bluuebunny/crossref_metadata_2025 huggingface dataset:
Measuring Verbal Communication in Initial Physical Therapy Encounters
Authors: Roberts Lisa C. , Whittle Christopher T. , Cleland Jennifer , Wald Mike
Published: November 2012

Background

Communication in clinical encounters is vital in ensuring a positive experience and outcome for both patient and clinician.

Objective

The purpose of this study was to measure verbal communication between physical therapists and patients with back pain during their initial consultation and trial management of the data using a novel, Web-based application.

Design

A cross-sectional study was conducted.

Methods

Nine musculoskeletal physical therapists and 27 patients with back pain participated in this study. Twenty-five initial consultations were observed, audio recorded, and categorized using the Medical Communications Behavior System. Data were managed using Synote, a freely available application enabling synchronization of audio recordings with transcripts and coded notes.

Results

In this sample, physical therapists spoke for 49.5% of the encounter and patients for 33.1%. Providers and patients spent little time overtly discussing emotions (1.4% and 0.9%, respectively). More-experienced clinicians used more “history/background probes,” more “advice/suggestion,” and less “restatement” than less-experienced staff, although they demonstrated a greater prevalence of talking concurrently and interrupting patients (7.6% compared with 2.6%).

Limitations

Although studies measuring actual behavior are considered to be the gold standard, audio recordings do not enable nonverbal behaviors to be recorded.

Conclusion

This study investigated a method for measuring the verbal content of clinical encounters in a physical therapy outpatient setting. The study has directly contributed to developing a research-friendly version of the application (ie, Synote Researcher). Given the pivotal role of communication in ensuring a positive experience and outcome for both patient and provider, investing time in further developing communication skills should be an on-going priority for providers. Further work is needed to explore affective behaviors and the prevalence of interrupting patients, considering differences in sex and provider experience.
Lessons from Hydropower Rich Paraguay
Authors: Thanju Jeewan Prasad , Canese Ricardo
Published: November 2012

Despite Paraguay being one of the largest net exporters of electricity in the world (for decades and the main electricity exporter in South America accounting for 85% of all exports), it is the second poorest nation in South America after Bolivia. It is the half owner of the 14,000MW Itaipu hydro electric complex. Paraguay gets a small fraction of the market price for the exported electricity to Brazil. The Brazilians viewpoint is that the spirit of the treaty is to recover the investment cost and not the commercial price. Hence, there is widespread discontent among the Paraguayans. One Paraguayan minister has commented that it is a real politik of an ant staring at an elephant.Likewise, in Yacyretá, a 3,100MW hydroelectric plant constructed in association with Argentina, Paraguay is not getting a good return. Construction work was stopped for several years by Argentina due to various reasons. Further, planning and feasibility studies were not done in sufficient detail. It is claimed that environmental and ecological considerations were not undertaken in its planning.Paraguay has not sufficiently benefited from the two huge bi-national hydro power projects. Experience of Paraguay may be good lessons for small but hydropower rich countries such as Nepal. Nepalese Officials dreaming to earn several tens of billions Rupees as export revenue from the half the electricity to be owned by Nepal from the proposed Pancheshwar Dam (6,480MW) need to remember the case of Paraguay.DOI: http://dx.doi.org/10.3126/hn.v9i0.7062 Hydro Nepal Vol.9 July 2011 7-11
Development and Strategy of Small Hydropower in China
Authors: Heng Liu , Xiaobo Hu
Published: November 2012

China is endowed with rich rural hydropower. According to the latest National Rural Water Resources Survey, the technically feasible potential amounts to 128GW, mainly distributed in the central and west part of China as well as those ethic regions, which are less developed but more populated. With the support of the Chinese government’s policy of ‘Self Construction, Self Management and Self Utilization’, Small Hydropower development has been scaled up. Thanks to the Small Hydropower (SHP) development and the grid construction, nowadays about one half of the territory, one third of the counties and 300 million rural population in China have access to electricity. The practice of China to realize rural electrification through SHP has attracted the attention of the world community including the United Nations. In future, China will continue to enhance the rural hydropower development and the environmental protection under the framework of the Renewable Energy Master Plan. Its experiences and technology could be learned by other developing countries.DOI: http://dx.doi.org/10.3126/hn.v9i0.7063 Hydro Nepal Vol.9 July 2011 12-14
Regional Cooperation: Time to Act
Authors: Thanju Jeewan Prasad
Published: November 2012

DOI: http://dx.doi.org/10.3126/hn.v9i0.7064 Hydro Nepal Vol.9 July 2011
India’s Nuclear Power Development and Nepal’s Hydropower after the Fukushima Accident
Authors: Pun Sant Bahadur
Published: November 2012

