Search results for: Thomas Cochrane

Authors: Nuo Xu, Sijing Chen

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Background: Childbirth is considered a critical traumatic event throughout our lives, positively or negatively impacting the mother's physiology, psychology, and even the whole family. Adverse birth experiences, such as labor pain, anxiety, and fear can negatively impact the mother. Studies had shown that the immersive nature of VR can distract attention from pain and increase focus on interventions for pain relief. However, the existing studies that applied VR to maternal delivery were still in their infancy and showed disparate results, and the small sample size is not representative, so this review analyzed the effects of VR in labor, such as on maternal pain and anxiety, with a view to providing a basis for future applications. Search strategy: We searched Pubmed, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wan-Fang database from the building to November 17, 2021. Selection Criteria: Randomized controlled trials (RCTs) that intervened the pregnant women aged 18-35 years with gestational >34 weeks and without complications with VR technology were contained within this review. Data Collection and Analysis: Two researchers completed the study selection, data extraction, and assessment of study quality. For quantitative data we used MD or SMD, and RR (risk ratio) for qualitative data. Random-effects model and 95% confidence interval (95% CI) were used. Main Results: 12 studies were included. Using VR could relieve pain during labor (MD=-1.81, 95% CI (-2.04, -1.57), P< 0.00001) and active period (SMD=-0.41, 95% CI (-0.68, -0.14), P= 0.003), reduce anxiety (SMD=-1.39, 95% CI (-1.99, -0.78), P< 0.00001) and improve satisfaction (RR = 1.32; 95% CI (1.10, 1.59); P = 0.003), but the effect on the duration of first (SMD=-1.12, 95% CI (-2.38, 0.13), P=0.08) and second (SMD=-0.22, 95% CI (-0.67, 0.24), P=0.35) stage of labor was not statistically significant. Conclusions: Compared with conventional care, VR technology can relieve labor pain and anxiety and improve satisfaction. However, extensive experimental validation is still needed.

Keywords: virtual reality, delivery, labor pain, anxiety, meta-analysis, systematic review

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Authors: Thomas Seemann, Melanie Seemann

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The work environment has changed considerably due to the COVID pandemic. A growing body of empirical research shows that employees feel increasingly stressed and anxious. They consider themselves more detached from the organization they work for than previously. Organizations need to readjust their leadership practices to cope with this situation and rebuild work motivation and resilience. We propose a leadership tool that focuses on two key dimensions, which we call the "task channel" and the "energy channel." Managing the task channel comprises balancing the challenge [C] of a task and the corresponding skill set [S] of the individual performing the task. Recent research findings shed light on how to balance these two factors and create optimal work conditions in the workplace. Managing the energy channel comprise balancing the workload [WL] of an employee and his/her capacity to work [CW]. This ensures that the mid-term and long-term effectiveness of employees is maintained and energy depletion, fatigue, and burn-out are prevented. Organizations can actively apply strategies to leverage wellsprings and effectively reenergize their workforce. Thinking through and acting upon these factors will provide leaders with the insights they need to maximize their people's performance and, at the same time, establish a more mindful workplace.

Keywords: resilience, motivation, employee engagement, leadership

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Authors: Zhipeng Yan, Janice Wing-Tung Kwong, Ching-Lung Lai

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Background: Advanced melanoma accounts for the majority of skin cancer death due to its poor prognosis. Nivolumab and ipilimumab are monoclonal antibodies targeting programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocytes antigen 4 (CTLA-4). Nivolumab and ipilimumab combination therapy has been proven to be effective for advanced melanoma. This systematic review and meta-analysis are to evaluate its clinical efficacy and adverse events. Method: A systematic search was done on databases (Pubmed, Embase, Medline, Cochrane) on 21 June 2020. Search keywords were nivolumab, ipilimumab, melanoma, and randomised controlled trials. Clinical trials fulfilling the inclusion criteria were selected to evaluate the efficacy of combination therapy in terms of prolongation of progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). The odd ratios and distributions of grade 3 or above adverse events were documented. Subgroup analysis was performed based on PD-L1 expression-status and BRAF-mutation status. Results: Compared with nivolumab monotherapy, the hazard ratios of PFS, OS and odd ratio of ORR in combination therapy were 0.64 (95% CI, 0.48-0.85; p=0.002), 0.84 (95% CI, 0.74-0.95; p=0.007) and 1.76 (95% CI, 1.51-2.06; p < 0.001), respectively. Compared with ipilimumab monotherapy, the hazard ratios of PFS, OS and odd ratio of ORR were 0.46 (95% CI, 0.37-0.57; p < 0.001), 0.54 (95% CI, 0.48-0.61; p < 0.001) and 6.18 (95% CI, 5.19-7.36; p < 0.001), respectively. In combination therapy, the odds ratios of grade 3 or above adverse events were 4.71 (95% CI, 3.57-6.22; p < 0.001) compared with nivolumab monotherapy, and 3.44 (95% CI, 2.49-4.74; p < 0.001) compared with ipilimumab monotherapy, respectively. High PD-L1 expression level and BRAF mutation were associated with better clinical outcomes in patients receiving combination therapy. Conclusion: Combination therapy is effective for the treatment of advanced melanoma. Adverse events were common but manageable. Better clinical outcomes were observed in patients with high PD-L1 expression levels and positive BRAF-mutation.

