Search results for: regional anesthesia and analgesia techniques (RAAT)

Authors: Joel Thomas, Alexa Squirini

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The key argument of this research is that every element of systems interoperability is an enabler of regional disaster resilience, and arguably should become a focal point for standardized measurement of communities’ ability to work together. Few resilience research efforts have focused on the development and application of solutions that measurably improve communities’ ability to work together at a regional level, yet a majority of the most devastating and disruptive disasters are those that have had a regional impact. The key findings of the research include a unique theoretical, mathematical, and operational approach to tangibly and defensibly measure and assess systems interoperability required to support crisis information management activities performed by governments, the private sector, and humanitarian organizations. A most effective way for communities to measurably improve regional disaster resilience is through deliberately executed disaster preparedness activities. Developing interoperable crisis information management capabilities is a crosscutting preparedness activity that greatly affects a community’s readiness and ability to work together in times of crisis. Thus, improving communities’ human and technical posture to work together in advance of a crisis, with the ultimate goal of enabling information sharing to support coordination and the careful management of available resources, is a primary means by which communities may improve regional disaster resilience. This model describes how systems interoperability can be qualitatively and quantitatively assessed when characterized as five forms of capital: governance; standard operating procedures; technology; training and exercises; and usage. The unique measurement framework presented defines the relationships between systems interoperability, information sharing and safeguarding, operational coordination, community preparedness and regional disaster resilience, and offers a means by which to implement real-world solutions and measure progress over the course of a multi-year program. The model is being developed and piloted in partnership with the U.S. Department of Homeland Security (DHS) Science and Technology Directorate (S&T) and the North Atlantic Treaty Organization (NATO) Advanced Regional Civil Emergency Coordination Pilot (ARCECP) with twenty-three organizations in Bosnia and Herzegovina, Croatia, Macedonia, and Montenegro. The intended effect of the model implementation is to enable communities to answer two key questions: 'Have we measurably improved crisis information management capabilities as a result of this effort?' and, 'As a result, are we more resilient?'

Keywords: disaster, interoperability, measurement, resilience

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Authors: Amrit Vasdev, Edwin Rho, Gurinder Vasdev

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Robotic surgery has enabled a new spectrum of minimally invasive breast reconstruction by improving visualization, surgeon posturing, and improved patient outcomes.1 The DaVinci robot system can be utilized in nipple sparing mastectomies and reconstructions. The process involves the insufflation of the subglandular space and a dissection of the mammary gland with a combination of cautery and blunt dissection. This case outlines a 35-year-old woman who has a long-standing family history of breast cancer and a diagnosis of a deleterious BRCA2 genetic mutation. She has decided to proceed with bilateral nipple sparing mastectomies with implants. Her perioperative mammogram and MRI were negative for masses, however, her left internal mammary lymph node was enlarged. She has taken oral contraceptive pills for 3-5 years and denies DES exposure, radiation therapy, human replacement therapy, or prior breast surgery. She does not smoke and rarely consumes alcohol. During the procedure, the patient received a standardized anesthetic for out-patient surgery of propofol infusion, succinylcholine, sevoflurane, and fentanyl. Aprepitant was given as an antiemetic and preoperative Tylenol and gabapentin for pain management. Concerns for the patient during the procedure included CO2 insufflation into the subcutaneous space. With CO2 insufflation, there is a potential for rapid uptake leading to severe acidosis, embolism, and subcutaneous emphysema.2To mitigate this, it is important to hyperventilate the patient and reduce both the insufflation pressure and the CO2 flow rate to the minimal acceptable by the surgeon. For intraoperative monitoring during this 6-9 hour long procedure, it has been suggested to utilize an Arterial-Line for end-tidal CO2 monitoring. However, in this case, it was not necessary as the patient had excellent cardiovascular reserve, and end-tidal CO2 was within normal limits for the duration of the procedure. A BIS monitor was also utilized to reduce anesthesia burden and to facilitate a prompt discharge from the PACU. Minimal Invasive Robotic Surgery will continue to evolve, and anesthesiologists need to be prepared for the new challenges ahead. Based on our limit number of patients, robotic mastectomy appears to be a safe alternative to open surgery with the promise of clearer tissue demarcation and better cosmetic results.

Keywords: anesthesia, mastectomies, robotic, hypercarbia

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Authors: Park, Yoon Hong, Wang, Jung Kab, Choi Seong-Won, Kim, Hong Kyu

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Itaewon-Ro is a special place where the Seoul Metropolitan city designated as the fist are of tourism, specially with the commercial supremacy that foreigners may like. It is the place that grew with regional specialty. Study on the vitalization factors of commercialist were analyzed on consumer shop choice factor, Physical environment based on commercial supremacy vitalization, Functional side of the road and regional specialty. However, since Itaewon seemed to take great place in the cultural factor, Because of its regional specialty, Research was processed. This study is the analysis on the vitalization of Itaewon commercialist that looked for important factors with AHP analysis on consumers use as commercialist. Based on the field study and preceded study, top three factors were distinguished with physical factor, cultural factor, landscape factor, and thirteen detail contents were found. This study focused on the choice of the consumer and with a consumer-based questionnaire, we analyzed the importance of vitalization factors. Results of the research are shown in the following paragraphs. In the Itaewon commercial market, mostly women in the 20~30s were the main consumers for meeting and hopping. Vitalization category that the consumer thinks it most importantly was 'attraction', 'various businesses', and 'convenience of transportation'. 'Attraction that cannot be seen in other places', Which was chosen as the most important factor was judged that Itaewon holds cultural identity that is shown in the process of development, Instead of showing artificial and physical composition.

Keywords: commercialist, vitalization factor, regional specialty, cultural factor, AHP analysis

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Authors: Ankit Shah, R. K. Shrivastava

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Flood and drought are two main features of hydrology which affect the human life. Floods are natural disasters which cause millions of rupees’ worth of damage each year in India and the whole world. Flood causes destruction in form of life and property. An accurate estimate of the flood damage potential is a key element to an effective, nationwide flood damage abatement program. Also, the increase in demand of water due to increase in population, industrial and agricultural growth, has let us know that though being a renewable resource it cannot be taken for granted. We have to optimize the use of water according to circumstances and conditions and need to harness it which can be done by construction of hydraulic structures. For their safe and proper functioning of hydraulic structures, we need to predict the flood magnitude and its impact. Hydraulic structures play a key role in harnessing and optimization of flood water which in turn results in safe and maximum use of water available. Mainly hydraulic structures are constructed on ungauged sites. There are two methods by which we can estimate flood viz. generation of Unit Hydrographs and Flood Frequency Analysis. In this study, Regional Flood Frequency Analysis has been employed. There are many methods for estimating the ‘Regional Flood Frequency Analysis’ viz. Index Flood Method. National Environmental and Research Council (NERC Methods), Multiple Regression Method, etc. However, none of the methods can be considered universal for every situation and location. The Narmada basin is located in Central India. It is drained by most of the tributaries, most of which are ungauged. Therefore it is very difficult to estimate flood on these tributaries and in the main river. As mentioned above Artificial Neural Network (ANN)s and Multiple Regression Method is used for determination of Regional flood Frequency. The annual peak flood data of 20 sites gauging sites of Narmada Basin is used in the present study to determine the Regional Flood relationships. Homogeneity of the considered sites is determined by using the Index Flood Method. Flood relationships obtained by both the methods are compared with each other, and it is found that ANN is more reliable than Multiple Regression Method for the present study area.

Keywords: artificial neural network, index flood method, multi layer perceptrons, multiple regression, Narmada basin, regional flood frequency

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Authors: C. G. Jinimole, A. Harsha

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One of the key problems facing in the analysis of Computed Tomography (CT) images is the poor contrast of the images. Image enhancement can be used to improve the visual clarity and quality of the images or to provide a better transformation representation for further processing. Contrast enhancement of images is one of the acceptable methods used for image enhancement in various applications in the medical field. This will be helpful to visualize and extract details of brain infarctions, tumors, and cancers from the CT image. This paper presents a comparison study of five contrast enhancement techniques suitable for the contrast enhancement of CT images. The types of techniques include Power Law Transformation, Logarithmic Transformation, Histogram Equalization, Contrast Stretching, and Laplacian Transformation. All these techniques are compared with each other to find out which enhancement provides better contrast of CT image. For the comparison of the techniques, the parameters Peak Signal to Noise Ratio (PSNR) and Mean Square Error (MSE) are used. Logarithmic Transformation provided the clearer and best quality image compared to all other techniques studied and has got the highest value of PSNR. Comparison concludes with better approach for its future research especially for mapping abnormalities from CT images resulting from Brain Injuries.

Keywords: computed tomography, enhancement techniques, increasing contrast, PSNR and MSE

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Authors: T. Davitashvili

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In this paper, some results of numerical simulation of the air flow dynamics in the troposphere over the Caucasus Mountains taking place in conditions of nonstationarity of large-scale undisturbed background flow are presented. Main features of the atmospheric currents changeability while air masses are transferred from the Black Sea to the land’s surface had been investigated. In addition, the effects of thermal and advective-dynamic factors of atmosphere on the changes of the West Georgian climate have been studied. It was shown that non-proportional warming of the Black Sea and Colkhi lowland provokes the intensive strengthening of circulation and effect of climate cooling in the western Georgia.

Keywords: regional climate, numerical simulation, local circulation, orographic effect

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Authors: Ahmad Almaududy Amri

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Southeast Asia is considered as an area which is important in terms of piratical studies. There are several reasons to this argument: firstly, it has the second highest figure of piracy attacks in the world from 2008 to 2012. Only the African Region transcends the number of piracies that were committed in Southeast Asia. Secondly, the geographical location of the region is very important to world trade. There are several sea lanes and straits which are normally used for international navigation mainly for trade purposes. In fact, there are six out of 25 busiest ports all over the world located in Southeast Asia. In ancient times, the main drivers of piracy were raiding for plunder and capture of slaves; however, in modern times, developments in politics, economics and even military technology have drastically altered the universal crime of piracy. There are a variety of motives behind modern day piracy including economic gains from receiving ransoms from government or ship companies, political and even terrorist reasons. However, it cannot be denied that piratical attacks persist and continue. States have taken measures both at the international and regional level in order to eradicate piratical attacks. The United Nations Convention on the Law of the Sea and the Convention on the Suppression of Unlawful Act against the Safety of Navigation served as the two main international legal frameworks in combating piracy. At the regional level, Regional Cooperation Agreement against Piracy and Armed Robbery and ASEAN measures are regard as prominent in addressing the piracy problem. This paper will elaborate the problems of piracy in Southeast Asia and examine the adequacy of legal frameworks at both the international and regional levels in order address the current legal measures in combating piracy. Furthermore, it will discuss current challenges in the implementation of anti-piracy measures at the international and regional levels as well as the way forward in addressing the issue.

