Search results for: surgical approach
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 14301

Search results for: surgical approach

13761 Thyroid Cancer Treatment in Yemen Under Blockade Conditions and Absence of Radioactive Iodine

Authors: Anis Al-Yakhiri

Abstract:

Introduction: The World Health Organization (WHO) classifies malignant epithelial thyroid tumors into four major groups (papillary, follicular, medullar and undifferentiated) . Papillary thyroid carcinoma (PTC) is the most common type, for about eight out of ten thyroid cancers belong to this histological type. Radioactive iodine (RAI) is considered effective for patients with total or nearly total thyroidectomy, but the beneficial effects of RAI are still controversial. War conditions forced us to study alternative methods of using radioactive iodine in the treatment of patients with PTC. Material and methods: Between January 2014 and June 2021, in Al-Yakhiri hospital, 57 Total Thyroidectomy with Radical BilateralNeckDissection (RBND) were performed, 50 for malignant disease,7 for false positive cytology.RBND involves surgical clearance of Levels II-VI. Mean age was 40.7 years old and 92% of the patients were female. 7(14%) patients had hypothyroidism which required preoperative thyroid hormone treatment. The Thyroid Stimulating Hormone- Suppression Therapy (TSH-ST) immediately started after RBND for mostpatients on the first day. It consisted in reducing the level of TSH< 0.1 mIU/L. Results: The Apron flap was used on most operations (40)80% and with lateral extensions had 10(20%). RBND involves surgical clearance of Levels II-VI performed in all operated patients, besides that, 4(8%) of them had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV) withclearance of Levels IB. The PTC was the most common 80.9% (38 patients from 47)by histopathological report. and 4(8%) patients of 50 had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV). The postoperative mortality rate not observed (0%). The postoperative morbidity rate was 22.8% (n =13).Seroma(8.7%),Hypocalcimia(7%), Wound infection(5.3%), Bleeding(1.8%). To suppress TSH and growth of any residual thyroid theTSH-ST (levothyroxine150 – 600mcg)was performed in all patients 57(100%) on the first day afterRBND. We tracked the results of treatment for two years in 30 patients with PTC, only 3 of them received radioactive iodine abroad. Biennial Recurrence rate for PTC appeared in one woman (2%), who had RAI postoperatively in the form of neck lymph nodes metastasis. Conclusion: For patients with PTC, thyroidectomy plus prophylacticRBND is a safe and efficient procedure and it results in lower recurrence rate. Postoperative treatment with exogenous thyroid hormone in doses sufficient to suppress TSH (not less than 150mcg), decreases incidence of recurrence. Total Thyroidectomy with RBND followed by TSH-ST, in our opinion, applicable optimal treatment scheme care for this patient population.

Keywords: thyroid cancer, Yemen war, absence of radioactive iodine, neck dissection, surgery results

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13760 Software Component Identification from Its Object-Oriented Code: Graph Metrics Based Approach

Authors: Manel Brichni, Abdelhak-Djamel Seriai

Abstract:

Systems are increasingly complex. To reduce their complexity, an abstract view of the system can simplify its development. To overcome this problem, we propose a method to decompose systems into subsystems while reducing their coupling. These subsystems represent components. Consisting of an existing object-oriented systems, the main idea of our approach is based on modelling as graphs all entities of an oriented object source code. Such modelling is easy to handle, so we can apply restructuring algorithms based on graph metrics. The particularity of our approach consists in integrating in addition to standard metrics, such as coupling and cohesion, some graph metrics giving more precision during the components identi cation. To treat this problem, we relied on the ROMANTIC approach that proposed a component-based software architecture recovery from an object oriented system.

Keywords: software reengineering, software component and interfaces, metrics, graphs

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13759 Outcome of Dacryocystorhinostomy with Peroperative Local Use of Mitomycin-C

Authors: Chandra Shekhar Majumder, Orin Sultana Jamie

Abstract:

Background: Dacryocystorhinostomy (DCR) has been a widely accepted surgical intervention for nasolacrimal duct obstructions. Some previous studies demonstrated the potential benefits of the peroperative application of agents like Mitomycin-C (MMC) with DCR to improve surgical outcomes. Relevant studies are rare in Bangladesh, and there are controversies about the dose, duration of MMC, and outcome. Therefore, the present study aimed to investigate the comparative efficacy of DCR with and without MMC in a tertiary hospital in Bangladesh. Objective: The study aims to determine the outcome of a dacryocystorhinostomy with preoperative local use of mitomycin–C. Methods: An analytical study was conducted in the Department of Ophthalmology, Sir Salimullah Medical College & Mitford Hospital, Dhaka, from January 2023 to September 2023. Seventy patients who were admitted for DCR operation were included according to the inclusion and exclusion criteria. Patients were divided into two groups: those who underwent DCR with peroperative administration of 0.2 mg/ml Mitomycin-C for 5 minutes (Group I) and those who underwent DCR alone (Group II). All patients were subjected to detailed history taking, clinical examination, and relevant investigations. All patients underwent DCR according to standard guidelines and ensured the highest peroperative and postoperative care. Then, patients were followed up at 7th POD, 1-month POD, 3 months POD, and 6 months POD to observe the success rate between the two groups by assessing tearing condition, irrigation, height of tear meniscus, and FDDT- test. Data was recorded using a pre-structured questionnaire, and collected data were analyzed using SPSS 23. Results: The mean age of the study patients was 42.17±6.7 (SD) years and 42.29±7.1 (SD) years in Groups I and II, respectively, with no significant difference (p=0.945). At the 6th month’s follow-up, group I patients were observed with 94.3% frequency of symptom-free, 85.6% patency of lacrimal drainage system, 68.6% had tear meniscus <0.1mm and 88.6% had positive Fluorescence Dye Disappearance Test (FDDT test). In group II, 91.4% were symptom-free, 68.6% showed patency, 57.1% had a height of tear meniscus < 0.1 mm, and 85.6% had FDDT test positive. But no statistically significant difference was observed (p<.05). Conclusion: The use of Mitomycin-C preoperatively during DCR offers better postoperative outcomes, particularly in maintaining patency and achieving symptom resolution with more FDDT test positive and improvement of tear meniscus in the MMC group than the control group. However, this study didn’t demonstrate a statistically significant difference between the two groups. Further research with larger sample sizes and longer follow-up periods would be beneficial to corroborate these findings.

