Search results for: focal dystonia

Authors: Yadav R. K., Baral S.

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Introduction: Nepal is one of the world’s least developed countries and has a high incidence of tuberculosis (TB). The TB prevalence survey in 2019 showed 69,000 Nepalese is developing TB and 4,000 die every year. Given its disproportionate impact on the impoverished segments of society, TB often thrusts patients into extreme poverty or exacerbates their existing economic struggles. Consequently, not only the patients but also their families suffer from the loss of livelihood. This study aims to assess the support of nutritional allowance on treatment compliance among retreatment tuberculosis patients in Nepal. This is a secondary analysis of data from HMIS (Health Management Information System) to investigate treatment compliance among tuberculosis patients and its association with nutritional allowance. The study population consisted of all individuals (N=2972) who had received services from July 16, 2021, to December 14, 2022. The SPSS 21version was used to conduct descriptive and bivariate analysis. Out of the total TB patients (n=2972), a third-fourth (65.9%) of TB patients were male. More than one-tenth (12.3%) of respondents received a nutrition support allowance. The TB treatment compliance rate was more (89.91%) in the nutrition support allowance group compared to the non-nutritional support group (87.98%). TB patients who received the nutritional support allowance were nearly twice as likely to have a higher TB treatment compliance rate compared to those who did not receive the nutritional support allowance. Providing nutritional allowance support to tuberculosis (TB) patients can play a significant role in improving treatment compliance and outcomes. Age and the type of TB are important factors that have shown statistical significance in relation to treatment compliance. Therefore, it is recommended to provide nutritional allowance support to both new and retreatment TB patients. To enhance treatment compliance among TB patients, it is beneficial to provide timely nutrition allowances and arrange home visits by TB focal persons.

Keywords: nutrition, support, treatment compliance, TB, Nepal

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Authors: Magdy Al Shourbagi

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Diabetes mellitus is the commonest cause of neuropathy. The common pattern is a distal symmetrical sensory polyneuropathy, associated with autonomic disturbances. Less often, Diabetes mellitus is responsible for a focal or multifocal neuropathy. Common causes for non-healing of diabetic foot are the infection and ischemia. Diabetes mellitus is associated with a defective cellular and humoral immunity. Particularly, decreased phagocytosis, decreased chemotaxis, impaired bacterial killing and abnormal lymphocytic function resulting in a reduced inflammatory reaction and defective wound healing. Hyperbaric oxygen therapy is defined by the Undersea and Hyperbaric Medical Society as a treatment in which a patient intermittently breathes 100% oxygen and the treatment chamber is pressurized to a pressure greater than sea level (1 atmosphere absolute). The pressure increase may be applied in mono-place (single person) or multi-place chambers. Multi-place chambers are pressurized with air, with oxygen given via face mask or endotracheal tube; while mono-place chambers are pressurized with oxygen. Oxygen gas plays an important role in the physiology of wound healing. Hyperbaric oxygen therapy can raise tissue oxygen tensions to levels where wound healing can be expected. HBOT increases the killing ability of leucocytes also it is lethal for certain anaerobic bacteria and inhibits toxin formation in many other anaerobes. Multiple anecdotal reports and studies in HBO therapy in diabetic patients report that HBO can be an effective adjunct therapy in the management of diabetic foot wounds and is associated with better functional outcomes.

Keywords: hyperbari oxygen therapy, diabetic foot, neuropathy, multiplace chambers

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Authors: Salam Kodsi

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In this research, we sought to focus on constructive play and examine its components in the context of two different educational approaches: Waldorf and normative schools. When they are free to choose, construction is one of the forms of play most favored by children. Its short-term and long-term cognitive contributions are apparent in various areas of development. The lack of empirical studies about play in Waldorf schools, which addresses the possibility of this incidental learning inspired the need to enrich the body of existing knowledge. 90 children (4-6 yrs.old) four preschools ( two normative, two Waldorf) participated in a small homogeneous city. Naturalistic observations documented the time frame, physical space, and construction materials related to the freeform building; processes of construction among focal representative children and its products. The study’s main finding with respect to the construction output points to a connection between educational approach and level of construction sophistication. Higher levels of sophistication were found at the Waldorf preschools than at the mainstream preschools. This finding emerged due to the differences in the level of sophistication among the older children in the two types of preschools, while practically no differences emerged among the younger children. Discussion of the research findings considered the differences between the play environments in terms of time, physical space, and construction materials. The construction processes were characterized according to the design model stages. The construction output was characterized according to the sophistication scale dimensions and the connections between approach, age and gender, and sophistication level.

Keywords: constructive play, preschool, design process model, complexity

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Authors: Nadine Osbild

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Recent urban development projects often try to cater to both high-tech innovation/start-up culture and local culture/sustainable living. In the process, the so-called “creative class” (Florida 2002) has become a focal point for innovative answers to increasing urban pressures. Our paper explores local subculture and art scenes as a place where current innovation policies and alternative approaches to urban future-making collide. We explore the (re-)making of prevalent understanding of creativity in the context of Munich – an economically successful and over-saturated city with a relatively conservative approach to innovation and disruption and no apparent need for the “creative class” remedy. In particular, we investigate the opportunities and manifestations of subculture in three urban development projects that are envisioned as collaborations between innovators and (sub)culturally oriented creativity. Following a co-production STS approach, we observe that these development projects serve as sites where understandings of innovation and creativity are configured and stabilized in keeping with broader socio-political and economic rationalities. What is more, the projects materialize a de-facto split between the two understandings of a “creative scene,” whereby alternative and potentially disruptive forms of creativity become sidelined or even prevented in Munich’s imagination of urban development in the name of innovation and economic growth. Thus taming the unruliness of creativity, Munich also manages to tame the disruptive threats of innovation, ensuring that the innovation-centered modes of future-making still leave socio-economic hierarchies intact while displacing (counter-)visions rooted in the subculture.

Keywords: creative districts, science and technology studies, public engagement, innovation studies

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Authors: Sofie Dewayani, Pratiwi Retnaningdyah

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Literacy practice is situated within the identity enactment in a particular time and space. The literacy practices in public places, ranging from city parks, urban slums to city roads are meeting places of discursive practices produced by dynamic interactions, and sometimes contestations, of social powers and capitals. The present paper examines the ways the literacy activists construct their sense of space in attempts to develop possibilities for literacy programs as they are sent to work with marginalized communities far away from their hometowns in Indonesia. In particular, this paper analyzes the activists’ reflections of identity enactment - othering, familiarity, and sense of comfort - as they are trying to make meaning of the communities’ literacy capitals and practices in the process of adapting with the communities. Data collected for this paper were travel diaries - serving as literacy narratives - obtained from a literacy residency program sponsored by the Indonesian Ministry of Education and Culture. The residency program itself involved 30 youths (18 to 30 years old) to work with marginalized communities in literacy activism programs. This paper analyzes the written narratives of four focal participants using Bakhtin’s chronotopes - the configurations of time and space - that figure into the youth’s meaning-making of literacy as well as their exercise of power and identity. Follow-up interviews were added to enrich the analysis. The analysis considers the youth’s ‘moment of departure’ a critical point in their reconstructions of self and space. This paper expands the discussions of literacy discourse and spatiality while lending its supports to literacy activism in highly diverse multicultural settings.

Keywords: chronotopes, discourse, identity, literacy activism

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Authors: Mounia El Jaouhari, Mira Goral, Samir Diouny

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Introduction: Previous research has indicated that language impairments are recognized as a feature of many neurodegenerative disorders, including non-language-led dementia subtypes such as Alzheimer´s disease (AD). In this preliminary study, the focal aim is to quantify the semantic content of naming and connected speech samples of Moroccan patients diagnosed with AD using two tasks taken from the culturally adapted and validated Moroccan version of the Boston Diagnostic Aphasia Examination. Methods: Five individuals with AD and five neurologically healthy individuals matched for age, gender, and education will participate in the study. Participants with AD will be diagnosed on the basis of the Moroccan version of the Diagnostic and Statistial Manual of Mental Disorders (DSM-4) screening test, the Moroccan version of the Mini Mental State Examination (MMSE) test scores, and neuroimaging analyses. The participants will engage in two tasks taken from the MDAE-SF: 1) Picture description and 2) Naming. Expected findings: Consistent with previous studies conducted on English speaking AD patients, we expect to find significant word production and retrieval impairments in AD patients in all measures. Moreover, we expect to find category fluency impairments that further endorse semantic breakdown accounts. In sum, not only will the findings of the current study shed more light on the locus of word retrieval impairments noted in AD, but also reflect the nature of Arabic morphology. In addition, the error patterns are expected to be similar to those found in previous AD studies in other languages.

Keywords: alzheimer's disease, anomia, connected speech, semantic impairments, moroccan arabic

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Authors: Bidzina Matsaberidze

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It is known that, in emergency situations, multi-attribute group decision-making (MAGDM) models are characterized by insufficient objective data and a lack of time to respond to the task. Evidence theory is an effective tool for describing such incomplete information in decision-making models when the expert and his knowledge are involved in the estimations of the MAGDM parameters. We consider an emergency decision-making model, where expert assessments on humanitarian aid from distribution centers (HADC) are represented in q-rung ortho-pair fuzzy numbers, and the data structure is described within the data body theory. Based on focal probability construction and experts’ evaluations, an objective function-distribution centers’ selection ranking index is constructed. Our approach for solving the constructed bicriteria partitioning problem consists of two phases. In the first phase, based on the covering’s matrix, we generate a matrix, the columns of which allow us to find all possible partitionings of the HADCs with the service centers. Some constraints are also taken into consideration while generating the matrix. In the second phase, based on the matrix and using our exact algorithm, we find the partitionings -allocations of the HADCs to the centers- which correspond to the Pareto-optimal solutions. For an illustration of the obtained results, a numerical example is given for the facility location-selection problem.

Keywords: emergency MAGDM, q-rung orthopair fuzzy sets, evidence theory, HADC, facility location problem, multi-objective combinatorial optimization problem, Pareto-optimal solutions

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Authors: Shveta Puri, Shiv Jyoti Pandey, G. M. Bhat, Neha Raina

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TheJammu and Kashmir region of the Northwest Himalaya had witnessed many devastating earthquakes in the recent past and has remained unexplored for any kind of seismic investigations except scanty records of the earthquakes that occurred in this region in the past. In this study, we have used local seismic data of year 2013 that was recorded by the network of Broadband Seismographs in J&K. During this period, our seismic stations recorded about 207 earthquakes including two moderate events of Mw 5.7 on 1st May, 2013 and Mw 5.1 of 2nd August, 2013.We analyzed the events of Mw 3-4.6 and the main events only (for minimizing the error) for source parameters, b value and sense of movement through waveform modeling for understanding seismotectonic and seismic hazard of the region. It has been observed that most of the events are bounded between 32.9° N – 33.3° N latitude and 75.4° E – 76.1° E longitudes, Moment Magnitude (Mw) ranges from Mw 3 to 5.7, Source radius (r), from 0.21 to 3.5 km, stress drop, from 1.90 bars to 71.1 bars and Corner frequency, from 0.39 – 6.06 Hz. The b-value for this region was found to be 0.83±0 from these events which are lower than the normal value (b=1), indicating the area is under high stress. The travel time inversion and waveform inversion method suggest focal depth up to 10 km probably above the detachment depth of the Himalayan region. Moment tensor solution of the (Mw 5.1, 02:32:47 UTC) main event of 2ndAugust suggested that the source fault is striking at 295° with dip of 33° and rake value of 85°. It was found that these events form intense clustering of small to moderate events within a narrow zone between Panjal Thrust and Kishtwar Window. Moment tensor solution of the main events and their aftershocks indicating thrust type of movement is occurring in this region.

