Search results for: visual outcome

Authors: Cajethan U. Ugwuoke

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Agriculture is taught in secondary schools to develop skills in students which will empower them to contribute to national economic development. Unfortunately, our educational system emphasizes the application of conventional teaching methods in delivering instructions, which fails to produce students competent enough to carry out agricultural production. This study was therefore aimed at examining the application of digital technologies as tools for transformative instructional delivery. Four specific purposes, research questions and hypotheses guided the study. The study adopted a descriptive survey research design where 80 subjects representing 64 teachers of agriculture and 16 principals in the Udenu local government area of Enugu State, Nigeria, participated in the study. A structured questionnaire was used to collect data. The assumption of normality was ascertained by subjecting the data collected to a normality test. Data collected were later subjected to mean, Pearson product-moment correlation, ANOVA and t-test to answer the research questions and test the hypotheses at a 5% significant level. The result shows that the application of digital technologies helps to reduce learners’ boredom (3.52.75), improves learners’ performance (3.63.51), and is used as a visual aid for learners (3.56.61), among others. There was a positive, strong and significant relationship between the application of digital technologies and effective instructional delivery (+.895, p=.001<.05, F=17.73), competency of teachers to the application of digital technologies and effective instructional delivery (+998, p=.001<0.5, F=16263.45), and frequency of the application of digital technologies and effective instructional delivery (+.999, p=.001<.05, F=31436.14). There was no evidence of autocorrelation and multicollinearity in the regression models between the application of digital technologies and effective instructional delivery (2.03, Tolerance=1.00, VIF=1.00), competency of teachers in the application of digital technologies and effective instructional delivery (2.38, Tolerance=1.00, VIF=1.00) and frequency of the application of digital technologies and effective instructional delivery (2.00, Tolerance=1.00, VIF=1.00). Digital technologies should be therefore applied in teaching to facilitate effective instructional delivery in agriculture.

Keywords: agricultural science, digital technologies, instructional delivery, learning

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Authors: Deepak Nathiya1, Ramesh Roop Rai, Pratima Singh1, Preeti Raj1, Supriya Suman, Balvir Singh Tomar

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Background: Sarcopenia is a catabolic state in liver cirrhosis (LC), accelerated with a breakdown of skeletal muscle to release amino acids which adversely affects survival, health-related quality of life, and response to any underlying disease. The primary objective of the study was to investigate the long-term effect of branched-chain amino acids (BCAA) supplementations on parameters associated with improved prognosis in sarcopenic patients with LC, as well as to evaluate its impact on cirrhotic-related events. Methods: We carried out a 24 week, single-center, randomized, open-label, controlled, two cohort parallel-group intervention trial comparing the efficacy of BCAA against lactoalbumin (L-ALB) on 106 sarcopenic liver cirrhotics. The BCAA (intervention) group was treated with 7.2 g BCAA per whereas, the lactoalbumin group was also given 6.3 g of L-Albumin. The primary outcome was to assess the impact of BCAA on parameters of sarcopenia: muscle mass, muscle strength, and physical performance. The secondary outcomes were to study combined survival and maintenance of liver function changes in laboratory and clinical markers in the duration of six months. Results: Treatment with BCAA leads to significant improvement in sarcopenic parameters: muscle strength, muscle function, and muscle mass. The total cirrhotic-related complications and cumulative event-free survival occurred fewer in the BCAA group than in the L-ALB group. Prognostic markers also improved significantly in the study. Conclusion: The current clinical trial demonstrated that long-term BCAAs supplementation improved sarcopenia and prognostic markers in patients with advanced liver cirrhosis.

Keywords: sarcopenia, liver cirrhosis, BCAA, quality of life

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Authors: Abir Dey, Shams Noman

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Introduction: Offshore Island is the remote and isolated area from the terrestrial mainland. They are deprived of their needs. The children from an offshore island are usually underserved in the case of health care because it is a remote area where the health care systems are quite poor compared to mainland. So, the proper information is required for appropriate planning to reduce underlying causes behind visual deprivation among the surviving children of the Offshore Island. Purpose: The purpose of this study was to determine ocular morbidities, knowledge, and barriers of eye care services among children in an Offshore Island. Methods: The study team visited, and all data were collected from different rural communities at Sandwip Upazila, Chittagong district for screening the children aged 5-16 years old by doing spot examination. The whole study was conducted in both qualitative and quantitative methods. To determine ocular status of children, examinations were done under skilled Ophthalmologists and Optometrists. A focus group discussion was held. The sample size was 490. It was a community based descriptive study and the sampling method was purposive sampling. Results: In total 490 children, about 56.90% were female and 43.10% were male. Among them 456 were school-going children (93.1%) and 34 were non-school going children (6.9%). In this study the most common ocular morbidity was Allergic Conjunctivitis (35.2%). Other mentionable ocular morbidities were Refractive error (27.7%), Blepharitis (13.8%), Meibomian Gland Dysfunction (7.5%), Strabismus (6.3%) and Amblyopia (6.3%). Most of the non-school going children were involved in different types of domestic work like farming, fishing, etc. About 90.04% children who had different ocular abnormalities could not attend to the doctor due to various reasons. Conclusions: The ocular morbidity was high in rate on the offshore island. Eye health care facility was also not well established there. Awareness should be raised about necessity of maintaining hygiene and eye healthcare among the island people. Timely intervention through available eye care facilities and management can reduce the ocular morbidity rate in that area.

Keywords: morbidities, screening, barriers, offshore island, knowledge

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Authors: Ratnakar Rao, Subair Khan, Hari Haran

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Posterior cruciate ligament (PCL) avulsion fractures is a rare condition and commonly mismanaged.Surgical reattachment has been shown to produce better result compared with conservative management.Only few techniques are reported in arthroscopic fixation of PCL Avulsion Fracture and they are complex.We describe a new technique in fixation of the PCL Avulsion fracture through a posterior trans septal portal using button fixation device (Mini Tight Rope). Eighteen patients with an isolated posterior cruciate ligament avulsion fracture were operated under arthroscopy. Standard Antero Medial Portal and Antero Lateral portals made and additional Postero Medial and Postero Lateral portals made and trans Septal portal established. Avulsion fracture identified, elevated, prepared. Reduction achieved using PCL Tibial guide (Arthrex) and fixation was achieved using Mini Tight Rope,Arthrex (2 buttons with a suture). Reduction confirmed using probe and Image intensifier. Postoperative assessment made clinically and radiologically. 15 patients had good to excellent results with no posterior sag or instability. The range of motion was normal. No complications were recorded per operatively. 2 patients had communition of the fragment while drilling, for one patient it was managed by suturing technique and the second patient PCL Reconstruction was done. One patient had persistent instability with poor outcome. Establishing trans septal portal helps in better visualization of the posterior compartment of the knee. Assessment of the bony fragment, preparation 0f the bone bed andit protects from injury to posterior neurovascular structures. Fixation using the button with suture (Mini Tight Rope) is stable and easily reproducible for PCL Avulsion fracture with single large fragment.

