Analysis of Fluid-structure Interaction for a Submerged Floating Tunnel

Abstract The behavior of a submerged floating tunnel (SFT) exposed to a water current of variable velocity is investigated through complex numerical analyses based on the Computational Fluid Dynamics (CFD) and the Finite Element Method (FEM) implemented in the ABAQUS code. An accurate modelling of turbulent phenomena is made, based on both Implicit Large Eddy Simulation and the RANS-based Spalart-Allmaras model, followed by a co-simulation procedure in which the fluid dynamics and the structural analysis are carried out separately and interfaced with each other. Circular and elliptical cross sections are considered, each of them fitted for combined railway and motorway services. The analysis is carried out in both static and dynamic way, by varying the current velocity with a given value of the residual buoyancy of the tunnel. The results emphasize the effect of the main parameters investigated, evidencing the great potentials of the adopted calculation tool for carrying out further investigations aimed at achieving useful elements for the design and optimization of the SFT

EVALUATION OF RATIONAL USE OF ANTIBIOTIC DRUGS IN SURGERY DEPARTMENT AT A TERTIARY CARE HOSPITAL

Objective: Antibiotics are the only drug where use in one patient can impact the effectiveness in another, so antibiotic misuse adversely impacts the patients and society. Improving antibiotic use improves patient outcomes and saves money. Antibiotic resistance has been identified as a major threat by the WHO due to the lack of development of new antibiotics and the increasing infections caused by multidrug resistance pathogens became untreatable. Methods: A prospective observational study was conducted for a period of 6 months. Data were collected from prescriptions and inpatient record files at the surgery department of the tertiary care hospital. Patients above age of 18 years of either gender whose prescription containing the antibiotics and patients who are willing to participate in the study were included in the study. Microsoft Excel was used for recording and analyzing the data of recruited subjects. Results: During our study period, we have collected 100 cases as per inclusion criteria, in total collected 100 cases, 52% are male and 48% are female. The mean age and standard deviation of the study population were found to be 46.61±16.12. The most commonly prescribed classification before and after the surgery is cephalosporin’s that is 57%. Results show that in pre-surgery, almost 93% of prescriptions have chosen the drugs as per ASHP guidelines, whereas in post-surgery, 95% of drugs have selected the drug as per ASHP guidelines. Conclusion: Our study has observed that some of the prescriptions are irrationally prescribed so the pharmacist has to take the responsibility to improve the awareness regarding rational prescribing of antibiotics. The national wide monitoring of antibiotics use, national schemes to obtain rational use of antibiotics, reassessing the prescriptions, education to practitioners, and surveys on antibiotics should be implemented

Clinical, magnetic resonance imaging, and histopathologic features of a hypoglossal malignant peripheral nerve sheath tumor in a maltese dog

Malignant tumours arising from peripheral nerves or displaying differentiation along the lines of the various elements of the nerve sheath are collectively referred to as MPNSTs. Histologically, in human MPNST, the malignant nature of these tumours is associated with an infiltrative and cellular proliferation of atypical, mitotically active spindle cells. Their predilection for sites varies with the species. In dogs the most common site for MPNST is the nerve roots or nerves of the brachial plexus, while the cranial nerve more frequently involved is the trigeminal nerve. In humans, hypoglossal peripheral nerve sheath tumours are rare, only few cases are described in literature; and the malignant forms are even exceptional. Fifty per cent of cases displayed both an intra- and extracrania component, and are referred as dumbbell-shaped tumours. To our knowledge this is the first case report an hypoglossal MPNST in a dog. In our case the tumour was dumbbell-shaped, with both intra-and extracranial components and associated with characteristic clinical signs of hypoglossal tumour. The malignant histological appearance of the lesion occurred without infiltrative growth

Observed Gender Differences in African American Mother‐Child Relationships and Child Behavior

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90334/1/j.1741-3729.2011.00688.x.pd

Clinical, magnetic resonance imaging, and histopathologic features of hypothalamic neuronal hamartoma in a young vizsla

Hypothalamic hamartomas (HH) are rare, tumor-like malformations thatoccurduring fetal development and are present at birth. They differ from neoplasms since they are not autonomous and they grow in proportion to normal brain growth, and consequently their relative size to the rest of the brain is the same for the lifetime of the patient. Hamartomas are non-progressive lesions and do not expand, spread or metastasize to other locations. In canine nervous system, vascular, neuronal and peripheral nerve fibers hamartomas have been described; to our knowledge, this is the first report describing the MRI features of a hypothalamic neuronal hamartoma in a dog

A homozygous missense variant in laminin subunit beta 1 as candidate causal mutation of hemifacial microsomia in Romagnola cattle

Hemifacial microsomia (HFM) was diagnosed in a 9-day-old Romagnola calf. The condition was characterized by microtia of the left ear, anotia of the right ear, asymmetry of the face, and deafness. Magnetic resonance imaging revealed agenesis of the right pinna and both tympanic bullae, asymmetry of the temporal bones and temporomandibular joints, and right pontine meningocele. Brainstem auditory evoked responses confirmed the impaired auditory capacity. At gross post mortem examination, there was agenesis and hypoplasia of the right and the left external ear, respectively. No histological abnormalities were detected in the inner ears. A trio whole-genome sequencing approach was carried out and identified a private homozygous missense variant in LAMB1 affecting a conserved residue (p.Arg668Cys). Genotyping of 221 Romagnola bulls revealed a carrier prevalence <2%. This represents a report of a LAMB1-related autosomal recessive inherited disorder in domestic animals and adds LAMB1 to the candidate genes for HFM