Keywords: dacryocystorhinostomy, mitomycin-c, dacryocystitis, nasolacrimal duct obstruction

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13758 Trends in Preoperative Self-Disclosure of Cannabis Use in Adult and Adolescent Orthopedic Surgical Patients: An Institutional Retrospective Study

Authors: Spencer Liu, William Chan, Marlena Komatz, Tommy Ramos, Mark Trentalange, Faye Rim, Dae Kim, Mary Kelly, Samuel Schuessler, Roberta Stack, Justas Lauzadis, Kathryn DelPizzo, Seth Waldman, Alexandra Sideris

Abstract:

Background & Significance: The increasing prevalence of cannabis use in the United States has important safety considerations in the perioperative setting, as chronic or heavy preoperative cannabis use may increase the risk of intraoperative complications, postoperative nausea and vomiting (PONV), increased postoperative pain levels, and acute side effects associated with cannabis use cessation. In this retrospective chart review study, we sought to determine the prevalence of self-reported cannabis use in the past 5-years at a single institution in New York City. We hypothesized that there is an increasing prevalence of preoperative self-reported cannabis use among adult and adolescent patients undergoing orthopedic surgery. Methods: After IRB approval for this retrospective study, surgical cases performed on patients 12 years of age and older at the hospital’s main campus and two ambulatory surgery centers between January 1st, 2018, and December 31st, 2023, with preoperatively self-disclosed cannabis use entered in the social history intake form were identified using the tool SlicerDicer in Epic. Case and patient characteristics were extracted, and trends in utilization over time were assessed by the Cochran-Armitage trend test. Results: Overall, the prevalence of self-reported cannabis use increased from 6.6% in 2018 to 10.6% in 2023. By age group, the prevalence of self-reported cannabis use among adolescents remained consistently low (2018: 2.6%, 2023: 2.6%) but increased with significant evidence for a linear trend (p < 0.05) within every adult age group. Among adults, patients who were 18-24 years old (2018: 18%, 2023: 20.5%) and 25-34 years old (2018: 15.9%, 2023: 24.2%) had the highest prevalences of disclosure, whereas patients who were 75 years of age or older had the lowest prevalence of disclosure (2018: 1.9%, 2023: 4.6%). Patients who were 25-34 years old had the highest percent difference in disclosure rates of 8.3%, which corresponded to a 52.2% increase from 2018 to 2023. The adult age group with the highest percent change was patients who were 75 years of age or older, with a difference of 2.7%, which corresponded to a 142.1% increase from 2018 to 2023. Conclusions: These trends in preoperative self-reported cannabis use among patients undergoing orthopedic surgery have important implications for perioperative care and clinical outcomes. Efforts are underway to refine and standardize cannabis use data capture at our institution.

Keywords: orthopedic surgery, cannabis, postoperative pain, postoperative nausea

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13757 Causal Relationship between Corporate Governance and Financial Information Transparency: A Simultaneous Equations Approach

Authors: Maali Kachouri, Anis Jarboui

Abstract:

We focus on the causal relationship between governance and information transparency as well as interrelation among the various governance mechanisms. This paper employs a simultaneous equations approach to show this relationship in the Tunisian context. Based on an 8-year dataset, our sample covers 28 listed companies over 2006-2013. Our findings suggest that internal and external governance mechanisms are interdependent. Moreover, in order to analyze the causal effect between information transparency and governance mechanisms, we found evidence that information transparency tends to increase good corporate governance practices.

Keywords: simultaneous equations approach, transparency, causal relationship, corporate governance

Procedia PDF Downloads 347
13756 Study of the Stability of Underground Mines by Numerical Method: The Mine Chaabet El Hamra, Algeria

Authors: Nakache Radouane, M. Boukelloul, M. Fredj

Abstract:

Method room and pillar sizes are key factors for safe mining and their recovery in open-stop mining. This method is advantageous due to its simplicity and requirement of little information to be used. It is probably the most representative method among the total load approach methods although it also remains a safe design method. Using a finite element software (PLAXIS 3D), analyses were carried out with an elasto-plastic model and comparisons were made with methods based on the total load approach. The results were presented as the optimization for improving the ore recovery rate while maintaining a safe working environment.

