Search results for: anterior gleno-humeral instability

Authors: Chaitanya R. Mali, V. Vinod, Ashwin W. Patwardhan

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Design of long vertical steam generator (SG) tubes in nuclear power plant involves an understanding of different aspects of flow boiling phenomenon such as flow instabilities, flow regimes, dry out, critical heat flux, pressure drop, etc. The knowledge of the prediction of local thermal hydraulic characteristics is necessary to understand these aspects. For this purpose, the methodology has been developed which covers all the flow boiling regimes to model full range flow boiling phenomenon. In this methodology, the vertical tube is divided into four sections based on vapor fraction value at the end of each section. Different modeling strategies have been applied to the different sections of the vertical tube. Computational fluid dynamics simulations have been performed on a vertical SG tube of 0.0126 m inner diameter and 23 m length. The thermal hydraulic parameters such as vapor fraction, liquid temperature, heat transfer coefficient, pressure drop, heat flux distribution have been analyzed for different designed heat duties (1.1 MW (20%) to 3.3 MW (60%)) and flow conditions (10 % to 80 %). The sensitivity of different boiling parameters such as bubble departure diameter, nucleation site density, bubble departure frequency on the thermal hydraulic parameters was also studied. Flow instability has been observed at 20 % designed heat duty and 20 % flow conditions.

Keywords: thermal hydraulics, boiling, vapor fraction, sensitivity

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Authors: Wei Yao

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A steerable and flexible drill is needed in orthopaedic surgery. For example, osteoarthritis is a common condition affecting millions of people for which joint replacement is an effective treatment which improves the quality and duration of life in elderly sufferers. Conventional surgery is not very accurate. Computer navigation and robotics can help increase the accuracy. For example, In Total Hip Arthroplasty (THA), robotic surgery is currently practiced mainly on acetabular side helping cup positioning and orientation. However, femoral stem positioning mostly uses hand-rasping method rather than robots for accurate positioning. The other case for using a flexible drill in surgery is Anterior Cruciate Ligament (ACL) Reconstruction. The majority of ACL Reconstruction failures are primarily caused by technical mistakes and surgical errors resulting from drilling the anatomical bone tunnels required to accommodate the ligament graft. The proposed new steerable drill system will perform orthopedic surgery through curved tunneling leading to better accuracy and patient outcomes. It may reduce intra-operative fractures, dislocations, early failure and leg length discrepancy by making possible a new level of precision. This technology is based on a robotically assisted, steerable, hand-held flexible drill, with a drill-tip tracking device and a multi-modality navigation system. The critical differentiator is that this robotically assisted surgical technology now allows the surgeon to prepare 'patient specific' and more anatomically correct 'curved' bone tunnels during orthopedic surgery rather than drilling straight holes as occurs currently with existing surgical tools. The flexible and steerable drill and its navigation system for femoral milling in total hip arthroplasty had been tested on sawbones to evaluate the accuracy of the positioning and orientation of femoral stem relative to the pre-operative plan. The data show the accuracy of the navigation system is better than traditional hand-rasping method.

Keywords: navigation, robotic orthopedic surgery, steerable drill, tracking

Procedia PDF Downloads 159

Authors: Hamitri-Guerfi Fatiha, Mekimene Lekhder, Madani Khodir, Youyou Ahcene

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Virgin olive oil is appreciated by consumers, the quality of the oil is regulated by the international olive oil council depends on its chemical composition, so, the correct packing conditions are a prerequisite to preserve oil color, flavor, and nutriments, from production to consumption. The contact of food with various materials of packaging, since the production, until their consumption constitutes one of the essential aspects of food safety (directive 76/833/CEE). In Algeria, plastic bottles, although, they are economic and light are largely used at packaging olive oil but not used in other countries. This is due to migration phenomena that can occur from these materials. Thus, the goal of this work is to examine the physicochemical behavior of the couple packaging plastic-oil during their exposure to three temperatures corresponding to the conditions of storage applied in Algeria. Like, it is difficult to compare blowers of bottles which are heavy engineering, it comes out from this study that the effect of heat, the absorption of water, the constraints of storage of acidity, as well as the composition of oil, the PET bottles showed a remarkable structural instability, this defect of quality was confirmed by the analysis of morphology by electronic scan microscopy. These bottles present a total migration significantly higher than the threshold of acceptance. Moreover, a metal contamination of oil by its packaging was confirmed by the spectroscopy of atomic absorption and a microanalysis. The differences observed between the results of the microanalysis applied and the mechanical characterizations of the various bottles are reported, showing the reality of the container-contents exchanges.

Keywords: interaction, stability, pet, virgin olive oil

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Authors: M. Wasy Akhtar

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Multi-modal film boiling simulations are carried out on adaptive octree grids. The liquid-vapor interface is captured using the volume-of-fluid framework adjusted to account for exchanges of mass, momentum, and energy across the interface. Surface tension effects are included using a volumetric source term in the momentum equations. The phase change calculations are conducted based on the exact location and orientation of the interface; however, the source terms are calculated using the mixture variables to be consistent with the one field formulation used to represent the entire fluid domain. The numerical model on octree representation of the computational grid is first verified using test cases including advection tests in severely deforming velocity fields, gravity-based instabilities and bubble growth in uniformly superheated liquid under zero gravity. The model is then used to simulate both single and multi-modal film boiling simulations. The octree grid is dynamically adapted in order to maintain the highest grid resolution on the instability fronts using markers of interface location, volume fraction, and thermal gradients. The method thus provides an efficient platform to simulate fluid instabilities with or without phase change in the presence of body forces like gravity or shear layer instabilities.

