Cost effectiveness analysis of using different monitoring modalities in treating severe traumatic brain injury (CESTBI) in neuro-ICU, HUSM, Kelantan

Introduction: There are two schools of thought in practicing neurotrauma monitoring for patients with severe traumatic brain injury (TBI); the application of the baseline neuro-monitoring (BNM) and the use of multiple modalities neurotrauma monitoring (M3) which is very expensive. The answer of which of the two monitoring systems is more eflicient and worth doing should be sought. Objective: To determine the cost effectiveness analysis between BNM and M3 monitoring modalities in the management of severe TBI. Methodology: Sixty-two patients with severe TBI admitted to Neuro-ICU, USM who fulfilled the predetermined criteria were selected using systematic random sampling. The macro and micro costing were performed on each of patient. Barthel Index was used to measure physical performance as an outcome six months after discharge. The analyses used were the Independent t- test, ANCOVA, and Repeated Measure ANOVA. Results: The mean total equipment cost of M3 was significantly higher at p = 0.049 (mean difference of RM23.74) after controlling other variables. The mean difference in Barthel Index after six months was significance between the two groups (p = 0.031), patients that were treated with M3 had higher score 163.7 (SD 30.03)J compared to those who were treated with BNM 146.83 (SD 30.36)]. However, the cost-effectiveness ratio of using M3 was significantly lowered (p=O.031) with a mean of RM476.29 was needed to increase a unit improvement in mean Barthel Index compared to RM629.12 if we used BNM. Conclusion: Although M3 is more costly, the outcome of patients treated with M3 was better than that of BNM. Therefore we can conclude that the used of multiple neuro-monitoring was more cost effective than the use of only baseline neuro-monitoring in treating severe traumatic brain injury

Hubungan Batas Cair Dan Plastisitas Indeks Tanah Lempung Yang Disubstitusi Pasir Terhadap Nilai Kohesi Tanah Pada Uji Direct Shear

The Clay has a low shear force properties, large density, small permeability coefficient and has alow bearing capacity. To increase the bearing capacity of the clay can be used a mixture of sand.In this study, the test is done by using the Direct Shear test, which will be a reference in relation ofliquid limit and plasticity index to the value of cohesion (c) of each soil sample that has beensubstituted with sand.Soil samples used an original soil samples and disturbed soil of clay that comes from threelocations: the area Margakaya Jati Agung South Lampung, Palputih Karang Anyar SouthLampung , and Belimbing Sari Jabung East Lampung. Clay will be mixed with sand No.40 sieve(0.43 mm) in accordance with the required percentage of the variation in sand content of 0%, 5%,10%, and 15%.Based on AASHTO classification system, the three of soil include to the class of ordinary clay soilup to bad as subgrade material. The addition of sand mixture into three types of clay causingdecreased shear strength. The greater the addition of sand content, then the value of cohesion (c),liquid limit and plasticity index of the soil will decrease and shear angle will increase

Standardising neonatal and paediatric antibiotic clinical trial design and conduct: the PENTA-ID network view.

Antimicrobial development for children remains challenging due to multiple barriers to conducting randomised clinical trials (CTs). There is currently considerable heterogeneity in the design and conduct of paediatric antibiotic studies, hampering comparison and meta-analytic approaches. The board of the European networks for paediatric research at the European Medicines Agency (EMA), in collaboration with the Paediatric European Network for Treatments of AIDS-Infectious Diseases network (www.penta-id.org), recently developed a Working Group on paediatric antibiotic CT design, involving academic, regulatory and industry representatives. The evidence base for any specific criteria for the design and conduct of efficacy and safety antibiotic trials for children is very limited and will evolve over time as further studies are conducted. The suggestions being put forward here are based on the adult EMA guidance, adapted for neonates and children. In particular, this document provides suggested guidance on the general principles of harmonisation between regulatory and strategic trials, including (1) standardised key inclusion/exclusion criteria and widely applicable outcome measures for specific clinical infectious syndromes (CIS) to be used in CTs on efficacy of antibiotic in children; (2) key components of safety that should be reported in paediatric antibiotic CTs; (3) standardised sample sizes for safety studies. Summarising views from a range of key stakeholders, specific criteria for the design and conduct of efficacy and safety antibiotic trials in specific CIS for children have been suggested. The recommended criteria are intended to be applicable to both regulatory and clinical investigator-led strategic trials and could be the basis for harmonisation in the design and conduct of CTs on antibiotics in children. The next step is further discussion internationally with investigators, paediatric CTs networks and regulators

Korelasi Kuat Tekan Dengan Kuat Geser Pada Tanah Lempung Yang Didistribusi Dengan Variasi Campuran Pasir

This research aims to determine the compressive strength and shear strength on clay which issubstituted with a mixture of sand variations. Soil tested in this study is derived from clay ofBelimbing Sari Village, Jabung District, East Lampung. This is done because if you set up astructure on top of the clay will cause some problems, among others, the small value ofcompressive strength and shear strength of the soil.To determine the effect of mixing clay with sand on the compressive strength and shear strength, itis done by varying the mixing of sand by 10%, 20%, 30%, 40%. From the test results it is obtainedthat the increase in shear strength to a maximum of 0.7534 kg / cm2 and a decrease in cohesionvalue of 0.10 kg / cm2 at mixing the sand as much as 40%. In the compressive strength reaches amaximum value at 30% of the mixing done 4 variation is equal to 0.4996 kg / cm3. The greater thelevel of sand were added then the lesser the value of the soil cohesion, friction angle and thecompressive strength will increase although the maximum compressive strength value in mixing30% sand

Sonographic detection of fetal extrathoracic pulmonary sequestration.