Keywords: PCL avulsion, arthroscopy, transeptal, minitight rope technique

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Authors: Ramanish Ravishankar, Azar Hussain, Mahmoud Loubani, Mubarak Chaudhry

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Background and Aims: Currently, there are no strict guidelines in cardiopulmonary bypass temperature management in cardiac surgery not involving the aortic arch. This study aims to compare patient outcomes undergoing mild hypothermia and normothermia. The aim of this study was to compare patient outcomes between mild hypothermia and normothermia undergoing on-pump cardiac surgery not involving the aortic arch. Methods: This was a retrospective cohort study from January 2015 until May 2023. Patients who underwent cardiac surgery with cardiopulmonary bypass temperatures ≥32oC were included and stratified into mild hypothermia (32oC – 35oC) and normothermia (>35oC) cohorts. Propensity matching was applied through the nearest neighbour method (1:1) using the risk factors detailed in the EuroScore using RStudio. The primary outcome was mortality. Secondary outcomes included post-op stay, intensive care unit readmission, re-admission, stroke, and renal complications. Patients who had major aortic surgery and off-pump operations were excluded. Results: Each cohort had 1675 patients. There was a significant increase in overall mortality with the mild hypothermia cohort (3.59% vs. 2.32%; p=0.04912). There was also a greater stroke incidence (2.09% vs. 1.13%; p=0.0396) and transient ischaemic attack (TIA) risk (3.1% vs. 1.49%; p=0.0027). There was no significant difference in renal complications (9.13% vs. 7.88%; p=0.2155). Conclusions: Patient’s who underwent mild hypothermia during cardiopulmonary bypass have a significantly greater mortality, stroke, and transient ischaemic attack incidence. Mild hypothermia does not appear to provide any benefit over normothermia and does not appear to provide any neuroprotective benefits. This shows different results to that of other major studies; further trials and studies need to be conducted to reach a consensus.

Keywords: cardiac surgery, therapeutic hypothermia, neuroprotection, cardiopulmonary bypass

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Authors: S. Haque, M. Kanapathy, E. Bollen, I. Younis, A. Mosahebi

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Background: Implant loss due to infection is the most devastating complication of implant-based breast reconstruction. The use of negative pressure wound therapy with instillation (NPWTi) for salvage of infected implant-based breast reconstructions has shown promising results to allow early reinsertion of a new implant as an alternative to current management of delayed reinsertion. This study compares the cost implication of NPWTi against current management of delayed reinsertion of infected breast implants. Methods: 20 cases of an infected breast implant treated with NPWTi (V.A.C. VERAFLO™ Therapy) followed by early re-insertion of a new implant were compared with 20 cases who had delayed reinsertion (non-NPWTi). Average cost per person was calculated using total operative expenses, cost of inpatient stay, cost of investigations, cost of antibiotics, and cost of outpatient visits. Results: Treatment with NPWTi allowed for earlier re-insertion of a new implant (NPWTi: 9.04 ± 2.92 days vs. non-NPWTi: 236.25 ± 123.89 days). The average cost per patient for NPWTi and non-NPWTi was £14,343.13 ± £2,786.70 and £8,920.31 ± £3,005.73 respectively. All patients treated with NPWTi had one admission and spent 11.9 ± 4.1days as an inpatient while non-NPWTi patients had 2.1 ± 0.3 admissions with total length of inpatient stay of 7.1 ± 5.8days. Patients treated with NPWTi had more surgeries (NPWTi: 3.35 ± 0.81 vs. non-NPWTi: 2.2 ± 0.41), however 3 non-NPWTi cases required flap reconstruction. Patients treated with NPWTi had fewer total outpatient visits (NPWTi: 12 ± 6 vs. non-NPWTi: 14.2 ± 6.3). Conclusion: Patients treated with NPWTi incurred higher average cost per patient, longer inpatient stay, and more procedures; however, had early re-insertion of new implants and fewer admissions and outpatient visits. A further study on patient-reported outcome is essential to compare cost against patient benefit.

Keywords: breast reconstruction, cost evaluation, infection, negative pressure wound therapy

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Authors: Umar Rehman, Holly Roy, K. T. Tsang, D. S. Jeyaretna, W Singleton, B. Fisher, P. A. Glew, J. Greig, Peter C. Whitfield

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Introduction: A brain abscess is a life-threatening condition, carrying significant mortality. It requires rapid identification and treatment. Management involves a combination of antibiotics and surgery. The aim of the current study was to identify common bacteria responsible for cerebral abscesses as well as the long term functional and neurological outcomes of patients following treatment in a retrospective series at a single UK neurosurgical centre. Methodology: We analysed patients that had received a diagnosis of 'cerebral abscess' or 'subdural empyema' between June 2002 and June 2018. This was done in the form of a retrospective review. The search resulted in a total of 180 patients; with 37 patients being excluded (spinal abscess, below 18 or non-abscess related admissions). Data were collected from medical case notes including information about demographics, comorbidities, immunosuppression, presentation, size/location of lesions, pathogens, treatment, and outcomes. Results: In total, we analysed 143 patients between the ages of 18-90. Focal neurological deficit and headaches were seen in 84% and 68% of patients respectively. 108 positive brain cultures were seen; with the largest proportion, 59.2% being gram-positive cocci, with strep intermedius being the most common pathogen identified in 13.9% of patients. Of the patients with positive blood cultures (n=11), 72.7% showed the same organism both in the blood and on the brain cultures. Long term outcomes (n=72) revealed that 48% of patients seizure-free without requiring anti-epileptics, 51.3% of patients had full recovery of their neurological symptoms. There was a mortality rate of 13.9% in the series. Conclusion: In conclusion, the largest bacterial cause of abscess within our population was due to gram-positive cocci. The majority of the patient demonstrated full neurological recovery with close to half of patients not requiring anti-epileptics following discharge.