Keywords: boiling flows, dynamic octree grids, heat transfer, interface capturing, phase change

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Authors: Martin Dupuy, Solange Grunenwald, Pierre-Louis Colombo, Laurence Mahieu, Pomone Richard, Philippe Bartoli

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Endonasal endoscopic trans-sphenoidal surgery for pituitary tumours has become a mainstay of treatment over the last two decades. Although it is generally accepted that there is no significant difference between endoscopic versus microscopic approach for surgical outcomes (endocrine and ophthalmologic status), nasal morbidity seems to the benefit of endoscopic procedures. Minimally invasive endoscopic surgery needs an operative learning curve to achieve surgeon’s efficiency. This learning curve is now well known for surgical outcomes and complications rate, however, few data are available for nasal morbidity. The aim of our series is to document operative experience and nasal quality of life after (NQOL) endoscopic trans-sphenoidal surgery. The prospective pituitary surgical cohort consisted of 525 consecutives patients referred to our Skull Base Diseases Department. Endoscopic procedures were performed by a single neurosurgeon using an uninostril approach. NQOL was evaluated using the Sino-Nasal Test (SNOT-22), the Anterior Base Nasal Inventory (ASBNI) and the Skull Base Inventory Score (SBIS). Data were collected before surgery during hospital stay and 3 months after the surgery. The seventy first patients were compared to the latest 70 patients. There was no significant difference between comparison score before versus after surgery for SNOT-22, ASBNI and SBIS during the single surgeon’s learning curve. Our series demonstrates that in our institution there is no statistically significant learning curve for NQOL after uninostril endoscopic pituitary surgery. A careful progression through sinonasal structures with very limited mucosal incision is associated with minimal morbidity and preserves nasal function. Conservative and minimal invasive approach could be achieved early during learning curve.

Keywords: pituitary surgery, quality of life, minimal invasive surgery, learning curve, pituitary tumours, skull base surgery, endoscopic surgery

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Authors: Elif N. Coban

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With the political instability that has prevailed in Lebanon since October 2019, followed by a global pandemic and a deepening concurrent economic crisis after the Beirut Port explosion on August 4, 2020, Syrian refugees in Lebanon have struggled to survive what the World Bank has described as one of the worst economic crises in decades. This study aims to assess the vulnerability of Syrian refugee women. It will present a comparative analysis of refugee and Lebanese households using data from Lebanon’s Labour Force and Household Conditions Survey (LFHLCS) and from VASyr surveys, which are comprehensive annual surveys conducted jointly by the United Nations High Commissioner for Refugees (UNHCR), the United Nations Children’s Fund (UNICEF), and the United Nations World Food Programme (WFP). The study adopts an intersectionality-based method, which deals with gender and marginalized communities from many different perspectives, to put forward a gender-oriented approach. Examining the distribution of socioeconomic status among Syrian and Lebanese households might help to understand the disproportionate burdens borne by women. In this context, multidimensional poverty (MP) helps depict fragile communities’ socioeconomic status and allows a fuller grasp the multiple aspects of deprivation. Finally, this understanding may pave the way to more inclusive policy for decision-makers and practitioners working on refugee issues.

Keywords: multidimensional poverty, gender studies, intersectionality, Syrian refugees, Lebanon

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Authors: Vu Hoang Thu Huong

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Background: Surface electrical stimulation (SES) is a popular non-invasive approach that offers a wide range of treatments for many diseases of physical therapy. It involves applying electrical stimulation to the skin via surface electrodes to stimulate nerve fibers. SES was regularly used to treat the back and upper or lower extremities, but it was rarely used to treat the chest and abdomen. SES on the thorax and abdomen should be administered with more attention because crucial organs are under those areas (i.e., heart, lungs, liver, etc.). In these areas, safety precautions are suggested, and some SES applications might even be a contraindication. The fact that physical therapists have less experience with SES in these situations can also be attributed to these. Although a few earlier studies applied it to these settings and discovered hopeful results, none of them highlight the relationship between the intensity of SES and its depth of impact for safety considerations. Objective: To assure feasibility when using SES in these areas, the purpose of this study is to summarize the common location and intensity of those areas that have been conducted in previous studies. Method: A thorough systematic review was conducted to determine the common surface electrode position for the thorax and abdomen areas. The studies with the randomized controlled design were systematically searched using inclusion and exclusion criteria through nine electronic databases, including Pubmed, Scopus, etc., between 1975 and Dec 2021. Results: Thirty-three studies with over 1800 participants and 4 types of SES (TENS, IFC, NMES, and FES) with various categories of department hospitals were found. Following an anterior, lateral, and posterior observation, the particular SES positions found that it concentrated on 6 regions (the thoracic, abdomen, upper lateral, lower lateral, upper back, and lower back regions), and its intensity for each region was also summarized. Conclusion: This systematic review figured out the popular locations of SES in the thorax and abdominal areas as well as a summarized maximum of intensity that was found in previous studies with outstanding outcomes.

Keywords: surface electrical stimulation, electrical stimulation, thoracic, abdomen, abdominal.

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Authors: Mohammed M. Mahdy Tawfeek

