Search results for: Enhanced Recovery after surgery

Authors: Emily Moore, Andrew Gaukroger, Matthew Solan, Lucy Bailey, Alexandra Boxall, Andrew Carne, Chintu Gadamsetty, Charlotte Morley, Katy Western, Iwona Kolodziejczyk

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Introduction: Rupture of the Achilles tendon is common and has a long recovery period. Most cases are managed non-operatively. Foot and Ankle Surgeons advise an ultrasound scan to check the gap between the torn ends. A large gap (with the ankle in equinus) is a relative indication for surgery. The definitive decision regarding surgical versus non-operative management can only be made once an ultrasound scan is undertaken and the patient is subsequently reviewed by a Foot and Ankle surgeon. To get to this point, the patient journey involves several hospital departments. In nearby trusts, patients reattend for a scan and go to the plaster room both before and after the ultrasound for removal and re-application of the cast. At a third visit to the hospital, the surgeon and patient discuss options for definitive treatment. It may take 2-3 weeks from the initial Emergency Department visit before the final treatment decision is made. This “wasted time” is ultimately added to the recovery period for the patient. In this hospital, Achilles rupture patients are seen in a weekly multidisciplinary OneStop Heel Pain clinic. This pathway was already efficient but subject to occasional frustrating delays if a key staff member was absent. A new pathway was introduced with the goal to reduce delays to a definitive treatment plan. Method: A retrospective series of Achilles tendon ruptures managed according to the 2019 protocol was identified. Time taken from the Emergency Department to have both an ultrasound scan and specialist Foot and Ankle surgical review were calculated. 30 consecutive patients were treated with our new pathway and prospectively followed. The time taken for a scan and for specialist review were compared to the 30 consecutive cases from the 2019 (pre-COVID) cohort. The new pathway includes 1. A new contoured splint applied to the front of the injured limb held with a bandage. This can be removed and replaced (unlike a plaster cast) in the ultrasound department, removing the need for plaster room visits. 2. Urgent triage to a Foot and Ankle specialist. 3. Ultrasound scan for assessment of rupture gap and deep vein thrombosis check. 4. Early decision regarding surgery. Transfer to weight bearing in a prosthetic boot in equinuswithout waiting for the once-a-week clinic. 5. Extended oral VTE prophylaxis. Results: The time taken for a patient to have both an ultrasound scan and specialist review fell > 50%. All patients in the new pathway reached a definitive treatment decision within one week. There were no significant differences in patient demographics or rates of surgical vs non-operative treatment. The mean time from Emergency Department visit to specialist review and ultrasound scan fell from 8.7 days (old protocol) to 2.9 days (new pathway). The maximum time for this fell from 23 days (old protocol) to 6 days (new pathway). Conclusion: Teamwork and innovation have improved the experience for patients with an Achilles tendon rupture. The new pathway brings many advantages - reduced time in the Emergency Department, fewer hospital visits, less time using crutches and reduced overall recovery time.

Keywords: orthopaedics, achilles rupture, ultrasound, innovation

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Authors: K. Amanzoui, A. Erragh, M. Elharit, A. Afif, K. Elfakhr, S. Kalouch, A. Chlilek

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Orthopedic surgery is a provider of pre and postoperative bleeding; patients are exposed to several risks, and different measures are proposed to reduce bleeding during surgery, called the transfusion-sparing method, including tranexamic acid, which has shown its effectiveness in numerous studies. A prospective analytical study in 50 children was carried out in the orthopedic traumatology operating room of the EL HAROUCHI hospital of the CHU IBN ROCHD in Casablanca over a period of six months (April to October 2022). Two groups were randomized: one receiving tranexamic acid (Group A) and a non-receiving control group (Group B). The average age was 10.3 years, of which 58.8% were female. The first type of surgery was thoracolumbar scoliosis (52%). The average preoperative hemoglobin was 12.28 g/dl in group A, against 12.67 g/dl in the control group. There was no significant difference between the two groups (p=0.148). Mean intraoperative bleeding was 396.29 ml in group A versus 412 ml in the control group. No significant difference was observed for this parameter (p=0.632). The average hemoglobin level in the immediate postoperative period in our patients is 10.2 g/dl. In group A, it was 10.95 g/dl versus 10.93 g/dl in group B. At H24 postoperative, the mean hemoglobin value was 10.29 g/dl in group A against 9.5 g/dl in group B. For group A, the blood loss recorded during the first 24 hours was 209.43 ml, against 372 ml in group B, with a significant difference between the two groups (p=0.001). There is no statistically significant difference between the 2 groups in terms of the use of fillers, ephedrine or intraoperative transfusion. While for postoperative transfusion, we note the existence of a statistically significant difference between group A and group B. It is suggested that the use of tranexamic acid is an effective, simple, and low-cost way to limit postoperative blood loss and the need for transfusion.

Keywords: tranexamic acid, blood loss, orthopedic surgery, children

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Authors: Reetika Sharma, Lalit Tejwani, Himanshu Shekhar, Arun Singhvi

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Purpose: To describe a novel technique of trabeculectomy targeting triple modulation on wound healing to increase the overall success rate. Method: Ten eyes of 10 patients underwent trabeculectomy with subconjunctival mitomycin C (0.4mg/ml for 4 minutes) application combined with Ologen implantation subconjunctivally and subsclerally. Five of these patients underwent additional phacoemulsification with intraocular lens implantation. The Ologen implant was wet with 0.1 ml Bevacizumab. Result: All the eyes achieved target intraocular pressure (IOP), which was maintained until one year of follow-up. Two patients needed anterior chamber reformation at day two post surgery. One patient needed cataract surgery after four months of surgery and achieved target intraocular pressure on two topical antiglaucoma medicines. Conclusion: Vascular endothelial growth factor (VEGF) concentration has been seen to increase in the aqueous humor after filtration surgery. Ologen implantation helps in collagen remodelling, antifibroblastic response, and acts as a spacer. Bevacizumab augmented Ologen, in addition, targets the increased VEGF and helps in decreasing scarring. Anti-VEGF augmented Ologen in trabeculectomy with mitomycin C (MMC) hence appears to have encouraging short-term intraocular pressure control.

