Relationship between Body Mass Index and in-hospital Outcomes of Acute Myocardial Infarction Patients at a Selected Critical Care Unit of a University Hospital - Egypt.

Myocardial infarction (MI) is acute and catastrophic event. It is one of the leading causes to morbidity and mortality worldwide. Multiple risk factors were found to be responsible for the occurrence of MI; among these factors are overweight and obesity. Therefore, the aim of the present study is to study the relationship between body mass index (BMI) and in-hospital outcomes among acute myocardial infarction patients at a selected critical care unit of a university hospital. Two research questions were formulated:1- What is the body mass index profile of acute myocardial infarction patients admitted to a selected critical care unit of a university hospital?; and 2: What is the relationship between body mass index and different in-hospital outcomes of acute myocardial infarction patients admitted to a selected critical care unit of a university hospital?. A descriptive exploratory research design was utilized. The current study was conducted at a selected critical care unit of a university hospital, in Egypt. A sample of convenience including 60 adult male and female patients was included in the current study. Two tools were developed by the researcher and utilized to collect data pertinent to the current study: Socio-demographic and medical data sheet which covers data about patients’ age, gender, diagnosis, body weight, height, length of ICU stay, past medical history, current or recent smoking, and at home medications; and Patient’s assessment sheet which was developed based on Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get with the Guidelines (GWTG). It covers data such as: patients’ presentation; laboratory findings; reperfusion strategy; medications within 24 hours of admission and at discharge; discharge intervention and in- hospital outcomes. Results: males represented the great majority (90%) of the studied sample. They had different BMI categories: overweight, grade I, and grade II obesity, in percentages of 33.3%, 30%, and 25% respectively, with a mean BMI of 31.52+ 4.96. No significant statistical relationship was found between BMI and gender. The studied group admitted as a result of acute anterior MI, acute inferior MI, and acute unspecific MI, in percentages of 45%, 30%& 25% respectively. No significant statistical relationship was found between BMI and diagnosis. Around two thirds of the studied group (58.2%) experienced different in hospital problems/outcomes: recurrent MI attacks (26.7%), cardiogenic shock (18.3%), C.V.S (6.6%), and Death (6.6%). High significant statistical relationship was found between BMI and in-hospital outcomes (Chi square = 46.13 at p<0.004). Based on findings of the present study it can be concluded that the majority of acute myocardial infarction patients had above normal BMI values ranging from over weight to the third grade obesity (in the current study), and obviously was significantly related to the adverse in hospital outcomes. Therefore, the current study recommends, the important role of the critical care nurse in monitoring myocardial infarction patients’ nutritional status through assessing their body mass index, thus providing individualized in hospital / at discharge instructions, which could enhance patients’ outcomes, and reduce complications. Key words: Acute Myocardial Infarction, Body Mass Index, Risk factors, In- hospital patients’ outcomes

The Determinants of Voluntary Disclosure in Emerging Markets: The Case of Egypt

This paper estimates the extent of voluntary disclosure and the impact of a comprehensive set of corporate governance attributes (firm size, firm age, firm profitability, firm leverage, board independent, the existence of audit committee, director ownership, block-holder ownership, Auditor Specialization and Auditor Type) on the extent of voluntary disclosure in Egypt. It is based on the measurement of disclosure to the published data generated from a checklist of 54 items to measure the levels of voluntary disclosure, which had been collected from reviewing manually the financial statements and electronic sites a sample of Egyptian companies listed on the Egyptian Stock Exchange (EGX). We also have level standard ordinary least square (OLS) regression analysis to test for our sample of 100 observations to companies listed on the Egyptian Stock Exchange in 2016. We find that the average level of voluntary disclosure is 18.38%. Our analysis also shows that the size of the firm, firm age, profitability of the firm, auditor specialisation, and ownership of director have a positive impact on voluntary disclosure. However, we find a negative relationship between firm leverage and voluntary disclosure. Our analysis also shows that board independence, audit committee, Block-holder ownership and Auditor Type have no impact on voluntary disclosure. The empirical evidence from this study improves the understanding of the voluntary corporate disclosure environment in Egypt as one of the emerging markets in the Middle East. Keywords: Corporate Governance, Firm characteristics, Voluntary Disclosure

Nurses’ Practices and Perception of Delirium in the Intensive Care Units of a Selected University Hospitals in Egypt

