Failure Categories Research Articles

Personalized cardiac rehabilitation in older geriatric patients: an analysis of age, heart failure subtypes, and physical metrics

Abstract Background While cardiac rehabilitation (CR) is recognized for enhancing physical fitness, psychological well-being, and overall quality of life in cardiac patients, its universal application often overlooks the heterogeneity within the geriatric population. This study delves into the effectiveness of CR among older geriatric patients, aiming to uncover the disparities in response across various demographics, heart failure subtypes, and angina classifications, thereby underscoring the imperative for personalized CR programs. Methods We retrospectively analyzed 438 CR participants from December 2020 to December 2023, stratifying them by age (median: 65.14 years, IQR: 57.23-72.64), sex (23.74% female), heart failure subtype, and CCS angina class to identify distinct response patterns to CR. The analysis included a comprehensive assessment of physical metrics pre- and post-12-week CR program following cardiac surgeries, transcatheter procedures, coronary events, and/or interventions. We employed the Wilcoxon Rank Sum test for statistical analysis, focusing on identifying non-responders and quantifying effect sizes (r) to determine the magnitude of change across various physical metrics. Results Notable improvements were observed in metabolic equivalents (METs) (+1.82), oxygen uptake (VO2 peak) (+6.36 mL/kg/min), Duke Activity Status Index (DASI) score (+14.79), moderate to vigorous physical activity (MVPA) (+131.28 minutes/week), sitting time (-1.21 hours/day), total activity (+145.65 minutes/week) and sit-to-stand repetitions (+2.65). The greatest effect sizes were observed in DASI score (r=0.750) and sit-to-stand (r=SIS) repetitions (r=0.610), consistent across demographics, heart failure, and CCS categories. Other metrics noted variable changes, with handgrip strength showing no consistent trend. Sensitivity analyses revealed that older geriatric patients (≥ 80 years) with HFpEF experienced significant improvements in DASI score (r=0.638), MVPA (r=0.636), and SIS (r=0.504), while those with HFrEF and HFmrEF showed no significant improvements in any physical metrics. CCS angina classification, common comorbidities, and initial referral events did not significantly influence outcomes. Conclusion This study reaffirms the efficacy of CR but crucially identifies the gaps in its universal application, particularly among older geriatric patients with diverse heart failure subtypes. Our analysis advocates for developing personalized CR programs tailored to patients' individual profiles to enhance effectiveness of rehabilitation. By addressing these specific needs, we can ensure more inclusive and optimized patient care, ultimately supporting the expansion of CR indications to foster a more holistic approach to cardiac health in the geriatric population.

Chronotropic Incompetence across Heart Failure Categories.

The HF syndrome is characterized by an autonomic unbalance with sympathetic hyperactivity which contributes to increased myocardial oxygen demand, oxidative stress, peripheral vasoconstriction, afterload mismatch with a progressive desensitization and down-regulation of cardiac β1-receptors. These changes, together with a few other structural and peripheral changes, lead to chronotropic incompetence (CI), such as the inability to increase heart rate (HR) consistently with activity or demand. CI, regardless of the method and cut-off adopted to define it, is associated with reduced exercise capacity and a worse prognosis. Furthermore, different pharmacological classes might interfere with the physiologic exercise-induced HR response, thus generating some confusion. In particular, the β-blockers, albeit lowering peak HR, are known to improve prognosis and left ventricular inotropic reserve so that their withdrawal should be avoided at least in HF with reduced and mildly reduced ejection fraction. Similarly, a still debated strategy to counterbalance a blunted exercise-induced HR response, is represented by rate-adapting pacing. The present review, besides supplying an overview on possible CI definitions, discusses the clinical impact of CI and potential pharmacological and non-pharmacological therapeutic strategies.

