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As embedded applications are subject to non-functional requirements (latency, safety, reliability, etc.) they require special care when it comes to providing assurances. Traditionally, these systems are quite static in their software and hardware composition. However, there is an increasing interest in enabling adaptivity and autonomy in embedded systems that cannot be satisfied with preprogrammed adaptations any more. Instead, it requires automated software composition in conjunction with model-based analyses that must adhere to requirements and constraints from various viewpoints. A major challenge in this matter is that embedded systems are subject to emergent constraints which are affected by inter-dependent properties resulting from the software composition and platform configuration. As these properties typically require an in-depth evaluation by complex analyses, a holistic formulation of parameters and their constraints is not applicable. We present a compositional framework for model-based integration of component-based embedded systems. The framework provides a structured approach to perform operations on a cross-layer model for model enrichment, synthesis and analysis. It thereby provides the overarching mechanisms to combine existing models, analyses and reasoning. Furthermore, it automates integration decisions and enables an iterative exploration of feasible system compositions. We demonstrate the applicability of this framework on a case study of a stereo-vision robot that uses a component-based operating system.

Összefoglaló. Bevezetés: Magyarországon 100 000 olyan értelmi sérült él, akik speciális ellátásra szorulnak. Előzőleg beszámoltunk az akut fogászati ellátás eredményeiről és problémáiról. Ahhoz azonban, hogy a teljes fogászati rehabilitáció felé lépéseket lehessen tenni, ismerni kell az ilyen betegek fogászati állapotát. Célkitűzés: Statisztikailag releváns, nagyobb beteganyagon felmérni az értelmi sérült betegek fogászati állapotát, összehasonlítva mind az orvosi rehabilitációs kezelésben részesülő betegek (főleg testi fogyatékosok), mind az általános populáció adataival. Módszer: A fogászati állapot felmérésére két betegcsoport állt rendelkezésünkre. Összesen 325 beteg statusát rögzítettük. A vizsgáltakat 3 csoportba osztottuk: enyhe (36), közepes (247) és súlyos (42) értelmi sérültek. Az értelmi sérült betegek fogászati állapotát DMF-T-indexszel mértük, és összehasonlítottuk az orvosi rehabilitációs kezelésben részesülő betegek és az általános populáció adataival is. Eredmények: A 325 szellemi sérült össz-DMF-T-indexének átlaga ± szórás: 11,04 ± 7,35; a carieses fogak számának átlaga: D = 3,66 ± 4,61; a hiányzó fogak számának átlaga: M = 5,22 ± 5,74. A fogmegtartó kezelés minimális volt: átlag F = 2,16 ± 3,12. Azoknak az értelmi sérülteknek, akik intézetben élnek, rosszabb a fogazati állapotuk, mint azoknak, akik családban vannak. Következtetések: Az eredményekből látszik, hogy az értelmi sérültek fogai elhanyagoltabbak, mint a normálpopuláció esetében. A DMF-T-index önmagában nem tükrözi ezeket a magállapításokat, csak akkor, ha szétbontva vizsgáljuk az adatokat. Orv Hetil. 2021; 162(42): 1698–1702. Summary. Introduction: There are 100,000 mentally disabled individuals in Hungary requiring special care. Previously, we reported the results and problems of acute dental care. However, in order to take the appropriate measures toward holistic dental rehabilitation, clarity regarding the condition of those mentally disabled individuals is necessary. Objective: To measure the dental health of mentally disabled individuals based on a large sample of patients, to compare the results with both differently-abled (i.e., primarily physically disabled) individuals and the general population. Methods: There were two available patient cohorts for the measurement of dental health. With the two cohorts combined, we recorded data about 325 patients. We split the patients into three groups: mild (36), medium (247), and severe (42) mental disability. We used DMF-T index to measure dental health status, and compared the results with those of physically disabled and the general population. Results: The mean ± deviation of DMF-T index of the disabled patients was 11.04 ± 7.35; the mean of decayed teeth: D = 3.66 ± 4.61; the missing teeth: M = 5.22 ± 5.74; the filled teeth: F = 2.16 ± 3.12. Mentally disabled patients living in institutions showed worse dental health than those living with families. Conclusions: The results show that the teeth of mentally disabled patients are more neglected than those of the general population. The DMF-T index does not mirror these conclusions unless we examine each data set separately. Orv Hetil. 2021; 162(42): 1698–1702.

Background: Dementia in late stages affects patients’ life like being dependent, malnourished, having psychological and sleep problems. Caregivers face physical, financial, medical, and psychological b urdens and are in need for support to complete caregiving responsibilities. Not all caregivers have the sufficient knowledge regarding how dementia affects the patients. Aim: To determine the burden of caregiving process on caregivers of moderate to severe and severe dementia patients, the type of support and knowledge that caregivers need during this process Methods: a cross -sectional study involving 101 caregivers of moderate to severe and severe dementia patients attending outpatient clinics and inpatien ts in Ain Shams University Hospitals. Demographic data of the patients and their caregivers were collected. A questionnaire was applied on caregivers including types of burden they experienced, types of support they needed and their knowledge about dementi a & its effect on patients’ life. Results: Most caregivers had different types of caregiving burdens. Ninety -eight percent (98%) of them had fear of future burden, 89% had physical& psychological burden and 69% had financial burden. Most caregivers needed support in caregiving. Eighty percent (80%) of them needed medical support, 59.4% needed physical support, 54.5% needed psychological support, 47.5% needed financial support, while only 8.9% needed social support. None of the caregivers had accurate previous knowledge about dementia. Ninety -three percent (93%) of caregivers predicted that dementia patients might need special care. Regarding dementia effect on patients, 88.1% of caregivers knew it had an effect on patients’ behavior, 74.3 % knew it affects s leep, 54.5% knew it affects safety, 53.5% agreed with its effect on patients’ activity and 48.5% knew it affects nutrition Conclusion: Caregiving of moderate to severe and severe dementia patients is associated with huge physical, psychological and financi al burdens. Most of the caregivers are in need of more support and knowledge to help them alleviate their burden and improve patients’ care and q uality of life

Protocol for a scoping review that aims to map the available evidence on existing or potential oral health models of care that explore the provision of co-located care among people with special needs.

AIMS Previous research has demonstrated that autistic individuals often experience difficulties accessing dental care, both as a result of autism specific difficulties and practitioners' attitudes towards autism. However, very little research exists that explores dental professionals' experiences of providing care to their autistic patients. The aim of this study was to investigate the strategies UK-based dental professionals' use when working with autistic patients METHODS AND RESULTS: In this study, dental professionals (n = 16) from a variety of specialty roles (special care, paediatrics, orthodontics) were interviewed. We asked participants to talk through, in depth, specific cases they had encountered in their practice, what sorts of accommodations they had provided, and what concerns had arisen during appointments. Thematic analysis was used to analyses the data and revealed four main themes: the unique dental needs associated with being autistic, effective adaptations to practice, the crucial role of the caregiver, and the importance of specialist knowledge CONCLUSION: Recommendations for how dentists can improve the dental experiences of autistic patients can be drawn from the specialist dentists' responses in this study. These include involving autistic patients in decisions about their treatment and being flexible and willing to work with autistic patients and their caregivers.

