Search results for: global surgery

Authors: Dalila Chaid, Yacine Houmel, Mohamed Lamine Belloulou

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Peripheral neuropathy is a rare but worrying complication of peripheral local anaesthesia. It is caused either by needle contact with the nerve root or by the direct toxicity of local anaesthetics, leading to nerve damage, injury or irritation. Although uncommon, it remains a major concern for anaesthetists. The aim of the study was to assess the prevalence of nerve block-associated neuropathy in knee surgery and to identify the contributing factors in order to minimise the occurrence of this complication. The study also assessed the severity and evolution of lesions, as well as the factors leading to neuropathic pain. Methodology: It is a retrospective observational study on cases of neuropathy related to nerve blocks of the lower limb for knee surgery over a period of seven years (2016-2022). The study included a total of 6,000 patients Analyse the anaesthetic and neuropathic pain-related parameters received from these patients to determine the prevalence and severity of neuropathy. Findings: the prevalence of nerve block-related neuropathy in our study is 5.8‰ for the sciatic nerve and 0.9‰ for the femoral nerve. This was higher compared to the reported rates in the literature, which were between 0.0 to 5‰ for the Sciatic nerve and 0.0 to 3.4‰ for the femoral nerve. These findings highlight the importance of identifying and implementing an ideal anesthesia procedure to reduce the risk of neuropathy associated with nerve blocks. Theoretical Importance: The findings of this study contribute to the existing literature on peripheral neuropathy following locoregional anesthesia. By identifying the prevalence and severity of neuropathy related to nerve blocks, as well as the underlying factors, we provide valuable insights for anesthetists to improve patient safety. This study also emphasizes the need for compliance with technical safety rules to minimize the occurrence of neuropathy. Data Collection and Analysis Procedures: For this study, 25 clinics with retrospective data were collected of neuropathy associated with nerve blocks for knee surgery over a span of seven years. Parameters related to anaesthesia and neuropathic pain were analysed to determine prevalence,severity, and progression of neuropathy. Comparison of our results with the existing literature in order to assess their significance. Questions Addressed: This study aims to define the following points: 1. The prevalence of neuropathy associated with nerve blocks for knee surgery. 2. The factors underlying the development of neuropathy after nerve blocks. 3. Reducing the risk of neuropathy by complying with technical safety rules. 4. Assessing the severity and evolution of neuropathic pain in these cases. Conclusion: this study highlights the need for careful consideration and implementation of anesthesia procedures during nerve blocks for knee surgery. The prevalence of neuropathy linked to these blocks was higher compared to the literature, emphasizing the importance of identifying and minimizing contributing factors. Compliance with technical safety rules is crucial to reduce the risk of peripheral neuropathy. This study provides valuable insights to anesthetists and contributes to improving patient safety in the field of locoregional anesthesia.

Keywords: phantom limb, neuropathic pain, lower limb amputee, ultrasound-guided locoreginal anesthesia

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Authors: Chuping Lo

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This paper presents a simple model demonstrating that ceteris paribus countries with lower barriers to accessing global data tend to earn higher incomes than other countries. Therefore, large countries that inherently have greater data resources tend to have higher incomes than smaller countries, such that the former may be more hesitant than the latter to liberalize cross-border data flows to maintain this advantage. Furthermore, countries with higher artificial intelligence (AI) intensity in production technologies tend to benefit more from economies of scale in data aggregation, leading to higher income and more trade as they are better able to utilize global data.

Keywords: digital intensity, digital divide, international trade, scale of economics

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Authors: Thampi Rawther, Sean O’Brien, Kamala Kanta Das

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Background: Intussusception in the adult is rarely from a benign cause and is almost always pathological. Causes include carcinomas, polyps, Meckel's diverticulum, or colonic diverticulum. Common symptoms include abdominal pain, intestinal obstruction, palpable abdominal mass, GI bleeding, and anemia. Sarcomatoid carcinoma is a rare type of small intestinal malignancy exhibiting carcinomatous and sarcomatous features. It primarily affects older patients, mean age 57, and is 1.5 times more prevalent in men. Method: This is an interesting case report of a patient presenting with intussusception secondary to a sarcomatoid tumor of the small bowel. Conclusion: Surgery is the treatment of choice in adults with intussusception due to the high malignancy potential. Furthermore, surgical resection of the affected bowel is the definitive form of therapy as small bowel sarcomatoid tumors are not responsive to chemotherapy and radiotherapy. Early surgical intervention helps reduce mortality as it allows for early staging, treatment, and monitoring of the tumor. The patient was fortunate to have presented with intussusception, facilitating early surgical intervention, and was found to have a low disease stage.

