Perception-Based Assessment of the Factors Causing Delays in Construction Projects

Construction delay is a widespread issue in the construction industry of developing countries, and Nepal is no exception. These delays extend project durations and lead to cost overruns and disputes among stakeholders. To address this problem, this study aimed to identify and analyze the significant factors that contribute to construction project delays in Nepal. To gather data, a well-structured questionnaire was developed and administered to a sample of 100 participants, including contractors, consultants, and civil engineers. Various statistical tests were conducted to ensure the data’s integrity and consistency, such as reliability assessments and factor analyses. The findings of the study highlighted multiple factors contributing to delays in construction projects such as inadequate design, poor communication, and coordination among stakeholders, insufficient experience and planning by contractors, delays in material delivery and testing, labor-related problems including shortages and low qualifications, and external factors like regulatory changes and unforeseen circumstances. By identifying these major causes of construction project delays, this study presented insightful information that can contribute to the analysis and evaluation of project performance.

LOTUS, a potent blocker of Nogo receptor-1 causing inhibition of axonal growth

Glia-derived axonal growth inhibitory proteins limit functional repair following damage to the adult cen- tral nervous system （CNS）. Nogo proteins, myelin-as- sociated glycoprotein （MAG）, oligodendrocyte myelin glycoprotein （OMgp） and B lymphocyte stimulator （BLyS）, are 4 inhibitors that commonly interact with the neuronal receptor, Nogo receptor-1 （NgR1）, lead- ing to inhibition of axonal growth. Here, we demon- strate that lateral olfactory tract usher substance （LOTUS） binds to NgR1 and blocks the binding of all four ligands to NgR1, resulting in the suppression of axonal growth inhibition induced by these NgR1 li- gands. LOTUS allows neurons to overcome NgRl-me- diated axonal growth inhibition, raising the possibility that LOTUS may be useful in future therapeutic ap- proaches as an endogenous potent inhibitor of NgR1 for promoting neuronal regeneration.

Whole exome sequencing identifies an AMBN missense mutation causing severe autosomal-dominant amelogenesis imperfecta and dentin disorders

Tooth development is a complex process that involves precise and time-dependent orchestration of multiple genetic, molecular,and cellular interactions. Ameloblastin(AMBN, also named "amelin" or "sheathlin") is the second most abundant enamel matrix protein known to have a key role in amelogenesis. Amelogenesis imperfecta(AI [MIM: 104500]) refers to a genetically and phenotypically heterogeneous group of conditions characterized by inherited developmental enamel defects. The hereditary dentin disorders comprise a variety of autosomal-dominant genetic symptoms characterized by abnormal dentin structure affecting either the primary or both the primary and secondary teeth. The vital role of Ambn in amelogenesis has been confirmed experimentally using mouse models. Only two cases have been reported of mutations of AMBN associated with non-syndromic human AI. However, no AMBN missense mutations have been reported to be associated with both human AI and dentin disorders.We recruited one kindred with autosomal-dominant amelogenesis imperfecta(ADAI) and dentinogenesis imperfecta/dysplasia characterized by generalized severe enamel and dentin defects. Whole exome sequencing of the proband identified a novel heterozygous C-T point mutation at nucleotide position 1069 of the AMBN gene, causing a Pro to Ser mutation at the conserved amino acid position 357 of the protein. Exfoliated third molar teeth from the affected family members were found to have enamel and dentin of lower mineral density than control teeth, with thinner and easily fractured enamel, short and thick roots, and pulp obliteration. This study demonstrates, for the first time, that an AMBN missense mutation causes non-syndromic human AI and dentin disorders.

