Search results for: 8D report

Authors: Natasha Goh, Sebastian Brown

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Purpose: This case report describes an unusual presentation of uveal melanoma. Method: Case notes, imaging, and histopathological specimen were reviewed for this case report. Result: The patient is a 62-year-old lady of Chinese heritage who had been receiving follow-up at the eye clinic of a tertiary hospital. She had a longstanding history of poor vision in her right eye after sustaining trauma to the eye at age 3. She was found to have a carotid-cavernous sinus fistula in the right eye in 2009 and underwent stenting in China. Unfortunately, this was unsuccessful and resulted in a painful blind eye. She had represented with headaches, worsening eye pain, and ptosis in Sydney in 2016. Her CT angiogram showed a calcified vascular structure in the orbit and globe, and she was offered a digital subtraction angiography by the neurosurgical team, which she ultimately declined. She had since been followed up at the eye clinic for the pthisical eye. Due to chronic ocular pain and recurrent conjunctivitis, the decision was made for an evisceration in 2021. The specimen was sent for routine histopathological examination and returned positive for uveal melanoma. The patient was subsequently referred to a melanoma center for further follow-up, which comprised serial imaging and radiotherapy treatment. Conclusion: Clinicians should bear in mind that uveal melanomas may present in a longstanding phthisical eye and in patients with no or little apparent risk factors.

Keywords: uveal melanoma, pthisical eye, carotid cavernous fistula, uveal melanoma risk factors

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Authors: Ryan J. Trefethen, Vincent H. Smith

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This study explores the relationship between national spending on the Medicaid program, and total Medicaid spending and enrollment in Montana, a state that ranks thirty-third in per capita income and thirty-seventh in median household income in the United States. The purpose of the research is to estimate the potential effects that specific changes to national healthcare policy would likely have on funding for the Montana Medicaid Program and enrollees in the program, members of families in poverty whose incomes are low, even though in many cases they have steady jobs. A particular concern is the effect on access to care for children in poverty who tend to be food insecure and, therefore, especially in need of access to health care. The research uses data collected from a variety of government publications, including the Medicaid Financial Management Report, the Medicaid Managed Care Enrollment Report, and the Centers for Medicare and Medicaid Services MSIS State Summaries for fiscal years 2000-2015. These data were examined using econometric analysis, to assess these impacts. The evidence indicates that the changes included in recent congressional legislative initiatives would potentially leave an additional 50,000 to 60,000 Montana residents, five to six percent of the state’s population, in poverty without access to health care. Impacts on children in poverty would potentially be substantial.

Keywords: children, healthcare, medicaid, montana, poverty

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Authors: Mohammad Abu-Taleb

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The final report of the Royal Commission into Australian financial services misconduct, released in February 2019, has had a significant impact on the financial advice industry. The recommendations released in the Commissioner’s final report include changes to ongoing fee arrangements, a new disciplinary system for financial advisers, and mandatory reporting of compliance concerns. This thesis aims to explore the impact of the Royal Commission’s recommendations on the operating model of financial advice firms in terms of advice products, processes, delivery models, and customer segments. Also, this research seeks to investigate whether the Royal Commission’s outcome has accelerated the use of enhanced technology solutions within the operating model of financial advice firms. And to identify the key challenges confronting financial advice firms whilst implementing the Commissioner’s recommendations across their operating models. In order to achieve the objectives of this thesis, a qualitative research design has been adopted through semi-structured in-depth interviews with 24 financial advisers and managers who are engaged in the operation of financial advice services. The study used the thematic analysis approach to interpret the qualitative data collected from the interviews. The findings of this thesis reveal that customer-centric operating models will become more prominent across the financial advice industry in response to the Commissioner’s final report. And the Royal Commission’s outcome has accelerated the use of advice technology solutions within the operating model of financial advice firms. In addition, financial advice firms have started more than before using simpler and more automated web-based advice services, which enable financial advisers to provide simple advice in a greater scale, and also to accelerate the use of robo-advice models and digital delivery to mass customers in the long term. Furthermore, the study identifies process and technology changes as, long with technical and interpersonal skills development, as the key challenges encountered financial advice firms whilst implementing the Commissioner’s recommendations across their operating models.

Keywords: hayne royal commission, financial planning advice, operating model, advice products, advice processes, delivery models, customer segments, digital advice solutions

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Authors: Amir AlAmeeri, Mohamed Ibrahim

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Various data points are constantly being measured in the production system, and due to the nature of the wells, these data points, such as pressure, temperature, water cut, etc.., fluctuations are constant, which requires high frequency monitoring and collection. It is a very difficult task to analyze these parameters manually using spreadsheets and email. An automated system greatly enhances efficiency, reduce errors, the need for constant emails which take up disk space, and frees up time for the operator to perform other critical tasks. Various production data is being recorded in an oil field, and this huge volume of data can be seen as irrelevant to some, especially when viewed on its own with no context. In order to fully utilize all this information, it needs to be properly collected, verified and stored in one common place and analyzed for surveillance and monitoring purposes. This paper describes how data is recorded by different parties and departments in the field, and verified numerous times as it is being loaded into a repository. Once it is loaded, a final check is done before being entered into a production monitoring system. Once all this is collected, various calculations are performed to report allocated production. Calculated production data is used to report field production automatically. It is also used to monitor well and surface facility performance. Engineers can use this for their studies and analyses to ensure field is performing as it should be, predict and forecast production, and monitor any changes in wells that could affect field performance.

