Search results for: surgical assessment unit

Authors: S. Feli, S. Tavousi Tafreshi, A. Ghasemi

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The present paper aims at evaluating the response of three-dimensional buildings with in-plan stiffness irregularities that have been subjected to two-way excitation ground motion records simultaneously. This study is broadly-based fragility assessment with greater emphasis on structural response at in-plan flexible and stiff sides. To this end, three type of three-dimensional 5-story steel building structures with stiffness eccentricities, were subjected to extensive nonlinear incremental dynamic analyses (IDA) utilizing Ibarra-Krawinkler deterioration models. Fragility assessment was implemented for different configurations of braces to investigate the losses in buildings with center of resisting (CR) eccentricities.

Keywords: Ibarra-Krawinkler, fragility assessment, flexible and stiff side, center of resisting

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Authors: Matthew J. Zagumny

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The QUEST is an assessment of scientific epistemic beliefs and was developed to measure students’ intellectual development in regards to beliefs about knowledge and knowing. The QUEST utilizes Q-sort methodology, which requires participants to rate the degree to which statements describe them personally. As a measure of personal theories of knowledge, the QUEST instrument is described with the Q-sort distribution and scoring explained. A preliminary demonstration of the QUEST assessment is described with two samples of undergraduate students (novice/lower division compared to advanced/upper division students) being assessed and their average QUEST scores compared. The usefulness of an assessment of epistemology is discussed in terms of the principle that assessment tends to drive educational practice and university mission. The critical need for university and academic programs to focus on development of students’ scientific epistemology is briefly discussed.

Keywords: scientific epistemology, critical thinking, Q-sort method, STEM undergraduates

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Authors: Tedman Cheuk-Yiu Chau, Xavier Harvey, Hung Nguyen

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Defunctioning ileostomies are frequently used as an adjunct to low anterior resection in the surgical treatment of rectal cancer. Despite reducing the rate of clinically relevant anastomotic leak, the burden of defunctioning ileostomy is significant, with up to two-thirds of patients reporting stoma-related morbidity. International data have demonstrated an increased risk of bowel dysfunction and lower quality of life in patients with delayed closure (greater than six months post-surgery). While timely reversal is safe and cost-effective, the time to the reversal in Australian and New Zealand public hospitals is not described in the published literature. Thus, it is important to assess the current timeliness of ileostomy closure in the Australian regional context and examine the reasons for the delay. A retrospective analysis of ileostomy closure in Launceston General Hospital (LGH) patients treated with low/ultra low anterior resection for rectal cancer between 2012 and 2019 was undertaken. 94 cases of rectal adenocarcinoma undergoing ultralow anterior resection were examined over the years between 2012-2019. Amongst these, 21 cases (22.3%) were not reversed due to disease progress, death prior to reversal, or surgical complication. Demographics, disease status, surgical technique, and hospital inpatient events of these cases were examined. An average waiting time of 213.2 days was noted. Reasons for the delay include non-specified/prolonged hospital waiting time (54%), delayed or complicated chemotherapy course (13%), surgical complication (11%), advanced age, and frailty(5%). Complication of a delayed ileostomy reversal includes post-operation ileus and the development of an incisional hernia. We conclude that a delayed reversal of ileostomy can contribute to a higher incidence of stoma-related co-morbidities and contribute to a longer hospital stay and therefore use of public hospital resources.

Keywords: anterior resection, colorectal surgery, ileostomy reversal, rectal cancer

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Authors: Yen-Hsia Lin, Ya-Fang Cheng, Hui-Zhu Chen, Chi-Hui Tiao

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This is a case study of a 70-year-old man suffering from Type 2 diabetes mellitus and hyperglycemia hyperosmolarity state. He was admitted into the intensive care unit from the 20th to 26th of October, 2015. After receiving relevant information through open-ended conversations, observation, and physical assessment, as well as the psychological, social and spiritual holistic nursing assessment, several clinical health problems such as unstable blood sugar, impaired skin integrity and lack of self-care management knowledge were identified by the author. During the period of care, the patient was encouraged to share and express his feelings, an active listening and initiating approach from the nursing team had led to the understanding of why the patient refused to use insulin. This knowledge enabled the nursing team to manage patient care by educating the patient with self-care management skills, such as foot wound care and insulin injection skills to slow the deterioration of complications. Also, the implementation of appropriate diet and exercise routine to improve patients’ style. By enhancing self-care ability in diabetic patients, they are able to return home with the skill to improve better quality life style.

