Search results for: effective outcome
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 10993

Search results for: effective outcome

10423 Development of Integrated Solid Waste Management Plan for Industrial Estates of Pakistan

Authors: Mehak Masood

Abstract:

This paper aims to design an integrated solid waste management plan for industrial estates taking Sundar Industrial Estate as case model. The issue of solid waste management is on the rise in Pakistan especially in the industrial sector. In this regard, the concept of development and establishment of industrial estates is gaining popularity nowadays. Without proper solid waste management plan it is very difficult to manage day to day affairs of industrial estates. An industrial estate contains clusters of different types of industrial units. It is necessary to identify different types of solid waste streams from each industrial cluster within the estate. In this study, Sundar Industrial Estate was taken as a case model. Primary and secondary data collection, waste assessment, waste segregation and weighing and field surveys were essential elements of the study. Wastes from each industrial process were identified and quantified. Currently 130 industries are in production but after full colonization of industries this number would reach 385. Elaborated process flow diagrams were made to characterize the recyclable and non-recyclables waste. From the study it was calculated that about 12354.1 kg/captia/day of solid waste is being generated in Sundar Industrial Estate. After the full colonization of the industrial estate, the estimated quantity will be 4756328.5 kg/captia/day. Furthermore, solid waste generated from each industrial sector was estimated. Suggestions for collection and transportation are given. Environment friendly solid waste management practices are suggested. If an effective integrated waste management system is developed and implemented it will conserve resources, create jobs, reduce poverty, conserve natural resources, protect the environment, save collection, transportation and disposal costs and extend the life of disposal sites. A major outcome of this study is an integrated solid waste management plan for the Sundar Industrial Estate which requires immediate implementation.

Keywords: integrated solid waste management plan, industrial estates, Sundar Industrial Estate, Pakistan

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10422 Design of Effective Decoupling Point in Build-To-Order Systems: Focusing on Trade-Off Relation between Order-To-Delivery Lead Time and Work in Progress

Authors: Zhiyong Li, Hiroshi Katayama

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Since 1990s, e-commerce and internet business have been grown gradually over the word and customers tend to express their demand attributes in terms of specification requirement on parts, component, product structure etc. This paper deals with designing effective decoupling points for build to order systems under e-commerce environment, which can be realized through tradeoff relation analysis between two major criteria, customer order lead time and value of work in progress. These KPIs are critical for successful BTO business, namely time-based service effectiveness on coping with customer requirements for the first issue and cost effective ness with risk aversive operations for the second issue. Approach of this paper consists of investigation of successful business standing for BTO scheme, manufacturing model development of this scheme, quantitative evaluation of proposed models by calculation of two KPI values under various decoupling point distributions and discussion of the results brought by pattern of decoupling point distribution, where some cases provide the pareto optimum performances. To extract the relevant trade-off relation between considered KPIs among 2-dimensional resultant performance, useful logic developed by former research work, i.e. Katayama and Fonseca, is applied. Obtained characteristics are evaluated as effective information for managing BTO manufacturing businesses.

Keywords: build-to-order (BTO), decoupling point, e-commerce, order-to-delivery lead time (ODLT), work in progress (WIP)

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10421 Burn/Traumatic Scar Maturation Using Autologous Fat Grafts + SVF

Authors: Ashok K. Gupta

Abstract:

Over the past few decades, since the bio-engineering revolution, autologous cell therapy (ACT) has become a rapidly evolving field. Currently, this form of therapy has broad applications in modern medicine and plastic surgery, ranging from the treatment/improvement of wound healing to life-saving operations. A study was conducted on 50 patients having to disfigure, and deform post burn scars and was treated by injection of extracted, refined adipose tissue grafts with their unique stem cell properties. To compare the outcome, a control of 20 such patients was treated with conventional skin or soft-tissue flaps or skin grafting, and a control of 10 was treated with more advanced microsurgical techniques such as Pre-fabricated flaps/pre laminated flaps / free flaps. Assessment of fat volume and survival post- follow up period was done by radiological aid, using MRI and clinically (Survival of the autograft and objective parameters for scar elasticity were evaluated skin elasticity parameters 3 to 9 months postoperatively). Recently, an enzyme that is involved in collagen crosslinking in fibrotic tissue, lysyl hydroxylase (LH2), was identified. This enzyme is normally active in bone and cartilage but hardly in the skin. It has been found that this enzyme is highly expressed in scar tissue and subcutaneous fat; this is in contrast to the dermis, where the enzyme is hardly expressed. Adipose tissue-derived stem cell injections are an effective method in the treatment of various extensive post-burn scar deformities that makes it possible to re-create the lost sub-dermal tissue for improvement in the function of involved joint movements.

Keywords: adipose tissue-derived stem cell injections, treatment of various extensive post-burn scar deformities, re-create the lost sub-dermal tissue, improvement in function of involved joint movements

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10420 Experience of Hydatid Disease of Liver at a Tertiary Care Center 7 Years Experience

Authors: Jibran Abbasy, Rizwan Sultan, Ammar Humayun, Tabish Chawla

Abstract:

Background: Hydatid disease caused by Echinococcus Granulosus affects liver in 70-90% of cases. Dogs are the definitive host while humans are the accidental host. Modalities used for its treatment are especially important for our population as the disease is endemic in many Asian countries. The aim of the study was to perform an audit of the various modalities used for treatment of hydatid disease of liver and the response to each modality in tertiary care center of Pakistan. Materials and Methods: Retrospective audit of patients diagnosed and treated for Hydatid disease of the liver at Aga Khan University Hospital from 1st January 2007 to 31st December 2014 was completed. All patients aged 16 and above were included. Patients who had extra hepatic disease and missing records were excluded. Outcome measures were morbidity, mortality and recurrence of the disease. Results: During the study period 56 patients were treated for isolated hepatic hydatid disease and were included. Mean age was 39 years with 48% being females and 52% males. Most common presenting complaint was abdominal pain seen in 53% of patients(n=41). Duration of symptoms was less than 6 months in 74% (n=38). Mostly right lobe was involved in 69% (n=38).Most common treatment modality used was surgery in 34 patients followed by PAIR in 14 patients while 8 patients were treated medically. At a median follow up of 34 months recurrence was seen in 2 patients treated with PAIR while no patient treated with surgery had recurrence with the median follow up of 20 months. While no morbidity and mortality were observed in PAIR, but in surgery 5 patients had morbidity while 1 patient had mortality. Conclusion: Our data is comparative to other studies in terms of morbidity, mortality, and recurrence. We had adequate follow up. In our study PAIR and surgery both are effective and have less complications and recurrence rate. Surgery is still the gold standard in terms of recurrence.