Keywords: nivolumab, ipilimumab, advanced melanoma, systematic review, meta-analysis

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Authors: Yusra Pintaningrum, Ilma Fahira Basyir, Sony Hilal Wicaksono, Vito A. Damay

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Background: Coronary artery calcium (CAC) scores play an important role in improving prognostic accuracy and can be selectively used to guide the allocation of statin therapy for atherosclerotic cardiovascular disease outcomes and potentially associated with the occurrence of MACE (Major Adverse Cardiovascular Event) and MI (Myocardial Infarction). Objective: This systematic review and meta-analysis aim to analyze the findings of a study about CAC Score and statin treatment effect on MI and MACE risk. Methods: Search for published scientific articles using the PRISMA (Preferred Reporting, Items for Systematic Reviews and Meta-Analysis) method conducted on PubMed, Cochrane Library, and Medline databases published in the last 20 years on “coronary artery calcium” AND “statin” AND “cardiovascular disease” Further systematic review and meta-analysis using RevMan version 5.4 were performed based on the included published scientific articles. Results: Based on 11 studies included with a total of 1055 participants, we performed a meta-analysis and found that individuals with CAC score > 0 increased risk ratio of MI 8.48 (RR = 9.48: 95% CI: 6.22 – 14.45) times and MACE 2.48 (RR = 3.48: 95% CI: 2.98 – 4.05) times higher than CAC score 0 individual. Statin compared against non-statin treatment showed a statistically insignificant overall effect on the risk of MI (P = 0.81) and MACE (P = 0.89) in an individual with elevated CAC score 1 – 100 (P = 0.65) and > 100 (P = 0.11). Conclusions: This study found that an elevated CAC scores individual has a higher risk of MI and MACE than a non-elevated CAC score individual. There is no significant effect of statin compared against non-statin treatment to reduce MI and MACE in elevated CAC score individuals of 1 – 100 or > 100.

Keywords: coronary artery calcium, statin, cardiovascular disease, myocardial infarction, MACE

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Authors: Fahad Al Beyahi, Justin Thomas, Md Mamunur Rashid

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Various definitions of digital well-being have emerged in recent years, most of which center on the impacts -beneficial and detrimental- of digital technology on health and well-being (psychological, social, and financial). Other definitions go further, emphasizing the attainment of balance, viewing digital well-being as wholly subjective, the individual’s perception of optimal balance between the benefits and ills associated with online connectivity. Based on this broad conceptualization of digital well-being, we undertook a global survey measuring various dimensions of this emerging construct. The survey was administered across 35 nations and 7 world regions, with 1000 participants within each territory (N= 35000). Along with attitudinal, behavioral, and sociodemographic variables, the survey included measures of depression, anxiety, problematic social media use, gaming disorder, and other relevant metrics. Coupled with nation-level policy audits, these data were used to create a multinational (global) digital well-being index. Nations are ranked based on various dimensions of digital well-being, and predictive models are used to identify resilience and risk factors for problem technology use. In this paper, we will discuss key findings from the survey and the index. This work can inform public policy and shape our responses to the emerging implications of lives increasingly lived online and interconnected with digital technology.

Keywords: technology, health, behavioral addiction, digital wellbeing

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Authors: Prejily Thomas John

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Flooding of urban areas often has an adverse impact on the dense population residing in cities. The vulnerable areas are the most affected due to flooding, which even results in loss of life. The increasing trend of urban floods is a universal phenomenon and leads to a vital loss in the physical, economic, social, and environmental dimensions. The shift from floods being natural disasters to man-made disasters due to unplanned urban growth is evident from national and international reports. Thiruvalla, bordered by the Manimala River in the Pathanamthitta district, is an important urban node and a drainage point of various estuaries. The city is often faced with flash floods and overflow from rivers since it is a low-lying land. The need for urban flood resilience for planned urban development is a necessity for livability in consideration of the topography. The paper focuses on developing an urban design framework in everyday urban spaces through the principles of resilient urbanism. The principles guide the creation of flood-resilient spaces and productive urban landscapes for the city to enable better and safer living conditions. A flood-resilient city not only prepares the city for disasters but also improves the ecological and economic conditions.

Keywords: everyday urban spaces, flood resilience, resilient urbanism, productive urban landscapes

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Authors: Rakan Hassan M. Alzahrani, Ziyad Alzahrani, Bader Bashrahil, Abdulrahman Elyasi, Abdullah a Ghaddaf, Rayan Alzahrani, Mohammed Alkathlan, Nawaf Alghamdi, Dakheelallah Almutairi

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Background: Corticosteroid irrigations, which regularly involve the off-label use of budesonide mixed with normal saline in high volume Sino-nasal irrigations, have been more commonly used in the management of post-operative chronic rhinosinusitis (CRS). Objective: This article attempted to measure the efficacy of post-operative budesonide nasal irrigation compared to normal saline-alone nasal irrigation in the management of chronic rhinosinusitis (CRS) through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: The databases PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched by two independent authors. Only RCTs comparing budesonide irrigation to normal saline alone irrigation for CRS with or without polyposis after functional endoscopic sinus surgery (FESS) were eligible. A random effect analysis model of the reported CRS-related quality of life (QOL) measures and the objective endoscopic assessment scales of the disease was done. Results: Only 6 RCTs met the eligibility criteria, with a total number of participants of 356. Compared to normal saline irrigation, budesonide nasal irrigation showed statically significant improvements in both the CRS-related quality of life (QOL) and the endoscopic findings (MD= -4.22 confidence interval [CI]: -5.63, -2.82 [P < 0.00001]), (SMD= -0.50 confidence interval [CI]: -0.93, -0.06 [P < 0.03]) respectively. Conclusion: Both intervention arms showed improvements in CRS-related QOL and endoscopic findings in post-FESS chronic rhinosinusitis with or without polyposis. However, budesonide irrigation seems to have a slight edge over conventional normal saline irrigation with no reported serious side effects, including hypothalamic-pituitary-adrenal (HPA) axis suppression.

