Antibiotic Prescribing in the Acute Care in Iraq

Background: Excessive and inappropriate use of antimicrobial agents among hospitalized patients remains an important patient safety and public health issue worldwide. Not only does this behavior incur unnecessary cost but it is also associated with increased morbidity and mortality. The objective of this study is to obtain an insight into the prescribing patterns of antibiotics in surgical and medical wards, to help identify a scope for improvement in service delivery. Method: A simple point prevalence survey included a convenience sample of 200 patients admitted to medical and surgical wards in a government teaching hospital in Baghdad between October 2017 and April 2018. Data were collected by a trained pharmacy intern using a standardized form. Patient’s demographics and details of the prescribed antibiotics, including dose, frequency of dosing and route of administration, were reported. Patients were included if they had been admitted at least 24 hours before the survey. Patients under 18 years of age, having a diagnosis of cancer or shock, or being admitted to the intensive care unit, were excluded. Data were checked and entered by the authors into Excel and were subjected to frequency analysis, which was carried out on anonymized data to protect patient confidentiality. Results: Overall, 88.5% of patients (n=177) received 293 antibiotics during their hospital admission, with a small variation between wards (80%-97%). The average number of antibiotics prescribed per patient was 1.65, ranging from 1.3 for medical patients to 1.95 for surgical patients. Parenteral third-generation cephalosporins were the most commonly prescribed at a rate of 54.3% (n=159) followed by nitroimidazole 29.4% (n=86), quinolones 7.5% (n=22) and macrolides 4.4% (n=13), while carbapenems and aminoglycosides were the least prescribed together accounting for only 4.4% (n=13). The intravenous route was the most common route of administration, used for 96.6% of patients (n=171). Indications were reported in only 63.8% of cases. Culture to identify pathogenic organisms was employed in only 0.5% of cases. Conclusion: Broad-spectrum antibiotics are prescribed at an alarming rate. This practice may provoke antibiotic resistance and adversely affect the patient outcome. Implementation of an antibiotic stewardship program is warranted to enhance the efficacy, safety and cost-effectiveness of antimicrobial agents.

A Taxonomy of Routing Protocols in Wireless Sensor Networks

The Internet of Everything (IoE) presents today a very attractive and motivating field of research. It is basically based on Wireless Sensor Networks (WSNs) in which the routing task is the major analysis topic. In fact, it directly affects the effectiveness and the lifetime of the network. This paper, developed from recent works and based on extensive researches, proposes a taxonomy of routing protocols in WSNs. Our main contribution is that we propose a classification model based on nine classes namely application type, delivery mode, initiator of communication, network architecture, path establishment (route discovery), network topology (structure), protocol operation, next hop selection and latency-awareness and energy-efficient routing protocols. In order to provide a total classification pattern to serve as reference for network designers, each class is subdivided into possible subclasses, presented, and discussed using different parameters such as purposes and characteristics.

Structural Analysis of an Active Morphing Wing for Enhancing UAV Performance

A numerical study of a design concept for actively controlling wing twist is described in this paper. The concept consists of morphing elements which were designed to provide a rigid and seamless skin while maintaining structural rigidity. The wing structure is first modeled in CATIA V5 then imported into ANSYS for structural analysis. Athena Vortex Lattice method (AVL) is used to estimate aerodynamic response as well as aerodynamic loads of morphing wings, afterwards a structural optimization performed via ANSYS Static. Overall, the results presented in this paper show that the concept provides efficient wing twist while preserving an aerodynamically smooth and compliant surface. Sufficient structural rigidity in bending is also obtained. This concept is suggested as a possible alternative for morphing skin applications. 