Keywords: echinococcous granulosus, puncture aspiration irrigation reaspiration (PAIR), surgery, hydatid disease

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10419 Instruction High-Leverage Practices in Reading Instruction for Adolescents

Authors: Nicole Pyle, Daniel Pyle, Christa Haring, Marty Hougen

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Effective special education teachers utilize evidence-based practices for adolescent reading instruction and target the skills needed to improve the reading of older struggling readers. High-Leverage Practices (HLPs) are critical to helping students with disabilities learn important content. Therefore, special education teachers are encouraged to implement HLPs to maximize the learning of students with disabilities, including students with reading difficulties. Teachers’ implementation of HLPs in reading comprehension instruction should aim to develop adolescents’ understanding of grade-level narrative texts and informational texts, including content area texts. Instruction High-Leverage Practices (11-22) that ensure effective implementation of evidence-based practice in reading comprehension instruction for adolescents are presented. Effective reading comprehension activities within the 12 Instruction HLPs are illustrated.

Keywords: high-leverage practices, adolescent, instructional activities, students with disabilities

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10418 Examining the Antecedents and Consequences of Work-Family Enrichment

Authors: Rujuta Matapurkar, Shivganesh Bhargava

Abstract:

This paper discusses work-family enrichment and its relationship with certain antecedents and outcomes while considering effect of mindfulness and organizational pride as moderators. The work-family enrichment has been the topic of interest for researchers as well as practitioners for decades now. It focusses on the positive side of work family interaction rather that the scarcity or balance principle. Research shows that work family enrichment is linked to multiple work place outcomes like job satisfaction, organization citizenship behavior and turnover intention. Enrichment is also linked to life outcomes like life satisfaction, wellbeing. Thus not only the individuals but the organizations too want to engage in the activities resulting in the positive spillover between work and non-work domains. One of the recent focus areas in organization behavior literature has been Mindfulness. Mindfulness is defined as a trait or state in which the mind focuses on the present. It is the conscious attention and awareness of the present thought. The research in the area of mindfulness at work suggests that the same is related to work family balance and job satisfaction. This paper discusses the possibility of mindfulness having effect on the relationship between antecedents of enrichment and enrichment. On the outcome side job embeddedness and job ambivalence are the newest additions to the retention literature. Job ambivalence talks about having strong positive as well as negative feelings about the job. Job ambivalence is the work outcome which is linked to turnover intention. This paper talks about the relationship between enrichment and job ambivalence. Another measure for work place outcomes which is discussed in recent research is job embeddedness. This term talks about the advantages of continuing with the job rather than quitting it. It is described as like a net or a web in which an individual can become stuck and is focused on why people stay rather than on how they leave. The research has have found that establishing or increasing job embeddedness is likely to increase retention, attendance, citizenship and job performance. This paper studies the relationship between enrichment and embeddedness. Lastly this paper studies whether organizational pride has an an effect on the relationship between enrichment and its outcomes. This paper concludes with the direction for future research.

Keywords: work-family enrichment, mindfulness, job ambivalence, job embeddedness, organizational pride

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10417 Opportunities for Effective Conflict Management Caused by Global Crises

Authors: Marine Kobalava

Abstract:

The article analyzes current global crises in the world, explains the causes of crises, substantiates that in the main cases the process accompanying the crisis are conflict situations. The paper argues that crises can become predictable if threats are identified and addressed by a company, organization, corporation, and others. Accordingly, mechanisms for the neutralization of conflict potential are proposed, the need to develop a communication strategy and create and redistribute information flows is justified. Conflict situations are assessed according to the types of crisis and it is considered that the conflict can become a prerequisite for the crisis. The paper substantiates the need to differentiate theories of crises and conflicts. Based on the evaluative judgment, conflict management measures are proposed taking into account institutionalization, conflict resolution norms and rules. The paper identifies the potential for conflicts created in the context of global crises and suggests local ways and mechanisms for their effective management. The involvement of the company's Public relations (PR) and relevant communication from the qualified staff is considered important. Conclusions are drawn on the problems of effective conflict management caused by global crises and recommendations for conflict resolution have been proposed.

Keywords: global crises, conflict situations, conflict identification, conflict management, conflict potential

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10416 Estimation of Effective Mechanical Properties of Linear Elastic Materials with Voids Due to Volume and Surface Defects

Authors: Sergey A. Lurie, Yury O. Solyaev, Dmitry B. Volkov-Bogorodsky, Alexander V. Volkov

Abstract:

The media with voids is considered and the method of the analytical estimation of the effective mechanical properties in the theory of elastic materials with voids is proposed. The variational model of the porous media is discussed, which is based on the model of the media with fields of conserved dislocations. It is shown that this model is fully consistent with the known model of the linear elastic materials with voids. In the present work, the generalized model of the porous media is proposed in which the specific surface properties are associated with the field of defects-pores in the volume of the deformed body. Unlike typical surface elasticity model, the strain energy density of the considered model includes the special part of the surface energy with the quadratic form of the free distortion tensor. In the result, the non-classical boundary conditions take modified form of the balance equations of volume and surface stresses. The analytical approach is proposed in the present work which allows to receive the simple enough engineering estimations for effective characteristics of the media with free dilatation. In particular, the effective flexural modulus and Poisson's ratio are determined for the problem of a beam pure bending. Here, the known voids elasticity solution was expanded on the generalized model with the surface effects. Received results allow us to compare the deformed state of the porous beam with the equivalent classic beam to introduce effective bending rigidity. Obtained analytical expressions for the effective properties depend on the thickness of the beam as a parameter. It is shown that the flexural modulus of the porous beam is decreased with an increasing of its thickness and the effective Poisson's ratio of the porous beams can take negative values for the certain values of the model parameters. On the other hand, the effective shear modulus is constant under variation of all values of the non-classical model parameters. Solutions received for a beam pure bending and the hydrostatic loading of the porous media are compared. It is shown that an analytical estimation for the bulk modulus of the porous material under hydrostatic compression gives an asymptotic value for the effective bulk modulus of the porous beam in the case of beam thickness increasing. Additionally, it is shown that the scale effects appear due to the surface properties of the porous media. Obtained results allow us to offer the procedure of an experimental identification of the non-classical parameters in the theory of the linear elastic materials with voids based on the bending tests for samples with different thickness. Finally, the problem of implementation of the Saint-Venant hypothesis for the transverse stresses in the porous beam are discussed. These stresses are different from zero in the solution of the voids elasticity theory, but satisfy the integral equilibrium equations. In this work, the exact value of the introduced surface parameter was found, which provides the vanishing of the transverse stresses on the free surfaces of a beam.

Keywords: effective properties, scale effects, surface defects, voids elasticity

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10415 Social Media as a Means of Participation in Democracies

Authors: C. Arslan, K. Yakar

Abstract:

Social media is one of the most important and effective means of social interaction among people in which they create, share and exchange their ideas via photos, videos or voice messages. Although there are lots of communication tools. Social media sites are the most prominent ones that allows the users articulate themselves in a matter of seconds all around the world with almost any expenses and thus, they became very popular and widespread after its emergence. As the usage of social media increases, it becomes an effective instrument in social matters. While it is possible to use social media to emphasize basic human rights and protest some failures of any government as in “Arab Spring”, it is also possible to spread propaganda and misinformation just to cause long lasting insurgency, upheaval, turmoil or disorder as an instrument of intervention to internal affairs and state sovereignty by some hostile groups or countries. It is certain that social media has positive effects on participation in democracies allowing people express themselves freely and limitlessly, but obviously, the misuse of it is very common and it is quite possible that even a five-minute-long video record can topple down a government or give a solid reason to a government to review its policies on some certain areas. As one of the most important and effective means of participation, social media presents some opportunities as well as risks. In this study, the place of social media for participation in democracies will be demonstrated under the light of opportunities and risks.

Keywords: social media, democracy, participation, risks, opportunities

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10414 [Keynote Speech]: Evidence-Based Outcome Effectiveness Longitudinal Study on Three Approaches to Reduce Proactive and Reactive Aggression in Schoolchildren: Group CBT, Moral Education, Bioneurological Intervention

Authors: Annis Lai Chu Fung

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While aggression had high stability throughout developmental stages and across generations, it should be the top priority of researchers and frontline helping professionals to develop prevention and intervention programme for aggressive children and children at risk of developing aggressive behaviours. Although there is a substantial amount of anti-bullying programmes, they gave disappointingly small effect sizes. The neglectful practical significance could be attributed to the overly simplistic categorisation of individuals involved as bullies or victims. In the past three decades, the distinction between reactive and proactive aggression has been well-proved. As children displaying reactively aggressive behaviours have distinct social-information processing pattern with those showing proactively aggressive behaviours, it is critical to identify the unique needs of the two subtypes accordingly when designing an intervention. The onset of reactive aggression and proactive aggression was observed at earliest in 4.4 and 6.8 years old respectively. Such findings called for a differential early intervention targeting these high-risk children. However, to the best of the author’s knowledge, the author was the first to establish an evidence-based intervention programme against reactive and proactive aggression. With the largest samples in the world, the author, in the past 10 years, explored three different approaches and their effectiveness against aggression quantitatively and qualitatively with longitudinal design. The three approaches presented are (a) cognitive-behavioral approach, (b) moral education, with Chinese marital arts and ethics as the medium, and (c) bioneurological measures (omega-3 supplementation). The studies adopted a multi-informant approach with repeated measures before and after the intervention, and follow-up assessment. Participants were recruited from primary and secondary schools in Hong Kong. In the cognitive-behavioral approach, 66 reactive aggressors and 63 proactive aggressors, aged from 11 to 17, were identified from 10,096 secondary-school children with questionnaire and subsequent structured interview. Participants underwent 10 group sessions specifically designed for each subtype of aggressor. Results revealed significant declines in aggression levels from the baseline to the follow-up assessment after 1 year. In moral education through the Chinese martial arts, 315 high-risk aggressive children, aged 6 to 12 years, were selected from 3,511 primary-school children and randomly assigned into four types of 10-session intervention group, namely martial-skills-only, martial-ethics-only, both martial-skills-and-ethics, and physical fitness (placebo). Results showed only the martial-skills-and-ethics group had a significant reduction in aggression after treatment and 6 months after treatment comparing with the placebo group. In the bioneurological approach, 218 children, aged from 8 to 17, were randomly assigned to the omega-3 supplement group and the placebo group. Results revealed that compared with the placebo group, the omega-3 supplement group had significant declines in aggression levels at the 6-month follow-up assessment. All three approaches were effective in reducing proactive and reactive aggression. Traditionally, intervention programmes against aggressive behaviour often adapted the cognitive and/or behavioural approach. However, cognitive-behavioural approach for children was recently challenged by its demanding requirement of cognitive ability. Traditional cognitive interventions may not be as beneficial to an older population as in young children. The present study offered an insightful perspective in aggression reduction measures.

Keywords: intervention, outcome effectiveness, proactive aggression, reactive aggression

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10413 Research Trends in Using Virtual Reality for the Analysis and Treatment of Lower-Limb Musculoskeletal Injury of Athletes: A Literature Review

Authors: Hannah K. M. Tang, Muhammad Ateeq, Mark J. Lake, Badr Abdullah, Frederic A. Bezombes

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There is little research applying virtual reality (VR) to the treatment of musculoskeletal injury in athletes. This is despite their prevalence, and the implications for physical and psychological health. Nevertheless, developments of wireless VR headsets better facilitate dynamic movement in VR environments (VREs), and more research is expected in this emerging field. This systematic review identified publications that used VR interventions for the analysis or treatment of lower-limb musculoskeletal injury of athletes. It established a search protocol, and through narrative discussion, identified existing trends. Database searches encompassed four term sets: 1) VR systems; 2) musculoskeletal injuries; 3) sporting population; 4) movement outcome analysis. Overall, a total of 126 publications were identified through database searching, and twelve were included in the final analysis and discussion. Many of the studies were pilot and proof of concept work. Seven of the twelve publications were observational studies. However, this may provide preliminary data from which clinical trials will branch. If specified, the focus of the literature was very narrow, with very similar population demographics and injuries. The trends in the literature findings emphasised the role of VR and attentional focus, the strategic manipulation of movement outcomes, and the transfer of skill to the real-world. Causal inferences may have been undermined by flaws, as most studies were limited by the practicality of conducting a two-factor clinical-VR-based study. In conclusion, by assessing the exploratory studies, and combining this with the use of numerous developments, techniques, and tools, a novel application could be established to utilise VR with dynamic movement, for the effective treatment of specific musculoskeletal injuries of athletes.