Background: Low-cost care strategies can be implemented to avert the morbidity and mortality associated with hypother- mia in preterm neonates. Objective: To determine the effect of massage therapy on body temperature of preterm neonates. Methods: A quasi-experimental design was conducted among 72 preterm neonates at a level II special care nursery in Western Kenya. Neonates were recruited on the third day of life and followed up for 10 days. Neonates in the intervention group were massaged three times a day for 15 minutes. Body temperature was monitored and recorded before, during and after each therapy session. Neonates in the control group received routine care: temperature monitoring three times a day, feeding and diaper change. Results: Neonates who received massage had higher mean body temperature than the control group during therapy on day 6 (p = .019) and after therapy on day 6 (p = .017) and day 8 (p = .005). A comparison within massage group (before/during, during/after, before/after) showed an increase in mean body temperature during therapy compared to before therapy (p

Objective: Colorectal cancer (CRC) is ranked the second most common cancer diagnosed in both men and women in Jordan. This paper aims to explore the unmet supportive care needs (USCNs), and their predictors among Jordanian survivors with CRC. Methods: A cross-sectional descriptive correlational research design with a convenience sample of 180 patients with CRC was conducted. Participants completed the Supportive Care Needs Survey-Short Form 34. Results: Jordanian patients with CRC reported their highest perceived level of need in the information and psychological domains. Multiple linear regression revealed that income and the number of chemotherapy sessions were significant predictors in the physical and daily living domains. Age, type of surgical treatment, and type of clinical setting were significant predictors of USCN in the psychological, patient care and support, and the health system and information domains. Conclusions: The health-care systems should work to meet all the supportive care needs for patients with CRC, particularly the informational and psychological needs domains where patients express unmet needs. Special care should be given according to age, type of surgery, and the doses of chemotherapy received. This study further confirms a disparity in the care and support provided to Jordanian cancer patients with different health-care settings in the country.

Összefoglaló. A veleszületett szívbetegségek egyik gyakori formáját jelentő atrioventricularis septumdefektus korrekciós műtétjének kritikus pontja a közös atrioventricularis szájadék elválasztásával a mitralis billentyű kialakítása. A korrekció sikere számos anatómiai variáns függvénye, ezért nem lehet minden esetben a tökéletes anatómiai viszonyokat kialakítani. A fennmaradó billentyűstenosisok, regurgitatiók a későbbi életkorban progressziót mutatva olyan hemodinamikai kórképeket, keringési elégtelenséget okozhatnak, melyek további beavatkozásokat igényelhetnek. A mitralis billentyűnek az atrioventricularis septumdefektushoz társuló betegsége koraszülöttkortól aggkorig minden életkorban előfordul, más-más műtéti megoldást igényelve. A szerzők részletezik a különböző életkorokra vonatkozóan a napjainkban lehetséges és szükséges műtéti megoldásokat, sebészi kihívásokat. A mitralis billentyű műbillentyűre történő cseréjében a klasszikus sebészi megoldások mellett napjainkban új beavatkozásokként jelentős számban jelentkeznek a katéteres intervenciós és hibrid megoldások. A felnőttkort egyre nagyobb számban megélő betegek fokozott odafigyelést, speciális ellátást igényelnek a kardiológusoktól, szívsebészektől. Orv Hetil. 2021; 162(35): 1397–1401. Summary. The critical point of the atrioventricular septal defect correction is to separate the common atrioventricular orifice, which results in the reconstruction of the mitral valve. The success of the correction depends on many anatomical aspects, therefore a perfect anatomical outcome is not always possible. The remaining valvular stenoses and regurgitations, showing progression at a later age, may result in hemodynamic disorders and circulatory insufficiency that may require further interventions. Mitral valve disease associated with atrioventricular septal defect occurs at all ages from preterm to adulthood, requiring different surgical solutions. The authors detail the possible and necessary surgical solutions and surgical challenges at different ages. In addition to the classic surgical solutions, a significant number of catheter interventional and hybrid solutions are emerging as new interventions in the replacement of the mitral valve with an artificial valve. An increasing number of patients living in adulthood require increased attention and special care from cardiologists and cardiac surgeons. Orv Hetil. 2021; 162(35): 1397–1401.

Ativisha consists of the dried tuberous root of the aconitum heterophyllum wall. ex royle of ranunculaceae family. a perennial herb native and endemic to western himalayas. it is popular drug that is extensively used in ayurvedic pediatric medicine, specially used in respiratory disorders, fever, diarrhoea and vomiting in children. the fact that the suppliers of crude herbal materials are mostly traders having limited knowledge of their true identity. due to unavailability and high cost, they use their substitutes and adulterants in order to get more and more benefits. children's being more vulnerable, special care has to be taken in selecting the drugs. this paper includes preliminary pharmacognostical but very important aspects to ensure the standard and quality assurance of the raw drug of ativisha. preliminary comparative pharmacognostic study of genuine and adulterant raw material in ativisha. here the sample genuine ativisha with both small and big sized starch grains and taste is bitter followed by salivation in the mouth it may official ativisha. where the other sample with big starch grains with sweet taste may be an adulterated market sample sold under the name of ativisha.

This article highlights an alternative sedation technique by providing inhalation sedation with nitrous oxide and oxygen alongside intravenous sedation with midazolam as an additional option for patients within special care dentistry. Two case reports are described, as well as a short overview of the available literature on this technique and the indications, advantages and disadvantages. This technique should be considered alongside other sedation techniques. As with all treatment for which sedation is provided, each case needs to be considered on an individual basis and the most appropriate option selected following discussion with the patient. CPD/Clinical Relevance: Although single sedation techniques provide a good level of sedation to facilitate dental treatment for the majority of patients, it is desirable to have an awareness of alternative sedation options that may be available for patients.

حرصت الشريعة الإسلامية على رعاية أفراد المجتمع، والعناية بهم، والتعامل معهم حسب إمکاناتهم وطاقتهم، کما اعتنت الشريعة الإسلامية بذوي الاحتياجات الخاصة عناية خاصة، في عباداتهم، ومعاملاتهم، وتسيير أمورهم، وفي هذا الصدد جاءت هذه الدراسة لتلقي الضوء على الهدايات الشرعية في التعامل مع ذوي الاحتياجات الخاصة (العميان، والصم والبکم، وأصحاب الإعاقات الحرکية، والإعاقات العقلية)، وحرصت الدراسة على إبراز أهم الأمور التي جاءت في القرآن الکريم وفي السنة النبوية في التعامل مع هذه الفئة من المجتمع، وکيفية دمجهم والإفادة منهم بما لا يجرح مشاعرهم، وخلصت الدراسة إلى عظيم عناية الشريعة بهم، وأن ذوي الاحتياجات الخاصة جزء من المجتمع يتحمل مسؤوليته، ويؤدي دوره في الحياة على قدر استطاعته، مع أمثلة من الواقع لکثير من ذوي الاحتياجات الخاصة مما قص علينا القرآن الکريم أو السنة النبوية أخبارهم. Extracted: Islamic Sharia is keen to provide care to members of society, take care of them, and deal with them according to their capabilities and energies. Also, Islamic Sharia is taking special care of people with special needs, in their worship, dealings, and managing their affairs. Based on that, this study was found to focus on the Legitimate guidance to deal with individuals with special needs such as (blind, deaf, dumb, motor and mental disabilities). The study also shows the most important affairs that was mentioned in the Holy Quran and Sunnah in dealing with this special group of the society, integrate them and benefit from them in a way that does not hurt their feelings. In conclusion, Islamic Sharia provides great care for individuals with special needs. Those people are part of the society, who take responsibilitys, and play their role in life as much as they can. With many examples from reality that was taken from the Holy Quran and Sunnah. Keywords: Hedayat- Sharia- People With Special Pneeds- -Eople- Determination.

