Huge Multinodular Goiter with occult carcinoma: A case report

Enlarged nodular goiters are becoming increasingly infrequent. They are still common in certain geographical areas and can present with compressive symptoms to the trachea, oesophagus and recurrent laryngeal nerve. Surgical treatment of enlarge goiter involves a high degree of skill which can lead to serious complications. We present a case 73 year old female patient who had huge enlarged multinodular goiter for more than 15 years. Surgery was planned and thyroidectomy was done. Surgical excision resolved the local symptoms. Histopathological examination revealed papillary carcinoma with multiple cysts and areas of haemorrhage and necrosis

Advanced skills required for engineering leaders in global product development

Thesis (S.M. in Engineering and Management)--Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2011.Cataloged from PDF version of thesis.Includes bibliographical references (p. 85-88).Observations from first hand experience on the Boeing 787 Program during development of perhaps the most important and exciting new commercial airplane in recent history has identified opportunities to enhance the global product development skills of key engineering leaders. Extreme challenges related to typical factors (e.g., cost, schedule, quality) are coupled with a radically different business model - one shaped by a product development strategy that relies heavily on globally dispersed risk-sharing partners. In addition, the 787 would use dramatically new carbon composite materials and manufacturing methods for the airplane structure, as well as advanced technologies for the airplane systems and propulsion. This was further complicated by the parallel development of new design software intended for use in creating, sharing, and managing all 787 product definition data. The lead design engineer - among the most critical resource on the product development team - must engage on all fronts. Given the complexities of this endeavor, advanced skills are necessary for engineering leaders to succeed, and Boeing must ensure they have these skills. This research was intended to specify some of these advanced skills, identify deficiencies in the current workforce, and suggest ways in which industry and academia might team together to address such deficiencies.by Harry H. Ayubi.S.M.in Engineering and Managemen

Estimation of the population attributable fraction of road-related injuries due to speeding and passing in Iran

OBJECTIVES: Speeding and passing are considered to be the main human factors resulting in road traffic injuries (RTIs). This study aimed to estimate the population attributeable fraction (PAF) of speeding and passing in RTIs in rural Iran during 2012. METHODS: The contribution of speeding and passing to RTI-related morbidity and mortality was estimated using the PAF method. The prevalence of speeding and passing was obtained from the national traffic police data registry. A logistic regression model was used to measure the association between the above risk factors and RTIs. RESULTS: Speeding accounted for 20.96 and 16.61 of rural road-related deaths and injuries, respectively. The corresponding values for passing were 13.50 and 13.44, respectively. Jointly, the PAF of these factors was 31.63 for road-related deaths and 27.81 for injuries. CONCLUSIONS: This study illustrates the importance of controlling speeding and passing as a high-priority aspect of public-health approaches to RTIs in Iran. It is recommended that laws restricting speeding and passing be enforced more strictly

Discrete Model of Ideological Struggle Accounting for Migration

A discrete in time model of ideological competition is formulated taking into account population migration. The model is based on interactions between global populations of non-believers and followers of different ideologies. The complex dynamics of the attracting manifolds is investigated. Conversion from one ideology to another by means of (i) mass media influence and (ii) interpersonal relations is considered. Moreover a different birth rate is assumed for different ideologies, the rate being assumed to be positive for the reference population, made of initially non-believers. Ideological competition can happen in one or several regions in space. In the latter case, migration of non-believers and adepts is allowed; this leads to an enrichment of the ideological dynamics. Finally, the current ideological situation in the Arab countries and China is commented upon from the point of view of the presently developed mathematical model. The massive forced conversion by Ottoman Turks in the Balkans is briefly discussed.Comment: 24 pages, with 5 figures and 52 refs.; prepared for a Special issue of Advances in Complex System

Epidemiological Patterns of Road Traffic Crashes During the Last Two Decades in Iran: A Review of the Literature from 1996 to 2014