The effect of ascorbic acid, QMix and other conditioning solutions on the bond strength of adhesively luted glass fiber-reinforced composite posts to root dentin, a laboratory study

PurposeThis study was designed to investigate the effect of post space conditioning with different solutions on the bond strength of glass FRC posts and evaluate the mode of resin failure. MethodsSixty extracted human single rooted teeth were root filled using a resin sealer and suitable gutta-percha cones. Post spaces were prepared, and the teeth randomly allocated into 5 groups according to their irrigation regimens which included the following solutions: 17 % EDTA, 2 % CHX, 3 % NaOCl, 10 % ascorbic acid and QMix solutions. Post spaces were irrigated with 5 ml of the solution for 15 s and subsequently washed with distilled water and dried with paper points. Glass FRC posts were cemented into their spaces using a self-adhesive resin cement. The specimens were mounted in plexiglass molds using autopolymerizing acrylic resin. A universal testing machine was used to measure post retention at a crosshead speed of 2 mm/min. The results were analyzed by one-way ANOVA followed by Tukey HSD test (α = 0.05). Dislodged posts and post spaces were examined microscopically to evaluate retention failure. ResultsThe Ascorbic acid group exhibited the highest mean retentive strength value at 229 N, followed by QMix at 198 N, NaOCl at 186 N, CHX at 170 N, and EDTA at 124 N. The mean value of the ascorbic acid group was significantly higher than EDTA group, p = 0.012. The failure category was primarily mixed. ConclusionsRinsing post spaces with ascorbic acid exhibited significantly superior bond strength. The failure mode was mixed. Clinical significanceIrrigating post spaces with ascorbic acid solution before luting FRC posts significantly improves their bond strength compared to irrigation with EDTA solution. Irrigation with QMix solution produced the second highest retentive strength but showed no statistical significance when compared to using ascorbic acid, NaOCl, CHX, or EDTA solutions.

Healthcare workers' knowledge of indicators for a palliative care approach.

Palliative care is an essential element of universal healthcare, yet not all people who need palliative care are able to receive it. One of the barriers to ensuring access for people who require palliative care is the identification of those eligible. This study evaluated healthcare workers' ability to identify patients who are eligible for palliative care based on their training or experience in palliative care. The setting for the study comprised the Heideveld Emergency Centre and Heideveld Community Day Centre in the Cape Metro, Cape Town, South Africa. This study made use of a cross-sectional survey of healthcare workers. Of the 55 participants in this study, most were able to correctly identify patients with cancer and chronic kidney disease as needing palliative care, but less accurate with other organ failure categories, trauma indications, or functional assessment of the patient. Participants who reported previous awareness training reported improved knowledge on the indications for a palliative care approach compared to no prior training. Our cohort was too small to analyse the results statistically. From what was analysed, the ability of healthcare workers to identify a person in need of palliative care could be better; more work is needed on our awareness training and basic training courses to improve this vital step.Contribution:This research highlights the fact that existing training for palliative care needs to be more applicable to the setting and that training of staff with existing courses does make a difference in knowledge.

Modelo Predictivo del Indicador de Reprobación de la Población Estudiantil de una Institución de Educación Superior (IES)

OBJECTIVE: To determine the multiple linear regression model of the HEI according to its grid of educational programs (EP), as well as analyzing the factors that affect the indicator of the subjects’ competencies achievement of the different study plans offered by TecNM in Tapachula Campus. MATERIAL AND METHOD: It is qualitative and quantitative in nature, based on a multiple linear regression model in which the failure indicator, educational programs and categories of knowledge are considered as variables, according to the Education Accreditation Council of Engineering (CACEI, by its acronym in Spanish). RESULTS: The seven categories of knowledge of the CACEI are considered fundamental for the training of competent engineers in accordance with the challenges of the 21st century. It is worth mentioning that the categories are not mutually exclusive but are interrelated and integrated throughout the engineering study program. CONCLUSIONS: The linking actions that are mostly implemented with the productive and service sector were detected, they are: Social Service and Professional Residency or professional internships, followed by the Promotion of Vacancies in the Job Boards of the HEI.