Keywords: hyperglycemia hyperosmolar state, type2 diabetes Mellitu, diabetes Mellitu foot care, intensive care

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Authors: Celeste Labuschagne, Sam Ramaila, Thasmai Dhurumraj

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Although formative assessment is acknowledged as crucial for teachers to gauge students’ understanding of subject content, applying formative assessment in an online context is more challenging than in a traditional Physical Sciences classroom. This study examines challenges experienced by Grade 10 Physical Sciences teachers when enacting online formative assessment. The empirical investigation adopted a generic qualitative design and involved three purposively selected Grade 10 Physical Sciences teachers from three different schools and quintiles within the Tshwane North District in South Africa. Data were collected through individual and focus group interviews. Technological, pedagogical, and content knowledge (TPACK) was utilised as a theoretical framework underpinning the study. The study identified a myriad of challenges experienced by Grade 10 Physical Sciences teachers when enacting online formative assessment. These challenges include the utilisation of Annual Teaching Plans, lack of technological knowledge, and internet connectivity. The Department of Basic Education faces the key imperative to provide continuous teacher professional development and concomitant online learning materials that can facilitate meaningful enactment of online formative assessment in various educational settings.

Keywords: COVID-19, challenges, online formative assessment, physical sciences, TPACK

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Authors: Ade Dwi Utami

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Pedagogic competence is the basic competence of teachers to perform their tasks as educators. The ability to assess has become one of the demands in teachers pedagogic competence. Teachers ability to assess is related to curriculum instructions and applications. This research is aimed at obtaining data concerning teachers ability to assess that comprises of understanding assessment, determining assessment type, tools and procedure, conducting assessment process, and using assessment result information. It uses mixed method of explanatory technique in which qualitative data is used to verify the quantitative data obtained through a survey. The technique of quantitative data collection is by test whereas the qualitative data collection is by observation, interview and documentation. Then, the analyzed data is processed through a proportion study technique to be categorized into high, medium and low. The result of the research shows that teachers ability to assess can be grouped into 3 namely, 2% of high, 4% of medium and 94% of low. The data shows that teachers ability to assess is still relatively low. Teachers are lack of knowledge and comprehension in assessment application. The statement is verified by the qualitative data showing that teachers did not state which aspect was assessed in learning, record children’s behavior, and use the data result as a consideration to design a program. Teachers have assessment documents yet they only serve as means of completing teachers administration for the certification program. Thus, assessment documents were not used with the basis of acquired knowledge. The condition should become a consideration of the education institution of educators and the government to improve teachers pedagogic competence, including the ability to assess.

Keywords: assessment, early childhood education, pedagogic competence, teachers

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Authors: Khalid Abdelghany

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Additive Manufacturing (AM) is the manufacturing technology that is used to fabricate fast products direct from CAD models in very short time and with minimum operation steps. Jointly with the advancement in medical computer modeling, AM proved to be a very efficient tool to help physicians, orthopedic surgeons and dentists design and fabricate patient-tailored surgical guides, templates and customized implants from the patient’s CT / MRI images. AM jointly with computer-assisted designing/computer-assisted manufacturing (CAD/CAM) technology have enabled medical practitioners to tailor physical models in a patient-and purpose-specific fashion and helped to design and manufacture of templates, appliances and devices with a high range of accuracy using biocompatible materials. In developing countries, there are some technical and financial limitations of implementing such advanced tools as an essential portion of medical applications. CMRDI institute in Egypt has been working in the field of Medical Additive Manufacturing since 2003 and has assisted in the recovery of hundreds of poor patients using these advanced tools. This paper focuses on the surgical and dental use of 3D printing technology in Egypt as a developing country. The presented case studies have been designed and processed using the software tools and additive manufacturing machines in CMRDI through cooperative engineering and medical works. Results showed that the implementation of the additive manufacturing tools in developed countries is successful and could be economical comparing to long treatment plans.

Keywords: additive manufacturing, dental and orthopeadic stents, patient specific surgical tools, titanium implants

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Authors: Mary Butler

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Background: Screening programmes for older drivers in Europe (though not the UK), and in many states in the US and in Australia are based on medical assessment of fitness to drive. These programmes require physicians (including general practitioners) to carry out an assessment of fitness to drive in their offices. In 2006, New Zealand changed from doing on-road driving tests with all older drivers from the age of 80, to a screening programme that uses medical assessment of fitness to drive only. Aim: This study set out to understand the experience of New Zealand GPs as they manage the process of medical assessment of fitness to drive assessments for older people. In particular, it aimed to establish how GPs understand the role of specialist driving assessment and rehabilitation carried out by occupational therapists. Design and setting: The study used an interpretive descriptive approach to analyze data from ten interviews with GPs in New Zealand. Results: The results indicated that GPs lack understanding about how occupational therapists can assist their patients, and tend to refer only when there is a disagreement with the patient. Conclusion: There are problems with the medical assessment of fitness to drive carried out by GPs, and there is a need for a more comprehensive community approach to driving cessation. Patients, families and the multidisciplinary team all have a role in deciding when driving cessation should occur. Occupational therapists have a particular responsibility for strategic leadership in this area of practice.