Abstract: When President George W. Bush and Indian Prime Minister Manmohan Singh signed the Indo-US Nuclear Declaration in 2005 and subsequently the Nuclear Suppliers Group waived off the embargo on India in 2008, there were tremors in Nepal that her hydropower would be displaced by India’s nuclear power plants. Nepal’s two quick hydropower plans ? 10,000MW in 10 Years and 25,000MW in 20 Years ? may be interpreted as indication of that tremor. But is India really banking on Nepal’s so called ‘huge’ hydropower potential? In a mere two decades, by 2032, India is planning to have 63,000MW of installed nuclear power. Will the recent Fukushima nuclear accident in Japan have any impact on her ambitious nuclear power development? To understand the issues, this article deals with India’s interesting nuclear history that had to innovate and indigenize when the ‘embargo’ was imposed after the 1974 Pokhran nuclear explosion. The article argues that the fast developing India is after Nepal’s stored water, that valuable resource getting increasingly scarce. Hydropower for her is a mere by-product, perhaps a bonus if she can get it at a cheap rate!DOI: http://dx.doi.org/10.3126/hn.v9i0.7065 Hydro Nepal Vol.9 July 2011 15-19
Short Term Hydro Thermal Scheduling using Lambda Gamma Iteration Method
Authors: Yadav Deepika , Naresh R. , Sarda V.K. , Sharma Veena , Goel Paras Mani
Published: November 2012

Abstract: Short term hydrothermal scheduling (STHTS) is a daily planning proposition in power system operation. The main purpose of hydro thermal generation scheduling is to minimize the overall operation cost and to satisfy the given constraints by optimally scheduling the power outputs of all hydro and thermal units under study periods, given electrical load and limited water resource. This paper presents the lambda-gamma iteration method for fixed head hydro-thermal problems. Also, hydro power input-output model with constant head has been developed for Sewa Hydro Electric Power Plant by using the curve fitting techniques by least square method in MATLAB 7.9 version software. From scheduling results, operational decisions can be made for the best performance under changing conditions of load, head, unit availability and other important constraints. Furthermore, these decisions may be used as an effective input to the on-line decision support system for real-time operation of reservoir systems in availability based tariff (ABT) context that results in increased power production and enhanced revenue earnings in the process of planning and management of a water resources project.DOI: http://dx.doi.org/10.3126/hn.v9i0.7068 Hydro Nepal Vol.9 July 2011 20-26
Engineering Geological Design of Underground Works for Upper Madi Hydroelectric Project
Authors: K.C. Prem Krishna , Panthi Krishna Kanta
Published: November 2012

Himalayan geology is termed as one of the youngest tectonic formations in the world. Tunneling in this region is hence complex in nature. The very complex geology in the region offers challenges in stability of even the best located underground structures. Tunneling in weak rock is more challenging in terms of stability and application of support. Moreover, in many occasion, prediction of the rock mass has been done optimistically in most of the underground projects in Nepal. In this paper, predicted versus actual rock mass condition has been compared for two already completed projects. Based on this needed support is calculated by empirical method for the project under investigation and later on verified by numerical analysis using the software Phase2. Stability analysis is also done for both high pressure headrace tunnel and underground surge shaft. Numerical method of analysis has an added advantage over empirical and analytical methods, particularly in complex geometry. The Phase2 code and the Hoek-Brown Failure criterion have been used to determine the state of stress, strength factor and deformations around the periphery and in the tunnel walls.DOI: http://dx.doi.org/10.3126/hn.v9i0.7069 Hydro Nepal Vol.9 July 2011 27-34
Multi-Purpose Melamchi Project, Nepal
Authors: Editor The
Published: November 2012

Several years ago, a volunteer project study team prepared a concept level Technical Report on the Multi-Purpose Melamchi Project (the MPMP, by Dan Jantzen, Bikash Pandey, Ratna Sansar Shrestha and Odd Hoftun, 2008). The ongoing Melamchi Project is single purpose project, to provide drinking water for the Kathmandu Valley. The Study Team wrote that the present Melamchi Project scope is limited and that its full potential should be harnessed by making it multi-purpose so that the more benefits are accrued to the people of Melamchi-Bagmati corridor. The MPMP authors propose a wide range of initiatives in hydropower generation, and making available additional water for irrigation in the Bagmati Irrigation Project. The cost estimates were prepared by Sanima Hydro and Engineering (P.) Ltd.; the Preliminary Environmental Assessment was undertaken by Dr. Toran Sharma; and the Irrigation Analysis was by Dilip Karki.Furthermore, the study team has proposed to implement the MPMP as a Public-Private Partnership, where the hydropower component is taken by the private sector. In addition to the 26km Melamchi-Sundarijal tunnel, other long additional tunnels are proposed in the Himalayan Geology.These ideas and proposals need to be further discussed for the benefits and risks, alike. The following is the Executive Summary of the MPMP report. The four figures presented are self-explanatory.DOI: http://dx.doi.org/10.3126/hn.v9i0.7070 Hydro Nepal Vol.9 July 2011 35-37
Potential of Renewable Electricity from Biomass Waste of IIT Roorkee Campus, India
Authors: Dutt Nitesh , Sharma M.P.
Published: November 2012

Abstract: Electricity production using conventional energy sources is associated with serious environmental problems like emission of pollutants, global warming and social problems. The world’s CO2 emissions are projected to rise from 29.0 billion MT in 2006 to 33.1 billion MT in 2015 and 40.4 billion MT in 2030. This increase in emissions indicates more global warming. The Indian Ministry of New and Renewable Energy (MNRE) has been supporting programs for the development of renewable energy sources which are not only unlimited but environmentally friendly — like biomass, solar, small hydro, wind, etc. If biomass is used sustainably, there is no net carbon emission over the time of a cycle of biomass production.Waste management is an important issue today. To handle the ever growing problem of waste, residents and companies are constantly looking for the best and least expensive methods. Types of waste generated by the Indian Institute of Technology Roorkee (IITR) include kitchen waste, municipal solid waste, sewage waste, and waste cooking oil. By utilizing biodegradable waste out of total waste clean energy can be generated and waste disposal problems solved.DOI: http://dx.doi.org/10.3126/hn.v9i0.7071 Hydro Nepal Vol.9 July 2011 38-43
Integrated Development of Rural Energy Systems through Pocket Area Approach for Energy Services: The REDP Experience, Nepal
Authors: Devkota Thakur Raj
Published: November 2012