Keywords: piracy, Southeast Asia, maritime security, legal frameworks

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Authors: Stefano Frassinelli, Alessandro Niccolai, Riccardo E. Zich

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Sport performance analysis is a technique that is becoming every year more important for athletes of every level. Many techniques have been developed to measure and analyse efficiently the performance of athletes in some sports, but in combat sports these techniques found in many times their limits, due to the high interaction between the two opponents during the competition. In this paper the problem will be framed. Moreover the physical performance measurement problem will be analysed and three different techniques to manage it will be presented. All the techniques have been used to analyse the performance of 22 high level Judo athletes.

Keywords: sport performance, physical performance, judo, performance coefficients

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Authors: Moh’d A. AL-Shboul

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Recently, and due to Arab spring and terrorism around the globe, pushing and driving most governments potentially to harmonize their border measures particularly the regional and an international transit trade within and among Customs Unions. The main purpose of this study is to investigate and provide an insight for monitoring and controlling the trade supply chain within and among different countries by using technological advancement (i.e. an electronic tracking system, etc.); furthermore, facilitate the local and intra-regional trade among countries through reviewing the recent trends and practical implementation of an electronic transit traffic and cargo that related to customs measures by introducing and supporting some case studies of several international and landlocked transit trade countries. The research methodology employed in this study was described as qualitative by conducting few interviews with managers, transit truck drivers, and traders and reviewing the related literature to collect qualitative data from secondary sources such as statistical reports, previous studies, etc. The results in this study show that Jordan and other countries around the globe that used an electronic tracking system for monitoring transit trade has led to a significant reduction in cost, effort and time in physical movement of goods internally and crossing through other countries. Therefore, there is no need to escort transit trucks by customs staff; hence, the rate of escort transit trucks is reduced by more than ninety percent, except the bulky and high duty goods. Electronic transit traffic has been increased; the average transit time journey has been reduced by more than seventy percent and has led to decrease in rates of smuggling up to fifty percent. The researcher recommends considering Jordan as regional and international office for tracking electronically and monitoring the transit trade for many considerations.

Keywords: electronic tracking system, facilitation system, regional and international corridor, supply chain security, transit trade

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Authors: Patria Yunita

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Kuznets’ environmental curve analysis suggests sacrificing economic development to reduce environmental problems. However, we hope to achieve sustainable economic development. In this case, Islamic social finance, especially that of waqf in Indonesia, can be used as a solution to bridge the problem of environmental damage to the sustainability of economic development. The Panel Logit Regression method was used to analyze the probability of increasing economic growth and the role of waqf in the environmental impact of CO₂ emissions. This study uses panel data from 33 Indonesian provinces. The data used were the National Waqf Index, Forest Area, Waqf Land Area, Growth Rate of Regional Gross Domestic Product (YoY), and CO₂ Emissions for 2018-2022. Data were obtained from the Indonesian Waqf Board, Climate World Data, the Ministry of the Environment, and the Bank of Indonesia. The results prove that CO₂ emissions have a negative effect on regional economic growth and that waqf governance in the waqf index has a positive effect on regional economic growth in 33 provinces.

Keywords: waqf, CO₂ emissions, panel logit analysis, sustainable economic development

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Authors: Xiaohan Ye

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Under the new normal situation, some urban spaces with the industrial base and regional features in Zhejiang, China have been selected to build a characteristic town, a kind of environmentally-friendly development platform with city-industry integrated, in an attempt to achieve the most optimized layout of productivity with the least space resource. After analysis on the connotation, mechanism and mode of characteristic town in Zhejiang, it is suggested in this paper that characteristic town should take improving the regional ecological environment as an important object in planning strategy from the perspective of ecological concept. Improved environmental quality, optimized resource allocation, and compact industrial distribution should be realized so as to drive the regional green and sustainable development. Finally, this paper analyzes location selection, industrial distribution, spatial organization and environment construction based on the exploration of the dream town of Zhejiang province, the first batch of provincial-level characteristic towns to demonstrate how to apply the ecological concept to the design of characteristic town.

Keywords: characteristic town, ecological concept, Hangzhou dream town, planning strategy

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Authors: Sergey Chirun

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Using of a combination of institutional analysis and network access has allowed the author to identify the characteristics of the informal institutions of regional political power and political regimes. According to the author, ‘field’ of activity of post-Soviet regimes, formed under the influence of informal institutions, often contradicts democratic institutional regional changes which are aimed at creating of a legal-rational type of political domination and balanced model of separation of powers. This leads to the gap between the formal structure of institutions and the real nature of power, predetermining the specific character of the existing political regimes.

