Search results for: needle stick injuries

Authors: Thampi Rawther, Jack Cecire, Andrew Sutherland

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Introduction: CT facilitates the diagnosis of potentially life-threatening injuries and facilitates early management. There is evidence that reduced CT acquisition time reduces mortality and length of hospital stay. Currently, there are variable recommendations for ideal timing. Indeed, the NHS standard contract for a major trauma service and STAG both recommend immediate access to CT within a maximum time of 60min and appropriate reporting within 60min of the scan. At Coffs Harbour Health Campus (CHHC), a CT radiographer is on site between 8am-11pm. Aim: To investigate the average time to CT at CHHC and assess for any significant relationship between time to CT and injury severity score (ISS) or time of triage. Method: All major trauma calls between Jan 2021-Oct 2021 were audited (N=87). Patients were excluded if they went from ED to the theatre. Time to CT is defined as the time between triage to the timestamp on the first CT image. Median and interquartile range was used as a measure of central tendency as the data was not normally distributed, and Chi-square test was used to determine association. Results: The median time to CT is 51.5min (IQR 40-74). We found no relationship between time to CT and ISS (P=0.18) and time of triage to time to CT (P=0.35). We compared this to other centres such as John Hunter Hospital and Gold Coast Hospital. We found that the median CT acquisition times were 76min (IQR 52-115) and 43min, respectively. Conclusion: This shows an avenue for improvement given 35% of CT’s were >30min. Furthermore, being proactive and aware of time to CT as an important factor to trauma management can be another avenue for improvement. Based on this, we will re-audit in 12-24months to assess if any improvement has been made.

Keywords: imaging, rural surgery, trauma surgery, improvement

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Authors: Asamaporn Puetpaiboon, Sunisa Chatmongkolchart, Nalinee Kovitwanawong, Osaree Akaraborworn

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Traumatic patients with massive bleeding require intensive resuscitation. The actual cost of anesthesia per case has never been clarified, so our study aimed to quantify the direct cost, and cost-to-charge ratio of anesthetic care in traumatic patients with intraoperative massive bleeding. This study was a prospective, observational, cost analysis study, conducted in Prince of Songkla University hospital, Thailand, with traumatic patients, of any mechanisms being recruited. Massive bleeding was defined as estimated blood loss of at least one blood volume in 24 hours, or a half of blood volume in 3 hours. The cost components were identified by the micro-costing method, and valued by the bottom-up approach. The direct cost was divided into 4 categories: the labor cost, the capital cost, the material cost and the cost of drugs. From September 2017 to August 2018, 10 patients with multiple injuries were included. Seven patients had motorcycle accidents, two patients fell from a height and another one was in a minibus accident. Two patients died on the operating table, and another two died within 48 hours. The median Sequential Organ Failure Assessment (SOFA) score was 8. The median intraoperative blood loss was 3,500 ml. The median direct cost, per case, was 250 United States Dollars (2017 exchange rate), and the cost-to-charge ratio was 0.53. In summary, the direct cost was nearly half of the hospital charge, for these traumatic patients with massive bleeding. However, our study did not analyze the indirect cost.

Keywords: cost, cost-to-charge ratio, micro-costing, trauma

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Authors: Abdulsalam Abiodun Salman, Abdulmumin Isah

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The study investigated the motivational factors that could enhance the teaching and understanding of ICT-driven cataloguing and classification (Cat and Class) practical classes among students of library and information science (LIS) in Kwara State Library Schools, Nigeria. It deployed a positivist research paradigm using a quantitative method by deploying the use of questionnaires for data collection. The population of the study is one thousand, one hundred and twenty-five (1,125) which was obtained from the department of each respective library school (the University of Ilorin, Ilorin (Unilorin); Federal Polytechnic Offa, (Fedpoffa); and Kwara State University (KWASU). The sample size was determined using the research advisor table. Hence, the study sample of one hundred and ten (110) was used. The findings revealed that LIS students were averagely motivated toward ICT-driven Cataloguing and Classification practical classes. The study recommended that modern cataloguing and classification tools for practical classes should be made available in the laboratories as motivational incentives for students. It was also recommended that library schools should motivate the students beyond the provision of these ICT-driven tools but also extend the practical class periods. Availability and access to medical treatment in case of injuries during the practical classes should be made available. Technologists/Tutors of Cat and Class practical classes should also be exposed to further training in modern trends, especially emerging digital knowledge and skills in cataloguing and classification. This will keep both the tutors and students abreast of the new development in the technological arena.

Keywords: cataloguing and classification, motivational factors, ICT-driven practical classes, LIS students, Nigeria

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Authors: Olajumoke A. Ojeleye

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The study assessed the patterns and extent of self-medication practice among adolescents in selected public senior secondary schools in Ife Central Local Government Area of Osun State. The objectives of the study were to find out the patterns of self-medication among adolescents, to elucidate whether age or gender has any effect on the self-medication patterns of adolescent, to ascertain to what extent adolescents indulge in self-medication, to examine the sources of drug information of these adolescents and also to examine the sources of these drugs. A cross-sectional design was employed for the study. A self-administered questionnaire tested for validity was used to collect data. Multistage sampling technique was used and 238 adolescents participated in the study. Data collection took two weeks and was analysed using Statistical Package for Social Sciences version 17. Results were presented using descriptive (e.g. frequency counts) and inferential statistics (e.g. chi-square). Results showed that more females (55.9%) than males (44.1%) practiced self-medication. Although the results showed that there is a low prevalence rate (33.6%) of self-medication among adolescents, chemists served as both the source of information on how to use the drug as well as the source of the drugs. Also, adolescents under study will only self-medicate in medical conditions such as malaria or wound/injuries but will prefer to see a doctor for conditions such as abdominal pain, infections or allergic reactions. It was recommended that government officials responsible for regulating and controlling of drugs should be more active in ensuring that safe drugs are made available over the counter and the consumer be given adequate information about the use of drugs and when to consult the doctor.