Keywords: Budesonide, chronic rhinosinusitis, corticosteroids, nasal irrigation, normal saline

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Authors: Ekpon Oghenetega Philip, Tayire Okabare Favour, Boye Ejobowah Thomas

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The study evaluated the resting systolic blood pressure (RSBP) and resting diastolic blood pressure (RDBP) of staff of a multi-national petroleum company in Nigeria with the aim of helping the staff maintain optimal health which is necessary to carry out their secular work. Eleven healthy male (age 36.9±10.48 years, mean±S.D) and 38 healthy female (39.99±12.23 years, mean±S.D) staff of the multi-national petroleum company performed an incremental exercise on a treadmill and cycle ergometers to determine RSBP and RDBP. An assessment of the health status of the staff of the company was carried out using a physical activity readiness questionnaire (PAR-Q) to determine their suitability for the program. Analysis of the t-test for male staff of RSBP shows that it was statistically significant with a calculated t value of 2.19, α = 0.05 and t-calculated for RSBP of female staff was 1.897, α = 0.05 showing a significance. While the t-calculated RSBP for male staff of the multi-national company is 0.44 with α =0.05 and the female RDBP is 4.129, α = 0.05 and they are all significant. It was recommended that staff of the company should regularly visit the company gym during their leisure hours to maintain optimum health.

Keywords: systolic blood pressure, diastolic blood pressure, exercise, pressure staff

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Authors: Sathyaseelan Subramaniam, Jacqueline Bober, Jennifer Chao, Shahriar Zehtabchi

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Background: Emergency physicians frequently evaluate skin and soft tissue infections in order to differentiate abscess from cellulitis. This helps determine which patients will benefit from incision and drainage. Our objective was to determine the operating characteristics of point-of-care ultrasound (POCUS) compared to clinical examination in identifying abscesses in emergency department (ED) patients with features of skin and soft tissue infections. Methods: We performed a comprehensive search in the following databases: Medline, Web of Science, EMBASE, CINAHL and Cochrane Library. Trials were included if they compared the operating characteristics of POCUS with clinical examination in identifying skin and soft tissue abscesses. Trials that included patients with oropharyngeal abscesses or that requiring abscess drainage in the operating room were excluded. The presence of an abscess was determined by pus drainage. No pus seen on incision or resolution of symptoms without pus drainage at follow up, determined the absence of an abscess. Quality of included trials was assessed using GRADE criteria. Operating characteristics of POCUS are reported as sensitivity, specificity, positive likelihood (LR+) and negative likelihood (LR-) ratios and the respective 95% confidence intervals (CI). Summary measures were calculated by generating a hierarchical summary receiver operating characteristic model (HSROC). Results: Out of 3203 references identified, 5 observational studies with 615 patients in aggregate were included (2 adults and 3 pediatrics). We rated the quality of 3 trials as low and 2 as very low. The operating characteristics of POCUS and clinical examination in identifying soft tissue abscesses are presented in the table. The HSROC for POCUS revealed a sensitivity of 96% (95% CI = 89-98%), specificity of 79% (95% CI = 71-86), LR+ of 4.6 (95% CI = 3.2-6.8), and LR- of 0.06 (95% CI = 0.02-0.2). Conclusion: Existing evidence indicates that POCUS is useful in identifying abscesses in ED patients with skin or soft tissue infections.

Keywords: abscess, point-of-care ultrasound, pocus, skin and soft tissue infection

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Authors: Dawit Thomas Lambamo

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Conduct disorder has become a major health and social problem; it is the most common psychiatric problem diagnosed among students which affect the academic and social interaction of students. This intervention was conducted in Dil Betigil primary school. After identifying six students with conduct disorder in Dil Betigil primary school, the intervention was conducted using a true experimental research design specifically pretest and posttest control group design. Data from teachers and parents of the students with conduct disorder were collected using adapted conduct disorder scale and semi-structured interview. The independent sample t-test of Pretest results of both experimental and control group indicated that there is no statistically significant difference between experimental and control groups. Intervention is carried out to enhance their social interaction and to decrees aggressive, a serious violation of rules and theft behavior of students in collaboration with teachers and parents. After six intervention weeks the post-test result showed that there was statistically significant difference in aggression and serious violation between the experimental and control groups, but there was no statistically significant mean difference regarding deceitful or theft between the experimental and control group.