Keywords: ologen, anti-VEGF, trabeculectomy, scarring

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Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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 Background and aims: Peripheral regional anesthesia has been integrated into most analgesia protocols for total knee arthroplasty which considered among the most painful surgeries with a huge potential for chronicization. The adductor canal block (ACB) has gained popularity. Similarly, the IPACK block has been described to provide analgesia of the posterior knee capsule. This study aimed to evaluate the analgesic efficacy of this block in patients undergoing primary PTG. Methods: 90 patients were randomized to receive either an IPACK, an anterior sciatic block, or a sham block (30 patients in each group + multimodal analgesia and a catheter in the KCA adductor canal). GROUP 1 KCA GROUP 2 KCA+BSA GROUP 3 KCA+IPACK The analgesic blocks were done under echo-guidance preoperatively respecting the safety rules, the dose administered was 20 cc of ropivacaine 0.25% was used. We were to assess posterior knee pain 6 hours after surgery. Other endpoints included quality of recovery after surgery, pain scores, opioid requirements (PCA morphine)(EPI info 7.2 analysis). Results: -groups were matched -A predominance of women (4F/1H). -average age: 68 +/-7 years -the average BMI =31.75 kg/m2 +/- 4. -70% of patients ASA2 ,20% ASA3. -The average duration of the intervention: 89 +/- 19 minutes. -Morphine consumption (PCA) significantly higher in group 1 (16mg) & group 2 (8mg) group 3 (4mg) - The groups were matched . -There was a correlation between the use of the ipack block and postoperative pain Conclusions :In a multimodal analgesic protocol, the addition of IPACK block decreased pain scores and morphine consumption ,

Keywords: regional anesthesia, analgesia, total knee arthroplasty, the adductor canal block (acb), the ipack block, pain

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Authors: Hong Je Kang, Young Chae Choi, Jin Sung Park, Isac Kim

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Purpose: Osteoporotic fractures are an important among postmenopausal women. When osteoporotic distal radial fractures occur, osteoporosis must be treated to prevent the hip and spine fractures. Intravenous injection of Zoledronic acid is expected to improve preventing osteoporotic fractures. Many articles reported the effect of intravenous Zoledronic acid to BMD of the hip and spine fracture or non-fracture patients with low BMD. However, that with distal radial fractures has rarely been reported. Therefore, the authors decided to study the effect of Zoledronic acid in BMD score, bone union, and bone turnover markers in the patients who underwent volar plating due to osteoporotic distal radial fractures. Materials: From April 2018 to May 2022, postmenopausal women aged 55 years or older who had osteoporotic distal radial fractures and who underwent surgical treatment using volar plate fixation were included. Zoledronic acid (5mg) was injected intravenously between 3 and 5 days after surgery. BMD scores after 1 year of operation were compared with the initial scores. Bone turnover markers were measured before surgery, after 3 months, and after 1 year. Radiological follow-up was performed every 2 weeks until the bone union and at 1 year postoperatively. Clinical outcome indicators were measured one year after surgery, and the occurrence of side effects was observed. Result: Total of 23 patients were included, with a lumbar BMD T score of -2.89±0.2 before surgery to -2.27±0.3 one year after surgery (p=0.012) and a femoral neck BMD T score of -2.45±0.3 before surgery to -2.36±0.3 (p=0.041) after one year, and all were statistically significant. Measured as bone resorption markers, serum CTX-1 was 337.43±10.4 pg/mL before surgery, 160.86±8.7 pg/mL (p=0.022) after three months, and 250.12±12.7 pg/mL (p=0.031) after one year. Urinary NTX-1 was 39.24±2.2 ng/mL before surgery, 24.46±1.2 ng/mL (p=0.014) after three months and 30.35±1.6 ng/mL (p=0.042) after one year. Measured as bone formation markers, serum osteocalcin was 13.04±1.1 ng/mL before surgery, 8.84±0.7 ng/mL (p=0.037) after 3 months and 11.1±0.4 ng/mL (p=0.026) after one year. Serum bone-specific ALP was 11.24±0.9 IU/L before surgery, 8.25±0.9 IU/L (p=0.036) after three months, and 10.2±0.9 IU/L (p=0.027) after one year. All were statistically significant. All cases showed bone union within an average of 6.91±0.3 weeks without any signs of failure. Complications were found in 5 out of 23 cases (21.7%), such as headache, nausea, muscle pain, and fever. Conclusion: When Zoledronic acid was used, BMD was improved in both the spine and femoral neck. This may reduce the likelihood and subsequent morbidity of additional osteoporotic fractures. This study is meaningful in that there was no difference in the duration of bone union and radiological characteristics in patients with distal radial fractures administrated with intravenous BP early after the fractures, and improvement in BMD and bone turnover indicators was measured.

Keywords: zeoldreonic acid, BMD, osteoporosis, distal radius

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Authors: Violina Angelova

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A comparative study has been carried out into the impact of organic meliorants on the uptake of heavy metals, micro and macroelements and the phytoremediation potential of enhanced tobacco BAC F3. The soil used as part of this experiment was sampled from the vicinity of the Non-Ferrous-Metal Works near Plovdiv, Bulgaria. The pot experiment carried out consisted of a randomized, complete block design containing nine treatments and three replications (27 pots). The treatments consisted of a control (with no organic meliorants) and compost and vermicompost meliorants (added at 5%, 10%, 15%, and 30%, and recalculated based on their dry soil weight). Upon reaching commercial ripeness, the tobacco plants were gathered. Heavy metals, micro and macroelement contents in roots, stems, and leaves of tobacco were analyzed by the method of the microwave mineralization. To determine the elements in the samples, inductively coupled emission spectrometry (Jobin Yvon Emission - JY 38 S, France) was used. The distribution of the heavy metals, micro, and macroelements in the organs of the enhanced tobacco has a selective character and depended above all on the parts of the plants and the element that was examined. Pb, Zn, Cu, Fe, Mn, P and Mg distribution in tobacco decreases in the following order: roots > leaves > stems, and for Cd, K, and Ca - leaves > roots > stems. The high concentration of Cd in the leaves and the high translocation factor indicate the possibility of enhanced tobacco to be used in phytoextraction. Tested organic amendments significantly influenced the uptake of heavy metals, micro and macroelements by the roots, stems, and leaves of tobacco. A correlation was found between the quantity of the mobile forms and the uptake of Pb, Zn, and Cd by the enhanced tobacco. The compost and vermicompost treatments significantly reduced heavy metals concentration in leaves and increased uptake of K, Ca and Mg. The 30% compost and 30% vermicompost treatments led to the maximal reduction of heavy metals in enhanced tobacco BAC F3. The addition of compost and vermicompost further reduces the ability to digest the heavy metals in the leaves, and phytoremediation potential of enhanced tobacco BAC F3. Acknowledgment: The financial support by the Bulgarian National Science Fund Project DFNI Н04/9 is greatly appreciated.

