History Of Accident Research Articles

Association of cardiovascular disease with hospital mortality in COVID-19 patients

Aim. To evaluate the relationship between the in-hospital mortality of patients with COVID-19 and the history of cardiovascular disease (CVD) using data from the Russian registry of patients with COVID-19.Material and methods. This study included 758 patients with COVID-19 (403 men, 355 women) aged from 18 to 95 years (median, 61 years), successively hospitalized in the COVID hospital of the Chazov National Medical Research Center of Cardiology from April through June 2020. Death predictors were studied using single- and multivariate regression analyses with the SPSS Statistics, Version 23.0 software.Results. During the stay in the hospital, 59 (7.8 %) patients with COVID-19 died, 677 (89.3 %) were discharged, and 22 (2.9 %) were transferred to other hospitals. The univariate regression analysis showed that the increase in age per decade was associated with a 92% increase in the risk of death [relative risk (RR), 1.92; 95% confidence interval (CI), 1.58-2.34; p <0.001], and an increase in the number of CVDs increases the risk of death by 71% (RR 1.71; 95% CI 1.42–2.07; p<0.001). The presence of one or more CVDs or specific diseases [atrial fibrillation, chronic heart failure (CHF), ischemic heart disease, myocardial infarction, history of cerebrovascular accidents], as well as diabetes mellitus were associated with a higher risk of fatal outcome during the hospitalization for COVID-19. The presence of any CVD increased the risk of in-hospital death by 3.2 times. However, when the model was adjusted for age and sex, this association lost its strength, and only the presence of CHF was associated with a 3-fold increase in the risk of death (RR, 3.16; 95 % CI, 1.64-6.09; p=0.001). Age was another independent predictor of death (RR, 1.05; 95 % CI, 1.03-1.08; p < 0.001).Conclusion. A history of CVD and the CVD number and severity are associated with a higher risk of death during the hospitalization for COVID-19; the independent predictors of in-hospital death are an age of 80 years and older and CHF.

Abstract 18072: Multiple Sclerosis and Covid-19-Related Myocarditis: A Brain and Heart Affectation

Introduction: Myocarditis (MC) and multiple sclerosis (MS) are inflammatory affectations of the myocardium and the central nervous system, respectively. It has been suggested that MS and MC share similar immunological dysfunctions. MS and MC also have associations with viral infection, and SARS-CoV-2 specifically has been associated with MC, indicating that a viral infection may induce or enhance a dysfunctional immune response favored by individuals' genetic susceptibility. Hypothesis: We hypothesized that patients with preexisting MS may be more susceptible to COVID-19-related MC. Methods: A retrospective study was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD codes, a cohort of patients admitted for COVID-19 as the primary diagnosis (index event) was identified. The cohort then was divided into two groups based on the presence of MS upon admission. The records of both groups were compared by demographics and a panel of 16 comorbidities. Pearson's chi-square and t-test were used to compare the group's characteristics when appropriate. A Kaplan-Meier analysis was then used to compare the probability of the outcome (MC) 90 days following the index event. A p-value of <0.05 was considered significant. Results: We found a total of 2,782,278 patients admitted for COVID-19, with 24,515 (0.88%) having a history of MS. Patients with MS were younger (mean age 58 vs. 60, p<0.0001), predominantly female (73%), and had more comorbidities (Elixhauser Comorbidity Index 8.8 vs. 6.3, p<0.0001). A history of hypertension, heart failure, obesity, cerebrovascular accident, drug abuse, smoking, asthma, cancer, diabetes, MC, and MI were significantly more prevalent in the MS group. No differences in rheumatoid arthritis, CKD, and HIV were identified. COVID-19 patients with pre-existing MS were significantly at higher risk of MC, 90 days after admission (Log-Rank p=0.04). Conclusions: Despite its striking analogies to MS, the precise mechanism by which SARS-CoV-2 induces MC is unknown. Our findings highlight the likelihood that SARS-CoV-2 can induce myocardial inflammation in patients with a dysfunctional immune response. Moreover, MS patients were more exposed to established cardiovascular disease risk factors.

Abstract 18267: Successful C-Section Delivery at 36 Weeks in a Patient With a Heartmate 3 LVAD

Introduction: Pregnancy in patients with advanced heart failure requiring left ventricular assist device (LVAD) support is risky and discouraged, though there are cases of successful deliveries. Hypothesis: A 29-year-old G3P2002 female with history of embolic cerebrovascular accident, postpartum hemorrhage, peripartum cardiomyopathy status-post HeartMate 3 (HM3) LVAD, became pregnant after intrauterine device dislodgement. She elected to continue the pregnancy against the advice of maternal-fetal medicine (MFM). A multidisciplinary team convened to plan for delivery. Methods: Warfarin and sacubitril-valsartan were stopped due to teratogenicity. Therapeutic anticoagulation with enoxaparin injections was started. Aspirin was continued. Low-dose digoxin was added for right ventricular support. A multidisciplinary team involving anesthesiology, MFM, and advanced heart failure (AHF) was convened. Through patient-centered shared decision-making, cesarean delivery was planned for 36 weeks. She was seen by MFM and AHF every two weeks with LVAD speed optimization under transthoracic echocardiogram (TTE) guidance and anti-Xa monitoring. Results: The patient was electively admitted at 35 weeks for pre-delivery optimization. Enoxaparin was switched to an unfractionated heparin infusion. Betamethasone was administered to facilitate fetal lung maturation. Twice-daily fetal non-stimulation tests were performed. LVAD speed was optimized with TTE guidance. Continuous hemodynamic monitoring was performed perioperatively with a Swan-Ganz catheter and arterial line. Femoral veno-arterial sheaths were placed in case extracorporeal membrane oxygenation was needed. Anesthesia was administered via spinal-epidural approach. LVAD speed was modulated as needed. A healthy neonate was delivered by cesarean section without complication at 36 weeks and 3 days. Conclusions: Pregnancy during LVAD support remains an extremely high-risk clinical situation, though this case demonstrates that it is possible to carry such a pregnancy to near-term.

Management of Trauma-induced External Root Cervical Resorption and Discolouration of the Maxillary Central Incisors: A Case Report with a Four-year Follow-up

Background: Clinicians often face a dilemma when determining the cause of a patient's tooth discolouration and how to treat it concurrently in the presence of trauma-induced external root cervical resorption. Objective: This case report describes the management of trauma-induced cervical resorption and discolouration of the maxillary central incisors with a four-year follow-up. Case Report: A 38-year-old gentleman requested that the shape and colour of his anterior teeth be restored. The patient had a history of a motorcycle accident 15 years ago, in 2003, that resulted in fractures in both maxillary central incisors. Clinical examination showed the presence of discoloured broken teeth 11 and 21, as well as a cervical defect in tooth 11 palatally. Upon radiographic examination, 11 and 21 were root canal treated, and there was cervical resorption related to 11. Treatment consisted of cervical resorption management, internal and external bleaching, and composite restoration of the maxillary central incisors. After a four-year follow-up, this report demonstrated the successful management of a complicated case involving trauma induced resorption and discolouration. The patient expressed satisfaction with the conservative strategy that was taken to treat his discoloured teeth. Conclusion: This clinical report, with a long follow-up record, helps to provide dental practitioners with a conservative, minimally invasive, patient-centred treatment alternative for a complicated tooth discoloration case.

