Search results for: american ocademy of orthopaedic surgeons

Authors: M. A. Askari, M. A. Nazari, P. Perrier, Y. Payan

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Growth and remodeling of biological structures have gained lots of attention over the past decades. Determining the response of the living tissues to the mechanical loads is necessary for a wide range of developing fields such as, designing of prosthetics and optimized surgery operations. It is a well-known fact that biological structures are never stress-free, even when externally unloaded. The exact origin of these residual stresses is not clear, but theoretically growth and remodeling is one of the main sources. Extracting body organs from medical imaging, does not produce any information regarding the existing residual stresses in that organ. The simplest cause of such stresses is the gravity since an organ grows under its influence from its birth. Ignoring such residual stresses might cause erroneous results in numerical simulations. Accounting for residual stresses due to tissue growth can improve the accuracy of mechanical analysis results. In this paper, we have implemented a computational framework based on fixed-point iteration to determine the residual stresses due to growth. Using nonlinear continuum mechanics and the concept of fictitious configuration we find the unknown stress-free reference configuration which is necessary for mechanical analysis. To illustrate the method, we apply it to a finite element model of healthy human face whose geometry has been extracted from medical images. We have computed the distribution of residual stress in facial tissues, which can overcome the effect of gravity and cause that tissues remain firm. Tissue wrinkles caused by aging could be a consequence of decreasing residual stress and not counteracting the gravity. Considering these stresses has important application in maxillofacial surgery. It helps the surgeons to predict the changes after surgical operations and their consequences.

Keywords: growth, soft tissue, residual stress, finite element method

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Authors: R. W. Walker, J. M. Lynch, K. Anderson, R. G. Middleton

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Hip and knee arthritis are two of the commonest conditions that result in elective orthopaedic outpatient referral. At clinic appointments advice given regarding lifestyle modifications or treatment options may not be fully understood by patients. The majority of patients now use the internet to research their condition and use this to inform their decision about treatments. This study assessed the quality of patient information regarding hip and knee arthritis. To assess the quality of patient information regarding knee and hip arthritis available on the internet. Two internet searches were carried out one month apart using the search terms “knee arthritis” and “hip arthritis” on Google, a search engine that accounts for over 90% or internet searches in the UK. Sites were evaluated using the DISCERN instrument, a validated tool for measuring the quality of consumer health information. The first 50 results for each search were analysed by two different observers and discrepancies in scores were reviewed by both observers together and a score was agreed upon. In total 200 search result websites were assessed, of which 84 fulfilled the inclusion criteria. 53% (n=44) were funded directly by commercial healthcare businesses and of these, 70% (n=31) were funded by a surgeon/hospital promoting end-user purchase of surgical intervention. Overall 35% (n=29) websites were “for-profit” information websites where funding was from advertising revenues from pharmaceutical and prosthesis companies. 81% (n=67) offered information about surgical treatments however only 43% (n=36) mentioned the risk of complications of surgery. 67% (n=56) did not have any reference to sources for the information they detailed and 57% (n=47) had no apparent date for the production of the information they offered. Overall 17% (n=14) of websites were judged as being of high quality, with 29% (n=24) being of moderate quality and 54% (n=45) being of low quality. The quality of health information regarding hip and knee arthritis on the internet is highly variable and the majority of websites assessed were of poor quality. A preponderance of websites were funded by a commercial surgical service offering athroplasty at consumer cost, with a further third being funded indirectly via advertising revenues from commercial businesses. The vast majority of websites only mentioned surgery as a treatment and nearly half of all websites did not mention the risks or complications of surgical intervention at all. This has implications for the consent process. As such, Clinicians should be aware of the heterogeneous nature of patient information on the internet and be prepared to advise their patients about good quality websites where further reliable information can be sought.

Keywords: hip osteoarthritis, informed consent, knee osteoarthritis, patient information

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Authors: B. Kuiper

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When Dwight D. Eisenhower delivered his final Presidential speech in 1961, he was using the opportunity to bid farewell to America, but he was also trying to warn his fellow countrymen about deeper challenges threatening the country. In this analysis, Eisenhower’s speech is examined in light of the impact it had on American culture, communication concepts, and political ramifications. The paper initially highlights the previous literature on the speech, especially in light of its 50^th anniversary, and reveals a man whose main concern was how the speech’s words would affect his beloved country. The painstaking approach to the wording of the speech to reveal the intent is key, particularly in light of analyzing the motivations according to “virtuous communication.” This philosophical construct indicates that Eisenhower’s Farewell Address was crafted carefully according to a departing President’s deepest values and concerns, concepts that he wanted to pass along to his successor, to his country, and even to the world.