Micro-hydro technologies together with other renewable energy technologies are being disseminated in various parts of Nepal to provide basic energy services as per the demand of the individual household or a particular community. These technologies use an integrated approach that helps address rural energy needs by providing basic rural energy services. The planning and implementation of rural energy systems in an integrated manner through the ‘Pocket Area Approach’, which takes into account the entire geographical area for the intervention, has been experimented in some of the pockets area in the country and is found quite effective to cater to basic rural energy services to the entire population of the area. This paper illustrates the approach and results achieved by Rural Energy Development Program (REDP).DOI: http://dx.doi.org/10.3126/hn.v9i0.7072 Hydro Nepal Vol.9 July 2011 44-47
The Unforgettable Indus River Flood-2010: A Review
Authors: Ali Arshad , Nosheen Ghazala , Khan K.A.
Published: November 2012

Floods are the unannounced natural disasters that destroy both lives and infrastructures. In July 2010 a huge and unpredictable flood struck Pakistan, especially the catchment area of the River Indus, extending from the north part of Khyber Pakhtun Khwa (KPK) Province south to the Arabian Sea. The top five rainfall intensities recorded at Risalpur, Islamabad, Murree, Cherat and Ghari Dopatta were 415mm, 394mm, 373mm, 372mm and 346mm, respectively. The Indus Flood-2010 affected nearly 20 million people spreading over 36 districts of the country. The death toll recorded was nearly 1,800 persons. More than 10 million people were subjected to contaminated drinking water. The destruction to cotton, rice, sugar cane, and animal fodder was recorded as 3,000 km2, 800 km2, 800 km2, and 1000 km2, respectively. And about five hundred thousand tons of wheat was destroyed. The Indus Flood of 2010 caused an estimated 43 billion US dollar loss to Pakistan and adversely affected its Gross Domestic Product (GDP). It brought on both the financial crises and socio-political concerns (such as infiltration of the Taliban in the form of a relief supporter). Though this flood has left everlasting impacts on the people of Pakistan, they could be better handled if the government and relief agencies were more determined, honest and committed.DOI: http://dx.doi.org/10.3126/hn.v9i0.7073 Hydro Nepal Vol.9 July 2011 48-51
Rural Drinking Water Quality Status in Central Development Region, Nepal: A Comparative Study of Spring water and Ground water
Authors: Pandey Bishnu , Shakya Suman
Published: November 2012

This study assesses the rural drinking water quality status in Central Development Region of Nepal. With a total of 250 samples collected from 15 districts of the region, drinking water quality of spring water and ground water representing hill and Terai (lowland) regions were tested and compared for their physicochemical parameters and faecal coliform contamination.None of the spring samples as well as ground water samples violated National Drinking Water Standards (NDWS) for electrical conductivity (EC), total dissolved solids (TDS), total suspended solids (TSS), appearance, chloride and nitrate. Similarly none violated the standards for total hardness (TH) indicating soft nature of the water. The spring samples were within the NDWS for manganese (Mn) and iron (Fe) whereas 15.4% and 39.0% of the ground water samples violated the standards for manganese and iron, respectively. Gravity water is found to be more alkaline than ground water. Faecal coliforms were the most problematic in both types of sources followed by Ammonia (NH3) and pH in spring sources and by iron, Mn, pH and ammonia in ground water sources, respectively. Spring sources were more contaminated by bacteria than ground water sources. Correlation and regression analysis revealed highly significant correlations between EC and TDS (r=0.979) and between CaH and TH (r=0.988) in ground water suggesting that aquifer chemistry of ground water to be mainly controlled by EC, TDS, TH, and CaH. Similarly, highly significant correlations were found between the following pairs in gravity water: EC and TDS (r=0.983), TA and TDS(r=0.853), CaH and TDS (r=0.912), TH and TDS (r=0.955), EC and CaH (r=0.898), and between CaH and TH (r=0.951).DOI: http://dx.doi.org/10.3126/hn.v9i0.7074 Hydro Nepal Vol.9 July 2011 52-56
The Concept of Wastes to Energy Using Sugary Wastes
Authors: Sarwar Fiza , Malik Wajeeha , Ahmed Muhammad Salman , Shahid Harja
Published: November 2012

Abstract: This study was designed using actual effluent from the sugary mills in an Up-flow Anaerobic Sludge Blanket (UASB) Reactor to evaluate treatability performance. The reactor was started-up in step-wise loading rates beginning from 0.05kg carbon oxygen demand (COD)/m3-day to 3.50kg-COD/m3-day. The hydraulic retention time (HRT) was slowly decreased from 96 hrs to eight hrs. It was observed that the removal efficiency of COD of more than 73% can be easily achieved at an HRT of more than 16 hours corresponding to an average organic loading rate (OLR) of 3.0kg-COD/m3-day, at neutral pH and constant temperature of 29°C. The average VFAs (volatile fatty acids) and biogas production was observed as 560mg/L and 1.6L/g-CODrem-d, respectively. The average methane composition was estimated as 62%. The results of this study suggest that the treatment of sugar mills effluent with the anaerobic technology seems to be more reliable, effective and economical.DOI: http://dx.doi.org/10.3126/hn.v9i0.7075 Hydro Nepal Vol.9 July 2011 57-62
Hydropower Potential of Montenegro
Authors: Ratko Mitrović
Published: November 2012