Purpose To improve outcomes of infants with neonatal abstinence syndrome (NAS) by implementing an evidence-based approach to care. Methods An interdisciplinary team developed and implemented an educational module about the elements and principles of trauma-informed care (TIC) and standardized education on NAS for mothers with substance use disorder (SUD). The team collaborated with community behavioral health professionals to secure the services of a certified recovery specialist. Primary outcome measures of average length of stay (LOS) and admissions to special care nursery (SCN) for NAS infants were analyzed. Results Following health care team education on TIC and implementation of the standardized NAS brochure, average LOS decreased significantly from 6.5 to 5.1 days from baseline period (January-December 2019) to the implementation period (February-June 2020; p = 0.03). There was no difference in SCN admission from the baseline period (February-June 2019) to the implementation period (February-June 2020). Referrals to certified recovery specialists did not change. Clinical implications Education on the impact of trauma on new mothers with SUD can promote collaboration between them and the neonatal team. Standardizing education for new mothers of infants with NAS can help to engage families of infants with NAS and improve clinical outcomes.

The article is devoted to the traditional food system of Azerbaijanis. It examines the technology of cooking national dishes, the place of the latter in the daily diet and ritual meals of Azerbaijanis. It is noted that in modern Azerbaijan, some of the rules of traditional food culture, etiquette, in particular when receiving national dishes and drinks, are observed mainly in family life. Today, national dishes are still used in everyday and festive meals. In the Mil-Mugan and Shirvan regions of Azerbaijan, table prayers are read before and after breakfast, lunch and dinner. The rules of etiquette provide special care and attention to the guest, elder, head of the family, children. For lunch and dinner, kebab, kalafur, pilaf, dolma, bozartma, etc. are specially prepared for the guest. The same national dishes were served on the Mavlid Holiday (in honor of the birth of the Prophet Muhammad) in the Mil-Mugan and Shirvan regions of Azerbaijan. The beneficial, healing properties of food are used in traditional medicine. Attention is drawn to the specifics of solemn meals, depending on the purposes of the ceremonies (mourning, wedding (engagement), family celebrations and folk holidays), as well as to the composition of dishes, the subtleties of the technology of their preparation for a large number of people. An extensive assortment of everyday, festive and ceremonial dishes, the degree of perfection of the rules of preparation, the traditional rules of table etiquette confirm the richness of the food culture of Azerbaijanis.

Objetivo: identificar e mapear as estratégias de enfrentamento e coping do estresse ocupacional utilizadas por profissionais de enfermagem no ambiente hospitalar. Método: trata-se de uma scoping review baseada nas recomendações do Joanna Briggs Institute. A coleta de dados ocorreu em junho de 2020, em bancos de dados que indexam artigos científicos, dissertações e teses. A análise ocorreu por estatística descritiva simples. Resultados: a amostra final foi constituída de 63 estudos, dos quais 49 (77,8%) correspondiam a artigos. As estratégias de enfrentamento do estresse ocupacional apresentadas nos estudos foram: coping ativo; autocuidado; Práticas Integrativas e Complementares; suporte social; capacitações; suporte organizacional; e estratégia negativa. Essas devem abarcar os níveis de prevenção primária, prevenção secundária e terciária. Conclusão: as estratégias de enfrentamento elencadas nos estudos contemplaram medidas que asseguram a redução de sobrecarga de trabalho; auxiliam o desenvolvimento de habilidades para lidar com o estresse; e elaborem programas de assistência especial.

Background: Given the special care needs of children with Chronic Kidney Disease and the key role of the family in providing these health services, the level of parental knowledge and awareness about their child’s disease status is essential. This study We aimed to determine the parental levelawareness level of awareness of parents with children with Chronic Kidney Disease in Ahvaz. Method: In this descriptive cross-sectional study, the census sampling method was used census. After completing demographic questionnaires and a researcher-made questionnaire, the level of parental knowledge and awareness was assessed in parents with children with Chronic Kidney Disease referred to Aboozar Hospital of Ahvaz. Results: The study involved 42 children with Chronic Kidney Disease and their parents. The mean±SD age of the children was 9.85 ±1.22 and the mean±SD duration of illness was 11.18 ± 9.38 months. Knowledge and awareness of parents were rated as 3 subjects (7.14%), 38 (90.4%), and 1 (2.3%) parentwith had poor Knowledge and awareness, 38 subjects (90.4%) as moderate, and 1 subject (2.3%) asggood knowledge and awareness, respectively. There was no significant difference in the level of knowledge and awareness between any of the studied demographic variables studied (P> 0.05). Except for occupation that there was only one employee and the average level of awareness was lower than that of housewives. (I don’t understand what you mean.) Conclusion: The results of this study showed that parents of children with Chronic Kidney Disease did not have a sufficient level of knowledge and awareness about their child care. So it seems necessary to provide training programs for this group.

Background: The advancements in intensive care in recent decades have enabled better survival of newborn. Knowledge of essential newborn care is important for the survival, growth, and development of a newborn. In spite of its essentiality, most health-care professionals do not know and follow the World Health Organization recommendation. Aim and objectives: The aim of this study was to assess the knowledge of nurses regarding essential newborn Care in Special Care Neonatal Units (SCANU). Materials and methods: This observational study was conducted among the nurses working in SCANU of Chattogram Medical College and Hospital, Chattogram Maa- O- Shishu Hospital and Bangabandu memorial hospital of University of Science and Technology, Chattogram (USTC) for 6 months. Purposive sampling technique were applied for selecting the sample. A structured data sheet was predesigned to collect data. Knowledge regarding Essential Newborn Care among the nurses graded as satisfactory or not satisfactory. Results: In this study it was observed that 69.0% nurses had completed diploma in nursing and midwife education, B. Sc in nursing 11.0%, diploma in nursing 7.0%. 56.0% nurses attended special courses/training in neonatology. 94.75% of the nurses had satisfactory knowledge regarding essential newborn care. 58.0% of nurses washed their hands with disinfectant solution before handling the baby, 99.0% mentioned that the baby must be breast feeding within 1st hour of delivery, 92.0% mentioned that baby must be fed 6 months of exclusive breast feed, 91.0% knew how to stabilize body temperature of low birth weight newborn. The knowledge regarding essential newborn care were almost similar with age, gender, religion, marital status, educational level, working place and attending special courses/training in neonatology. Conclusion: Most of the nurses working in SCANU of both Government and non-government hospitals of Chattogram have good knowledge regarding ENC. This knowledge appeared irrespective of their age, gender, religion, marital status, working place and special courses/training in neonatology. J Bangladesh Coll Phys Surg 2021; 39(3): 185-192

A group of society may have a child with excessive mobility activity different from the rest of the children, to find difficulty in dealing with him and control his unintended actions, which may make their parents not take him anywhere for fear of embarrassment caused by his actions resulting from his many movements without realizing and awareness that he is a different child and classified as a category with special needs, and that he needs special care and different from other healthy children and that his awareness and understanding is not like the rest of the children of his age, he and those like his condition are not Stupid as some parents and their teachers think at school, and they are not careless or stubborn, but on the contrary they may appear smart and creative in many situations. The appropriate internal design environment must be available in behavioral treatment centers that are compatible with the activities of hyperactivity disorders and distract attention to meet the behavioral, psychological and physical needs by taking into account the foundations and design considerations of these spaces, which affect the abilities, privacy and comfort of these children. The research aims to propose the criteria and foundations of successful internal design that are compatible with the activities of the category of hyperactivity disorders and distracting attention, to apply them to the study and analysis of the internal spaces of one of the treatment and behavioral centers in Saudi Arabia, which are in line with the continuing requirements of this category, through proposals to develop the architectural and internal design of functional spaces that can contribute to associations and centers related to the design of this type of behavioral therapeutic buildings for people with special needs of the category of hyperactivity disorders and distract environmentally proportional attention to their different needs, to reach results and recommendations that would elevate that important category of society.

