Search results for: open temporomandibular joint surgery

Authors: Igor Miňo, Lenka Lešková

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Over the past 80 years, open-field method has evolved as a commonly used tool for the analysis of animal behaviour. The study was carried out using 50 kennel-reared purebred puppies of the German Shepherd dog breed. All dogs were tested in 5^th, 7^th, and 9^th week of age. For the purpose of behavioural analysis, an open-field evaluation report was designed prior to testing to ensure the most convenient, rapid, and suitable way to assess selected behavioural patterns in field conditions. Onset of vocalisation, intensity of vocalisation, level of physical activity, response to sound, and overall behaviour was monitored in the study. Correlations between measures of height, weight and chest circumference, and behavioural characteristics in the 5^th, 7^th, and 9^th week of age were not statistically significant. Onset of vocalisation, intensity of vocalisation, level of physical activity and response to sound differed on statistically significant level between 5^th, 7^th, and 9^th week of age. Results suggest that our practical assessment report may be used as an applicable method to evaluate the suitability of service dog puppies for future working roles.

Keywords: dog, behaviour, open-field, testing

Procedia PDF Downloads 217

Authors: Brooke Sweeney, David White, Felix Amparano, Nick A. Clark, Amy R. Beck, Mathew Lindquist, Lora Edwards, Julie Vandal, Jennifer Lisondra, Katie Cox, Renee Arensberg, Allen Cummins, Jazmine Cedeno, Jason D. Fraser, Kelsey Dean, Helena H. Laroche, Cristina Fernandez

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Background: National organizations call for standardized pre-surgical requirements and education to optimize postoperative outcomes. Since 2017 our surgery program has used defined protocols and educational curricula pre- and post-surgery. In response to patient outcomes, our educational content was refined to include quizzes to assess patient knowledge and surgical preparedness. We aim to optimize adolescent pre-bariatric surgery preparedness by improving overall aggregate pre-surgical assessment performance from 68% to 80% within 12 months. Methods: A multidisciplinary improvement team was developed within the weight management clinic (WMC) of our tertiary care, free-standing children’s hospital. A manual has been utilized since 2017, with limitations in consistent delivery and patient uptake of information. The curriculum has been improved to include quizzes administered during WMC visits prior to bariatric surgery. The initial outcome measure is the pre-surgical quiz score of adolescents preparing for bariatric surgery. Process measure was the number of questions answered correctly to test the questions. Baseline performance was determined by a patient assessment survey of pre-surgical preparedness at patient visits. Plan-Do-Study-Act cycles (PDSA) included: 1) creation and implementation of a refined curriculum, 2) development of 5 new quizzes based upon learning objectives, and 3) improving provider-lead teaching and quiz administration within clinic workflow. Run charts assessed impact over time. Results: A total of 346 quiz questions were administered to 34 adolescents. The outcome measure improved from a baseline mean of 68% to 86% following PDSA 2 cycles, and it was sustained. Conclusion/Implication: Patient/family comprehension of surgical preparedness improved with standardized education via team member-led teaching and assessment using quizzes during pre-surgical clinic visits. The next steps include launching redesigned teaching materials with modules correlated to quizzes and assessment of comprehension and outcomes post-surgically.

Keywords: bariatric surgery, adolescent, clinic, pre-bariatric training

Procedia PDF Downloads 60

Authors: Ran An, Dang Wang

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Background: Mechanical ventilation has been confirmed to increase the incidence of postoperative pulmonary complications (PPCs), and several studies have shown that low tidal volumes combined with positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RM) reduce the incidence of PPCs. However, the optimal lung-protective ventilatory strategy remains unclear. Methods: Multiple databases were searched for randomized controlled trials (RCTs) published prior to October 2023. The association between individual PEEP (iPEEP) or other forms of lung-protective ventilation and the incidence of PPCs was evaluated by Bayesian network meta-analysis. Results: We included 58 studies (11610 patients) in this meta-analysis. The network meta-analysis showed that low ventilation (LVt) combined with iPEEP and RM was associated with significantly lower incidences of PPCs [HVt: OR=0.38 95CrI (0.19, 0.75), LVt: OR=0.33, 95% CrI (0.12, 0.82)], postoperative atelectasis, and pneumonia than was HVt or LVt. In abdominal surgery, LVT combined with iPEEP or medium-to-high PEEP and RM were associated with significantly lower incidences of PPCs, postoperative atelectasis, and pneumonia. LVt combined with iPEEP and RM was ranked the highest, which was based on SUCRA scores. Conclusion: LVt combined with iPEEP and RM decreased the incidences of PPCs, postoperative atelectasis, and pneumonia in noncardiac surgery patients. iPEEP-guided ventilation was the optimal lung protection ventilation strategy. The quality of evidence was moderate.

Keywords: protection ventilation strategies, postoperative pulmonary complications, network meta-analysis, noncardiac surgery

Procedia PDF Downloads 33

Authors: Sabo Elizabeth

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Electronic learning is increasingly popular learning approach in higher educational institutions due to vast growth of internet technology. This approach is important in human capital development. An investigation of open distance and e-learning facilities and information need by open and distance learning students was carried out in Jalingo, Nigeria. Structured questionnaires were administered to 70 registered ODL students of the NOUN. Information sourced from the respondents covered demographic, economic and institutional variables. Data collected for demographic variables were computed as frequency count and percentages. Assessment of the effectiveness of ODL facilities and information need among open and distance learning students was computed on a three or four point Likert Rating Scale. Findings indicated that there are more men compared to women. A large proportion of the respondents are married and there are more matured students in ODL compared to the youth. A high proportion of the ODL students obtained qualifications higher than the secondary school certificate. The proportion of computer literate ODL students was high, and large number of the students does not own a laptop computer. Inadequate e -books and reference materials, internet gadgets and inadequate books (hard copies) and reference material are factors that limit utilization of e-learning facilities in the study areas. Inadequate computer facilities and power back up caused inconveniences and delay in administering and use of e learning facilities. To a high extent, open and distance learning students needed information on university time table and schedule of activities, availability and access to books (hard and e-books) and reference materials. The respondents emphasized that contact with course coordinators via internet will provide a better learning and academic performance.