Endovascular Treatment of Basilar Artery Stenosis

Abstract Objective To analyze epidemiological characteristics and therapeutic evolution of patients with basilar artery (BA) stenosis who underwent endovascular therapy in a reference service. Methods Observational retrospective study of a case report of individuals with BA stenosis who underwent endovascular therapy in an endovascular neurosurgery reference service, between November 2005 and May 2018. Results The prevalence was higher among male patients, with 60% of the cases. As for age, it ranged from 18 to 81 years old, with a mean of 60.2 years old. In terms of comorbidities, systemic arterial hypertension was found in 93% of the patients, and dyslipidemia in 86.7%. The initial symptoms were previous history of ischemic cerebrovascular accident (CVA) in 43.3% of the cases and dizziness in 46.7%. The degree of stenosis ranged from 90 to a 98% of obstruction, with a mean of 92.8%. Neurological deficit was observed in 23.3% of the cases postoperatively, and the postoperative death rate was 10% (3/30). There were no intraoperative adverse events. Conclusion The applicability of endovascular stenting therapy in high-grade BA stenosis proved to be a safe and effective technique with lower morbimortality rates and faster recovery.

Sobretratamiento en personas con enfermedad cardiovascular establecida y diabetes tipo 2

Introduction and objectivesTo estimate the prevalence of patients with established cardiovascular disease (CVD) and type 2 diabetes mellitus (DM2) who are overtreated. MethodsCross-sectional study, which included a consecutive sample of adults, with CVD (defined as a history of acute myocardial infarction, cerebrovascular accident and/or peripheral arterial disease) and DM2, active affiliates to institutional prepaid of a high complexity hospital in Argentina. Overtreatment was defined as those who had at least one glycosylated hemoglobin (HbA1c) value <7% in the last year and had been prescribed at least one drug with a high risk of hypoglycemia (insulin and/or sulfonylureas and/or glinides) as part of their therapeutic scheme. ResultsA total of 1153 persons with established CVD and DM2 were included, 68.08% male, with a mean age of 75.38 years (SD=10.07), 89.59% had arterial hypertension, 52.82% were active smokers, and the average body mass index was 29.80kg/m2 (SD=5.03). As established CVD, 63.23% had a history of coronary disease, 38.86% of stroke, and 13.44% of peripheral vascular disease. The prevalence of overtreatment was 13.87% (95%CI: 11.93-16.01). Among the 160 overtreated patients, 88.13% were prescribed insulin, 12.5% sulfonylureas, and 4.38% glinides. ConclusionsThe prevalence of overtreatment among individuals with CVD and DM2 (14%) is comparatively lower than the rates reported in other studies. However, the clinical implications of these findings remain significant: the potential escalation of adverse side effects, such as hypoglycemia; the subsequent elevation in healthcare expenses due to superfluous treatments; and the possible strain on the healthcare system's capabilities, including the diversion of crucial medical resources —such as physician hours, essential equipment, and hospital beds— from those who are genuinely in need.

AYURVEDIC MANAGEMENT OF CELLULITIS BY JALAUKAVACHARANA: A CASE STUDY

Cellulitisis an acute inflammatory condition of the skin that is characterized by localized pain, erythema, swelling and heat.[1] It is a common bacterial skin infection affecting the dermal and subcutaneous tissues, and poses significant challenges to modern medical treatments due to its recurrent nature and potential complications. In this case study, we explore the efficacy of Ayurvedic interventions in the management of cellulitis, presenting a comprehensive analysis of a single patient's experience. "Vranashoph" is the term from Ayurveda that refers to the inflammation or swelling of wounds or injuries. In Ayurvedic terminology, "Vrana" means wound or injury, and "Shotha" means swelling or inflammation. Here a case of a 32-year-old patient has been presented having cellulitis changes over left lower extremity. The patient had history of Accident 4 years back and after that inflammation and pain and difficulty in movement have been recurrent features. Jalaukavacharan was the choice of treatment .The procedure was done over 8 weeks which reduced the signs and improved the discoloration of the affected part. The case will be discussed here in detail.