Keywords: conduct, disorder, social interaction, interaction

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Authors: Van Truong Pham

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Background: Self-management was described as a potential strategy for blood pressure control in patients with hypertension. However, the effects of self-management interventions on blood pressure, self-efficacy, medication adherence, and body mass index (BMI) in older adults with hypertension have not been systematically evaluated. We evaluated the effects of self-management interventions on systolic blood pressure (SBP) and diastolic blood pressure (DBP), self-efficacy, medication adherence, and BMI in hypertensive older adults. Methods: We followed the recommended guidelines of preferred reporting items for systematic reviews and meta-analyses. Searches in electronic databases including CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science, and other sources were performed to include all relevant studies up to April 2019. Studies selection, data extraction, and quality assessment were performed by two reviewers independently. We summarized intervention effects as Hedges' g values and 95% confidence intervals (CI) using a random-effects model. Data were analyzed using Comprehensive Meta-Analysis software 2.0. Results: Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly improved blood pressure control, self-efficacy, medication adherence, whereas the effect of self-management on BMI was not significant in older adult patients with hypertension. The following Hedges' g (effect size) values were obtained: SBP, -0.34 (95% CI, -0.51 to -0.17, p < 0.001); DBP, -0.18 (95% CI, -0.30 to -0.05, p < 0.001); self-efficacy, 0.93 (95%CI, 0.50 to 1.36, p < 0.001); medication adherence, 1.72 (95%CI, 0.44 to 3.00, p=0.008); and BMI, -0.57 (95%CI, -1.62 to 0.48, p = 0.286). Conclusions: Self-management interventions significantly improved blood pressure control, self-efficacy, and medication adherence. However, the effects of self-management on obesity control were not supported by the evidence. Healthcare providers should implement self-management interventions to strengthen patients' role in managing their health care.

Keywords: self-management, meta-analysis, blood pressure control, self-efficacy, medication adherence, body mass index

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Authors: Ulli Heinlein, Thomas Freimann

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Pre-applied bonded membranes are used as positive-side waterproofing on concrete basements, are installed before the concrete work, and achieve a tear-resistant and waterproof bond with the subsequently placed fresh concrete. This bond increases redundancy compared to lose waterproofing membranes by preventing lateral water migrations in the event of damage. So far, the membranes have been tested in the laboratory, but it is not yet known how they behave on construction sites in the presence of dirt, soil, cement paste or moisture. This article, therefore, conducts investigations on six construction sites using 18 test slabs where the pre-applied bonded membranes are selectively contaminated or wetted. Subsequently, cores are taken, and the influence of the contaminations on the adhesive tensile strength and waterproof bond is tested. Pre-applied bonded membranes with smooth or granular but closed surfaces show no sensitivity to wetness, whereas open-pored membranes with nonwovens do not tolerate standing water. Contaminations decline the performance of all pre-applied bonded membranes since a separating layer is formed between the bonding layer and the concrete. The influence depends on the thickness of the contamination and its mechanical properties.

Keywords: waterproofing, positive-side waterproofing, basement, pre-applied bonded waterproofing membrane, In-situ testing, lateral water migrations

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Authors: Thomas Yeboah

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Cloud Computing is newly paradigm in computing that promises a delivery of computing as a service rather than a product, whereby shared resources, software, and information are provided to computers and other devices as a utility (like the electricity grid) over a network (typically the Internet). As Cloud Computing is a newly style of computing on the internet. It has many merits along with some crucial issues that need to be resolved in order to improve reliability of cloud environment. These issues are related with the load balancing, fault tolerance and different security issues in cloud environment.In this paper the main concern is to develop an effective load balancing algorithm that gives satisfactory performance to both, cloud users and providers. This proposed algorithm (hybrid Bee Ant Colony algorithm) is a combination of two dynamic algorithms: Ant Colony Optimization and Bees Life algorithm. Ant Colony algorithm is used in this hybrid Bee Ant Colony algorithm to solve load balancing issues whiles the Bees Life algorithm is used for optimization of job scheduling in cloud environment. The results of the proposed algorithm shows that the hybrid Bee Ant Colony algorithm outperforms the performances of both Ant Colony algorithm and Bees Life algorithm when evaluated the proposed algorithm performances in terms of Waiting time and Response time on a simulator called CloudSim.

Keywords: ant colony optimization algorithm, bees life algorithm, scheduling algorithm, performance, cloud computing, load balancing

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Authors: Fiona Bei Na Tan, Glen Wen Kiat Ho, Ee Leen Liow, Li Yin Tan, Sean Wei Loong Ho

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Background: Shoulder arthroscopy is an increasingly common procedure. Pneumothorax post-shoulder arthroscopy is a rare complication. Objectives: Our aim is to highlight a case report of pneumothorax post shoulder arthroscopy and to conduct a literature review to evaluate the possible risk factors associated with developing a pneumothorax during or after shoulder arthroscopy. Case Report: We report the case of a 75-year-old male non-smoker who underwent left shoulder arthroscopy without regional anaesthesia and in the left lateral position. The general anaesthesia and surgery were uncomplicated. The patient was desaturated postoperatively and was found to have a pneumothorax on examination and chest X-ray. A chest tube drain was inserted promptly into the right chest. He had an uncomplicated postoperative course. Methods: PubMed Medline and Cochrane database search was carried out using the terms shoulder arthroplasty, pneumothorax, pneumomediastinum, and subcutaneous emphysema. We selected full-text articles written in English. Results: Thirty-two articles were identified and thoroughly reviewed. Based on our inclusion and exclusion criteria, 14 articles, which included 20 cases of pneumothorax during or after shoulder arthroscopy, were included. Eighty percent (16/20) of pneumothoraxes occurred postoperatively. In the articles that specify the side of pneumothorax, 91% (10/11) occur on the ipsilateral side of the arthroscopy. Eighty-eight percent (7/8) of pneumothoraxes occurred when subacromial decompression was performed. Fifty-six percent (9/16) occurred in patients placed in the lateral decubitus position. Only 30% (6/20) occurred in current or ex-smokers, and only 25% (5/20) had a pre-existing lung condition. Overall, of the articles that posit a mechanism, 75% (9/12) deem the pathogenesis to be multifactorial. Conclusion: The exact mechanism of pneumothorax is currently unknown. Awareness of this complication and timely recognition are important to prevent life-threatening sequelae. Surgeons should have a low threshold to obtain diagnostic plain radiographs in the event of clinical suspicion.

