Search results for: flood incidence report

Authors: Mohamed A. Hammad, Dzul Azri Mohamed Noor, Syed Azhar Syed Sulaiman, Abeer Kharshid, Nor Azizah Aziz, Tarek M. Elsayed

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Medication safety is always an issue. In 2015, the National Pharmaceutical Control Bureau released a statement requesting all statins manufacturers in Malaysia to include the risk of diabetes information in the drug information leaflet in response to United States Food and Drug Administration (U.S. FDA) report. However, the data regarding this warning label in Malaysia is limited, so there is still some uncertainty whether such risk can also be observed in the Malaysian population or not. The study aims to determine the effect of statins on HbA1c% in type 2 diabetic outpatients in endocrine clinics at Hospital Pulau Pinang between June 2015 and May 2016 in Malaysia. In a prospective cohort study, records of 400 type 2 diabetic patients (control group 104 patients not using statin and treatment group 296 patients using statin) were reviewed to identify demographic criteria and lab tests. The prevalence of glycemic control (Glycated hemoglobin, HbA1C ≤ 7% for patient < 65 years, and < 8% for patient ≥ 65 years) was estimated, according to American Diabetes Association guidelines 2015. The results were presented as descriptive statistics. From 296 patients with Type 2 diabetes using statins cohort with a mean age of 57.52 ± 12.2 years, only 81 (27.4%) cases had controlled glycemia, and 215 (72.6%) had uncontrolled glycemia, CI: 95% (6.3–11.1). While the control group 104 diabetic patients had a mean age 46.1 ± 18 years and distributed among 59 (56.7%) patients with controlled diabetes and 45 (43.3%) cases, had uncontrolled glycemia, CI: 95% (5.2–10.3). The relative risk (RR) of uncontrolled glycemia in diabetic patients used statins was 1.68, and the excessive relative risk (ERR) was 68%. The absolute risk (AR) was 29.3%, and the number needed to harm (NNH) was 4. Diabetic patients using statins have more risk of uncontrolled glycemia than the patients with Type 2 diabetes non-using statins.

Keywords: diabetes mellitus, HbA1c, Malaysia, outpatients, statin, type 2, uncontrolled glycemia

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Authors: Brigitta Szabo, Miklosi Monika

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Background/Aims: In early childhood, the context of development is the caregiver-child relationship. Maternal attachment style plays a major role in the intergenerational transmission of psychopathology. The aim of this study was to explore the relationship between the mothers’ attachment style, mindful parenting, and perception of the child. Method: Data was collected from 144 non-clinical mothers who have a child below the age of 3 years. Mothers completed self-report questionnaires, including the following scales: a demographic questionnaire, Attachment Style Questionnaire (ASQ), Interpersonal Mindfulness in Parenting Scale (IMP), and the Mothers’ Object Relations Scale (MORS-SF). K-means cluster analysis was used to identify the mothers’ attachment styles. Mediation analyses with Mothers’ Object Relations Scale (MORS-SF) positive emotions and dominance subscales as dependent variables, mothers’ attachment style (ASQ) as an independent variable, and mindful parenting (IMP) as a mediator were conducted. Results: Four attachment styles (secure, preoccupied, fearful, dismissing) were identified. The relationship between mothers’ attachment style and mindful parenting was significant (R2 = .51; F(4,139) = 36.60; p < .001). Compared to the secure attachment style as a reference group, both preoccupied and dismissing styles were related to lower levels of mindful parenting; however, this relationship was the strongest in case of fearful style. In mediation analysis the direct effects of mothers’ attachment style on the perception of the child were not significant (MORS positive emotions: R2= .29; F(5,138) = 11.22; p < .001; MORS dominance: R2= .39 F(5,138) = 17.54, p < .001). However, indirect effects through mindful parenting were significant; higher levels of mindful parenting were associated with higher levels of MORS positive emotions and lower levels of MORS dominance. Conclusions: These findings suggest that attachment styles are related to the perception of the child through mindful parenting. Mindfulness-based parenting training might be useful in case of attachment-related problems to improve the parent-child relationship.

Keywords: mindfulness, mindful parenting, attachement, perception

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Authors: Shalu Jain, Anju Bansal, Anup Kumar, Sunita Saxena

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Objectives: The novel TMPRSS2:ERG gene fusion is a common somatic event in prostate cancer that in some studies is linked with a more aggressive disease phenotype. Thus, this study aims to determine whether clinical variables are associated with the presence of TMPRSS2:ERG-fusion gene transcript in Indian patients of prostate cancer. Methods: We evaluated the clinical variables with presence and absence of TMPRSS2:ERG gene fusion in prostate cancer and BPH association of clinical patients. Patients referred for prostate biopsy because of abnormal DRE or/and elevated sPSA were enrolled for this prospective clinical study. TMPRSS2:ERG mRNA copies in samples were quantified using a Taqman chemistry by real time PCR assay in prostate biopsy samples (N=42). The T2:ERG assay detects the gene fusion mRNA isoform TMPRSS2 exon1 to ERG exon4. Results: Histopathology report has confirmed 25 cases as prostate cancer adenocarcinoma (PCa) and 17 patients as benign prostate hyperplasia (BPH). Out of 25 PCa cases, 16 (64%) were T2: ERG fusion positive. All 17 BPH controls were fusion negative. The T2:ERG fusion transcript was exclusively specific for prostate cancer as no case of BPH was detected having T2:ERG fusion, showing 100% specificity. The positive predictive value of fusion marker for prostate cancer is thus 100% and the negative predictive value is 65.3%. The T2:ERG fusion marker is significantly associated with clinical variables like no. of positive cores in prostate biopsy, Gleason score, serum PSA, perineural invasion, perivascular invasion and periprostatic fat involvement. Conclusions: Prostate cancer is a heterogeneous disease that may be defined by molecular subtypes such as the TMPRSS2:ERG fusion. In the present prospective study, the T2:ERG quantitative assay demonstrated high specificity for predicting biopsy outcome; sensitivity was similar to the prevalence of T2:ERG gene fusions in prostate tumors. These data suggest that further improvement in diagnostic accuracy could be achieved using a nomogram that combines T2:ERG with other markers and risk factors for prostate cancer.

Keywords: prostate cancer, genetic rearrangement, TMPRSS2:ERG fusion, clinical variables

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Authors: Judith Correa-Gomez, Cristina Garcia-De la Pena, Veronica Avila-Rodriguez, David R. Aguillon-Gutierrez

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Kemp's ridley (Lepidochelys kempii) is the smallest species of sea turtle. It nests on the beaches of the Gulf of Mexico during summer. To date, there is no information about congenital anomalies in this species, which could be an important factor to be considered as a survival threat. The aim of this study was to determine congenital anomalies in dead embryos and hatchlings of Kemp's ridley sea turtle during 2020 nesting season. Fieldwork was conducted at the 'Campamento Tortugero Barra Norte', on the shores of Tuxpan, Veracruz, Mexico. A total of 95 nests were evaluated, from which 223 dead embryos and hatchlings were collected. Anomalies were detected by detailed physical examinations. Photographs of each anomaly were taken. From the 223 dead turtles, 213 (95%) showed a congenital anomaly. A total of 53 types of congenital anomalies were found: 22 types on the head region, 21 on the carapace region, 6 on the flipper region, and 4 regarding the entire body. The most prevalent anomaly in the head region was the presence of prefrontal supernumerary scales (42%, 93 occurrences). On the carapace region, the most common anomaly was the presence of supernumerary gular scales (59%, 131 occurrences). The two most common anomalies on the flipper region were amelia in fore flippers and rear bifurcation of flippers (0.9%, 2 occurrences each). The most common anomaly involving the entire body was hypomelanism (35%, 79 occurrences). These results agree with the recent studies on congenital malformations on sea turtles, being the head and the carapace regions the ones with the highest number of congenital anomalies. It is unknown whether the reported anomalies can be related to the death of these individuals. However, it is necessary to develop embryological studies in this species. To our best knowledge, this is the first worldwide report on Kemp’s ridley sea turtle anomalies.