SAT143 Domains Of Cognitive Dysfunction In Patients With Post-Bariatric Hypoglycemia

Abstract Disclosure: A.M. Puleio: None. A.L. Sheehan: None. G.J. Musen: None. M. Patti: Consulting Fee; Self; AstraZeneca, Fractyl Laboratories. Other; Self; Eiger Pharmaceuticals - Consulting, MBX Biosceinces - Consulting, Hanmi Pharmaceutical - Consulting, Recordati - Consulting. Objective: Bariatric surgery is a highly effective treatment for obesity and associated comorbidities. Studies suggest bariatric surgery may result in improved cognitive function and brain volume in parallel with improved cardiometabolic function. However, some post-bariatric individuals develop post-bariatric hypoglycemia (PBH), which can be frequent and severe. Whether repeated episodes of hypoglycemia can impact cognitive function in PBH is unknown. The objective of this pilot study was to determine whether individuals with PBH display reduced cognitive function compared to surgical non-hypoglycemic counterparts. Inclusion/Exclusion Criteria: Adults aged 18-70 years, with a history of Roux-en-Y gastric bypass (RYGB), without a current diagnosis of diabetes, were recruited and enrolled into two groups: individuals with PBH (PBH+), and asymptomatic individuals with history of prior RYGB without hypoglycemia (RYGB non-hypo). Individuals with a history of traumatic brain injury or cerebrovascular accident, active treatment with any medications for diabetes (other than acarbose), active alcohol/substance abuse, known neuroendocrine tumor, or active depression (score &amp;gt;4 for Patient Health Questionnaire-2 (PHQ-2)) were excluded. Methods: Fourteen adults (PBH+, n=7; RYGB non-hypo, n=7) completed assessments of executive function (Delis Kaplan Executive Function System), working memory and attention (Wechsler Memory Scale Third Edition), as well as psychomotor speed (grooved pegboard). Premorbid intelligence was estimated using the National Adult Reading Test. Results: Individuals with PBH+ displayed significantly decreased performance on tests of category fluency (p &amp;lt;0.01), category switching (p &amp;lt;0.01), and category switching accuracy (p &amp;lt;0.01), compared to those in the RYGB non-hypo group. Performance in other verbal fluency measures, including the first (p =0.03) and third interval (p = 0.045), were significantly lower in PBH+ vs. RYGB non-hypo. All other assessments did not differ, including the estimation of premorbid intelligence (p=0.14). Conclusion: PBH+ individuals may be at greater risk for cognitive impairment compared to RYGB non-hypo individuals, as suggested by the impaired semantic processing and cognitive flexibility, as well as greater difficulty initiating and sustaining word retrieval in PBH+. Groups did not differ in cognitive assessments of psychomotor speed, memory, attention, and executive function. Clinicians should be alert for symptoms of cognitive dysfunction in PBH+ patients and consider neurocognitive testing in parallel with assessment of glycemic control, as well as other potential cognitive risk factors. Larger, longitudinal trials are necessary to further elucidate the impact of hypoglycemia on cognition and risk of dementia in patients with PBH. Presentation: Saturday, June 17, 2023

Acute Cerebral Vascular Events after Carotid Endarterectomy

Introduction. Acute cerebrovascular accident is recognized as the leading pathology in the structure of cerebrovascular diseases (CVD). Annually 6 million cases of CVD are registered in the world. Fatal outcomes from this pathology in Russia occur 1.5–2 times more often than in developed countries. According to the All-Russian Center for Preventive Medicine, 25% of males and 39% of females die from CVD. The incidence of CVD in Russia ranges from 460 to 560 cases per 100 thousand people. This pathology may be caused by carotid artery stenosis resulting from atherosclerotic vascular lesions and plaque formation which lead to embolism and stroke.Materials and methods. The study analyzed 341 medical histories of patients hospitalized at the Bashkir State Medical University Clinic (BSMU Clinic) in 2022, who underwent carotid endarterectomy (CEE) (288 of them had a history of chronic cerebrovascular accident) and 278 medical histories of patients with acute cerebrovascular accident, hospitalized at the Neurologic Clinic of the Avicenna Tajik State Medical University in 2022.Results and discussion. Perioperative complications that occurred during CEE at BSMU Clinic in 2022 included 12 cases of acute cerebrovascular accident of ischemic type (3.52%) and 2 cases of transient ischemic attack (0.6%), which is lower than the same rates in previously published observations at the same clinic.Conclusion. The number of complications resulting from the CEE does not exceed the global rates. Quantitative and qualitative indicators of carotid reconstructions demonstrate positive trends. Acute cerebrovascular accident requires clarifying the cause of its occurrence and taking measures to prevent ischemic strokes, including angiosurgical interventions.