THE CHARACTERISTIC， DISTRIBUTION AND CAUSING FACTORC OF THE DISABLED IN HENAN PROVINCE

Henan Province is not only one of the provinces with the most POpulation, but also one of the provinces with the most disabled people in China. The characteristics of the disabled People, the distribution law of six typeS of the disabled, and the reason c

Livelihood Economic Activities Causing Deforestation in Northern Ghana: Evidence of Sissala West District

Policymakers and international organizations are making the conscious effort to address climate change through afforestation and sustainable ecosystem management. Economic activities including agriculture, mining, and infra-structure improvement to meet basic human needs continuously degrade the natural and forest resources. The rate of deforestation in Ghana is alarming due to over-reliance on forest resources by forest-dependent communities. Perceived causes of deforestation differ from individuals and groups perspec-tive. This depends on factors including environmental knowledge, education level, market demand and socio-economic activities. Simple random sampling and key informant interview with the aid of semi-structured questionnaire was used to elicit information from the indigenes of Sissala West District to determine their perceptions of causes of deforestation. The study indicated that poverty, high illiteracy, population growth and lack of alternative source of livelihood were the indirect causes which trigger livelihood economic activities such as farming, charcoal burning, wood logging and hunting leading to degradation of the ecosystem. It was also realized that majority of the indigenes are uneducated and this contributes to their unawareness of rate of de-forestation. Recommendations suggested to address challenges were enforce-ment of bye-laws and stringent government environmental policies to deter people from degrading the forest. Education, agroforestry, afforestation, and provision of alternative livelihood were also good interventions suggested.

In silico analysis of a disease-causing mutation in PCDH15 gene in a consanguineous Pakistani family with Usher phenotype

AIM： To map Usher phenotype in a consanguineous Pakistani family and identify disease-associated mutation in a causative gene to establish phenotype-genotype correlation.· METHODS： A consanguineous Pakistani family in which Usher phenotype was segregating as an autosomal recessive trait was ascertained. On the basis of results of clinical investigations of affected members of this family disease was diagnosed as Usher syndrome（USH）. To identify the locus responsible for the Usher phenotype in this family, genomic DNA from blood sample of each individual was genotyped using microsatellite Short Tandem Repeat（STR） markers for the known Usher syndrome loci. Then direct sequencing was performed to find out disease associated mutations in the candidate gene.· RESULTS： By genetic linkage analysis, the USH phenotype of this family was mapped to PCDH15 locus on chromosome 10q21.1. Three different point mutations in exon 11 of PCDH15 were identified and one of them,c.1304AC was found to be segregating with the disease phenotype in Pakistani family with Usher phenotype.This, c.1304 A C transversion mutation predicts an amino-acid substitution of aspartic acid with an alanine at residue number 435（p.D435A） of its protein product.Moreover, in silico analysis revealed conservation of aspartic acid at position 435 and predicated this change as pathogenic.·CONCLUSION：Theidentificationofc.1304ACpathogenic mutation in PCDH15 gene and its association with Usher syndrome in a consanguineous Pakistani family is thefirst example of a missense mutation of PCDH15 causing USH1 phenotype. In previous reports, it was hypothesized that severe mutations such as truncated protein of PCDH15 led to the Usher I phenotype and that missense variants are mainly responsible for non-syndromic hearing impairment.

Discussion on the Prevention and Treatment of COVID-19 Causing Lung Disease and Heart Damage Based on Lei Zhongyi's Theory of Intermingled Phlegm,Blood Stasis and Toxin

Novel coronavirus infection not only damages lung function,but also causes myocardial injury,elevated myocardial enzymes and heart failure,especially for patients with basic heart diseases who develop COVID-19,the first consideration should be the protection of cardiac function.Based on the theory of intermingled phlegm,blood stasis and toxin of heart disease put forward by Master Lei Zhongyi,the dialectical treatment thinking of COVID-19 patients from the concept of damage of phlegm,blood stasis and toxin to the heart were discussed.During the diagnosis,critical stage and recovery period of COVID-19,expectorant and blood-activating agents,heat and detoxification agents can be added to promote lung and asthma,free Bizheng and remove blood stasis,calm the heart and calm the mind,and promote the recovery of cardiopulmonary functions.