Delirium is a common but frequently undetected complication in hospitalized critically ill patients leading to poor outcomes, prolonged hospital stays, and increased costs of care. Therefore, because of their daily contact with critically ill patients, critical care nurses are at the frontline of patients’ care and are in a unique position to improve their outcomes through timely identification of individuals at risk, early detection of signs and symptoms of delirium, and providing the needed intervention. Aim of the study: to assess critical care nurses’ practices and perception of delirium among critically ill patients in different critical care settings. Research Design: A descriptive exploratory research design was utilized in this study. Research questions: To achieve the aim of the present study, the following two research questions were formulated: 1-What is the current nurses’ practice of delirium assessment in the critical care units? 2- How critical care nurses perceive delirium among critically ill patients?. Setting: The study was carried out at different Critical Care Departments at Cairo University Hospitals, in Egypt. Sample: A sample of convenience including all nurses (120) working at different critical care departments was included in the current study. Tools of data collection: Two tools were used to collect data pertinent to the current study: Socio demographic data sheet (covers data such as gender, age, years of experience, attended staff development courses, working hours, etc……);  and Nursing practices and perceptions assessment sheet: was adopted from Devlin, et al., (2008). It covers data related to frequency of evaluating patients for level of sedation and presence of delirium; presence of delirium; frequency of using delirium assessment sheet; received education regarding ICU sedation assessment and ICU delirium assessment, and statements that pertain to delirium in the ICU. Results: the current study revealed that inspite of having many years of experience in working with critically ill patients, all ICU nurses (100%) ranked delirium assessment as the fourth priority after level of conscious, pain assessment, handling agitation, and caring for devices. More than half of the studied nurses (54.2%) never assessed delirium, and 100% of nurses never received training about assessing and handling delirium. Conclusion: delirium is an under diagnosed problem in the ICU; it is a common response to the ICU environment. It is challenging to be assessed among critically ill patients and represents a problem that requires active intervention on the part of caregivers. Recommendations: Incorporating cognitive assessment in general, and delirium assessment in particular into nursing education courses; Integration of delirium assessment and management into daily nursing care of critically ill patients, and training critical care nurses about early recognition of delirium among critically ill patients Key wards: delirium, delirium assessment & nurses' perception and practices

Effect of Alpha-Lipoic Acid on Atrial Fibrillation after Open Heart Surgery

Background: Postoperative atrial fibrillation (POAF) is associated with increased morbidity and mortality, and an inflammatory process is involved in its pathogenesis. We aimed to study the possible effect of alpha-lipoic acid (ALA) as an antioxidant on atrial fibrillation after cardiac surgery. Methods: The study included ninety patients who underwent cardiac surgery, either valvular or coronary artery bypass grafting using cardiopulmonary bypass, and were randomized into two groups: Control and ALA groups. Blood samples were obtained to measure preoperative and postoperative levels of malondialdehyde (MDA), glutathione, C-reactive protein (CRP) and interleukin-6 (IL-6). The patients were monitored for the occurrence of atrial fibrillation until the day of discharge. Results: POAF occurred in 33% in the control group versus 11% in the ALA group (p=0.011).  When compared to the control group, ALA significantly decreased the postoperative levels of MDA (4.78±0.91 vs. 5.36±1.03 nmol/ml; p= 0.006) CRP (19.44±3.14 vs. 26.56±6.29 mg/dl; p <0.001) and IL-6 (22.25±2.2 vs. 25.37±2.5 pg/ml; p< 0.001) while glutathione level increased significantly in patients who received ALA (26.4±4.59 vs. 23.44±5.11 mg/l; p= 0.005). Conclusion: ALA may help in the prevention of atrial fibrillation following cardiac surgery through exerting antioxidant and anti-inflammatory effects

Forward-looking Disclosure and Corporate Governance Characteristics: Evidence from China.

This paper investigates the relationship between forward-looking disclosure (FLD) and a range of corporate governance characteristics in the Chinese stock markets. It finds that the implementation of certain monitoring and control mechanisms, such as independent directors on the board of directors, can improve the extent of FLD. However, separating the roles of the CEO and the chairman of the board of directors is of little help in explaining any improvement in FLD. In contrast, ownership structure appears to play an essential role in determining FLD policies. Indeed, listed firms with high levels of foreign ownership tend to disclose more forward-looking information. Of particular interest, the association between state ownership and FLD is likely to be non-linear, and the inflection point at which the association becomes negative occurs at a state ownership over 38%. In summary, this study provides new evidence on the impact of FLD on corporate governance characteristics on in China’s unique institutional environment. Keywords: Forward-looking Disclosure, Corporate Governance Characteristics, Firm Characteristics, Information Asymmetry, and Chin

Effect of Nano Silica De-agglomeration, and Methods of Adding Super-plasticizer on the Compressive Strength, and Workability of Nano Silica Concrete