As the existing total hydropower potential of Montenegro is outdated, an attempt is made to re estimate the potential and also to assess the possibility of the utilization of the total hydropower potential in Montenegro in newly created conditions and opportunities. The methodology used is based on energy potential for each watercourse individually taking account of the total amount of water from precipitation and transit waters at the territory of Montenegro. This paper for the first time integrally analyses hydropower potential in both gauged and ungauged major watercourses and their tributaries. It provides insight into the total hydropower potential and technically exploitable hydropower potential for both Run-of-River and storage projects, which may serve as a good basis for strategic planning of exploitation of this resource. It bears specific importance since hydropower exploitation of the remaining 82% of this potential is expected in the near future. The technically exploitable hydropower potential is assessed as 9840 GWh in a year.DOI: http://dx.doi.org/10.3126/hn.v9i0.7076 Hydro Nepal Vol.9 July 2011 63-68
Doing a Dam Better: The Lao People’s Democratic Republic and the Story of Nam Theun 2
Authors: Thanju Jeewan Prasad
Published: November 2012

By Ian C. Poster and Jayasankar Shivakumar, EditorsWashington, DC: The International Bank for Reconstruction and Development/World Bank, 189pp., US$25.00.DOI: http://dx.doi.org/10.3126/hn.v9i0.7077 Hydro Nepal Vol.9 July 2011 69-70
The Low Cost High Value Ceramic Colloidal Silver Filter: Household Water Treatment System
Authors: Editor The
Published: November 2012

No AbstractDOI: http://dx.doi.org/10.3126/hn.v9i0.7078 Hydro Nepal Vol.9 July 2011 71
Interview with Mr. Gokarna Bista
Authors: Thanju Jeewan Prasad
Published: November 2012

No AbstractDOI: http://dx.doi.org/10.3126/hn.v9i0.7079 Hydro Nepal Vol.9 July 2011 79-82
Virtual Water in Food Production
Authors: Editor The
Published: November 2012

No AbstractDOI: http://dx.doi.org/10.3126/hn.v9i0.7080 Hydro Nepal Vol.9 July 2011 78
Gravity Ropeway and Tuin Technology: An Alternative Transportation
Authors: Aryal Sarita , Giri Shradha
Published: November 2012

No AbstractDOI: http://dx.doi.org/10.3126/hn.v9i0.7081 Hydro Nepal Vol.9 July 2011 79-80
Trends in Hydropower Development in Nepal
Authors: Editor The
Published: November 2012

No AbstractDOI: http://dx.doi.org/10.3126/hn.v9i0.7082 Hydro Nepal Vol.9 July 2011 81
International News Vol.9 2011
Authors: Editor The
Published: November 2012

No AbstractDOI: http://dx.doi.org/10.3126/hn.v9i0.7083 Hydro Nepal Vol.9 July 2011 84-86
National News Vol.9 2011
Authors: Editor The
Published: November 2012

No AbstractDOI: http://dx.doi.org/10.3126/hn.v9i0.7084 Hydro Nepal Vol.9 July 2011 87-88
An overview of the basic science of concussion and subconcussion: where we are and where we are going
Authors: Dashnaw Matthew L. , Petraglia Anthony L. , Bailes Julian E.
Published: November 2012

There has been a growing interest in the diagnosis and management of mild traumatic brain injury (TBI), or concussion. Repetitive concussion and subconcussion have been linked to a spectrum of neurological sequelae, including postconcussion syndrome, chronic traumatic encephalopathy, mild cognitive impairment, and dementia pugilistica. A more common risk than chronic traumatic encephalopathy is the season-ending or career-ending effects of concussion or its mismanagement. To effectively prevent and treat the sequelae of concussion, it will be important to understand the basic processes involved. Reviewed in this paper are the forces behind the primary phase of injury in mild TBI, as well as the immediate and delayed cellular events responsible for the secondary phase of injury leading to neuronal dysfunction and possible cell death. Advanced neuroimaging sequences have recently been developed that have the potential to increase the sensitivity of standard MRI to detect both structural and functional abnormalities associated with concussion, and have provided further insight into the potential underlying pathophysiology. Also discussed are the potential long-term effects of repetitive mild TBI, particularly chronic traumatic encephalopathy. Much of the data regarding this syndrome is limited to postmortem analyses, and at present there is no animal model of chronic traumatic encephalopathy described in the literature. As this arena of TBI research continues to evolve, it will be imperative to appropriately model concussive and even subconcussive injuries in an attempt to understand, prevent, and treat the associated chronic neurodegenerative sequelae.
A prospective study of physician-observed concussion during a varsity university ice hockey season: incidence and neuropsychological changes. Part 2 of 4
Authors: Echlin Paul S. , Skopelja Elaine N. , Worsley Rachel , Dadachanji Shiroy B. , Lloyd-Smith D. Rob , Taunton Jack A. , Forwell Lorie A. , Johnson Andrew M.
Published: November 2012

Object

The primary objective of this study was to measure the incidence of concussion according to a relative number of athlete exposures among 25 male and 20 female varsity ice hockey players. The secondary objective was to present neuropsychological test results between preseason and postseason play and at 72 hours, 2 weeks, and 2 months after concussion.