Keywords: automation, oil production, Cheleken, exploration and production (E&P), Caspian Sea, allocation, forecast

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Authors: Shantanu Vyas, Neerja Meena

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Facial infiltrating lipomatosis is a rare lipomatous lesion, first described by Slavin in 1983. It is a benign pseudotumor pathology. It corresponds to a non-encapsulated collection of mature adipocytes infiltrating the local tissue and hyperplasia of underlying bone leading to a craniofacial deformity. Very few cases have been reported in the literature. We report the case of a 19-year-old female patient, who was consulted for a swelling of the right hemiface progressively evolving since birth. Physical examination revealed facial asymmetry. On palpation, the mass was soft, painless, not compressible, not pulsatile, not fluctuating. In view of the asymptomatic nature and slow progression of the lesion, a lipomatous tumour, namely lipoma, was suggested. CT scan image shows a hyperplastic subcutaneous fat on the right hemiface. On the right jugal and temporal areas, there is a subcutaneous formation of fatty density, poorly limited, with no detectable peripheral capsule. It merges with the adjacent fat. In the bone window, there was a hyperplasia of underlying bone. Facial lipomatosis infiltration of the face is a benign pseudotumor pathology. As a result, it can be confused with other disorders, in particular, hemifacial hyperplasia. Combination of physical and radiological findings can establish the diagnosis. Surgical treatment is done for cosmetic purposes.

Keywords: cosmetic correction and facial assemetry, aesthetic results, facial infiltration, surgery

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Authors: Hamd Ahmed

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During the Persian Gulf War in 1991s, The confederation forces were surprised when they were being shot at by friendly forces in Iraqi desert. As obvious was the fact that they were mislead due to the lack of proper guidance and technology resulting in unnecessary loss of life and bloodshed. This unforeseen incident along with many others led the US department of defense to open the doors of GPS. In the very beginning, this technology was for military use, but now it is being widely used and increasingly popular among the public due to its high accuracy and immeasurable significance. The GPS system simply consists of three segments, the space segment (the satellite), the control segment (ground control) and the user segment (receiver). This project work is about designing a 1.57GHZ mixer for triple conversion GPS receiver .The GPS Front-End receiver based on super heterodyne receiver which improves selectivity and image frequency. However the main principle of the super heterodyne receiver depends on the mixer. Many different types of mixers (single balanced mixer, Single Ended mixer, Double balanced mixer) can be used with GPS receiver, it depends on the required specifications. This research project will provide an overview of the GPS system and details about the basic architecture of the GPS receiver. The basic emphasis of this report in on investigating general concept of the mixer circuit some terms related to the mixer along with their definitions and present the types of mixer, then gives some advantages of using singly balanced mixer and its application. The focus of this report is on how to design mixer for GPS receiver and discussing the simulation results.

Keywords: GPS , RF filter, heterodyne, mixer

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Authors: Asiful H. Seikh, Jabair A. Mohammed, Ubair A. Samad, Mohammad A. Alam, Saeed M. Al-Zahrani, El-Sayed M. Sherif

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Three coating formulations were fabricated by incorporating different percentages of MIO (micaceous iron oxide ) (1, 2, and wt%) with ball-milled nanocrystalline Al (2 wt%) particles, which was optimized earlier. These coatings were characterized by means of different methods, namely, SEM, TGA, pendulum hardness, scratch test, and nano-indentation. The EIS measurements were carried out to report the effect of adding MIO powder in fabricated coatings on their corrosion behavior in 3.5 wt% NaCl solutions. In order to report the effect of immersion time on the corrosion and degradation of the prepared coatings, the EIS data were also acquired after various exposure periods of time, i.e., 1 h, 7 d, 14 d, 21 d, and 30 d in the test chloride solution. It has been found that the obtained EIS data for the fabricated coatings proved that the presence of 2% MIO provided the highest corrosion resistance amongst all coatings and that effect was recorded after all immersion periods of time. But, the MIO-incorporated coatings have less corrosion resistance than Al based epoxy coatings. It was also shown that with prolonged immersion, the resistance to corrosion declined after 7d, then with a longer period of immersion, i.e. 14 d, 21 d, and 30 d increases the resistance to corrosion by forming oxide products on the coatings surface. The results obtained from both mechanical and electrochemical testing confirmed that the fabricated coating with 2 wt% Al exhibited better hardness and higher resistance to corrosion as compared to coatings with 1 wt% Al and 3 wt% Al.

Keywords: epoxy coatings, nanomaterials, corrosion resistance, EIS, nanoindentation

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Authors: Milica Lazic, Jovana Jestrovic

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The aim of this research is to examine moderating role of positive and negative affect, defined as traits, in relationship between a number of stressful life events to which an individual is exposed and life satisfaction. The tendency to experience positive and negative emotions is considered as relatively independent, and life satisfaction depends on presence and intensity of emotions of different valence. However, the role of positive and negative affect can be much more complex. It can change the direction and/or intensity of correlation between a number of stressful life events and life satisfaction. Thus, this question is important for two reasons, (I) better comprehension of inconsistent result of correlation intensity between stressful events and life satisfaction (II) verification on what conditions positive and negative affect have a protective role, and on what conditions the positive and/or negative affect is vulnerability factor. Longitudinal data were collected in two waves from 660 adolescents. Firstly, participants completed the Positive and Negative Affect Schedule. A year later, Life events questionnaire, which measures the number of stressful events in the past six months and Satisfaction with Life Scale were administered. The data were analyzed using hierarchical regression analyses: three-way interaction. The results show that number of life events, positive and negative effect contribute to the level of life satisfaction. The check of moderation role shows the significant three-way interaction of number of life event, and both, positive and negative affect. Individuals who report high level of positive affect, estimate to be moderate to highly satisfied with their lives, regardless of number of stressors to which they are exposed and also how often they experience negative emotions. Individuals, who often experience negative emotions and rarely positive, report the lowest level of life satisfaction. It doesn't change despite the number of stressors they were exposed to. Individuals who report that rarely experience not only positive than also negative emotions estimate different level of life satisfaction depending on number of stressors they were exposed to. Under the influence of numerous stressors, their level of life satisfaction is low, and it's equal to life satisfaction level of individuals who often experience negative and rarely positive emotions. The result of this research shows that tendency to often experience positive emotions is the protective factor in situation when individuals are exposed to high number of stressors. On the other hand, tendency to rarely experience positive emotions present vulnerability factor. Conclusions and practical implications are further discussed.

