Optimal Relief Research Articles

Optimal Location of Rescue Centers Using GIS and Multi-criteria Decision Making Methods (Case Study: Urmia City)

INTRODUCTION: Pre-crisis planning is one of the important issues facing managers and planners, especially in the field of crisis management. In recent years, the world has faced an increasing number of natural and man-made disasters, such as earthquakes. Moreover, the growing effect of disasters on communities has highlighted the need for efficient and effective emergency logistics operations in this field, and some criteria are provided for decision-making and prioritization of relief centers in crisis situations. METHODS: In the current research, Analytic Network Process (ANP) and PROMETHEE (Preference Ranking Organization Method for Enriching Evaluations) methods were used for analysis and ranking, and construction cost and usage time indicators were considered for the first time. Criteria were also defined and evaluated as layers according to global standards and crisis management criteria in the region. In addition, geographic information systems and expertschr('39') opinions were used to evaluate the indicators. FINDINGS: Due to the higher weight value, safety (0.36), usage time (0.24), as well as concentration and coverage level (0.22) received priority for the selection of the most optimal relief sites in crisis situations. Therefore, centers, such as Amini Stadium and Golestan Park, which had a lower performance status in terms of the mentioned indicators, compared to other options, were placed in a lower rank in the final ranking, in comparison with other centers. CONCLUSION: The indicators identified in order of importance were security, time of use, concentration and coverage level, and compatible access. In the end, Takhti Stadium, Saat Park, and Rajaei Stadium received priority for the establishment of relief centers in terms of performance and the weight value of the mentioned indicators in time of crisis.

Unilateral versus bilateral hilar stents for the treatment of cholangiocarcinoma: a multicenter international study.

BackgroundEndoscopic placement of hilar stents is an accepted palliative therapy for patients with advanced, unresectable cholangiocarcinoma. However, whether unilateral versus bilateral stent placement provides optimal relief continues to be a subject of debate. The aim of this study was to compare the technical and clinical outcomes in patients with inoperable cholangiocarcinoma who received unilateral or bilateral self-expanding metal stents (SEMS).MethodsWe conducted a multicenter, international retrospective study of 187 patients with cholangiocarcinoma who received unilateral or bilateral SEMS. Outcomes included, but were not limited to, technical success, clinical success, adverse events, stent occlusion, and survival time. Results were further stratified based on the Bismuth classification.ResultsFifty patients received unilateral stents and 137 patients received bilateral stents. All patients achieved technical success. The clinical success rates were 86% for unilateral stents and 82.5% for bilateral stents (P>0.99). Clinical success was not statistically different for either group when stratified by the Bismuth classification (P=0.62 and P=0.72 respectively). There were significantly more adverse events in the bilateral stents group (11.7% vs. 0%, P=0.007). There was no greater risk of stent occlusion when bilateral stents were used (unadjusted P=0.71, adjusted P=0.81). There was a greater risk of death for patients who received bilateral SEMS (hazard ratio 1.78, 95% confidence interval 1.09-2.89; P=0.02).ConclusionsUnilateral and bilateral drainage had similar technical and clinical success rates. However, bilateral stents had a higher risk of death and more adverse events. Therefore, unilateral SEMS placement is sufficient for relief of biliary obstruction secondary to cholangiocarcinoma.

Оптимальное определение рельефа поверхности по совокупности фотометрических и альтиметрических данных

Оптимальное определение рельефа поверхности по совокупности фотометрических и альтиметрических данных

Achromatic refractive–diffractive double-relief microprisms

The Fresnel-prism technique has become an important medical option for the diagnostics and treatment of strabismus in children. However, the application of prisms in ophthalmology generally involves chromaticity problems: the formed optical images are distorted due to the dispersion of white light at the microrelief and the applied microprisms reduce the contrast of the images of the test charts, and in turn, the accuracy of eye diagnostics drops. In this study, a novel method was developed for the total chromatism compensation using a special microprismatic refractive–diffractive structure with double microrelief: the first refractive microrelief was used for light beam deflection, whereas the second diffractive one was used for compensating the chromatism of the first microprism. The dispersion chromatism of the first refractive prism and the diffraction chromatism of the second microprism grating are oppositely directed. Thereby, dispersion chromatism can be completely compensated by diffraction grating. The optimal characteristics of these achromatic refractive–diffractive structures were calculated, and the necessary angles and optimal relief pitches of the ophthalmic microprisms were obtained. Achromatic structures were manufactured according to the calculated parameters, and their optical characteristics were experimentally investigated. The main advantage of such optical devices is that they are flat and very thin. The findings indicate the possibility of designing effective achromatic microprisms.