Keywords: Amelia, hypomelanism, morphology, supernumerary scales

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Authors: Frieda Eivazi, Nikita L. Mullings

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Soils are recipient for surfactants in herbicide formulations. Surfactants entering the soil environment can possibly disrupt different chemical, physical and biological interactions. Therefore, it is critical that we understand the fate, behavior and transport of surfactants upon entering the soil. A comprehensive study was conducted to examine effect of surfactants on nutrient uptake, microbial community, and enzyme activity. The research was conducted in the greenhouse growing corn (Zea mays) as a test plant in a factorial experiment (three surfactants at two different rates with control, and three herbicides) organized as randomized blocked design. Surfactants evaluated were Activator 90, Agri-Dex, and Thrust; herbicides were glyphosate, atrazine, and bentazon. Treatments examined were surfactant only, herbicide only, and surfactant + herbicide combinations. Corn was planted in fertilized soils (silt loam and silty clay) with moisture content maintained at the field capacity for optimum growth. This paper will report results of above mentioned treatments on acid phosphatase, beta-glucosidase, arylsulfatase, beta-glucosaminidase, and dehydrogenase activities. In general, there were variations in the enzyme activities with some inhibition and some being enhanced by the treatments. Activator 90 appeared to have the highest inhibitory effect on enzymatic activities. Atrazine application significantly decreased the activities of acid phosphatase, beta-glucosidase, and dehydrogenase in both soils; however, combination of Atrazine + Agridex increased the acid phosphatase activity while significantly inhibiting the other enzyme activities in soils. It was concluded that long-term field studies are needed to validate changes in nutrient uptake, microbial community and enzyme activities due to surfactant-herbicide combination effects.

Keywords: herbicides, nutrient cycling, soil enzymes, surfactant

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Authors: Vivek Bhat, Rohini Kelkar, Sanjay Biswas

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Introduction: Cancer patients are at increased risk of bacterial infections. This may due to the disease process itself, the effect of chemotherapeutic drugs or invasive procedures such as catheterization. A wide variety of bacteria including some emerging pathogens are increasingly being reported from these patients. The incidence of multidrug-resistant organisms particularly in the Gram negative group is also increasing, with higher resistance rates seen to cephalosporins, β-lactam/β-lactam inhibitor combinations, and the carbapenems. This study documents the bacteriological spectrum of infections and their resistance patterns in cancer patients. Methods: This study includes all bacterial isolates recovered from infections cancer patients over a period of 18 months. Samples included Blood cultures, Pus/wound swabs, urine, tissue biopsies, body fluids, catheter tips and respiratory specimens such as sputum and bronchoalveolar lavage (BAL). All samples were processed in the microbiology laboratory as per standard laboratory protocols. Organisms were identified to species level and antimicrobial susceptibility testing was performed manually by the disc diffusion technique or in the Vitek-2 (Biomereux, France) instrument. Interpretations were as per Clinical laboratory Standards Institute (CLSI) guidelines. Results: A total of 1150 bacterial isolates were cultured from 884 test samples during the study period. Of these 227 were Gram-positive and 923 were Gram-negative organisms. Staphylococcus aureus (99 isolates) was the commonest Gram-positive isolate followed by Enterococcus (79) and Gr A Streptococcus (30). Among the Gram negatives, E. coli (304), Pseudomonas aeruginosa (201) and Klebsiella pneumoniae (190) were the most common. Of the Staphylococcus aureus isolates 27.2% were methicillin resistant. Only 5.06% enterococci were vancomycin resistant. High rates of resistance to cefotaxime and ciprofloxacin were seen amongst E. coli (84.8% & 83.55%) and Klebsiella pneumoniae (71 & 62.1%) respectively. Resistance to carbapenems (meropenem) was high at 70% in Acinetobacter spp.; however all isolates were sensitive to colistin. Among the aminoglycosides, amikacin retained good efficacy against Escherichia coli (82.9%) and Pseudomonas aeruginosa (78.1%). Occasional isolates of emerging pathogens such as Chryseobacterium indologens, Roseomonas, and Achromobacter xyloxidans were also recovered. Conclusion: The common infections in cancer patients include respiratory, wound, tract infections and sepsis. The commonest isolates include Staphylococcus aureus, Enterococci, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. There is a high level of resistance to the commonly used antibiotics among Gram-negative organisms.

Keywords: bacteria, resistance, infection, cancer

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Authors: Naufal Ahmed, Michael Lwin

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Background: MPFL reconstructions are ideally performed with au-tografts like gracilis semitendinosus tendon, which may be associated with donor site morbidity and complications. In this case series, we have tried to use fiber tape, which avoids the above complications and also keeps the graft virgin. This kind of synthetic graft has been used successfully in rotator cuffs and ACJ reconstructions with good results. Materials and methods: It was a retrospective data analysis of 45 patients who underwent this procedure from 2014-2020 under a single consultant in a DGH . These patiens have been followed up at 6 weeks, 6 months, 1 year, and 1 ½ years with clinical assessment and KOOS scores. We compared the results with the NJR and also with the Belgium report and was found to be satisfactory and comparable with them. Surgical technique : We used Arthrex fiber tape for the reconstruction of MPFL . Initially, two parallel holes drilled over sup aspect of the patella with help of an image intensifier, and then fiber wire passed through them from the medial to the lateral side and back to the medial side. The fiber wire was attached to the schottle point on the femoral side, giving a good extra articular internal brac-ing to the MPFL. All patients were scoped before the procedure, and the final tightening over the femoral side was done directly under vision to see the position of the patella. Results: We had 45 MPFL reconstructions along with 4 additional procedures 1 ACLR, 2 ACL REPAIR, 1 TTT advancement ( revision MPFL ). There were 14 males and 31 females, and their average age was 25 (13-55 ). We did not have any donor site morbidity, no infection, no fractures, no recurrent dislocations, no reoperations yet. Conclusion: Fiber tape is a feasible and appropriate option for MPFL reconstruction. We haven’t seen any re -operation in our 5 year follow up. This technique avoids the use of autograft, which can be used in the future if needed for revision surgeries. We don’t lose anything by following this simple novel technique.