Keywords: general surgery, small bowel tumour, imaging, unique

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Authors: Michael A. Unbehauen, Gregory D. Sloan, Alberto J. Squatrito

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Missile proliferation and global stability are intrinsically linked. Missile threats continually appear at the forefront of global security issues. North Korea’s recently demonstrated nuclear and intercontinental ballistic missile (ICBM) capabilities, for the first time since the Cold War, renewed public interest in strategic missile defense capabilities. To protect from limited ICBM attacks from so-called rogue actors, the United States developed the Ground-based Midcourse Defense (GMD) system. This study examines if the GMD missile defense shield has contributed to a safer world or triggered a new arms race. Based upon increased missile-related developments and the lack of adherence to international missile treaties, it is generally perceived that the GMD system is a destabilizing factor for global security. By examining the current state of arms control treaties as well as existing missile arsenals and ongoing efforts in technologies to overcome U.S. missile defenses, this study seeks to analyze the contribution of GMD to global stability. A thorough investigation cannot ignore that, through the establishment of this limited capability, the U.S. violated longstanding, successful weapons treaties and caused concern among states that possess ICBMs. GMD capability contributes to the perception that ICBM arsenals could become ineffective, creating an imbalance in favor of the United States, leading to increased global instability and tension. While blame for the deterioration of global stability and non-adherence to arms control treaties is often placed on U.S. missile defense, the facts do not necessarily support this view. The notion of a renewed arms race due to GMD is supported neither by current missile arsenals nor by the inevitable development of new and enhanced missile technology, to include multiple independently targeted reentry vehicles (MIRVs), maneuverable reentry vehicles (MaRVs), and hypersonic glide vehicles (HGVs). The methodology in this study encapsulates a period of time, pre- and post-GMD introduction, while analyzing international treaty adherence, missile counts and types, and research in new missile technologies. The decline in international treaty adherence, coupled with a measurable increase in the number and types of missiles or research in new missile technologies during the period after the introduction of GMD, could be perceived as a clear indicator of GMD contributing to global instability. However, research into improved technology (MIRV, MaRV and HGV) prior to GMD, as well as a decline of various global missile inventories and testing of systems during this same period, would seem to invalidate this theory. U.S. adversaries have exploited the perception of the U.S. missile defense shield as a destabilizing factor as a pretext to strengthen and modernize their militaries and justify their policies. As a result, it can be concluded that global stability has not significantly decreased due to GMD; but rather, the natural progression of technological and missile development would inherently include innovative and dynamic approaches to target engagement, deterrence, and national defense.

Keywords: arms control, arms race, global security, GMD, ICBM, missile defense, proliferation

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Authors: Elad Harison

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The paper identifies the complex links between post-COVID-19 inflationary pressures and global supply chains. Throughout the COVID-19 lockdowns and long periods after the termination of social distancing policies, consumers, notably in the U.S., have confronted and still face disruptions in the supply of goods. The study analyzes the monetary policy in the U.S. that led to the significant shift in consumer demand during a limited supply period, hence resulting in shortages and emphasizing inflationary dynamics. We argue that the monetary guidelines applied by the U.S. government further elevated the scope of supply chain disruptions.

Keywords: consumer demand, COVID-19, inflation, monetary policy, supply chain

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Authors: Ssembatya Joseph Mary

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Introduction: Cryptococcal infection in the Central Nervous System (CNS) is frequently seen in human immunodeficiency virus (HIV) patients and others with low immunity as an opportunistic fungal infection. However, CNS cryptococcal granuloma (cryptococcoma) in immunocompetent patients is rare. We present a case of CNS cryptococcoma in an immunocompetent patient and review the literature to illustrate the diagnosis and treatment of such lesions. Case presentation: A 62-year-old, HIV-negative, immunocompetent female patient with no known chronic illness presented with 5 months history of a progressive headache associated with on and off episodic generalized tonic-clonic convulsions. She had been to several hospitals before she was referred to our center with a diagnosis of a brain tumor. Before referral and despite a negative CSF analysis result, she had received treatment for bacterial meningitis with no success. At Mbarara Regional Referral Hospital (MRRH), she had surgery with an excision biopsy which showed features consistent with cryptococcosis on histology. The patient had a successful adjuvant treatment with antifungal drugs following surgery. Conclusion: The diagnosis of a parasitic CNS infection, particularly cryptococcal infection mimicking neoplastic lesions in an immunocompetent patient, was unusual. Surgical management of such lesions from different reports has a bad outcome and management remains totally conservative.

Keywords: Cryptococcal meningitis, immunocompetent patient, Uganda, low resource setting

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Authors: Zixuan Yang

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This paper presents an analysis of the necessary consideration culture in distributed design through a thorough literature review and case study. The literature review has identified that the need for understanding cultural differences in product design and user evaluations is highlighted by analyzing cross-cultural influences; culture plays a significant role in distributed work, particularly in establishing team cohesion, trust, and credibility early in the project. By applying approaches of Geert Hofstede's dimensions and Fukuyama's trust analysis, a case study of a global design project, i.e., multicultural distributed teamwork solving the problem in terms of reducing the risk of deep vein thrombosis, showcases cultural dynamics, emphasizing trust-building and decision-making. The lessons learned emphasized the importance of cultural awareness, adaptability, and the utilization of scientific theories to enable effective cross-cultural collaborations in global design, providing valuable insights into navigating cultural diversity within design practices.