Keywords: open and distance learning, information required, electronic books, internet gadgets, Likert scale test

Procedia PDF Downloads 322

Authors: Nuhi Arslani, Stojan Potrc, Timotej Mikuljan

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Background: In Department of Abdominal and General Surgery of University Medical Centre Maribor, we treated 578 patients for rectal cancer between 2004 and 2014. During and after treatment we especially concentrated on monitoring local and systemic complications. Methods: For analysis, we used data gathered from preoperative diagnostic tests, reports gathered during operation, reports from the pathohistologic review, and reports on complications after surgery and follow up. Results: In the case of 573 (out of 578) patients (99.1%) we performed resection. R0 was achieved in 551 patients (96,1%). R1 was achieved in 8 patients (1,4%). R2 was achieved in 14 patients (2,4%). Local complications were reported in 78 (13.5%) patients and systemic complications were reported in 68 (11.7%). We would like to point out the low number of local and systemic complications. Conclusions: With advances in surgical techniques, with a multimodal-multidisciplinary approach and with the use of total mesorectal excision we experienced a significant improvement in reducing the number of local and systemic complications in patients with rectal cancer. However, there still remains the question for truly optimal care for each patient with rectal cancer and his quality of life after surgical treatment.

Keywords: local complications, rectal cancer, resection, systemic complications

Procedia PDF Downloads 164

Authors: Mansoureh Karimollahi, Mehriar Adrmohammadi, Mohsen Mohammadi

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Introduction: Patient satisfaction with nursing care is considered as an important indicator of the quality and effectiveness of the health care system, and improving the quality of care is not possible without paying attention to the opinions and expectations of patients. Considering that the scales for assessing satisfaction with nursing care in our country are not comprehensive and measure very few areas, therefore, in this study, psychometrically, the Persian version of the Newcastle Nursing Care Satisfaction Scale was used in patients hospitalized in the wards. Internal medicine and general surgery were discussed. Methods: This cross-sectional study was conducted on 200 patients admitted to the surgery and internal departments of hospitals affiliated to Ardabil University of Medical Sciences. The Newcastle nursing care satisfaction scale was used for the first time in Iran in comparison with the good nursing care scale from the patients' point of view to evaluate the criterion validity. The Newcastle nursing care satisfaction scale was used after translation, validity, and reliability. Results: The level of satisfaction of patients and the experience of patients with nursing care was at a favorable level, respectively, with an average of 111.8 ± 14.2 and 69.07 ± 14.8. Total CVI was estimated at 0.96 for the experience section, 0.95 for the satisfaction section, and 0.96 for the whole scale. The index (CVR) was also 0.95 for the experience section, 0.95 for the satisfaction section, and 0.95 for the whole scale. Criterion validity was also estimated using 0.725 correlation. The validity of the construct was also confirmed using the goodness of fit index (X2=1932/05, p=0.013, KMO=0.913). Convergent validity was estimated at 0.99 in the experience subscale and 0.98 in the satisfaction subscale. . The overall reliability in the experience subscale and satisfaction subscale was 94%, 92%, and 98%, respectively, which indicated the acceptable reliability of the questionnaire. Conclusion: The Persian version of the Newcastle nursing care satisfaction scale as a comprehensive tool that can be easily completed by patients and is easy to interpret, has good validity and reliability and can be used in patient care centers, in departments Surgery, and internal medicine are recommended.

Keywords: psychometrics, Newcastle nursing care satisfaction scale, nursing care satisfaction, general surgery department

Procedia PDF Downloads 92

Authors: Atmaja Patel

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Since the development of lasers in 1951, the first medical application was reported by Goldman in 1962. In 1960, T.H. Maiman produced the first Ruby laser and was used in cardiovascular surgery by McGuff in 1963. After a long time of investigations and new developments in laser technology first clinical applications were performed by Choy and Ginsburg in 1983. Introduction of the first true dental laser was in 1989. This paper is to highlight the various treatments and prevention of periodontal diseases. Lasers have become more predictable and effective form of treatment for periodontal diseases. The advantages of lasers include reduced use of anaesthesia, coagulation that yields a dry surgical field and hence better visibility, reduced need of sutures, minimal swelling and scarring, less pain and medication, faster healing and increased patient acceptance.

Keywords: lasers, periodontal surgery, diode laser, healing

Procedia PDF Downloads 316

Authors: Linyu Wang, Liguo Qiao, Jianhong Xiang, Hao Xu

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In semantic communication, the existing joint Source Channel coding (JSCC) wireless communication system without pilot has unstable transmission performance and can not effectively capture the global information and location information of images. In this paper, a pilot-free image transmission system of joint source channel based on multi-level semantic information (Multi-level JSCC) is proposed. The transmitter of the system is composed of two networks. The feature extraction network is used to extract the high-level semantic features of the image, compress the information transmitted by the image, and improve the bandwidth utilization. Feature retention network is used to preserve low-level semantic features and image details to improve communication quality. The receiver also is composed of two networks. The received high-level semantic features are fused with the low-level semantic features after feature enhancement network in the same dimension, and then the image dimension is restored through feature recovery network, and the image location information is effectively used for image reconstruction. This paper verifies that the proposed multi-level JSCC algorithm can effectively transmit and recover image information in both AWGN channel and Rayleigh fading channel, and the peak signal-to-noise ratio (PSNR) is improved by 1~2dB compared with other algorithms under the same simulation conditions.

