Pre Period Research Articles

Clinical profile and outcome of children with diabetic ketoacidosis admitted in a tertiary care centre in kerala during the pre and post COVID period

Clinical profile and outcome of children with diabetic ketoacidosis admitted in a tertiary care centre in kerala during the pre and post COVID period

Covid-19 Induced Herding: A Case of Sectoral Indices of The Indian Stock Market

Herding tendencies are likely to be more prominent during the crisis period. The Covid-19 outbreak has been nothing less than a crisis for the world. Assuming the possibility of Covid-19 induced herding among investors, this study attempts to examine the behaviour in the Indian stock market (S&P BSE) by analyzing the daily returns data of 10 indices and the S&P BSE Sensex using the CSAD model from January 01, 2015 to December 31, 2020, by dividing the period into three sets: whole period, pre Covid-19 outbreak period and during Covid-19 outbreak period. The complete analysis is done for three different states of the markets (general – overall market condition, bullish and bearish). The study finds the Indian stock market to experience sector specific herding behavior during Covid-19 period under the study, in general, as well as during bullish and bearish trends.

Do Financial Crises Matter for Nonlinear Exchange Rate and Stock Market Cointegration? A Heterogeneous Nonlinear Panel Data Model with PMG Approach

The existing literature has explained the causality flow from the exchange rates toward the stock market without explaining the role of the economic crisis in effecting this nexus. This study examines the role of the financial crisis in affecting the nonlinear causality flowing from the exchange rates toward the stock market indexes of the ASEAN-5 region. The precrisis, postcrisis, and overall sample duration comprised 365, 650, and 1085 observations over the periods from January 2002 to January 2008, January 2010 to January 2020, and January 2002 to January 2020, respectively. The results showed that the conventional symmetrical panel ARDL (PARDL) model was not able to formulate long-run cointegration between currency value fluctuations and stock market indexes for both regimes, i.e., the post recessionary and pre recessionary periods. However, asymmetrical cointegration was established between the currency values and stock market indexes for the pre recessionary period and the overall sampling time frame by utilizing the panel-based NARDL framework (PNARDL). The study suggests practical implications for the exporters and importers to consider the regime as well as both the negative and positive shocks in the international dollar values while making forward contractual agreements.

Performance assessment of three alkali-treated fly ashes as a pavement base-course material

Alkali-treated fly ash can efficiently serve as a construction material for various purposes. The efficacy of these alkali-treated fly ash must be critically studied for their proper usage in real-life scenarios. In the present study, the effectiveness of an alkali-treated low calcium fly ash (Class F) as a pavement base course material in the pre and post-construction period of the pavement has been investigated. The low calcium fly ash (Class F) was treated with three different alkalis, namely sodium hydroxide (NaOH), potassium hydroxide (KOH), and calcium hydroxide (Ca(OH)2), to study the influence of alkali type, its dose and curing period on the compressive strength and permeability characteristics of alkali-treated fly ash samples as these properties would prominently influence its behavior as a base course. In addition, the microstructural study of different alkali-treated ash samples was done to correlate the microstructural developments with these engineering properties. It was observed that 12% NaOH-treated fly ash samples, 16% KOH, and 16% Ca(OH)2-treated fly ash samples at 28 curing days show an optimum compressive strength value for a stabilized base material in pavements as per various guidelines. Finally, the usability of these optimized alkali-treated fly ash samples as a base material was investigated through a numerical study of a simple two-layered pavement structure. The surface and interface deformations of the pavement under various loading conditions revealed that these optimized alkali-treated fly ashes serve as a better base course than granular material. Also, of the chosen three alkali-treated fly ashes, optimized Ca(OH)2-stabilized fly ash performs comparatively better than others in terms of compressive strength and resisting deformation for these typical pavements.