A case of isolated hepatic actinomycosis causing right pulmonary empyema

The clinical picture of actinomycosis was first described in 1878.Actinomycosis agents are found in the natural flora of the oral cavity, upper gastrointestinal system and female genital systems. Actinomyces israelii is usually responsible for the infections and causes chronic suppurative and granulomatous infections. The most common disease form is cervicofascial infection. Liver is involved in 5% of all actinomycosis infections. Liver involvement secondary to any primary infection site in the abdomen frequently occurs. In 15% of abdominal infections the liver is also involved. However, in very rare cases, a primary focus cannot be found, and these cases are called primary or isolated hepatic actinomycosis （IHA）. IHA which is frequently seen as a solitary abscess can be confused with a malignancy both clinically and radiologically.

Distribution and Formation Causes of PM_(2.5) and O_(3) Double High Pollution Events in China during 2013–20

Fine particulate matter(PM_(2.5))and ozone(O_(3))double high pollution(DHP)events have occurred frequently over China in recent years,but their causes are not completely clear.In this study,the spatiotemporal distribution of DHP events in China during 2013–20 is analyzed.The synoptic types affecting DHP events are identified with the Lamb–Jenkinson circulation classification method.The meteorological and chemical causes of DHP events controlled by the main synoptic types are further investigated.Results show that DHP events(1655 in total for China during 2013–20)mainly occur over the North China Plain,Yangtze River Delta,Pearl River Delta,Sichuan Basin,and Central China.The occurrence frequency increases by 5.1%during 2013–15,and then decreases by 56.1%during 2015–20.The main circulation types of DHP events are“cyclone”and“anticyclone”,accounting for over 40%of all DHP events over five main polluted regions in China,followed by southerly or easterly flat airflow types,like“southeast”,“southwest”,and“east”.Compared with non-DHP events,DHP events are characterized by static or weak wind,high temperature(20.9℃ versus 23.1℃)and low humidity(70.0%versus 64.9%).The diurnal cycles of meteorological conditions cause PM_(2.5)(0300–1200 LST,Local Standard Time=UTC+8 hours)and O_(3)(1500–2100 LST)to exceed the national standards at different periods of the DHP day.Three pollutant conversion indices further indicate the rapid secondary conversions during DHP events,and thus the concentrations of NO_(2),SO_(2) and volatile organic compounds decrease by 13.1%,4.7%and 4.4%,respectively.The results of this study can be informative for future decisions on the management of DHP events.

Importance of diet and intestinal microbiota in the prevention of colorectal cancer-colonoscopy early screening diagnosis

Colorectal cancer is a term used to describe colon and rectal cancer,which is the third most common type of cancer.A MEDLINE and PubMed search resulted in the inclusion of manuscripts written in the last 10 years,using keywords relevant to the topic of the manuscript.By analyzing the aim of the searched studies and manuscripts,adequate articles were included that described the stated problem.The frequency of colorectal cancer varies with climate,nutrition,and many other factors,primarily endogenous,hereditary,intestinal microbiome,as well as external factors,such as exposure of the individual to stress,and bad eating habits.Colon cancer and rectal cancer or colorectal cancer in general in the early stages of the disease,may not show symptoms or are barely noticeable.Colorectal cancer symptoms will most often not develop until the disease has progressed to stage 2 or beyond.Regular screening tests for colon or rectal cancer,especially colonoscopy,are recommended as part of a regular checkup for people aged 50 years or younger who are at high risk due to a family history of the disease or other cancers.Diet and colonoscopy as an early screening method play an important role in the prevention of colorectal cancer.

