bluuebunny/crossref_metadata_2025 huggingface dataset:
Organization Factors That Influence Transfer of Training among Employees at Farmers’ Organisation Authority (FOA) Headquarters, Kuala Lumpur
Authors: Ahmad Roshidah , Yahya Khulida Kirana
Published: September 2019

Transfer of training is important to organisations as they have devoted lot of money to send their employees for training to increase the employees’ knowledge, skills and abilities. This paper examines the relationships of rewards, supervision, and peer relationship on the transfer of training involving employees at FOA Headquarters, Kuala Lumpur. Self-administered questionnaires were adapted from various sources and consisted of items related to transfer of training, rewards, supervision and peer relationships. A total of 344 questionnaires were distributed but only 265 were returned and used for further assessment. This study applied descriptive statistics, reliability and inferential analysis to examine the relationships among the variables. The results showed that only rewards and supervision had significant relationship with transfer of training while peer relationship was found to be insignificant.
Revamping the design of Preschoolers Islamic Education by Integrating Islamic Design Principles and Cognitive Theory of Multimedia Learning: A Needs Assessment Study
Authors: Idris Wan Irma Sabrina , Abdul Razak Rafiza , Halili Siti Hajar , Abdul Rahman Siti Soraya , Hamzah Hasleena
Published: September 2019

This study aims at identifying the needs in applying Islamic Design Principles in developing multimedia learning for Islamic Education among children. Teaching methods of Islamic education have not seen much improvement and lack of creativity. Current designs and content of multimedia learning materials were not suitable in teaching Islamic education. Thus this study initiated in integrating Islamic design principles; 1) Tawheed, 2) Dhikir 3) Haya and 4) Iqtisad with Cognitive Multimedia Learning Theory.  It involved a needs analysis survey research design concerning parents and teachers of preschool as participants. The result of this study indicated positive responses received upon this matter indicating that the elements of Islamic design principles were relevant in multimedia learning for preschool Islamic Education. The integration of multimedia learning theory and Islamic Design Principles in designing multimedia learning for children. This was because the impacts of multimedia learning and Islamic design principles were important for the future of early children education, it was sensible for Islamic design principles were applied to multimedia learning content. There was a need to develop learning aids in teaching Islamic values education to the children. Multimedia learning can help in sculpting the Islamic character of the children while coaching them the virtuous values in Islam; an example of the ethic in Prophet Muhammad (P.B.U.H.), good behavior and action will help the children in their personal life. Besides, this paper will help instructional design to design and develop a multimedia learning for Islamic preschool in future.
The Hybrid Method Of Video And 360° Image In Silat Learning/ Pendekatan Hibrid Video dan Imej 360° dalam Pembelajaran Silat
Authors: Mohamad Hanafiah Nur Faiezah , Mat Noor Siti Fadzilah , Mohamed Hazura
Published: September 2019

The hybrid method of video and 360° image in silat learning is the solution of video based learning issues on the minimum of interactive activities, lack of interaction between user and video and limited point of view. The aim of this research is to identify the effectiveness of silat learning courseware using the hybrid method of video and 360° image towards students' achievement in silat subject. This research is also done to identify the usability of silat learning courseware based on easy to learn, interface and satisfaction matrixes. Pre-test and post-test were conducted to measure students' achievement while usability questionnaire was used to measure the usability of silat learning courseware using the hybrid method of video and 360° image. The research found that silat learning courseware using the hybrid method of video and 360° image gave positive impact towards students' achievement in silat subject. The level of usability of the silat learning courseware is high with the mean score for all the matrixes is over 4.00. This research shows that the usage of multimedia courseware especially using the hybrid method of video and 360° image is useful for students, help them to increase their achievement in silat and encourage the usage of multimedia based learning in silat learning in Malaysia.
The Awareness Level among the Perak Muslim Community towards the Perak Ar-Ridzuan Waqf/ Tahap Kesedaran Masyarakat Islam di Perak Mengenai Wakaf Perak Ar-Ridzuan
Authors: Muhammad Fidlizan , Abdul Razak Azila , Awang Salwa Amirah , Mohd Hussin Mohd Yahya , Aliyasak Mohd Zul Izwan
Published: September 2019

Waqf is an essential element in the development of Islam. However, there are many existing issues  in the management and development of waqf nowadays that inhibit the benefits of development to be enjoyed by the society. The Perak Ar-Ridzuan Waqf (WPAR) was established in 2015 with the aim to manage the development of waqf in Perak efficiently. Nevertheless, the issue of funding shortage to expedite the development has been the key issue. Therefore, this study purposively to identify the level of awareness of the Muslim community in the state of Perak regarding WPAR from the aspects of establishment, development planning, waqf method and others. This study employs the quantitative method through the use of questionnaire forms as the instrument to obtain the data that contains two sections in which the part A is for respondents' profile and the part B is specifically for respondents' knowledge on WPAR. A total of 312 respondents were involved in this study. Analysis of descriptive and crosstab were applied to analyze the gathered data. The finding of the study shows that the level of knowledge among the Muslim community pertaining WPAR in the planned development projects, waqf method and matching donation incentive prepared by the Maybank Islamic were unknown by the majority of respondents. Similar situations occured among respondents who are and had served as the mosque committees. The implication of this study proves that the existence of WPAR is still less known to the Muslim community in Perak. This condition needs a serious attention from the authority to ensure that the establishment of WPAR is able to attain its goal and realize all waqf development projects according to the allocated funding and time.
Second Law Analysis of an Energy Storage System Consisting of an Electrolysis Plant and the Graz Cycle With Internal H2/O2 Combustion
Authors: Dybe Simeon , Tanneberger Tom , Stathopoulos Panagiotis
Published: September 2019