Keywords: adolescents, drugs, patterns, self-medication

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Authors: Zahra Heydari

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Introduction: One of the major clinical issues is acute renal failure, which is caused by ischemia-reperfusion of the kidney and is associated with high mortality. Despite advances in this area, important issues such as tissue necrosis, cell apoptosis, and so on in damaged tissue are suggestive for more researches and study on this subject. Objective: Evaluation of the potential utility of Ezetimibe in reducing injuries and cell death induced by kidney ischemia/ reperfusion through inducing expression changes of different cellular pathways in adult Sprague-Dawley rats. Materials and methods: Forty rats weighing 180-200g were divided into 4 groups. For this purpose, the first right kidneys of the rats were removed during surgery. After 20 days, the left renal artery was closed with a soft clamp and reperfusion was performed. After 24 hours, blood samples were collected and sent to the laboratory with kidneys to measure bax and bcl-2 by Western blotting and histopathological tests. Results: Quantitative damage reviews of Kidney tissue indicates damage Acute and severe tubular lesions were observed in the ischemia group. Also, the amount of injury was significantly reduced in the treatment group. There was also a significant difference between the ischemia and sham groups. In general, the results show that a single dose of 1.2 mg/kg of ezetimibe can reduce the bax/ bcl-2 ratio compared to the ischemia group. In general, the results showed Ezetimibe is effective in reducing cell damage and death due to ischemia/ reperfusion after renal ischemia through changes in the expression of various cellular pathways in rats.

Keywords: acute renal failure, renal ischemia-reperfusion injury, ezetimibe, apoptosis

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Authors: V. M. B. K. T. Malwanage, S. Samita

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Core stability is one of the major determinants that contribute to preventing injuries, enhance performance, and improve quality of life of the human. Endurance of the four major muscle groups of the central ‘core’ of the human body is identified as the most reliable determinant of core stability amongst the other numerous causes which contribute to readily make one’s core stability. This study aimed to develop a ‘Core Stability Index’ to confer a single value for an individual’s core stability based on the four endurance test scores. Since it is possible that at least some of the test scores are not independent, possibility of constructing a single index using the multivariate method exploratory factor analysis was investigated in the study. The study sample was consisted of 400 healthy young individuals with the mean age of 23.74 ± 1.51 years and mean BMI (Body Mass Index) of 21.1 ± 4.18. The correlation analysis revealed highly significant (P < 0.0001) correlations between test scores and thus construction an index using these highly inter related test scores using the technique factor analysis was justified. The mean values of all test scores were significantly different between males and females (P < 0.0001), and therefore two separate core stability indices were constructed for the two gender groups. Moreover, having eigen values 3.103 and 2.305 for males and females respectively, indicated one factor exists for all four test scores and thus a single factor based index was constructed. The 95% reference intervals constructed using the index scores were -1.64 to 2.00 and -1.56 to 2.29 for males and females respectively. These intervals can effectively be used to diagnose those who need improvement in core stability. The practitioners should find that with a single value measure, they could be more consistent among themselves.

Keywords: construction of indices, endurance test scores, muscle endurance, quality of life

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Authors: C. K. Kishore Kumar, B. P. Aruna

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We have made an attempt to analyze the role of sports in the contemporary society. This paper critically analyses how developed as well as developing countries spend huge amount of money every year in conducting various sports and games, development of sports infrastructure, manufacturing of sports equipment and get into bidding to organize international events like Olympic, World Cup games like foot ball, soccer, tennis etc., Throughout the world, Sports and Commerce have joined together. Sports in today’s world has become a large profit making industry. An attempt is further made to understand that the players or sports persons are only a small part of this huge industry, more than the players, there are various other people, corporations, Nation as a whole who are making huge profits from the sports industry. This industrialization has indeed changed the whole scenario of sports. Top level sports are purely a business nowadays and so fans are sucked into believing they are part of their club. In reality they are merely cash cows to be milked by a greedy, grasping and corrupt business that cares nothing but making money. In no previous time period have we seen the type of growth in the commercialization of sports that we have seen in the last 3 decades. Athletes are leveled with prize money and/or appearances fees so much so, that injuries may be ignored, educational opportunities are put aside in the quest for success which is ultimately money. Industrialization and commercialization of sports has taken a key role in the economic development of the country. The purpose of this paper is to explore as to how sports once considered as a leisure time activity has become an activity for money and in turn has taken a lead role in the economic development of a country.

Keywords: contemporary society, economic development, industrialization of sports, commercialization of sports, leisure time activity

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Authors: Raheel Shakoor Siddiqui, Sanjay Narayana Murthy, Manikandar Srinivas Cheruvu, Kash Akhtar

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Major trauma is a dynamic public health epidemic that is continuously evolving. Major trauma care services rely on multi-disciplinary team input involving highly trained pre and in-hospital critical care teams. Pre-hospital critical care teams (PHCCTs), major trauma centres (MTCs), trauma units, and rehabilitation facilities all form an efficient and organised trauma system. England comprises 27 MTCs funded by the National Health Service (NHS). Major trauma care entails enhanced resuscitation protocols coupled with the expertise of dedicated trauma teams and rapid radiological imaging to improve trauma outcomes. Literature reports a change in the demographic of major trauma as elderly patients (silver trauma) with injuries sustained from a fall of 2 metres or less commonly present to services. Evidence of an increasing population age with multiple comorbidities necessitates treatment within the first hour of injury (golden hour) to improve trauma survival outcomes. Staffing and funding pressures within the NHS have subsequently led to a shortfall of available physician-led PHCCTs. Thus, there is a strong emphasis on targeted research and funding to appropriately deploy resources to deprived areas. This review article will discuss the current English trauma system whilst critically appraising present challenges, identifying insufficiencies, and recommending aims for an improved future trauma system in England.

