Iridoschisis and keratoconus in a patient with severe allergic eye disease and compulsive eye rubbing: a case report

Background Iridoschisis is a rare disorder characterized by splitting of the anterior and posterior iris stroma, resulting in disintegrated iris fibrils which float freely in the anterior chamber. We report an exceptional case of bilateral iridoschisis occurring in conjunction with keratoconus and severe allergic eye disease. Case Presentation A 24-year-old white man had had periocular contact dermatitis and allergic eye disease from the age of 3 years. He was allergic to grass, animal hair, and pollen and worked grooming horses. He compulsively rubbed his eyes. There was no history of previous blunt trauma to either eye. There were signs of bilateral iridoschisis and keratoconus with allergic conjunctivitis, all of which were more severe in his right eye. An open drainage angle was identified bilaterally on gonioscopy, excluding primary angle closure. There was no evidence of glaucoma in either eye. Conclusions There are two previous cases reporting the combination of iridoschisis and keratoconus, but no clear common etiology has been identified. In this case there was no evidence of angle closure but there were signs of allergic conjunctivitis. This amalgamation of signs might be explained on the basis of habitual eye rubbing. Treating the allergic eye disease has attenuated this behavior.</p

Evaluasi Kinerja Infrastruktur Transportasi Udara di Ibukota Provinsi

Adanya penurunan kualitas infrastruktur transportasi di Indonesia menjadikan penelitian mengenai perbedaan kondisi antara kebutuhan dan kemampuan sektor transportasi udara perlu untuk dilaksanakan dalam rangka peningkatan kinerja infrastruktur transportasi udara. Artikel ini menitikberatkan pada analisa jumlah dan pertumbuhan penumpang, jumlah dan pertumbuhan kargo dan juga kebijakan yang diterapkan oleh pemerintah terkait infrastruktur transportasi udara. Berdasarkan analisa multi kriteria yang didapatkan dari data primer dan sekunder, penelitian yang bersifat eksploratif ini akan memberikan gambaran kondisi infrastruktur transportasi udara berdasarkan lalu lintas udara di infrastruktur bandara dan beberapa sudut pandang pemangku kepentingan seperti pemerintah pusat, pemerintah daerah, akademisi dan praktisi. Peningkatan pertumbuhan penumpang merupakan indikator utama kinerja transportasi udara sedangkan pertumbuhan barang hanya sebagai indikator sekunder jika dinilai dari sudut pandang pemerintah pusat maupun pemerintah daerah. [The Evaluation of Air Transportation Infrastructure Performance in Indonesian Capital Province] The research related to the difference between supply and demand of air transportation due to the decrease in the quality of the transportation infrastructure in Indonesia is needed in order to improve the performance of the air transportation infrastructure. This paper focuses on the analysis of the number and growth of passengers, the number and growth of cargos, and related government policies in air transportation sector. Based on multi-criteria analysis derived from primary and secondary data, this exploratory study will provide the condition of air transportation infrastructure based on the air traffic at the airport and several stakeholders perspectives such as central government, local government, academics and practitioners. The increase in passenger growth is the key indicator of air transportation performance while the cargo growth only serves as the secondary indicator if measured from the viewpoint of the central government and local government

