Search results for: american ocademy of orthopaedic surgeons

Authors: Raquel Rossini, Edelvais Caldeira

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The aim of this work is to investigate the motivation for the metaphorical uses of two verb combinations: come out and take over. Drawing from cognitive semantics theories, image schemas and metaphors, it was attempted to demonstrate that: a) the metaphorical senses of both 'come out' and 'take over' extend from both the verbs and the particles central (spatial) senses in such verb combinations; and b) the particles 'out' and 'over' also contribute to the whole meaning of the verb combinations. In order to do so, a random selection of 579 concordance lines for come out and 1,412 for take over was obtained from the Corpus of Contemporary American English – COCA. One of the main procedures adopted in the present work was the establishment of verb and particle central senses. As per the research questions addressed in this study, they are as follows: a) how does the identification of trajector and landmark help reveal patterns that contribute for the identification of the semantic network of these two verb combinations?; b) what is the relationship between the schematic structures attributed to the particles and the metaphorical uses found in empirical data?; and c) what conceptual metaphors underlie the mappings from the source to the target domains? The results demonstrated that not only the lexical verbs come and take, but also the particles out and over play an important whole in the different meanings of come out and take over. Besides, image schemas and conceptual metaphors were found to be helpful in order to establish the motivations for the metaphorical uses of these linguistic structures.

Keywords: cognitive linguistics, English syntax, multi-word verbs, prepositions

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Authors: Shokoufeh Abrisham, Seyed Mahmoud Hossieni, Elham Pishbin

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In this paper, a hybrid method based on the fault tree analysis (FTA) and Bayesian networks (BNs) are employed to evaluate the team performance quality of advanced cardiac life support (ACLS) procedures in emergency department. According to American Heart Association (AHA) guidelines, a category relying on staff action leading to clinical incidents and also some discussions with emergency medicine experts, a fault tree model for ACLS procedure is obtained based on the human performance. The obtained FTA model is converted into BNs, and some different scenarios are defined to demonstrate the efficiency and flexibility of the presented model of BNs. Also, a sensitivity analysis is conducted to indicate the effects of team leader presence and uncertainty knowledge of experts on the quality of ACLS. The proposed model based on BNs shows that how the results of risk analysis can be closed to reality comparing to the obtained results based on only FTA in medical procedures.

Keywords: advanced cardiac life support, fault tree analysis, Bayesian belief networks, numan performance, healthcare systems

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Authors: Madeleine Cox

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Objective: discussion of diagnosis of vernix caseosa peritonitis, recovery and subsequent caesarean seciton Case: 30 year old G4P1 presented in labour at 40 weeks, planning a vaginal birth afterprevious caesarean section. She underwent an emergency caesarean section due to concerns for fetal wellbeing on CTG. She was found to have a thin lower segment with a very small area of dehiscence centrally. The operation was uncomplicated, and she recovered and went home 2 days later. She then represented to the emergency department day 6 post partum feeling very unwell, with significant abdominal pain, tachycardia as well as urinary retention. Raised white cell count of 13.7 with neutrophils of 11.64, CRP of 153. An abdominal ultrasound was poorly tolerated by the patient and did not aide in the diagnosis. Chest and abdominal xray were normal. She underwent a CT chest and abdomen, which found a small volume of free fluid with no apparent collection. Given no obvious cause of her symptoms were found and the patient did not improve, she had a repeat CT 2 days later, which showed progression of free fluid. A diagnostic laparoscopy was performed with general surgeons, which reveled turbid fluid, an inflamed appendix which was removed. The patient improved remarkably post operatively. The histology showed periappendicitis with acute appendicitis with marked serosal inflammatory reaction to vernix caseosa. Following this, the patient went on to recover well. 4 years later, the patient was booked for an elective caesarean section, on entry into the abdomen, there were very minimal adhesions, and the surgery and her subsequent recovery was uncomplicated. Discussion: this case represents the diagnostic dilemma of a patient who presents unwell without a clear cause. In this circumstance, multiple modes of imaging did not aide in her diagnosis, and so she underwent diagnostic surgery. It is important to evaluate if a patient is or is not responding to the typical causes of post operative pain and adjust management accordingly. A multiteam approach can help to provide a diagnosis for these patients. Conclusion: Vernix caseosa peritonitis is a rare cause of acute abdomen post partum. There are few reports in the literature of the initial presentation and no reports on the possible effects on future pregnancies. This patient did not have any complications in her following pregnancy or delivery secondary to her diagnosis of vernix caseosa peritonitis. This may assist in counselling other women who have had this uncommon diagnosis.

Keywords: peritonitis, obstetrics, caesarean section, pain

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Authors: Bahia Braktia, Ana Marcela Montenegro Sanchez

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Social media, such as Facebook, Twitter, and YouTube, has been used for teaching and learning for quite some time. These platforms have been proven to be a good tool to improve various language skills, students’ performance of the English language, motivation as well as trigger the authentic language interaction. However, little is known about the potential effects of social media usage on the learning performance of Arabic language learners. The present study explores the potential role that the social media technologies play in learning Arabic as a foreign language at a university in Southeast of United States. In order to investigate this issue, an online survey was administered to examine the perceptions and attitudes of American students learning Arabic. The research questions were: How does social media, specifically Facebook and Twitter, impact the students' Arabic language skills, and what is their attitude toward it? The preliminary findings of the study showed that students had a positive attitude toward the use of social media to enhance their Arabic language skills, and that they used a range of social media features to expose themselves to the Arabic language and communicate in Arabic with native Arabic speaking friends. More detailed findings will be shared in the light data analysis with the audience during the presentation.

