1,104 research outputs found

    Cancer pain managment: experience of 702 consecutive cases in a teaching hospital in Hong Kong

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    Effective pain control is essential in the management of patients with cancer. We present here our experience in the management of 702 patients with cancer pain by the Pain Management Team, Department of Anaesthesiology, Queen Mary Hospital. Patients were discharged from the Pain Management Team with a visual analogue scale of pain (VAS) less than 3 in 87.7% of cases, and more than 90% of patients had improved appetite and sleep on discharge. These promising results were achieved through an emphasis on comfort and function, close liaison among clinicians from different specialties, and a variety of analgesic modalities. Oral drugs remained the mainstay of treatment, supplemented by alternative routes of drug administration such as subcutaneous, intravenous and transdermal delivery. Main side effects observed included nausea (16%) and constipation (8%). Neural blockade, including coeliac plexus blockade, and intercostal nerve blockade, and administration of opioids via subarachnoid or epidural routes were also employed in selected patients.published_or_final_versio

    A state-of-the-art review on theory and engineering applications of eigenvalue and eigenvector derivatives

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    Eigenvalue and eigenvector derivatives with respect to system design variables and their applications have been and continue to be one of the core issues in the design, control and identification of practical engineering systems. Many different numerical methods have been developed to compute accurately and efficiently these required derivatives from which, a wide range of successful applications have been established. This paper reviews and examines these methods of computing eigenderivatives for undamped, viscously damped, nonviscously damped, fractional and nonlinear vibration systems, as well as defective systems, for both distinct and repeated eigenvalues. The underlying mathematical relationships among these methods are discussed, together with new theoretical developments. Major important applications of eigenderivatives to finite element model updating, structural design and modification prediction, performance optimization of structures and systems, optimal control system design, damage detection and fault diagnosis, as well as turbine bladed disk vibrations are examined. Existing difficulties are identified and measures are proposed to rectify them. Various examples are given to demonstrate the key theoretical concepts and major practical applications of concern. Potential further research challenges are identified with the purpose of concentrating future research effort in the most fruitful directions.Ministry of Education (MOE)The first and third authors gratefully acknowledge the financial support from the Singapore Ministry of Education through the award of research project grant AcRF Tier 1 RG183/17

    A Mobile App Platform for Discovering Learning Profiles and Analytics

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    Exploring Characteristics of Fine-Grained Behaviors of Learning Mathematics in Tablet-Based E-Learning Activities

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    Attributes of teaching and learning contexts provide rich information about how students participate in learning activities. By tracking and analyzing snapshots of these attributes captured continuously throughout the duration of the learning activities, teachers can identify individual students who need special attention and apply different pedagogical actions to them. This paper describes the results of the work-in-progress study in exploring characteristics of fine-grained behaviors of learning mathematics in tablet-based e-learning activities. An experimental platform called SkyApp is built. Through SkyApp, teachers can create e-learning activities and track learning records of students after the delivery of the activities. SkyApp supports capturing, storing and analyzing of fine-grained behaviors of students. Pilot tests have been done in two primary schools for eight months. The review of the tests demonstrates the potential in performing learning analytics. By applying clustering algorithms on multiple learning metrics of marks, time and number of attempts for students in solving mathematics questions, classification of students by learning characteristics of performance and engagement can be formulated. [For the complete proceedings, see ED579335.]published_or_final_versio

    Epidemiological and Evolutionary Dynamics of Influenza B Viruses in Malaysia, 2012-2014

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    Epidemiological and evolutionary dynamics of influenza B Victoria and Yamagata lineages remained poorly understood in the tropical Southeast Asia region, despite causing seasonal outbreaks worldwide. From 2012-2014, nasopharyngeal swab samples collected from outpatients experiencing acute upper respiratory tract infection symptoms in Kuala Lumpur, Malaysia, were screened for influenza viruses using a multiplex RT-PCR assay. Among 2,010/3,935 (51.1%) patients infected with at least one respiratory virus, 287 (14.3%) and 183 (9.1%) samples were tested positive for influenza A and B viruses, respectively. Influenza-positive cases correlate significantly with meteorological factors-total amount of rainfall, relative humidity, number of rain days, ground temperature and particulate matter (PM10). Phylogenetic reconstruction of haemagglutinin (HA) gene from 168 influenza B viruses grouped them into Yamagata Clade 3 (65, 38.7%), Yamagata Clade 2 (48, 28.6%) and Victoria Clade 1 (55, 32.7%). With neuraminidase (NA) phylogeny, 30 intra-clade (29 within Yamagata Clade 3, 1 within Victoria Clade 1) and 1 inter-clade (Yamagata Clade 2-HA/Yamagata Clade 3-NA) reassortants were identified. Study of virus temporal dynamics revealed a lineage shift from Victoria to Yamagata (2012-2013), and a clade shift from Yamagata Clade 2 to Clade 3 (2013-2014). Yamagata Clade 3 predominating in 2014 consisted of intra-clade reassortants that were closely related to a recent WHO vaccine candidate strain (B/Phuket/3073/2013), with the reassortment event occurred approximately 2 years ago based on Bayesian molecular clock estimation. Malaysian Victoria Clade 1 viruses carried H274Y substitution in the active site of neuraminidase, which confers resistance to oseltamivir. Statistical analyses on clinical and demographic data showed Yamagata-infected patients were older and more likely to experience headache while Victoria-infected patients were more likely to experience nasal congestion and sore throat. This study describes the evolution of influenza B viruses in Malaysia and highlights the importance of continuous surveillance for better vaccination policy in this region.published_or_final_versio