Keywords: b-value, moment tensor, seismotectonics, source parameters

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Authors: Suzan Ghaddar, Aline Pinon, Manuel Gallardo-villagran, Mona Diab-assaf, Bruno Therrien, Bertrand Liagre

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Colorectal cancer (CRC) is the third most common cancer and exhibits a consistently rising incidence worldwide. Despite notable advancements in CRC treatment, frequent occurrences of side effects and the development of therapy resistance persistently challenge current approaches. Eventually, innovations in focal therapies remain imperative to enhance the patient’s overall quality of life. Photodynamic therapy (PDT) emerges as a promising treatment modality, clinically used for the treatment of various cancer types. It relies on the use of photosensitive molecules called photosensitizers (PS), which are photoactivated after accumulation in cancer cells, to induce the production of reactive oxygen species (ROS) that cause cancer cell death. Among commonly used metal-based drugs in cancer therapy, ruthenium (Ru) possesses favorable attributes that demonstrate its selectivity towards cancer cells and render it suitable for anti-cancer drug design. In vitro studies using distinct arene-Ru complexes, encapsulating porphin PS, are conducted on human HCT116 and HT-29 colorectal cancer cell lines. These studies encompass the evaluation of the antiproliferative effect, ROS production, apoptosis, cell cycle progression, molecular localization, and protein expression. Preliminary results indicated that these complexes exert significant photocytotoxicity on the studied colorectal cancer cell lines, representing them as promising and potential candidates for anti- cancer agents.

Keywords: colorectal cancer, photodynamic therapy, photosensitizers, arene-ruthenium complexes, apoptosis

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Authors: Sibel Ecemis Kilic, Neslihan Karatas

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The concept of urban renewal came up with interventions to the urban areas which have social and economic problems aimed at gaining the city. In Turkey after 2000, urban renewal has become a frequent topic on the agenda; regulations have been developed in this regard. Urban renewal project would be a focal point for the formation of the city in the near future. The future of the city is directly related to how to achieve these applications. Urban renewal policies will be decisive in the positive or negative development of the potential of the existing renewal process. Urban renewal is seen as a refreshing new planned action for reshaping unplanned and uncontrolled growth of big cities/metropolitan areas. In this context, Izmir is one of the largest metropolitan areas which came on the agenda of urban renewal application in the recent period. Izmir, which is the third largest city of Turkey, is an important trade and port city. The city, located west of Turkey, is a gate opening to Europe. In particular, continued its development rapidly after the Republican Period, it has become an important big city today. Assessment of the current situation shows that the majority of existing residential areas was formed with squatters and unplanned settlements in Izmir city center. Therefore, an important part of these areas have significant problems in terms of the quality of life, safety, and environmental quality. Legal residential areas which have had developed before 2000 is seen inadequate security in terms of an earthquake. In this study, the central policies in Turkey and local policies in İzmir about urban renewal will be considered. In addition, urban renewal projects that are being implemented or applied in Izmir were discussed and suggestions will be developed in accordance with this policy.

Keywords: urban transformation, Izmir, urban planning, urban renewal

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Authors: Ratri Werdiningtyas, Yongping Wei, Andrew Western

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The status quo of social-ecological systems is the results of not only natural processes but also the accumulated consequence of policies applied in the past. Often water management objectives are challenging and are only achieved to a limited degree on the ground. In choosing water management approaches, it is important to account for current conditions and important differences due to varied histories. Since the mid-nineteenth century, Victorian water management has evolved through a series of policy regime shifts. The main goal of this research to explore and identify the stages of the evolution of the water policy instruments as practiced in Victoria from 1890-2016. This comparative historical analysis has identified four stages in Victorian policy instrument development. In the first stage, the creation of policy instruments aimed to match the demand and supply of the resource (reserve condition). The second stage begins after natural system alone failed to balance supply and demand. The focus of the policy instrument shifted to an authority perspective in this stage. Later, the increasing number of actors interested in water led to another change in policy instrument. The third stage focused on the significant role of information from different relevant actors. The fourth and current stage is the most advanced, in that it involved the creation of a policy instrument for synergizing the previous three focal factors: reserve, authority, and information. When considering policy in other jurisdiction, these findings suggest that a key priority should be to reflect on the jurisdictions current position among these four evolutionary stages and try to make improve progressively rather than directly adopting approaches from elsewhere without understanding the current position.

Keywords: policy instrument, policy transformation, socio-ecolgical system, water management

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Authors: Muhammad Idnan, Arshad Javid, Muhammad Nadeem

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The present study was conducted from April 2013 to March 2014 to observe the behavioral parameters of Chinkara (Gazella bennettii) under captive conditions by comparing the captive-born and wild-caught animals for conservation strategies. Understanding the behavioral conformations plays a significant role in captive management. Due to human population explosion and mechanized hunting, the captive breeding seems to be the best way for sports hunting, bush meat, for leather industry and horns for traditional medicinal usage. Primarily, captive management has been used on trial and error basis due to deficiency of ethology of this least concerned species. Behavior of [(20 wild-caught (WC) and 10 captive-bred (CB)] adult Chinkara was observed at captive breeding facilities for ungulates at Ravi Campus, University of Veterinary and Animal Sciences at Kasur district which is situated on southeast side of Lahore. The average annual rainfall is about 650 mm, with frequent raining during monsoon. A focal sample was used to observe the various behavioral patterns for CB and WC chinkara. A similarity was observed in behavioral parameters in WC and CB animals, however, when the differences were considered, WC male deer showed a significantly higher degree of agonistic interaction as compared to the CB male chinkara. These findings suggest that there is no immediate impact of captivity on behavior of chinkara nevertheless 10 generations of captivity. It is suggested that the Chinkara is not suitable for domestication and for successful deer farming, a further study is recommended for ethology of chinkara.

