An evaluation of secondary prophylaxis for rheumatic heart disease in rural Egypt.

Although essentially disappeared from the industrialized world, rheumatic heart disease (RHD) is still prevalent in developing countries, with 300,000 new cases identified each year. In Aswan, Egypt, RHD affects about 2.3% of children with over 90% of the cases being subclinical. Secondary prophylaxis has proved to be an effective method of preventing the progression of RHD. However, its efficacy is limited by low patient adherence. A systematic, generalizable tool is necessary to outline, and ultimately address these barriers.A 43-item semi-structured questionnaire was developed based on the three domains outlined by Fishbein (capability, intention, and health care barriers). A preliminary evaluation of the barriers to RHD prophylaxis use in Aswan, Egypt was carried out as a pilot study using this tool. Participants were local school children diagnosed with RHD or flagged as high-risk (as per a set of echocardiographic criteria developed by the Aswan Heart Centre) through a previous screening program of randomly selected 3,062 school children in Aswan.29 patients were interviewed (65.5% adherent to RHD prophylaxis). Compared to non-adherent patients, adherent patients had better understanding of the disease (68.4% versus 20% in the non-adherent group, p = 0.021), and were more aware of the consequences of missing prophylaxis doses (79% versus 40% of non-adherent patients, p = 0.005). Furthermore, 90% of non-adherent patients consciously choose to miss injection appointments (as compared to 31.6% of adherent patients, p = 0.005). Clinic wait time was the most frequently reported deterrent for both groups.A standardized tool that systematically outlines barriers to prophylaxis is a necessary first step to improving adherence to penicillin. Although individually developed tools exist for specific populations, a generalizable tool that takes into account the demographic and cultural differences in the populations of interest will allow for more reliable data collection methodology. Application of this tool will be used to further explore barriers to prophylaxis adherence and inform the basis for the design of future KT interventions

THE PREDICTED 2020 GLOBAL ECONOMIC CRISIS: CAUSES AND PROSPECTS

While the whole world is awaiting for the expected new economic recession 2020 that might lead to a financial crisis such as the 2008 crisis, this research paper addresses the indicators of this recession and its possible causes as well as the damages resulting from its occurrence and which countries are more affected by it, with a try to reach some recommendations to avoid this recession or dealing with it if it’s actually happens

Sternal healing after bilateral internal mammary arteries use for Coronary artery bypass grafting in diabetic Patients; short-term results

Background:  Bilateral internal mammary artery (BIMA) use may improve long-term outcomes after coronary artery bypass grafting (CABG); however, the risk of infection is high.   Skeletonization of the internal mammary may decrease the risk of infection, especially in patients with diabetes. Our study aimed at evaluation of sternal healing in diabetic patients with different techniques of bilateral internal mammary artery harvesting. Methods: This prospective randomized study included 200 diabetic patients who underwent CABG using BIMA between 2017 and 2019. We divided patients into two groups; Group A had skeletonization of both internal mammary arteries, and Group B had pedicled left mammary and skeletonized right mammary. Patients were observed for three months, post-operatively for any sternal wound problems. Results: There was no significant difference regarding the baseline variables. Type I diabetes mellitus was present in 25% in group A (n= 24) and 13.64% in group B (n= 12) (p= 0.324). There was no difference in harvest time between groups (83 ±4 vs. 81 ±3 minutes in group A vs. B, respectively. P= 0.1). The mean number of grafts was 3± 0.5 in Group A and 3± 0.6 in Group B (p= 0.8). Postoperative drainage was 402.9 ± 174.1 ml in Group A vs. 387.2 ± 153.6 ml in Group B (p= 0.474). The duration of ICU stay did not differ significantly between groups (2± 0.7 in Group A vs. 2± 0.5 in Group B; p= 0.8). Deep sternal wound infection occurred in 4.17% in group A (n= 4) and 4.55% in group B (n= 4) (p= 0.705). Superficial wound infection occurred in eight patients in group A (8.33%) and eight patients in group B (9.1%) (p= 0.59). No patient had sternal dehiscence in group A vs. four patients in group B (4.55%) (p= 0.39). Conclusion: We did not find differences between bilateral mammary artery harvest with skeletonization of both arteries versus skeletonization of the right mammary only on sternal healing nor wound infection in diabetic patients undergoing CABG. A larger study is recommended