Keywords: deep learning, JSCC, pilot-free picture transmission, multilevel semantic information, robustness

Procedia PDF Downloads 116

Authors: N. Ahmadi, H. Yousefnia, A. Bahrami-Samani

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Chitosan is a natural and biodegradable polysaccharide with special characteristic for application in intracavital therapy. 166Ho-chitosan has been reported for the treatment of hepatocellular carcinoma and RSV with promising results. The aim of this study was to prepare 186/188Re-chitosan for radiosynovectomy purposes and investigate the probability of its leakage from the knee joint. 186/188Re was produced by neutron irradiation of the natural rhenium in a research reactor. Chemical processing was performed to obtain (186/188Re)-NaReO4- according to the IAEA manual. A stock solution of chitosan was prepared by dissolving in 1 % acetic acid aqueous solution (10 mg/mL). 1.5 mL of this stock solution was added to the vial containing the activity and the mixture was stirred for 5 min in the room temperature. The radiochemical purity of the complex was checked by the ITLC method, showing the purity of higher than 98%. Distribution of the radiolabeled complex was determined after intra-articular injection into the knees of rats. Excellent retention was observed in the joint with approximately no activity in the other organs.

Keywords: chitosan, leakage, radiosynovectomy, rhenium

Procedia PDF Downloads 337

Authors: Wang Ye, Wei Wei

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Residential block construction of big cities in China began in the 1950s, and four models had far-reaching influence on modern residential block in its development process, including unit compound and residential district in 1950s to 1980s, and gated community and open community in 1990s to now. Based on analysis of the four models’ fabric, the article takes residential blocks in Hangzhou west area as an example and carries on the studies from urban structure level and block special level, mainly including urban road network, land use, community function, road organization, public space and building fabric. At last, the article puts forward semi-open sub-community strategy to improve the current fabric.

Keywords: Hangzhou west area, residential block model, residential block fabric, semi-open sub-community strategy

Procedia PDF Downloads 415

Authors: T. Giansetto, E. Pierrot, P. Picavet, M. Lefebvre, S. Claeys, M. Balligand

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Objective: To test the low sensitivity of the Allberg and Miles index to the stifle opening angle, to evaluate the displacement of the patella after a Modified Maquet Technique using this index, and to assess the incidence of patella luxation post-Modified Maquet Technique in dogs. Materials and methods: Medical records were reviewed from 2012 to 2017. Allberg Miles index was determined for each stifle pre and post-operatively, as well as the stifle joint opening of each case. The occurrence of patella luxation was recorded. Results: 137 stifles on 116 dogs were reviewed. The stifle opening angle did not influence the Allberg Miles index (p=0.41). Pre and post-operative index showed a distal displacement of the patella after a Modified Maquet Procedure, especially at a 90° of stifle opening angle. Only 1/137 cases demonstrated patella luxation after the surgery. Conclusion: The Allberg Miles radiographic index is largely independent of the stifle opening angle and can be used to assess the proximo-distal position of the patella in relation to the femoral trochlear groove. If patella baja is clearly induced by the Modified Maquet Technique, the latter does not seem to predispose patients to post-operative patella luxation in a large variety of dog breeds.

Keywords: rlca, modified Maquet technique, patella luxation, orthopedic

Procedia PDF Downloads 126

Authors: Pushkar Umaranikar, Chris Pollett

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An online advertisement system and its implementation for the Yioop open source search engine are presented. This system supports both selling advertisements and displaying them within search results. The selling of advertisements is done using a system to auction off daily impressions for keyword searches. This is an open, ascending price auction system in which all accepted bids will receive a fraction of the auctioned day’s impressions. New bids in our system are required to be at least one half of the sum of all previous bids ensuring the number of accepted bids is logarithmic in the total ad spend on a keyword for a day. The mechanics of creating an advertisement, attaching keywords to it, and adding it to an advertisement inventory are described. The algorithm used to go from accepted bids for a keyword to which ads are displayed at search time is also presented. We discuss properties of our system and compare it to existing auction systems and systems for selling online advertisements.

Keywords: online markets, online ad system, online auctions, search engines

Procedia PDF Downloads 323

Authors: Mohammad Java Esmaeily

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Background: We evaluate the effects of tissue and organ perfusion during and after coronary artery bypass graft surgery with either colloid (Voluven) or crystalloid (Lactated ringers) as a prime solution. Materials and Methods: In this prospective randomized-controlled trial study, 70 patients undergoing on-pump coronary artery bypass graft surgery were randomly assigned to receive either colloid (Voluven) or crystalloid (Lactated ringer's) as a prime solution for initiation of cardiopulmonary bypass machine procedure. Tissue and organ perfusion markers, including lactate, troponin I, liver and renal function tests and electrolytes, were measured sequentially before induction (T1) to the second days after surgery (T5). Results: With the exception of chloride and potassium levels, no significant differences were detected in other measurements, and laboratory results were identical entirely in the two groups. Conclusion: Voluven® (hydroxyethyl starch, HES 130/0.4) has a not significant difference in comparison with crystalloid (Lactated ringer's) as priming solution on the basis of organ and tissue perfusion tests assessment.