Nowadays, nano silica appears to be one of the attractive cement substitution alternatives for researchers. Several authors have studied the physical effects of its incorporation on cement, despite of significant inconsistencies in reported results, specially workability and compressive strength of resulting concrete. This paper presents a thorough experimental investigation testing more than 16 concrete mixtures, which covers some of the main reasons of these inconsistencies. One of these problems is the method of applying the nano particles, as they are highly agglomerated, and if applied directly in a bulk composite, they often lose their high-surface area due to grain growth or unavailability of the high surface area where it matters. The presented research investigated how agglomeration can affect the compressive strength, and workability of normal strength concrete. Different methods of de-agglomeration were tested, as sonication, homogenization, and stirring. Besides, optimization of the super plasticizer's addition timing to concrete incorporating nano silica (NS) is elaborately investigated by adding the superplasticizer in different timings of addition; starting by adding NS to superplasticizer and water then applying de-agglomeration method, ending with de-agglomeration of NS alone with portion of water, then adding SP to the other portion of water before application them to the dry components. Results showed that sonication proved to be the most significant de-agglomeration method as it enhanced the gain in compressive strength of concrete by 23% by using only 1% nano silica as cement substitution. Sonication of NS also helped increasing the concrete workability significantly as a result of better dispersion of NS. As for the superplasticizer addition time, sonication of NS alone with portion of water, then adding SP to the other portion of water before application them to the concrete dry components showed a significant performance as compared to the other timings, as the compressive strength reached an increase of 26% compared to the control specimens. Keywords: Nano silica, concrete, plasticizers, agglomeration, workability, strength

Multimedia: Different Processes

The topic includes four main themes: (1) The Collaborative Work in Cloud Storage Services: The collaborative work is seen as a force for the individual and community. It, in the field of education, expresses the interaction among students of individual differences who work within collaborative aims and skills to achieve a specific aim. In addition, cloud storage predicts a tremendous change in the way information is stored and applications are run. That is, instead of storing information and running programs on PCs, everything will be hosted in a cloud that can be accessed anywhere and processed by addition or deletion collaboratively. (2) Computer- supported collaborative learning environment (CSCL): Collaborative learning is an umbrella term for a variety of educational approaches involving joint intellectual effort by students, or students and teachers together. It is based on the idea that learning is naturally a social act in which the participants talk among themselves. A group of students engaged in collaborative learning works together to achieve shared goals. (3) Mobile learning: Mobile learning is a term that has been used widely in different places all over the world. it has been encouraged to be used in higher education institutions because of a set of factors such as the availability of mobile phones, their ability to motivate students, and the freedom and privacy they provide to share information. Mobile learning is defined as E-learning that uses mobile devices or learning connected to a mobile device, Laouris & Eteokleous. (4) Open-Source Learning Management Systems: The integration of many Educational technologies in education have been widely promoted for their potential to enrich, enhance and extend student-learning experiences. Hence, pioneer educational establishments all over the world try to benefit of these technologies as much as possible to convey knowledge resources to both of the learner and teacher in least time, effort and cost. One of these educational technology tools which has been prominent in the field of education and technology integration is Learning Management Systems known as LMS

Outcome Prediction After Open Heart Surgery

oai:oai.journals.escts.net:article/6Abstract: Background: Mortality is the most commonly used outcome measure after cardiac surgery. Various risk scores were developed to predict mortality after cardiac surgery with many differences among these scores. We evaluated the accuracy of Acute Physiology And Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score and Cardiac Surgery Score (CASUS) in predicting mortality in our patient population. Methods: Between October 2015 and December 2017, 103 adult patients who underwent open heart surgery were evaluated. The clinical characteristics, outcomes and risk scores data of the patients were collected. Accuracy of the scores was assessed using receiver operating curve (ROC) and the multivariate logistic regression analysis. Results: 103 patients were enrolled with mortality rate of 10.3%.  The non-survivors group showed statistically significant lower E.F, higher platelet count, higher bilirubin level and lower Po2 level (P value: 0.015, 0.020, 0.038, 0.006) respectively. Both APACHE II and SOFA scores performed better than CASUS score in predicting mortality in this study. However, APACHE II score (Area Under Curve “AUC”:0.878, sensitivity: 80%, specificity: 78.5%) and the preoperative platelet count independently predicted mortality after cardiac surgery. Conclusion: Both APACHE II and SOFA scores showed a high power in predicting mortality after cardiac surgery but APACHE II score rises as the best tool for risk stratification in our patient population. Keywords: Mortality; Cardiac surgery; Risk scores