Keywords: Eisenhower, mass communication, political speech, rhetoric

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Authors: Jinpa Palmo

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In many research, omega 3 fatty acid which is a polyunsaturated fatty acids is proved to be very important and essential nutrients having many different health benefits but apart from other fatty acids, it cannot be synthesise by our human body. Therefore, we have to get these fatty acids by consuming diets and supplements rich in it. Even though human beings can live by consuming other important nutrients but can live much healthier and longer by consuming omega 3 fatty acids. American heart association AHA recommends for daily intake of omega 3 fatty acids specially by those people with coronary heart disease. Fish considering as nutritional valuable animal is mostly due to its lipid content (fish oil) in which these omega 3 fatty acids are present very significantly. Fish does not actually produce these omega 3 fatty acid in their body, but receive these fatty acids through the food web in which phytoplankton are the chief source of these omega fatty acids.

Keywords: fatty acid, fish, disease, health

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Authors: Lakmali Anthony, Madeline Gillies

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Background: Incisional and ventral hernias are highly prevalent, with primary ventral hernias occurring in approximately 20% of adults and incisional hernias developing in up to 30% of midline abdominal incisions. Recent data from the United States have shown an increasing incidence of elective incisional and ventral hernia repair (IVHR) and emergency repair of complicated hernias. This study examines Australian population trends in IVHR over a two-decade study period. Methods: This retrospective study was performed using procedure data from the Australian Institute of Health and Welfare, and population data from the Australian Bureau of Statistics captured between 2000 and 2021 to calculate incidence rates per 100,000 population by age and sex for selected subcategories of IVHR operations. Trends over time were evaluated using simple linear regression. Results: There were 809,308 IVHR operations performed in Australia during the study period. The cumulative incidence adjusted for the population was 182 per 100,000; this increased by 9.578 per year during the study period (95% CI = 8.431- 10.726, p<.001). IVHR for primary umbilical hernias experienced the most significant increase in population-adjusted incidence, 1.177 per year. (95% CI = 0.654- 1.701, p<.001). Emergency IVHR for incarcerated, obstructed, and strangulated hernias increased by 0.576 per year (95% CI = 0.510 -0.642, p<.001). Only 20.2% of IVHR procedures were performed as day surgery. Conclusions: Australia has seen a significant increase in IVHR operations performed in the last 20 years, particularly those for primary ventral hernias. IVHR for hernias complicated by incarceration, obstruction, and strangulation also increased significantly. The proportion of IVHR operations performed as day surgery is well below the target set by the Royal Australasian College of Surgeons. With the increasing incidence of IVHR operations and an increasing proportion of these being emergent, elective IVHR should be performed as day surgery when it is safe.

Keywords: ventral, incisional, hernia, trends

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Authors: Kathrina Aseanne Acapulco-Gomez, Shayne Julieane Morales, Tzar Francis Verame

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Mean platelet volume (MPV) is the most accurate measure of the size of platelets and is routinely measured by most automated hematological analyzers. Several studies have shown associations between MPV and cardiovascular risks and outcomes. Although its measurement may provide useful data, MPV remains to be a diagnostic tool that is yet to be included in routine clinical decision making. The aim of this systematic review and meta-analysis is to determine summary estimates of the diagnostic accuracy of mean platelet volume for the diagnosis of myocardial infarction among adult patients with angina and/or its equivalents in terms of sensitivity, specificity, diagnostic odds ratio, and likelihood ratios, and to determine the difference of the mean MPV values between those with MI and those in the non-MI controls. The primary search was done through search in electronic databases PubMed, Cochrane Review CENTRAL, HERDIN (Health Research and Development Information Network), Google Scholar, Philippine Journal of Pathology, and Philippine College of Physicians Philippine Journal of Internal Medicine. The reference list of original reports was also searched. Cross-sectional, cohort, and case-control articles studying the diagnostic performance of mean platelet volume in the diagnosis of acute myocardial infarction in adult patients were included in the study. Studies were included if: (1) CBC was taken upon presentation to the ER or upon admission (within 24 hours of symptom onset); (2) myocardial infarction was diagnosed with serum markers, ECG, or according to accepted guidelines by the Cardiology societies (American Heart Association (AHA), American College of Cardiology (ACC), European Society of Cardiology (ESC); and, (3) if outcomes were measured as significant difference AND/OR sensitivity and specificity. The authors independently screened for inclusion of all the identified potential studies as a result of the search. Eligible studies were appraised using well-defined criteria. Any disagreement between the reviewers was resolved through discussion and consensus. The overall mean MPV value of those with MI (9.702 fl; 95% CI 9.07 – 10.33) was higher than in those of the non-MI control group (8.85 fl; 95% CI 8.23 – 9.46). Interpretation of the calculated t-value of 2.0827 showed that there was a significant difference in the mean MPV values of those with MI and those of the non-MI controls. The summary sensitivity (Se) and specificity (Sp) for MPV were 0.66 (95% CI; 0.59 - 0.73) and 0.60 (95% CI; 0.43 – 0.75), respectively. The pooled diagnostic odds ratio (DOR) was 2.92 (95% CI; 1.90 – 4.50). The positive likelihood ratio of MPV in the diagnosis of myocardial infarction was 1.65 (95% CI; 1.20 – 22.27), and the negative likelihood ratio was 0.56 (95% CI; 0.50 – 0.64). The intended role for MPV in the diagnostic pathway of myocardial infarction would perhaps be best as a triage tool. With a DOR of 2.92, MPV values can discriminate between those who have MI and those without. For a patient with angina presenting with elevated MPV values, it is 1.65 times more likely that he has MI. Thus, it is implied that the decision to treat a patient with angina or its equivalents as a case of MI could be supported by an elevated MPV value.