Evaluasi Kinerja Infrastruktur Transportasi Udara di Ibukota Provinsi

Adanya penurunan kualitas infrastruktur transportasi di Indonesia menjadikan penelitian mengenai perbedaan kondisi antara kebutuhan dan kemampuan sektor transportasi udara perlu untuk dilaksanakan dalam rangka peningkatan kinerja infrastruktur transportasi udara. Artikel ini menitikberatkan pada analisa jumlah dan pertumbuhan penumpang, jumlah dan pertumbuhan kargo dan juga kebijakan yang diterapkan oleh pemerintah terkait infrastruktur transportasi udara. Berdasarkan analisa multi kriteria yang didapatkan dari data primer dan sekunder, penelitian yang bersifat eksploratif ini akan memberikan gambaran kondisi infrastruktur transportasi udara berdasarkan lalu lintas udara di infrastruktur bandara dan beberapa sudut pandang pemangku kepentingan seperti pemerintah pusat, pemerintah daerah, akademisi dan praktisi. Peningkatan pertumbuhan penumpang merupakan indikator utama kinerja transportasi udara sedangkan pertumbuhan barang hanya sebagai indikator sekunder jika dinilai dari sudut pandang pemerintah pusat maupun pemerintah daerah. [The Evaluation of Air Transportation Infrastructure Performance in Indonesian Capital Province] The research related to the difference between supply and demand of air transportation due to the decrease in the quality of the transportation infrastructure in Indonesia is needed in order to improve the performance of the air transportation infrastructure. This paper focuses on the analysis of the number and growth of passengers, the number and growth of cargos, and related government policies in air transportation sector. Based on multi-criteria analysis derived from primary and secondary data, this exploratory study will provide the condition of air transportation infrastructure based on the air traffic at the airport and several stakeholders perspectives such as central government, local government, academics and practitioners. The increase in passenger growth is the key indicator of air transportation performance while the cargo growth only serves as the secondary indicator if measured from the viewpoint of the central government and local government

Public Perception of the Fifth Generation of Cellular Networks (5G) on Social Media

With the advancement of social media networks, there are lots of unlabeled reviews available online, therefore it is necessarily to develop automatic tools to classify these types of reviews. To utilize these reviews for user perception, there is a need for automated tools that can process online user data. In this paper, a sentiment analysis framework has been proposed to identify people’s perception towards mobile networks. The proposed framework consists of three basic steps: preprocessing, feature selection, and applying different machine learning algorithms. The performance of the framework has taken into account different feature combinations. The simulation results show that the best performance is by integrating unigram, bigram, and trigram features

Effect of surgical experience and spine subspecialty on the reliability of the {AO} Spine Upper Cervical Injury Classification System

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (&lt; 5 years, 5–10 years, 10–20 years, and &gt; 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (&lt; 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs &gt; 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (&lt; 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs &gt; 20 years: 0.62), and only surgeons with &gt; 20 years of experience did not have substantial reliability on assessment 2 (&lt; 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs &gt; 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

PERANCANGAN UNIVERSITAS GORONTALO UTARA DENGAN PENEKANAN ARSITEKTUR METAMORFOSIS

Era reformasi telah membawa perubahan besar pada sistem pemerintahan negara, salah satunya ditujukan dengan pemekaran daerah-daerah yang meliputi pemekaran Provinsi, Kabupaten/Kota, dan Kecamatan bahkan Desa. Provinsi Gorontalo merupakah hasil pemekaran dari Provinsi Sulawesi Utara. Provinsi Gorontalo memiliki 5 Kabupaten dan 1 Kota yang salah satu Kabupatennya yakni Kabupaten Gorontalo Utara. Universitas Gorontalo Utara dengan Konsep Arsitektur Metamorfosis berlokasi di Jalan Poros Gorontalo Utara-Manado atau tepatnya site pada kampus&nbsp; Bina Taruna Gorontalo Utara yang direncanakan di atas lahan seluas ± 1 Ha. Universitas Gorontalo Utara dengan Konsep Arsitektur Metamorfosis ini merupakan kampus dengan massa tunggal sebanyak 4 lantai, fakultas-fakultas yang terdiri dari fakultas Teknik, fakultas Hukum, fakultas Ekonomi, fakultas ilmu Sosial dan Politik, fakultas Keguruan dan Ilmu Pendidikan. Penampilan bangunan secara umum menggunakan tema Arsitektur Metamorfosis. Hal ini tampak pada penempatan bangunan pada siteplan dan permainan ruang yang mengambil filosofi kupu-kupu. Selain itu kesan modern terlihat dari bentuk bangunan yang tegas dan simple sehingga memberi kesan elegan

Optic disc optical coherence tomography imaging through a black intraocular lens.

A 49-year-old female presented to ophthalmology with intractable diplopia, secondary to decompensated esotropia. Her diplopia was controlled for several years with spectacle prisms, and thereafter with an occlusive contact lens until she became contact lens intolerant