Search results for: oblique shock

Authors: Atoui Oussama, Maazoun Azer, Belkassem Bachir, Pyl Lincy, Lecompte David

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For many decades, researchers have been focused on understanding the dynamic behavior of different structures and materials subjected to fragment impact or blast loads separately. The explosion mechanics, as well as the impact physics studies dealing with the numerical modeling of the response of protective structures under the synergistic effect of a blast wave and the impact of fragments, are quite limited in the literature. This article numerically evaluates the nonlinear dynamic behavior and damage mechanisms of Aluminum plates EN AW-1050A- H24 under different combined loading scenarios varied by the sequence of the applied loads using the commercial software LS-DYNA. For one hand, with respect to the terminal ballistic field investigations, a Lagrangian (LAG) formulation is used to evaluate the different failure modes of the target material in case of a fragment impact. On the other hand, with respect to the blast field analysis, an Arbitrary Lagrangian-Eulerian (ALE) formulation is considered to study the fluid-structure interaction (FSI) of the shock wave and the plate in case of a blast loading. Four different loading scenarios are considered: (1) only blast loading, (2) only fragment impact, (3) blast loading followed by a fragment impact and (4) a fragment impact followed by blast loading. From the numerical results, it was observed that when the impact load is applied to the plate prior to the blast load, it suffers more severe damage due to the hole enlargement phenomenon and the effects of crack propagation on the circumference of the damaged zone. Moreover, it was found that the hole from the fragment impact loading was enlarged to about three times in diameter as compared to the diameter of the projectile. The validation of the proposed computational model is based in part on previous experimental data obtained by the authors and in the other part on experimental data obtained from the literature. A good correspondence between the numerical and experimental results is found.

Keywords: computational analysis, combined loading, explosion mechanics, hole enlargement phenomenon, impact physics, synergistic effect, terminal ballistic

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Authors: Aashutosh Garg, Ankur Rajpal, A. A. Kazmi

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The efficiency of an on-site wastewater treatment system named Johkasou was evaluated based on its pollutant removal efficiency over 10 months. This system was installed at IIT Roorkee and had a capacity of treating 7 m3/d of sewage water, sufficient for a group of 30-50 people. This system was fed with actual wastewater through an equalization tank to eliminate the fluctuations throughout the day. Methanol and ammonium chloride was added into this equalization tank to increase the Chemical Oxygen Demand (COD) and ammonia content of the influent. The outlet from Johkasou is sent to a tertiary unit consisting of a Pressure Sand Filter and an Activated Carbon Filter for further treatment. Samples were collected on alternate days from Monday to Friday and the following parameters were evaluated: Chemical Oxygen Demand (COD), Biochemical Oxygen Demand (BOD), Total Suspended Solids (TSS), and Total Nitrogen (TN). The Average removal efficiency for Chemical Oxygen Demand (COD), Biochemical Oxygen Demand (BOD), Total Suspended Solids (TSS), and Total Nitrogen (TN) was observed as 89.6, 97.7, 96, and 80% respectively. The cost of treating the wastewater comes out to be Rs 23/m3 which includes electricity, cleaning and maintenance, chemical, and desludging costs. Tests for the coliforms were also performed and it was observed that the removal efficiency for total and fecal coliforms was 100%. The sludge generation rate is approximately 20% of the BOD removal and it needed to be removed twice a year. It also showed a very good response against the hydraulic shock load. We performed vacation stress analysis on the system to evaluate the performance of the system when there is no influent for 8 consecutive days. From the result of stress analysis, we concluded that system needs a recovery time of about 48 hours to stabilize. After about 2 days, the system returns again to original conditions and all the parameters in the effluent become within the limits of National Green Tribunal (NGT) standards. We also performed another stress analysis to save the electricity in which we turned the main aeration blower off for 2 to 12 hrs a day and the results showed that we can turn the blower off for about 4-6 hrs a day and this will help in reducing the electricity costs by about 25%. It was concluded that the Johkasou system can remove a sufficient amount of all the physiochemical parameters tested to satisfy the prescribed limit set as per Indian Standard.

Keywords: on-site treatment, domestic wastewater, Johkasou, nutrient removal, pathogens removal

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Authors: Basma Hassabo, Sarah Ahmed, Aisha Hameed

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Aims and Objectives: To determine the incidence of maternal mortality amongst pregnant women with sickle cell disease (SCD) in the United Kingdom and to determine exact cause of death in these women. Background: SCD is caused by the ‘sickle’ gene and is characterized by episodes of severe bone pain and other complications like acute chest syndrome, chronic pulmonary hypertension, stroke, retinopathy, chronic renal failure, hepato-splenic crises, avascular bone necrosis, sepsis and leg ulcers. SCD is a continual cause of maternal mortality and fetal complications, and it comprises 1.5% of all Direct and Indirect deaths in the UK. Sepsis following premature rupture of membranes with ascending infection, post-partum infection and pre-labour overwhelming septic shock is one of its leading causes of death. Over the last fifty years of maternal mortality reports in UK, between 1 to 4 pregnant women died in each triennium. Material and Method: This is a retrospective study that involves pregnant women who died from SCD complications in the UK between 1952-2012. Data were collected from the UK Confidential Enquiries into Maternal Death and its causes between 1952–2012. Prior to 1985, exact cause of death in this cohort was not recorded. Results: 33 deaths reported between 1964 and 1984. 17 deaths were reported due to sickle cell disease between 1985 and 2012. Five women in this group died of sickle cell crisis, one woman had liver sequestration crisis, two women died of venous thromboembolism, two had myocardial fibrosis and three died of sepsis. Remaining women died of amniotic fluid embolism, SUDEP, myocardial ischemia and intracranial haemorrhage. Conclusion: The leading causes of death in sickle cell sick pregnant women are sickle cell crises, sepsis, venous thrombosis and thromboembolism. Prenatal care for women with SCD should be managed by a multidisciplinary team that includes an obstetrician, nutritionist, primary care physician, and haematologist. In every sick Sickle Cell woman Sickle Cell crises should be on the top of the list of differential diagnosis. Aggressive treatment of complications with low threshold to commence broad-spectrum antibiotics and LMWH contribute to better outcomes.

Keywords: incidence, maternal mortality, sickle cell disease (SCD), uk

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Authors: Lito M. Amit, Venecio U. Ultra, Young-Woong Song

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The business process outsourcing (BPO) in the Philippines is expanding rapidly attracting more than 2% of total employment. Currently, the BPO industry is confronted with several issues pertaining to sustainable productivity such as meeting the staffing gap, high rate of employees’ turnover and workforce retention, and the occupational health and safety (OHS) of call center agents. We conducted a survey of OHS programs and health concerns among call center agents in the Philippines and determined the sociocultural factors that affect the vulnerability of call center agents to occupational health risks and hazards. The majority of the agents affirmed that OHS are implemented and OHS orientation and emergency procedures were conducted at employment initiations, perceived favorable and convenient working environment except for occasional noise disturbances and acoustic shock, visual, and voice fatigues. Male agents can easily adjust to the demands and changes in their work environment and flexible work schedules than female agents. Female agents have a higher tendency to be pressured and humiliated by low work performance, experience a higher incidence of emotional abuse, psychological abuse, and experience more physical stress than male agents. The majority of the call center agents had a night-shift schedule and regardless of other factors, night shift work brings higher stress to agents. While working in a call center, higher incidence of headaches and insomnia, burnout, suppressed anger, anxiety, and depressions were experienced by female, younger (21-25 years old) and those at night shift than their counterpart. Most common musculoskeletal disorders include body pain in the neck, shoulders and back; and hand and wrist disorders and these are commonly experienced by female and younger workers. About 30% experienced symptoms of cardiovascular and gastrointestinal disorders and weakened immune systems. Overall, these findings have shown the variable vulnerability by a different subpopulation of call center agents and are important in the occupational health risk prevention and management towards a sustainable human resource for BPO industry in the Philippines.