Keywords: culture, distributed design, global design, Geert Hofstede's dimensions, Fukuyama's trust analysis

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Authors: Wendy Flory, Kazi Czarnecki, Matthijs Mercy, Mark Joswiak, Mary Beth Seasholtz

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Polyurethane Materials are present in a wide range of industrial segments such as Furniture, Building and Construction, Composites, Automotive, Electronics, and more. Dow is one of the leaders for the manufacture of the two main raw materials, Isocyanates and Polyols used to produce polyurethane products. Dow is also a key player for the manufacture of Polyurethane Systems/Formulations designed for targeted applications. In 1990, the first analytical chemometric models were developed and deployed for use in the Dow QC labs of the polyols business for the quantification of OH, water, cloud point, and viscosity. Over the years many models have been added; there are now over 140 models for quantification and hundreds for product identification, too many to be reasonable for support. There are 29 global models alone for the quantification of OH across > 70 products at many sites. An attempt was made to consolidate these into a single model. While the consolidated model proved good statistics across the entire range of OH, several products had a bias by ASTM E1655 with individual product validation. This project summary will show the strategy for global model updates for OH, to reduce the number of models for quantification from over 140 to 5 or less using chemometric methods. In order to gain an understanding of the best product groupings, we identify clusters by reducing spectra to a few dimensions via Principal Component Analysis (PCA) and Uniform Manifold Approximation and Projection (UMAP). Results from these cluster analyses and a separate validation set allowed dow to reduce the number of models for predicting OH from 29 to 3 without loss of accuracy.

Keywords: hydroxyl, global model, model maintenance, near infrared, polyol

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Authors: Shu Tao, Rong Wang, Huizhong Shen, Ye Huang

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High-resolution mapping of fuel combustion is essential for reducing uncertainties in assessments of greenhouse gases and air pollutant emissions. Such inventories provide valuable information for inferring carbon sinks, modeling pollutant transport, and developing control strategies. Previous inventories included only a few fuel types and were derived using national population proxies which may distort the geographical variation within countries. In this study, a global 0.1 degree by 0.1 degree geo-referenced inventory of fuel combustion (PKU-FUEL-2007) was developed for 64 fuel sub-types along with uncertainty analysis for the year 2007. Sub-national fuel consumption of large countries and major power-station locations were used. The disaggregation error can be reduced significantly by using the sub-nationally energy data, because the uneven distribution of per-capita fuel consumption within countries is taken into consideration. The PKU-FUEL was used to generate global emission inventories of CO2 (PKU-CO2-2007), polycyclic aromatic hydrocarbons (PKU-PAHs-2007), and black carbons (PKU-BC-2007). Atmospheric transport modeling and expsoure assessment were conducted for BC and PAHs based on the inventory.

Keywords: fuel, emission, BC, PAHs, atmospheric transport, exposure

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Authors: Mohammad H. Yarmohammadian, Masoud Ferdosi, Abbas Haghshenas, Fatemeh Rezaei

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Surgical procedures aim at preserving human life and improving quality of their life. However, there are many potential risk sources that can cause serious harm to patients. For centuries, managers believed that technical competence of a surgeon is the only key to a successful surgery. But over the past decade, risks are considered in terms of process-based safety procedures, teamwork and inter departmental communication. Aims: This study aims to determine how the process- biased surgical risk management should be done in terms of project management tool named ABS (Activity Breakdown Structure). Settings and Design: This study was conducted in two stages. First, literature review and meeting with professors was done to determine principles and framework of surgical risk management. Next, responsible teams for surgical patient journey were involved in following meeting to develop the process- biased surgical risk management. Methods and Material: This study is a qualitative research in which focus groups with the inductive approach is used. Sampling was performed to achieve representativeness through intensity sampling biased on experience and seniority. Analysis Method used: context analysis of interviews and consensus themes extracted from FDG meetings discussion was the analysis tool. Results: we developed the patient journey process in 5 main phases, 24 activities and 108 tasks. Then, responsible teams, transposition and allocated places for performing determined. Some activities and tasks themes were repeated in each phases like patient identification and records review because of their importance. Conclusions: Risk management of surgical departments is significant as this facility is the hospital’s largest cost and revenue center. Good communication between surgical team and other clinical teams outside surgery department through process- biased perspective could improve safety of patient under this procedure.

Keywords: risk management, activity breakdown structure (ABS), surgical department, medical sciences

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Authors: Marlin Mubarak

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Background: Endometriosis is a complex disabling disease affecting young females in the reproductive period mainly. The aim of this project is to generate a diagnostic model to predict severity and stage of endometriosis prior to Laparoscopic surgery. This will help to improve the pre-operative diagnostic accuracy of stage 3 & 4 endometriosis and as a result, refer relevant women to a specialist centre for complex Laparoscopic surgery. The model is based on the British Society of Gynaecological Endoscopy (BSGE) pain questionnaire, clinical examination and ultrasound scan. Design: This is a prospective, observational, study, in which women completed the BSGE pain questionnaire, a BSGE requirement. Also, as part of the routine preoperative assessment patient had a routine ultrasound scan and when recto-vaginal and deep infiltrating endometriosis was suspected an MRI was performed. Setting: Luton & Dunstable University Hospital. Patients: Symptomatic women (n = 56) scheduled for laparoscopy due to pelvic pain. The age ranged between 17 – 52 years of age (mean 33.8 years, SD 8.7 years). Interventions: None outside the recognised and established endometriosis centre protocol set up by BSGE. Main Outcome Measure(s): Sensitivity and specificity of endometriosis diagnosis predicted by symptoms based on BSGE pain questionnaire, clinical examinations and imaging. Findings: The prevalence of diagnosed endometriosis was calculated to be 76.8% and the prevalence of advanced stage was 55.4%. Deep infiltrating endometriosis in various locations was diagnosed in 32/56 women (57.1%) and some had DIE involving several locations. Logistic regression analysis was performed on 36 clinical variables to create a simple clinical prediction model. After creating the scoring system using variables with P < 0.05, the model was applied to the whole dataset. The sensitivity was 83.87% and specificity 96%. The positive likelihood ratio was 20.97 and the negative likelihood ratio was 0.17, indicating that the model has a good predictive value and could be useful in predicting advanced stage endometriosis. Conclusions: This is a hypothesis-generating project with one operator, but future proposed research would provide validation of the model and establish its usefulness in the general setting. Predictive tools based on such model could help organise the appropriate investigation in clinical practice, reduce risks associated with surgery and improve outcome. It could be of value for future research to standardise the assessment of women presenting with pelvic pain. The model needs further testing in a general setting to assess if the initial results are reproducible.