Analisis Perawatan Mesin Kapal dengan Metode Reliability Centered Maintenance (RCM) di PT Jasa Armada Indonesia Tbk

Maintenance of the ship is a task aimed at ensuring that the ship continues to operate in a normal and seaworthy condition. This work is related to the ship's machinery system and other equipment on board. If the ship does not receive regular maintenance, it can impact the condition and performance of the ship. By implementing Reliability Centered Maintenance (RCM), information about the steps needed to ensure optimal operation of the engine or equipment can be obtained. RCM is a method used to develop Preventive Maintenance. In Time Directed (TD), there are two components, namely the schottel Asd component and the valve on the cylinder head. In Condition Directed (CD), there are three components found in the three pipe components: fuel pipe, oil, and engine coolant. In Failure Finding (FF), there are four components found in the seachast component, injector pump, fuel filter, and air. Based on the application of the RCM method used, the recommended maintenance actions for the Finding Failure (FF) category include daily, weekly, and monthly inspection activities. Meanwhile, for the Time Directed (TD) category, maintenance actions involve scheduling component replacements based on predetermined intervals. Keywords: FMEA, LTA, Maintenance, RCM

Usefulness of Heart Failure Categories Based on Left Ventricular Ejection Fraction.

Heart failure guidelines have recently introduced a narrow category with mildly reduced left ventricular ejection fraction (LVEF) (heart failure with mildly reduced ejection fraction; LVEF 41%-49%) between the previous categories of reduced (heart failure with reduced ejection fraction; LVEF ≤40%) and preserved (heart failure with preserved ejection fraction; LVEF ≥50%) ejection fraction. Grouping of continuous measurements into narrow categories can be questioned if their variability is high. We constructed a cohort of all 9716 new cases of chronic heart failure with an available LVEF in Stockholm, Sweden, from January 1, 2015, until December 31, 2020. All values of LVEF were collected over time, and patients were followed up until death, moving out of Stockholm, or end of study. Mixed models were used to quantify within-person variance in LVEF, and multistate Markov models, with death as an absorbing state, to quantify the stability of LVEF categories. LVEF values followed a normal distribution. The SD of the within-person variance in LVEF over time was 7.4%. The mean time spent in any LVEF category before transition to another category was on average <1 year for heart failure with mildly reduced ejection fraction. Probabilities of transitioning between categories during the first year were substantial; patients with heart failure with mildly reduced ejection fraction had a probability of <25% of remaining in that category 1 year later. LVEF follows a normal distribution and has considerable variability over time, which may impose a risk for underuse of efficient treatment. The heart failure with mildly reduced ejection fraction category is especially inconstant. Assumptions of a patient's current LVEF should take this variability and the normal distribution of LVEF into account.

Retrospective Follow-up Assessment of Risk Variables Influencing the Outcome of Autologous Tooth Transplantation

IntroductionThis retrospective study aimed to identify which patient-, donor tooth–, recipient site–, and surgical procedure–related variables may influence the outcome of tooth autotransplantation. MethodsThe sample included 128 autotransplants performed in 122 patients. Single-visit clinical/imaging examinations were used to define the outcome as successful, survival, or failure. The association of potential indicators with the survival or failure categories was analyzed individually and adjusted for confounders through multivariate logistic regression models. ResultsAfter a follow-up period of 1 to 30.11 years, success was achieved in 71.8% of autotransplants, whereas the survival and failure groups had rates of 14.1% each, and the grouped success/survival rate reached 85.9%. An extraoral time >15 minutes and difficult handling/placement were strong/independent risk covariates for survival and failure categories (odds ratio >1, P < .05). Additionally, unerupted/partially erupted status of the donor tooth was a significant indicator for survival, whereas deficient bone level at the recipient site, surgical extraction, poor initial stability, and lack of prophylactic antibiotics were independently linked to failure (odds ratio > 1, P < .05). The root morphology and socket status acted as modifiers of the effect of the recipient site location on the survival group (P > .05). ConclusionBased on the results of this study, unerupted/partially erupted status of the donor tooth, surgical extraction, total extraoral time >15 minutes, deficient recipient’s bone level, difficult handling/placement of the autotransplant, poor initial stability, and lack of prophylactic antibiotics during the surgical procedure must be considered with caution when performing autotransplantation because of their deleterious influence on the outcome.

