Sickle Cell Disease: Review of Managements in Pregnancy and the Outcome in Ampang Hospital, Selangor

The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.

Beyond Taguchi’s Concept of the Quality Loss Function

Dr. Genichi Taguchi looked at quality in a broader term and gave an excellent definition of quality in terms of loss to society. However the scope of this definition is limited to the losses imparted by a poor quality product to the customer only and are considered during the useful life of the product and further in a certain situation this loss can even be zero. In this paper, it has been proposed that the scope of quality of a product shall be further enhanced by considering the losses imparted by a poor quality product to society at large, due to associated environmental and safety related factors, over the complete life cycle of the product. Moreover, though these losses can be further minimized with the use of techno-safety interventions, the net losses to society however can never be made zero. This paper proposes an entirely new approach towards defining product quality and is based on Taguchi’s definition of quality.

Criminal Protection Objectivity of the Child's Right to Life and Physical and Psychological Safety

Nowadays, child affairs is a matter of both national and international interests. This issue is regarded a vital topic for various scientific fields across ages, and for all the communities without exception. However, the nature of child caring may vary due to the verities in science perspectives. So, considering child's affairs from different perspectives is helpful to have a complementary image about this matter. The purpose behind selecting this topic is to keep a balance between the victim on the one hand, and the guardian and the offender on the other hand, (i.e.) to avoid any kind of excessiveness either in the protection of the child and its rights not in the punishment of the offender. This is achieved through considering various legal materials in the Iraqi legislation and in the comparative legislations that are concerned with the child's issue and the extent to which the child makes use of these rights. The scope of this study involves the crimes that are considered as aggressions against the child's right to life, and the crimes that are dangerous to their physical and psychological safety. So, this study comprehensively considers the intentional murder of child, child murder to avoid disgrace, child kidnapping, child abandonment, physical abuse for the sake of punishment or not, child circumcision, verbal violence, and abstaining from leaving a child with a person who has the right of custody. This study ends with the most significant concluding points that have been derived throughout this study, which are: Unlike the Iraqi legislation, the Egyptian legislation defines the child in the Article 2 of the Child Law No. 12 of 1996 amended by the Law No. 126 of 2008 that the child is a person who does not exceed 18 years of age. Some legislation does not provide special criminal protection for child intentional murder, as in the Iraqi and the Egyptian legislation. However, some others have provided special criminal protection for a child, as in French and Syrian legislations. Child kidnapping is regarded as one of the most dangerous crimes that affects the child and the family as well, as it may expose the child's life to danger or to death. The most significant recommendations from the researcher are: The Iraqi legislation is recommended to take the necessary measures to establish a particular legislation for the child by including all the legal provisions that are associated with this weak creature, and make use of the Egyptian legislator’s experience as a pioneer in this respect. Both the Iraqi legislation and the Egyptian legislation are recommended to enact special laws to protect a child from the crimes of intentional murder, as the crime of child murder is currently subjected to the same provisions consider for adult murder.

To Know the Way to the Unknown: A Semi-Experimental Study on the Implication of Skills and Knowledge for Creative Processes in Higher Education

From a theoretical perspective, expertise is generally considered a precondition for creativity. The assumption is that an individual needs to master the common and accepted rules and techniques within a certain knowledge-domain in order to create something new and valuable. However, real life cases, and a limited amount of empirical studies, demonstrate that this assumption may be overly simple. In this article, this question is explored through a number of semi-experimental case studies conducted within the fields of music, technology, and youth culture. The studies indicate that, in various ways, expertise plays an important part in creative processes. However, the case studies also indicate that expertise sometimes leads to an entrenched perspective, in the sense that knowledge and experience may work as a path into the well-known rather than into the unknown. In this article, these issues are explored with reference to different theoretical approaches to creativity and learning, including actor-network theory, the theory of blind variation and selective retention, and Csikszentmihalyi’s system model. Finally, some educational aspects and implications of this are discussed.