Keywords: prime, colloid, crystalloid, lactate, troponin, hydroxyethyl starch

Procedia PDF Downloads 83

Authors: Sylvain Devie, Pierre-Philippe Robet, Yannick Aoustin, Maxime Gautier

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The aim of this paper is to show that the observation of the external effort and the sensor-less control of a system is limited by the mechanical system. First, the model of a one-joint robot with a prismatic joint is presented. Based on this model, two different procedures were performed in order to identify the mechanical parameters of the system and observe the external effort applied on it. Experiments have proven that the accuracy of the force observer, based on the DC motor current, is limited by the mechanics of the robot. The sensor-less control will be limited by the accuracy in estimation of the mechanical parameters and by the maximum static friction force, that is the minimum force which can be observed in this case. The consequence of this limitation is that industrial robots without specific design are not well adapted to perform sensor-less precision tasks. Finally, an efficient control law is presented for high effort applications.

Keywords: control, identification, robot, co-manipulation, sensor-less

Procedia PDF Downloads 157

Authors: Oleg Sapelnikov, Ruslan Latypov, Darina Ardus, Samvel Aivazian, Andrey Shiryaev, Renat Akchurin

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OBJECTIVE: MAZE procedure is one of the most effective surgical methods in atrial fibrillation (AF) treatment. Nowadays we are all aware of its modifications. In our study we conducted clinical analysis of “Box lesion+” approach during MAZE procedure in two-year follow-up. METHODS: We studied the results of the open-heart on-pump procedures performed in our hospital from 2017 to 2018 years. Thirty-two (32) patients with atrial fibrillation (AF) were included in this study. Fifteen (15) patients had concomitant coronary bypass grafting and seventeen (17) patients had mitral valve repair. Mean age was 62.3±8.7 years; prevalence of men was admitted (56.1%). Mean duration of AF was 4.75±5.44 and 7.07±8.14 years. In all cases, we performed endocardial Cryo-MAZE procedure with one-time myocardium revascularization or mitral-valve surgery. All patients of this study underwent pulmonary vein (PV) isolation and ablation of mitral isthmus with additional isolation of LA posterior wall (Box-lesion+ procedure). Mean follow-up was 2 years. RESULTS: All cases were performed without any complications. Additional isolation of posterior wall did not prolong the operative time and artificial circulation significantly. Cryo-MAZE procedure directly lasted 20±2.1 min, the whole operation time was 192±24 min and artificial circulation time was 103±12 min. According to design of the study, we performed clinical investigation of the patients in 12 months and in 2 years from the initial procedure. In 12 months, the number of AF free patients 81.8% and 75.8% in two years of follow-up. CONCLUSIONS: Isolation of the left atrial posterior wall and perimitral area may considerably improve the efficacy of surgical treatment, which was demonstrated in significant decrease of AF recurrences during the whole period of follow-up.

Keywords: atrial fibrillation, cryoablation, left atrium isolation, open heart procedure

Procedia PDF Downloads 123

Authors: Prabir Patel, Eugene Ming Han Lim

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Introduction: Current literature shows that postoperative pulmonary complications following abdominal surgery may be reduced by using lower than conventional tidal volumes intraoperatively together with moderate levels of positive end expiratory pressure (PEEP). The recent studies demonstrated significant reduction demonstrated significant reduction in major complications in elective abdominal surgery through the use of lower tidal volumes (6-8 ml/kg predicted body weight), PEEP of 5 cmH20 and recruitment manoeuvres compared to higher ‘conventional’ volumes (10-12 mls/kg PBW) without lung recruitment. Our objective was to retrospectively audit current practice for patients undergoing major abdominal surgery in Sir Charles Gairdner Hospital. Methods: Patients over 18 undergoing elective general surgery lasting more than 3 hours and intubated during the duration of procedure were included in this audit. Data was collected over a 6 month period. Patients who had hepatic surgery, procedures necessitating one-lung ventilation, transplant surgery, documented history of pulmonary or intracranial hypertension were excluded. Results: 58 suitable patients were identified and notes were available for 54 patients. Key findings: Average peak airway pressure was 21cmH20 (+4), average peak airway pressure was less than 30 cmH20 in all patients, and less than 25 cmH20 in 80% of the cases. PEEP was used in 81% of the cases. Where PEEP was used, 75% used PEEP more than or equal to 5 cmH20. Average tidal volume per actual body weight was 7.1 ml/kg (+1.6). Average tidal volume per predicted body weight (PBW) was 8.8 ml/kg (+1.5). Average tidal volume was less than 10 ml/kg PBW in 90% of cases; 6-8 ml/kg PBW in 40% of the cases. There was no recorded use of recruitment manoeuvres in any cases. Conclusions: In the vast majority of patients undergoing prolonged abdominal surgery, a lung protective strategy using moderate levels of PEEP, peak airway pressures of less than 30 cmH20 and tidal volumes of less than 10 cmH20/kg PBW was utilised. A recent randomised control trial demonstrated benefit from utilising even lower volumes (6-8 mls/kg) based on findings in critical care patients, but this was compared to volumes of 10-12 ml/kg. Volumes of 6-8 ml/kg PBW were utilised in 40% of cases in this audit. Although theoretically beneficial, clinical benefit of lower volumes than what is currently practiced in this institution remains to be seen. The incidence of pulmonary complications was much lower than in the other cited studies and a larger data set would be required to investigate any benefit from lower tidal volume ventilation. The volumes used are comparable to results from published local and international data but PEEP utilisation was higher in this audit. Strategies that may potentially be implemented to ensure and maintain best practice include pre-operative recording of predicted body weight, adjustment of default ventilator settings and education/updates of current evidence.