Keywords: life events, life satisfaction, subjective well-being, positive and negative affect

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Authors: Vikram Singh

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This paper aims to take into account carbon tax or cap-and-trade legislation to manage Delhi carbon emissions after a post-Kyoto treaty. This report estimated the influence of the carbon taxes or rebate/compensation cost at the household level. Here, the three possible scenarios will help to comprehend the difference between a straightforward compensation/rebate, and two clearly denoting progressive formula. The straightforward compensation is basically minimizing the regressive applications that will bears on cost. On the other hand, both the progressive formula will generate extra revenue, which will help for feasibility of more efficient, vehicles, appliances and buildings in the low-income household. For the hypothetical case of carbon price $40/tonne, low-income household for both urban and rural region could experience price burden up to 5% and 9% on their income as compared to 3% and 7% for high-income household respectively. The survey report also shown that carbon emission due low-income household are primarily by the substantive requirement like housing and transportation whereas almost 40% emission due to high-income household are by luxurious and non-essential items. The equal distribution of revenue cum incentives will not completely overcome high-income household’s investment in inessential items. However, it will merely help in investing their income in energy efficient and less carbon intensive items. Therefore, the rebate distribution on per capita basis instead on per households will benefit more especially large families at low-income group.

Keywords: household emission, carbon credit, carbon intensity, green house gas emission, carbon generation based insentives

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Authors: Esther Cabezas-Rivas

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Ordinary differential equations (ODE) are a fundamental part of the curriculum for most engineering degrees, and students typically have difficulties in the subsequent abstract mathematical calculations. To enhance their motivation and profit that they are digital natives, we propose a teamwork project that includes the creation of a video. It should explain how to model mathematically a real-world problem transforming it into an ODE, which should then be solved using the tools learned in the lectures. This idea was indeed implemented with first-year students of a BSc in Engineering and Management during the period of online learning caused by the outbreak of COVID-19 in Spain. Each group of 4 students was assigned a different topic: model a hot water heater, search for the shortest path, design the quickest route for delivery, cooling a computer chip, the shape of the hanging cables of the Golden Gate, detecting land mines, rocket trajectories, etc. These topics should be worked out through two complementary channels: a written report describing the problem and a 10-15 min video on the subject. The report includes the following items: description of the problem to be modeled, detailed obtention of the ODE that models the problem, its complete solution, and interpretation in the context of the original problem. We report the outcomes of this teaching in context and active learning experience, including the feedback received by the students. They highlighted the encouragement of creativity and originality, which are skills that they do not typically relate to mathematics. Additionally, the video format (unlike a common presentation) has the advantage of allowing them to critically review and self-assess the recording, repeating some parts until the result is satisfactory. As a side effect, they felt more confident about their oral abilities. In short, students agreed that they had fun preparing the video. They recognized that it was tricky to combine deep mathematical contents with entertainment since, without the latter, it is impossible to engage people to view the video till the end. Despite this difficulty, after the activity, they claimed to understand better the material, and they enjoyed showing the videos to family and friends during and after the project.

Keywords: active learning, contextual teaching, models in differential equations, student-produced videos

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Authors: Hanifa Maryani Ahmad, Muslim Yusuf

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Background: Unilateral crossbite can be defined as an abnormal transverse relationship between the upper and lower teeth where the mandibular buccal cusp occluding to the maxillary buccal cusp and which involves only one side of the arch. This report describes the treatment of an adolescent female with Class III malocclussion unilateral crossbite resulting from a mildly constricted maxillary arch. The patient had a Class III skeletal relationship, Class III molar relationships, unilateral crossbite on the left side, and deviated midlines. Objectives: The treatment objectives were to correct the abnormal transverse relationship, achieve proper dental inclination, and correct the unilateral crossbites to improve the facial profile. Case management: The treatment protocol was using transpalatal arch with extension arm modification to expand the maxillary arch. Following the levelling and aligning stage of treatment, using a vertical loop while mandibular arch was expanded after getting an end to end relationship on the anterior side. Results: Corrections of the unilateral crossbite were achieved in 4 months. The treatment is still on process because the canines relationship were not corrected. Conclusions: This report highlights a treatment using transpalatal arch with extension arm modification that can be used to expand the transverse width of an arch to correct the discrepancy. Even though the treatment processes were still ongoing, the correction of the unilateral crossbite have been achieved in 4 months by only using the transpalatal arch.

Keywords: crossbite unilateral, late growing, non-extraction, transpalatal arch

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Authors: Barbosa M. L. S., von Ancken A. C. B., Coelho C. P.

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In order to improve the treatment of epileptic dogs, this case report aims toobjective todescribe the use of the homeopathic medicine Cicuta virosa for the treatmentof seizuresin dogs that already use allopathy to control them. Howeach patient presents symptoms individually, the choice of medicationhomeopathic treatment must also be individualized. He was treated in the municipality of RibeirãoPires, São Paulo - Brazil, an animal of the canine species, female, 7 years old, SRD, with a history of seizuregeneralized tonic-clonic for two years, with a variable frequency of 1-2 seizures perday. With no identifiable etiology, the patient used phenobarbital daily, and the dose ofmedication was increased according to the frequency of seizures. The serum concentration of phenobarbital within 12 hours of itsadministration via blood sample was within the range ofreference. The patient experienced weight gain and intermittent sedation. the choice ofhomeopathic medicine Cicuta virosa 6 cH, prepared according to the PharmacopoeiaBrazilian Homeopathic Medicine, occurred due to its characteristic action on the nervous system, especially in epileptic animals that present with seizures, spasmodic contractions of the muscles of the whole body starting from the head, mouth, extremely violent, with rigidity and opisthotonos, extreme agitation, contortionsmultiple. The animal was submitted to treatment with 2 globules orally twicea day for 30 days. The treatment resulted in a clinical cure as there was no moreseizures, being effective to control this symptom.