Keywords: Chinkara (Gazella bennettii), domestication, deer farming, ex-situ conservation

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Authors: Mona Hejazi, Ali Motie Nasrabadi

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Epilepsy is a persistent neurological disorder that affects more than 50 million people worldwide. Hence, there is a necessity to introduce an efficient prediction model for making a correct diagnosis of the epileptic seizure and accurate prediction of its type. In this study we consider how the Effective Connectivity (EC) patterns obtained from intracranial Electroencephalographic (EEG) recordings reveal information about the dynamics of the epileptic brain and can be used to predict imminent seizures, as this will enable the patients (and caregivers) to take appropriate precautions. We use this definition because we believe that effective connectivity near seizures begin to change, so we can predict seizures according to this feature. Results are reported on the standard Freiburg EEG dataset which contains data from 21 patients suffering from medically intractable focal epilepsy. Six channels of EEG from each patients are considered and effective connectivity using Directed Transfer Function (DTF) and Granger Causality (GC) methods is estimated. We concentrate on effective connectivity standard deviation over time and feature changes in five brain frequency sub-bands (Alpha, Beta, Theta, Delta, and Gamma) are compared. The performance obtained for the proposed scheme in predicting seizures is: average prediction time is 50 minutes before seizure onset, the maximum sensitivity is approximate ~80% and the false positive rate is 0.33 FP/h. DTF method is more acceptable to predict epileptic seizures and generally we can observe that the greater results are in gamma and beta sub-bands. The research of this paper is significantly helpful for clinical applications, especially for the exploitation of online portable devices.

Keywords: effective connectivity, Granger causality, directed transfer function, epilepsy seizure prediction, EEG

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Authors: Thirayu Jumsai na Ayudhya

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Initial attempts to understand about what architecture means to people as they go about their everyday life through my previous research revealed that knowledge such as environmental psychology, environmental perception, environmental aesthetics, did not adequately address a perceived need for the contextualized and holistic theoretical framework. In my previous research, it is found that people’s making senses of their everyday architecture can be described in terms of four super‐ordinate themes; (1) building in urban (text), (2) building in (text), (3) building in human (text), (4) and building in time (text). For more comprehensively understanding of how people make sense of their everyday architectural experience, in this ongoing research Phuket Old town was selected as the focal urban context where the distinguish character of Chino-Portuguese is remarkable. It is expected that in a unique urban context like Phuket old town unprecedented super-ordinate themes will be unveiled through the reflection of people’s everyday experiences. The ongoing research of people’s architectural experience conducted in Phuket Island, Thailand, will be presented succinctly. The research will address the question of how do people make sense of their everyday architecture/buildings especially in a unique urban context, Phuket Old town, and identify ways in which people make sense of their everyday architecture. Participant-Produced-Photograph (PPP) and Interpretative Phenomenological Analysis (IPA) are adopted as main methodologies. PPP allows people to express experiences of their everyday urban context freely without any interference or forced-data generating by researchers. With IPA methodology a small pool of participants is considered desirable given the detailed level of analysis required and its potential to produce a meaningful outcome.

Keywords: architectural experience, the everyday architecture, Phuket, Thailand

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Authors: Geetanjali Sharma

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Guillain Barre’ syndrome (GBS) is an auto-immune mediated demyelination poly-radiculo-neuropathy. Clinical features include progressive symmetrical ascending muscle weakness of more than two limbs, areflexia with or without sensory, autonomic and brainstem abnormalities, the purpose of this study was to determine subclinical neurological changes of CNS with GBS and to establish the presence of central demyelination in GBS. The study was prospective and conducted in the Department of Physiology, Pt. B. D. Sharma Post-graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India to find out early central demyelination in clinically diagnosed patients of GBS. These patients were referred from the department of Medicine of our Institute to our department for electro-diagnostic evaluation. The study group comprised of 40 subjects (20 clinically diagnosed GBS patients and 20 healthy individuals as controls) aged between 6-65 years. Brain Stem evoked Potential (BAEP) were done in both groups using RMS EMG EP mark II machine. BAEP parameters included the latencies of waves I to IV, inter peak latencies I-III, III-IV & I-V. Statistically significant increase in absolute peak and inter peak latencies in the GBS group as compared with control group was noted. Results of evoked potential reflect impairment of auditory pathways probably due to focal demyelination in Schwann cell derived myelin sheaths that cover the extramedullary portion of auditory nerves. Early detection of the sub-clinical abnormalities is important as timely intervention reduces morbidity.

Keywords: brainstem, demyelination, evoked potential, Guillain Barre’

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Authors: Eman G. Alayad, Mazen G. Aleyad, Mohammed Alshahrani, Ibrahim Alnaami

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Introduction: Cerebral venous thrombosis (CVT) is a rare type of cerebrovascular disease that can occur at any age. Patients with CVT commonly present with headache, focal neurological deficit, decreased level of consciousness and seizures. Many etiologic risk factors have been reported for CVT, high altitude and oral contraceptive pill some of them. Case Presentation: A 37-year-old woman living in Abha city in the southeastern area of Saudi Arabia. (about 10,000 feet-3000 m) over the sea. complaining acute onset of severe diffuse headache and generalized tonic clonic convulsions. Followed by loss of consciousness. She was on contraceptive pills for the last 3 years. No significant Medical or surgical history. Brain CT revealed subarachnoid hemorrhage, with MRI findings showing thrombosis in transvers sinus. There was no vascular malformations such as aneurysm, arteriovenous malformation (AVM), or dural arteriovenous fistula. A CVT with subarachnoid hemorrhage was our final diagnosis based on clinical presentation and radiographic findings. Discussion: Patients with CVT had evidence of cortical SAH by 10 of 233, others found 3% of SAH was caused by CVT, indicating that the presence of cortical SAH without involvement of the basal cisterns may provide an early sign of underlying CVT. However, what is more interesting in this case, is the relationship of high altitude with CVT and SAH, which previously undescribed. Conclusion: High-altitude climbing per se was described as a risk factor for the development of CVT, though its occurrence was probably rare. Whether it is primary in etiology due to high altitude induced hypercoagulable state of unknown origin or due to cerebrovascular disturbances there is a need for further investigation especially at this unusual presentation of subarachnoid hemorrhage.