Keywords: business process outsourcing industry, health risk of call center agents, socio-cultural determinants, Philippines

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Authors: Rubai M. Ochieng

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Cancer, which accounts for 7 percent of deaths per year in Kenya, is the third highest cause of death after infectious and cardiovascular diseases. Awareness Campaigns have tended to focus on leading cancers including breast and cervical for women as well as prostrate and Esophageal for men. Consequently, less common cancers such as Acute Myeloid Leukemia (AML) are rarely properly understood by the general population and a section of the medical fraternity. Diagnoses of AML in patients who may not have heard about it sometimes results in shock, denial and confusion not just to the diagnosed, but also to their family and friends. The diagnosed and caregivers are bound to receive a lot of contradicting information about prognosis, care and treatment of AML. This information, which often comes from diverse sources including doctors, friends, internet and social media platforms, causes further confusion and panic. The situation is handled differently by different people. Religious people sometimes resort to prayer. This paper, written from the perspective of a care giver, is based on data collected from a case of Acute Myeloid Leukemia diagnosed in a 32 year old male who lost his life within six weeks of diagnosis. The sample constitutes of 16 people who participated in prayers. Out of this total, 5 were males including the diagnosed and 11 were females. All the 16 were Christians of protestant orientation including Anglicans, Quakers and Church of God members. Data was collected by the researcher herself through participant of observation. Findings discuss how the 16 participants prayed individually at different times, together in an overnight prayer meeting and every morning through a group social media platform. They shared songs and words of encouragement from the bible. The group prayed for healing, peace and strength to the diagnosed and family, financial breakthrough and doctors’ work and decisions, among other challenges that came with the situation. The paper reveals the immense benefits of prayer to the diagnosed and his close relatives and friends. They include acceptance of the condition and a positive attitude in handling the challenges that arose from the disease and treatment processes. The challenges arising from the prayer approach of handling the situation are also discussed. The paper concludes that prayer as therapy goes a long way in cancer management.

Keywords: acute myeloid leukemia, Kenya, participant observation, prayer

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Authors: Siddharth Jain, Abhenil Mittal, Surendra Kumar Sharma

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Background: With its recent emergence and re-emergence, dengue has become a major international public health concern, imposing significant financial burden especially in developing countries. Despite aggressive control measures in place, India experienced one of its largest outbreaks in 2015 with Delhi being most severely affected. There is a lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak. Methods: This prospective observational study conducted at an apex tertiary care center in Delhi, India included confirmed adult dengue patients admitted between August-November 2015. Patient demographics, clinical details, and laboratory findings were recorded in a predesigned proforma. Appropriate statistical tests were used to summarize and compare the clinical and laboratory characteristics and derive predictors of mortality and severe disease, while developing a clinical risk score for mortality. Serotype analysis was also done for 75 representative samples to identify the dominant serotypes. Results: Data of 369 patients were analyzed (mean age 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (DHF Grade 1,2)and 46 (12%) developed dengue shock syndrome (DSS). Twenty two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnoea at rest were identified as independent predictors of severe disease. Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnoea) which, if ≥ 22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were DENV-2 and DENV-4. Conclusion: Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine the outcome in dengue patients. Timely referral/access to health care is important. Development and use of validated predictors of disease severity and simple clinical risk scores, which can be applied in all healthcare settings, can help minimize mortality and morbidity, especially in resource limited settings.

Keywords: dengue, mortality, predictors, severity

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Authors: Tharwat Ibrahim Rushdy, Warda Youssef Mohammed Morsy, Hanaa Ali Ahmed Elfeky

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Background: Intra-aortic balloon pump (IABP) is the first and the most commonly used mechanical circulatory support for patients with acute coronary syndromes and cardiogenic shock. Therefore, critical care nurses not only have to know how to monitor and operate the IABP, but also to provide interventions for preventing possible complications. Aim of the study: To assess nurses' knowledge and practices regarding care of patients connected to IABP at the ICUs of Cairo University Hospitals. Research design: A descriptive exploratory design was utilized. Sample: Convenience samples of 40 nurses were included in the current study. Setting: This study was carried out at the Intensive Care Units of Cairo University Hospitals. Tools of data collection: Three tools were developed, tested for clarity, and feasibility: a- Nurses' personal background sheet, b- IABP nurses' knowledge self-administered questionnaire, and c- IABP Nurses' practice observational checklist. Results: The majority of the studied sample had unsatisfactory knowledge and practice level (88% & 95%) respectively with a mean of 9.45+2.94 and 30.5+8.7, respectively. Unsatisfactory knowledge was found regarding description and physiological effects, nursing care, indications, contraindications, complications, weaning, and removal of IABP in percentage of 95%, 90%, 72.5%, and 57.5%, respectively, with a mean total knowledge score of 9.45 +2.94. In addition, unsatisfactory practice was found regarding about preparation and initiation of IABP therapy, nursing practice during therapy, weaning, and removal of IABP in percentages of (97.5%, 97.5%, and 90%), respectively. Finally, knowledge level was found to differ significantly in relation to gender (t = 2.46 at P ≤ 0.018). However, gender didn't play a role in relation to practice (t = 0.086 at P≤ 0.932). Conclusion: In spite of having vital role in assessment and management of critically ill patients, critical care nurses in the current study had in general unsatisfactory knowledge and practice regarding care of patients connected to IABP. Recommendation: updating knowledge and practice of ICU nurses through carrying out continuing educational programs about IABP; strict observation of nurses' practice when caring for patients connected to IABP and provision of guidance to correct of poor practices and replication of this study on larger probability sample selected from different geographical locations.

Keywords: knowledge, practice, intra-aortic balloon pump (IABP), ICU nurses, intensive care unit (ICU), introduction

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Authors: Cláudia Patrocínio, Beatriz Fernandes, Ana Filipa Pires

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Background: Mirror therapy (MT) is used to improve motor function after stroke. During MT, a mirror is placed between the two upper limbs (UL), thus reflecting movements of the non- affected side as if it were the affected side. Objectives: The aim of this review is to analyze the evidence on the effec.tiveness of MT in the recovery of UL function in population with post chronic stroke. Methods: The literature search was carried out in PubMed, ISI Web of Science, and PEDro database. Inclusion criteria: a) studies that include individuals diagnosed with stroke for at least 6 months; b) intervention with MT in UL or comparing it with other interventions; c) articles published until 2023; d) articles published in English or Portuguese; e) randomized controlled studies. Exclusion criteria: a) animal studies; b) studies that do not provide a detailed description of the intervention; c) Studies using central electrical stimulation. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. Studies with < 4 on PEDro scale were excluded. Eighteen studies met all the inclusion criteria. Main results and conclusions: The quality of the studies varies between 5 and 8. One article compared muscular strength training (MST) with MT vs without MT and four articles compared the use of MT vs conventional therapy (CT), one study compared extracorporeal shock therapy (EST) with and without MT and another study compared functional electrical stimulation (FES), MT and biofeedback, three studies compared MT with Mesh Glove (MG) or Sham Therapy, five articles compared performing bimanual exercises with and without MT and three studies compared MT with virtual reality (VR) or robot training (RT). The assessment of changes in function and structure (International Classification of Functioning, Disability and Health parameter) was carried out, in each article, mainly using the Fugl Meyer Assessment-Upper Limb scale, activity and participation (International Classification of Functioning, Disability and Health parameter) were evaluated using different scales, in each study. The positive results were seen in these parameters, globally. Results suggest that MT is more effective than other therapies in motor recovery and function of the affected UL, than these techniques alone, although the results have been modest in most of the included studies. There is also a more significant improvement in the distal movements of the affected hand than in the rest of the UL.