IFRS Convergence and Value Relevance of Accounting Information: Evidence from Indian Financial Reporting

International studies have recorded evidences of improved accounting information attributed to the adoption of International Financial Reporting Standards (IFRS). The concurrent literature is however, scant in India. This study is one of the first of its kind to explore value relevance in the context of financial reporting for a large sample in India since IFRS convergence. The paper examines the value relevance of financial reporting of firms listed on the National Stock Exchange (NSE) in India by employing the Ohlson, (1995) Price Model. It aims to identify whether fundamental accounting variables like book value per share (BVPS) and earnings per share (EPS) are more value relevant after the IFRS converged Indian Accounting Standards (IndAS) became mandatory for listed firms. The hypotheses are tested using multivariate panel regressions on the annual data of 910 listed firms from 2013-14 to 2018-19 – resulting in 5460 observations – to include the pre and post mandatory convergence periods. The study documents a statistically significant association between stock prices of our sample firms and their key accounting variables (BVPS and EPS) along with an increase in the explanatory power of the model during the post mandatory convergence period.

Impact Of COVID-19 On Sexual Function

Corona virus (COVID-19) pandemic affected the people lives worldwide. The infection with COVID-19, social distancing, curfew and limitations leading to changes in lifestyles resulted in multiple systemic and psychological problems in individual’s health. Although there are numerous data in term of effects of (COVID-19) infection on the respiratory, gastrointestinal and nervous systems, few studies are available regarding its influence on men’s sexual function. The aim of this study is to detect the impact of COVID-19 on the sexual performance of COVID-19 recovered men. A cross-sectional study was conducted between September 2021 and March 2022 in Erbil and Duhok cities (Kurdistan region of Iraq). One hundred male patients recovered from COVID-19 infection enrolled in the study. International Index of Erectile Function-15 scoring was assessed twice; one before and the second one at least two months after recovery from COVID -19 infection. The mean IIEF-15 score was lower for participants after COVID-19 infection (66.9 ±8.39) when compared to pre COVID-19 period (70.95±1.14) (p< .001). By comparing their scores of pre with post Covid-19, significant decrement were found in the scores of (erectile function, orgasmic function, intercourse satisfaction and overall satisfaction) (p< .001, p < .001, p < .001, p < .001, respectively), only the reduction in desire domain was statistically insignificant (p = .01). The results indicate that COVID-19 infection has a significant effect on men sexual performance on short term.

Morphohydraulic of a dam-impacted large river: The São Francisco River, Brazil

Many studies have highlighted dam impacts in the reduction of the transmission of nutrient loads and suspended sediments downstream, increasing coastal erosion (sediment budget) and water residence time, beyond modifying the channel planform on a reach scale. However, the morphohydraulic changes, which are induced by flow regulation, have been little explored. This study has sought to analyze temporal changes in the at-a-station hydraulic geometry from 9 cross-sections along the São Francisco River, comparing the pre and post-dam periods. In addition to that, it was also sought to compare our results with other tropical river systems and assess the relationships of morphohydraulic parameters with channel patterns and functional trends. We have used field data collected by the National Water Agency and the Geological Survey of Brazil covering the middle, lower-middle, and lower courses of the São Francisco River. Potential functions were extracted using the least squares fit method. We have applied the Mann-Whitney non-parametric statistical test to assess any dataset changes. Finally, we have analyzed the data through the ternary diagram. Our results have demonstrated that the São Francisco River has high bank stability and variations in flow are mainly accommodated by changes both in depth and flow velocity. We found changes in the sensitivity of width, depth, and velocity in the post-dam period that imply high mobility of the cross-sections in the ternary diagram. Changes in land use patterns are potentially associated with these observed changes. Despite the São Francisco banks being stable in the analyzed cross-sections, the sensitivity of the channel width increased in the post-dam period. Differences were observed between the response patterns in the post-dam period in the physiographic provinces of the São Francisco River. However, the increase in width sensitivity predominates, with few exceptions. Hydraulic geometry analyses have proved to be essential for the characterization of the functional dynamics of river systems and allowing inferences about sediment transport conditions, flow stage, and channel stability.