Keywords: cerebral venous thrombosis, high-altitude, subarachnoid hemorrhage, stroke

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Authors: Naim Izet Kajtazi

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Context: Frequently, the cause of raised intracranial pressure remains unresolved and rarely is related to spinal tumors, moreover less to spinal medulloblastoma without primary brain focus. Process: An 18-year-old woman had a 3-month history of headaches and impaired vision. Neurological examination revealed bilateral sixth cranial nerve palsies with bilateral papilloedema of grade III. No focal brain or spine lesion was found on imaging. Consecutive lumbar punctures showed high opening pressure and subsequent increasing protein level. The meningeal biopsy was negative. At one point, she developed an increasing headache, vomiting and back pain. Spine MRI showed diffuse nodular leptomeningeal enhancement with the largest nodule at T6–T7. Malignant cells were detected in cerebrospinal fluid. She underwent laminectomy with excisional biopsy, and pathology showed medulloblastoma WHO grade IV. Outcome: She was treated with chemotherapy and craniospinal irradiation and made a good recovery. Relevance: Primary spinal leptomeningeal medulloblastoma is extremely rare, especially without primary brain focus, but may cause increased intracranial pressure, even in the early microscopic phases, and it should be considered in the differential diagnosis if conventional and aggressive treatment of idiopathic intracranial hypertension fails. We assume that arachnoiditis from tumor seeding caused increased intracranial pressure. Appropriate neurosurgical intervention and surgical biopsy are mandated if a suspicious lesion is detected. Consider proper rescreening of the whole neuroaxis in refractory cases of intracranial hypertension.

Keywords: CNS infection, IIH, headache, primary spinal leptomeningeal medulloblastoma

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Authors: Ranjith Menon, Abathar Aladi, Hans-Christean Nahser, Maneesh Bhojak, Sacha Nevin, Paul Eldridge

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Background: Spontaneous subarachnoid haemorrhage (SAH) accounts for approximately 5% of all strokes. Patients with spontaneous SAH (as shown by CT or lumbar puncture) undergo investigations to identify or exclude an underlying structural cause, typically cerebral aneurysm. However in 10 - 20% of cases, no structural cause is found. This includes more than one imaging modality (intracranial MRA, CTA, 4DCTA and/or DSA) and in some spinal MRI. Objective: To determine; 1) If an underlying structural or vascular cause can be identified in non-aneurysmal SAH patients by comparing different imaging modalities at presentation and at follow-up. 2) If MRI spine in patients with non-aneurysmal SAH reveals an underlying SAH cause. 3)The functional outcome at discharge. Results: We performed a retrospective analysis of all non-traumatic SAH patients admitted to the Walton centre from January 2009 to December 2015. There were 1457 patients with non-traumatic SAH admitted to the Walton centre of whom 21.8% (n=300) patients were diagnosed with non-aneurysmal SAH. Males were 65.6% and females were 43.3%. The presenting symptoms were sudden onset headache (93.6%), the focal neurological deficit (12%), loss of consciousness (10.6%) and others (6%). About 285 patients received 2 modalities of imaging (CTA & DSA), 192 received 3 modalities of imaging (CTA, MRA & DSA) and 137 received MRI spine (51/137 whole spine). The modified Rankin Score at discharge were: mRS 0 = 292 (97.33%), mRS 1-2 = 6, mRS 6 = 1 (cardiac arrest in IHD patient) and unknown in 1. Follow-up imaging at 3 to 6 months in 190 (63.3%) patients did not identify an underlying cause. Conclusion: This retrospective analysis concludes that non-aneurysmal SAH has a good functional outcome. A single imaging modality (CTA (4DCTA) or MRA or DSA) was adequate to exclude an underlying cause of SAH and a delayed imaging failed to identify a cause. Routinely performing MRI spine in this group of patients appears not to be necessary according to this evidence.

Keywords: stroke, non-aneurysmal subarachnoid haemorrhage, neuroimaging, modified rankin score

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Authors: Subhasisa Nath, David Waugh, Graham Ormondroyd, Morwenna Spear, Andy Pitman, Paul Mason

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Wood is one of the most sustainable and environmentally favourable materials and is chemically treated in timber industries to maximise durability. To increase the chemical preservative uptake and retention by the wood, current limiting incision technologies are commonly used. This work reports the effects of single pulse CO2 laser-incision and frequency tripled Nd:YAG percussion laser-incision on the characteristics of laser-incised holes in the Radiata Pine. The laser-incision studies were based on changing laser wavelengths, energies and focal planes to conclude on an optimised combination for the laser-incision of Radiata Pine. The laser pulse duration had a dominant effect over laser power in controlling hole aspect ratio in CO2 laser-incision. A maximum depth of ~ 30 mm was measured with a laser power output of 170 W and a pulse duration of 80 ms. However, increased laser power led to increased carbonisation of holes. The carbonisation effect was reduced during laser-incision in the ultra-violet (UV) regime. Deposition of a foamy phase on the laser-incised hole wall was evident irrespective of laser radiation wavelength and energy. A maximum hole depth of ~20 mm was measured in the percussion laser-incision in the UV regime (355 nm) with a pulse energy of 320 mJ. The radial and tangential faces had a significant effect on laser-incision efficiency for all laser wavelengths. The laser-incised hole shapes and circularities were affected by the wood anatomy (earlywoods and latewoods in the structure). Subsequently, the mechanism of laser-incision is proposed by analysing the internal structure of laser-incised holes.