Understanding smart service failure: The case of smart restaurants

Is smart dining a smart choice? This research steers away from the positive connotation of smart service to embark on the smart service failure phenomenon. It draws on expectancy disconfirmation theory with data collection from two studies. Findings reveal a triadic model of service failure in smart eateries with respect to core smartness failure, smartness servicescape failure, and smartness interactivity failure. These primary failure categories are attributed to patrons’ overexpectations from smart services, as well as their personal needs and smart performance-induced cognitive evaluations. Importantly, social media hype seems to play a major role in customers’ overexpectation. This research on one hand enriches the discourse on smart dining and restaurants, while on the other hand, it bridges the gap between smart service and service failure by providing a field inquiry to answer questions such as why smart services fail and how usage of technology could backfire when services are dominated by smart devices with little employee intervention. In essence, this work contributes to the smart service literature by understanding the drawbacks of technology.

Sex differences in mortality and hospitalization in heart failure with preserved and mid-range ejection fraction: a systematic review and meta-analysis of cohort studies.

The influence of sex on the prognosis of heart failure with preserved or intermediate ejection fraction (HFpEF and HFmrEF) remains uncertain. This study aimed to investigate whether sex differences impact the prognosis of patients diagnosed with HFpEF and HFmrEF. A comprehensive search across three databases (PubMed, the Cochrane Library, and Embase) was conducted to identify sex-related prognostic cohort studies focusing on HFpEF and HFmrEF. Risk estimates were synthesized using the random effects model. The analysis included 14 cohorts comprising 41,508 HFpEF patients (44.65% males) and 10,692 HFmrEF patients (61.79% males). Among HFpEF patients, men exhibited significantly higher rates of all-cause mortality (13 studies; hazard ratio (HR): 1.24, 95% confidence interval (CI): 1.15 to 1.33)) and cardiovascular disease mortality (5 studies; HR: 1.22, 95% CI: 1.14 to 1.31) compared to women. However, no significant difference was observed in HF admissions. For HFmrEF patients, men displayed notably higher all-cause mortality (HR: 1.21, 95% CI: 1.12 to 1.31) but no significant differences in cardiovascular mortality or HF admissions. These findings suggest that male patients diagnosed with HFpEF and HFmrEF may face a more unfavorable prognosis in terms of all-cause mortality. Variations were noted in cardiovascular mortality and HF admissions, indicating potential complexities in sex-related prognostic factors within these heart failure categories. In summary, male patients with HFpEF and HFmrEF may have a more unfavorable prognosis.

Congestive Heart Failure Category Classification Using Neural Networks in Short-Term Series

Congestive heart failure carries immense importance in the realm of public health. This significance arises from its substantial influence on the number of lives lost, economic burdens, the potential for prevention, and the opportunity to enhance the well-being of both individuals and the broader community through decision-making in healthcare. Several researchers have proposed neural networks for classification of different congestive heart failure categories. However, there is little information about the confidence of the prediction on short-term series. Therefore, evaluating classification models is required for effective decision-making in healthcare. This paper explores the use of three classical variants of neural networks to classify three groups of patients with congestive heart failure. The study considered the iterative method Multilayer Perceptron neural network (MLP), two non-iterative models (Extreme Learning Machine (ELM) and Random Vector Functional Link Network (RVFL)), and the CNN approach. The results showed that the deep feature learning system obtained better classification rates than MLP, ELM, and RVFL. Several scenarios designed by coupling some deep feature maps with the RVFL and MLP models showed very high simulation accuracy. The overall accuracy rate of CNN–MLP and CNN–RVFL varies between 98% and 99%.

Completion Rates and Timeliness of Diagnostic Colonoscopies for Rectal Bleeding in Primary Care.