Successful management of severe hypoglycemia induced by total parenteral nutrition in patients with hepatocellular injury: Three cases reports

BACKGROUND Glucose imbalance is common in total parenteral nutrition(TPN).Hypoglycemia seems to be less frequent than hyperglycemia,but it influences the clinical outcome to a greater extent.Therefore,it should be effectively prevented and treated.However,there is no relevant report on how to treat hypoglycemia caused by TPN in patients with liver cell injury.CASE SUMMARY We present three patients with liver cell injury who developed severe hypo-glycemia during or after TPN infusion.The causes of severe hypoglycemia and glucose-raising strategies were discussed.According to the physiological charac-teristics of the hepatocellular injury,the ratio of nutrition components prescribed in TPN was appropriately adjusted for the three cases.We simultaneously reduced the dose of insulin and fat emulsion,and increased the dose of glucose in TPN.The blood glucose level was restored to normal range and clinical symptoms were eliminated.CONCLUSION When hypoglycemia occurs during or after TPN in patients with hepatocellular injury,physicians need to simultaneously reduce insulin and fat emulsion,and increase glucose,and correct severe hypoglycemia in time to reduce its adverse consequences.

Analysis of the causes of primary revision after unicompartmental knee arthroplasty: A case series

BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.

Survival and risk analysis of patients with COVID-19 in Iran

Objective:To evaluate the risk factors of death caused by COVID-19 in Iran.Methods:This study was a retrospective cohort study from February 20,2020,to August 22,2022,in the hospitals in Isfahan,Iran.The data were collected through a researcher-made checklist.To determine the risk factors of the death,logistic regression and Cox regression models were used.For each variable,the odds ratio and 95%confidence interval were also reported.Results:1885 Patients were included.The age of deceased persons was significantly higher than that of the surviving persons.The risk of death for the age group above 60 years was about 14 times higher than that of people aged 19-35 years[95%CI:14.41(2.02-102.99),P<0.01].Hypertension[95%CI:1.92(1.47-2.5),P<0.01],diabetes[95%CI:1.62(1.23-2.13),P<0.001],and chronic obstructive pulmonary disease[95%CI:1.92(1.47-2.50),P<0.01]were also risk factors of mortality.Conclusions:This study reveals that the mortality rate due to COVID-19 is associated with old age,longer hospitalization in the ICU,increased length of stay,and comorbidities of high blood pressure,diabetes,and chronic pulmonary disease.

Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis

BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)constitutes a prevalent emergency within Gastroenterology,encompassing 80%-90%of all gastrointestinal hemorrhage incidents.This condition is distinguished by its abrupt onset,swift progression,and notably elevated mortality rate.AIM To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis.METHODS We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023,utilizing our medical record system.Data pertaining to general patient information,etiological factors,disease outcomes,and other relevant variables were meticulously collected and analyzed.RESULTS Among the 532 patients diagnosed with ANVUGIB,the male-to-female ratio was 2.91:1,with a higher prevalence among males.Notably,43.6%of patients presented with black stool as their primary complaint,while 27.4%had hematemesis as their initial symptom.Upon admission,17%of patients exhibited both hematemesis and black stool,while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding.Urgent routine blood examinations at admission revealed that 75.8%of patients had anemia,with 63.4%experiencing moderate to severe anemia,and 1.5%having extremely severe anemia(hemoglobin<30 g/L).With regard to etiology,53.2%of patients experienced bleeding without a definitive trigger,24.2%had a history of using gastric mucosa-irritating medications,24.2%developed bleeding after alcohol consumption,2.8%attributed it to improper diet,1.7%to emotional excitement,and 2.3%to fatigue preceding the bleeding episode.Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals,while bleeding due to alcohol consumption showed the opposite trend.Additionally,diet-related bleeding was more common among the young age group compared to the middle-aged group.Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB(73.3%),followed by gastrointestinal malignancies(10.9%),acute gastric mucous lesions(9.8%),and androgenic upper gastrointestinal bleeding(1.5%)among inpatients with ANVUGIB.Of the 532 patients with gastrointestinal bleeding,68 underwent endoscopic hemostasis,resulting in an endoscopic treatment rate of 12.8%,with a high immediate hemostasis success rate of 94.1%.

