Complications of breast cancer metastasis may be the first manifestation of the disease. We report a rare case of left eye ptosis secondary to cavernous sinus syndrome in a 34-year-old lady due to refusal of proper medical treatment for metastatic breast cancer. The delay in seeking medical treatment was attributed to her use of Traditional Chinese Medicine (TCM).
In this work, a machine learning application was constructed to predict the logistics performance index based on economic attributes. The prediction procedure employs both linear and non-linear machine learning algorithms. The macroeconomic panel dataset is used in this investigation. Furthermore, it was combined with the microeconomic panel dataset obtained through the data envelopment analysis method for evaluating financial efficiency. The procedure was implemented in six ASEAN member countries. The non-linear algorithm of an artificial neural network performed best on the complex pattern of a collective instance of these six countries, followed by the penalized linear of the Ridge regression method. Due to the limited amount of training data for each country, the artificial neural network prediction procedure is only applicable to the datasets of Singapore, Malaysia, and the Philippines. Ridge regression fits the Indonesia, Thailand and Vietnam datasets. The results provide precise trend forecasting. Macroeconomic factors are driving up the logistics performance index in Vietnam in 2020. Malaysia logistics performance is influenced by the logistics business's financial efficiency. The results at the country level can be used to track, improve, and reform the country's short-term logistics and supply chain policies. This can bring significant gains in national logistics and supply chain capabilities, as well as support for global trade collaboration, all for the long-term development of the region.
The aim of this study was to compare 4 methods of central corneal thickness (CCT) measurements in terms of their agreement, repeatability, and measurement time.
Ocular hypertension caused by endogenous Cushing syndrome from an ectopic adrenocorticotropic hormone-producing tumor is rare. We report an 11-year-old boy who presented with intraocular pressures (IOPs) of 50 mm Hg in both eyes. Surgical resection of the tumor was performed with subsequent normalization of serum cortisol and IOP levels.
This study examines the impact of the barrier of adopting hybrid strategy on strategic performance using the oil sector in Iraq as a case. International oil companies consider various strategies in order to achieve superior performance. The procedure needs to overcome certain essential barriers for the adoption of the hybrid strategy that combines the cost leadership and differentiation strategy. The questionnaire was distributed online due to the COVID-19 pandemic that led to the closure of companies in the country. Out of the 537 questionnaires answered, 483 were used for further analysis which yielded usable response rate of 90%. The structural equation modeling results confirmed that the high costs of technologies, the priority of other external matters, inadequate industry regulation, insufficient supply, organizational capabilities, strategic capabilities, and financial capabilities are significantly related to strategic performance. The researchers recommend conducting an in-depth study of the phenomenon based on theoretical and empirical foundations, especially considering the relationship between the barriers of a hybrid strategy and strategic performance based on linear and non-compensatory relationships. This research sheds light on the barriers to adopting the hybrid strategy required by the oil sector as it relies on continuous production.
To assess the intra-observer repeatability and inter-observer reproducibility of central corneal thickness (CCT) measurements of PachPen (Accutome, Inc., Pennsylvania, USA), a hand-held, portable ultrasonic pachymeter when used by an ophthalmic nurse compared to an ophthalmologist. Ophthalmology Clinic, University of Malaya Medical Center In this prospective study, CCT was measured in 184 eyes of 92 healthy subjects, first by a corneal surgeon experienced in ultrasound pachymetry (Observer 1) followed by an ophthalmic nurse new to the procedure (Observer 2). Nine measurements were obtained from each eye by each observer, independently. Measurements were compared between the observers. Coefficients of repeatability and reproducibility were calculated. The Bland-Altman plot was used to assess agreement between observers. Mean age of the study population was 54.3 ± 15.2 years old and consisted of 43.5% male. Mean CCT as measured by Observers 1 and 2 were 528.3 ± 32.9 and 530.7 ± 33.3 µm, respectively. Observer 1 showed higher repeatability of measurements compared to that of Observer 2 (coefficient of repeatability 3.46 vs. 5.55%). The measurements by both observers showed high correlation (0.96) and good agreement (mean difference -2.4 µm; 95% limits of agreement -21.4, 16.7 µm). Coefficient of reproducibility of measurements between observers was 5.08%. Accutome PachPen hand-held ultrasound pachymeters gives excellent intra-observer repeatability and inter-observer reproducibility by personnel of different training grades.
To report the rate of cystoid macular oedema (CMO) as detected by spectral-domain optical coherence tomography (SD-OCT) after intraoperative complication during phacoemulsification. The secondary objectives include comparing mean macular thickness and best-corrected visual acuity (BCVA) between those who developed postoperative CMO against those who did not.
To evaluate the outcome of intravitreal bevacizumab in the treatment of radiation-induced cystoid macular oedema among patients who underwent external beam radiotherapy for nasopharyngeal carcinoma.
