Study on Asphalt Pavement Distress: A Case Study in Turkish Republic of Northern Cyprus

In past few years, Pavement Engineers are exploring new techniques and methods to reduce the cost of pavement construction, while increasing its service life. So it manages the ingredient of pavement material due to the pavement failure, although to characterize the thickness of pavement layers. The road must be designed and properly constructed in the site and then proper maintenance necessary. Meanwhile, the road must not be designed in a short period because of deterioration will start and shows the distress on the pavement surface like surface deformation, surface defect bleeding, disintegration pothole, and cracking. The causes of deterioration are environmental factors (moisture, climate), improper maintenance, Poor material, improper pavement design, traffic overload, traffic volume and subgrade failure. This research paper evaluates the current condition of asphalt pavement distresses which are existed in North Cyprus. A condition survey conducted from Lefkosa to Famagusta and the length of the highway is 57.9 km. It has achieved and proved 10 types of pavement distress in the study area such as potholes, Patching, Bleeding Slippage, Block, Transverse, Longitudinal, alligator. Furthermore, it analyzes the severity separately. It was concluded that the best maintenance alternative for the treatment of distresses in North Cyprus is crack filling, patching, an overlay, and shoulder enhancement

Kelayakan Raspberry Pi Sebagai Web Server: Perbandingan Kinerja Nginx, Apache, Dan Lighttpd Pada Platform Raspberry Pi

Raspberry Pi is a small-sized computer, but it can function like an ordinary computer. Because it can function like a regular PC then it is also possible to run a web server application on the Raspberry Pi. This paper will report results from testing the feasibility and performance of running a web server on the Raspberry Pi. The test was conducted on the current top three most popular web servers, which are: Apache, Nginx, and Lighttpd. The parameters used to evaluate the feasibility and performance of these web servers were: maximum request and reply time. The results from the test showed that it is feasible to run all three web servers on the Raspberry Pi but Nginx gave the best performance followed by Lighttpd and Apache

The Relationship between Workplace Bullying for Nurses and Leadership Styles

Background: Workplace bullying is a social and organizational problem within the nursing profession; this phenomenon has significant negative effects and is closely associated with leadership styles. Aim: This study aimed to examine the relationship between workplace bullying for nurses and leadership styles. Design: A descriptive correlational design was used in this study. Setting: This study was conducted at El-Obour Hospital for Health Insurance, Kafr El-Sheikh Branch. Sample: Consisted of a representative sample of staff nurses (N=295). Tools: Two tools were used for data collection: The Negative Acts Questionnaire-Revised (NAQ-R) and the Multifactor Leadership Questionnaire (MLQ). Results: (61.7%) of staff nurses were highly exposed to workplace bullying. Also, the most dominant style was laissez-faire leadership, with the highest mean percentage of respondents. There was a statistically significant negative correlation between staff nurses' exposure to workplace bullying and transformational leadership. There was also a statistically significant negative correlation between staff nurses' exposure to workplace bullying and transactional leadership. While, there was a statistically significant positive correlation between staff nurses' exposure to workplace bullying and laissez-faire leadership. Conclusion: There was a statistically significant, negative correlation between staff nurses’ exposure to workplace bullying (r =-0.285, p< 0.001) and leadership styles. Recommendation: Healthcare organizations should suggest policies and rules to prevent bullying and punish bullies. Nurse Managers should encourage staff nurses to report workplace bullying incidents. Further studies: Explore the staff nurses' perceptions about bullying before and after applying a training program about bullying and strategies to deal with it

Kelayakan Raspberry Pi sebagai Web Server: Perbandingan Kinerja Nginx, Apache, dan Lighttpd pada Platform Raspberry Pi

Raspberry Pi is a small-sized computer, but it can function like an ordinary computer. Because it can function like a regular PC then it is also possible to run a web server application on the Raspberry Pi. This paper will report results from testing the feasibility and performance of running a web server on the Raspberry Pi. The test was conducted on the current top three most popular web servers, which are: Apache, Nginx, and Lighttpd. The parameters used to evaluate the feasibility and performance of these web servers were: maximum request and reply time. The results from the test showed that it is feasible to run all three web servers on the Raspberry Pi but Nginx gave the best performance followed by Lighttpd and Apache.Keywords: Raspberry Pi, web server, Apache, Lighttpd, Nginx, web server performanc

Interventional Spine and Pain Procedure Credentialing: Guidelines from the American Society of Pain & Neuroscience

Background: The discipline of interventional pain management has changed significantly over the past decade with an expected greater evolution in the next decade. Not only have the number of procedures increased, some of the procedures that were created for spine surgeons are becoming more facile in the hands of the interventional pain physician. Such change has outpaced academic institutions, societies, and boards. When a pain physician is in the credentialing process for novel procedure privileges, it can leave the healthcare system in a challenging situation with little to base their decision upon. Methods: This paper was developed by a consensus working group from the American Society of Pain and Neuroscience from various disciplines. The goal was to develop processes and resources to aid in the credentialing process. Results: These guidelines from the American Society of Pain and Neuroscience provide background information to help facilities create a process to appropriately credential physicians on novel procedures. They are not intended to serve as a standard or legal precedent. Conclusion: This paper serves as a guide for facilities to credential physicians on novel procedures

