusions: Our study demonstrates a positive association between male companionship during antenatal care, labor and delivery with the uptake of postpartum family planning. Our study suggests more sensitization to involve the male partners, improving the education on contraception during antenatal care and further research to assess the sustained uptake of contraception beyond the postpartum period.

Keywords: postpartum, family planning, contraception, male partner, uptake

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604 Transformation of Traditional Marketplaces in an Urban Context: Case of Chalai Market, Thiruvananthapuram

Authors: Aswathy Vijayan, Sharath Sunder Rajeev

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Trade has been fundamental in the footprint of human civilization since ancient time. In most of the historic cities, city development was along trading routes, where marketplaces are the major entrance to a city and hence a major element of the urban fabric. Marketplaces are where the commercial activities flourish, people, having a sense of belonging to the place, where they easily fit in. Acknowledging the built environment in and around the market in a way, creating a sense of place is an important factor in the success of public spaces. Local markets are developed in an organic manner, which adds on to the people experience and perception of urban space. With the city development, the commercial needs within the city increase, hence marketplaces flourish, irrespective of the functional segregation within. The work-live culture in the marketplaces diminishes as the commercial expansion washes away the residential patches within it. Real estate flourishes as the newer infills are without considering the carrying capacity of the place. Chalai market is a prominent business center serving the regional level of Thiruvananthapuram city. The transformation trend of marketplaces in city cores are understood from case study on Fatimid Cairo Marketplace. The parameters that led to transformation of marketplaces in a global context is considered for the analysis of the Chalai market. The structure of the marketplace over the years is analyzed in terms of transformation in location, transformation in the land- use, change in commodity, and transformation in movement and activity. The aim of the research is to emphasize the need to understand the transformation trend, in creating a suitable development pattern for the city. The unregulated transformation within the city core has led to tremendous transformation in the user group and user pattern and eventually to the commercial trend. With the change in lifestyle and need for new amenities have led to addition of new infills leading to the degradation of the native commerce. Hence addressing the transformation of marketplaces are crucial to maintaining the locational significance and cultural importance and heritage of the place.

Keywords: bazaar, market centers, marketplaces, traditional city, traditional market, urban fabric

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603 Differentiated Ways of Supporting Social-Emotional Wellbeing and Mental Health of Children and Youth

Authors: Jolanta Jonak

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Emotional wellbeing is crucial for healthy development of children, youth, and adolescence. Lack of healthy emotional development and functioning can lead to many challenges in academic, social, and physical domains. Unfortunately, mental health problems are steadily increasing over the past several years and significantly intensified during and after the Covid 19 pandemic. Some experts warn that globally, we are entering a mental health crisis pandemic. Prior to the Covid 19 pandemic in 2020, a considerable number of youth aged 6-17 experienced a mental health disorder each year, with half of all mental health conditions beginning by age 14. The most common mental health disorders in children are Attention-Deficit/Hyperactivity Disorder (ADHD), behavior problems, anxiety, and depression. In U.S. schools, youth with these diagnoses tend to be classified under the umbrella of Emotional Disability. Several concerning trends have been emerging about the mental health of U.S. high school students. These trends have been steadily increasing for the past decade, particularly having increasing numbers of high school students who experienced persistent feelings of sadness or hopelessness, seriously considered attempting suicide, made a suicide plan, and attempted suicide. The number of students who felt persistently sad or hopeless increased across every racial and ethnic group. Parents, educators, and mental health providers are key stakeholders that are responsible for actively and effectively supporting struggling youth. A commonly faced challenge is that mental wellbeing is not supported as effectively as it should be. When effective prevention is paired with enhanced treatment developed on a multidisciplinary approach, mental health and emotional wellbeing in young people can be positively enhanced. Major health organizations including the Center for Disease Control and the National Institutes of Health encourage health professionals and other stakeholders to focus on addressing emotional wellbeing and mental health of young people.

