ABSTRACT
BACKGROUND: Peak flow is a crucial but simple test used to categorize the severity of an episode of an acute exacerbation of asthma. It should be regularly done in all the patients who present with asthma acute exacerbation in the emergency department. The British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) guidelines stipulate peak flow use as one of the main tools to categorize acute asthma into moderate, severe, and life-threatening asthma. The BTS and SIGN guidelines also state peak flow is to be utilized in monitoring the disease and to guide in treating patients with acute asthma. METHODS AND MATERIALS: This study aims to identify the adherence to BTS/SIGN guidelines around the use of peak expiratory flow rate (PEFR) in assessing the severity of patients presenting with acute exacerbation of asthma in a district general hospital. The retrospective cohort study involved collating data between October 2022 and February 2023 from our hospital electronic system. The data collected about the use of PEFR and whether the patients were being classified by severity in presentation following this was compared to the BTS/SIGN 158 asthma guidelines. Following this, the data analysis was done using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States). RESULTS: Data from 92 patients were collated. PEFR was recorded for 29.3% (n=27) of patients and acute exacerbation of asthma severity was documented in merely 17.4% (n=16) patients. CONCLUSION: The results indicate a significant proportion of the patient cohort analyzed did not have peak flow readings, there is clear room for improvement, and further intervention is needed in order for the department to adhere to the gold standard guidelines (i.e., BTS/SIGN 158), and thus improve the management and monitoring of acute asthma exacerbations. Future directions can include departmental education, posters as a reminder, and prompts on the electronic system used to alert users to check PEFR when a diagnosis of acute asthma exacerbation is documented.
ABSTRACT
Energy, a basic input to the economic system, plays a pivotal function in development; at the same time, it raises concerns and hurdles to global economies as a result of negative externalities associated with its usage. Economies set various measures to limit these negative externalities and encourage citizens toward renewable energy utilization. Considering a panel of high-income economies over the period of 1990-2020, we empirically examine whether energy-related tax policies (ENT) are helpful to tackle the issue of energy-related greenhouse gas emissions (ENGHGs). Furthermore, we also investigate the role of digitalization (DIG) and financial risk (FINR) for its possible impact on ENGHGs. The advanced econometric techniques include diagnostic tests, Method of Moment Quantile Regression (MMQR), for robustness validation quantile regression, and finally Dumitrescu and Hurlin panel causality check. The findings reveal that ENT policies of selected economies are not helpful to limit ENGHGs in 25th and 50th quantiles effectively. Nevertheless, due to the progressive rise in ENT in the 75th and 90th quantiles, ENT significantly helps to smoothen the path towards a sustainable future. Furthermore, GDP increases, while improvement in FINR decreases ENGHGs. As the selected economies are developed and high-income, it is suggested that a progressive rise in ENT may further limit the issue of ENGHGs.
Subject(s)
Greenhouse Gases , Economic Development , Income , Renewable Energy , Public Policy , Carbon Dioxide/analysisABSTRACT
A rare formation of a pyogenic liver abscess can be found in patients with a ruptured appendix. Here, we discuss a 49-year-old male with a past medical history significant for drug-induced pancreatitis from metformin, type II diabetes, obesity, and hypertension who presented with right upper quadrant pain. He was diagnosed with a 12.6 cm pyogenic liver abscess. Upon further chart review, the patient had a laparoscopic appendectomy done nine months ago, with the findings of a ruptured appendix. The liver abscess cultures grewFusobacterium nucleatum - a common culprit of acute appendicitis reported in several case studies and clinical trials. This case report highlights the importance of including appendectomy as an essential part of history-taking and diagnostic differential for pyogenic liver abscesses.
ABSTRACT
We present an analysis and evaluation of breast cancer detection and diagnosis using segmentation models. We used an advanced semantic segmentation method and a deep convolutional neural network to identify the Breast Imaging Reporting and Data System (BI-RADS) lexicon for breast ultrasound images. To improve the segmentation results, we used six models to analyse 309 patients, including 151 benign and 158 malignant tumour images. We compared the Unet3+ architecture with several other models, such as FCN, Unet, SegNet, DeeplabV3+ and pspNet. The Unet3+ model is a state-of-the-art, semantic segmentation architecture that showed optimal performance with an average accuracy of 82.53% and an average intersection over union (IU) of 52.57%. The weighted IU was found to be 89.14% with a global accuracy of 90.99%. The application of these types of segmentation models to the detection and diagnosis of breast cancer provides remarkable results. Our proposed method has the potential to provide a more accurate and objective diagnosis of breast cancer, leading to improved patient outcomes.