The American Society of Pain and Neuroscience (ASPN) practical guidelines to study design and scientific manuscript preparation in neuromodulation

Background: Healthcare clinical and even policy decisions are progressively made based on research-based evidence. The process by which the appropriate trials are developed and well-written manuscripts by means of evidence-based medicine recommendations has resulted in unprecedented necessity in evidence-based medicine in neuromodulation. Methods: The essential considerations in the planning of neuromodulation research are discussed in the light of available scientific literature as well as the authors\u27 scientific expertise regarding research study design and scientific manuscript preparation. Conclusion: This article should enable the reader to understand how to appropriately design a clinical research study and prepare scientific manuscripts. The high-quality and well-designed studies, when performed and reported effectively, support evidence-based medicine and foster improved patient outcomes

Demographics and PainDETECT as Predictors of 24-Month Outcomes for 10 kHz SCS in Nonsurgical Refractory Back Pain

BACKGROUND: Nonsurgical refractory back pain (NSRBP) is broadly defined as chronic refractory back pain in patients who have not had previous spine surgery and, because they are deemed inappropriate candidates for surgery, are reliant on conventional medical management (CMM), which often provides poor long-term outcomes. High-frequency spinal cord stimulation (10kHz SCS) has demonstrated high rates of pain relief and improvements in functioning in patients with NSRBP. However, despite the use of temporary trial stimulation to select patients who will respond to therapy, some patients fail to achieve long-term therapy response with permanent implants. Prediction analysis founded on patients\u27 baseline characteristics may enrich the appropriate selection of patients for permanent implantation. OBJECTIVES: To examine baseline patient characteristics to predict long-term pain and functional responses to treatment with 10 kHz SCS for NSRBP. STUDY DESIGN: A retrospective analysis of baseline patient characteristics as predictors of 24-month pain and functional outcomes from a previous multicenter randomized controlled trial of 10 kHz SCS in patients with NSRBP. PATIENTS: Patients diagnosed with chronic, neuropathic, axial, low back pain refractory to CMM who had had no previous spine surgery, were deemed unsuitable candidates for it according to a spine surgeon, were implanted with 10kHz SCS and continued with CMM for up to 24 months. METHODS: The baseline characteristics of and 24-month outcomes in the 125 implanted patients who participated in the NSRBP randomized controlled trial (RCT) were included in this analysis. The baseline characteristics included demographics, baseline pain on the visual analog scale (VAS), baseline function based on the Oswestry Disability Index (ODI), mental health according to the patient health questionnaire-9 (PHQ-9), neuropathic pain as measured by PainDETECT, and each patient\u27s temporary trial response. Patient response at 24 months was defined as absolute change from the baseline on the VAS and ODI, and each patient was also classified as a pain responder (achieving at least a 50% decrease in VAS pain score from the baseline) and a function responder (at least a 10-point decrease in ODI or a 24-month score of no more than 20 points). Multivariate prediction models based on regression and classification and regression tree (CART) techniques were developed using the response variables discussed above as the dependent variables and the baseline characteristics as the independent variables. RESULTS: Different factors contributed to pain and functional outcomes. Patients presenting with neuropathic pain (PainDETECT \u3e= 19) and female gender had higher odds of being pain responders to 10 kHz SCS therapy than did males and those without neuropathic pain. Both higher age and depression score (PHQ-9) independently reduced the odds that a patient would be an ODI responder. Years since diagnosis, the reason the patient was deemed unsuitable for spine surgery, and pain etiology were not predictive of pain or functional outcomes. LIMITATIONS: A retrospective sub-analysis of a single pragmatic randomized controlled trial. CONCLUSIONS: There may be an opportunity to increase pain relief and functional improvement if additional patient screening accompanies the temporary lead trial. The presence of neuropathic pain, female gender, age, and depression had some predictive value, but this analysis demonstrates the treatment efficacy of 10 kHz SCS across a wide range of patients with NSRBP

Cost-effectiveness of 10-kHz Spinal Cord Stimulation Therapy Compared With Conventional Medical Management Over the First 12 Months of Therapy for Patients With Nonsurgical Back Pain: Randomized Controlled Trial

Objective: This analysis evaluated if spinal cord stimulation (SCS) at 10 kHz plus conventional medical management (CMM) is cost-effective compared with CMM alone for the treatment of nonsurgical refractory back pain (NSRBP). Methods: NSRBP subjects were randomized 1:1 into the 10-kHz SCS (n = 83) or CMM (n = 76) group. Outcomes assessed at 6 months included EQ-5D 5-level (EQ-5D-5L), medication usage, and healthcare utilization (HCU). There was an optional crossover at 6 months and follow-up to 12 months. The incremental cost-effectiveness ratio (ICER) was calculated with cost including all HCU and medications except for the initial device and implant procedure, and cost-effectiveness was analyzed based on a willingness-to-pay threshold of \u3c $50,000 per quality-adjusted life-year. Results: Treatment with 10-kHz SCS resulted in a significant improvement in quality of life (QOL) over CMM (EQ-5D-5L index score change of 0.201 vs -0.042, p \u3c 0.001) at a lower cost, based on reduced frequency of HCU resulting in an ICER of -$4964 at 12 months. The ICER was -$8620 comparing the 6 months on CMM with postcrossover on 10-kHz SCS. Conclusions: Treatment with 10-kHz SCS provides higher QOL at a lower average cost per patient compared with CMM. Assuming an average reimbursement for device and procedure, 10-kHz SCS therapy is predicted to be cost-effective for the treatment of NSRBP compared with CMM within 2.1 years