Keywords: trauma, orthopaedics, major trauma, trauma system, trauma network

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Authors: A. M. Prasad

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Knowledge of variations of nerves of gluteal region is important for clinicians administering intramuscular injections, for orthopedic surgeons dealing with the hip surgeries, possibly for physiotherapists managing the painful conditions and paralysis of this region. Herein, we report multiple variations of the nerves of gluteal region. In the current case, the sciatic nerve was absent. The common peroneal and tibial nerves arose from sacral plexus and reached the gluteal region through greater sciatic foramen above and below piriformis respectively. The common peroneal nerve gave a muscular branch to the gluteus maximus. The inferior gluteal nerve and posterior cutaneous nerve of the thigh arose from a common trunk. The common trunk was formed by three roots. Upper and middle roots arose from sacral plexus and entered gluteal region through greater sciatic foramen respectively above and below piriformis. The lower root arose from the pudendal nerve and joined the common trunk. These variations were seen in the right gluteal region of an adult male cadaver aged approximately 70 years. Innervation of gluteus maximus by common peroneal nerve and presence of a common trunk of inferior gluteal nerve and posterior cutaneous nerve of the thigh make this case unique. The variant nerves may be subjected to iatrogenic injuries during surgical approach to the hip. They may also get compressed if there is a hypertrophy of the piriformis syndrome. Hence, the knowledge of these variations is of importance to clinicians, orthopedic surgeons and possibly for physiotherapists.

Keywords: gluteal region, multiple variations, nerve injury, sciatic nerve

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Authors: Kwei Huan Liw, Sashi B. Darshan

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Background: Double eyelid surgery has become one of the most sought-after aesthetic procedures among Asians. Many surgeons perform surgical blepharoplasty and various other methods of non-incisional blepharoplasty. Face-Q is a validated method of measuring patient satisfaction for facial aesthetic procedures. Here we have analyzed the overall eye satisfaction score, the upper eyelid appraisal score and the adverse effect on eyes score Methods: 274 patients (548 eyes), aged between 18 to 40 years old, were recruited from 2015-2018. Each patient underwent a non-incisional double-eyelid blepharoplasty using a single-knotted continuous buried suture. 3 – 5 stab incisions were made depending on the upper eyelid size. A needle loaded with 7-0 nylon is passed from the lateral most wound through the dermis and the conjunctiva in an alternate fashion into the remaining stab wounds. The suture is then tunneled back laterally in the deeper dermis and knotted securely with the suture end. The knot is then buried within the orbicularis oculi muscle. Each patient was required to fill the Face-Q questionnaire before the procedure and 2 weeks post procedure. The results are described based on the percentage of the maximum achievable score. Patients were reviewed after 12 to 18 months to assess the long-term outcome. Results: The overall eye satisfaction score demonstrated a high level of post-operative satisfaction (97.85%), compared to 27.32% pre-operatively. The appraisal of upper eyelid scores showed drastic improvement in perception post-operatively (95.31%) compared to 21.44% pre-operatively. Adverse effect on eyes score showed a very low post-operative complication rate (0.4%) The long-term follow-up showed 6 cases that had developed asymmetrical folds. Only 1 patient agreed for revision surgery. The other 5 patients were still satisfied with the outcome and were not keen for revision surgery. None of the cases had loosening of knots. Conclusion: Modified single-knot continuous buried suture technique is a simple and non-invasive method to create aesthetically pleasing non-surgical double-eyelids, which has long-term effects. Proper patient selection is crucial and good surgical technique is required to achieve a desirable outcome.

Keywords: blepharoplasty, double-eyelid, face-Q, non-incisional

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Authors: Hayley Lawrence, Nabi Shah, Sarah Dyer

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Aims: Lumbar punctures are a common bedside procedure performed in acute medicine. Published guidance exists on the standardised documentation of invasive procedures in order to reduce the risk of complications. The audit aim was to assess current standards of documentation in accordance with both the GMC and the National Standards for Invasive Procedures guidelines. A second cycle was conducted after introducing a standardised sticker created using current guidelines. This would assess whether the sticker improved documentation, aiming for 100% standard in each step of the procedure. Methods: An initial prospective audit of current practice was conducted over a 3-month period. Patients were identified by their presenting complaints and by colleagues assessing acute medical patients. Initial findings were presented locally, and a further prospective audit was conducted following the implementation of a standardised sticker. Results: 19 lumbar punctures were included in the first cycle and 13 procedures in the second. Pre-procedure documentation was collected for each cycle, whereby documentation of ‘Indication’ improved from 5.3% to 84.6%, ‘Consent’ from 84.2% to 100%, ‘Coagulopathy’ from 0% to 61.5%, ‘Drug Chart checked’ from 0% to 100%, ‘Position of patient’ from 26.3% to 100% and use of ‘Aseptic Technique’ from 83.3% to 100% from the first to the second cycle respectively. ‘Level of Doctor’ and ‘Supervision’ decreased from 53% to 31% and 53% to 46%, respectively, in the second cycle. Documentation of the procedure itself also demonstrated improvements, with ‘Level of Insertion’ 15.8% to 100%, ‘Name of Antiseptic Used’ 11.1% to 69.2%, ‘Local Anaesthetic Used’ 26.3% to 53.8%, ‘Needle Gauge’ 42.1% to 76.9%, ‘Number of Attempts’ 78.9% to 100% and ‘Traumatic/Atraumatic’ procedure 26.3% to 92.3%, respectively. A similar number of opening pressures were documented in each cycle at 57.9% and 53.8%, respectively, but its documentation was deemed ‘Not Applicable’ in a higher number of patients in the second cycle. Post-procedure documentation improved, with ‘Number of Samples obtained’ increasing from 52.6% to 92.3% and documentation of ‘Immediate Complications’ increasing from 78.9% to 100%. ‘Dressing Applied’ was poorly documented in the first cycle at 16.7%. This was not included on the standardised sticker, resulting in 0% documentation in the second cycle. Documentation of Clinicians’ Name and Bleep reduced from 63.2% to 15.4%, but when the name only was analysed, this increased to 84.6%. Conclusions: Standardised stickers for lumbar punctures do improve documentation and hence should result in improved patient safety. There is still room for improvement to reach 100% standard in each area, especially with respect to the clinician’s name and contact details being documented. Final adjustments will be made to the sticker before being included in a lumbar puncture kit, which will be made readily available in the acute medical wards. Future audits could be extended to include other common bedside procedures performed in acute medicine to ensure documentation of all these procedures reaches 100% standard.