Rectal bleeding is the most common presenting symptom of colorectal cancer, and guidelines recommend timely follow-up, usually with colonoscopy to ensure timely diagnoses of colorectal cancer. Identify loop closure rates and vulnerable process points for patients with rectal bleeding. Retrospective cohort study, using medical record review of patients aged ≥ 40 with index diagnosis of rectal bleeding at 2 primary practices-an urban academic practice and affiliated community health center, between January 1, 2018, and December 31, 2020. Patients were classified as having completed recommended follow-up workup ("closed loop") vs. not ("open loop"). Open loop patient cases were categorized into six types of process failures. A total of 837 patients had coded diagnoses of rectal bleeding within study window. Sixty-seven were excluded based on prior colectomy, clinical presentation more consistent with upper GI bleed, no rectal bleeding documented on chart review, or expired during the follow-up period, leaving 770 patients included. Primary outcomes were percentages of patient cases classified as "open loops" and distribution of these cases into six categories of process failure that were identified. 22.3% of patients (N = 172) failed to undergo timely recommended workup for rectal bleeding. Largest failure categories were patients for whom no procedure was ordered (N = 62, 36%), followed by patients with procedures ordered but never scheduled (N = 44, 26%) or scheduled but subsequently cancelled or not kept (N = 31, 18%). While open loops increased after the onset of the COVID-19 pandemic, this difference was not significant within our study period. Significant numbers of patients presenting to primary care with rectal bleeding fail to undergo recommended workup. The majority either have no procedure ordered, or procedure ordered but never scheduled or cancelled and not kept, suggesting these are important failure modes to target in future interventions. Ensuring reliable ordering and processes for timely scheduling and completion of procedures represent critical areas for improving the diagnostic process for patients with rectal bleeding in primary care.

Abstract 13532: Long-Term Survival of Different Heart Failure Categories in Patients Discharged Owing to Coronary Artery Disease With/Without Acute Coronary Syndrome

Background: Heart failure (HF) has been classified into distinct phenotypes based on left ventricular ejection fraction (LVEF). We conducted this retrospective cohort study to explore the long-term survival prognosis of different types of HF especially the HF with improved ejection fraction (HFimpEF) group. Methods: We collected patients who had ever been hospitalized owing to coronary artery disease or acute coronary syndrome between July 2006 and June 2017 at National Taiwan University Hospital (NTUH) and NTUH Hsin-Chu Branch. Patients were classified as (1) HF with reduced ejection fraction (HFrEF); (2) HFimpEF; (3) HF with mildly reduced ejection fraction (HFmrEF); (4) HF with preserved ejection fraction (HFpEF); according to echocardiography-derived LVEF during or after the index hospitalization. The date of the first echocardiography during or after the index hospitalization was defined as the index date. All patients were followed from their index date until death or the end of the study (December 31 2017), whichever occurred first. Results: Totally, 11549 patients were categorized into 4 groups (HFrEF group, n = 986; HFimpEF group, n = 461; HFmrEF group, n = 1454; and HFpEF group, n = 8648). The crude mortality rate during follow-up in HFrEF group, HFimpEF group, HFmrEF group, and HFpEF group was 60.4%, 28.0%, 36.6%, and 18.3%, respectively. Patients in HFimpEF group, HFmrEF group, and HFpEF group all possessed a significantly reduced risk of all-cause mortality compared with HFrEF group (adjusted hazard ratio [HR] 0.241, 95% confidence interval [CI] 0.199-0.292 for HFimpEF group; 0.443, 95% CI 0.393-0.500 for HFmrEF group; and 0.292, 95% CI 0.262-0.324 for HFpEF group). Using the time-varying Cox regression model to deal with the immortal time bias, we found a persistent lower risk of all-cause mortality in patients in HFimpEF group compared with patients in HFrEF group (adjusted HR 0.579, 95% CI 0.467-0.718). Conclusion: Patients in HFrEF group had the worst long-term survival prognosis and patient in HFpEF group had the best long-term survival prognosis. Patients in HFimpEF group represented a distinctive population with good survival prognosis than HFrEF group and HFmrEF group.

A netnographic study with social media comments for investigating service failures

AbstractThis study demonstrates a netnographic study to investigate airline service failure types and to test differences of linguistic patterns among complaint types on social media user comments. User comments in an airline's Facebook community were scraped and service failure types were systematically classified with the measurement developed by thematic coding and literature review. The results presented frequently occurring service failure categories in airline service operations. A T‐Test was conducted to confirm the significant differences in linguistic characteristics between complaint comments and non‐complaint comments. Word frequency analysis showed distinctive word themes between the two comment groups. Research and managerial implications were provided.