Keywords: mean platelet volume, MPV, myocardial infarction, angina, chest pain

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Authors: Sheridan Wigginton

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This research project investigates the representation of Dominicans and Dominican culture in nine widely-used Spanish textbooks in universities and colleges in the United States. The project uses the “culture” standard established by the American Council on the Teaching of Foreign Languages to examine the texts. The organization, commonly referred to by its acronym ACTFL, describes products as books, tools, foods, laws, music, and games; practices as patterns of social interactions; and perspectives as meanings, attitudes, values, and ideas. The content analysis of the texts will also specifically include visual analysis of the physical representation of the people depicted in Dominican-themed culture activities to more clearly integrate issues of color and national identity into the discussion.

Keywords: blackness, culture, Dominican republic, foreign language education, national identity, Spanish, textbooks

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Authors: Vaikunthan Rajaratnam

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Intro: Motor imagery (MI) and mental practice (MP) can be an alternative to acquire mastery of surgical skills. One component of using this technique is the use of a mental script. The aim of this study was to design and develop a mental script for basic micro suturing training for skill acquisition using a low-fidelity rubber glove model and to describe the detailed methodology for this process. Methods: This study was based on a design and development research framework. The mental script was developed with 5 expert surgeons performing a cognitive walkthrough of the repair of a vertical opening in a rubber glove model using 8/0 nylon. This was followed by a hierarchal task analysis. A draft script was created, and face and content validity assessed with a checking-back process. The final script was validated with the recruitment of 28 participants, assessed using the Mental Imagery Questionnaire (MIQ). Results: The creation of the mental script is detailed in the full text. After assessment by the expert panel, the mental script had good face and content validity. The average overall MIQ score was 5.2 ± 1.1, demonstrating the validity of generating mental imagery from the mental script developed in this study for micro suturing in the rubber glove model. Conclusion: The methodological approach described in this study is based on an instructional design framework to teach surgical skills. This MP model is inexpensive and easily accessible, addressing the challenge of reduced opportunities to practice surgical skills. However, while motor skills are important, other non-technical expertise required by the surgeon is not addressed with this model. Thus, this model should act a surgical training augment, but not replace it.

Keywords: mental script, motor imagery, cognitive walkthrough, verbal protocol analysis, hierarchical task analysis

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Authors: Miriam Sosa, Edgar Ortiz, Alejandra Cabello

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This paper examines the volatility changes and leverage effects of the MILA stock markets and their changes since the 2007 global financial crisis. This group integrates the stock markets from Chile, Colombia, Mexico and Peru. Volatility changes and leverage effects are tested with a symmetric GARCH (1,1) and asymmetric TARCH (1,1) models with a dummy variable in the variance equation. Daily closing prices of the stock indexes of Chile (IPSA), Colombia (COLCAP), Mexico (IPC) and Peru (IGBVL) are examined for the period 2003:01 to 2015:02. The evidence confirms the presence of an overall increase in asymmetric market volatility in the Peruvian share market since the 2007 crisis.

Keywords: financial crisis, Latin American Integrated Market, TARCH, GARCH

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Authors: John Scanlon, Antony Raymond, Randeep Aujla, Peter D’Alessandro, Satyen Gohil

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Background: The incidence of significant acute chondral injuries with patella dislocation is around 10-15%. It is accepted that chondral procedures should only be performed in the presence of joint stability Methods:Patients were identified from surgeon/hospital logs. Patient demographics, lesion size and location, surgical procedure, patient reported outcome measures, post-operative MR imaging, and complications were recorded. PROMs and patient satisfaction was obtained. Results:20 knees (18 patients) were included. Mean age was 18.6 years (range; 11-39), and the mean follow-up was 16.6 months (range; 2-70). The defect locations were the lateral femoral condyle (9/20; 45%), patella (9/20; 45%), medial femoral condyle (1/20; 5%) and the trochlea (1/20; 5%). The mean defect size was 2.6cm2. Twelve knees were treated with cartilage fixation, 5 with microfracture, and 3 with OATS. At follow up, the overall mean Lysholm score was 77.4 (± 17.1), with no chondral regenerative procedure being statistically superior. There was no difference in Lysholm scores between those patients having acute medial patellofemoral ligament reconstruction versus medial soft tissue plication (p=0.59). Five (25%) knees required re-operation (one arthroscopic arthrolysis; one patella chondroplasty; two removal of loose bodies; one implant adjustment). Overall, 90% responded as being satisfied with surgery. Conclusion: Our aggressive pathway to identify and treat acute cartilage defects with early operative intervention and patella stabilisation has shown high rates of satisfaction and Lysholm scores. The full range of chondral restoration options should be considered by surgeons managing these patients.