Wrong Side of the Track: Crimes in the Railroad Industry in the US, 2000–2017

The extant criminological literature on railroad crimes is scant, and historically focused on crimes against railroads (e.g., train robberies), or safety at railroad crossings, or train stations in relation to the distribution of crimes. To date, studies have not examined the extent of crime committed by railroads, nor how those violations are punishment. This study draws attention to the scope of railroad crimes and their punishment in the US using all reported/known railroad safety violations for the year 2000–2017 ( N = 14,380). During this time period, the railroad industry ranks third for the number of crimes committed by a US business sector. The study begins by examining the early history of railroad accidents and the influence of railroad tycoons and their personal characteristics as factors that have shaped the railroad industry in the US. Relevant railroad regulations are also examined.

Bioseguridad y accidentes laborales en laboratoristas clínicos de Jaén, Perú, 2019

Introduction. Biosafety standards are principles that, correctly applied, prevent occupational accidents in the clinical laboratory. Objectives. Determine the level of knowledge and application of biosafety standards and their relationship with occupational accidents in clinical laboratory workers in the Jaén health subregion, Peru, 2019. Material and methods. Analytical observational study carried out in a population of 50 workers. The level of knowledge and application of biosafety standards, as well as the history of occupational accidents, were assessed using structured and previously validated questionnaires. Results. 30.0% (15/50) and 14% (7/50) of the workers observed a high and low level of knowledge of biosafety regulations, respectively; Likewise, 68.0% (34/50) said they applied them. Regarding the history of work accidents, 36.0% (18/50) of the workers stated that they had had a work accident, of which 55.6% (10/18) were due to needle or capillary puncture. The bivariate analysis showed that personnel who do not apply biosafety standards are twice as likely to have a work accident (PR: 2.13; 95% CI: 1.03-4.41). Conclusions. A significant percentage of clinical laboratory workers in Jaén, Peru, 2019, are unaware of and do not apply biosafety standards, which is related to workplace accidents, mainly due to sharp objects.

Prevalence of atrial septal defects and patent foramen ovale in a cohort of sudden cardiac death patients undergoing autopsy

BackgroundPatent foramen ovale (PFO) and atrial septal defects (ASD) have been described in up to 30 % of subjects in autopsy series but contemporary data are scarce. It is important to confirm the prevalence of ASD/PFO in the general population given the potential associated stroke risk and the increasing availability of intervention via PFO closure. MethodsA state-wide prospective out-of-hospital cardiac arrest registry (OHCA) identified all patients aged 1 to 50 years who experienced OHCA in Victoria, Australia from April 2019 to April 2022 and subsequently underwent autopsy with a cardiac cause of death identified. Autopsy was performed including visual description of any ASD and identification of probe patency of foramen ovale. ResultsA total of 517 patients underwent autopsy in the setting of sudden cardiac death; 36 patients (6.9 %) had a probe-patent foramen ovale, 2 patients (0.4 %) had secundum ASD, and 2 patients (0.4 %) had both a PFO and ASD (1 of whom had undergone percutaneous repair of both lesions). Twelve patients (2.3 %) had a prior history of cerebrovascular accident either recorded on medical history or detected on neuropathological examination; however none of these patients had a PFO or ASD. ConclusionsThe combined rate of PFO and ASD in a cohort of 517 patients undergoing autopsy was 7.9 %. None of these patients had experienced a cerebrovascular accident. This rate of PFOs appears lower than earlier reports and raises the possibility that the relative risk of an associated stroke could be higher than previously estimated.