The expansion of renewable energy generation must go hand in hand with measures for reliable energy supply and energy storage. A combination of hydrogen and oxygen as storing media provided from electrolysis at high pressure and zero emission power plants is a very promising option. The Graz cycle is an oxy-fuel combined power cycle that can operate with internal H2/O2 combustion and steam as working fluid. It offers thermal efficiencies up to 68.5% (lower heating value - LHV). This work applies a second law analysis to the Graz cycle and determines its exergetic efficiency. Exergy destruction is broken down to the cycle's components, thus providing insights on the location and magnitude of the cycle's inefficiencies. A sensitivity analysis identifies the cycle's exergetic and energetic efficiency as a function of representative parameters, offering an approach for future improvements. The combination of the cycle with an electrolysis plant is subsequently analyzed as an electric energy storage system. The round trip efficiency of the storage and back conversion system is computed by taking into account the additional compression of the reactants. As part of this analysis, the effect of the electrolyzer's operational pressure is studied by comparing several commercial electrolyzers.
Numerical Research on the Toroidal Shock Wave Focusing Detonation Initiation
Authors: Chen Xiang , Zhao Ningbo , Zheng Hongtao , Jia Xiongbin , Liu Shizheng , Liu Qingbo
Published: September 2019

Pressure gain combustion (PGC) is considered to be a potential technology to increase the cycle efficiency of gas turbine. As one viable candidate for PGC, rotating detonation engine (RDE) draws more attention due to its significant advances in continuous mode of operation. In practical, one of the basic challenges for RDE application is to reliably initiate detonation wave. For this purpose, both detonation initiation mechanism and enhancement approach are urgently needed to be understood. In this work, a toroidal shock wave focusing detonation initiator is presented. On this basis, the two-dimensional numerical simulations are carried out to investigate the detonation initiation characteristics by using the toroidal shock wave focusing. All of the flame acceleration, shock wave focusing, detonation wave forming, and propagation are analyzed in detail. The numerical results show that the toroidal shock wave focusing initiator developed in this study can rapidly realize the detonation initiation over a short distance and performs significantly better than the traditional smooth or obstructed tube based imitators under different operating conditions. Under the same operating condition, the novel developed initiator decreases time of 59.2% and distance of 84.7% for the smooth tube based initiator, and time of 52% and distance of 78.9% for the obstructed one. Besides, the multifield analysis indicates that both the local explosion induced by shock wave focusing in concave cavity and the entrainment vortex generated by shock wave and jet flame in front of diaphragm are important mechanisms to initiate detonation wave. This study is expected to enhance the understanding of the physical mechanism of shock wave focusing detonation initiation and contribute to the development of detonation propulsion technology.
Geometric Mistuning Reduced-Order Model Development Utilizing Bayesian Surrogate Models for Component Mode Calculations
Authors: Beck Joseph A. , Brown Jeffrey M. , Kaszynski Alex A. , Carper Emily B. , Gillaugh Daniel L.
Published: September 2019

Integrally bladed rotors (IBRs) are meant to be rotationally periodic structures. However, unique variations in geometries and material properties from sector-to-sector, called mistuning, destroy the structural periodicity. This results in mode localization that can induce forced response levels greater than what is predicted with a tuned analysis. Furthermore, mistuning and mode localization are random processes that require stochastic treatments when analyzing the distribution of fleet responses. Generating this distribution can be computationally intensive when using the full finite element model (FEM). To overcome this expense, reduced-order models (ROMs) have been developed to accommodate fast calculations of mistuned forced response levels for a fleet of random IBRs. Usually, ROMs can be classified by two main families: frequency-based and geometry-based methods. Frequency-based ROMs assume mode shapes do not change due to mistuning. However, this assumption has been shown to cause errors that propagate to the fleet distribution. To circumvent these errors, geometry-based ROMs have been developed to provide accurate predictions. However, these methods require recalculating modal data during ROM formulations. This increases the computational expense in computing fleet distributions. A new geometry-based ROM is presented to reduce this cost. The developed ROM utilizes a Bayesian surrogate model in place of sector modal calculations required in ROM formulations. The method, surrogate modal analysis for geometry mistuning assessments (SMAGMA), will propagate uncertainties of the surrogate prediction to forced response. ROM accuracies are compared to the true forced response levels and results computed by a frequency-based ROM.
Nondimensional Parameters’ Effects on Hybrid Darrieus–Savonius Wind Turbine Performance
Authors: Roshan Armin , Sagharichi Amir , Maghrebi Mohammad Javad
Published: September 2019