Earnings Quality of Healthcare Companies in Nigeria Before and After IFRS Adoption

The major objective of this study was to examine the effect of the adoption of IFRS on the reported earnings quality of listed healthcare companies in Nigeria. It was prompted by the adoption of the IFRS where objectives include ensuring a true and fair presentation of financial statements to enable informed decision making. Using a census sampling technique, seven listed healthcare companies were selected for study. It covered a period of 18 years, 2003 to 2020, nine years each of pre and post adoption of IFRS. Earnings quality (EQ), the dependent variable, was measured by using the Gullet, Kilgore and Geddie (2018) model. Secondary data were extracted from published accounts of the companies for the pre and post IFRS adoption period. The results of the analyses showed that mean EQ scores for post IFRS adoption period were greater than that of pre adoption period. Further analyses, using paired sample t test statistics indicated that the difference in mean EQ score was statistically significant. It was therefore concluded that the adoption of IFRS has a positive significant effect on the quality of reported earnings of healthcare sector companies listed in the Nigerian Stock Exchange. It was recommended that the adoption of IFRS be encouraged and diligently enforced by regulators in Nigeria.

Robust goal programming approach for healthcare network management for perishable products under disruption

In this paper, a robust goal programming model for a healthcare network design problem under disruption is developed. The objective of the proposed multi-period, multi-echelon model is to simultaneously optimize the total deviation from the considered three goals, including minimizing network cost, maximizing network coverage, and maximizing network reliability. Distribution uncertainty of healthcare demand and facility capacity is captured. The perishability of healthcare products is regarded with limited shelf-life. Using an option contract ensures appropriate coordination with suppliers during pre and post-disaster periods. Via handling the tractable robust budget-based counterpart model, suitable strategies are proposed to present the designed network's efficiency and effectiveness. Risk mitigation strategies deal with disrupted demand and supply in the healthcare network with specific impacts on coverage, cost, and reliability of the services. The proposed cooperate coverage mechanism provides appropriate service coverage under disruption propagation. Finally, the option contract has achieved cost-efficient coordination under demand uncertainty. Furthermore, practical managerial insights are demonstrated by investigating a real-life case study and conducting extensive sensitivity analyses.

1791. Leveraging EMR Alerts for Vancomycin Time Outs

Abstract Background Vancomycin represented the most used antibiotic at our academic medical center from 2014-2022. To enhance compliance with the “antibiotic time out” part of the CDC Core Elements for Stewardship, we designed an electronic medical record (EMR) best practice alert (BPA) to assist providers in identifying patients eligible for vancomycin discontinuation. Methods This is a single center, retrospective pre (06/01/14-2/24/20)/post (02/25/20-03/31/22) comparison of vancomycin utilization after the introduction of a locally validated automated vancomycin time-out. The BPA alerted on patients who had received vancomycin for 72h, had no microbiological evidence of methicillin resistant S. aureus, and had no infectious diseases consult. While other vancomycin reduction strategies had previously been implemented as part of the stewardship program, no other intervention debuted during the same time period. An interrupted time series analysis was performed to assess immediate and ongoing trend changes of institutional vancomycin use. Wilcoxon rank sum and chi2 analyses were also performed. Results There were 36,817 inpatient vancomycin orders placed. The BPA triggered during 1,881 (15.7%) orders in the post-BPA period, which was 49.6% of the 3,794 orders still active at 72h. After BPA introduction, there was an immediate decrease in vancomycin days of therapy (DOT)/1000 patient days (PD) ±SE (-8.5 ±3.6; P = 0.021) followed by a significant decrease in the monthly trend relative to the pre-intervention trend (-0.7 DOT/1000 PD ±0.2; P< 0.001). Median vancomycin DOT/1000 PD decreased from 145.9 (IQR 140.2-153.0) to 117.3 (IQR 107.7-122.6) in pre and post periods respectively (P< 0.001). Length of therapy (LOT) decreased, orders were more commonly discontinued by day 5, and orders were more likely to be discontinued prior to discharge. Separate analysis including only orders with >72h showed similar results (Table 1). Table 1Vancomycin length of therapy (LOT) pre and post-BPA Time Out.Figure 1Vancomycin days of therapy per 1000 patient days (DOT/1000PD) trends pre and post-BPA Time Out. Conclusion Introduction of an EMR automated vancomycin time out was an effective tool to decrease vancomycin utilization at an academic medical center. Disclosures All Authors: No reported disclosures.