Keywords: room and pillar, mining, total load approach, elasto-plastic

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13755 Gait Analysis in Total Knee Arthroplasty

Authors: Neeraj Vij, Christian Leber, Kenneth Schmidt

Abstract:

Introduction: Total knee arthroplasty is a common procedure. It is well known that the biomechanics of the knee do not fully return to their normal state. Motion analysis has been used to study the biomechanics of the knee after total knee arthroplasty. The purpose of this scoping review is to summarize the current use of gait analysis in total knee arthroplasty and to identify the preoperative motion analysis parameters for which a systematic review aimed at determining the reliability and validity may be warranted. Materials and Methods: This IRB-exempt scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist strictly. Five search engines were searched for a total of 279 articles. Articles underwent a title and abstract screening process followed by full-text screening. Included articles were placed in the following sections: the role of gait analysis as a research tool for operative decisions, other research applications for motion analysis in total knee arthroplasty, gait analysis as a tool in predicting radiologic outcomes, gait analysis as a tool in predicting clinical outcomes. Results: Eleven articles studied gait analysis as a research tool in studying operative decisions. Motion analysis is currently used to study surgical approaches, surgical techniques, and implant choice. Five articles studied other research applications for motion analysis in total knee arthroplasty. Other research applications for motion analysis currently include studying the role of the unicompartmental knee arthroplasty and novel physical therapy protocols aimed at optimizing post-operative care. Two articles studied motion analysis as a tool for predicting radiographic outcomes. Preoperative gait analysis has identified parameters than can predict postoperative tibial component migration. 15 articles studied motion analysis in conjunction with clinical scores. Conclusions: There is a broad range of applications within the research domain of total knee arthroplasty. The potential application is likely larger. However, the current literature is limited by vague definitions of ‘gait analysis’ or ‘motion analysis’ and a limited number of articles with preoperative and postoperative functional and clinical measures. Knee adduction moment, knee adduction impulse, total knee range of motion, varus angle, cadence, stride length, and velocity have the potential for integration into composite clinical scores. A systematic review aimed at determining the validity, reliability, sensitivities, and specificities of these variables is warranted.

Keywords: motion analysis, joint replacement, patient-reported outcomes, knee surgery

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13754 An Approach for Estimation in Hierarchical Clustered Data Applicable to Rare Diseases

Authors: Daniel C. Bonzo

Abstract:

Practical considerations lead to the use of unit of analysis within subjects, e.g., bleeding episodes or treatment-related adverse events, in rare disease settings. This is coupled with data augmentation techniques such as extrapolation to enlarge the subject base. In general, one can think about extrapolation of data as extending information and conclusions from one estimand to another estimand. This approach induces hierarchichal clustered data with varying cluster sizes. Extrapolation of clinical trial data is being accepted increasingly by regulatory agencies as a means of generating data in diverse situations during drug development process. Under certain circumstances, data can be extrapolated to a different population, a different but related indication, and different but similar product. We consider here the problem of estimation (point and interval) using a mixed-models approach under an extrapolation. It is proposed that estimators (point and interval) be constructed using weighting schemes for the clusters, e.g., equally weighted and with weights proportional to cluster size. Simulated data generated under varying scenarios are then used to evaluate the performance of this approach. In conclusion, the evaluation result showed that the approach is a useful means for improving statistical inference in rare disease settings and thus aids not only signal detection but risk-benefit evaluation as well.

Keywords: clustered data, estimand, extrapolation, mixed model

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13753 A Multimodal Approach to Improve the Performance of Biometric System

Authors: Chander Kant, Arun Kumar

Abstract:

Biometric systems automatically recognize an individual based on his/her physiological and behavioral characteristics. There are also some traits like weight, age, height etc. that may not provide reliable user recognition because of there common and temporary nature. These traits are called soft bio metric traits. Although soft bio metric traits are lack of permanence to uniquely and reliably identify an individual, yet they provide some beneficial evidence about the user identity and may improve the system performance. Here in this paper, we have proposed an approach for integrating the soft bio metrics with fingerprint and face to improve the performance of personal authentication system. In our approach we have proposed a combined architecture of three different sensors to elevate the system performance. The approach includes, soft bio metrics, fingerprint and face traits. We have also proven the efficiency of proposed system regarding FAR (False Acceptance Ratio) and total response time, with the help of MUBI (Multimodal Bio metrics Integration) software.

Keywords: FAR, minutiae point, multimodal bio metrics, primary bio metric, soft bio metric

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13752 Double Clustering as an Unsupervised Approach for Order Picking of Distributed Warehouses

Authors: Hsin-Yi Huang, Ming-Sheng Liu, Jiun-Yan Shiau

Abstract:

Planning the order picking lists of warehouses to achieve when the costs associated with logistics on the operational performance is a significant challenge. In e-commerce era, this task is especially important productive processes are high. Nowadays, many order planning techniques employ supervised machine learning algorithms. However, the definition of which features should be processed by such algorithms is not a simple task, being crucial to the proposed technique’s success. Against this background, we consider whether unsupervised algorithms can enhance the planning of order-picking lists. A Zone2 picking approach, which is based on using clustering algorithms twice, is developed. A simplified example is given to demonstrate the merit of our approach.

