Non-invasive and minimally invasive techniques for urodynamic stress incontinence of urine in women

1. Extra-corporeal magnetic energy stimulation of pelvic floor muscles for urodynamic stress incontinence;Objective: To assess the efficacy and practicalities of extra-corporeal magnetic energy stimulation of pelvic floor muscles as a non-invasive technique for urodynamic stress incontinence of urine in women.Design: Prospective non-controlled study.Setting: 2 district general hospitals.Population: Female patients with urodynamic stress incontinence of urine.Main outcome measures: Pad test, continence diary, quality of life assessment using the King's health and EuroQol questionnaires as well as side effects and drop out.Method; 18, twice weekly sessions. Assessment was made on recruitment, at the end of treatment and at 3 months follow up.Results: 48 patients were recruited, 31 completed treatment sessions and 27 attended for follow up at 3 months. There was no significant change in outcome measures at the end of treatment as well as at 3 months follow up. Side effects were encountered by 52.1 % of patients and the drop out rate was 35.4%. Relevant side effects were significantly more common in those who dropped out.Conclusions; Extra-corporeal magnetic energy stimulation of pelvic floor muscles seems unlikely to improve urodynamic stress incontinence of urine. This appears to be due to the passive nature of the contractions evoked. Side effects are prominent and appear to contribute to the drop out rate.2. Transvaginal radiofreguency remodelling of the endopelvic fascia for urodynamic stress incontinence due to urethral hypermobility:Objective: To assess the efficacy and safety of transvaginal radiofrequency remodelling of the endopelvic fascia as a minimally invasive technique for urodynamic stress incontinence of urine due to urethral hypermobility in women.Design: Prospective non-controlled study.Setting: 3 district general hospitals and 1 university hospital.Population: Female patients with urodynamic stress incontinence of urine due to urethral hypermobility.Main outcome measures: Pad test, urodynamic assessment, continence diary, pain scores and operative as well as post-operative complications.Method: Transvaginal radiofrequency of the endopelvic fascia. Assessment was made on recruitment, during hospital admission and at 3,6 and 12 months follow up.Results: 24 patients were available for analysis. A rising failure rate was noted as early as 3 months, leading to a cumulative cure rate of 36% at 12 months follow up. No major complications were encountered and pain scores were mild.Conclusions: The effectiveness of transvaginal radiofrequency remodelling of the endopelvic fascia for urodynamic stress incontinence of urine due to urethral hypermobility appears to be low. Inherent weakness of the endopelvic fascia appears to be the main reason. The technique has a low complication and pain profile.3. Comparison between the tension·free vaginal tape (TVT), pelvicol as well as short autologous slings for urodynamic stress incontinence:Objective: To compare the efficacy and morbidity of the tension·free vaginal tape (TVT), pelvicol as well as short autologous slings, as minimally invasive technique for urodynamic stress incontinence of urine in women.Design: Muticentre randomised controlled single blind study.Setting: 4 district general hospitals and 2 teaching university hospitals.Population: Female patients with urodynamic stress incontinence of urine.Main outcome measures: Quality of life and symptom assessment using Bristol Female Lower Urinary Tract Symptoms as well as EuroQol questionnaires, pad test, continence diary, operating time, stay in hospital, operative as well as post-operative complications.Method: Tension-free vaginal tape (TVT) , pelvicol or short autologous sling insertion. Assessment was made on recruitment, during hospital stay and at 6 weeks as well as 6 and 12 months follow up.Results: A total of 181 patients were recruited. An interim analysis of re-operation rate showed a significantly higher rate with pelvicol, necessitating closure of this arm. All pelvicol failures appeared after 6 months, raising the possibility of a delayed reaction. No significant difference was observed between the tension-free vaginal tape (TVT) and short autologous slings in terms of operative as well as post-operative complications, pad test and continence diary. Operating time and post-operative stay in hospital were significantly shorter following the tension-free vaginal tape (TVT) sling than after the short autologous one. This reduces the higher capital cost of the tension free vaginal tape (TVT) sling. There was also a short term advantage in quality of life assessment.Conclusions: Pelvicol slings are associated with a delayed failure, and should not therefore be used for continence surgery. Although both the tension-free vaginal tape (TVT) and short autologous slings are equally effective and have a comparable complications profile, the tension-free vaginal tape (TVT) sling is quicker to insert and is followed by a shorter stay in hospital; 2 features that reduce its higher cost. It is also associated with a better quality of life change in the short term

Inventory risk based technique for spare parts utilization

The equipment breakdown due to unavailability of spare parts has incurred challenges for the manufacturing industry in managing the inventory. Consequently, the problem of spare parts unavailability has lead the organization towards unproductive and eventually impact the financial performance.Therefore, maintaining good system has direct connection with spare parts availability. The inventory planner always strive hard to ensure that the spare parts are always available for the maintenance used.Nevertheless, maintaining high inventories of spare parts often conflict from meeting the needs of equipment reliability for the manufacturing plant.In view of this situation, management of spare parts become critical in ensuring the equipment reliability.This paper describes an innovative risk quantification technique using Binary Decision Diagram (BDD) for the spare parts inventory control.The technique modified the BDD concept by translating the failure history into binary decision.From the binary process, the data will be converted into spare parts probability table and failure impact is analyzed. These two functions of risk, will be calculated in order gain the risk in monetary value