Keywords: deep endometriosis, endometriosis, minimally invasive, MRI, ultrasound.

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Authors: Kasidis Chomrat, Nopasit Chakpitak, Anukul Tamprasirt, Annop Thananchana

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Internet of Things devices or IoT and Edge Computing has become one of the biggest things happening in innovations and one of the most discussed of the potential to improve and disrupt traditional business and industry alike. With rises of new hang cliff challenges like COVID-19 pandemic that posed a danger to workforce and business process of the system. Along with drastically changing landscape in business that left ruined aftermath of global COVID-19 pandemic, looming with the threat of global energy crisis, global warming, more heating global politic that posed a threat to become new Cold War. How emerging technology like edge computing and usage of specialized design visual processing units will be great opportunities for business. The literature reviewed on how the internet of things and disruptive wave will affect business, which explains is how all these new events is an effect on the current business and how would the business need to be adapting to change in the market and world, and example test benchmarking for consumer marketed of newer devices like the internet of things devices equipped with new edge computing devices will be increase efficiency and reducing posing a risk from a current and looming crisis. Throughout the whole paper, we will explain the technologies that lead the present technologies and the current situation why these technologies will be innovations that change the traditional practice through brief introductions to the technologies such as cloud computing, edge computing, Internet of Things and how it will be leading into future.

Keywords: internet of things, edge computing, machine learning, pattern recognition, image classification

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Authors: Shadab Shishegar, Sophie Duchesne, Genevieve Pelletier

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Sustainability as one of the key elements of Smart cities, can be realized by employing Real Time Control Strategies for city’s infrastructures. Nowadays Stormwater management systems play an important role in mitigating the impacts of urbanization on natural hydrological cycle. These systems can be managed in such a way that they meet the smart cities standards. In fact, there is a huge potential for sustainable management of urban stormwater and also its adaptability to global challenges like climate change. Hence, a dynamically managed system that can adapt itself to instability of the environmental conditions is desirable. A Global Predictive Real Time Control approach is proposed in this paper to optimize the performance of stormwater management basins in terms of flooding prevention. To do so, a mathematical optimization model is developed then solved using Genetic Algorithm (GA). Results show an improved performance at system-level for the stormwater basins in comparison to static strategy.

Keywords: environmental sustainability, optimization, real time control, storm water management

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Authors: M. Yilmaz, I. Yilmaz, M. Uysal

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The Earth system generates different phenomena that are observable at the surface of the Earth such as mass deformations and displacements leading to plate tectonics, earthquakes, and volcanism. The dynamic processes associated with the interior, surface, and atmosphere of the Earth affect the three pillars of geodesy: shape of the Earth, its gravity field, and its rotation. Geodesy establishes a characteristic structure in order to define, monitor, and predict of the whole Earth system. The traditional and new instruments, observables, and techniques in geodesy are related to the gravity field. Therefore, the geodesy monitors the gravity field and its temporal variability in order to transform the geodetic observations made on the physical surface of the Earth into the geometrical surface in which positions are mathematically defined. In this paper, the main components of the gravity field modeling, (Free-air and Bouguer) gravity anomalies are calculated via recent global models (EGM2008, EIGEN6C4, and GECO) over a selected study area. The model-based gravity anomalies are compared with the corresponding terrestrial gravity data in terms of standard deviation (SD) and root mean square error (RMSE) for determining the best fit global model in the study area at a regional scale in Turkey. The least SD (13.63 mGal) and RMSE (15.71 mGal) were obtained by EGM2008 for the Free-air gravity anomaly residuals. For the Bouguer gravity anomaly residuals, EIGEN6C4 provides the least SD (8.05 mGal) and RMSE (8.12 mGal). The results indicated that EIGEN6C4 can be a useful tool for modeling the gravity field of the Earth over the study area.