Keywords: order picking, warehouse, clustering, unsupervised learning

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13751 Implementing a Screening Tool to Assist with Palliative Care Consultation in Adult Non-ICU Patients

Authors: Cassey Younghans

Abstract:

Background: Current health care trends demonstrate that there is an increasing number of patients being hospitalized with complex comorbidities. These complex needs require advanced therapies, and treatment goals often focus on doing everything possible to prolong life rather than focusing on the individual patient’s quality of life which is the goal of palliative care efforts. Patients benefit from palliative care in the early stages of the illness rather than after the disease progressed or the state of acuity has advanced. The clinical problem identified was that palliative care was not being implemented early enough in the disease process with patients who had complex medical conditions and who would benefit from the philosophy and skills of palliative care professionals. Purpose: The purpose of this quality improvement study was to increase the number of palliative care screenings and consults completed on adults after being admitted to one Non-ICU and Non-COVID hospital unit. Methods: A retrospective chart review assessing for possible missed opportunities to introduce palliation was performed for patients with six primary diagnoses, including heart failure, liver failure, end stage renal disease, chronic obstructive pulmonary disease, cerebrovascular accident, and cancer in a population of adults over the ago of 19 on one medical-surgical unit over a three-month period prior to the intervention. An educational session with the nurses on the benefits of palliative care was conducted by the researcher, and a screening tool was implemented. The expected outcome was to have an increase in early palliative care consultation with patients with complex comorbid conditions and a decrease in missed opportunities for the implementation of palliative care. Another retrospective chart review was completed following completion of the three month piloting of the tool. Results: During the retrospective chart review, 46 patients were admitted to the medical-surgical floor with the primary diagnoses identified in the inclusion criteria. Six patients had palliative care consults completed during that time. Twenty-two palliative care screening tools were completed during the intervention period. Of those, 15 of the patients scored a 7 or higher, suggesting that a palliative care consultation was warranted. The final retrospective chart review identified that 4 palliative consults were implemented during that time of the 31 patients who were admitted over the three month time frame. Conclusion: Educating nurses and implementing a palliative care screening upon admission can be of great value in providing early identification of patients who might benefit from palliative care. Recommendations – It is recommended that this screening tool should be used to help identify the patents of whom would benefit from a palliative care consult, and nurses would be able to initiated a palliative care consultation themselves.

Keywords: palliative care, screening, early, palliative care consult

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13750 A 15 Minute-Based Approach for Berth Allocation and Quay Crane Assignment

Authors: Hoi-Lam Ma, Sai-Ho Chung

Abstract:

In traditional integrated berth allocation with quay crane assignment models, time dimension is usually assumed in hourly based. However, nowadays, transshipment becomes the main business to many container terminals, especially in Southeast Asia (e.g. Hong Kong and Singapore). In these terminals, vessel arrivals are usually very frequent with small handling volume and very short staying time. Therefore, the traditional hourly-based modeling approach may cause significant berth and quay crane idling, and consequently cannot meet their practical needs. In this connection, a 15-minute-based modeling approach is requested by industrial practitioners. Accordingly, a Three-level Genetic Algorithm (3LGA) with Quay Crane (QC) shifting heuristics is designed to fulfill the research gap. The objective function here is to minimize the total service time. Preliminary numerical results show that the proposed 15-minute-based approach can reduce the berth and QC idling significantly.

Keywords: transshipment, integrated berth allocation, variable-in-time quay crane assignment, quay crane assignment

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13749 Demonstrating the Efficacy of a Low-Cost Carbon Dioxide-Based Cryoablation Device in Veterinary Medicine for Translation to Third World Medical Applications

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

Abstract:

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

Keywords: cryoablation, cryotherapy, interventional oncology, veterinary technology

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13748 Collaborative Learning Aspect for Training Hip and Knee Joint Anatomy

Authors: Nasir Mustafa

Abstract:

One of the prerequisites required for an efficient diagnosis in a medical practice is to have a strong command of both functional and clinical anatomy. In this study, we introduce a new collaborative approach to the effective teaching of the knee and hip joints. In the present teaching model, anatomists, orthopedists and physical therapists present the anatomy of the hip and knee joints in small groups. Courses for the hip and knee joints were scheduled during the early stages of the medical curriculum. Students of nursing and physical therapy were grouped together to sensitize to the importance of a collaborative effort. The study results clearly demonstrate that nursing students and physical therapy students appreciated this teaching approach. The collaborative approach further proved to be a suitable method to teach both functional and clinical anatomy of the hip and knee joints. Aside from this training, a collaborative approach between medical students and physical therapy students was also successful for a healthcare organization.

Keywords: hip and knee joint anatomy, collaborative, Anatomy teaching, Nursing students, Physiotherapy students

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13747 Familiarity with Nursing and Description of Nurses Duties

Authors: Narges Solaymani

Abstract:

medical training of patients. Nursing is a very important profession in the societies of the world. Although in the past, all caregivers of the sick and disabled were called nurses, nowadays, a nurse is a person who has a university education in this field. There are nurses in bachelor's, master's, and doctoral degrees in nursing. New courses have been launched in the master's degree based on duty-oriented nurses. A nurse cannot have an independent treatment center but is a member of the treatment team in established treatment centers such as hospitals, clinics, or offices. Nurses can establish counseling centers and provide nursing services at home. According to the standards, the number of nurses should be three times the number of doctors or twice the number of hospital beds, or there should be three nurses for every thousand people. Also, international standards show that in the internal and surgical department, every 4 to 6 patients should have a nurse.