ЦЕРЕБРОВАСКУЛЯРНАЯ ПАТОЛОГИЯ У ПАЦИЕНТОВ C ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА (РЕЗУЛЬТАТЫ НЕЙРОВИЗУАЛИЗАЦИИ)

Introduction. Cerebral microangiopathy associated with vascular risk factors makes a significant contribution to the deterioration of the morphological state of the brain. The aim of the study was to assess the neurological status and state of the brain in patients with stable coronary heart disease (CHD) who are treated in the cardiology department before coronary bypass surgery. Material and methods. 170 male patients, aged 58±6 years, were examined. Patients with a history of acute cerebrovascular accident, trauma and brain masses, carotid artery stenosis &gt;50%, depression and dementia were not included. All of them underwent a neurological examination and testing according to the Mini Mental Status Assessment Scale (MSSS). The brain examination was performed on a multislice computed tomography (MSCT) Somatom Sensation 64, Siemens. In describing the results, the following were taken into account: the width of the ventricles of the brain (the age norm of the width of the third ventricle is &lt;7 mm for persons under 60 years of age, and &lt;9 mm - over 60 years of age), leukoaraiosis, cysts, signs of cortical atrophy, the ventriculocranial index 3 (VKI 3) was calculated - the ratio of the maximum width of the third ventricle to the greatest distance between the internal plates of the skull bones (age norms: persons 41-60 years old - 3.3%; 61-70 years old - 3.9%; over 70 years old - 4.3%). Standard methods of descriptive statistics were used. Results. After a neurological examination, it was found that the frequency of occurrence of vestibulopathy syndrome was 24%, asthenic syndrome - 56%, mild cognitive impairment syndrome - 46% (test results for KShOPS - 27 [26; 28] points). The identified neurological symptoms were accompanied by morphological changes in the brain tissues. The width of the third ventricle was 7.6 ± 2.0 mm, the IHF index was 3 - 4.2%, the number of patients with leukoaraiosis was 26%, with signs of cortical atrophy - 19% of patients. When comparing the obtained results of neuroimaging with the established age norms, it was found that, despite the fact that the average age of our patients did not exceed 60 years, the width of the third ventricle in them corresponded to the indicators of the age category of healthy people over 60 years old, and the values of the VKI 3 index corresponded to the age norms. for healthy subjects over 70 years of age. Conclusion. The data obtained indicate that asthenia, moderate cognitive disorders, disorders of the coordinating-motor sphere are very common in patients with coronary artery disease. Neuroimaging signs of cerebral microangiopathy (leukoareosis, expansion of cerebrospinal fluid spaces) indicate the vascular nature of the identified neurological disorders. Issues of progression of cerebrovascular pathology in this cohort of patients require further study.

The Effect of Mandibular Impacted Third Molar on Fracture of Mandibular Angle and Condyle: An Observational Study

Objective: The factors that may increase the risk of mandibular angle fractures are the abrupt change in angulation and its association with impacted teeth. Condyle, a common mandibular fracture site, is spared if the impact is absorbed in the angle. The study aimed to determine the relationship between the status of impacted mandibular third molars and mandibular angle and condylar fractures in patients with a history of road traffic accidents, within the age group of 18 to 50 years. Methods: In this observational study, 136 patients were examined clinically to diagnose mandibular angle and/or condylar fractures which were confirmed using an orthopantomogram. The status of the mandibular third molars was assessed radiographically. Results: Among the 173 fracture sites detected, 43 were diagnosed at the angle and 130 at the condyle. The demographic assessment demonstrated an age predisposition between 31 and 50 years (44%) in males and 21 and 30 years (47%) in females, with an overall peak incidence in the age group of 21 to 30 years (45%). There was a significant relationship between the status of impacted third molars and the occurrence of angle (P&lt;0.01) and condylar fractures (P=0.05). The incidence of angle and condylar fractures in patients with/without associated impacted mandibular third molars were found to be 91% and 64% and 9% and 36%, respectively. Conclusions: The presence of impacted third molars had a significant relationship with the high incidence of angle fractures and the low incidence of condylar fractures. Knowledge about the common fracture patterns associated with impacted mandibular third molars would alert the clinician to contemplate fractures based on the anatomic distribution.