Building Information Modelling for Construction Delay Management

The Kingdom of Saudi Arabia (KSA) is not an exception in relying on the growth of its construction industry to support rapid population growth. However, its need for infrastructure development is constrained by low productivity levels and cost overruns caused by factors such as delays to project completion. Delays in delivering a construction project are a global issue and while theories such as Optimism Bias have been used to explain such delays, in KSA, client-related causes of delays are also significant. The objective of this paper is to develop a framework-based approach to explore how the country’s construction industry can manage and reduce delays in construction projects through building information modelling (BIM) in order to mitigate the cost consequences of such delays.  It comprehensively and systematically reviewed the global literature on the subject and identified gaps, critical delay factors and the specific benefits that BIM can deliver for the delay management.  A case study comprising of nine hospital projects that have experienced delay and cost overruns was also carried out. Five critical delay factors related to the clients were identified as candidates that can be mitigated through BIM’s benefits. These factors are: Ineffective planning and scheduling of the project; changes during construction by the client; delay in progress payment; slowness in decision making by the client; and poor communication between clients and other stakeholders. In addition, data from the case study projects strongly suggest that optimism bias is present in many of the hospital projects. Further validation via key stakeholder interviews and documentations are planned.

A Study on the Impacts of Computer Aided Design on the Architectural Design Process

Computer-aided design (CAD) tools have been extensively used by the architects for the several decades. It has evolved from being a simple drafting tool to being an intelligent architectural software and a powerful means of communication for architects. CAD plays an essential role in the profession of architecture and is a basic tool for any architectural firm. It is not possible for an architectural firm to compete without taking the advantage of computer software, due to the high demand and competition in the architectural industry. The aim of this study is to evaluate the impacts of CAD on the architectural design process from conceptual level to final product, particularly in architectural practice. It examines the range of benefits of integrating CAD into the industry and discusses the possible defects limiting the architects. Method of this study is qualitatively based on data collected from the professionals’ perspective. The identified benefits and limitations of CAD on the architectural design process will raise the awareness of professionals on the potentials of CAD and proper utilization of that in the industry, which would result in a higher productivity along with a better quality in the architectural offices.

The Need for Including Hepatitis a Vaccine in Routine Childhood Immunization Programs in Europe as a Response to the Influx of Refugees from the Middle East and North Africa (MENA) Regions

The world is facing an unprecedented displacement crisis. Recently, over 1.1 million asylum seekers have been granted protection status in the European Union (EU). The majority of these asylum seekers were from countries of the Middle East and North Africa (MENA) region.This influx carries with it a potential introduction of infectious diseases that have been eliminated in the EU, which poses a challenge for EU health authorities. Compared to MENA region countries where Hepatitis A Virus (HAV) endemicity is high to intermediate, member states of the EU show very low (Western Europe) to low (Eastern Europe) levels of HAV endemicity. Because of this situation, there is an ongoing public health concern in high-income countries, like members of the EU, that many adults remain susceptible to HAV outbreaks. The overwhelming majority of the EU members’ states do not include HAV vaccine in their immunization calendars. Hence, this paper urgently calls for the implementation of new policies regarding HAV in EU members’ states.

Analytical Model to Predict the Shear Capacity of Reinforced Concrete Beams Externally Strengthened with CFRP Composites Conditions

This paper presents a proposed analytical model for predicting the shear strength of reinforced concrete beams strengthened with CFRP composites as external reinforcement. The proposed analytical model can predict the shear contribution of CFRP composites of RC beams with an acceptable coefficient of correlation with the tested results. Based on the comparison of the proposed model with the published well-known models (ACI model, Triantafillou model, and Colotti model), the ACI model had a wider range of 0.16 to 10.08 for the ratio between tested and predicted ultimate shears at failure. Also, an acceptable range of 0.27 to 2.78 for the ratio between tested and predicted ultimate shears by the Triantafillou model. Finally, the best prediction (the ratio between the tested and predicted ones) of the ultimate shear capacity is observed by using Colotti model with a range of 0.20 to 1.78. Thus, the contribution of the CFRP composites as external reinforcement can be predicted with high accuracy by using the proposed analytical model.