Keywords: Nurse, Intensive Care, CPR, Bandage

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13746 Welding Process Selection for Storage Tank by Integrated Data Envelopment Analysis and Fuzzy Credibility Constrained Programming Approach

Authors: Rahmad Wisnu Wardana, Eakachai Warinsiriruk, Sutep Joy-A-Ka

Abstract:

Selecting the most suitable welding process usually depends on experiences or common application in similar companies. However, this approach generally ignores many criteria that can be affecting the suitable welding process selection. Therefore, knowledge automation through knowledge-based systems will significantly improve the decision-making process. The aims of this research propose integrated data envelopment analysis (DEA) and fuzzy credibility constrained programming approach for identifying the best welding process for stainless steel storage tank in the food and beverage industry. The proposed approach uses fuzzy concept and credibility measure to deal with uncertain data from experts' judgment. Furthermore, 12 parameters are used to determine the most appropriate welding processes among six competitive welding processes.

Keywords: welding process selection, data envelopment analysis, fuzzy credibility constrained programming, storage tank

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13745 Officinal Quality Assurance: Investigation near the Pharmacists Dispensary at Oran- Algeria

Authors: S. Boulenouar, A. Boukli Hacene, S. Brahmi

Abstract:

Quality is an old concept but which recently became omnipresent in the society. It is a pledge of the well done job and therefore the satisfaction of the customer. Now, dispensing pharmacies seem to be held away from this approach. Officinal staff is called to dispense drugs. However this essential function is rarely studied and taken into account. To contribute to the good use of medicines and to reduce the dangers, it is important to consider the dispensation of drugs practised in the pharmacies. It is a both descriptive and retrospective study .The descriptive part is to conduct a survey near to the dispensary pharmacists. The retrospective section concentrates on the analysis of medicine prescriptions dispensed to patients. Following the survey that we carried out near the pharmacists of dispensary of the town of Oran, it appears that in majority, they are not inclined, by themselves, to take up the challenge of quality at the dispensary. The approach requires time and a motivation that pharmacists do not have for the moment. Efforts are still needed on the part of pharmacists, but also of authorities and organizations in charge of quality in the dispensary. At the end of this work, it seems to us that the implementation of a quality approach is part of our reflection on the added value of the pharmacist of dispensary in the drug chain.

Keywords: customer satisfaction, dispensary, dispensing of the drug, quality approach

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13744 Developing an Audit Quality Model for an Emerging Market

Authors: Bita Mashayekhi, Azadeh Maddahi, Arash Tahriri

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The purpose of this paper is developing a model for audit quality, with regard to the contextual and environmental attributes of the audit profession in Iran. For this purpose, using an exploratory approach, and because of the special attributes of the auditing profession in Iran in terms of the legal environment, regulatory and supervisory mechanisms, audit firms size, and etc., we used grounded theory approach as a qualitative research method. Therefore, we got the opinions of the experts in the auditing and capital market areas through unstructured interviews. As a result, the authors revealed the determinants of audit quality, and by using these determinants, developed an Integrated Audit Quality Model, including causal conditions, intervening conditions, context, as well as action strategies related to AQ and their consequences. In this research, audit quality is studied using a systemic approach. According to this approach, the quality of inputs, processes, and outputs of auditing determines the quality of auditing, therefore, the quality of all different parts of this system is considered.

Keywords: audit quality, integrated audit quality model, demand for audit service, supply of audit, grounded theory

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13743 Determinants of Economic Growth in Pakistan: A Structural Vector Auto Regression Approach

Authors: Muhammad Ajmair

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This empirical study followed structural vector auto regression (SVAR) approach proposed by the so-called AB-model of Amisano and Giannini (1997) to check the impact of relevant macroeconomic determinants on economic growth in Pakistan. Before that auto regressive distributive lag (ARDL) bound testing technique and time varying parametric approach along with general to specific approach was employed to find out relevant significant determinants of economic growth. To our best knowledge, no author made such a study that employed auto regressive distributive lag (ARDL) bound testing and time varying parametric approach with general to specific approach in empirical literature, but current study will bridge this gap. Annual data was taken from World Development Indicators (2014) during period 1976-2014. The widely-used Schwarz information criterion and Akaike information criterion were considered for the lag length in each estimated equation. Main findings of the study are that remittances received, gross national expenditures and inflation are found to be the best relevant positive and significant determinants of economic growth. Based on these empirical findings, we conclude that government should focus on overall economic growth augmenting factors while formulating any policy relevant to the concerned sector.

Keywords: economic growth, gross national expenditures, inflation, remittances

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13742 The Using of Social Marketing Approach for Conducting Anti-Corruption Campaign: A Review of Literature

Authors: Rosidah Rosidah

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The paper aims to identify and examine the effectiveness of social marketing as an approach for conducting anti-corruption campaign. Social marketing has been widely used to promote social change for the benefit of individual and society; such as for promoting healthy foods consumption, encouraging breastfeeding, reducing smoking, solving alcohol problem and drunk driving. Therefore, it is believed that this approach can be promising to be used in anti-corruption campaign. It is because social marketing can be useful of prompting people to act in accordance to the existing norms that denounce corruption, or help to establish new norms that more averse to corruption. It has established into evidence and insight based approaches to social campaign that focus on changing people’s behavior. Qualitative approach will be used in this study, with the using of literature review and secondary data analysis as the research methods. This paper is still on preliminary stage, which its results is expected to provide fundamental basis for designing model of intervention (anti-corruption campaign) using social marketing approaches.