Keywords: assessment, driving, older people, occupational therapy

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Authors: Mikhail Bouniaev

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The paper reviews design and implementation of a Calculus Course required for the Biomedical Competency Based Program developed as a joint project between The University of Texas Rio Grande Valley, and the University of Texas’ Institute for Transformational Learning, from the theoretical perspective as presented in scholarly work on active learning, formative assessment, and on-line teaching. Following a four stage curriculum development process (objective, content, delivery, and assessment), and theoretical recommendations that guarantee effectiveness and efficiency of assessment in active learning, we discuss the practical recommendations on how to incorporate a strong formative assessment component to address disciplines’ needs, and students’ major needs. In design and implementation of this project, we used Constructivism and Stage-by-Stage Development of Mental Actions Theory recommendations.

Keywords: active learning, assessment, calculus, cognitive demand, mathematics, stage-by-stage development of mental action theory

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Authors: Lisa Bennett, Cynthia Walters, Cynthia Argani, Andy Satin, Geeta Sood, Kerri Huber, Lisa Grubb, Woodrow Noble, Melissa Eichelberger, Darlene Zinalabedini, Eric Ausby, Jeffrey Snyder, Kevin Kirchoff

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Background: Surgical site infections (SSIs) within the obstetric population pose a variety of complications, creating clinical and personal challenges for the new mother and her neonate during the postpartum period. Our journey to achieve compliance with the SSI core measure for cesarean sections revealed many opportunities to improve these outcomes. Objective: Achieve and sustain core measure compliance keeping surgical site infection rates below the national benchmark pooled mean of 1.8% in post-operative patients, who delivered via cesarean section at the Johns Hopkins Bayview Medical Center. Methods: A root cause analysis was performed and revealed several environmental, pharmacologic, and clinical practice opportunities for improvement. A multidisciplinary approach led by the OB Safety Nurse, OB Medical Director, and Infectious Disease Department resulted in the implementation of fourteen interventions over a twenty-month period. Interventions included: post-operative dressing changes, standardizing operating room attire, broadening pre-operative antibiotics, initiating vaginal preps, improving operating room terminal cleaning, testing air quality, and re-educating scrub technicians on technique. Results: Prior to the implementation of our interventions, the SSI quarterly rate in Obstetrics peaked at 6.10%. Although no single intervention resulted in dramatic improvement, after implementation of all fourteen interventions, the quarterly SSI rate has subsequently ranged from to 0.0% to 2.70%. Significance: Taking an introspective look at current practices can reveal opportunities for improvement which previously were not considered. Collectively the benefit of these interventions has shown a significant decrease in surgical site infection rates. The impact of this quality improvement project highlights the synergy created when members of the multidisciplinary team work in collaboration to improve patient safety, and achieve a high quality of care.

Keywords: cesarean section, surgical site infection, collaboration and teamwork, patient safety, quality improvement

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Authors: Karlygash Adamova

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This article is focused on the KazTest as one of the most important high-stakes tests and the key tool in Kazakh language assessment. The research will also include the brief introduction to the language policy in Kazakhstan. Particularly, it is going to be changed significantly and turn from bilingualism (Kazakh, Russian) to multilingual policy (three languages - Kazakh, Russian, English). Therefore, the current status of the abovementioned languages will be described. Due to the various educational reforms in the country, the language evaluation system should also be improved and moderated. The research will present the most significant test of Kazakhstan – the KazTest, which is aimed to evaluate the Kazakh language proficiency. Assessment is an ongoing process that encompasses a wide area of knowledge upon the productive performance of the learners. Test is widely defined as a standardized or standard method of research, testing, diagnostics, verification, etc. The two most important characteristics of any test, as the main element of the assessment - validity and reliability - will also be described in this paper. Therefore, the preparation and design of the test, which is assumed to be an indicator of knowledge, and it is highly important to take into account all these properties.

Keywords: multilingualism, language assessment, testing, language policy

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Authors: Qing Cao

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Generally speaking, China has a relatively high level of intellectual property (IP) infringement. Risk assessment is indispensable in the strategic planning process. To complement the current literature in international business, the paper sheds the light on how to assess IP risk for foreign companies in planning market entry to China. Evaluating internal and external IP environment, proposed in the paper, consists of external analysis, internal analysis and further internal analysis. Through position the company’s IP environment, the risk assessment approach enables the foreign companies to either build the corresponding IP strategies or abort the entry plan beforehand to minimize the IP risks.