Keywords: rotator cuff repair, decompression, pressure, complication

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Authors: Misbah Nizamani, Saira Malik

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

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

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Authors: Robert J. Thomas, Colton Bedke, Andrew Sorensen

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The exemplary mechanical performance and durability of ultra-high performance concrete (UHPC) has led to its rapid emergence as an advanced cementitious material. The uncharacteristically high mechanical strength and ductility of UHPC makes it a promising potential material for defense structures which may be subject to highly dynamic loads like impact or blast. However, the mechanical response of UHPC under dynamic loading has not been fully characterized. In particular, there is a need to characterize the energy absorption of UHPC under high-frequency shear loading. This paper presents preliminary results from a parametric study of the dynamic shear energy absorption of UHPC using the Charpy impact test. UHPC mixtures with compressive strengths in the range of 100-150 MPa exhibited dynamic shear energy absorption in the range of 0.9-1.5 kJ/m. Energy absorption is shown to be sensitive to the water/cement ratio, silica fume content, and aggregate gradation. Energy absorption was weakly correlated to compressive strength. Results are highly sensitive to specimen preparation methods, and there is a demonstrated need for a standardized test method for high frequency shear in cementitious composites.

Keywords: Charpy impact test, dynamic shear, impact loading, ultra-high performance concrete

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Authors: Revai Boterere

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The study explores the decolonial theory in the context of engaging with living heritages in the formally colonised through the case of the Great Zimbabwe World Heritage Site. It followed a qualitative research paradigm in the form of a situational analysis, with both primary and secondary data sources examined to enable an analysis focusing on the decolonial discourse and practice at Great Zimbabwe. Unlike the dominant model (in terms of interpretation) used at Great Zimbabwe, that of Thomas Huffman, which views the site as ruins, new literature (Ashton Sinamai, 2017, 2020; Webber Ndoro, 1994, 2005; ShadreckChirikure 2008, etal 2016; Njabulo Chipanguraetal 2019) on zimbabwe culture, Great Zimbabwe World Heritage Site is a living site, a shrine, and a cultural landscape. it argue that the new literature, perhaps decolonial, remain in the hands of academics and not synthesised down to the interpreters. This is a problem, and it needs to be addressed. There is need of a pragmatic thrust to decolonisation at the Great Zimbabwe World Heritage Site. Though there are efforts to involve local communities at Great Zimbabwe as a decolonial approach, there is need to reorder the current system of producing knowledge in place. This paper will unpack these debates of decoloniality between what Huffman’s propositions of the interpretation of Great Zimbabwe vis-a-vis the new decolonial school of thought by local researchers.

Keywords: cultural tourism, decoloniality, living heritage, local community

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Authors: Joseph Thomas Eghwerido, Julian I. Mbegbu

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In modelling environment processes, we apply multidisciplinary knowledge to explain, explore and predict the Earth's response to natural human-induced environmental changes. Thus, the analysis of spatial-time ecological and environmental studies, the spatial parameters of interest are always heterogeneous. This often negates the assumption of stationarity. Hence, the dispersion of the transportation of atmospheric pollutants, landscape or topographic effect, weather patterns depends on a good estimate of spatial covariance. The generalized linear mixed model, although linear in the expected value parameters, its likelihood varies nonlinearly as a function of the covariance parameters. As a consequence, computing estimates for a linear mixed model requires the iterative solution of a system of simultaneous nonlinear equations. In other to predict the variables at unsampled locations, we need to know the estimate of the present sampled variables. The geostatistical methods for solving this spatial problem assume covariance stationarity (locally defined covariance) and uniform in space; which is not apparently valid because spatial processes often exhibit nonstationary covariance. Hence, they have globally defined covariance. We shall consider different existing methods of solutions of spatial covariance of a space-time processes at unsampled locations. This stationary covariance changes with locations for multiple time set with some asymptotic properties.

Keywords: parametric, nonstationary, Kernel, Kriging

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Authors: Nickson Kipng’etich Lang’at, Thomas Thoruwa, John Abraham, John Wanyoko

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Green tea is made from the top two leaves and buds of a shrub, Camellia sinensis, of the family Theaceae and the order Theales. The green tea leaves are picked and immediately sent to be dried or steamed to prevent fermentation. Fluid bed drying technique is a common drying method used in drying green tea because of its ease in design and construction and fluidization of fine tea particles. Major problems in this method are significant loss of chemical content of the leaf and green appearance of tea, retention of high moisture content in the leaves and bed channeling and defluidization. The energy associated with the drying technology has been shown to be a vital factor in determining the quality of green tea. As part of the implementation, prototype dryer was built that facilitated sequence of operations involving steaming, cooling, pre-drying and final drying. The major findings of the project were in terms of quality characteristics of tea leaves and energy consumption during processing. The optimal design achieved a moisture content of 4.2 ± 0.84%. With the optimum drying temperature of 100 ºC, the specific energy consumption was 1697.8 kj.Kg^-1 and evaporation rate of 4.272 x 10^-4 Kg.m^-2.s^-1. The energy consumption in a fluidized system can be further reduced by focusing on energy saving designs.