Management of Paediatric Pain: Knowledge and Practice of Healthcare Providers at a Tertiary Centre, Southern Nigeria

Background: Many disease processes and interventional procedures in paediatrics are associated with pain. In spite of its frequency, it is undertreated globally, exposing children to the risks of long-term physical and psychological sequelae, which can have adverse effects on future treatments.
 Objectives: To ascertain the knowledge, attitude and practice of healthcare providers towards management of paediatric pain at the University of Port Harcourt Teaching Hospital.
 Methods: In this cross-sectional survey, a semi-structured and self-administered questionnaire was distributed amongst a convenient sample of physicians and nurses attached to clinical departments/units where children are cared for, and those in educational units, between June and August 2017. Their knowledge and attitude toward pain management were analysed using Epi Info v7 software (CDC, USA).
 Results: One hundred and ninety seven subjects participated in the study, 95(48.2%) physicians and 102(51.8%) nurses, all of various cadres. Seventy-four percent of them had more than 5 years working experience. One third of participants (30.4%) could name up to 3 non-pharmacological methods of pain management, of which the commonest were cold compress (48(24.4%) with nurses>physicians), followed by hot compress (38(19%)) and distraction (24(12%)). The commonest procedures for which non-pharmacological interventions of pain management were usually applied included immunisation of infants (20%) and venepuncture (17%) while lumbar puncture was the least (1.5%). Half of respondents (52%) had never prescribed/administered morphine to children.
 Conclusion: Healthcare providers had poor knowledge of paediatric pain management. There is an urgent need to build their capacity to enable optimal relief of pain among paediatric patients.

Vision-based assessment of parkinsonism and levodopa-induced dyskinesia with pose estimation

BackgroundDespite the effectiveness of levodopa for treatment of Parkinson’s disease (PD), prolonged usage leads to development of motor complications, most notably levodopa-induced dyskinesia (LID). Persons with PD and their physicians must regularly modify treatment regimens and timing for optimal relief of symptoms. While standardized clinical rating scales exist for assessing the severity of PD symptoms, they must be administered by a trained medical professional and are inherently subjective. Computer vision is an attractive, non-contact, potential solution for automated assessment of PD, made possible by recent advances in computational power and deep learning algorithms. The objective of this paper was to evaluate the feasibility of vision-based assessment of parkinsonism and LID using pose estimation.MethodsNine participants with PD and LID completed a levodopa infusion protocol, where symptoms were assessed at regular intervals using the Unified Dyskinesia Rating Scale (UDysRS) and Unified Parkinson’s Disease Rating Scale (UPDRS). Movement trajectories of individual joints were extracted from videos of PD assessment using Convolutional Pose Machines, a pose estimation algorithm built with deep learning. Features of the movement trajectories (e.g. kinematic, frequency) were used to train random forests to detect and estimate the severity of parkinsonism and LID. Communication and drinking tasks were used to assess LID, while leg agility and toe tapping tasks were used to assess parkinsonism. Feature sets from tasks were also combined to predict total UDysRS and UPDRS Part III scores.ResultsFor LID, the communication task yielded the best results (detection: AUC = 0.930, severity estimation: r = 0.661). For parkinsonism, leg agility had better results for severity estimation (r = 0.618), while toe tapping was better for detection (AUC = 0.773). UDysRS and UPDRS Part III scores were predicted with r = 0.741 and 0.530, respectively.ConclusionThe proposed system provides insight into the potential of computer vision and deep learning for clinical application in PD and demonstrates promising performance for the future translation of deep learning to PD clinical practices. Convenient and objective assessment of PD symptoms will facilitate more frequent touchpoints between patients and clinicians, leading to better tailoring of treatment and quality of care.