Keywords: physical therapy, mirror therapy, chronic stroke, upper limb, hemiplegia

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Authors: Shweh Fern Loo, Jun Yin Ong, Than Zaw Oo

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Acute respiratory distress syndrome (ARDS) is a common serious condition of bilateral lung infiltrates that develops secondary to various underlying conditions such as diseases or injuries. ARDS with severe hypercapnia is associated with higher ICU mortality and morbidity. Venovenous Extracorporeal membrane oxygenation (VV-ECMO) support has been established to avert life-threatening hypoxemia and hypercapnic respiratory failure despite optimal conventional mechanical ventilation. However, VV-ECMO is relatively not advisable in particular groups of patients, especially in multi-organ failure, advanced age, hemorrhagic complications and irreversible central nervous system pathology. We presented a case of a 79-year-old Chinese lady without any pre-existing lung disease admitted to our hospital intensive care unit (ICU) after acute presentation of breathlessness and chest pain. After extensive workup, she was diagnosed with rapidly progressing acute interstitial pneumonia with ARDS and hypercapnia respiratory failure. The patient received lung protective strategies of mechanical ventilation and neuromuscular blockage therapy as per clinical guidelines. However, hypercapnia respiratory failure was refractory, and she was deemed not a good candidate for VV-ECMO support given her advanced age and high vasopressor requirements from shock. Alternative therapy with extracorporeal CO2 removal (ECCO2R) was considered and implemented. The patient received 12 days of ECCO2R paired with muscle paralysis, optimization of lung-protective mechanical ventilation and dialysis. Unfortunately, the patient still had refractory hypercapnic respiratory failure with dual vasopressor support despite prolonged therapy. Given failed and futile medical treatment, the family opted for withdrawal of care, a conservative approach, and comfort care, which led to her demise. The effectivity of extracorporeal CO2 removal may depend on disease burden, involvement and severity of the disease. There is insufficient data to make strong recommendations about its benefit-risk ratio for ECCO2R devices, and further studies and data would be required. Nonetheless, ECCO2R can be considered an alternative treatment for refractory hypercapnic respiratory failure patients who are unsuitable for initiating venovenous ECMO.

Keywords: extracorporeal CO2 removal (ECCO2R), acute respiratory distress syndrome (ARDS), acute interstitial pneumonia (AIP), hypercapnic respiratory failure

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Authors: Thomas Rowan, Mohammed Seaid

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A fast finite volume solver for multi-layered shallow water flows with mass exchange and an erodible bed is developed. This enables the user to solve a number of complex sediment-based problems including (but not limited to), dam-break over an erodible bed, recirculation currents and bed evolution as well as levy and dyke failure. This research develops methodologies crucial to the under-standing of multi-sediment fluvial mechanics and waterway design. In this model mass exchange between the layers is allowed and, in contrast to previous models, sediment and fluid are able to transfer between layers. In the current study we use a two-step finite volume method to avoid the solution of the Riemann problem. Entrainment and deposition rates are calculated for the first time in a model of this nature. In the first step the governing equations are rewritten in a non-conservative form and the intermediate solutions are calculated using the method of characteristics. In the second stage, the numerical fluxes are reconstructed in conservative form and are used to calculate a solution that satisfies the conservation property. This method is found to be considerably faster than other comparative finite volume methods, it also exhibits good shock capturing. For most entrainment and deposition equations a bed level concentration factor is used. This leads to inaccuracies in both near bed level concentration and total scour. To account for diffusion, as no vertical velocities are calculated, a capacity limited diffusion coefficient is used. The additional advantage of this multilayer approach is that there is a variation (from single layer models) in bottom layer fluid velocity: this dramatically reduces erosion, which is often overestimated in simulations of this nature using single layer flows. The model is used to simulate a standard dam break. In the dam break simulation, as expected, the number of fluid layers utilised creates variation in the resultant bed profile, with more layers offering a higher deviation in fluid velocity . These results showed a marked variation in erosion profiles from standard models. The overall the model provides new insight into the problems presented at minimal computational cost.

Keywords: erosion, finite volume method, sediment transport, shallow water equations

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Authors: Xiujing Chen, Thammananya Sakcharoen, Wilailuk Niyommaneerat

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China's tourism industry is in a state of shock and recovery, although COVID-19 has brought great impact and challenges to the tourism industry. The theory of sustainable development originates from the contradiction of increasing awareness of environmental protection and the pursuit of economic interests. The sustainable development of tourism should consider social, economic, and environmental factors and develop tourism in a planned and targeted way from the overall situation. Guilin is one of the popular tourist cities in China. However, there exist several problems in Guilin tourism, such as low quality of scenic spot construction and low efficiency of tourism resource development. Due to its unwell-managed, Guilin's tourism industry is facing problems such as supply and demand crowding pressure for tourists. According to the data from 2009 to 2019, there is a change in the degree of sustainable development of Guilin tourism. This research aimed to evaluate the sustainable development state of Guilin tourism using the DPSIR (driving force/pressure/state/impact/response) framework and to provide suggestions and recommendations for sustainable development in Guilin. An improved TOPSIS (technology for order preference by similarity to an ideal solution) model based on the entropy weights relationship is applied to the quantitative analysis and to analyze the mechanisms of sustainable development of tourism in Guilin. The DPSIR framework organizes indicators into sub-five categories: of which twenty-eight indicators related to sustainable aspects of Guilin tourism are classified. The study analyzed and summarized the economic, social, and ecological effects generated by tourism development in Guilin from 2009-2019. The results show that the conversion rate of tourism development in Guilin into regional economic benefits is more efficient than that into social benefits. Thus, tourism development is an important driving force of Guilin's economic growth. In addition, the study also analyzed the static weights of 28 relevant indicators of sustainable development of tourism in Guilin and ranked them from largest to smallest. Then it was found that the economic and social factors related to tourism revenue occupy the highest weight, which means that the economic and social development of Guilin can influence the sustainable development of Guilin tourism to a greater extent. Therefore, there is a two-way causal relationship between tourism development and economic growth in Guilin. At the same time, ecological development-related indicators also have relatively large weights, so ecological and environmental resources also have a great influence on the sustainable development of Guilin tourism.

Keywords: DPSIR framework, entropy weights analysis, sustainable development of tourism, TOPSIS analysis

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Authors: Hanwei Gao, Louis Jezequel, Eric Cabrol, Bernard Vitry

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The chassis system is composed of complex elements that take up all the loads from the tire-ground contact area and thus it plays an important role in numerous specifications such as durability, comfort, crash, etc. During the development of new vehicle projects in Renault, durability validation is always the main focus while deployment of comfort comes later in the project. Therefore, sometimes design choices have to be reconsidered because of the natural incompatibility between these two specifications. Besides, robustness is also an important point of concern as it is related to manufacturing costs as well as the performance after the ageing of components like shock absorbers. In this paper an approach is proposed aiming to realize a multi-objective optimization between chassis endurance and comfort while taking the random factors into consideration. The adaptive-sparse polynomial chaos expansion method (PCE) with Chebyshev polynomial series has been applied to predict responses’ uncertainty intervals of a system according to its uncertain-but-bounded parameters. The approach can be divided into three steps. First an initial design of experiments is realized to build the response surfaces which represent statistically a black-box system. Secondly within several iterations an optimum set is proposed and validated which will form a Pareto front. At the same time the robustness of each response, served as additional objectives, is calculated from the pre-defined parameter intervals and the response surfaces obtained in the first step. Finally an inverse strategy is carried out to determine the parameters’ tolerance combination with a maximally acceptable degradation of the responses in terms of manufacturing costs. A quarter car model has been tested as an example by applying the road excitations from the actual road measurements for both endurance and comfort calculations. One indicator based on the Basquin’s law is defined to compare the global chassis durability of different parameter settings. Another indicator related to comfort is obtained from the vertical acceleration of the sprung mass. An optimum set with best robustness has been finally obtained and the reference tests prove a good robustness prediction of Chebyshev PCE method. This example demonstrates the effectiveness and reliability of the approach, in particular its ability to save computational costs for a complex system.