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Objective: The aim of this work is to compare the outcome of photoactivated chromophore for keratitis-cross linking (PACK-CXL) window absorption (WA) alone with combined PACK-CXL WA and standard anti-microbial therapy (SAT) for the treatment of infectious keratitis. Patients and Methods: This is a randomized prospective comparative clinical trial. Thirty eyes with clinically suspected infectious keratitis were randomly assigned into two equal groups of 15 eyes each: Group (A) was treated by PACK-CXL WA alone and group (B) was treated by PACK-CXL WA combined with SAT. Identification of organisms was made by lab study before treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT (AS-OCT). Written informed consent was obtained from all participants and the study was approved by the research ethics committee of the Faculty of Medicine, Zagazig University. The work has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for studies involving humans. Results: Complete healing and resolution (Successful treatment) were observed in 10 eyes (66.7%) of a group (A) and 14 eyes (93.3%) of group (B) and failure was observed in 5 eyes (33.3%) of a group (A) and one eye (6.67%) of group (B). They were statistically significant (P =0.042 and 0.003) in a comparison between both groups regarding success and failure of treatment, respectively. Complete corneal healing was reported in the third month postoperatively in 10 eyes (66.7%) of group (A) and 14 eyes (93.3%) of group (B). Complications were absent in 12 patients (80%) in group (A) and 14 patients (93.3%) of group (B); however, perforation and impending perforation were found in 3 patients of group (A) and only one patient of group (B). Conclusion: PACK-CXL is a promising, non-invasive treatment option for infectious keratitis, especially when performed with the window absorption (WA) technique, either alone or combined with SAT. It has a synergistic effect with a standard antimicrobial treatment that gives good outcome results in the treatment of infectious keratitis. Also, it avoids the antibiotics resistance that has become rapidly spreading worldwide.

Keywords: corneal cross linking, infectious keratitis, PACK-CXL, window absorption

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Authors: Davood Mousanezhad, Ashkan Vaziri

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As a traditional cellular structure, hexagonal honeycombs are known for their high strength-to-weight ratio. Here, we introduce a class of fractal-appearing hierarchical metamaterials by replacing the vertices of the original non-hierarchical hexagonal grid with smaller hexagons and iterating this process to achieve higher levels of hierarchy. It has been recently shown that the isotropic in-plane Young's modulus of this hierarchical structure at small deformations becomes 25 times greater than its regular counterpart with the same mass. At large deformations, we find that hierarchy-dependent elastic buckling introduced at relatively early stages of deformation decreases the value of Poisson's ratio as the structure is compressed uniaxially leading to auxeticity (i.e., negative Poisson's ratio) in subsequent stages of deformation. We also show that the topological hierarchical architecture and instability-induced pattern transformations of the structure under compression can be effectively used to tune the propagation of elastic waves within the structure. We find that the hierarchy tends to shift the existing phononic bandgaps (defined as frequency ranges of strong wave attenuation) to lower frequencies while opening up new bandgaps. Deformation is also demonstrated as another mechanism for opening more bandgaps in hierarchical structures. The results provide new insights into the role of structural organization and hierarchy in regulating mechanical properties of materials at both the static and dynamic regimes.

Keywords: cellular structures, honeycombs, hierarchical structures, metamaterials, multifunctional structures, phononic crystals, auxetic structures

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Authors: F. Esfandyari Darabad, Z. Samadi

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Natural environments have always been affected by one of the most important natural hazards, which is called, the mass movements that cause instability. Identifying the unstable regions and separating them so as to detect and determine the risk of environmental factors is one of the important issues in mountainous areas development. In this study, the northwest of Sabalan hillsides overlooking the Meshkin city and the surrounding area of that have been delimitated, in order to analyze the range processes such as landslides and debris flows based on structural and geomorphological conditions, by means of using GIS. This area due to the high slope of the hillsides and height of the region and the poor localization of roads and so because of them destabilizing the ranges own an inappropriate situation. This study is done with the purpose of identifying the effective factors in the range motion and determining the areas with high potential for zoning these movements by using GIS. The results showed that the most common range movements in the area, are debris flows, rocks falling and landslides. The effective factors in each one of the mass movements, considering a small amount of weight for each factor, the weight map of each factor and finally, the map of risk zoning for the range movements were provided. Based on the zoning map resulted in the study area, the risking level of damaging has specified into the four zones of very high risk, high risk, medium risk, low risk, in which areas with very high and high risk are settled near the road and along the Khyav river and in the  mountainous district.

Keywords: debris flow, environmental hazards, GIS, landslide

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Authors: Megha Ramnik Kotecha

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To study whether there is any clinical correlation between pterygium and dry eye and to evaluate the status of tear film in patients with pterygium. Methods: 100 eyes with pterygium were compared with 100 control eyes without pterygium. Patients between 20 – 70 years were included in the study. Detailed history was taken and Schirmer’s test and TBUT were performed on all to evaluate the status of dry eye. Schirmer’s test ˂10 mm and TBUT ˂10 seconds was considered abnormal. Results: Maximum number (52) of patients affected with dry eye in both the groups were in the age group 31-40 years which statistically showed age as a significant factor of association for both pterygium and dry eye (P<0.01).Schirmer’s test was slightly reduced in patients with pterygium(18.73±5.69 mm). TBUT was significantly reduced in the case group (12.26±2.24sec).TBUT decreased maximally in 51-60 yrs age group (13.00±2.77sec) with pterygium showing a tear film unstability. On comparision of pterygia and controls with normal and abnormal tear film, Odd’s Ratio was 1.14 showing risk of dry eye in pterygia patients to be 1.14 times higher than controls. Conclusion: Whether tear dysfunction is a precursor to pterygium growth or pterygium causes tear dysfunction is still not clear. Research and clinical evidence, however, suggest that there is a relationship between the two. This study is, therefore, undertaken to investigate the correlation between pterygium and dry eye. The patients with pterygia were compared with normals to evaluate their status regarding dryness. A close relationship exists between ocular irritation symptoms and functional evidence of tear instability. Schirmer’s test and TBUT should routinely be used in the outpatient department to diagnose dry eye in patients with pterygium and these patients should be promptly treated to prevent any sight threatening complications.