    Biodiesel sustainability: The global impact of potential biodiesel production on the energy–water–food (EWF) nexus

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    A data-driven model is used to analyse the global effects of biodiesel on the energy–water–food (EWF) nexus, and to understand the complex environmental correlation. Several criteria to measure the sustainability of biodiesel and four main limiting factors for biodiesel production are discussed in this paper. The limiting factors includes water stress, food stress, feedstock quantity and crude oil price. The 155-country model covers crude oil prices ranging from USD10/bbl to USD160/bbl, biodiesel refinery costs ranging from -USD0.30/L to USD0.30/L and 45 multi-generation biodiesel feedstocks. The model is capable of ascertaining changes arising from biodiesel adoption in terms of light-duty diesel engine emissions (NO, CO, UHC and smoke opacity), water stress index (WSI), dietary energy supply (DES), Herfindahl–Hirschman index (HHI) and short-term energy security. With the addition of potential biodiesel production, the renewable energy sector of global primary energy profile can increase by 0.43%, with maximum increment up to 10.97% for Malaysia. At current crude oil price of USD75/bbl and refinery cost of USD0.1/L, only Benin, Ireland and Togo can produce biodiesel profitably. The model also shows that water requirement varies non-linearly with multi-feedstock biodiesel production as blending ratio increases. Out of the 155 countries, biodiesel production is limited by feedstock quantity for 82 countries, 47 are limited by crude oil price, 20 by water stress and 6 by food stress. The results provide insights for governments to set up environmental policy guidelines, in implementing biodiesel technology as a cleaner alternative to diesel

    Mitochondrial alterations in children with chronic liver disease

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    Background: Over recent years it has become apparent that the hepatocyte mitochondrion functions both as a cause and as a target of liver injury. Resultant dysfunction of mitochondria yields deficient oxidative phosphorylation, increased generation of reactive oxygen species, impairment of other metabolic pathways and activation of both necrotic and apoptotic pathways of cellular death.Methods: This study was conducted on 26 children and adolescents with chronic liver disease who presented to or were following up in the Pediatric Hepatology Clinic, Children’s Hospital, Ain-Shams University. They were divided into three groups according to the aetiology of liver disease (GI=patients with Wilson’s disease (WD), GII=patients with chronic hepatitis C, GIII=patients with chronic liver disease other thanWilson’s and chronic hepatitis C).Ultrasound-guided gun liver biopsies were performed, under local anaesthesia for all the 26 patients, using a modified 18-gauge truecut needle. Two liver biopsy cores were taken from each patient. One for light and electron microscopic examinations and the other was immediately immersed in liquid nitrogen to be frozen and used forstudying mitochondrial DNA deletions by PCR.Results: Liver steatosis was higher in the group of patients with Wilson’s disease and other liver disease. Electron microscopic examination of the mitochondria revealed significant mitochondrial pleomorphism in patients with Wilson’s disease and patients with chronic hepatitis C infection. Enlarged mitochondria were found to bemore prevalent among patients with chronic  hepatitis infection.Three of our patients (11.53%) had mitochondrial DNA deletions. We developed scoring system for mitochondrial affection in our patients, 7 patients (32%) were considered to have mild mitochondrial affection,9 patients (41%) had moderate mitochondrial affection, while 6 patients (27%) had severe mitochondrial affection. Four of the studied patients had no mitochondrial affection.Conclusion: Mitochondria affection is common in chronic liver disease. This mitochondrial affection might be responsible for some of the chronic liver disease manifestation such as easy fatiguability and steatosis

    Effect of multimorbidity on utilisation and out-of-pocket expenditure in Indonesia: quantile regression analysis

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    Background Multimorbidity (the presence of two or more non-communicable diseases) is a major growing challenge for many low-income and middle-income countries (LMICs). Yet, its effects on health care costs and financial burden for patients have not been adequately studied. This study investigates the effect of multimorbidity across the different percentiles of healthcare utilisation and out-of-pocket expenditure (OOPE). Methods We conducted a secondary data analysis of the 2014/2015 Indonesian Family Life Survey (IFLS-5), which included 13,798 respondents aged ≥40 years. Poisson regression was used to assess the association between sociodemographic characteristics and the total number of non-communicable diseases (NCDs), while multivariate logistic regression and quantile regression analysis was used to estimate the associations between multimorbidity, health service use and OOPE. Results Overall, 20.8% of total participants had two or more NCDs in 2014/2015. The number of NCDs was associated with higher healthcare utilisation (coefficient 0.11, 95% CI 0.07–0.14 for outpatient care and coefficient 0.09 (95% CI 0.02–0.16 for inpatient care) and higher four-weekly OOPE (coefficient 27.0, 95% CI 11.4–42.7). The quantile regression results indicated that the marginal effect of having three or more NCDs on the absolute amount of four-weekly OOPE was smaller for the lower percentiles (at the 25th percentile, coefficient 1.0, 95% CI 0.5–1.5) but more pronounced for the higher percentile of out-of-pocket spending distribution (at the 90th percentile, coefficient 31.0, 95% CI 15.9–46.2). Conclusion Multimorbidity is positively correlated with health service utilisation and OOPE and has a significant effect, especially among those in the upper tail of the utilisation/costs distribution. Health financing strategies are urgently required to meet the needs of patients with multimorbidity, particularly for vulnerable groups that have a higher level of health care utilisation
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