Grade and Maximum Tumor Dimension as Determinants of Lymphadenectomy in Patients with Endometrioid Endometrial Cancer (EEC)

Introduction: Endometrial Cancer is a common gynecologic malignancy primarily treated with complete surgical staging, which may include complete pelvic and para-aortic lymphadenectomy. The role of lymphadenectomy is controversial, especially the intraoperative indications for the procedure. Three factors are important in decision to proceed with lymphadenectomy: Myometrial invasion, maximum tumor dimension, and histology. Many institutions incorporate these criteria in varying degrees in the decision to proceed with lymphadenectomy. This investigation assesses the use of intraoperatively measured MTD with and without pre-operative histologic grade. Methods: This study compared retrospectively EEC patients with intraoperatively measured MTD ≤2 cm to those with MTD >2 cm from January 1, 2002 to August 31, 2017. This assessment compared those with MTD ≤ 2cm with endometrial biopsy (EB) grade 1-2 to patients with MTD > 2cm with EB grade 3. Lymph node metastasis (LNM), recurrence, and survival were compared in these groups. Results: This study reviewed 222 patient cases. In tumors > 2 cm, LNM occurred in 20% cases while in tumors ≤ 2 cm, LNM was found in 6% cases (p=0.04). Recurrence and mean survival based on last follow up visit in these two groups were not statistically different (p=0.78 and 0.36 respectively). Data demonstrated a trend that when combined with preoperative EB International Federation of Gynecology and Obstetrics (FIGO) grade, a higher proportion of patients with EB FIGO Grade 3 and MTD > 2 cm had LNM compared to those with EB FIGO Grade 1-2 and MTD ≤ 2 cm (43% vs, 11%, p=0.06). LNM was found in 15% of cases in which lymphadenectomy was performed based on current practices, whereas if the criteria of EB FIGO 3 and MTD > 2 cm were used the incidence of LNM would have been 44% cases. However, using this criterion, two patients would not have had their nodal metastases detected. Compared to the current practice, the sensitivity and specificity of the proposed criteria would be 60% and 81%, respectively. The PPV and NPV would be 43% and 90%, respectively. Conclusion: The results indicate that MTD combined with EB FIGO grade can detect LNM in a higher proportion of cases when compared to current practice. MTD combined with EB FIGO grade may eliminate the need of frozen section sampling in a substantial number of cases.

A Social Cognitive Investigation in the Context of Vocational Training Performance of People with Disabilities

The study reported here investigated social cognitive theory (SCT) in the context of Vocational Rehab (VR) for people with disabilities. The prime purpose was to increase knowledge of VR phenomena and make recommendations for improving VR services. The sample consisted of 242 persons with Spinal Cord Injuries (SCI) who completed questionnaires. A further 32 participants were Trainers. Analysis of questionnaire data was carried out using factor analysis, multiple regression analysis, and thematic analysis. The analysis suggested that, in motivational terms, and consistent with research carried out in other academic contexts, self-efficacy was the best predictor of VR performance. The author concludes that that VR self-efficacy predicted VR training performance.

Manufacturing Process of S-Glass Fiber Reinforced PEKK Prepregs

The aim of this study is to investigate the fundamental science/technology related to novel S-glass fiber reinforced polyether- ketone-ketone (GF/PEKK) composites and to gain insight into bonding strength and failure mechanisms. Different manufacturing techniques to make this high-temperature pre-impregnated composite (prepreg) were conducted i.e. mechanical deposition, electrostatic powder deposition, and dry powder prepregging techniques. Generally, the results of this investigation showed that it was difficult to control the distribution of the resin powder evenly on the both sides of the fibers within a specific percentage. Most successful approach was by using a dry powder prepregging where the fibers were coated evenly with an adhesive that served as a temporary binder to hold the resin powder in place onto the glass fiber fabric.

Dead Bodies that Matter: A Consensual Qualitative Research on the Lived Experience of Embalmers

Embalmers are widely recognized as someone who mends the cadavers, but behind that is a great deal of work. These professionals are competent in physiology, chemicals, and cosmetics. Another is that such professionals face cadavers day-to-day. Given this background, the researchers intended to find out the lived experience of embalmers. The purpose of the present study is to discover the essence of the work of these professionals, to determine factors that influence their work, the depths of their life and on how the occupation affects upon physical, emotional-mental, spiritual, moral and social aspects. The researchers used the Consensual Qualitative Research, and eight embalmers, seven male and one female, from Manila and Bulacan were interviewed using open-ended questions and were used to triangulate the results. A primary research team conducted the consensus of domains, and an external auditor reviewed the results. A personal data sheet was also used, this helped the researchers group the respondents according to demographic profile. The results of the consensual qualitative research investigation revealed the four core components of the lived experience of embalmers which are motivation, struggles, acceptance, and contentment. The results revealed core components that play an important role in their everyday lives as an embalmer, daily hardships, and source of their pleasures. The present study will help future researchers, embalmers, and society.

Big Brain: A Single Database System for a Federated Data Warehouse Architecture

Traditional federated architectures for data warehousing work well when corporations have existing regional data warehouses and there is a need to aggregate data at a global level. Schibsted Media Group has been maturing from a decentralised organisation into a more globalised one and needed to build both some of the regional data warehouses for some brands at the same time as the global one. In this paper, we present the architectural alternatives studied and why a custom federated approach was the notable recommendation to go further with the implementation. Although the data warehouses are logically federated, the implementation uses a single database system which presented many advantages like: cost reduction and improved data access to global users allowing consumers of the data to have a common data model for detailed analysis across different geographies and a flexible layer for local specific needs in the same place.

Implementation of a Low-Cost Instrumentation for an Open Cycle Wind Tunnel to Evaluate Pressure Coefficient

Wind tunnel experiments for aerodynamic profiles display numerous advantages, such as: clean steady laminar flow, controlled environmental conditions, streamlines visualization, and real data acquisition. However, the experiment instrumentation usually is expensive, and hence, each test implies a incremented in design cost. The aim of this work is to select and implement a low-cost static pressure data acquisition system for a NACA 2412 airfoil in an open cycle wind tunnel. This work compares wind tunnel experiment with Computational Fluid Dynamics (CFD) simulation and parametric analysis. The experiment was evaluated at Reynolds of 1.65 e5, with increasing angles from -5° to 15°. The comparison between the approaches show good enough accuracy, between the experiment and CFD, additional parametric analysis results differ widely from the other methods, which complies with the lack of accuracy of the lateral approach due its simplicity.

Interaction of between Cd and Zn in Barley (Hordeum vulgare L.) Plant for Phytoextraction Method

The aim of this research is to remediation of the cadmium (Cd) pollution in agricultural soils by using barley (Hordeum vulgare L.) plant. For this purpose, a pot experiment was done in greenhouse conditions. Cadmium (100 mg/kg) as CdSO4.8H2O forms was applied to each pot and incubated during 30 days. Then Ethylenediamine tetraacetic acid (EDTA) chelate was applied to each pot at five doses (0, 3, 6, 8 and 10 mmol/kg) 20 days before harvesting time of the barley plants. The plants were harvested after two months planting. According to the pot experiment results, Cd and Zn amounts of barley plant increased with increasing EDTA application and Zn and Cd contents of barley 20,13 and 1,35 mg/kg for 0 mmol /kg EDTA; 58,61 and 113,24 mg/kg for 10 mmol/kg EDTA doses, respectively. On the other hand, Cd and Zn concentrations of experiment soil increased with EDTA application to the soil samples. Zinc and Cd concentrations of soil 0,31 and 0,021 mg/kg for 0 mmol /kg EDTA; 2,39 and 67,40 mg/kg for 10 mmol/kg EDTA doses, respectively. These increases were found to be statistically significant at the level of 1 %. According to the results of the pot experiment, some heavy metal especially Cd pollution of barley (Hordeum vulgare L.) plant province can be remediated by the phytoextraction method.