Storytelling in prevention: the case-study of accidents at work. How the narrative method can enhance the prevention of occupational injuries.

This article aims to analyze the elements of the narrative which, applied to investigations of accidents at work, transform them into stories, making the dynamics of accidents clearer, more complete and emotionally engaging and also capable of being transferred to a non-experts audience. The theoretical reference identified for the analysis of the accident histories is the work of the Lithuanian semiologist Algirdas Julien Greimas. The title, the dimensions of space and time, the characters (according to the actantial model), the point of view, the structure of the story (following the canonical narrative scheme), and the moral of the tale are the elements of the narration analyzed in this article. This article illustrates how the dynamics of accidents can lend themselves to being told according to the typical categories of narration and textual organization, resulting in them being enriched with important elements for the communication of prevention and the learning of safe behaviour. The accident investigation that becomes history takes on important characteristics also in terms of communication: the contents become clearer, more accessible and more engaging. Unlike traditional surveys, injury stories, through the elements of the narrative and in particular with the addition of indications for prevention, become an efficient learning and sharing tool valid in training contexts, and the contents effectively usable in practice of prevention workers. The narration applied to accidents at work, allowing for greater attention to the elements of the context, relationships and the emotional sphere of the various actors involved, is able to bring out more clearly the important and various factors that can contribute to causing an accident, becoming thus an effective tool for the transfer of indications for prevention.

Evaluation of the functional status of the “unaffected” hand in hemiplegic patients

Objectives: To evaluate the functional status of the unaffected hand in hemiplegic patients and its relationships with activities of daily living. Methods: This cross-sectional study included 30 right, 30 left hemiplegic patients with ischemic cerebrovascular accident history in last year, and 30 healthy volunteers. All participants were right-hand dominant. Data on age, gender, height, weight, comorbidities, duration of stroke, Brunnstrom recovery stages were recorded. Handgrip strength (with Jamar-type dynamometer), pinch strengths (with pinch-meter), and hand dexterity [with Nine Hole Peg Test (NHPT)] were evaluated in unaffected hand in patient groups and in both hands in control group. Lawton Instrumental Activities of Daily Living Scale (Lawton-IADL) and Functional Independence Measure (FIM) were applied to patient groups. Results: Hand grip and pinch strengths were lower, NHPT duration was longer in right (p=0.004, p=0.03, p&lt;0.001) and left (p=0.03, p=0.02, p=0.002) hemiplegia groups compared to control group. Hand grip and pinch strengths were positively, NHPT duration was negatively correlated with FIM self-care performance (r:0.47 p&lt;0.00, r:0.38 p=0.003, r:-0.40 p=0.002), and Lawton-IADL scores (r:0.48 p&lt;0.001, r:0.42 p=0.001, r:-0.56 p&lt;0.001). Conclusion: Ipsilesional hand, which is considered unaffected, functions are impaired in hemiplegic patients. This functional impairment is associated with greater dependence on activities of daily living.

Effects of mobile phone using on driving behavior and risk of traffic accidents

In this study, a questionnaire was made to find out the behavior of drivers towards the use of the mobile phone while driving, therefore representative samples were taken from different regions of Irbid Governorate, which included the Department of Vehicle Licensing, universities and commercial centers. As a result of the research, it was found that the most important factor that affects driver's behavior is the purpose of their mobile phone use whether making calls, sending text messages, or even browsing social media applications, secondly, the drivers' reaction to incoming calls whether receiving or ignoring calls. Or parking aside to respond, third comes the driver's history of traffic violations or previous traffic accidents. It was also concluded that about 22% of respondents who frequently use cellphones while driving, take calls while they drive, in comparison with just 1% of them who rarely use mobile phones while driving or just take calls for emergency, on the other hand a large percentage of 89% of respondents who always use their cellphones while driving use all of the means of taking or making calls, texting or browsing social media while driving, in comparison with 1% and 5% of them who never or rarely use cellphone while driving respectively. Furthermore, and according to the results of respondents with previous violations or tickets, it was found that people who never use cellphones while driving contribute in nearly no violations if compared to people who always use their phones who seem to commit many types of violations such as speed violations, red light crossing, double parking, cellphone using while driving tickets or even traffic accidents.