ABSTRACT
The phenomenal increase in global temperature and variation in climate change are the replications of nature, alarming governments to limit the emissions of greenhouse gases (GHGs) and adopt green innovation and environmental-friendly clean and green technologies. In this paper, we empirically investigate whether there are any changes in excessive consumption of energy from conventional sources, expansion of urbanization, carbon dioxide (CO2) emissions, and economic growth in six different regions, namely, East Asia (EA), South Asia (SA), Southeast Asia (SEA), Central Asia (CA), Eastern Europe (EE), and the Middle East and North Africa (MENA), under the Belt and Road Initiatives of panel data over the period of 1985 to 2017. The empirical methods include a panel co-integration check, heterogeneity test, panel Granger causality test, pooled mean group (PMG), and augmented mean group (AMG). To verify the outcomes, robustness tests were carried out using the fully modified ordinary least squares (FMOLS) and dynamic ordinary least squares (DOLS) approaches. Our results confirm that CO2 emissions are primarily influenced by excessive utilization of conventional energy, economic growth, and expansion of urbanization. The findings confirm the co-integrating relationships among the variables in all six regions. Moreover, the panel causality analysis identified a bidirectional causal relationship between energy consumption, economic growth, urbanization, and CO2 emissions. While these results can play an instrumental role in formulating CO2 emission policies among our selected countries, our research can also assist policymakers and governments in other developing countries implement important policy initiatives. In this regard, the findings suggest that the current environment-related polices of Belt and Road Initiatives (BRI) do not efficiently tackle CO2 emissions. In order to achieve the CO2 emission degradation objective, the Belt and Road countries should restructure their environment-related policies by limiting the consumption of conventional energy and expansion of urbanization. The adaptation and establishment of such a panoramic policy program can assist emerging economies to acquire consolidated and environmentally sustainable economic growth.
Subject(s)
Carbon Dioxide , Urbanization , Biodiversity , Temperature , Economic Development , Renewable EnergyABSTRACT
Household electricity conservation is a non-negligible aspect of environmental pollution with growing importance for an eco-friendly economy and society. However, debates regarding household electricity consumption have placed more emphasis on the physical attributes of the dwellings, demographic characteristics and the socioeconomic behaviour of households; few studies have directly discussed the awareness of environmental pollution. Based on the 'China Family Panel Studies' surveys with an extracted 8249 households in 25 provinces from 2014 to 2018, we analyse whether or not and to what extent the awareness of environmental pollution impacts household electricity consumption. The study finds that the awareness of environmental pollution rather than actual environmental pollution increases household electricity consumption. The finding is robust under various model specifications. Given a 1% increase in the awareness of environmental pollution, households living in southern China, located in eastern China or living in an urban area were found to have higher electricity consumption. To address possible estimation bias due to self-selection, we design a quasi-policy-shock variable to describe the severity of the perceived environmental pollution and run the propensity score matching regression (PSM). The finding still holds.
Subject(s)
Environmental Pollution , Family Characteristics , China , Surveys and Questionnaires , ElectricityABSTRACT
Background Abdominal radiography is one of the most routinely performed radiological investigations in hospitals. It is one of the initial investigations done in hospitals. Numerous studies have shown that abdominal X-rays have low sensitivity in several conditions such as acute abdominal pain. Methodology This study aims to first identify whether the Royal College of Radiology guidelines are being adhered to while requesting abdominal X-rays and, second, to identify the number of unnecessary requests made in the Betsi Cadwaladr health board. This is a retrospective audit of abdominal X-ray request data collected between the 1st and 23rd of August 2022. Data were collected from the electronic radiology record system. iRefer guidelines by the Royal College of Radiology were used as a reference to compare the requests made, and data were then analysed accordingly. Data are reported descriptively using percentages. Data analysis was done using SPSS version 20 (IBM Corp., Armonk, NY, USA). Results Of the total 242 abdominal X-rays noted, 89.67% of requests were according to the iRefer guidelines while 10.33% of requests were not. A total of 73.14% of cases were suspected to have an intestinal obstruction, and the positivity rate for the same was only 12.39%. Conclusions The majority of the requests followed the guidelines. However, there is an urgent need to develop local guidelines to reduce needless abdominal X-rays.