Keywords: anti-corruption campaign, behavioral change, social influence, social marketing

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13741 The Role of Gastric Decompression on Postoperative Nausea and Vomiting in Orthognathic Surgery

Authors: Minna Salim, James Brady

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Postoperative nausea and pain (PONV) are adverse effects following surgical procedures. It is especially pronounced in patients undergoing orthognathic surgery, as their mouth is closed postoperatively using wires or rubber bands. Postoperative mouth closure increases the discomfort and risk of complications associated with nausea and vomiting. Many surgeons and institutions apply gastric decompression in hopes of aspirating stomach contents and, therefore, decreasing PONV incidence. This review observed that PONV incidence was not affected by gastric decompression overall. However, the effect of gastric decompression on PONV in orthognathic surgery was variable. This paper aims to summarize the findings of gastric decompression on PONV and to determine the need for it in orthognathic surgery.

Keywords: gastric decompression, nasogastric tube, orthognathic surgery, postoperative nausea, vomiting

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13740 Rapid Design Approach for Electric Long-Range Drones

Authors: Adrian Sauer, Lorenz Einberger, Florian Hilpert

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The advancements and technical innovations in the field of electric unmanned aviation over the past years opened the third dimension in areas like surveillance, logistics, and mobility for a wide range of private and commercial users. Researchers and companies are faced with the task of integrating their technology into airborne platforms. Especially start-ups and researchers require unmanned aerial vehicles (UAV), which can be quickly developed for specific use cases without spending significant time and money. This paper shows a design approach for the rapid development of a lightweight automatic separate-lift-thrust (SLT) electric vertical take-off and landing (eVTOL) UAV prototype, which is able to fulfill basic transportation as well as surveillance missions. The design approach does not require expensive or time-consuming design loop software. Thereby developers can easily understand, adapt, and adjust the presented method for their own project. The approach is mainly focused on crucial design aspects such as aerofoil, tuning, and powertrain.

Keywords: aerofoil, drones, rapid prototyping, powertrain

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13739 Application of a Hybrid Modified Blade Element Momentum Theory/Computational Fluid Dynamics Approach for Wine Turbine Aerodynamic Performances Prediction

Authors: Samah Laalej, Abdelfattah Bouatem

Abstract:

In the field of wind turbine blades, it is complicated to evaluate the aerodynamic performances through experimental measurements as it requires a lot of computing time and resources. Therefore, in this paper, a hybrid BEM-CFD numerical technique is developed to predict power and aerodynamic forces acting on the blades. Computational fluid dynamics (CFD) simulation was conducted to calculate the drag and lift forces through Ansys software using the K-w model. Then an enhanced BEM code was created to predict the power outputs generated by the wind turbine using the aerodynamic properties extracted from the CFD approach. The numerical approach was compared and validated with experimental data. The power curves calculated from this hybrid method were in good agreement with experimental measurements for all velocity ranges.

Keywords: blade element momentum, aerodynamic forces, wind turbine blades, computational fluid dynamics approach

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13738 Conservative and Surgical Treatment of Antiresorptive Drug-Related Osteonecrosis of the Jaw with Ultrasonic Piezoelectric Bone Surgery under Polyvinylpyrrolidone Iodine Irrigation: A Case Series of 13 Treated Sites

Authors: Esra Yuce, Isil D. S. Yamaner, Murude Yazan

Abstract:

Aims and objective: Antiresorptive agents including bisphosphonates and denosumab as strong suppressors of osteoclasts are the most commonly used antiresorptive medications for the treatment of osteoporosis which counteract the negative quantitative alteration of trabecular and cortical bone by inhibition of bone turnover. Oral bisphosphonate therapy for the treatment of osteopenia, osteoporosis or Paget's disease is associated with the low-grade risk of osteonecrosis of the jaw, while higher-grade risk is associated with receiving intravenous bisphosphonates therapy in the treatment of multiple myeloma and bone metastases. On the other hand, there has been a remarkable increase in incidences of antiresorptive related osteonecrosis of the jaw (ARONJ) in oral bisphosphonate users. This clinical presentation will evaluate the healing outcomes via piezoelectric bone surgery under the irrigation of PVP-I solution irrigation in patients received bisphosphonate therapy. Material-Method: The study involved 8 female and 5 male patients that have been treated for ARONJ. Among 13 necrotic sites, 9 were in the mandible and 4 were in the maxilla. All of these 13 patients treated with surgical debridement via piezoelectric bone surgery under irrigation by solution with 3% PVP-I concentration in combination with long-term antibiotic therapy and 5 also underwent removal of mobile segments of bony sequestrum. All removable prosthesis in 8 patients were relined with soft liners during the healing periods in order to eliminate chronic minor traumas. Results: All patients were on oral bisphosphonate therapy for at least 2 years and 5 of which had received intravenous bisphosphonates up to 1 year before therapy with oral bisphosphonates was started. According to the AAOMS staging system, four cases were stage II, eight cases were stage I, and one case was stage III. The majority of lesions were identified at sites of dental prostheses (38%) and dental extractions (62%). All patients diagnosed with ARONJ stage I had used unadjusted removable prostheses. No recurrence of the symptoms was observed during the present follow-up (9–37 months). Conclusion: Despite their confirmed effectiveness, the prevention and treatment of osteonecrosis of the jaw secondary to oral bisphosphonate therapy remain major medical challenges. Treatment with piezoelectric bone surgery with irrigation of povidone-iodine solution was effective for management of bisphosphonate-related osteonecrosis of the jaw. Taking precautions for patients treated with oral bisphosphonates, especially also denture users, may allow for a reduction in the rate of developing osteonecrosis of the maxillofacial region.