Keywords: intellectual property, IP environment, risk assessment

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Authors: B. M. Alshammari, M. A. El-Kady

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This paper presents a unified framework for assessment of reserve-based reliability levels in electric power systems. The unified approach is based on reserve-based analysis and assessment of the relationship between available generation capacities and required demand levels. The developed approach takes into account the load variations as well as contingencies which occur randomly causing some generation and/or transmission capacities to be lost (become unavailable). The calculated reserve based indices, which are important to assess the reserve capabilities of the power system for various operating scenarios are therefore probabilistic in nature. They reflect the fact that neither the load levels nor the generation or transmission capacities are known with absolute certainty. They are rather subjects to random variations and consequently. The calculated reserve-based reliability indices are all subjects to random variations where only expected values of these indices can be evaluated. This paper presents a unified approach to reserve-based reliability assessment of power systems using various reserve assessment criteria. Practical applications are also presented for demonstration purposes to the Saudi electricity power grid.

Keywords: assessment, power system, reserve, reliability

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Authors: Yang Luo, Beibei Wang

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In this paper, we present a design methodology of lightweight register transfer level (RTL) hardware threat implemented based on a MAX II FPGA platform. The dynamic power consumed by the toggling of the various bit of registers as well as the dynamic power consumed per unit of logic circuits were analyzed. The hardware threat was designed taking advantage of the differences in dynamic power consumed per unit of logic circuits to hide the transfer information. The experiment result shows that the register hardware threat was successfully implemented by using different dynamic power consumed per unit of logic circuits to hide the key information of DES encryption module. It needs more than 100000 sample curves to reduce the background noise by comparing the sample space when it completely meets the time alignment requirement. In additional, an external trigger signal is playing a very important role to detect the hardware threat in this experiment.

Keywords: side-channel analysis, hardware Trojan, register transfer level, dynamic power

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Authors: Saman Khairani

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Assessment is a pivotal component of the teaching and learning process, serving as a critical tool for evaluating student progress, diagnosing learning needs, and informing instructional decisions. In the context of English Language Teaching (ELT), effective assessment practices are essential to promote meaningful learning experiences and foster continuous improvement in language proficiency. This paper delves into various assessment strategies, explores associated challenges, and highlights best practices for assessing student learning in ELT. The paper begins by examining the diverse forms of assessment, including formative assessments that provide timely feedback during the learning process and summative assessments that evaluate overall achievement. Additionally, alternative methods such as portfolios, self-assessment, and peer assessment play a significant role in capturing various aspects of language learning. Aligning assessments with learning objectives is crucial. Educators must ensure that assessment tasks reflect the desired language skills, communicative competence, and cultural awareness. Validity, reliability, and fairness are essential considerations in assessment design. Challenges in assessing language skills—such as speaking, listening, reading, and writing—are discussed, along with practical solutions. Constructive feedback, tailored to individual learners, guides their language development. In conclusion, this paper synthesizes research findings and practical insights, equipping ELT practitioners with the knowledge and tools necessary to design, implement, and evaluate effective assessment practices. By fostering meaningful learning experiences, educators contribute significantly to learners’ language proficiency and overall success.

Keywords: ELT, formative, summative, fairness, validity, reliability

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Authors: N. Musayeva, N. Rustamova, N. Bagirov, S. Ibadov

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Purpose: to analyze the long-term results of external dacryocystorhinostomy (DCR), which remains the preferred primary procedure in the surgical treatment of lacrimal duct obstruction in chronic dacryocystitis. Methodology: long-term results of external DCR (after 3 years) performed on 90 patients (90 eyes) with chronic dacryocystitis from 2018 to 2020 were evaluated. The Azerbaijan National Center of Ophthalmology, named after acad. Zarifa Aliyeva. 15 of the patients were men, 75 – women. The average age was 45±3.2 years. Surgical operations were performed under local anesthesia. All patients suffered from diabetes mellitus for more than 3 years. All patients underwent external DCR and silicone drainage (tube) was implanted. In the postoperative period (after 3 years), lacrimation, purulent discharge, and the condition of the scar at the operation site were assessed. Results: All patients were under observation for more than 18 months. In general, the effectiveness of the surgical operation was 93.34%. Recurrence of disease was observed in 6 patients and in 3 patients (3.33%), the scar at the site of the operation was rough (non-cosmetic). In 3 patients (3.33%) – the surgically formed anastomosis between the lacrimal sac and the nasal bone was obstructed by scar tissue. These patients were reoperated by trans canalicular laser DCR. Conclusion: Despite the long-term (more than a hundred years) use of external DCR, it remains one of the primary techniques in the surgery of chronic dacryocystitis. Due to the high success rate and good long-term results of DCR in the treatment of chronic dacryocystitis in patients suffering from diabetes mellitus, we recommend external DCR for this group of patients.