Keywords: arthroscopy, fibertape, MPFL reconstruction, recurrent patella dislocation

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Authors: Celine Davis

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The novel coronavirus 2019 (COVID-19) is an infectious disease caused by the virus SARS-CoV-2, which has detrimental respiratory, cardiovascular, and neurological effects impacting over one million lives in the United States. New researches has emerged indicating long-term neurologic consequences in those who survive COVID-19 infections, including more than seven million Americans and another 27 million people worldwide. These consequences include attentional deficits, memory impairments, executive function deficits and aphasia-like symptoms which fall within the purview of speech-language pathology. The National Health Interview Survey (NHIS) is a comprehensive annual survey conducted by the National Center for Health Statistics (NCHS), a branch of the Centers for Disease Control and Prevention (CDC) in the United States. The NHIS is one of the most significant sources of health-related data in the country and has been conducted since 1957. The longitudinal nature of the study allows for analysis of trends in various variables over the years, which can be essential for understanding societal changes and making treatment recommendations. This current study will utilize NHIS data from 2020-2022 which contained interview questions specifically related to COVID-19. Adult cases of individuals between the ages of 18-50 diagnosed with COVID-19 in the United States during 2020-2022 will be identified using the National Health Interview Survey (NHIS). Multiple regression analysis of self-reported data confirming COVID-19 infection status and challenges with concentration, communication, and memory will be performed. Latent class analysis will be utilized to identify subgroups in the population to indicate whether certain demographic groups have higher susceptibility to cognitive-linguistic deficits associated with COVID-19. Completion of this study will reveal whether there is an association between confirmed COVID-19 diagnosis and heightened incidence of cognitive deficits and subsequent implications, if any, on activities of daily living. This study is distinct in its aim to utilize national survey data to explore the relationship between confirmed COVID-19 diagnosis and the prevalence of cognitive-communication deficits with a secondary focus on resulting activity limitations. To the best of the author’s knowledge, this will be the first large-scale epidemiological study investigating the associations between cognitive-linguistic deficits, COVID-19 and implications on activities of daily living in the United States population. These findings will highlight the need for targeted interventions and support services to address the cognitive-communication needs of individuals recovering from COVID-19, thereby enhancing their overall well-being and functional outcomes.

Keywords: cognition, COVID-19, language, limitations, memory, NHIS

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Authors: Opara Monica Onyinyechi, Ahmad Iqmer Nashriq Mohd Nazan, Suriani Ismail

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Introduction: Global estimates of malaria indicate that at least 3.3 billion people are at risk of being infected with malaria and 1.2 billion are at high risk. The review investigates the effectiveness of health education strategies to increase the level of malaria knowledge and ITN ownership among the populations of sub-Sahara African countries. Methods: A literature search was conducted using Science direct, CINAHL, PubMed, Prisma, Pico, Cochrane library and PsycINFO databases to retrieve articles published between 2000 until 2020. Eleven studies that reported on malaria prevention and intervention using health education strategies conducted in sub-Saharan Africa were included in the final review. Results: Four studies used educational interventions to teach appropriate ITN strategies and promote ITN usage. Two others focused on improving knowledge of malaria transmission, prevention, treatment, and its signs and symptoms. The remaining five studies assessed both ITN use and malaria knowledge. Of these, 10 were eligible for meta-analysis. On average, health education interventions significantly increase the odds of a person in the intervention group to report better malaria knowledge (odds ratio 1.30, 95% CI: 1.00 to 1.70, P= 0.05) and higher ITN ownership (odds ratio 1.53, 95% CI: 1.02 to 2.29, P= 0.004) compared to those in the control group. The odds of ITN ownership also substantially increases when the intervention was based on a theory or model (odds ratio 5.27, 95% CI: 3.24 to 8.58, P= 0.05). Conclusion: Our review highlights the various health education strategies used in sub-Saharan Africa to curb malaria over the past two decades. Meta-analysis findings show that health education intervention is moderately effective in improving malaria knowledge and ITN ownership and has contributed to the effort of global malaria strategy.

Keywords: malaria, health education, insecticide treated nets, sub-Saharan Africa, meta-analysis

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Authors: Riaz A. Agha, Ishani Barai, Shivanchan Rajmohan, Seon Lee, Mohammed O. Anwar, Alex J. Fowler, Dennis P. Orgill, Douglas G. Altman

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Introduction: Medical knowledge is growing fast. Evidence-based medicine works best if the evidence is reported well. Past studies have shown reporting quality to be lacking in the field of surgery. Reporting guidelines are an important tool for authors to optimize the reporting of their research. The objective of this study was to analyse the frequency and strength of recommendation for such reporting guidelines within surgical journals. Methods: A systematic review of the 198 journals within the Journal Citation Report 2014 (surgery category) published by Thomson Reuters was undertaken. The online guide for authors for each journal was screened by two independent groups and results were compared. Data regarding the presence and strength of recommendation to use reporting guidelines was extracted. Results: 193 journals were included (as five appeared twice having changed their name). These had a median impact factor of 1.526 (range 0.047 to 8.327), with a median of 145 articles published per journal (range 29-659), with 34,036 articles published in total over the two-year window 2012-2013. The majority (62%) of surgical journals made no mention of reporting guidelines within their guidelines for authors. Of the journals (38%) that did mention them, only 14% (10/73) required the use of all relevant reporting guidelines. The most frequently mentioned reporting guideline was CONSORT (46 journals). Conclusion: The mention of reporting guidelines within the guide for authors of surgical journals needs improvement. Authors, reviewers and editors should work to ensure that research is reported in line with the relevant reporting guidelines. Journals should consider hard-wiring adherence to them. This will allow peer-reviewers to focus on what is present, not what is missing, raising the level of scholarly discourse between authors and the scientific community and reducing frustration amongst readers.

Keywords: CONSORT, guide for authors, PRISMA, reporting guidelines, journal impact factor, citation analysis

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Authors: Yutong Xu, Wanting Zhang, Jia Wang, Zihan Guo, Weiguang Ma

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Background: The resilience education of intern nursing students has significant implications for the development and improvement of the nursing workforce. The clinical internship period is a critical time for enhancing resilience. Aims: To evaluate the resilience level of Chinese nursing interns and identify the factors affecting resilience early in their careers. Methods: The cross-sectional study design was adopted. From March 2022 to May 2023, 512 nursing interns in tertiary care hospitals were surveyed online with the Connor-Davidson Resilience Scale, the Clinical Learning Environment scale for Nurse, and the Career Adapt-Abilities Scale. Structural equation modeling was used to clarify the relationships among these factors. Indirect effects were tested using bootstrapped Confidence Intervals. Results: The nursing interns showed a moderately high level of resilience[M(SD)=70.15(19.90)]. Gender, scholastic attainment, had a scholarship, career adaptability and clinical learning environment were influencing factors of nursing interns’ resilience. Career adaptability and clinical learning environment positively and directly affected their resilience level (β = 0.58, 0.12, respectively, p＜0.01). career adaptability also positively affected career adaptability (β = 0.26, p < 0.01), and played a fully mediating role in the relationship between clinical learning environment and resilience. Conclusion: Career adaptability can enhance the influence of clinical learning environment on resilience. The promotion of career adaptability and the clinical teaching environment should be the potential strategies for nursing interns to improve their resilience, especially for those female nursing interns with low academic performance. Implications for Nursing Educators Nursing educators should pay attention to the cultivation of nursing students' resilience; for example, by helping them integrate to the clinical learning environment and improving their career adaptability. Reporting Method: The STROBE criteria were used to report the results of the observations critically. Patient or Public Contribution No patient or public contribution.