Lost to follow up and clinical outcomes of HIV adult patients on antiretroviral therapy in care and treatment centres in Tanga City, north-eastern Tanzania

Scaling up of Antiretroviral (ARV) drugs is crucial and should be a perpetual venture in developing countries in-order to increase the survival period of HIV/AIDS individuals. In Tanzania, information on the rate of patients considered as lost to follow up during treatment with ARVs is scarce. The objective of this study was to determine the rate of lost to follow up and treatment outcome among patients attending two care and treatment clinics (CTCs) in Tanga City in north-eastern Tanzania. A descriptive observational study was carried out on cohorts from Tanga AIDS Working Group and Bombo Regional Hospital. The total number of patients identified as “lost to follow up” were 89 of which 14 (15.7%) died. Among those who died, 3 (21.4%) died between the second week and 3 months after ARV initiation. Of those still alive (84.3%; 75/89), 25% (19/75) were still on ARVs, whereas 47 (62.7%) self transferred to other CTCs. Proper patient documentation with actual residence address is a crucial aspect for adherence. Similarly, frequent prompt tracing of patient should be part of any drug interventional programme linking   facility and communities

Acceptability of malaria rapid diagnostic tests administered by village health workers in Pangani District, North eastern Tanzania.

BACKGROUND: Malaria continues to top the list of the ten most threatening diseases to child survival in Tanzania. The country has a functional policy for appropriate case management of malaria with rapid diagnostic tests (RDTs) from hospital level all the way to dispensaries, which are the first points of healthcare services in the national referral system. However, access to these health services in Tanzania is limited, especially in rural areas. Formalization of trained village health workers (VHWs) can strengthen and extend the scope of public health services, including diagnosis and management of uncomplicated malaria in resource-constrained settings. Despite long experience with VHWs in various health interventions, Tanzania has not yet formalized its involvement in malaria case management. This study presents evidence on acceptability of RDTs used by VHWs in rural northeastern Tanzania. METHODS: A cross-sectional study using quantitative and qualitative approaches was conducted between March and May 2012 in Pangani district, northeastern Tanzania, on community perceptions, practices and acceptance of RDTs used by VHWs. RESULTS: Among 346 caregivers of children under 5 years old, no evidence was found of differences in awareness of HIV rapid diagnostic tests and RDTs (54 vs. 46 %, p = 0.134). Of all respondents, 92 % expressed trust in RDT results, 96 % reported readiness to accept RDTs by VHWs, while 92 % expressed willingness to contribute towards the cost of RDTs used by VHWs. Qualitative results matched positive perceptions, attitudes and acceptance of mothers towards the use of RDTs by VHWs reported in the household surveys. Appropriate training, reliable supplies, affordability and close supervision emerged as important recommendations for implementation of RDTs by VHWs. CONCLUSION: RDTs implemented by VHWs are acceptable to rural communities in northeastern Tanzania. While families are willing to contribute towards costs of sustaining these services, policy decisions for scaling-up will need to consider the available and innovative lessons for successful universally accessible and acceptable services in keeping with national health policy and sustainable development goals

Supply chain management of laboratory supportive services and its potential implications on the quality of HIV diagnostic services in Tanzania

Background: Reliable supply of laboratory supportive services contributes significantly to the quality of HIV diagnostic services. This study assessed the status of supply chain management of laboratory supportive services and its potential implications on the quality of HIV diagnostic services in selected districts of Tanzania.Methods: The study was conducted in 39 health facilities (HFs) from eight districts in four regions of Tanzania, namely Iringa, Mtwara, Tabora and Tanga. Facilities with care and treatment centres for HIV/AIDS patients were purposively selected for the study. The study utilized a quantitative method of data collection. A questionnaire was administered to heads of laboratories to obtain information on laboratory supply chain management.Results:  A total of 39 health facilities (HF) were included in the study. This included 23 public and 16 private facilities. In 82% of the HFs, ordering of supplies was performed by the laboratory departments. The information commonly used to forecast requirements of the laboratories included the number of tests done (74.4%; n=29), current stock levels (69.2%; n=27), average monthly consumption (64.1%, n=25) and minimum and maximum stock levels (10.2%, n=4). Emergency orders were significantly common in public than private facilities (73.9% vs. 56.3%, p=0.004).  Delivery of ordered supplies took 1 to 180 days with a significantly longer period for public than private facilities (32.5 vs. 13.1 days, p=0.044). Most of the public HFs ordered supplies from diverse sources compared to private facilities (68.2% vs. 31.8%).Conclusion: There was a weak inventory management system and delays in delivery of supplies in the majority of HFs, which are likely to impede quality of HIV care and treatment. Strengthening capacity for data management and ensure constant supply will potentially improve the quality of HIV diagnostic services