Keywords: bacteria, cerebral abscess, long term outcome, neurological deficit

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Authors: T. Nishimura, K. Doi, H. Fujimoto, Y. Hoshikawa, T. Wada

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In Japan, it is expected that reasonable accommodation for persons with disabilities will progress further. In particular, there is an urgent need to enhance information support for visually impaired persons who have difficulty accessing information. Recently, tactile symbols have been attached to various surfaces, such as the content labels of containers and packaging of various everyday products. The advantage of tactile symbols is that they are useful for visually impaired persons who cannot read Braille. The method of displaying tactile symbols is prescribed by the International Organization for Standardization (ISO). However, the quantitative data on the shapes and dimensions of tactile symbols is insufficient. In this study, through an evaluation experiments, we examine the easy-to-distinguish shapes and dimensions of tactile symbols used for various applications, including the content labels on containers and packaging. Visually impaired persons participated in the experiments. They used tactile symbols on a daily basis. The details and processes of the experiments were orally explained to the participants prior to the experiments, and the informed consent of the participants was obtained. They were instructed to touch the test pieces of tactile symbols freely with both hands. These tactile symbols were selected because they were likely to be easily distinguishable symbols on the content labels of top surfaces of containers and packaging based on a hearing survey that involved employees of an organization of visually impaired and a social welfare corporation, as well as academic experts of support technology for visually impaired. The participants then answered questions related to ease of distinguishing of tactile symbols on a scale of 5 (where 1 corresponded to ‘difficult to distinguish’ and 5 corresponded to ‘easy to distinguish’). Hearing surveys were also performed in an oral free answer manner with the participants after the experiments. This study revealed the shapes and dimensions regarding easily distinguishable tactile symbols attached to containers and packaging. We expect that this knowledge contributes to improvement of the quality of life of visually impaired persons.

Keywords: visual impairment, accessible design, tactile symbol, containers and packaging

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Authors: Piotr Muzyk, Beata Morawiec, Mariusz Opara, Andrzej Tomasik, Brygida Przywara-Chowaniec, Wojciech Jachec, Ewa Nowalany-Kozielska, Damian Kawecki

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Background: Coronary bifurcation is one of the most complex lesion in patients with coronary ar-tery disease. Provisional T-stenting is currently one of the recommended techniques. The aim was to assess optimal methods of treatment in the era of drug-eluting stents (DES). Methods: The regis-try consisted of data from 1916 patients treated with coronary percutaneous interventions (PCI) using either first- or second-generation DES. Patients with bifurcation lesion entered the analysis. Major adverse cardiac and cardiovascular events (MACCE) were assessed at one year of follow-up and comprised of death, acute myocardial infarction (AMI), repeated PCI (re-PCI) of target ves-sel and stroke. Results: Of 1916 registry patients, 204 patients (11%) were diagnosed with bifurcation lesion >50% and entered the analysis. The most commonly used technique was provi-sional T-stenting (141 patients, 69%). Optimization with kissing-balloons technique was performed in 45 patients (22%). In 59 patients (29%) second-generation DES was implanted, while in 112 pa-tients (55%), first-generation DES was used. In 33 patients (16%) both types of DES were used. The procedure success rate (TIMI 3 flow) was achieved in 98% of patients. In one-year follow-up, there were 39 MACCE (19%) (9 deaths, 17 AMI, 16 re-PCI and 5 strokes). Provisional T-stenting resulted in similar rate of MACCE to other techniques (16% vs. 5%, p=0.27) and similar occurrence of re-PCI (6% vs. 2%, p=0.78). The results of post-PCI kissing-balloon technique gave equal out-comes with 3% vs. 16% of MACCE in patients in whom no optimization technique was used (p=0.39). The type of implanted DES (second- vs. first-generation) had no influence on MACCE (4% vs 14%, respectively, p=0.12) and re-PCI (1.7% vs. 51% patients, respectively, p=0.28). Con-clusions: The treatment of bifurcation lesions with PCI represent high-risk procedures with high rate of MACCE. Stenting technique, optimization of PCI and the generation of implanted stent should be personalized for each case to balance risk of the procedure. In this setting, the operator experience might be the factor of better outcome, which should be further investigated.

Keywords: coronary bifurcation, drug eluting stents, long-term follow-up, percutaneous coronary interventions

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Authors: Obasa Joshua Ifeoluwa

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Phonetics is the foundation and most important part of language learning. This article, through an acoustic experiment as well as using Praat software, uses Yoruba students’ Chinese consonants, vowels, and tones pronunciation to carry out a visual comparison with that of native Chinese speakers. This article is aimed at Yoruba native speakers learning Chinese phonetics; therefore, Yoruba students are selected. The students surveyed are required to be at an elementary level and have learned Chinese for less than six months. The students selected are all undergraduates majoring in Chinese Studies at the University of Lagos. These students have already learned Chinese Pinyin and are all familiar with the pinyin used in the provided questionnaire. The Chinese students selected are those that have passed the level two Mandarin proficiency examination, which serves as an assurance that their pronunciation is standard. It is discovered in this work that in terms of Mandarin’s consonants pronunciation, Yoruba students cannot distinguish between the voiced and voiceless as well as the aspirated and non-aspirated phonetics features. For instance, while pronouncing [ph] it is clearly shown in the spectrogram that the Voice Onset Time (VOT) of a Chinese speaker is higher than that of a Yoruba native speaker, which means that the Yoruba speaker is pronouncing the unaspirated counterpart [p]. Another difficulty is to pronounce some affricates like [tʂ]、[tʂʰ]、[ʂ]、[ʐ]、 [tɕ]、[tɕʰ]、[ɕ]. This is because these sounds are not in the phonetic system of the Yoruba language. In terms of vowels, some students find it difficult to pronounce some allophonic high vowels such as [ɿ] and [ʅ], therefore pronouncing them as their phoneme [i]; another pronunciation error is pronouncing [y] as [u], also as shown in the spectrogram, a student pronounced [y] as [iu]. In terms of tone, it is most difficult for students to differentiate between the second (rising) and third (falling and rising) tones because these tones’ emphasis is on the rising pitch. This work concludes that the major error made by Yoruba students while pronouncing Chinese sounds is caused by the interference of their first language (LI) and sometimes by their lingua franca.

