Regional infraclavicular blocks via the coracoid approach for below-elbow surgery: a comparison between ultrasound guidance with, or without, nerve stimulation

This randomised, observer-blinded study compared brachial plexus infraclavicular block under ultrasound guidance with, or without, nerve stimulation, for patients undergoing below-elbow surgery. Sixty-six patients, aged 18-70 years, with American Society Anesthesiologists’ status I, II or III, were randomised into two groups. Brachial plexus infraclavicular block achieved success rates of 76% in the ultrasound guidance without nerve stimulation group and 82% in the ultrasound guidance with nerve stimulation group, but was not significantly different (p-value 0.55). Block supplementation rates were 18.2% in the ultrasound guidance without nerve stimulation group vs. 12.2% in the ultrasound guidance with nerve stimulation group (p-value 0.55), resulting in 100% of the ultrasound guidance without nerve stimulation group reaching complete successful block, compared to 97% of the ultrasound guidance with nerve stimulation group. The mean performance time was significantly shorter in the ultrasound guidance without nerve stimulation group compared to the ultrasound guidance with nerve stimulation group (8.9 ± 3.9 minutes and 14.7 ± 3.3 minutes, respectively, p-value 0.001). Block onset time was 24.39 ± 4.3 minutes and 21.51 ± 2.4 minutes for the ultrasound guidance without nerve stimulation group and the ultrasound guidance with nerve stimulation group, respectively. The block onset time was significantly different between the groups (mean difference of 2.88, p-value 0.023). However, there was no difference in the time to readiness for surgery or surgical analgesia between the groups: ultrasound guidance without nerve stimulation (33.3 ± 8 minutes), and ultrasound guidance with nerve stimulation (36 ± 6 minutes) (p-value 0.09). Patients’ satisfaction was 93.9% vs. 87.9% in the ultrasound guidance without nerve stimulation group and the ultrasound guidance with nerve stimulation group, respectively (p-value 0.39). In this study, the use of ultrasound guidance alone for brachial plexus infraclavicular block provided rapid performance and yielded a high success rate without the aid of a nerve stimulator.Keywords: brachial plexus infraclavicular block, coracoid approach, nerve stimulation, ultrasound guidanceSouth Afr J Anaesth Analg 2013;19(5):263-26

The economic indicators impact on economic growth a case of Southeast Asian countries / Azmin Jamaludin

This paper aims to determine the causality relationship between Foreign Direct Investment, Exports and Imports and Growth and to examine the relationship between the dependent variable and independent variables for South East Asia countries over a period of time from 1981 to 2010. For this purpose, Johansen Cointegration and Granger-causality test will be used to determine the causal relationship between FDI, export and import and growth in the long run. The empirical result for causality relationship found that Malaysia is independence where there is no long run causality relationship between variables. Finding for Indonesia, it was found that there is unidirectional long run causality relationship between GDP and import where the direction is from GDP Granger cause import. For Singapore and Thailand, the results found that there is causality relationship between variables in the long run where for Singapore it was found the existence of GDP-led FDI , Export-led FDI, Import-led FDI and there also bidirectional causality between import and export. Finding of GDP-led FDI and Export-led FDI were also found in Hsiao and Hsiao (2006) paper, this indicates that the finding is valid. Other than that Hsiao and Hsiao (2006) also found that there is no significant causality relationship in the long run between variables for Malaysia country. Meanwhile, there is existence of export-led FDI and Export-led Import for Thailand countries. In conclusion, the foreign trade gives an impact towards the economic growth in the long run. Therefore to stabilize the economic growth, role of FDI is important in transferring technology and knowledge increases. The role of import and export also important in stimulating the economic growth for Southeast Asian countries

Nature as symbolism of aesthetics in the traditional Malay living environment

This section identifies peoples' aspirations towards aesthetical symbolism of nature in their contemporary living environments. It also discovers the level of people's knowledge about their d"relling architecture. According to survey findings, people's perceptions relating to aspects of aesthetics are always associated with nature, and the natural appreciation towards it. Colour, water and carving traditions are attributes of nature that have been transformed into symbolic cultural meanings and cosmological understandings by indigenous societies. They add value and quality to the living environment and manifest the relationship between Man and nature, Man and God, as well as Man and Man. They also act as the catalyst intellectual development and creativity in relation to design, gardens and crafts in the built environment

Confusion, Coercion and Compromise in Malaysian Federalism

A di8scussion pape

CFD ANALYSIS OF MODIFIED IMPELLER FOR PAINT MIXER

By using the Computational Fluid Dynamics (CFD) program, the impeller's output could be visualized without creating a prototype which would cost the time and money. For this research, simulation of computational fluid dynamics is performed on two forms of impeller design (Counterflow and Sawtooth) and modification of their design (4-Sided Impeller and Inclined Blade Sawtooth Impeller) for evaluation 2 technique of simulating was used to analyse the rotation of the impellers which are the Multiple Reference Frame method and the Moving Wall method. The simulations result shown by vector of velocity and wall shear of vectors. The efficiency of the impellers is then measured on the basis of the result obtained comparatively. The results of this project are important in determining an effective impeller to mix industrial paint in a homogeneous way

Judicial activism and judicial restraint in the constitutional adjudication institution of Malaysia