#2572 CLINICAL CHARACTERISTICS OF ACUTE KIDNEY INJURY IN PATIENTS WITH GLUFOSINATE POISONING

Abstract Background and Aims Glufosinate-containing herbicide is widely used in agriculture. According to previous reports, glufosinate poisoning causes various complications, but there are few reports of nephrotoxicity. In this study, we investigated the incidence and clinical characteristics of acute kidney injury (AKI) in patients with glufosinate poisoning. Method This study performed between 2008 and 2021 included 76 patients categorized into the AKI and the non-AKI groups. The incidence, clinical characteristics, and severity of AKI were compared between the AKI (n=54) and the non-AKI (n=22) groups, based on the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease classification. Results The incidence of AKI was 71.1%, of which 40.9%, 26.3%, and 3.9% patients were classified into the Risk, Injury, and Failure categories, respectively. Patients in the AKI group were older (62.6±14.2 years vs. 54.9±16.2 years, P=0.045) and poorer renal function (73.9±25.2 mL/min/1.73 m² vs. 94.5±35.5 mL/min/1.73 m², P=0.006) on admission. The length of hospitalization was longer (17.2±17.2 days vs. 7.6±7.6 days, P=0.014) in AKI group, and the mean amount of glufosinate ingested was higher in AKI group than that in non-AKI group (250±172 mL vs. 152±121 mL, P=0.032). In addition, the serum bicarbonate level was lower in AKI group than in non-AKI group (19.9±4.7 vs. 23.0±3.3, P=0.006). Notably, intensive care unit admissions (81.5% vs. 40.9%, P=0.001) and mechanical ventilator support (68.5% vs. 22.7%, P&amp;lt;0.001) were more frequently required in the AKI group. Multivariate logistic regression analysis showed that serum bicarbonate concentration on admission remained significant predictors of AKI in patient with glufosinate poisoning. Conclusion Serum bicarbonate is helpful to predict the development of patients with glufosinate poisoning.

Usefulness of heart failure categories based on left ventricular ejection fraction

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): This study was sponsored by AstraZeneca. Introduction Heart failure, a common disease with a mortality on par with many cancers, is one of the costliest diseases to society in the western world. Current heart failure guidelines are based on categories of left ventricular ejection fraction (LVEF) and have recently introduced a narrow category with mid-range/mildly reduced ejection fraction (HFmrEF; LVEF 41-49%) between the previous categories with reduced (HFrEF; LVEF ≤40%) and preserved (HFpEF; LVEF ≥50%) ejection fraction. The grouping of continuous variables into narrow categories can be questioned if the variability is high. Purpose To determine the shape of the LVEF distribution and quantify the stability of LVEF categories over time in a large real-world heart failure population, in order to establish the usefulness of LVEF categories for treatment decisions. Methods Population-based observational cohort study of all new cases of chronic heart failure in Region Stockholm, Sweden, from 2016-01-01 until 2020-12-31. All available values of LVEF were collected over time and patients were followed until death or end of study. Mixed models were used to quantify within-person variance in LVEF, and Multistate Markov models, with death as an absorbing state, to quantify the stability of LVEF categories. Results During the study period, 8,455 patients were diagnosed with heart failure. LVEF values followed a perfect normal distribution. The standard deviation of the within-person variance in LVEF was 7.4%. Regardless of initial LVEF category, age or sex, the mean time spent in any LVEF category before transition to another category (mean sojourn time) was on average less than 0.6 years (Figure 1). The one-year probabilities of transitioning between states were substantial (Figure 2). Patients with HFmrEF had a probability of 1/4 of remaining in that category one year later; the probability of patients with HFrEF of remaining in that category one year later was 1/4 for women and 1/3 for men; and patients with HFpEF had a probability of remaining in that category of 2/3 for women and 1/2 for men. Conclusion In patients with heart failure, LVEF has considerable variability over time. Hence, LVEF has limited use for categorisation of the heart failure population into narrow categories.