Context: Despite considerable attention given to health statistics of road traffic crashes (RTCs), the epidemiological aspects of injuries resulting from RTCs are not fully understood in Iran and other developing countries. The aim of this review was to study the epidemiological pattern and issues arising due to RTCs in Iran. Evidence Acquisition: The scope of this study involves data from a broad range of published literature on RTCs in Iran. Data collection for this study was conducted by searching for keywords such as traffic accidents, traffic crashes, motorcycle accidents, motorcycle crashes, motorcycle injury, motor vehicle injury, motor vehicle crashes and motor vehicle accidents, Iran and Iranian in various databases such as Embase, PubMed, Google Scholar, Scopus, Magiran, Iranian scientific information database (SID) and IranMedex. Results: This study comprised of 95 articles. It is evident from this review that a large number of severe RTCs occur due to collision of two or more vehicles and most of the victims are males aged between 30 and 39 years. Male pedestrian, drivers and passengers are more likely to be severely injured in comparison to females. One of the most prevalent causes of death among adults involved in the RTCs are head injuries and the majority of deaths occur prior to hospitalization. Mortality rates for RTCs are higher in summer, especially during midnight among all age groups. The most common individual and environmental risk factors associated with RTCs include lack of attention, getting trapped in the car, listening to music, fatigue and sleepiness, duration and distance and negligence of seatbelt usage while driving. Conclusions: The findings of the current study will be beneficial in prevention of RTCs and its associated complications and hence will be vital for policy makers, health service managers and stakeholders

Epidemiological and clinical characteristics of patients with hydatid cysts in Khorasan Razavi Province, from 2011 to 2014

Background: This study aimed to investigate the epidemiological and clinical aspects of patients with hydatid cyst during 2011 to 2014. Methods: This cross-sectional study was conducted in Khorasan Razavi Prov-ince, the Northeast of Iran, from 2011 to 2014. The study population was all cases with hydatid cyst who diagnosed in governmental and private laboratories, hospitals and health centers (HC) in Khorasan Razavi Province during 2011-14. Results: The prevalence rate of hydatidosis was 1.44 per 100000 individuals. Of 357 cases, 54.9 were women, 40.3 rural, 45.8 housewives, and 3.4 were Afghan. The mean age of women was higher than that of men (39.13�18.9 compared to 34.7�17.9 yr, respectively, P-value=0.025). The highest proportion of cases (39.2) was in the age group of 21-40 yr old. Abdominal pain was re-ported in 42.3 of cases. Liver involvement was the most common localization of hydatid cyst reported in 59.4 of patients, and 8.4 had multiple organ in-volvement. The common diagnosis methods of the disease were radiology (42.3) followed by CT scan (37.8). 45.9 of patients had domestic dog and hygiene principles of washing the vegetables was adhered by 6.7 of patients. Conclusion: The prevalence of human hydatidosis, as a most important neglected disease, should be considered by health policy-makers in public health domain. In addition, educational programs to better recognition of the disease symptoms, and to identify the infection sources are needed in high risk group of population. � 2016, Tehran University of Medical Sciences (TUMS). All rights reserved

Quality of care in adult patients with inflammatory bowel disease transferring between healthcare providers: multicentre audit

Background: Inflammatory bowel disease (IBD) predominantly affects young adults at critical socioeconomic periods of their lives. There are no studies examining the process of transfer of care for adult patients with IBD changing healthcare providers. Our aims were to assess the quality of referral information provided when patients with an established IBD diagnosis transfer care between heathcare providers and to assess the impact of referral quality on patient outcome. / Methods: Retrospective data pertaining to IBD transfer of care referrals were collected from 16 hospitals across London over a 2-month period. Data were collected on patient demographics, source and content of referral and cross-referenced with an established transfer of care checklist. Patient outcome within the 6 months following transfer was also documented. / Results: 154 cases were identified, over half of which transferred due to patient relocation. Details included in transfer letters were in many cases incomplete. In over 70% of cases, the letter came from primary care, including when a tertiary opinion was sought. Although referrals from primary care contained fewer patient data points, there was no association with poor patient outcomes at 6 months. / Conclusion: This is the first study examining the quality of transfer of care in adult patients with IBD. We highlighted a significant and underreported issue and found that the majority of referrals were led by primary care. Though the inclusion in the referral of fewer data points was not associated with poor outcomes, we highlighted an area where gastroenterologists might take more responsibility to provide smooth and robust transfer of care