Symptom Onset to First-Medical-Contact in ST-Segment Elevation Myocardial Infarction Patients

ST-segment elevation myocardial infarctions (STEMI) make up approximately 25% to 40% of total myocardial infarction (MI) presentations. The total occlusion of the coronary artery that results in a STEMI makes timeliness to reperfusion crucial. Previously, the focus has been on decreasing door-to-balloon time (D2B). Although D2B time plays an important role in achieving timely treatment, it is only one component of the route from symptom onset to reperfusion. It has been shown that total ischemic time is a better predictor of clinical outcomes, including mortality and infarct time. Delays between symptom onset to first-medical-contact (FMC) consume the majority of total ischemic time, and remains one of the main reasons that patients do not receive timely care. Factors affecting symptom onset to FMC for STEMI patients receiving primary PCI as a method of reperfusion at the Aswan Heart Center (AHC) in Egypt and the Hamilton General Hospital (HGH) in Canada were examined using the prospectively collected data held in the STEMI registries at these sites and a modified version of the Response to Systems Questionnaire applied in Egypt. Exploring factors linked to early and late presentation in STEMI patients showed that delays were associated with gender, smoking, cardiac history, cardiogenic shock and mortality rate. Furthermore, the type and number of symptoms, presence and actions of bystanders, emotional response and the actions of the patients, as well as transportation time was shown to be different among delay groups.ThesisMaster of Science (MSc

Laser Powder Bed Fusion of Nickel-based Superalloys

This thesis aims to investigate the manufacturability of nickel-based superalloys, IN625 and IN718, using the laser powder bed fusion (LPBF) process. The study provides a better understanding of the process-structure-property of nickel-based superalloys, their fatigue life, and subsequent post-processing. First, the process-structure-property was investigated by selecting a wide range of process parameters to print coupons for IN625 and IN718. Next, a subset of process parameters was defined that would produce high relative density (>99%), low surface roughness (~2 μm), and a low tensile RS. Second, a multi-scale finite element model was constructed to predict the temperature gradients, cooling rates, and their effect on RS. At constant energy density, RS is affected by scan speed, laser power, and hatch spacing, respectively. Third, the optimum set of parameters was used to manufacture and test as-built and shot-peened samples to investigate the fatigue life without costly heat treatment processes. It was found that shot peening resulted in a fatigue life comparable to wrought heat-treated unnotched specimen. Additionally, IN625 had a better fatigue life compared to IN718 due to higher dislocations density as well as the absence of γ´ and γ´´ in IN718 due to the rapid cooling in LPBF. Finally, the effect of post-processing on dimensional accuracy and surface integrity was investigated. A new approach using low-frequency vibration-assisted drilling (VAD) proved feasible by enhancing the as-built hole accuracy while inducing compressive in-depth RS compared to laser peening, which only affects the RS. These favorable findings contributed to the scientific knowledge of LPBF of nickel-based superalloys by determining the process parameters optimum window and reducing the post-processes to obtain a high fatigue life, a better dimensional accuracy, and improved surface integrity.ThesisDoctor of Philosophy (PhD

Timing of Coronary Artery Bypass Grafting Surgery after Acute Myocardial Infarction

Background: Optimal timing for CABG surgery after myocardial infarction remains a matter of debate. The aim of our study was to analyze the effect of timing of CABG after acute myocardial infarction on operative mortality and morbidity. Methods: This prospective study included 60 patients who underwent isolated CABG within 30 days of acute myocardial infarction over 20 months (from the first of November 2014 till the end of June 2016) in Kasr Al-Ainy University Hospitals. Patients were divided into two groups; the early group (0 – 3 days) included 14 patients (23.3%) and the late group (4 – 30 days) included 46 patients (76.7%). The primary outcome was all-cause hospital mortality. Results: Our study included 43 males (71.7%) and 17 females (28.3%). The mean age was 58.4 ± 7.3 years. The total mortality rate was 8.3%. Patients undergoing early CABG experienced a higher mortality rate than those undergoing late CABG (21.4% vs 4.3%, P = 0.043). Also, early CABG was associated with more postoperative complications. Cardiogenic shock and early CABG were independent risk factors of mortality. Conclusion: CABG in the first 3 days after acute myocardial infarction was associated with high mortality and morbidity in comparison with late CABG. This suggests that CABG may best be deferred for more than 3 days after acute MI in non-urgent cases

The Tectonics of the Double Skin:: Green Building or Just more Hi-Tech Hi-Jinx?