Keywords: evaporation rate, fluid bed dryer, maceration, specific energy consumption

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Authors: Kuixi Du, Thomas J. Lipscomb

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The proficiency in Mathematics skills is fundamental to success in the STEM disciplines. In the US, beginning college students who are placed in remedial/developmental Mathematics courses frequently struggle to achieve academic success. Therefore, Mathematics remediation in college has become an important concern, and providing Mathematics remediation is a prevalent way to help the students who may not be fully prepared for college-level courses. Programs vary, however, and the effectiveness of a particular remedial Mathematics program must be empirically demonstrated. The purpose of this study was to apply the sharp regression discontinuity (RD) technique to determine the effectiveness of the Jack Leaps Summer (JLS) Mathematic remediation program in supporting improved Mathematics learning outcomes among newly admitted Mathematics students in the South Dakota State University. The researchers studied the newly admitted Fall 2019 cohort of Mathematics majors (n=423). The results indicated that students whose pretest score was lower than the cut-off point and who were assigned to the JLS program experienced significantly higher scores on the post-test (Math 101 final score). Based on these results, there is evidence that the JLS program is effective in meeting its primary objective.

Keywords: causal inference, mathematisc remedial program evaluation, quasi-experimental research design, regression discontinuity design, cohort studies

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Authors: Ehsan Arabian, Thomas Sattelmayer

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The formation of nitrogen dioxide NO2 in the exhaust duct of a MAN dual fuel test engine has been investigated numerically. The dual fuel engine concept with premixed lean methane combustion ignited through diesel pilot flames reveals high potential for the abatement of the NOx formation. The drawback of this combustion method, however, is the high NO2 formation due to the increasing concentration of unburned hydrocarbons. This promotes the conversion of NO to NO2, which is toxic and characterized through its yellow color. The results presented in this paper cover a wide range of engine operation points from full load to part load for different air to fuel ratios. The effects of temperature, pressure and concentrations of unburned methane and nitric oxide on NO2 formation in the exhaust duct has been investigated on the basis of a zero-dimensional well stirred reactor model implemented in Cantera, which calculates the steady state of a uniform composition for a certain residence time. It can be shown that the simulated conversion of NO to NO2 match the experimental results fairly well. The partial oxidation of methane followed by CO production can be predicted as well. It can also be concluded that the lower temperature limit for which no conversion takes place, depends mainly on the concentration of the unburned hydrocarbons in the exhaust.

Keywords: cantera, dual fuel engines, exhaust tract, numerical modeling of NO2 formation, well stirred reactor

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Authors: Syeda Sahra, Abdullah Jahangir, Rachelle Hamadi, Ahmad Jahangir, Allison Glaser

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Background: Antimicrobial resistance is on the rise. The use of redundant and inappropriate antibiotics is contributing to recurrent infections and resistance. Newer antibiotics with more robust coverage for gram-negative bacteria are in great demand for complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), hospital-acquired bacterial pneumonia (H.A.B.P.), and ventilator-associated bacterial pneumonia (V.A.B.P.). Objective: We performed this meta-analysis to evaluate the efficacy and safety profile of a new antibiotic, Imipenem/cilastatin/relebactam, compared to other broad-spectrum antibiotics for complicated infections. Search Strategy: We conducted a systemic review search on PubMed, Embase, and Central Cochrane Registry. Selection Criteria: We included randomized clinical trials (R.C.T.s) with the standard of care as comparator arm with Imipenem/cilastatin/relebactam as intervention arm. Analysis: For continuous variables, the mean difference was used. For discrete variables, we used the odds ratio. For effect sizes, we used a confidence interval of 95%. A p-value of less than 0.05 was used for statistical significance. Analysis was done using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I2 statistic. Results: The authors observed similar efficacy at clinical and microbiologic response levels on early follow-up and late follow-up compared to the established standard of care. The incidence of drug-related adverse events, serious adverse events, and drug discontinuation due to adverse events were comparable across both groups. Conclusion: Imipenem/cilastatin/relebactam has a non-inferior safety and efficacy profile compared to peer antibiotics to treat severe bacterial infections (cUTIs, cIAIs, H.A.B.P., V.A.B.P.).

Keywords: bacterial pneumonia, complicated intra-abdominal infections, complicated urinary tract infection, Imipenem, cilastatin, relebactam

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Authors: Thomas Roche, Erica Wilson, Elizabeth Goode

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Universities across the globe are considering how to effect meaningful change in their higher education (HE) delivery in the face of increasingly diverse student cohorts and shifting student learning preferences. This paper reports on a descriptive case study of whole-of-institution curriculum reform at one regional Australian university, where more traditional 13-week semesters were replaced with a 6-week immersive block model drawing on active learning pedagogy. Based on a synthesis of literature in best practice HE pedagogy and principles, the case study draws on student performance data and senior management staff interviews (N = 5) to outline the key changes necessary for successful HE transformation to deliver increased student pass rates and retention. The findings from this case study indicate that an institutional transformation to an immersive block model requires both a considered change in institutional policy and process as well as the appropriate resourcing of roles, governance committees, technical solutions, and, importantly, communities of practice. Implications for practice at higher education institutions considering reforming their curriculum model are also discussed.