The war between the Armagnacs and the Burgundians seen from Beveren The attempted assassination of John the Fearless in 1408, unknown to this day, was a retaliation for the murder of his rival Louis of Orleans in Paris the previous year. The hired killer, a Fleming, was captured and entrusted to the special care of Jean Le Chien, bailiff and steward of Beveren, in whom the duke of Burgundy placed deep confidence. The agressor was therefore executed at the castle of Beveren. Thus the effects of the war between Armagnacs and Burgundians were felt as far as Beveren, a seigneury located on the northeast border of the county of Flanders.

Globe prominence (proptosis) may be caused by a variety of congenital or acquired conditions and poses unique challenges to aesthetic and reconstructive surgery. Once the underlying cause of proptosis is determined, a treatment plan consisting of surgical and medical procedures can be formed. Thyroid eye disease is the most common cause of proptosis and helps guide treatment options for proptosis. Although common eyelid and orbital procedures are used for proptosis correction, special care must be taken due to the unique difficulties of the distorted anatomy. Various surgical procedures and less invasive treatments can be combined to provide optimal aesthetic and functional results.

The mother's struggle after giving birth takes a long time. One of them is to restore a fresher and more relaxed body shape.Because it cannot be denied, after birth the body will feel weak because of the energy released.The muscles that feel are usually tense, especially for women who give birth normally.This condition is of course intolerable, special care is needed to restore the mother's body to recovery.Solus Per Aqua (SPA) postpartum is one way to restore body shape.Solus Per Aqua (SPA) massage can be useful to improve blood circulation and restore the body to be firmer and make the body more comfortable and relaxed.This study aims to determine the Solus Per Aqua (SPA) Massage in mothers can reduce complaints during postpartum.The type of this research is quasi-experimental using a pretest and posttest design by treating the research subject.The samples in this study were 20 mothers who came to Mombykids from day 2 to 14.The sampling technique used simple random sampling.The variables in this study were spa massage and complaints during postpartum.Data collection was carried out using checklist and questionnaire.Data processing was performed using the "Wilcoxon" statistical test with a significance level of 0.05.The results of this study showed that complaints of mothers before spa massaging experienced complaints during the postpartum period including postpartum pain 25 %, non-smooth milk production 60%, stress 15%, and almost 75% of mothers felt relaxed / comfortable after spa massaging.This study concluded that there is a significant effect of spa massage in reducing complaints during the postpartum period.For the next researchers, because of the limitations in conducting this research, the variables were studied in general,it is expected that next research can expand the research into the variables studied, for example those related to uterine involution, lactation, or postpartum exercise and there may be new findings that need to be reexamined.

Family members of critically ill patients experience significant psychosocial changes during and after exposure to the critical care environment. During the critical care period, providers focus on the patient's critical condition and pay little attention to the family's needs, so they required special care. A cross-sectional design was used to collect data by using an online survey that includes sociodemographic questionnaire and Critical Care Family Needs Inventory. A total of 177 family members participated. Results indicated that the most important psychosocial need was assurance followed by information, comfort, and support. Nurses should identify these needs and help family members cope with the psychosocial aspects of care. Future research should focus on how these needs evolve over time as well as the effectiveness of related coping mechanisms.

Because of a lack of proper breastfeeding education to mothers and the visitation policy in the special care nursery, breastfeeding initiation and maintenance can be very challenging for both the mother and her infant who is admitted to the neonatal special care nursery after birth. Difficulties associated with forming initial bonds may contribute to some mothers changing their mind about their initially chosen feeding method. The aim of this quasi-experimental study was to evaluate the effectiveness of an e-learning breastfeeding program on maternal breastfeeding outcomes. Thirty-four mothers in the comparison group received routine care; 34 in the intervention group received an e-learning breastfeeding program and routine care. The program included 28 modules of different topics downloaded to a personal tablet computer. Each module elaborated on a breastfeeding issue and provided video clips to show practice steps. During the mothers' 3- to 5-day stay in the postpartum unit, they could repeatedly watch selected topics related to their situations at their own pace. After adjusting for each infant's birth weight, mothers in the intervention group had better attachment to their infants, greater perceived nurse support, and a higher exclusive breastfeeding rate than mothers in the comparison group. Using a tablet computer device to disseminate breastfeeding education is a feasible and supplemental method for postpartum mothers whose infants are in the special care nursery. Through the demonstrated situations, mothers are better prepared to understand their high-risk infants and the situations they may encounter during breastfeeding.

Zusammenfassung Hintergrund Die Qualitatssicherungs-Richtlinie Fruh- und Reifgeborene (QFR-RL) des Gemeinsamen Bundesausschusses fordert seit 2014 die Einhaltung fester Pflege-Schlussel in der neonatologischen Intensivmedizin. Dies stellt Personalplaner insbesondere von kleineren Krankenhausern oft vor erhebliche Schwierigkeiten, da es eines umfangreichen Personalpools zur Sicherstellung der Richtlinienkonformitat bedarf. Es bedarf daher verlasslicher Parameter, um die Personalplanung auf eine valide Grundlage zu stellen. Fragestellung Wie konnen die nach QFR-RL im Mittel notwendigen Soll-Pflege-Vollzeitaquivalente (VZA-Soll) innerhalb einer DRG sowie bezogen auf das Relativgewicht (VZA-Soll / RGa) rechnerisch bestimmt werden? Wie stellen sich diese im Vergleich zu realen Aufwanden im Krankenhaus (VZA-Ist) bzw. Planaufwanden gemas InEK-Kalkulation (VZA-Norm) dar? Methoden Eingeschlossen wurden alle Neugeborenen mit sehr geringem Geburtsgewicht unter 1.500 g (very low birth weight, VLBW), die im Zeitraum 08/2013 – 07/2018 behandelt wurden. Die Bestimmung der erforderlichen Soll-Pflege-Vollzeitaquivalente (VZA-Soll) erfolgte anhand von Schichten mit 1:1-, 1:2- und 1:4-Betreuung durch Zeiten invasiver und nichtinvasiver Beatmung sowie eines Geburtsgewichts von Ergebnisse 856 (50,1 % weiblich) VLBW wurden analysiert. Zwischen den verschiedenen DRGs variierten die erforderlichen Soll-Pflege-Vollzeitaquivalente (VZA-Soll) zwischen 0,02 (95%-Konfidenzintervall (KI) 0,02–0,02) und 1,16 VZA (95%-KI 0,96–1,37). Die Ergebnisse waren konsistent mit den realen Aufwanden (VZA-Ist) sowie den Planaufwanden gemas InEK-Kalkulation (VZA-Norm). Bezogen auf das Relativgewicht zeigte sich ein mittlerer Pflegeaufwand um 0,02 VZA / Relativgewichtspunkt (VZA-Soll / RGa). Schlussfolgerung Anhand des entwickelten Ansatzes kann mit vertretbarem Aufwand der mittlere Pflegebedarf innerhalb einer DRG in Anlehnung an die Vorgaben der QFR-RL ermittelt und fur eine prospektive Pflegepersonalplanung genutzt werden. Eine Uberprufung der schichtbezogenen Dokumentation ist vor dem Hintergrund des Regelungsinhalts der QFR-RL aktuell nicht moglich.

The protective rites of a newborn are an important part of neonatal care according to Ayurvedic principles. Similar to the organization of Special Care Neonatal Unit (SCNU) which is essential for reducing neonatal mortality and improving quality of life of survivors, Ayurveda advises meticulous organization of sutikagriha (the puerparial room) and kumaragara (the infant care room) along with rakshakarma (protective rites) for maintaining strict asepsis and providing a healthy environment to the mother and infant. An understanding of these protective rites and infant care room is mandatory to incorporate the Ayurvedic neonatal care into the modern neonatal care which is attempted in this paper. Relevant Ayurvedic treatises like Charaka Samhita, Susruta Samhita, Kasyapa Samhita, Ashtanga Sangraha and Ashtanga Hridaya were studied along with the guidelines by National Neonatology Forum of India for the setting up of a Special Care Neonatal Unit (SCNU). A comparison of the kumaragara and rakshakarma with Special Care Neonatal Units of modern neonatology reveals that highly recommended aseptic measures in the form of rakshas or amulets, dhupana or fumigation, vigil for graharoga or infectious diseases, etc. were followed in Ayurvedic nursing homes even before the advent of modern neonatology and construction and standard of care in a kumaragara is similar to that in an SCNU. There are a lot more principles to be adopted from Ayurveda for guiding future integrative medicine.