Keywords: chassis durability, Chebyshev polynomials, multi-objective optimization, polynomial chaos expansion, ride comfort, robust design

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Authors: Selen Unaldi, Emmanuel Richaud, Matthieu Gervais, Laurent Berthe

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Aircrafts are painted with several layers to guarantee their protection from external attacks. For aluminum AA 2024-T3 (metallic structural part of the plane), a protective primer is applied to ensure its corrosion protection. On top of this layer, the top coat is applied for aesthetic aspects. During the lifetime of an aircraft, top coat stripping has an essential role which should be operated as an average of every four years. However, since conventional stripping processes create hazardous disposals and need long hours of labor work, alternative methods have been investigated. Amongst them, laser stripping appears as one of the most promising techniques not only because of the reasons mentioned above but also its controllable and monitorable aspects. The application of a laser beam from the coated side provides stripping, but the depth of the process should be well controlled in order to prevent damage to a substrate and the anticorrosion primer. Apart from that, thermal effects should be taken into account on the painted layers. As an alternative, we worked on developing a process that includes the usage of shock wave propagation to create the stripping via mechanical effects with the application of the beam from the substrate side (back face) of the samples. Laser stripping was applied on thickness-specified samples with a thickness deviation of 10-20%. First, the stripping threshold is determined as a function of power density which is the first flight off of the top coats. After obtaining threshold values, the same power densities were applied to specimens to create large stripping zones with a spot overlap of 10-40%. Layer characteristics were determined on specimens in terms of physicochemical properties and thickness range both before and after laser stripping in order to validate the substrate material health and coating properties. The substrate health is monitored by measuring the roughness of the laser-impacted zones and free surface energy tests (both before and after laser stripping). Also, Hugoniot Elastic Limit (HEL) is determined from VISAR diagnostic on AA 2024-T3 substrates (for the back face surface deformations). In addition, the coating properties are investigated as a function of adhesion levels and anticorrosion properties (neutral salt spray test). The influence of polyurethane top-coat thickness is studied in order to verify the laser stripping process window for industrial aircraft applications.

Keywords: aircraft coatings, laser stripping, laser adhesion tests, epoxy, polyurethane

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Authors: Somayeh Khanjani, Samaneh Nabavi, Shirin Jalili

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Aluminum phosphide (ALP) is an inorganic phosphide used to control insects and is a highly effective insecticide and rodenticide used frequently to protect stored grain. Acute poisoning with this compound is common in some countries including India and Iran, and is a serious health problem. In Iran it was known as "rice tablet", for its use to preserve rice. Two kinds of rice tablets one being herbal while other containing 3g aluminum phosphide (AlP) are available for use in Iranian households to protect stored food grains from pests and rodents. The toxicity of Aluminum phosphide is attributed to the liberation of phosphine gas in contact with water or weak acid and is the major cause of poisoning and deaths. Rice tablet (Aluminum Phosphid) poisoning may be associated with serious and sometimes incurable complications. In 61.3% of patients were shown uniform ingestion. Vomiting was the most common symptoms reported by 96.4% patients. Agitation was reported in 36.9% and felling of thirsty in 27.9 %. Although many complications such as Hypotension, Adult Respiratory Distress Syndrome (ARDS), Acute Renal Failure (ARF) AND Multi Organ Failure (MOF) were the common complications observed in these patients, but the most lethal complication was Cardiac Arrhythmias occurred in 36.9% of cases. Abdominal pain in 31.4% of the patients, nausea in 79.4% of the patients and 41.1% of the patients showed metabolic acidosis. Suicidal intention was the most common cause of poisoning leading to deaths in 18.6% of the patients. Aluminum phosphide can cause either elevation, decrease or no change in electrolytes, bicarbonate and blood glucose level. The possible mechanism for changes in blood glucose levels are complex and depend on the balance of factors which increase its concentration and those which reduce it. AlP poisoning has been postulated to stimulate cortisol which leads to increasing blood level of cortisol, also it may cause stimulation of glucagon, and Adrenaline secretion; in addition, it can inhibit insulin synthesis which may lead to hyperglycemia. Another suggested mechanism of hyperglycemia is rennin activity in some cases, an increase in magnesium level of plasma and that of tissues, and high phosphate level. Although hyperglycemia is most frequent in this poisoning and also is known as a marker of poor prognostic, hypoglycemia in aluminum phosphide poisoning is a rare finding which may be so dangerous. Patients showed sever hypotension and sever acidosis in addition to sever hypoglycemia. The presenting features of AlP intoxication are rapid onset of shock, severe metabolic acidosis, cardiac dysrhythmias and adult respiratory distress syndrome (ARDS).

Keywords: aluminum phosphide (ALP), rice tablet, poisoning, phosphine gas

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Authors: Shilpa Avarebeel

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Background: India is one of the seven identified countries in South-East Asia region, regularly reporting dengue infection and may soon transform into a major niche for dengue epidemics. Objective: To study the clinical profile of dengue in our setting with special reference to respiratory complication. Study design: Descriptive and exploratory study, for one year in 2014. All patients confirmed as dengue infection were followed and their clinical profile, along with outcome was determined. Study proforma was designed based on the objective of the study and it was pretested and used after modification. Data was analyzed using statistical software SPSS-Version 16. Data were expressed as mean ±S .D for parametric variables and actual frequencies or percentage for non-parametric data. Comparison between groups was done using students’ t-test for independent groups, Chie square test, one-way ANOVA test, Karl Pearson’s correlation test. Statistical significance is taken at P < 0.05. Results: Study included 134 dengue positive cases. 81% had dengue fever, 18% had dengue hemorrhagic fever, and one had dengue shock syndrome. Most of the cases reported were during the month of June. Maximum number of cases was in the age group of 26-35 years. Average duration of hospital stay was less than seven days. Fever and myalgia was present in all the 134 patients, 16 had bleeding manifestation. 38 had respiratory symptoms, 24 had breathlessness, and 14 had breathlessness and dry cough. On clinical examination of patients with respiratory symptoms, all twenty-eight had hypoxia features, twenty-four had signs of pleural effusion, and four had ARDS features. Chest x-ray confirmed the same. Among the patients with respiratory symptoms, the mean platelet count was 26,537 c/cmm. There was no statistical significant difference in the platelet count in those with ARDS and other dengue complications. Average four units of platelets were transfused to all those who had ARDS in view of bleeding tendency. Mechanical ventilator support was provided for ARDS patients. Those with pleural effusion and pulmonary oedema were given NIV (non-invasive ventilation) support along with supportive care. However, steroids were given to patients with ARDS and 10 patients with signs of respiratory distress. 100%. Mortality was seen in patients with ARDS. Conclusion: Dengue has to be checked for those presenting with fever and breathlessness. Supportive treatments remain the cornerstone of treatment. Platelet transfusion has to be given only by clinical judgment. Steroids have no role except in early ARDS, which is controversial. Early NIV support helps in speedy recovery of dengue patients with respiratory distress.

Keywords: adult respiratory distress syndrome, dengue fever, non-invasive ventilation, pulmonary complication

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Authors: Lei Zhou, Chao Li, Ruiqi Ren, Dan Li, Yali Wang, Daxin Ni, Zijian Feng, Qun Li

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Background: Since the first human infection with avian influenza A(H7N9) case was reported in China on 31 March 2013, five epidemics have been observed in China through February 2013 and September 2017. Though the overall mortality rate of H7N9 has remained as high as around 40% throughout the five epidemics, the specific mortality rate in Mainland China varied by provinces. We conducted a descriptive analysis of mortality rates of H7N9 cases to explore the various severity features of the disease and then to provide clues of further analyses of potential factors associated with the severity of the disease. Methods: The data for analysis originated from the National Notifiable Infectious Disease Report and Surveillance System (NNIDRSS). The surveillance system and identification procedure for H7N9 infection have not changed in China since 2013. The definition of a confirmed H7N9 case is as same as previous reports. Mortality rates of H7N9 cases are described and compared by time and location of reporting, age and sex, and genetic features of H7N9 virus strains. Results: The overall mortality rate, the male and female specific overall rates of H7N9 is 39.6% (608/1533), 40.3% (432/1072) and 38.2% (176/461), respectively. There was no significant difference between the mortality rates of male and female. The age-specific mortality rates are significantly varied by age groups (χ²=38.16, p < 0.001). The mortality of H7N9 cases in the age group between 20 and 60 (33.17%) and age group of over 60 (51.16%) is much higher than that in the age group of under 20 (5.00%). Considering the time of reporting, the mortality rates of cases which were reported in the first (40.57%) and fourth (42.51%) quarters of each year are significantly higher than the mortality of cases which were reported in the second (36.02%) and third (27.27%) quarters (χ²=75.18, p < 0.001). The geographic specific mortality rates vary too. The mortality rates of H7N9 cases reported from the Northeast China (66.67%) and Westeast China (56.52%) are significantly higher than that of H7N9 cases reported from the remained area of mainland China. The mortality rate of H7N9 cases reported from the Central China is the lowest (34.38%). The mortality rates of H7N9 cases reported from rural (37.76%) and urban (38.96%) areas are similar. The mortality rate of H7N9 cases infected with the highly pathogenic avian influenza A(H7N9) virus (48.15%) is higher than the rate of H7N9 cases infected with the low pathogenic avian influenza A(H7N9) virus (37.57%), but the difference is not statistically significant. Preliminary analyses showed that age and some clinical complications such as respiratory failure, heart failure, and septic shock could be potential risk factors associated with the death of H7N9 cases. Conclusions: The mortality rates of H7N9 cases varied by age, sex, time of reporting and geographical location in mainland China. Further in-depth analyses and field investigations of the factors associated with the severity of H7N9 cases need to be considered.