Due to the outbreak of Covid-19 epidemic, work stress among health sector employees has risen too high. The study aims at determining the effect of the current coronavirus epidemic in the form of stress perceived among the medical workers in Pakistan and to discover the moderating role played by a healthy climate in offsetting it. The data was collected from 255 medical workers through a self-administered online questionnaire. Multiple Hierarchical Regression was used as a tool to test the hypotheses of the study. The results obtained indicate a correlation between the pandemic and the stress caused by it among the health workers, whereas, the role of a wholesome climate in the reduction of stress among them was found lacking. Sub-hypotheses indicate that the healthy environment provided by supervisors is effective in reducing the impact of workers' handling of the Covid-19 epidemic and perceived stress, while the healthy environment provided by hospitals in general or by workgroups fails to cause such positive change. This revelation necessitates the adoption of compulsory precautionary measures on the part of relevant authorities, because increase in stress caused by the pandemic can prove more lethal than the pandemic itself. The threat of the coronavirus pandemic has emerged as a massive socio-economic challenge for the global community, especially for the developing countries like Pakistan which faces serious socio-economic challenges in the current scenario. On account of the similarity of situations, the results obtained through this study can be safely generalized to other developing countries, particularly from the South Asian region.
To compare homocysteine (Hcy) concentration in the blood plasma, vitreous and aqueous of eyes with proliferative diabetic retinopathy (PDR) against control, and to investigate associations between Hcy concentration in blood plasma with that of aqueous and vitreous in these two groups.
Environmental pollution has been a major concern for researchers and policymakers. A number of studies have been conducted to enquire the causes of environmental pollution which suggested numerous policies and techniques as remedial measures. One such major source of environmental pollution, as reported by previous studies, has been the garbage resulting from disposed hospital wastes. The recent outbreak of the COVID-19 pandemic has resulted into mass generation of medical waste which seems to have further deteriorated the issue of environmental pollution. This necessitates active attention from both the researchers and policymakers for effective management of medical waste to prevent the harm to environment and human health. The issue of medical waste management is more important for countries lacking sophisticated medical infrastructure. Accordingly, the purpose of this study is to propose a novel application for identification and classification of 10 hospitals in Iraq which generated more medical waste during the COVID-19 pandemic than others in order to address the issue more effectively. We used the Multi-Criteria Decision Making (MCDM) method to this end. We integrated MCDM with other techniques including the Analytic Hierarchy Process (AHP), linear Diophantine fuzzy set decision by opinion score method (LDFN-FDOSM), and Artificial Neural Network (ANN) analysis to generate more robust results. We classified medical waste into five categories, i.e., general waste, sharp waste, pharmaceutical waste, infectious waste, and pathological waste. We consulted 313 experts to help in identifying the best and the worst medical waste management technique within the perspectives of circular economy using the neural network approach. The findings revealed that incineration technique, microwave technique, pyrolysis technique, autoclave chemical technique, vaporized hydrogen peroxide, dry heat, ozone, and ultraviolet light were the most effective methods to dispose of medical waste during the pandemic. Additionally, ozone was identified as the most suitable technique among all to serve the purpose of circular economy of medical waste. We conclude by discussing the practical implications to guide governments and policy makers to benefit from the circular economy of medical waste to turn pollutant hospitals into sustainable ones.
Regardless of the prevalence and value of change initiatives in contemporary organizations, these often face resistance by employees. This resistance is the outcome of change recipients' cognitive and behavioral reactions towards change. To better understand the causes and effects of reactions to change, a holistic view of prior research is needed. Accordingly, we provide a systematic literature review on this topic. We categorize extant research into four major and several subcategories: micro and macro reactions. We analyze the essential characteristics of the emerging field of change reactions along research issues and challenges, benefits of (even negative) reactions, managerial implications, and propose future research opportunities.
The side sensitive synthetic chart was proposed to improve the performance of the synthetic chart to monitor shifts in the coefficient of variation (γ), by incorporating the side sensitivity feature where successive non-conforming samples must fall on the same side of the control limits. The existing side sensitive synthetic- γ chart is only evaluated in terms of the average run length (ARL) and expected average run length (EARL). However, the run length distribution is skewed to the right, hence the actual performance of the chart may be frequently different from what is shown by the ARL and EARL. This paper evaluates the entire run length distribution by studying the percentiles of the run length distribution. It is shown that false alarms frequently happen much earlier than the in-control ARL (ARL0), and small shifts are often detected earlier compared to the ARL1. Subsequently, this paper proposes an alternative design based on the median run length (MRL) and expected median run length (EMRL). The optimal design based on the MRL shows smaller out-of-control MRL (MRL1), which shows a quicker detection of the out-of-control condition, compared to the existing design, while the results from the optimal design based on the EMRL is similar to that of the existing designs. Comparisons with the synthetic-γ chart without side sensitivity shows that side sensitivity reduces the median number of samples required to detect a shift and reduces the variability in the run length. Finally, the proposed designs are implemented on an actual industrial example.
Greenhouse gas emissions and global warming are recent issues of upward trend. This study sought to underline the causal relationships between engagement modes with green technology, environmental, social, and governance (ESG) ratio, and circular economy. Our investigation also captured benchmarking of energy companies' circular economy behaviors. A hybrid-stage partial least squares structural equation modeling (PLS-SEM) and multi-criteria decision-making (MCDM) analysis have been adopted. This study collected 713 questionnaires from heads of departments and managers of energy companies. The findings of this study claimed that engagement modes with green technology affect the circular economy and sustainability. The findings revealed that ESG ratings have a mediating role in the nexus among engagement modes with green technology and circular economy. The results of the MCDM application revealed the identification of the best and worst energy companies of circular economy behaviours. This study is exceptional because it is among the first to address the issues of greenhouse gas emissions by providing decisive evidence about the level of circular economy behaviors in energy companies.