The use of electricity in transport is one of the great hopes in the fight against climate change. However, electric cars require significant amounts of lithium, an element which the world's largest reservoirs are in the Atacama Desert in northern Chile. The impact of mining in this area remains poorly recognized. Taking into account Atacama?s natural, cultural and scientific value, it is crucial to redefine the current assessment of the potential benefits and threats resulting from the exploitation of lithium deposits. The Atacama?s floristic, faunistic and geological values co-create an ecosystem sensitive to interference, which should be treated with special care under changing climate. Until now, however, politics and the economy have marginalized nature protection activities. Social awareness increase related to the lithium battery production should go hand in hand with the intensification of work on the wide use of compensation actions and increasing the recycling capacity of lithium batteries. Wykorzystanie energii elektrycznej w transporcie stanowi jedną z wielkich nadziei w walce ze zmianami klimatycznymi. Budowa samochodow elektrycznych wymaga jednak znacznych ilości litu, pierwiastka, ktorego najwieksze na świecie rezerwuary znajdują sie na pustyni Atakama w polnocnym Chile. Wplyw gornictwa na ten obszar pozostaje slabo udokumentowany. Biorąc pod uwage przyrodniczą, kulturową i naukową wartośc Atakamy nalezy zredefiniowac dotychczasowe podejście do potencjalnych korzyści i zagrozen wynikających z eksploatacji chilijskich zloz litu. Walory florystyczne, faunistyczne oraz geologiczne Atakamy wspoltworzą bowiem wrazliwy na ingerencje ekosystem, ktory w obliczu postepujących zmian klimatycznych powinien byc otoczony szczegolną troską. Do tej pory jednak polityka i gospodarka marginalizowaly dzialania związane z ochroną przyrody. Wzrost świadomości spolecznej związanej z procesem produkcji baterii litowych powinien iśc w parze z intensyfikacją prac nad szerokim zastosowaniem dzialan kompensacyjnych oraz zwiekszeniem mozliwości recyklingu baterii litowych.

Background: a system of reforming of psychiatric care in Russia has led to a reduction of beds in psychiatric hospitals. At the same time it is known about permanent high need among elderly patients in the appropriate psychiatric care. In this regard, it became necessary to study the adequacy of the assistance provided to the needs of patients.The aim of the research: to investigate and compare clinic-epidemiological characteristics of the contingent of the elderly and senile inpatients in the city psychiatric care system and at the research institution.Materials and methods: as a material for the research served data from the reports from Moscow Clinical Psychiatric Hospital #13 (MCPH #13) and the clinic of Mental Health Research Centre (MHRC) about the patients older than 65 treated in 2017–2018.The results: this article contains comparative data about contingents of elderly psychiatric in-patients treated in the Moscow City Clinical Psychiatric Hospital #13 and in the Mental Health Research Center (MHRC). Collation of the indicated contingents allowed to determine that city psychiatric care satisfactorily meets needs of the severe psychiatric patients older than 65. However the experience of the clinic of the MHRC differs. This clinic has some peculiarities: it does not use involuntary hospitalization and it gives preference to difficult cases, where diagnosis is unclear, and where there is a challenge to find an appropriate treatment regimen; patients that require special care are also rarely admitted. This experience indicates that there is significant number of cases when hospitalization of patients with moderate mental disorders is also absolutely necessary. The majority of such cases consists of patients, suffering with depression and the necessity of their admission is dictated by the impossibility to adjust proper therapy in out- patient care.Conclusion: the contemporary Moscow city psychiatric service do not meet needs of the discussed category of patients for inpatient care. Whether it is necessary to improve it, or to provide this niche to scientific and commercial institutions is a matter of further research.

PurposeThe purpose of the study is to assess the quality of life (QOL) of older adults and explore factors associated with it.Design/methodology/approachA cross-sectional study was conducted in a remote community in Nepal. A total of 671 older adults aged 60 years were enrolled in the study. QOL was measured by WHOQOL-OLD questionnaire. Data were analyzed using multiple logistic regression.FindingsMost participants were female (53.0%), illiterate (70.6%), married (64.2%) and living with family (59.3%). Among participants, 82.4% had fair QOL, and the autonomy domain received the lowest score (average = 10.98). After adjusting the model, the elderly aged Originality/valueThe five predictors – age, income sufficiency, depression, social support and healthcare service affordability – were found to significantly affect QOL. This study suggests special care strategies for vulnerable older adults addressing the issues that affect geriatric depression. This article provides relevant information to the government to consider increment of income, encourage family and community for social support and make health services affordable for older adults.

Autism is not a disease, but rather a spectrum disorder in the brain that causes autistic people cannot be completely cured. The best thing that can be done is to provide appropriate care to help people with autism adjust to their conditions, both therapeutically and educatively. Adequate facilities are urgently needed to develop and explore the potential that exists in every autistic person. The service facilities available at this time are still not good enough in terms of safety and comfort, and have not been able to meet the needs of people with autism to support their personal development activities. So that it is felt necessary to have a special Care Center for people with autism who are able to be a good and appropriate means of therapy and learning for people with autism to develop their abilities. This was realized by using the Human Centered Design (HCD) method and the concept of applying the principles of The Autism ASPECTSS Design Index to create a good and appropriate Autism Care Center, and in accordance with the characteristics and needs of people with autism.

espanolObjetivo: La biopsia es el estandar de oro para el diagnostico de lesiones bucales. El manejo y cuidado correctos de la biopsia durante todos los pasos (antes, durante y despues de obtener una biopsia) es muy importante para proporcionar muestras de tejido adecuadas para la evaluacion microscopica por parte de los patologos. Este estudio tuvo como objetivo evaluar y comparar los conocimientos de estudiantes de odontologia (SD) y dentistas generales (GD) sobre las instrucciones posteriores a la biopsia oral. Material y Metodos: Se utilizo un cuestionario que constaba de dos partes: 1) Datos demograficos y autoevaluacion del cono-cimiento de la biopsia por parte de los participantes y 2) 11 items sobre el correcto almacenamiento y trans-porte de la biopsia oral a un laboratorio de histopatologia. STATA analizo los datos recopilados de los cuestionarios.Resultados: 48 GD y 131 SD participaron en este estudio. La puntuacion de conocimiento de los DS (5,43 ± 2,01) fue significativamente menor que la de los GD (8,33 ± 1,78) (p EnglishObjective: Biopsy is the gold standard for the diagnosis of oral lesions. Correct management and care of biopsy at all steps (before, during and after obtaining a biopsy) is highly important to provide proper tissue samples for microscopic assessment by pathologists. This study aimed to assess and compare the knowledge of dental students (DSs) and general dentists (GDs) on post-oral biopsy instructions. Material and Methods: A questionnaire including two parts was used: 1) Demographic data and self-evaluation of biopsy knowledge by the participants and 2) 11 items about the correct oral biopsy storage and transport to a histopathology laboratory. The data collected from the questionnaires were analyzed by STATA. Results: 48 GDs and 131 DSs participated in this study. The knowledge score of the DSs (5.43±2.01) was significantly lower than GDs (8.33±1.78) (p

Placenta accreta spectrum (PAS) disorder is a serious condition that frequently requires special care in specialized centers. Migrant pregnant women face economic and social disadvantages that place them in situations of pervasive health disparities and, thus, poorer pregnancy outcomes can be expected.Describe the care of migrants without health insurance, affected by PAS and treated in a reference center for PAS.The institutional registry of PAS in a private Latin American center was reviewed in search of migrant patients, identifying three patients without health insurance, with PAS, referred outside the traditional administrative channels, in the context of an inter-institutional collaboration program.Migration imposes additional difficulties in the management of complex obstetric pathologies such as PAS. We recommend interinstitutional collaboration as a strategy to bring patients affected by PAS to experienced hospitals.