Keywords: authoritarianism, institutions, political regime, social networks, transformation

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Authors: Stuti Modi, Aditi Kambli

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This paper addresses the need for intelligent water management and distribution system in smart cities to ensure optimal consumption and distribution of water for drinking and sanitation purposes. Water being a limited resource in cities require an effective system for collection, storage and distribution. In this paper, applications of two mostly widely used particular types of data-driven models, namely artificial neural networks (ANN) and fuzzy logic-based models, to modelling in the water resources management field are considered. The objective of this paper is to review the principles of various types and architectures of neural network and fuzzy adaptive systems and their applications to integrated water resources management. Final goal of the review is to expose and formulate progressive direction of their applicability and further research of the AI-related and data-driven techniques application and to demonstrate applicability of the neural networks, fuzzy systems and other machine learning techniques in the practical issues of the regional water management. Apart from this the paper will deal with water storage, using ANN to find optimum reservoir level and predicting peak daily demands.

Keywords: artificial neural networks, fuzzy systems, peak daily demand prediction, water management and distribution

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Authors: Vasudha Govil, Prashant Kumar, Ishwar Singh, Kiranpreet Kaur

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Traumatic brain injury leads to elevated intracranial pressure. Intraocular pressure (IOP) may also be affected by intracranial pressure. Increased venous pressure in the cavernous sinus is transmitted to the episcleral veins, resulting in an increase in IOP. All drugs used in anesthesia induction can change IOP. Irritation of the gag reflex after usage of the endotracheal tube can also increase IOP; therefore, the administration of anesthetic drugs, which make the lowest change in IOP, is important, while cardiovascular depression must also be avoided. Thiopentone decreases IOP by 40%, whereas etomidate decreases IOP by 30-60% for up to 5 minutes. Hundred patients (age 18-55 years) who underwent emergency craniotomy for TBI are selected for the study. Patients are randomly assigned to two groups of 50 patients each accord¬ing to the drugs used for induction: group T was given thiopentone sodium (5mg kg-1) and group E was given etomi¬date (0.3mg kg-1). Preanaesthesia intraocular pressure (IOP) was measured using Schiotz tonometer. Induction of anesthesia was achieved with etomidate (0.3mg kg-1) or thiopentone (5mg kg-1) along with fentanyl (2 mcg kg-1). Intravenous rocuronium (0.9mg kg-1) was given to facilitate intubation. Intraocular pressure was measured after 1 minute of induction agent administration and 5 minutes after intubation. Maintainance of anesthesia was done with isoflurane in 50% nitrous oxide with fresh gas flow of 5 litres. At the end of the surgery, the residual neuromuscular block was reversed and the patient was shifted to ward/ICU. Patients in both groups were comparable in terms of demographic profile. There was no significant difference between the groups for the hemody¬namic and respiratory variables prior to thiopentone or etomidate administration. Intraocular pressure in thiopentone group in left eye and right eye before induction was 14.97±3.94 mmHg and 14.72±3.75 mmHg respectively and for etomidate group was 15.28±3.69 mmHg and 15.54±4.46 mmHg respectively. After induction IOP decreased significantly in both the eyes (p<0.001) in both the groups. After 5 min of intubation IOP was significantly less than the baseline in both the eyes but it was more than the IOP after induction with the drug. It was found that there was no statistically significant difference in IOP between the two groups at any point of time. Both the drugs caused a significant decrease in IOP after induction and after 5 minutes of endotracheal intubation. The mechanism of decrease in IOP by intravenous induction agents is debatable. Systemic hypotension after the induction of anaesthesia has been shown to cause a decrease in intra-ocular pressure. A decrease in the tone of the extra-ocular muscles can also result in a decrease in intra-ocular pressure. We observed that it is appropriate to use etomidate as an induction agent when elevation of intra-ocular pressure is undesirable owing to the cardiovascular stability it confers in the patients.

Keywords: etomidate, intraocular pressure, thiopentone, traumatic

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Authors: M. Jayandran

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Continual professional development is an important concept for safety professionals to strengthen the knowledge base and to achieve the required qualifications or international memberships in a given time. But the main problems which have observed among most of the safety aspirants are as follows: lack of focus, inferiority complex, superiority complex, lack of interest and lethargy, family and off job stress, health issues, usage of drugs and alcohol, and absenteeism. A HSE trainer should be an expert in soft skills and other stress, emotional handling techniques, so as to manage the above aspirants during training. To do this practice, a trainer has to brainstorm himself of few of the soft skills like personnel resilience, mnemonic techniques, mind healing, and subconscious suggestion techniques by integrating with an emotional intelligence quotient of the aspirants. By adopting these techniques, a trainer can successfully deliver the course and influence the different types of audience to achieve success in training.