Keywords: foreign language learning, social media, students’ perceptions, survey

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Authors: Dalila Chaid, Bennameur Fedilli, Mohammed Amine Bellelou

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The study focuses on the experience of lower-limb amputees, who face both physical and psychological challenges due to their disability. Chronic neuropathic pain and various types of limb pain are common in these patients. They often require orthopaedic interventions for issues such as dressings, infection, ulceration, and bone-related problems. Research Aim: The aim of this study is to determine the most suitable anaesthetic technique for lower-limb amputees, which can provide them with the greatest comfort and prolonged analgesia. The study also aims to demonstrate the effectiveness and cost-effectiveness of ultrasound-guided local regional anaesthesia (LRA) in this patient population. Methodology: The study is an observational analytical study conducted over a period of eight years, from 2010 to 2018. It includes a total of 955 cases of revisions performed on lower limb stumps. The parameters analyzed in this study include the effectiveness of the block and the use of sedation, the duration of the block, the post-operative visual analog scale (VAS) scores, and patient comfort. Findings: The study findings highlight the benefits of ultrasound-guided LRA in providing comfort by optimizing post-operative analgesia, which can contribute to psychological and bodily repair in lower-limb amputees. Additionally, the study emphasizes the use of alpha2 agonist adjuvants with sedative and analgesic properties, long-acting local anaesthetics, and larger volumes for better outcomes. Theoretical Importance: This study contributes to the existing knowledge by emphasizing the importance of choosing an appropriate anaesthetic technique for lower-limb amputees. It highlights the potential of ultrasound-guided LRA and the use of specific adjuvants and local anaesthetics in improving post-operative analgesia and overall patient outcomes. Data Collection and Analysis Procedures: Data for this study were collected through the analysis of medical records and relevant documentation related to the 955 cases included in the study. The effectiveness of the anaesthetic technique, duration of the block, post-operative pain scores, and patient comfort were analyzed using statistical methods. Question Addressed: The study addresses the question of which anaesthetic technique would be most suitable for lower-limb amputees to provide them with optimal comfort and prolonged analgesia. Conclusion: The study concludes that ultrasound-guided LRA, along with the use of alpha2 agonist adjuvants, long-acting local anaesthetics, and larger volumes, can be an effective approach in providing comfort and improving post-operative analgesia for lower-limb amputees. This technique can potentially contribute to the psychological and bodily repair of these patients. The findings of this study have implications for clinical practice in the management of lower-limb amputees, highlighting the importance of personalized anaesthetic approaches for better outcomes.

Keywords: neuropathic pain, ultrasound-guided peripheral nerve block, DN4 quiz, EMG

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Authors: Vanessa L. Haro

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Beginning with a historical foundation of Mexico, this marks the start of a close examination of this major Latin American country by providing the context needed to understand the reasons for Mexico’s strengths and struggles today, specific to their response to the issue of gender violence. Responding to the challenge of combating gender violence and inequality, Mexico has created social programs and initiatives in hopes of addressing these issues and modernizing their gender norms, which currently disempower and dehumanize women, while simultaneously denying women the necessary tools needed to fight back or bring balance to the gender scales. Nevertheless, women in Mexico have made their voices heard with the most salient image of that of the mothers protesting while holding the photos of their young daughters who lost their lives. This case study on gender issues in Mexico works to acknowledge the diverse forces that contribute to the issue of gender violence, and to make a statement that this is a crisis that requires a more dynamic response within Mexico’s social welfare policies, and should not be allowed to continue to progress as a normative phenomenon. As the advocacy groups and protesters cry out, “Ni una menos! (Not one less), meaning we will not lose one more woman and making the statement that all women’s lives matter.

Keywords: gender issues, Mexico, poverty, social welfare

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Authors: Shaker A. Aladwan

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This paper aims to explore the Barriers to innovation leadership in Jordanian public sector organizations. Qualitative approach was adopted, and content analysis was used to analyze the 18 assessment reports which are extracted from the public innovation award in Jordan, then, 20 semi-structured interviews were conducted with the key persons who are involved with innovation initiatives in the public sector organizations in Jordan. Several Barriersthat face the innovation leadership in the Jordanian public sector organizations. Managerially, the challenges include lack of innovation vision, implementation lack of innovation core values, lack of strategic planning for innovation, bad bureaucracy culture, and excessive centralization. Technically, the challenges include lack of task assignment for employees, lack of resources, lack of innovative training programs, lack of knowledge sharing, and the failure of governments to formulate policies and regulations. most of the studies focused on innovation in the non-public sector organizations, and most of them were conducted in the American and Western countries, which are different in terms of culture, kinds of innovation, barriers, and drivers. Thus, this paper provides new insights into barriers to innovation leadership in the public sector and in a new research context. This paper also provides a theoretical contribution by diagnosing the barriers facing innovation within the context of public administration in developing countries.