Keywords: social emotional wellbeing, disability, learning, prevention

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602 Designing Creative Events with Deconstructivism Approach

Authors: Maryam Memarian, Mahmood Naghizadeh

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Deconstruction is an approach that is entirely incompatible with the traditional prevalent architecture. Considering the fact that this approach attempts to put architecture in sharp contrast with its opposite events and transpires with attending to the neglected and missing aspects of architecture and deconstructing its stable structures. It also recklessly proceeds beyond the existing frameworks and intends to create a different and more efficient prospect for space. The aim of deconstruction architecture is to satisfy both the prospective and retrospective visions as well as takes into account all tastes of the present in order to transcend time. Likewise, it ventures to fragment the facts and symbols of the past and extract new concepts from within their heart, which coincide with today’s circumstances. Since this approach is an attempt to surpass the limits of the prevalent architecture, it can be employed to design places in which creative events occur and imagination and ambition flourish. Thought-provoking artistic events can grow and mature in such places and be represented in the best way possible to all people. The concept of event proposed in the plan grows out of the interaction between space and creation. In addition to triggering surprise and high impressions, it is also considered as a bold journey into the suspended realms of the traditional conflicts in architecture such as architecture-landscape, interior-exterior, center-margin, product-process, and stability-instability. In this project, at first, through interpretive-historical research method and examining the inputs and data collection, recognition and organizing takes place. After evaluating the obtained data using deductive reasoning, the data is eventually interpreted. Given the fact that the research topic is in its infancy and there is not a similar case in Iran with limited number of corresponding instances across the world, the selected topic helps to shed lights on the unrevealed and neglected parts in architecture. Similarly, criticizing, investigating and comparing specific and highly prized cases in other countries with the project under study can serve as an introduction into this architecture style.

Keywords: anti-architecture, creativity, deconstruction, event

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601 The Relevance of Personality Traits and Networking in New Ventures’ Success

Authors: Caterina Muzzi, Sergio Albertini, Davide Giacomini

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The research is aimed to investigate the role of young entrepreneurs’ personality traits and their contextual background on the success of entrepreneurial initiatives. In the literature, the debate is still open about the main drivers in predicting entrepreneurial success. Classical theories are focused on looking at specific personality traits that could lead to successful start-ups initiatives, while emerging approaches are more interested in young entrepreneurs’ contextual background (such as the family of origin, the previous experience and their professional network). An online survey was submitted to the participants of an entrepreneurial training initiative organised by the Italian Young Entrepreneurs Association (Confindustria) in Brescia headquarter (AIB). At the time the authors started data collection for this research, the third edition of the initiative was just concluded and involved a total amount of 37 young future entrepreneurs. In the literature General self-efficacy (GSE) and, more specifically, entrepreneurial self-efficacy (ESE) have often been associated to positive performances, as they allow future entrepreneurs to effectively cope with entrepreneurial activities, both at an early stage and in new venture management. In a counter-intuitive manner, optimism is not always associated with entrepreneurial positive results. Too optimistic people risk taking hazardous risks and some authors suggest that moderately optimistic entrepreneurs achieve more positive results than over-optimistic ones. Indeed highly optimistic individuals often hold unrealistic expectations, discount negative information, and mentally reconstruct experiences so as to avoid contradictions The importance of context has been increasingly considered in entrepreneurship literature and its role strongly emerges starting from the earliest entrepreneurial stage and it is crucial to transform the “intention of entrepreneurship” into the actual start-up. Furthermore, coherently with the “network approach to entrepreneurship”, context embeddedness allow future entrepreneurs to leverage relationships built through previous experiences and/or thanks to the fact of belonging to families of entrepreneurs. For the purpose of this research, entrepreneurial success was measured by the fact of having or not founded a new venture after the training initiative. In this research, the authors measured GSE, ESE and optimism using already tested items that showed to be reliable also in this case. They collected 36 completed questionnaires. The t-test for independent samples run to measure significant differences in means between those that already funded the new venture and those that did not. No significant differences emerged with respect to all the tested personality traits, but a logistic regression analysis, run with contextual variables as independent ones, showed that personal and professional networking, made both before and during the master, is the most relevant variable in determining new venture success. These findings shed more light on the process of new venture foundation and could encourage national and local policy makers to invest on networking as one of the main drivers that could support the creation of new ventures.

Keywords: entrepreneurship, networking, new ventures, personality traits

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600 Association of Temperature Factors with Seropositive Results against Selected Pathogens in Dairy Cow Herds from Central and Northern Greece

Authors: Marina Sofia, Alexios Giannakopoulos, Antonia Touloudi, Dimitris C Chatzopoulos, Zoi Athanasakopoulou, Vassiliki Spyrou, Charalambos Billinis