Keywords: personnel resilience, mnemonic techniques, mind healing, sub conscious suggestion techniques

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Authors: Aparna Datta, Mahabub Alam

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Animal welfare is comparatively new area of research in Bangladesh and welfare concern for animal is increasing day by day. The study was conducted to investigate the animal welfare violations during treatment at different level of hospitals in Bangladesh and India. This study was conducted between January and May, 2017. The recorded data (N=180) were categorized into eight major types of violation like - delay in starting treatment, non-specific treatment, surgery without anesthesia, use of unsterilized needle, rough and painful handling, fearful approach, multiple pricking during injection and use of blunt needle. Categorized groups were analyzed according to different hospitals like Upazila Veterinary Hospitals, Bangladesh (UVHs), SAQ-Teaching Veterinary Hospital, Bangladesh (SAQTVH) and Veterinary College and Research Institute, India (VCRI). Among all hospitals, violation during treatment more frequently occurred in UVH. Among all violations, surgery without anesthesia was only found in UVH (80%) and it was belong to considerable number of cases (80%). In the view of other major violations like - non-specific treatment was 69% in UVHs, 13% in SAQTVH and 5% in VCRI. Use of unsterilized instruments during treatment was also higher in UVHs (65%) than SAQTVH (5%) and VCRI (1%). But delay in starting treatment varied insignificantly and it was 26-42% across the different levels of hospitals. Although multiple pricking during injection was found 30% cases in UVH, but statistical variations with other level of hospitals were unnoticed (p>0.05). The findings of this study will help to take necessary steps to control violation against animal welfare during treatment. A comprehensive study considering all levels of hospitals including field treatment is also recommended to find out the welfare violations during treatment.

Keywords: animal welfare, treatment, veterinary hospitals, violations

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Authors: Asamaporn Puetpaiboon, Sunisa Chatmongkolchart, Nalinee Kovitwanawong, Osaree Akaraborworn

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Traumatic patients with massive bleeding require intensive resuscitation. The actual cost of anesthesia per case has never been clarified, so our study aimed to quantify the direct cost, and cost-to-charge ratio of anesthetic care in traumatic patients with intraoperative massive bleeding. This study was a prospective, observational, cost analysis study, conducted in Prince of Songkla University hospital, Thailand, with traumatic patients, of any mechanisms being recruited. Massive bleeding was defined as estimated blood loss of at least one blood volume in 24 hours, or a half of blood volume in 3 hours. The cost components were identified by the micro-costing method, and valued by the bottom-up approach. The direct cost was divided into 4 categories: the labor cost, the capital cost, the material cost and the cost of drugs. From September 2017 to August 2018, 10 patients with multiple injuries were included. Seven patients had motorcycle accidents, two patients fell from a height and another one was in a minibus accident. Two patients died on the operating table, and another two died within 48 hours. The median Sequential Organ Failure Assessment (SOFA) score was 8. The median intraoperative blood loss was 3,500 ml. The median direct cost, per case, was 250 United States Dollars (2017 exchange rate), and the cost-to-charge ratio was 0.53. In summary, the direct cost was nearly half of the hospital charge, for these traumatic patients with massive bleeding. However, our study did not analyze the indirect cost.

Keywords: cost, cost-to-charge ratio, micro-costing, trauma

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Authors: Ravi Kiran Pothamsetty, Radha Rani Ghosh, Baby Paul Thaliath

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Radiation therapy has undergone many advancements and evloved from 2D to 3D. Recently, with rapid pace of drug discoveries, cutting edge technology, and clinical trials has made innovative advancements in computer technology and treatment planning and upgraded to intensity modulated radiotherapy (IMRT) which delivers in homogenous dose to tumor and normal tissues. The present study was a hospital-based experience comparing two different conformal radiotherapy techniques for brain tumors. This analytical study design has been conducted at Regional Cancer Centre, India from January 2014 to January 2015. Ten patients have been selected after inclusion and exclusion criteria. All the patients were treated on Artiste Siemens Linac Accelerator. The tolerance level for maximum dose was 6.0 Gyfor lenses and 54.0 Gy for brain stem, optic chiasm and optical nerves as per RTOG criteria. Mean and standard deviation values of PTV98%, PTV 95% and PTV 2% in IMRT were 93.16±2.9, 95.01±3.4 and 103.1±1.1 respectively; for 3DCRT were 91.4±4.7, 94.17±2.6 and 102.7±0.39 respectively. PTV max dose (%) in IMRT and 3D-CRT were 104.7±0.96 and 103.9±1.0 respectively. Maximum dose to the tumor can be delivered with IMRT with acceptable toxicity limits. Variables such as expertise, location of tumor, patient condition, and TPS influence the outcome of the treatment.