Balancing Perspective of the Woman Protagonist Between Traditional Approach and Economic Independence in Manju Kapur’s Novel: Home

The place of women in her household and within her society has always been persisted a matter of conflict not only in Indian environment but throughout the world civilization since the very primitive times of human enlightenment. The spiritual ideologies of every religion and the constitution of India inspired by the different religions generally advocates that every person must have the equality in every sphere of life and some essential rights of their own to live their respective lives with self-respect and self-reputation, being a member of his/her corresponding community. But the social construct of every civilization has ever been dominated by the customary rituals of every socio-cultural phenomenon as well as the mind set-up of people belonged to every conventional society. These socio-cultural constructs may vary from one community to the another. With the impact of education, advancement and modernization prevailed in most of the societies, the outlook of the community has been changed for the reputation and place of the women resulted to their growth in every domain of life but some orthodox communities are still there and these do not want to confer the freedom and equal rights to women of their community for which they actually deserve. These women of the said communities have been victimized to their exploitation and in their miserable predicament. They are not only harassed in the previous past historical context of the society but are being dominated and prosecuted in the present civilization also. These women are still expected to lead their lives as slaves to their traditional households and to work or to dance like the puppets according to the directions of their male-counterparts of orthodox patriarchal system of the civilization being continued as the custom of the conventional society. Even though, these women of the society might be well-educated, might be employed in different professions, such as; successful teachers, administrators and business-women etc., who are showing their dexterity in every walk of life as no any field has been left behind where they have not shown and proved their effective contribution to society for its growth, development and welfare etc. But still, they are lacking to establish their own independent identity within their household and their distinctive communities. They are educated enough, who have been come out of the thick darkness of their illiteracy, stupefaction and ignorance by piercing the rays of hope through education and economic growth towards their upliftment. These women have made their sincere endeavours towards their well-being but unfortunately, they are still a failure category to secure for themselves a respectable and reputable place within the male members of their own households. There they are still considered as an essential usable asset to run the households skillfully without raising their voice even a little. In short, they have been freed from illiteracy but they are still in the bound of the traditional patriarchal; system of the society. These women have become an earning member for their families, who are working inside and outside of their homes to serve and feed their families but still they are the part of their humiliation, exploitation and oppression under the mental set-up of the traditional patriarchal system of society. Hence, there is no any other way by which they may escape themselves from the clutch of traditional bounds over them. Subsequently, they have to make balance between their little economic independence with the traditional outlook of the society and of their familial households.

Fiber post bonding with beta-tricalcium phosphate incorporated root dentin adhesive. SEM, EDX, FTIR, rheometric and bond strength study.

The aim was to formulate an experimental adhesive (EA) and added nanoparticles (NPs) of beta-tricalcium phosphate (β-TCP) to see the impact on pushout bond strength (PBS) and other mechanical properties. Three adhesives were prepared, including EA (control, without β-TCP NPs), 2.5%-β-TCP NPs containing adhesive (2.5%-NPA), and 5% β-TCP NPs containing adhesive (5%-NPA). For the characterization of the NPs, scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) spectroscopy was accomplished. For the adhesive's characterization, rheological assessment, and degree of conversion (DC) analysis were performed. PBS of these adhesives against resin fiber post to root dentin, interfacial failure categories, and resin dentin interface analysis were also assessed. The β-TCP NPs were seen as agglomerated asymmetrical particles on SEM. These NPs were composed primarily of calcium (Ca), and phosphorus (P). Rheological evaluation of the adhesive's showed a drop in the viscosity of all adhesives at greater angular frequencies. The greatest DC was detected for the EA group (67.54 ± 7.9) followed by 2.5%-NPA group (45.32 ± 5.1), whereas the lowest DC values were seen for the 5%-NPA group (38.97 ± 6.5). Concerning PBS, the 2.5%-NPA revealed the highest values at the coronal (12.81 ± 3.0) and middle (8.50 ± 2.3) sections, whereas, for the apical section, the highest PBS values were seen for the 5%-NPA (4.9 ± 1.6). Most of the failures for all adhesive groups were seen at the adhesive-dentin interface (cohesive type failures) for all root segments (coronal, middle, and apical). The resin-dentin interface analysis verified hybrid layer and resin tag formation for all adhesives, but the presence of dispersed β-TCP NPs was only seen in the two NP-reinforced adhesives. The adding of β-TCP NPs in the adhesive could be beneficial as it could improve its PBS. Suitable rheological properties and dentin interaction were also observed for NP-reinforced adhesives. A reduced DC was seen for both β-TCP NP-containing adhesives as compared to the EA. RESEARCH HIGHLIGHTS: Experimental adhesives were reinforced with beta-tricalcium phosphate (β-TCP) nanocrystals. The β-TCP NPs were seen as agglomerated asymmetrical particles on SEM. These NPs were composed primarily of calcium (Ca), and phosphorus (P). β-TCP adhesives demonstrated superior pushout bond strength and a drop in the adhesive viscosity at greater angular frequencies compared to control adhesive. The greatest DC was detected for the EA group followed by 2.5%- β-TCP group, whereas the lowest DC values were for the 5%- β-TCP group.