Chemical and Process Inherent Safety Analysis of Large-Scale Suspension Poly(Vinyl Chloride) Production

In this work, a safety assessment was carried out for the suspension polymerization method, known for the lack of studies about its sustainable performance and long history of chemical accidents. Therefore, a safety analysis was conducted using the inherent safety methodology to assess and determine the inherent risks of the poly(vinyl chloride) (PVC) suspension production process using computer-aided process engineering (CAPE). The indicators were calculated using data from safety databases and the specialized literature, considering downstream stages like vinyl chloride monomer (VCM) recovery, PVC purification and PVC drying. The obtained indicators revealed that the process has a negative performance regarding inherent safety, with a total inherent safety index of 30. The chemical inherent safety index had a value of 19, with the main chemical risk of the process being presented by the vinyl chloride monomer (with a value of 11), along with the risk of the exothermic reactions. The process safety index had a value of 15, highlighting the inventory as the primary concern of the process (with a value of 5), followed by the presence of unsafe equipment such as furnaces, burners, and dryers. The safety structure index had a score of 3, categorizing the process as probably risky, with the reaction and purification stages being more susceptible to accidents. Lastly, it is recommended to reduce the size of the process inventory and to substitute out unsafe process units.

Machine learning approaches exploring the optimal number of driver profiles based on naturalistic driving data

Driver behavior analytics is an important concept that plays a significant role in the understanding of road crashes. This paper investigates the optimal number of driver profiles to understand the most important characteristics that differentiate drivers and extract useful insights on the value of using different clustering approaches in profile recognition. To this end, two Machine Learning clustering algorithms, the K-Means and OPTICS algorithms, are applied on driving data from a large naturalistic experiment using almost 18 K trips recorded from 130 drivers. The results revealed 3 profiles, the less risky drivers, the modest drivers and the more aggressive drivers. Clustering was based on 3 important driving behavior characteristics, namely the number of speeding, headway and harsh events per 100 km. The less risky drivers profile was revealed by both algorithms, whereas drivers of higher aggressiveness are distinguished by K-Means based on the driving feature that dominates the rest. The OPTICS algorithm showed that many drivers, especially the aggressive ones, present unique behavior that cannot be grouped together with other drivers. The interpretability of driver profiles resulting from the application of these unsupervised learning techniques is worsened as the number of clusters increases. The association between driver profiles and individual characteristics leads to the conclusion that aggressiveness is mainly driven by personality traits and less by specific characteristics such as gender, age or past accident history. The results of this study can be potentially used to develop profile-specific applications that provide feedback to drivers and reduce their crash risk.

Lightning Strikes on Metal and Composite Aircraft And Their Mitigation

In this paper, the history of aircraft accidents due to lightning strikes and the statistics of lightning strikes on commercial aircraft are briefly mentioned. The mechanism of interaction between lightning and aircraft is described. Lightning can be simulated in the laboratory. Lightning testing is based on identifying and reproducing the key elements of a typical lightning current waveform; and also on classifying the various parts of an aircraft into different lightning zones. The evolution of aircraft structural materials from wood to metal to composites is traced; some of the newer hybrid materials (‘fibre-metal laminates’) that combine the advantages of metals and composites are mentioned. The lightning mitigation measures implemented by the world’s two major aircraft manufacturers, Airbus and Boeing, are briefly described. Some of the nanomaterials proposed for enhancing the surface electrical conductivity of structural composites are reviewed.