Keywords: athletes, lower-limb musculoskeletal injury, rehabilitation, return-to-sport, virtual reality

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10412 The Effectiveness of Incidental Physical Activity Interventions Compared to Other Interventions in the Management of People with Low Back Pain: A Systematic Review and Meta-Analysis

Authors: Hosam Alzahrani, Martin Mackey, Emmanuel Stamatakis, Marina B. Pinheiro, Manuela Wicks, Debra Shirley

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Objective: To investigate the effectiveness of incidental (non-structured) physical activity interventions compared with other commonly prescribed interventions for the management of people with low back pain (LBP). Methods: We performed a systematic review with meta-analyses of eligible randomized controlled trials obtained by searching Medline, Scopus, CINAHL, EMBASE, and CENTRAL. This review considered trials investigating the effect of incidental physical activity interventions compared to other interventions in people aged 18 years or over, diagnosed with non-specific LBP. Analyses were conducted separately for short-term (≤3 months), intermediate-term (> 3 and < 12 months), and long-term (≥ 12 months), for each outcome. The analyses were conducted using the weighted mean difference (WMD). The overall quality of evidence was assessed using the GRADE system. Meta-analyses were only performed for pain and disability outcomes as there was insufficient data on the other outcomes. Results: For pain, the pooled results did not show any significant effects between the incidental physical activity intervention and other interventions at any time point. For disability, incidental physical activity was not statistically more effective than other interventions at short-term; however, the pooled results favored incidental physical activity at intermediate-term (WMD= -6.05, 95% CI: -10.39 to -1.71, p=0.006) and long-term (WMD= -6.40 95% CI: -11.68 to -1.12, p=0.02) follow-ups among participants with chronic LBP. The overall quality of evidence was rated “moderate quality” based on the GRADE system. Conclusion: The incidental physical activity intervention provided intermediate and long disability relief for people with chronic LBP, although this improvement was small and not likely to be clinically important.

Keywords: physical activity, incidental, low back pain, systematic review, meta-analysis

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10411 The Benefits of a Totally Autologous Breast Reconstruction Technique Using Extended Latissimus Dorsi Flap with Lipo-Modelling: A Seven Years United Kingdom Tertiary Breast Unit Results

Authors: Wisam Ismail, Brendan Wooler, Penelope McManus

Abstract:

Introduction: The public perception of implants has been damaged in the wake of recent negative publicity and increasingly we are finding patients wanting to avoid them. Planned lipo-modelling to enhance the volume of a Latissimus dorsi flap is a viable alternative to silicone implants and maintains a Totally Autologous Technique (TAT). Here we demonstrate that when compared to an Implant Assisted Technique (IAT), a TAT offers patients many benefits that offset the requirement of more operations initially, with reduced short and long term complications, reduced symmetrisation surgery and reduced revision rates. Methods. Data was collected prospectively over 7 years. The minimum follows up was 3 years. The technique was generally standardized in the hand of one surgeon. All flaps were extended LD flaps (ELD). Lipo-modelling was performed using standard techniques. Outcome measures were unplanned secondary procedures, complication rates, and contralateral symmetrisation surgery rates. Key Results Were: Lower complication rates in the TAT group (18.5% vs. 33.3%), despite higher radiotherapy rates (TAT=49%, IAT=36.8%), TAT was associated with lower subsequent symmetrisation rates (30.6% vs. 50.9%), IAT had a relative risk of 3.1 for subsequent unplanned procedure, Autologous patients required an average of 1.76 sessions of lipo-modelling, Conclusions: Using lipo-modelling to enable totally autologous LD reconstruction offers significant advantages over an implant assisted technique. We have shown a lower subsequent unplanned procedure rate, lower revision surgery, and less contralateral symmetrisation surgery. We anticipate that a TAT will be supported by patient satisfaction surveys and long-term patient-reported cosmetic outcome data and intended to study this.

Keywords: breast, Latissimus dorsi, lipomodelling, reconstruction

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10410 Photoactivated Chromophore for Keratitis-Cross Linking Window Absorption Alone versus Combined Pack-CXL Window Absorption and Standard Anti-microbial Therapy for Treatment of Infectious Keratitis: A Prospective Study

Authors: Mohammed M. Mahdy Tawfeek

Abstract:

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

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

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10409 Physiological Response of Water-Restricted Xhosa Goats Supplemented with Vitamin C

Authors: O.F. Akinmoladun, F.N. Fon, C.T. Mpendulo, O. Okoh

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The sustainability of livestock production is under threat as a result of water scarcity, fluctuating precipitation, and high environmental temperature. These combined stressors have impacted negatively on general animal production and welfare, necessitating a very reliable and cost-effective management practices, especially in arid and water-limited regions of the world. Instead of the above, this study was designed to investigate the growth performance and physiological response of water-restricted Xhosa ear-lobe goats fed diets supplemented with single or multiple vitamin C (VC) during summer. The total forty-eight goats used for the experiment were balanced for body weight and randomly assigned to the seven treatment groups (seven goats/treatment): GI (W100%); GII (W70%); GIII (W50%); GIV (W70%+3g/day VC); GV ((W50% +3g/day VC); GVI (W70%+3g/d VC+extra 5g on every eight-day); GVII (W50%+3g/d VC+extra 5g on every eight-day). The design was a complete randomized design and VC was administered per os. At the end of the 75-day feeding trial, GIII (W50%) animals were the most affected (P<0.05) and the effect was more pronounced in their body condition scores (BCs). Weight loss and depression in feed intake due to water restriction (P<0.05) were attenuated by VC treated groups (GIV-GVII). Changes in body thermal gradient (BTG) and rectal temperature (RcT) were similar (P>0.05) across the various experimental groups. The attenuation effect of VC was significant in responses to respiratory rate (RR) and cortisol. Supplementation of VC (either single or multiple) did not significantly (P>0.05) improve water restriction effect on body condition scores (BCs) and FAMACHA©. The current study found out that Xhosa ear lobe goats can adapt to the prevailing bioclimatic changes and limited water intake. However, supplementation of vitamin C can be beneficial at modulating these stressful stimuli. Continuous consistencies in the outcome of vitamin C on water-stressed animals can help validate recommendations especially to farmers in the arid and water-limited regions across the globe.