Keywords: innovation, excellence award, challenges, public sector, jordan

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Authors: T. Rakhi, Thrivikram Shenoy

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Esophageal atresia is a disorder of maldevelopment of esophagus with or without a connection to the trachea. Radiological reviews are needed in consultation with the pediatric surgeon and neonatologist and we report a rare case of esophageal atresia associated with atrial septal defect-patent ductus arteriosus complex. A 2-day old female baby born at term, weighing 3.010kg, admitted to the Neonatal Intensive Care Unit with respiratory distress and excessive oral secretions. On examination, continuous murmur and cyanosis were seen. Esophageal atresia was suspected, after a failed attempt to pass a nasogastric tube. Chest radiograph showed coiling of the nasogastric tube and absent gas shadow in the abdomen. Echocardiography confirmed Patent Ductus Arteriosus with Atrial Septal Defect not in failure and was diagnosed with esophageal atresia with suspected fistula posted for surgical repair. After preliminary management with oxygenation, suctioning in prone position and antibiotics, investigations revealed Hb 17gms serum biochemistry, coagulation profile and C-Reactive Protein Test normal. The baby was premedicated with 5mcg of fentanyl and 100 mcg of midazolam and a rapid awake laryngoscopy was done to rule out difficult airway followed by induction with o2 air, sevo and atracurium 2 mg. Placement of a 3.5 tube was uneventful at first attempt and after confirming bilateral air entry positioned in the lateral position for Right thoracotomy. A pulse oximeter, Echocardiogram, Non-invasive Blood Pressure, temperature and a precordial stethoscope in left axilla were essential monitors. During thoracotomy, both the ends of the esophagus and the fistula could not be located after thorough search suggesting an on table finding of type A esophageal atresia. The baby was repositioned for gastrostomy, and cervical esophagostomy ventilated overnight and extubated uneventful. Absent gas shadow was overlooked and the purpose of this presentation is to create an awareness between the neonatologist, pediatric surgeons and anesthesiologist regarding variation of typing of Tracheoesophageal fistula pre and intraoperatively. A need for imaging modalities warranted for a definitive diagnosis in the presence of a gasless stomach.

Keywords: anesthetic, atrial septal defects, esophageal atresia, patent ductus arteriosus, perioperative, chest x-ray

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Authors: Norimichi Nagano, Yoshio Hirano, Tsutomu Yasukawa

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Mesenchymal stem cells are thought to confer neuroprotection, facilitate tissue regeneration and exert their effects on retinal degenerative diseases, however, adverse events such as proliferative vitreoretinopathy and preretinal membrane disease associated with cell suspension transplantation have also been reported. We have recently developed human (allogeneic) adipose tissue-derived mesenchymal stem cell (adMSC) sheets through our proprietary sheet transformation technique, which could potentially mitigate these adverse events. To clarify the properties of our adMSC sheets named PAL-222, we performed in vitro studies such as viability testing, cytokine secretions by ELISA, immunohistochemical study, and migration assay. The viability of the cells exceeded 70%. Vascular Endothelial Growth Factor (VEGF) and Pigment Epithelium-Derived Factor (PEDF), which are quite important cytokines for the retinal area, were observed. PAL-222 expressed type I collagen, a strength marker, type IV collagen, a marker of the basement membrane, and elastin, an elasticity marker. Finally, the migration assay was performed and showed negative, which means that PAL-222 is stably kept in the topical area and does not come to pieces. Next, to evaluate the efficacy in vivo, we transplanted PAL-222 into the subretinal space of the eye of Royal College of Surgeons rats with congenital retinal degeneration and assessed it for three weeks after transplantation. We confirmed that PAL-222 suppressed the decrease in the thickness of the outer nuclear layer, which means that the photoreceptor protective effect treated with PAL-222 was significantly higher than that in the sham group. (p < 0.01). This finding demonstrates that PAL-222 showed their retinoprotective effect in a model of congenital retinal degeneration. As the study suggested the efficacy of PAL-222 in both in vitro and in vivo studies, we are presently engaged in clinical trials of PAL-222 for myopic chorioretinal atrophy, which is one of the retinal degenerative diseases, for the purpose of regenerative medicine.

Keywords: cell sheet, clinical trial, mesenchymal stem cell, myopic chorioretinal atrophy

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Authors: A. Shebani, C. Pislaru

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Wear of materials is an everyday experience and has been observed and studied for long time. The prediction of wear is a fundamental problem in the industrial field, mainly correlated to the planning of maintenance interventions and economy. Pin-on-disc test is the most common test which is used to study the wear behaviour. In this paper, the pin-on-disc (AEROTECH UNIDEX 11) is used for the investigation of the effects of normal load and hardness of material on the wear under dry and sliding conditions. In the pin-on-disc rig, two specimens were used; one, a pin which is made of steel with a tip, is positioned perpendicular to the disc, where the disc is made of aluminium. The pin wear and disc wear were measured by using the following instruments: The Talysurf instrument, a digital microscope, and the alicona instrument; where the Talysurf profilometer was used to measure the pin/disc wear scar depth, and the alicona was used to measure the volume loss for pin and disc. After that, the Archard model, American Society for Testing and Materials model (ASTM), and neural network model were used for pin/disc wear modelling and the simulation results are implemented by using the Matlab program. This paper focuses on how the alicona can be considered as a powerful tool for wear measurements and how the neural network is an effective algorithm for wear estimation.