Keywords: dry eye, pterygium, Schirmer's test, tear break up time (TBUT)

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Authors: Gi-Young Park, Dong Rak Kwon, Sung Cheol Cho

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Objective: The synovium is known to be involved in many pathological characteristic processes. Also, synovitis is common in advanced osteoarthritis. We aimed to evaluate the clinical, radiographic, and ultrasound findings in patients with knee osteoarthritis and to compare the clinical and imaging findings between knee osteoarthritis with and without synovial hypertrophy confirmed by ultrasound. Methods: One hundred knees (54 left, 46 right) in 95 patients (64 women, 31 men; mean age, 65.9 years; range, 43-85 years) with knee osteoarthritis were recruited. The Visual Analogue Scale (VAS) was used to assess the intensity of knee pain. The severity of knee osteoarthritis was classified according to Kellgren and Lawrence's (K-L) grade on a radiograph. Ultrasound examination was performed by a physiatrist who had 24 years of experience in musculoskeletal ultrasound. Ultrasound findings, including the thickness of joint effusion in the suprapatellar pouch, synovial hypertrophy, infrapatellar tendinosis, meniscal tear or extrusion, and Baker cyst, were measured and detected. The thickness of knee joint effusion was measured at the maximal anterior-posterior diameter of fluid collection in the suprapatellar pouch. Synovial hypertrophy was identified as the soft tissue of variable echogenicity, which is poorly compressible and nondisplaceable by compression of an ultrasound transducer. The knees were divided into two groups according to the presence of synovial hypertrophy. The differences in clinical and imaging findings between the two groups were evaluated by independent t-test and chi-square test. Results: Synovial hypertrophy was detected in 48 knees of 100 knees on ultrasound. There were no significant differences in demographic parameters and VAS score except in sex between the two groups (P<0.05). Medial meniscal extrusion and tear were significantly more frequent in knees with synovial hypertrophy than those in knees without synovial hypertrophy. K-L grade and joint effusion thickness were greater in patients with synovial hypertrophy than those in patients without synovial hypertrophy (P<0.05). Conclusion: Synovial hypertrophy in knee osteoarthritis was associated with greater suprapatellar joint effusion and higher K-L grade and maybe a characteristic ultrasound feature of late knee osteoarthritis. These results suggest that synovial hypertrophy on ultrasound can be regarded as a predictor of rapid progression in patients with knee osteoarthritis.

Keywords: knee osteoarthritis, synovial hypertrophy, ultrasound, K-L grade

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Authors: Shikha Gupta, Suneet Kathuria, Supriya Sampley, Sunil Katyal

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Opioids are being increasingly used these days as adjuvants to local anesthetics in spinal anesthesia. The aim of this prospective, randomized, double‑blind study is to compare the effects of adding sufentanil or fentanyl to low dose bupivacaine in spinal anesthesia for endoscopic urological procedures. A total of 90 elective endoscopic urological surgery patients, 40‑80 years old, received spinal anesthesia with 7.5 mg hyperbaric bupivacaine 0.5% (Group A) or by adding sufentanil 10 μg (Group B) or fentanyl 25 μg (Group C) to 5 mg hyperbaric bupivacaine 0.5%. These groups were compared in terms of the quality of spinal anesthesia as well as analgesia. Analysis of variance and Chi‑square test were used for Statistical analysis. The onset of sensory and motor blockade was significantly rapid in Group A as compared with Groups B and C. The maximum upper level of sensory block was higher in Group A patients than Groups B and C patients. Quality of analgesia was significantly better and prolonged in sufentanil group as compared with other two groups. Motor block was more intense and prolonged in Group A as compared with Groups B and C patients. Request for post‑operative analgesic was significantly delayed in Group B patients. Hence in conclusions, spinal anesthesia for endoscopic urological procedures in elderly patients using low dose bupivacaine (5 mg) combined with 10 μg sufentanil is associated with a lower incidence of hemodynamic instability, better quality and prolonged duration as compared to that by adding 25 μg fentanyl.

Keywords: adjuvants, bupivacaine, fentanyl, intrathecal, low dose spinal, sufentanil

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Authors: Prabesh Karki, Shyam Thapa Chettri, Bajarang Prasad Sah, Manoj Bhattarai, Sudeep Mishra

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Introduction: Frontal sinus is frequently described as the most difficult sinus to access surgically due to its proximity to the cribriform plate, orbit, and anterior ethmoid artery. Frontal sinus surgery requires a detailed understanding of the cellular structure and FSDP unique to each patient, making high-resolution CT scans an indispensable tool to assess the difficulty of planned sinus surgery. International Frontal Sinus Anatomy Classification (IFAC) was developed to provide a more precise nomenclature for cells in the frontal recess, classifying cells based on their anatomic origin. Objectives: To assess the proportion of frontal cell variants defined by IFAC, variation with respect to age and gender. Methods: 54 cases were enrolled after a detailed clinical history, thorough general and physical examinations, and CT a report ordered in a film. Assessment and tabulation of the presence of frontal cells according to the IFAC analyzed. The prevalence of each cell type was calculated, and data were entered in MS Excel and analyzed using Statistical Package for the Social Sciences (SPSS). Descriptive statistics and frequencies were defined for categorical and numerical variables. Frequency, percentage, the mean and standard deviation were calculated. Result: Among 54 patients, 30 (55.6%) were male and 24 (44.4%) were female. The patient enrolled ranged from 18 to 78 years. Majority33.3% (n=18) were in age group of >50 years.According to IFAC, Agger nasi cells (92.6%) were most common, whereas supraorbital ethmoidal cells were least common 16 (29.6%). Prevalence of other frontoethmoidal cells was SAC- 57.4%, SAFC- 38.9%, SBC- 74.1%, SBFC- 33.3%, FSC- 38.9% of 54 cases. Conclusion: IFAC is an international consensus document that describes an anatomically precise nomenclature for classifying frontoethmoidal cells' anatomy. This study has defined the prevalence, symmetry and reliability of frontoethmoidal cells as established by the IFAC system as in other parts of the world.

Keywords: frontal sinus, frontoethmoidal cells, international frontal sinus anatomy classification

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Authors: De Castro-Pardo M., Cabello J. M., Martin J. M., Ruiz F.