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Fertility of dairy cattle can be affected by heat stress when the ambient temperature increases above 30°C and the relative humidity ranges from 35% to 50%. The present study was conducted on dairy cattle farms during summer months in Greece and aimed to identify the serological profile against pathogens that could affect fertility and to associate the positive serological results at herd level with temperature factors. A total of 323 serum samples were collected from clinically healthy dairy cows of 8 herds, located in Central and Northern Greece. ELISA tests were performed to detect antibodies against selected pathogens that affect fertility, namely Chlamydophila abortus, Coxiella burnetii, Neospora caninum, Toxoplasma gondii and Infectious Bovine Rhinotracheitis Virus (IBRV). Eleven climatic variables were derived from the WorldClim version 1.4. and ArcGIS V.10.1 software was used for analysis of the spatial information. Five different MaxEnt models were applied to associate the temperature variables with the locations of seropositive Chl. abortus, C. burnetii, N. caninum, T. gondii and IBRV herds (one for each pathogen). The logistic outputs were used for the interpretation of the results. ROC analyses were performed to evaluate the goodness of fit of the models’ predictions. Jackknife tests were used to identify the variables with a substantial contribution to each model. The seropositivity rates of pathogens varied among the 8 herds (0.85-4.76% for Chl. abortus, 4.76-62.71% for N. caninum, 3.8-43.47% for C. burnetii, 4.76-39.28% for T. gondii and 47.83-78.57% for IBRV). The variables of annual temperature range, mean diurnal range and maximum temperature of the warmest month gave a contribution to all five models. The regularized training gains, the training AUCs and the unregularized training gains were estimated. The mean diurnal range gave the highest gain when used in isolation and decreased the gain the most when it was omitted in the two models for seropositive Chl.abortus and IBRV herds. The annual temperature range increased the gain when used alone and decreased the gain the most when it was omitted in the models for seropositive C. burnetii, N. caninum and T. gondii herds. In conclusion, antibodies against Chl. abortus, C. burnetii, N. caninum, T. gondii and IBRV were detected in most herds suggesting circulation of pathogens that could cause infertility. The results of the spatial analyses demonstrated that the annual temperature range, mean diurnal range and maximum temperature of the warmest month could affect positively the possible pathogens’ presence. Acknowledgment: This research has been co‐financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH–CREATE–INNOVATE (project code: T1EDK-01078).

Keywords: dairy cows, seropositivity, spatial analysis, temperature factors

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599 Principles of Risk Management in Surgery Department

Authors: Mohammad H. Yarmohammadian, Masoud Ferdosi, Abbas Haghshenas, Fatemeh Rezaei

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Surgical procedures aim at preserving human life and improving quality of their life. However, there are many potential risk sources that can cause serious harm to patients. For centuries, managers believed that technical competence of a surgeon is the only key to a successful surgery. But over the past decade, risks are considered in terms of process-based safety procedures, teamwork and inter departmental communication. Aims: This study aims to determine how the process- biased surgical risk management should be done in terms of project management tool named ABS (Activity Breakdown Structure). Settings and Design: This study was conducted in two stages. First, literature review and meeting with professors was done to determine principles and framework of surgical risk management. Next, responsible teams for surgical patient journey were involved in following meeting to develop the process- biased surgical risk management. Methods and Material: This study is a qualitative research in which focus groups with the inductive approach is used. Sampling was performed to achieve representativeness through intensity sampling biased on experience and seniority. Analysis Method used: context analysis of interviews and consensus themes extracted from FDG meetings discussion was the analysis tool. Results: we developed the patient journey process in 5 main phases, 24 activities and 108 tasks. Then, responsible teams, transposition and allocated places for performing determined. Some activities and tasks themes were repeated in each phases like patient identification and records review because of their importance. Conclusions: Risk management of surgical departments is significant as this facility is the hospital’s largest cost and revenue center. Good communication between surgical team and other clinical teams outside surgery department through process- biased perspective could improve safety of patient under this procedure.

Keywords: risk management, activity breakdown structure (ABS), surgical department, medical sciences

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598 Pyridoxine Effectiveness and Safety for Postpartum Lactation Inhibition: A Systematic Review

Authors: Doua AlSaad, Ahmed Awaisu, Samah Elsalem, Palli Valapila Abdulrouf, Binny Thomas, Moza AlHail