Keywords: vitamin C, Xhosa ear-lobe, thermotolerance, water stress

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10408 Effective Student Engaging Strategies to Enhance Academic Learning in Middle Eastern Classrooms: An Action Research Approach

Authors: Anjum Afrooze

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The curriculum at General Sciences department in Prince Sultan University includes ‘Physical science’ for Computer Science, Information Technology and Business courses. Students are apathetic towards Physical Science and question, as to, ‘How this course is related to their majors?’ English is not a native language for the students and also for many instructors. More than sixty percent of the students come from institutions where English is not the medium of instruction, which makes student learning and academic achievement challenging. After observing the less enthusiastic student cohort for two consecutive semesters, the instructor was keen to find effective strategies to enhance learning and further encourage deep learning by engaging students in different tasks to empower them with necessary skills and motivate them. This study is participatory action research, in which instructor designs effective tasks to engage students in their learning. The study is conducted through two semesters with a total of 200 students. The effectiveness of this approach is studied using questionnaire at the end of each semester and teacher observation. Major outcomes of this study were overall improvement in students attitude towards science learning, enhancement of multiple skills like note taking, problem solving, language proficiency and also fortifying confidence. This process transformed instructor into engaging and reflecting practitioner. Also, these strategies were implemented by other instructors teaching the course and proved effective in opening a path to changes in related areas of the course curriculum. However, refinement in the strategies could be done based on student evaluation and instructors observation.

Keywords: group activity, language proficiency, reasoning skills, science learning

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10407 Nurturing of Children with Results from Their Nature (DNA) Using DNA-MILE

Authors: Tan Lay Cheng (Cheryl), Low Huiqi

Abstract:

Background: All children learn at different pace. Individualized learning is an approach that tailors to the individual learning needs of each child. When implementing this approach, educators have to base their lessons on the understanding that all students learn differently and that what works for one student may not work for another. In the current early childhood environment, individualized learning is for children with diverse needs. However, a typical developing child is also able to benefit from individualized learning. This research abstract explores the concept of utilizing DNA-MILE, a patented (in Singapore) DNA-based assessment tool that can be used to measure a variety of factors that can impact learning. The assessment report includes the dominant intelligence of the user or, in this case, the child. From the result, a personalized learning plan that is tailored to each individual student's needs. Methods: A study will be conducted to investigate the effectiveness of DNA-MILE in supporting individualized learning. The study will involve a group of 20 preschoolers who were randomly assigned to either a DNA-MILE-assessed group (experimental group) or a control group. 10 children in each group. The experimental group will receive DNA Mile assessments and personalized learning plans, while the control group will not. The children in the experimental group will be taught using the dominant intelligence (as shown in the DNA-MILE report) to enhance their learning in other domains. The children in the control group will be taught using the curriculum and lesson plan set by their teacher for the whole class. Parents’ and teachers’ interviews will be conducted to provide information about the children before the study and after the study. Results: The results of the study will show the difference in the outcome of the learning, which received DNA Mile assessments and personalized learning plans, significantly outperformed the control group on a variety of measures, including standardized tests, grades, and motivation. Conclusion: The results of this study suggest that DNA Mile can be an effective tool for supporting individualized learning. By providing personalized learning plans, DNA Mile can help to improve learning outcomes for all students.

Keywords: individualized, DNA-MILE, learning, preschool, DNA, multiple intelligence

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10406 The Use of Coronary Calcium Scanning for Cholesterol Assessment and Management

Authors: Eva Kirzner

Abstract:

Based on outcome studies published over the past two decades, in 2018, the ACC/AHA published new guidelines for the management of hypercholesterolemia that incorporate the use of coronary artery calcium (CAC) scanning as a decision tool for ascertaining which patients may benefit from statin therapy. This use is based on the recognition that the absence of calcium on CAC scanning (i.e., a CAC score of zero) usually signifies the absence of significant atherosclerotic deposits in the coronary arteries. Specifically, in patients with a high risk for atherosclerotic cardiovascular disease (ASCVD), initiation of statin therapy is generally recommended to decrease ASCVD risk. However, among patients with intermediate ASCVD risk, the need for statin therapy is less certain. However, there is a need for new outcome studies that provide evidence that the management of hypercholesterolemia based on these new ACC/AHA recommendations is safe for patients. Based on a Pub-Med and Google Scholar literature search, four relevant population-based or patient-based cohort studies that studied the relationship between CAC scanning, risk assessment or mortality, and statin therapy that were published between 2017 and 2021 were identified (see references). In each of these studies, patients were assessed for their baseline risk for atherosclerotic cardiovascular disease (ASCVD) using the Pooled Cohorts Equation (PCE), an ACC/AHA calculator for determining patient risk based on assessment of patient age, gender, ethnicity, and coronary artery disease risk factors. The combined findings of these four studies provided concordant evidence that a zero CAC score defines patients who remain at low clinical risk despite the non-use of statin therapy. Thus, these new studies confirm the use of CAC scanning as a safe tool for reducing the potential overuse of statin therapy among patients with zero CAC scores. Incorporating these new data suggest the following best practice: (1) ascertain ASCVD risk according to the PCE in all patients; (2) following an initial attempt trial to lower ASCVD risk with optimal diet among patients with elevated ASCVD risk, initiate statin therapy for patients who have a high ASCVD risk score; (3) if the ASCVD score is intermediate, refer patients for CAC scanning; and (4) and if the CAC score is zero among the intermediate risk ASCVD patients, statin therapy can be safely withheld despite the presence of an elevated serum cholesterol level.