Keywords: CO2 Laser, Nd: YAG laser, incision, drilling, wood, hole characteristics

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Authors: Professor Jo Angouri, Polina Mesinioti, Chris Turner

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In order for a group of ad-hoc professional to perform as a team, a shared understanding of the problem at hand and an agreed action plan are necessary components. This is particularly significant in complex, time sensitive professional settings such as in trauma emergencies. In this context, team briefings prior to the patient arrival (pre-briefings) constitute a critical event for the performance of the team; they provide the necessary space for co-constructing a shared understanding of the situation through summarising information available to the team: yet the act of summarising is widely assumed in medical practice but not systematically researched. In the vast teamwork literature, terms such as ‘shared mental model’, ‘mental space’ and ‘cognate labelling’ are used extensively, and loosely, to denote the outcome of the summarising process, but how exactly this is done interactionally remains under researched. This paper reports on the forms and functions of pre-briefings in a major trauma centre in the UK. Taking an interactional approach, we draw on 30 simulated and real-life trauma emergencies (15 from each dataset) and zoom in on the use of pre-briefings, which we consider focal points in the management of trauma emergencies. We show how ad hoc teams negotiate sharedness of future orientation through summarising, synthesising information, and establishing common understanding of the situation. We illustrate the role, characteristics, and structure of pre-briefing sequences that have been evaluated as ‘efficient’ in our data and the impact (in)effective pre-briefings have on teamwork. Our work shows that the key roles in the event own the act of summarising and we problematise the implications for leadership in trauma emergencies. We close the paper with a model for pre-briefing and provide recommendations for clinical practice, arguing that effective pre-briefing practice is teachable.

Keywords: summarising, medical emergencies, interaction analysis, shared/mental models

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Authors: Lay Poh Tan, Chor Yong Tay, Haiyang Yu

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Micro-contact printing is a form of soft lithography that uses the relief patterns on a master polydimethylsiloxane (PDMS) stamp to form patterns of self-assembled monolayers (SAMs) of ink on the surface of a substrate through conformal contact technique. Here, we adopt this method to print proteins of different dimensions on our biodegradable polymer substrates. We started off with printing 20-500 μm scale lanes of fibronectin to engineer the shape of bone marrow derived human mesenchymal stem cell (hMSCs). After 8 hours of culture, the hMSCs adopted elongated shapes, and upon analysis of the gene expressions, genes commonly associated with myogenesis (GATA-4, MyoD1, cTnT and β-MHC) and neurogenesis (NeuroD, Nestin, GFAP, and MAP2) were up-regulated but gene expression associated to osteogenesis (ALPL, RUNX2, and SPARC) were either down modulated or remained at the nominal level. This is the first evidence that cellular morphology control via micropatterning could be used to modulate stem cell fate without external biochemical stimuli. We further our studies to modulate the focal adhesion (FA) instead of the macro shape of cells. Micro-contact printed islands of different smaller dimensions were investigated. We successfully regulated the FAs into dense FAs and elongated FAs by micropatterning. Additionally, the combined effects of hard (40.4 kPa), and intermediate (10.6 kPa) PA gel and FAs patterning on hMSCs differentiation were studied. Results showed that FA and matrix compliance plays an important role in hMSCs differentiation, and there is a cross-talk between different physical stimulants and the significance of these stimuli can only be realized if they are combined at the optimum level.

Keywords: micro-contact printing, polymer substrate, cell-material interaction, stem cell differentiation

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Authors: Marina Benito-Parejo, Raul Perez-Lopez, Miguel Herraiz, Carolina Guardiola-Albert, Cesar Martinez

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Persistency, long-term memory and randomness are intrinsic properties of time-series of earthquakes. The Rescaled Range Analysis (RS-Analysis) was introduced by Hurst in 1956 and modified by Mandelbrot and Wallis in 1964. This method represents a simple and elegant analysis which determines the range of variation of one natural property (the seismic energy released in this case) in a time interval. Despite the simplicity, there is complexity inherent in the property measured. The cumulative curve of the energy released in time is the well-known fractal geometry of a devil’s staircase. This geometry is used for determining the maximum and minimum value of the range, which is normalized by the standard deviation. The rescaled range obtained obeys a power-law with the time, and the exponent is the Hurst value. Depending on this value, time-series can be classified in long-term or short-term memory. Hence, an algorithm has been developed for compiling the RS-Analysis for time series of earthquakes by days. Completeness time distribution and locally stationarity of the time series are required. The interest of this analysis is their application for a complex seismic crisis where different earthquakes take place in clusters in a short period. Therefore, the Hurst exponent has been obtained for the seismic crisis of Alhoceima (Mediterranean Sea) of January-March, 2016, where at least five medium-sized earthquakes were triggered. According to the values obtained from the Hurst exponent for each cluster, a different mechanical origin can be detected, corroborated by the focal mechanisms calculated by the official institutions. Therefore, this type of analysis not only allows an approach to a greater understanding of a seismic series but also makes possible to discern different types of seismic origins.

Keywords: Alhoceima crisis, earthquake time series, Hurst exponent, rescaled range analysis

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Authors: K. M. Pratap Shankar, Dattatreya Rao, Sai Prasad

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Background: Skin diseases are among the most common health problems worldwide and are associated with a considerable burden. Eczema is such a skin ailment which cause psychological, social and financial burden on the patient and their families. Management of eczema with antibiotics, antihistamines, steroids etc., are available but even after their use relapses, recurrences and other complications are very common. Aim: The aim of this study was to assess the efficacy of leech application in the management of vicarcikā (Eczema) with Histopathological study. Methods: For the present study 10 patients having the classical symptoms of Vicarcikā, were randomly selected as per the inclusion and exclusion criteria from O.P.D. & I.P.D. sections of Śalya department, S.V. Āyurvedic Hospital, Tirupati. Minimum 4 sittings of Leech application was carried out with seven days interval. Total duration of treatment was 6 weeks. Biopsy samples were collected from the lesion site before and after treatment. Histopathological examination was done by the pathologist. Results: In eczema (dermatitis) the leech application therapy gives excellent response by reducing the inflammatory component, hyperkeratosis, spongiosis, irregular acanthosis and by evoking a granulation tissue response in the dermis and in most of the cases with complete recovery from the lesion. Most of the cases in the study were chronic dermatitis and sebhoric keratosis, almost all local/focal pigmented lesions is totally relieved by leech therapy especially in cases of sebhoric keratosis. Conclusion: In the present study it was found that, leech application evokes significant changes at histological level specifically in reduction of inflammatory component, hyperkeratosis, spongiosis and irregular acanthosis. It was also found that there was a considerable formation of granulation tissue, which helps in formation of healthy new tissues.