Keywords: H7N9 virus, Avian Influenza, mortality, China

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Authors: Elena Maria Scalisi

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The increasing production and the use of TiO₂ nanoparticles (NPs) have inevitably led to their release into the environment, thereby posing a threat to organisms and also for human. Human exposure to TiO₂-NPs may occur during both manufacturing and use. TiO₂-NPs are common in consumer products for dermal application, toothpaste, food colorants, and nutritional supplements, then oral exposure may occur during use of such products. Into the body, TiO₂-NPs thanks to their small size (<100 nm), can, through testicular blood barrier inducing effect on testis and then on male reproductive health. The nanoscale size of TiO₂ increase the surface-to-volume ratio making them more reactive in a cell, then TiO₂ NPs increase their ability to produce reactive oxygen species (ROS). In male germ cells, ROS may have important implications in maintaining the normal functions of mature spermatozoa at physiological levels, moreover, in spermatozoa they are important signaling molecules for their hyperactivation and acrosome reaction. Nevertheless, an excess of ROS by external inputs such as NPs can increased the oxidative stress (OS), which results in damage DNA and apoptosis. The aim of our study has been investigate the impact of TiO₂ NPs on human spermatozoa, evaluating DNA damage and the expression of proteins involved in cell stress. According WHO guidelines 2021, we have exposed human spermatozoa in vitro to TiO₂ NP at concentrations 50 ppm, 100 ppm, 250 ppm, and 500 ppm for 1 hour (at 37°C and CO₂ at 5%). DNA damage was evaluated by Sperm Chromatin Dispersion Test (SCD) and TUNEL assay; moreover, we have evaluated the expression of biomarkers of oxidative stress like Heat Shock Protein 70 (HSP70) and Metallothioneins (MTs). Also, sperm parameters as motility viability have been evaluated. Our results not report a significant reduction in motility of spermatozoa at the end of the exposure. On the contrary, the progressive motility was increased at the highest concentration (500 ppm) and was statistically significant compared to control (p <0.05). Also, viability was not changed by exposure to TiO₂-NPs (p <0.05). However, increased DNA damage was observed at all concentrations, and the TUNEL assay highlighted the presence of single strand breaks in the DNA. The spermatozoa responded to the presence of TiO₂-NPs with the expression of Hsp70, which have a protective function because they allow the maintenance of cellular homeostasis in stressful/ lethal conditions. A positivity for MTs was observed mainly for the concentration of 4 mg/L. Although the biological and physiological function of the metallothionein (MTs) in the male genital organs is unclear, our results highlighted that the MTs expressed by spermatozoa maintain their biological role of detoxification from metals. Our results can give additional information to the data in the literature on the toxicity of TiO₂-NPs and reproduction.

Keywords: human spermatozoa, DNA damage, TiO₂-NPs, biomarkers

Procedia PDF Downloads 119

Authors: Ashok Kumar Rastogi

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Glass is a material commonly used for Glassdoor, glass bottles, cookware, and containers. It can be harmful, as it is a hard and blunt object. Glass has been associated with severe injury and is a common cause of injuries warranting hospital visits to the emergency department (ED). These injuries can be accidental or intentionally inflicted. Broken glass injuries can be severe, even deadly. If broken glass shards fall out on your arm, it may cause fatal injuries. Case history: A 20-year-old male dead body was found aside the road, police informed, and a video recording ceased during an investigation. In the video recording, the person was in a drunken state (unable to walk and disoriented), wandering in the residential area road. He saw a barber shop, the shop door made of Glass. Suddenly, he hit the Glassdoor with his right hand forcefully. The Glassdoor broke into multiple pieces, and multiple injuries were seen over the right hand. Observations: Multiple small and large lacerations were seen over the right anterior part of the elbow. The main injury looked like an incised wound caused by a hard and sharp object. The main injury was noted as a laceration of size 13 x 06 cm bone deep, placed obliquely over the anteromedial aspect of the right elbow joint, its medial end at medial end of elbow joint while its anterior end was 04 cm below the elbow joint with laceration of underline brachialis muscles and complete transaction of ulnar artery and vein, skin margins looking sharply cut with irregular margins with tiny cuts at the medial lower border of laceration. Injuries were antemortem and fresh in nature, caused by hard and blunt objects but looking like hard and sharp objects. All organs were found pale, and the cause of death was shock and hemorrhage because of ulnar vessel injury. Conclusion: The findings of this case report highlight the potentially lethal consequences of glass injuries, especially those involving Glassdoors. The study underscores the importance of accurate interpretation and identification of wounds caused by Glass, as they may resemble injuries caused by other objects. It emphasizes the challenges faced by autopsy surgeons when determining the cause and manner of death in cases where visual evidence of injury is absent or when the weapon is not recovered. Ultimately, this case report serves as a reminder of the potential dangers posed by Glass and the importance of comprehensive forensic examinations.

Keywords: glassdoor, incised, wound, laceration, autopsy

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Authors: Elizabeth Laguaite, Alexandria Purdy

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Heart transplant recipients face psycho-physiological stressors, including pain, lengthy hospitalizations, delirium, and existential crises. They pose an increased risk for Post Traumatic Stress Disorder (PTSD) and can be a predictor of poorer mental and physical Health-Related Quality of Life (HRQOL) outcomes and increased mortality. There is limited research on the prevention of Post Traumatic Stress Symptoms (PTSS) in transplant patients. This case report focuses on a collaborative Music and Art Therapy intervention used to improve outcomes for HMH transplant recipient John (Alias). John, a 58-year-old man with congestive heart failure, was admitted to HMH in February of 2021 with cardiogenic shock, cannulated with an Intra-aortic Balloon Pump, Impella 5.5, and Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) as a bridge to heart and kidney transplant. He was listed as status 1 for transplant. Music Therapy and Art Therapy (MT and AT) were ordered by the physician for mood regulation, trauma processing and anxiety management. During MT/AT sessions, John reported a history of anxiety and depression exacerbated by medical acuity, shortness of breath, and lengthy hospitalizations. He expressed difficulty sleeping, pain, and existential questions. Initially seen individually by MT/AT, it was determined he could benefit from a collaborative approach due to similar thematic content within sessions. A Life Review intervention was developed by MT/AT. The purpose was for him to creatively express, reflect and process his medical narrative, including the identification of positive and negative events leading up to admission at HMH, the journey to transplant, and his hope for the future. Through this intervention, he created artworks that symbolized each event and paired them with songs, two of which were composed with the MT during treatment. As of September 2023, John has not been readmitted to the hospital and expressed that this treatment is what “got him through transplant”. MT and AT can provide opportunities for a patient to reminisce through creative expression, leading to a shift in the personal meaning of these experiences, promoting resolution, and ameliorating associated trauma. The closer to trauma it is processed, the less likely to develop PTSD. This collaborative MT/AT approach could improve long-term outcomes by reducing mortality and readmission rates for transplant patients.