Keywords: anaesthesia, intraoperative ventilation, PEEP, tidal volume

Procedia PDF Downloads 762

Authors: Millicent N. Khumalo, Phesheya E. Dlamini

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Shrub-encroachment leads to a gain or loss of soil organic carbon (SOC) in previously open rangelands. The stabilization mechanisms controlling the storage of soil organic carbon (SOC) within aggregates of shrub-encroached grassland soils are poorly understood, especially in shallow plinthic soils. In this study, physical fractionation of surface soils (0- 10 cm) collected from open and shrub-encroached grasslands was conducted to determine the distribution of SOC within macro-and- microaggregates. Soil aggregates were classified into four fractions by a wet-sieving procedure, namely >2000 (large macro-aggregates), 212-2000 (small macro-aggregates), 50-212 (microaggregates) and < 50µm (silt+clay). In both shrub-encroached and open grassland soils, SOC was greater in the silt+clay fraction. In this fraction, SOC was on average 133% greater in shrub-encroached compared to open grassland. The greater SOC within the silt+clay fraction is due to the greater surface area and thus more exchange sites for carbon absorption. This implies that the SOC physically protected within the silt+clay is stored long-term.

Keywords: aggregate fractions, shrub-encroachment, soil organic carbon, stabilization

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Authors: Natália Botica, Luís Luís, Paulo Bernardes

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The Côa Valley, listed World Heritage since 1998, presents more than 1300 open-air engraved rock panels. The Archaeological Park of the Côa Valley recorded the rock art motifs, testing various techniques based on direct tracing processes on the rock, using natural and artificial lighting. In this work, integrated in the "Open Access Rock Art Repository" (RARAA) project, we present the methodology adopted for the vectorial drawing of the rock art motifs based on orthophotos taken from the photogrammetric survey and 3D models of the rocks. We also present the information system designed to integrate the vector drawing and the characterization data of the motifs, as well as the open access sharing, in order to promote their reuse in multiple areas. The 3D models themselves constitute a very detailed record, ensuring the digital preservation of the rock and iconography. Thus, even if a rock or motif disappears, it can continue to be studied and even recreated.

Keywords: rock art, archaeology, iron age, 3D models

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Authors: Klazina T. Havinga, Hilde R. H. de Geus

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Introduction: Pre-operative coagulation management of Apixaban prescribed patients, a new oral anticoagulant (a factor Xa inhibitor), is difficult, especially when chronic kidney disease (CKD) causes drug overdose. Apixaban is not dialyzable due to its high level of protein binding. An antidote, Andexanet α, is available but expensive and has an unfavorable short half-life. We report the successful extracorporeal removal of Apixaban prior to emergency surgery with the CytoSorb® Hemoadsorption device. Methods: A 89-year-old woman with CKD, with an Apixaban prescription for atrial fibrillation, was presented at the ER with traumatic rib fractures, a flail chest, and an unstable spinal fracture (T12) for which emergency surgery was indicated. However, due to very high Apixaban levels, this surgery had to be postponed. Based on the Apixaban-specific anti-factor Xa activity (AFXaA) measurements at admission and 10 hours later, complete clearance was expected after 48 hours. In order to enhance the Apixaban removal and reduce the time to operation, and therefore reduce pulmonary complications, CRRT with CytoSorb® cartridge was initiated. Apixaban-specific anti-factor Xa activity (AFXaA) was measured frequently as a substitute for Apixaban drug concentrations, pre- and post adsorber, in order to calculate the adsorber-related clearance. Results: The admission AFXaA concentration, as a substitute for Apixaban drug levels, was 218 ng/ml, which decreased to 157 ng/ml after ten hours. Due to sustained anticoagulation effects, surgery was again postponed. However, the AFXaA levels decreased quickly to sub-therapeutic levels after CRRT (Multifiltrate Pro, Fresenius Medical Care, Blood flow 200 ml/min, Dialysate Flow 4000 ml/h, Prescribed renal dose 51 ml-kg-h) with Cytosorb® connected in series into the circuit was initiated (within 5 hours). The adsorber-related (indirect) Apixaban clearance was calculated every half hour (Cl=Qe * (AFXaA pre- AFXaA post/ AFXaA pre) with Qe=plasma flow rate calculated with Ht=0.38 and system blood flow rate 200 ml-min): 100 ml/min, 72 ml/min and 57 ml/min. Although, as expected, the adsorber-related clearance decreased quickly due to saturation of the beads, still the reduction rate achieved resulted in a very rapid decrease in AFXaA levels. Surgery was ordered and possible within 5 hours after Cytosorb initiation. Conclusion: The CytoSorb® Hemoadsorption device enabled rapid correction of Apixaban associated anticoagulation.

Keywords: Apixaban, CytoSorb, emergency surgery, Hemoadsorption

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Authors: Andreas Savvides, Chloe Kadi

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The objective of this study is to investigate how the planning and design of open parks within neighborhoods and communities can promote physical activity in order to enhance the health of the local population. An extensive literature review was conducted for studies regarding the relationship between health and physical activity and the park characteristics that can promote physical activity among people. The findings of the literature review were then compared and analysed, in order to identify the main characteristics of urban parks that can promote physical activity and enhance public health. In order to find out how the characteristics identified in the literature were applied in real life, an analysis of three existing parks in three different countries was conducted. The parks, apart from their geographical location, also vary in size and layout. The parks were chosen because they are urban open parks and they include facilities for physical activity.