THE USE OF PAIR CHECKS MODEL IN TEACHING DESCRIPTIVETEXT TO IMPROVE STUDENT’S WRITING ABILITY. Iqbal Shalahudin Al Ayubi: 157010022

This research is aimed to see the use of pair checks model in teaching descriptive text in improving student’s writing ability in Pasundan 6 junior high school. Richards and Renandya(2002) stated that writing is themost difficult skill for L2 or second language learner to master. Pair checks model is a collaborative learning model, where students are required to study as a group. Learn how to write as a group is expected to be beneficial for students as they learn to compose their works together. In seventh grade of junior high school, students learn about descriptive text. Descriptive text is a basic form of writing where students have to describe something in their way. Therefore, descriptive text is used to obtain data for the research, to see theirimprovement in writing. The research is processed through qualitative method, the data are analysed from the results of thedocumentation study,observation, test, and questionnaire. The research was conducted in SMP Pasundan 6 Bandung, with 26 students as the participants. Pair checks model is implemented when teaching descriptive text, student checks each other’s works and shares their thoughts in writing a descriptive text. The results show that there is improvement in writing after the model is implemented. There are 19 students who improved their score in writing a descriptive text. Class improvement shows 12% improvement after the model is implemented.Most of the students are happy when learning with pair checks model.Key Words:Pair Checks Model, Writing, Descriptive Tex

Towards NHS Zero: greener gastroenterology and the impact of virtual clinics on carbon emissions and patient outcomes. A multisite, observational, cross-sectional study

OBJECTIVE: The National Health Service (NHS) produces more carbon emissions than any public sector organisation in England. In 2020, it became the first health service worldwide to commit to becoming carbon net zero, the same year as the COVID-19 pandemic forced healthcare systems globally to rapidly adapt service delivery. As part of this, outpatient appointments became largely remote. Although the environmental benefit of this change may seem intuitive the impact on patient outcomes must remain a priority. Previous studies have evaluated the impact of telemedicine on emission reduction and patient outcomes but never before in the gastroenterology outpatient setting. METHOD: 2140 appointments from general gastroenterology clinics across 11 Trusts were retrospectively analysed prior to and during the pandemic. 100 consecutive appointments during two periods of time, from 1 June 2019 (prepandemic) to 1 June 2020 (during the pandemic), were used. Patients were telephoned to confirm the mode of transport used to attend their appointment and electronic patient records reviewed to assess did-not-attend (DNA) rates, 90-day admission rates and 90-day mortality rates. RESULTS: Remote consultations greatly reduced the carbon emissions associated with each appointment. Although more patients DNA their remote consultations and doctors more frequently requested follow-up blood tests when reviewing patients face-to-face, there was no significant difference in patient 90-day admissions or mortality when consultations were remote. CONCLUSION: Remote consultations greatly reduced the carbon emissions associated with each appointment. Although more patients DNA their remote consultations and doctors more frequently requested follow-up blood tests when reviewing patients face-to-face, there was no significant difference in patient 90-day admissions or mortality when consultations were remote

Securitizing the Muslim Brotherhood: state violence and authoritarianism in Egypt after the Arab Spring

Unprecedented levels of state violence against the Muslim Brotherhood, and the widespread acceptance of this violence by Egyptians following the July 2013 military coup, have been under-examined by scholars of both critical security studies and Middle East politics, reflecting implicit assumptions that state violence is unexceptional beyond Europe. This article explores how the deployment of such levels of violence was enabled by a securitization process in which the Egyptian military successfully appropriated popular opposition to Muslim Brotherhood rule, constructing the group as an existential threat to Egypt and justifying special measures against it. The article builds on existing critiques of the Eurocentrism of securitization theory, alongside the writings of Antonio Gramsci, to further refine its application to non-democratic contexts. In addition to revealing the exceptionalism of state violence against the Muslim Brotherhood and highlighting the important role of nominally non-state actors in constructing the Muslim Brotherhood as a threat to Egypt, the article also signals the role of securitization in re-establishing authoritarian rule in the wake of the 2011 uprising. Thus, we argue that securitization not only constitutes a break from ‘normal politics’ but may also be integral to the reconstitution of ‘normal politics’ following a period of transition