Vertical axial wind turbines are the most commonly used turbines in residential and urban areas. This paper investigates the effect of combining Darrieus and Savonius wind turbines on power output and introduces a wind turbine with high starting torque addition to the wide working domain. A two-dimensional computational fluid dynamics transient simulation is developed, and a moving mesh is implemented for rotating moving parts. Comprehensive research has been carried out to investigate the effects of the initial overlap ratio (ɛ), arc angle Ø, and curvature (α) of Savonius blades on the performance of the turbine and 18 models are simulated at seven tip speed ratios. The results showed that combining the Darrieus turbine with the Savonius turbine has a favorable effect on self-starting performance. Also, it was observed that by changing each of the parameters, the primary model performance could be significantly improved. Finally, it is concluded that ɛ = 0.25, α = 0.25, and ∅ = 150 deg are the optimum values of the parameters which increase turbine power output compared to conventional vertical-axis turbines.
Flat Spiral Coil Design for Higher Riveting Force and Energy Saving in the Electromagnetic Riveting Process
Authors: Cui Junjia , Zeng Chaochao , Jiang Hao , Li Guangyao
Published: September 2019

Electromagnetic riveting (EMR) belongs to the green manufacturing process, which has the advantages of low noise, no pollution, and large riveting force. In this paper, the influences of structural parameters of a flat spiral coil on riveting force and energy saving were investigated, and the cross-section geometry, base angle, and height of the coil section were designed. The EMR simulation models with fully coupled electromagnetic–thermal–mechanical were built in ls-dyna software, and the riveting force was adopted to assess the performances of different types of coils. The results showed that the riveting force given by trapezoid cross-section coil was the largest compared with rectangular, pentagonal, and circular types. Moreover, the increase in the base angle and height of the coil section had a positive effect on improving the riveting force and energy saving. In addition, weights analyses showed that the contribution rates of three structural parameters (length of the bottom edge, base angle, and height) of the coil to energy saving were 0.5231, 0.2347, and 0.2422, respectively. In general, the riveting force was improved and discharge energy was saved by adjusting geometric parameters of the coil. The research could provide guidance for the coil design in the EMR process.
Evaluation of Thermal Stratification Inside a New Model of Spherical Water Storage Tank Using a Computational Fluid Dynamics 6 Degrees of Freedom Solver
Authors: Bouzaher Mohamed Taher , Noureddine Belghar , Bensaci Charaf-Eddine , Bouchahm Nora , Guerira Belhi
Published: September 2019

In this work, a computational analysis of a spherical solar hot water storage tank during the discharging process is carried out by using the commercial code ansys-fluent.15. The study investigates a new type of spherical heat storage tank. A hinged baffle is fixed at the tank vertical axis to increase the discharge flow rate without a thermocline layer. The dynamic mesh LAYERING technique is used to update the computational domain during the movement of the hinged baffle. The passive pitching of the submerged baffle is due to the fluid-dynamic loads. This model limits the mixture between hot and cold water regardless of the inlet flow rate. A comparative study between tanks with typical diffusers and the hinged baffle model is considered. The comparison of the computational fluid dynamics results with available experimental data showed a good agreement. Examinations of the temperature contours indicate that for the typical models, the interaction between the incoming cold water and the stored hot water gives rise to a thick thermocline layer where its temperature and thickness are related to the intensity of the mixing process. The suggested model shows high stratification efficiency along the discharging process.
Evaluation of Two-Phase Frictional Pressure Drop Correlations Against Experimental Data
Authors: Li Wei , Shen Kunrong , Zheng Boren , Ma Xiang , Sherif S. A. , He Yan
Published: September 2019

Results are presented here from an experimental investigation on tube side two-phase characteristics that took place in four tested tubes—the 1EHT-1, 1EHT-2, 4LB, and smooth tubes. The equivalent outer diameter of the tube was 9.52 mm and the inner diameter was 8.32 mm. Condensation tests were conducted using refrigerant R410A at a saturation temperature of 318 K, over a mass flow range of 150–450 kg m−2 s−1, with inlet and outlet vapor qualities of 0.8 and 0.2, respectively. Evaporation tests were performed at a saturation temperature of 279 K, over a mass flow range of 150–380 kg m−2 s−1, with inlet and outlet vapor qualities of 0.2 and 0.8, respectively. Pressure drop data of the four tested tubes were collected to evaluate five identified prediction correlations based on the separated flow model and the homogeneous flow model. The separated flow approaches presented predictions with average MAEs of 24.9% and 16.4% for condensation and evaporation data, respectively, while the average MAEs of the homogeneous flow model were 31.6% and 43.4%, respectively. Almost all the identified correlations underestimated the frictional pressure drop of the 4LB tube with MAEs exceeding 30%. An earlier transition of different flow patterns was expected to occur in the EHT tubes while developing a new diabatic flow pattern map is needed for the 4LB tube. A new correlation was presented based on the two-phase multiplier Φ and the Martinelli parameter Xtt, which exhibited excellent predictive results for the experimental data.
Numerical Investigation of a Turbulent Jet Flame With a Compact Skeletal Mechanism
Authors: Chopkap Noume Hermann , Bomba Valentin , Obounou Marcel
Published: September 2019