A Paradigm for Characterization and Checking of a Human Noise Behavior

This paper presents a paradigm for characterization and checking of human noise behavior. The definitions of ‘Noise’ and ‘Noise Behavior’ are devised. The concept of characterization and examining of Noise Behavior is obtained from the proposed paradigm of Psychoacoustics. The measurement of human noise behavior is discussed through definitions of noise sources and noise measurements. The noise sources, noise measurement equations and noise filters are further illustrated through examples. The theory and significance of solar energy acoustics is presented for life and its activities. Human comfort and health are correlated with human brain through physiological responses and noise protection. Examples of heat stress, intense heat, sweating and evaporation are also enumerated.

Comparison between Pushover Analysis Techniques and Validation of the Simplified Modal Pushover Analysis

One of the main drawbacks of the Modal Pushover Analysis (MPA) is the need to perform nonlinear time-history analysis, which complicates the analysis method and time. A simplified version of the MPA has been proposed based on the concept of the inelastic deformation ratio. Furthermore, the effect of the higher modes of vibration is considered by assuming linearly-elastic responses, which enables the use of standard elastic response spectrum analysis. In this thesis, the simplified MPA (SMPA) method is applied to determine the target global drift and the inter-story drifts of steel frame building. The effect of the higher vibration modes is considered within the framework of the SMPA. A comprehensive survey about the inelastic deformation ratio is presented. After that, a suitable expression from literature is selected for the inelastic deformation ratio and then implemented in the SMPA. The estimated seismic demands using the SMPA, such as target drift, base shear, and the inter-story drifts, are compared with the seismic responses determined by applying the standard MPA. The accuracy of the estimated seismic demands is validated by comparing with the results obtained by the nonlinear time-history analysis using real earthquake records.

Representations of Childcare Robots as a Controversial Issue

This paper interrogates online representations of robot companions for children, including promotional material by manufacturers, media articles and technology blogs. The significance of the study lies in its contribution to understanding attitudes to robots. The prospect of childcare robots is particularly controversial ethically, and is associated with emotive arguments. The sampled material is restricted to relatively recent posts (the past three years) though the analysis identifies both continuous and changing themes across the past decade. The method extrapolates social representations theory towards examining the ways in which information about robotic products is provided for the general public. Implications for social acceptance of robot companions for the home and robot ethics are considered.

Laser Registration and Supervisory Control of neuroArm Robotic Surgical System

This paper illustrates the concept of an algorithm to register specified markers on the neuroArm surgical manipulators, an image-guided MR-compatible tele-operated robot for microsurgery and stereotaxy. Two range-finding algorithms, namely time-of-flight and phase-shift, are evaluated for registration and supervisory control. The time-of-flight approach is implemented in a semi-field experiment to determine the precise position of a tiny retro-reflective moving object. The moving object simulates a surgical tool tip. The tool is a target that would be connected to the neuroArm end-effector during surgery inside the magnet bore of the MR imaging system. In order to apply flight approach, a 905-nm pulsed laser diode and an avalanche photodiode are utilized as the transmitter and receiver, respectively. For the experiment, a high frequency time to digital converter was designed using a field-programmable gate arrays. In the phase-shift approach, a continuous green laser beam with a wavelength of 530 nm was used as the transmitter. Results showed that a positioning error of 0.1 mm occurred when the scanner-target point distance was set in the range of 2.5 to 3 meters. The effectiveness of this non-contact approach exhibited that the method could be employed as an alternative for conventional mechanical registration arm. Furthermore, the approach is not limited by physical contact and extension of joint angles.

Review of Studies on Agility in Knowledge Management

Agility in Knowledge Management (AKM) tries to capture agility requirements and their respective answers within the framework of knowledge and learning for organizations. Since it is rather a new construct, it is difficult to claim that it has been sufficiently discussed and analyzed in practical and theoretical realms. Like the term ‘agile learning’, it is also commonly addressed in the software development and information technology fields and across the related areas where those technologies can be applied. The organizational perspective towards AKM, seems to need some more time to become scholarly mature. Nevertheless, in the literature one can come across some implicit usages of this term occasionally. This research is aimed to explore the conceptual background of agility in KM, re-conceptualize it and extend it to business applications with a special focus on e-business.