Intra-articular dexmedetomidine with bupivacaine versus bupivacaine alone for postoperative analgesia after knee arthroscopy

Background: Optimal relief of pain after knee arthroscopy is essential for early rehabilitation and mobilisation and to minimise postoperative morbidity. This study’s aim was to assess dexmedetomidine as an additive to intra-articular (IA) bupivacaine in terms of analgesic duration and postoperative rescue analgesic consumption following arthroscopic knee surgery.Methods: A total of 70 patients, ASA physical status I and II, undergoing knee arthroscopy under general anaesthesia were enrolled in this double-blinded randomised controlled study, after Pan African Clinical Trial Registry (PACTR201507001048242) approval was obtained. Patients were randomly assigned into two groups; the bupivacaine group (B) received IA 19 ml bupivacaine 0.5% + 1 ml normal saline, bupivacaine dexmedetomidine group (BD) received IA injection of 19 ml bupivacaine 0.5% + dexmedetomidine 100 μg (1 ml). Postoperative visual analogue pain score (VAS), duration of analgesia and postoperative analgesic requirement were assessed.Results: VAS scores at rest and on mobilisation were significantly lower in the BD group at 4 h, 6 h and 8 h postoperatively in comparison with group B (p < 0.05). VAS scores were comparable between studied groups during the first 2 h, and at 12 h and 24 h postoperatively. Duration of analgesia was significantly longer in group BD (458.9 ± 93.5 min) than in the B group (229.1 ± 83.7 min) (p < 0.05). Postoperative analgesic consumption was lowered in the BD group compared with the B group (p < 0.05).Conclusions: Adding dexmedetomidine to IA bupivacaine after knee arthroscopy prolongs analgesic duration and decreases postoperative analgesic requirement.Keywords: arthroscopy, dexmedetomidine, intra-articular, postoperative pain

Automated vision-based analysis of levodopa-induced dyskinesia with deep learning.

Levodopa is the gold standard therapy for Parkinson's disease (PD), but its prolonged usage leads to additional motor complications, namely levodopa-induced dyskinesia (LID). To assess LID and adjust drug regimens for optimal relief, patients attend regular clinic visits. However, the intermittent nature of these visits can fail to capture important changes in a person's condition. With the recent emergence of deep learning achieving impressive results in a wide array of fields including computer vision, there is an opportunity for video analysis to be used for automated assessment of LID. Deep learning for pose estimation was studied as a viable means of extracting body movements from PD assessment videos. Movement features were computed from joint trajectories. Results show that features derived from vision-based analysis have moderate to good correlation with clinician ratings of dyskinesia severity. This study presents the first application of deep learning to video analysis in PD, and demonstrates promise for future development of a non-contact system for objective PD assessment.

Colored Glasses to Mitigate Photophobia Symptoms Posttraumatic Brain Injury.

After a concussion or mild traumatic brain injury (mTBI), patients often suffer from light sensitivity, or photophobia, which contributes to decreased quality of life post-mTBI. Whereas sunglasses may provide some relief from photophobia, they are not practical indoors or in low light. A light-mitigation strategy can be easily used indoors as needed to optimize the relief. We have found that many photophobic patients experience relief using colored sunglasses. To provide the athletic trainer with a means and method to assess whether an athlete is suffering from photophobia after concussion and to determine if colored glasses provide relief. Cross-sectional study. Rehabilitation clinic. Fifty-one patients being treated after concussion. We assessed postconcussion patients for visual symptoms including photophobia and photosensitivity. Off-the-shelf glasses were used to determine whether specific colors provided relief from photophobia. Screening was done using a penlight and multiple pairs of colored glasses. Self-reported mitigation of photophobia symptoms and the specific color frequency that reduced symptoms in each individual. Of the 39 patients studied who had visual symptoms, 76% complained of photophobia. Using glasses of 1 or more colors, symptoms were relieved in 85% of patients reporting photophobia. The colors that provided the most relief were blue, green, red, and purple. No adverse events were reported. An empirical assessment of frequency-specific photophobia is easy to perform. A traditional penlight is used to elicit photophobia and then the colored glasses are tested for optimal relief. Frequency-specific photophobia can be reduced with a strategy of light-mitigation therapy, including colored glasses, sunglasses, hats, and light avoidance. This, we believe, helps to improve the patient's quality of life and may aid in the recovery process. More work is needed to identify the best colors and methods of mitigating frequency-specific photophobia.