Keywords: patella dislocation, chondral restoration, knee, patella stabilisation

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Authors: F. Erdal, E. Dogan, F. E. Uz

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In this study, firefly optimization based optimum design algorithm is presented for the grillage systems. Naming of the algorithm is derived from the fireflies, whose sense of movement is taken as a model in the development of the algorithm. Fireflies’ being unisex and attraction between each other constitute the basis of the algorithm. The design algorithm considers the displacement and strength constraints which are implemented from LRFD-AISC (Load and Resistance Factor Design-American Institute of Steel Construction). It selects the appropriate W (Wide Flange)-sections for the transverse and longitudinal beams of the grillage system among 272 discrete W-section designations given in LRFD-AISC so that the design limitations described in LRFD are satisfied and the weight of the system is confined to be minimal. Number of design examples is considered to demonstrate the efficiency of the algorithm presented.

Keywords: firefly algorithm, steel grillage systems, optimum design, stochastic search techniques

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Authors: Rene Valdiviezo-Issa

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In this paper, we use Mexico’s Households Income and Expenditures (ENIGH) survey to explain the behaviour that the urban-rural expenditure gap has had since Mexico’s incorporation to the North American Free Trade Agreement (NAFTA) in 1994 and we compare it with the latest available survey, which took place in 2014. We use real trimestral expenditure per capita (RTEPC) as the measure of welfare. We use quantile regressions and a quantile regression decomposition to describe the gap between urban and rural distributions of log RTEPC. We discover that the decrease in the difference between the urban and rural distributions of log RTEPC, or inequality, is motivated because of a deprivation of the urban areas, in very specific characteristics, rather than an improvement of the urban areas. When using the decomposition we observe that the gap is primarily brought about because differences in returns to covariates between the urban and rural areas.

Keywords: quantile regression, urban-rural inequality, inequality in Mexico, income decompositon

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Authors: Alexander Cramer, Kenneth Cramer

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Since the inauguration of President George Washington in 1789, the United States of America has seen the governance of some 44 individual presidents. Although such presidents share a variety of attributes, they still differ from one another on many others. Significantly, these traits may be used to construct distinct sets of 'families' of presidents throughout American history. By comparatively analyzing data from experts on the U.S. presidency – in this case, the C-SPAN Presidential Historians Surveys from 2000, 2009, and 2017 – this article identifies a consistent set of six presidential families: the All Stars; the Conservative Visionaries; the Postwar Progressives; the Average Joes; the Forgettables; and the Regrettables. In situating these categories in history, this article argues that U.S. presidents can be accurately organized into cohesive, like-performing families whose constituents share a common set of criteria.

Keywords: C-SPAN, POTUS presidential performance, presidential ranking, presidential studies, presidential surveys, United States

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Authors: Selman Selim Akyüz, Mete Kazaz

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Since The First Gulf War, USA, “Leader of The Free World” has been in trouble with terror. The USA created a complexity in The Middle East and paid the price with terrorist attacks in homeland. USA has made serious mistakes in terms of antiterrorism and fight against its supporters. Democrats have repaired damages caused by the Republican Party's management. Old methods about antiterrorism have been slowly abandoned. Hollywood, too, has played an important part in this war. Sometimes, Hollywood became an unquestioned patriot, sometimes it cried for the death of American Soldiers far away. In this study, messages in The Homeland, broadcast in the USA and a lot of countries around the world, are analyzed in terms of Washington’s foreign policy and position of the CIA in the fight against antiterrorism. The series reflect an orientalist viewpoint and has been criticized for offensive policy against the government. Homeland wanted to offer a perspective for the USA to be the “Leader of The Free World” again but with a liberal-democrat approach, dialogue and rational intelligence methods.

Keywords: antiterrorism, CIA, homeland, USA

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Authors: Katherine Anson

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This paper takes a closer look at the use of day-to-day informal working practices in Latin American spatial, cultural activism against gentrification. Through a discursive analysis of the Ecuadorian communally made film documentary San Roque: A House for All (2015), and the study of the political conflict around the gentrification of the place, the essay illustrates how the purposeful showcase of indigenous uses of space claims ownership over the city’s downtown area. This argument concludes that by making visible everyday indigenous ways of production in relation to space, the video contests the neoliberalist aim to proletarianize the urban poor, and therefore, to transform them into a landless group. This approach demonstrates that through representations of their own cultural working practices grassroots organizations consciously deconstruct/contest the capitalist urbanization of space.

Keywords: cultural activism, gentrification, indigenous working traditions, neoliberalism, urban displacement, everyday forms of resistance

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Authors: Soner Guler, Eylem Guzel, Mustafa Gülen

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Recently, concrete-filled steel tube columns are highly popular in high-rise buildings. The main aim of this study is to evaluate the axial load capacities of circular high strength concrete-filled steel tube columns according to Eurocode 4 (EC4) and American Concrete Institute (ACI) design codes. The axial load capacities of fifteen concrete-filled steel tubes stub columns were compared with design codes EU4 and ACI. The results showed that the EC4 overestimate the axial load capacity for all the specimens.