Keywords: Chinese, Yoruba, error analysis, experimental phonetics, consonant, vowel, tone

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Authors: Yasser Aboel-Magd

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This research addresses the critical issue of accessibility for individuals with special needs and the broader implications of disability on one's ability to lead an independent and integrated life within society. It highlights the consequences of injury, illness, or disability not only on the physical level but also on psychological, social, educational, economic, and functional aspects of life. The study emphasizes the importance of inclusive design in urban spaces, reflecting on how a society's treatment of individuals with disabilities serves as a measure of its progress. The research delves into the challenges faced by people with special needs in the Kingdom, where, despite advancements in various sectors, there is a noticeable lack of accommodating public opportunities for this significant demographic. It argues for the necessity of a Saudi building code that considers the needs of a diverse population during the design phase. The paper discusses the role of urban space as a fundamental element in urban formation and its impact on the societal integration of individuals with special needs. The study explores a variety of inclusive design principles, ranging from physical features like ramps and tactile paving to digital and cognitive accessibility measures such as screen readers, closed captions, plain language, and visual aids. It also considers the impact of wayfinding and appropriate lighting design on the orientation and assistance of individuals within urban spaces at the lowest cost. The researchers connect inclusive design with sustainable practices, advocating for environments that are not only environmentally friendly but also adaptable and lasting. The paper concludes with the assertion that the integration of accessibility, universal design, and sustainability signifies a society's commitment to inclusivity and the empowerment of all individuals, paving the way for a future where everyone can participate fully and independently in society.

Keywords: accessibility, inclusive design, Saudi building code, disability inclusion, socioeconomic progress

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Authors: Zahra R. Almansoor

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Background: Selective serotonin reuptake inhibitors (SSRI’s) and cognitive behavioural therapy (CBT) are the main treatment methods used for patients with obsessive compulsive disorder (OCD) under the National Institute of Health and Care Excellence (NICE) guidelines. Yet many patients are left with residual symptoms or remit, so several other therapeutic approaches have been explored. Objective: The objective was to systematically review the available literature regarding the treatment efficacy of current and potential approaches and diagnostic strategies. Method: First, studies were examined concerning diagnosis, prognosis, and influencing factors. Then, one reviewer conducted a systematic search of six databases using stringent search terms. Results of studies exploring the efficacy of treatment interventions were analysed and compared separately for adults and children. This review was limited to randomised controlled trials (RCT’s) conducted from 2016 onwards, and an improved Y-BOCS (Yale- Brown obsessive compulsive scale) score was the primary outcome measure. Results: Technology-based interventions including internet-based cognitive behavioural therapy (iCBT) were deemed as potentially effective. Discrepancy remains about the benefits of SSRI use past one year, but potential medication adjuncts include amantadine. Treatments such as association splitting and family and mindfulness strategies also have future potential. Conclusion: A range of potential therapies exist, either as treatment adjuncts to current interventions or as sole therapies. To further improve efficacy, it may be necessary to remodel the current NICE stepped-care model, especially regarding the potential use of lower intensity, cheaper treatments, including iCBT. Although many interventions show promise, further research is warranted to confirm this.

Keywords: family and group treatment, mindfulness strategies, novel treatment approaches, standard treatment, technology-based interventions

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Authors: Deonie Botha

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Digital transformation and the digitization of occupational health and safety training have grown exponentially due to a variety of contributing factors. The literature suggests that digitalization has numerous benefits but also has associated challenges. The aim of the paper is to develop an understanding of both the perceived benefits and challenges of digitalization in an occupational health and safety context in an effort to design and develop e-learning interventions that will optimize the benefits of digitalization and address the associated challenges. The paper proposes, deliberate and tests the design principles of an e-learning intervention to ensure alignment with the requirements of a digitally transformed environment. The results of the research are based on a literature review regarding the requirements and effect of the Fourth Industrial Revolution on learning and e-learning in particular. The findings of the literature review are enhanced with empirical research in the form of a case study conducted in an organization that designs and develops e-learning content in the occupational health and safety industry. The primary findings of the research indicated that: (i) The requirements of learners and organizations in respect of e-learning are different than previously (i.e., a pre-Fourth Industrial Revolution related work setting). (ii) The design principles of an e-learning intervention need to be aligned with the entire value chain of the organization. (iii) Digital twins support and enhance the design and development of e-learning. (iv)Learning should incorporate a multitude of sensory experiences and should not only be based on visual stimulation. (v) Data that are generated as a result of e-learning interventions should be incorporated into big data streams to be analyzed and to become actionable. It is therefore concluded that there is general consensus on the requirements that e-learning interventions need to adhere to in a digitally transformed occupational health and safety work environment. The challenge remains for organizations to incorporate data generated as a result of e-learning interventions into the digital ecosystem of the organization.

Keywords: digitalization, training, fourth industrial revolution, big data

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Authors: WonSun Chen, James Boylan, Erwin Muharemovic, Denny Meyer

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In Australia, drivers aged between 18 and 24 remained at high risk of road fatality over the last decade. Despite the successful implementation of the Graduated Licensing System (GLS) that supports young drivers in their early phases of driving, the road fatality statistics for these drivers remains high. In response to these statistics, studies conducted in Australia prior to the start of the COVID-19 pandemic have demonstrated the benefits of using telematics devices for improving driving behaviour, However, the impact of COVID-19 lockdown on young drivers’ driving behaviour has emerged as a global concern. Therefore, this naturalistic study aimed to evaluate and compare the driving behaviour(such as acceleration, braking, speeding, etc.) of young drivers with the adoption of in-vehicle telematics devices. Forty-two drivers aged between 18 and 30 and residing in the Australian state of Victoria participated in this study during the period of May to October 2022. All participants drove with the telematics devices during the first 30-day. At the start of the second 30-day, twenty-one participants were randomised to an intervention group where they were provided with an additional telematics ray device that provided visual feedback to the drivers, especially when they committed to aggressive driving behaviour. The remaining twenty-one participants remined their driving journeys without the extra telematics ray device (control group). Such trustworthy data enabled the assessment of changes in the driving behaviour of these young drivers using a machine learning approach in Python. Results are expected to show participants from the intervention group will show improvements in their driving behaviour compared to those from the control group.Furthermore, the telematics data enable the assessment and quantification of such improvements in driving behaviour. The findings from this study are anticipated to shed some light in guiding the development of customised campaigns and interventions to further address the high road fatality among young drivers in Australia.