Evaluation of knowledge of vitamin D aspects among pharmacy and engineering students in University of Sharjah, United Arab Emirates

Background: Vitamin D plays a major role in health. Several health disorders have been associated with its deficiency. The objectives of this study were to evaluate the knowledge of and attitude towards vitamin D of pharmacy and engineering students in the University of Sharjah, United Arab Emirates.Methods: A descriptive cross-sectional study was conducted during February-April, 2018. A 30 questions survey in English was designed, pre-validated and distributed to 250 students. The questionnaire was designed to evaluate and compare student’s knowledge and awareness of vitamin D.Results: 213 participants completed the survey producing a response rate of 85.2%. The majority of students were Arabs, females and of age ranging 21-23 years. Almost all pharmacy students were familiar with many aspects of vitamin D. Unlike engineering (66; 66.6%), most (113; 99.1%) pharmacy students know the meaning of osteoporosis. Knowledge of pharmacy students on vitamin D was generally better than that of engineering students particularly with questions on technical parameters of vitamin D levels and dosage. Students who took vitamin D test were advised by a physician. Most of the students from both colleges have a positive attitude to receive information on vitamin D through brochures, lectures/seminars and workshops.Conclusions: Awareness of non-health sciences and to some extent of pharmacy students seems to be inadequate and efforts are needed to increase awareness of the public in general of the importance of vitamin to health status

Simplicial Flat Norm with Scale

We study the multiscale simplicial flat norm (MSFN) problem, which computes flat norm at various scales of sets defined as oriented subcomplexes of finite simplicial complexes in arbitrary dimensions. We show that the multiscale simplicial flat norm is NP-complete when homology is defined over integers. We cast the multiscale simplicial flat norm as an instance of integer linear optimization. Following recent results on related problems, the multiscale simplicial flat norm integer program can be solved in polynomial time by solving its linear programming relaxation, when the simplicial complex satisfies a simple topological condition (absence of relative torsion). Our most significant contribution is the simplicial deformation theorem, which states that one may approximate a general current with a simplicial current while bounding the expansion of its mass. We present explicit bounds on the quality of this approximation, which indicate that the simplicial current gets closer to the original current as we make the simplicial complex finer. The multiscale simplicial flat norm opens up the possibilities of using flat norm to denoise or extract scale information of large data sets in arbitrary dimensions. On the other hand, it allows one to employ the large body of algorithmic results on simplicial complexes to address more general problems related to currents.Comment: To appear in the Journal of Computational Geometry. Since the last version, the section comparing our bounds to Sullivan's has been expanded. In particular, we show that our bounds are uniformly better in the case of boundaries and less sensitive to simplicial irregularit

Examining the Export-Led Growth Hypothesis: Empirical Evidence from Sudan

The current study analyzes the relationship between Sudan's income growth and exports from 1970 to 2020. The system of equations using the Autoregressive Distributed Lag (ARDL) approach has been employed. The ARDL results showed that there exists a long-run relationship between the variables considered in the estimated model. The researchers observed a negative lagged error-correction term coefficient, which is highly significant in all cases supporting cointegration. The result reveals the existence of a long-run equilibrium relationship between GDP, export, import, labor force, and trade policy. This confirms that the export-led growth hypothesis is valid for Sudan. Thus, the most essential conclusion is that the economy’s export expansion strategy is completely dependent on the imports of raw materials and capital inputs and the kind of goods being exported. The coefficient of import is of significance, which offers strong support for the import compression hypothesis. The most important policy implication of the findings is the implementation of an appropriate and optimal approach that can boost exports to increase economic growth substantially. Policy-makers should focus on export diversification strategies and invest more in Sudan’s ability to provide value-added services to meet international export demand

Flat Norm Decomposition of Integral Currents

Currents represent generalized surfaces studied in geometric measure theory. They range from relatively tame integral currents representing oriented compact manifolds with boundary and integer multiplicities, to arbitrary elements of the dual space of differential forms. The flat norm provides a natural distance in the space of currents, and works by decomposing a $d$-dimensional current into $d$- and (the boundary of) $(d+1)$-dimensional pieces in an optimal way. Given an integral current, can we expect its flat norm decomposition to be integral as well? This is not known in general, except in the case of $d$-currents that are boundaries of $(d+1)$-currents in $\mathbb{R}^{d+1}$ (following results from a corresponding problem on the $L^1$ total variation ($L^1$TV) of functionals). On the other hand, for a discretized flat norm on a finite simplicial complex, the analogous statement holds even when the inputs are not boundaries. This simplicial version relies on the total unimodularity of the boundary matrix of the simplicial complex -- a result distinct from the $L^1$TV approach. We develop an analysis framework that extends the result in the simplicial setting to one for $d$-currents in $\mathbb{R}^{d+1}$, provided a suitable triangulation result holds. In $\mathbb{R}^2$, we use a triangulation result of Shewchuk (bounding both the size and location of small angles), and apply the framework to show that the discrete result implies the continuous result for $1$-currents in $\mathbb{R}^2$.Comment: 17 pages, adds some related work and application