The present work assesses the capabilities of a compact skeletal mechanism, derived using an in-house reduction code, to accurately model chemical processes in a turbulent CH4/H2/N2 flame. To this end, a numerical investigation of the DLR-A flame is performed using the free and open-source code openfoam with the derived mechanism. Specifically, the numerical investigation is performed using the Reynolds-averaged Navier–Stokes (RANS) approach and a compact skeletal mechanism consisting of 51 elementary reactions among 21 species. The skeletal mechanism is derived from the GRI3.0 mechanism using an improved multistage reduction method. The k − ɛ model is used as a closure for the RANS equations, while the source terms in the species and energy transport equations are closed by the partially stirred reactor (PaSR) model. The radiation term is modeled by the P-1 model. The numerical results show a good agreement with the experimental data.
The State-of-the-Art Technology of H-Type Darrieus Wind Turbine Rotors
Authors: Jain Siddhant , Saha Ujjwal K.
Published: September 2019

There has been a resurgence of interest in the development of small-scale vertical-axis wind turbines (VAWTs) in the past few decades as is evident from the plethora of published scientific work. This attention may be attributed to the desperate need for cheaper, cleaner, and off-grid mechanisms for generating electric power. In such hasty scenario, VAWTs are being considered as one of the potential solution for small-scale power generation. Among the VAWTs, H-type Darrieus rotors have undergone extensive exploration. In this review work, an attempt has been made to assemble all the major areas of research done in the field of H-type Darrieus rotor development. These areas include the aerodynamic models, computational fluid dynamics (CFD) methods and turbulence models, self-starting and dynamic stalling behavior, blade-vortex interaction and wake studies, and blade designs and optimization studies, besides topics of special interest like blade curvature effects and skewed flows. Overall, the work gives a comprehensive review of the state-of-the-art technology of the H-type Darrieus rotor. Finally, recommendations have been made for each of the areas keeping in view of the technological development.
Investigation of a Desalination System With the Hybrid Solar/Electrical Heating Module
Authors: Nguyen Van-Thoai , Hung Wei-Cheng , Cheng Tsung-Chieh , Fang Te-Hua
Published: September 2019

An integrated desalination system with a combination of electrical heating by power supply and solar heating by Fresnel lens with the sun tracking system was investigated in this study. The experiments were carried out under the climatic conditions of Kaohsiung City (22 deg36′58″ N, 120 deg18′47″ E), Taiwan. With only solar heating by the Fresnel lens, the temperature of the seawater is strongly dependent on the position of the seawater tray and climatic conditions, and seawater evaporation is not stable. To maintain the uniform evaporation of seawater, an electrical heating plate was also used to provide energy for the desalination process. The results indicate that there are two desalination processes: evaporation on the surface of the seawater and boiling inside the seawater. The production of distilled water is greatly improved with this solar/electrical desalination system, especially at the boiling temperature. The results indicate that the energy efficiency and recovery efficiency of this desalination system increase rapidly as electrical power increases. In this study, the commercial energy efficiency of the system can reach 85%, and the recovery efficiency can approach 56.52%. Additionally, a higher annual productivity (6036 l) is obtained, and the cost per liter of distilled water is about 0.152 (US$/l).
Developing the Actuator Disk Model to Predict the Fluid–Structure Interaction in Numerical Simulation of Multimegawatt Wind Turbine Blades
Authors: Behrouzifar Ali , Darbandi Masoud
Published: September 2019

The fluid–structure interaction (FSI) is generally addressed in multimegawatt wind turbine calculations. From the fluid flow perspective, the semi-analytical approaches, like actuator disk (AD) model, were commonly used in wind turbine rotor calculations. Indeed, the AD model can effectively reduce the computational cost of full-scale numerical methods. Additionally, it can substantially improve the results of pure analytical methods. Despite its great advantages, the AD model has not been developed to simulate the FSI problem in wind turbine simulations. This study first examines the effect of constant (rigid) cone angle on the performance of the chosen benchmark wind turbine. As a major contribution, this work subsequently extends the rigid AD model to nonrigid applications to suitably simulate the FSI. The new developed AD-FSI solver uses the finite-volume method to calculate the aerodynamic loads and the beam theory to predict the structural behaviors. A benchmark megawatt wind turbine is simulated to examine the accuracy of the newly developed AD-FSI solver. Next, the results of this solver are compared with the results of other researchers, who applied various analytical and numerical methods to obtain their results. The comparisons indicate that the new developed solver calculates the aerodynamic loads reliably and predicts the blade deflection very accurately.
A Variable-Curvature Spiral-Coil Heat Exchanger for Automobile Exhaust Heat Recovery
Authors: Zhu Yu , Yang Fengye , Guo Yueguang
Published: September 2019