Keywords: driving behaviour, naturalistic study, telematics data, young drivers

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Authors: Eveline Muika Kabongo, Peter Delobelle, Ferdinand Mukumbang, Edward Nicol

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Introduction: Studies have been conducted to establish the effect of the MomConnect program in South Africa, but these studies did not focus on the stakeholders' and implementers' perspectives and the underlying program theory of the MomConnect initiative program. We strived to obtain stakeholders’ perspectives and assumptions on the MomConnect program and develop an initial program theory (IPT) of how the MomConnect initiative was expected to work. Methods: A realist-informed explanatory design used. The interviewer was performed with 10 key informants selected purposively among MomConnect key informants at the a national level of NDoH South Africa. The interview was done via zoom and lasted for 30 to 60 minutes. Introduction and abduction inferencing approaches were applied. The deductive and inductive approaches were performed during the analysis. ICAMO hereustic framework was used to analysed the data in order to get key informants expectations on how the MomConnect will work or not. Results: We developed three folk’s theories illustrating how the key informants’ expected the MomConnect to work. These theories showed that the MomConnect intended to provide users with health information and education that will empower and motivate them with knowledge which will allow the improvement of health services delivery among HCPs and improvement of the uptake of MCH services among pregnant women and mothers and decrease the rate of maternal and child mortality in the country. The lack of an updated mechanism to link women to the outcome was an issue. Another problem enlightened was the introduction of the WhatsApp program instead of SMS messaging, which was free of charge to women. Conclusion: The Folk’s theory developed from this study provided an insight into how the MomConnect was expected to work and what did not work. The folk’s theory will be merged with information from candidate theories on synthesis review and document review to develop our initial program theory of the MomConnect initiative.

Keywords: mHealth, MomConnect program, realist evaluation, maternal and child health, maternal and child health services, introduction, theory-driven

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Authors: Ranjit Kumar Sahu, Ramakar Jha

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Urban Water Management is the practice of managing freshwater, waste water, and storm water as components of a basin-wide management plan. It builds on existing water supply and sanitation considerations within an urban settlement by incorporating urban water management within the scope of the entire river basin. The pervasive problems generated by urban development have prompted, in the present work, to study the spatial extent of urbanization in Golden Triangle of Odisha connecting the cities Bhubaneswar (20.2700° N, 85.8400° E), Puri (19.8106° N, 85.8314° E) and Konark (19.9000° N, 86.1200° E)., and patterns of periodic changes in urban development (systematic/random) in order to develop future plans for (i) urbanization promotion areas, and (ii) urbanization control areas. Remote Sensing, using USGS (U.S. Geological Survey) Landsat8 maps, supervised classification of the Urban Sprawl has been done for during 1980 - 2014, specifically after 2000. This Work presents the following: (i) Time series analysis of Hydrological data (ground water and rainfall), (ii) Application of SWMM (Storm Water Management Model) and other soft computing techniques for Urban Water Management, and (iii) Uncertainty analysis of model parameters (Urban Sprawl and correlation analysis). The outcome of the study shows drastic growth results in urbanization and depletion of ground water levels in the area that has been discussed briefly. Other relative outcomes like declining trend of rainfall and rise of sand mining in local vicinity has been also discussed. Research on this kind of work will (i) improve water supply and consumption efficiency (ii) Upgrade drinking water quality and waste water treatment (iii) Increase economic efficiency of services to sustain operations and investments for water, waste water, and storm water management, and (iv) engage communities to reflect their needs and knowledge for water management.

Keywords: Storm Water Management Model (SWMM), uncertainty analysis, urban sprawl, land use change

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Authors: Ladda Silanoi

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One of the main purposes in establishment of ASEAN Community is educational development. All countries in ASEAN shall then prepare for plans and strategies for country development. Therefore, Thailand set up the policy concerning educational management for all educational institutions to understand about ASEAN Community. However, some educational institutions lack of precision in determining the curriculums of ASEAN Community, especially schools in rural areas, for example, schools along the common border with Laos, and Cambodia. One of the effective methods to promote the precision in ASEAN Community is to design additional learning courses. The important process of additional learning courses design is to provide learning outcomes of ASEAN Community for course syllabus determination. Therefore, the researcher is interested in developing teachers in the schools of common border with Laos, and Cambodia to provide learning outcomes and learning process. This research has the objective of developing the learning outcomes and learning process management of basic education along Thailand, Laos, and Cambodia Common Border for the ASEAN Community Preparation. Research methodology consists of 2 steps. Step 1: Delphi Technique was used to provide guidelines in development of learning outcomes and learning process. Step 2: Action Research procedures was employed to study the result of additional learning courses design. Result of the study: By using Delphi technique, consensus is expected to be achieved, from 50 experts in the study within 3 times of the survey. The last survey found that experts’ opinions were compatible on every item (inter-quartile range = 0) leading to the arrangement of training courses in step of Action Research. The result from the workshop found that teachers in schools of Srisaket and Bueng Kan provinces could be able to provide learning outcomes of all courses.

Keywords: learning outcome and learning process, basic education, ASEAN Community preparation, Thailand Laos and Cambodia common border

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Authors: Tesfahiwot Abay Weldearegay

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Ethiopian Federal ministry of health, in collaboration with different partners, provides financial support from sustainable development grants and global fund budget sources to Regional health science colleges through the regional health bureau to improve the quality of training and avail professionals based on the regional health bureau demand from the year of 2012 to 2019EC. It was mainly focused on health extension workers (HEW) Level III&IV, Health Information technicians (HIT), Emergency Medical technicians (EMT), laboratory technicians, Pharmacy technicians, Anesthesia Level V, Radiography, midwifery, Environmental health and biomedical equipment technician. Laboratory technician, Radiography and Pharmacy technician, was retooling program. The study aims at assessing the Utilization and outcome of budgets transferred through regional health bureau to regional health science colleges. The study used both quantitative and qualitative approaches to develop sufficient data to explain the utilization of the budget, and outcomes obtained from the transferred budget and to identify the gaps. The data for the study were obtained through structured questionnaires and interviews was conducted to increase the reliability of the data. Nationally, students enrolled in different disciplines at RHSC through budget support for RHB to improve the quality of training were 87 840 students and the total Budget transferred, according to MOU was 895,752,038 Ethiopian birr. Among the students enrolled nationally in different disciplines at RHSC through budget support only 72% of students have graduated from different disciplines. In Hareri and Addis Ababa, all enrolled students were graduated (100%). At the same time, Oromia 69%, Amara 77%, SNNP 58% students graduated, respectively. The demand of the regional health bureau and the enrollment capacity of health science colleges increased from year to year. The financial support added great value to the HSCs to cop with problems related to student fees, skill lab materials and renovation.