Klebsiella pneumoniae: a case report of pneumonia and cephalosporins resistant clinical isolate

Background: Klebsiella pneumoniae (K. pneumoniae) is a Gram-negative bacterium that causes respiratory, urinary tract and blood stream infections associated with community and nosocomial infections with serious health implications. Objective: The study aimed to determine the management response of the patient, from the empirical stage until discharge. Also to identify the aetiology and evaluate antimicrobial susceptibility profile of the isolate. Case management and methods: A case of a 55-year-old-male patient with pneumonia-like symptoms, who presented to Sheikh Muhammad Jidda Specialist Hospital, Kano, Nigeria. The patient was empirically administered with ceftazidime antibiotic, resulting in mild irritation as a symptom of side effects, with no positive response from the patient. Later, the treatment was reviewed to maxipime (1g/50 mL) infusion, which was parenterally administered twice daily for 10 days. The symptoms completely resolved, and the patient fully recovered and was discharged on day 15. Routine and specific bacteriological investigations were conducted to establish the aetiology. A positive string test was conducted on the isolate for the detection of hypermucoviscosity. A polymerase chain reaction (PCR) assay was performed to detect the rmpA gene associated with hypermucoviscosity that causes hypervirulence. Results: Results showed that K. pneumoniae was the causative agent with resistance to generations of cephalosporins (second and third). The therapy was successful using maxipime, a fourth-generation cephalosporin (cefepime). The findings indicated that the isolate is multidrug-resistant. The formation of a viscous filament ≥5 mm, confirmed the hypermucoviscosity of the isolate. PCR gel electrophoresis results of the amplified rmpA gene showed ~600 bp band size and was confirmed by DNA sequencing. Conclusion: The use of maxipime as antibiotic therapy for the treatment of the patient with pneumonia infection was successful. The isolate was resistant to second and third-generation cephalosporins. It is important to achieve accurate and prompt identification of such resistant and virulent strains to avoid community-based spread

Analysis of power losses and Lifetime for the inverter in electric Vehicles using variable voltage Control and variable switching Frequency modified pwm

With the increasing demand for reduced emissions and improved fuel economy, the automakers are focusing on the development of electric vehicles (EVs). The performance requirements for EVs includes high driving range and long life of its components. The power converters are among the most stressed and less reliable EV drivetrain components. Hence, improving the lifetime of the power converters is essential for the success of EV adoption. The lifetime of the power converters can be improved by reducing thermal stress of the power devices, which represents the main cause of failure. Since the temperature and power losses of the power device are proportional, thermal stress can be reduced by minimizing the power losses. In addition to the lifetime improvement, minimizing the power losses of the power converters can extend the EV range since the power demand under a given loading conditions is reduced. In this regard, this thesis aims to study the impact of an existing power loss reduction technique known as variable dc-bus voltage control (VVC) on the inverter lifetime. In addition, it proposes a new pulse width modulation (PWM) strategy called variable switching frequency modified PWM (VSF-MPWM) for three-phase two level voltage source inverter. The VSF-MPWM aims to minimize the inverter power losses, but without sacrificing the output current quality. In order to study the impact of the VVC on the inverter lifetime, a lifetime estimation method is first presented. This method uses the Artemis urban and US06 driving cycles in order to obtain the thermal loading, and consequently the lifetime consumption of the inverter power devices. Then, the VSF-MPWM is proposed, which minimizes the switching loss by clamping any of the three-phase legs at the phase current peak and by reducing the number of commutations through variable switching frequency. However, in order to achieve an acceptable current quality, the proposed VSF-MPWM controls both the clamping period and the switching frequency according to the current quality constraints of the conventional PWM strategy. The impact of the VVC on the inverter lifetime and the performance of the proposed VSF-MPWM on the inverter power losses and current quality are investigated through MATLAB Simulink. The lifetime analysis reveals that the VVC has the ability to improve the lifetime of the inverter by a factor of 5.06 and 3.43 under Artemis urban and US06 driving cycles, respectively, compared to the conventional constant dc-bus voltage control (CVC). On the other hand, the simulation result shows that the proposed VSF-MPWM can save up to 35.4 % and 23.8 % of switching and power losses, respectively, compared to the conventional PWM. Meanwhile, the VSF-MPWM can obtain the same output current quality as that of the conventional PWM