Keywords: homeopathy, cicuta virosa, epilepsy, veterinary medicine

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Authors: Chanho Park, Juneseok You, Kuewhan Jang, Sungsoo Na

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Detection technique of nanotoxic materials is strongly imperative, because nano-toxic materials can harmfully influence human health and environment as their engineering applications are growing rapidly in recent years. In present work, we report the DNA immobilized quartz crystal microbalance (QCM) based sensor for detection of nano-toxic materials such as silver ions, Hg2+ etc. by using functionalization of quartz crystal with a target-specific DNA. Since the mass of a target material is comparable to that of an atom, the mass change caused by target binding to DNA on the quartz crystal is so small that it is practically difficult to detect the ions at low concentrations. In our study, we have demonstrated fast and in situ detection of nanotoxic materials using quartz crystal microbalance. We report the label-free and highly sensitive detection of silver ion for present case, which is a typical nano-toxic material by using QCM and silver-specific DNA. The detection is based on the measurement of frequency shift of Quartz crystal from constitution of the cytosine-Ag+-cytosine binding. It is shown that the silver-specific DNA measured frequency shift by QCM enables the capturing of silver ions below 100pM. The results suggest that DNA-based detection opens a new avenue for the development of a practical water-testing sensor.

Keywords: nano-toxic ions, quartz crystal microbalance, frequency shift, target-specific DNA

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Authors: Thomas Suarez, Anne-Sophie Grenouilleau, Erwan Autin, Alexandre Biosse-Duplan, Emmanuelle Blondet, Laurence Chazalette, Marie Coniel, Agnes Dessaigne, Sylvie Lascols, Andrea Lasserre, Candice Legris, Pierre Liot, Aline Metais, Karine Petitprez, Christophe Varlet, Christian Saout

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Background: The role of biological sex and gender identity -whether assigned or chosen- as health determinants are far from a recent discovery: several reports have stressed out how being a woman or a man could affect health on various scales. However, taking it into consideration beyond stereotypes and rigid binary assumptions still seems to be a work in progress. Method: The report is a synthesis on a variety of specific topics, each of which was studied by a specialist from the French National Authority for Health (HAS), through an analysis of existing literature on both healthcare policy construction process and instruments (norms, data analysis, clinical trials, guidelines, and professional practices). This work also implied a policy analysis of French recent public health laws and a retrospective study of guidelines with a gender mainstreaming approach. Results: The analysis showed that though sex and gender were well-known determinants of health, their consideration by both public policy and health operators was often incomplete, as it does not incorporate how sex and gender interact, as well as how they interact with other factors. As a result, the health and social care systems and their professionals tend to reproduce some stereotypical and inadequate habits. Though the data available often allows to take sex and gender into consideration, such data is often underused in practice guidelines and policy formulation. Another consequence is a lack of inclusiveness towards transgender or intersex persons. Conclusions: This report first urges for raising awareness of all the actors of health, in its broadest definition, that sex and gender matter beyond first-look conclusions. It makes a series of recommendations in order to reshape policy construction in the health sector on the one hand and to design public health instruments to make them more inclusive regarding sex and gender on the other hand. The HAS finally committed to integrate sex and gender preoccupations in its workings methods, to be a driving force in the spread of these concerns.

Keywords: biological sex, determinants of health, gender, healthcare policy instruments, social accompaniment

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Authors: Robin Ratnasingham, Maher Elshakankiri

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This research report will look at how to make a smart washroom to increase public hygiene and cleanliness. The system would use IoT devices to pick up various activities in the washroom and notify the appropriate stakeholders or devices to regulate the condition of the washroom. As more people are required to physically go back to the office or school, ensuring a clean and sanitized washroom is even more important now than before. It would help prevent virus outbreaks and safeguard the organization from shutdowns or slowdowns in their business. A framework of the suggested smart washroom was introduced to help reduce the chances of a virus outbreak. Most organizations outsource renovation or implementation to an external party. Using the smart washroom framework, we looked at vendors that provide smart washroom solutions. There are IoT vendors that cannot match the framework, and there are vendors that can support the framework design. This segment is a niche market, and most of the devices are similar in their basic functions. However, all the vendors have unique characteristics to give them a competitive advantage over the rest of the IoT washroom companies. Ultimately, the organization would need to decide if they want to add IoT devices to enable smart capability or renovate the washroom to create a fluid IoT smart washroom design. The report would introduce an IoT smart washroom framework to help organizations design a cohesive preventive measure network for the daily maintenance routine. The framework is designed to help understand how to manage washroom cleanliness more efficiently and to provide guidance in achieving this goal. The leading result is eliminating potential viral outbreaks that could jeopardize the organization.

