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Dayang Anita Abdul Aziz,1 Marjmin Osman,1 Mohd Fadli Abdullah,1 Felicia Lim,2 Rufinah Teo,2 Fook Choe Cheah,3 Shareena Ishak,3 Rohana Jaafar,3 Swee Fong Tang,3 Bilkis Abdul Aziz,3 Hasniah Abdul Latif,3 Zarina Abdul Latiff31Department of Surgery, UKM Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia; 2Department of Anaesthesia, UKM Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia; 3Department of Pediatrics, UKM Medical Centre, 56000 Cheras, Kuala Lumpur, MalaysiaBackground: In pediatric patients, video-assisted thoracoscopic surgery (VATS) is usually carried out using three to five working ports. The port-less technique (PLT) means only one or two ports are used; in most cases only the telescope would require a port. At our center, the VATS services were started in 2008, initially using the standard three-ports technique but shortly after this was replaced with PLT for all neonatal and pediatric VATS. The rationale of doing PLT was so that working instruments could move easier in the pediatric thoracic cavity. Furthermore, budget constraints did not allow us to purchase trocars of different sizes.Patients and methods: A review of all PLT cases was carried out at our institution from January 2008 to September 2018. We documented the diagnosis and type of surgery performed, age at surgery, number of ports used, conversion rate, morbidity and mortality as well as gross chest wall growth.Results: A total of 46 PLT cases were carried out; 16 were in neonates (34.7%). Conversion to thoracotomy occurred in five patients (10.8%). Diagnosis ranged from congenital anomalies like esophageal atresia to infective cause like empyema thoracis. Immediate morbidity occurred in four patients (8.7%) and there was one perioperative mortality (2.2%). The majority of PLTs (54%) were using two ports, and another 46% of PLTs were successfully carried out using one port. All neonatal and infant PLT cases were using one port (46%). Maximum follow-up was for 5 years and gross growth of chest wall was good.Conclusion: PLT is a feasible and safe technique for a variety of cases for neonatal and pediatric surgical intrathoracic pathology. We recommend PLT for all neonatal and pediatric VATS.Keywords: pediatric, thoracoscopy, VATS, port-less

Rosnah Sutan,1 May Luu Yeong,1 Zaleha Abdullah Mahdy,2 Ahmad Shuhaila,2 Jaafar Rohana,3 Shareena Ishak,3 Khadijah Shamsuddin,1 Aniza Ismail,1 Idayu Badillah Idris,1 Saperi Sulong4 1Department of Community Health, 2Department of Obstetrics and Gynecology, 3Department of Pediatrics, 4Department of Medical Records, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia Introduction: The aim of this study was to determine the trend of head circumference as predictor of microcephaly among term infants born in a teaching hospital in Malaysia from 2011 to 2015. Methodology: This was a cross-sectional study using data from the electronic birth census. The independent variables were mothers’ age and height, parity, birth weight and birth length. All term newborns, both alive and stillbirth, with 37–41 completed gestational weeks, and a birth weight of at least 500 g was extracted from the census. Results: A total of 26,503 newborns fulfilled the inclusion criteria (13,655 males, 12,840 females). The mean head circumferences for male and female newborns were 32.93 cm (± SD 1.32) and 32.56 cm (± SD 1.31). The average head circumference for Malaysian newborns was found to be smaller than the World Health Organization Standard Growth Chart for Term Infant. A total of 17.6% (n=4,669) of the total samples were observed to have microcephaly. Among them, 73.2% (n=3,419) were non-proportionate microcephaly with normal birth weight of 2.5kg and above. Bivariate analyses showed that all independent variables were significant predictors of microcephaly. Both simple and multiple logistic regressions demonstrated that low birth weight was the most significant predictors for microcephaly (adjusted OR 12.14, 95% CI 10.80, 13.65). Conclusion: There is an increasing trend of microcephaly across the years and the low birth weight was noted as the main predictor of microcephaly. Future studies are needed to determine the possible cause of increasing microcephaly by controlling for birth weight and gestational age of the neonates. Keywords: SGA, perinatal, growth chart, IUGR, birth parameter, occipito-frontal

Electromyostimulation is a nonpharmacological prevention method for osteoporosis that is safe and feasible for the elderly and people with physical disabilities. Our previous study demonstrated that random pulse train (RdPT) electromyostimulation of rat quadriceps induces an increase in the mechanical properties of the contralateral unstimulated femoral neck. However, the efficacy of this stimulation on other untested bones is still unclear. The objective of this research is to investigate the response of previously unstimulated bones to single-site electromyostimulation. The left quadriceps of rats were stimulated electrically by periodic pulse train (PrPT) or RdPT with 2 mA-magnitude pulses at 552 μs and a 50% duty ratio. The stimulation effect was examined on the diaphysis of long bones and lumbar vertebrae (L2–L5) by quasi-static mechanical tests and microcomputed tomography analysis. RdPT increased the strain energy at the stimulated left femur but did not change the properties of the other long bones. For the lumber vertebrae, on the other hand, both stimulations showed similar results. The stiffness of lumbar vertebra increased in L2, and the stiffness and the maximum load decreased in L4. Additionally, the BMC (bone mineral content), BV (bone volume), and TV (tissue volume) were reduced in L2, but not changed in L4. The other vertebrae were not affected by the stimulations. In conclusion, RdPT influences not only the stimulated femur, but also the lumbar vertebrae site-dependently as well as PrPT. These findings suggest the whole-body scale effect of electromyostimulation, however, which is not positive in all the bones, requiring further investigations for its clinical applications.

Seorang ayah mengeluh, “Kelihatannya tanggung jawab mendidik anak-anak menjadi semakin sulit. Terlalu banyak ancaman di sekitar kita yang bisa merusak dan mengganggu pertumbuhan mereka. Saya tidak mengerti apa yang harus saya perbuat!” Yang lain, seorang ibu dari tiga anak mengatakan, “Saya dibesarkan oleh orang tua yang ultraotoriter, dan hanya itulah satu-satunya cara yang saya tahu tentang membesarkan anak. Tetapi saya tidak ingin anak-anak saya kehilangan masa kecil mereka seperti saya, ibu mereka!” Kalimat-kalimat di atas adalah beberapa ekspresi kekuatiran para orang tua dalam membesarkan dan memastikan keberhasilan anak-anak mereka di masa depan. Kebingungan, keragu-raguan, dan stres adalah bumbu dari parenting. Banyak orang tua mengalaminya karena mereka berkeinginan untuk menolong anak-anak mereka bertumbuh secara totalitas, tetapi merasa tidak berdaya. Di lain pihak, sering para orang tua beranggapan bahwa parenting adalah aktivitas yang bisa dilakukan secara naluriah, otomatis, dan tanpa direncanakan. Akibatnya, mereka tidak pernah secara sengaja mempelajari parenting. Padahal, parenting merupakan tanggung jawab utama orang tua. Menurut Jack O. Balswick dan Judith K. Balswick, “Kenyataannya orang tua di sebagian besar masyarakat hanya berharap anak-anak mereka tumbuh dengan sendirinya menjadi orang dewasa yang normal dan sehat.” Namun sayangnya, hal tersebut bukanlah realitas yang kita temukan di masyarakat. Drastisnya perubahan lingkungan hidup dan tahap-tahap pertumbuhan anak menuntut penyesuaian yang berkelanjutan dalam parenting dan selalu saja ada masalah yang muncul karena kegagalan dalam proses penyesuaian tersebut. Biasanya, reaksi para orang tua adalah panik dan bingung karena mereka tidak mengantisipasi perubahan yang terjadi. Ketidakmampuan untuk menghadapi perubahan-perubahan tersebut menghasilkan keluarga-keluarga yang tidak mampu berfungsi sebagaimana mestinya (dysfunctional families), dan anak-anak yang bermasalah. Akhirnya, parenting mereka tidak hanya mempengaruhi para anggota keluarga, tetapi juga seluruh masyarakat karena masyarakat sendiri merupakan suatu sistem yang terdiri dari sejumlah keluarga. Artikel ini adalah paparan hasil sebuah studi lapangan yang dilakukan antara Maret hingga Mei 1998 di Baguio City, Filipina. Penelitian tersebut dirancang sebagai studi kasus perbandingan yang berkonsentrasi pada praktek-praktek parenting dari sejumlah keluarga Kristen Filipina dan Tionghoa. Dimulai dengan pengertian dasar tentang parenting, artikel ini menyajikan secara singkat hasil penelitian di atas dalam kerangka kerjanya dan kemudian diakhiri dengan sebuah usulan berupa parameter-parameter kurikulum untuk pelayanan keluarga di gereja.

Researchers are increasingly becoming fascinated by the possibilities of utilizing natural fibre, which is a byproduct of production processes, as an addition in concrete. This fibre exhibits a low density and is amenable to chemical changes. The primary aim of this research study is to examine the influence of agave cantula roxb. fibre (ACRF) in low-density foamed concrete (FC) after being subjected to different doses of alkali treatment using sodium hydroxide (NaOH). Various weight fractions of treated ACRF were employed in the FC mix, namely 0% (as the control), 1%, 2%, 3%, 4%, and 5%. FC with a density of 1060 kg/m³ was produced and subsequently tested. The three types of strength properties that have been evaluated and analysed included flexural, tensile, and compressive strengths. The findings from this study have revealed that the inclusion of 3% of treated ACRF in FC yields highly favourable results in relation to strength properties. The use of treated ACRF improves the FC's strength characteristics, particularly its bending and tensile strength, by bridging microscopic cracks and filling up gaps. It is noteworthy to emphasize that accumulation and unequal dispersion of ACRF are possible if the weight fraction of ACRF applied above the optimal value of 3% which led to decrease in FC's strength properties. This exploratory work will lead to a better understanding of the potential applications of treated ACRF in FC. It is critical to encourage the long-term development and implementation of FC products and technology. [ABSTRACT FROM AUTHOR]

Electromagnetic damper has been given special attention by many researchers and thus is among the important research areas in vibration system. This paper examines electromagnetic damper effect through simulation and experimental study. A vibration test rig incorporating a simple electromagnetic damper is designed and tested to examine the impact of electromagnetic force. The vibration system test rig can be operated as free vibration as well as a forced vibration system. In the simulation phase, the MATLAB model of the electromagnetic damper system is developed, considering its dynamic behavior. This simulation allows for the evaluation of the damper's effectiveness in reducing vibration amplitudes and settling times. Subsequently, an experimental setup is constructed to validate the simulation results. One of the key findings of this research is the comparison of different materials used as the outer cylinder of the electromagnetic damper system. The results indicate that aluminum exhibits a superior damping coefficient value of 2.8 kgs-1 compared to Nylon, which has a damping coefficient of 1.9 kgs-1. This observation highlights the significant impact of the damper's material choice on the vibration system's amplitude and settling time. The implementation of aluminum as the outer cylinder results in reduced amplitudes and quicker settling times in the vibration system. The combination of simulation and experimental studies enhances the understanding of the electromagnetic force's influence and validates the findings. The comparison of different materials for the damper's outer cylinder underscores the importance of material selection in achieving optimal damping coefficients and improved vibration system performance. [ABSTRACT FROM AUTHOR]

The incidence of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (E. coli) bacteria has become a global problem and has increased in recent years. The purpose of this study was to analyze the risk factors for the incidence of UTI in inpatients at Dr. Soetomo General Academic Hospital, Surabaya. This research was an analytic descriptive study. Specimens were sent to the Clinical Microbiology Laboratory using sterile containers and processed according to standard laboratory procedures. It resulted in ESBL-producing E. coli that were used as a case group and non ESBL-producing E. coli as a control group. The identification and testing of antibiotic susceptibility were carried out using the BD Phoenix™ Automated Microbiology System. Ninety-four bacterial isolates were collected, consisting of 54 (57.4%) ESBL-producing E. coli bacteria and 40 (42.6%) non ESBL-producing E. coli bacteria. Recurrent UTIs (OR = 4.31; ρ =0.002; 95% CI = 1.68-11.04) and catheter use (ρ = 0.049; OR = 4.250; 95% CI = 1.050-17.210) were used as independent risk factors caused by ESBL-producing E. coli bacteria. Recurrent UTIs and catheter use were dependent risk factors caused by ESBL-producing E. coli bacteria. [ABSTRACT FROM AUTHOR]

This paper presents an approach to optimize the short-term traffic prediction performance on freeways using multiple artificial neural network topologies under different network and traffic condition settings. The approach encourages multimodel techniques that are capable of improving the prediction system performance over single-model approaches. Using a mix of neural network topologies, the short-term speed prediction performance was extensively evaluated under different input settings and various prediction horizons (from 5 to 20 min). To enable the networks to learn from historical information, a long-term memory component was introduced to the input patterns to allow the networks to build internal representation of recurrent conditions, in addition to the short-term memory that is encoded in the most recent information. Optimal settings were determined by maximizing the performance under different traffic conditions observed at the target location, as well as upstream and downstream locations. Comparative statistical analysis with naive and heuristic approaches showed that the optimized neural network approach resulted in better prediction performance. The study shows that the optimal settings were consistently more dependent on the long-term memory component as prediction horizon increases. CE Database subject headings: Traffic management; Predictions; Optimization; Neural networks.

This study presents an approach to extract properties from spatiotemporal traffic speed contour maps using tools from the field of digital image analysis. The new measures are derived from second-order statistics and quantify properties such as smoothness, homogeneity, regularity, and randomness in traffic operations. Four measures were selected: angular second moment (ASM), contrast (CON), inverse difference moment, and entropy. Each measure was used to characterize speed contour maps derived from different traffic conditions. To avoid information redundancy, correlation was examined between first- and second-order measures, which resulted in disqualifying one of the four measures. The sensitivity of the new measures to variations in traffic conditions was also investigated using nearly 14,000 30 min speed contour maps generated from a section of 5.44 km of the freeway in five weekdays. It was found that the speed range of 32-48 km/h exhibited the highest randomness (entropy) and least smoothness (ASM). The lowest level of homogeneity (CON) was observed in the range of 48-80 km/h. The new measures were also used to evaluate the level of service. CE Database subject headings: Traffic analysis; Traffic surveillance; Maps; Imaging techniques.