Keywords: art therapy, music therapy, critical care, PTSD, trauma, transplant

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Authors: Ankita Singh, Chandan Gorain, Amirul I. Mallick

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Successful adherence of the mucosal epithelial cells is the key early step for Campylobacter jejuni pathogenesis (C. jejuni). A set of Surface Exposed Colonization Proteins (SECPs) are among the major factors involved in host cell adherence and invasion of C. jejuni. Among them, constitutively expressed surface-exposed lipoprotein adhesin of C. jejuni, JlpA, interacts with intestinal heat shock protein 90 (hsp90α) and contributes in disease progression by triggering pro-inflammatory response via activation of NF-κB and p38 MAP kinase pathway. Together with its ability to express in the bacterial surface, higher sequence conservation and predicted predominance of several B cells epitopes, JlpA protein reserves its potential to become an effective vaccine candidate against wide range of Campylobacter sps including C. jejuni. Given that chickens are the primary sources for C. jejuni and persistent gut colonization remain as major cause for foodborne pathogenesis to humans, present study explicitly used chickens as model to test the immune-protective efficacy of JlpA protein. Taking into account that gastrointestinal tract is the focal site for C. jejuni colonization, to extrapolate the benefit of mucosal (intragastric) delivery of JlpA protein, a food grade Nisin inducible Lactic acid producing bacteria, Lactococcus lactis (L. lactis) was engineered to express recombinant JlpA protein (rJlpA) in the surface of the bacteria. Following evaluation of optimal surface expression and functionality of recombinant JlpA protein expressed by recombinant L. lactis (rL. lactis), the immune-protective role of intragastric administration of live rL. lactis was assessed in commercial broiler chickens. In addition to the significant elevation of antigen specific mucosal immune responses in the intestine of chickens that received three doses of rL. lactis, marked upregulation of Toll-like receptor 2 (TLR2) gene expression in association with mixed pro-inflammatory responses (both Th1 and Th17 type) was observed. Furthermore, intragastric delivery of rJlpA expressed by rL. lactis, but not the injectable form, resulted in a significant reduction in C. jejuni colonization in chickens suggesting that mucosal delivery of live rL. lactis expressing JlpA serves as a promising vaccine platform to induce strong immune-protective responses against C. jejuni in chickens.

Keywords: chickens, lipoprotein adhesion of Campylobacter jejuni, immuno-protection, Lactococcus lactis, mucosal delivery

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Authors: Srinivas Bathini, Duraichelvan Raju, Simona Badilescu, Muthukumaran Packirisamy

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A bio-sensing method, based on the plasmonic property of gold nano-islands, has been developed for detection of exosomes in a clinical setting. The position of the gold plasmon band in the UV-Visible spectrum depends on the size and shape of gold nanoparticles as well as on the surrounding environment. By adsorbing various chemical entities, or binding them, the gold plasmon band will shift toward longer wavelengths and the shift is proportional to the concentration. Exosomes transport cargoes of molecules and genetic materials to proximal and distal cells. Presently, the standard method for their isolation and quantification from body fluids is by ultracentrifugation, not a practical method to be implemented in a clinical setting. Thus, a versatile and cutting-edge platform is required to selectively detect and isolate exosomes for further analysis at clinical level. The new sensing protocol, instead of antibodies, makes use of a specially synthesized polypeptide (Vn96), to capture and quantify the exosomes from different media, by binding the heat shock proteins from exosomes. The protocol has been established and optimized by using a glass substrate, in order to facilitate the next stage, namely the transfer of the protocol to a microfluidic environment. After each step of the protocol, the UV-Vis spectrum was recorded and the position of gold Localized Surface Plasmon Resonance (LSPR) band was measured. The sensing process was modelled, taking into account the characteristics of the nano-island structure, prepared by thermal convection and annealing. The optimal molar ratios of the most important chemical entities, involved in the detection of exosomes were calculated as well. Indeed, it was found that the results of the sensing process depend on the two major steps: the molar ratios of streptavidin to biotin-PEG-Vn96 and, the final step, the capture of exosomes by the biotin-PEG-Vn96 complex. The microfluidic device designed for sensing of exosomes consists of a glass substrate, sealed by a PDMS layer that contains the channel and a collecting chamber. In the device, the solutions of linker, cross-linker, etc., are pumped over the gold nano-islands and an Ocean Optics spectrometer is used to measure the position of the Au plasmon band at each step of the sensing. The experiments have shown that the shift of the Au LSPR band is proportional to the concentration of exosomes and, thereby, exosomes can be accurately quantified. An important advantage of the method is the ability to discriminate between exosomes having different origins.

Keywords: exosomes, gold nano-islands, microfluidics, plasmonic biosensing

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Authors: S. Mehrab Amiri, Nasser Talebbeydokhti

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Modeling sediment transport processes by means of numerical approach often poses severe challenges. In this way, a number of techniques have been suggested to solve flow and sediment equations in decoupled, semi-coupled or fully coupled forms. Furthermore, in order to capture flow discontinuities, a number of techniques, like artificial viscosity and shock fitting, have been proposed for solving these equations which are mostly required careful calibration processes. In this research, a numerical scheme for solving shallow water and Exner equations in fully coupled form is presented. First-Order Centered scheme is applied for producing required numerical fluxes and the reconstruction process is carried out toward using Monotonic Upstream Scheme for Conservation Laws to achieve a high order scheme.  In order to satisfy C-property of the scheme in presence of bed topography, Surface Gradient Method is proposed. Combining the presented scheme with fourth order Runge-Kutta algorithm for time integration yields a competent numerical scheme. In addition, to handle non-prismatic channels problems, Cartesian Cut Cell Method is employed. A trained Multi-Layer Perceptron Artificial Neural Network which is of Feed Forward Back Propagation (FFBP) type estimates sediment flow discharge in the model rather than usual empirical formulas. Hydrodynamic part of the model is tested for showing its capability in simulation of flow discontinuities, transcritical flows, wetting/drying conditions and non-prismatic channel flows. In this end, dam-break flow onto a locally non-prismatic converging-diverging channel with initially dry bed conditions is modeled. The morphodynamic part of the model is verified simulating dam break on a dry movable bed and bed level variations in an alluvial junction. The results show that the model is capable in capturing the flow discontinuities, solving wetting/drying problems even in non-prismatic channels and presenting proper results for movable bed situations. It can also be deducted that applying Artificial Neural Network, instead of common empirical formulas for estimating sediment flow discharge, leads to more accurate results.

Keywords: artificial neural network, morphodynamic model, sediment continuity equation, shallow water equations

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Authors: Takamitsu Kodama, Eiji Kawamoto

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Introduction: Ultrasound in emergency room has advantages of safer, faster, repeatable and noninvasive. Especially focused Point-Of-Care Ultrasound (POCUS) is used daily for prompt and accurate diagnoses, for quickly identifying critical and life-threatening conditions. That is why ultrasound has demonstrated its usefulness in emergency medicine. The true value of ultrasound has been once again recognized in recent years. It is thought that all resident physicians working at emergency room should perform an ultrasound scan to interpret signs and symptoms of deteriorating patients in the emergency room. However, a practical education on ultrasound is still in development. To resolve this issue, we established a new educational program using high-fidelity simulators and evaluated the efficacy of this course. Methods: Educational program includes didactic lectures and skill stations in half-day course. Instructor gives a lecture on POCUS such as Rapid Ultrasound in Shock (RUSH) and/or Focused Assessment Transthoracic Echo (FATE) protocol at the beginning of the course. Then, attendees are provided for training of scanning with cooperation of normal simulated patients. In the end, attendees learn how to apply focused POCUS skills at clinical situation using high-fidelity simulators such as SonoSim® (SonoSim, Inc) and SimMan® 3G (Laerdal Medical). Evaluation was conducted through surveillance questionnaires to 19 attendees after two pilot courses. The questionnaires were focused on understanding course concept and satisfaction. Results: All attendees answered the questionnaires. With respect to the degree of understanding, 12 attendees (number of valid responses: 13) scored four or more points out of five points. High-fidelity simulators, especially SonoSim® was highly appreciated to enhance learning how to handle ultrasound at an actual practice site by 11 attendees (number of valid responses: 12). All attendees encouraged colleagues to take this course because the high level of satisfaction was achieved. Discussion: Newly introduced educational course using high-fidelity simulators realizes the circle of learning to deepen the understanding on focused POCUS by gradual stages. SonoSim® can faithfully reproduce scan images with pathologic findings of ultrasound and provide experimental learning for a growth number of beginners such as resident physicians. In addition, valuable education can be provided if it is used combined with SimMan® 3G. Conclusions: Newly introduced educational course using high-fidelity simulators is supposed to be effective and helps in providing better education compared with conventional courses for emergency physicians.