Keywords: resilience, clinical learning environment, career adaptability, nursing interns

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Authors: Saleh Dabil

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This study investigates the level of existence of organized retail crime in supermarkets of Riyadh, Saudi Arabia. The store managers, security managers and general employees were asked about the types of retail crimes occur in the stores. Three independent variables were related to the report of organized retail theft. The independent variables are: (1) the supermarket profile (volume, location, standard and type of the store), (2) the social physical environment of the store (maintenance, cleanness and overall organizational cooperation), (3) the security techniques and loss prevention electronics techniques used. The theoretical framework of this study based on the social disorganization theory. This study concluded that the organized retail theft, in specific, organized theft is moderately apparent in Riyadh stores. The general result showed that the environment of the stores has an effect on the prevalence of organized retail theft with relation to the gender of thieves, age groups, working shift, type of stolen items as well as the number of thieves in one case. Among other reasons, some factors of the organized theft are: economic pressure of customers based on the location of the store. The dealing of theft also was investigated to have a clear picture of stores dealing with organized retail theft. The result showed that mostly, thieves sent without any action and sometimes given written warning. Very few cases dealt with by police. There are other factors in the study can be looked up in the text. This study suggests solving the problem of organized theft; first is ‘the well distributing of the duties and responsibilities between the employees especially for security purposes’. Second is ‘installation of strong security system’ and ‘making well-designed store layout’. Third is ‘giving training for general employees’ and ‘to give periodically security skills training of employees’. There are other suggestions in the study can be looked up in the text.

Keywords: organized crime, retail, theft, loss prevention, store environment

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Authors: Ashokkumar Subbiah

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This study investigates the impact of factors that influenced the success of construction planning for a major construction project in Qatar. An approach of participant observation is adopted which is informed by the principles of ethnography: one that reports the participants’ view of their world rather than imposing an artificial theoretical framework upon it. As participant observant, key factors were observed and identified that had an impact on the management and execution of the construction planning. It is found that a ‘shadow culture’ exists between the project participants which, it is argued, is only observable from the perspective of an embedded participant observer. The shadow culture acts to enable the management of the planning process, and its efficacy relates to the ‘quality’ of human inter-relationships amongst immediate stakeholders. Whilst this study uses the concept of shadow culture, it is treated as both a methodological stance and one of the findings of this research in the context of the major construction project in Qatar. The concept of shadow culture is not imposed upon the findings, but instead is used as a research tool: respondents report their own worldview and this is reported from the view of a participant observant in a manner that is understandable and useful to those who are not part of the construction project. The findings of this study identify similar factors influencing the planning process of the Qatar project, but the shadow culture predominantly influences these factors towards the failure of planning process. The research concludes by questioning the assumption that construction planning is a mechanistic process that has to be conducted solely by the planning team. Instead, it is a highly social phenomenon in which the seemingly mechanistic process is made workable by the quality of relationships that exist in the project. Drawing on this the final section provides a series of recommendations that may be helpful in enhancing the efficacy of project planning; these include better training/education at the pre-construction phase; recognition of the importance of shadow processes at management levels, and better appreciation of the impact of contract type and chosen procurement route.

Keywords: construction planning, participant observation, project participants, shadow culture

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Authors: Luciano Tarantino, Emanuele Balzano, Paolo Tarantino, Riccardo Aurelio Nasto, Aurelio Nasto

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Liver transplantation (OLT) is contraindicate in Portal Vein tumor Thrombosis (PVTT) from Hepatocellular Carcinoma at hepatic hilum(pH-HCC) Surgery,Thermal ablation and chemotherapy show poorer outcomes Electrochemotherapy (ECT) has been successfully used in patients with pH-HCC with PVTT. We report the results of ECT as downstaging aimed to definitive cure by OLT. F.P. 53 years HBV related Cirrhosis Child-Pugh B7 class; EGDS F2 aesophageal Varices. Diabetes. April 2016 : Enhanced Computed Tomography (CT) detected HCC(n.3 nodules in VII-VIII-VI;diameter range=25 cm) and PVTT of right portal vein. The patient was considered ineligible for OLT. May 2016: first ablation session with percutaneous Radiofrequency-ablation(RFA) of 3 HCC-nodules . August 2016: second ablation session with ECT of PVTT. CT october 2016: disappearance of PVTT and patent right portal vein. No intraparenchymal recurrence. CT march 2017: No recurrence in portal vein and in the left lobe. local recurrence in the VII-VIII segments. May 2017 : transarterial chemoembolization (TACE) of right lobe recurrences. CT October 2017: patent right portal vein. No recurrence. The patient was reconsidered for OLT. He underwent OLT in April 2018. At 36-months follow-up , no intrahepatic recurrence of HCC occurred. March 2021: enhanced CT and PET/CT detected a single small nodule (1.5 cm) uptaking tracer in the left upper pulmonary lobe, no hepatic recurrence . CT-guided FNB showed metastasis from HCC . June 2021: left lung upper lobectomy . At the current time the patient is alive and recurrence-free at 64 months follow-up. ECT Could be aneffective technique as pre-OLT dowstaging in HCC with PVTT.

Keywords: liver tumor ablation, interventional ultrasound, electrochemotherapy, liver transplantation

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Authors: Christine Ysabelle G. Roman, Pauline Torres

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Background: Hypertrophic cardiomyopathy is a disease of marked heterogeneity. It is a genetically determined heart disease characterized by significant myocardium hypertrophy that results in diastolic dysfunction, left ventricular outflow tract obstruction, and an increased risk of arrhythmias. The primary treatment in patients with such conditions is negative inotropic drugs, such as beta-blockers, calcium channel antagonists, and disopyramide. However, for those who remain symptomatic and need septal reduction therapy, surgical septal myectomy or alcohol septal ablation are options. Case Summary: A 19 – year old female presented in the authors’ institution with easy fatigability. The consult was done a year prior, and 2D echocardiography was requested which showed concentric left ventricular hypertrophy, asymmetrically hypertrophied interventricular septum (IVS) with the largest diameter of 3.3cm & subaortic dynamic obstruction with a maximum gradient of 47 mmHg. A repeat echo a year later showed asymmetric septal hypertrophy (IVS measuring at 3cm) with the systolic anterior motion of anterior mitral valve leaflet and left ventricular outflow tract obstruction (peak gradient of 50mmHg). The patient then underwent alcohol septal ablation and was discharged stable after four days of admission. Conclusion: Hypertrophic obstructive cardiomyopathy, a cardiovascular genetic disease, results in various patterns of left ventricular hypertrophy and abnormality of mitral valve apparatus. The patient is managed medically initially. However, despite optimal drug therapy and significant left ventricular outflow tract obstruction, significant heart failure symptoms or syncope require invasive treatment.

Keywords: hypertrophic obstructive cardiomyopathy, left ventricular outflow tract obstruction, alcohol septal ablation, alcohol

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Authors: Amal Sellami, Ahlem Ammar

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Writing is acknowledged to be a cognitively demanding and complex task. Indeed, the writing process is composed of three iterative sub-processes, namely planning, translating (writing), and reviewing. Not only do second or foreign language learners need to write according to this process, but they also need to respect the norms and rules of language and writing in the text to-be-produced. Accordingly, researchers have suggested to approach writing as a collaborative task in order to al leviate its complexity. Consequently, collaboration has been implemented during the whole writing process or only during planning orreviewing. Researchers report that implementing collaboration during the whole process might be demanding in terms of time in comparison to individual writing tasks. Consequently, because of time constraints, teachers may avoid it. For this reason, it might be pedagogically more realistic to limit collaboration to one of the writing sub-processes(i.e., planning or reviewing). However, previous research implementing collaboration in planning or reviewing is limited and fails to explore the effects of the seconditionson the written text. Consequently, the present study examines the effects of collaboration in planning and collaboration in reviewing on the written text. To reach this objective, quantitative as well as qualitative methods are deployed to examine the written texts holistically and in terms of fluency, complexity, and accuracy. Participants of the study include 4 pairs in each group (n=8). They participated in two experimental conditions, which are: (1) collaborative planning followed by individual writing and individual reviewing and (2) individual planning followed by individual writing and collaborative reviewing. The comparative research findings indicate that while collaborative planning resulted in better overall text quality (precisely better content and organization ratings), better fluency, better complexity, and fewer lexical errors, collaborative reviewing produces better accuracy and less syntactical and mechanical errors. The discussion of the findings suggests the need to conduct more comparative research in order to further explore the effects of collaboration in planning or in reviewing. Pedagogical implications of the current study include advising teachers to choose between implementing collaboration in planning or in reviewing depending on their students’ need and what they need to improve.