An Elaborate Survey on Node Replication Attack in Static Wireless Sensor Networks

Recent innovations in the field of technology led to the use of   wireless sensor networks in various applications, which consists of a number of small, very tiny, low-cost, non-tamper proof and resource constrained sensor nodes. These nodes are often distributed and deployed in an unattended environment, so as to collaborate with each other to share data or information. Amidst various applications, wireless sensor network finds a major role in monitoring battle field in military applications. As these non-tamperproof nodes are deployed in an unattended location, they are vulnerable to many security attacks. Amongst many security attacks, the node replication attack seems to be more threatening to the network users. Node Replication attack is caused by an attacker, who catches one true node, duplicates the first certification and cryptographic materials, makes at least one or more copies of the caught node and spots them at certain key positions in the system to screen or disturb the network operations. Preventing the occurrence of such node replication attacks in network is a challenging task. In this survey article, we provide the classification of detection schemes and also explore the various schemes proposed in each category. Also, we compare the various detection schemes against certain evaluation parameters and also its limitations. Finally, we provide some suggestions for carrying out future research work against such attacks.

Comparison of Real-Time PCR and FTIR with Chemometrics Technique in Analysing Halal Supplement Capsules

Halal authentication and verification in supplement capsules are highly required as the gelatine available in the market can be from halal or non-halal sources. It is an obligation for Muslim to consume and use the halal consumer goods. At present, real-time polymerase chain reaction (RT-PCR) is the most common technique being used for the detection of porcine and bovine DNA in gelatine due to high sensitivity of the technique and higher stability of DNA compared to protein. In this study, twenty samples of supplements capsules from different products with different Halal logos were analyzed for porcine and bovine DNA using RT-PCR. Standard bovine and porcine gelatine from eurofins at a range of concentration from 10-1 to 10-5 ng/µl were used to determine the linearity range, limit of detection and specificity on RT-PCR (SYBR Green method). RT-PCR detected porcine (two samples), bovine (four samples) and mixture of porcine and bovine (six samples). The samples were also tested using FT-IR technique where normalized peak of IR spectra were pre-processed using Savitsky Golay method before Principal Components Analysis (PCA) was performed on the database. Scores plot of PCA shows three clusters of samples; bovine, porcine and mixture (bovine and porcine). The RT-PCR and FT-IR with chemometrics technique were found to give same results for porcine gelatine samples which can be used for Halal authentication.

Optimization of Soybean Oil by Modified Supercritical Carbon Dioxide

The content of omega-3 in soybean oil is important in the development of infants and is an alternative for the omega-3 in fish oils. The investigation of extraction of soybean oil is needed to obtain the bioactive compound in the extract. Supercritical carbon dioxide extraction is modern and green technology to extract herbs and plants to obtain high quality extract due to high diffusivity and solubility of the solvent. The aim of this study was to obtain the optimum condition of soybean oil extraction by modified supercritical carbon dioxide. The soybean oil was extracted by using modified supercritical carbon dioxide (SC-CO2) under the temperatures of 40, 60, 80 °C, pressures of 150, 250, 350 Bar, and constant flow-rate of 10 g/min as the parameters of extraction processes. An experimental design was performed in order to optimize three important parameters of SC-CO2 extraction which are pressure (X1), temperature (X2) to achieve optimum yields of soybean oil. Box Behnken Design was applied for experimental design. From the optimization process, the optimum condition of extraction of soybean oil was obtained at pressure 338 Bar and temperature 80 °C with oil yield of 2.713 g. Effect of pressure is significant on the extraction of soybean oil by modified supercritical carbon dioxide. Increasing of pressure will increase the oil yield of soybean oil.

Calibrations and Effect of Different Operating Conditions on the Performance of a Fluid Power Control System with Servo Solenoid Valve

The current investigation presents a study on the hydraulic performance of an electro-hydraulic servo solenoid valve controlled linear piston used in hydraulic systems. Advanced methods have been used to measure and record laboratory experiments, to ensure accurate analysis and evaluation. Experiments have been conducted under different values of temperature (28, 40 and 50 °C), supply pressure (10, 20, 30, 40 and 50 bar), system stiffness (32 N/mm), and load (0.0 & 5560 N). It is concluded that increasing temperature of hydraulic oil increases the quantity of flow rate, so it achieves an increase of the quantity of flow by 5.75 % up to 48.8 % depending on operating conditions. The values of pressure decay at low temperature are less than the values at high temperature. The frequency increases with the increase of the temperature. When we connect the springs to the system, it decreases system frequency. These results are very useful in the process of packing and manufacturing of fluid products, where the properties are not affected by 50 °C, so energy and time are saved.