Justices of Malaysian’s courts have the constitutional role of upholding the Federal Constitution, rule of law and safeguarding human rights. In dispensing justice, the judges have shown their creativity in dealing with cases of intrusion by the executive and legislature and their willingness to expand the spectrum of human rights in protecting liberties of the individual against the authorities. The attitude is not shared by all judges and certainly not without restraint. It can be observed in the various decision that judges are also aware of their defined role and the limits of their jurisdiction to the extent that some judges have been regarded as positivist and literalists. In addition to its duty to defend liberties of the people the court also been bestowed with the responsibility of safeguarding the right and autonomy of the federating states. Such issues have emerged several times and been dealt with by the courts ever since the inception of the federation. This paper divulges into cases concerning constitutional and human rights issues as decided by the courts whereby traces of judicial activism and judicial restraint could be identified. The challenging task of striking a balance between creativity and subjectivity with obedience and objectivity need to be treated with care and caution in order not to upset other constitutional organs as the backlash is very much felt until today. Initially, the paper set out the structure and feature if constitutional adjudication institution in the country. The discussion that entails focuses on judicial decisions on selected issues concerning the fundamental aspect of the constitution such as the main concepts of the constitution, the relationship between the federal government and the state governments and human rights. It can be observed from these decisions that there are a few strands of judicial approach in dispensing justice by the courts since the Independence of 1957

A New Technique To Design Coating Structure For Energy Saving Glass Using The Genetic Algorithm

Energy saving glass is a specially coated glass with metallic-oxide coating that helps save energy by reflecting heat from the sun in the infrared region. Properties of an energy saving glass reflect the heat of infrared radiation while allowing visible white light to pass through the glass. Due to the presence of this metallic coating, some amount of useful radio frequency (RF) or microwave signals are attenuated. Magnitude for some wireless communication signals such as mobile phones (GSM, UMTS and 3G), global positioning system (GPS), wireless network (Wi-Fi), wireless broadband (WiMAX, LTE) are weaken. This limits the efficiency of the energy saving glass function in the wireless communication of microwave signals. In order to overcome this problem, currently there are three solutions; the first solution is to etch a structured design shape on the coated side of the glass, the second solution is by using different types of materials at the fabrication stage of energy saving glass process, and lastly, the common practice to address the signal attenuation is by employing numerous repeaters to improve signals. However, by changing materials during fabrication and having additional repeaters will incur extra cost through many aspects. Therefore this research focuses on the first solution that is to remove a portion of a structured design shape on the coated side of the glass. Currently, the shape is in the regular symmetrical forms such as square, triangle, circle, pentagon, rectangle, and octagon. This research proposed a modified regular shape which is based on the best selected regular shape, modified using genetic algorithm on the central processing unit (CPU). Genetic algorithm is a method which is easily transferred to the existing simulations and models. In order to evaluate the proposed approach, two different regular shapes are selected namely the Modified Single Square Loop (MSSL) and Single Square Loop (SSL). After modifying these shapes using the Genetic algorithm and Parallel Genetic algorithm, the outputs are simulated in the Computer Simulation Technology (CST) simulation software. Result shows that SSL with 10% coated part results -29.3044dB of return loss

A discourse on housing based on cultural meanings in Malaysia

The central aim of the thesis is building a discourse on housing, highlighting the necessity to maintain quality through sustaining the cultural meanings, which originate from nature, cosmology, worldviews, and traditional values of Malaysian society. The thesis critically addresses the housing policies and strategies, in which the visions of quality are still very ambiguous. The Malaysian government has adopted a housing policy, which imposes homogeneity and similarity on the diverse multicultural ethnic societies that are affluent with indigenous knowledge, tradition and unique identities in their dwelling architectures.The research approach is divided into three major parts, and the conclusion. The aim of Part One is to draw attention to the Malaysian housing phenomena and the thesis aspiration. The first chapter covers the country background and its social -cultural context. Despite the cultural diversity, the Malaysians possess a common attitude towards nature. The thesis identifies the philosophical notion of boundary, as a valuable intellectual tool in developing an indigenous model for housing. Boundary has subconsciously driven the formation of various cultural and architectural identities in the Malaysian indigenous dwelling environment. The second chapter continues the process of enlightening the housing discourse by clarifying the need to decipher the meanings related to housing, human perceptions, and aestheticsThe second part of the thesis discourse establishes three chapters, which form the philosophical structure of the thesis. The aim of Part Two is to demonstrate the components of cultural meanings, which are the motivating forces responsible for the formation of indigenous dwelling architecture. For the purpose of the research, the study concentrates on the indigenous Malay society as the focus group. This part explores on the qualities originating from the indigenous worldviews of the Malay society, followed by identification of the characteristics of the indigenous model, including the notions of adaptation, sustainability and boundary. The end chapter of Part Two is an intellectual discourse, which supports the main components of the indigenous model.Part Three is the empirical study, in which the author gains insights directly from examining people's perceptions, i.e. from the open -ended questionnaire survey and the indigenous dwelling typologies survey analysis. The aim is to explore the relationship between people and the qualities of living environment through the contribution of cultural meanings. The study enhances more on what the author have already done in the deductive part (Part Two). The outcome of the empirical studies demonstrates the manifestation of these notions in different indigenous dwelling architectural typologies and works of art.The conclusion chapter distils the information gained from the findings of both theoretical framework and empirical studies, by identifying the crucial domains for obtaining quality through cultural meanings in the living environment. It also provides recommendations concerning the future housing policy, strategies, planning, and design guidelines for housing in which the architects, planners and housing authorities are able to interpret, and implement in search of a national architectural identity for housing in Malaysia, which is tolerant, sustainable and unifying