Keywords: collaboration, writing, collaborative planning, collaborative reviewing

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Authors: Esther Paul, Ibrahim A. M. Alzaydani, Al Hakami, Caryl Beynon

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Research Objectives and Goal: The main aim of the current study was to explore the perspectives of healthcare workers on Healthcare-associated infections (HAI) and infection control measures in a tertiary care Hospital in Abha, Saudi Arabia. As per our knowledge, this is perhaps the first qualitative study on HAI to be done in Saudi Arabia. The goal of the study was to understand the perspectives of the healthcare workers on the current protocol and guidelines for HAI and infections control measures in the hospital, the effectiveness of the current protocol for HAI and infection control measures and ways of reducing the incidence of HAI and improve infection control measures. Methods used: A qualitative research design was used to collect the data from 25 healthcare workers consisting of doctors and nurses, recruited by Snowball strategy via semi-structured interviews which were audio-recorded and transcribed verbatim immediately. An interview guide consisting of open-ended questions about the existing HAI and infection control practices in the healthcare facility, the awareness of the healthcare workers about HAI and the need for safe infection control measures were used to collect the data. The transcribed data were analyzed using the thematic analysis method. Results: Using thematic analysis four themes were identified.1.Knowledge of HAI and infection control 2. Infection control measures in practice 3. The gap in infection control measures and HAI 4. Required Implementations. The first theme covered the participants' knowledge on HAI, its definition, the types of HAI and the infection control measures.Most of the participants were aware of HAI and had some idea of the definition of HAI, its significance and the dangers posed by HAI, but few residents had no idea of the types of HAI. The second theme was focussed on the infection control measures in practice. Most of the participants were aware of the importance of infection control measures like hand hygiene, catheter care, and waste disposal. The nurses were responsible for most of the disinfection and sterilization measures and practiced it effectively. However, some doctors and residents had no inkling about these measures. The third theme emphasized that although most of the participants were aware of HAI and infection control measures and were in practice. There were some lacunae regarding their knowledge of the different types of HAI, Personal Protective Equipment practices, communication among the healthcare personnel and the hospital administrations and the means of waste disposal. The fourth and the final theme identified that most of the participants felt the need for implementations of changes regarding existing protocols, workshops/seminars, methods of waste disposal and sterilization and disinfection practices. Conclusion: The current qualitative study concluded that there is a need for better educational programs and hands-on training for all the healthcare personnel including the paramedical staff as well. The residents should have adequate knowledge of infection control practices to guide the nurses and should share the responsibility with the nurses in the practice of effective infection control measures

Keywords: healthcare-associated infections, infection control measures, perspectives, qualitative

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Authors: Meng-Jie Hsiao, Cam Nguyen

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Wide-band devices in Ku band (12-18 GHz) and K band (18-27 GHz) have received significant attention for high-data-rate communications and high-resolution sensing. Especially, devices operating around 24 GHz is attractive due to the 24-GHz unlicensed applications. One of the most important components in RF systems is power amplifier (PA). Various PAs have been developed in the Ku and K bands on GaAs, InP, and silicon (Si) processes. Although the PAs using GaAs or InP process could have better power handling and efficiency than those realized on Si, it is very hard to integrate the entire system on the same substrate for GaAs or InP. Si, on the other hand, facilitates single-chip systems. Hence, good PAs on Si substrate are desirable. Especially, Si-based PA having good linearity is necessary for next generation communication protocols implemented on Si. We report a 16.5 to 25.5 GHz Si-based PA having flat saturated power of 19.5 ± 1.5 dBm, output 1-dB power compression (OP1dB) of 16.5 ± 1.5 dBm, and 15-23 % power added efficiency (PAE). The PA consists of a drive amplifier, two main amplifiers, and lump-element Wilkinson power divider and combiner designed and fabricated in TowerJazz 0.18µm SiGe BiCMOS process having unity power gain frequency (fMAX) of more than 250 GHz. The PA is realized as a cascode amplifier implementing both heterojunction bipolar transistor (HBT) and n-channel metal–oxide–semiconductor field-effect transistor (NMOS) devices for gain, frequency response, and linearity consideration. Particularly, a body-floating technique is utilized for the NMOS devices to improve the voltage swing and eliminate parasitic capacitances. The developed PA has measured flat gain of 20 ± 1.5 dB across 16.5-25.5 GHz. At 24 GHz, the saturated power, OP1dB, and maximum PAE are 20.8 dBm, 18.1 dBm, and 23%, respectively. Its high performance makes it attractive for use in Ku/K-band, especially 24 GHz, communication and radar systems. This paper was made possible by NPRP grant # 6-241-2-102 from the Qatar National Research Fund (a member of Qatar Foundation). The statements made herein are solely the responsibility of the authors.

Keywords: power amplifiers, amplifiers, communication systems, radar systems

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Authors: Sahar Javadi-Novashnagh, Mohammad Moradi-Shahrbabak, Mostafa Sadeghi, Katarzyna Ropka-Molik, Hossein Moradi-Shahrbabak, Maria Consuelo Mura

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The objective of this study was to investigate two single nucleotide polymorphisms located in exon 2 (g.939A > G) and intron 3 (g.4349A > G) of fatty acid binding protein 3 (FABP3) gene in two Iranian sheep breeds, Lori-Bakhtiari and Zel, using polymerase chain reaction -restriction fragment length polymorphism (PCR-RFLP) approach. The association of the polymorphisms with growth traits and blood parameters was also examined. Results revealed a g.939A > G SNP (single nucleotide polymorphism) in the exon 2 exhibiting three genotypes: AA, AG, and GG. Statistical analysis indicated that this polymorphism significantly influenced blood triglyceride (P < 0.05) and cholesterol (P < 0.08) levels as well as weaning weight (P < 0.05). Animals with AG genotype had the highest blood triglyceride level and weaning weight while the highest amount of blood cholesterol was observed in animals with GG genotype. On the other hand, no significant effect was observed on birth and fat-tail weight traits. The intron 3 (g.4349A > G) was monomorphic across the studied samples. Lori-Bakhtiari breed showed significantly higher blood triglyceride and cholesterol levels, as also birth and weaning weight compared to Zel breed (P < 0.01). Considering that the literature is bereft of any report on the association study between FABP3 SNPs and sheep growth traits and blood parameters, our findings suggest that the investigated polymorphism might be one of the main genetic factors affecting growth and physiological traits in sheep.