Comparative study of the effectiveness of the surgical technique with and without preservation of the conchal cartilage in otoplasty through the measure of the cephalo-auricular and scapho-conchal angles

ObjectivesProminent ear abnormalities affect 5% of the population. A prospective, double-blind study of patients who underwent otoplasty procedures to correct these abnormalities was conducted to compare two surgical techniques. They diverge by the preservation or not of conchal cartilage. MethodsThe two techniques were compared by measuring the cephalo-auricular and scapho-conchal angles. Measurements were performed in pre and 6-months post-operative periods using alginate molding. Twenty patients were randomly assigned to two groups (with and without cartilage preservation) with 10 participants each. Student’s t-test, Covariance Analysis Model (ANCOVA), and non-parametric Mann–Whitney were used in the statistical analyses. ResultsA significant reduction in the average of the cephalo-auricular and scapho-conchal angles was observed in both surgical procedures (p<0.001). However, no significant difference was found between them (p=0.887). ConclusionThe two techniques analyzed in this study fulfilled their objectives. Therefore, further comparative studies are needed to confirm the superiority of one over the other. Level IEvidence obtained from at least one properly designed randomized controlled trial.

The relationship between the perception of surgical fear and nursing satisfaction.

Since patient satisfaction is considered a criterion in the evaluation of nursing care, it is important and necessary to know the factors associated with satisfaction. The aim of this study is to determine the relationship between surgical fear and satisfaction with nursing care in surgical patients. This descriptive correlational study was conducted with 110 patients who underwent planned major surgical intervention in a university hospital in Turkey. A patient introduction form, the Surgical Fear Questionnaire and Newcastle Satisfaction with Nursing Care Scale were used to collect data, as well as a face to face interview with patients during the pre and postoperative periods. The results showed that the surgical fear levels of the patients were low, their satisfaction with nursing care was high, and a weak correlation existed between the fear and satisfaction levels. We recommend nursing care interventions aimed at keeping the surgical fear levels of patients low and their satisfaction high.

Pre or perioperative period: when is the best time to produce platelet-rich plasma in dogs?

&#x0D; When evaluating published studies on the production of platelet-rich plasma (PRP), it is possible to observe that there is no consensus on when blood should be collected and processed. Some perform blood collection before surgery, prior to the administration of drugs, fluids, or any surgical trauma, while others collect blood during the perioperative period. The present objective was to determine the best moment for PRP production based on the platelet count. Blood samples were collected from 20 healthy female dogs at two distinct moments: before surgery, prior to anesthesia and fluid therapy (M0), and later, in the operation room, after administration of the anesthetics and intravenous fluids (M1). To obtain PRP, blood was centrifuged at 1200 rpm for ten minutes, then at 1600 rpm for ten minutes. Results showed that the blood collected at M1 had a 29% decrease in platelet count compared to M0 (highly significant statistical difference). It is recommended that blood collection, which is an essential step for producing platelet-rich plasma, shall be done during the pre-operative period.&#x0D;

Electrocardiogram, Echocardiogram and NT-proBNP in Screening for Thromboembolism Pulmonary Hypertension in Patients after Pulmonary Embolism.

Background: The annual mortality of patients with untreated chronic thromboembolism pulmonary hypertension (CTEPH) is approximately 50% unless a timely diagnosis is followed by adequate treatment. In pulmonary embolism (PE) survivors with functional limitation, the diagnostic work-up starts with echocardiography. It is followed by lung scintigraphy and right heart catheterization. However, noninvasive tests providing diagnostic clues to CTEPH, or ascertaining this diagnosis as very unlikely, would be extremely useful since the majority of post PE functional limitations are caused by deconditioning. Methods: Patients after acute PE underwent a structured clinical evaluation with electrocardiogram, routine laboratory tests including NT-proBNP and echocardiography. The aim of this study was to verify whether the parameters from echocardiographic or perhaps electrocardiographic examination and NT-proBNP concentration best determine the risk of CTEPH. Results: Out of the total number of patients (n = 261, male n = 123) after PE who were included in the study, in the group of 155 patients (59.4%) with reported functional impairment, 13 patients (8.4%) had CTEPH and 7 PE survivors had chronic thromboembolic pulmonary disease (CTEPD) (4.5%). Echo parameters differed significantly between CTEPH/CTEPD cases and other symptomatic PE survivors. Patients with CTEPH/CTEPD also had higher levels of NT-proBNP (p = 0.022) but concentration of NT-proBNP above 125 pg/mL did not differentiate patients with CTEPH/CTEPD (p > 0.05). Additionally, the proportion of patients with right bundle brunch block registered in ECG was higher in the CTEPH/CTED group (23.5% vs. 5.8%, p = 0.034) but there were no differences between the other ECG characteristics of right ventricle overload. Conclusions: Screening for CTEPH/CTEPD should be performed in patients with reduced exercise tolerance compared to the pre PE period. It is not effective in asymptomatic PE survivors. Patients with CTEPH/CTED predominantly had abnormalities indicating chronic thromboembolism in the echocardiographic assessment. NT-proBNP and electrocardiographic characteristics of right ventricle overload proved to be insufficient in predicting CTEPH/CTEPD development.