Visual and Clinical Outcome in Patients with Corneal Lacerations

In industrialized nations, corneal lacerations are one of the most common reason for hospitalization. This study was designed to study visual and clinical outcome in patients presenting with full thickness corneal lacerations in Indian population and to ascertain the impact of various preoperative and operative factors influencing prognosis after repair of corneal lacerations. Males in third decade with injuries at work with metallic objects were common. Lens damage, hyphema, vitreous hemorrhage, retinal detachment and endophthalmitis were seen. All the patients underwent primary repair within first 24 hours of presentation. At 3 months, 74.3% had a good visual outcome. About 5.7% of patients had no perception of light.In conclusion, various demographic and preoperative factors like age, time of presentation, vision at presentation, length of corneal wound, involvement of visual axis, associated ocular features like hyphaema, lenticular changes, vitreous haemorrhage and retinal detachment are significant prognostic indicators for final visual outcome.

Assessment of Occupational Exposure and Individual Radio-Sensitivity in People Subjected to Ionizing Radiation

The estimation of accumulated radiation doses in people professionally exposed to ionizing radiation was performed using methods of biological (chromosomal aberrations frequency in lymphocytes) and physical (radionuclides analysis in urine, whole-body radiation meter, individual thermoluminescent dosimeters) dosimetry. A group of 84 "A" category employees after their work in the territory of former Semipalatinsk test site (Kazakhstan) was investigated. The dose rate in some funnels exceeds 40 μSv/h. After radionuclides determination in urine using radiochemical and WBC methods, it was shown that the total effective dose of personnel internal exposure did not exceed 0.2 mSv/year, while an acceptable dose limit for staff is 20 mSv/year. The range of external radiation doses measured with individual thermo-luminescent dosimeters was 0.3-1.406 µSv. The cytogenetic examination showed that chromosomal aberrations frequency in staff was 4.27±0.22%, which is significantly higher than at the people from non-polluting settlement Tausugur (0.87±0.1%) (р ≤ 0.01) and citizens of Almaty (1.6±0.12%) (р≤ 0.01). Chromosomal type aberrations accounted for 2.32±0.16%, 0.27±0.06% of which were dicentrics and centric rings. The cytogenetic analysis of different types group radiosensitivity among «professionals» (age, sex, ethnic group, epidemiological data) revealed no significant differences between the compared values. Using various techniques by frequency of dicentrics and centric rings, the average cumulative radiation dose for group was calculated, and that was 0.084-0.143 Gy. To perform comparative individual dosimetry using physical and biological methods of dose assessment, calibration curves (including own ones) and regression equations based on general frequency of chromosomal aberrations obtained after irradiation of blood samples by gamma-radiation with the dose rate of 0,1 Gy/min were used. Herewith, on the assumption of individual variation of chromosomal aberrations frequency (1–10%), the accumulated dose of radiation varied 0-0.3 Gy. The main problem in the interpretation of individual dosimetry results is reduced to different reaction of the objects to irradiation - radiosensitivity, which dictates the need of quantitative definition of this individual reaction and its consideration in the calculation of the received radiation dose. The entire examined contingent was assigned to a group based on the received dose and detected cytogenetic aberrations. Radiosensitive individuals, at the lowest received dose in a year, showed the highest frequency of chromosomal aberrations (5.72%). In opposite, radioresistant individuals showed the lowest frequency of chromosomal aberrations (2.8%). The cohort correlation according to the criterion of radio-sensitivity in our research was distributed as follows: radio-sensitive (26.2%) — medium radio-sensitivity (57.1%), radioresistant (16.7%). Herewith, the dispersion for radioresistant individuals is 2.3; for the group with medium radio-sensitivity — 3.3; and for radio-sensitive group — 9. These data indicate the highest variation of characteristic (reactions to radiation effect) in the group of radio-sensitive individuals. People with medium radio-sensitivity show significant long-term correlation (0.66; n=48, β ≥ 0.999) between the values of doses defined according to the results of cytogenetic analysis and dose of external radiation obtained with the help of thermoluminescent dosimeters. Mathematical models based on the type of violation of the radiation dose according to the professionals radiosensitivity level were offered.

Quantifying Key Factors Affecting Leagile Manufacturing System

In today’s market, striving hard has become necessary for the industries to survive due to the intense competition and globalization. In earlier days, there were few sellers and limited numbers of buyers, so customers were having fewer options to buy the product. But today, the market is highly competitive and volatile. Industries are focusing on robotics, advance manufacturing methods like AJM (Abrasive Jet Machining), EDM (Electric Discharge Machining), ECM (Electrochemical Machining) etc., CAD/CAM, CAE to make quality products and market them in shortest possible time. Leagile manufacturing system is ensuring best available solution at minimum cost to meet the market demand. This paper tries to assimilate the concept of Leagile manufacturing system in today’s scenario and evaluating key factors affecting Leagile manufacturing using digraph technique.

Moving towards a General Definition of Public Happiness: A Grounded Theory Approach to the Recent Academic Research on Well-Being

Although there seems to be a growing interest in the study of the citizen’s happiness as an alternative measure of a country’s progress to GDP, happiness as a public concern is still an ambiguous concept, hard to define. Moreover, different notions are used indiscriminately to talk about the same thing. This investigation aims to determine the conceptions of happiness, well-being and quality of life that originate from the indexes that different governments and public institutions around the world have created to study them. Through the Scoping Review method, this study identifies the recent academic research in this field (a total of 267 documents between 2006 and 2016) from some of the most popular social sciences databases around the world, Web of Science, Scopus, JSTOR, Sage, EBSCO, IBSS and Google Scholar, and in Spain, ISOC and Dialnet. These 267 documents referenced 53 different indexes and researches. The Grounded Theory method has been applied to a sample of 13 indexes in order to identify the main categories they use to determine these three concepts. The results show that these are multi-dimensional concepts and similar indicators are used indistinctly to measure happiness, well-being and quality of life.

A Study on Strategy of Coordinative Symbiosis between New and Old Buildings: Case Study of Shanghai Citic Plaza and Surroundings

Along with the acceleration of Chinese urbanization, the expansion, renovation and demolition of old buildings is on the stage together with the design and construction of new buildings every day in downtown of the old city area. The coordinative symbiosis between new and old buildings is an important problem which needs to be solved in the process of urban development. By studying and analyzing the case of Shanghai Citic Plaza and surroundings, this paper contributes to discussing the concept, value and problems to be solved of the coordination of new and old buildings, meanwhile, striking the balance between new and old buildings from the aspects of architectural form, space, function and local context. As a result, the strategy of the coordinative symbiosis between new and old buildings is summarized, which can offer some guiding principles to urban development from now on.

Thermodynamic Analysis of an Ejector-Absorption Refrigeration Cycle with Using NH3-H2O

In this paper, the ejector-absorption refrigeration cycle is presented. This article deals with the thermodynamic simulation and the first and second law analysis of an ammonia-water. The effects of parameters such as condenser, absorber, generator, and evaporator temperatures have been investigated. The influence of the various operating parameters on the performance coefficient and exergy efficiency of this cycle has been studied. The results show that when the temperature of different parts increases, the performance coefficient and the exergy efficiency of the cycle decrease, except for evaporator and generator, that causes an increase in coefficient of performance (COP). According to the results, absorber and ejector have the highest exergy losses in the studied conditions.

Revised Technology Acceptance Model Framework for M-Commerce Adoption

Following the E-Commerce era, M-Commerce is the next big phase in the technology involvement and advancement. This paper intends to explore how Indian consumers are influenced to adopt the M-commerce. In this paper, the revised Technology Acceptance Model (TAM) has been presented on the basis of the most dominant factors that affect the adoption of M-Commerce in Indian scenario. Furthermore, an analytical questionnaire approach was carried out to collect data from Indian consumers. These collected data were further used for the validation of the presented model. Findings indicate that customization, convenience, instant connectivity, compatibility, security, download speed in M-Commerce affect the adoption behavior. Furthermore, the findings suggest that perceived usefulness and attitude towards M-Commerce are positively influenced by number of M-Commerce drivers (i.e. download speed, compatibility, convenience, security, customization, connectivity, and input mechanism).