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In this paper, we propose a new Water Sustainability Indicator based on a Multi-Reference methodology that permits modeling compensation between the analysed criteria and provides a participative approach. The proposed indicator provides results based on 19 variables grouped into 5 dimensions: availability, access, resilience, good governance and economic capacity. The indicator was applied to assess water sustainability in 27 European countries. The results showed that Finland, the Netherlands, Sweden and the United Kingdom obtained the best global results in terms of weak water (compensatory) sustainability. In terms of strong water (non-compensatory) sustainability, no country gained acceptable results in terms of strong sustainability. Climate change and the state of freshwater resources were detected as especially vulnerable in all the analysed countries. The results identified some eastern European countries with low GDP and good performance of availability and cost of water, with bad results in terms of governance and water productivity. These results could jeopardize water sustainability in the event of a potential economic development if these limitations are not addressed. In a context of economic and political instability due to the current armed conflict in nearby countries such as Ukraine, it is especially important to pay attention to these countries, whose good governance indicators could worsen even more. The proposed indicator allowed to the identification of warning signs and could contribute to the improvement in decision-making processes. Moreover, it could improve the monitoring of international water policies.

Keywords: water sustainability, composite indicators, compensatory approach, sustainability European policies

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Authors: Gusa Hall, Barrie Keeler, Achal Khanna

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Introduction: NICE guidelines have highlighted the consequences of IV fluid mismanagement. The main aim of this study was to audit fluid prescribing post laparotomies to identify if fluids were prescribed in accordance to NICE guidelines. Methodology: Retrospective database search of eight specific laparotomy procedures (colectomy right and left, Hartmann’s procedure, small bowel resection, perforated ulcer, abdominal perineal resection, anterior resection, pan proctocolectomy, subtotal colectomy) highlighted 29 laparotomies between April 2019 and May 2019. Two of 29 patients had secondary procedures during the same admission, n=27 (patients). Database case notes were reviewed for date of procedure, length of admission, fluid prescribed and amount, nasal gastric tube output, daily bloods results for electrolytes sodium and potassium and operational losses. Results: n=27 based on 27 identified patients between April 2019 – May 2019, 93% (25/27) received IV fluids, only 19% (5/27) received the correct IV fluids in accordance to NICE guidelines, 93% (25/27) who received IV fluids had the correct electrolytes levels (sodium & potassium), 100% (27/27) patients received blood tests (U&E’s) for correct electrolytes levels. 0% (0/27) no documentation on operational losses. IV fluids matched nasogastric tube output in 100% (3/3) of the number of patients that had a nasogastric tube in situ. Conclusion: A PubMed database literature review on barriers to safer IV prescribing highlighted educational interventions focused on prescriber knowledge rather than how to execute the prescribing task. This audit suggests IV fluids post laparotomies are not being prescribed consistently in accordance to NICE guidelines. Surgical management plans should be clearer on IV fluids and electrolytes requirements for the following 24 hours after the plan has been initiated. In addition, further teaching and training around IV prescribing is needed together with frequent surgical audits on IV fluid prescribing post-surgery to evaluate improvements.

Keywords: audit, IV Fluid prescribing, laparotomy, NICE guidelines

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Authors: Shuo Mu, Guangzhi Jiang, Jinsa Chen

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The analysis of Indel for RNA sequencing of clinical samples is easily affected by sequencing experiment errors and software selection. In order to improve the efficiency and accuracy of analysis, we developed an automatic reporting system for Indel recognition and annotation based on image snapshot of transcriptome reads alignment. This system includes sequence local-assembly and realignment, target point snapshot, and image-based recognition processes. We integrated high-confidence Indel dataset from several known databases as a training set to improve the accuracy of image processing and added a bioinformatical processing module to annotate and filter Indel artifacts. Subsequently, the system will automatically generate data, including data quality levels and images results report. Sanger sequencing verification of the reference Indel mutation of cell line NA12878 showed that the process can achieve 83% sensitivity and 96% specificity. Analysis of the collected clinical samples showed that the interpretation accuracy of the process was equivalent to that of manual inspection, and the processing efficiency showed a significant improvement. This work shows the feasibility of accurate Indel analysis of clinical next-generation sequencing (NGS) transcriptome. This result may be useful for RNA study for clinical samples with microsatellite instability in immunotherapy in the future.

Keywords: automatic reporting, indel, next-generation sequencing, NGS, transcriptome

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Authors: Koami West Togbetse

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The global shift towards clean and sustainable energy sources, known as the energy transition, is compelling numerous countries to transition from polluting energy systems to cleaner alternatives, commonly referred to as green energies. In this context, cobalt holds significant importance as a crucial mineral in facilitating this energy transition due to its pivotal role in electric batteries. Considering the Democratic Republic of Congo’s reputation for political instability and its position as the largest producer of cobalt, possessing over 50% of the world’s reserves, we have assessed the potential conflicts that may arise as a result of the rapid increase in cobalt demand. The results show that cobalt does not appear to be a determinant contributing to all past conflicts over the study period in the Democratic Republic of Congo (DRC). Gold, on the other hand, stands out as one of the coveted metals for rebel groups engaged in rampant exploitation, increasing the likelihood of conflicts occurring. However, a more in-depth analysis reveals a shift in the relationship between cobalt production and conflict events around 2006. Prior to 2006, increased cobalt production was significantly associated with a reduction in conflict events. However, after 2006, this relationship became positive, indicating that higher cobalt production is now linked to a slight increase in conflict events. This suggests a change in the dynamics affecting conflicts related to cobalt production before and after 2006. According to our predictive model, cobalt has the potential to emerge increasingly as a contributing factor, just like gold.