Keywords: wear modelling, Archard Model, ASTM Model, Neural Networks Model, Pin-on-disc Test, Talysurf, digital microscope, Alicona

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Authors: David E. Wilkins

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While colonialism in its many guises remains the dominant theoretical framework within which to analyze Indigenous relations with state powers, this paper takes a deep look at the treaty, policy, and statutory efforts initiated by both Indigenous peoples and colonial, and later federal representatives within what is now the United States that were intended to create a Native constituent state of the union. While these plans ultimately failed, they are indicative of the reality that, throughout much of the shared Indigenous and American history, there were both Native and non-Native political elites who were keen on the idea of incorporating Indigenous peoples into the burgeoning body politic. This paper explores why these plans arose, who the architects were that devised them, which Native peoples were involved in, and why they ultimately failed to be enacted. Although governmental relations within the US remain fraught and unpredictable, Native nations continue to wield a form of sovereignty that, while truncated, has maintained their distinctive political statuses. There is much to be learned from the exploration of these mixed successes and failures. There are other examples across the globe whereby Indigenous peoples like the Saami and the Māori have secured greater clarity of their retained autonomy through structural political arrangements with the states that have laid claim to their territories while the Ainu struggle to regain their status.

Keywords: indigenous, sovereignty, diplomacy, intergovernmental

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Authors: Seini G. Kaufusi

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Background. Physician-assisted death (PAD) has and continues to be a controversial issue in the U.S. Dying with dignity statutes exists in 9 U.S. jurisdictions that permit competent adults diagnosed with a terminal illness and given a prognosis of 6 month or less to live to request medication to hasten death. Robust advocacy for and against PAD influences policy, and opinions vary. Aim. This study aims to explore the association between race and the attitudes toward physician-assisted death in the U.S. Methods. Data for this study derives from the General Social Survey (GSS) dataset, a national survey conducted by the National Opinion Research Center (NORC) that focuses on the opinions and values of American’s. A cross-sectional design and probability sample from the 2018 data set was used to randomly select respondents. Results. The results indicated that race is significantly associated with attitudes towards physician-assisted death. The level of significance suggests a strong positive association, and the direction indicated that Black and Other racial groups have higher rates of positive decision about PAD. Conclusion. Although attitudes towards PAD varied, Black and other racial groups had favorable decisions for PAD. Further research is crucial in the continuous debate on PAD and understanding the influences of predictors for or against PAD.

Keywords: attitudes, euthanasia, physician-assisted death, race

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Authors: Jacob Nortey

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Introduction: In recent years, there has been an enormous success in discoveries of scientific knowledge in medicine coupled with the advancement of technology. Despite all these successes, diagnoses and treatment of diseases have become complex. According to the Ibero – American Study of Adverse Effects (IBEAS), about 10% of hospital patients suffer from secondary damage during the care process, and approximately 2% die from this process. Many clinical decision support systems have been developed to help mitigate some healthcare medical errors. Method: Relevant databases were searched, including ones that were peculiar to the clinical decision support system (that is, using google scholar, Pub Med and general google searches). The articles were then screened for a comprehensive overview of the functionality, consultative style and statistical usage of Dxplain Clinical decision support systems. Results: Inferences drawn from the articles showed high usage of Dxplain clinical decision support system for problem-based learning among students in developed countries as against little or no usage among students in Low – and Middle – income Countries. The results also indicated high usage among general practitioners. Conclusion: Despite the challenges Dxplain presents, the benefits of its usage to clinicians and students are enormous.

Keywords: dxplain, clinical decision support sytem, diagnosis, support systems

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Authors: Tamara Thompson

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This presentation will address the vocality of American soprano Sibyl Sanderson (1865–1903) in Massenet’s Manon and Esclarmonde as discernible from documentary sources such as vocal treatises, annotated scores, and correspondence. These sources will then be compared and contrasted with Sanderson’s reception in French press. Sanderson sang Manon in 1888, which Massenet revised for her. She then created the role of Esclarmonde for the 1889 l'Exposition Universelle in Paris. The soprano appeared as the Byzantine Empress more than 100 times in the nine months following the premiere, which secured her fame and an international operatic career frought with controversy and criticism as well as adulation. Before her débuts as Manon and Esclarmonde, Sanderson received musical training in California and Paris from multiple teachers with varied and opposing methods. There will be an exploration of the ways in which the disparate pedagogic influences such as those taught by Giovanni Sbriglia and Jean de Reszké may have guided Sanderson’s vocal strategies, and possibly caused or promoted the severe vocal pathologies she battled in subsequent years. In addition, there is interrogation of the vocal writing and revisions made to the titular roles for Sanderson in order to assess how these factors may have affected her technique and vocal health.

Keywords: French, nineteenth-century, opera, pedagogy, vocality

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Authors: Naso Isaiah Thanavisuth, Patompong Satapornpong

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Introduction: Covid-19 has been a global pandemic for some time now, causing severe symptoms to patients that received the virus. However, there has been no report on this gene in the Thai population. Objective: Our aim in this study is to explore and compare the frequency of HLA-C allele that is associated with severe COVID-19 symptoms in Thais and other populations. Method: 200 general Thai population were enrolled in this study. The genotyping of HLA -C alleles were determined by the polymerase chain reaction with sequence-specific oligonucleotide probes (PCR-SSOP) and Luminex®IS 100 system (Luminex Corporation, Austin, Texas, USA). Results: We found that the frequency of alleles HLA-C* 01:02 (16.00%), HLA-C* 08:01(10.50%), HLA-C* 03:04 (10.25%),HLA-C* 07:02 (10.00%), HLA-C* 03:02 (9.25%), HLA-C* 07:01 (6.75%), HLA-C* 04:01 (5.00%), HLA-C* 06:02 (4.00%), HLA-C* 04:03 (4.00%), and HLA-C* 07:04 (3.75%) were more common in the Thai population. HLA-C* 01:02 (16.00%) allele was the highest frequency in the North, Center, and North East groups in Thailand, but there was the South region that was not significantly different when compared with the other groups of the region. Additionally, HLA-C∗14:02 allele was similarly distributed in Thais (3.00%), African Americans (1.98%), Caucasians (2.08%), Hispanics (1.71%), North American Natives (1.34%) and Asians (5.01%) by p-value = 0.6506, 0.6506, 0.6506, 0.6135 and 0.7182, respectively. Conclusion: Genetic variation database is important to identify HLA can be a risk factor for severe COVID-19 in many populations. In this study, we will support the research of the HLA markers for screening severe COVID-19 in many populations.