Physiology of midbrain head movement neurons in cervical dystonia

Early theories for cervical dystonia, as promoted by Hassler, emphasized the role of the midbrain interstitial nucleus of Cajal. Focus then shifted to the basal ganglia, and it was further supported with the success of deep brain stimulation. Contemporary theories suggested the role of the cerebellum, but even more recent hypotheses renewed interest in the midbrain. Although the pretectum was visited on several occasions, we still do not know about the physiology of midbrain neurons in cervical dystonia. We analyzed the unique database of pretectal neurons collected in the 1970s and 1980s during historic stereotactic surgeries aimed to treat cervical dystonia. This database is valuable because such recordings could otherwise never be obtained from humans. We found the following 3 types of eye or neck movement sensitivity: eye-only neurons responded to pure vertical eye movements, neck-only neurons were sensitive to pure neck movements, and the combined eye-neck neurons responded to eye and neck movements. There were the 2 neuronal subtypes: burst-tonic and tonic. The eye-neck or eye-only neurons sustained their activity during eccentric gaze holding. In contrast, the response of neck-only and eye-neck neurons exponentially decayed during neck movements. Modern quantitative analysis of a historic database of midbrain single units from patients with cervical dystonia might support novel hypotheses for normal and abnormal head movements. This data, collected almost 4 decades ago, must be carefully viewed, especially because it was acquired using a less sophisticated technology available at that time and the aim was not to address specific hypothesis, but to make an accurate lesion providing optimal relief from dystonia. © 2017 International Parkinson and Movement Disorder Society.

Development and Evaluation of Matrix Tablet by Taking New Chemicals Combination of Chitosan and Eudragit-l 100

Objective: The objective of this study is to develop extended release matrix tablet by taking mixture of chitosan and anionic polymers and then to study the drug release pattern for a low solubility drug Tramadol Hydrochloride (TH). TH has mean elimination half-life is ~6 hrs and requires dosing every 6 hrs in order to maintain optimal relief of chronic pain. So once-daily extended-release tablets are formulated by taking Chitosan (CS) and anionic polymers Eudragit-L100-55 . Methods : The tablets were prepared by direct compression method. In vitro drug release was carried out under simulated gastric and intestinal condition to achieve drug release more than 20 hrs. Fourier transform infrared spectroscopy (FTIR) study was conducted to study any interaction between dug and ingredients. Results : CS and Eudragit-L combination form a Poly Electrolyte Complex which is responsible for extending drug release for low solubility drug. This complex formation is also confirmed by FTIR study. Conclusion: Stability studies (40oC and 75 ± 5%RH) for 3 months indicated that Tramadol hydrochloride was stable in the matrix tablets. Key words: Chitosan, Eudragit-L100, Tramadol Hydrochloride, Matrix Tablet, FTIR.

Real-time relief distribution in the aftermath of disasters – A rolling horizon approach

This paper presents a rolling horizon-based framework for real-time relief distribution in the aftermath of disasters. This framework consists of two modules. One is a state estimation and prediction module, which predicts relief demands and delivery times. The other is a relief distribution module, which solves for optimal relief distribution flows. The goal is to minimize the total time to deliver relief goods to satisfy the demand, considering uncertain data and of the risk-averse attitude of the decision-maker. A numerical example based on the large-scale earthquake that occurred on September 21, 1999 in Taiwan is presented to demonstrate the system.

Validation of a novel combination hearing aid and tinnitus therapy device.

Most patients with tinnitus also have hearing loss. Hearing aids have been well-documented to provide amelioration for both hearing and tinnitus problems. Some hearing aids have built-in noise/sound generators that are intended to provide added benefit to patients with tinnitus. It has not been proven, however, whether these "combination instruments" are more effective for tinnitus management than hearing aids alone. The purpose of this study was to collect initial data addressing this question. Thirty individuals meeting study requirements (bothersome tinnitus, hearing aid candidate, and no use of hearing aids for the previous 12 months) were enrolled. All participants initially completed the primary outcome questionnaire (Tinnitus Functional Index [TFI]) and then returned to be fitted with combination instruments. The hearing aid portion of the devices was adjusted to optimize hearing ability. Participants were then randomized to either the experimental group (n = 15) or the control group (n = 15). The experimental group had the noise feature of the instruments activated and adjusted to achieve optimal relief from tinnitus. The control group did not have the noise portion activated. Following the hearing aid fitting, all study participants also received brief tinnitus counseling. Participants returned 1 to 2 weeks later for a follow-up appointment to confirm proper fit of the instruments and to make any necessary programming adjustments. Additionally, they returned 3 months after the fitting to complete the TFI, which also concluded their participation in the study. Both groups revealed significant improvement, as indicated by reductions in mean TFI index scores. Differences between groups at 3 months were not statistically significant. However, the experimental group showed a mean reduction in the TFI score that was 6.4 points greater than that for the control group. The difference approached significance (p = 0.09), suggesting that a larger group of participants may have resulted in a significant difference between groups. This possibility is tempered by the fact that effect sizes, which control for variation, were very similar between groups. Results of this study suggest that the use of hearing aids alone or hearing aids plus the use of sound generators both provide significant benefit with respect to alleviating effects of tinnitus. A larger controlled clinical trial is needed to obtain more definitive results regarding the two configurations of hearing aids.

Microstructure Development, Nanomechanical, and Dynamic Compression Properties of Spark Plasma Sintered TiB2-Ti-Based Homogeneous and Bi-layered Composites

The growing threats due to increased use of small-caliber armor piercing projectiles demand the development of new light-weight body armor materials. In this context, TiB2 appears to be a promising ceramic material. However, poor sinterability and low fracture toughness remain two major issues for TiB2. In order to address these issues together, Ti as a sinter-aid is used to develop TiB2-(x wt pct Ti), (x = 10, 20) homogeneous composites and a bi-layered composite (BLC) with each layer having Ti content of 10 and 20 wt pct. The present study uniquely demonstrates the efficacy of two-stage spark plasma sintering route to develop dense TiB2-Ti composites with an excellent combination of nanoscale hardness (~36 GPa) and indentation fracture toughness (~12 MPa m 1/2 ). In case of BLC, these properties are not compromised w.r.t. homogeneous composites, suggesting the retention of baseline material properties even in the bilayer design due to optimal relief of residual stresses. The better indentation toughness of TiB2(10 wt pct Ti) and TiB2-(20 wt pct Ti) composites can be attributed to the observed crack deflection/arrest, indicating better damage tolerance. Transmission electron microscope investigation reveals the presence of dense dislocation networks and deformation twins in a-Ti at the grain boundaries and triple pockets, surrounded by TiB2 grains. The dynamic strength of around 4 GPa has been measured using Split Hopkinson Pressure Bar tests in a reproducible manner at strain rates of the order of 600 s � 1 . The damage progression under high strain rate has been investigated by acquiring real time images for the entire test duration using ultra-high speed imaging. An attempt has been made to establish microstructure-property correlation and a simple analysis based on Mohr–Coulomb theory is used to rationalize the measured strength properties.

Optimization and analysis of multi-layer diffractive optical elements in visible waveband

An optimization for diffraction efficiency of the multi-layer diffractive optical elements (MLDOEs) is presented, then the construction process of optimization program is introduced in detail. A new optimization initial point is proposed, which contributes to analyze the relationship between the optimal relief heights and the base materials. Through the optimization examples, diffraction efficiency higher than 99.7% from F line (486.1327nm) to C line (656.2725nm) of visible waveband can be achieved, and the polychromatic integral diffraction efficiency (PIDE) over the entire waveband is 99.94%. Moreover, this paper compares and analyzes optimization results of different glass pairs, and the relationship between the optimal relief heights pairs and base materials pairs is obtained.