Keywords: student retention, immersive scheduling, block model, curriculum reform, active learning, higher education pedagogy, higher education policy

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Authors: Mei Sze Wong, Huanyu Mou, Wai-Tong Chien

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Background: Breastmilk is the most nutritious food for infants to support their growth and protect them from infection. Therefore, breastfeeding promotion is an important topic for infant health; whereas, different educational and supportive approaches to interventions have been prompted and targeted at antenatal, postnatal, or both periods to promote and sustain exclusive breastfeeding. This systematic review aimed to identify the effective approaches of educational and supportive interventions to improve breastfeeding. Outcome measures were exclusive breastfeeding, partial breastfeeding, and breastfeeding self-efficacy, being analyzed in terms of ≤ 2 months, 3-5 months, and ≥ 6 months postpartum. Method: Eleven electronic databases and the reference lists of eligible articles were searched. English or Chinese articles of randomized controlled trials on educational and supportive intervention with the above breastfeeding outcomes over recent 20 years were searched. Quality appraisal and risk of bias of the studies were checked by Effective Public Health Practice Project tool and Revised Cochrane risk-of-bias tool, respectively. Results: 13 articles that met the inclusion criteria were included; and they had acceptable quality and risk of bias. The optimal structure, format, and delivery of the interventions significantly increased exclusive breastfeeding rate at ≤ 2 months and ≥ 6 months and breastfeeding self-efficacy at ≤ 2 months included: (a) delivering from antenatal to postnatal period, (b) multicomponent involving antenatal group education, postnatal individual breastfeeding coaching and telephone follow-ups, (c) both individual and group basis, (d) being guided by self-efficacy theory, and (e) having ≥ 3 sessions. Conclusion: The findings showed multicomponent theory-based interventions with ≥ 3 sessions that delivered across antenatal and postnatal period; using both face-to-face teaching and telephone follow-ups can be useful to enhance exclusive breastfeeding rate for more than 6 months and breastfeeding self-efficacy over the first two months of postpartum.

Keywords: breastfeeding self-efficacy, education, exclusive breastfeeding, primiparous, support

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Authors: Radu Soflau, Lia-Ecaterina Oltean

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Background: Increasing evidence supports the efficacy of psychological interventions for psychosis. However, it is unclear which one of these interventions is most likely to address negative psychotic symptoms and related outcomes. We aimed to determine the relative efficacy of psychological and psychosocial interventions for negative symptoms, overall psychotic symptoms, and related outcomes. Methods: To attain this goal, we conducted a systematic review and network meta-analysis. We searched for potentially eligible trials in PubMed, EMBASE, PsycInfo, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases up until February 08, 2022. We included randomized controlled trials that investigated the efficacy of psychological for adults with psychosis. We excluded interventions for prodromal or “at risk” individuals, as well as patients with serious co-morbid medical or psychiatric conditions (others than depressive and/or anxiety disorders). Two researchers conducted study selection and performed data extraction independently. Analyses were run using STATA network and mvmeta packages, applying a random effect model under a frequentist framework in order to compute standardized mean differences or risk ratio. Findings: We identified 47844 records and screened 29466 records for eligibility. The majority of eligible interventions were delivered in addition to pharmacological treatment. Treatment as usual (TAU) was the most frequent common comparator. Theoretically driven psychological interventions generally outperformed TAU at post-test and follow-up, displaying small and small-to-medium effect sizes. A similar pattern of results emerged in sensitivity analyses focused on studies that employed an inclusion criterion for relevant negative symptom severity. Conclusion: While the efficacy of some psychological interventions is promising, there is a need for more high-quality studies, as well as more trials directly comparing psychological treatments for negative psychotic symptoms.

Keywords: psychosis, network meta-analysis, psychological interventions, efficacy, negative symptoms

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Authors: Carolin Anna Joy, Rohith K. R, Rehin Sulay, Parvathy Santhoshkumar, G.Anil Kumar, Vibin Ipe Thomas

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Ullmann coupling reactions are gaining great relevance owing to their contribution in the synthesis of biologically and pharmaceutically important compounds. Palladium and many other heavy metals have proven their excellent ability in coupling reaction, but the toxicity matters. The first-row transition metal also possess toxicity, except in the case of iron and manganese. The suitability of manganese as a catalyst is achieving great interest in oxidation, reduction, C-H activation, coupling reaction etc. In this presentation, we discuss the thermo chemistry of ligand free manganese catalyzed C-O coupling reaction between phenol and aryl halide for the synthesis of biaryl ethers using Density functional theory techniques. The mechanism involves an oxidative addition-reductive elimination step. The transition state for both the step had been studied and confirmed using Intrinsic Reaction Coordinate (IRC) calculation. The barrier height for the reaction had also been calculated from the rate determining step. The possibility of other mechanistic way had also been studied. To achieve further insight into the mechanism, substrate having various functional groups is considered in our study to direct their effect on the feasibility of the reaction.