Keywords: concrete-filled steel tube column, axial load capacity, Eurocode 4, ACI design codes

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Authors: Maxwel F. Silva, José Geraldo Pedrosa

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The issue revolves around the discourse on development that was current in Brazil in the late nineteenth and early twentieth century and its relation to industrialization as idea of civility, modernity and progress. The main objective of this paper is to analyze the workmanship of the visionary entrepreneur and organic intellectual Roberto Cochrane Simonsen (1889-1948). In the set of speeches, lectures and conferences pronounced by Simonsen, the USA constantly appears like model of civilization. The hypothesis is that, as base of the proposals of industrialization defended by him there was an idea of Americanism that would serve of foundation to a way of thinking and acting. For Simonsen, the construction of a nation is directly related to its industrialization. In his thought, develop the Brazil means to structure the country with rational economic mechanisms. This paper investigates the American influences on the discourse of Simonsen about the development of Brazil.

Keywords: Americanism, development of Brazil, Simonsen, social discourse

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Authors: Ben D. Atkins

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This study will examine the impact of September 11, 2001, terrorist attacks on the organizational development of American federal law enforcement through focusing on the Federal Bureau of Investigation. Content analysis of discourse in a federal law enforcement practitioner publication along with official FBI statements will be used to gain a better understanding of FBI organizational changes that have taken place since the events of September 11, 2001. Analysis of content trends in the FBI Law Enforcement Bulletin and public discourse of FBI officials from 1999 to 2005 indicate that, in addition to structural changes, the bureau has also undergone a variety of cultural changes. The results offer some support for the institutional theoretical perspective, suggesting that post-9/11 organizational changes such as new mission priorities and the establishment of new branches were partially initiated due to a variety external pressures, which lends support for coercive isomorphism. Furthermore, structural changes are discussed in relation to the attainment and maintenance of organizational legitimacy.

Keywords: institutional theory, organizational theory, law enforcement, public administration

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Authors: P.P. Rupasinghe, A.H. Farid

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The Aleutian mink disease virus (AMDV, Carnivore amdoparvovirus 1) causes persistent infection, plasmacytosis, and formation and deposition of immune complexes in various organs in adult mink, leading to glomerulonephritis, arteritis and sometimes death. The disease has no cure nor an effective vaccine, and identification and culling of mink positive for anti-AMDV antibodies have not been successful in controlling the infection in many countries. The failure to eradicate the virus from infected farms may be caused by keeping false-negative individuals on the farm, virus transmission from wild animals, or neighboring farms. The identification of sources of infection, which can be performed by comparing viral sequences, is important in the success of viral eradication programs. High mutation rates could cause inaccuracies when viral sequences are used to trace back an infection to its origin. There is no published information on the mutation rate of AMDV either in vivo or in vitro. The in vivo estimation is the most accurate method, but it is difficult to perform because of the inherent technical complexities, namely infecting live animals, the unknown numbers of viral generations (i.e., infection cycles), the removal of deleterious mutations over time and genetic drift. The objective of this study was to determine the mutation rate of AMDV on which no information was available. A homogenate was prepared from the spleen of one naturally infected American mink (Neovison vison) from Nova Scotia, Canada (parental template). The near full-length genome of this isolate (91.6%, 4,143 bp) was bidirectionally sequenced. A group of black mink was inoculated with this homogenate (descendant mink). Spleen sampled were collected from 10 descendant mink after 16 weeks post-inoculation (wpi) and from anther 10 mink after 176 wpi, and their near-full length genomes were bi-directionally sequenced. Sequences of these mink were compared with each other and with the sequence of the parental template. The number of nucleotide substitutions at 176 wpi was 3.1 times greater than that at 16 wpi (113 vs 36) whereas the estimates of mutation rate at 176 wpi was 3.1 times lower than that at 176 wpi (2.85×10-3 vs 9.13×10-4 substitutions/ site/ year), showing a decreasing trend in the mutation rate per unit of time. Although there is no report on in vivo estimate of the mutation rate of DNA viruses in animals using the same method which was used in the current study, these estimates are at the higher range of reported values for DNA viruses determined by various techniques. These high estimates are logical based on the wide range of diversity and pathogenicity of AMDV isolates. The results suggest that increases in the number of nucleotide substitutions over time and subsequent divergence make it difficult to accurately trace back AMDV isolates to their origin when several years elapsed between the two samplings.

Keywords: Aleutian mink disease virus, American mink, mutation rate, nucleotide substitution

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Authors: T. Borja-Alvarez, V. Jiménez-Borja, M. Jiménez Borja, C. J. Jiménez-Mosquera