Keywords: brain tumors, intensity modulated radiotherapy (IMRT), three dimensional conformal radiotherapy (3D-CRT), radiation therapy oncology group (RTOG)

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Authors: Karuna Sutthibenjakul, Sunisa Chatmongkolchart

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Background: Postinduction hypotension is common and occurs more often in elderly patients. We aimed to determine risk factors for hypotension after induction among elderly patients (aged 65 years and older) who underwent elective non-cardiac surgery under general anesthesia. Methods: This cohort study analyzed from 580 data between December 2017 and July 2018 at a tertiary university hospital in south of Thailand. Hypotension is defined as more than 30% decrease mean arterial pressure from baseline after induction within 20 minutes or the use of vasopressive agent to treat low blood pressure. Intraoperative parameters were blood pressure and heart rate at T0, TEI, T5, T10, T15 and T20 (immediately after arrival at operating room, time after intubation, 5, 10, 15 and 20 minutes after intubation) respectively. Results: The median age was 72.5 (68, 78) years. A prevalence of post-induction hypotension was 64.8%. The highest prevalence (39.7%) was at 15 minutes after intubation. The association of post-induction hypotension is rising with diuretic drug as preoperative medication (P-value=0.016), hematocrit level (P-value=0.031) and the degree of hypertension immediately after arrival at operating room (P-value<0.001). Increasing fentanyl dosage during induction was associated with hypotension at intubation time (P-value<0.01) and 5 minutes after intubation (P-value<0.001). There was no statistically significant difference in the increasing propofol dosage. Conclusion: The degree of hypertension immediately after arrival at operating room and increasing fentanyl dosage were a significant risk factors for postinduction hypotension in elderly patients.

Keywords: risk factors, post-induction, hypotension, elderly

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Authors: Naresh Kumar Verma

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Nuclear energy being adapted as a renewable energy source and its production by developing countries has turned into a major strategic concern and politics by the developed world. The West seem to be the sole proprietor of such energy source and any country opting for such energy production either face significant hurdles or geopolitical challenges in developing such energy source. History of West Asia is full of interference by external powers which has been integral in the incessant conflict in the region. Whether it was the creation of Israel, the Gulf war of 1991, or the invasion of Iraq in 2003, and more recently the Iranian nuclear conundrum, the soil of West Asia has always been a witness to the play of extra regional powers game. Iran, being a theocratic state has been facing such threats and challenges, regarding its intentions and its capability in such energy production. The paper will try to assess the following issues: -Politics of Renewable Energy Generation. -Geographical and strategic significance of Iran’s nuclear programme. -Challenges in the path of Iran developing nuclear energy as a RE source. -The interests of the regional and extra-regional actors in challenging Iranian Nuclear Programme.

Keywords: developing countries, geopolitics, Iran, nuclear energy, renewable energy

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Authors: Renalda El Samra, Elie Bou-Zeid, Hamza Kunhu Bangalath, Georgiy Stenchikov, Mutasem El Fadel

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The regional-scale impact of climate change over complex terrain was examined through high-resolution dynamic downscaling conducted using the Weather Research and Forecasting (WRF) model, with initial and boundary conditions from a High-Resolution Atmospheric Model (HiRAM). The analysis was conducted over the eastern Mediterranean, with a focus on the country of Lebanon, which is characterized by a challenging complex topography that magnifies the effect of orographic precipitation. Four year-long WRF simulations, selected based on HiRAM time series, were performed to generate future climate projections of extreme temperature and precipitation over the study area under the conditions of the Representative Concentration Pathway (RCP) 4.5. One past WRF simulation year, 2008, was selected as a baseline to capture dry extremes of the system. The results indicate that the study area might be exposed to a temperature increase between 1.0 and 3ºC in summer mean values by 2050, in comparison to 2008. For extreme years, the decrease in average annual precipitation may exceed 50% at certain locations in comparison to 2008.

Keywords: HiRAM, regional climate modeling, WRF, Representative Concentration Pathway (RCP)

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Authors: Christantus Begealawuh Nchongayi

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As clearly stated in goal 14 of sustainable development goals, global oceans greatly contribute to making the earth habitable for mankind. This explains why ocean governance is an important global concern today. The emerging maritime security problems and the impact of climate change on African oceans, evidenced by tropical cyclones as seen recently in the Southern region of Africa, is also an indication that maritime governance and policymaking are important elements of peace and security in Africa. Within the last decade, there have been commendable efforts towards maritime governance and policymaking in Africa, although implementation of existing maritime policies is still lacking. This paper provides a snapshot of the overall state of the maritime policymaking process in Africa. It specifically explores the challenges facing policymakers in developing national and regional maritime security strategy in the East African Community. For methodology, the paper relied on primary and secondary data. Primary data was collected from informal discussions with policymakers and key policy-making bodies in Africa, and from a survey of public opinions. The study found that the Africa Integrated Maritime Strategy (2050 AIMS) is a recent template for regional and national maritime security policymaking in Africa and that although maritime security has in the past not been prioritized in the security agenda of the East African Community, developing and aligning a regional maritime security strategy to the 2050 AIMS will result to positive regional integration outcomes in East Africa.

Keywords: 2050 Africa integrated maritime strategy, east African community, maritime policy-making, maritime security

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Authors: N. Gharooni-Dowrani, B. Gharooni-Dowrani

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The benefits of hilotherapy following orthogonathic surgery have been explored in recent years, demonstrating reduction in patient pain and swelling post-operatively. However, hilotherapy is not always widely accessible to all patients following orthognathic surgery. In this study, 50 patients were examined at Luton and Dunstable Hospital, half (25) of which used hilotherm masks post operatively and half of which opted for traditional ice packs in order to aid recovery. This study demonstrated that the use of hilotherapy reduced patient pain when analgesia need and use were analysed, as well as shortening inpatient stay. Although no current hilotherm masks are available without rental services in our trust, this study demonstrated the positive outcomes that they may bring, which may be worth future investment for our department.