Keywords: chronic dacryocystitis, diabetes mellitus, external dacryocystorhinostomy, long-term results

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Authors: Maziyar Nouraee

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Electronic markets in recent decades contribute remarkably in business transactions. Many organizations consider traditional ways of trade non-economical and therefore they do trade only through electronic markets. There are different categorizations of electronic markets functions. In one classification, functions of electronic markets are categorized into classes as information, transactions, and value added. In the present paper, effects of the three classes on the two major elements of the supply chain management are measured. The two elements are decrease in the product unit cost and reduction in response time to the customer. The results of the current research show that among nine minor elements related to the three classes of electronic markets functions, six factors and three factors influence on reduction of the product unit cost and reduction of response time to the customer, respectively.

Keywords: electronic commerce, electronic market, B2B trade, supply chain management

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Authors: Gabriela Wasileski, Debra L. Stanley

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Maryland efforts to decrease the juvenile criminality and recidivism shifts towards evidence based sentencing. While in theory the evidence based sentencing has an impact on the reduction of juvenile delinquency and drug abuse; the assessment of juveniles’ risk and needs usually lacks crucial information about juvenile’s prior victimization. The Maryland Comprehensive Assessment and Service Planning (MCASP) Initiative is the primary tool for developing and delivering a treatment service plan for juveniles at risk. Even though it consists of evidence-based screening and assessment instruments very little is currently known regarding the effectiveness and the impact of the assessment in general. In keeping with Maryland’s priority to develop successful evidence-based recidivism reduction programs, this study examined results of assessments based on MCASP using a representative sample of the juveniles at risk and their assessment results. Specifically, it examined: (1) the results of the assessments in an electronic database (2) areas of need that are more frequent among delinquent youth in a system/agency, (3) the overall progress of youth in an agency’s care (4) the impact of child victimization and trauma experiences reported in the assessment. The project will identify challenges regarding the use of MCASP in Maryland, and will provide a knowledge base to support future research and practices.

Keywords: Juvenile Justice, assessment of risk and need, victimization and crime, recidivism

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Authors: P. K. Singhal, R. Naresh, V. Sharma

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This paper presents the three optimization models, namely New Binary Artificial Bee Colony (NBABC) algorithm, NBABC with Local Search (NBABC-LS), and NBABC with Genetic Crossover (NBABC-GC) for solving the Wind-Thermal Unit Commitment (WTUC) problem. The uncertain nature of the wind power is incorporated using the Weibull probability density function, which is used to calculate the overestimation and underestimation costs associated with the wind power fluctuation. The NBABC algorithm utilizes a mechanism based on the dissimilarity measure between binary strings for generating the binary solutions in WTUC problem. In NBABC algorithm, an intelligent scout bee phase is proposed that replaces the abandoned solution with the global best solution. The local search operator exploits the neighboring region of the current solutions, whereas the integration of genetic crossover with the NBABC algorithm increases the diversity in the search space and thus avoids the problem of local trappings encountered with the NBABC algorithm. These models are then used to decide the units on/off status, whereas the lambda iteration method is used to dispatch the hourly load demand among the committed units. The effectiveness of the proposed models is validated on an IEEE 10-unit thermal system combined with a wind farm over the planning period of 24 hours.

Keywords: artificial bee colony algorithm, economic dispatch, unit commitment, wind power

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Authors: Leonardo Alfredo Mendoza, Cristian Munoz, Marco Aurelio Pacheco, Manoela Kohler, Evelyn Batista, Rodrigo Moura

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Natural Language Processing (NLP) techniques are increasingly more powerful to be able to interpret the feelings and reactions of a person to a product or service. Sentiment analysis has become a fundamental tool for this interpretation but has few applications in languages other than English. This paper presents a classification of sentiment analysis in Portuguese with a base of comments from social networks in Portuguese. A word embedding's representation was used with a 50-Dimension GloVe pre-trained model, generated through a corpus completely in Portuguese. To generate this classification, the bidirectional long short-term memory and bidirectional Gated Recurrent Unit (GRU) models are used, reaching results of 99.1%.

Keywords: natural processing language, sentiment analysis, bidirectional long short-term memory, BI-LSTM, gated recurrent unit, GRU

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Authors: Jaria A. Polog, Norjana Lao-Pimping, Bedoria M. Macabalang, Monrizah M. Guiling

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Ultrasound-guided single-shot peripheral nerve blocks (PNB) such as erector spinae plane block (ESPB) and pectoral nerve block (PECS I and II) are emerging anesthetic techniques used to provide complete surgical anesthesia without general anesthesia and adequate postoperative analgesia for breast surgeries. Peripheral nerve blocks with sedation could be a better option for breast surgery than general anesthesia in patients with multiple preexisting comorbidities and those refusing general anesthesia. However, an anesthesiologist with optimum knowledge of regional anesthesia and ultrasound experience plays a key factor in the success of doing PNB.