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Research on child sexual abuse has predominantly focused on female survivors. This has resulted in less research looking at the particular context in which this abuse takes place for boys and the impact this abuse may have on male survivors. The aim of this study is to examine the sex and age of the perpetrators of child sexual abuse and explore gender differences in the impact along with the subjective interpretation that survivors attribute to these experiences. The data for this study was obtained from Ecuadorian university students (M = 230, F = 293) who reported sexual abuse using the ISPCAN Child Abuse Screening Tool Retrospective version (ICAST-R). Participants completed Horowitz's Impact of Event Scale (IES) and were also requested to choose among neutral, positive, and negative adjectives to describe these experiences. The results indicate that in the case of males, perpetrators were both males (adults =27%, peers =20%, relatives =10.3%, cousins =7.4%) and young females (girlfriends or ex-girlfriends =25.6%, neighborhood =20.7%, school =16.7%, cousins =15.3%, strangers =12.8%). In contrast, almost all females reported that adult males were the perpetrators (relatives =29.6%, neighborhood =11.9%, strangers =19.9%, family friends =9.7%). Regarding the impact of these events, significant gender differences emerged. More females (50%) than males (20%) presented symptoms of post-traumatic stress disorder (PTSD). Gender differences also surfaced in the way survivors interpret their experiences. Almost half of the male participants selected the word “consensual” followed by the words “normal”, “helped me to mature”, “shameful”, “confusing”, and “traumatic”. In contrast, almost all females chose the word “non-consensual” followed by the words “shameful”, “traumatic”, “scary”, and “confusing”. In conclusion, the findings of this study suggest that young females and adult males were the most common perpetrators of sexually abused boys whereas adult males were the most common perpetrators of sexually abused girls. The impact and the subjective interpretation of these experiences were more negative for girls than for boys. The factors that account for the gender differences in the impact and the interpretation of these experiences need further exploration. It is likely that the cultural expectations of sexual behaviors for boys and girls in Latin American societies may partially explain the differential impact in the way these childhood sexual abuse experiences are interpreted in adulthood. In Ecuador, as is the case in other Latin American countries, the machismo culture not only accepts but encourages early sexual behaviors in boys and negatively judges premature sexual behavior in females. The result of these different sexual expectations may be that sexually abused boys may re-define these experiences as “consensual” and “normal” in adulthood, even though these were not consensual at the time of occurrence. Future studies are needed to more deeply understand the different contexts of sexual abuse for boys and girls in order to analyze the long-term impact of these experiences.

Keywords: abuse, child, gender differences, sexual

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Authors: Feguens Pierre

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For a long time, Latin American countries have been introduced to numerous programs and public policies focused on improving the agricultural sector in terms of sustainability, as well as in terms of the relationship between producers and consumers, aimed at improve farmers' income and allow consumers to have access to quality products, encouraging alternative agriculture. Therefore, in Brazil, among the programs, that is, the public policies that have encompassed alternative agriculture, in other words organic, we have the Community that Supports Agriculture (CSA) which ensures a relationship between producers and consumers focused on a solidarity economy, also protecting the environment. This work aims to understand the importance of the Community Supporting Agriculture (CSA), as well as the challenges it has faced over time. Particularly in the case of Brazil. A bibliographic methodology was used to theoretically analyze through several books and articles the performance of (CSA) in Brazil.

Keywords: community supporting agriculture, importance, challenges, producer, consumer

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Authors: Stuart Noel

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In a streetcar Named Desire, Tennessee Williams presents Blanche DuBois, a most complex and intriguing character who often uses prestige language to project the image of an upper-class speaker and to disguise her darker and complicated self. She embodies various fascinating and contrasting characteristics. Like New Orleans (the locale of the play), Blanche represents two opposing images. One image projects that of genteel, Southern charm and beauty, speaking formally and using prestige language and what some linguists refer to as “hypercorrection,” and the other image reveals that of a soiled, deteriorating façade, full of decadence and illusion. Williams said on more than one occasion that Blanche’s use of such language was a direct reflection of her personality and character (as a high school English teacher). Prestige language is an exaggeratedly elevated, pretentious, and oftentimes melodramatic form of one’s language incorporating superstandard or more standard speech than usual in order to project a highly authoritative individual identity. Speech styles carry personal identification meaning not only because they are closely associated with certain social classes but because they tend to be associated with certain conversational contexts. Features which may be considered to be “elaborated” in form (for example, full forms vs. contractions) tend to cluster together in speech registers/styles which are typically considered to be more formal and/or of higher social prestige, such as academic lectures and news broadcasts. Members of higher social classes have access to the elaborated registers which characterize formal writings and pre-planned speech events, such as lectures, while members of lower classes are relegated to using the more economical registers associated with casual, face-to-face conversational interaction, since they do not participate in as many planned speech events as upper-class speakers. Tennessee Williams’s work is characteristically concerned with the conflict between the illusions of an individual and the reality of his/her situation equated with a conflict between truth and beauty. An examination of Blanche DuBois reveals a recurring theme of art and decay and the use of prestige language to reveal artistry in language and to hide a deteriorating self. His graceful and poetic writing personifies her downfall and deterioration. Her loneliness and disappointment are the things so often strongly feared by the sensitive artists and heroes in the world. Hers is also a special and delicate human spirit that is often misunderstood and repressed by society. Blanche is afflicted with a psychic illness growing out of her inability to face the harshness of human existence. She is a sensitive, artistic, and beauty-haunted creature who is avoiding her own humanity while hiding behind her use of prestige language. And she embodies a partial projection of Williams himself.