Keywords: invasive procedure, lumbar puncture, medical record keeping, procedure checklist, procedure documentation, standardised documentation

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Authors: Gayan Mapitiya

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Maintaining good occupational health and safety (OHS) performance is significant at the coalface, especially in industries such as mining, power, and construction. Coalface workers are vulnerable to high OHS risks such as working at heights, working with mobile plants and vehicles, working with underground and above ground services, chemical emissions, radiation hazards and explosions at everyday work. To improve OHS performance of workers, OHS key performance indicators (KPIs) (for example, lost time injuries (LTI), serious injury frequency rate (SIFR), total reportable injury frequency rate (TRIFR) and number of near misses) are widely used by managers in making OHS business decisions such as investing in safety equipment and training programs. However, in many organizations, workers at the coalface hardly see any relevance or value addition of OHS KPIs to their everyday work. Therefore, the aim of the study was to understand why coalface workers perceive that OHS KPIs are not practically relevant to their jobs. Accordingly, this study was conducted as a qualitative case study focusing on a large electricity and gas firm in Australia. Semi-structured face to face interviews were conducted with selected coalface workers to gather data on their attitude towards OHS KPIs. The findings of the study revealed that workers at the coalface generally have no understanding of the purpose of KPIs, the meaning of each KPI, origin of KPIs, and how KPIs are correlated to organizational performance. Indeed, KPIs are perceived as ‘meaningless obstacles’ imposed on workers by managers without a rationale. It is recommended to engage coalface workers (a fair number of representatives) in both KPIs setting and revising processes while maintaining a continuous dialogue between workers and managers in regards OHS KPIs.

Keywords: KPIs, coalface, OHS risks, case-study

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Authors: Efua Ehiaguina, Haruna Moda

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Interest in the development of appropriate safety culture in the oil and gas industry has taken centre stage among stakeholders in the industry. Human behaviour has been identified as a major contributor to occupational accidents, where abnormal activities associated with safety management are taken as normal behaviour. Poor safety culture is one of the major factors that influence employee’s safety behaviour at work, which may consequently result in injuries and accidents and strengthening such a culture can improve workers safety performance. Nigeria oil and gas industry has contributed to the growth and development of the country in diverse ways. However, in terms of safety and health of workers, this industry is a dangerous place to work as workers are often exposed to occupational safety and health hazard. To ascertain the impact of employees’ safety and how it impacts health and safety compliance within the local industry, online safety culture survey targeting frontline workers within the industry was administered covering major subjects that include; perception of management commitment and style of leadership; safety communication method and its resultant impact on employees’ behaviour; employee safety commitment and training needs. The preliminary result revealed that 54% of the participants feel that there is a lack of motivation from the management to work safely. In addition, 55% of participants revealed that employers place more emphasis on work delivery over employee’s safety on the installation. It is expected that the study outcome will provide measures aimed at strengthening and sustaining safety culture in the Nigerian oil and gas industry.

Keywords: oil and gas safety, safety behaviour, safety culture, safety compliance

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Authors: Hannah K. M. Tang, Muhammad Ateeq, Mark J. Lake, Badr Abdullah, Frederic A. Bezombes

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Based on a theoretical assessment of current literature, virtual reality (VR) could help to treat sporting injuries in a number of ways. However, it is important to obtain rehabilitation specialists’ perspectives in order to design, develop and validate suitable content for a VR application focused on treatment. Subsequently, a one-day observation and interview study focused on the use of VR for the treatment of lower limb musculoskeletal conditions in athletes was conducted at St George’s Park England National Football Centre with rehabilitation specialists. The current paper established the methods suitable for obtaining practitioner’s viewpoints through observation and interview in this context. Particular detail was provided regarding the method of qualitatively processing interview results using the qualitative data analysis software tool NVivo, in order to produce a narrative of overarching themes. The observations and overarching themes identified could be used as a framework and success criteria of a VR application developed in future research. In conclusion, this work explained the methods deemed suitable for obtaining practitioner’s viewpoints through observation and interview. This was required in order to highlight characteristics and features of a VR application designed to treat lower limb musculoskeletal injury of athletes and could be built upon to direct future work.

Keywords: athletes, lower-limb musculoskeletal injury, rehabilitation, return-to-sport, virtual reality

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Authors: Rabie Fadil, Parshuram Aarotale, Shubha Majumder, Bijay Guargain

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Hemorrhage is the loss of blood from the circulatory system and leading cause of battlefield and postpartum related deaths. Early detection of hemorrhage remains the most effective strategy to reduce mortality rate caused by traumatic injuries. In this study, we investigated the physiological changes via non-invasive cardiac signals at rest and under different hemorrhage conditions simulated through graded lower-body negative pressure (LBNP). Simultaneous electrocardiogram (ECG), photoplethysmogram (PPG), blood pressure (BP), impedance cardiogram (ICG), and phonocardiogram (PCG) were acquired from 10 participants (age:28 ± 6 year, weight:73 ± 11 kg, height:172 ± 8 cm). The LBNP protocol consisted of applying -20, -30, -40, -50, and -60 mmHg pressure to the lower half of the body. Beat-to-beat heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean aerial pressure (MAP) were extracted from ECG and blood pressure. Systolic amplitude (SA), systolic time (ST), diastolic time (DT), and left ventricle Ejection time (LVET) were extracted from PPG during each stage. Preliminary results showed that the application of -40 mmHg i.e. moderate stage simulated hemorrhage resulted significant changes in HR (85±4 bpm vs 68 ± 5bpm, p < 0.01), ST (191 ± 10 ms vs 253 ± 31 ms, p < 0.05), LVET (350 ± 14 ms vs 479 ± 47 ms, p < 0.05) and DT (551 ± 22 ms vs 683 ± 59 ms, p < 0.05) compared to rest, while no change was observed in SA (p > 0.05) as a consequence of LBNP application. These findings demonstrated the potential of cardiac signals in detecting moderate hemorrhage. In future, we will analyze all the LBNP stages and investigate the feasibility of other physiological signals to develop a predictive machine learning model for early detection of hemorrhage.