Keywords: FABP3 gene, fatness, weaning weight, blood triglyceride, cholesterol, Zel, Lori-Bakhtiari

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Authors: Haroon Khan, Chul Min Kim, Sung Yeol Kim, Sanket Goel, Prabhat K. Dwivedi, Ashutosh Sharma, Gyu Man Kim

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Enzymatic biofuel cells (EBFCs) have drawn the attention of researchers due to its demanding application in medical implants. In EBFCs, electricity is produced with the help of redox enzymes. In this study, we report the fabrication of membraneless EBFC with new design of electrodes to overcome microchannel related limitations. The device consists of double layer of electrodes on both sides of Y-shaped microchannel to reduce the effect of oxygen depletion layer and diffusion of fuel and oxidant at the end of microchannel. Moreover, the length of microchannel was reduced by half keeping the same area of multiwalled carbon nanotubes (MWCNT) electrodes. Polydimethylsiloxane (PDMS) stencils were used to pattern MWCNT electrodes on etched Indium Tin Oxide (ITO) glass. PDMS casting was used to fabricate microchannel of the device. Both anode and cathode were modified with glucose oxidase and laccase. Furthermore, these enzymes were covalently bound to carboxyl MWCNTs with the help of EDC/NHS. Glucose used as fuel was oxidized by glucose oxidase at anode while oxygen was reduced to water at the cathode side. The resulted devices were investigated with the help of polarization curves obtained from Chronopotentiometry technique by using potentiostat. From results, we conclude that the performance of double layer EBFC is improved 15 % as compared to single layer EBFC delivering maximum power density of 71.25 µW cm-2 at a cell potential of 0.3 V and current density of 250 µA cm-2 at micro channel height of 450-µm and flow rate of 25 ml hr-1. However, the new device was stable only for three days after which its power output was rapidly dropped by 75 %. This work demonstrates that the power output of membraneless EBFC is improved comparatively, but still efforts will be needed to make the device stable over long period of time.

Keywords: EBFC, glucose, MWCNT, microfluidic

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Authors: Itsuo Yokoyama, Rikako Kikuti, Miti Sekikawa, Tosinori Asai, Sarai Tsuyoshi

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Introduction: Vascular access for hemodialysis therapy is often difficult, even for experienced medical personnel. Ultrasound guided needle placement have been performed occasionally but is not always helpful in certain cases with complicated vascular anatomy. Obtaining precise anatomical knowledge of the vascular structure is important to prevent access-related complications. With augmented reality (AR) device such as AR glasses, the virtual vascular structure is shown superimposed on the actual patient vessels, thus enabling the operator to maneuver catheter placement easily with free both hands. We herein report our method of AR guided vascular access method in dialysis treatment Methods: Three dimensional (3D) object of the arm with arteriovenous fistula is computer graphically created with 3D software from the data obtained by computer tomography, ultrasound echogram, and image scanner. The 3D vascular object thus created is viewed on the screen of the AR digital display device (such as AR glass or iPad). The picture of the vascular anatomical structure becomes visible, which is superimposed over the real patient’s arm, thereby the needle insertion be performed under the guidance of AR visualization with ease. By this method, technical difficulty in catheter placement for dialysis can be lessened and performed safely. Considerations: Virtual reality technology has been applied in various fields and medical use is not an exception. Yet AR devices have not been widely used among medical professions. Visualization of the virtual vascular object can be achieved by creation of accurate three dimensional object with the help of computer graphical technique. Although our experience is limited, this method is applicable with relative easiness and our accumulating evidence has suggested that our method of vascular access with the use of AR can be promising.

Keywords: abdominal-aorta, calcification, extraskeletal, dialysis, computer graphics, 3DCG, CT, calcium, phosphorus

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Authors: Caren Hilger, Silke Burkert, Friederike Kendel

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Men with localized prostate cancer (PCa) have to choose among different treatment options, such as active surveillance (AS) and radical prostatectomy (RP). All available treatment options may be accompanied by specific psychological or physiological side effects. Depending on the nature and extent of these side effects, patients are more or less likely to be satisfied or to struggle with their treatment decision in the long term. Therefore, the aim of this study was to assess and explain decisional regret in men with localized PCa. The role of erectile functioning as one of the main physiological side effects of invasive PCa treatment, depressive symptoms as a common psychological side effect, and the association of erectile functioning and depressive symptoms with decisional regret were investigated. Men with localized PCa initially managed with AS or RP (N=292) were matched according to length of therapy (mean 47.9±15.4 months). Subjects completed mailed questionnaires assessing decisional regret, changes in erectile functioning, depressive symptoms, and sociodemographic variables. Clinical data were obtained from case report forms. Differences among the two treatment groups (AS and RP) were calculated using t-tests and χ²-tests, relationships of decisional regret with erectile functioning and depressive symptoms were computed using multiple regression. Men were on average 70±7.2 years old. The two treatment groups differed markedly regarding decisional regret (p<.001, d=.50), changes in erectile functioning (p<.001, d=1.2), and depressive symptoms (p=.01, d=.30), with men after RP reporting higher values, respectively. Regression analyses showed that after adjustment for age, tumor risk category, and changes in erectile functioning, depressive symptoms were still significantly associated with decisional regret (B=0.52, p<.001). Additionally, when predicting decisional regret, the interaction of changes in erectile functioning and depressive symptoms reached significance for men after RP (B=0.52, p<.001), but not for men under AS (B=-0.16, p=.14). With increased changes in erectile functioning, the association of depressive symptoms with decisional regret became stronger in men after RP. Decisional regret is a phenomenon more prominent in men after RP than in men under AS. Erectile functioning and depressive symptoms interact in their prediction of decisional regret. Screening and treating depressive symptoms might constitute a starting point for interventions aiming to reduce decisional regret in this target group.

Keywords: active surveillance, decisional regret, depressive symptoms, erectile functioning, prostate cancer, radical prostatectomy

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Authors: Eric Noe Hernandez Rodriguez, Cristian Esneider Penuela Cruz

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Magnesium is a biocompatible and biodegradable material that has gained increased interest for application in resorbable orthopedic implants. However, to date, much research is being conducted to overcome the main disadvantage: its low corrosion resistance. In this work, we report our findings on the development and application of TiO₂-MgO coatings to improve and modulate the corrosion resistance of magnesium pieces. The plasma electrolytic oxidation (PEO) technique was employed to obtain the TiO₂-MgO coatings. The effect of the experimental parameters on the modulation of the TiO₂:MgO ratio was investigated. The most critical parameters were the chemical composition of the precursor electrolytic solution and the current density. According to scanning electron microscopy (SEM) observations, the coatings were porous; however, they become more compact as the current density increases. XRD measurements showed that the coatings are formed by a composite consisting of TiO₂ and MgO oxides, whose ratio can be changed by the experimental conditions. TiO₂ had the anatase crystalline structure, while the MgO had the FCC crystalline structure. The corrosion resistance was evaluated through the corrosion current (Icorr) measured at room temperature by the polarization technique (Tafel). For doing it, Hank's solution was used in order to simulate the body fluids. Also, immersion tests were conducted. Tafel curves showed an improvement of the corrosion resistance at some coated magnesium pieces in contrast to control pieces (uncoated). Corrosion currents were lower, and the corrosion potential changed to positive values. It was observed that the experimental parameters allowed to modulate the protective capacity of the coatings by changing the TiO₂:MgO ratio. Coatings with a higher content of TiO₂ (measured by energy dispersive spectroscopy) showed higher corrosion resistance. Results showed that TiO₂-MgO coatings can be successfully applied to improve the corrosion resistance of Mg pieces in simulated body fluid; even more, the corrosion resistance can be tuned by changing the TiO₂:MgO ratio.