Methods

Every player underwent baseline assessments using the Sport Concussion Assessment Tool-2 (SCAT2), Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), and MRI. Each regular season and postseason game was observed by 2 independent observers (a physician and a nonphysician observer). Players with a diagnosed concussion were removed from the game, examined in the team physician's office using the SCAT2 and ImPACT, and sent to undergo MRI.

Results

Eleven concussions occurred during the 55 physician-observed games (20%). The incidence of concussion, expressed as number of concussions per 1000 athlete exposures, was 10.70 for men and women combined in regular season play, 11.76 for men and women combined across both the regular season and playoff season, 7.50 for men and 14.93 for women in regular season play, and 8.47 for men across both the regular season and playoff season. One male player experienced repeat concussions. No concussions were reported during practice sessions, and 1 concussion was observed and diagnosed in an exhibition game. Neuropsychological testing suggested no statistically significant preseason/postseason differences between athletes who sustained a physician-diagnosed concussion and athletes who did not sustain a physician-diagnosed concussion on either the ImPACT or SCAT2. The athletes who sustained a physician-diagnosed concussion demonstrated few reliable changes postinjury.

Conclusions

Although the incidence of game-related concussions per 1000 athlete exposures in this study was half the highest rate reported in the authors' previous research, it was 3 times higher than the incidence reported by other authors within the literature concerning men's collegiate ice hockey and 5 times higher than the highest rate previously reported for woman's collegiate ice hockey. Interestingly, the present results suggest a substantively higher incidence of concussion among women (14.93) than men (7.50). The reproducible and significantly higher incidence of concussion among both men and woman ice hockey players, when compared with nonphysician-observed games, suggests a significant underestimation of sports concussion in the scientific literature.
Congenital os odontoideum arising from the secondary ossification center without prior fracture
Authors: McHugh Brian J. , Grant Ryan A. , Zupon Alyssa B. , DiLuna Michael L.
Published: November 2012

The etiology of os odontoideum has been debated in the literature since the condition was initially described. The authors present the case of a 4-year-old girl who was found to have an os odontoideum with atlantoaxial instability after a motor vehicle collision. Imaging performed 3 years earlier demonstrated an incompletely ossified, cartilaginous, orthotopic os separated from the body of the odontoid process at the level of the secondary ossification center with a short odontoid process. This case presents the earliest imaging demonstration of the presence of a congenital orthotopic os odontoideum at the secondary ossification center. The authors review the pertinent literature and propose that the etiology of os odontoideum is multifactorial and related to the embryology and vascular supply to the odontoid process.
An Islamic Perspective of Assisted Reproductive Technologies
Authors: Nordin Musa Mohd
Published: November 2012

Not available DOI: http://dx.doi.org/10.3329/bjms.v11i4.12594 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12
Ethics of Human Cloning: A Comparative Study of Western Secular and Islamic Bioethics Perspectives
Authors: Islam Sharmin , Nordin Rusli Bin , Shamsuddin Ab Rani , Noor Hanapi Bin Mohd
Published: November 2012

The comparative approach regarding the ethics of surrogacy from the Western secular and Islamic bioethical view reveals both commensurable and incommensurable relationship. It is not either straight forward commensurable or straight forward incommensurable. Islamic bioethics is straight-forward in prohibiting reproductive cloning on its own features and also guess social chaos and anarchy. Western secular bioethics has both arguments and counter arguments both for and against this scientific innovation. Both are eager to highlight the welfare of the society as a whole but the approaches are not always the same. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12595 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12
Pregnancy and Nutrition
Authors: Shahid Asma Rumanaz , Ul Hosna Asma , Alam Ashraful
Published: November 2012

Pregnancy is a specially important time in womens life to focus on proper health care and nutrition.  Nutrition during childhood and adolescence influence a womens preconceptional nutritional status which  subsequently influence the outcome of pregnancy and health of the baby. Good nutrition is the key to a successful  pregnancy for both mother and child. The mothers nutrition from the moment of conception is an  important factor in the development of the infants metabolic pathway and future wellbeing. The diet during  pregnancy should be adequate to provide maintenance of maternal health, the need of growing fetus, the  strength and vitality required during labour and successful lactation. All women need to gain weight during  pregnancy. Weight gain during pregnancy depends on pre-pregnancy weight. Ahealthy weight gain for most  of the women is between 25-35Lb. During pregnancy a women has different nutritional need for different  trimester to meet extra food needs and extra caloric requirement. Normal weight women need an extra 300  kcal /day during the 2nd and 3rd trimester of pregnancy. The total amount of needed calorie 2000-2500  kcal/day for a normal weight women. Needs for almost all nutrients are greater during pregnancy for own  bodies growth, for baby and successful lactation. The dietetic advice given to the mother should be reasonable  and realistic to the individual women. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12596 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12
Outcome of Tumor Lysis Syndrome with Hydration and Alkalinization in Children with Acute Lymphoblastic Leukemia
Authors: Sultana Armin , Islam Afiqul , Akhtar Gulshan , Rahman Md Abdur
Published: November 2012