Keywords: blood pressure, hemorrhage, lower-body negative pressure, LBNP, machine learning

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Authors: Salaheddine Bendak, Sara S. Alnaqbi

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The seat belt is a vital tool in improving traffic safety conditions and minimising injuries due to traffic accidents. Most developing countries are facing a big problems associated with the human and financial losses due to traffic accidents. One way to minimise these losses is the use of seat belts by passengers both in the front and rear seats of a vehicle; however, at the same time, close to nothing is known about the rates of seat belt utilisation among rear seat passengers in many developing countries. Therefore, there is a need to estimate these rates in order to know the extent of this problem and how people interact with traffic safety measures like seat belts and find demographic characteristics that contribute to wearing or non-wearing of seat belts with the aim of finding solutions to improve wearing rates. In this paper, an observational study was done to gather data on restraints use in motor vehicle rear seats in eight observational stations in a rapidly developing country, the United Arab Emirates (UAE), and estimate a use rate for the whole country. Also, a questionnaire was used in order to study demographic characteristics affecting the wearing of seatbelts in rear seats. Results of the observational study showed that the overall wearing/usage rate was 12.3%, which is considered very low when compared to other countries. Survey results show that single, male, less educated passengers from Arab and South Asian backgrounds use seat belts reportedly less than others. Finally, solutions are put forward to improve this wearing rate based on the results of this study.

Keywords: Seat belts, traffic crashes, United Arab Emirates, rear seats

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Authors: Ahmed Gonnah, Omar Masoud, Mohamed Abdel-Wahab, Ahmed ElMosalamy, Abdulrahman Al-Naseem

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Introduction: Fibroadenomas are solid, mobile, and non-tender benign breast lumps, with the highest prevalence amongst young women aged between 15 and 35. Symptoms can include discomfort, and they can become problematic, particularly when they enlarge, resulting in many referrals for biopsies, with fibroadenomas accounting for 30-75% of the cases. Diagnosis is based on triple assessment that involves a clinical examination, ultrasound imaging and mammography, as well as core needle biopsies. Current management includes observation for 6-12 months, with the indication of definitive surgery, in cases that are older than 35 years or with fibroadenoma persistence. Serious adverse effects of surgery might include nipple-areolar distortion, scarring and damage to the breast tissue, as well as the risks associated with surgery and anesthesia, making it a non-feasible option. Methods: A literature search was performed on the databases EMBASE. MEDLINE/PubMed, Google scholar and Ovid, for English language papers published between 1st of January 2000 and 17th of March 2021. A structured protocol was employed to devise a comprehensive search strategy with keywords and Boolean operators defined by the research question. The keywords used for the search were ‘HIFU’, ‘High-Intensity Focused Ultrasound’, ‘Fibroadenoma’, ‘Breast’, ‘Lesion’. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Recently, a thermal ablative technique, High Intensity Focused Ultrasound (HIFU), was found to be a safe, non-invasive, and technically successful alternative, having displayed promising outcomes in reducing the volume of fibroadenomas, pain experienced by patients, and the length of hospitalization. Quality of life improvement was also evidenced, exhibited by the disappearance of symptoms, and enhanced physical activity post-intervention, in addition to patients’ satisfaction with the cosmetic results and future recommendation of the procedure to other patients. Conclusion: Overall, HIFU is a well-tolerated treatment associated with a low risk of complications that can potentially include erythema, skin discoloration and bruising, with the majority of this self-resolving shortly after the procedure.

Keywords: ultrasound, HIFU, breast, efficacy, side effects, fibroadenoma

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Authors: Larissa M. Vargas, Julia M. Sacchi, Renata O. Pereira, Lucas S. Asano, Iara C. Araújo, Patricia Fiorino, Vera Farah

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The aim of this study was to evaluate the occurrence of subclinical organ injuries induced by high-fat diet. Male wistar rats (n=5/group) were divided in control diet group (CD), commercial rat chow, and hyperlipidic diet (30% lipids) group (HD) administrated during 8 weeks, starting after weaning. All the procedures followed the rules of the Committee of Research and Ethics of the Mackenzie University (CEUA Nº 077/03/2011). At the end of protocol the animals were euthanized by anesthesia overload and the left kidney was removed. Intrarenal lipid deposition was evaluated by histological analyses with oilred. Kidney slices were stained with picrosirius red to evaluate the area of the Bowman's capsule (AB) and space (SB), and glomerular tuft area (GT). The renal expression of sterol regulatory element–binding protein (SREBP-2) was performed by Western Blotting. Creatinine concentration (serum and urine) and lipid profile were determined by colorimetric kit (Labtest). At the end of the protocol there was no differences in body weight between the groups, however the HD showed a marked increase in lipid deposits, glomeruli and tubules, and biochemical analysis for cholesterol and triglycerides. Moreover, in the kidney, the high-fat diet induced a reduction in the AB (13%), GT (18%) and SB (17%) associated with a reduction in glomerular filtration rate (creatinine clearance). The renal SRBP2 expression was increased in HD group. These data suggests that consumption of high-fat diet starting in childhood is associated with subclinical renal damage and function.

Keywords: high-fat diet, kidney, intrarenal lipid deposition, SRBP2

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Authors: Anissa Mary Thomas Thattil, Nancy Angeline Gnanaselvam, B. Ramakrishna Goud

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Faecal sludge management (FSM) is an unorganized sector, and in India, there is an absence of regulations regarding the collection, transport, treatment, and disposal of faecal sludge. FSM has a high degree of occupational hazards that need to be thoroughly understood in order to shape effective solutions. On-field observations of five FSM operations were conducted in Anekal Taluk of southern Karnataka. All five of the FSM operations were privately owned and snowball method of sampling was employed. Two types of FS operations observed were: mechanical emptying involving direct human contact with faecal sludge and mechanical emptying without direct human contact with faecal sludge. Each operation was manned by 3-4 faecal sludge operators (FSOs). None of the observed FSOs used personal protective equipment. According to the WHO semi-quantitative risk assessment, the very high risk occupational hazards identified were dermal contact with faecal sludge, inhalation of toxic gases, and social stigma. The high risk hazards identified were trips and falls, injuries, ergonomic hazards, substance abuse, and mental health problems. In all five FSM operations, the collected faecal sludge was discharged untreated onto abandoned land. FSM in India is fraught with occupational and environmental hazards which need to be urgently addressed. This includes formalizing the institution of FSM, contextualized behaviour change communication, capacity building of local bodies, awareness programmes among agriculturists and FSOs, and designation of sites for the safe harnessing of faecal sludge as soil nutrient.