Keywords: point-of-care ultrasound, high-fidelity simulators, education, circle of learning

Procedia PDF Downloads 256

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

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Background: Before becoming qualified nurses, newly graduated nurses(NGNs) must experience a painful transition period, even transition shocks. Transition shocks are public health issues. To address the transition issue of NGNs, many programs or interventions have been developed and implemented. However, there are no studies to understand and assess the transition state of newly graduated nurses from work to life, from external abilities to internal emotions. Aims: Assess the transition status of newly graduated nurses in China. Identify the factors influencing the transition status of newly graduated nurses. Methods: The multi-center cross-sectional study design was adopted. From May 2022 to June 2023, 1261 newly graduated nurse in hospitals were surveyed online with the the Demographic Questionnaire and Transition Status Scale for Newly Graduated Nurses. SPSS 26.0 were used for data input and statistical analysis. Statistic description were adopted to evaluate the demographic characteristics and transition status of NGNs. Independent-samples T-test, Analysis of Variance and Multiple regression analysis was used to explore the influencing factors of transition status. Results: The total average score of Transition Status Scale for Newly Graduated Nurses was 4.00（SD = 0.61）. Among the various dimensions of Transition Status, the highest dimension was competence for nursing work, while the lowest dimension was balance between work and life. The results showed factors influencing the transition status of NGNs include taught by senior nurses, night shift status, internship department, attribute of working hospital, province of work and residence, educational background, reasons for choosing nursing, types of hospital, and monthly income. Conclusion: At present, the transition status score of new nurses in China is relatively high, and NGNs are more likely to agree with their own transition status, especially the dimension of competence for nursing work. However, they have a poor level of excess in terms of life-work balance. Nursing managers should reasonably arrange the working hours of NGNs, promote their work-life balance, increase the salary and reward mechanism of NGNs, arrange experienced nursing mentors to teach, optimize the level of hospitals, provide suitable positions for NGNs with different educational backgrounds, pay attention to the culture shock of NGNs from other provinces, etc. Optimize human resource management by intervening in these factors that affect the transition of new nurses and promote a better transition of new nurses.

Keywords: newly graduated nurse, transition, humanistic car, nursing management, nursing practice education

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Authors: John Hardy

Abstract:

Over the last decade, the world has witnessed an unprecedented rise in the quality and availability of violent extremist propaganda. This phenomenon has been fueled primarily by three interrelated trends: rapid adoption of online content mediums by creators of violent extremist propaganda, increasing sophistication of violent extremist content production, and greater coordination of content and action across violent extremist organizations. In particular, the self-styled ‘Islamic State’ attracted widespread attention from its supporters and detractors alike by mixing shocking video and imagery content in with substantive ideological and political content. Although this practice was widely condemned for its brutality, it proved to be effective at engaging with a variety of international audiences and encouraging potential supporters to seek further information. The reasons for the noteworthy success of this kind of shock-value propaganda content remain unclear, despite many governments’ attempts to produce counterpropaganda. This study examines violent extremist propaganda distributed by five terrorist organizations between 2010 and 2016, using material released by the ‎Al Hayat Media Center of the Islamic State, Boko Haram, Al Qaeda, Al Qaeda in the Arabian Peninsula, and Al Qaeda in the Islamic Maghreb. The time period covers all issues of the infamous publications Inspire and Dabiq, as well as the most shocking video content released by the Islamic State and its affiliates. The study uses frame analysis to distinguish thematic from symbolic content in violent extremist propaganda by contrasting the ways that substantive ideology issues were framed against the use of symbols and violence to garner attention and to stylize propaganda. The results demonstrate that thematic content focuses significantly on diagnostic frames, which explain violent extremist groups’ causes, and prognostic frames, which propose solutions to addressing or rectifying the cause shared by groups and their sympathizers. Conversely, symbolic violence is primarily stylistic and rarely linked to thematic issues or motivational framing. Frame analysis provides a useful preliminary tool in disentangling substantive ideological and political content from stylistic brutality in violent extremist propaganda. This provides governments and researchers a method for better understanding the framing and content used to design narratives and propaganda materials used to promote violent extremism around the world. Increased capacity to process and understand violent extremist narratives will further enable governments and non-governmental organizations to develop effective counternarratives which promote non-violent solutions to extremists’ grievances.

Keywords: countering violent extremism, counternarratives, frame analysis, propaganda, terrorism, violent extremism

Procedia PDF Downloads 156

Authors: Hanan Bin Nakhi, Asaad M. Albadrawi, Maged Al Shahat, ‎Entesar Mandani

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Background:‎ Kawasaki disease (KD) is one of the most common vasculitis of childhood. ‎It is considered the leading cause of acquired heart disease in children. The ‎peak age of occurrence is 6 to 24 months, with 80% of affected children being ‎less than 5 years old. There are only a few reports of KD in infants younger ‎than 6 months. Infants had a higher incidence of atypical KD and of coronary ‎artery complications. This case report from Kuwait will reinforce considering ‎atypical KD in case of sepsis like condition with negative cultures and ‎unresponding to systemic antibiotics. Early diagnosis allows early treatment ‎with intravenous immune globulin (IVIG) and so decreases the incidence of ‎cardiac aneurysm.‎ Case Report:‎ A 2 month old female infant, product of full term normal delivery to ‎consanguineous parents, presented with fever and poor feeding. She was ‎admitted and treated as urinary tract infection as her urine routine revealed ‎pyurea. The baby continued to have persistent fever and hypoactivity inspite ‎of using intravenous antibiotics. Latter, she developed non purulent ‎conjunctivitis, skin mottling, oedema of the face / lower limb and was treated ‎in intensive care unit as a case of septic shock. In spite of her partial general ‎improvement, she continued to look unwell, hypoactive and had persistent ‎fever. Septic work up, metabolic, and immunologic screen were negative. KD ‎was suspected when the baby developed polymorphic erythematous rash and ‎noticed to have peeling of skin at perianal area and periangular area of the ‎fingers of the hand and feet. IVIG was given in dose of 2 gm/kg/day in single ‎dose and aspirin 100 mg/kg/day in four divided doses. The girl showed marked ‎clinical improvement. The fever subsided dramatically and the level acute ‎phase reactant markedly decreased but the platelets count increased to ‎‎1600000/mm3. Echo cardiography showed mild dilatation of mid right ‎coronary artery. Aspirin was continued in a dose of 5 mg/kg/d till repeating ‎cardiac echo. ‎Conclusion:‎ A high index of suspicion of KD must be maintained in young infants with ‎prolonged unexplained fever. Accepted criteria should be less restrictive to ‎allow early diagnosis of a typical KD in infants less than 6 months of age. ‎Timely appropriate treatment with IVIG is essential to avoid severe coronary ‎sequels.‎

Keywords: Kawasaki disease, atypical Kawasaki disease, infantile Kawasaki disease, hypo activity‎ ‎

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Authors: Juliette MacDonald, Jun Li, Wenji Xiang, Mingwei Zhao

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Shanghai International College of Fashion and Innovation (SCF) was created as a result of a collaborative partnership agreement between the University of Edinburgh and Donghua University. The College provides two programmes: Fashion Innovation and Fashion Interior Design and the overarching curriculum has the intention of developing innovation and creativity within an international learning, teaching, knowledge exchange and research context. The research problem presented here focuses on the multi-national/cultural faculty in the team, the challenges arising from difficulties in communication and the associated limitations of management frameworks. The teaching faculty at SCF are drawn from China, Finland, Korea, Singapore and the UK with input from Flying Faculty from Fashion and Interior Design, Edinburgh College of Art (ECA), for 5 weeks each semester. Rather than fully replicating the administrative and pedagogical style of one or other of the institutions within this joint partnership the aim from the outset was to create a third way which acknowledges the quality assurance requirements of both Donghua and Edinburgh, the academic and technical needs of the students and provides relevant development and support for all the SCF-based staff and Flying Academics. It has been well acknowledged by those who are involved in teaching across cultures that there is often a culture shock associated with transnational education but that the experience of being involved in the delivery of a curriculum at a Joint Institution can also be very rewarding for staff and students. It became clear at SCF that if a third way might be achieved which encourages innovative approaches to fashion education whilst balancing the expectations of Chinese and western concepts of education and the aims of two institutions, then it was going to be necessary to construct a framework which developed close working relationships for the entire teaching team, so not only between academics and students but also between technicians and administrators at ECA and SCF. The attempts at co-construction and integration are built on the sharing of cultural and educational experiences and knowledge as well as provision of opportunities for reflection on the pedagogical purpose of the curriculum and its delivery. Methods on evaluating the effectiveness of these aims include a series of surveys and interviews and analysis of data drawn from teaching projects delivered to the students along with graduate successes from the last five years, since SCF first opened its doors. This paper will provide examples of best practice developed by SCF which have helped guide the faculty and embed common core values and aims of co-construction regulations and management, whilst building a pro-active TNE (Trans-National Education) team which enhances the learning experience for staff and students alike.