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Background: It has been suggested that pyridoxine has an anti-lactogenic effect. Studies of the efficacy of pyridoxine in suppressing lactation have reported conflicting results. The aim of this review is to evaluate the effectiveness and safety of high-dose pyridoxine in postpartum lactation inhibition. Methods: This systematic review included published trials that compared the efficacy and/or safety of pyridoxine to placebo or to other pharmacological agents for the inhibition of postpartum lactation. We searched PubMed, Embase, ScienceDirect, CINAHL, AMED, the Cochrane library, and the clinical trials registry to identify relevant literature. No limit was imposed on the year of publication of the studies, and the review included studies published until 15 January 2016. Two reviewers independently extracted data and assessed the risk of bias. Results: Seven studies were included, with a total of 1155 women, of which 471 women received pyridoxine. Three studies were randomized controlled trials, while the remaining four studies were non-randomized controlled trials. All of the included studies were relatively small (n = 18 – 482). The studies compared pyridoxine with placebo, bromocriptine, and/or stilboestrol. Pyridoxine was given orally, with a total daily dose of 450 – 600 mg for 5 to 7 days. Two trials (n = 349 participants) indicated that pyridoxine was effective in inhibiting lactation in approximately 95% of the enrolled patients. All other studies failed to demonstrate pyridoxine efficacy through either clinical assessment or prolactin level measurements. Pyridoxine safety was assessed by two trials in which no serious untoward side-effects were reported. Overall, the risk of bias for most of the studies was low to moderate. Conclusion: Current evidence supporting the effectiveness of high dose pyridoxine in the inhibition of postpartum lactation is inconsistent and insufficient. Larger randomized trials are needed to confirm the efficacy of pyridoxine in postpartum lactation inhibition. Acknowledgment: This review received a grant from the Medical Research Center of Hamad Medical Corporation in Qatar (grant number: 15100/15).

Keywords: pyridoxine, safety, effectiveness, lactation inhibition

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597 Analysis of Post-vaccination Immunity in Children with Severe Chronic Diseases Receiving Immunosuppressive Therapy by Specific IgG Antibodies Definition Method

Authors: Marina G. Galitskaya, Svetlana G. Makarova, Andrey P. Fisenko.

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Children on medication-induced immunosuppression are at high risk of developing severe course infectious diseases. Therefore, preventive vaccination is especially important for these children. However, due to the immunosuppressive effects of treatment for the underlying disease, the effectiveness of vaccination may decrease below the protective level. In a multidisciplinary children's medical center, post-vaccination immunity was studied in 79 children aged 4-17 years. The children were divided into 2 groups: Group 1 (38 children) with kidney pathology (Nephrotic Syndrome) and Group 2 (41 children) with inflammatory bowel diseases (Ulcerative Colitis, Crohn's Disease). Both groups of children were vaccinated according to the national vaccination calendar and received immunosuppressive therapy (prednisolone, methotrexate, cyclosporine, and other drugs) for at least 1 year. Using the enzyme-linked immunosorbent assay method, specific IgG antibodies to vaccine-preventable infections were determined: measles, rubella, mumps, diphtheria, pertussis, tetanus, and hepatitis B. The study showed the percentage of children with positive IgG values for vaccine-preventable infections. The highest percentage of children had protective antibody levels to measles (84.2% in children with nephrotic syndrome and 92.6% in those with inflammatory bowel disease) and rubella (71% and 80.4%, respectively). The lowest percentage of children with protective antibodies was for hepatitis B (5.2% and 29.2% respectively). Antibodies to mumps, diphtheria, pertussis, and tetanus were found not in all children (from 39,4% to 82,9%). The remaining percentage of children did not have detectable IgG antibodies to vaccine-preventable infections. Not all children, despite the previous vaccination, preserved antibodies to vaccine-controlled infections and remained unprotected by specific IgG antibodies. The issue of a booster vaccine dose should be considered in children without contraindications to vaccination. Children receiving long-term immunosuppressive therapy require an individual vaccination approach, including a specific definition of the performed vaccination.

Keywords: immunosuppressive therapy, inflammatory bowel diseases, nephrotic syndrome, post-vaccination immunity, specific antibodies, vaccine-preventable infections.

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596 Heat Loss Control in Stave Cooled Blast Furnace by Optimizing Gas Flow Pattern through Burden Distribution

Authors: Basant Kumar Singh, S. Subhachandhar, Vineet Ranjan Tripathi, Amit Kumar Singh, Uttam Singh, Santosh Kumar Lal

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Productivity of Blast Furnace is largely impacted by fuel efficiency and controlling heat loss is one of the enabling parameters for achieving lower fuel rate. 'I' Blast Furnace is the latest and largest Blast Furnace of Tata Steel Jamshedpur with working volume of 3230 m³ and with rated capacity of 3.055 million tons per annum. Optimizing heat losses in Belly and Bosh zone remained major challenge for blast furnace operators after its commissioning. 'I' Blast has installed Cast Iron & Copper Staves cooling members where copper staves are installed in Belly, Bosh & Lower Stack whereas cast iron staves are installed in upper stack area. Stave cooled Blast Furnaces are prone to higher heat losses in Belly and Bosh region with an increase in coal injection rate as Bosh gas volume increases. Under these conditions, managing gas flow pattern through proper burden distribution, casting techniques & by maintaining desired raw material qualities are of utmost importance for sustaining high injection rates. This study details, the burden distribution control by Ore & Coke ratio adjustment at wall and center of Blast Furnace as the coal injection rates increased from 140 kg/thm to 210 kg/thm. Control of blowing parameters, casting philosophy, specification for raw materials & devising operational practice for controlling heat losses is also elaborated with the model that is used to visualize heat loss pattern in different zones of Blast Furnace.