Double skin façade systems are employed increasingly in high profile buildings, designed by famous Architects, using acclaimed engineering consultants, and being touted as an exemplary "green” building strategy. It is a new technology that is more often found in high-end European and Pacific Rim architecture, and far less often in North American building. For the majority of mainstream architects, double skin technology remains elusive. From perspectives of both knowledge and budget, double skin systems are often beyond the scope of most commercially driven, North American projects. The question arises as to whether or not double skin buildings truly are more environmentally responsible and sustainable. Is North American commercial architecture missing out on potential energy and environmental savings? The Double Skin Façade is based on the notion of exterior walls that respond dynamically to varying ambient conditions, and that can incorporate a range of integrated sun-shading, natural ventilation, and thermal insulation devices or strategies. Early modern architects such as Le Corbusier, with his "mur-neutralisant”7, and Alvar Aalto, in the window design of the Paimio Sanitorium, explored this new building technology. Early solar passive design exemplified in the "trombe” wall, is also viewed as a precursor to modern double skin systems.8 Only recently has double skin technology become analogous with explorations in transparent and glass architecture, and moreover, acclaimed as environmentally "responsible” design. This paper represents the findings of a team of upper level B.Arch. and Masters students who have conducted an initial investigation into double skin cladding systems. The study has allowed us to begin to ascertain whether or not these systems represent a valid approach to energy efficient and environmentally responsible design or are, as they might appear, just another "cool” high-tech style. Does this type of skin system represent environmentally "responsible' versus "responsive” design? The end result of the research will be posted on the School website so that it can be shared with others interested in the findings.

Exploring Foreign Muslim Tourist Preferences in Halal Tourism: A Study of Indonesia’s Halal Market

This study investigates the preferences of foreign Muslim tourists in Indonesia's halal tourism sector, with a particular focus on their expectations regarding halal accommodation, products, destinations, and regulations. This study aims to identify deficiencies in policy implementation, infrastructure development, and international marketing that impede Indonesia's potential as a prominent global halal tourism destination. A qualitative research methodology was employed, incorporating interviews and focus group discussions with seven stakeholders: religious scholars, tourism operators, business owners, and foreign Muslim tourists. Data were analyzed using NVivo 12 and Atlas 7 software to extract key themes and insights. The findings revealed significant inconsistencies in halal certification, infrastructure, and international marketing strategies. Foreign Muslim tourists prioritize halal-certified services, cultural authenticity, and inclusivity. However, the inadequate implementation of halal standards, limited halal-friendly infrastructure, and ineffective international promotion efforts constrain Indonesia's capacity to attract more Muslim travelers. Policy recommendations include the enhancement and standardization of halal certification processes, improvement of halal-friendly infrastructure, and implementation of targeted international marketing campaigns. Strategies to promote inclusivity among non-Muslim tourists have also been proposed to support sustainable growth. This study offers novel perspectives by integrating cultural identity, contemporary tourism approaches, and global expectations. It examines the intersection of faith-based travel and accessibility and presents practical suggestions for establishing Indonesia as a leading destination for halal tourism

Modelling Machining-induced Residual Stresses after Laser-assisted Turning of Steels

Abstract. The current study examines the effects of laser assistance on machining-induced residual stresses (RS), using finite element modelling, during turning of AISI 4340 steel at different feed rates. Dry orthogonal cutting was modelled, along with the pre-heating effect of the laser beam. Laser-assisted machining (LAM) resulted in higher surface tensile RS compared to conventional machining, with more pronounced effects at lower feed rates. This is basically because the assisted material experienced higher plastic deformation, due to thermal softening, as well as higher temperatures, which are both attributed to the pre-heating effect of LAM