Viz.ai Implementation of Stroke Augmented Intelligence and Communications Platform to Improve Indicators and Outcomes for a Comprehensive Stroke Center and Network.

Comprehensive stroke centers continually strive to narrow neurointerventional time metrics. Although process improvements have been put in place to streamline workflows, complex pathways, disparate imaging locations, and fragmented communications all highlight the need for continued improvement. This Quality Improvement Initiative (VISIION) was implemented to assess our transition to the Viz.ai platform for immediate image review and centralized communication and their effect on key performance indicators in our comprehensive stroke center. We compared periods before and following deployment. Sequential patients having undergone stroke thrombectomy were included. Both direct arriving large-vessel occlusion and Brain Emergency Management Initiative telemedicine transfer large-vessel occlusion cases were assessed as were subgroups of OnHours and OffHours. Text messaging thread counts were compared between time periods to assess communications. Mann-Whitney U and Student t tests were used. Eighty-two neurointerventional cases were analyzed pre vs. post time periods: (DALVO-OnHours 7 versus 7, DALVO-OffHours 10 versus 5, BEMI-OnHours 13 versus 6, BEMI-OffHours 17 versus 17). DALVO-OffHours had a 39% door-to-groin reduction (157 versus 95 minutes, P = .009). DALVO-All showed a 32% reduction (127 versus 86 minutes, P = .006). BEMI-All improved 33% (42 versus 28 minutes, P = .036). Text messaging thread counts improved 30% (39 versus 27, P = .04). There was an immediate improvement following Viz.ai implementation for both direct arriving and telemedicine transfer thrombectomy cases. In the greatest opportunity subset (direct arriving large-vessel occlusion-OffHours: direct arriving cases requiring team mobilization off-hours), we noted a 39% improvement. With Viz.ai, we noted that immediate access to images and streamlined communications improved door-to-groin time metrics for thrombectomy. These results have implications for future care processes and can be a model for centers striving to optimize workflow and improve thrombectomy timeliness.

OGC P09 Optimising the management of perioperative anaemia in patients with oesophagogastric cancer