Keywords: blast furnace, staves, gas flow pattern, belly/bosh heat losses, ore/coke ratio, blowing parameters, casting, operation practice

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595 An Ethnographic Study of Commercial Surrogacy Industry in India

Authors: Dalia Bhattacharjee

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Motherhood as an institution is considered as sacred. Reproduction and motherhood have always been a concern of the private space of home. However, with the emergence of technologies like the Assisted Reproductive Technologies (ARTs), this intimate area has moved into the public. A woman can now become a mother with artificial insemination done by expert medical professionals in a hospital. With this development, the meanings of motherhood and childrearing have altered. Mothers have been divided into ‘ovarian mothers’ (those who provide the eggs), ‘uterine mothers’ (those who carry out the pregnancy and give birth), and ‘social mothers’ (those who raise the child). Thus, the ART business deconstructs motherhood by defining who the biological mother is and who the social mother is and who – despite contributing parts or processes of her body to the life of the child is not a mother, but merely the donor of a product, be it the egg or the womb, which is owned by those who are favoured by the contract. The industry of commercial surrogacy in India has been estimated to be of $2.3 billion as of 2012. There are many women who work as surrogate mothers in this industry for the exchange of money. It runs like a full-fledged business guided by a highly profit oriented capitalist market. The reproductive labourers are identified as mere womb renters or victims and not as active agents in such arrangements. Such a discourse undercuts the agency exercised by the women. The present study is an ethnography into the commercial surrogacy industry in India. This journey furthers the understanding of the dilemmas faced by the reproductive labourers. The paper emphasizes on the experiences of reproduction and motherhood outside the private space of the home in the commercial surrogacy industry in India, and, argues that this multiplicity of experiences need much focus and attention, where, the consumer becomes ‘the’ citizen and the women workers continue to be victims. The study draws on the narratives of the reproductive labourers, who remain at the center, and yet, at the periphery of such arrangements. This feminist ethnography is informed by the feminist standpoint theory to account for and analyse these varied experiences which further the understanding of the dilemmas faced by the reproductive labourers.

Keywords: commercial surrogacy, ethnography, motherhood, standpoint theory

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594 Application of Hydrologic Engineering Centers and River Analysis System Model for Hydrodynamic Analysis of Arial Khan River

Authors: Najeeb Hassan, Mahmudur Rahman

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Arial Khan River is one of the main south-eastward outlets of the River Padma. This river maintains a meander channel through its course and is erosional in nature. The specific objective of the research is to study and evaluate the hydrological characteristics in the form of assessing changes of cross-sections, discharge, water level and velocity profile in different stations and to create a hydrodynamic model of the Arial Khan River. Necessary data have been collected from Bangladesh Water Development Board (BWDB) and Center for Environment and Geographic Information Services (CEGIS). Satellite images have been observed from Google earth. In this study, hydrodynamic model of Arial Khan River has been developed using well known steady open channel flow code Hydrologic Engineering Centers and River Analysis System (HEC-RAS) using field surveyed geometric data. Cross-section properties at 22 locations of River Arial Khan for the years 2011, 2013 and 2015 were also analysed. 1-D HEC-RAS model has been developed using the cross sectional data of 2015 and appropriate boundary condition is being used to run the model. This Arial Khan River model is calibrated using the pick discharge of 2015. The applicable value of Mannings roughness coefficient (n) is adjusted through the process of calibration. The value of water level which ties with the observed data to an acceptable accuracy is taken as calibrated model. The 1-D HEC-RAS model then validated by using the pick discharges from 2009-2018. Variation in observed water level in the model and collected water level data is being compared to validate the model. It is observed that due to seasonal variation, discharge of the river changes rapidly and Mannings roughness coefficient (n) also changes due to the vegetation growth along the river banks. This river model may act as a tool to measure flood area in future. By considering the past pick flow discharge, it is strongly recommended to improve the carrying capacity of Arial Khan River to protect the surrounding areas from flash flood.

Keywords: BWDB, CEGIS, HEC-RAS

Procedia PDF Downloads 163