Keywords: urban planning, active living behaviour, open parks, sustainable mobility

Procedia PDF Downloads 125

Authors: Sara De Pelsmaeker, Catarina Ferreira da Silva, Janne Prawit

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Recent studies show that enzymatically hydrolysed collagen is absorbed and distributed to joint tissues, where it has analgesic and active anti-inflammatory properties. Reviews of the associated relevant literature also support this theory. However, these studies are all using hydrolyzed collagen from animal hide or skin. This study looks into the effect of daily supplementation of hydrolyzed cartilage collagen (HCC), which has a different composition. A consumer study was set up using a double-blind placebo-controlled design with a control group using twice a day 0.5gr of maltodextrin and an experimental group using twice 0.5g of HCC, over a trial period of 12 weeks. A follow-up phase of 4 weeks without supplementation was taken into the experiment to investigate the ‘wash-out’ phase. As this consumer study was conducted during the lockdown periods, a specific app was designed to follow up with the participants. The app had the advantage that in this way, the motivation of the participants was enhanced and the drop-out range of participants was lower than normally seen in consumer studies. Participants were recruited via various sports and health clubs across the UK as we targeted a general population of people that considered themselves in good health. Exclusion criteria were ‘not experiencing any medical conditions’ and ‘not taking any prescribed medication’. A minimum requirement was that they regularly engaged in some level of physical activity. The participants had to log the type of activity that they conducted and the duration of the activity. Weekly, participants were providing feedback on their joint health and subjective pain using the validated pain measuring instrument Visual Analogue Scale (VAS). The weekly repoAbstract Public Health and Wellbeing Conferencerting section in the app was designed with simplicity and based on the accuracy demonstrated in previous similar studies to track subjective pain measures of participants. At the beginning of the trial, each participant indicated their baseline on joint pain. The results of this consumer study indicated that HCC significantly improved joint health and subjective pain scores compared to the placebo group. No significant differences were found between different demographic groups (age or gender). The level of activity, going from high intensive training to regular walking, did not significantly influence the effect of the HCC. The results of the wash-out phase indicated that when the participants stopped the HCC supplementation, their subjective pain scores increased again to the baseline. In conclusion, the results gave a positive indication that the daily supplementation of HCC can contribute to the overall mobility and wellbeing of a general active population

Keywords: VAS-score, food supplement, mobility, joint health

Procedia PDF Downloads 161

Authors: P. Vanichkobchinda

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The Logistics Transportation techniques, Open Vehicle Routing (OVR) is an approach toward transportation cost reduction, especially for long distance pickup and delivery nodes. The outstanding characteristic of OVR is that the route starting node and ending node are not necessary the same as in typical vehicle routing problems. This advantage enables the routing to flow continuously and the vehicle does not always return to its home base. This research aims to develop a heuristic for the open vehicle routing problem with pickup and delivery under time window and loading capacity constraints to minimize the total distance. The proposed heuristic is developed based on the Insertion method, which is a simple method and suitable for the rapid calculation that allows insertion of the new additional transportation requirements along the original paths. According to the heuristic analysis, cost comparisons between the proposed heuristic and companies are using method, nearest neighbor method show that the insertion heuristic. Moreover, the proposed heuristic gave superior solutions in all types of test problems. In conclusion, the proposed heuristic can effectively and efficiently solve the open vehicle routing. The research indicates that the improvement of new transport's calculation and the open vehicle routing with "Insertion Heuristic" represent a better outcome with 34.3 percent in average. in cost savings. Moreover, the proposed heuristic gave superior solutions in all types of test problems. In conclusion, the proposed heuristic can effectively and efficiently solve the open vehicle routing.

Keywords: business competitiveness, cost reduction, SMEs, logistics transportation, VRP

Procedia PDF Downloads 682

Authors: Omid Azimaraghi, Noushin Khazaei

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Background: Fluid therapy is an important aspect of the perioperative period and a major challenge for anesthesiologists. To authors best knowledge, there is a lack of strong guidance and evidence regarding the optimal approach to fluid therapy. Therefore a variety of medical devices have been introduced to help physicians. In this study, we aimed to evaluate the effectiveness of pleth variability index in guiding fluid therapy in different patient positions. Materials and Methods: Inclusion criteria consisted of patients aged 18-50 years old and classified as American Society of Anesthesiologists physical status I and II, who were candidates for elective thyroidectomy surgery. In total, 36 patients meeting the inclusion criteria were enrolled in the study. After induction of anesthesia and start of mechanical ventilation Pleth variability index was measured in the supine position, then patients were placed in Trendelenburg and reverse Trendelenburg position (30 degrees, 5 minutes); Pleth Variability Index has measured again in the mentioned positions. Results: Mean PVI (Pleth Variability Index) in the supine position was 14.3 ± 3.7 in comparison to 21.5 ± 4.3 in the reverse Trendelenburg position. The mean PVI in Trendelenburg position was 9.1 ± 2.0 in Trendelenburg position (p < 0.05). Conclusion: In conclusion, we found that Pleth Variability Index varies with patient position and this should be taken into account when using this index during fluid therapy.