Keywords: conflicts, natural resources, energy transition, geopolitics

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Authors: Xie Xiaobin, Zhang Yan, Shi Yipeng, Sun Wenying, Chen Shuang, Cai Zhipeng, Zhang Hong, Zhang Lixia, Xie Like

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Objective: The objective of this research is to compare the efficacy of the late in-situ surgical revision augmented with continuous infusion and needle revision on failed trabeculectomy blebs. Methods From December 2018 to December 2021, a prospective randomized controlled trial was performed on 44 glaucoma patients with failed bleb ≥ 6months with medically uncontrolled in Eye Hospital, China Academy of Chinese Medical Sciences. They were randomly divided into two groups. 22 eyes of 22 patients underwent the late in-situ surgical revision with continuous anterior chamber infusion in the study group, and 22 of 22 patients were treated with needle revision in the control group. Main outcome measures include preoperative and postoperative intraocular pressure (IOP), the number of anti-glaucoma medicines, the operation success rate, and the postoperative complications. Results The postoperative IOP values decreased significantly from the baseline in both groups (both P<0.05). IOP was significantly lower in the study group than in the control group at one week, 1, and 3 months postoperatively (all P<0.05). IOP reductions in the study group were substantially more prominent than in the control group at all postoperative time points (all P<0.05). The complete success rate in the study group was significantly higher than in the control group (71.4% vs. 33.3%, P<0.05), while the complete failure rate was significantly lower in the study group (0% vs. 28.5%, P<0.05). According to Cox’s proportional hazards regression analysis, high IOP at baseline was independently associated with increased risks of complete failure (adjusted hazard ratio=1.141, 95% confidence interval=1.021-1.276, P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). Conclusion: Both in-situ surgical and needle revision have acceptable success rates and safety for the late failed trabeculectomy blebs, while the former is likely to have a higher level of efficacy over the latter. Needle revision may be insufficient for eyes with low target IOP.

Keywords: glaucoma, trabeculectomy blebs, in-situ surgical revision, needle revision

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Authors: Vimal O. Kumar, C. K. Muthukumaran, P. Rakesh

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Liquid rocket engine (LRE) combustion chamber is subjected to pressure oscillation during the combustion process. The combustion noise (acoustic noise) is a broad band, small amplitude, high frequency component pressure oscillation. They constitute only a minor fraction ( < 1%) of the entire combustion process. However, this high frequency oscillation is huge concern during the design phase of LRE combustion chamber as it would cause catastrophic failure of the chamber. Depends on the chamber geometry, certain frequencies form standing wave pattern, and they resonate with high amplitude and are known as Eigen modes. These Eigen modes could cause failures unless it is suppressed to be within safe limits. These modes are categorized into radial, tangential, and azimuthal modes, and their structure inside the combustion chamber is of interest to the researchers. In the present proposal, experimental as well as numerical simulation will be performed to obtain the frequency-amplitude characteristics of the model combustion chamber for different baffle configuration. The main objective of this study is to find effect of baffle configuration that would provide better suppression of acoustic modes. The experimental study aims at measuring the frequency amplitude characteristics at certain points in the chamber wall. The experimental measurement will be also used for scheme used in numerical simulation. In addition to experiments, numerical simulation would provide detailed structure of the Eigenmodes exhibited and their level of suppression with the aid of different baffle configurations.

Keywords: baffle, instability, liquid rocket engine, pressure response of chamber

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Authors: S. M. Amin Hosseini, Oriol Pons, Albert de la Fuente

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After natural disasters, displaced people (DP) require important numbers of housing units, which have to be erected quickly due to emergency pressures. These tight timeframes can cause the multiplication of the environmental construction impacts. These negative impacts worsen the already high energy consumption and pollution caused by the building sector. Indeed, post-disaster housing, which is often carried out without pre-planning, usually causes high negative environmental impacts, besides other economic and social impacts. Therefore, it is necessary to establish a suitable strategy to deal with this problem which also takes into account the instability of its causes, like changing ratio between rural and urban population. To this end, this study aims to present a model that assists decision-makers to choose the most suitable building technology for post-disaster housing units. This model focuses on the alternatives sustainability and fulfillment of the stakeholders’ satisfactions. Four building technologies have been analyzed to determine the most sustainability technology and to validate the presented model. In 2003, Bam earthquake DP had their temporary housing units (THUs) built using these four technologies: autoclaved aerated concrete blocks (AAC), concrete masonry unit (CMU), pressed reeds panel (PR), and 3D sandwich panel (3D). The results of this analysis confirm that PR and CMU obtain the highest sustainability indexes. However, the second life scenario of THUs could have considerable impacts on the results.

Keywords: sustainability, post-disaster temporary housing, integrated value model for sustainability assessment, life cycle assessment

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Authors: Mohammad Abdullah Almalki

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Background: Despite the frequent usage of ankle arthroscopy, there is limited medical literature regarding its indications, patterns of admissions, surgical outcomes, and associated complicated at Saudi Arabia. Hence, this study would highlight the surgical outcomes of such surgical approach that will assist orthopedic surgeons to detect which surgical procedure needs to be done as well as to help them regarding their diagnostic workups. Methods: At the Orthopedic Division of King Abdul‑Aziz Medical City in Riyadh and through a cross‑sectional design and convenient sampling techniques, the present study had recruited 20 subjects who fulfill the inclusion and exclusion criteria between 2016 and 2018. Data collection was carried out by a questionnaire designed and revised by an expert panel of health professionals. Results: Twenty patients were reviewed (11M and 9F) with an average age of 40.1 ± 12.2. Only 30% of the patients (5M, 1F) have no comorbidity, but 70% of patients (7M, 8F) were having at least one comorbidity. The most common indications were osteochondritis dissecans (n = 7, 35%), ankle fracture without dislocation (n = 4, 20%), and tibiotalar impingement (n = 3, 15%). Patients recorded pain in all cases (100%). The top four symptoms after pain were instability (30%, n = 6), muscle weakness (15%, n = 3) swelling (15%, n = 3), and stiffness (5%, n = 1). Two‑third of cases reached to their full healthy status and toe‑touch weight‑bearing was seen in two patients (10%). Conclusion: Ankle arthroscopy improved the rehabilitation rates in our tertiary care center. In addition, the surgical outcomes are favorable in our hospital since it has a very short length of stay, unexpended surgery, and fewest physiotherapy sessions.