Keywords: HLA-C * 14:02, COVID-19, allele frequency, Thailand

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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: Mary Titilayo Olowe

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The controversies that trailed the political campaign and eventual choice of Donald Trump as the American president is so great that expectations are high as to what the content of his inaugural speech will portray. Given the fact that language is a dynamic vehicle of expressing intentions, the speech needs to be objectively assessed so as to access its content in the manner intended through the three strands of meaning postulated by the Systemic Functional Grammar (SFG): the ideational, the interpersonal and the textual. The focus of this paper, however, is on the interpersonal meaning which deals with how language exhibits social roles and relationship. This paper, therefore, attempts to analyse President Donald Trump’s inaugural speech to elicit interpersonal meaning in it. The analysis is done from the perspective of mood and modality which are housed in SFG. Results of the mood choice which is basically declarative, reveal an information-centered speech while the high option for the modal verb operator ‘will’ shows president Donald Trump’s ability to establish an equal and reliant relationship with his audience, i.e., the Americans. In conclusion, the appeal of the speech to different levels of Interpersonal meaning is largely responsible for its overall effectiveness. One can, therefore, understand the reason for the massive reaction it generates at the center of global discourse.

Keywords: interpersonal, modality, mood, systemic functional grammar

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Authors: Vishwanath Mali, Hemant Warhatkar, Raju Pawade

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Drilling of bone has been always challenging for surgeons due to the adverse effect it may impart to bone tissues. Force has to be applied manually by the surgeon while performing conventional bone drilling which may lead to permanent death of bone tissues and nerves. During bone drilling the temperature of the bone tissues increases to higher values above 47 ⁰C that causes thermal osteonecrosis resulting into screw loosening and subsequent implant failures. An attempt has been made here to study the input drilling parameters and surgical drill bit geometry affecting bone health during bone drilling. A One Factor At a Time (OFAT) method is used to plan the experiments. Input drilling parameters studied include spindle speed and feed rate. The drill bit geometry parameter studied include point angle and helix angle. The output variables are drilling thrust force and bone temperature. The experiments were conducted on goat femur bone at room temperature 30 ⁰C. For measurement of thrust forces KISTLER cutting force dynamometer Type 9257BA was used. For continuous data acquisition of temperature NI LabVIEW software was used. Fixture was made on RPT machine for holding the bone specimen while performing drilling operation. Bone specimen were preserved in deep freezer (LABTOP make) under -40 ⁰C. In case of drilling parameters, it is observed that at constant feed rate when spindle speed increases, thrust force as well as temperature decreases and at constant spindle speed when feed rate increases thrust force as well as temperature increases. The effect of drill bit geometry shows that at constant helix angle when point angle increases thrust force as well as temperature increases and at constant point angle when helix angle increase thrust force as well as temperature decreases. Hence it is concluded that as the thrust force increases temperature increases. In case of drilling parameter, the lowest thrust force and temperature i.e. 35.55 N and 36.04 ⁰C respectively were recorded at spindle speed 2000 rpm and feed rate 0.04 mm/rev. In case of drill bit geometry parameter, the lowest thrust force and temperature i.e. 40.81 N and 34 ⁰C respectively were recorded at point angle 70⁰ and helix angle 25⁰ Hence to avoid thermal necrosis of bone it is recommended to use higher spindle speed, lower feed rate, low point angle and high helix angle. The hard nature of cortical bone contributes to a greater rise in temperature whereas a considerable drop in temperature is observed during cancellous bone drilling.

Keywords: bone drilling, helix angle, point angle, thrust force, temperature, thermal necrosis

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Authors: Langhit Kurar, Loren Charles

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Introduction: In light of recent BOAST 12 (August 2016) published guidance on management of ankle fractures, the project aimed to highlight key discrepancies throughout the care trajectory from admission to point of discharge at a district general hospital. Wide breadth of data covering three key domains: accident and emergency, radiology, and orthopaedic surgery were subsequently stratified and recommendations on note documentation, and outpatient follow up were made. Methods: A retrospective twelve month audit was conducted reviewing results of ankle fracture management in 37 patients. Inclusion criterion involved all patients seen at Darent Valley Hospital (DVH) emergency department with radiographic evidence of an ankle fracture. Exclusion criterion involved all patients managed solely by nursing staff or having sustained purely ligamentous injury. Medical notes, including discharge summaries and the PACS online radiographic tool were used for data extraction. Results: Cross-examination of the A & E domain revealed limited awareness of the BOAST 12 recent publication including requirements to document skin integrity and neurovascular assessment. This had direct implications as this would have changed the surgical plan for acutely compromised patients. The majority of results obtained from the radiographic domain were satisfactory with appropriate X-rays taken in over 95% of cases. However, due to time pressures within A & E, patients were often left without a post manipulation XRAY in a backslab. Poorly reduced fractures were subsequently left for a long period resulting in swollen ankles and a time-dependent lag to surgical intervention. This had knocked on implications for prolonged inpatient stay resulting in hospital-acquired co-morbidity including pressure sores. Discussion: The audit has highlighted several areas of improvement throughout the disease trajectory from review in the emergency department to follow up as an outpatient. This has prompted the creation of an algorithm to ensure patients with significant fractures presenting to the emergency department are seen promptly and treatment expedited as per recent guidance. This includes timing for X-rays taken in A & E. Re-audit has shown significant improvement in both documentation at time of presentation and appropriate follow-up strategies. Within the orthopedic domain, we are in the process of creating an ankle fracture pathway to ensure imaging and weight bearing status are made clear to the consulting clinicians in an outpatient setting. Significance/Clinical Relevance: As a result of the ankle fracture algorithm we have adapted the BOAST 12 guidance to shape an intrinsic pathway to not only improve patient management within the emergency department but also create a standardised format for follow up.