Keywords: cholesterol, cardiovascular disease, statin therapy, coronary calcium

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10405 Estimation of Effective Radiation Dose Following Computed Tomography Urography at Aminu Kano Teaching Hospital, Kano Nigeria

Authors: Idris Garba, Aisha Rabiu Abdullahi, Mansur Yahuza, Akintade Dare

Abstract:

Background: CT urography (CTU) is efficient radiological examination for the evaluation of the urinary system disorders. However, patients are exposed to a significant radiation dose which is in a way associated with increased cancer risks. Objectives: To determine Computed Tomography Dose Index following CTU, and to evaluate organs equivalent doses. Materials and Methods: A prospective cohort study was carried at a tertiary institution located in Kano northwestern. Ethical clearance was sought and obtained from the research ethics board of the institution. Demographic, scan parameters and CT radiation dose data were obtained from patients that had CTU procedure. Effective dose, organ equivalent doses, and cancer risks were estimated using SPSS statistical software version 16 and CT dose calculator software. Result: A total of 56 patients were included in the study, consisting of 29 males and 27 females. The common indication for CTU examination was found to be renal cyst seen commonly among young adults (15-44yrs). CT radiation dose values in DLP, CTDI and effective dose for CTU were 2320 mGy cm, CTDIw 9.67 mGy and 35.04 mSv respectively. The probability of cancer risks was estimated to be 600 per a million CTU examinations. Conclusion: In this study, the radiation dose for CTU is considered significantly high, with increase in cancer risks probability. Wide radiation dose variations between patient doses suggest that optimization is not fulfilled yet. Patient radiation dose estimate should be taken into consideration when imaging protocols are established for CT urography.

Keywords: CT urography, cancer risks, effective dose, radiation exposure

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10404 Rock Property Calculation for Determine Hydrocarbon Zone Based on Petrophysical Principal and Sequence Stratigraphic Correlation in Blok M

Authors: Muhammad Tarmidzi, Reza M. G. Gani, Andri Luthfi

Abstract:

The purpose of this study is to identify rock zone containing hydrocarbons with calculating rock property includes volume shale, total porosity, effective porosity and water saturation. Identification method rock property based on GR log, resistivity log, neutron log and density rock. Zoning is based on sequence stratigraphic markers that are sequence boundary (SB), transgressive surface (TS) and flooding surface (FS) which correlating ten well log in blok “M”. The results of sequence stratigraphic correlation consist of eight zone that are two LST zone, three TST zone and three HST zone. The result of rock property calculation in each zone is showing two LST zone containing hydrocarbons. LST-1 zone has average volume shale (Vsh) 25%, average total porosity (PHIT) 14%, average effective porosity (PHIE) 11% and average water saturation 0,83. LST-2 zone has average volume shale (Vsh) 19%, average total porosity (PHIT) 21%, average effective porosity (PHIE) 17% and average water saturation 0,82.

Keywords: hydrocarbons zone, petrophysic, rock property, sequence stratigraphic

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10403 Determinants of Domestic Violence among Married Women Aged 15-49 Years in Sierra Leone by an Intimate Partner: A Cross-Sectional Study

Authors: Tesfaldet Mekonnen Estifanos, Chen Hui, Afewerki Weldezgi

Abstract:

Background: Intimate partner violence (hereafter IPV) is a major global public health challenge that tortures and disables women in the place where they are ought to be most secure within their own families. The fact that the family unit is commonly viewed as a private circle, violent acts towards women remains undermined. There are limited research and knowledge about the influencing factors linked to IPV in Sierra Leone. This study, therefore, estimates the prevalence rate and the predicting factors associated with IPV. Methods: Data were taken from Sierra-Leone Demographic and Health Survey (SDHS, 2013): the first in its form to incorporate information on domestic violence. Multistage cluster sampling research design was used, and information was gathered by a standard questionnaire. A total of 5185 respondents selected were interviewed, out of whom 870 were never been in union, thus excluded. To analyze the two dependent variables: experience of IPV, ‘ever’ and 'last 12 months prior to the survey', a total of 4315 (currently or formerly married) and 4029 women (currently in union) were included respectively. These dependent variables were constructed from the three forms of violence namely physical, emotional and sexual. Data analysis was applied using SPSS version 23, comprising three-step process. First, descriptive statistics were used to show the frequency distribution of both the outcome and explanatory variables. Second, bivariate analysis adopting chi-square test was applied to assess the individual relationship between the outcome and explanatory variables. Third, multivariate logistic regression analysis was undertaken using hierarchical modeling strategy to identify the influence of the explanatory variables on the outcome variables. Odds ratio (OR) and 95% confidence interval (CI) were utilized to examine the association of the variables considering p-values less than 0.05 statistically significant. Results: The prevalence of lifetime IPV among ever married women was 48.4%, while 39.8% of those currently married experienced IPV in the previous year preceding the survey. Women having 1 to 4 and more than 5 number of ever born babies were almost certain to encounter lifetime IPV. However, women who own a property, and those who referenced 3-5 reasons for which wife-beating is acceptable were less probably to experience lifetime IPV. Attesting parental violence, partner’s dominant marital behavior, and women afraid of their partner were the variables related to both experience of IPV ‘ever’ and ‘the previous year prior to the survey’. Respondents who concur that wife-beating is sensible in certain situations and occupations under the professional category had diminished chances of revealing IPV in the year prior to the data collection. Conclusion: This study indicated that factors significantly correlated with IPV in Sierra-Leone are mostly linked with husband related factors specifically, marital controlling behaviors. Addressing IPV in Sierra-Leone requires joint efforts that target men raise awareness to address controlling behavior and empower security in affiliations.