Keywords: orthognathic surgery, orthodontics, hilotherapy, OMFS

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Authors: Hong Zhang, Runlian Miao, Min Zhang

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Coordinated development of Beijing-Tianjin-Hebei region is of great importance and has been emphasized by the government in recent years. Beijing-Tianjin-Hebei region accumulates a large part of S&T resources of the whole country and boasts the most influential achievements. In order to improve innovation capability of the region, universities, research institutions and enterprises from Beijing, Tianjin and Hebei have cooperated in many forms, but technological innovation is not so satisfactory due to unbalanced allocation, poor sharing and low utilization efficiency of S&T resources. Therefore, it’s very necessary to promote resources sharing, optimize their overall layout, and enhance their innovation performance, which can further deepen coordination development of the region. This study focuses on S&T resources with the methods of documents research plus field investigation and qualitative research combing plus quantitive research. It starts from the macro background of promoting coordinated development of Beijing-Tianjin-Hebei region and arrives at improving regional innovation capability. Firstly, the author makes a literature review on coordinated development of Beijing-Tianjin-Hebei region and summarizes that coordinated development has been carried forward in the major fields which lay foundation for regional innovation; secondly, analyzes current S&T resources distribution and coordinated innovation by taking key industries as the examples; based on analysis of the status quo of resources sharing and innovation in the region, the author points out problems and obstacles that holdbacks coordinated innovation of the region and at last raises some suggestions to resources sharing and regional innovation. It reaches the conclusion that an efficient management mechanism, market laws, favorable environment, model innovation and incentive measures can help to accelerate resources sharing and regional innovation in the region.

Keywords: Beijing-Tianjin-Hebei region, coordinated development, innovation, S&T resources

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Authors: Simeon Karafolas, Maciej Woźniak

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Mostly of public financing programs at national and regional level are funded from European Union sources. EU can participate directly to a national and regional program (example LEADER initiative, URBAN…) or indirectly by funding regional or national funds. Funds from European Union are provided from EU multiannual financial framework form which the annual budget is programmed. The adjusted program 2007-2013 of the EU considered commitments of almost 1 trillion Euros for the EU-28 countries. Provisions of the new program 2014-2020 consider commitments of more than 1 trillion Euros. Sustainable growth, divided to Cohesion and Competitiveness for Growth an Employment, is one of the two principal categories; the other is the preservation and management of natural resources. Through this financing process SMEs benefited of EU and public sources by receiving grants for their investments. Most of the financial instruments are available indirectly through the national financial intermediaries. Part of them is managed by the European Investment Fund. The paper focuses on the public financing to SMEs by examining case studies on divers forms of public help. It tries to distinguish the efficiency of the examined good practices and therefore try to have some conclusions on the possibility of application to other regions.

Keywords: DIFASS, grants, SMEs, public financing

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Authors: Liu Danping

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Walking space has very important historical and cultural value in ancient and even modern urban development. As far as the footpath itself is concerned, it reflects the spatial organization mode and traditional architectural construction characteristics of mountain cities. In terms of the spatial nature of streets, traditional streets contain the history of urban development and the most primitive urban life. The slow walking speed allows people to carefully perceive the space and scenery along the way. The real city life in the streets often makes people feel the cultural connotation and unique charm of the city. According to the regional characteristics of pedestrian traffic in the main urban area of Chongqing, the charm of chongqing is discussed. Based on the study of chongqing characteristic walking space elements, this paper summarizes the characteristics of Chongqing urban walking traffic, analyzes the existing problems of mountain city walking traffic, and takes Yuzhong Peninsula as an example to analyze the charm promotion strategy of urban walking traffic.

Keywords: mountain city, walking space, urban charm, urban renewal, regional culture

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Authors: Tyler D. Cesarone, Tatiana M. Wugalter

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The movement of patients from the Global North to the Global South in pursuit of inexpensive healthcare and touristic experiences dominates the academic discourse on international medical travel (IMT). However, medical travel exists in higher numbers between Global South countries as patients who lack trust in, and feel disenfranchised by, their national healthcare systems seek treatment in nearby countries. Through a review of the existing literature, this paper examines patterns of IMT in the Middle East, Southeast Asia, and Southern Africa, distinguishing North-South medical tourism from South-South intra-regional medical mobility (IRMM). Evidence from these case studies demonstrates that notions of medical distrust and disenfranchisement, rooted in low-resourced and poor quality healthcare systems, are key drivers of IRMM in the Global South. The movement of patients from lower income to proximate higher income countries not only reveals tensions between patients and their healthcare systems but widens gaps in the quality of healthcare between departing and destination countries. In analyzing these cross-regional similarities, the paper moves beyond the current literature’s focus on singular case studies to expose global patterns of South-South IRMM. This presents a shift from the traditional focus on North-South medical tourism, demonstrating how disparities in healthcare systems both influence and are influenced by IRMM.