Keywords: biomaterials, PEO, corrosion resistance, magnesium

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Authors: Rukhsana Kausar, Issam Malki

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The integration and assimilation of ethnic minority immigrants (EMIs) and their subsequent generations remains a serious unsettled issue in most of the host countries. This study conducts the labour market gender analysis to investigate specifically whether second generation of ethnic minority immigrants in the UK is gaining access to professional and managerial employment and advantaged occupational positions on par with their native counterparts. The data used to examine the labour market achievements of EMIs is taken from Labour Force Survey (LFS) for the period 2014-2018. We apply a multivalued treatment under ignorability as proposed by Cattaneo (2010), which refers to treatment effects under the assumptions of (i) selection – on – observables and (ii) common support. We report estimates of Average Treatment Effect (ATE), Average Treatment Effect on the Treated (ATET), and Potential Outcomes Means (POM) using three estimators, including the Regression Adjustment (RA), Augmented Inverse Probability Weighting (AIPW) and Inverse Probability Weighting- Regression Adjustment (IPWRA). We consider two cases: the case with four categories where the first-generation natives are the base category, the second case combine all natives as a base group. Our findings suggest the following. Under Case 1, the estimated probabilities and differences across groups are consistently similar and highly significant. As expected, first generation natives have the highest probability for higher career attainment among both men and women. The findings also suggest that first generation immigrants perform better than the remaining two groups, including the second-generation natives and immigrants. Furthermore, second generation immigrants have higher probability to attain higher professional career, while this is lower for a managerial career. Similar conclusions are reached under Case 2. That is to say that both first – generation and second – generation immigrants have a lower probability for higher career and managerial attainment. First – generation immigrants are found to perform better than second – generation immigrants.

Keywords: immigrnats, second generation, occupational attainment, ethnicity

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Authors: Emily Moore, Dora Amos, Tracy Ellimah, Natasha Parrott

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Postoperative haematoma is a well-recognised complication of thyroid surgery with an incidence of 1-5%. Haematoma formation causes progressive airway obstruction, necessitating emergency bedside haematoma evacuation in up to ¼ of patients. ENT UK, BAETS and DAS have developed consensus guidelines to improve perioperative care, recommending that all healthcare staff interacting with patients undergoing thyroid surgery should be trained in managing post-thyroidectomy haematoma. The aim was to assess the effectiveness of a hybrid simulation model in improving clinician’s confidence in dealing with this surgical emergency. A hybrid simulation was designed, consisting of a standardised patient wearing a part-task trainer to mimic a post-thyroidectomy haematoma in a real patient. The part-task trainer was an adapted C-spine collar with layers of silicone representing the skin and strap muscles and thickened jelly representing the haematoma. Both the skin and strap muscle layers had to be opened in order to evacuate the haematoma. Boxes have been implemented into the appropriate post operative areas (recovery and surgical wards), which contain a printed algorithm designed to assist in remembering a sequence of steps for haematoma evacuation using the ‘SCOOP’ method (skin exposure, cut sutures, open skin, open muscles, pack wound) along with all the necessary equipment to open the front of the neck. Small-group teaching sessions were delivered by ENT and anaesthetic trainees to members of the multidisciplinary team normally involved in perioperative patient care, which included ENT surgeons, anaesthetists, recovery nurses, HCAs and ODPs. The DESATS acronym of signs and symptoms to recognise (difficulty swallowing, EWS score, swelling, anxiety, tachycardia, stridor) was highlighted. Then participants took part in the hybrid simulation in order to practice this ‘SCOOP’ method of haematoma evacuation. Participants were surveyed using a Likert scale to assess their level of confidence pre- and post teaching session. 30 clinicians took part. Confidence (agreed/strongly agreed) in recognition of post thyroidectomy haematoma improved from 58.6% to 96.5%. Confidence in management improved from 27.5% to 89.7%. All participants successfully decompressed the haematoma. All participants agreed/strongly agreed, that the sessions were useful for their learning. Multidisciplinary team simulation teaching is effective at significantly improving confidence in both the recognition and management of postoperative haematoma. Hybrid simulation sessions are useful and should be incorporated into training for clinicians.

Keywords: thyroid surgery, haematoma, teaching, hybrid simulation

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Authors: P. Tardi, B. Szilagyi, A. Makai, P. Acs, M. Hock, M. Jaromi

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Osteoporosis is becoming a major public health problem, particularly in postmenopausal women, as the incidence of this disease is getting higher. Nowadays, one of the most common chronic musculoskeletal diseases is osteoporosis. Osteoporosis-related knowledge is an important contributor to prevent or to treat osteoporosis. The most important strategies to prevent or treat the disease are increasing the level of physical activity at all ages, cessation of smoking, reduction of alcohol consumption, adequate dietary calcium, and vitamin D intake. The aim of the study was to measure the osteoporosis-related knowledge and physical activity among women age over 50 years. For the measurements, we used the osteoporosis questionnaire (OPQ) to examine the disease-specific knowledge and the global physical activity questionnaire (GPAQ) to measure the quantity and quality of the physical activity. The OPQ is a self-administered 20-item questionnaire with five categories: general information, risk factors, investigations, consequences, and treatment. There are four choices per question (one of them is the 'I do not know'). The filler gets +1 for a good answer, -1 point for a bad answer, and 0 for 'I do not know' answer. We contacted with 326 women (63.08 ± 9.36 year) to fill out the questionnaires. Descriptive analysis was carried out, and we calculated Spearman's correlation coefficient to examine the relationship between the variables. Data were entered into Microsoft Excel, and all statistical analyses were performed using SPSS (Version 24). The participants of the study (n=326) reached 8.76 ± 6.94 points on OPQ. Significant (p < 0.001) differences were found in the results of OPQ according to the highest level of education. It was observed that the score of the participants with osteoporosis (10.07 ± 6.82 points) was significantly (p=0.003) higher than participants without osteoporosis (9.38 ± 6.66 points) and the score of those women (6.49 ± 6.97 points) who did not know that osteoporosis exists in their case. The GPAQ results showed the sample physical activity in the dimensions of vigorous work (479.86 ± 684.02 min/week); moderate work (678.16 ± 804.5 min/week); travel (262.83 ± 380.27 min/week); vigorous recreation (77.71 ± 123.46 min/week); moderate recreation (115.15 ± 154.82 min/week) and total weekly physical activity (1645.99 ± 1432.88 min/week). Significant correlations were found between the osteoporosis-related knowledge and the physical activity in travel (R=0.21; p < 0.001), vigorous recreation (R=0.35; p < 0.001), moderate recreation (R=0.35; p < 0.001), total vigorous minutes/week (R=0.15; p=0.001) and total moderate minutes/week (R=0.13; p=0.04) dimensions. According to the results that were achieved, the highest level of education significantly determines osteoporosis-related knowledge. Physical activity is an important contributor to prevent or to treat osteoporosis, and it showed a significant correlation with osteoporosis-related knowledge. Based on the results, the development of osteoporosis-related knowledge may help to improve the level of physical activity, especially recreation. Acknowledgment: Supported by the ÚNKP-20-1 New National Excellence Program of The Ministry for Innovation and Technology from the Source of the National Research, Development and Innovation Fund.