Simulation of a Sensitive Mid-infrared (MIR) D-Shaped Optical Fiber Water Pollutant Sensor

In this work, an efficient optical sensor is proposed for the sensitive detection of various pollutants in water. The suggested optical sensor is based on an indium fluoride (InF3) glass fabricated as a D-shaped optical fiber. The polished surface of the D-shaped fiber is coated with a gold grating to induce the surface plasmon resonance (SPR). The SPR depends on the optical properties of the polluted water analyte in physical contact with the grating. The proposed optical SPR fiber sensor operates within the mid-infrared (MIR) range (3000–4500 nm) to detect any slight change in the water refractive index (RI) due to any pollutants. The full vectorial finite element method (FVFEM) is utilized to calculate the modal properties of the reported sensor. High sensor sensitivity of 17,834 nm/RIU (refractive index units) is achieved for the detection of dissolution of nitric acid (HNO3) in water at a concentration of 14% v/v (volume/volume). Additionally, the reported sensor detects the dissolution of hydrogen peroxide (H2O2) in water investigated at concentrations of 15% v/v and 30% v/v, with sensitivities of 12,308 nm/RIU and 17,143 nm/RIU, respectively. Further, suspending polystyrene beads of diameter 0.1 μm in the water at a concentration of 10% v/v gives a maximum sensitivity of 5333 nm/RIU. Therefore, the proposed sensor provides a promising approach for the detection of water pollutants in the MIR wavelength regime, rather than the weaker response in the near infrared

Five-Year Longitudinal Follow-Up of Restorative Neurostimulation Shows Durability of Effectiveness in Patients With Refractory Chronic Low Back Pain Associated With Multifidus Muscle Dysfunction

Background: Adults with refractory, mechanical chronic low back pain associated with impaired neuromuscular control of the lumbar multifidus muscle have few treatment options that provide long-term clinical benefit. This study hypothesized that restorative neurostimulation, a rehabilitative treatment that activates the lumbar multifidus muscles to overcome underlying dysfunction, is safe and provides relevant and durable clinical benefit to patients with this specific etiology. Materials and Methods: In this prospective five-year longitudinal follow-up of the ReActiv8-B pivotal trial, participants (N = 204) had activity-limiting, moderate-to-severe, refractory, mechanical chronic low back pain, a positive prone instability test result indicating impaired multifidus muscle control, and no indications for spine surgery. Low back pain intensity (10-cm visual analog scale [VAS]), disability (Oswestry Disability Index), and quality of life (EuroQol's “EQ-5D-5L” index) were compared with baseline and following the intent-to-treat principle, with a supporting mixed-effects model for repeated measures that accounted for missing data. Results: At five years (n = 126), low back pain VAS had improved from 7.3 to 2.4 cm (−4.9; 95% CI, −5.3 to −4.5 cm; p &lt; 0.0001), and 71.8% of participants had a reduction of ≥50%. The Oswestry Disability Index improved from 39.1 to 16.5 (−22.7; 95% CI, −25.4 to −20.8; p &lt; 0.0001), and 61.1% of participants had reduction of ≥20 points. The EQ-5D-5L index improved from 0.585 to 0.807 (0.231; 95% CI, 0.195–0.267; p &lt; 0.0001). Although the mixed-effects model attenuated completed-case results, conclusions and statistical significance were maintained. Of 52 subjects who were on opioids at baseline and had a five-year visit, 46% discontinued, and 23% decreased intake. The safety profile compared favorably with neurostimulator treatments for other types of back pain. No lead migrations were observed. Conclusion: Over a five-year period, restorative neurostimulation provided clinically substantial and durable benefits with a favorable safety profile in patients with refractory chronic low back pain associated with multifidus muscle dysfunction. Clinical Trial Registration: The Clinicaltrials.gov registration number for the study is NCT02577354; registration date: October 15, 2016; principal investigator: Christopher Gilligan, MD, Brigham and Women's Hospital, Boston, MA, USA. The study was conducted in Australia (Broadmeadow, New South Wales; Noosa Heads, Queensland; Welland, South Australia; Clayton, Victoria), Belgium (Sint-Niklaas; Wilrijk), The Netherlands (Rotterdam), UK (Leeds, London, Middlesbrough), and USA (La Jolla, CA; Santa Monica, CA; Aurora, CO; Carmel, IN; Indianapolis, IN; Kansas City, KS; Boston, MA; Royal Oak, MI; Durham, NC; Winston-Salem, NC; Cleveland, OH; Providence, RI; Spartanburg, SC; Spokane, WA; Charleston, WV).</p