Keywords: husband behavior, married women, partner violence, Sierra Leone

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10402 Evaluation of the Efficacy of Basic Life Support Teaching in Second and Third Year Medical Students

Authors: Bianca W. O. Silva, Adriana C. M. Andrade, Gustavo C. M. Lucena, Virna M. S. Lima

Abstract:

Introduction: Basic life support (BLS) involves the immediate recognition of cardiopulmonary arrest. Each year, 359.400 and 275.000 individuals with cardiac arrest are attended in emergency departments in USA and Europe. Brazilian data shows that 200.000 cardiac arrests occur every year, and half of them out of the hospital. Medical schools around the world teach BLS in the first years of the course, but studies show that there is a decline of the knowledge as the years go by, affecting the chain of survival. The objective was to analyze the knowledge of medical students about BLS and the retention of this learning throughout the course. Methods: This study included 150 students who were at the second and third year of a medical school in Salvador, Bahia, Brazil. The instrument of data collection was a structured questionnaire composed of 20 questions based on the 2015 American Heart Association guideline. The Pearson Chi-square test was used in order to study the association between previous training, sex and semester with the degree of knowledge of the students. The Kruskal-Wallis test was used to evaluate the different yields obtained between the various semesters. The number of correct answers was described by average and quartiles. Results: Regarding the degree of knowledge, 19.6% of the female students reached the optimal classification, a better outcome than the achieved by the male participants. Of those with previous training, 33.33% were classified as good and optimal, none of the students reached the optimal classification and only 2.2% of them were classified as bad (those who did not have 52.6% of correct answers). The analysis of the degree of knowledge related to each semester revealed that the 5th semester had the highest outcome: 30.5%. However, the acquaintance presented by the semesters was generally unsatisfactory, since 50% of the students, or more, demonstrated knowledge levels classified as bad or regular. When confronting the different semesters and the achieved scores, the value of p was 0.831. Conclusion: It is important to focus on the training of medical professionals that are capable of facing emergency situations, improving the systematization of care, and thereby increasing the victims' possibility of survival.

Keywords: basic life support, cardiopulmonary ressucitacion, education, medical students

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10401 Catalytic Conversion of Biomass Derived Intermediates into Gasoline

Authors: Sandeep K. Saxena, N. Viswanadham, Ala’a H. Al-Muhtaseb

Abstract:

In an attempt to facilitate effective conversion of biomass derived products into gasoline rich in aromatics and iso-paraffins, various zeolite catalysts with special features such as nano crystallite size and acidity has been synthesized and evaluated. The catalyst (NZ) exhibits highest gasoline yield of about 74wt% with aromatics and iso-paraffins as major components. The product measures Research Octane Number (RON) of about 95, which is desirable for the gasoline specifications. Moreover, considerable amount of the Liquefied Petroleum Gas (LPG) (15wt%) and light olefins (14wt%) are also formed as bi-product that adds value to the process. The study reveals the effective conversion of bio- ethanol to high-octane gasoline.

Keywords: biomass, ethanol, acetone, gasoline, zeolite

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10400 Extent of I.C.T Application in Record Management and Factors Hindering the Utilization of E-Learning in the Government Owned Universities in Enugu State, Nigeria

Authors: Roseline Unoma Chidobi

Abstract:

The purpose of this study is to identify the extent of Information Communication Technology (ICT) application in record management and some factors militating against the utilization of e-learning in the universities in Enugu state. The study was a survey research the quantitative data were collected through a 30 – item questionnaire title extent of ICT Application in Record management and militating Factors in the utilization of e-learning (EIARMMFUE). This was administered on a population of 603 respondents made up of university academic staff and senior administrative staff. The data were analyzed using mean, standard deviation and t-test statistics on a modified 4 point rating scale. Findings of the study revealed among others that ICT are not adequately applied in the management of records in the Universities in Nigeria. Factors like wrong notion or superstitious believe hinder the effective utilization of e – learning approach. The study recommended that the use of ICT in record management should be enhanced in order to achieve effective school management. All the factors militating against the effective utilization of e-learning approach should be addressed for the maximum realization of teaching and learning.

Keywords: e-learning, information communication, teaching, technology, tertiary institution

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10399 A Comparison of Outcomes of Endoscopic Retrograde Cholangiopancreatography vs. Percutaneous Transhepatic Biliary Drainage in the Management of Obstructive Jaundice from Hepatobiliary Tuberculosis: The Philippine General Hospital Experience

Authors: Margaret Elaine J. Villamayor, Lobert A. Padua, Neil S. Bacaltos, Virgilio P. Bañez

Abstract:

Significance: This study aimed to determine the prevalence of Hepatobiliary Tuberculosis (HBTB) with biliary obstruction and to compare the outcomes of ERCP versus PTBD in these patients. Methodology: This is a cross-sectional study involving patients from PGH who underwent biliary drainage from HBTB from January 2009 to June 2014. HBTB was defined as having evidence of TB (culture, smear, PCR, histology) or clinical diagnosis with the triad of jaundice, fever, and calcifications on imaging with other causes of jaundice excluded. The primary outcome was successful drainage and secondary outcomes were mean hospital stay and complications. Simple logistic regression was used to identify factors associated with success of drainage, z-test for two proportions to compare outcomes of ERCP versus PTBD and t-test to compare mean hospital stay post-procedure. Results: There were 441 patients who underwent ERCP and PTBD, 19 fulfilled the inclusion criteria. 11 underwent ERCP while 8 had PTBD. There were more successful cases in PTBD versus ERCP but this was not statistically significant (p-value 0.3615). Factors such as age, gender, location and nature of obstruction, vices, coexisting pulmonary or other extrapulmonary TB and presence of portal hypertension did not affect success rates in these patients. The PTBD group had longer mean hospital stay but this was not significant (p-value 0.1880). There were no complications reported in both groups. Conclusion: HBTB comprises 4.3% of the patients undergoing biliary drainage in PGH. Both ERCP and PTBD are equally safe and effective in the management of biliary obstruction from HBTB.

Keywords: cross-sectional, hepatobiliary tuberculosis, obstructive jaundice, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic biliary drainage

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10398 Properties of Modified Dry Masonry Mixtures for Effective Masonry Units

Authors: Vyacheslav S. Semenov, Tamara A. Rozovskaya

Abstract:

The paper is devoted to the problem of the development of dry light-weight mixtures with hollow ceramics microspheres (CMS) for masonry works. For the one-layer fencing structures including effective masonry units, the use of “warm” masonry mortars is necessary. The used light-weight masonry mortars do not provide the brand strength and thermal uniformity of the fencing structures because of high average density. The CMS are effective light-weight aggregate for such mortars. The influence of the dosage of CMS on the physics-and-mechanics parameters and the technological properties of the masonry mortars were studied. The optimal mixture compositions have been obtained and their main properties have been determined. The influence of an air-entraining admixture and redispersible polymer powders on the average density and physics-and-mechanics parameters of the masonry mortars were studied. The optimal compositions of light-weight dry masonry mixtures with CMS have been suggested.