Keywords: ankle, fracture, BOAST, radiology

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Authors: Irfan Mehmood

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The goal of this study is to examine The Bluest Eye (1979) by Toni Morrison from a Marxist perspective, a literary theory developed by Louis Althusser, which emphasizes capitalism and class conflict in the modern world. Marxist literary philosophy holds that the absence of opportunities for lower-class people to own and earn properties and resources of production is the main cause of their repression. In The Communist Manifesto (1848), Karl Marx divided society into two main classes, the proletariat (the lowest class) and the bourgeois (the ruling class). Marx contends that the proletarian class has been brutally exploited by the bourgeois class in all facets of existence. The exploitation of the lower class by means of hegemony and capitalism is covered by Toni Morrison in her first novel, The Bluest Eye (1979). The goal of this study is to determine how Morrison's chosen work highlights the struggle of oppressed African Americans against entrenched systems of hegemony, interpellation, and state apparatuses. This study will look more closely at the claim that all of the miseries experienced by Afro-Americans are mostly the result of the capitalist class structure and that they can also enjoy the blessings of life through unity, hard work, and economic stability.

Keywords: class conflict; African American culture; hegemony; interpellation; state apparatuses

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Authors: Yudi Zhao, Ziyun Zhou, Yueting Yao, Shuying Dai, Zhiling Yan, Longyu Yang, Chuanyin Li, Li Shi, Yufeng Yao

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HPV16 E4 gene plays an important role in viral genome amplification and release. Therefore, a variation of the E4 gene nucleic acid sequence may affect the carcinogenicity of HPV16. In order to understand the relationship between the variation of HPV16 E4 gene and cervical cancer, this study was to amplify and sequence the DNA sequences of E4 genes in 118 HPV16-positive cervical cancer patients and 151 HPV16-positive asymptomatic individuals. After obtaining E4 gene sequences, the phylogenetic trees were constructed by the Neighbor-joining method for gene variation analysis. The results showed that: 1) The distribution of HPV16 variants between the case group and the control group differed greatly (P = 0.015)，and the Asian-American（AA）variant was likely to relate to the occurrence of cervical cancer. 2) DNA sequence analysis showed that there were significant differences in the distribution of 8 variants between the case group and the control group (P < 0.05). And 3) In European (EUR) variant, two variations, C3384T (L18L) and A3449G (P39P), were associated with the initiation and development of cervical cancer. The results suggested that the variation of HPV16 E4 gene may be a contributor affecting the occurrence as well as the development of cervical cancer, and different HPV16 variants may have different carcinogenic capability.

Keywords: cervical cancer, HPV16, E4 gene, variations

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Authors: Veronica Diaz Quezada

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A study and its preliminary results are presented. The research is descriptive and exploratory and it is still in process. Its objective is to develop an assessment method in the field of fostering values using competence mathematics problem solving. This is part of a more extensive research that aims at contributing to educational integration in Latin America, particularly to the development of proposals to link education for citizenship and the mathematics lessons. This is being carried out by research teams of University of Barcelona-España; University Nacional of Costa Rica; University Autónoma of Querétaro-México; Pontificia University Católica of Perú, University Nacional of Villa María- Argentina and University of Los Lagos-Chile, in the context of Andrés Bello Chair for the Association of Latin American Universities. This research was developed and implemented in Chile in 2016, using mixed research methods. It included interviews and a problem-solving math test with ethical values that was administered to students of the secondary education of the regions of Los Ríos and of the Lakes of Chile. The results show the lack of integration between the teaching of values and science discipline.

Keywords: citizenchip, ethical values, mathematics, secondary school, solving problem

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Authors: Brad Curabba

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Utilising active, process-based learning methods to improve critical thinking and writing skills of second language (L2) writers brings unique challenges. To comprehensively satisfy different learners' needs, when commenting on student work, instructors can embed multiple feedback methods so that the capstone of their abilities as writers can be achieved. This research project assesses faculty and student perceptions regarding the effectiveness of various feedback practices used in process-based writing classrooms with L2 students at the American University of Sharjah (AUS). In addition, the research explores the challenges encountered by faculty during the provision of feedback practices. The quantitative research findings are based on two concurrent electronically distributed anonymous surveys; one aimed at students who have just completed a process-based writing course, and the other at instructors who delivered these courses. The student sample is drawn from multiple sections of Academic Writing I and II, and the faculty survey was distributed among the Department of Writing Studies (DWS) faculty. Our findings strongly suggest that all methods of feedback are deemed equally important by both students and faculty. Students, in particular, find process writing and its feedback practices to have greatly contributed to their writing proficiency.