Keywords: emergency medical technician, radiography, Biomedical, health extension

Procedia PDF Downloads 66

Authors: Ting Kai Chia, Ruifeng Yan, Feifei Bai, Tapan Saha

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This research presents a real-world power system oscillation incident in 2022 originated by a hybrid solar photovoltaic (PV) and wind renewable energy farm with a rated capacity of approximately 300MW in Australia. The voltage and reactive power outputs recorded at the point of common coupling (PCC) oscillated at a sub-synchronous frequency region, which sustained for approximately five hours in the network. The reactive power oscillation gradually increased over time and reached a recorded maximum of approximately 250MVar peak-to-peak (from inductive to capacitive). The network service provider was not able to quickly identify the location of the oscillation source because the issue was widespread across the network. After the incident, the original equipment manufacturer (OEM) concluded that the oscillation problem was caused by the incorrect setting recovery of the hybrid power plant controller (HPPC) in the voltage and reactive power control loop after a loss of communication event. The voltage controller normally outputs a reactive (Q) reference value to the Q controller which controls the Q dispatch setpoint of PV and wind plants in the hybrid farm. Meanwhile, a feed-forward (FF) configuration is used to bypass the Q controller in case there is a loss of communication. Further study found that the FF control mode was still engaged when communication was re-established, which ultimately resulted in the oscillation event. However, there was no detailed explanation of why the FF control mode can cause instability in the hybrid farm. Also, there was no duplication of the event in the simulation to analyze the root cause of the oscillation. Therefore, this research aims to model and replicate the oscillation event in a simulation environment and investigate the underlying behavior of the HPPC and the consequent oscillation mechanism during the incident. The outcome of this research will provide significant benefits to the safe operation of large-scale renewable energy generators and power networks.

Keywords: PV, oscillation, modelling, wind

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Authors: Misbah Nizamani, Saira Malik

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Introduction: Bariatric surgery is the most effective treatment for patients suffering from morbid obesity. Laparoscopic sleeve gastrectomy (LSG) accounts for over 50% of total bariatric procedures. The aim of our meta-analysis is to investigate the effectiveness and safety of Enhanced Recovery After Surgery (ERAS) protocols for patients undergoing laparoscopic sleeve gastrectomy. Method: To gather data, we searched PubMed, Google Scholar, ScienceDirect, and Cochrane Central. Eligible studies were randomized controlled trials and cohort studies involving adult patients (≥18 years) undergoing bariatric surgeries, i.e., Laparoscopic sleeve gastrectomy. Outcome measures included LOS, postoperative narcotic usage, postoperative pain score, postoperative nausea and vomiting, postoperative complications and mortality, emergency department visits and readmission rates. RevMan version 5.4 was used to analyze outcomes. Results: Three RCTs and three cohorts with 1522 patients were included in this study. ERAS group and control group were compared for eight outcomes. LOS was reduced significantly in the intervention group (p=0.00001), readmission rates had borderline differences (p=0.35) and higher postoperative complications in the control group, but the result was non-significant (p=0.68), whereas postoperative pain score was significantly reduced (p=0.005). Total MME requirements became significant after performing sensitivity analysis (p= 0.0004). Postoperative mortality could not be analyzed on account of invalid data showing 0% mortality in two cohort studies. Conclusion: This systemic review indicated the effectiveness of the application of ERAS protocols in LSG in reducing the length of stay, post-operative pain and total MME requirements postoperatively, indicating the feasibility and assurance of its application.

Keywords: eras protocol, sleeve gastrectomy, bariatric surgery, enhanced recovery after surgery

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Authors: Sadhana Sharma, Neha Sharma, Hardik Khandelwal, Arti Sharma

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Background: It is widely acknowledged globally that parents must advocate for their children's drug and substance abuse prevention. However, many parents find it difficult to advocate due to systemic and logistical barriers. Alternatives to introducing advocacy, awareness, and support for the prevention of drug and substance abuse to children could occur in schools. However, little research has been conducted on the development of advocates for substance abuse in school settings. Objective: to evaluate the effectiveness of a school-based addiction prevention and control created as part of the Rajasthan Addiction Prevention Project (a partnership between state-community initiative). Methods: We conducted an evaluation in this study to determine the impact of a RAPP on a primary outcome (substance abuse knowledge) and other outcomes (family–school partnership, empowerment, and support). Specifically, between September-December 2022, two schools participated in the intervention group (advocacy training), and two schools participated in the control group (waiting list). The RAPP designed specialised 2-hrs training to equip teachers-parents with the knowledge and skills necessary to advocate for their own children and those of other families. All participants were required to complete a pre- and post-survey. Results: The intervention group established school advocates in schools where trained parents volunteered to lead support groups for high-risk children. Compared to the participants in the wait list control group, those in the intervention group demonstrated greater education knowledge, P = 0.002, and self-mastery, P = 0.04, and decreased family–school partnership quality, P = 0.002.Conclusions: The experimental evaluation of school-based advocacy programme revealed positive effects on substance abuse that persist over time. The approach wa s deemed feasible and acceptable by both parents and the school.

Keywords: prevention, school based, addiction, advocacy

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Authors: Edwina Owusu Panin, Kwame Baah Owusu Panin

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This abstract intends to demonstrate multiple strategies of autism management in Ghana by exploring the possibilities. The advantages of adopting creative art forms as a therapeutic method. Autism is a developmental disorder that includes social interaction, communication, and repetitive behaviours. In Ghana, as in many other countries, there is a rising demand for effective intervention and support for people with autism and their families. Creative arts such as music, dance, drama and visual arts have shown promise in promoting communication, social interaction and inclusion of people with autism. These art forms provide alternative channels for self-expression and can be powerful tools for autistic people to interact with the world, their friends and families around them. Creative art forms interventions have been found to improve social skills, improve emotion regulation, promote creativity and increase self-confidence in people with autism. This study examines existing programs and interventions in Ghana involving creative art forms for people with autism through a comparative analysis. It explores the different approaches, methods and results of these interventions. By comparing and evaluating these programs, the study aims to identify best practices, challenges and areas for development in managing autism through the creative arts in Ghana. Although many schools and rehabilitation centres employ various forms in therapeutic approaches for autism. There is no comparative analysis of which type of autism and which creative art forms is suitable. The results of this study will contribute to the development of evidence-based practices for the management of autism in Ghana. It provides valuable information about the effectiveness of creative arts interventions and helps inform policy makers, educators, therapists and other stakeholders involved in autism support. Ultimately, the goal is to improve the well-being and quality of life of people with autism in Ghana and their families by promoting inclusive and accessible interventions that harness the power of creative art forms.