Keywords: faecal sludge, faecal sludge management, FSM, occupational hazards, sanitation

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Authors: Patience Manjengwa-Hungwe, Carmen White

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Background: Odyssean malaria refers to malaria acquired by infected mosquito bites from malaria endemic to non-endemic regions by mechanical modes of transport, such as airplanes, water vessels, trains and vehicles. Odyssean Malaria is rare and is characterised by absence of travel history to malaria endemic areas. As not anticipated in non-endemic areas, late diagnosis and treatment lead to a high case fatality rate. On 26 September 2014, the Outbreak Response Unit at the National Institute of Communicable Diseases was notified of a suspected death from Odyssean Malaria in Johannesburg, Gauteng Province, a non-endemic area. The main objective of this investigation was to identify the etiological agent's mode and source of transmission. Methods: Epidemiological surveys were conducted with the deceased’s family and clinical details were obtained from doctors who treated the victim in Southrand, Johannesburg. Blood samples were collected prior to death and sent to the National Health Laboratory Services, Johannesburg laboratory for a full blood count, urea electrolytes, creatinine, and C-reactive protein. Environmental assessments and entomological investigations, including collection of mosquito and larvae, were conducted at the deceased’s home and surrounding areas and sent to the laboratory for analysis. Results: Epidemiological surveys revealed no travel history, no mechanical transmission through blood transfusion and no previous possible exposure of the victim to malaria mosquitoes. Laboratory findings indicated that the platelet count was low. A further smear revealed that the malaria parasite was present and malaria antigen for P. falciparum was positive. Entomological findings revealed that none of the six adult or larval mosquitoes collected on site were malaria vectors. Dumping sites found at the back of the house were identified as possible sites where mosquitoes from endemic places could possibly breed. Conclusion: Given that there was no travel history or the possibility of mechanical transmission (blood transfusion or needle), the research team concluded that it is highly probable that the infection was acquired through an infective Anopheles mosquito inadvertently translocated from a Malaria endemic area by mechanical modes of transport. We recommend that clinicians in non-endemic malaria areas be aware of this type of malaria and test for malaria in patients showing malaria-like symptoms.

Keywords: Odyssean Malaria, vector Bourne, malaria, epidemiological surveys

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Authors: Fikri Turk, Sahika Pinar Akyer, Mevci Ozdemir, Mehmet Bulent Ozdemir, Ilgaz Akdogan

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The complications such as bleeding, thrombosis and air embolism depend on injuries emissary veins is often encountered in surgery. Detailed descriptions of the mastoid foramen, occipital foramen, parietal foramen, posterior condylar canal and foramen vesalius are lacking in the literature. For this reason, the purpose of our study was to explore and represent the morphology and morphometry of these emissary foramina in order to prevent complications and to guide for surgeons. The present study was made on 60 dry human skull in the laboratories of Pamukkale University, Faculty of Medicine Department of Anatomy. After taken photograph of emissary foramens by Canon 650D professional camera, the evaluation and measurement’s these foramens made with Matlab program by computer. The overall prevalence of mastoid foramen was 90.52%, occipital foramen was 72.52%, parietal foramen was 42.85%, posterior condylar canal was 91.25% and foramen vesalius was 78.26%. The mean diameter of the mastoid foramen was 1.81±0.76 mm, occipital foramen was 1.20±0.25 mm, parietal foramen was 1.49±0.46 mm, posterior condylar canal was 2.83±1.33 mm and foramen vesalius was 1.74±0.60 mm. Distances between emissary foramina and fixed bony landmarks were measured. Emissary veins are important in clinic practice and surgical procedures because they act a route of spread of exracranial infection to the intracranial structures and these veins may be a significant bleeding during surgery of the skull and they can be source of thrombosis and air embolism. The detailed anatomical knowledge of these veins and foraminas may help to prevent complications and to guide for surgeons.

Keywords: emissary foramina, mastoid foramen, occipital foramen, parietal foramen, posterior condylar canal, foramen vesalius, morphology, morphometry

Procedia PDF Downloads 365

Authors: Sara Hasani

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This research focuses on natural sudden onset disasters characterised as ‘occurring with little or no warning and often cause excessive injuries far surpassing the national response capacities’. Based on the panel analysis of the historic record of 4,252 natural onset disasters between 1980 to 2015, a predictive method was developed to predict the human impact of the disaster (fatality, injured, homeless) with less than 3% of errors. The geographical dispersion of the disasters includes every country where the data were available and cross-examined from various humanitarian sources. The records were then filtered into 4252 records of the disasters where the five predictive variables (disaster type, HDI, DRI, population, and population density) were clearly stated. The procedure was designed based on a combination of pattern recognition techniques and rule-based clustering for prediction and discrimination analysis to validate the results further. The result indicates that there is a relationship between the disaster human impact and the five socio-economic characteristics of the affected country mentioned above. As a result, a framework was put forward, which could predict the disaster’s human impact based on their severity rank in the early hours of disaster strike. The predictions in this model were outlined in two worst and best-case scenarios, which respectively inform the lower range and higher range of the prediction. A necessity to develop the predictive framework can be highlighted by noticing that despite the existing research in literature, a framework for predicting the human impact and estimating the needs at the time of the disaster is yet to be developed. This can further be used to allocate the resources at the response phase of the disaster where the data is scarce.