Keywords: mastectomy, peripheral nerve block, erecto spinae block, PECS-2 block

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Authors: Stephanie Cheng, Benjamin Poh, Vivyan Tay, Sachin Mathur

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Aim: Diabetes mellitus (DM) is a worldwide pandemic affecting 500 million people. It is known to be associated with increased susceptibility to soft tissue infections (STI). Despite being a major public health burden, the literature relating the effects of DM and the presentation, severity and healing of STIs in general surgical patients remain limited. Methods: We conducted a retrospective review of all patients admitted with STI in a tertiary teaching hospital over a 12-month period. Patient demographics and surgical outcomes were collected and analyzed. Results: During the study period, 1059 patients were admitted for STIs, of which 936 (88%) required surgical intervention. Diabetic patients were presented with a higher body-mass index (BMI) (28 vs 26), larger abscess size (24 vs 14 cm²) and a longer length of stay (LOS)(4.4 days vs 2.9 days). They also underwent a higher proportion of wide debridement as well as application of negative pressure wound therapy (NPWT) (42% vs 35%). More diabetic patients underwent subsequent re-operation within the same sitting (8 vs 4). There were no differences in re-admission rates within 30 days nor subsequent abscess formation in those followed for 6 months. Conclusion: The incidence of STIs among DM patients represents a significant disease burden; surgeons should consider intensive patient counseling and partnering with primary care providers in order to help reduce the incidence of future STI admissions based on lifestyle modification and glucose control.

Keywords: general surgery, emergency general surgery, acute care surgery, soft tissue infections, diabetes mellitus

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Authors: Amenah Dhannoon, Ciaran Martin Hurley, Laura Wrafter, Podraic J. Regan

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Introduction: The COVID-19 pandemic continues to present unprecedented challenges for healthcare systems. This has resulted in the pragmatic shift in the practice of plastic surgery units worldwide. During this period, many units reported a significant fall in urgent melanoma referrals, leading to patients presenting with advanced disease requiring more extensive surgery and inferior outcomes. Our objective was to evaluate our unit's experience with both non-invasive and invasive melanoma during the COVID-19 pandemic and characterize our experience and contrast it to that experienced by our neighbors in the UK, mainland Europe and North America. Methods: a retrospective chart review was performed on all patients diagnosed with invasive and non-invasive cutaneous melanoma between March to December of 2019 (control) compared to 2020 (COVID-19 pandemic) in a single plastic surgery unit in Ireland. Patient demographics, referral source, surgical procedures, tumour characteristics, radiological findings, oncological therapies and follow-up were recorded. All data were anonymized and stored in Microsoft Excel. Results: A total of 589 patients were included in the study. Of these, 314 (53%) with invasive melanoma, compared to 275 (47%) with the non-invasive disease. Overall, more patients were diagnosed with both invasive and non-invasive melanoma in 2020 than in 2019 (p<0.05). However, significantly longer waiting times in 2020 (64 days) compared to 2019 (28 days) (p<0.05), with the majority of the referral being from GP in 2019 (83%) compared to 61% in 2020. Positive sentinel lymph node were higher in 2019 at 56% (n=28) compared to 24% (n=22) in 2020. There was no statistically significant difference in the tutor characteristics or metastasis status. Discussion: While other countries have noticed a fall in the melanoma diagnosis. Our units experienced a higher number of disease diagnoses. This can be due to multiple reasons. In Ireland, the government reached an early agreement with the private sector to continue elective surgery on an urgent basis in private hospitals. This allowed access to local anesthetic procedures and local skin cancer cases were triaged to non-COVID-19 provider centers. Our unit also adapted a fast, effective and minimal patient contact strategy for triaging skin cancer based on telemedicine. Thirdly, a skin cancer nurse specialist maintained patient follow-ups and triaging a dedicated email service. Finally, our plastic surgery service continued to maintain a virtual complex skin cancer multidisciplinary team meeting during the pandemic, ensuring local clinical governance has adhered to each clinical case. Conclusion: Our study highlights that with the prompt efficient restructuring of services, we could reserve successful management of skin cancer even in the most devastating times. It is important to reflect on the success during the pandemic and emphasize the importance of preparation for a potentially difficult future

Keywords: malignant melanoma, skin cancer, COVID-19, triage

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Authors: Mohsen Shirani, Micaela Demichela

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During the last decades, a number of food crises such as Bovine Spongiform Encephalopathy (BSE), Mad-Cow disease, Dioxin in chicken food, Food-and-Mouth Disease (FMD), have certainly inflicted the reliability of the food industry. Consequently, the trend in applying different scientific methods of risk assessment in food safety has obtained more attentions in the academic and practice. However, lack of practical approach considering entire food supply chain is tangible in the academic literature. In this regard, this paper aims to apply risk assessment tool (FMEA) with integration of Human Factor along the entire supply chain of food production and test the method in a case study of Diary production, and analyze its results.