Keywords: free-air gravity anomaly, Bouguer gravity anomaly, global model, land gravity

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

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

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

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Authors: Alaa Badawi, Suzan Sayegh, Mohamed Sallam, Eman Sadoun, Mohamed Al-Thani, Muhammad W. Alam, Paul Arora

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Background: The dual burden of tuberculosis (TB) and diabetes mellitus (DM) has increased over the past decade with DM prevalence increasing in countries already afflicted with a high burden of TB. The coexistence of the two conditions presents a serious threat to global public health. Objective: The present study examines the global relationship between the prevalence of DM and the incidence of TB to evaluate their coexistence worldwide and their contribution to one another. Methods: This is an ecological longitudinal study covering the period between years 2000 to 2012. We utilized data from the WHO and World Bank sources and International Diabetes Federation to estimate prevalence of DM (%) and the incidence of TB (per 100,000). Measures of central tendency and dispersion as well as the harmonic mean and linear regression were used for different WHO regions. The association between DM prevalence and TB incidence was examined by quartile of DM prevalence. Results: The worldwide average (±S.D.) prevalence of DM within the study period was 6.6±3.8% whereas TB incidence was 135.0±190.5 per 100,000. DM prevalence was highest in the Eastern Mediterranean (8.3±4.1) and West Pacific (8.2±5.6) regions and lowest in the Africa (3.5±2.6). TB incidence was highest in Africa (313.1±275.9 per 100,000) and South-East Asia (216.7±124.9) and lowest in the European (46.5±68.6) and American (47.2±52.9) regions. Only countries with high DM prevalence (>7.6%) showed a significant positive association with TB incidence (r=0.17, p=0.013). Conclusion: A positive association between DM and TB may exist in some – but not all – world regions, a dual burden that necessitates identifying the nature of this coexistence to assist in developing public health approaches that curb their rising burden.

Keywords: diabetes mellitus, tuberculosis, disease burden, global association

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Authors: Samar Mousa, Ryan Kerstein, Mohanad Adam

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Regional anaesthesia has been associated with favourable outcomes in patients undergoing a wide range of surgeries. Beneficial effects have been demonstrated in terms of postoperative respiratory and cardiovascular endpoints, 7-day survival, time to ambulation and hospital discharge, and postoperative analgesia. Our project aimed at assessing the regional anaesthesia practice in the plastic surgery department of Buckinghamshire trust and finding out ways to improve the service in collaboration with the anaesthesia team. It is a retrospective study associated with a questionnaire filled out by plastic surgeons and anaesthetists to get the full picture behind the numbers. The study period was between 1/3/2022 and 23/5/2022 (12 weeks). The operative notes of all patients who had an operation under plastic surgery, whether emergency or elective, were reviewed. The criteria of suitable candidates for the regional block were put by the consultant anaesthetists as follows: age above 16, single surgical site (arm, forearm, leg, foot), no drug allergy, no pre-existing neuropathy, no bleeding disorders, not on ant-coagulation, no infection to the site of the block. For 12 weeks, 1061 operations were performed by plastic surgeons. Local cases were excluded leaving 319 cases. Of the 319, 102 patients were suitable candidates for regional block after applying the previously mentioned criteria. However, only seven patients had their operations under the regional block, and the rest had general anaesthesia that could have been easily avoided. An online questionnaire was filled out by both plastic surgeons and anaesthetists of different training levels to find out the reasons behind the obvious preference for general over regional anaesthesia, even if this was against the patients’ interest. The questionnaire included the following points: training level, time taken to give GA or RA, factors that influence the decision, percentage of RA candidates that had GA, reasons behind this percentage, recommendations. Forty-four clinicians filled out the questionnaire, among which were 23 plastic surgeons and 21 anaesthetists. As regards the training level, there were 21 consultants, 4 associate specialists, 9 registrars, and 10 senior house officers. The actual percentage of patients who were good candidates for RA but had GA instead is 93%. The replies estimated this percentage as between 10-30%. 29% of the respondents thought that this percentage is because of surgeons’ preference to have GA rather than RA for their operations without medical support for the decision. 37% of the replies thought that anaesthetists prefer giving GA even if the patient is a suitable candidate for RA. 22.6% of the replies thought that patients refused to have RA, and 11.3% had other causes. The recommendations were in 5 main accesses, which are protocols and pathways for regional blocks, more training opportunities for anaesthetists on regional blocks, providing a separate block room in the hospital, better communication between surgeons and anaesthetists, patient education about the benefits of regional blocks.

Keywords: regional anaesthesia, regional block, plastic surgery, general anaesthesia

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Authors: Karan Gupta

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The floods cause huge loos each year, and their impact gets manifold with the increase of total duration of flood as well as recession time. Moreover, floods have increased in recent years due to climate change in floodplains. In the context of global climate change, the agreement in Paris convention (2015) stated to keep the increase in global average temperature well below 2°C and keep it at the limit of 1.5°C. Thus, this study investigates the impact of increasing temperature on the stage, discharge as well as total flood duration and recession time in the Meghna River basin in Bangladesh. This study considers the 100-year return period flood flows in the Meghna river under the specific warming levels (SWLs) of 1.5°C, 2°C, and 4°C. The results showed that the rate of increase of duration of flood is nearly 50% lesser at ∆T = 1.5°C as compared to ∆T = 2°C, whereas the rate of increase of duration of recession is 75% lower at ∆T = 1.5°C as compared to ∆T = 2°C. Understanding the change of total duration of flood as well as recession time of the flood gives a better insight to effectively plan for flood mitigation measures.