Keywords: fluid therapy, Pleth Variability Index, position, surgery

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Authors: Dana El-Mughayyar, Neil Manson, Erin Bigney, Eden Richardson, Dean Tripp, Edward Abraham

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Use of narcotics to treat pain has increased over the past two decades and is a contributing factor to the current public health crisis. Understanding the pre-operative risks of chronic narcotic use may be aided through investigation of psychological measures. The objective of the reported study is to determine predictors of narcotic use two years post-surgery in a thoracolumbar spine surgery population, including an array of psychological factors. A prospective observational study of 191 consecutively enrolled adult patients having undergone thoracolumbar spine surgery is presented. Baseline measures of interest included the Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia, Multidimensional Scale for Perceived Social Support (MSPSS), Chronic Pain Acceptance Questionnaire (CPAQ-8), Oswestry Disability Index (ODI), Numeric Rating Scales for back and leg pain (NRS-B/L), SF-12’s Mental Component Summary (MCS), narcotic use and demographic variables. The post-operative measure of interest is narcotic use at 2-year follow-up. Narcotic use is collapsed into binary categories of use and no use. Descriptive statistics are run. Chi Square analysis is used for categorical variables and an ANOVA for continuous variables. Significant variables are built into a hierarchical logistic regression to determine predictors of post-operative narcotic use. Significance is set at α < 0.05. Results: A total of 27.23% of the sample were using narcotics two years after surgery. The regression model included ODI, NRS-Leg, time with condition, chief complaint, pre-operative drug use, gender, MCS, PCS subscale helplessness, and CPAQ subscale pain willingness and was significant χ² (13, N=191)= 54.99; p = .000. The model accounted for 39.6% of the variance in narcotic use and correctly predicted in 79.7% of cases. Psychological variables accounted for 9.6% of the variance over and above the other predictors. Conclusions: Managing chronic narcotic usage is central to the patient’s overall health and quality of life. Psychological factors in the preoperative period are significant predictors of narcotic use 2 years post-operatively. The psychological variables are malleable, potentially allowing surgeons to direct their patients to preventative resources prior to surgery.

Keywords: narcotics, psychological factors, quality of life, spine surgery

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Authors: Antarip Bhattacharya, Dhritiman Maitra

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Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia due to autonomous production of parathormone (PTH) and the third most common endocrine disorder. Upto 2% of postmenopausal women could have this condition. Primary hyperparathyroidism is characterized by hypercalcemia with a high or insufficiently suppressed level of parathyroid hormone and is caused by a solitary parathyroid adenoma in 85-90% of patients. PHPT may also be caused by parathyroid hyperplasia (involving multiple glands) or parathyroid carcinoma. Associated morbidities and sequelae include decreased bone mineral density, fractures, kidney stones, hypertension, cardiac comorbidities and psychiatric disorder which entail huge costs for treatment. In the year 2021, by virtue of running a Breast and Endocrine Surgery clinic in a Tier 1 city at a tertiary care hospital, the opportunity to be associated with patients of hyperparathyroidism came our way. Here, we shall describe the spectrum of clinical presentations and customisation of treatment for parathyroid diseases with reference to the above patients. A retrospective analysis of the data of all patients presenting with symptoms of parathyroid diseases was made and classified according to the cause. 13 patients had presented with symptoms of hyperparathyroidism and each case presented with unique symptoms and necessitated detailed evaluation. The treatment or surgery offered to each patient was tailored to his/her individual disease and led to favourable outcomes. Diseases affecting parathyroid are not as rare as we believe. Each case merits detailed clinical evaluation, investigations and tailoring of suitable treatment with regard to medical management and extent of surgery. Intra-operative frozen section/iOPTH monitoring are really useful adjuncts for intra-operative decision making.

Keywords: hyperparathyroidism, parathyroid adenoma, parathyroid surgery, PTH

Procedia PDF Downloads 121

Authors: Shao-Huang Wu, Ai-Yun Wu, Meng-Chen Wu, Chun-Liang Wu, Kai-Ping Shaw, Hsiao-Ting Chen

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Objective: To analyze the forensic autopsy data of known passengers and compare it with the National database of the autopsy report in 2017, and obtain the special patterned injuries, which can be used as the reference for the reconstruction of hit-and-run motor vehicle accidents. Methods: Analyze the items of the Motor Vehicle Accident Report, including Date of accident, Time occurred, Day, Acc. severity, Acc. Location, Acc. Class, Collision with Vehicle, Motorcyclists Codes, Safety equipment use, etc. Analyzed the items of the Autopsy Report included, including General Description, Clothing and Valuables, External Examination, Head and Neck Trauma, Trunk Trauma, Other Injuries, Internal Examination, Associated Items, Autopsy Determinations, etc. Materials: Case 1. The process of injury formation: the car was chased forward and collided with the scooter. The passenger wearing the helmet fell to the ground. The helmet crashed under the bottom of the sedan, and the bottom of the sedan was raised. Additionally, the sedan was hit on the left by the other sedan behind, resulting in the front sedan turning 180 degrees on the spot. The passenger’s head was rotated, and the cervical spine was fractured. Injuries: 1. Fracture of atlantoaxial joint 2. Fracture of the left clavicle, scapula, and proximal humerus 3. Fracture of the 1-10 left ribs and 2-7 right ribs with lung contusion and hemothorax 4. Fracture of the transverse process of 2-5 lumbar vertebras 5. Comminuted fracture of the right femur 6. Suspected subarachnoid space and subdural hemorrhage 7. Laceration of the spleen. Case 2. The process of injury formation: The motorcyclist wearing the helmet fell to the left by himself, and his chest was crushed by the car going straight. Only his upper body was under the car and the helmet finally fell off. Injuries: 1. Dislocation of atlantoaxial joint 2. Laceration on the left posterior occipital 3. Laceration on the left frontal 4. Laceration on the left side of the chin 5. Strip bruising on the anterior neck 6. Open rib fracture of the right chest wall 7. Comminuted fracture of both 1-12 ribs 8. Fracture of the sternum 9. Rupture of the left lung 10. Rupture of the left and right atria, heart tip and several large vessels 11. The aortic root is nearly transected 12. Severe rupture of the liver. Results: The common features of the two cases were the fracture or dislocation of the atlantoaxial joint and both helmets that were crashed. There were no atlantoaxial fractures or dislocations in 27 pedestrians (without wearing a helmet) versus motor vehicle accidents in 2017 the National database of an autopsy report, but there were two atlantoaxial fracture or dislocation cases in the database, both of which were cases of falling from height. Conclusion: The cervical spine fracture injury of the motorcyclist, who was wearing a helmet, is very likely to be a patterned injury caused by his/her fall and rollover under the sedan. It could provide a reference for forensic peers.