Keywords: process writing, feedback, formative feedback, composition, reflection

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Authors: Santiago Guerra Fernández

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Abstract—This study is focused on exploring the conditions for the development of Galician music in the communities of Latin America after the massive arrival of Galician immigrants in the late nineteenth and early twentieth centuries, fleeing from hunger and misery in Spain. Migration would be accentuated after 1936 with the arrival of refugees from the Spanish Civil War due to their Republican political militancy fleeing fascism. The aim of this paper is to investigate the part that miscegenation with other local musical traditions has played within Galician expat music, helping to understand the complexity of contemporary Galician identity. Through archival work, the focus is set on examining the different traditional dances (such as the ‘muiñeira’), folk instruments (bagpipes, ‘pandeireta’), and poetic forms (‘cantiga’, ‘copla’) that were exported to Argentina and Cuba. Although research about migrant Galician music has been conducted in Spanish scholarship, there is a gap in the English literature on the topic that this paper intends to fill in. The results show how these musical traditions have played an essential role in shaping the social life and customs of Galician emigrants. By virtue of its malleability and blending properties, music serves here as an indicator of social cohesion.

Keywords: folk, Galicia, migration, identity

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Authors: William Elnemer, Nauman Hussain, Samir Al-Ali, Henry Shu, Diane Ghanem, Babar Shafiq

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Introduction: The incidence of infection in open tibial shaft injuries varies depending on the severity of the injury, with rates ranging from 1.8% for Gustilo-Anderson type I to 42.9% for type IIIB fractures. The timely administration of antibiotics upon presentation to the emergency department (ED) is an essential component of fracture management, and evidence indicates that prompt delivery of antibiotics is associated with improved outcomes. The objective of this study is to identify factors that contribute to the expedient administration of antibiotics. Methods: This is a retrospective study of open tibial shaft fractures at an academic Level I trauma center. Current Procedural Terminology (CPT) codes identified all patients treated for open tibial shaft fractures between 2015 and 2021. Open fractures were identified by reviewing ED and provider notes, and with ballistic fractures were considered open. Chart reviews were performed to extract demographics, fracture characteristics, postoperative outcomes, time to operative room, time to antibiotic order, and delivery. Univariate statistical analysis compared patients who received early antibiotics (EA), which were delivered within one hour of ED presentation, and those who received late antibiotics (LA), which were delivered outside of one hour of ED presentation. A multivariate analysis was performed to investigate patient, fracture, and transport/ED characteristics contributing to faster delivery of antibiotics. The multivariate analysis included the dependent variables: ballistic fracture, activation of Delta Trauma, Gustilo-Andersen (Type III vs. Type I and II), AO-OTA Classification (Type C vs. Type A and B), arrival between 7 am and 11 pm, and arrival via Emergency Medical Services (EMS) or walk-in. Results: Seventy ED patients with open tibial shaft fractures were identified. Of these, 39 patients (55.7%) received EA, while 31 patients (44.3%) received LA. Univariate analysis shows that the arrival via EMS as opposed to walk-in (97.4% vs. 74.2%, respectively, p = 0.01) and activation of Delta Trauma (89.7% vs. 51.6%, respectively, p < 0.001) was significantly higher in the EA group vs. the LA group. Additionally, EA cases had significantly shorter intervals between the antibiotic order and delivery when compared to LA cases (0.02 hours vs. 0.35 hours, p = 0.007). No other significant differences were found in terms of postoperative outcomes or fracture characteristics. Multivariate analysis shows that a Delta Trauma Response, arrival via EMS, and presentation between 7 am and 11 pm were independent predictors of a shorter time to antibiotic administration (Odds Ratio = 11.9, 30.7, and 5.4, p = 0.001, 0.016, and 0.013, respectively). Discussion: Earlier antibiotic delivery is associated with arrival to the ED between 7 am and 11 pm, arrival via EMS, and a coordinated Delta Trauma activation. Our findings indicate that in cases where administering antibiotics is critical to achieving positive outcomes, it is advisable to employ a coordinated Delta Trauma response. Hospital personnel should be attentive to the rapid administration of antibiotics to patients with open fractures who arrive via walk-in or during late-night hours.

Keywords: antibiotics, emergency department, fracture management, open tibial shaft fractures, orthopaedic surgery, time to or, trauma fractures

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Authors: Safi Haider

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This work seeks to understand the fundamental mourning ceremonies termed azadari in the tristate Shi’i community. Azadari, a name derived from the Arabic aza (mourning) and the Persian dari (commemoration) as it exists in the Tri-State Shi'i community has a unique relation to the hearts and minds of its adherents. It shows the development of the community from the various perspective offered by the participants of this work. This work seeks to analyze Azadari in the light of the Tri-State Shi'i community, which is a deeply diverse community, consisting of immigrants from various other countries, including Pakistan, India, Iran, and the Arab communities. At its heart, this work is an ethnography, it seeks to know the experience of those who are a part of the Muharram commemorations and it seek to see what the underlying psychological and the social foundations of Azadari are. Five people from each of the four communities were interviewed, and the aim was to have at least two men, two women, two youth, two elders, and one person from either of these categories. What was found was that the Shi’i community is scarcely a monolith in its mourning practices, and there is a great difference not only when comparing one cultural community to another, but also within the communities as well. This work seeks to analyze azadari from the various perspective of the Shi’i community in the tri-state area. This work seeks to analyze interviews from twenty people in total: two men, two women, two youth, and two adults from each of the communities of the Shi’i of the tristate area, for a total of twenty people. Two Priests were also interviewed for the sake of the paper as well.