ABSTRACT
The staggering rise in global temperature and abrupt change of climate are the responses of nature alerting humanity to limit the emissions of hazardous gases and adopt environmentally-benign life style. The present study explores empirically whether any changes in environmental policy stringency (EPSI), political risk (PR), and the interaction term of EPSI*PR result in any alteration of consumption-based carbon emissions (CBCE) of the 24 advanced OECD economies over the period of 1990-2020. Prior to the empirical estimations, various diagnostic tests are employed. The empirical techniques include, panel cointegration check, Cross-sectional Augmented Autoregressive Distributed Lags (CS-ARDL), and Dumitrescu & Hurlin panel causality test. The findings confirm that imports, gross domestic product, and stringency of environment policies activate CBCE in short-run. Whereas, a unit improvement in political risk and its interaction with environmental policy stringency give rise to 0.231 MtCO2 of CBCE in long run. Interestingly, the squared term of environmental policy stringency effectively tackles such emissions. Based on the findings, we conclude that the present environment related policies of OECD member states does not effectively limit CBCE. In order to achieve genuine emissions reduction goals, the selected nations should restructure their environment related policies by prioritizing increments in environmental policy stringency along with minimizing the risks involved in the political system.
Subject(s)
Economic Development , Organisation for Economic Co-Operation and Development , Biodiversity , Carbon , Carbon Dioxide , Cross-Sectional Studies , Renewable Energy , TemperatureABSTRACT
To sustain global warming below 2 °C, carbon dioxide emission mitigation has become an extensive worldwide priority. This paper proposes a comprehensive assessment by evaluating the effects of technology transfer, human capital, and renewable energy on carbon dioxide emissions among seven different regions along with the Belt and Road Initiatives from 2008 to 2018. Based on econometric estimations, it is found that human capital, renewable energy, and technology transfer show a negative but significant association with carbon dioxide emissions, indicating that an increase in human capital, renewable energy, and technology transfer can reduce carbon dioxide emissions in the Belt and Road countries. On the other hand, we found a positive and significant relationship between carbon dioxide emissions, economic growth, and foreign direct investment (FDI), indicating that economic growth and foreign direct investment increase carbon emissions. The findings of this study reveal that the adaptation of technology transfer, renewable energy consumption, and human capital are key factors in the reduction of carbon dioxide emissions in the Belt and Road counties. Our findings provide evidence of the social advantages of investing in advanced human capital, renewable energy, and technology transfer suggesting a promising route for devoting climate change without impeding economic growth.
Subject(s)
Carbon Dioxide , Technology Transfer , Economic Development , Humans , Investments , Renewable EnergyABSTRACT
This study aims to investigate the relationship between carbon emissions (CO2) and economic policy uncertainty for East Asian countries. During recent decades, climate change has become a severe issue globally. To our understanding, the impact of economic policy uncertainty (EPU) on CO2 emissions has not been thoroughly studied in the environment-energy literature. To overcome this research gap, this study explores the link between EPU, CO2 emissions, foreign direct investment (FDI), and renewable energy for the panel of four East Asian economies, namely, China, Japan, South Korea, and Singapore, from 1997 to 2020. We used second-generation econometric estimations to confirm cross-sectional dependence, cointegration, and stationarity among the selected variables. This study finds that economic policy uncertanity (EPU), trade, and GDP have a positive correlation with carbon emissions. However, FDI and renewable energy consumption boost the quality of the environment of East Asian economies. The outcomes of the Dumitrescu-Hurlin panel causality estimation revealed two-way association between CO2 and economic policy uncertainty, CO2 and energy consumption, CO2 and economic growth, and CO2 and trade. Afterward, we use the FMOLS estimations for robustness check. Based on the inclusive outcomes, we draw substantial suggestions for decision-makers and urge them to consider the potential negative effects of EPU on CO2 emissions policies. In addition to this, if policymakers seek to simultaneously control EPU and CO2 emissions, they should work out for alternate ways such as the use of green technology related to energy, foreign capital investment, and renewable energy consumption to mitigate CO2 emissions.