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135413/1/jum198655283.pd

A roadmap to develop dementia research capacity and capability in Pakistan: a model for low- and middle-income countries

Objective To produce a strategic roadmap for supporting the development of dementia research in Pakistan. Background While global research strategies for dementia research already exist, none is tailored to the specific needs and challenges of low- and middle-income countries (LMIC) like Pakistan. Methods We undertook an iterative consensus process with lay and professional experts to develop a Theory of Change-based strategy for dementia research in Pakistan. This included Expert Reference Groups (ERGs), strategic planning techniques, a “research question” priority survey, and consultations with Key Opinion Leaders. Results We agreed on ten principles to guide dementia research in Pakistan, emphasizing pragmatic, resource sparing, real-world approaches to support people with dementia, both locally and internationally. Goals included capacity/capability building. Priority research topics included raising awareness and understanding of dementia, and improving quality of life. Conclusion This roadmap may be a model for other LMIC health ecosystems with emerging dementia research cultures

Prevalence of resistance associated polymorphisms in Plasmodium falciparum field isolates from southern Pakistan

<p>Abstract</p> <p>Background</p> <p>Scarce data are available on <it>Plasmodium falciparum </it>anti-malarial drug resistance in Pakistan. The aim of this study was, therefore, to determine the prevalence of <it>P. falciparum </it>resistance associated polymorphisms in field isolates from southern Pakistan.</p> <p>Methods</p> <p>Blood samples from 244 patients with blood-slide confirmed <it>P. falciparum </it>mono-infections were collected between 2005-2007. Single nucleotide polymorphisms in the <it>P. falciparum </it>chloroquine resistance transporter (<it>pfcrt </it>K76T), multi drug resistance (<it>pfmdr1 </it>N86Y), dihydrofolate reductase (<it>pfdhfr </it>A16V, N51I, C59R, S108N, I164L) and dihydropteroate synthetase (<it>pfdhps </it>A436S, G437A and E540K) genes and <it>pfmdr1 </it>gene copy numbers were determined using PCR based methods.</p> <p>Results</p> <p>The prevalence of <it>pfcrt </it>76T and <it>pfmdr1 </it>86Y was 93% and 57%, respectively. The prevalence of <it>pfdhfr </it>double mutations 59R + 108N/51R + 108N was 92%. The <it>pfdhfr </it>triple mutation (51I, 59R, 108N) occurred in 3% of samples. The <it>pfdhfr </it>(51I, 59R, 108N) and <it>pfdhps </it>(437G, 540E) quintuple mutation was found in one isolate. <it>Pfdhps </it>437G was observed in 51% and 540E in 1% of the isolates. One isolate had two <it>pfmdr1 </it>copies and carried the <it>pfmdr1 </it>86Y and <it>pfcrt </it>76T alleles.</p> <p>Conclusions</p> <p>The results indicate high prevalence of <it>in vivo </it>resistance to chloroquine, whereas high grade resistance to sulphadoxine-pyrimethamine does not appear to be widespread among <it>P. falciparum </it>in southern Pakistan.</p

Utilization of Sodium Hydroxide (Naoh) to Treat Used Tyres as Sand Partial Replacement in Engineered Cementitious Composites

Engineered cementitious composites (ECC) is distinct for the tensile strain-hardening behaviour and tensile ductility contrasting to the quasi-brittle nature of ordinary concrete. The blended materials of ECC only consist of cement, sand, water, fibre, and admixture. The depleting and limited resources of sand in many countries have led to the research on alternative materials to replace sand partially or fully in the concrete mixture. Therefore, this study aims to utilize the crumb rubber (CR) in ECC as a partial sand replacement to enhance the ductility and energy dissipation capacity of the composite. The additional of CR in the ECC cause reduction of compressive strength of the composites due to its smooth surface resulting to less bonding with cement matrix. Hence, the CR is being treated with 10% sodium hydroxide (NaOH) to improve its surface roughness and enhance the adhesion between CR and cement matrix in the composites. The compressive strength results for ECC contained CR treated for duration of 2 days and 4 days were recorded. Two days is the optimum duration of CR treatment using 10% sodium hydroxide (NaOH) to lessen the reduction of the compressive strength of the rubberized engineered cementitious composites (R-ECC)