The skin of pretmature neonates require a special care as it is thin, the pH is low, and they lose more heat and water. Due to the increasing number of preterm births, the stable preterm babies get an early discharge early from the hospital. At home they require meticulous skin care for their survival and both father and mother are equally responsible for providing care to their preterm neonates. Henceforth it is essential to develop an evidence-based protocol and train both father and mother in the care of the preterm neonateTo develop a protocol and check its effectiveness in skill development of parents (father and mother) regarding skin care and oil massage of their preterm neonates admitted in Neonatal units, Nehru Hospital, PGIMER, ChandigarhNeonatal Nursery (NNN), Maternity ward, Nehru Hospital, PGIMER, Chandigarh. A quantitative research approach and operational design were selected. The study was conducted on 45 parents of 31 neonates selected using the total enumeration sampling technique. Protocol on the skin, eye, cord care and oil massage of preterm neonates was developed, validated, demonstration, and return demonstration were taken after the pretest. Observational checklists were used to assess the father and mother's skills in three-four consecutive observations. Data was analyzed using SPSS version 20.0. Maximum 30(97%) mothers became skilled in the third observation; on the other hand, more fathers achieved skill by the fourth observation. Once all the father and mother achieved skill performance of 85-90%. The final return demonstration was taken on their preterm neonate. A significant improvement in skills scores of both fathers’ and mothers' was observed within and in between the subsequent observations.The research shows that there was a significant increase in the skills of father and mother. This shows that the operational study to develop a protocol and check its effectiveness in skill development of parents (father and mother) regarding skin care and oil massage of their preterm neonates was a success.

Amputees with lower limb loss need special care during daily life activities to make the movement natural as before amputation. No such work exists covering the main aspects from causes of amputation to the psycho-social impact of the amputees after using the prosthetic device. This review presents for lower limb prosthesis; the study of lower limb amputation, design & development, control strategies & machine learning algorithms, the psycho-social impact of prosthetic users, and design trends in patents. Research articles, review papers, magazines, letters, study reports, surveys, and patents, etc. have been used as sources for this review. Traumatic injuries and different diseases have been found as common causes of amputation. Design & development section illustrates design mechanisms, the categories of passive, active, & semi-active prostheses, an overview of a subset of commercially available prosthetic devices, and 3D printing of the accessories. The control section provides information about control techniques, sensors used, machine learning algorithms, and their key outcomes. Quality of life, phantom limb pain, and psycho-social impact of prosthetic users have been summarized for different countries that are believed to attract the interest of the readers. We have also developed an open-source database “FAKH-50” for patents to emphasize the design trends and advancements in lower limb prostheses from 1970 to 2020. Overall trend analysis determined is in the descending order as the knee (48%) > ankle (28%) > foot (22%) > hip (2%) patents in the current version of our database. The forthcoming section highlights the challenges and prospects of the domain. A mutual observation demands the design of a bio-compatible, lightweight, and economic prosthesis to track the normal human gait by eliminating phantom limb pain. This will empower the amputees to live a quality life in society. This work may be beneficial for researchers, technicians, clinicians, and amputees.

Self-compacting concrete (SCC) is a lean concrete brew which can consolidate under its weight. Because of its dynamic nature SCC finds its space in critical situations and segments with thronged reinforcement. Extensive usage of SCC helps to eradicate phonic damages on the worksite meagerly induced by the shaking of concrete. The supremacy of using SCC requires less time to site the concrete in substantial sections. By differing micro silica ratio as partial replacement of cement an effort is made to read the strength characteristics of SCC. Micro silica has the versatile property, and when added as the admixture in the initial stages, concrete can perform better both in the firm and coarsened state. EFNARC specifications have been used to finalize the trial mixes with various percentages of micro silica (5%, 10%). In this study, special care has been taken to study the staging of a concrete mix with micro silica, super plasticizer, and VMA. The identified compressive strength of cubes at 5% replacement is 28% elevated than that of a 10% replacement. Although there are more experiments with the proportionate blend the good attempt is made with the available vernacular fibres to study the performance of fabricated high strength concrete in a brief manner.

تنوعت علاقات مصر مع القبائل النوبية خلال عصر الدولة القديمة نتيجة تنوع أغراض مصر من تلک القبائل وديارها، منها ما کان ذو طابع سياسية وحربي بحت مثل اهتمام ملوک الأسرة السادسة بالنوبة بسبب الضغط الذي وقع على الحدود المصرية من قبل البدو الأسيويين، وتعدي هذا الاهتمام من مجرد إرسال الحملات إلى استخدام الجنود النوبيون کمرتزقة في الجيش المصري، ومنها ما کان ذو طابع إقتصادي حيث کانت بلاد النوبة هي البلاد المصدرة للذهب والعاج والعديد من الخيرات التي کان الملک وحاشيته يتهافتون للحصول عليها بالإضافة إلي کونها معبر للتجارة المصرية إلي قلب أفريقيا. ونتيجة لذلک عمل الملوک المصريون على السيطرة على بلاد النوبة بيد من حديد في الوقت الذي کان يسکن بها القبائل المعروفة بأسم المجموعة (أ) ثم وفد عليهم قبائل عرفت بقبائل المجموعة (ج) مع نهاية عصر الدولة القديمة، تعني هذه الدراسة بذکر أثر القبائل النوبية على مصر خلال عصر الدولة القديمة من خلال المصادر المصرية والنوبية المعاصرة وتشمل أيضا على التعريف بأهم القبائل النوبية التي ظهرت في المصادر المصرية وما خلفته تلک القبائل من آثار تعطينا فکرة عن الجوانب المختلفة لحياتها. The Relations between Egypt and Nubian tribes diversed during old kingdom period, As a result of the diversed Egyptian needs from the Nubian tribes and their lands. Some of these relations were political and martial such as the sixth dynasty special care of Nubia because of the Asiatic Bedouin danger in their times, So Egyptian kings recruited the Nubian warriors as soldiers in the Egyptian army beside the military campaigns which they led on their lands. On the other hand we can consider the economic motive as a strong motive for the Egyptian king, As Nubia was a source of gold, ivory and other goods for the king and his courtyards, in addition to this Nubia was a passage for the Egyptian trade, which goes to center Africa. All of these motives make us believe that Egyptian domination over Nubia was very harsh when it was inhabited by the tribes known as group (A) tribes then a new tribes came in the latest days of the old kingdom period whom we know as group (C) tribes, in this research I will talk about the Nubian tribes effect on Egypt through the Egyptian and contemporarily Nubian resources, and I will talk about the Nubian tribes from the ancient Egyptian texts and Nubian monuments which give as an idea about How these Nubian tribes lived their life.