Keywords: autism, therapeutic, creative art, art form

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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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Authors: Asma AlQahtani, Jumana AlHadad, Maryam AlQallaf, Shoug AlHasan

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New product development (NPD) is the complete process of bringing a new product to the customer by integrating the two broad divisions; one involving the idea generation, product design and detail engineering; and the other involving market research and marketing analysis. It is a common practice for companies to undertake some of these tasks simultaneously (concurrent engineering) and also consider them as an ongoing process (continuous development). The current study explores the framework and methodology for a new product development process utilizing the Quality Function Deployment (QFD) tool for bringing the customer opinion into the product development process. An elaborate customer survey with focus groups in the region was carried out to ensure that customer requirements are integrated into new products as early as the design stage including identifying the recognition of need for the new product. A QFD Matrix (House of Quality) was prepared that links customer requirements to product engineering requirements and a feasibility study and risk assessment exercise was carried out for a Small and Medium Enterprise (SME) in Kuwait for development of the new product. SMEs in Kuwait, particularly in manufacturing sector are mainly focused on serving the local demand, and often lack of product quality adversely affects the ability of the companies to compete on a regional/global basis. Further, lack of focus on identifying customer requirements often deters SMEs to envisage the idea of a New Product Development. The current study therefore focuses in utilizing QFD Matrix right from the conceptual design to detail design and to some extent, extending the link this to design of the manufacturing system. The outcome of the project resulted in a development of the prototype for a new molded product which can ensure consistency between the customer’s requirements and the measurable characteristics of the product. The Engineering Economics and Cost studies were also undertaken to analyse the viability of the new product, the results of which was also linked to the successful implementation of the initial QFD Matrix.

Keywords: Quality Function Deployment, QFD Matrix, new product development, NPD, Kuwait SMEs, prototype development

Procedia PDF Downloads 391

Authors: Shirin jalili, Hadi Shirzad, Mahasti Modarresi, Samaneh Nabavi, Somayeh Khanjani

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Identifying the source tissue of biological material found at crime scenes can be very informative in a number of cases. Despite their usefulness, current visual, catalytic, enzymatic, and immunologic tests for presumptive and confirmatory tissue identification are applicable only to a subset of samples, might suffer limitations such as low specificity, lack of sensitivity, and are substantially impacted by environmental insults. In addition their results are operator-dependent. Recently the possibility of discriminating body fluids using mRNA expression differences in tissues has been described but lack of long term stability of that Molecule and the need to normalize samples for each individual are limiting factors. The use of DNA should solve these issues because of its long term stability and specificity to each body fluid. Cells in the human body have a unique epigenome, which includes differences in DNA methylation in the promoter of genes. DNA methylation, which occurs at the 5′-position of the cytosine in CpG dinucleotides, has great potential for forensic identification of body fluids, because tissue-specific patterns of DNA methylation have been demonstrated, and DNA is less prone to degradation than proteins or RNA. Previous studies have reported several body fluid-specific DNA methylation markers.The presence or absence of a methyl group on the 5’ carbon of the cytosine pyridine ring in CpG dinucleotide regions called ‘CpG islands’ dictates whether the gene is expressed or silenced in the particular body fluid. Were described methylation patterns at tissue specific differentially methylated regions (tDMRs) to be stable and specific, making them excellent markers for tissue identification. The results demonstrate that methylation-based tissue identification is more than a proof-of-concept. The methodology holds promise as another viable forensic DNA analysis tool for characterization of biological materials.

Keywords: DNA methylation, forensic science, epigenome, tDMRs

Procedia PDF Downloads 413

Authors: Angkrit Phitchayangkoon, Ar-Aishah Dadeh

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Background: A key aim of triage is to identify the patients with high risk of cardiac arrest because they require intensive monitoring, resuscitation facilities, and early intervention. We aimed to identify the predicting factors such as initial vital signs, serum pH, serum lactate level, initial capillary blood glucose, and Modified Early Warning Score (MEWS) which affect the occurrence of cardiac arrest in an emergency department (ED). Methods: We conducted a retrospective data review of ED patients in an emergency department (ED) from 1 August 2014 to 31 July 2016. Significant variables in univariate analysis were used to create a multivariate analysis. Differentiation of predicting factors between cardiac arrest patient and non-cardiac arrest patients for occurrence of cardiac arrest in an emergency department (ED) was the primary outcome. Results: The data of 527 non-trauma patients with Emergency Severity Index (ESI) 1-3 were collected. The factors found to have a significant association (P < 0.05) in the non-cardiac arrest group versus the cardiac arrest group at the ED were systolic BP (mean [IQR] 135 [114,158] vs 120 [90,140] mmHg), oxygen saturation (mean [IQR] 97 [89,98] vs 82.5 [78,95]%), GCS (mean [IQR] 15 [15,15] vs 11.5 [8.815]), normal sinus rhythm (mean 59.8 vs 30%), sinus tachycardia (mean 46.7 vs 21.7%), pH (mean [IQR] 7.4 [7.3,7.4] vs 7.2 [7,7.3]), serum lactate (mean [IQR] 2 [1.1,4.2] vs 7 [5,10.8]), and MEWS score (mean [IQR] 3 [2,5] vs 5 [3,6]). A multivariate analysis was then performed. After adjusting for multiple factors, ESI level 2 patients were more likely to have cardiac arrest in the ER compared with ESI 1 (odds ratio [OR], 1.66; P < 0.001). Furthermore, ESI 2 patients were more likely than ESI 1 patients to have cardiovascular disease (OR, 1.89; P = 0.01), heart rate < 55 (OR, 6.83; P = 0.18), SBP < 90 (OR, 3.41; P = 0.006), SpO2 < 94 (OR, 4.76; P = 0.012), sinus tachycardia (OR, 4.32; P = 0.002), lactate > 4 (OR, 10.66; P = < 0.001), and MEWS > 4 (OR, 4.86; P = 0.028). These factors remained predictive of cardiac arrest at the ED. Conclusion: The factors related to cardiac arrest in the ED are ESI 1 patients, ESI 2 patients, patients diagnosed with cardiovascular disease, SpO2 < 94, lactate > 4, and a MEWS > 4. These factors can be used as markers in the event of simultaneous arrival of many patients and can help as a pre-state for patients who have a tendency to develop cardiac arrest. The hemodynamic status and vital signs of these patients should be closely monitored. Early detection of potentially critical conditions to prevent critical medical intervention is mandatory.