Objective: To observe the out come of tumor lysis syndrome (TLS) following treatment with hydration and alkalinization in children with acute lymphoblastic leukemia.Methodology: This is an observational study which included 30 diagnosed ALL children who were at high risk of developing TLS in the Department of Pediatric Hematology & Oncology, BSMMU, from January 2010 to July 2010. Result: The mean (±SD) age was found 10.2±2.9 years and maximum (46.7%) numbers were found between 11 to 15 years. Male female ratio was 2.3:1. High risk patients for developing TLS presented with huge organomegaly such as hepatomegaly, splenomegaly, and lymphadenopathy associated with fever, anemia, and bony tenderness. For diagnosis of Acute Lymphoblastic Leukemia (ALL) bone marrow study was done in all patients and immunophenotyping in 40.0% patients. Hydration, Alkalinization, Tab Allopurinol and Oral Aluminum hydroxide were used in all study patients while treatment. WBC and serum uric acid were found higher in all patients during baseline investigation. After hydration and Alkalinization serum potassium, serum phosphate, serum calcium and serum creatinine level were normal within 72 hours and serum uric acid within day five. Mortality was found 6.7% and the cause of mortality was septicemia. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12598 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12
Lead Exposure and Intellectual Function: Findings from Primary School Children in Bangladesh
Authors: Haque Mahbuba , Faruquee M H , Lahiry Suman , Tasmin Saira , Yasmin Rabeya , Yasmin Nawzia , Chaklader Mainul Alam
Published: November 2012

Backgrounds: About 120 million people around the world are overexposed to lead which is neurotoxic and 99 percent of the most severely affected children are in the developing world including Bangladesh. Methods and Materials: The present cross-sectional ecological study was carried out to explore the impact of lead poisoning on the intelligence level among 84 primary school children of a school of Bangladesh, aged between 8 and 14 years from September 2010 through January 2011. The research instrument was an interviewer questionnaire, questionnaire for IQ test and assessment of blood lead level (inductively-coupled plasma mass spectrometry with collision/reaction cells) of the study subjects after obtaining permission from their parents and the school authority. Results: Data were cross-checked and frequency distribution and association using chi-square test was accomplished. Background information depicted majority (69.1%) of the children aged10-11 years (mean = 10.25 ±1.177 yrs), female (51.2%), parents having primary level of education or below (73.8% in case of father and 77.4% in mother) and from lower socioeconomics (78.6% earned BDT 10,000 or below per month). Among all, majority (56%) were found to be moron, 27.4% in borderline, while 8.3% were imbecile with the same proportion with normal level. By their blood lead level. Majority (70.2%) had blood lead level up to 10 microgram/dl and the rest (29.8%) had more than 10 microgram/dl. Though no statistically significant association was found between IQ level of the children and their blood lead level (p>0.05), the health problems found among the respondents as abdominal pain (53.57%), impatience (14.29%), nausea (10.71%) and all other problems (loss of concentration to study, ear problem, anorexia and loss of weight) amounting for 21.43% are suggestive of chronic lead poisoning. Conclusion:Further studies in large scale with larger samples including comparative studies of inter-industrial areas have been strongly recommended. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12599 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12
Histomorphometric study of the human spleen
Authors: Alim Abdul , Nurunnabi Abu Sadat Mohammad , Mahbub Sabiha , Ara Shamim
Published: November 2012

Context: The spleen is the largest single mass of lymphoid tissue in all vertebrates. Histological changes are evident in advancing age along with functional capability of the human spleen. A cross-sectional, descriptive type of study was done in the Department of Anatomy, Dhaka Medical College, Dhaka, from January to December 2008, to see the age related microscopic changes in the human spleen. Methods: 30 human spleens were collected from the unclaimed dead bodies that were under examination in the Department of Forensic Medicine of Dhaka Medical College, Dhaka. The samples were divided into three age-groups including group A (15-29 years), group B (30-49 years) & group C (50-69 years). Then 5 best prepared histological slides from each group were taken and examined under the light compound microscope to determine the thickness of capsule, diameter, number and percent amount of white pulp in the human spleen. Results: The thickness of the splenic capsule were found 84.60±7.97 ?m, 117.92±4.16 ?m, and 132.17±6.37 ?m in group A, B and C respectively. The diameter of the white pulp were found 0.32±0.01 mm, 0.32±0.01 mm and 0.31±0.01 mm, while the number of white pulp per sq. mm were 2.28±1.04, 2.38±0.93 and 2.04±0.76 in group A, B and C respectively. Moreover, the amounts of the white pulp were determined 23.09±1.38, 24.45±1.84 and 22.54±1.08 in group A, B and C respectively. The difference in thickness of the splenic capsule was statistically significant among the study groups (p<0.001). However, no difference was found in diameter, number and percentage of the white pulp of the spleen among those age groups. Conclusion: The thickness of the capsule of the spleen was found to increase with advancing age in humans. However, no age change was evident in diameter, number or amount of the white pulp. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12600 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12
Assessment of Thyroid Disorder in FarWestern Part of Nepal: A Hospital Based Study
Authors: Yadav Naval Kishor , Hanpari C , Shrewastwa Mukesh Kumar , Mittal Rabindra Kumar , Koner Bidhan Chandra
Published: November 2012