Subject(s)
Carbon Dioxide , Carbon , Cross-Sectional Studies , Economic Development , Renewable Energy , UncertaintyABSTRACT
To tackle the issue of climate change and environmental degradation debates regarding carbon neutrality is on the rise. Regional Comprehensive Economic Cooperation (RCEP), the leading trading union, covers nearly third of global economy, world population, is responsible for thirty percent of global trade and global gross domestic product. The existent study tests the impact of financial, economic, political, and composite risk on consumption-based carbon dioxide emissions (CCO2) in selected RCEP economies during the period of 1990 to 2020. The empirical analysis consists of cross-sectional dependence, slope heterogeneity, cross-sectional augmented panel unit root test, Westerlund cointegration, second-generation cross-section augmented autoregressive distributed lags model (CS-ARDL), and panel causality test. Further, we explore the role of imports, renewable energy supply, exports, and gross domestic product per-capita on CCO2. The empirical results suggest that the less political risk help to mitigate while the lower financial, economic, and composite risk increase CCO2 emissions in selected RCEP economies. Moreover, exports and renewable energy supply show mitigating effect, whereas imports show upsurge in CCO2. Additionally, a bidirectional causality exists between exports and CCO2, imports and CCO2, GDP per-capita and CCO2, political risk and CCO2, and renewable energy and CCO2 emissions, while a one-way causality from financial risk, composite risk, and economic risk to CCO2. Renewable energy supplies along with the improvement in sub-components of political risk, for instance, corruption, government stability, would help to effectively tackle the issue of CCO2 emissions.
Subject(s)
Commerce , Economic Development , Carbon Dioxide , Cross-Sectional Studies , Internationality , Renewable EnergyABSTRACT
Since climate change mitigation is the central debate of modern literature, the realization of carbon neutrality in response to diversified macroeconomic variables is the most crucial concern of international economies. However, the critical role of trade and renewable electricity output in export diversification-environmental nexus is missing. Therefore, this study investigates the combined influence of trade openness, exports diversification, and renewable electricity output on carbon dioxide emissions (CO2) in China from 1989 through 2019. Applying novel time series econometric techniques robust to structural breaks, following new outcomes are obtained. Firstly, long-run equilibrium cointegration existed among the under-analysis variables. Secondly, export diversification and renewable electricity output are predicted to decelerate CO2, supporting carbon neutrality in the long run. Thirdly, trade openness and gross domestic product accelerated the CO2, delaying carbon neutrality accomplishment. Most importantly, significant structural break dummy interacting with trade openness implicated that during the post-2001 era, China's trade openness extensively deteriorated the environmental quality in the face of trade liberalization obtained after joining the World Trade Organization (WTO). Based on empirical results, export diversification and renewable electricity production policies should be mutually non-exclusive and closely coordinated. Further, to counter the carbon emission acceleration impact of trade openness, increasing the share of green tradable products is suggested. Finally, bilateral trade restructuring is recommended to realize the long-term dream of economic sustainability and carbon neutrality.
Subject(s)
Carbon Dioxide , Economic Development , Carbon Dioxide/analysis , China , Electricity , Gross Domestic Product , Renewable EnergyABSTRACT
Usher syndrome type I is a rare genetic autosomal recessive disease caused by mutations in specific genes that provide instructions for making proteins involved in normal hearing, vision, and balance. It is characterized by hearing impairment due to the inability of auditory nerves to send sensory input to the brain leading to hearing loss along with retinitis pigmentosa (RP), which is a progressive, bilateral, symmetrical retinal degeneration involving photoreceptor cells. We report a 32-year-old male patient who presented to us with complaints of night blindness and progressive vision loss for the past 20 years. He had bilateral hearing loss leading to deaf-mutism. In addition, his developmental milestones were delayed. His fundoscopic findings were consistent with RP and his electroretinography confirmed reduced retinal activity. Pure tone audiometry confirmed bilateral sensory neural hearing. His mother was a known case of Usher syndrome type 1. His family history was remarkable for multiple consanguineous marriages in both his parental and maternal families and a confirmed diagnosis of Usher syndrome in paternal uncle. The patient was tried on hearing aids and vitamin A medication but with minimal improvement in his overall condition. A multidisciplinary approach, involving an audiologist, speech, and language therapist was adapted to help the patient. Early genetic testing can help diagnose such cases in its early stages and genetic counseling regarding the detrimental effects of consanguineous marriages can play a very positive role in genetic diseases, especially those with autosomal recessive inheritance patterns.
ABSTRACT
The development of robotic devices able to perform manipulation tasks mimicking the human hand has been assessed on large scale. This work stands in the challenging scenario where soft materials are combined with bio-inspired design in order to develop soft grippers with improved grasping and holding capabilities. We are going to show a low-cost, under-actuated and adaptable soft gripper, highlighting the design and the manufacturing process. In particular, a critical analysis is made among three versions of the gripper with same design and actuation mechanism, but based on different materials. A novel actuation principle has been implemented in both cases, in order to reduce the encumbrance of the entire system and improve its aesthetics. Grasping and holding capabilities have been tested for each device, with target objects varying in shape, size and material. Results highlight synergy between the geometry and the intrinsic properties of the soft material, showing the way to novel design principles for soft grippers.