Keywords: American drama, prestige language, Southern American literature, Tennessee Williams

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Authors: Max Butler

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Melanoma accounts for 80% of skin cancer-related deaths globally. The poor prognosis and increasing incidence of melanoma impose a significant burden on global healthcare systems. Early detection, precise diagnosis, and preventative strategies are critical to improving patient outcomes. Dermoscopy is the gold standard for specialist assessments of pigmented skin lesions, as it can differentiate between benign and malignant growths with greater accuracy than visual inspection. In the United Kingdom, guidelines from the National Institute of Clinical Excellence (NICE) state dermoscopy should be used in all specialist assessments of pigmented skin lesions. Compliance with this guideline is low, resulting in missed and delayed melanoma diagnoses. To address this problem, a quality improvement project was initiated at Buckinghamshire Healthcare Trust (BHT) within the plastic surgery department. The target group was a trainee and consultant plastic surgeons conducting outpatient skin cancer clinics. Analysis of clinic documentation over a one-month period found that only 62% (38/61) of patients referred with pigmented skin lesions were examined using dermoscopy. To increase dermoscopy rates, teaching was delivered to the department highlighting national guidelines and the evidence base for dermoscopic examination. In addition, clinic paperwork was redesigned to include a text box for dermoscopic examination. Reauditing after the intervention found a significant increase in dermoscopy rates (52/61, p = 0.014). In conclusion, implementing a quality improvement project with targeted teaching and documentation template templates successfully increased dermoscopy rates. This is a promising step toward improving early melanoma detection and patient outcomes.

Keywords: melanoma, dermoscopy, plastic surgery, quality improvement

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Authors: Valentine Ubanako

Abstract:

This paper investigates a situation that has given rise to a particular kind of variety or category of users of English in Cameroon which I have called here Non-native expatriate English (Users). This paper asserts that Non-expatriates in Cameroon (those who work for native speakers of English) use English in a peculiar manner which is worth investigating. This paper thus looks into the kind of English they use and their attitudes towards other users of different varieties of English and how these non-native expatriates form new identities and try to negotiate social ascendency within a local context. Data for this paper is collected through observation, interviews and questionnaires. Some Cameroonians, especially the educated, believe that they must move to Europe or America, study to a very high level and struggle to be like the white man whereas, the lowly educated (working with native English expatriates), are living their European and American dream in Cameroon among their brothers. Thus, educational attainment is not a necessary criterion for social ascendency.

Keywords: non-native expatriate English, native expatriates, varieties of English, English language, linguistics

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Authors: Huseyin Cetin, Halil Akmese, Sercan Aras, Vahit Aytekin

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Economic crisis, terrorism, global crisis and the relations between countries are the factors affecting tourism industry and tourism industry is vulnerable against these factors. In our study, there are two dimensions about Russian crisis. The crisis between Russia and Ukraine and decreased oil prices in global market have been entailed Russian economic crisis. This crisis has induced that the ruble, Russian currency, has depreciated against American dollars and consequently the purchasing power of Russian has weakened. This is the first dimension of our study. Second dimension is a political crisis between Turkey and Russia owing to the fact that the Russian Warcraft was brought down by Turkish army. The aim of this study is to explain the impact of the consequences of Russian crisis on Turkish tourism industry. The study has been limited only Antalya province.

Keywords: economic crisis, Turkey-Russian crisis, Turkey's tourism industry, tourism in Turkey

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Authors: Marta Kozuń, Krystian Toczewski, Sylwester Gerus, Justyna Wolicka, Kamila Boberek, Jarosław Filipiak, Dariusz Patkowski

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Long gap esophageal atresia is a congenital defect and is a challenge for pediatric surgeons all over the world. There are different surgical techniques in use to treat atresia. One of them is esophageal elongation but the optimal suture placement technique to achieve maximum elongation with low-risk complications is still unknown. The aim of the study was to characterize the process of esophageal elongation from the biomechanical point of view. Esophagi of white Pekin Duck was used as a model based on the size of this animal which is similar to a newborn (2.5-4kg). The specimens were divided into two groups: the control group (CG) and the group with sutures (SG). The esophagi of the control group were mounted in the grips of the MTS Tytron 250 testing machine and tensile test until rupture was performed. The loading speed during the test was 10mm/min. Then the SG group was tested. Each esophagus was cut into two equal parts and that were fused together using surgical sutures. The distance between both esophagus parts was 20mm. Ten both ends were mounted on the same testing machine and the tensile test with the same parameters was conducted. For all specimens, force and elongation were recorded. The biomechanical properties, i.e., the maximal force and maximal elongation, were determined on the basis of force-elongation curves. The maximal elongation was determined at the point of maximal force. The force achieved with the suture group was 10.1N±1.9N and 50.3N±11.6N for the control group. The highest elongation was also obtained for the control group: 18mm±3mm vs. 13.5mm ±2.4mm for the suture group. The presented study expands the knowledge of elongation of esophagi. It is worth emphasizing that the duck esophagus differs from the esophagus of a newborn, i.e., its wall lacks striated muscle cells. This is why the parts of animal esophagi used in the research are may characterized by different biomechanical properties in comparison with newborn tissue.