Keywords: ankle, arthroscopy, indications, patterns

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Authors: Jacqueline Michella Anak Nathen

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Subgrade soil is an essential component in the design of road structures as it provides lateral support to the pavement. One of the main reasons for the failure of the pavement is the settlement of the subgrade and the high susceptibility to moisture, which leads to a loss of strength of the subgrade. Construction over weak or soft subgrade affects the performance of the pavement and causes instability of the pavement. If the mechanical properties of the subgrade soils are lower than those required, the soil stabilisation method can be an option to improve the soil properties of the weak subgrade. Soil stabilisation is one of the most popular techniques for improving poor subgrade soils, resulting in a significant improvement in the subgrade soil’s tensile strength, shear strength, and bearing capacity. Soil stabilisation encompasses the various methods used to alter the properties of soil to improve its engineering properties. Soil stabilisation can be broadly divided into four types: thermal, electrical, mechanical, and chemical. The most common method of improving the physical and mechanical properties of soils is stabilisation using binders such as cement and lime. However, soil stabilisation with conventional methods using cement and lime has become uneconomical in recent years, so there is a need to look for an alternative, such as fiber. Although not a new technique, adding fiber is a very practical alternative to soil stabilisation. Various types of fibers, such as natural, synthetic, and waste fibers, have been used as stabilising agents to improve the strength and durability of subgrade soils. This review provides a comprehensive comparison of the effectiveness of natural, synthetic, and waste fibers in stabilising subgrade soils.

Keywords: subgrade, soil stabilisation, pavement, fiber, stabiliser

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Authors: Siti Khadijah Che Osmi, Mohammed Ahmad Syed

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Underground structures are crucial components which required detailed analysis and design. Tunnels, for instance, are massively constructed as transportation infrastructures and utilities network especially in urban environments. Considering their prime importance to the economy and public safety that cannot be compromised, thus any instability to these tunnels will be highly detrimental to their performance. Recent experience suggests that tunnels become vulnerable during earthquakes and blast scenarios. However, a very limited amount of studies has been carried out to study and understanding the dynamic response and performance of underground tunnels under those unpredictable extreme hazards. In view of the importance of enhancing the resilience of these structures, the overall aims of the study are to evaluate probabilistic future performance of shallow tunnels subjected to seismic and blast loads by developing detailed fragility analysis. Critical non-linear time history numerical analyses using sophisticated finite element software Midas GTS NX have been presented about the current methods of analysis, taking into consideration of structural typology, ground motion and explosive characteristics, effect of soil conditions and other associated uncertainties on the tunnel integrity which may ultimately lead to the catastrophic failure of the structures. The proposed fragility curves for both extreme loadings are discussed and compared which provide significant information the performance of the tunnel under extreme hazards which may beneficial for future risk assessment and loss estimation.

Keywords: fragility analysis, seismic loads, shallow tunnels, blast loads

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Authors: Natalia Selezneva

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The level of crime depends on a number of factors, such as political and economic instability, social inequality and ineffective legislation. A special place in the overall level of crime takes juvenile delinquency. United Nations Standard Minimum developed rules for the administration of juvenile justice (The Beijing Rules), in order to ensure the rights of juvenile offenders under the various legal systems. Most countries support these recommendations, and Russia is no exception. Russia's criminal code establishes the minimum age of criminal liability; types of crimes for which the possible involvement of minors to justice; punishment; sentencing and execution of punishment for minors. However, these provisions cause heated debates in the scientific literature. The high level of juvenile crime indicates the ineffectiveness of legal regulation of criminal liability of minors. In order to ensure compliance with international standards require new and modern approaches to improve national legislation and practice of its application. Achieving this goal will be achieved through the following tasks: 1. Create sub-branches of law regulating the legal status of minors; 2. Improving the types of penalties; 3. The possibility of using alternative measures; 4. The introduction of the procedure of extrajudicial settlement of the conflict. The criminal law of each country depends on the historical, national and cultural characteristics. The development of the Russian legislation taking into account international experience is extremely essential and will be a new stage in the formation of a legal state, especially in the sphere of protection of the rights of juvenile offenders.

Keywords: criminal law, juvenile offender, punishment, the age of criminal responsibility

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Authors: Feisal Khudher Mahmood, Abdul Samad Rahman Sultan

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Iraq had been a diverse society with races, cultures and religions that peacefully coexistence. The phenomenon of internal displacement occurred after April 2003, because of political instability as will as the deterioration of the political and security situation as a result of United States of America occupation. Biggest internal displacement have occurred (and keep happening) since 10th of June 2014 due to rise of Islamic State of Iraq and Syria (ISIS) and it’s occupation of one third of country territories. This crisis effected directly 3,275,000 people and reflected negatively on the social fabric of Iraq community and led to waves of sectorial violence that swept the country. Internal displaced communities are vulnerable, especially under non functional and weak government, that led to lose of essential human rights and dignity. Using Geographic Information System (GIS) and Geospatial Techniques, two types of internal displacement have been found; voluntary and forced. Both types of displacement are highly influenced by location, race and religion. The main challenge for Iraqi government and NGOs will be after defeating ISIS. Helping the displaced to resettle within their community and to re-establish the coexistence. By spatial-statical analysis hot spots of future conflicts among displaced community have been highlighted. This will help the government to tackle future conflicts before they occur. Also, it will be the base for social conflict early warning system.