Keywords: Ashura, Imam Husayn, Islam, Muharram, Shi'i

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Authors: Felicia Masenu

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Identity formation remains central to diaspora populations as they are known to have multiple attachments to places, including the 'ancestral homeland.' This paper emphasizes the potency of the ancestral homeland in the imagination of diaspora populations and a 'yearning' for an eventual return. This has led to the repatriation and visits of many Diasporan Africans to Africa. What have also been highlighted are the motivations, experiences, and challenges associated with the return of African Americans to Africa, as well as some of the idealistic expectations that Diasporan Africans have regarding the ancestral homeland. When Diasporan Africans visit Africa, they are faced with different kinds of situations that are challenging. Yet, the number of visits to Africa by Diasporan Africans, particularly, African Americans, keep increasing. This paper draws on the life history of Imahkus Nzinga, an African American who repatriated to Ghana in the 1990s, as a case study of African Americans’ relentless quest to pursue the ancestral homeland, despite the challenges involved. The paper argues that the quest for identity construction remains the overriding motivation for African Americans in their decision to repatriate to Africa, and discusses how in this case, Imahkus Nzinga attempts to reconcile what is called in this paper 'identity struggle.'

Keywords: African Americans, Diaspora, identity formation, identity struggle, repatriation

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Authors: I. M. Sujaul, M. A. Sobahan, A. A. Edriyana, F. M. Yahaya, R. M. Yunus

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This study was carried out to investigate the adverse effect of industrial waste water on surface water quality in Gebeng industrial estate, Pahang, Malaysia. Surface water was collected from 6 sampling stations. Physico-chemical parameters were characterized based on in-situ and ex-situ analysis according to standard methods by American Public Health Association (APHA). Selected heavy metals were determined by using Inductively Coupled Plasma Mass Spectrometry (ICP MS). The result reveled that the concentration of heavy metals such as Pb, Cu, Cd, Cr and Hg were high in samples. The result showed that the value of Pb and Hg were higher in the wet season in comparison to dry season. According to Malaysia National Water Quality Standard (NWQS) and Water Quality Index (WQI) all the sampling station were categorized as class IV (highly polluted). The present study reveled that the adverse effects of careless disposal of wastes and directly discharge of effluents affected on surface water quality. Therefore, the authorities should implement the laws to ensure the proper practices of waste water management for environmental sustainability around the study area.

Keywords: water, heavy metals, water quality index, Gebeng

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Authors: Gizem Barreto Martins

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This paper explores the subversive potential inherent in the theatrical language employed within Arthur Miller's The Crucible. The research argues that this play intricately weaves ideological connections with its audience and the historical epoch it represents, effectively serving as a channel for ideological and cultural interaction potentially exerting subversive influences on social and political realms. Using a historical-materialist methodology that situates the play within its historical and political context, all while examining its connections with theater and literary theories, the paper raises a fundamental query: How does this dramatic work embody subversion, presenting a style unburdened by the performative conventions of daily life and prevailing codes and systems of representation? In response to this inquiry, the study asserts that theatrical language has the capacity to function as a subversive catalyst against prevailing ideologies, actively contributing to the process of social transformation. To substantiate this claim, the research conducts a detailed analysis of the selected play, employing the semiotic framework pioneered by Gilles Deleuze and Felix Guattari.

Keywords: arthur miller, The crucible, gilles deleuze, felix guattari, theater and literary theories

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Authors: Scott Cavinder

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Surgical site infections (SSI) are a known complication to any surgical procedure and are one of the most common nosocomial infections. Globally it is estimated 300 million surgical procedures take place annually, with an incidence of SSI’s estimated to be 11 of 100 surgical patients developing an infection within 30 days after surgery. The specific purpose of the project is to address the PICOT (Problem, Intervention, Comparison, Outcome, Time) question: In patients who have undergone cardiothoracic or vascular surgery (P), does implementation of a post-operative care bundle based on current EBP (I) as compared to current clinical agency practice standards (C) result in a decrease of SSI (O) over a 12-week period (T)? Synthesis of Supporting Evidence: A literature search of five databases, including citation chasing, was performed, which yielded fourteen pieces of evidence ranging from high to good quality. Four common themes were identified for the prevention of SSI’s including use and removal of surgical dressings; use of topical antibiotics and antiseptics; implementation of evidence-based care bundles, and implementation of surveillance through auditing and feedback. The Iowa Model was selected as the framework to help guide this project as it is a multiphase change process which encourages clinicians to recognize opportunities for improvement in healthcare practice. Practice/Implementation: The process for this project will include recruiting postsurgical participants who have undergone cardiovascular or thoracic surgery prior to discharge at a Northwest Indiana Hospital. The patients will receive education, verbal instruction, and return demonstration. The patients will be followed for 12 weeks, and wounds assessed utilizing the National Healthcare Safety Network//Centers for Disease Control (NHSN/CDC) assessment tool and compared to the SSI rate of 2021. Key stakeholders will include two cardiovascular surgeons, four physician assistants, two advance practice nurses, medical assistant and patients. Method of Evaluation: Chi Square analysis will be utilized to establish statistical significance and similarities between the two groups. Main Results/Outcomes: The proposed outcome is the prevention of SSIs in the post-op cardiothoracic and vascular patient. Implication/Recommendation(s): Implementation of standardized post operative care bundles in the prevention of SSI in cardiovascular and thoracic surgical patients.

Keywords: cardiovascular, evidence based practice, infection, post-operative, prevention, thoracic, surgery

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