Abstract Background Patients with oesophagogastric malignancy are predisposed to anaemia due to iron deficiency from chronic luminal blood loss. In the pre and post-operative periods, anaemia is associated with increased morbidity and mortality, principally through an increased blood transfusion (BTF) requirement. Anaemia of iron deficiency can be treated with oral or parenteral iron therapy. Newer preparations of parenteral iron therapy have lower rates of complications and are increasingly available. This study explored the effects of an anaemia management pathway on the detection and treatment of perioperative anaemia, as well as the post-operative course of patients undergoing staging and surgical resection of oesophagogastric malignancy. The impact of different forms of iron therapy was also examined. Methods A retrospective analysis was performed of patients undergoing resection of oesophageal, oesophagogastric or gastric malignancies between 12/11/2014 and 31/12/2021 at a tertiary oesophagogastric malignancy centre. A structured pathway for the management of perioperative anaemia was introduced on 1/4/2019 and patients were split into those receiving treatment on the anaemia management pathway compared to historical controls receiving standard treatment before this point. Clinicopathological variables were recorded from the hospital system tracking the haemoglobin (Hb) from diagnosis, through to the day of surgery and in the postoperative period. Other variables identified included iron therapy in the pre or postoperative period, blood transfusion rates, length of stay data and survival as of 01/03/2022. Anaemia was defined using both strict anaemia (Hb &amp;lt; 100g/L) and WHO anaemia (Hb &amp;lt; 120g/L for females and Hb &amp;lt; 130g/L for males) criteria. All analyses and statistical tests were conducted using R software. Results There were 171 patients treated under the new anaemia management pathway, and 343 historical controls receiving standard management. The overall prevalence of anaemia at the point of diagnosis was 33.7% using WHO criteria. Anaemia was more prevalent in patients with gastric malignancies (49%) than those with oesophageal malignancies (19%, p= 0.008) or OGJ malignancies (32%, p=0.017). Following the introduction of the anaemia management pathway, the blood transfusion (BTF) rates and the average length of stay did not change. The proportion of patients with WHO defined anaemia receiving IV iron therapy increased from 0.3% to 18% in the pre-operative period (p &amp;lt; 0.001), and from 2% to 39% in the post-operative period (p &amp;lt; 0.001). In the postoperative period, in-patient IV iron was more effective than oral (p &amp;lt; 0.001) or no iron treatment (p &amp;lt; 0.001) in improving haemoglobin post-operatively at a 6-week follow-up. Conclusions Anaemia is common in patients with oesophagogastric malignancy and patients with gastric cancer were more likely to be anaemic than other patient groups. The introduction of a perioperative anaemia management pathway can improve the use of iron therapy for anaemic patients, but we did not detect a difference in postoperative blood transfusions. IV iron treatment is significantly better than oral or no iron treatment in improving postoperative haemoglobin. IV iron should therefore be incorporated into post-operative management guidelines for post-operative anaemia and used preferentially to oral iron. Further studies should look to prospectively characterise the impacts of iron treatment and explore further variables such as quality of life in the postoperative period.

OGC P24 The effect of the pandemic on the number of examined lymph nodes following major oesophophagogastric resection

Abstract Background Lymph node yield following oesophagogastric (OG) cancer resection remains a valuable prognosticator of overall patient survival. It is also a quality indicator of histopathological assessment and a surrogate marker of surgical technique. The Royal College of Pathologists’ state a minimum lymph node yield of 15 per specimen should obtained in 100% of cases where a radical OG resection has been undertaken. It is well known that the COVID-19 pandemic placed immense strain on NHS services. This study aimed to evaluate its effect on lymph node yield reporting following major OG resection in a large volume tertiary unit. Methods Retrospective National OG Cancer Audit (NOGCA) metrics were collected. Histological data including total lymph node yield and positive node status were extracted from patient records. Patient data was categorised into two study periods; pre-pandemic (March 2018-Feb 2020) and pandemic (March 2020- Feb 2022) following the first UK national lockdown. Comparative analysis between the two study periods was performed and for lymph node yield &amp;gt;15 per specimen a X2 statistic calculated. Results In the pre COVID period a total of 280 (excluding GIST) resections were performed, 75% (210) oesophagectomies v. 25% (70) gastrectomies. The median age was 69 (range 25–90, males= 189 v. females =91). In the post pandemic period a total of 188 resections were performed, 72% (135) oesophagectomies v. 28% (53) gastrectomies. The median age was 69 (38–87, males = 142 v. female= 46). Lymph node yield was available for 275 resections in pre-pandemic study period, with a median nodal yield of 20 (5–61). In the pandemic study period lymph node yield data was available for 180 patients, median 19.5 (0–69). The minimum nodal yield (&amp;gt;15) was obtained in 80.7% of resection specimens pre-pandemic v. 68.9% in the pandemic study period (p= 0.00382). Conclusions Our study demonstrates a higher rate of inadequate nodes examined in the post pandemic study period. Despite staffing pressures, efforts should be made to improve number of nodes examined to provide robust prognostic data.