To improve the fuel efficiency of automobile engines and reduce pollution owing to automobile exhaust, this study discusses a fixed-curvature spiral-coil heat exchanger that recovers exhaust heat. Herein, the heat transfer performance of the spiral coil is studied via experimental testing and numerical simulation. In this study, a new type of variable-curvature spiral coil is designed to improve the efficiency of the heat exchanger. The effect of different conical angles on the resistance and heat transfer performance of the spiral coil within a range of Reynolds numbers of 4000–14,000 was analyzed. The heat exchange efficiency is a combination of the convective heat transfer and the overall heat recovery. The results of this study indicate that for a spiral-coil tube of length L, increasing the cone angle improves the convective heat transfer outside the tube. However, as the flow resistance increases, the exhaust heat recovery of a variable-curvature spiral-coil heat exchanger (VSE) is up to 18.8% higher than that of a constant curvature spiral-coil heat exchanger. The combined performance of VSE is excellent when the cone angle is 15 deg.
Acute myocardial infarction in a young elite cyclist: a missed opportunity
Authors: Thompson Christopher SG , Pass Marc , Timothy Thomas , Hung John , Egred Mohaned
Published: September 2019

A 27-year-old elite-level professional cyclist presented to the emergency department with a 6-hour history of chest pain and vomiting after prematurely aborting a competitive event. ECG demonstrated anterior ST segment elevation myocardial infarction, and blood tests revealed a grossly elevated high-sensitivity troponin T. Emergent coronary angiography confirmed the presence of a thrombus in the mid-left anterior descending artery with possible spontaneous coronary artery dissection. The patient recovered well following balloon angioplasty and thrombus aspiration, despite delayed recognition, invasive investigation and intervention.
Brucellosis, an uncommon cause of acute acalculous cholecystitis: two new cases and concise review
Authors: Hariz Anis , Beji Imen , Hamdi Mohamed Salah , Cherif Eya
Published: September 2019

Acalculous cholecystitis etiologies while numerous, some of them are less-known such as brucellosis. In this report, we elaborate the clinical findings, investigations and management of two female patients presenting acalculous cholecystitis in whom diagnosis of acute brucellosis was retained. Both patients had fever, asthenia and abdominal tenderness. Laboratory results showed evidence of inflammation as well as hepatic cytolysis while cholestasis was noted in one patient. In both cases, ultrasound study and CT confirmed the presence of acalculous cholecystitis. Serology (tube agglutination test) led to the diagnosis of brucellosis. Diagnosis of brucellosis-related acute cholecystitis was established in both cases based on imaging findings as well as serology without resorting to cholecystectomy. Favourable clinical response to specific antibiotic therapy further supported our diagnosis as well as our decision to avoid surgery. Although few cases have been reported, brucellosis must be considered as a cause of acalculous cholecystitis, especially in endemic countries.
Paediatric oropharyngeal tularaemia requiring surgical intervention
Authors: Nemmour Amina , Bakri Adzreil , Fischer Claude A , Brand Yves
Published: September 2019

Tularaemia is a rare infectious disease endemic in most European countries caused by the bacteriumFrancisella tularensis.1Patients often show acute non-specific symptoms, which causes a delay in diagnosis and proper treatment, potentially resulting in significant morbidities such as deep neck abscess, meningitis, endocarditis and septic shock. The authors present a case of a 5-year old boy with a 4-day history of fever, sore throat and painful cervical lymphadenopathy, whose clinical progression worsened despite being treated with recommended antibiotics as per WHO guidelines once the diagnosis of Tularaemia was confirmed by serologic tests. He developed a parapharyngeal abscess and a persistent left necrotic cervical lymph node, which both were surgically drained and excised, respectively, and an extended course of antibiotic was given. Subsequently, the patient fully recovered from the illness and the follow-up was negative for relapse.
Hashimoto’s encephalopathy: a rare cause of delirium
Authors: Ogbebor Osakpolor , Patel Kavya
Published: September 2019

Cognitive impairment is a frequent presentation of patients who come to the hospital. We report a case of a patient who presents with a common symptom, however, with a rare disease. This is an 84-year-old woman with a history of hypertension and atrial fibrillation who was reported to have confusion of 3 weeks. Investigations, including a complete blood count, MRI imaging of the brain, cerebrospinal fluid analysis and paraneoplastic screen, were all negative. Of note, thyroid peroxidase antibody was elevated. She did not have a history of thyroid disease. Following this, an assessment of Hashimoto encephalopathy was made. She was started on steroids and she showed remarkable recovery within 2 months, therefore, confirming the diagnosis. This case report emphasises the need to consider Hashimoto’s encephalopathy as a differential for delirium especially when other common aetiologies have been ruled out.
Massive prosthetic aortic abscess: an overarching plight 7 years post-Bentall’s procedure
Authors: McCann Michael , Stamp Nikki , Larbalestier Robert
Published: September 2019

Infections of proximal aortic vascular grafts are a catastrophic complication of aortic surgery. Despite aggressive antimicrobial and surgical intervention, mortality and reinfection rates remain significant. Here, we describe a man aged 71 years with a medical history of bioprosthetic aortic valve with aortic arch replacement (modified Bentall’s procedure), who developed a large periprosthetic abscess due toStaphylococcus aureus7 years after his initial surgery. The patient’s preference was to avoid redo surgery, however despite high-dose intravenous flucloxacillin and oral rifampicin therapy, there was rapid progression of the abscess, necessitating urgent surgery. Notwithstanding the burden of infection, the patient underwent successful surgical excision and graft re-implantation and remains independent and well, almost 2 years postoperatively.
Think before you leap: cutaneous hypersensitivity to polytetrafluoroethylene arteriovenous graft masquerading as infection
Authors: Iqbal Rabia , Bhandare Deepti , St Louis Myron , Ruchi Rupam
Published: September 2019