Keywords: internal displacement, Iraq, ISIS, human security, human rights, GIS, spatial-statical analysis

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Authors: G. Erkomaishvili, M. Kobalava, T. Lazariashvili, N. Damenia

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Current state of foreign direct investment (FDI) in Georgia is analyzed and evaluated in the paper, the existing legislative background for regulating investments and stimulating policies to attract investments are shown. It is noted that in developing countries encouragement of investment activity, support and implementation are of the most important tasks, implying a consistent investment policy, investor-friendly tax regime and the legal system, reducing administrative barriers and restrictions, fare competitive conditions and business development infrastructure. The work deals with the determining factor of FDIs and the main directions of stimulation, as well as prospective industries where new investments are needed. Contributing and hindering factors and stimulating measures are analyzed. As a result of the research, the direct and indirect factors attracting FDI have been identified. Facilitating factors to FDI inflow are as follows: simplicity of starting business, geopolitical location, low taxes, access to credit, ease of ownership registration, natural resources, low burden of regulations, low level of corruption and low crime rates. Hindering factors to FDI inflow are as follows: small market, lack of policy for attracting investments, low qualification of the workforce (despite the large number of unemployed people it is difficult to find workers with necessary special skills and qualifications), high interest rates, instability of national currency exchange rate, presence of conflict zones within the country and so forth.

Keywords: foreign direct investment, investor, investment attracting marketing policies, reinvestment

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Authors: Pedro Ferraz-Gameiro

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Introduction: The Pellegrini-Stieda lesion is the result of post-traumatic calcification and/or ossification on the medial collateral ligament (MCL) of the knee. When this calcification is accompanied by gonalgia and limitation of knee flexion, it is called Pellegrini-Stieda syndrome. The pathogenesis is probably the calcification of a post-traumatic hematoma at least three weeks after the initial trauma or secondary to repetitive microtrauma. On anteroposterior radiographs, a Pellegrini-Stieda lesion is a linear vertical ossification or calcification of the proximal portion of the MCL and usually near the medial femoral condyle. Patients with Pellegrini-Stieda syndrome present knee pain associated with loss of range of motion. The treatment is usually conservative with analgesic and anti-inflammatory drugs, either systemic or intra-articular. Physical medicine and rehabilitation techniques associated with shock wave therapy can be a way of reduction of pain/inflammation. Patients who maintain instability with significant limitation of knee mobility may require surgical excision. Methods: Research was done using PubMed central using the terms Pellegrini-Stieda syndrome. Discussion/conclusion: Medical treatment is the rule, with initial rest, anti-inflammatory, and physiotherapy. If left untreated, this ossification can potentially form a significant bone mass, which can compromise the range of motion of the knee. Physical medicine and rehabilitation techniques associated with shock wave therapy are a way of reduction of pain/inflammation.

Keywords: knee, Pellegrini-Stieda syndrome, rehabilitation, shock waves therapy

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Authors: E. A. Krasikov

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Dependence of the materials properties on neutron irradiation intensity (flux) is a key problem while usage data of the accelerated materials irradiation in test reactors for forecasting of their capacity for work in realistic (practical) circumstances of operation. Investigations of the reactor pressure vessel steel radiation degradation dependence on fast neutron fluence (embrittlement kinetics) at low flux reveal the instability in the form of the scatter of the experimental data and wave-like sections of embrittlement kinetics appearance. Disclosure of the steel degradation oscillating is a sign of the steel structure cyclic self-recovery transformation as it take place in self-organization processes. This assumption has received support through the discovery of the similar ‘anomalous’ data in scientific publications and by means of own additional experiments. Data obtained stimulate looking-for ways to management of the structural steel radiation stability (for example, by means of nano - structure modification for radiation defects annihilation intensification) for creation of the intelligent self-recovering material. Expected results: - radiation degradation theory and mechanisms development, - more adequate models of the radiation embrittlement elaboration, - surveillance specimen programs improvement, - methods and facility development for usage data of the accelerated materials irradiation for forecasting of their capacity for work in realistic (practical) circumstances of operation, - search of the ways for creating of the radiation stable self-recovery intelligent materials.

Keywords: degradation, radiation, steel, wave-like kinetics

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Authors: H. E. Ferrari, R. Farengo, C. F. Clauser

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Tungsten (W) will be used in ITER as one of the plasma facing components (PFCs). The W could migrate to the plasma center. This could have a potentially deleterious effect on plasma confinement. Electron cyclotron resonance heating (ECRH) can be used to prevent W accumulation. We simulated a series of H mode discharges in ASDEX U with PFC containing W, where central ECRH was used to prevent W accumulation in the plasma center. The experiments showed that the W density profiles were flat after a sawtooth crash, and become hollow in between sawtooth crashes when ECRH has been applied. It was also observed that a saturated kink mode was active in these conditions. We studied the effect of saturated kink like instabilities on the redistribution of W impurities. The kink was modeled as the sum of a simple analytical equilibrium (large aspect ratio, circular cross section) plus the perturbation produced by the kink. A numerical code that follows the exact trajectories of the impurity ions in the total fields and includes collisions was employed. The code is written in Cuda C and runs in Graphical Processing Units (GPUs), allowing simulations with a large number of particles with modest resources. Our simulations show that when the W ions have a thermal velocity distribution, the kink has no effect on the W density. When we consider the plasma rotation, the kink can affect the W density. When the average passing frequency of the W particles is similar to the frequency of the kink mode, the expulsion of W ions from the plasma core is maximum, and the W density shows a hollow structure. This could have implications for the mitigation of W accumulation.

Keywords: impurity transport, kink instability, tungsten accumulation, tungsten dynamics

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