Keywords: antiresorptive drug related osteonecrosis, bisphosphonate therapy, piezoelectric bone surgery, povidone iodine

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13737 Revisiting Domestication and Foreignisation Methods: Translating the Quran by the Hybrid Approach

Authors: Aladdin Al-Tarawneh

Abstract:

The Quran, as it is the sacred book of Islam and considered the literal word of God (Allah) in Arabic, is highly translated into many languages; however, the foreignising or the literal approach excessively stains the quality and discredits the final product in the eyes of its receptors. Such an approach fails to capture the intended meaning of the Quran and to communicate it in any language. Therefore, this study is conducted to propose a different approach that seeks involving other ones according to a hybrid model. Indeed, this study challenges the binary adherence that is highly used in Translation Studies (TS) in general and in the translation of the Quran in particular. Drawing on the genuine fact that the Quran can be communicated in any language in terms of meaning, and the translation is not sacred; this paper approaches the translation of the Quran by blending different methods like domestication or foreignisation in a systematic way, avoiding the binary choice made by many translators. To reach this aim, the paper has a conceptual part that seeks to elucidate and clarify the main methods employed in TS, and criticise and modify them to propose the new hybrid approach (the hybrid model) for translating the Quran – that is, the deductive method. To support and validate the outcome of the previous part, a comparative model is employed in order to highlight the differences between the suggested translation and other widely used ones – that is, the inductive method. By applying this methodology, the paper proves that there is a deficiency of communicating the original meaning of the Quran in light of the foreignising approach. In conclusion, the paper suggests producing a Quran translation has to take into account the adoption of many techniques to express the meaning of the Quran as understood in the original, and to offer this understanding in English in the most native-like manner to serve the intended target readers.

Keywords: Quran translation, hybrid approach, domestication, foreignization, hybrid model

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13736 Intensive Care Unit Patient Self-Determination When Facing Cardiovascular Surgery for the First Time

Authors: Hsiao-Lin Fang

Abstract:

The Patient Self-Determination Act is based on the belief that each life is unique. The act regards each patient as an autonomous entity and explicitly protects the patient’s rights to know and make decisions and choices while ensuring that the patient’s wish for a peaceful end is granted. Even when the patient is unconscious and unable to express himself/herself, the patient’s self-determination and its exercise are still protected under the law. The act also ensures that healthcare professionals (HCPs) have a specific set of rules to follow and complete legal protection when their patients are unable to express themselves clearly. This report is about a 55-year-old female patient who weighed 110 kg and was diagnosed with acute type A aortic dissection. The case was that the patient suddenly felt backache and nausea during sleep before daybreak and was therefore transferred to this hospital from the original one. After the doctor explained the patient’s conditions, it was concluded that surgery was necessary. However, the patient’s family was immediately against the surgery after having heard its possible complications. Nevertheless, the patient was still willing to receive the surgery. Being at odds with her family, the patient decided to sign the surgery agreement herself and agreed to receive the two surgical procedures: (1) ascending aorta replacement and (2) innominate artery debranching. After the surgery, the patient did not regain consciousness and therefore received computed tomography scanning of the brain, which revealed false lumen involving proximal left common carotid artery, left subclavian artery and innominate artery, and severe compression of the true lumen with total/subtotal occlusion in the left common carotid artery. On the following day, the doctor discussed two further surgical procedures: (1) endografting for descending aorta and (2) endografting for left common carotid artery and subclavian artery with the family. However, as the patient’s postoperative recovery of consciousness only reached the level of stupor and her family had no intention of subsequent healthcare for the patient, the family made the joint decision three days later to have the endotracheal tube removed from the patient and let her die a natural death. Suggestion: An advance directive (AD) can be created beforehand. Once the patient is in a special clinical state (e.g., terminal illness, permanent vegetative state, etc.), the AD can determine whether to sustain the patient’s life through ‘medical intervention’ or to respect the patient’s rights to choose a peaceful end and receive palliative care. Through the expression of self-determination, it is possible to respect the patient’s medical practice autonomy and protect the patient’s dignity and right to a peaceful end, thereby respecting and supporting the patient’s decision. This also allows the three sides: the patient, the family and the medical team to understand the patient’s true wish in the process of advance care planning (ACP) and thereby promote harmony in the HCP-patient relationship.

Keywords: intensive care unit patient, cardiovascular surgery, self-determination, advance directive

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13735 Preservation of Endocrine Function after Central Pancreatectomy without Anastomoses for a Mid Gland Pancreatic Insulinoma: A Case Report

Authors: Karthikeyan M., Paul M. J.

Abstract:

This abstract describes a case of central pancreatectomy (CP) for a 50-year-old woman with a neuroendocrine tumor in the mid-body of the pancreas. CP, a parenchyma-sparing surgical option, preserves the distal pancreas and spleen, reducing the risk of pancreatic endocrine and exocrine insufficiency compared to traditional resections. The patient, initially misdiagnosed with transient ischemic attack, presented with hypoglycemic symptoms and was found to have a pancreatic lesion. Post-operative results were positive, with a reduction in pancreatic drain volume and normalization of blood sugar levels. This case highlights CP's efficacy in treating centrally located pancreatic lesions while maintaining pancreatic function.

Keywords: central pancreatectomy without anastomosis, no endocrine deficiency on follow-op, less post-op hospital stay, less post-op complications

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13734 Enhancing Students’ Achievement, Interest and Retention in Chemistry through an Integrated Teaching/Learning Approach

Authors: K. V. F. Fatokun, P. A. Eniayeju

Abstract:

This study concerns the effects of concept mapping-guided discovery integrated teaching approach on the learning style and achievement of chemistry students. The sample comprised 162 senior secondary school (SS 2) students drawn from two science schools in Nasarawa State which have equivalent mean scores of 9.68 and 9.49 in their pre-test. Five instruments were developed and validated while the sixth was purely adopted by the investigator for the study, Four null hypotheses were tested at α = 0.05 level of significance. Chi square analysis showed that there is a significant shift in students’ learning style from accommodating and diverging to converging and assimilating when exposed to concept mapping- guided discovery approach. Also t-test and ANOVA that those in experimental group achieve and retain content learnt better. Results of the Scheffe’s test for multiple comparisons showed that boys in the experimental group performed better than girls. It is therefore concluded that the concept mapping-guided discovery integrated approach should be used in secondary schools to successfully teach electrochemistry. It is strongly recommended that chemistry teachers should be encouraged to adopt this method for teaching difficult concepts.

Keywords: integrated teaching approach, concept mapping-guided discovery, achievement, retention, learning styles and interest

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13733 Evaluation of Hydrogen Particle Volume on Surfaces of Selected Nanocarbons

Authors: M. Ziółkowska, J. T. Duda, J. Milewska-Duda

Abstract:

This paper describes an approach to the adsorption phenomena modeling aimed at specifying the adsorption mechanisms on localized or nonlocalized adsorbent sites, when applied to the nanocarbons. The concept comes from the fundamental thermodynamic description of adsorption equilibrium and is based on numerical calculations of the hydrogen adsorbed particles volume on the surface of selected nanocarbons: single-walled nanotube and nanocone. This approach enables to obtain information on adsorption mechanism and then as a consequence to take appropriate mathematical adsorption model, thus allowing for a more reliable identification of the material porous structure. Theoretical basis of the approach is discussed and newly derived results of the numerical calculations are presented for the selected nanocarbons.

Keywords: adsorption, mathematical modeling, nanocarbons, numerical analysis

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13732 Comparison of the Effects of Alprazolam and Zaleplon on Anxiety Levels in Patients Undergoing Abdominal Gynecological Surgery

Authors: Shekoufeh Behdad, Amirhossein Yadegari, Leila Ghodrati, Saman Yadegari

Abstract:

Context: Preoperative anxiety is a common psychological reaction experienced by all patients undergoing surgery. It can have negative effects on the patient's well-being and even impact surgical outcomes. Therefore, finding effective interventions to reduce preoperative anxiety is important in improving patient care. Research Aim: The aim of this study is to compare the effects of oral administration of zaleplon (5 mg) and alprazolam (0.5 mg) on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Methodology: This study is a double-blind, randomized clinical trial conducted after receiving approval from the university's ethics committee and obtaining written informed consent from the patients. The night before the surgery, patients were randomly assigned to receive either 0.5 mg of alprazolam or 5 mg of zaleplon orally. Anxiety levels, measured using a 10-cm visual analog scale, and hemodynamic variables (blood pressure and heart rate) were assessed before drug administration and on the morning of the operation after the patient entered the pre-operation room. Findings: The study found that there were no significant differences in mean anxiety levels or hemodynamic variables before and after administration of either drug in both groups (P value > 0.05). This suggests that both 0.5 mg of alprazolam and 5 mg of zaleplon effectively reduce preoperative anxiety in women undergoing abdominal surgery without serious side effects. Theoretical Importance: This study contributes to the understanding of the effectiveness of alprazolam and zaleplon in reducing preoperative anxiety. It adds to the existing literature on pharmacological interventions for anxiety management, specifically in the context of gynecological abdominal surgery. Data Collection: Data for this study were collected through the assessment of anxiety levels using a visual analog scale and measuring hemodynamic variables, including systolic, diastolic, and mean arterial blood pressures, as well as heart rate. These measurements were taken before drug administration and on the morning of the surgery. Analysis Procedures: Statistical analysis was performed to compare the mean anxiety levels and hemodynamic variables before and after drug administration in the two groups. The significance of the differences was determined using appropriate statistical tests. Questions Addressed: This study aimed to answer the question of whether there are differences in the effects of alprazolam and zaleplon on preoperative anxiety levels in women undergoing gynecological abdominal surgery. Conclusion: The oral administration of both 0.5 mg of alprazolam and 5 mg of zaleplon the night before surgery effectively reduces preoperative anxiety in women undergoing abdominal surgery. These findings have important implications for the management of preoperative anxiety and can contribute to improving the overall surgical experience for patients.

Keywords: zaleplon, alprazolam, premedication, abdominal surgery

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