A Thirteen-Level Asymmetrical Cascaded H-Bridge Single Phase Inverter

This paper presents a thirteen-level asymmetrical cascaded H-bridge single phase inverter. In this configuration, the desired output voltage level is achieved by connecting the DC sources in different combinations by triggering the switches. The modes of operation are explained well for positive level generations. Moreover, a comparison is made with conventional topologies of diode clamped, flying capacitors and cascaded-H-bridge and some recently proposed topologies to show the significance of the proposed topology in terms of reduced part counts. The simulation work has been carried out in MATLAB/Simulink environment. The experimental work is also carried out for lower rating to verify the performance and feasibility of the proposed topology. Further the results are presented for different loading conditions.

Preparation of Carbon Nanofiber Reinforced HDPE Using Dialkylimidazolium as a Dispersing Agent: Effect on Thermal and Rheological Properties

High-density polyethylene reinforced with carbon nanofibers (HDPE/CNF) have been prepared via melt processing using dialkylimidazolium tetrafluoroborate (ionic liquid) as a dispersion agent. The prepared samples were characterized by thermogravimetric (TGA) and differential scanning calorimetric (DSC) analyses. The samples blended with imidazolium ionic liquid exhibit higher thermal stability. DSC analysis showed clear miscibility of ionic liquid in the HDPE matrix and showed single endothermic peak. The melt rheological analysis of HDPE/CNF composites was performed using an oscillatory rheometer. The influence of CNF and ionic liquid concentration (ranging from 0, 0.5, and 1 wt%) on the viscoelastic parameters was investigated at 200 °C with an angular frequency range of 0.1 to 100 rad/s. The rheological analysis shows the shear-thinning behavior for the composites. An improvement in the viscoelastic properties was observed as the nanofiber concentration increases. The progress in the modulus values was attributed to the structural rigidity imparted by the high aspect ratio CNF. The modulus values and complex viscosity of the composites increased significantly at low frequencies. Composites blended with ionic liquid exhibit slightly lower values of complex viscosity and modulus over the corresponding HDPE/CNF compositions. Therefore, reduction in melt viscosity is an additional benefit for polymer composite processing as a result of wetting effect by polymer-ionic liquid combinations.

Quality Evaluation of Grape Seed Oils of the Ionian Islands Based on GC-MS and Other Spectroscopic Techniques

Grape seeds are waste products of wineries and often referred to as an important agricultural and industrial waste product with the potential to be used in pharmaceutical, food, and cosmetic applications. In this study, grape seed oil from traditional Ionian varieties was examined for the determination of the quality and the characteristics of each variety. Initially, the fatty acid methyl ester (FAME) profiles were analyzed using Gas Chromatography-Mass Spectrometry, after transesterification. Furthermore, other quality parameters of the grape seed oils were determined by Spectroscopy techniques, UV-Vis and Raman included. Moreover, the antioxidant capacity of the oil was measured by 2,2'-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS) and 2,2-Diphenyl-1-picrylhydrazyl (DPPH) assays and their antioxidant capacity expressed in Trolox equivalents. K and ΔΚ indices were measured in 232, 268, 270 nm, as an oil quality index. The results indicate that the air-dried grape seed total oil content ranged from 5.26 to 8.77% w/w, which is in accordance with the other grape seed varieties tested in similar studies. The composition of grape seed oil is predominated with linoleic and oleic fatty acids, with the linoleic fatty acid ranging from 53.68 to 69.95% and both the linoleic and oleic fatty acids totaling 78-82% of FAMEs, which is analogous to the fatty acid composition of safflower oil. The antioxidant assays ABTS and DPPH scored high, exhibiting that the oils have potential in the cosmetic and culinary businesses. Above that, our results demonstrate that Ionian grape seed oils have prospects that can go further than cosmetic or culinary use, into the pharmaceuticals industry. Finally, the reclamation of grape seeds from wineries waste stream is in accordance with the bio-economy strategic framework and contributes to environmental protection.