Objectives: This study was conducted to know the status of thyroid disorder in people of far western region  of Nepal.Methods: A total of 808 cases, out of which 133 male and 675 female were included and study  was carried out using data retrieved from the register maintained in the Department of Biochemistry of the  Nepalgunj Teaching Hospital, Kohalpur, Banke, Nepal, between 1st January, 2011 and 28th February, 2012.  The variables collected were age, sex, and thyroid function profile including free T3, free T4 and TSH. The  data was analyzed using Excel 2003, R 2.8.0 Statistical Package for the Social Sciences (SPSS) for Windows  Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version. Results: The percentage  of thyroid disorders was 33.66% in people of far western region of Nepal. The people were highly affected  by overt hyperthyroidism (14.9%) followed by subclinical hyperthyroidism (9.9%). The subclinical  hypothyroidism was 7.9% while 1% overt hypothyroidism only. Serum fT3, fT4 and TSH level were significantly  different in male and females. Similarly, fT3, fT4 and TSH levels show statistically significant differences  in different thyroid disorders. The fT3 and fT4 level in overt hyperthyroidism and subclinical  hypothyroidism showed statistically significant differences when compared with euthyroidism group.  Likewise, TSH level also shows statistically significant in all the thyroid disorders when compared with  euthyroidism group. The fT3 and fT4 levels were statistically insignificant in all the age groups whereas  TSH level showed statistically significant different in all the age groups. The fT3 and fT4 level in 21-40  years showed statistically significant when compared with serum level of fT3 and fT4 of 0-20 years.  Similarly, serum level of TSH in 21-40 and 41-60 years also showed statistically significant when compared  with serum level of TSH of 0-20 years. Conclusion: The people residing in far western region have risk for  thyroid disorders. They were suffering with thyroid disorder, especially overt hyperthyroidism (14.9%) and  subclinical hyperthyroidism (9.9%). Further studies are required to characterize the reasons for this high  prevalence of overt hyperthyroidism and subclinical hyperthyroidism. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12601 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12
Intrarater Reliability of Chest Expansion using Cloth Tape Measure Technique
Authors: Mohan Vikram , Dzulkifli Nurul Hafizah , Justine Maria , Haron Rohani , Joseph H Leonard , Rathinam Chandrasekar
Published: November 2012

Objective: The Objective of this study was to determine the intrarater reliability of chest expansion at three different anatomical landmarks using a cloth tape measure among healthy peoples. Materials and Methods: 120 healthy male and female volunteers were evaluated on two occasions in different days. The measures   consisted of chest expansion measurement at axilla, fourth intercostals and xiphoid levels. The measurements   were taken in the standing position with the arms hanging sideways at all the three different anatomical landmarks. The test-retest reliability of the measurements was determined by intraclass correlation coefficient (ICC) and standard error of measurements (SEMs). Results: An acceptable reliability was determined  by ICC values greater than than 0.85 and SEMs less than 5%. The mean age of the subjects was 21.93 years. ICC of all measures ranged between 0.95 to 0.97 and SEMs were 1.9%, 1.8%, 1.5% at the axillary, fourth intercostals and xiphoid level respectively. Conclusions: The findings of this study suggested that, the cloth   tape measurement was reliable at all the three different anatomical landmarks of the chest wall. Therefore, this measurement technique could be used as an outcome measure for chest expansion in the management   of cardiorespiratory conditions. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12602 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12
Knowledge of breast feeding among primigravida mothers
Authors: Mohite R V , Mohite V  R , Kakade S V
Published: November 2012

Background : Breast feeding, the most natural way of infant feeding to satisfy nutritional, metabolic and psychological needs of the baby. Objectives : To assess the knowledge of breast feeding among primi- gravida mothers attending ante-natal clinic and to determine the association between socio-demographic variables with their knowledge. Materials and Methods : Hospital based cross sectional study was conducted at Ante-natal clinic of Krishna Hospital and Medical Research Center, Karad district Satara. Pre-tested structured proforma used to collect information from 590 married primi gravid mothers attending anti-natal clinic during study period by utilizing personal interview method. Statistical Analysis : socio-demographic frequency percentage distribution, knowledge scoreing and statistical association was analysed by using chi-square test. Results: Out of 590 primi gravida mothers,59.66% showed fair quality of knowledge about breast feeding. knowledge about rooming in, family support for breast feeding & burping after breast feeding  was 97.7%, 95.4% , 93.5% however weaning, colostrums feed, hazards of bottle feeding and prelactal food was 84%, 82.7%,75.5% and 54% respectively. Statistical association was existed between age, education, religion, socio-economic status & occupation of respondents with their knowledge about breast feeding (?2=151.52, p < 0.0001*; ?2=211.27,p<0.0001*; ?2=133.91,p < 0.0001*; ?2=35.59,p < 0.0001* and    ?2=131.04,p<0.0001*) respectively. Conclusion: knowledge of breast feeding among primi gravida mothers attending ANC clinic was of fair in quality. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12603 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12
Prevalence of Ciprofloxacin Resistance Among Gram-Negative Bacilli at a Specialist Hospital in Saudi Arabia
Authors: Ahmad Shamweel
Published: November 2012