Keywords: acanthosis, eczema, hyperkeratosis, leech application, spongiosis

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Authors: Rehema Kabare

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As urban development initiatives continue to emerge and are implemented amid rapid urbanization and climate change effects in the global south, the plight of women is only being noticed. The pandemic exposed the atrocities, violence and unsafety women and girls face daily both in their homes and in public urban spaces. This is a result of poorly implemented and managed urban structures, which women have been left out of during design and implementation for centuries. The UN Habitat’s HerCity toolkit provides a unique opportunity to change course for both governments and civil society actors where women and girls are onboarded onto urban development initiatives, with their designs and ideas being the focal point. This toolkit proves that when women and girls design, they design for everyone. The HerCity HerStreets, Public Space Improvement Initiative, resulted in a design that focused on two aspects: Streets are a shared resource, and Streets are public spaces. These two concepts illustrate that for streets to be experienced effectively as cultural spaces, they need to be user-friendly, safe and inclusive. This report demonstrates how the HerCity HerStreets as a pilot project can be a benchmark for designing urban spaces in African cities. The project focused on five dimensions to improve the air quality of the space, the space allocation to street vending and bodaboda (passenger motorcycle) stops parking and the green coverage. The process displays how digital tools such as Minecraft and Kobo Toolbox can be utilized to improve citizens’ participation in the development of public spaces, with a special focus on including vulnerable groups such as women, girls and youth.

Keywords: urban space, sustainable development, gender and the city, digital tools and urban development

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Authors: M. Rahou, A. J. Andrews, G. Rosengarten

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One of the main challenges in high-temperature solar thermal applications transfer concentrated solar radiation to the load with minimum energy loss and maximum overall efficiency. The use of a solar concentrator in conjunction with bundled optical fibres has potential advantages in terms of transmission energy efficiency, technical feasibility and cost-effectiveness compared to a conventional heat transfer system employing heat exchangers and a heat transfer fluid. In this paper, a theoretical and computer simulation method is described to estimate the net solar radiation transmission from a solar concentrator into and through optical fibres to a thermal application at the end of the fibres over distances of up to 100 m. A key input to the simulation is the angular distribution of radiation intensity at each point across the aperture plane of the optical fibre. This distribution depends on the optical properties of the solar concentrator, in this case, a parabolic mirror with a small secondary mirror with a common focal point and a point-focus Fresnel lens to give a collimated beam that pass into the optical fibre bundle. Since solar radiation comprises a broad band of wavelengths with very limited spatial coherence over the full range of spectrum only ray tracing models absorption within the fibre and reflections at the interface between core and cladding is employed, assuming no interference between rays. The intensity of the radiation across the exit plane of the fibre is found by integrating across all directions and wavelengths. Results of applying the simulation model to a parabolic concentrator and point-focus Fresnel lens with typical optical fibre bundle will be reported, to show how the energy transmission varies with the length of fibre.

Keywords: concentrated radiation, fibre bundle, parabolic dish, fresnel lens, transmission

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Authors: Enjie Xu, Zhen Huang, Kunpeng Zhu, Jianping Hu, Xiaolong Ma, Yongjie Wang, Jiazhuang Zhu, Chunlin Zhang

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Abstract: Hypoxia and dedifferentiation of osteosarcoma (OS) cells leads to poor prognosis. We plan to identify the role of hypoxia on dedifferentiation and the associated signaling pathways. We performed a sphere formation assay and determined spheroid cells as dedifferentiated cells by detecting stem cell-like markers. RNAi assay was used to explore the expression relationship between hypoxia inducible factor 1 subunit alpha (HIF1A) and platelet derived growth factor receptor beta (PDGFRB). We obtained PDGFRB knockdown and overexpression cells through lentiviral infection experiments and the effects of PDGFRB on cytoskeleton rearrangement and cell adhesion were explored by immunocytochemistry. Wound-healing experiments, transwell assays, and animal trials were employed to investigate the effect of PDGFRB on OS metastasis. Dedifferentiated OS cells were found to exhibit high expression of HIF1A and PDGFRB, and HIF1A promoted the expression of PDGFRB, subsequently activated ras homolog family member A (RhoA), and increased the phosphorylation of myosin light chain (MLC). PDGFRB also enhanced the phosphorylation of focal adhesion kinase (FAK). The OS cell morphology and vinculin distribution were altered by PDGFRB. PDGFRB also promoted cell dedifferentiation and had a significant impact on the metastasis of OS cells both in vitro and in vivo. Our results demonstrated that HIF1A up-regulated PDGFRB under hypoxic conditions, and PDGFRB regulated the actin cytoskeleton by activating RhoA and subsequently phosphorylating MLC, thereby promoting OS dedifferentiation and pulmonary metastasis.

Keywords: osteosarcoma, dedifferentiation, metastasis, cytoskeleton rearrangement, PDGFRB, hypoxia

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Authors: S. H. Jang

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Posterior reversible encephalopathy syndrome (PRES) is characterized by acute neurologic symptoms (visual loss, headache, altered mentality and seizures) and by typical imaging findings (bilateral subcortical and cortical edema with predominatly posterior distribution). Nephrotic syndrome is a syndrome comprising signs of proteinuria, hypoalbuminemia, and edema. It is well known that hypertension predispose patient with nephrotic syndrome to PRES. A 45-year old male was referred for suddenly developed vertigo, disequilibrium. He had previous history of nephrotic syndrome. His medical history included diabetes controlled with medication. He was hospitalized because of generalized edema a few days ago. His vital signs were stable. On neurologic examination, his mental state was alert. Horizontal nystagmus to right side on return to primary position was observed. He showed good grade motor weakness and ataxia in right upper and lower limbs without other sensory abnormality. Brain MRI showed increased signal intensity in FLAIR image, decreased signal intensity in T1 image and focal enhanced lesion in T1 contrast image at whole midbrain, pons and cerebellar peduncle symmetrically, which was compatible with vasogenic edema. Laboratory findings showed severe proteinuria and hypoalbuminemia. He was given intravenous dexamethasone and diuretics to reduce vasogenic edema and raise the intra-vascular osmotic pressure. Nystagmus, motor weakness and limb ataxia improved gradually over 2 weeks; He recovered without any neurologic symptom and sign. Follow-up MRI showed decreased vasogenic edema fairly. We report a case of brain stem PRES in normotensive, nephrotic syndrome patient.

Keywords: posterior reversible encephalopathy syndrome, MRI, nephrotic syndrome, vasogenic brain edema

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Authors: Rabin Paudel, Dambar Bahadur Mahato, Prabin Poudel, Bijaya Neupane, Sakar Jha

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Understanding Human-Elephant Conflict (HEC) is very important in countries like Nepal, where solutions to escalating conflicts are urgently required. However, most of the HEC mitigation measures implemented so far have been done on an ad hoc basis without the detailed understanding of nature and extent of the damage. This study aims to assess the current scenario of HEC in regards to crop and property damages by Wild Asian Elephant and people’s perception towards existing mitigating measures and elephant conservation in Buffer zone area of Bardia National Park. The methods used were a questionnaire survey (N= 178), key-informant interview (N= 18) and focal group discussions (N= 6). Descriptive statistics were used to determine the nature and extent of damage and to understand people’s perception towards HEC, its mitigation measures and elephant conservation. Chi-square test was applied to determine the significance of crop and property damages with respect to distance from the park boundary. Out of all types of damage, crop damage was found to be the highest (51%), followed by house damage (31%) and damage to stored grains (18%) with winter being the season with the greatest elephant damage. Among 178 respondents, the majority of them (82%) were positive towards elephant conservation despite the increment in HEC incidents as perceived by 88% of total respondents. Among the mitigation measures present, the most applied was electric fence (91%) followed by barbed wire fence (5%), reinforced concrete cement wall (3%) and gabion wall (1%). Most effective mitigation measures were reinforced concrete cement wall and gabion wall. To combat increasing crop damage, the insurance policy should be initiated. The efficiency of the mitigation measures should be timely monitored, and corrective measures should be applied as per the need.

Keywords: crop and property damage, elephant conflict, Asiatic wild elephant, mitigation measures

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Authors: Heru Al Amin

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Sarcoidosis is a granulomatous inflammatory disorder of unclear etiology that can affect multiple different organ systems. Isolated cardiac sarcoidosis is a very rare condition that causes lethal arrhythmia and heart failure. A definite diagnosis of cardiac sarcoidosis remains challenging. The use of multimodality imaging plays a pivotal role in the diagnosis of this entity. Case summary: In this report, we discuss a case of a 50-year-old woman who presented with recurrent palpitation, dizziness, vertigo and presyncope. Electrocardiogram revealed variable heart blocks, including first-degree AV block, second-degree AV block, high-degree AV block, complete AV block, trifascicular block and sometimes supraventricular arrhythmia. Twenty-four hours of Holter monitoring show atrial bigeminy, first-degree AV block and trifascicular block. Transthoracic echocardiography showed Thinning of basal anteroseptal and inferred septum with LV dilatation with reduction of Global Longitudinal Strain. A dual-chamber pacemaker was implanted. CT Coronary angiogram showed no coronary artery disease. Cardiac magnetic resonance revealed basal anteroseptal and inferior septum thinning with focal edema with LGE suggestive of sarcoidosis. Computed tomography of the chest showed no lymphadenopathy or pulmonary infiltration. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) of the whole body showed. We started steroids and followed up with the patient. Conclusion: This case serves to highlight the challenges in identifying and managing isolated CS in a young patient with recurrent syncope with variable heart block. Early, even late initiation of steroids can improve arrhythmia as well as left ventricular function.

Keywords: cardiac sarcoidosis, conduction abnormality, syncope, cardiac MRI

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Authors: Ghada Esheba, Ghadeer Aldoobi, Salwa Almalk, Abrar Alshareef, Eman Al-khairi, Eman Yaseen

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Background: In Saudi Arabia, ovarian cancer ranked seventh among female population and is the most common female genital tract malignancy after endometrial cancer. A slight increase in the incidence of ovarian cancer was observed from 2001–2008. Makkah, Riyadh, and the eastern region of Saudi Arabia had the highest incidence rate ratio for the number of ovarian cancer cases (1). Differentiating metastatic adenocarcinomas from primary ovarian carcinomas, especially those of endometrioid and mucinous type is clinically significant and a challenge for clinicians and pathologists, yet the distinction has important therapeutic and prognostic implications. Aim: To clarify the most important histopathological criteria to differentiate between primary ovarian surface epithelial tumors especially mucinous and endometrioid subtypes, and metastatic adenocarcinoma and to evaluate the value of a panel of antibodies consisting of CK7, CK20, and CDX-2 in the distinction between primary ovarian surface epithelial tumors and metastatic adenocarcinoma. Material and methods: This study was carried out on 26 cases of primary ovarian surface epithelial neoplasms and 14 cases of metastatic ovarian adenocarcinoma. All cases were studied immunohistochemically using CK7, CK20, and CDX-2. Results: All cases of primary ovarian adenocarcinoma were positive for CK7. 25% and 58% of mucinous borderline mucinous tumor and mucinous carcinoma respectively were positive for CK20. Only 42% of mucinous carcinoma were positive for CDX-2. All cases of endometrioid carcinomas were negative for both CK20 and CDX-2. All cases of metastatic adenocarcinoma from the colon were negative for CK7 and positive for CK20 and CDX-2. Conclusions: CK7 is an important positive marker for primary ovarian tumors, while CK20 and CDX-2 are useful markers for colorectal carcinoma metastatic to the ovary. Caution should be taken as primary ovarian mucinous tumors may stain positive for CK20, CDX-2, or both, however, they usually exhibit a focal pattern of reactivity.

Keywords: adenoma, endometrioid, malignancy, ovarian

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