Keywords: flood, climate change, Paris convention, Bangladesh, inundation duration, recession duration

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Authors: Osamu Komori, Shinto Eguchi, Hiroshi Okamura, Momoko Ichinokawa

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The long time-series data on population assessments are essential for global ecosystem assessment because the temporal change of biomass in such a database reflects the status of global ecosystem properly. However, the available assessment data usually have limited sample sizes and the ratio of populations with low abundance of biomass (collapsed) to those with high abundance (non-collapsed) is highly imbalanced. To allow for the imbalance and uncertainty involved in the ecological data, we propose a binary regression model with mixed effects for inferring ecosystem status through an asymmetric logistic model. In the estimation equation, we observe that the weights for the non-collapsed populations are relatively reduced, which in turn puts more importance on the small number of observations of collapsed populations. Moreover, we extend the asymmetric logistic regression model using propensity score to allow for the sample biases observed in the labeled and unlabeled datasets. It robustified the estimation procedure and improved the model fitting.

Keywords: double robust estimation, ecological binary data, mixed effect logistic regression model, propensity score

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Authors: Laxmi Prasad Bhattarai

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Climate change is regarded as one of the most fundamental threats to sustainable livelihood and global development. There is a growing global concern in linking community-managed forests as potential climate change mitigation projects. This study was conducted to explore local people’s perception on climate change and the role of community forestry (CF) to combat climate change impacts. Two active community forest user groups (CFUGs) from Kaski and Syangja Districts in Nepal were selected as study sites, and various participatory tools were applied to collect primary data. Although most of the respondents were unaware about the words “Climate Change” in study sites, they were quite familiar with the irregularities in rainfall season and other weather extremities. 60% of the respondents had the idea that, due to increase in precipitation, there is a frequent occurrence of erosion, floods, and landslide. Around 85% of the people agreed that community forests help in stabilizing soil, reducing the natural hazards like erosion, landslide. Biogas as an alternative source of cooking energy, and changes in crops and their varieties are the common adaptation measures that local people start practicing in both CFUGs in Nepal.

Keywords: community forestry, climate change, global warming, adaptation, Nepal

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Authors: Rahele Mosleh

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This paper gives a survey of results on global stability of extended Ross model for malaria by constructing some elegant Lyapunov functions for two cases of epidemic, including disease-free and endemic occasions. The model is a nonlinear seven-dimensional system of ordinary differential equations that simulates this phenomenon in a more realistic fashion. We discuss the existence of positive disease-free and endemic equilibrium points of the model. It is stated that extended Ross model possesses invariant solutions for human and mosquito in a specific domain of the system.

Keywords: global stability, invariant solutions, Lyapunov function, stationary points

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Authors: Theodorus Holtzhausen

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With a growing number of professionals in healthcare moving freely between countries and also in general a more mobile global workforce, awareness of cultural differences have become more urgent for health care workers to apply proper care. There is a slowly emerging trend in health care due to globalisation that may create a more uniform cultural base for administering healthcare, but it is still very vulnerable to being hijacked and misdirected by major commercial interests. Veterinary clinics and medical clinics promoting alternative remedies lacking evidence based support and simultaneously practicing medicine as a science have become more common. Such ‘holistic’ clinics see these remedies more as a belief system causing no harm with minimal impact but with added financial benefit to the facility. With the inarguable acceptance and realisation of the interconnection between evolutionary aspects of cognition, knowledge and culture as a global but vulnerable cognition-gaining process affecting us all, we can see the enormous responsibility we carry. Such a responsibility for creating global well-being calling for an universally applicable ethic. Such an ethic with the potential of having significant impact on our cognition gaining process.

Keywords: veterinary health care, ethics, wellbeing, veterinary clinics

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Authors: Jia Yin Tan, Daniel Rambei, Kate Mann, Samuel price, Ahmed Aboelela

Abstract:

Introduction: Breastfeeding is a complex process, influenced by various factors. Tongue-tie may lead to breastfeeding difficulties due to an inability to suck effectively, causing sore nipples and poor infant weight gain. In the UK, most frenotomies on infants are performed by doctors, nurses, health visitors or midwives. Objectives: Evaluation of safety and efficacy of a multispecialty nurse-led rapid access tongue-tie service at Sheffield Children’s Hospital, run jointly by the ENT and paediatric surgery departments. Methodology: A retrospective observational study, including all patients attending the ENT and paediatric surgery nurse-led tongue tie clinics between 1/10/2021 and 30/09/2022. Results: During the study period there were 1135 referrals for frenotomy, with a mean of 15 days between referral to clinic episode. 86.8% of referred patients underwent frenotomy, with a complication rate of 0.1% and revision rate of 5.4%. Conclusions: Our findings suggest that our rapid access nurse-led outpatient tongue tie service is safe and efficacious, with low complication and revision rates. This suggests a potential for developing a community-based service, allowing safe and effective care closer to home.