Keywords: cultural co-construction, educational team management, multi-cultural challenges, TNE integration for teaching teams

Procedia PDF Downloads 100

Authors: Tin Yee Ling, Kavita Maravar, Ruzica Ardalic

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Background: Uterine torsion (UT) in pregnancy of more than 45-degree along the longitudinal axis is a rare occurrence, and the aetiology remains unclear. Case: A 34-year-old G2P1 woman with a history of one previous caesarean section presented at 36+2 weeks with sudden onset lower abdominal pain, syncopal episode, and tender abdomen on examination. She was otherwise haemodynamically stable. Cardiotocography showed a pathological trace with initial prolonged bradycardia followed by a subsequent tachycardia with reduced variability. An initial diagnosis of uterine dehiscence was made, given the history and clinical presentation. She underwent an emergency caesarean section which revealed a 180-degree UT along the longitudinal axis, with oedematous left round ligament lying transverse anterior to the uterus and a segment of large bowel inferior to the round ligament. Detorsion of uterus was performed prior to delivery of the foetus, and anterior uterine wall was intact with no signs of rupture. There were no anatomical uterine abnormalities found other than stretched left ovarian and round ligaments, which were repaired. Delivery was otherwise uneventful, and she was discharged on day 2 postpartum. Discussion: UT is rare as the number of reported cases is within the few hundreds worldwide. Generally, the uterus is supported in place by uterine ligaments, which limit the mobility of the structure. The causes of UT are unknown, but risk factors such as uterine abnormalities, increased uterine ligaments’ flexibility in pregnancy, and foetal malposition has been identified. UT causes occlusion of uterine vessels, which can lead to ischaemic injury of the placenta causing premature separation of the placenta, preterm labour, and foetal morbidity and mortality if delivery is delayed. Diagnosing UT clinically is difficult as most women present with symptoms similar to placenta abruption or uterine rupture (abdominal pain, vaginal bleeding, shock), and one-third are asymptomatic. The management of UT involves surgical detorsion of the uterus and delivery of foetus via caesarean section. Extra vigilance should be taken to identify the anatomy of the uterus experiencing torsion prior to hysterotomy. There have been a few cases reported with hysterotomy on posterior uterine wall for delivery of foetus as it may be difficult to identify and reverse a gravid UT when foetal well-being is at stake. Conclusion: UT should be considered a differential diagnosis of acute abdominal pain in pregnancy. It is crucial that the torsion is addressed immediately as it is associated with maternal and foetal morbidity and mortality.

Keywords: uterine torsion, pregnancy complication, abdominal pain, torted uterus

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Authors: Neha Batra Bali, Monika Tomar, Vinay Gupta

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A reagentless biosensor for detection of urea based on ZnO-CuO composite thin film is presented in following work. Biosensors have immense potential for varied applications ranging from environmental to clinical testing, health care, and cell analysis. Immense growth in the field of biosensors is due to the huge requirement in today’s world to develop techniques which are both cost effective and accurate for prevention of disease manifestation. The human body comprises of numerous biomolecules which in their optimum levels are essential for functioning. However mismanaged levels of these biomolecules result in major health issues. Urea is one of the key biomolecules of interest. Its estimation is of paramount significance not only for healthcare sector but also from environmental perspectives. If level of urea in human blood/serum is abnormal, i.e., above or below physiological range (15-40mg/dl)), it may lead to diseases like renal failure, hepatic failure, nephritic syndrome, cachexia, urinary tract obstruction, dehydration, shock, burns and gastrointestinal, etc. Various metal nanoparticles, conducting polymer, metal oxide thin films, etc. have been exploited to act as matrix to immobilize urease to fabricate urea biosensor. Amongst them, Zinc Oxide (ZnO), a semiconductor metal oxide with a wide band gap is of immense interest as an efficient matrix in biosensors by virtue of its natural abundance, biocompatibility, good electron communication feature and high isoelectric point (9.5). In spite of being such an attractive candidate, ZnO does not possess a redox couple of its own which necessitates the use of electroactive mediators for electron transfer between the enzyme and the electrode, thereby causing hindrance in realization of integrated and implantable biosensor. In the present work, an effort has been made to fabricate a matrix based on ZnO-CuO composite prepared by pulsed laser deposition (PLD) technique in order to incorporate redox properties in ZnO matrix and to utilize the same for reagentless biosensing applications. The prepared bioelectrode Urs/(ZnO-CuO)/ITO/glass exhibits high sensitivity (70µAmM⁻¹cm⁻²) for detection of urea (5-200 mg/dl) with high stability (shelf life ˃ 10 weeks) and good selectivity (interference ˂ 4%). The enhanced sensing response obtained for composite matrix is attributed to the efficient electron exchange between ZnO-CuO matrix and immobilized enzymes, and subsequently fast transfer of generated electrons to the electrode via matrix. The response is encouraging for fabricating reagentless urea biosensor based on ZnO-CuO matrix.

Keywords: biosensor, reagentless, urea, ZnO-CuO composite

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Authors: T. Kuchukhidze, N. Jalagonia, T. Archuadze, G. Bokuchava

Abstract:

The growing scientific-technological progress in modern civilization causes actuality of producing construction materials which can successfully work in conditions of high temperature, radiation, pressure, speed, and chemically aggressive environment. Such extreme conditions can withstand very few types of materials and among them, ceramic materials are in the first place. Corundum ceramics is the most useful material for creation of constructive nodes and products of various purposes for its low cost, easy accessibility to raw materials and good combination of physical-chemical properties. However, ceramic composite materials have one disadvantage; they are less plastics and have lower toughness. In order to increase the plasticity, the ceramics are reinforced by various dopants, that reduces the growth of the cracks. It is shown, that adding of even small amount of carbon fibers and carbon nanotubes (CNT) as reinforcing material significantly improves mechanical properties of the products, keeping at the same time advantages of alundum ceramics. Graphene in composite material acts in the same way as inorganic dopants (MgO, ZrO2, SiC and others) and performs the role of aluminum oxide inhibitor, as it creates shell, that gives possibility to reduce sintering temperature and at the same time it acts as damper, because scattering of a shock wave takes place on carbon structures. Application of different structural modification of carbon (graphene, nanotube and others) as reinforced material, gives possibility to create multi-purpose highly requested composite materials based on alundum ceramics. In the present work offers simplified technology for obtaining of aluminum oxide ceramics, reinforced with carbon nanostructures, during which chemical modification with doping carbon nanostructures will be implemented in the process of synthesis of final powdery composite – Alumina. In charge doping carbon nanostructures connected to matrix substance with C-O-Al bonds, that provide their homogeneous spatial distribution. In ceramic obtained as a result of consolidation of such powders carbon fragments equally distributed in the entire matrix of aluminum oxide, that cause increase of bending strength and crack-resistance. The proposed way to prepare the charge simplifies the technological process, decreases energy consumption, synthesis duration and therefore requires less financial expenses. In the implementation of this work, modern instrumental methods were used: electronic and optical microscopy, X-ray structural and granulometric analysis, UV, IR, and Raman spectroscopy.

Keywords: ceramic materials, α-Al₂O₃, carbon nanostructures, composites, characterization, hot-pressing

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