Polytetrafluoroethylene (PTFE) graft is a synthetic graft commonly used in chronic haemodialysis patients. Expected complications of synthetic grafts include infection, thrombosis, oedema and pain. PTFE is a non-textile graft that is chemically inert, electronegative and hydrophobic. Due to their chemical properties, PTFE grafts have lower risks of these adversities. We present a patient with a rare case of cutaneous hypersensitivity to a PTFE graft.
Interstitial pneumonia with autoimmune features and platypnea-orthopnea syndrome
Authors: Mathew Uthara , Mittal Ankit , Vyas Surabhi , Ray Animesh
Published: September 2019

Interstitial pneumonia with autoimmune features (IPAF) is a recently proposed terminology for interstitial lung disease (ILD) with evidence of autoimmunity that does not meet the criteria for a defined connective tissue disease (CTD). Although ILD is well recognised in patients with established CTD, it is rarely the sole presenting feature of CTD. We report a case of 22-year-old male patient, who presented with progressive shortness of breath for 2 months and had features suggestive of platypnea-orthodeoxia syndrome (POS). Imaging revealed ILD with usual interstitial pneumonia pattern. Patient had features of autoimmune disorder but did not fulfil the criteria for any CTD and hence was labelled as IPAF. His POS was attributed predominantly to the lower lobe disease. The patient responded well to immunosuppressive treatment. A systematic review of literature of all cases with POS due to pulmonary parenchymal involvement has also been done.
Birt-Hogg-Dubé syndrome presenting with spontaneous pneumothorax and extensive pulmonary cysts in the absence of skin lesions or renal pathology
Authors: Kumar Kartik , Ross Clare
Published: September 2019

Birt-Hogg-Dubé (BHD) syndrome is an autosomal dominant condition which classically manifests with skin lesions such as fibrofolliculomas, pulmonary cysts that predispose to spontaneous pneumothorax and an increased risk of developing renal cell carcinoma. We describe the case of a patient who presented with a spontaneous pneumothorax on a background of multiple lung cysts, in the absence of cutaneous fibrofolliculomas and renal tumours. A germline mutation in the folliculin FLCN gene was subsequently identified, confirming BHD syndrome. Our case highlights the importance of considering a broad differential diagnosis for the cause of a spontaneous pneumothorax in the presence of unexplained cystic lung disease and emphasises the value of maintaining a high index of clinical suspicion for inherited causes of pneumothoraces.
Encephalopathy in a kidney transplant recipient
Authors: Albuquerque Inês , Monteiro Ana Raquel , Soares Neuza , Ferreira Susana
Published: September 2019

A 60-year-old man presented several times to the emergency department due to confusion and behavioral changes. He was a kidney transplant recipient dependent on hemodialysis due, presumably, to chronic nephropathy of the transplanted kidney, and was not under any immunosuppressive therapy. He was admitted to the hospital ward due to elevation of C reactive protein and severe proteinuria, leukocyturia and erythrocyturia. The alterations found in the spot urine examination were suggestive of nephritic syndrome, consistent with chronic nephropathy of the transplanted kidney. The neurologic deterioration, however, remained unexplained. CT of the brain and cerebrospinal fluid examination were unremarkable. Infection, auto-immune disease and malignancy were excluded. Corticoid therapy was started for rejection nephropathy. The patient improved dramatically and ultimately the transplanted kidney was removed. Chronic nephropathy of the transplanted kidney was confirmed histologically and the patient remained clinically asymptomatic, without corticoid therapy.
Partial nephrogenic diabetes insipidus associated with lithium therapy
Authors: Nandoshvili Eka , Hyer Steve , Johri Nikhil
Published: September 2019

A 40-year-old Caucasian man developed excessive thirst and polyuria particularly at night over the preceding 6 months. He had been taking lithium for 16 years for the treatment of bipolar affective disorder. Investigations revealed subnormal maximum urinary concentrating ability after 8 hours of water deprivation and only a borderline response of urine osmolality to exogenous desmopressin given by intramuscular injection. A plasma copeptin concentration was elevated at 23 pmol/L. These results were consistent with partial nephrogenic diabetes insipidus. He was encouraged to increase his water intake as dictated by his thirst. In addition, he received amiloride with some improvement in his symptoms. Clinicians should be aware of the risk of nephrogenic diabetes insipidus with long-term lithium use and seek confirmation by a supervised water deprivation test augmented with a baseline plasma copeptin. If increased water intake is insufficient to control symptoms, amiloride may be considered.
Statin-induced delayed rhabdomyolysis
Authors: Sharma Umesh
Published: September 2019