Keywords: FMEA, food supply chain, risk assessment, human factor

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Authors: Chana Pavneet

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Background: In more recent years in dentistry, a greater emphasis has been placed on competency-based education (CBE) programmes. Undergraduate and postgraduate curriculums have been reformed to reflect these changes, and adopting a CBE approach has shown to be beneficial to trainees and places an emphasis on continuous lifelong learning. The literature is vast; however, very little work has been done specifically to the assessment of competence in dentistry and even less so in oral surgery. The majority of the literature tends to opinion pieces. Some small-scale studies have been undertaken in this area researching assessment tools which can be used to assess competence in oral surgery. However, there is a lack of general consensus on the preferable assessment methods. The aim of this review is to identify the assessment methods available and their usefulness. Methods: Electronic databases (Medline, Embase, and the Cochrane Database of systematic reviews) were searched. PRISMA guidelines were followed to identify relevant papers. Abstracts of studies were reviewed, and if they met the inclusion criteria, they were included in the review. Papers were reviewed against the critical appraisal skills programme (CASP) checklist and medical education research quality instrument (MERQSI) to assess their quality and identify any bias in a systematic manner. The validity and reliability of each assessment method or tool were assessed. Results: A number of assessment methods were identified, including self-assessment, peer assessment, and direct observation of skills by someone senior. Senior assessment tended to be the preferred method, followed by self-assessment and, finally, peer assessment. The level of training was shown to affect the preferred assessment method, with one study finding peer assessment more useful in postgraduate trainees as opposed to undergraduate trainees. Numerous tools for assessment were identified, including a checklist scale and a global rating scale. Both had their strengths and weaknesses, but the evidence was more favourable for global rating scales in terms of reliability, applicability to more clinical situations, and easier to use for examiners. Studies also looked into trainees’ opinions on assessment tools. Logbooks were not found to be significant in measuring the competence of trainees. Conclusion: There is limited literature exploring the methods and tools which assess the competence of oral surgery trainees. Current evidence shows that the most favourable assessment method and tool may differ depending on the stage of training. More research is required in this area to streamline assessment methods and tools.

Keywords: competence, oral surgery, assessment, trainees, education

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Authors: Virakti Dhaval Shah

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Advances in technology and the changes in lifestyle and work expectations amid the COVID-19 pandemic are requiring changes to vocational assessment, provision of vocational training, and identification of job matches for individuals with intellectual disability. Vocational assessment involves the assessment of interests, skills, abilities, and strengths/weaknesses, as well as a detailed understanding of healthcare, familial, social, community, workplace-related and policy-level protective and risk factors impacting the individual. In India, vocational assessment procedures such as interviews play a major role in vocational placement today. Unfortunately, many of the most widely used vocational assessment instruments in India were developed in the 1970s to 2000s and have not been revised since. Hence, there is a dire need to update existing tools and prepare a structured approach for vocational service providers to meet the unique employment needs of individuals with intellectual disabilities. To address this need, this project designed a multi-domain assessment toolkit for a structured approach to vocational assessment, training, and job placement for individuals with intellectual disabilities in India. Methods included conducting an empirical review of the available tools currently in use in India for the vocational assessment of persons with intellectual disabilities. Domains addressed in the instrument review were organized into a structured system, and additional items related to contemporary technology, pandemic-related experiences of persons with disabilities, and changes in lifestyle and work expectations due to the pandemic were added. Items assessing behaviors, provision of vocational training, and identification of job matches for individuals with intellectual disabilities were developed. The proposed tool has the potential to benefit organizations working with and preparing individuals with intellectual disabilities to find successful employment by undertaking a structured approach to vocational assessment, rehabilitation, training, and placement. It can be particularly useful for guiding new professionals doing vocational rehabilitation in India.

Keywords: intellectual disability, rehabilitation, vocational assessment, vocational rehabilitation

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Authors: J. Milton, C. Uzoigwe, O. Ayeko, B. Offorha, K. Anderson, R. G. Middleton

Abstract:

Background: We used the UK National Hip Fracture database to determine the effect of institution hip fracture case volume on hip fracture healthcare outcomes in 2019. Using logistic regression for each healthcare outcome, we compared the best performing 50 units with the poorest performing 50 units in order to determine if the unit volume was associated with performance for each particular outcome. Method: We analysed 175 institutions treating a total of 67,673 patients over the course of a year. Results: The number of hip fractures seen per unit ranged between 86 and 952. Larger units tendered to perform health assessments more consistently and mobilise patients more expeditiously post-operatively. Patients treated at large institutions had shorter lengths of stay. With regard to most other outcomes, there was no association between unit case volume and performance, notably compliance with the Best Practice Tariff, time to surgery, proportion of eligible patients undergoing total hip arthroplasty, length of stay, delirium risk, and pressure sore risk assessments. Conclusion: There is no relationship between unit volume and the majority of health care outcomes. It would seem that larger institutions tend to perform better at parameters that are dependent upon personnel numbers. However, where the outcome is contingent, even partially, on physical infrastructure capacity, there was no difference between larger and smaller units.