Keywords: IoT, smart washroom, public hygiene, cleanliness, virus outbreaks, safeguard

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Authors: Emil Danehorn, Ulla Peterson, Marie Oscarsson, Goldina Smirthwaite, Katarina Swahnberg

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Swedish students who choose to study abroad are common, but there has been limited research on exchange students. There are indications that some Swedish exchange students have been exposed to violence, but it is not known if they, already before their semester abroad, are more exposed to violence than students who remain on campus. Our aim was to investigate potential differences in exposure to physical, sexual, and emotional violence between prospective exchange students and campus students and between male and female students in general, as well as to determine any associations between mental health and exposure to violence among students in the total sample. Method: Comparative cross-sectional design using an online survey containing the NorVold Abuse Questionnaire and the General Health Questionnaire 12. A total of 565 participants took part in the study. Results: Prospective exchange students were less exposed to emotional violence compared to campus students. About one-half of all the participating female students had been exposed to sexual violence and about one-third of all the male students had been exposed to physical violence. The results also indicated that exposure to more than one form of violence was associated with poor mental health for students as a group. Conclusion: Prospective exchange students as a group do not report more exposure to physical and sexual violence than campus students but do report less exposure to emotional violence. However, the overall frequency of exposure to violence among the students was high. This highlights the need for proactive efforts for everyone, not least for exchange students who will be staying in a new environment unknown to them.

Keywords: sexual violence, physical violence, emotional violence, exchange students, mental health

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Authors: Fatma Al Abdullah, Shahad Al Ameer, Ritaj Jaragh, Fatimah Khajah, Rawan Qambar, Amr Nounou

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Kuwait currently manufactures its tankers in foreign countries. Oil tankers play a role in the supply chain of the oil industry. Therefore, with Kuwait’s sufficient financial resources, the country should secure itself strategically in order to protect its oil industry to sustain economic development. The purpose of this report is designing an oil tankers’ shipyard facility. Basing the shipyard facility in Kuwait will have great economic rewards. The shipbuilding industry directly enhances the industrial chain in terms of new job and business opportunities as well as educational fields. Heavy Engineering Industries & Shipbuilding Co. K.S.C. (HEISCO) was chosen as a host due to benefits that will result from HEISCO’s existing infrastructure and expertise to reduce cost. The Facility Design methodology chosen has been used because it covers all aspects needed for the report. The oil tanker market is witnessing a shift from crude tankers to product tankers. Therefore the Panamax tanker (product tanker) was selected to be manufactured in the facility. The different departments needed in shipyards were identified based on studying different global shipyards. Technologies needed to build ships helped in the process design. It was noticed that ships are engineer to order. The new layout development of the proposed shipyard is currently in progress. A feasibility study will be conducted to ensure the success of the facility after developing the shipyard’s layout.

Keywords: oil tankers, shipbuilding, shipyard, facility design, Kuwait

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Authors: Nazmul Haque, Syeda Tasnuva Maria

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Sheehan's Syndrome (SS), also known as postpartum hypopituitarism, is a rare but potentially serious condition resulting from ischemic necrosis of the pituitary gland, often occurring during or after childbirth. This syndrome is characterized by hypopituitarism, leading to deficiencies in various hormones produced by the pituitary gland. The primary cause is typically severe postpartum hemorrhage, leading to inadequate blood supply and subsequent necrosis of the pituitary tissue. This chronic hypopituitarism sometimes plays the role of premature atherosclerosis, which may lead to cardiovascular disease. This abstract provides a comprehensive overview of Sheehan's Syndrome with ischaemic heart disease, encompassing its pathophysiology, clinical manifestations, and current management strategies. The disorder presents a wide spectrum of symptoms, including chest pain, fatigue, amenorrhea, lactation failure, hypothyroidism, and adrenal insufficiency. Timely diagnosis is crucial, as delayed recognition can lead to complications and long-term health consequences. We herein report a patient complaining of chronic fatigue symptoms, aggressiveness, chest pain, and breathlessness with repeated LOC that were diagnosed with SS with IHD. The patient was treated with antiplatelet, antianginal, steroids, and hormone replacement with marked improvement in his overall condition.

Keywords: ischaemic heart disease, Sheehan's syndrome, post-partum haemorrhage, pituitary gland

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Authors: Roni Rachel Mendelson, Caileigh Pudela

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Bacillus cereus is a toxin-producing, facultatively anaerobic gram-positive bacterium that is widely distributed environmentally. It can quickly multiply at room temperature with an abundantly present preformed toxin. When ingested, this toxin can cause gastrointestinal illness, which is the commonly known manifestation of the disease. Bacillus cereus sepsis is a disease that is mostly concerning in the population of the immunocompromised patients. One of them is acute lymphoblastic leukemia’s patients during induction. Pediatric acute lymphoblastic leukemia is a common pediatric hematologic malignancy. It is characterized by the rapid proliferation of poorly differentiated lymphoid progenitor cells inside the bone marrow. We present here a 21-month-old boy undergoing induction chemotherapy for acute lymphoblastic leukemia who developed bacillus sepsis bacteremia and, as a result, multi organ failure leading to seizures and multiple strokes. Our case report highlights the extensive overall and neurological damage that can be caused because of bacillus cereus bacteremia, which can lead to higher mortality rate and decreased in survivorship in a highly curable disease. It is very subtle and difficult to recognize and appears to be deteriorating extremely fast. There should be a low threshold for work up and empiric coverage for neutropenic patients during acute lymphoblastic leukemia induction therapy.

Keywords: acute lymphoblastic leukemia, bacillus cereus, immunocompromised, sepsis

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Authors: Yuri Seu, Hyun Jin Park, Jin Seo Park, Yong-Suk Moon, HongtaeKim, Mi-Sun Hur

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The present case report describes bifid ureters arising directly from the separate calyces and renal pelvis of the kidney. It was a single common ureter leading away from the bladder, which was separated into incompletely duplicated ureters near the level of the anterior superior iliac supine. These two branches then entered the left kidney through their own courses. Each ureter traveled anterior and posterior to the renal vein, respectively. These two ureters formed a Y-shaped pattern. One ureter coursed anterior to the renal vein with shorter length, and it terminated at the renal pelvis that was divided into major calices in approximately lower two thirds of the kidney. The other ureter coursed posterior to the renal vein with longer length, terminating at approximately the upper third of the kidney. The renal calices in the upper third of the kidney were directly connected to the posterior ureter, whereas the other major calices in the lower two thirds of the kidney formed the renal pelvis connecting to the anterior ureter. Thus, convergence of the major calices was separated according to the terminations of two ureters. These anomalous ureters were traced to the calices of the kidney, thereby providing a reference of a rare variation of the ureter. The bifid ureters arising from the separate calyces and renal pelvis should be considered by radiologists when evaluating images and diagnosing possible complications of these anomalies.

Keywords: bifid ureters, kidney, major calices, renal pelvis

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Authors: Richard Okyere Boadu, Judith Obiri-Yeboah, Kwame Adu Okyere Boadu, Nathan Kumasenu Mensah, Grace Amoh-Agyei

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Routine health information system (RHIS) quality assurance has become an important issue, not only because of its significance in promoting a high standard of patient care but also because of its impact on government budgets for the maintenance of health services. A routine health information system comprises healthcare data collection, compilation, storage, analysis, report generation, and dissemination on a routine basis in various healthcare settings. The data from RHIS give a representation of health status, health services, and health resources. The sources of RHIS data are normally individual health records, records of services delivered, and records of health resources. Using reliable information from routine health information systems is fundamental in the healthcare delivery system. Quality assurance practices are measures that are put in place to ensure the health data that are collected meet required quality standards. Routine health information system quality assurance practices ensure that data that are generated from the system are fit for use. This study considered quality assurance practices in the RHIS processes. Methods: A cross-sectional study was conducted in eight health facilities in Tarkwa Sub-Municipal Health Service in the western region of Ghana. The study involved routine quality assurance practices among the 90 health staff and management selected from facilities in Tarkwa Sub-Municipal who collected or used data routinely from 24th December 2019 to 20th January 2020. Results: Generally, Tarkwa Sub-Municipal health service appears to practice quality assurance during data collection, compilation, storage, analysis and dissemination. The results show some achievement in quality control performance in report dissemination (77.6%), data analysis (68.0%), data compilation (67.4%), report compilation (66.3%), data storage (66.3%) and collection (61.1%). Conclusions: Even though the Tarkwa Sub-Municipal Health Directorate engages in some control measures to ensure data quality, there is a need to strengthen the process to achieve the targeted percentage of performance (90.0%). There was a significant shortfall in quality assurance practices performance, especially during data collection, with respect to the expected performance.

Keywords: quality assurance practices, assessment of routine health information system quality, routine health information system, data quality

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Authors: Mustafa Cam, Nedim Ongun, Ufuk Kutluana

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Introduction: Restless LegsSyndrome (RLS) is a common, under-recognized disorder disrupts sleep and diminishes quality of life (1). The most common conditions highly associated with RLS include renalfailure, iron and folic acid deficiency, peripheral neuropathy, pregnancy, celiacdisease, Crohn’sdiseaseandrarelymalignancy (2).Despite a clear relation between low peripheral iron and increased prevalence and severity of RLS, the prevalence and clinical significance of RLS in iron-deficientanemic populations is unknown (2). We report here a case of RLS due to iron deficiency in the setting of neuroendocrinetumor. Report of Case: A 35 year-old man was referred to our clinic with general weakness, weight loss (10 kg in 2 months)and 2-month history of uncomfortable sensations in his legs with urge to move, partially relieved by movement. The symptoms were presented very day, worsening in the evening; the discomfort forced the patient to getup and walk around at night. RLS was severe, with a score of 22 at the International RLS ratingscale. The patient had no past medical history. The patient underwent a complete set of blood analyses and the following ab normal values were found (normal limitswithinbrackets): hemoglobin 9.9 g/dl (14-18), MCV 70 fL (80-94), ferritin 3,5 ng/mL (13-150). Brain and spinemagnetic resonance imaging was normal. The patient consultated with gastroenterology clinic and gastointestinal systemendoscopy was performed for theetiology of the iron deficiency anemia. After the gastricbiopsy, results allowed us to reach the diagnosis of neuroen docrine tumor and the patient referred to oncology clinic. Discussion: The first important consideration from this case report is that the patient was referred to our clinic because of his severe RLS symptoms dramatically reducing his quality of life. However, our clinical study clearly demonstrated that RLS was not the primary disease. Considering the information available for this patient, we believe that the most likely possibility is that RLS was secondary to iron deficiency, a very well-known and established cause of RLS in theliterature (3,4). Neuroendocrine tumors (NETs) are rare epithelial neoplasms with neuroendocrine differentiation that most commonly originate in the lungs and gastrointestinal tract (5). NETs vary widely in their clinical presentation; symptoms are often nonspecific and can be mistaken for those of other more common conditions (6). 50% of patients with reported disease stage have either regional or distant metastases at diagnosis (7). Accurate and earlier NET diagnosis is the first step in shortening the time to optimal care and improved outcomes for patients (8). The most important message from this case report is that RLS symptoms can sometimes be thesign of a life-threatening condition. Conclusion: Careful and complete collection of clinical and laboratory data should be carried out in RLS patients. Inparticular, if RLS onset coincides with weight loss and iron deficieny anemia, gastricendos copy should be performed. It is known about that malignancy is a rare etiology in RLS patients and to our knowledge; it is the first case with neuro endocrine tumor presenting with RLS.