Etitiological Relationship between Hyperlipidemia and Acute Pancreatitis

Hyperlipidemia is a kind of pancreatitis caused by high triglyceride levels in the blood. The morbidity and mortality of this disease continue to increase worldwide, and it has become one of the most common gastrointestinal diseases in developed countries worldwide. Although many studies have been conducted, the pathogenesis still cannot be defined. Many studies have shown that this may be related to the triglyceride decomposition products free fatty acids are the main toxic substances, which can directly damage pancreatic acinar cells and vascular endothelial cells, causing tissue ischemia and acidic environment. Therefore, this paper focuses on the correlation of triglycerides and their decomposition products in plasma and provides evidence on the pathogenesis of AP and the disease progression of AP. Finally, the future potential to prevent and treat acute pancreatitis by some new drugs to reduce plasma triglycerides is summarized.

The Impacts and Causes of Land Fragmentation on Farm Productivity: Case Review of East African Countries

This report provides an overall assessment of land fragmentation problems in East Africa. Many parts of East Africa have become highly fragmented, putting development systems and activities in these areas at risk of complete collapse. Land fragmentation occurs when land gets converted for agriculture, industrialization, or urbanization, invaded by non-local plants, or enclosed for individual use and by subdividing farmlands into subsequent smaller units called parcels with varying average farm sizes. Fragmentation results from inappropriate agricultural development processes and ineffective land use planning that fails to recognize how farmland is used, and the importance of its interconnected areas. Insecurity of tenure and resource rights are key factors in making this possible. Land fragmentation is one of the key reasons why the ability of most resources in East Africa becomes scarcer, and those remaining become “privatized” by more powerful community members—keen to maintain their access to them. Such individualistic attitudes are new and disadvantage the poorest even further by affecting the traditional customary safety nets and agricultural outputs. Neither the government nor customary governance systems effectively protect resource access for the poorest. This review summary report identifies the key causes, measures, and implications, government interventions, and the common remedies to land fragmentation problems in the East African Countries of Kenya, Uganda, Rwanda, and Tanzania including neighboring Ethiopia, and the Sudan. The findings indicated from 2005 to 2015, the population kept increasing for all the named countries in East Africa with Rwanda and Uganda having a substantial increase in population density. The study review further explores the trend in the performance of agriculture by average farm sizes within the intervals of five years by highlighting their strong linkages and found that the average farm size has declined drastically, especially for Kenya. This can only mean that small farms kept becoming smaller and smaller and that there were more small-scale farmers. The results further depicted that the major and commonly cultivated food crops among the East African countries include maize, sorghum, rice, cassava, sweet potatoes, bananas, Irish potatoes, beans, peas, etc., with maize yields (Mt/ha) in 2003 for Uganda being the highest (1.79 Mt/ha) and the lowest in Rwanda (0.77 Mt/ha) respectively. Therefore, from the review results, recommendations are being made as to how the negative impacts of land fragmentation on agricultural productivity can be reduced or mitigated. One way is by community sensitization and awareness about the importance of land consolidation and its proposition on farm productivity.

Eternal Climate Change Patterns and the Causes and Countermeasures of Global Climate Change

It is an objective fact that the weather is unpredictable.Even the famous meteorologist,Academician Chu Ko Chen,has only a partial understanding of the changing laws of wind and rain.Even though ancient people summarized the 24 solar terms by observing the annual activities of the sun for a long time,because they ignored the impact of the activities of the moon on the Earth’s climate change on a small scale,the 24 solar terms they summarized often could not accurately predict the change of the Earth’s climate.Therefore,the author studied the influence of lunar activities on the Earth’s climate change,finds out the law of the influence of lunar activities on the Earth’s climate change on a small scale,and summarizes the eternal climate change pattern determined by the activities of the sun and the moon.In addition,the author also reveals the causes and countermeasures of global warming and the frequent occurrence of extreme weather as well as environmental change.