An elderly woman with a history of hypertension, hypothyroidism, mesenteric vein thrombosis, depression and hyperlipidaemia on statins for >9 years presented with new-onset leg weakness, falls, dark-coloured urine, transaminitis and rhabdomyolysis (creatinine phosphokinase 12 896 U/L; aldolase 45.9 (normal <7.7 U/L). Workup for autoimmune myositis was negative. The patient had clinical and laboratory improvement with discontinuation of statins with the return of clinical strength and creatinine phosphokinase back to baseline levels (51 U/L) within 2 weeks.
Systemic steroids for the management of choroidal neovascular membrane with pigment epithelial tear and recalcitrant subretinal fluid
Authors: Bilgic Alper , Sudhalkar Aditya
Published: September 2019

A 67-year-old man was diagnosed to have dry age related macular degeneration in the right eye and a choroidalneovascular membrane (CNVM) with a large pigment epithelial detachment in the left eye, confirmed with clinical examination, angiography and optical coherence tomography scans. He received an intravitreal injection of bevacizumab in the right eye and developed a retinal pigment epithelial (RPE) tear 3 weeks later. 3 consecutive ranibizumab injections failed to clear the subretinal fluid (SRF). A course of systemic steroids was administered and this improved the vision. Subsequently, the patient received one more ranibizumab injection and the disease process resolved. The left eye corrected distance visual acuity (LE CDVA) was 20/30 at the final visit (1 year after the last injection). Systemic steroids may be a management option in patients with CNVM and RPE tear with recalcitrant SRF if there is no contraindication to their use.
Unusual olecranon mass with ulnar nerve compressive neuropathy caused by a haemophilic pseudotumour
Authors: Yeung Caleb Matthew , Blazar Philip
Published: September 2019

A 55-year-old man with a history of haemophilia A and bilateral haemophilic arthropathy of the elbows presented with an enlarging left elbow mass and worsening paresthesias in the ulnar distribution of the left hand. The mass, originally thought to be olecranon bursitis and treated as such, was found to be due to a haemophilic pseudotumour. The patient underwent successful excision of the haemophilic pseudotumour with concomitant ulnar nerve decompression and had sustained resolution of the pseudotumour and symptoms at 10 years of follow-up. This case demonstrates the need for consideration of haemophilic pseudotumour in the differential diagnosis for olecranon masses and cubital tunnel compressive neuropathy in patients with haemophilia, and highlights the viability of surgical excision as a therapeutic option for the treatment of haemophilic pseudotumours in the elbow.
Quality improvement in maternal and newborn healthcare: lessons from programmes supported by the German development organisation in Africa and Asia
Authors: Goyet Sophie , Broch-Alvarez Valerie , Becker Cornelia
Published: September 2019

Improving the quality of maternal and child healthcare (MCH) is a mandatory step on the path to reaching the Sustainable Development Goals and Universal Health Coverage. Quality improvement (QI) in MCH is a strong focus of the bilateral development cooperation provided by Germany to help strengthen the health systems of countries with high maternal and child mortality rates and/or with high unmet needs for family planning. In this article, we report on the findings of an analysis commissioned by a community of practice on MCH, of Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ). The objectives were to review the QI interventions implemented through programmes which have received technical assistance from GIZ on behalf of the German Federal Ministry for Economic Cooperation and Development in 14 Asian and African countries, to identify and describe the existing approaches and their results, and finally to draw lessons learnt from their implementation. Our analysis of the information contained in programme documents and reports identified five main methodologies used to improve the quality of care: capacity-building and supervision, governance and regulation, systemic QI at facility level, support to infrastructures, and community support. It is difficult to attribute the observed progresses in maternal and neonatal health to a particular agency, programme or intervention. We acknowledge that systemic implementation research embedded within the programmes would facilitate an understanding of the determinants of successful QI interventions, would better assess their effectiveness, and therefore better guide future bilateral aid programmatic decisions.
Effect of airtime incentives on response and cooperation rates in non-communicable disease interactive voice response surveys: randomised controlled trials in Bangladesh and Uganda
Authors: Gibson Dustin G , Wosu Adaeze C. , Pariyo George William , Ahmed Saifuddin , Ali Joseph , Labrique Alain B , Khan Iqbal Ansary , Rutebemberwa Elizeus , Flora Meerjady Sabrina , Hyder Adnan A
Published: September 2019

Background

The global proliferation of mobile phones offers opportunity for improved non-communicable disease (NCD) data collection by interviewing participants using interactive voice response (IVR) surveys. We assessed whether airtime incentives can improve cooperation and response rates for an NCD IVR survey in Bangladesh and Uganda.

Methods

Participants were randomised to three arms: a) no incentive, b) 1X incentive or c) 2X incentive, where X was set to airtime of 50 Bangladesh Taka (US$0.60) and 5000 Ugandan Shillings (UGX; US$1.35). Adults aged 18 years and older who had a working mobile phone were sampled using random digit dialling. The primary outcomes, cooperation and response rates as defined by the American Association of Public Opinion Research, were analysed using log-binomial regression model.