Keywords: neurology, neuroendocrine tumor, restless legs syndrome, sleep

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Authors: Stephanie Giordano, Eric Lam, Rosa Plasencia

Abstract:

An important piece of active aging is ensuring people have the right support to meet individual needs. Using NCI-AD data, we will look at measures of satisfaction with community access and needed services among people with physical disabilities receiving LTSS in the US. National Core Indicators—Aging and Disabilities (NCI-AD) is a voluntary effort by State Medicaid, aging, and disability agencies across the US to measure and track their own performance. NCI-AD uses a standardized survey – the Adult Consumer Survey (ACS), to hear directly from people receiving services about the quality of services and supports they receive. Data from the 2018-19 ACS found that compared to people without a physical disability, those with a physical disability were more likely to make choices about the services they receive, including when and how often they receive those services. Yet people with a physical disability were less likely to report they get enough assistance with everyday activities (e.g., shopping, housework, and taking medications) and self-care (e.g., dressing or bathing) and more likely to report that services and supports do not fully meet their needs and goals. A further breakdown by age shows that people 40-65 years old with a physical disability experienced even greater barriers to being as active in the community as they would like to be, indicating a need to better support people as they age with or into a disability. We will explore how these and other outcomes were affected by COVID-19, take a closer look at outcomes by demographics (e.g., race/ethnicity, gender, and mental health diagnoses) and discuss implications on the future needs of service systems.

Keywords: quality-of-life, long-term services and supports, person-centered, community

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Authors: Nino Gogatishvili, Davit Kvernadze, Giorgi Japharidze

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Background and aims: Landau Kleffner syndrome (LKS) is a rare disorder with epileptic seizures and acquired aphasia. It usually starts in initially healthy children. The first symptoms are language regression and behavioral disturbances, and the sleep EEG reveals abnormal epileptiform activity. The aim was to discuss the efficacy of Clobazam for Landau Kleffner syndrome. Case report: We report a case of an 11-year-old boy with an uneventful pregnancy and delivery. He began to walk at 11 months and speak with simple phrases at the age of 2,5 years. At the age of 18 months, he had febrile convulsions; at the age of 5 years, the parents noticed language regression, stuttering, and serious behavioral dysfunction, including hyperactivity, temper outbursts. The epileptic seizure was not noticed. MRI was without any abnormality. Neuropsychological testing revealed verbal auditory agnosia. Sleep EEG showed abundant left fronto-temporal spikes, reaching over 85% during non-rapid eye movement sleep (non-REM sleep). Treatment was started with Clobazam. After ten weeks, EEG was improved. Stuttering and behavior also improved. Results: Since the start of Clobazam treatment, stuttering and behavior improved. Now, he is 11 years old, without antiseizure medication. Sleep EEG shows fronto-temporal spikes on the left side, over 10-49 % of non-REM sleep, bioccipital spikes, and slow-wave discharges and spike-waves. Conclusions: This case provides further support for the efficacy of Clobazam in patients with LKS.

Keywords: Landau-Kleffner syndrome, antiseizure medication, stuttering, aphasia

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Authors: Buket Canbaz Öztürk, N. Füsun Çam, Günseli Yaprak, Osman Candan

Abstract:

The external terrestrial radiation exposure is related to the types of rock from which the soils originate. Higher radiation levels are associated with igneous rocks, such as granite, and lower levels with sedimentary rocks. Therefore, this study aims to assess the gamma radiation exposure of soils associated with granitic rocks in Kapıdağ Peninsula, Turkey. In the ongoing study, a comprehensive survey carried out systematically as a part of the environmental monitoring program on radiologic impact of the granitoid areas in Western Anatolia. The activity measurements of the gamma emitters (238U, 232Th and 40K) in the surface soil samples and the granitic rocks carried out by means of NaI(Tl) gamma-ray spectrometry system. To evaluate the radiological hazard of the natural radioactivity, the absorbed dose rate (D), the annual effective dose rate (AED), the radium equivalent activity (Raeq) and the external (Hex) hazard index were calculated according to the UNSCEAR 2000 report. The corresponding absorbed dose rates in air from all natural radionuclides were always much lower than 200 nGy h-1 and did not exceed the typical range of worldwide average values noticed in the UNSCEAR (2000) report. Furthermore, the correlation between soil and granitic rock samples were utilized, and external gamma radiation exposure distribution was mapped in Kapıdağ Peninsula.

Keywords: external absorbed dose, granitic rocks, Kapıdağ Peninsula, soil

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Authors: Blanca Fatela Cantillo, Silvia Iglesias Cerrato, Guadalupe Garrido Ceca

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Purpose: Bleb dysfunction is a late complication following glaucoma filtration surgery. We describe our surgical technique for excision and reconstruction of a hypertrophic bleb complication using bovine pericardium patch graft (Tutopatch®) and amniotic membrane. Material and methods: The case report presents a hypertrophic bleb over the cornea with good intraocular pressure control. The hanging bleb without leak caused dysesthesia and high irregular astigmatism. Bleb reconstruction involved the excision of corneal fibrous material and avascular conjunctiva, preserving the original scleral and tennon. Bovine pericardium patch graft (Tutopatch®) was sited over these with fixed sutures, reinforcing the underlying scleral, and the conjunctiva advanced. The superior epithelium corneal defect was covered using an amniotic membrane. Conclusion: Repair of bleb dysfunction with varied techniques has been reported, including conjunctival advancement, use of scleral patch graft, dural patch graft, or pericardium. Additional use of amniotic membrane promotes epithelialization and exhibits anti-fibrotic and anti-inflammatory features. Reconstruction with bovine pericardium patch graft and amniotic membrane resulted in pain relief, visual rehabilitation, and good aesthetic results, with preservation of bleb function.