The Design of Indexable Gear Insert and Cutting Parameter Optimization

The gear is widely used in manufacturing industry. The object of study is straight spur gear. According to the feature of involute gear, a three-edged indexable milling insert is designed. Firstly, the milling model is built in Deform3D. Then, the optimal relief angle is gained based on the cutting temperature and the optimal relief angle is 6°. The cutting parameters are researched and the optimal parameters are obtained according to the cutting force.

An evaluation of total disintegration time for three different doses of sublingual fentanyl tablets in patients with breakthrough pain.

IntroductionBreakthrough pain is common among patients with cancer and presents challenges to effective pain management. Breakthrough pain is characterized by rapid onset, severe intensity, and duration typically lasting <1 h. Thus, optimal relief from breakthrough pain is best attained by administering analgesics with dissolution times and bioavailabilities that closely match the onset and duration of breakthrough pain. The objective of this study was to assess complete disintegration time of three different doses of sublingual fentanyl tablets in opioid-tolerant patients.MethodsThis was a single-center, non-randomized, open-label study. Opioid-tolerant adult patients (N = 30) with chronic pain were assigned to one of three dose groups and self-administered a single 100, 200, or 300 μg sublingual fentanyl tablet (Abstral®, Galena Biopharma, Portland, OR, USA). Time to complete disintegration was measured by each patient with a stopwatch and independently verified by study personnel.ResultsDisintegration time (mean ± SD) for sublingual fentanyl tablets (all doses) was 88.2 ± 55.1 s. Mean disintegration times tended to be slightly longer for the 200 μg (96.7 ± 57.9 s) and 300 μg doses (98.6 ± 64.8 s) compared to the 100 μg dose (69.5 ± 40.5 s). Differences were not statistically significant. Disintegration time was not significantly different between men and women and was not affected by age.ConclusionSublingual fentanyl tablets dissolved rapidly (average time <2 min) in all patients, with the higher doses taking slightly more time to dissolve.Electronic supplementary materialThe online version of this article (doi:10.1007/s40122-013-0019-6) contains supplementary material, which is available to authorized users.

Emergency Decision Engineering Model Based on Sequential Games

When emergency breaks out, the problem how to make timely and efficiently the emergency decision is focus issue in emergency management. So an engineering model is established by using dynamic games firstly. Then the process of sequential games between decision maker and emergency is analyzed in detail. The information about emergency is got through finitely sequential games in order to bring forth the optimal relief plan and to provide support for the decision-making when an emergency occurs. Finally, the optimal relief plan that was generated by using the engineering model of sequential games is given by a specific example.

Technology Research on Relief Annealing of 65Mn Metal Rubber

The paper had researched relief annealing of 65Mn Metal Rubber. Test results had shown that relief annealing significantly changed static and dynamic loss factors of 65Mn Metal Rubber. The influence of annealing temperature, annealing time, Metal Rubber density and cooling to static and dynamic loss factors was obviously different. The optimal relief annealing parameters of 65Mn Metal Rubber were annealing temperature 270°C, annealing time 25 minutes, Metal Rubber density 1.46g/cm3, and oil cooling.

Serine-Threonine Ubiquitination Mediates Downregulation of BST-2/Tetherin and Relief of Restricted Virion Release by HIV-1 Vpu

The HIV-1 protein Vpu counteracts the antiviral activity of the innate restriction factor BST-2/tetherin by a mechanism that partly depends on its interaction with β-TrCP, a substrate adaptor for an SCF (Skp-Cullin 1-F box) E3 ubiquitin ligase complex. This suggests that Vpu stimulates the ubiquitination of BST-2 and that this underlies the relief of restriction. Here, we show that Vpu stimulates ubiquitination of BST-2. Mutation of all potential ubiquitination sites in the cytoplasmic domain of BST-2, including lysines, cysteines, serines, and threonines, abrogates Vpu-mediated ubiquitination. However, a serine-threonine-serine sequence specifically mediates the downregulation of BST-2 from the cell surface and the optimal relief of restricted virion release. Serine-threonine ubiquitination of BST-2 is likely part of the mechanism by which Vpu counteracts innate defenses.