Keywords: disaster management, natural disaster, pattern recognition, prediction

Procedia PDF Downloads 154

Authors: Zanib Nafees, Amir Razaghizad, Ibtisam Mahmoud, Abhinav Sharma, Renzo Cecere

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More than one million surgeries are performed each year in Canada, resulting in more than 100,000 associated serious adverse events (SAEs) per year. These are defined as unintended injuries or complications that adversely affect the well-being of patients. In recent years, there has been a proliferation of digital health interventions that have the potential to assist, monitor, and educate patients—facilitating self-care following post-operative discharge. Among digital health, interventions are interactive-voice response technologies (IVRs), which have been shown to be highly effective in certain medical settings. Although numerous IVR-based interventions have been developed, their effectiveness and utility remain unclear, notably in post-operative settings. To the best of our knowledge, no systematic or scoping reviews have evaluated this topic to date. Thus, the objective of this scoping review protocol is to systematically map and explore the literature and evidence describing and examining IVR tools, implementation, evaluation, outcome, and experience for post-operative patients. The focus will be primarily on the evaluation of baseline performance status, clinical assessment, treatment outcomes, and patient management, including self-management and self-monitoring. The objective of this scoping review is to assess the extent of the literature to direct future research efforts by identifying gaps and limitations in the literature and to highlight relevant determinants of positive outcomes in the emerging field of IVR monitoring for health outcomes in post-operative patients.

Keywords: digital healthcare technologies, post-surgery, interactive voice technology, interactive voice response

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Authors: Mostafa Mabrouk, Basma E. Abdel-Ghany, Mona Moaness, Bothaina M. Abdel-Hady, Hanan H. Beherei

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Tissue engineering became a promising field for bone repair and regenerative medicine in which cultured cells, scaffolds and osteogenic inductive signals are used to regenerate tissues. The annual cost of treating bone defects in Egypt has been estimated to be many billions, while enormous costs are spent on imported bone grafts for bone injuries, tumors, and other pathologies associated with defective fracture healing. The current study is aimed at developing a more strategic approach in order to speed-up recovery after bone damage. This will reduce the risk of fatal surgical complications and improve the quality of life of people affected with such fractures. 3D scaffolds loaded with cheap nano-particles that possess an osteogenic effect were prepared by nano-electrospinning. The Microstructure and morphology characterizations of the 3D scaffolds were monitored using scanning electron microscopy (SEM). The physicochemical characterization was investigated using X-ray diffractometry (XRD) and infrared spectroscopy (IR). The Physicomechanical properties of the 3D scaffold were determined by a universal testing machine. The in vitro bioactivity of the 3D scaffold was assessed in simulated body fluid (SBF). The bone-bonding ability of novel 3D scaffolds was also evaluated. The obtained nanofibrous scaffolds demonstrated promising microstructure, physicochemical and physicomechanical features appropriate for enhanced bone regeneration. Therefore, the utilized nanomaterials loaded with the drug are greatly recommended as cheap alternatives to growth factors.

Keywords: bone regeneration, cheap scaffolds, nanomaterials, active molecules

Procedia PDF Downloads 191

Authors: Isabella Schwartz, Ori Safran, Naama Karniel, Michal Abel, Adina Berko, Martin Seyres, Tamir Tsoar, Sigal Portnoy

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Virtual Reality allows to manipulate the patient’s perception, thereby providing a motivational addition to real-time biofeedback exercises. We aimed to test the effect of manipulated virtual kinematic intervention on measures of active and passive Range of Motion (ROM), pain, and disability level in individuals with traumatic stiff shoulder. In a double-blinded study, patients with stiff shoulder following proximal humerus fracture and non-operative treatment were randomly divided into a non-manipulated feedback group (NM-group; N=6) and a manipulated feedback group (M-group; N=7). The shoulder ROM, pain, and the Disabilities of the Arm, Shoulder and Hand (DASH) scores were tested at baseline and after the 6 sessions, during which the subjects performed shoulder flexion and abduction in front of a graphic visualization of the shoulder angle. The biofeedback provided to the NM-group was the actual shoulder angle and the feedback provided to the M-group was manipulated so that 10° were constantly subtracted from the actual angle detected by the motion capture system. The M-group showed greater improvement in the active flexion ROM, with median and interquartile range of 197.1 (140.5-425.0) compared to 142.5 (139.1-151.3) for the NM-group (p=.046). Also, the M-group showed greater improvement in the DASH scores, with median and interquartile range of 67.7 (52.8-86.2) compared to 89.7 (83.8-98.3) for the NM-group (p=.022). Manipulated intervention is beneficial in individuals with traumatic stiff shoulder and should be further tested for other populations with orthopedic injuries.

Keywords: virtual reality, biofeedback, shoulder pain, range of motion

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Authors: Zhou Shangcheng, Yi Sicen

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Objective: To understand the mortality patterns of Zhangwan District in 2010 and provide the basis for the development of scientific and rational health policy. Methods: Data are collected from the Sixth Census of Zhangwan District and disease surveillance system. The statistical analysis include death difference between age, gender, region and time and the related factors. Methods developed for the Global Burden of Disease (GBD) Study by the World Bank and World Health Organization (WHO) were adapted and applied to Zhangwan District population health data. DALY rate per 1,000 was calculated for varied causes of death. SPSS 16 is used by statistic analysis. Results: From the data of death population of Zhangwan District we know the crude mortality rate was 6.03 ‰. There are significant differences of mortality rate in male and female population which was respectively 7.37 ‰ and 4.68 ‰. 0 age group population life expectancy in Zhangwan District in 2010 was 78.40 years old(Male 75.93, Female 81.03). The five leading causes of YLL in descending order were: cardiovascular diseases(42.63DALY/1000), malignant neoplasm (23.73DALY/1000), unintentional injuries (5.84DALY/1000), Respiratory diseases(5.43 DALY/1000), Respiratory infections (2.44DALY/1000). In addition, there are strong relation between the marital status , educational level and mortality in some to a certain extend. Conclusion Zhangwan District, as city level, is at lower mortality levels. The mortality of the total population of Zhangwan District has a downward trend and life expectancy is rising.