The oral cavity is a window or mirror to the overall health of the body, and it reveals the early signs and symptoms of systemic diseases. The aim of the study was to assess the dental considerations for visually challenged patients treated in the Special Care Department in a hospital setting. A total of 20 cases were collected from the special care clinic. The data collected were assembled year wise and compiled in excel sheets with age, gender, periodontal status and oral hygiene status. The incomplete cases were removed. Frequency distribution statistical tests were used to calculate the frequency of age, gender, periodontal status and oral hygiene status of visually challenged patients. The comparison of the frequency of age, in visually challenged patients were common in the age group of 30 to 50 years of age. On comparing gender, males 60% were higher than females 40%. On comparing the frequency of periodontal status, it showed more prevalence of Generalized chronic gingivitis 55%, than Localised periodontitis 30% and generalized chronic periodontitis 15%. On comparing dental procedures done, the highest procedure done was restoration 85%. On comparing oral hygiene status, it showed more patients affected with OHI score 3.4 in the age group

Background The Mother Infant Care Center at Fort Belvoir Community Hospital (FBCH) recently revised its asymptotic neonatal hypoglycemia (ANH) protocol and adopted 40% glucose gel into its treatment pathway. The previous protocol used infant formula as the primary intervention. Purpose To evaluate the effectiveness of 40% glucose gel on exclusive human milk diet rates, time on protocol, level II Special Care Nursery (SCN) admission rates, length of stay (LOS), and total hospital costs for newborns with ANH at FBCH. Methods Infants with ANH were treated with 40% glucose gel (n = 35) and compared with a historical group of infants with ANH (n = 29) who were treated with formula. Results Exclusive human milk diet rates increased by 33.6%. The mean time on protocol dropped by 1.13 hours. The SCN admission rates dropped by 2.4% in the postimplementation group. The mean LOS was more than 12 hours less in the postimplementation group. The mean total cost per patient was $1190.60 lower after implementation of 40% glucose gel. Implications for practice The use of 40% glucose gel is a patient-focused, less-invasive, and cost-effective treatment of ANH. Implications for research More studies are needed to better define neonatal hypoglycemia. The use of 40% glucose gel is safe for use in infants with ANH; however, more studies are needed to examine its comprehensive benefits.

Autism Spectrum Disorder (ASD) is a complex intellectual and developmental disability clinically diagnosed when s/he is 2 or three years old. These children demand special care to meet their special needs to enable optimized potentials in their development. This qualitative study aims at understanding the stressors affecting the quality of life of the primary care-giver. Parenting for children with ASD is usually more complicated and demanding than for children without disabilities. Four case studies were selected to represent typical mothers of ASD children in different phases of development. Their ages ranged from 29-50 years old and the ages of their children were 6 to 22 years old. Research credibility is constructed through interviews with significant others and observation of social media activities. The instrument for the study is WHO-QoL-BREF which is adjusted for an interview protocol. The results indicated that mothers who were not supported by their spouse and family members often had to deal with the uncertain future alone. Those who felt accomplished in caring for their children were strengthened by the parenting experiences. Support from professionals is crucial for mothers in addition to support from significant others and peers, in maintaining their quality of life.

Membrane proteins are incredibly important biomolecules because they mediate interactions between a cell's external and internal environment. Obtaining information about membrane protein structure and interactions is thus important for understanding these essential biomolecules. Compared with the analyses of water-soluble proteins, the structural analysis of membrane proteins is more challenging owing to their unique chemical properties and the presence of lipid components that are necessary to solubilize them. The combination of covalent labeling (CL) and mass spectrometry (MS) has recently been applied with great success to study membrane protein structure and interactions. These studies have demonstrated the many advantages that CL-MS methods have over other traditional biophysical techniques. In this review, we discuss both amino acid-specific and non-specific labeling approaches and the special considerations needed to address the unique challenges associated with interrogating membrane proteins. This review highlights the aspects of this approach that require special care to be applied correctly and provides a comprehensive review of the membrane protein systems that have been studied by CL-MS. © 2020 John Wiley & Sons Ltd. Mass Spec Rev.

Children and youth with special health care needs, belongs to a group of individuals presenting several health issues of variable complexity and special care needs in health, one of them a successful dental treatment. The high prevalence of oral pathologies is not the only complication we found in dental attention; there are also behaviour and communication disorders, affecting the cooperation level in dental treatment. In spite of the limitations previously mentioned, different adaptations and techniques have surged in order to achieve a successful dental treatment. In this article we describe animal assisted therapy as a useful complementary method for pediatric dental treatment. Objective: Describe the experience of animal assisted therapy in pediatric dentistry treatment of children and youth with special health care needs. Methods: Descriptive-retrospective study performed in 2019, revision of 32 clinical digital records of Hospital, of children and youth with special health care needs, ages between 4-13 years old, and their pediatric dentistry treatment records with animal assisted therapy. Results: 32 patients with dental treatment, in 26 patients (81.25%) dental treatment was successful; 36 dental procedures were performed, 19 invasive and 17 non invasive. Conclusion: The implementation of animal assisted therapy as a complement of pediatric dentistry treatment had a high acceptance and allowed successful invasive and non invasive dental procedures in children and youth with special health care needs.

Panoramic imaging is the most widely requested radiographic technique in dentistry. In orthodontics, the clinical and radiographic examinations are routinely carried out along with dental and skeletal photographs as a part of diagnosis and treatment planning. The evaluation of radiographs of patients after orthodontic treatment is important in understanding the possible changes that tend to occur post-treatment. This study aims to analyze the incidental findings present in the radiographs of patients who previously underwent orthodontic treatment. A total of 30 patients (18 females; 12 male) were randomly selected from the Orthodontic clinic at the Department of Orthodontics, Saveetha Dental College and Hospital, Chennai. Two independent examiners analyzed the panoramic radiographs for anomalies and pathologies. The result showed the most common finding, which was periodontal pathology (Generalised bone loss, widening of periodontal ligament space, or both, loss of lamina dura) with a prevalence of 36.7%. All the patients taken into the study had at least one anomaly. In conclusion, the relevant findings were observed in all the radiographs & special care should be taken while evaluating them to diagnose alterations that may require other dental treatments.

The number of maternal deaths in North Sumatra in 2017 was recorded in Labuhanbatu Regency and Deli Serdang Regency as many as 15 deaths, Langkat Regency with 13 deaths, and Batubara Regency with 11 deaths. Efforts to accelerate the reduction of Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) are carried out to ensure that every mother is able to access quality maternal health services, such as maternal health services, delivery assistance by trained health personnel in health care facilities, postpartum care for mothers and babies, special care and referrals if complications occur, the ease of obtaining maternity and childbirth leave and family planning services. Efforts to reduce MMR and IMR are not only the responsibility of one sector, but need the involvement and roles of other stakeholders to accelerate the reduction of MMR/IMR. This study aims to provide recommendations for the reduction of MMR/IMR through the role of stakeholders in North Sumatra. The study used a qualitative method with a phenomenological approach which was conducted from May to September 2019. The research locations were: Mandailing Natal Regency, Deli Serdang Regency, Simalungun Regency, and Sibolga City. The research subjects consisted of 3 (three) elements, namely: Government, Private and Community. Data collection was carried out through observation and through Focus Group Discussion (FGD). This study concludes that the model of efforts to reduce maternal and infant mortality rates must be carried out in a holistic and integrative manner with medical, social, and cultural approaches, starting from health services for adolescent girls, women of productive age, pregnant women, maternity, newborns and toddlers. Efforts to reduce MMR and IMR are the responsibility of all DPOs and elements of academia, business and community, whose programs and activities are integrated. Efforts to reduce MMR and IMR must be viewed from various perspectives, including from a medical, social and cultural perspective.

A penetrating central nervous system (CNS) injury on account of an arrowhead is a rarity in the modern era. When managing such cases surgically, special care is taken to prevent injury to the neurovascular structures lying in the vicinity of the wound. Fired arrows are categorized as low-velocity missiles, but the size, shape and aerodynamic stability of the missile are also important factors in establishing the complexity of the wound. We present three such cases of penetrating injury of the CNS by fired arrows, two injuring the head and the third injuring the spinal cord. The arrowheads were successfully retrieved without any complications. Salient features to be taken care of while managing such patients have also been also discussed.