Keywords: cardiac arrest, predicting factor, emergency department, emergency patient

Procedia PDF Downloads 145

Authors: Antonello Durante, James Duff, Kevin Kelly

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The visual needs of people in modern work based buildings are changing. Self-illuminated screens of computers, televisions, tablets and smart phones have changed the relationship between people and the lit environment. In the past, lighting design practice was primarily based on providing uniform horizontal illuminance on the working plane, but this has failed to ensure good quality lit environments. Lighting standards of today continue to be set based upon a 100 year old approach that at its core, considers the task illuminance of the utmost importance, with this task typically being located on a horizontal plane. An alternative method focused on appearance has been proposed, as opposed to the traditional performance based approach. Mean Room Surface Exitance (MRSE) and Target-Ambient Illuminance Ratio (TAIR) are two new metrics proposed to assess illumination adequacy in interiors. The hypothesis is that these factors will be superior to the existing metrics used, which are horizontal illuminance led. For the six past years, research has examined this, within the Dublin Institute of Technology, with a view to determining the suitability of this approach for application to general lighting practice. Since the start of this research, a number of key findings have been produced that centered on how occupants will react to various levels of MRSE. This paper provides a broad update on how this research has progressed. More specifically, this paper will: i) Demonstrate how MRSE can be measured using HDR images technology, ii) Illustrate how MRSE can be calculated using scripting and an open source lighting computation engine, iii) Describe experimental results that demonstrate how occupants have reacted to various levels of MRSE within experimental office environments.

Keywords: illumination hierarchy (IH), mean room surface exitance (MRSE), perceived adequacy of illumination (PAI), target-ambient illumination ratio (TAIR)

Procedia PDF Downloads 167

Authors: Arifuzzaman Nayeem, Tafannum Torsha, Tanvir Manzur, Shaurav Alam

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Performance evaluation of reinforced concrete (RC) beams subjected to accidental fire is significant for post-fire capacity measurement. Mechanical properties of any RC beam degrade due to heating since the strength and modulus of concrete and reinforcement suffer considerable reduction under elevated temperatures. Moreover, fire-induced thermal dilation and shrinkage cause internal stresses within the concrete and eventually result in cracking, spalling, and loss of stiffness, which ultimately leads to lower service life. However, conducting full-scale comprehensive experimental investigation for RC beams exposed to fire is difficult and cost-intensive, where the finite element (FE) based numerical study can provide an economical alternative for evaluating the post-fire capacity of RC beams. In this study, an attempt has been made to study the fire behavior of RC beams using FE software package ABAQUS under different durations of fire. The damaged plasticity model of concrete in ABAQUS was used to simulate behavior RC beams. The effect of temperature on strength and modulus of concrete and steel was simulated following relevant Eurocodes. Initially, the result of FE models was validated using several experimental results from available scholarly articles. It was found that the response of the developed FE models matched quite well with the experimental outcome for beams without heat. The FE analysis of beams subjected to fire showed some deviation from the experimental results, particularly in terms of stiffness degradation. However, the ultimate strength and deflection of FE models were similar to that of experimental values. The developed FE models, thus, exhibited the good potential to predict the fire behavior of RC beams. Once validated, FE models were then used to analyze several RC beams having different strengths (ranged between 20 MPa and 50 MPa) exposed to the standard fire curve (ASTM E119) for different durations. The post-fire performance of RC beams was investigated in terms of load-deflection behavior, flexural strength, and deflection characteristics.

Keywords: fire durations, flexural strength, post fire capacity, reinforced concrete beam, standard fire

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Authors: Fanniyah Anis, Bram Kilapong

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Myocardial reperfusion injury is defined as the cellular damage that results from a period of ischemia, followed by the reestablishment of the blood supply to the infarcted tissue. Ventricular tachycardia is one of the most commonly encountered reperfusion arrhythmia as one of the types of myocardial perfusion injury. Prompt and early treatment can reduce mortality, despite limited resources of the hospital in high risk patients with history of triple vessel disease. Case report, Male 53 years old has been diagnosed with NSTEMI with 3VD and comorbid disease of Hypertension and has undergone revascularization management with Percutaneous coronary intervention. Ventricular tachycardia leading to cardiac arrest occurred right after the stent was inserted. Resuscitation was performed for almost 2 hours until spontaneous circulation returned. Patient admitted in ICU with refractory cardiac shock despite using combination of ionotropic and vasopressor agents under standard non-invasive monitoring due to the limitation of the hospital. Angiography was performed again 5 hours later to exclude other possibilities of blockage of coronary arteries and conclude diagnosis of myocardial reperfusion injury. Patient continually managed with combination of antiplatelet agents and maintenance dose of anti-arrhythmia agents. The handling of the patient was to focus more on supportive and preventive from further deteriorating of the condition. Patient showed clinically improvement and regained consciousness within 24 hours. Patient was successfully discharged from ICU within 3 days without any neurological sequela and was discharge from hospital after 3 days observation in general ward. Limited Resource of hospital did not refrain the physician from attaining a good outcome for this myocardial reperfusion injury case and angiography alone can be used to confirm the diagnosis of myocardial reperfusion injury.

Keywords: limited resources hospital, myocardial reperfusion injury, prolonged resuscitation, refractory cardiogenic shock, reperfusion arrhythmia, revascularization, triple-vessel disease

Procedia PDF Downloads 287

Authors: Mathew Wakefield, Matthew Mitchell, Lisa Wise, Christopher McCarthy

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The properties of memory representations in artificial neural networks have cognitive implications. Distributed representations that encode instances as a pattern of activity across layers of nodes afford memory compression and enforce the selection of a single point in instance space. These encoding schemes also appear to distort the representational space, as well as trading off the ability to validate that input information is within the bounds of past experience. In contrast, a localist representation which encodes some meaningful information into individual nodes in a network layer affords less memory compression while retaining the integrity of the representational space. This allows the validity of an input to be determined. The validity (or familiarity) of input along with the capacity of localist representation for multiple instance selections affords a memory sampling approach that dynamically balances the bias-variance trade-off. When the input is familiar, bias may be high by referring only to the most similar instances in memory. When the input is less familiar, variance can be increased by referring to more instances that capture a broader range of features. Using this approach in a localist instance memory network, an experiment demonstrates a relationship between representational conflict, generalization performance, and memorization demand. Relatively small sampling ranges produce the best performance on a classic machine learning dataset of visual objects. Combining memory validity with conflict detection produces a reliable confidence judgement that can separate responses with high and low error rates. Confidence can also be used to signal the need for supervisory input. Using this judgement, the need for supervised learning as well as memory encoding can be substantially reduced with only a trivial detriment to classification performance.

Keywords: artificial neural networks, representation, memory, conflict monitoring, confidence

Procedia PDF Downloads 111