Keywords: heavy metals, micro and macroelements, enhanced tobacco BAC F3, phytoremediation, organic meliorants

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Authors: Ming-Yeh Lu, Shiao-Shing Chen, Saikat Sinha Ray, Hung-Te Hsu

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The submerged anaerobic osmotic membrane bioreactor (AnOMBR) integrated with periodic microfiltration (MF) extraction for simultaneous phosphorus and clean water recovery from wastewater was evaluated. A laboratory-scale AnOMBR used cellulose triacetate (CTA) membranes with effective membrane area of 130 cm² was fully submerged into a 5 L bioreactor at 30-35 ℃. Active layer was orientated to feed stream for minimizing membrane fouling and scaling. Additionally, a peristaltic pump was used to circulate magnesium sulphate (MgSO₄) solution applied as draw solution (DS). Microfiltration membrane periodically extracted about 1 L solution when the TDS reaches to 5 g/L to recover phosphorus and simultaneously control the salt accumulation in the bioreactor. During experiment progress, the average water flux was around 1.6 LMH. The AnOMBR process showed greater than 95% removal of soluble chemical oxygen demand (sCOD), nearly 100% of total phosphorous whereas only partial of ammonia was removed. On the other hand, the average methane production of 0.22 L/g sCOD was obtained. Subsequently, the overall performance demonstrates that a novel submerged AnOMBR system is potential for simultaneous wastewater treatment and resource recovery from wastewater. Therefore, the new concept of this system can be used to replace for the conventional AnMBR in the future.

Keywords: anaerobic treatment, forward osmosis, phosphorus recovery, membrane bioreactor

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Authors: Albert Suryaprawira

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Patients requiring correction of severe Class III skeletal discrepancy historically has been among the most challenging treatments for orthodontists. Correction of an aesthetic and functional problem is crucially important. This is a case report of an adult male aged 18 years who complained of difficulty in chewing and speaking. Patient has a prominent profile with mandibular excess. The pre-treatment cephalometric radiograph was taken to analyse the skeletal problem and to measure the amount of bone movement and the prediction soft tissue response. The panoramic radiograph was also taken to analyse bone quality, bone abnormality, third molar impaction, etc. Before the surgery, the pre-surgical cephalometric radiograph was taken to re-evaluate the plan and to settle the final amount of bone cut. After the surgery, the post-surgical cephalometric radiograph was taken to confirm the result with the plan. The superimposition between those radiographs was performed to analyse the outcome. It includes the superimposition of the cranial base, maxilla, and mandible. Superimposition is important to describe the amount of hard and soft tissue movement. It is also important to predict the possibility of relapse after the surgery. The patient needs to understand all the surgical plan, outcome and relapse prevention. The surgery included mandibular set back by bilateral sagittal split osteotomies. Although the discrepancy was severe using this combination of treatment and the use of radiographic superimposition, an aesthetically pleasing and stable result was achieved.

Keywords: cephalometric, mandibular set back, orthognathic, superimposition

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Authors: Paul Holmes, Mike N. G.

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Foundation-year doctors face increased stress, pressure and uncertainty when starting new rotations throughout their first years of work. This research questionnaire resulted in an induction cheat sheet and induction video that enhanced the Junior doctor's understanding of how to work effectively within the plastic surgery department at NHS Tayside. The objectives and goals were to improve the transition between cohorts of junior doctors in ward 26 at Ninewells Hospital. Before this quality improvement project, the induction pack was 74 pages long and over eight years old. With the support of consultant Mike Ng a new up-to-date induction was created. This involved a questionnaire and cheat sheet being developed. The questionnaire covered clerking, venipuncture, ward pharmacy, theatres, admissions, specialties on the ward, the cardiac arrest trolley, clinical emergencies, discharges and escalation. This audit has three completed cycles between August 2022 and August 2023. The cheat sheet developed a concise two-page A4 document designed for doctors to be able to reference easily and understand the essentials. The document format is a table containing ward layout; specialty; location; physician associate, shift patterns; ward rounds; handover location and time; hours coverage; senior escalation; nights; daytime duties, meetings/MDTs/board meetings, important bleeps and codes; department guidelines; boarders; referrals and patient stream; pharmacy; absences; rota coordinator; annual leave; top tips. The induction video is a 10-minute in-depth explanation of all aspects of the ward. The video explores in more depth the contents of the cheat sheet. This alternative visual format familiarizes the junior doctor with all aspects of the ward. These were provided to all foundation year 1 and 2 doctors on ward 26 at Ninewells Hospital at NHS Tayside Scotland. This work has since been adopted by the General Surgery Department, which extends to six further wards and has improved the effective handing over of the junior doctor’s role between cohorts. There is potential to further expand the cheat sheet to other departments as the concise document takes around 30 minutes to complete by a doctor who is currently on that ward. The time spent filling out the form provides vital information to the incoming junior doctors, which has a significant possibility to improve patient care.

Keywords: induction, junior doctor, handover, plastic surgery

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Authors: Chaiyakrit Raoupatham, Ram Hari Dhakal, Chalermchai Wanichlamlert

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This paper is aimed to introduce the solution of concrete slump recovery using chemical admixture type-F (superplasticizer, naphthalene base) to the practice, in order to solve unusable concrete problem due to concrete loss its slump, especially for those tropical countries that have faster slump loss rate. In the other hand, randomly adding superplasticizer into concrete can cause concrete to segregate. Therefore, this paper also develops the estimation model used to calculate amount of second dose of superplasticizer need for concrete slump recovery. Fresh properties of ordinary Portland cement concrete with volumetric ratio of paste to void between aggregate (paste content) of 1.1-1.3 with water-cement ratio zone of 0.30 to 0.67 and initial superplasticizer (naphthalene base) of 0.25%- 1.6% were tested for initial slump and slump loss for every 30 minutes for one and half hour by slump cone test. Those concretes with slump loss range from 10% to 90% were re-dosed and successfully recovered back to its initial slump. Slump after re-dosed was tested by slump cone test. From the result, it has been concluded that, slump loss was slower for those mix with high initial dose of superplasticizer due to addition of superplasticizer will disturb cement hydration. The required second dose of superplasticizer was affected by two major parameter, which were water-cement ratio and paste content, where lower water-cement ratio and paste content cause an increase in require second dose of superplasticizer. The amount of second dose of superplasticizer is higher as the solid content within the system is increase, solid can be either from cement particles or aggregate. The data was analyzed to form an equation use to estimate the amount of second dosage requirement of superplasticizer to recovery slump to its original.

Keywords: estimation model, second superplasticizer dosage, slump loss, slump recovery

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Authors: Laurence G. Almoguera, Vitaliana U. Malamug, Armando N. Espino, Marvin M. Cinense

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The mangrove pens were modified to produce mud crab (Scylla serrata) and milkfish (Chanos chanos) in a polyculture system. The modification of mangrove pens was done by adding excavations inside the pen. The water quality parameters (dissolved oxygen, pH, salinity, and temperature) were monitored, the recovery and the production rate in each pen were evaluated. The experiment was conducted for a rearing period of 143 days in nine mangrove pens, each having an area of 32 m² with an average net enclosure height of 3 m from the soil surface. The three different pens constructed (existing design - with canal only, with 43% excavation by area, and 54% excavation by area) were designated as T₁, T₂, and T₃, respectively. All experimental units were stocked with 31 pieces of crablets (with 33.3 g average weight) and additional 130 pieces of milkfish fingerlings (with 0.11 g average weight) to the modified mangrove pens. The water quality parameters recorded in the pens were favorable for the growth and recovery of the mud crab and milkfish, except for dissolved oxygen (DO). It was found to be the reason for the total mortality of the stocked milkfish. For mud crab, the highest mean recovery was recorded in T₂ (34.41%), followed by T₃ (26.91%) and the lowest in T1 (21.50%). The production rate followed the same trend as the recovery, where T₂ (74.49 g/m²) obtained the highest, followed by T₃ (55 g/m2) and the lowest was in T₁ (34.87 g/m²). The statistical analysis revealed that the variations of the mud crab recovery were not significant, while in terms of production rate, modified mangrove pens were found to be more effective than the existing design. Due to the total mortality of the cultured milkfish, the current set-up of modified mangrove pens was found to be not suitable for the polyculture system of milkfish and mud crab production.

Keywords: aquasilviculture, milkfish, modified mangrove pen, mud crab, polyculture, production rate

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Authors: Hamide Azimi Lolaty, Fateme Alsadat Ghanipoor, Azar Ramzani, Reza Ali Mohammadpoor, Alireza Babaei

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Background and Objective: Despite the merits behind orthognathic surgery, self-care training in such patients seems logical. The current research was performed pursuing the goal of outlining the effect of training mindfulness-based self-care on Self-Esteem (SE) and Body Image Concern (BIC) of orthognathic surgery candidate patients. Material and Methods: The present study was performed using a semi-experimental method with pre-and post-design in the control and intervention groups. The eligible patients to enter the Babol-based Shahid Beheshti Orthognathic Surgery Clinic were conveniently divided into two 25-person groups. The variables of Self-Esteem and Body Image Concern were measured before and after executing the eight 90-minute training sessions and in the follow-up period done three months after executing the intervention using Cooper Smith’s Self-Esteem Inventory (CSEI) and Body Image Concern Inventory (BICI). The data were analyzed using ANOVA and the independent t-test and using SPSS-26, the data were analyzed at a 0.05 level. Results: As a result of the intervention, the intervention group’s SE score critically changed on average from 25.4±7.31 in the pre-intervention to 31.16±7.05 in the post-intervention and to 40.45±3.51 in the follow-up period (P=0.01), the intervention group’s BIC score changed on average from 60.28±16.47 in the pre-intervention to 47.15±80.47 in the post-intervention and to 32.20 ± 10.73 in the follow-up period. This difference was meaningful (P=0.001). But due to time and the intervention interaction, the control group underwent this significant reduction with a delay. The study revealed the scores of the SE as 32± 6.84 and that of the BIC as 43.32±10.64 in the control group didn’t result in any meaningful statistical difference (P<0.05). Conclusion: Training mindfulness-based self-care exerts an effect on the SE and BIC of the patients undergoing orthognathic surgery. Therefore, it’s recommended to train mindfulness-based self-care for orthognathic surgery candidate patients.

Keywords: self-care, mindfulness, self-esteem, body image concern, orthognathic surgery

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Authors: Patti Kastanias, Wei Wang, Karyn Mackenzie, Sandra Robinson, Susan Wnuk

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Obesity is a worldwide epidemic and is recognized as a chronic disease. Pain in the obese individual is a multidimensional issue. An increase in BMI is positively correlated with pain incidence and severity, especially in central obesity where individuals are twice as likely to have chronic pain. Both obesity and chronic pain are also associated with mood disorders. Pain is worse among obese individuals with depression and anxiety. Bariatric surgery provides patients with an effective solution for long-term weight loss and associated health problems. However, not much is known about acute and chronic pain after bariatric surgery and its contributing factors, including mood disorders. Nurse practitioners (NPs) at one large multidisciplinary bariatric surgery centre led two studies to examine acute and chronic pain and pain management over time after bariatric surgery. The purpose of the initial study was to examine the incidence and severity of acute and chronic pain after bariatric surgery. The aim of the secondary study was to further examine chronic pain, specifically looking at psychological factors that influence severity or incidence of both neuropathic and somatic pain as well as changes in opioid use. The initial study was a prospective, longitudinal study where patients having bariatric surgery at one surgical center were followed up to 6 months postop. Data was collected at 7 time points using validated instruments for pain severity, pain interference, and patient satisfaction. In the second study, subjects were followed longitudinally starting preoperatively and then at 6 months and 1 year postoperatively to capture changes in chronic pain and influencing variables over time. Valid and reliable instruments were utilized for all major study outcomes. In the first study, there was a trend towards decreased acute post-operative pain over time. The incidence and severity of chronic pain was found to be significantly reduced at 6 months post bariatric surgery. Interestingly, interference of chronic pain in daily life such as normal work, mood, and walking ability was significantly improved at 6 months postop however; this was not the case with sleep. Preliminary results of the secondary study indicate that pain severity, pain interference, anxiety and depression are significantly improved at 6 months postoperatively. In addition, preoperative anxiety, depression and emotional regulation were predictive of pain interference, but not pain severity. The results of our regression analyses provide evidence for the impact of pre-existing psychological factors on pain, particularly anxiety in obese populations.

Keywords: bariatric surgery, mood disorders, obesity, pain

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Authors: Jeffrey A. Lavarias, Jessie C. Elauria, Arnold R. Elepano, Engelbert K. Peralta, Delfin C. Suministrado

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Shelling process is one of the primary processes and critical steps in the processing of chocolate or any product that is derived from cocoa beans. It affects the quality of the cocoa nibs in terms of flavor and purity. In the Philippines, small-scale food processor cannot really compete with large scale confectionery manufacturers because of lack of available postharvest facilities that are appropriate to their level of operation. The impact of this study is to provide the needed intervention that will pave the way for cacao farmers of engaging on the advantage of value-adding as way to maximize the economic potential of cacao. Thus, provision and availability of needed postharvest machines like mechanical cacao sheller will revolutionize the current state of cacao industry in the Philippines. A mechanical cacao sheller was developed, fabricated, and evaluated to establish optimum shelling conditions such as moisture content of cocoa beans, clearance where of cocoa beans passes through the breaker section and speed of the breaking mechanism on shelling recovery, shelling efficiency, shelling rate, energy utilization and large nib recovery; To establish the optimum level of shelling parameters of the mechanical sheller. These factors were statistically analyzed using design of experiment by Box and Behnken and Response Surface Methodology (RSM). By maximizing shelling recovery, shelling efficiency, shelling rate, large nib recovery and minimizing energy utilization, the optimum shelling conditions were established at moisture content, clearance and breaker speed of 6.5%, 3 millimeters and 1300 rpm, respectively. The optimum values for shelling recovery, shelling efficiency, shelling rate, large nib recovery and minimizing energy utilization were recorded at 86.51%, 99.19%, 21.85kg/hr, 89.75%, and 542.84W, respectively. Experimental values obtained using the optimum conditions were compared with predicted values using predictive models and were found in good agreement.

Keywords: cocoa beans, optimization, RSM, shelling parameters

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Authors: Jayprakash Yadav, Nivedita Patra

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Polyhydroxybutyrate (PHB) is an interesting material in the field of medical science, pharmaceutical industries, and tissue engineering because of its properties such as biodegradability, biocompatibility, hydrophobicity, and elasticity. PHB is naturally accumulated by several microbes in their cytoplasm during the metabolic process as energy reserve material. PHB can be extracted from cell biomass using halogenated hydrocarbons, chemicals, and enzymes. In this study, a cheaper and non-toxic solvent, acetone, was used for the extraction process. The different parameters like acetone percentage, and solvent pH, process temperature, and incubation periods were optimized using the Response Surface Methodology (RSM). RSM was performed and the determination coefficient (R2) value was found to be 0.8833 from the quadratic regression model with no significant lack of fit. The designed RSM model results indicated that the fitness of the response variable was significant (P-value < 0.0006) and satisfactory to denote the relationship between the responses in terms of PHB recovery and purity with respect to the values of independent variables. Optimum conditions for the maximum PHB recovery and purity were found to be solvent pH 7, extraction temperature - 43 °C, incubation time - 70 minutes, and percentage acetone – 30 % from this study. The maximum predicted PHB recovery was found to be 0.845 g/g biomass dry cell weight and the purity was found to be 97.23 % using the optimized conditions.

Keywords: acetone, PHB, RSM, halogenated hydrocarbons, extraction, bacillus subtilis.

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Authors: Kafuko M. Maria, Namisango Fatuma, Byomire Gorretti

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Mobile learning (m-learning) is steadily growing and has undoubtedly derived benefits to learners and tutors in different learning environments. This paper investigates the variation in benefits derived from enhanced classroom learning through use of m-learning platforms in the context of a developing country owing to the fact that it is still in its initial stages. The study focused on how basic technology-enhanced pedagogic innovation like cell phone-based learning is enhancing classroom learning from the learners’ perspective. The paper explicitly indicates the opportunities presented by enhanced learning to a conventional learning environment like a physical classroom. The findings were obtained through a survey of two universities in Uganda in which data was quantitatively collected, analyzed and presented in a three banded diagram depicting the variation in the obtainable benefits. Learners indicated that a smartphone is the most commonly used device. Learners also indicate that straight lectures, student to student plus student to lecturer communication, accessing learning material and assignments are core activities. In a TEL environment support by smartphones, learners indicated that they conveniently achieve the prior activities plus discussions and group work. Learners seemed not attracted to the possibility of using TEL environment to take lectures, as well as make class presentations. The less attractiveness of these two factors may be due to the teacher centered approach commonly applied in the country’s education system.

Keywords: technology enhanced learning, m-learning, classroom learning, perceived benefits

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Authors: Kamalesh Kumar Singh

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Due to increasing trends of electronic waste, specially the ICT related gadgets, their green recycling is still a greater challenge. This article presents a two-stage, eco-friendly hydrometallurgical route for the recovery of gold from the delaminated metallic layers of waste mobile phone Printed Circuit Boards (PCBs). Initially, mobile phone PCBs are downsized (1x1 cm²) and treated with an organic solvent dimethylacetamide (DMA) for the separation of metallic fraction from non-metallic glass fiber. In the first stage, liberated metallic sheets are used for the selective dissolution of copper in an aqueous leaching reagent. Influence of various parameters such as type of leaching reagent, the concentration of the solution, temperature, time and pulp density are optimized for the effective leaching (almost 100%) of copper. Results have shown that 3M nitric acid is a suitable reagent for copper leaching at room temperature and considering chemical features, gold remained in solid residue. In the second stage, the separated residue is used for the recovery of gold by using sulphuric acid with a combination of halide salt. In this halide leaching, Cl₂ or Br₂ is generated as an in-situ oxidant to improve the leaching of gold. Results have shown that almost 92 % of gold is recovered at the optimized parameters.

Keywords: printed circuit boards, delamination, leaching, solvent extraction, recovery

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Authors: Masoumeh Mofarrah, Amir NahanMoghadam

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Higher oil prices and increasing oil demand are main reasons for great attention to Enhanced Oil Recovery (EOR). Comprehensive researches have been accomplished to develop, appraise, and improve EOR methods and their application. Recently, Artificial Intelligence (AI) gained popularity in petroleum industry that can help petroleum engineers to solve some fundamental petroleum engineering problems such as reservoir simulation, EOR project risk analysis, well log interpretation and well test model selection. This study presents a historical overview of most popular AI tools including neural networks, genetic algorithms, fuzzy logic, and expert systems in petroleum industry and discusses two case studies to represent the application of two mentioned AI methods for selecting an appropriate EOR method based on reservoir characterization infeasible and effective way.

Keywords: artificial intelligence, EOR, neural networks, expert systems

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Authors: Evelyn Marie Richmond, Andrew McBride, Chris Johnston, John Marley

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Background: Good quality patient information resources for orthognathic treatment help to reinforce information delivered during the initial consultation and help patients make informed decisions about their care. The Consultant Orthodontists and a Dental Core Trainee noted limited patient engagement with the British Orthodontic Society (BOS) 'Your Jaw Surgery' online resources and that the existing BOS patient information leaflet (PIL) could be customised and developed to meet local requirements. Aim: The quality improvement project (QIP) aimed to improve patients' understanding of orthognathic treatment by ensuring at least 90% of patients had read the new in-house patient information leaflet (PIL) and a minimum of 50% of patients had accessed the British Orthodontic Society (BOS) 'Your Jaw Surgery' online resources before attending the joint orthognathic multidisciplinary clinic by June 2023. Methods: The QIP was undertaken in the orthodontic department of the School of Dentistry, Belfast. Data was collected prospectively during a 6-month period from January 2023 to June 2023 over 3 Plan, Do, Study, Act (PDSA) cycles. Suitable patients were identified at consultant orthodontic new patient clinics. Following initial consultation for orthognathic treatment, patients were contacted to complete a patient questionnaire. Design: The change ideas were a poster with a QR code directing patients to the BOS 'Your Jaw Surgery' website in consultation areas and a new in-house PIL with a QR code directing patients to the BOS 'Your Jaw Surgery' website. Results: In PDSA cycle 1, 86.7% of patients were verbally directed to the BOS 'Your Jaw Surgery' website, and 53.3% accessed the online resources after their initial consultation. Although 100% of patients reported reading the existing PIL, only 64.3% felt it discussed the risks of orthognathic treatment in sufficient detail. By PDSA cycle 3, 100% of patients reported being directed to the BOS 'Your Jaw Surgery' website, however, only 58.3% engaged with the website. 100% of patients who read the new PIL felt that it discussed the risks of orthognathic treatment in sufficient detail. Conclusion: The slight improvement in access to the BOS 'Your Jaw Surgery' website shows that patients do not necessarily choose to access information online despite its availability. The uptake of the new PIL was greater than reported patient engagement with the BOS 'Your Jaw Surgery' website, which indicates patients still value written information despite the availability of online resources.

Keywords: orthognathic surgery, patient information resources, quality improvement project, risks

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Authors: Munish Saroch, Amit Saini

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Introduction: Many children with congenital malformation of inner ear have undergone cochlear implant (CI) surgery. The results for cochlear implant surgery in these children are very encouraging and provide a ray of hope for these patients. Objective: The main objective of this presentation is to prove that even in Mondini’s deformity Minimal incision cochlear implantation improves cosmesis, reduces post-operative infection and earliest switch on of device. Methods: We report a case of two-year-old child suffering from Mondini’s deformity who underwent CI with minimal incision cochlear implantation (MICI). MICI has been developed with the aims of reducing the impact of surgery on the patient without any preoperative shaving of hairs. Results: Patient after surgery with MICI showed better looking postauricular scar, low post-operative morbidity in comparison to conventional wider access approach and hence earliest switch on of device (1st post operative day). Conclusion: We are of opinion that MICI is safe and successful in Mondini’s deformity.

Keywords: CI, Cochlear Implant, MICI, Minimal Incision Cochlear Implantation, HL, Hearing Loss, HRCT, High Resolution Computer Tomography, MRI, Magnetic resonance imaging, SCI, Standard cochlear implantation

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Authors: Guillaume Soubeyran, Fabrice Micoud, Benoit Morin, Jean-Philippe Poirot-Crouvezier, Magali Reytier

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Proton Exchange Membrane Fuel Cell (PEMFC) technology is considered as a solution for the reduction of CO2 emissions. However, this technology still meets several challenges for high-scale industrialization. In this context, the increase of durability remains a critical aspect for competitiveness of this technology. Fortunately, performance degradations in nominal operating conditions is partially reversible, meaning that if specific conditions are applied, a partial recovery of fuel cell performance can be achieved, while irreversible degradations can only be mitigated. Thus, it is worth studying the optimal conditions to rejuvenate these reversible degradations and assessing the long-term impact of such procedures on the performance of the cell. Reversible degradations consist mainly of anode Pt active sites poisoning by carbon monoxide at the anode, heterogeneities in water management during use, and oxidation/deactivation of Pt active sites at the cathode. The latter is identified as a major source of reversible performance loss caused by the presence oxygen, high temperature and high cathode potential that favor platinum oxidation, especially in high efficiency operating points. Hence, we studied here a recovery procedure aiming at reducing the platinum oxides by decreasing cathode potential during operation. Indeed, the application of short air starvation phase leads to a drop of cathode potential. Cell performances are temporarily increased afterwards. Nevertheless, local temperature and current heterogeneities within the cells are favored and shall be minimized. The consumption of fuel during the recovery phase shall also be considered to evaluate the global efficiency. Consequently, the purpose of this work is to find an optimal compromise between the recovery of reversible degradations by air starvation, the increase of global cell efficiency and the mitigation of irreversible degradations effects. Different operating parameters have first been studied such as cell voltage, temperature and humidity in single cell set-up. Considering the global PEMFC system efficiency, tests showed that reducing duration of recovery phase and reducing cell voltage was the key to ensure an efficient recovery. Recovery phase frequency was a major factor as well. A specific method was established to find the optimal frequency depending on the duration and voltage of the recovery phase. Then, long-term degradations have also been studied by applying FC-DLC cycles based on NEDC cycles on a 4-cell short stack by alternating test sequences with and without recovery phases. Depending on recovery phase timing, cell efficiency during the cycle was increased up to 2% thanks to a mean voltage increase of 10 mV during test sequences with recovery phases. However, cyclic voltammetry tests results suggest that the implementation of recovery phases causes an acceleration of the decrease of platinum active areas that could be due to the high potential variations applied to the cathode electrode during operation.

Keywords: durability, PEMFC, recovery procedure, reversible degradation

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Authors: Dimitra V. Peristeri, Hussameldin M. Nour, Amiya Ahsan, Sameh Abogabal, Krishna K. Singh, Muhammad Shafique Sajid

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Introduction: The use of optimal skin antiseptic agents for the prevention of surgical site infection (SSI) is of critical importance, especially during abdominal surgical procedures. Alcohol-based chlorhexidine gluconate (CHG) and aqueous-based povidone-iodine (PVI) are the two most common skin antiseptics used nowadays. The objective of this article is to evaluate the effectiveness of alcohol-based CHG versus aqueous-based PVI used for skin preparation before abdominal surgery to reduce SSIs. Methods: Standard medical databases such as MEDLINE, Embase, Pubmed, and Cochrane Library were searched to find randomised, controlled trials (RCTs) comparing alcohol-based CHG skin preparation versus aqueous-based PVI in patients undergoing abdominal surgery. The combined outcomes of SSIs were calculated using an odds ratio (OR) with 95% confidence intervals (95% CI). All data were analysed using Review Manager (RevMan) Software 5.4, and the meta-analysis was performed with a random effect model analysis. Results: A total of 11 studies, all RCTs, were included (n= 12072 participants), recruiting adult patients undergoing abdominal surgery. In the random effect model analysis, the use of alcohol-based CHG in patients undergoing abdominal surgery was associated with a reduced risk of SSI compared to aqueous-based PVI (OR: 0.84; 95% CI [0.74, 0.96], z= 2.61, p= 0.009). Conclusion: Alcohol-based CHG may be more effective for preventing the risk of SSI compared to aqueous-based PVI agents in abdominal surgery. The conclusion of this meta-analysis may add a guiding value to reinforce current clinical practice guidelines.

Keywords: skin preparation, surgical site infection, chlorhexidine, skin antiseptics

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Authors: Shekoufeh Behdad, Amirhossein Yadegari, Leila Ghodrati, Saman Yadegari

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Context: Preoperative anxiety is a common psychological reaction experienced by all patients undergoing surgery. It can have negative effects on the patient's well-being and even impact surgical outcomes. Therefore, finding effective interventions to reduce preoperative anxiety is important in improving patient care. Research Aim: The aim of this study is to compare the effects of oral administration of zaleplon (5 mg) and alprazolam (0.5 mg) on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Methodology: This study is a double-blind, randomized clinical trial conducted after receiving approval from the university's ethics committee and obtaining written informed consent from the patients. The night before the surgery, patients were randomly assigned to receive either 0.5 mg of alprazolam or 5 mg of zaleplon orally. Anxiety levels, measured using a 10-cm visual analog scale, and hemodynamic variables (blood pressure and heart rate) were assessed before drug administration and on the morning of the operation after the patient entered the pre-operation room. Findings: The study found that there were no significant differences in mean anxiety levels or hemodynamic variables before and after administration of either drug in both groups (P value > 0.05). This suggests that both 0.5 mg of alprazolam and 5 mg of zaleplon effectively reduce preoperative anxiety in women undergoing abdominal surgery without serious side effects. Theoretical Importance: This study contributes to the understanding of the effectiveness of alprazolam and zaleplon in reducing preoperative anxiety. It adds to the existing literature on pharmacological interventions for anxiety management, specifically in the context of gynecological abdominal surgery. Data Collection: Data for this study were collected through the assessment of anxiety levels using a visual analog scale and measuring hemodynamic variables, including systolic, diastolic, and mean arterial blood pressures, as well as heart rate. These measurements were taken before drug administration and on the morning of the surgery. Analysis Procedures: Statistical analysis was performed to compare the mean anxiety levels and hemodynamic variables before and after drug administration in the two groups. The significance of the differences was determined using appropriate statistical tests. Questions Addressed: This study aimed to answer the question of whether there are differences in the effects of alprazolam and zaleplon on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Conclusion: The oral administration of both 0.5 mg of alprazolam and 5 mg of zaleplon the night before surgery effectively reduces preoperative anxiety in women undergoing abdominal surgery. These findings have important implications for the management of preoperative anxiety and can contribute to improving the overall surgical experience for patients.

Keywords: zaleplon, alprazolam, premedication, abdominal surgery

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Authors: Seema Dutt Bandhu, Yashi Bansal, Tania Moudgil, Barinder Kaur

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Introduction: Scleral perforation during the passage of suture needle is a known complication of strabismus surgery. The present study was conducted to evolve a safe and easy technique of passing the suture needle through the sclera. A scleral tunnel was created with a 26-guage needle through which the suture needle was passed. The rest of the steps of strabismus surgery were carried out as usual. Material and Methods: After taking clearance from the Institutional Ethics Committee, an interventional study was carried out on twenty patients. The scleral tunnel technique was performed on the patients of strabismus after taking written informed consent. Before passing the suture needle through the sclera during strabismus surgery, a tunnel through approximately half the thickness of the sclera was created with the help of a bent 26-gauge needle. The suture needle was then passed through this tunnel. Rest of the steps of the surgery were carried out in the conventional manner. In a control group of same number of patients, the surgery was performed in the conventional method. Both the groups were followed up for any complications. Ease of passing suture and surgeons’ satisfaction with the technique was noted on a 10-point Likert scale. Results: None of the patients in either group suffered from any complications. Four surgeons participated in the study. The average Likert scale score of the surgeons for satisfaction with the technique was 4.5 on a scale of 5. The score for ease of passage of suture needle was 5 on a score of 5. Discussion: Scleral perforation during passing the sutures through the sclera is a known complication of strabismus surgery. Incidence reported is 7.8% It occurs due to inappropriate engagement of the scleral tissue or passage of the suture needle along a wrong axis during the process of passing the suture needle. The needle track technique eases the passage of passing the suture needle through the sclera as the engagement of the scleral tissue can be done with greater control with a 26-guage needle. The surgeons have reported that they are highly satisfied with the technique and they have reported that the technique eased the passage of the suture needle through the sclera.

Keywords: suture, scleral tunnel, strabismus, scleral perforation

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Authors: Bezuglov Eduard, Ryland Morgans, Talibov Oleg, Kalinin Evgeny, Butovsky Mikhail, Savin Evgeny, Tzgoev Eduard, Artemii Lazarev, Bekzhan Pirmakhanov, Anthony C. Hackney

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Currently, there is conflicting evidence regarding the efficacy of citrulline for physical performance and post-exercise recovery. Moreover, the vast majority of studies conducted used physically active volunteers from the general population and heterogeneous exercise protocols that are not specific to most sports. A single use of citrulline, regardless of the dose, will not have a significant effect on physical performance and post-exercise recovery in highly trained soccer players performing sport-specific exercises at maximum intensity. To evaluate the effectiveness of a single administration of citrulline at various doses in adult male professional soccer players performing sport-specific exercise at maximum intensity. A randomized, double-blind, placebo-controlled study analyzing eighteen soccer players from the top divisions of several European countries. The participants were randomized into three groups of six and performed a field-based soccer-specific test at 115% VO2max for 18-minutes. Comparative analysis of the cardiovascular system, physical activity, subjective perceived fatigue and post-exercise recovery was conducted. There were no statistically significant differences in more than one analyzed parameter. A single application of 3 to 6 grams of citrulline does not affect physical performance, subjective feeling of fatigue and post-exercise recovery in adult professional soccer players who have performed a sport-specific test. Currently, citrulline cannot be recommended for use as a supplement in adult professional soccer players

Keywords: citrulline, performance, recovery, soccer players

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Authors: Yuqing Chen, Ying Xu, Renfa Li

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The development of matrix completion theory provides new approaches for data gathering in Wireless Sensor Networks (WSN). The existing matrix completion algorithms for WSN mainly consider how to reduce the sampling number without considering the real-time performance when recovering the data matrix. In order to guarantee the recovery accuracy and reduce the recovery time consumed simultaneously, we propose a new ALM algorithm to recover the weather monitoring data. A lot of experiments have been carried out to investigate the performance of the proposed ALM algorithm by using different parameter settings, different sampling rates and sampling models. In addition, we compare the proposed ALM algorithm with some existing algorithms in the literature. Experimental results show that the ALM algorithm can obtain better overall recovery accuracy with less computing time, which demonstrate that the ALM algorithm is an effective and efficient approach for recovering the real world weather monitoring data in WSN.

Keywords: wireless sensor network, matrix completion, singular value thresholding, augmented Lagrange multiplier

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Authors: Maxim S. Botalov, Svetlana М. Titova, Denis V. Smyshlyaev, Grigory M. Bunkov, Evgeny V. Kirillov, Sergey V. Kirillov, Maxim A. Mashkovtsev, Vladimir N. Rychkov

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In uranium production, in-situ leaching (ISL) with its relatively low cost has become an important technology. As the orebody containing uranium most often contains a considerable value of other metals, particularly rare earth metals it has rendered feasible to recover the REM from the barren ISL solutions, from which the major uranium content has been removed. Ural Federal University (UrFU, Ekaterinburg, Russia) have performed joint research on the development of industrial technologies for the extraction of REM and Scandium compounds from Uranium ISL solutions. Leaching experiments at UrFU have been supported with multicomponent solution model. The experimental work combines solvent extraction with advanced ion exchange methodology in a pilot facility capable of treating 500 kg/hr of solids. The pilot allows for the recovery of a 99% concentrate of scandium oxide and collective concentrate with over 50 % REM content, with further recovery of heavy and light REM concentrates (99%).

Keywords: extraction, ion exchange, rare earth elements, scandium

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Authors: Young Min Kim, Jeong Lak Sohn, Eui Soo Yoon

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This study describes the optimization of supercritical carbon dioxide (S-CO2) power cycle for recovering waste heat from a gas turbine. An S-CO2 cycle that recovers heat from small industrial and aeroderivative gas turbines can outperform a steam-bottoming cycle despite its simplicity and compactness. In using S-CO2 power cycles for waste heat recovery, a split cycle was studied to maximize the net output power by incorporating the utilization efficiency of the waste heat (lowering the temperature of the exhaust gas through the heater) along with the thermal efficiency of the cycle (minimizing the temperature difference for the heat transfer, exergy loss). The cooling condition of the S-CO2 WHR system has a great impact on the performance and the optimum low pressure of the system. Furthermore, the optimum high pressure of the S-CO2 WHR systems for the maximum power from the given heat sources is dependent on the temperature of the waste heat source.

Keywords: exergy loss, gas turbine, optimization, supercritical CO2 power cycle, split cycle, waste heat recovery

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Authors: Mihail Nagea, Olivera Lupescu, Elena Taina Avramescu, Cristina Patru

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Classical education of orthopedic surgeons involves lectures, self study, workshops and cadaver dissections, and sometimes supervised practical training within surgery, which quite seldom gives the young surgeons the feeling of being unable to apply what they have learned especially in surgical practice. The purpose of this paper is to present a different approach from the classical one, which enhances the practical skills of the orthopedic trainees and prepare them for future practice. The paper presents the content of the research project 2015-1-RO01-KA202-015230, ERASMUS+ VET ‘Collaborative learning for enhancing practical skills for patient-focused interventions in gait rehabilitation after orthopedic surgery’ which, using e learning as a basic tool , delivers to the trainees not only courses, but especially practical information through videos and case scenarios including gait analysis in order to build patient focused therapeutic plans, adapted to the characteristics of each patient. The outcome of this project is to enhance the practical skills in orthopedic surgery and the results are evaluated following the answers to the questionnaires, but especially the reactions within the case scenarios. The participants will thus follow the idea that any mistake within solving the cases might represent a failure of treating a real patient. This modern approach, besides using interactivity to evaluate the theoretical and practical knowledge of the trainee, increases the sense of responsibility, as well as the ability to react properly in real cases.

Keywords: interdisciplinary approach, gait analysis, orthopedic surgery, vocational training

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Authors: Sadegh Torfi

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Realization of anticipated energy efficiency from recuperative run-around energy recovery (RER) systems requires identification of the system components influential parameters. Because simulation modeling is considered as an integral part of the design and economic evaluation of RER systems, it is essential to calibrate the developed models and validate the performance predictions by means of comparison with data from experimental measurements. Several theoretical and numerical analyses on RER systems by researchers have been done, but generally the effect of distance between hot and cold flow is ignored. The objective of this study is to develop a thermohydroulic model for a typical RER system that accounts for energy loss from the interconnecting piping and effects of interconnecting pipes length performance of run-around energy recovery systems. Numerical simulation shows that energy loss from the interconnecting piping is change linear with pipes length and if pipes are properly isolated, maximum reduction of effectiveness of RER systems is 2% in typical piping systems.

Keywords: combined heat and power, heat recovery, effectiveness, CGS

Procedia PDF Downloads 179