Keywords: osteoporosis, osteoporosis-related knowledge, physical activity, prevention

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Authors: Paola Utreras, Yazmina Olmos, Loreto Sanhueza

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This work has the purpose of study and incorporate Problem Based Learning (PBL) for engineering students, through the analysis of several thermal images of dwellings located in different geographical points of the Region de los Ríos, Chile. The students analyze how heat is transferred in and out of the houses and how is the relation between heat transfer and climatic conditions that affect each zone. As a result of this activity students are able to acquire significant learning in the unit of heat and temperature, and manage to reverse previous conceptual errors related with energy, temperature and heat. In addition, student are able to generate prototype solutions to increase thermal efficiency using low cost materials. Students make public their results in a report using scientific writing standards and in a science fair open to the entire university community. The methodology used to measure previous Conceptual Errors has been applying diagnostic tests with everyday questions that involve concepts of heat, temperature, work and energy, before the unit. After the unit the same evaluation is done in order that themselves are able to evidence the evolution in the construction of knowledge. As a result, we found that in the initial test, 90% of the students showed deficiencies in the concepts previously mentioned, and in the subsequent test 47% showed deficiencies, these percent ages differ between students who carry out the course for the first time and those who have performed this course previously in a traditional way. The methodology used to measure Significant Learning has been by comparing results in subsequent courses of thermodynamics among students who have received problem based learning and those who have received traditional training. We have observe that learning becomes meaningful when applied to the daily lives of students promoting internalization of knowledge and understanding through critical thinking.

Keywords: engineering students, heat flow, problem-based learning, thermal images

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Authors: Talal Asif, Maya Kosinska, Lucas Georger, Krish Sardesai, Muhammad Shah Miran

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This article presents a case review and literature review focused on the challenges of managing subaortic membranes (SAM) in young adult patients with mild aortic regurgitation (AR) or aortic stenosis (AS). The study aims to discuss the diagnosis of SAM, imaging studies used for assessment, management strategies in young patients, the risk of valvular damage, and the controversy surrounding prophylactic resection in mild AR. The management of SAM in adults poses challenges due to limited treatment options and potential complications, necessitating further investigation into the progression of AS and AR in asymptomatic SAM patients. The case presentation describes a 40-year-old male with muscular dystrophy who presented with symptoms and was diagnosed with SAM. Various imaging techniques, including CT chest, transthoracic echocardiogram (TTE), and transesophageal echocardiogram (TEE), were used to confirm the presence and severity of SAM. Based on the patient's clinical profile and the absence of surgical indications, medical therapy was initiated, and regular outpatient follow-up was recommended to monitor disease progression. The discussion highlights the challenges in diagnosing SAM, the importance of imaging studies, and the potential complications associated with SAM in young patients. The article also explores the management options for SAM, emphasizing surgical resection as the definitive treatment while acknowledging the limited success rates of alternative approaches. Close monitoring and prompt intervention for complications are crucial in the management of SAM. The concluding statement emphasizes the need for further research to explore alternative treatments for SAM in young patients.

Keywords: subaortic membrane, management, case report, literature review, aortic regurgitation, aortic stenosis, left ventricular outflow obstruction, guidelines, heart failure

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Authors: Dong Yue, Hua Chen

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The study region Xihu Harbor in Xiangshan County, Ningbo City is located in the central coast of Zhejiang Province. Concerning the wave dispating issue, Ningbo government firstly introduced Spartina alterniflora in 1980s. In the 1990s, S. alterniflora spread so rapidly thus a ‘grassland’ in the sea has been created nowadays. It has become the most important invasive plant of China’s coastal tidal flats. Although S. alterniflora had some ecological and economic functions, it has also brought series of hazards. It has ecological hazards on many aspects, including biomass and biodiversity, hydrodynamic force and sedimentation process, nutrient cycling of tidal flat, succession sequence of soil and plants and so on. On engineering, it courses problems of poor drainage and channel blocking. On economy, the hazard mainly reflected in the threat on aquaculture industry. The purpose of this study is to explore an ecological, feasible and economical way to manage Spartina alterniflora and use the land formed by it, taking Xihu Harbor in Xiangshan County as a case. Comparison method, mathematical modeling, qualitative and quantitative analysis are utilized to proceed the study. Main outcomes are as follows. By comparing a series of S. alterniflora managing methods which include the combination of mechanical cutting and hydraulic reclamation, waterlogging, herbicide and biological substitution from three standpoints – ecology, engineering and economy. It is inferred that the combination of mechanical cutting and hydraulic reclamation is among the top rank of S. alternifora managing methods. The combination of mechanical cutting and hydraulic reclamation means using large-scale mechanical equipment like large screw seagoing dredger to excavate the S. alterniflora with root and mud together. Then the mix of mud and grass was blown off nearby coastal tidal zone transported by pipelines, which can cushion the silt of tidal zone to form a land. However, as man-made land by coast, the reclamation area’s ecological sensitivity is quite high and will face high possibility of flood threat. Therefore, the reclamation area has many reasonability requirements, including ones on location, specific scope, water surface rate, direction of main watercourse, site of water-gate, the ratio of ecological land to urban construction land. These requirements all became important basis when the planning was being made. The water system planning, green space system planning, road structure and land use all need to accommodate the ecological requests. Besides, the profits from the formed land is the managing project’s source of funding, so how to utilize land efficiently is another considered point in the planning. It is concluded that by aiming at managing a large area of S. alterniflora, the combination of mechanical cutting and hydraulic reclamation is an ecological, feasible and economical method. The planning of reclamation area should fully respect the natural environment and possible disasters. Then the planning which makes land use efficient, reasonable, ecological will promote the development of the area’s city construction.

Keywords: ecological management, ecological planning method, reclamation area, Spartina alternifora, Xihu harbor

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Authors: Mohammad Emran, Colton Wayne, Shannon M Koehler, P. Stephen Almond, Haroon Patel

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Purpose: Assessment of anastomotic perfusion in Hirschsprung disease using Indocyanine Green (ICG)-near-infrared (NIR) fluorescence angiography. Introduction: Anastomotic stricture and leak are well-known complications of Hirschsprung pull-through procedures. Complications are due to tension, infection, and/or poor perfusion. While a surgeon can visually determine and control the amount of tension and contamination, assessment of perfusion is subject to surgeon determination. Intraoperative use of ICG-NIR enhances this decision-making process by illustrating perfusion intensity and adequacy in the pulled-through bowel segment. This technique, proven to reduce anastomotic stricture and leak in adults, has not been studied in children to our knowledge. ICG, an FDA approved, nontoxic, non-immunogenic, intravascular (IV) dye, has been used in adults and children for over 60 years, with few side effects. ICG-NIR was used in this report to demonstrate the adequacy of perfusion during transanal pullthrough for Hirschsprung’s disease. Method: 8 patients with Hirschsprung disease were evaluated with ICG-NIR technology. Levels of affected area ranged from sigmoid to total colonic Hirschsprung disease. After leveling, but prior to anastomosis, ICG was administered at 1.25 mg (< 2 mg/kg) and perfusion visualized using an NIR camera, before and during anastomosis. Video and photo imaging was performed and perfusion of the bowel was compared to surrounding tissues. This showed the degree of perfusion and demarcation of perfused and non-perfused bowel. The anastomosis was completed uneventfully and the patients all did well. Results: There were no complications of stricture or leak. 5 of 8 patients (62.5%) had modification of the plan based on ICG-NIR imaging. Conclusion: Technologies that enhance surgeons’ ability to visualize bowel perfusion prior to anastomosis in Hirschsprung’s patients may help reduce post-operative complications. Further studies are needed to assess the potential benefits.

Keywords: colonic anastomosis, fluorescence angiography, Hirschsprung disease, pediatric surgery, SPY

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