Keywords: patterned injuries, atlantoaxial fracture or dislocation, accident reconstruction, motorcycle accident with helmet, forensic autopsy data

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Authors: N. Hammid, F. Bouarab-Dahmani, T. Berkane

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Since its appearance, the MOOC (massive open online course) is gaining more and more intention of the educational communities over the world. Apart from the current MOOCs design and purposes, the creators of MOOC focused on the importance of the connection and knowledge exchange between individuals in learning. In this paper, we present a conceptual model for massive open online blended courses where teachers over the world can collaborate and exchange their experience to get a common efficient content designed as a MOOC opened to their students to live a better learning experience. This model is based on disciplines’ concepts capitalization and the detection of the obstacles met by their students when faced with problem situations (exercises, projects, case studies, etc.). This detection is possible by analyzing the frequently of semantic errors committed by the students. The participation of teachers in the design of the course and the attendance by their students can guarantee an efficient and extensive participation (an important number of participants) in the course, the learners’ motivation and the evaluation issues, in the way that the teachers designing the course assess their students. Thus, the teachers review, together with their knowledge, offer a better assessment and efficient connections to their students.

Keywords: massive open online course, MOOC, online learning, e-learning

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Authors: Livia Eisler, Cristiane C. B. Alves, Cristina L. F. Ortolani, Kurt Faltin Jr.

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Purpose: This paper proposes a technically simple diagnosis method among orthodontists and maxillofacial surgeons in order to evaluate discrete bone alterations. The methodology consists of a protocol to optimize the diagnosis and minimize the possibility for orthodontic and ortho-surgical retreatment. Materials and Methods: A protocol of image processing and analysis, through ImageJ software and its plugins, was applied to 20 pairs of lateral cephalometric images obtained from cone beam computerized tomographies, before and 1 year after undergoing orthognathic surgery. The optical density of the images was analyzed in the condylar region to determine possible bone alteration after surgical correction. Results: Image density was shown to be altered in all image pairs, especially regarding the condyle contours. According to measures, condyle had a gender-related density reduction for p=0.05 and condylar contours had their alterations registered in mm. Conclusion: A simple, viable and cost-effective technique can be applied to achieve the more detailed image-based diagnosis, not depending on the human eye and therefore, offering more reliable, quantitative results.

Keywords: bone resorption, computer-assisted image processing, orthodontics, orthognathic surgery

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Authors: Zafer Yüce, Paşa Yayla, Alev Taşkın

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There are heaps of analytical methods to estimate the crack growth life of a component. Soft computing methods have an increasing trend in predicting fatigue life. Their ability to build complex relationships and capability to handle huge amounts of data are motivating researchers and industry professionals to employ them for challenging problems. This study focuses on soft computing methods, especially random forest regressors and artificial neural networks with hyperparameter optimization algorithms such as grid search and random grid search, to estimate the crack growth life of an aircraft wing splice joint under variable amplitude loading. TensorFlow and Scikit-learn libraries of Python are used to build the machine learning models for this study. The material considered in this work is 7050-T7451 aluminum, which is commonly preferred as a structural element in the aerospace industry, and regarding the crack type; corner crack is used. A finite element model is built for the joint to calculate fastener loads and stresses on the structure. Since finite element model results are validated with analytical calculations, findings of the finite element model are fed to AFGROW software to calculate analytical crack growth lives. Based on Fighter Aircraft Loading Standard for Fatigue (FALSTAFF), 90 unique fatigue loading spectra are developed for various load levels, and then, these spectrums are utilized as inputs to the artificial neural network and random forest regression models for predicting crack growth life. Finally, the crack growth life predictions of the machine learning models are compared with analytical calculations. According to the findings, a good correlation is observed between analytical and predicted crack growth lives.

Keywords: aircraft, fatigue, joint, life, optimization, prediction.

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Authors: Guy Rubin, Ravit Shay, Nimrod Rozen

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The accuracy of a diagnostic test used to classify a patient as having disease or being disease-free is a valuable piece of information to be used by the physician when making treatment decisions. Finger laceration, suspected to have nerve injury is a challenging decision for the treating surgeon. The purpose of this study was to evaluate the sensitivity, specificity and predictive values of six clinical tests in the diagnosis of digital nerve injury. The six clinical tests included light touch, pin prick, static and dynamic 2-point discrimination, Semmes Weinstein monofilament and wrinkle test. Data comparing pre-surgery examination with post-surgery results of 42 patients with 52 digital nerve injury was evaluated. The subjective examinations, light touch, pin prick, static and dynamic 2-point discrimination and Semmes-Weinstein monofilament were not sensitive (57.6, 69.7, 42.4, 40 and 66.8% respectively) and specific (36.8, 36.8, 47.4, 42.1 and 31.6% respectively). Wrinkle test, the only objective examination, was the most sensitive (78.1%) and specific (55.6%). This result gives no pre-operative examination the ability to predict the result of explorative surgery.

Keywords: digital nerve, injury, nerve examination, Semmes-Weinstein monofilamen, sensitivity, specificity, two point discrimination, wrinkle test

Procedia PDF Downloads 338