Keywords: global South, healthcare quality, international medical travel (IMT), intra-regional medical mobility (IRMM), medical disenfranchisement, medical distrust, medical tourism

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Authors: Dinakaran Venkatachalam, Paul Chambers, Kavitha Kongara, Preet Singh

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The objective of this study is to formulate different topical preparations containing articaine and to investigate their permeation through goat skin. Initially, articaine and its hydrochloride salt were compared for in vitro permeation using Franz cell model. Goat skin samples were collected after euthanizing male goat kids purchased from the dairy goat farmers. Subcutaneous fat was removed and the skin was mounted on the donor chamber (orifice area 1.00 cm²) and drugs were applied onto the epidermis. Phosphate buffer saline (pH 7.4) was used to maintain sink condition in the receptor chamber (8 ml) of the Franz cell. Samples (0.4 ml) were collected at various intervals over 24 hours after each sampling equal volume of PBS was replaced in the receptor chamber. Articaine in the collected samples were quantified using LC/MS. The results suggested that articaine free base permeates better than its hydrochloride salt through goat skin. This study results support the fact that local anesthetics in its base form are lipophilic and thus penetrates faster through cell membranes than their salts. Later, articaine free base was formulated either using ethanol and octyl salicylate or dimethyl sulfoxide (DMSO) as penetration enhancers and was compared for in vitro permeation. The transdermal flux of articaine in the formulation containing DMSO was approximately 3.8 times higher than that of the formulation containing ethanol and octyl salicylate. Further studies to evaluate the local anesthetic efficacy of the topical formulation containing articaine for dermal anesthesia in animals have been planned.

Keywords: articaine, dermal anesthesia, local anesthetic, transdermal

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Authors: Abdullah Saeidi, Aydin Gülses, Christan Flörke

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Skin cancer of the face region is the most common type of malignancy and surgical excision is the preferred approach. However, the clinical long term results reported in the literature are still controversial. Objectives: To describe; 1. Demographical characteristics 2. Affected site, distribution and TNM classification regarding tumor type 3. Surgical aspects • Surgical removal: excision principles, safety margins, the need for secondary resection, primary reconstruction/ defect closure, anesthesia protocol, duration of hospital stay (if any) • Secondary intervention for defect closure/reconstruction: Flap technique, anesthesia protocol, duration of hospital stay (if any), postoperative wound management etc. 4. Tumor recurrences 5. Clinical outcomes 6. Studying the possible therapy approach throw Biostatistical relation and correlation between multiple Histological, diagnostics and clinical Faktors. following surgical ablation of the skin cancer of the head and neck region. Methods: Selection and statistical analysis of medical records of patients who had admitted to the Department of Oral and Maxillofacial Surgery, Universitätsklinikum Schleswig Holstein, Campus Kiel during the period of 2015-2019 will be retrospectively evaluated. Data will be collected via ORBIS Information-Management-System (ORBIS AG, Saarbrücken, Germany).

Keywords: non melanoma skin cancer, face skin cancer, skin reconstruction, non melanoma skin cancer recurrence, non melanoma skin cancer metastases

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Authors: Qinke Sun, Liang Zhou

Abstract:

The ‘Dragon-Elephant Debate’ between China and India is an important manifestation of global multipolarity in the 21st century. The two rising powers have carried out economic reforms one after another in the interval of more than ten years, becoming the fastest growing developing country and emerging economy in the world. At the same time, the development differences between China and India have gradually attracted wide attention of scholars. Based on the continuous annual night light data (DMSP-OLS) from 1992 to 2012, this paper systematically compares and analyses the regional development differences between China and India by Gini coefficient, coefficient of variation, comprehensive night light index (CNLI) and hot spot analysis. The results show that: (1) China's overall expansion from 1992 to 2012 is 1.84 times that of India, in which China's change is 2.6 times and India's change is 2 times. The percentage of lights in unlighted areas in China dropped from 92% to 82%, while that in India from 71% to 50%. (2) China's new growth-oriented cities appear in Hohhot, Inner Mongolia, Ordos, and Urumqi in the west, and the declining cities are concentrated in Liaoning Province and Jilin Province in the northeast; India's new growth-oriented cities are concentrated in Chhattisgarh in the north, while the declining areas are distributed in Uttar Pradesh. (3) China's differences on different scales are lower than India's, and regional inequality of development is gradually narrowing. Gini coefficients at the regional and provincial levels have decreased from 0.29, 0.44 to 0.24 and 0.38, respectively, while regional inequality in India has slowly improved and regional differences are gradually widening, with Gini coefficients rising from 0.28 to 0.32. The provincial Gini coefficient decreased slightly from 0.64 to 0.63. (4) The spatial pattern of China's regional development is mainly east-west difference, which shows the difference between coastal and inland areas; while the spatial pattern of India's regional development is mainly north-south difference, but because the southern states are sea-dependent, it also reflects the coastal inland difference to a certain extent. (5) Beijing and Shanghai present a multi-core outward expansion model, with an average annual CNLI higher than 0.01, while New Delhi and Mumbai present the main core enhancement expansion model, with an average annual CNLI lower than 0.01, of which the average annual CNLI in Shanghai is about five times that in Mumbai.

Keywords: spatial pattern, spatial difference, DMSP-OLS, China, India

Procedia PDF Downloads 151