Keywords: tongue tie, frenotomy, cost, nurse-led

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Authors: Özgür Bahadir, Meltem Kurtuncu

Abstract:

The study was designed as quasi-experimental and conducted to determine the effect of music therapy on anxiety, fear and pain management in 6-12-year-old children undergoing surgery. The present study was carried out between 01.01.2016 and 19.08.2016 in BEU. Application and Research Center. The children aged 6 -12 who applied for surgery between the mentioned dates constituted the universe of the study. In the quasi-experimental study that was conducted in the clinics where children received operational treatment, two groups were formed: experimental group (the children who received musical therapy before the surgery) and control group (the children who were administered surveys and the surgery service routines only). Each group consisted of 30 children, and the participants of the study were 60 children in total. Necessary permissions were obtained from the parents of the children hospitalized before the beginning of the implementation. The data was collected through Child Anxiety Sensitivity Index (CASI), “Fear In Medical Treatment Scale”, Face, Legs, Activity, Cry, Consolability Scale (FLACC), Visual Analog Scale (VAS) and Participant Information Form. In the analysis of the data, Kolmogorov-Smirnov distribution scale was used to examine the normality of the distribution along with descriptive statistics methods (Frequency, Percentage, Mean, Standard Deviation). Data was presented in the tables in numbers and percentages. Means were demonstrated along with the standard deviations. The research compared children received; case and control groups include socio-demographic perspective, non-significant difference statistically among similar groups are intertwined. The general level of fear regarding the medical processes before returning to service after the operation and 30 minutes before getting discharged was found to be significantly low in the experimental group compared to control group (p<0.05). No statistically significant difference was found between experimental and control groups in terms of general level of fear regarding the medical processes before the operation, during the operation day and in the recovery room after the operation (p>0.05). Total CASI AD (anxiety sensitivity) levels before the operation, day of the operation and 30 minutes before the discharge for patients in experimental group was found to be significantly higher than the control group (p>0.05). There was no statistically significant difference between the experimental and control groups in the total CASI AD levels for the post-operative recovery room and for returning to the service room after the operation (p>0.05). VAS levels for patients in the experimental group in the post-operative recovery room was significantly higher than the control group (p>0.05). There was no statistically significant difference between the groups in terms of VAS findings in returning to service room after the operation and in 30 minutes before the discharge (p>0.05). As a result of the research; applied children music therapy in the experimental group anxiety, fear, and pain of the scales, their scores average, is lower than the control group children in this situation an increase in the satisfaction of children and parents was observed. In line with this, music therapy preoperative anxiety, fear, and can be used as an effective method of decreasing postoperative pain clinics is suggested.

Keywords: anxiety, children, fear, music therapy, pain

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Authors: Ilirian Laçi, Alketa Spahiu

Abstract:

Ageing causes an increase in the number of patients with spinal canal stenosis. Most of the patients have back pain, leg pain, numbness of the legs, as well as urinary incontinence as a very common symptoms. Urinary incontinence impairs the quality of life. Correction of the symptom of urinary incontinence is possible in the early and adequate treatment of spinal stenosis. Methods: This study observed patients with urinary incontinence and spinal canal stenosis. These patients underwent mechanical decompression of the spinal stenosis through surgery. At the same time, these patients were observed clinically with clinical consultations. Cystoscopy and urodynamic tests were conducted at intervals of 2 and 6 months. As a result of treatment, 60% of patients did recover. The patients in this group who benefit from treatment were the patients who were early diagnosed and treated. Conclusions: An important factor in the prognosis of this pathology is the early diagnosis and treatment. The proper treatment of this pathology makes it curable in most cases. An important role in this pathology is played by the neurosurgeon. Surgery accompanied by laminotomy and mechanical decompression is the best way of treatment. Other factors that played a role in this pathology are also a large number of childbirths for women, obesity, etc.

Keywords: urinary incontinence, quality of life, spinal canal stenosis, early diagnosis, treatment

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Authors: Daniel Hyun

Abstract:

Dental implants are one of the top 3 reasons to sue a dentist for malpractice. It involves dental implant complications, usually because of the angle of the implant from the surgery. At present, surgeons usually use a 3D-printed navigator that is customized for the patient’s teeth. However, those can’t be reused for other patients as they require time. Therefore, I made a guiding device to assist the surgeon in implant operations. The surgeon can input the objective of the operation, and the device constantly checks if the surgery is heading towards the objective within the set range, telling the surgeon by manipulating the LED. We tested the prototypes’ consistency and accuracy by checking the graph, average standard deviation, and the average change of the calculated angles. The accuracy of performance was also acquired by running the device and checking the outputs. My first prototype used accelerometer and gyroscope sensors from the Arduino MPU6050 sensor, getting a changeable graph, achieving 0.0295 of standard deviations, 0.25 of average change, and 66.6% accuracy of performance. The second prototype used only the gyroscope, and it got a constant graph, achieved 0.0062 of standard deviation, 0.075 of average change, and 100% accuracy of performance, indicating that the accelerometer sensor aggravated the functionality of the device. Using the gyroscope sensor allowed it to measure the orientations of separate axes without affecting each other and also increased the stability and accuracy of the measurements.