Keywords: sixth census, Zhangwan district, death level differences, influencing factors, cause of death

Procedia PDF Downloads 271

Authors: Bilge Kaan Tekelioglu, Mehmet Celik, Mahmut Ali Gokce, Ladine Celik, Yusuf Uzun

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A male mature barn owl (Tyto alba) was brought to Cukurova University Ceyhan Veterinary Medicine Faculty at the beginning of January 2017. The bird was found at a local state elementary school’s garden where had been terribly damaged by metal wires. On the clinical examination, the animal was in shock and atonic position at arrival and seems to have feather problems and severe injuries. The ears, eyes, claws and wounded areas were checked and no signs of viral, microbial or ecto-parasitic infection were observed. The bird has been declared by U.S. wild life Office as endangered species. At first, the owl was kept in silent, warm and darkened cabinet against shock and warmed fluid replacement was started by % 5 dextrose solution per orally. On the second day, we started per oral forced feeding with chicken flesh meat dipped into the dextrose solution. On the third day, the bird was continued to be fed with fresh meat. At the fourth day, the owl was started to be fed with chicks during the next 3 days died by natural means which has been supplied by a local breeder. At the first 3 days 1 chick per day and the following days 2 chicks per day has been given per orally. The tenth day we started flying exercises in a small and non-windowed room safely. The saved owl was kept in this room for 10 more days. Finally, the owl was released at the habitation where it had been found injured. This study has one more time proved that, if you save one, you can save more. Wild life is in danger all over the world. Every living creature has right and deserves a chance to live.

Keywords: wild life, barn owl, Tyto alba, rescue, life support, feeding

Procedia PDF Downloads 360

Authors: Grace C. Kuroki, Yixin Hu, Bailey Surtees, Rebecca Krimins, Nicholas J. Durr, Dara L. Kraitchman

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The purpose of this study was to perform a Phase I veterinary clinical trial with a low-cost, carbon-dioxide-based, passive thaw cryoablation device as proof-of-principle for application in pets and translation to third-world treatment of breast cancer. This study was approved by the institutional animal care and use committee. Client-owned dogs with subcutaneous masses, primarily lipomas or mammary cancers, were recruited for the study. Inclusion was based on clinical history, lesion location, preanesthetic blood work, and fine needle aspirate or biopsy confirmation of mass. Informed consent was obtained from the owners for dogs that met inclusion criteria. Ultrasound assessment of mass extent was performed immediately prior to mass cryoablation. Dogs were placed under general anesthesia and sterilely prepared. A stab incision was created to insert a custom 4.19 OD x 55.9 mm length cryoablation probe (Kubanda Cryotherapy) into the mass. Originally designed for treating breast cancer in low resource settings, this device has demonstrated potential in effectively necrosing subcutaneous masses. A dose escalation study of increasing freeze-thaw cycles (5/4/5, 7/5/7, and 10/7/10 min) was performed to assess the size of the iceball/necrotic extent of cryoablation. Each dog was allowed to recover for ~1-2 weeks before surgical removal of the mass. A single mass was treated in seven dogs (2 mammary masses, a sarcoma, 4 lipomas, and 1 adnexal mass) with most masses exceeding 2 cm in any dimension. Mass involution was most evident in the malignant mammary and adnexal mass. Lipomas showed minimal shrinkage prior to surgical removal, but an area of necrosis was evident along the cryoablation probe path. Gross assessment indicated a clear margin of cryoablation along the cryoprobe independent of tumor type. Detailed histopathology is pending, but complete involution of large lipomas appeared to be unlikely with a 10/7/10 protocol. The low-cost, carbon dioxide-based cryotherapy device permits a minimally invasive technique that may be useful for veterinary applications but is also informative of the unlikely resolution of benign adipose breast masses that may be encountered in third world countries.

Keywords: cryoablation, cryotherapy, interventional oncology, veterinary technology

Procedia PDF Downloads 131

Authors: I. Szer, J. Szer, K. Czarnocki, E. Błazik-Borowa

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People on construction scaffoldings work in dynamically changing, often unfavourable climate. Additionally, this kind of work is performed on low stiffness structures at high altitude, which increases the risk of accidents. It is therefore desirable to define the parameters of the work environment that contribute to increasing the construction worker occupational safety level. The aim of this article is to present how changes in microclimate parameters on scaffolding can impact the development of dangerous situations and accidents. For this purpose, indicators based on the human thermal balance were used. However, use of this model under construction conditions is often burdened by significant errors or even impossible to implement due to the lack of precise data. Thus, in the target model, the modified parameter was used – apparent environmental temperature. Apparent temperature in the proposed Scaffold Use Risk Assessment Model has been a perceived outdoor temperature, caused by the combined effects of air temperature, radiative temperature, relative humidity and wind speed (wind chill index, heat index). In the paper, correlations between component factors and apparent temperature for facade scaffolding with a width of 24.5 m and a height of 42.3 m, located at south-west side of building are presented. The distribution of factors on the scaffolding has been used to evaluate fitting of the microclimate model. The results of the studies indicate that observed ranges of apparent temperature on the scaffolds frequently results in a worker’s inability to adapt. This leads to reduced concentration and increased fatigue, adversely affects health, and consequently increases the risk of dangerous situations and accidental injuries

Keywords: apparent temperature, health, safety work, scaffoldings

Procedia PDF Downloads 183

Authors: Shalini Priyadarshini

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The notion of performance measurement has held great appeal for the industry and research communities alike. This idea is also true for the construction sector, and some propose that performance measurement and productivity analysis are two separate management functions, where productivity is a subset of performance, the latter requiring comprehensive analysis of comparable factors. Labor productivity is considered one of the best indicators of production efficiency. The construction industry continues to account for a disproportionate share of injuries and illnesses despite adopting several technological and organizational interventions that promote worker safety. Specialty trades contractors typically complete a large fraction of work on any construction project, but insufficient body of work exists that address subcontractor safety and productivity issues. Literature review has revealed the possibility of a relation between productivity, safety and other factors and their links to project, organizational, task and industry performance. This research posits that there is an association between productivity and performance at project as well as organizational levels in the construction industry. Moreover, prior exploration of the importance of safety within the performance-productivity framework has been anecdotal at best. Using structured questionnaire survey and organization- and project level data, this study, which is a combination of cross-sectional and longitudinal research designs, addresses the identified research gap and models the relationship between productivity, safety, and performance with a focus on specialty trades in the construction sector. Statistical analysis is used to establish a correlation between the variables of interest. This research identifies the need for developing and maintaining productivity and safety logs for smaller businesses. Future studies can design and develop research to establish causal relationships between these variables.

Keywords: construction, safety, productivity, performance, specialty trades

Procedia PDF Downloads 278