Environmental and Climate Justice in Palestine

To have a clean, safe, and functional environment is not only essential for the purpose of preservation, but also imperative for safeguarding the most fundamental of human rights. Resolution 45/94 of the United Nations (UN) General Assembly also stresses and acknowledges that: “all individuals are entitled to live in an environment adequate for their health and wellbeing” (United Nations Digital Library System, 1991). Environmental and climate justice, which: “emerged in the context of the local environmental struggles of directly oppressed groups”, is a global movement dedicated to ensuring equal protection of people’s human rights (i.e., water, health, life, etc.) in the face of the climate crisis. Moreover, health, environment and human rights are part of the 2030 agenda (in particular, SDG 1, SDG 5, SDG 6, SDG 7, SDG 13, SDG 16, SDG 17). Individually, both environmental and climate justice are rooted in an intersectional outlook, by which they highlight the common threads between communities and the people’s inclusion, irrespective of race, class, or gender, in the pursuit of justice. On the other hand, they recognise and acknowledge the role and consequences of climate change in economic, social, and political dimensions;thus, drawing emphasis on the rights of people under the emerging inequities. In the case of Palestine, the Palestinian community is increasingly becoming vulnerable to these effects and the resulting inequalities of climate change. This vulnerability stems from: 1) The right to life;clean WASH;equitable work opportunities;access to resources;and free movement;are all examples of human rights that the Israeli colonial regime infringes upon;2) Infrastructure is essential for climate adaptation: 61% of the West Bank is ultimately barred from building infrastructure (B’Tselem, 2019) and Gaza Strip has major gaps in infrastructure due to intentional destruction by Israel;3) Palestinian deprivation of the sovereign right to natural resources by Israel;4) Apartheid system in water accessibility: Israeli water usage per person is over three times higher than that of Palestinians (their usage is under the WHO recommended minimum per day) (B’Tselem, 2023);and 5) Violent settler attacks. In 2022 alone, the Applied Research Institute-Jerusalem (ARIJ) recorded 1527 settler attacks that targeted land, properties, livestock, agriculture and even Palestinian civilians. The ongoing neglect of these concerns and the persistent colonization of Palestine by Israel unequivocally and unwaveringly affect the human rights of Palestinians. The power dynamics at play especially hamper the Palestinian ability to exercise and fulfill their inalienable human rights and to tackle the obstacles to justice in their environment.

Moral Perspective as Depicted in the Archetypes on Divine-Human Perspective of Dianshizhai Pictorial

This article examines the archetypes related to the divine-human perspective in the Dianshizhai Pictorial and uses the basic theory of“Myth-Archetype Criticism”to analyze the concepts of moral perspective and the view of cause and effect reflected in the text.It summarizes the interactive modes and various archetypes of cause and effect in three contexts:gods to humans,humans to gods,and humans to humans,explores the social reality and the relevant views of moral perspective and causality reflected in the illustrated magazine,and reveals the archetype foundation of the narrative of moral perspective retribution in Dianshizhai Pictorial in the three dimensions of psychology,literature,and society.

Climate Changes and Sustainability

Climate change is the phrase used to describe long-term changes in temperatures and weather patterns. Changes in the atmosphere and their interactions with diverse geologic, chemical, biological, and geographic variables are the main contributors to this cyclical adjustment of the Earth’s climate. Such changes may be induced purposefully, because of burning fossil fuels, clearing forests, and raising animals, or they may be natural, brought on by significant volcanic eruptions or variations in the sun’s activity. By significantly increasing the amount of greenhouse gases already in the atmosphere, this heightens the greenhouse effect and contributes to global warming. This work includes several additional theoretical and practical explanations of sustainable development. The theoretical work encompasses hundreds of researches that identify requirements for how development routes might satisfy sustainable development (SD) criteria using economic theory, complex systems approach, ecological science, and other techniques. The agreements made by the Parties in various nations across the world will consider a wide range of perspectives about what would be considered undesirable effects on the environment, the climate system, sustainability, economic growth, or food production.