Keywords: reconstruction, hypertrophic bleb, bovine pericardium, amniotic membrane, dysesthesia of the bleb

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Authors: Waqas Ahmad, Eisha Tahir, Shahper Aqeel, Imran Khalid Niazi, Amjad Iqbal

Abstract:

Background: Breast conservation surgery applies a number of techniques for accurate localization of lesions. Wire localization remains the method of choice in non-palpable breast cancers post-neoadjuvant chemotherapy. Objective: The aim of our study was to determine the accuracy of wire localization procedures in our department and compare it with internationally set protocols as per the Royal College of Radiologists. Post wire mammography, as well as the margin status of the postoperative specimen, assessed the accuracy of the procedure. Methods: We retrospectively reviewed the data of 225 patients who presented to our department from May 2014 to June 2015 post neoadjuvant chemotherapy with non-palpable cancers. These patients are candidates for wire localized lumpectomies either under ultrasound or stereotactic guidance. Metallic marker was placed in all the patients at the time of biopsy. Post wire mammogram was performed in all the patients and the distance of the wire tip from the marker was calculated. The presence or absence of the metallic clip in the postoperative specimen, as well as the marginal status of the postoperative specimen, was noted. Results: 157 sonographic and 68 stereotactic wire localization procedures were performed. 95% of the wire tips were within 1 cm of the metallic marker. Marginal status was negative in 94% of the patients in histopathological specimen. Conclusion: Our audit report declares more than 95% accuracy of image guided wire localization in successful excision of non-palpable breast lesions.

Keywords: breast, cancer, non-palpable, wire localization

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Authors: Rabaya Basori, Arup K. Raychaudhuri

Abstract:

In recent years, a variety of semiconductor nanowires (NWs) has been synthesized and used as basic building blocks for the development of electronic and optoelectronic nanodevices. Dielectrophoresis (DEP) has been widely investigated as a scalable technique to trap and manipulate polarizable objects. This includes biological cells, nanoparticles, DNA molecules, organic or inorganic NWs and proteins using electric field gradients. In this article, we have used DEP force to localize nanowire growth by physical vapor deposition (PVD) method as well as control of NW diameter on field assisted growth of the NWs of CuTCNQ (Cu-tetracyanoquinodimethane); a metal-organic charge transfer complex material which is well known of resistive switching. We report a versatile analysis platform, based on a set of nanogap electrodes, for the controlled growth of nanowire. Non-uniform electric field and dielectrophoretic force is created in between two metal electrodes, patterned by electron beam lithography process. Suspended CuTCNQ nanowires have been grown laterally between two electrodes in the vicinity of electric field and dielectric force by applying external bias. Growth and diameter dependence of the nanowires on external bias has been investigated in the framework of these two forces by COMSOL Multiphysics simulation. This report will help successful in-situ nanodevice fabrication with constrained number of NW and diameter without any post treatment.

Keywords: nanowire, dielectrophoretic force, confined growth, controlled diameter, comsol multiphysics simulation

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Authors: Karissa Graham, Andrew Campbell-Lloyd

Abstract:

The deep inferior epigastric artery perforator flap (DIEP) is used to reconstruct large volumes of tissue. The DIEP flap is based on the deep inferior epigastric artery (DIEA) and vein. Accurate knowledge of the anatomy of these vessels allows for efficient dissection of the flap, minimal damage to surrounding tissue, and a well vascularized flap. A 54 year old lady was assessed for bilateral delayed autologous reconstruction with DIEP free flaps. The right DIEA was consistent with the described anatomy. The left DIEA had a vessel branching shortly after leaving the external iliac artery and before entering the muscle. This independent branch entered the muscle and had a long intramuscular course to the largest perforator. The main DIEA vessel demonstrated a type II branching pattern but had perforators that were too small to have a viable DIEP flap. There were no communicating arterial branches between the independent vessel and DIEA, however, there was one venous communication between them. A muscle sparing transverse rectus abdominis muscle flap was raised using the main periumbilical perforator from the independent vessel. Our case report demonstrated an unreported anatomical variant of the DIEA. A few anatomical variants have been described in the literature, including a unilateral absent DIEA and peritoneal-cutaneous perforators that had no connection to the DIEA. Doing a pre-operative CTA helps to identify these rare anatomical variations, which leads to safer, more efficient, and effective operating.

Keywords: aberrant anatomy, CT angiography, DIEP anatomy, free flap

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Authors: Nitin Dwivedi, Jigna Shah

Abstract:

Aim and objective of study: This article indicates a comparison among various generations of dendrimers, a dendrimer is a bioactive material has repetitively branched molecule and used for delivery of various therapeutic active agents. This debut report compares the effect various generations of PPI dendrimers for brain targeting and management of neurodegenerative disorders potential on single platform. This report involves the study of the various mechanism of synthesis ligand anchored various generations PPI dendrimers deliver the drug directly to the CNS, prove their effectiveness in the management of the various neurodegenerative disease. Material and Methods: The Memantine an anti-Alzheimer drug loaded in different generations (3.0G, 4.0G, and 5.0G) of PPI dendrimers which were synthesized were synthesized. The various studies investigate the effect of PPI dendrimers generation on different characteristic parameters i.e. synthesis procedure, drug loading, release behavior, hemolysis profile at different concentration, MRI study for determine the route drug from olfactory transfer, animal model study in vitro, as well as in vivo performance. The outcomes of the investigation indicate drug delivery benefit as well as superior biocompatibility of 4.0G PPI dendrimer over 3.0G and 5.0G dendrimer, respectively. Results and Conclusion: The above study indicate the superiority of in drug delivery system with maximum drug utilization and minimize the drug dose for neurodegenerative disorder over 5.0G PPI dendrimers. So, 4.0G PPI dendrimers are the safe formulations for the symptomatic treatment of the neurodegenerative disorder. The fifth-generation poly(propyleneimine) (PPI) dendrimers, inherent toxicity due to the presence of many peripheral cationic groups is the major issue that limits their applicability.

Keywords: Alzheimer disease, generation, memantine, PPI

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