Deconstructing Betrayal, Discrimination and Guilt in Khaled Hosseini’s “The Kite Runner”

The current study undertakes a detailed analysis of Khaled Hosseini’s The Kite Runner representative novel. Hosseini, an Afghan born American writer depicts a war-torn Afghanistan in various universal themes i.e., family re-union, discrimination, regret, childhood, guilt, womanhood, betrayal, religion and salvation that played a considerable role in abating commission of crimes in Afghanistan during pre and post-Taliban periods which ended up shaping the interminable psychological scars of the protagonist. In his work, Hosseini reveals the devastating status of Afghans in general and women and children in particular who have, for decades, been irrationally marginalized and confined to the four walls of their homes by the society. His quests for wealth, love, loyalty and unqualified peace among Afghan citizenry whom he equates to have rights just like other human beings globally is the only means through which the protagonist considers a key to chart out a new future. Moreover, in reference to the Pashtun and Hazara ethnic communities’ customs and traditions and by use of historical, factual, real and fictional information, the article discusses the constructive human relations in a society bedeviled with mistrust, confusion, doubt and betrayal. Besides, by adopting the historical perspective method, the study examines how discrimination as a theme has been utilized to portray Hosseini’s literary image as a protagonist writer. Finally, a summary of the paper along with recommendations is made in the conclusion section.

MORPHOLOGICAL DEVELOPMENT OF THE DIGESTIVE TRACT AT PRE AND POST HATCH PERIOD IN BROILER CHICKS (Gallus gallus domesticus)

The objective of this study was to evaluate the morphological development and growth of different segments of the digestive tract at pre and post hatch period of broiler chickens. A total sixty birds divided into: thirty of embryos at the days 10th , 15th and 20th of incubation period and thirty of chicks at the days 1st , 15th , 30th of post hatch period were used, as ten for each age. The live body weight taken of each bird and after careful evisceration, their digestive tracts segments (esophagus with crop, proventriculus, ventriculus, small intestine and large intestine) were dissected. The location, shape and weight of the collected organs were recorded. Morphological results showed that esophagus divided into two regions by crop cervical esophagus and thoracic esophagus. Stomach was divided into two parts, glandular stomach (proventriculus) and the muscular stomach (ventriculus). Small intestine divided into three parts these are represented by duodenum, jejunum and ileum. Large intestine represented by cecum and colon. Data of the absolute weight of each organ separately, showed increasing with age, were the increasing significantly different between ages (p≤0.05), while the data of the weight of each organ separately relative to body weight showed increasing at pre hatch period and at hatch day, but these values decrease at 15th day of post hatch period.

Sport-related Structural Brain Injury in High School and College American Football Athletes, 2002-2020: Effect of Lystedt Law.

A previous report revealed an average of 7.2 (0.67 per 100,000 participants) sport-related structural brain injuries (SRSBIs) with macroscopic lesions per year in high school (HS) and college football players. The Lystedt law and other rule changes have been implemented with intent to reduce the risk of brain injury in football. To update the profile of SRSBIs in HS and college football players and evaluate the efficacy of legislation intended to reduce brain injuries. Descriptive epidemiology study. Level 4. We retrospectively reviewed 18 academic years (July 2002 through June 2020) of SRSBIs catalogued by the National Registry of Catastrophic Sports Injuries. The incidence of SRSBIs was assessed at the HS level during the pre (July 2002 through June 2009), transitional (July 2009 through June 2014), and post (July 2014 through June 2020) universal adoption time periods of the Lystedt law. In addition, the incidence of SRSBIs during the second half of the study (2011-2012 through 2019-2020) was compared with the first half of the study (2002-2003 through 2010-2011). During the study period, there was a total of 228 SRSBIs (12.7 per year, 1.01 per 100,000 participants): 212 (93%, 11.8 per year, 1.00 per 100,000) in HS athletes and 16 (7%, 0.89 per year, 1.17 per 100,000) in college athletes. There were 52 fatalities (2.9 per year, 0.22 per 100,000 participants) with 46 (2.56 per year, 0.22 per 100,000) in HS athletes and 6 (0.33 per year, 0.43/100,000) in college athletes. There was no significant difference in risk of HS total SRSBIs or fatalities during the 3 Lystedt periods. The risk of combined SRSBI cases [relative risk (RR) = 1.22, P = 0.13] and fatalities (RR = 1.20, P = 0.52) was similar in the second half of the study compared with the first half of the study. Despite implementation of rule changes intended to reduce head injury, in particular the Lystedt law, the incidence of SRSBIs has remained unchanged. Further research is necessary to develop effective prevention programs for SRSBIs. SRSBIs remain a persistent problem in HS and college American football. The recent head injury rule changes have not been effective at reducing SRSBIs.