Keywords: Density functional theory, Molecular Modeling, ligand free, biaryl ethers, Ullmann coupling

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Authors: Omar Sorour, Michael Leahy, Thomas Irvine, Vladimir Koren

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Introduction: Covid encephalitis is a rare yet dangerous complication, particularly affecting the older and immunocompromised. Symptoms range from confusion to delirium, coma, and seizures. Although neurological manifestations have become more well-characterized in COVID patients, little is known about whether priorneurological abnormalities may predispose patients to COVID encephalopathy. Case Description: A 73 y.o. male with a CT and MRI-confirmed stable, prior 9 mm cavernoma in the right frontal lobe and no past history of seizures was hospitalized with generalized weakness, abdominal pain, nausea, and shortness of breath with subsequent COVID pneumonia. Three days after the initial presentation, the patient developed a spontaneous generalized tonic-clonic seizure consistent with presumed COVID encephalitis, along with somnolence and confusion. A day later, the patient had two other seizure episodes. Follow-up EEG suggested an inter-ictal epileptic focus with sharp waves corresponding to roughly the same location as the patient’s pre-existing cavernoma. The patient’s seizures stopped shortly thereafter, while his encephalopathy continued for days. Conclusion: We illustrate that a pre-existing anatomic cortical abnormality may act as a potential nidus for new-onset seizure activity in the context of suggested COVID encephalopathy. Future studies may further demonstrate that manifestations of COVIDencephalopathy in certain patients may be more predictable than initially assumed.

Keywords: cavernoma, covid, encephalopathy, seizures

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Authors: Thomas C. Nash

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New Zealand has a small, yet racially diverse, population of only 4.6 million people, consisting of a majority European immigrant population and a large indigenous Maori population. Because disparities in healthcare often exist among minority populations, it could be expected that the White and Maori populations of New Zealand would have unequal access to healthcare. In order to understand the ways these disparities may present themselves, it became important to travel to New Zealand in order to interview both Western and natural healthcare professionals, public health officials, health activists and Maori people. In observing the various mechanisms within the New Zealand healthcare system, some stand out as effective ways of alleviating the racial disparities often seen in healthcare. These include the efficiency of regional District Health Boards, the benefits of individuals making decisions regarding their treatment plans and the importance of cohesion among the Maori and White populations. In forming a conclusion around these observations, it is evident that the integration of Maori culture into contemporary New Zealand has benefited the healthcare system. This unity has generated support for non-Western medical treatments, in turn forming a healthcare system that creates low barriers to entry for non-traditional forms of healthcare. These low barriers allow individuals to allocate available healthcare resources in ways that are most beneficial for them and are consistent with their tastes and preferences, maximizing efficiency.

Keywords: alternative and complementary healthcare, low barriers to entry, Maori populations, racial cohesion

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Authors: Shohreh Ghasemi

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Introduction: Managing oral and maxillofacial trauma is a multifaceted challenge, as it can have life-threatening consequences and significant functional and aesthetic impact. Navigation techniques have been introduced to improve surgical precision to meet this challenge. A machine learning algorithm was also developed to support clinical decision-making regarding treating oral and maxillofacial trauma. Given these advances, this systematic meta-analysis aims to assess the efficacy of navigational techniques in treating oral and maxillofacial trauma and explore the impact of machine learning on their management. Methods: A detailed and comprehensive analysis of studies published between January 2010 and September 2021 was conducted through a systematic meta-analysis. This included performing a thorough search of Web of Science, Embase, and PubMed databases to identify studies evaluating the efficacy of navigational techniques and the impact of machine learning in managing oral and maxillofacial trauma. Studies that did not meet established entry criteria were excluded. In addition, the overall quality of studies included was evaluated using Cochrane risk of bias tool and the Newcastle-Ottawa scale. Results: Total of 12 studies, including 869 patients with oral and maxillofacial trauma, met the inclusion criteria. An analysis of studies revealed that navigation techniques effectively improve surgical accuracy and minimize the risk of complications. Additionally, machine learning algorithms have proven effective in predicting treatment outcomes and identifying patients at high risk for complications. Conclusion: The introduction of navigational technology has great potential to improve surgical precision in oral and maxillofacial trauma treatment. Furthermore, developing machine learning algorithms offers opportunities to improve clinical decision-making and patient outcomes. Still, further studies are necessary to corroborate these results and establish the optimal use of these technologies in managing oral and maxillofacial trauma

Keywords: trauma, machine learning, navigation, maxillofacial, management

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Authors: Abdullah I. Alkraiji, Thomas W. Jackson, Ian Murray

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The proliferation of health data standards today is somewhat overlapping and conflicting, resulting in market confusion and leading to increasing proprietary interests. The government role and support in standardization for health data are thought to be crucial in order to establish credible standards for the next decade, to maximize interoperability across the health sector, and to decrease the risks associated with the implementation of non-standard systems. The normative literature missed out the exploration of the different steps required to be undertaken by the government towards the development of national health data standards. Based on the lessons learned from a qualitative study investigating the different issues to the adoption of health data standards in the major tertiary hospitals in Saudi Arabia and the opinions and feedback from different experts in the areas of data exchange and standards and medical informatics in Saudi Arabia and UK, a list of steps required towards the development of national health data standards was constructed. Main steps are the existence of: a national formal reference for health data standards, an agreed national strategic direction for medical data exchange, a national medical information management plan and a national accreditation body, and more important is the change management at the national and organizational level. The outcome of this study can be used by academics and practitioners to develop the planning of health data standards, and in particular those in developing countries.

Keywords: interoperabilty, medical data exchange, health data standards, case study, Saudi Arabia

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