Keywords: dry mortar mixtures, light-weight dry mixtures, hollow ceramics microspheres, masonry mortars, “warm” mortars, air-entraining admixture, redispersible polymer powders

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10397 Audit of Urgent and Non-Urgent Patient Visits to the Emergency: A Case-Control Study

Authors: Peri Harish Kumar, Rafique Umer Harvitkar

Abstract:

Background: The emergency department mandates maximum efficacy in the utilization of the available resources. Non-urgent patient visits pose a serious concern to the treatment, patient triage, and resources available. Aims and Objectives: We conducted a retrospective case-control study of the emergency department patient list from October 2019 to November 2022. A total of 839 patients formed part of the study. Somatic complaints, vital signs, diagnostic test results, admission to the hospital, etc., were some of the criteria used for the categorization of patients. Results: The proportion of non-urgent visits varied from 7.2% to 43%, with a median of 21%. Somatic complaints were the least associated with further hospital admissions (n=28%), while diagnostic test results were the most significant indicator of further hospital admissions (n=74%). Effective triage helped minimize emergency department admissions by 36%. Conclusion: Our study shows that effective triaging, patient counselling, and round-the-clock consumable monitoring helped in the effective management of patients admitted and also significantly helped provide treatment to the patients most in need.

Keywords: urgent visits, non-urgent visits, traiging, emergency department admissions

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10396 Post Mutiny Institutional Buildings of India: A Visual Language of Reconciliation

Authors: Aruna Ramani Grover

Abstract:

In 1857 the British army in Bengal rose in mutiny. The outcome of a yearlong stifle was the abolition of the East India Company and establishment of Crown rule in 1958. Despite being a political democracy back home, with the declaration of Queen Victoria as Empress of India, the British established themselves as imperialistic successors to the Mughals in India. With the institution of the Crown role in the sub-continent, there was a serious endeavour for systematic governance. This led to infrastructure development and creation of institutions as well. The outcome was many public buildings like courts, railway- stations and headquarters, senates, post offices, banks, libraries, memorial halls, museums, memorials, theatres, government colleges, residential-schools and clock towers. These were built in the old and emerging urban settlements of the sub-continents. In the realm of architecture, like all political masters of the past, the British architects too encountered the living tradition of the sub-continent. A bewildering plethora of buildings in various climatic zones, using local materials and crafted with tools and techniques of the region by local craftsmen had to be understood and assimilated. The19th century British architects who built in India, designed institutional buildings which were functional and responded to the need of the user. In visual terms however, it was a completely different story. Using the manifest elements of the complex and layered indigenous tradition, they fashioned buildings to create an architecture of reconciliation. Treating the traditional architecture as a pattern book, finished buildings was served up to the local population coloured by their understanding of tradition. This paper will discuss a series of building some of which are the Senate House and Law courts at Madras, the Municipal Building and Gateway of India in Bombay, the Muir college in Allahabad, Mayo college Ajmer, the Mubarak Mahal in Jaipur to demonstrate how a visual language of reconciliation was created.

Keywords: infrastructure, British architects, tradition, pattern book, reconciliation

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10395 Impact of Storytelling for Effective Marketing and Reputation Management of Heritage Tourism Destination with Special Reference to Haflong (Assam, India)

Authors: Rohit Sarin

Abstract:

This paper is an attempt to prove the impact of storytelling for effective marketing and maintaining the reputation of the destination for long run. This notable aspect of heritage tourism is cultural exchange among the various communities who visit our country India. Every destination has a life cycle like the product known as destination life cycle. India is considered to be the hub of cultural heritage tourism; its cultural heritage tourism can be traced back to several centuries. Heritage tourism has gained the popularity of global cuisine activity. The statistics of 2014 reveals 903 million International Tourist in heritage tourism destination is done to know the impact of storytelling for their visit to particulars heritage tourism destination. SWOT analysis of the destination is undertaken for the research purpose. A collection of data from the travel agency was taken who visited the heritage tourism destination and were asked to fill questionnaire for the research purpose to know the impact of storytelling for their visit to destination. A total of 100 respondents filled the questionnaire. Likert scale was used in the paper also highlighted the scope, advantage and disadvantage of storytelling for effective marketing and reputation management.

Keywords: destination life cycle, heritage tourism, random sampling, reputation management, storytelling

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10394 A Modified Open Posterior Approach for the Fixation of Posterior Cruciate Ligament Tibial Avulsion Fractures

Authors: Babak Mirzashahi, Arvin Najafi, Pejman Mansouri, Mahmoud Farzan

Abstract:

Background: The most effective treatment of posterior cruciate ligament (PCL) tears and the consequence of untreated PCL injuries remain controversial. Objectives: The aim of this study is to assess outcomes of fixation of tibial posterior cruciate ligament (PCL) avulsion fractures via a modified technique. Patients and Methods: From January, 2009 to March, 2012, there were 45 cases of PCL tibial avulsion fractures that were referred to our hospital and were managed through a modified open posterior approach. Fixation of Tibial PCL avulsion fractures were fixed by means of a lag screw and washer placed through our modified open posterior approach. Range of motion was begun on the first postoperative day. Clinical stability, range of motion, gastrocnemius muscle strength, radiographic investigation, and patient’s overall quality of life was analyzed at final follow up visit. Results: The average of overall musculoskeletal functional evaluation scores was 15 (range 3–35). All patients achieved union of their fracture and had clinically stable knees at the latest follow-up. The mean preoperative Lysholm score for 15 knees was 62 ± 8 (range, 50-75); the mean postoperative Lysholm score was 92± 7 (range, 75-101). A significant difference in Lysholm scores between preoperative and final follow-up evaluations was found (P < .05). At first-year follow-up, 42 (93%) patients revealed a difference of less than 10 mm in thigh circumference between their injured and healthy knees. Conclusions: The management of displaced large PCL avulsion fractures with placement of a cancellous lag screw with washer by means of the modified open posterior approach leads to satisfactory clinical, radiographic, and functional results and reduces the operation time and less blood loss. Level of evidence: IV.

Keywords: posterior cruciate ligament, tibial fracture, lysholm knee score, patient outcome assessment

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