Keywords: institution volume, mortality, neck of femur fractures, osteoporosis

Procedia PDF Downloads 75

Authors: Deepak Ganjiwale, Karthik Vishwanathan

Abstract:

Objective: Splinting is a great domain of occupational therapy profession.Making a splint for the patient would depend upon the need or requirement of the problems and deformities. Swan neck deformity is not very common in finger it may occur after any disease. Conservative treatment of the swan neck deformity is available by using different static splints only. There are very few reports of surgical correction of swan-neck deformity in benign hypermobility syndrome. Method: This case report describes the result of surgical intervention and hand splint in a twenty year old lady with past history of cardiovascular stroke with no residual neurological deficit. She presented with correctable swan neck deformity and failed to improve with static ring splints to correct the deformity. She was noted to have hyperlaxity (EhlerDanlos type) as per modified Beighton’s score of 5/9. She underwent volar plate plication of the proximal interphalangeal joint of the left ring finger along with hemitenodesis of ulnar slip of flexor digitorum superficialis (FDS) tendon whereby, the ulnar slip of FDS was passed through a small surgically created rent in A2 pulley and sutured back to itself. Result: Postoperatively, the patient was referred to occupational therapy for splinting with the instruction that the splint would work some time for as static and some time as dynamic for positional and correction of the finger. Conclusion: After occupational therapy intervention and splinting, the patient had a full correction of the swan-neck deformity with near full flexion of the operated finger and is able to work independently.

Keywords: swan neck, finger, deformity, splint, hypermobility

Procedia PDF Downloads 240

Authors: Saidulu Gadari, Manoj Kumar Yadav, V. K. Satheesh, Debasis Bhattacharyya, S. S. V. Ramakumar, Subhajit Sarkar

Abstract:

Most Fluid Catalytic Cracking Units (FCCUs) are big profit makers and hence, always operated with several constraints. It is the primary source for production of gasoline, light olefins as petrochemical feedstocks, feedstock for alkylate & oxygenates, LPG, etc. in a refinery. Increasing unit capacity and improving product yields as well as qualities such as gasoline RON have dramatic impact on the refinery economics. FCCUs are often debottlenecked significantly beyond their original design capacities. Depending upon the unit configuration, operating conditions, and feedstock quality, the FCC unit can have a variety of bottlenecks. While some of these are aimed to increase the feed rate, improve the conversion, etc., the others are aimed to improve the reliability of the equipment or overall unit. Apart from investment cost, the other factors considered generally while evaluating the debottlenecking options are shutdown days, faster payback, risk on investment, etc. A low-cost solution such as replacement of feed injectors, air distributor, steam distributors, spent catalyst distributor, efficient cyclone system, etc. are the preferred way of upgrading FCCU. It also has lower lead time from idea inception to implementation. This paper discusses various bottlenecks generally encountered in FCCU and presents a case study on improvement of performance of one of the FCCUs in IndianOil through implementation of cost-effective technical solution including use of improved internals in Reactor-Regeneration (R-R) section. After implementation reduction in regenerator air, gas superficial velocity in regenerator and cyclone velocities by about 10% and improvement of CLO yield from 10 to 6 wt% have been achieved. By ensuring proper pressure balance and optimum immersion of cyclone dipleg in the standpipe, frequent formation of perforations in regenerator cyclones could be addressed which in turn improved the unit on-stream factor.

Keywords: FCC, low-cost, revamp, debottleneck, internals, distributors, cyclone, dipleg

Procedia PDF Downloads 200

Authors: A. A. Ajayi-Banji, M. A. Adegbile, T. D. Akpenpuun, J. Bello, O. Omobowale, D. A. Jenyo

Abstract:

Ceramic ware waste applicability as coarse aggregate was considered in this study for dense masonry unit production. The waste was crushed into 1.4 mm particle size and mixed with natural fine aggregate in the ratio 2:3. Portland ordinary cement, aggregate, and water mix ratio was 1:7:0.5. Masonry units produced were cured for 7, 21 and 28 days prior to compressive test. The result shows that curing age have a significant effect on all the compressive strength indices inspected except for Young’s modulus. Crushing force and the compressive strength of the ceramic-natural fine aggregate blocks increased by 11.7 – 54.7% and 11.6 – 59.2% respectively. The highest ceramic-natural fine block compressive strength at yield and peak, 4.97 MPa, was obtained after 21 days curing age. Ceramic aggregate introduced into the dense blocks improved the suitability of the blocks for construction purposes.

Keywords: ceramic ware waste, co-ballast, dense masonry unit, compressive strength, curing time

Procedia PDF Downloads 391