Gray area between policy success and failure: Assessing the degree of success of Law Number 7 of 2016 in the salt industrialization program in West Nusa Tenggara Province

Salt problems in Indonesia are quite complex and persistent, including reliance on imports, low quality, poor trade administration, and high costs. The central government has issued a policy that protects salt farmers, regulates salt imports, and implements the PUGaR program. The NTB Provincial Government as the fourth largest contributor to salt production in Indonesia has a Salt Industrialization Program policy. This article analyzed the existing policies for overcoming the problems and achieving the expected results. Using a descriptive qualitative research method with Policy Success theory proposed by Allan McConnell as its analytical tool, this article examines the success/failure of salt policy from the process, program, and political dimensions, as well as the level of success using the degree of policy success/failure. The results of the study showed that the criterion for maintaining policy objectives/instruments and policy legitimacy on the process dimension is included in tolerable failure because there is still a failure to maintain objectives and legitimacy even though it is not significant. The criterion for building a sustainable coalition is included in conflicted failures because it has not involved all stakeholders in policy formulation. In the program dimension, the criteria for implementation that is aligned with objectives, achieving the expected outcomes, and providing benefits for the target group are included in the conflicted failure category because there are balanced conditions between success and failure. Meanwhile, the political dimension cannot be measured because it still receives minimal public attention.

Clinical characteristics of acute kidney injury in patients with glyphosate surfactant herbicide poisoning.

In this study, we investigated the clinical characteristics of acute kidney injury (AKI) in patients with glyphosate surfactant herbicide (GSH) poisoning. This study was performed between 2008 and 2021 and included 184 patients categorized into the AKI (n = 82) and nonAKI (n = 102) groups. The incidence, clinical characteristics, and severity of AKI were compared between the groups based on the Risk of renal dysfunction, Injury to the kidney, Failure or Loss of kidney function, and End-stage kidney disease (RIFLE) classification. The incidence of AKI was 44.5%, of which 25.0%, 6.5%, and 13.0% of patients were classified into the Risk, Injury, and Failure categories, respectively. Patients in the AKI group were older (63.3 ± 16.2 years vs. 57.4 ± 17.5 years, p = 0.02) than those in the non-AKI group. The length of hospitalization was longer (10.7 ± 12.1 days vs. 6.5 ± 8.1 days, p = 0.004) and hypotensive episodes occurred more frequently in the AKI group (45.1% vs. 8.8%, p &lt; 0.001). Electrocardiographic (ECG) abnormalities on admission were more frequently observed in the AKI group than in the non-AKI group (80.5% vs. 47.1%, p &lt; 0.001). Patients in the AKI group had poorer renal function (estimated glomerular filtration rate at the time of admission, 62.2 ± 22.9 mL/min/1.73 m2 vs. 88.9 ± 26.1 mL/min/1.73 m2 , p &lt; 0.001) on admission. The mortality rate was higher in the AKI group than in the non-AKI group (18.3% vs. 1.0%, p &lt; 0.001). Multiple logistic regression analysis showed that hypotension and ECG abnormalities upon admission were significant predictors of AKI in patients with GSH poisoning. The presence of hypotension on admission may be a useful predictor of AKI in patients with GSH intoxication.