Experimental on Free and Forced Heat Transfer and Pressure Drop of Copper Oxide-Heat Transfer Oil Nanofluid in Horizontal and Inclined Microfin Tube

In this paper, the combined free and forced convection heat transfer of the Copper Oxide-Heat Transfer Oil (CuO-HTO) nanofluid flow in horizontal and inclined microfin tubes is studied experimentally. The flow regime is laminar, and pipe surface temperature is constant. The effect of nanoparticle and microfin tube on the heat transfer rate is investigated with the Richardson number which is between 0.1 and 0.7. The results show an increasing nanoparticle concentration between 0% and 1.5% leads to enhance the combined free and forced convection heat transfer rate. According to the results, five correlations are proposed to provide estimating the free and forced heat transfer rate as the increasing Richardson number from 0.1 to 0.7. The maximum deviation of both correlations is less than 16%. Moreover, four correlations are suggested to assess the Nusselt number based on the Rayleigh number in inclined tubes from 1800000 to 7000000. The maximum deviation of the correlation is almost 16%. The Darcy friction factor of the nanofluid flow has been investigated. Furthermore, CuO-HTO nanofluid flows in inclined microfin tubes.

Comparing Field Displacement History with Numerical Results to Estimate Geotechnical Parameters: Case Study of Arash-Esfandiar-Niayesh under Passing Tunnel, 2.5 Traffic Lane Tunnel, Tehran, Iran

Underground structures are of those structures that have uncertainty in design procedures. That is due to the complexity of soil condition around. Under passing tunnels are also such affected structures. Despite geotechnical site investigations, lots of uncertainties exist in soil properties due to unknown events. As results, it possibly causes conflicting settlements in numerical analysis with recorded values in the project. This paper aims to report a case study on a specific under passing tunnel constructed by New Austrian Tunnelling Method in Iran. The intended tunnel has an overburden of about 11.3m, the height of 12.2m and, the width of 14.4m with 2.5 traffic lane. The numerical modeling was developed by a 2D finite element program (PLAXIS Version 8). Comparing displacement histories at the ground surface during the entire installation of initial lining, the estimated surface settlement was about four times the field recorded one, which indicates that some local unknown events affect that value. Also, the displacement ratios were in a big difference between the numerical and field data. Consequently, running several numerical back analyses using laboratory and field tests data, the geotechnical parameters were accurately revised to match with the obtained monitoring data. Finally, it was found that usually the values of soil parameters are conservatively low-estimated up to 40 percent by typical engineering judgment. Additionally, it could be attributed to inappropriate constitutive models applied for the specific soil condition.

FRP Bars Spacing Effect on Numerical Thermal Deformations in Concrete Beams under High Temperatures

5 In order to eradicate the degradation of reinforced concrete structures due to the steel corrosion, professionals in constructions suggest using fiber reinforced polymers (FRP) for their excellent properties. Nevertheless, high temperatures may affect the bond between FRP bar and concrete, and consequently the serviceability of FRP-reinforced concrete structures. This paper presents a nonlinear numerical investigation using ADINA software to investigate the effect of the spacing between glass FRP (GFRP) bars embedded in concrete on circumferential thermal deformations and the distribution of radial thermal cracks in reinforced concrete beams submitted to high temperature variations up to 60 °C for asymmetrical problems. The thermal deformations predicted from nonlinear finite elements model, at the FRP bar/concrete interface and at the external surface of concrete cover, were established as a function of the ratio of concrete cover thickness to FRP bar diameter (c/db) and the ratio of spacing between FRP bars in concrete to FRP bar diameter (e/db). Numerical results show that the circumferential thermal deformations at the external surface of concrete cover are linear until cracking thermal load varied from 32 to 55 °C corresponding to the ratio of e/db varied from 1.3 to 2.3, respectively. However, for ratios e/db >2.3 and c/db >1.6, the thermal deformations at the external surface of concrete cover exhibit linear behavior without any cracks observed on the specified surface. The numerical results are compared to those obtained from analytical models validated by experimental tests.