Monte Carlo design of optimal wire mesh collimator for breast tumor imaging process.

This paper presents the modeling of breast tumor imaging process using wire mesh collimator gamma camera. Previous studies showed that the wire mesh collimator has a potential to improve the sensitivity of the tumor detection. In this paper, we extend our research significantly, to find an optimal configuration of the wire mesh collimator specifically for semi-compressed breast tumor detection, by looking into four major factors: weight, sensitivity, spatial resolution and tumor contrast. The numbers of layers in the wire mesh collimator is varied to optimize the collimator design. The statistical variations of the results are studied by simulating multiple realizations for each experiment using different starting random numbers. All the simulation environments are modeled using Monte Carlo N-Particle Code (MCNP). The quality of the detection is measured directly by comparing the sensitivity, spatial resolution and tumor contrast of the images produced by the wire mesh collimator and benchmarked that with a standard multihole collimator. The proposed optimal configuration of the wire mesh collimator is optimized by selecting the number of layers in wire mesh collimator, where the tumor contrast shows a relatively comparable value to the multihole collimator, when it is tested with uniformly semi-compressed breast phantom. The wire mesh collimator showed higher number of sensitivity because of its loose arrangement while the spatial resolution of wire mesh collimator does not shows much different compared to the multihole collimator. With a relatively good tumor contrast and spatial resolution, and increased in sensitivity, a new proposed wire mesh collimator gives a significant improvement in the wire mesh collimator design for breast cancer imaging process. The proposed collimator configuration is reduced to 44.09% from the total multihole collimator weight

K-Means clustering of optimized wireless network sensor using genetic algorithm

Wireless sensor network is one of the main technology trends that used in several different applications for collecting, processing, and distributing a vast range of data. It becomes an essential core technology for many applications related to sense surrounding environment. In this paper, a two-dimensional WSN scheme was utilized for obtaining various WSN models that intended to be optimized by genetic algorithm for achieving optimized WSN models. Such optimized WSN models might contain two cluster heads that are close to each other, in which the distance between them included in the sensing range, and this demonstrates the presence of a redundant number of cluster heads. This problem exceeded by reapplying the clustering of all sensors found in the WSN model. The distance measure was used to detect handled problem, while K-means clustering was used to redistributing sensors around the alternative cluster head. The result was extremely encouraging in rearranging the dispersion of sensors in the detecting region with a conservative method of modest number of cluster heads that acknowledge the association for all sensors nearby

Performing the Egyptian revolution : origins of collective restraint action in the Midan

This research was supported by a Carnegie Trust for the Universities of Scotland grant.In January/February 2011, the world watched with admiration the Egyptian revolution that toppled President Housni Mubarak. The demonstration in Midan al-Tahrir (Liberation Square in central Cairo), which was the nucleus of the revolution, highlighted a largely spontaneous, civil and peaceful political performance. However, this performance was temporary, contradicting subsequent bloody conflicts in post-revolutionary Egypt. This article examines the socio-political origins of the Midan performance. It argues that the demonstrators exercised collective restraint, which was temporary but necessary, in order to topple Mubarak. Building on Norbert Elias’ civilising process theory and social movements literature, it is argued that the origins of this performance are found in a collective knowledge of regime strategy and narrative, Egyptian socio-political values and existing repertoires of contention. Drawing on primary sources and semi-structured interviews, the article contends that the demonstrators exercised collective restraint to reframe regime narrative and draw public support for the revolution.PostprintPeer reviewe

Nonlinear finite element analysis of axially crushed cotton fibre composite corrugated tubes

It is proven experimentally that introducing corrugation along a shell generator together with a proper advanced composite material will enhance the crashworthiness performance of energy device units. This is because corrugation along the shell generator will force the initial crushing to occur at a predetermined region along the tube generator. On the other hand, a proper composite material offers vast potential for optimally tailoring a design to meet crashworthiness performance requirements. In this paper, the energy absorption characteristics of cotton fibre/propylene corrugated tubes are numerically studied. Finite element simulation using ABAQUS/Explicit was carried out to examine the effects of parametric modifications on the tube’s energy absorption capability. Results showed that the tube’s energy absorption capability was affected significantly by varying the number of corrugation and aspect ratios. It is found that as the number of corrugations increases, the amount of absorbed energy significantly increases

On the effects of geometrical shapes in failure modes in natural – conventional fiber reinforced composite tube: a review

Background: Natural and synthetic fibers are known for their low density, easier fabrication than metallic in several engineering applications. Furthermore, their structural rigidity is high and they can be used for advanced applications, such as aerospace applications and automotive industry sector. Methods: Owing to this in depth, studies had been conducted to evaluate its failure modes and process of fabrication for axial and lateral crushing behaviour to replace metallic materials. In this review paper, failure modes and geometrical designs such as shapes, triggering and geometry have been examined, where these factors are affected on crashworthiness parameters. The main aim of this review article is the reported work done in crushing behavior and failure modes of natural, synthetic and manufacturing technique process parameters on fibers reinforced composite tubes. Results: The results showed that the failure modes and crushing behavior in composite tubes depend on the type of material reinforced composite tubes and structure. Conclusion: The failure modes and crushing behavior in composite tubes depend on the type of material reinforced composite tubes and structure

Reflectance response of optical fiber sensor coated with graphene oxide towards ethanol

In this paper, optical multimode fiber reflectance sensor for ethanol with different concentrations in water was developed. The sensor was coated with graphene oxide (GO) by drop-casting technique. The dynamic response of GO nanostructured thin film coated on optical multimode fiber tip exposed to ethanol liquid was investigated. GO thin film was characterized via Raman microscopy and Scanning Electron Microscopy (SEM). The reflectance decreased by 37% when the fiber tip was exposed to 5% concentration of ethanol in water. The sensor shows fast response and recovery as low as 30 s and 45 s, respectively

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe