Search results for: american ocademy of orthopaedic surgeons

Authors: Ayda Khosravanihaghighi, Pramod Koshy, Bill Walsh, Vedran Lovric, Charles Christopher Sorrell

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There is an increasing demand for orthopedic implants owing to the increasing numbers of the aging population. Titanium alloy (Ti6Al4V) is a common material used for orthopedic implants owing to its advantageous properties in terms of good corrosion resistance, minimal elastic modulus mismatch with bone, bio-inertness, and high mechanical strength. However, it is important to improve the bioactivity and osseointegration of the titanium alloy and this can be achieved by coating the implant surface with suitable ceramic materials. In the present work, pure and doped-ceria (CeO₂) coatings were deposited by spin coating on the titanium alloy surface in order to enhance the biological interactions between the surface of the implant and the surrounding tissue. In order to examine the bone-binding ability of an implant, simulated body fluid (SBF) tests were conducted in order to assess the capability of apatite layer formation on the surface and thus predict in vivo bone bioactivity. Characterization was done using scanning electron microscopy (SEM) and X-ray diffraction (XRD) analyses to determine the extent of apatite formation. Preliminary tests showed that the CeO₂ coatings were biocompatible and that the extent of apatite formation and its characteristics can be enhanced by doping with suitable metal ions.

Keywords: apatite layer, biocompatibility, ceria, orthopaedic implant, SBF, spin coater, Ti-implant

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Authors: Hsiao-ting Lin

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This paper analyzes the history of Taiwan’s secret program to develop its nuclear weapons during the Cold War. In July 1971, US President Richard Nixon shocked the world when he announced that his national security adviser Henry Kissinger had made a secret trip to China and that he himself had accepted an invitation to travel to Beijing. This huge breakthrough in the US-PRC relationship was followed by Taipei’s loss of political legitimacy and international credibility as a result of its UN debacle in the fall that year. Confronted with the Nixon White House’s opening to the PRC, leaders in Taiwan felt being betrayed and abandoned, and they were obliged to take countermeasures for the sake of national interest and regime survival. Taipei’s endeavor to create an effective nuclear program, including the possible development of nuclear weapons capabilities, fully demonstrates the government’s resolution to pursue its own national policy, even if such a policy was guaranteed to undermine its relations with the United States. With hindsight, Taiwan’s attempt to develop its own nuclear weapons did not succeed in sabotaging the warming of US-PRC relations. Worse, it was forced to come to a full stop when, in early 1988, the US government pressured Taipei to close related facilities and programs on the island. However, Taiwan’s abortive attempt to develop its nuclear capability did influence Washington’s and Beijing’s handling of their new relationship. There did develop recognition of a common American and PRC interest in avoiding a nuclearized Taiwan. From this perspective, Beijing’s interests would best be served by allowing the island to remain under loose and relatively benign American influence. As for the top leaders on Taiwan, such a policy choice demonstrated how they perceived the shifting dynamics of international politics in the 1960s and 1970s and how they struggled to break free and pursue their own independent national policy within the rigid framework of the US-Taiwan alliance during the Cold War.

Keywords: taiwan, richard nixon, nuclear program, chiang Kai-shek, chiang ching-kuo

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Authors: Shahzad Ali

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This article expounds the coverage of Pak-US relations in the context of Osama Bin Laden killing in four selected leading newspapers of UK and the US viz The Telegraph, The Guardian, The New York Times and The Washington Post during the specific time period of three months, i.e., April-June, 2011. The study is scrutinized on the basis of Operation Neptune Spear. The research study is theoretically linked with the propaganda model of Herman and Chomsky and the Shoemaker and Reeve‘s theory of content effect, specifically the impact of foreign policy as a driving instrument influencing the nature and treatment of the coverage of Pak-US relations. The relations between Pakistan and USA are of great importance in the context of Bin Laden. The Pak-US relations were less aggravated and hostile in pre OBL period but post OBL period worsened these relations. It is also interesting to mention that the policies of these newspapers were dependent on the foreign policy of their countries. It was explored that the news coverage was found favorable as and when the relations Pakistan and the US or UK were cordial and smooth. And it turned into negative and unfavorable when the relations were in strain and deteriorating and endorsed various studies that the Western mainstream media tried to be more nationalistic in projecting official stance while covering foreign coverage instead of adhering to universal cannon of journalism, i.e., objectivity, fairness, and neutrality, etc. Overall 219 news items of these four selected newspapers regarding Pak-US relations in the context of pre and post OBL’s killing operation were undertaken for analysis. The ratio of negative slants was found higher as compared to the positive and neutral slants. Besides, the ratio of news items with unfavorable frames was found higher in post OBL operation in comparison of pre-era of the coverage related to Pak-US relations in the leading British and American newspapers.

Keywords: Osama Bin Laden, Pakistan, USA, UK, relations, Guardian, Washington Post, Telegraph, New York Times, Operation Neptune Spear

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Authors: Rishabh Nagpal, Riya Uchagaonkar, Venkata Naga Narasimha Ashish Mernedi, Ahmed Hambaba

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The rapid evolution of technology in the communication sector continually seeks to bridge the gap between different communities, notably between the deaf community and the hearing world. This project develops a comprehensive American Sign Language (ASL) recognition system, leveraging the advanced capabilities of convolutional neural networks (CNNs) and vision transformers (ViTs) to interpret and translate ASL in real-time. The primary objective of this system is to provide an effective communication tool that enables seamless interaction through accurate sign language interpretation. The architecture of the proposed system integrates dual networks -VGG16 for precise spatial feature extraction and vision transformers for contextual understanding of the sign language gestures. The system processes live input, extracting critical features through these sophisticated neural network models, and combines them to enhance gesture recognition accuracy. This integration facilitates a robust understanding of ASL by capturing detailed nuances and broader gesture dynamics. The system is evaluated through a series of tests that measure its efficiency and accuracy in real-world scenarios. Results indicate a high level of precision in recognizing diverse ASL signs, substantiating the potential of this technology in practical applications. Challenges such as enhancing the system’s ability to operate in varied environmental conditions and further expanding the dataset for training were identified and discussed. Future work will refine the model’s adaptability and incorporate haptic feedback to enhance the interactivity and richness of the user experience. This project demonstrates the feasibility of an advanced ASL recognition system and lays the groundwork for future innovations in assistive communication technologies.

Keywords: sign language, computer vision, vision transformer, VGG16, CNN

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Authors: Yibo Shao, Jiajie Liu

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This article uncovers the practice of pragmatism of Singaporean foreign policy by analyzing its foreign diplomatic behavior. It also points out the Singapore’s hedging strategy on the relations between China and American and how to balance these two greater powers in Southeast Asian. This paper used qualitative approach by reviewing literature and policy documents intensively to find out the responses to our research questions.

Keywords: hedging, pragmatism, Sino-Singapore relations, South China Sea

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Authors: Chu-Ching Hsu

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This paper focuses on how the government-led language policies and the political changes in Taiwan manipulate the languages choice in translations and what translation strategies are employed by the translator to show his or her language ideology behind the power struggles and decision-making. Therefore, framed by Lefevere’s theoretical concept of translating as rewriting, and carried out a diachronic and chronological study, this paper specifically sets out to investigate the language ideology and translator’s idiolect of Chinese language translations of Anglo-American novels. The examples drawn to explore these issues were taken from different versions of Chinese renditions of Mark Twain’s English-language novel The Adventures of Huckleberry Finn in which there are several different dialogues originally written in the colloquial language and dialect used in the American state of Mississippi and reproduced in Mark Twain’s works. Also, adapted corpus methodology, many examples are extracted as instances from the translated texts and source text, to illuminate how the translators in Taiwan deal with the dialectal features encoded in Twain’s works, and how different versions of Chinese translations are employed by Taiwanese translators to confirm the language polices and to express their language identity textually in different periods of the past five decades, from the 1960s onward. The finding of this study suggests that the use of Taiwanese dialect and language patterns in translations does relate to the movement of the mother-tongue language and language ideology of the translator as well as to the issue of language identity raised in the island of Taiwan. Furthermore, this study confirms that the change of political power in Taiwan does bring significantly impact in language policy-- assimilationism, pluralism or multiculturalism, which also makes Taiwan from a monolingual to multilingual society, where the language ideology and identity can be revealed not only in people’s daily communication but also in written translations.

Keywords: language politics and policies, literary translation, mother-tongue, multiculturalism, translator’s ideology

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Authors: Tugce Caliskan

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The gentrification literature in Turkey provided important insights regarding the analysis of the socio-spatial change in İstanbul mostly through the existing gentrification theories which were produced in Anglo-American literature. Yet early researches focused on the classical gentrification while failing to notice other place-specific forms of the phenomena. It was only after the mid-2000s that scholarly attention shifted to the recent discussions in the mainstream such as the neoliberal urban policies, government involvement, and resistance. Although these studies have considerable potential to contribute to the geography of gentrification, it seems that copying the linear timeline of Anglo-American conceptualization limited the space to introduce contextually nuanced way of process in Turkey. More specifically, the gentrification literature in Turkey acknowledged the linear timeline of the process drawing on the mainstream studies, and, made the spontaneous classical gentrification as the starting point in İstanbul at the expense of contextually specific forms of the phenomenon that took place in the same years. This paper is an attempt to understand place-specific forms of gentrification through the abandonment of the linear understanding of time. In this vein, this paper approaches the process as moving both linear and cyclical rather than the waves succeeded each other. Maintaining a dialectical relationship between the cyclical and the linear time, this paper investigates how the components of gentrification have been taken place in the cyclical timeline while becoming bolder in the linear timeline. This paper argues that taking the (re)investment in the secondary circuit of capital and class transformation as the core characteristics of gentrification, and accordingly, searching for these components beyond the linear timeline provide strategic value to decenter the perspectives, not merely for Turkish studies. In this vein, this strategy revealed that Western experience of gentrification did not travel, adopted or copied in Turkey but gentrification -as an abstract and general concept- has emerged as a product of different contextual, historical and temporal forces which must be considered within the framework of state-led urbanization as early as 1980 differing from the Global North trajectories.

Keywords: comparative urbanism, geography of gentrification, linear and cyclical timeline, state-led gentrification

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Authors: Simone Belli, Sergio Minniti, Valeria Santoro

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ICTs and technology transfer can benefit and move a country forward in economic and social development. However, ICT and access to the Internet have been inequitably distributed in most developing countries. In terms of science production and dissemination, this divide articulates itself also through the inequitable distribution of access to scientific knowledge and networks, which results in the exclusion of developing countries from the center of science. Developing countries are on the fringe of Science and Technology (S&T) production due not only to low investment in research but also to the difficulties to access international scholarly literature. In this respect, Open access (OA) initiatives and knowledge infrastructure represent key elements for both producing significant changes in scholarly communication and reducing the problems of developing countries. The spreading of the OA movement in the region, exemplified by the growth of regional and national initiatives, such as the creation of OA institutional repositories (e.g. SciELO and Redalyc) and the establishing of supportive governmental policies, provides evidence of the significant role that OA is playing in reducing the scientific gap between Latin American countries and improving their participation in the so-called ‘global knowledge commons’. In this paper, we map OA publications in Latin America and observe how Latin American countries are moving forward and becoming a leading force in widening access to knowledge. Our analysis, developed as part of the H2020 EULAC Focus research project, is based on mixed methods and consists mainly of a bibliometric analysis of OA publications indexed in the most important scientific databases (Web of Science and Scopus) and OA regional repositories, as well as the qualitative analysis of documents related to the main OA initiatives in Latin America. Through our analysis, we aim at reflecting critically on what policies, international standards, and best practices might be adapted to incorporate OA worldwide and improve the infrastructure of the global knowledge commons.

Keywords: open access, LAC countries, scientific publications, bibliometric analysis

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Authors: Ugo Galvanetto, Pirto G. Pavan, Mirco Zaccariotto

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The discipline of Computer-integrated surgery (CIS) will provide equipment able to improve the efficiency of healthcare systems and, which is more important, clinical results. Surgeons and machines will cooperate in new ways that will extend surgeons’ ability to train, plan and carry out surgery. Patient specific CIS of the brain requires several steps: 1 - Fast generation of brain models. Based on image recognition of MR images and equipped with artificial intelligence, image recognition techniques should differentiate among all brain tissues and segment them. After that, automatic mesh generation should create the mathematical model of the brain in which the various tissues (white matter, grey matter, cerebrospinal fluid …) are clearly located in the correct positions. 2 – Reliable and fast simulation of the surgical process. Computational mechanics will be the crucial aspect of the entire procedure. New algorithms will be used to simulate the mechanical behaviour of cutting through cerebral tissues. 3 – Real time provision of visual and haptic feedback A sophisticated human-machine interface based on ergonomics and psychology will provide the feedback to the surgeon. The present work will address in particular point 2. Modelling the cutting of soft tissue in a structure as complex as the human brain is an extremely challenging problem in computational mechanics. The finite element method (FEM), that accurately represents complex geometries and accounts for material and geometrical nonlinearities, is the most used computational tool to simulate the mechanical response of soft tissues. However, the main drawback of FEM lies in the mechanics theory on which it is based, classical continuum Mechanics, which assumes matter is a continuum with no discontinuity. FEM must resort to complex tools such as pre-defined cohesive zones, external phase-field variables, and demanding remeshing techniques to include discontinuities. However, all approaches to equip FEM computational methods with the capability to describe material separation, such as interface elements with cohesive zone models, X-FEM, element erosion, phase-field, have some drawbacks that make them unsuitable for surgery simulation. Interface elements require a-priori knowledge of crack paths. The use of XFEM in 3D is cumbersome. Element erosion does not conserve mass. The Phase Field approach adopts a diffusive crack model instead of describing true tissue separation typical of surgical procedures. Modelling discontinuities, so difficult when using computational approaches based on classical continuum Mechanics, is instead easy for novel computational methods based on Peridynamics (PD). PD is a non-local theory of mechanics formulated with no use of spatial derivatives. Its governing equations are valid at points or surfaces of discontinuity, and it is, therefore especially suited to describe crack propagation and fragmentation problems. Moreover, PD does not require any criterium to decide the direction of crack propagation or the conditions for crack branching or coalescence; in the PD-based computational methods, cracks develop spontaneously in the way which is the most convenient from an energy point of view. Therefore, in PD computational methods, crack propagation in 3D is as easy as it is in 2D, with a remarkable advantage with respect to all other computational techniques.

Keywords: computational mechanics, peridynamics, finite element, biomechanics

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Authors: Zikun Li, Regine Talleyrand

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Negative body image is one of the most common causes of eating disorders, and it is not only happening to women. Regardless of the increasing attention that researchers and practitioners have been paying to the male population and their body image concerns, men of color have yet to be fully represented or studied. Given the consensus that the sociocultural experiences of people of color may play a significant role in their health and well-being, this study focused on assessing the mechanism through which sociocultural factors may influence men of color’s perceptions of body image. In particular, this study focused on untangling how interpersonal and media pressure, as well as ethnic-racial identities and perceptions, would impact body dissatisfaction in terms of muscularity, body fat, and height in men of color and how this mechanism is moderated across different ethnic-racial groups. The structural equation modeling approach was therefore applied to achieve the research goal. With the sample size of 181 self-identified Black, Indigenous, and People of Color male participants aged 20-50 (M=33.33, SD=6.9) through surveying on Amazon’s MTurk platform, the proposed model achieved a modestly acceptable model fit with the pooled sample, X2(836) = 1412.184, CFI = 0.900, RMSEA = 0.062 [0.056, 0.067]. And SRMR = 0.088, And it explained 89.5% of the variance in body dissatisfaction. The results showed that of all the direct effects on body dissatisfaction, interpersonal appearance pressure exhibited the strongest effect (β = 0.410***), followed by media appearance pressure (β = 0.272**) and self-hatred feeling (β = 0.245**). The ethnic-racial related factors (i.e., stereotype endorsement, ethnic-racial salience, and nationalistic assimilation) statistically influenced body dissatisfaction through the mediators of media appearance pressure and/or self-hatred feeling. Furthermore, the moderation analysis between Black/African American men and non-Black/African American men revealed the substantial differences in how ethnic/racial identity impacts one’s perception of body image, and the Black/African American men were found to be influenced by sociocultural factors at a higher level, compared with their counterparts. The impacts of demographic characteristics (i.e., SES, weight, height) on body dissatisfaction were also examined. Instead of considering interpersonal appearance pressure and media pressure as two subscales under one construct, this study considered them as two separate and distinct sociocultural factors. The good model fit to the data indicates this rationality and encourages scholars to reconsider the impacts of two sources of social pressures on body dissatisfaction. In addition, this study also provided empirical evidence of the moderation effect existing within the population of men of color, which reveals the heterogeneity existing across different ethnic-racial groups and implies the necessity to study individual ethnic-racial groups so as to better understand the mechanism of sociocultural influences on men of color’s body dissatisfaction. These findings strengthened the current understanding of the body image concerns exciting among men of color and meanwhile provided empirical evidence for practitioners to provide tailored health prevention and treatment options for this growing population in the United States.

Keywords: men of color, body image concerns, sociocultural factors, structural equation modeling

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Authors: Armine Vahanyan

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Humanity has been still coping with the new COVID-19 pandemic. Healthcare providers, economists, psychologists, and other specialists speak about the impact of the virus on different spheres of our life. In the list of similar discussions, the impact of pandemics on global education is of utmost importance. Ideally, providing quality education services should be crucial, and the ways education programs are being adapted will determine the success or failure of the service providers. The paper aims to summarize the research touching upon the current situation of higher education in Armenia. The research includes data from official reports, surveys among education leads, faculty, and students, as well as personal observations and consideration. Through descriptive analysis, the findings of the research are being presented from various aspects. Interim results of the research unveiled two major issues in the sector of higher education in Armenia. On the one hand, the entire compulsory digitization of instruction, assessment, and grading has evoked serious gaps related to the lack of technical competencies. There is an urgent need for professional development programs that will address most of the concerns due to the shift to the online instruction mode. On the other hand, online teaching and learning require revision and adaptation of the existing curricula. Given that the content of certain programs may not be compromised, the teaching methods, the assignments, and evaluation require profound transformation, which will still be in line with course learning outcomes and student learning outcomes. The given paper focuses on the ways the mentioned issues are being addressed in Armenia. The extent of commitment for changes and adaptability to the new situation varies from the government-funded and private universities. In particular, the paper compares and contrasts activities and measures taken at the Armenian State Pedagogical University and the American University of Armenia. Thus, the Pedagogical University focused on the use of Google Classroom as the only means for teaching and learning as well as adopted the compulsory synchronous instruction mode. The American University, on the contrary, kept practicing the academic freedom, enabling both synchronous and asynchronous instruction modes, ensuring alignment of the course learning outcomes and student learning outcomes. The State University utilized the assignments and assessment, which would work for the on-campus instruction mode, while the American university employed a variety of assignments applicable for online teaching mode. The latter has suggested the utilization of multiple apps, internet sources, and online library access for a better online instant. Discussions with faculty through online forums and/or professional development workshops also facilitate restructuring and adaptation of the courses. Finally, the paper will synthesize the results of the undertaken research and will outline the e-learning perspectives and opportunities boosted by the known devastating healthcare issue.

Keywords: assessment, compulsory digitization of education services, online teaching, instruction mode, program restructuring

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Authors: Juliana Pereira Tigre

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In the current critical debate on the process of globalization, on the one hand, arises the accusation that neoliberalism standardizes the so-called American way of life on the cultures of the world, operating as a system of subtle domination, expropriating and incorporating the other. On the other hand, it is defended that neoliberalism begins its career of political and economic order as a sensitive conception to the otherness, imposing itself at present due to its peaceful management of pluralism and defense of individual freedom. In this sense, this paper aims to discuss the extent to which the neoliberalism and the otherness converge or diverge in contemporaneity and the guiding principles of globalization.

Keywords: otherness, globalization, neoliberalism, social sciences

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Authors: Benjamin Newman

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The picture of an adverse contest between two parties has often been used as an archetypal description of the Anglo-American adversarial criminal trial. However, in actuality, guilty pleas and plea-bargains have been dominating the procedure for over the last half-a-century. Characterised by two adverse parties, the court adjudicative system in the Anglo-American world adhere to the adversarial procedure, and while further features have been attributed and the values that are embedded within the procedure vary, it is a system that we have no adequate theory. Damaska had argued that the adversarial conflict-resolution mode of administration of justice stems from a liberal laissez-faire concept of a value neutral liberal state. Having said that, the court’s neutrality has been additionally rationalised in light of its liberal end as a safeguard from the state’s coercive force. Both conceptions of the court’s neutrality conflict in cases where the by-standing role disposes of its liberal duty in safeguarding the individual. Such is noticeable in plea bargains, where the defendant has the liberty to plead guilty, despite concerns over wrongful convictions and deprivation of liberty. It is an inner liberal tension within the notion of criminal adversarialism, between the laissez-faire mode which grants autonomy to the parties and the safeguarding liberal end of the trial. Langbein had asserted that the adversarial system is a criminal procedure for which we have no adequate theory, and it is by reference to political and moral theories that the research aims to articulate a normative account. The paper contemplates on the above liberal-tension, and by reference to Duff’s ‘calling-to-account’ theory, argues that autonomy is of inherent value to the criminal process, being considered a constitutive element in the process of being called to account. While the aspiration is that the defendant’s guilty plea should be genuine, the guilty-plea decision must be voluntary if it is to be considered a performative act of accountability. Thus, by valuing procedural autonomy as a necessary element within the criminal adjudicative process, it assimilates a liberal procedure, whilst maintaining the liberal end by holding the defendant to account.

Keywords: liberal theory, adversarial criminal procedure, criminal law theory, liberal perfectionism, political liberalism

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Authors: Madhuri Goswami

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The matrix of power establishes the hegemonic dominance and supremacy of one group through exercising repression and relegation upon the other. However, the injustice done to any race, ethnicity, or caste has instigated the protest and resistance through various modes -social campaigns, political movements, literary expression and so on. Consequently, the search for identity, the means of claiming it and strive for recognition have evolved as the persistent phenomena all through the world. In the discourse of protest and minority literature, these two discourses -African American and Indian Dalit- surprisingly, share wrath and anger, hope and aspiration, and quest for identity and struggle for self-assertion. African American and Indian Dalit are two geographically and culturally apart communities that stand together on a single platform. This paper has sought to comprehend the form and investigate the formation of identity in general and in the literary work of Toni Morrison and Indian Dalit writing, particular, i.e., Black identity and Dalit identity. The study has speculated two types of identity, namely, individual or self and social or collective identity in the literary province of these marginalized literature. Morrison’s work outsources that self-identity is not merely a reflection of an inner essence; it is constructed through social circumstances and relations. Likewise, Dalit writings too have a fair record of discovery of self-hood and formation of identity, which connects to the realization of self-assertion and worthiness of their culture among Dalit writers. Bama, Pawar, Limbale, Pawde, and Kamble investigate their true self concealed amid societal alienation. The study has found that the struggle for recognition is, in fact, the striving to become the definer, instead of just being defined; and, this striving eventually, leads to the introspection among them. To conclude, Morrison as well as Indian marginalized authors, despite being set quite distant, communicate the relation between individual and community in the context of self-consciousness, self-identification and (self) introspection. This research opens a scope for further research to find out similar phenomena and trace an analogy in other world literatures.

Keywords: identity, introspection, self-access, struggle for recognition

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Authors: Divya Sharma

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Nic Pizzolatto’s True Detective offers profound mythological and philosophical ramblings for audiences with literary sensibilities. An American Sothern Gothic with its bayon landscape of the Gulf Coast of Louisiana, where two detectives Rustin Cohle and Martin Hart begin investigating the isolated murder of Dora Lange, only to discover an entrenched network of perversion and corruption, offers an existential outlook. The proposed research paper shall attempt to investigate the pervasive themes of gothic and existentialism in the music of the first season of the series.

Keywords: gothic, music, existentialism, mythology, philosophy

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Authors: Peiyin Hung, Katy Kozhimannil, Michelle Casey, Ira Moscovice

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Background/Objective: The loss of obstetric services has been a pressing concern in urban and rural areas nationwide. This study aims to determine factors that contribute to the loss of obstetric care through closures of a hospital or obstetric unit. Methods: Data from 2002-2013 American Hospital Association annual surveys were used to identify hospitals providing obstetric services. We linked these data to Medicare Healthcare Cost Report Information for hospital financial indicators, the US Census Bureau’s American Community Survey for zip-code level characteristics, and Area Health Resource files for county- level clinician supply measures. A discrete-time multinomial logit model was used to determine contributing factors to obstetric unit or hospital closures. Results: Of 3,551 hospitals providing obstetrics services during 2002-2013, 82% kept units open, 12% stopped providing obstetrics services, and 6% closed down completely. State-level variations existed. Factors that significantly increased hospitals’ probability of obstetric unit closures included lower than 250 annual birth volume (adjusted marginal effects [95% confidence interval]=34.1% [28%, 40%]), closer proximity to another hospital with obstetric services (per 10 miles: -1.5% [-2.4, -0.5%]), being in a county with lower family physician supply (-7.8% [-15.0%, -0.6%), being in a zip code with higher percentage of non-white females (per 10%: 10.2% [2.1%, 18.3%]), and with lower income (per $1,000 income: -0.14% [-0.28%, -0.01%]). Conclusions: Over the past 12 years, loss of obstetric services has disproportionately affected areas served by low-volume urban and rural hospitals, non-white and low-income communities, and counties with fewer family physicians, signaling a need to address maternity care access in these communities.

Keywords: access to care, obstetric care, service line discontinuation, hospital, obstetric unit closures

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Authors: G. Alston Rush, Gus A. Rush III, M. F. Horstemeyer

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This study compares the shell-facemask responses of four commonly used American football helmets, under the National Operating Committee on Standards for Athletic Equipment (NOCSAE) drop impact test method, to show that the test standard would more accurately simulate in-use conditions by modification to include the facemask. In our study, the need for a more vigorous systematic approach to football helmet testing procedures is emphasized by comparing the Head Injury Criterion (HIC), the Gadd Severity Index (SI), and peak acceleration values for different helmets at different locations on the helmet under modified NOCSAE standard drop tower tests. Drop tests were performed on the Rawlings Quantum Plus, Riddell 360, Schutt Ion 4D, and Xenith X2 helmets at eight impact locations, impact velocities of 5.46 and 4.88 meters per second, and helmet configurations with and without facemasks. Analysis of NOCSAE drop test results reveal significant differences (p < 0.05) for when the facemasks were attached to helmets, as compared to the NOCSAE Standard, without facemask configuration. The boundary conditions of the facemask attachment can have up to a 50% decrease (p < 0.001) in helmet performance with respect to peak acceleration. While generally, all helmets with the facemasks gave greater HIC, SI, and acceleration values than helmets without the facemasks, significant helmet dependent variations were observed across impact locations and impact velocities. The variations between helmet responses could be attributed to the unique design features of each helmet tested, which include different liners, chin strap attachments, and faceguard attachment systems. In summary, these comparative drop test results revealed that the current NOCSAE standard test methods need improvement by attaching the facemasks to helmets during testing. The modified NOCSAE football helmet standard test gives a more accurate representation of a helmet’s performance and its ability to mitigate the on-field impact.

Keywords: football helmet testing, gadd severity index, head injury criterion, mild traumatic brain injury

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Authors: Fae Princess Bermudez

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Background: One of the least significant leads on a 12-lead electrocardiogram is the augmented right lead (aVR), as it is not as specific compared to the other leads. In this case series, the value of lead aVR, which is more often than not ignored, is highlighted. Three cases of aVR ST segment elevation on 12-lead electrocardiogram are described, with the end outcome of demise of all three patients. The importance of immediate revascularization is described to improve prognosis in this group of patients. Objectives: This case series aims to primarily present under-reported cases of isolated aVR ST-segrment elevation myocardial infarction (STEMI), their course and outcome. More specific aims are to identify the criteria in determination of isolated aVR STEMI, know its clinical significance, and determine appropriate management for patients with this ECG finding. Method: A short review of previous studies, case reports, articles and guidelines from 2011-2016 was done. The author reviewed available literature, sorted out those that proved to be significant for the presented cases, and described them in conjunction with the aforementioned cases. Findings: Based on the limited information on these rare or under-reported cases, it was found that isolated aVR STEMI had a poorer prognosis that led to significant mortality and morbidity of patients. The significance of aVR ST-elevation was that of an occlusion of the left coronary artery or a severe three-vessel disease in the presence of an Acute Coronary Syndrome. Guidelines from American Heart Association/American College of Cardiology Foundation in 2013 already recognized ST-elevation of lead aVR in isolation as a STEMI; hence, recommended that patients with this particular ECG finding should undergo reperfusion strategies to improve prognosis. Conclusion: The indispensability of isolated aVR ST-segment elevation on ECG should alert physicians, especially Emergency physicians, to the high probability of Acute Coronary Syndrome with a very poor prognosis. If this group of patients is not promptly managed, demise may ensue, with cardiogenic shock as the most probable cause. With this electrocardiogram finding, physicians must be quick to make clinical decisions to increase chances of survival of this group of patients.

Keywords: AVR ST-elevation, diffuse ST-segment depression, left coronary artery infarction, myocardial infarction

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Authors: Chengzhu Liao, Jianbo Zhang, Haiou Wang, Jing Ming, Huili Li, Yanyan Li, Hua Cheng, Sie Chin Tjong

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Since Bonfield’s group’s pioneer work, there has been growing interest amongst the materials scientists, biomedical engineers and surgeons in the use of novel biomaterials for the treatment of bone defects and injuries. This study focuses on the fabrication, mechanical characterization and biocompatibility evaluation of high density polyethylene (HDPE) reinforced with hydroxyapatite nanorods (HANR) and carbon nanofibers (CNF). HANRs of 20 wt% and CNFs of 0.5-2 wt% were incorporated into HDPE to form biocomposites using traditional melt-compounding and injection molding techniques. The mechanical measurements show that CNF additions greatly improve the tensile strength and Young’s modulus of HDPE and HDPE-20% nHA composites. Meanwhile, the nHA and CNF fillers were found to be effective to improve dimensional and thermal stability of HDPE. The results of osteoblast cell cultivation and dimethyl thiazolyl diphenyl thiazolyl tetrazolium (MTT) tests showed that the HDPE/ CNF-nHA nanocomposites are biocompatible. Such HDPE/ CNF-nHA hybrids are found to be potential biomaterials for making orthopedic joint/bone replacements.

Keywords: biocompatibility, biocomposite, carbon nanofiber, high density polyethylene, hydroxyapatite

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Authors: Alisher Agzamov, Hanan Al Harbi

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BACKGROUND: The timely assessment and treatment of ICU Surgical and Medical Oncology patients is important for Oncology surgeons and Medical Oncologists and Intensivists. We hypothesized that the use of Robot Physician’s (RP - 7) ICU management and care in ICU can improve ICU physician rapid response to unstable ICU Oncology patients. METHODS: This is a prospective study using a before-after, cohort-control design to test the effectiveness of RP. We have used RP to make multidisciplinary ICU rounds in the ICU and for Emergency cases. Data concerning several aspects of the RP interaction including the latency of the response, the problem being treated, the intervention that was ordered, and the type of information gathered using the RP were documented. The effect of RP on ICU length of stay and cost was assessed. RESULTS: The use of RP was associated with a reduction in latency of attending physician face-to-face response for routine and urgent pages compared to conventional care (RP: 10.2 +/- 3.3 minutes vs conventional: 220 +/- 80 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 150 +/- 55 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for patients with AML (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 20 % compared with the prerobot era, and there was an ICU cost savings of KD2.5 million attributable to the use of RP. CONCLUSION: The use of RP enabled rapid face-to-face ICU Intensivist - physician response to unstable ICU Oncology patients and resulted in decreased ICU cost and LOS.

Keywords: robot physician, oncology patients, rp - 7 in icu management, cost and icu occupancy

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Authors: Marinelle El-Khoury, Lina Bouhaya, Nivine Abbas, Hassan Sleiman

Abstract:

The road network in the north of Lebanon is a prime example of the lack of pavement design and execution in Lebanon.  These roads show major distresses and hence, should be tested and evaluated. The aim of this research is to investigate and determine the deficiencies in road surface design in Lebanon, and to propose an environmentally friendly asphalt mix design. This paper consists of several parts: (i) evaluating pavement performance and structural behavior, (ii) identifying the distresses using visual examination followed by laboratory tests, (iii) deciding the optimal solution where rehabilitation or reconstruction is required and finally, (iv) identifying a sustainable method, which uses recycled material in the proposed mix. The asphalt formula contains Reclaimed Asphalt Pavement (RAP) in the base course layer and in the asphalt layer. Visual inspection of the roads in Tripoli shows that these roads face a high level of distress severity. Consequently, the pavement should be reconstructed rather than simply rehabilitated. Coring was done to determine the pavement layer thickness. The results were compared to the American Association of State Highway and Transportation Officials (AASHTO) design methodology and showed that the existing asphalt thickness is lower than the required asphalt thickness. Prior to the pavement reconstruction, the road materials were tested according to the American Society for Testing and Materials (ASTM) specification to identify whether the materials are suitable. Accordingly, the ASTM tests that were performed on the base course are Sieve analysis, Atterberg limits, modified proctor, Los Angeles, and California Bearing Ratio (CBR) tests. Results show a CBR value higher than 70%. Hence, these aggregates could be used as a base course layer. The asphalt layer was also tested and the results of the Marshall flow and stability tests meet the ASTM specifications. In the last section, an environmentally friendly mix was proposed. An optimal RAP percentage of 30%, which produced a well graded base course and asphalt mix, was determined through a series of trials.

Keywords: asphalt mix, reclaimed asphalt pavement, California bearing ratio, sustainability

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Authors: Nathan Garcia

Abstract:

The polarizing dialogue of contemporary political America results from core philosophical differences. But these differences are beyond ideological and reach metaphysical distinction. Good intellectual historians have theorized that fundamental concepts such as freedom, God, and nature have been sterilized of their intellectual vigor. They are partially correct. 19th-century pragmatist Charles Sanders Peirce offers a penetrating philosophy which can yield greater insight into the contemporary political divide. Peirce argues that metaphysical and ethical issues are derivative of operational logic. His triadic logical structure and ensuing metaphysical principles constructed therefrom is contemporaneously applicable for three reasons. First, Peirce’s logic aptly scrutinizes the logical processes of liberal and conservative mindsets. Each group arrives at a cosmological root metaphor (abduction), resulting in a contemporary assessment (deduction), ultimately prompting attempts to verify the original abduction (induction). Peirce’s system demonstrates that liberal citizens develop a cosmological root metaphor in the concept of fairness (abduction), resulting in a contemporary assessment of, for example, underrepresented communities being unfairly preyed upon (deduction), thereby inciting anger toward traditional socio-political structures suspected of purposefully destabilizing minority communities (induction). Similarly, conservative citizens develop a cosmological root metaphor in the concept of freedom (abduction), resulting in a contemporary assessment of, for example, liberal citizens advocating an expansion of governmental powers (deduction), thereby inciting anger towards liberal communities suspected of attacking freedoms of ordinary Americans in a bid to empower their interests through the government (induction). The value of this triadic assessment is the categorization of distinct types of inferential logic by their purpose and boundaries. Only deductive claims can be concretely proven, while abductive claims are merely preliminary hypotheses, and inductive claims are accountable to interdisciplinary oversight. Liberals and conservative logical processes preclude constructive dialogue because of (a) an unshared abductive framework, and (b) misunderstanding the rules and responsibilities of their types of claims. Second, Peircean metaphysical principles offer a greater summary of the contemporaneously divisive political climate. His insights can weed through the partisan theorizing to unravel the underlying philosophical problems. Corrosive nominalistic and essentialistic presuppositions weaken the ability to share experiences and communicate effectively, both requisite for any promising constructive dialogue. Peirce’s pragmatist system can expose and evade fallacious thinking in pursuit of a refreshing alternative framework. Finally, Peirce’s metaphysical foundation enables a logically coherent, scientifically informed orthopraxis well-suited for American dialogue. His logical structure necessitates radically different anthropology conducive to shared experiences and dialogue within a dynamic, cultural continuum. Pierce’s fallibilism and sensitivity to religious sentiment successfully navigate between liberal and conservative values. In sum, he provides a normative paradigm for intranational dialogue that privileges individual experience and values morally defensible notions of freedom, God, and nature. Utilizing Peirce’s thought will yield fruitful analysis and offers a promising philosophical alternative for framing and engaging in contemporary American political discourse.

Keywords: Charles s. Peirce, american politics, logic, pragmatism

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Authors: Jeffrey R. Mueller

Abstract:

This paper expands on the role of the professor by detailing the origins of the profession, adding some of the unique contributions of North American Universities, as well as some of the best practice recommendations, to the unique tripartite role of the professor. It describes current challenges to the profession including the ever-controversial student rating of professors. It continues with the significance of empowerment to the role of the professor. It concludes with a predictive prescription for the future of the professoriate and the role of the university-level educational administrator toward that end.

Keywords: professoriate history, tripartite role, challenges, empowerment, shared governance, administratization

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Authors: Livia Eisler, Cristiane C. B. Alves, Cristina L. F. Ortolani, Kurt Faltin Jr.

Abstract:

Purpose: This paper proposes a technically simple diagnosis method among orthodontists and maxillofacial surgeons in order to evaluate discrete bone alterations. The methodology consists of a protocol to optimize the diagnosis and minimize the possibility for orthodontic and ortho-surgical retreatment. Materials and Methods: A protocol of image processing and analysis, through ImageJ software and its plugins, was applied to 20 pairs of lateral cephalometric images obtained from cone beam computerized tomographies, before and 1 year after undergoing orthognathic surgery. The optical density of the images was analyzed in the condylar region to determine possible bone alteration after surgical correction. Results: Image density was shown to be altered in all image pairs, especially regarding the condyle contours. According to measures, condyle had a gender-related density reduction for p=0.05 and condylar contours had their alterations registered in mm. Conclusion: A simple, viable and cost-effective technique can be applied to achieve the more detailed image-based diagnosis, not depending on the human eye and therefore, offering more reliable, quantitative results.

Keywords: bone resorption, computer-assisted image processing, orthodontics, orthognathic surgery

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Authors: Raid Hommady, Waseem Al-Talalwah, Shorok Al Dorazi, Roger Soames

Abstract:

The iliolumbar artery is a regular branch of posterior division of the internal iliac artery. The present study investigate 82 specimens to identify the origin of iliolumbar artery. The present study targets the sciatic nerve root supply from iliolumbar artery based on its origin and course. In present study, the ililumbar artery arose from the posterior division of internal iliac artery in 52.2%. In few cases, it arose from dorsomedial aspect of the internal iliac artery in 28.8%. In few cases, the iliolumbar artery arose from the dorsal aspects of the internal iliac artery as well as from the common and external iliac artery 1.7%. Also, the iliolumbar artery arose from the sciatic artery as well as from superior and inferior gluteal arteries in 5.1%. Conversely, it found to be congenital absent in 8.5%. Therefore, the posterior trunk of the internal iliac artery is the most common origin of the iliolumbar artery. With the origin variability of the iliolumbar artery, there is a vascular supply variability of the lumbosacral trunk and sacral root of sciatic nerve. The iliolumbar artery provides vascular supply for lumbosacral trunk 57.3% in whereas the sacral root in 5.1%. As a result, surgeons should pay attention to these variations to decrease iatrogenic fault.

Keywords: iliolumbar, sciatic artery, internal iliac, external iliac, posterior division

Procedia PDF Downloads 309

Authors: Alisher Agzamov, Hanan Al Harbi

Abstract:

BACKGROUND: The timely assessment and treatment of ICU Surgical and Medical Oncology patients is important for Oncology surgeons and Medical Oncologists and Intensivists (1). We hypothesized that the use of Robot Physician’s (RP - 7) ICU management and care in ICU can improve ICU physician rapid response to unstable ICU Oncology patients. METHODS: This is a prospective study of 1501 oncology patients using a before-after, cohort-control design to test the effectiveness of RP. We have used RP to make multidisciplinary ICU rounds in the ICU and for Emergency cases. Data concerning several aspects of the RP interaction, including the latency of the response, the problem being treated, the intervention that was ordered, and the type of information gathered using the RP, were documented. The effect of RP on ICU length of stay and cost was assessed. RESULTS: The use of RP was associated with a reduction in latency of attending physician face-to-face response for routine and urgent pages compared to conventional care (RP: 10.2 +/- 3.3 minutes vs conventional: 210 +/- 40 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 140 +/- 35 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for oncology patients (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 29 % compared with the prerobot era, and there was an ICU cost savings of KD2.2 million attributable to the use of RP. CONCLUSION: The use of RP enabled rapid face-to-face ICU Intensivist - physician response to unstable ICU Oncology patients and resulted in decreased ICU cost and LOS.

Keywords: robot physician, oncology patients, icu management and care, cost and icu occupancy

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Authors: Yousef Abu Amrieh

Abstract:

This paper explores how Arab American novelist Rabih Alameddine's recent novel The Angel of History (2016) appropriates certain motifs, tropes, and themes from Shakespeare's The Tempest. In particular, Alameddine's novel re-tells the story of Caliban and his mother from the perspective of a Yemeni bastard whose mis/fortunes take him to the US shores in the eighties of the previous century. The novel, specifically, re-writes the scene in which Caliban is gazed at by European travelers like Stephano and Trinculo whose first reaction to seeing him is to consider how to sell him or give him as a gift when they safely return to Europe. The novel contests Shakespeare's representation of Caliban as 'marketable' through depicting his daily experiences in modern day America.

Keywords: appropriation, Alameddine, Shakespeare, The Tempest

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Authors: Maggie Hall, Haley O'Neill

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The U.S. faces a severe shortage of abortion providers, exacerbated by the June 2022 Dobbs v. Jackson Women’s Health Organization decision. Midwives, especially certified nurse midwives, are well-positioned to fill this gap in abortion care. However, a lack of clinical education and training prevents midwives from exercising their full scope of practice. National and international organizations that set obstetrics and midwifery education standards, including the International Confederation of Midwives, American College of Obstetricians and Gynecologists, and American Public Health Association, call for expansion of midwifery-managed abortion care through the first trimester. In the U.S., midwifery programs are accredited based on compliance with ACME standards and compliance is a prerequisite for the American Midwifery Certification Board exams. We conducted a literature review of studies in the last five years regarding abortion didactic and clinical education barriers via CINAHL, EBSCO and PubMed database reviews. We gave preference for primary sources within the last five years; however, due to the rapid changes in abortion education and access, we also included literature from 2012-2022. We evaluated ACME-accredited programs in relation to their geography within abortion-protected or restricted states and assessed state-specific barriers to abortion care education and provision as clinical students. There are 43 AMCB-accredited midwifery schools in 28 states across the U.S. Twenty schools (47%) are in the 15 states in which advanced practice clinicians can provide non-surgical abortion care, such as medication abortion and MVA procedures. Twenty-four schools (56%) are in the 16 states in which abortion care provision is restricted to Licensed Physicians and cannot offer in-state clinical training opportunities for midwifery students. Six schools are in the five states in which abortion is completely banned and are geographically concentrated in the southernmost region of the U.S., including Alabama, Kentucky, Louisiana, Tennessee, and Texas. Subsequently, these programs cannot offer in-state clinical training opportunities for midwifery students. Notably, there are seven ACME programs in six states that do not restrict abortion access by gestational age, including Colorado, Connecticut, Washington, D.C., New Jersey, New Mexico, and Oregon. These programs may be uniquely positioned for midwifery involvement in abortion care beyond the first trimester. While the following states don’t house ACME programs, abortion care can be provided by advanced practice clinicians in Rhode Island, Delaware, Hawaii, Maine, Maryland, Montana, New Hampshire, and Vermont, offering clinical placement and/or new ACME program development opportunities. We identify existing barriers to clinical education and training opportunities for midwifery-managed abortion care, which are both geographic and institutional in nature. We recommend expansion and standardization of clinical education and training opportunities for midwifery-managed abortion care in ACME-accredited programs to improve access to abortion care. Midwifery programs and teaching hospitals need to expand education, training, and residency opportunities for midwifery students to strengthen access to midwife-managed abortion care. ACNM and ACME should re-evaluate accreditation criteria and the implications of ACME programs in states where students are not able to learn abortion care in clinical contexts due to state-specific abortion restrictions.

Keywords: midwifery education, abortion, abortion education, abortion access

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Authors: Ahmed Gendia, Waseem Kamran

Abstract:

Objective: Total Laparoscopic hysterectomy (TLH) remains a common approach among laparoscopic surgeons. However, this approach depends on the use of uterine manipulator to facilitate the surgery. Although many studies reported the effectiveness of TLH with uterine manipulator, only few reported TLH without the use of any uterine or vaginal manipulation. the aim of this report is to demonstrate our Technique (kamran's TLH) in performing TLH without the use of any uterine or vaginal manipulation in benign conditions and report our intra- and post-operative outcomes. Methodology : surgical technique will be demonstrated through a short video highlighting the easy and safe to learn surgical steps. Additionally, the data of 86 patients who underwent KTLH for benign condition were retrospectively analyzed. the data included intra- and postoperative finding and complications. Results : A total of 86 hysterectomies were performed utilizing the Kamran's TLH ( KTHL). Mean age was 52.2 (±11) years old and BMI was 28.2(±7). Mean operative time was 64.7(±27.9) minutes and estimated bloods loss was 46.2(±54.6) ml. No intraoperative complications were recorded and there was no conversion to open surgery. Only one patient required readmission and surgery for vaginal vault dehiscence. Conclusion & Significance: Uterine manipulator is a key component in performing laparoscopic hysterectomy. However, our approach demonstrated that TLH can be safely performed without the use of any uterine or vaginal manipulation.

Keywords: laparoscopic hystrectomy, TLH, uterine manipulator, surgery

Procedia PDF Downloads 155

Authors: André Rui Coelho Fernandes, Mariana Rufino, Divakar Hamal, Amr Sousa, Emma Fossett, Kamalpreet Cheema

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Aim: A single patella tendon rupture is relatively uncommon, but a simultaneous bilateral event is a rare occurrence and has been scarcely reviewed in the literature. This review was carried out to analyse the existing literature on this event, with the aim of proposing a standardised approach to the diagnosis and management of this injury. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three independent reviewers conducted searches in PubMed, OvidSP for Medline and Embase, as well as Cochrane Library using the same search strategy. From a total of 183 studies, 45 were included, i.e. 90 patellas. Results: 46 patellas had a Type 1 Rupture equating to 51%, with Type 3 being the least common, with only 7 patellas sustaining this injury. The mean Insall-Salvio ratio for each knee was 1.62 (R) and 1.60 (L) Direct Primary Repair was the most common surgical technique compared to Tendon Reconstruction, with End to End and Transosseous techniques split almost equally. Brace immobilisation was preferred over cast, with a mean start to weight-bearing of 3.23 weeks post-op. Conclusions: Bilateral patellar tendon rupture is a rare injury that should be considered in patients with knee extensor mechanism disruption. The key limitation of this study was the low number of patients encompassed by the eligible literature. There is space for a higher level of evidence study, specifically regarding surgical treatment choice and methods, as well as post-operative management, which could potentially improve the outcomes in the management of this injury.

Keywords: trauma and orthopaedic surgery, bilateral patella, tendon rupture, trauma

Procedia PDF Downloads 135