Results

Between 14 June and 14 July 2017, 440 262 phone calls were made in Bangladesh. The cooperation and response rates were, respectively, 28.8% (353/1227) and 19.2% (580/3016) in control, 39.2% (370/945) and 23.9% (507/2120) in 50 Taka and 40.0% (362/906) and 24.8% (532/2148) in 100 Taka incentive groups. Cooperation and response rates, respectively, were significantly higher in both the 50 Taka (risk ratio (RR) 1.36, 95% CI 1.21 to 1.53) and (RR 1.24, 95% CI 1.12 to 1.38), and 100 Taka groups (RR 1.39, 95% CI 1.23 to 1.56) and (RR 1.29, 95% CI 1.16 to 1.43), as compared with the controls. In Uganda, 174 157 phone calls were made from 26 March to 22 April 2017. The cooperation and response rates were, respectively, 44.7% (377/844) and 35.2% (552/1570) in control, 57.6% (404/701) and 39.3% (508/1293) in 5000 UGX and 58.8% (421/716) and 40.3% (535/1328) in 10 000 UGX groups. Cooperation and response rates were significantly higher, respectively in the 5000 UGX (RR 1.29, 95% CI 1.17 to 1.42) and (RR 1.12, 95% CI 1.02 to 1.23), and 10 000 UGX groups (RR 1.32, 95% CI 1.19 to 1.45) and (RR 1.15, 95% CI 1.04 to 1.26), as compared with the control group.

Conclusion

In two diverse settings, the provision of an airtime incentive significantly improved both the cooperation and response rates of an IVR survey, with no significant difference between the two incentive amounts.

Trial registration number

NCT03768323.
The potential impact of austerity on attainment of the Sustainable Development Goals in Brazil
Authors: Souza Luis Eugenio Portela Fernandes de , Barros Rafael Damasceno de , Barreto Maurício Lima , Katikireddi Srinivasa Vittal , Hone Thomas V , Paes de Sousa Rômulo , Leyland Alastair , Rasella Davide , Millett Christopher J , Pescarini Julia
Published: September 2019

In the recent decades, Brazil has outperformed comparable countries in its progress toward meeting the Millennium Development Goals. Many of these improvements have been driven by investments in health and social policies. In this article, we aim to identify potential impacts of austerity policies in Brazil on the chances of achieving the sustainable development goals (SDGs) and its consequences for population health. Austerity’s anticipated impacts are assessed by analysing the change in federal spending on different budget programmes from 2014 to 2017. We collected budget data made publicly available by the Senate. Among the selected 19 programmes, only 4 had their committed budgets increased, in real terms, between 2014 and 2017. The total amount of extra money committed to these four programmes in 2017, above that committed in 2014, was small (BR$9.7 billion). Of the 15 programmes that had budget cuts in the period from 2014 to 2017, the total decrease amounted to BR$60.2 billion (US$15.3 billion). In addition to the overall large budget reduction, it is noteworthy that the largest proportional reductions were in programmes targeted at more vulnerable populations. In conclusion, it seems clear that the current austerity policies in Brazil will probably damage the population’s health and increase inequities, and that the possibility of meeting SDG targets is lower in 2018 than it was in 2015.
Tracking coverage, dropout and multidimensional equity gaps in immunisation systems in West Africa, 2000–2017
Authors: Wariri Oghenebrume , Edem Bassey , Nkereuwem Esin , Nkereuwem Oluwatosin O , Umeh Gregory , Clark Ed , Idoko Olubukola T , Nomhwange Terna , Kampmann Beate
Published: September 2019

Background

Several West African countries are unlikely to achieve the recommended Global Vaccine Action Plan (GVAP) immunisation coverage and dropout targets in a landscape beset with entrenched intra-country equity gaps in immunisation. Our aim was to assess and compare the immunisation coverage, dropout and equity gaps across 15 West African countries between 2000 and 2017.

Methods

We compared Bacille Calmette Guerin (BCG) and the third dose of diphtheria–tetanus–pertussis (DTP3) containing vaccine coverage between 2000 and 2017 using the WHO and Unicef Estimates of National Immunisation Coverage for 15 West African countries. Estimated subregional median and weighted average coverages, and dropout (DTP1–DTP3) were tracked against the GVAP targets of ≥90% coverage (BCG and DTP3), and ≤10% dropouts. Equity gaps in immunisation were assessed using the latest disaggregated national health survey immunisation data.

Results

The weighted average subregional BCG coverage was 60.7% in 2000, peaked at 83.2% in 2009 and was 65.7% in 2017. The weighted average DTP3 coverage was 42.3% in 2000, peaked at 70.3% in 2009 and was 61.5% in 2017. As of 2017, 46.7% of countries (7/15) had met the GVAP targets on DTP3 coverage. Average weighted subregional immunisation dropouts consistently reduced from 16.4% in 2000 to 7.4% in 2017, meeting the GVAP target in 2008. In most countries, inequalities in BCG, and DTP3 coverage and dropouts were mainly related to equity gaps of more than 20% points between the wealthiest and the poorest, high coverage regions and low coverage regions, and between children of mothers with at least secondary education and those with no formal education. A child’s sex and place of residence (urban or rural) minimally determined equity gaps.

Conclusions

The West African subregion made progress between 2000 and 2017 in ensuring that its children utilised immunisation services, however, wide equity gaps persist.