Keywords: long gap atresia treatment, esophageal elongation, biomechanical properties, soft tissue

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Authors: Thi. A. D. Tran, Matthieu Arnold, Dominique Adolphe, Laurence Schcher, Guillaume Reys

Abstract:

During daily oral health cares, dental surgeons are in contact with numerous potentially infectious germs from patients' saliva and blood. In order to take into account these risks, a product development process has been unrolled to propose to the dental surgeon a personal protection equipment that is suitable with their expectations in terms of images, protection and comfort. After a consumer study, to evaluate how the users wear the garment and their expectations, specifications have been carried out and technical solutions have been developed in order to answer to the maximum of the desiderata. Thermal studies and comfort studies have been performed. The obtained results lead to define the technical solutions concerning the design of the new scrub. Three main functions have been investigated, the ergonomic aspect, the protection and the thermal comfort. In terms of ergonomic aspect, instrumented garments have been worn and pressure measurements have been done. The results highlight that a raglan shape for the sleeves has to be selected for a better dynamic comfort. Moreover, spray tests helped us to localize the potential contamination area and therefore protection devices have been placed on the garment. Concerning the thermal comfort, an I-R study was conducted in consulting room under the real working conditions; the heating zones have been detected. Based on these results, solutions have been proposed and implemented in a new gown. This new gown is currently composed of three different parts; a protective layer placed in the chest area to avoid contamination; a breathable layer placed in the back and in the armpits and a normal PET/Cotton fabric for the rest of the gown. Through the fitting tests conducted in hospital, it was obtained that the new design was highly appreciated. Some points can nevertheless be further improved. A final product will be produced based on necessary improvements.

Keywords: comfort, dentists, garment, thermal

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Authors: Nicole Kalemba, Fernando Campa-Planas, Ana-Beatriz Hernández-Lara, Maria Victória Sánchez-Rebull

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The purpose of this paper is to determine the effects of service quality on US airlines’ economic performance. In order to cover this goal, it has been considered four different indexes of service quality in the air transportation industry, and also two indicators of economic performance, revenues and return on investment (ROI). Data from American airline companies over a period that covers from 2006 to 2013 have been used in order to determine if airlines’ profitability increases when service quality improves. Considering the effects on airlines’ profitability, the results confirm the positive and significant influence of service quality on the ROI of the companies in our study. Meanwhile, a non-significant effect was found for airline revenues related to quality. No previous research in this area has been done and these findings could encourage airline companies to invest in quality as far as this policy can have a return on their profitability.

Keywords: airlines, economic performance, key performance indicators, quality

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Authors: Ayyoub Jamali, Jennie Edlund, Alena Kozlová

Abstract:

This paper evaluates the monitoring, prevention, and enforcing mechanisms of the core values of international organisations (IOs) in a comparative human rights perspective. The IOs in focus are the European Union, the Council of Europe, the African Union, and the Organization of American States. The paper will take the founding treaties of these IOs and their relevant protocols as a starting point to identify the values and the mechanisms used for their implementation. It will explore the scope of violations, the procedures in place and evaluate what type of response to those breaches seems to work best in terms of achieving its declared objectives. The study will identify and compare the weaknesses and strengths of each mechanism used by the IOs and recognize common challenges and means, thereby drawing inter-organizational comparisons. Consequently, the findings of this paper can be used among the IOs to improve their system and thus enhance their effectiveness.

Keywords: international organizations, core values, human rights, enforcement mechanism, compliance

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Authors: Rimel Mwamba, Mohan Gundeti

Abstract:

Introduction: The use of robot-assisted laparoscopic surgeries (RALS) has largely increased in recent years, offering faster and safer treatment options for pediatric patients. In the field of urology, RALS has shown a significant advantage over laparoscopic and open surgeries but continues to be controversial in pediatric cases due to limited comprehensive data on its use. Methods: In this review, we aim to summarize the factors associated with RALS use in pediatric cases involving pyeloplasty, ureteral reimplantation, heminephrectomy, and lower urinary tract reconstruction. We used PubMed, EMBASE, and the Cochrane Database of Systematic Reviews to systematically search for literature on the topic. We then critically assessed and compiled data on RALS outcomes, complications, and associated factors. Results: To date, numerous comparative studies have been conducted on pediatric RALS, with only one randomized control trial investigating the nuances of robotic use against standard of care treatments. These robotic approaches have shown promise in post-surgical outcomes for pediatric patients undergoing upper and lower urinary tract reconstruction. Barriers to use still persist, however, showcasing a need to increase access to the technology, refine instruments for pediatric use, address cost barriers, and provide proper training for surgeons. Conclusion: RALS providesan opportunity to improve pediatric patient outcomes for numerous urologic complications. Additional studies are required to better compare the use of RALS with current standard practices. Due to the difficult nature of conducting randomized control trials, additional prospective observational studies are needed.

Keywords: pediatric urology, robot-assisted laparoscopic surgeries (RALS), pyeloplasty, ureteral reimplantation, heminephrectomy, and lower urinary tract reconstruction

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