Many epidemiologic studies use metabolomics for discovery-based research. The degree to which sample handling may influence findings, however, is poorly understood. In 2016, serum samples from 13 volunteers from the US Department of Agriculture’s Beltsville Human Nutrition Research Center were subjected to different clotting (30 minutes/120 minutes) and refrigeration (0 minutes/24 hours) conditions, as well as different numbers (0/1/4) and temperatures (ice/refrigerator/room temperature) of thaws. The median absolute percent difference (APD) between metabolite levels and correlations between levels across conditions were estimated for 628 metabolites. The potential for handling artifacts to induce false-positive associations was estimated using variable hypothetical scenarios in which 1%–100% of case samples had different handling than control samples. All handling conditions influenced metabolite levels. Across metabolites, the median APD when extending clotting time was 9.08%. When increasing the number of thaws from 0 to 4, the median APD was 10.05% for ice and 5.54% for room temperature. Metabolite levels were correlated highly across conditions (all r’s ≥ 0.84), indicating that relative ranks were preserved. However, if handling varied even modestly by case status, our hypotheticals showed that results can be biased and can result in false-positive findings. Sample handling affects levels of metabolites, and special care should be taken to minimize effects. Shorter room-temperature thaws should be preferred over longer ice thaws, and handling should be meticulously matched by case status.

One of the major problems which most dental professionals face is cross contamination and cross infection. During the fabrication of dental prosthesis, special care should be taken for every step, especially impressions as they are one of the main concern. This is because impressions are one of the most known to be the main source of infection for any potentially infectious material . To check the practice of disinfection level among the dental practitioners, a questionnaire containing 15 questions was prepared. This survey was carried between the month of June 2019 to March 2020 among the dental practitioners living in Chennai, Tamil Nadu, India. This survey was carried under an online platform where the participants responded to their answers. Based on their responses, the result was tabulated. We got a result of about 64% practitioners practicing protocol to disinfect impressions 65% use alginate to take impressions. 44% use 2% glutaraldehyde to disinfect impressions. 46% prefer spraying disinfectant over impression tray. Based on much research, it was reported that dental technicians were suffering from infections in hand restoratory systems, so on humanitarian basis we dentists can take better measures ourselves in avoiding cross contamination to fellow dental technicians by following proper and simple methods for disinfection of impressions before sending them to dental laboratories. To conclude awareness workshops, programs must be organised to create awareness among dentists to present cross infections.

As we all know that the success of complete denture restoration depends on the occlusion given in the specific patient, as occlusion plays a major role in retention, stability, support of the denture. Occlusion is a very fine and complex topic to be taken into consideration while fabricating a complete denture.Occlusion has a considerable influence on the outcome of every Prosthodontic treatment modality. There are various occlusalschemes in the literature foe complete denture fabrication, but none of the one accepted universally. In patients with resorbed ridges, special care is to be taken for fabrication of complete denture occlusion, as there is less retention, stability and support. In order to overcome these problems lingualizedocclusal scheme has gained favor. So the success of a stable denture depends more on the occlusal scheme given on the denture.

Death certification requires the same effort and dedication as all reports by doctors during their patients’ lifetimes. The physician must follow the basic instructions to complete a death certificate correctly, taking special care to fill in the sequence of causes of death. In the case of a pandemic, completion of the death certificate falls to the primary care physician and therefore the official bodies must publish instructions based on international recommendations. It should be established as soon as possible whether it is possible to report deaths telematically. While this is not possible, in a pandemic procedures should be put in place to enable the immediate reporting of deaths to the health authorities.

Background According to the World Health Organization, two billion people will attain the age of 60 years or more by 2050. Ageing is a major risk factor for a number of neurodegenerative disorders, which currently possess challenge to the global health status, carrying economic and social consequences. Therefore, attention has been dedicated towards the development of neuroprotective agents derived from natural sources. Honeybee products, such as honey, bee pollen, bee bread, propolis, royal jelly, beeswax, and bee venom have been used for therapeutic purposes since ancient times in Egypt, Greece, and China. Despite the emergence of modern medicine, bee products remain clinically relevant owing to their potential as anti-inflammatory, anti-oxidant, and neuroprotective agents. Scope and approach This review demonstrates the potential of bee products against neurological disorders in the light of the current literature. Key findings and conclusions Bee products and individual isolated components have enormous therapeutic potential for multiple neurological disorders. The different studies show overall neuroprotective and nerve-tonic characteristics of bee products, mainly due to their anti-oxidant, anti-inflammatory and anti-apoptotic features. However, some limitations such as allergic reactions and the cytotoxic effect of some bee products warrant a special care in its development as drug leads in future studies.

Objectives: The objective of study is to estimate the morbidity and mortality of newborns admitted at Special Care Newborn Unit (SCNU) of tertiary care hospital. Materials and methods: This hospital based retrospective study was carried out in SCNU, department of pediatrics, over a period of 4 years from 1st January 2016 to 31st December 2019. All newborns (0- 28 days) admitted into the SCNU during the study period were included in the study. Data were collected from the monthly reporting format and patient case records. Then they were compiled in MS excel and analyzed using appropriate statistical tools. Results: During this period of 4 years total 5649 number of patients were admitted in SCNU, inborn 3657 (64.7%) and out born 1992 (35.2%). 58.7% of babies were male. Almost equal number of normal weight (50.2%) and low birth weight babies (49.7%) were admitted. Similarly equal number of term (49.4%) and preterm babies (50.5%) were admitted. Birth asphyxia, babies with birth weight below 1800gm requiring special care, neonatal sepsis and jaundice requiring phototherapy were common morbidities requiring admission. Mortality was 11.4% which is higher in out born (14.3%) than inborn (9.9%). Birth asphyxia (53.9%) is the commonest cause of mortality followed by respiratory distress syndrome (RDS) with prematurity (23.2%) and neonatal sepsis (12.4%). Sepsis is higher in out born unit (18.5%) than inborn (7.7%). Highest number of death occurs in early neonatal period (88.5%) and among low birth weight baby (58.7%). First 72 hours of admission is crucial for survival as 78.2 % babies die during this period. Conclusion: Birth asphyxia, RDS with prematurity and neonatal sepsis are common cause of mortality. It is largely preventable by comprehensive antenatal, natal, neonatal care and health awareness among patients and society.

In Vietnam, hundreds of trafficked persons are officially identified and returned to Vietnamese society each year. There are also a large number of self-returned victims who have not been identified. Because of the devastating impact of human trafficking, victims need special care from communities and government agencies to support their recovery. The Vietnamese government has applied a wide range of strategies during the victim support process. Cooperation between governmental agencies has been increasingly recognised as an essential factor in the responses to human trafficking. However, there are still significant gaps in the research on inter-agency collaboration to support victims in Vietnam. This paper draws on the interviewees’ perspectives on the victim support measures, their successes, and limitations.

The aim of this study is to explore the wear performance of AISI 316L stainless steel fabricated via selective laser melting along different directions with respect to the building direction and via post annealing. The wear behavior of the alloy under high-speed sliding was investigated with high sliding velocities of up to 1 m/s. It was shown that the wear behavior of the alloy was completely different from that in quasi-static wear environments. The high-speed wear resistance was significantly affected by the building direction. After the annealing heat treatment of the alloy at 800 °C for 4 h, the high-speed wear resistance significantly decreased. Therefore, special care must be taken in using SLM 316L alloys when subjected to wear environments with high sliding velocities.