Keywords: implant, guide, accelerometer, gyroscope, handpiece

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Authors: Ravshan A. Ibadov, Sardor Kh. Ibragimov

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Objective. The aim of the study was to optimize the protocol of cardiopulmonary resuscitation (CPR) after cardiovascular surgical interventions. Methods. The experience of CPR conducted on patients after cardiovascular surgical interventions in the Department of Intensive Care and Resuscitation (DIR) of the Republican Specialized Scientific-Practical Medical Center of Surgery named after Academician V. Vakhidov is presented. The key to the new approach is the rapid elimination of reversible causes of cardiac arrest, followed by either defibrillation or electrical cardioversion (depending on the situation) before external heart compression, which may damage sternotomy. Careful use of adrenaline is emphasized due to the potential recurrence of hypertension, and timely resternotomy (within 5 minutes) is performed to ensure optimal cerebral perfusion through direct massage. Out of 32 patients, cardiac arrest in the form of asystole was observed in 16 (50%), with hypoxemia as the cause, while the remaining 16 (50%) experienced ventricular fibrillation caused by arrhythmogenic reactions. The age of the patients ranged from 6 to 60 years. All patients were evaluated before the operation using the ASA and EuroSCORE scales, falling into the moderate-risk group (3-5 points). CPR was conducted for cardiac activity restoration according to the American Heart Association and European Resuscitation Council guidelines (Ley SJ. Standards for Resuscitation After Cardiac Surgery. Critical Care Nurse. 2015;35(2):30-38). The duration of CPR ranged from 8 to 50 minutes. The ARASNE II scale was used to assess the severity of patients' conditions after CPR, and the Glasgow Coma Scale was employed to evaluate patients' consciousness after the restoration of cardiac activity and sedation withdrawal. Results. In all patients, immediate chest compressions of the necessary depth (4-5 cm) at a frequency of 100-120 compressions per minute were initiated upon detection of cardiac arrest. Regardless of the type of cardiac arrest, defibrillation with a manual defibrillator was performed 3-5 minutes later, and adrenaline was administered in doses ranging from 100 to 300 mcg. Persistent ventricular fibrillation was also treated with antiarrhythmic therapy (amiodarone, lidocaine). If necessary, infusion of inotropes and vasopressors was used, and for the prevention of brain edema and the restoration of adequate neurostatus within 1-3 days, sedation, a magnesium-lidocaine mixture, mechanical intranasal cooling of the brain stem, and neuroprotective drugs were employed. A coordinated effort by the resuscitation team and proper role allocation within the team were essential for effective cardiopulmonary resuscitation (CPR). All these measures contributed to the improvement of CPR outcomes. Conclusion. Successful CPR following cardiac surgical interventions involves interdisciplinary collaboration. The application of an optimized CPR standard leads to a reduction in mortality rates and favorable neurological outcomes.

Keywords: cardiac surgery, cardiac arrest, resuscitation, critically ill patients

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Authors: G. Sevilla, S. Zapata, F. Giraldo, E. Torres, C. Collazos

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This work describes a framework for teaching of global software engineering (GSE) in university undergraduate programs. This framework proposes a method of teaching that incorporates adequate techniques of software requirements elicitation and validated tools of communication, critical aspects to global software development scenarios. The use of proposed framework allows teachers to simulate small software development companies formed by Latin American students, which build information systems. Students from three Latin American universities played the roles of engineers by applying an iterative development of a requirements specification in a global software project. The proposed framework involves the use of a specific purpose Wiki for asynchronous communication between the participants of the process. It is also a practice to improve the quality of software requirements that are formulated by the students. The additional motivation of students to participate in these practices, in conjunction with peers from other countries, is a significant additional factor that positively contributes to the learning process. The framework promotes skills for communication, negotiation, and other complementary competencies that are useful for working on GSE scenarios.

Keywords: requirements analysis, distributed requirements engineering, practical experiences, collaborative support

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Authors: Geetanjali Panda, Suvrakanti Chakraborty

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In this paper, Newton-like descent methods are proposed for unconstrained optimization problems, which use q-derivatives of the gradient of an objective function. First, a local scheme is developed with alternative sufficient optimality condition, and then the method is extended to a global scheme. Moreover, a variant of practical Newton scheme is also developed introducing a real sequence. Global convergence of these schemes is proved under some mild conditions. Numerical experiments and graphical illustrations are provided. Finally, the performance profiles on a test set show that the proposed schemes are competitive to the existing first-order schemes for optimization problems.

Keywords: Descent algorithm, line search method, q calculus, Quasi Newton method

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Authors: Lydia Nkechi Philip

Abstract:

Due to its well-documented commitment to sustainability across diverse global markets, Unilever, a multinational consumer goods powerhouse, serves as a compelling case study. The study's goal is to critically examine Unilever's CSR initiatives, assessing their alignment with international standards and the impact on consumer perceptions and loyalty. The study investigates how Unilever's CSR practices resonate with consumers in various regions using a mixed-methods approach that includes surveys and interviews. The conceptual framework considers the role of sustainable marketing practices as a bridge builder in the CSR-consumer relationship. The findings are expected to provide valuable insights for businesses seeking to navigate the complex terrain of global markets while remaining ethical and sustainable. As consumers place a higher value on socially responsible brands, this study examines Unilever's CSR impact on consumer behavior. The abstract captures the essence of the study, providing a sneak peek at the methodology, key objectives, and anticipated contributions to our understanding of CSR's role in shaping consumer attitudes and loyalty in the global marketplace.

Keywords: Unilever, consumer loyalty, sustainable marketing practices, consumer loyalties

Procedia PDF Downloads 59