Background: Resistance to antimicrobials of different structural classes including fluoroquinolones has arisen in a multitude of bacterial species both in the community and the hospitals. This may complicate the therapeutic management of infections. Decreased susceptibility to fluoroquinolones arises mainly by singlestep mutations in the gyrA and parC genes, which encode the fluoroquinolones targets, the topoisomerase enzymes, conferring cross resistance to all fluoroquinolones. Accumulation of multiple mutations in several genes confers increasing level of resistance associated with clinical failure. However, even low level resistance can generate therapeutic failure. In 1998, some mobile elements with a potential for the horizontal transfer of the quinolone resistance genes were described. The loci which are responsible for this plasmid-mediated quinolone resistance, which have been designated as qnrA, qnrB and qnrS, have been identified in the Enterobacteriaceae species. Aim: To evaluate the susceptibility pattern of the isolates to various antibiotics and to know the prevalence rate of ciprofloxacin resistance in our hospital. Materials & Methods: A total of 916 gram-negative bacilli (GNB) were isolated from different clinical specimens over a period of nine months, were subjected to antibiotic susceptibility testing. Isolates with resistance or with a decreased susceptibility to ciprofloxacin (£20 mm) were then screened for their minimum inhibitory concentration(MIC) by using the E-test. Results: Out of 916 GNB, 321 (35%) isolates were resistant to ciprofloxacin. The MIC of these isolates ranged from 4 to >32?g/ml.Conclusion: The resistance rate to ciprofloxacin was 35% in our study. Most of the ciprofloxacin resistant isolates were from urinary tract infections (UTI). The ciprofloxacin resistance was also closely associated with multi-drug resistance, thus limiting the treatment options. Ciprofloxacin resistance can be used as a general surrogate marker of multidrug resistance, thus limiting the already restricted treatment options. The considerably high MIC values for ciprofloxacin in this study reflected the extent of the treatment problems for these resistant isolates and a need for the continuous evaluation of the commonly used antibiotics. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12604 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12
Use of fluorescein diacetate (FDA) staining to detect viable Mycobacterium tuberculosis
Authors: Islam Shamima , Rahman Farjana , Munshi Saurab Kisore , Ahmed Jewel , Kamal S M Mostafa , Noor Rashed
Published: November 2012

Objective: Drug resistant tuberculosis has long been a common problem prevailing in developing countries including Bangladesh. Present study focused on the rapid identification of live Mycobacterium tuberculosis among treatment failure cases.Materials and Methods: Sputum samples from a total of 100 category-I and category-II treatment failure cases, assumed as multidrug resistant tuberculosis, were studied through fluorescein diacetate (FDA) staining under light emitting diode (LED) fluorescence microscope. Considering culture method as gold standard, we also compared the results of FDA staining with that of auramine O staining.Results: A total of 85% acid-fast bacilli were detected by FDA staining, 82% by auramine O staining and a total of 85% isolates were detected in Lowenstein-Jensen (LJ) culture. The sensitivity of FDA staining (96.47%) was estimated to be slightly higher than that of auramine O staining (91.76%). Moreover,76.47% cases were detected as multidrug resistant tuberculosis (MDR-TB). Conclusion: Taken together, FDA staining method has been proposed to be appropriate for the rapid diagnosis of drug resistant tuberculosis. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12605 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12
Plasma total homocysteine is not associated with peripheral neuropathy in a groups Bangladeshi type 2 diabetic subjects
Authors: Rahman MM , Hassan Z , Biswas KB , Bhowmik NB , Ali L
Published: November 2012

Aims: The present study was undertaken to explore the relationship of plasma homocysteine in the pathogenesis of neuropathy in diabetic patients.Subjects and Methods: Forty two type 2 diabetic patients [22 with neuropathy (DN group) and 20 without neuropathy (DNN group)], age range between 35-70 years had relatively controlled glycemia and duration of diabetes 7-15 years, were studied. Motor and sensory nerve conduction velocities and action potential amplitudes of peripheral nerves were determined by following standard protocol. HbA1c was estimated by modified HPLC (BIO-RAD Variant, USA). Serum C-peptide was measured by enzyme linked immunosorbentassay (ELISA), plasma total homocysteine by Fluorescent Polarization Immunoassay (FPIA). Results: Age, BMI and blood pressure of the study subjects were. Duration of diabetes between DN and DNN groups was comparable. DN group had significantly higher fasting glucose levels (9.8±3.8, mmol/l) compared to the DNN group (6.9±1.8, p=0.004). This trend was also reflected in the HbA1c level: 8.7± 2.1 vs 7.2±1.6 in DN group and DNN group respectively (p=0.009). The two diabetic groups had relatively higher absolute C-peptide level compared to the controls (p=ns). DN and DNN groups had significantly higher plasma homocysteine level compared to the Controls. But between the two diabetic groups no significant difference was observed. Ulnar and peroneal motor nerve conduction velocities and compound muscle action potentials in the diabetic neuropathy group significantly lower compared to diabetic counterpart and the controls. Ulnar and sural sensory nerve conduction velocities and action potentials were significantly lower in the diabetic neuropathy group compared to the diabetic counterpart and the controls. Plasma homocysteine did not show any correlation with nerve conduction velocities  and action potential amplitudes.Conclusions: The data concluded that (i) Diabetic neuropathy may not  be related to hyperhomocysteinemia in type 2 diabetic patients of Bangladeshi origin; (ii) Hyperglycemia, even at milder level, is related to neuronal dysfunction in these subjects; and (ii) Hyperinsulinemia don't seem to be prerequisite for neuropathy in these subjects. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12607 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct12