Search results for: trauma and grief recovery

Authors: Barbara Papp

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Purpose: This article aims to rethink the relationship between the trauma and the choice of professions. By studying a homogenous sample of respondents, it seeks answers to the following question: how did personal losses that were caused by historical upheavals motivate people to enter the helping professions. By becoming helping professionals, the respondents of the survey sought to handle both historical representation and self-representation. How did psychotherapists working in the second half of the 20th century (Kádár-era in Hungary) shape their course of life? How did their family members respond to their choice of career? What forces supported or hindered them? How did they become professional helpers? Methodology: When interviewing 40 psychotherapists, the interviewer used the oral history technique. In-depth interviews were made with a focus on motivation. First, the collected material was examined using traditional content analysis tools: searching for content patterns, applying a word frequency analysis, and identifying the connections between key events and key persons. Second, a narrative psychological content analysis (NarrCat) was made. Findings: Interconnections were established between attachment, family and historical traumas and career choices. The history of the mid-20th-century period was traumatic and full of losses for the families of most of the psychotherapists concerned. Those experiences may have considerably influenced their choice of career. Working as helping therapists, they could get the opportunity to revise their losses. Conclusion: The results revealed core components that play a role in the psychotherapists’ choice of career, and also emphasized the importance of post-traumatic growth.

Keywords: biography, identity, narrative psychological content analysis, psychotherapists, trauma

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Authors: Neeti Rustagi, Naveen Dutt, Arvind Sinha, Mahaveer S. Rhodha, Pankaja R. Raghav

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Background: Pre-hospital trauma care services are in developing stage in fast-urbanizing cities of India including Jodhpur. Training of health professionals in providing necessary pre-hospital trauma care is an essential step in decreasing accident related morbidity and mortality. The current study explores the response of a medical graduate toward helping an accident victim in a pre-hospital setting before patient can be transferred to definitive trauma facility. Methodology: This study examines the perceived competence in predicting response to an accident victim by medical graduates in Jodhpur, Rajasthan. Participants completed measures of attitude, normative influence and perceived behavior control toward providing pre-hospital care to an accident victim. Likert scale was used to measure the participant responses. Preliminary and descriptive analysis were used using SPSS 21.0. Internal consistency of the responses received was measured using Cronbach’s alpha. Results: Almost all medical graduates agreed that road accidents are common in their area (male: 92%; female: 78%). More male medical graduates (28%) reported helping an accident victim as compared to female physicians (9%) in the previous three months. Majority of study participants (96%) reported that providing immediate care to an accident victim is essential to save the life of an individual. Experience of helping an accident victim was considered unpleasant by the majority of female participants (70%) as compared to male participants (36%). A large number of participants believed that their friends (80%) and colleagues (96%) would appreciate them helping an accident victim in a pre-hospital setting. A large number of participants also believed that they possess the necessary skills and competencies (80%) towards helping a roadside accident victim in the pre-hospital care environment. Perceived competence of helping a roadside accident victim until they are transferred to a health facility was reported by less than half of the participants (male: 56%; female: 43%). Conclusion: Medical graduates have necessary attitude, competencies, and intention of helping a roadside accident victim. The societal response towards helping a road side accident victim is also supportive. In spite of positive determinants, a large proportion of medical graduates have perceived lack of competence in helping a roadside accident victim. This is essential to explore further as providing pre-hospital care to a roadside accident victim is an essential step in establishing the continuum of care to an accident victim especially in countries where pre-hospital services are in developing phase.

Keywords: prehospital care, perceived behavior, perceived competence, medical graduates

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Authors: Recep Kesli, Huseyin Bilgin, Ela Tasdogan, Ercan Kurtipek

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Aim: The aim of this study was to compare resin based Bactec plus aerobic/anaerobic blood culture bottles (Becton Dickinson, MD, USA) and polymeric beads based BacT/Alert FA/FN plus blood culture bottles (bioMerieux, NC, USA) in terms of microorganisms recovery rates and time to detection (TTD) in the patients receiving antibiotic treatment. Method: Blood culture samples were taken from the patients who admitted to the intensive care unit and received antibiotic treatment. Forty milliliters of blood from patients were equally distributed into four types of bottles: Bactec Plus aerobic, Bactec Plus anaerobic, BacT/Alert FA Plus, BacT/Alert FN Plus. Bactec Plus and BacT/Alert Plus media were compared to culture recovery rates and TTD. Results: Blood culture samples were collected from 382 patients hospitalized in the intensive care unit and 245 patients who were diagnosed as having bloodstream infections were included in the study. A total of 1528 Bactec Plus aerobic, Bactec Plus anaerobic, BacT/Alert FA Plus, BacT/Alert FN Plus blood culture bottles analyzed and 176, 144, 154, 126 bacteria or fungi were isolated, respectively. Gram-negative and gram-positive bacteria were significantly more frequently isolated in the resin-based Bactec Plus bottles than in the polymeric beads based BacT/Alert Plus bottles. The Bactec Plus and BacT/Alert Plus media recovery rates were similar for fungi and anaerobic bacteria. The mean TTDs in the Bactec Plus bottles were shorter than those in the BacT/Alert Plus bottles regardless of the microorganisms. Conclusion: The results of this study showed that resin-containing media is a reliable and time-saving tool for patients who are receiving antibiotic treatment due to sepsis in the intensive care unit.

Keywords: Bactec Plus, BacT/Alert Plus, blood culture, antibiotic

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Authors: Ana M. Prieto del Pino

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As is well known, UN Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (1988) was a landmark regarding the seizure of proceeds of crime. Depriving criminals of the profits from their activity became a priority at an international level in the fight against organised crime. Enabling confiscation of proceeds of illicit traffic in narcotic drugs and psychotropic substances, criminalising money laundering and confiscating the proceeds thereof are the three measures taken in order to achieve that purpose. The beginning of 21st century brought the declaration of war on corruption and on the illicit enjoyment of the profits thereof onto the international scene. According to the UN Convention against Transnational Organised Crime (2000), States Parties should adopt the necessary measures to enable the confiscation of proceeds of crime derived from offences (or property of equivalent value) and property, equipment and other instrumentalities used in offences covered by that Convention. The UN Convention against Corruption (2003) states asset recovery explicitly as a fundamental principle and sets forth measures aiming at the direct recovery of property through international cooperation in confiscation. Furthermore, European legislation has made many significant strides forward in less than twenty years concerning money laundering, confiscation, and asset recovery. Crime does not pay, let there be no doubt about it. Nevertheless, we must be very careful not to sing out of tune with individual rights and legal guarantees. On the one hand, innocent individuals and businesses must be protected, since they should not pay for the guilty ones’ faults. On the other hand, the rule of law must be preserved and not be tossed aside regarding those who have carried out criminal activities. An in-depth analysis of judicial decisions on money laundering and confiscation of proceeds of crime issued by European national courts and by the European Court of Human Rights in the last decade has been carried out from a human rights, legal guarantees and criminal law basic principles’ perspective. The undertaken study has revealed the violation of the right to property, of the proportionality principle legal and the infringement of basic principles of states’ domestic substantive and procedural criminal law systems. The most relevant ones have to do with the punishment of money laundering committed through negligence, non-conviction based confiscation and a too-far reaching interpretation of the notion of ‘proceeds of crime’. Almost everything in life has a bright and a dark side. Confiscation of criminal proceeds and asset recovery are not an exception to this rule.

Keywords: confiscation, human rights, money laundering, organized crime

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Authors: Hitesh Gupta, Surender Dabas

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TORS is increasingly gaining widespread use and has been explored as minimally invasive surgery for the treatment of supraglottic cancer (SGC). Being a central critical role of Supraglottis in deglutition, swallowing outcomes post TORS remain a most important factor. Available published studies show inconsistent swallowing outcomes and are deficient in standardized outcome measures, description of swallowing recovery and rehabilitation. So, the objective of this study is to find out swallowing outcomes in SGC patients after TORS provided with early dysphagia management using standardized measures. Prospectively 16 patients were recruited in the study who underwent TORS for primary tumor of Supraglottis, involving one or more sub-sites or invading to sites other than Supraglottis at the BLK Super Specialty Hospital, New Delhi from March 2019 to June 2020. All patients were evaluated for dysphagia with subsequent swallowing rehabilitation on post operative day 3 in the hospital or at the time of discharge, whichever was earlier. Functional oral intake scale (FOIS) and penetration-aspiration score (PAS) were used as outcome measures to quantify swallowing recovery at one month and six month post operatively. Post TORS, patients achieved functional swallow in less than one month, where resection was limited to Supraglottis, while the recovery was delayed in patients with extended resection to tongue base or hypopharynx. Overall, out of Total 16 cases including all supraglottis sub-catagories, 13 (81%) could remove their NG tube (FOIS ≥5 and PAS=1 ) within 6 months. In which 8 cases(62%) achieved functional swallow in less than one month. Swallowing outcomes post TORS supraglottic laryngectomy are favorable if provided with early dysphagia management (or swallowing rehabilitation).

Keywords: dysphagia, supraglottic cancer, swallowing, TORS

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Authors: Maurice Bilioniere, Katie Lanneau

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Suddenly appeared in 2011, invasions of sargasso seaweeds Fluitans and Natans are a climatic hazard which causes many problems in the Caribbean. Faced with the growth and frequency of the phenomenon of massive sargasso stranding on their coasts, the French West Indies are moving towards the path of industrial recovery. In this context of innovative projects, we will analyze the necessary requirements for the management and performance of the supply chain, taking into account the observed volatility of the sargasso input. Our prospective approach will consist in studying the theoretical framework of modeling a hybrid supply chain by coupling the discreet event simulation (DES) with a valuation of the process costs according to the "activity-based costing" method (ABC). The PREVA approach (PRocess EVAluation) chosen for our modeling has the advantage of evaluating the financial flows of the logistic process using an analytical model chained with an action model for the evaluation or optimization of physical flows.

Keywords: sargasso, PREVA modeling, supply chain, ABC method, discreet event simulation (DES)

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Authors: Gloria James, S. K. Nema, T. S. Anantha Singh, P. Vadivel Murugan

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The usage of tyre has increased enormously in day to day life. The used tyre and rubber products pose major threat to the environment. Conventional thermal techniques such as low temperature pyrolysis and incineration produce high molecular organic compounds (condensed and collected as aromatic oil) and carbon soot particles. Plasma gasification technique can dispose tyre waste and generate combustible gases and avoid the formation of high molecular aromatic compounds. These gases generated in plasma gasification process can be used to generate electricity or as fuel wherever required. Although many experiments have been done on plasma pyrolysis of tyres, very little work has been done on plasma gasification of tyres. In this work plasma gasification of waste tyres have been conducted in a fixed bed reactor having graphite electrodes and direct current (DC) arc plasma system. The output of this work has been compared with the previous work done on plasma pyrolysis of tyres by different authors. The aim of this work is to compare different process based on gas generation, efficiency of the process and explore the most effective option for energy recovery from waste tyres.

Keywords: plasma, gasification, syngas, tyre waste

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Authors: Claire Stafford, John Lewis, Ashley Stripling

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The aim of this study is to examine the relationship between both the independent effects and intersection between COVID-19 and the Black Lives Matter (BLM) movement simultaneously to investigate how the two events have coincided with impacting race-based traumatic stress in Black Americans. Four groups will be surveyed: Black Americans who participated in BLM-related activism, Black Americans who did not participate in BLM-related activism, White Americans who participated in BLM-related activism, and White Americans who did not participate in BLM-related activism. Participants are between the ages of 30 and 50. All participants will be administered a Brief Trauma Questionnaire with an additional question asking whether or not they have ever tested positive for COVID-19. Based on prior findings, it is expected that Black Americans will have significantly higher levels of COVID-19 contraction, with Black Americans who participated in BLM-related activism having the highest levels of contractions. Additionally, Black Americans who participated in BLM-related activism will likely have the highest self-reported rates of traumatic experiences due to the compounding effect of both the pandemic and the BLM movement. With the development of the COVID-19 pandemic, stark racial disparities between Black and White Americans have become more defined. Compared to White Americans, Black Americans have more COVID-19-related cases and hospitalizations. Researchers must investigate and attempt to mitigate these disparities while simultaneously critically questioning the structure of our national health care system and how it serves our marginalized communities. Further, a critical gaze must be directed at the geopolitical climate of the United States in order to holistically look at how both the COVID-19 pandemic and the Black Lives Matter (BLM) movement have interacted and impacted race-based stress and trauma in African Americans.

Keywords: COVID-19, black lives matter movement, race-based traumatic stress, activism

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Authors: Surya Prasad Sharma, Suyash Katdare, Syed Ainul Hussain

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Human-induced factors contributed to the population decline of crocodylians in India which became evident by the mid-20th century when authorities forewarned the extinction risk for the crocodile and proposed regulation in the crocodile trade. The proposed action led to the enactment of national and international wildlife regulations to prohibit the trade-in of crocodile skins and parts. Subsequently, conservation translocation programs were initiated to restore the species in the wild through a 'head-start' approach. In India, the crocodile conservation program, which began in the early 1970s, has been one of India's longest-running conservation initiatives. The gharial (Gavialis gangeticus) population has benefitted, and the gharial number increased rapidly owing to these efforts. The immediate risk of extinction was averted as the gharial has recovered due to decades-long cumulative conservation efforts, the consideration of the genetic for monitoring the recovery of the recovered populations is still lacking. Hence, we assessed the genetic diversity of the Girwa gharial population in India using six polymorphic nuclear microsatellites loci and mitochondrial control region. The number of alleles per loci ranged between 2 to 5, and the allelic richness (Ar) was 2.67 ± 0.49, and the observed (Ho) and expected (He) heterozygosities were 0.42 ± 0.08 and 0.42 ± 0.09, respectively. The M-ratio yielded a value of (0.41 ± 0.16) lower than critical M, suggesting a genetic bottleneck in the Girwa population. We observed more mitochondrial control region haplotypes in the Girwa population than previously reported in the largest gharial population in the Chambal River. Overall, our study indicates that genetic diversity remains low despite the recovery in the Girwa population. Hence, we recommend a range-wide genetic assessment of gharial populations using high-throughput techniques to identify the source population and plan future translocation programs.

Keywords: conservation translocation, recovery, crocodile, bottleneck

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Authors: Nicki Mohammadi, Emma Reford, Natalia Romano Spica, Laura Tabacof, Jenna Tosto-Mancuso, David Putrino, Christopher P. Kellner

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Introductory Statement: The onset of the COVID-19 pandemic demanded an unprecedented need for the rapid development, dispersal, and application of infection testing. However, despite the impressive mobilization of resources, individuals were incredibly limited in their access to tests, particularly during the initial months of the pandemic (March-April 2020) in New York City (NYC). Access to COVID-19 testing is crucial in understanding patients’ illness experiences and integral to the development of COVID-19 standard-of-care protocols, especially in the context of overall access to healthcare resources. Succinct Description of basic methodologies: 18 Patients in a COVID-19 Remote Patient Monitoring Program (Precision Recovery within the Mount Sinai Health System) were interviewed regarding their experience with COVID-19 during the first wave (March-May 2020) of the COVID-19 pandemic in New York City. Patients were asked about their experiences navigating COVID-19 diagnoses, the health care system, and their recovery process. Transcribed interviews were analyzed for thematic codes, using grounded theory to guide the identification of emergent themes and codebook development through an iterative process. Data coding was performed using NVivo12. References for the domain “testing” were then extracted and analyzed for themes and statistical patterns. Clear Indication of Major Findings of the study: 100% of participants (18/18) referenced COVID-19 testing in their interviews, with a total of 79 references across the 18 transcripts (average: 4.4 references/interview; 2.7% interview coverage). 89% of participants (16/18) discussed the difficulty of access to testing, including denial of testing without high severity of symptoms, geographical distance to the testing site, and lack of testing resources at healthcare centers. Participants shared varying perspectives on how the lack of certainty regarding their COVID-19 status affected their course of recovery. One participant shared that because she never tested positive she was shielded from her anxiety and fear, given the death toll in NYC. Another group of participants shared that not having a concrete status to share with family, friends and professionals affected how seriously onlookers took their symptoms. Furthermore, the absence of a positive test barred some individuals from access to treatment programs and employment support. Concluding Statement: Lack of access to COVID-19 testing in the first wave of the pandemic in NYC was a prominent element of patients’ illness experience, particularly during their recovery phase. While for some the lack of concrete results was protective, most emphasized the invalidating effect this had on the perception of illness for both self and others. COVID-19 testing is now widely accessible; however, those who are unable to demonstrate a positive test result but who are still presumed to have had COVID-19 in the first wave must continue to adapt to and live with the effects of this gap in knowledge and care on their recovery. Future efforts are required to ensure that patients do not face barriers to care due to the lack of testing and are reassured regarding their access to healthcare. Affiliations- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 2Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY

Keywords: accessibility, COVID-19, recovery, testing

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Authors: Jayakrishnan U.

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A concept of adding two strokes to a four stroke Otto or Diesel engine cycle presented here for the waste heat recovery in a four stroke internal combustion engine. Four stroke Diesel cycle and Otto cycle engines have very low thermal efficiency due to high amount of energy loss in exhaust and also on the cooling of the engine. It is estimated about 35 percent of fuel energy is lost in exhaust of engine and 30 percent in cooling of engine. So by modifying a four-stroke Otto or Diesel engine by adding two-stroke heat recovery steam cycle is presented here. Water injection is used to get an additional power stroke by partial compression of the exhaust gases at the end of third stroke in a four stroke I.C.Engine. It is the conversion of a four-stroke cycle to a six-stroke cycle. By taking a four stroke petrol engine of known dimensions, an ideal thermodynamic model is used to analyse and calculate the events of exhaust gas compression and following two strokes of water injection. By changing the exhaust valve closing timing during exhaust stroke and analysing it on various points, an optimum amount of exhaust gas re-compression and amount of water injection can be found for maximizing efficiency and fuel economy. It is achieved by changing the exhaust valve timing and finding an optimum amount of exhaust re-compression, maximizing the net mean effective pressure of the steam expansion stroke (MEPsteam). Specific fuel consumption of the engine also decreases increasing the fuel economy. The valve closing timings for maximum MEPsteam is limited by either 1 bar or dew point temperature of expansion gas or moisture mixture to avoid moisture formation. By modifying the four-stroke Otto or Diesel cycle by adding two water injection stroke has the potential to significantly increase the engine efficiency and fuel economy.

Keywords: internal combustion engine, engine efficiency, six-stroke cycle, water injection, specific fuel consumption

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Authors: C. Mendoza Ramírez, M. Gambús Ordaz, R. Mercado Ojeda.

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Chemical solutions flooding with surfactants, based on their property of reducing the interfacial tension between crude oil and water, is a potential application of chemical enhanced oil recovery (CEOR), however, the high-rate retention of surfactants associated with adsorption in the porous medium and the complexity of the mineralogical composition of the reservoir rock generates a limitation in the efficiency of displacement of crude oil. This study evaluates the effect of the concentration of a mixture of anionic-non-ionic surfactants with silica nanoparticles, in a rock sample composed of 25.14% clay minerals of the kaolinite, chlorite, halloysite and montmorillonite type, according to the results of X-Ray Diffraction analysis and Scanning Electron Spectrometry (XRD and SEM, respectively). The amount of the surfactant mixture adsorbed on the clay rock minerals was analyzed from the construction of its calibration curve and the 4-Region Isotherm Model in a UV-Visible spectroscopy. The adsorption rate of the surfactant in the clay rock averages 32% across all concentrations, influenced by the presence of the surface area of the substrate with a value of 1.6 m2/g and by the mineralogical composition of the clay that increases the cation exchange capacity (CEC). In addition, on Region I and II a final concentration measurement is not evident in the UV-VIS, due to its ionic nature, its high affinity with the clay rock and its low concentration. Finally, for potential CEOR applications, the adsorption of these mixed surfactant systems is considered due to their industrial relevance and it is concluded that it is possible to use concentrations in Region III and IV; initially the adsorption has an increasing slope and then reaches zero in the equilibrium where interfacial tension values are reached in the order of x10-1 mN/m.

Keywords: anionic–nonionic surfactants, clay rock, adsorption, 4-region isotherm model, cation exchange capacity, critical micelle concentration, enhanced oil recovery

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Authors: Chernet Mulugeta, Girma Seyoum, Yeshineh Demrew, Kehabtimer Shiferaw

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Background: Obstetric fistula (OF) is a serious medical condition that includes an abnormal opening between the vagina and bladder (vesico-vaginal fistula) or the vagina and rectum (recto-vaginal fistula). It is usually caused by prolonged obstructed labour. Despite its serious health and psychosocial consequences, there is a paucity of evidence regarding the time it takes to heal from OF. Objective: The aim of this study was to assess the time to cure from obstetric fistula and its predictors among women admitted to Addis Ababa Hamlin Fistula Hospital, Addis Ababa, Ethiopia. Methodology: An institution-based retrospective cohort study was conducted from January 2015 to December 2020 among a randomly selected 434 women with OF in Addis Ababa Hamlin Fistula Hospital. Data was collected using a structured checklist adapted from a similar study. The open data kit (ODK) collected data was exported and analyzed by using STATA (14.2). Kaplan Meir was used to compare the recovery time from OF. To identify the predictors of OF, a Cox regression model was fitted, and an adjusted hazard ratio with a 95% confidence interval was used to estimate the strength of the associations. Results: The average time to recover from obstetric fistula was 3.95 (95% CI: 3.0-4.6) weeks. About ¾ of the women [72.8% (95% CI - 0.65-1.2)] were physically cured of obstetric fistula. Having secondary education and above [AHR=3.52; 95% CI (1.98, 6.25)] compared to no formal education, having a live birth [AHR=1.64; 95% CI (1.22, 2.21)], having an intact bladder [AHR=2.47; 95% CI (1.1, 5.54)] compared to totally destructed, and having a grade 1 fistula [AHR=1.98; 95% CI (1.19, 3.31)] compared to grade 3 were the significant predictors of shorter time to cure from an obstetric fistula. Conclusion and recommendation: Overall, the proportion of women with OF who were not being cured was unacceptably high. The time it takes for them to recover from the fistula was also extended. It connotes us to work on the identified predictors to improve the time to recovery from OF.

Keywords: time to recovery, obstetric fistula, predictors, Ethiopia

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Authors: Nader Nciri, Suil Song, Namho Kim, Namjun Cho

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Properties and compositions of bitumen and bitumen-derived liquids have significant influences on the selection of recovery, upgrading and refining processes. Optimal process conditions can often be directly related to these properties. The end uses of bitumen and bitumen products are thus related to their compositions. Because it is not possible to conduct a complete analysis of the molecular structure of bitumen, characterization must be made in other terms. The present paper focuses on physico-chemical analysis of two different types of bitumens. These bitumen samples were chosen based on: the original crude oil (sand oil and crude petroleum), and mode of process. The aim of this study is to determine both the manufacturing effect on chemical species and the chemical organization as a function of the type of bitumen sample. In order to obtain information on bitumen chemistry, elemental analysis (C, H, N, S, and O), heavy metal (Ni, V) concentrations, IATROSCAN chromatography (thin layer chromatography-flame ionization detection), FTIR spectroscopy, and 1H NMR spectroscopy have all been used. The characterization includes information about the major compound types (saturates, aromatics, resins and asphaltenes) which can be compared with similar data for other bitumens, more importantly, can be correlated with data from petroleum samples for which refining characteristics are known. Examination of Asphalt Ridge froth bitumen showed that it differed significantly from representative petroleum pitches, principally in their nonhydrocarbon content, heavy metal content and aromatic compounds. When possible, properties and composition were related to recovery and refining processes. This information is important because of the effects that composition has on recovery and processing reactions.

Keywords: froth bitumen, oil sand, asphalt ridge, petroleum pitch, thin layer chromatography-flame ionization detection, infrared spectroscopy, 1H nuclear magnetic resonance spectroscopy

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Authors: André Rui Coelho Fernandes, Mariana Rufino, Divakar Hamal, Amr Sousa, Emma Fossett, Kamalpreet Cheema

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Aim: A single patella tendon rupture is relatively uncommon, but a simultaneous bilateral event is a rare occurrence and has been scarcely reviewed in the literature. This review was carried out to analyse the existing literature on this event, with the aim of proposing a standardised approach to the diagnosis and management of this injury. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three independent reviewers conducted searches in PubMed, OvidSP for Medline and Embase, as well as Cochrane Library using the same search strategy. From a total of 183 studies, 45 were included, i.e. 90 patellas. Results: 46 patellas had a Type 1 Rupture equating to 51%, with Type 3 being the least common, with only 7 patellas sustaining this injury. The mean Insall-Salvio ratio for each knee was 1.62 (R) and 1.60 (L) Direct Primary Repair was the most common surgical technique compared to Tendon Reconstruction, with End to End and Transosseous techniques split almost equally. Brace immobilisation was preferred over cast, with a mean start to weight-bearing of 3.23 weeks post-op. Conclusions: Bilateral patellar tendon rupture is a rare injury that should be considered in patients with knee extensor mechanism disruption. The key limitation of this study was the low number of patients encompassed by the eligible literature. There is space for a higher level of evidence study, specifically regarding surgical treatment choice and methods, as well as post-operative management, which could potentially improve the outcomes in the management of this injury.

Keywords: trauma and orthopaedic surgery, bilateral patella, tendon rupture, trauma

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Authors: H. M. D. Prabhashana Herath, M. D. Anuradha Wickramasinghe, A. M. C. Kalpani Polgolla, R. A. C. Prasad Ranasinghe, M. Anusha Wijewardane

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The demand for thermal comfort in buildings in hot and humid climates increases progressively. In general, buildings in hot and humid climates spend more than 60% of the total energy cost for the functionality of the air conditioning (AC) system. Hence, it is required to install energy efficient AC systems or integrate energy recovery systems for both new and/or existing AC systems whenever possible, to reduce the energy consumption by the AC system. Integrate a Rotary Thermal Wheel as the energy recovery device of an existing AC system has shown very promising with attractive payback periods of less than 5 years. A rotary thermal wheel can be located in the Air Handling Unit (AHU) of a central AC system to recover the energy available in the return air stream. During this study, a sensitivity analysis was performed using a CFD (Computational Fluid Dynamics) software to determine the optimum design parameters (i.e., rotary speed and parameters of the matrix profile) of a rotary thermal wheel for hot and humid climates. The simulations were performed for a sinusoidal matrix geometry. Variation of sinusoidal matrix parameters, i.e., span length and height, were also analyzed to understand the heat exchanging performance and the induced pressure drop due to the air flow. The results show that the heat exchanging performance increases when increasing the wheel rpm. However, the performance increment rate decreases when increasing the rpm. As a result, it is more advisable to operate the wheel at 10-20 rpm. For the geometry, it was found that the sinusoidal geometries with lesser spans and higher heights have higher heat exchanging capabilities. Considering the sinusoidal profiles analyzed during the study, the geometry with 4mm height and 3mm width shows better performance than the other combinations.

Keywords: air conditioning, computational fluid dynamics, CFD, energy recovery, heat exchangers

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Authors: R. Ahmadi, A. Khodadadi, M. Abdollahi

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The removal of copper from a dilute synthetic wastewater (10 mg/L) was studied by ion flotation at laboratory scale. Anionic sodium dodecyl sulfate (SDS) was used as a collector and ethanol as a frother. Different parameters such as pH, collector and frother concentrations, foam height and bubble size distribution (multi bubble ion flotation) were tested to determine the optimum flotation conditions in a Denver type flotation machine. To see into the effect of bubbles size distribution in this paper, a nano-micro bubble generator was designed. The nano and microbubbles that are generated in this way were combined with normal size bubbles generated mechanically. Under the optimum conditions (concentration of SDS: 192mg/l, ethanol: 0.5%v/v, pH value: 4 and froth height=12.5 cm) the best removal obtained for the system Cu/SDS with a dry foam (water recovery: 15.5%) was 85.6%. Coalescence of nano-microbubbles with bubbles of normal size belonging to mechanical flotation cell improved the removal of Cu to a maximum floatability of 92.8% and reduced the water recovery to a 13.1%.The flotation time decreased considerably at 37.5% when the multi bubble ion flotation was used.

Keywords: froth flotation, copper, water treatment, optimization, recycling

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Authors: N. Al-Orfi, M. S. El-Shahawi, A. S. Bashammakh

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The electrochemical response of glassy carbon electrode (GCE) for the sensitive and selective determination of dianabol steroid (DS) in phosphate, Britton-Robinson (B-R) and HEPES buffers of pH 2.0 - 11, 2.0 - 11 and 6.2 - 8.0, respectively using cyclic voltammetry (CV) and differential pulse- adsorptive cathodic stripping voltammetry (DP-CSV) at bare GCE was studied. The dependence of the CV response of the developed cathodic peak potential (Ep, c), peak current (ip, c) and the current function (ip, c / υ1/2) on the scan rate (υ) at the bare GCE revealed the occurrence of electrode coupled chemical reaction of EC type mechanism. The selectivity of the proposed method was assessed in the presence of high concentrations of major interfering species e.g. uric acid, ascorbic acid, citric acid, glucose, fructose, sucrose, starch and ions Na+, K+, PO4-3, NO3- and SO42-. The recovery of the method was not significant where t(critical)=2.20 > texp=1.81-1.93 at 95% confidence. The analytical application of the sensor for the quantification of DS in biological fluids as urine was investigated. The results were demonstrated as recovery percentages in the range 95±2.5-97±4.7% with relative standard deviation (RSD) of 0.5-1.5%.

Keywords: dianabol, determination, modified electrode, urine

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Authors: Lou Gargouri

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This paper examines how Fanny Cabon's solo performance, Gardiennes (2018) strategically crafts empathetic witnessing through the artist's vocal and physical embodiment of her female ancestors' testimonies, dramatizing the cyclical inheritance of reproductive trauma across generations. Drawing on affect theory and the concept of ethical co-presence, we argue that Cabon's raw voicing of illegal abortions, miscarriages, and abuse through her shape-shifting presence generates an intimate energy loop with the audience. This affective resonance catalyzes recognition of historical injustices, consecrating each singular experience while building collective solidarity. Central to Cabon's political efficacy is her transparent self-revelation through intimate impersonation, which fosters identification with diverse characters as interconnected subjects rather than objectified others. Her solo form transforms the isolation often associated with women's marginalization into radical inclusion, repositioning them from victims to empowered survivors. Comparative analysis with other contemporary works addressing abortion rights illuminates how Gardiennes subverts the traditional medical and clerical gazes that have long governed women's bodies. Ultimately, we contend Gardiennes models the potential of solo performance to harness empathy as a subversive political force. Cabon's theatrical alchemy circulates the effects of injustice through the ethical co-presence of performer and spectator, forging intersubjective connections that reframe marginalized groups traditionally objectified within dominant structures of patriarchal power. In dramatizing how the act of witnessing another's trauma can generate solidarity and galvanize resistance, Cabon's work demonstrates the role of embodied performance in catalyzing social change through the recuperation of women's voices and lived experiences. This paper thus aims to contribute to the emerging field of feminist solo performance criticism by illuminating how Cabon's innovative dramaturgy bridges the personal and the political. Her strategic mobilization of intimacy, identification, and co-presence offers a model for how the affective dynamics of autobiographical performance can be harnessed to confront gendered oppression and imagine more equitable futures. Gardiennes invites us to consider how the circulation of empathy through ethical spectatorship can foster the collective alliances necessary for advancing the unfinished project of women's liberation.

Keywords: gender and sexuality studies, solo performance, trauma studies, affect theory

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Authors: Pavel Bulai, Taras Pitlik, Tatsiana Kulahava, Timofei Lipski

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The method of Electrocardiography (ECG) interpretation for post-exercise recovery tracking was developed. Metabolic indices (aerobic and anaerobic) were designed using ECG-derived features. This study reports the associations between aerobic and anaerobic indices and classical parameters of the person’s physiological state, including blood biochemistry, glycogen concentration and VO2max changes. During the study 9 participants, healthy, physically active medium trained men and women, which trained 2-4 times per week for at least 9 weeks, fulfilled (i) ECG monitoring using Apple Watch Series 4 (AWS4); (ii) blood biochemical analysis; (iii) maximal oxygen consumption (VO2max) test, (iv) bioimpedance analysis (BIA). ECG signals from a single-lead wrist-wearable device were processed with detection of QRS-complex. Aerobic index (AI) was derived as the normalized slope of QR segment. Anaerobic index (ANI) was derived as the normalized slope of SJ segment. Biochemical parameters, glycogen content and VO2max were evaluated eight times within 3-60 hours after training. ECGs were recorded 5 times per day, plus before and after training, cycloergometry and BIA. The negative correlation between AI and blood markers of the muscles functional status including creatine phosphokinase (r=-0.238, p < 0.008), aspartate aminotransferase (r=-0.249, p < 0.004) and uric acid (r = -0.293, p<0.004) were observed. ANI was also correlated with creatine phosphokinase (r= -0.265, p < 0.003), aspartate aminotransferase (r = -0.292, p < 0.001), lactate dehydrogenase (LDH) (r = -0.190, p < 0.050). So, when the level of muscular enzymes increases during post-exercise fatigue, AI and ANI decrease. During recovery, the level of metabolites is restored, and metabolic indices rising is registered. It can be concluded that AI and ANI adequately reflect the physiology of the muscles during recovery. One of the markers of an athlete’s physiological state is the ratio between testosterone and cortisol (TCR). TCR provides a relative indication of anabolic-catabolic balance and is considered to be more sensitive to training stress than measuring testosterone and cortisol separately. AI shows a strong negative correlation with TCR (r=-0.437, p < 0.001) and correctly represents post-exercise physiology. In order to reveal the relation between the ECG-derived metabolic indices and the state of the cardiorespiratory system, direct measurements of VO2max were carried out at various time points after training sessions. The negative correlation between AI and VO2max (r = -0.342, p < 0.001) was obtained. These data testifying VO2max rising during fatigue are controversial. However, some studies have revealed increased stroke volume after training, that agrees with findings. It is important to note that post-exercise increase in VO2max does not mean an athlete’s readiness for the next training session, because the recovery of the cardiovascular system occurs over a substantially longer period. Negative correlations registered for ANI with glycogen (r = -0.303, p < 0.001), albumin (r = -0.205, p < 0.021) and creatinine (r = -0.268, p < 0.002) reflect the dehydration status of participants after training. Correlations between designed metabolic indices and physiological parameters revealed in this study can be considered as the sufficient evidence to use these indices for assessing the state of person’s aerobic and anaerobic metabolic systems after training during fatigue, recovery and supercompensation.

Keywords: aerobic index, anaerobic index, electrocardiography, supercompensation

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Authors: Devon Simpson

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Recycled Manure Solids (RMS), attained via centrifugation from Canadian dairy farms, were synthesized into a non-polluting fertilizer by bonding micronutrients (Fe, Zn, and Mn) to cellulose fibers and then assessed for the effectiveness of nutrient recovery in tomatoes. Manure management technology is critical for improving the sustainability of agroecosystems and has the capacity to offer a truly circular economy. The ability to add value to manure byproducts offers an opportunity for economic benefits while generating tenable solutions to livestock waste. The dairy industry is under increasing pressure from new environmental protections such as government restrictions on manure applications, limitations on herd size as well as increased product demand from a growing population. Current systems use RMS as bedding, so there is a lack of data pertaining to RMS use as a fertilizer. This is because of nutrient distribution, where most nutrients are retained in the liquid effluent of the solid-liquid separation. A literature review on the physical and chemical properties of dairy manure further revealed more data for raw manure than centrifuged solids. This research offers an innovative perspective and a new avenue of exploration in the use of RMS. Manure solids in this study were obtained directly from dairy farms in Salmon Arm and Abbotsford, British Columbia, and underwent physical, chemical, and biological characterizations pre- and post-synthesis processing. Samples were sent to A&L labs Canada for analysis. Once characterized and bonded to micronutrients, the effect of synthesized RMS on nutrient recovery in tomatoes was studied in a greenhouse environment. The agricultural research package ‘agricolae’ for R was used for experimental design and data analysis. The growth trials consisted of a randomized complete block design (RCBD) that allowed for analysis of variance (ANOVA). The primary outcome was to measure nutrient uptake, and this was done using an Inductively Coupled Plasma Mass Spectrometer (IC-PMS) to analyze the micronutrient content of both the tissue and fruit of the tomatoes. It was found that treatments containing bonded dairy manure solids had an increased micronutrient concentration. Treatments with bonded dairy manure solids also saw an increase in yield, and a brix analysis showed higher sugar content than the untreated control and a grower standard.

Keywords: aoecosystems, dairy manure, micronutrient fertilizer, manure management, nutrient recovery, nutrient recycling, recycled manure solids, regenerative agricugrlture, sustainable farming

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Authors: Harveen Kaur Tatla, Parisa Niknejad, Rajender Gupta, Bipro Ranjan Dhar, Mohd. Adana Khan

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Sewage sludge management presents a pressing challenge in the realm of wastewater treatment, calling for sustainable and efficient solutions. This study explores the integration of Hydrothermal Liquefaction (HTL) and Anaerobic Digestion (AD) as a promising approach to address the complexities associated with sewage sludge treatment. The integration of these two processes offers a complementary and synergistic framework, allowing for the mitigation of inherent limitations, thereby enhancing overall efficiency, product quality, and the comprehensive utilization of sewage sludge. In this research, we investigate the optimal sequencing of HTL and AD within the treatment framework, aiming to discern which sequence, whether HTL followed by AD or AD followed by HTL, yields superior results. We explore a range of HTL working temperatures, including 250°C, 300°C, and 350°C, coupled with residence times of 30 and 60 minutes. To evaluate the effectiveness of each sequence, a battery of tests is conducted on the resultant products, encompassing Total Ammonia Nitrogen (TAN), Chemical Oxygen Demand (COD), and Volatile Fatty Acids (VFA). Additionally, elemental analysis is employed to determine which sequence maximizes energy recovery. Our findings illuminate the intricate dynamics of HTL and AD integration for sewage sludge management, shedding light on the temperature-residence time interplay and its impact on treatment efficiency. This study not only contributes to the optimization of sewage sludge treatment but also underscores the potential of integrated processes in sustainable waste management strategies. The insights gleaned from this research hold promise for advancing the field of wastewater treatment and resource recovery, addressing critical environmental and energy challenges.

Keywords: Anaerobic Digestion (AD), aqueous phase, energy recovery, Hydrothermal Liquefaction (HTL), sewage sludge management, sustainability.

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Authors: Saimir Heta, Kastriot Haxhirexha, Virtut Velmishi, Nevila Alliu, Ilma Robo

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Background: Testicular rotation can occur at any age. The possibility to save the testicle is the fastest possible surgical intervention which is indicated by the presence of acute pain even at rest. The time element is more important to diagnose and proceed further with surgical intervention. Testicular damage is a consequence which mainly depends on the moment of onset of symptoms, at the time when the symptoms are diagnosed, the earliest action to be performed is surgical intervention. Sometimes medical tests are needed to confirm a diagnosis, or to help identify another cause for symptoms; for example, the urine test, that is used to check for infection, associated with the scrotal ultrasound test. Control of blood flow to the longitudinal supply vessels of the testicles is indicated. The sign that indicates testicular rotation is a reduction in blood flow. This is the element which is distinguished from ultrasound examination. Surgery may be needed to determine if the patient’s symptoms are caused by the rotation of the testis or any other condition. Discussion: As a surgical intervention of the emergency, the torsion of the test depends very much on the duration of the torsion, as the success in the life of the testicle depends on the fastest surgical intervention. From the previous clinic, it is noted that in any case presented to the pediatric patient diagnosed with testicular rotation, there is always a link with personal history that the patient refers to the presence of a previous episode of testicular trauma. Literature supports this fact very logically. Conclusions: Salvation without testicular atrophy depends closely on establishing the diagnosis of testicular rotation as soon as possible. Following the logic above, it can be said that the diagnosis for rotation should be performed as soon as possible, to avoid consequences that will not be favorable for the patient.

Keywords: acute scrotum, test torsion, newborns, clinical presentation

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Authors: Mohammad Hossein Karimi Darvanjooghi, Sara Magdouli, Satinder Kaur Brar

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It has been reported that the microorganism’s attachment to the surfaces of ore samples is a key factor that influences the biooxidation in pretreatment for recovery of gold in sulfide-bearing ores. In this research, the implementation of D-(+)-Sucrose on the biooxidation of ore samples were studied in a semi-pilot experiment. The experiments were carried out in five separate jacketed columns (1 m height and 6 cm diameter) at a constant temperature of 37.5 ̊C and saturated humidity. The airflow rate and recycling solution flow rate were studied in the research and the optimum operating condition were reported. The ore sample (0.49 ppm gold grade) was obtained from the Hammond Reef mine site containing 15 wt.% of pyrite which included 98% of gold according to the results of micrograph images. The experiments were continued up to 100 days while air flow rates were chosen to be 0.5, 1, 1.5, 2, and 3 lit/min and the recycling solution (Containing 9K media and 0.4 wt.% D-(+)-Sucrose) flow rates were kept 5, 8, 15 ml/hr. The results indicated that the addition of D-(+)-Sucrose increased the bacterial activity due to the overproduction of extracellular polymeric substance (EPS) up to 95% and for the condition that the recycling solution and air flow rate were chosen to be 8 ml/hr and 2 lit/min, respectively, the maximum pyrite dissolution of 76% was obtained after 60 days. The results indicated that for the air flow rates of 0.5, 1, 1.5, 2, and 3 lit/min the ratio of daily pyrite dissolution per daily solution lost were found to be 0.025, 0.033, 0.031, 0.043, and 0.009 %-pyrite dissolution/ml-lost. The implementation of this microorganisms and the addition of D-(+)-Sucrose will enhance the efficiency of gold recovery through faster biooxidation process and leads to decrease in the time and energy of operation toward desired target; however, still other parameters including particle size distribution, agglomeration, aeration design, chemistry of recycling solution need to be controlled and monitored for reaching the optimum condition.

Keywords: column tests, biooxidation, gold recovery, Ferroplasma acidophilum, optimization

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Authors: Wei Qu, Cassandra Agius, Nikki Varvazovsky, Angela Meade

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The goals of the case study are to address the importance of early diagnosis of osmotic demyelination syndrome (ODS) and to analyse the types, duration, and intensities of the rehabilitation program to promote neurological and functional recovery. It can be associated with biphasic course of disease and severe neurological and neuropsychiatric symptoms. Although a few treatment modalities, such as plasmapheresis, immunoglobulin therapy, steroid, and thyrotrophin-releasing hormone, have been suggested, there is no effective treatment for ODS. The overall prognosis of established ODS is generally poor. A high proportion of patients have a severe permanent disability, which has led to social, economic, and emotional burdens to carers and societies. In this case, a 69-year-old retired pensioner with chronic alcoholism was admitted to the hospital with a reduced level of consciousness and tonic-clonic seizure. He had severe hyponatraemia (serum sodium 118 mmol/L) and hypokalemia (serum potassium 2.8 mmol/L). He was treated with anticonvulsants, 150ml 3% hypertonic saline over one hour, and 40 mmol potassium chloride over one hour, and his sodium was increased by 11 mmol/L in the first 24 hours. However, he had worsened neurological symptoms with quadriplegia, dysphagia, anarthria, and confusion, and the radiological features suggested the diagnosis of ODS. He had minimal neurological recovery during the first four weeks of hospital admission. He was treated with seven weeks of a multi-disciplinary intensive rehabilitation program. On discharge, he had made a significant cognitive and functional recovery and could mobilize independently without a walking aid. In conclusion, ODS can still occur despite correcting sodium following the current clinical guidelines. Patients with severe neurological deficits in the context of osmotic demyelination syndrome would benefit from intensive rehabilitation to facilitate their functional improvement and to promote their quality of life.

Keywords: osmotic demyelination syndrome, hyponatremia, central pontine and extrapontine myelinolysis, rehabilitation

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Authors: A. Nour Eddine, D. Chalet, L. Aixala, P. Chessé, X. Faure, N. Hatat

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Thermal power technology such as the TEG (Thermo-Electric Generator) arouses significant attention worldwide for waste heat recovery. Despite the potential benefits of marine application due to the permanent heat sink from sea water, no significant studies on this application were to be found. In this study, a test rig has been designed and built to test the performance of the TEG on engine operating points. The TEG device is built from commercially available materials for the sake of possible economical application. Two types of commercial TEM (thermo electric module) have been studied separately on the test rig. The engine data were extracted from a commercial Diesel engine since it shares the same principle in terms of engine efficiency and exhaust with the marine Diesel engine. An open circuit water cooling system is used to replicate the sea water cold source. The characterization tests showed that the silicium-germanium alloys TEM proved a remarkable reliability on all engine operating points, with no significant deterioration of performance even under sever variation in the hot source conditions. The performance of the bismuth-telluride alloys was 100% better than the first type of TEM but it showed a deterioration in power generation when the air temperature exceeds 300 °C. The temperature distribution on the heat exchange surfaces revealed no useful combination of these two types of TEM with this tube length, since the surface temperature difference between both ends is no more than 10 °C. This study exposed the perspective of use of TEG technology for marine engine exhaust heat recovery. Although the results suggested non-sufficient power generation from the low cost commercial TEM used, it provides valuable information about TEG device optimization, including the design of heat exchanger and the types of thermo-electric materials.

Keywords: internal combustion engine application, Seebeck, thermo-electricity, waste heat recovery

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Authors: Jong-Bae Lee, Seongsoo Lee

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This paper proposes an adaptive discharge time control method to balance cell voltages in alternating battery cell discharging method. In the alternating battery cell discharging method, battery cells are periodically discharged in turn. Recovery effect increases battery output voltage while the given battery cell rests without discharging, thus battery operation time of target system increases. However, voltage mismatch between cells leads two problems. First, voltage difference between cells induces inter-cell current with wasted power. Second, it degrades battery operation time, since system stops when any cell reaches to the minimum system operation voltage. To solve this problem, the proposed method adaptively controls cell discharge time to equalize both cell voltages. In the proposed method, battery operation time increases about 19%, while alternating battery cell discharging method shows about 7% improvement.

Keywords: battery, recovery effect, low-power, alternating battery cell discharging, adaptive discharge time control

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Authors: Nicholas Bayfield, Mark Newman

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Case Presentation: A 48-year-old male was brought in by ambulance after an out-of-hospital cardiac arrest, with 20 minutes of good-quality cardiopulmonary resuscitation in the community. Return of spontaneous circulation was achieved with defibrillation, revealing an inferior ST-elevation myocardial infarction. He was revascularized emergently in the cath lab and stabilised. Following the procedure, he was noted to have paradoxical respiratory movements of the sternum and high oxygen requirements. CT imaging demonstrated a flail chest with bilateral anterior rib 1-7 fractures as well as a large left-sided extra-pleural haematoma and small haemopneumothorax, secondary to CPR. The patient’s ventilation was stabilised with oxygen via a high-flow humidifier. Pain relief was provided. The anatomy of his rib fractures was not easily amenable to operative fixation. In addition, he was considered to be a high-risk operative candidate due to his recent arrest. He was managed thus non-operatively with an external vacuum dressing applied to the anterior chest wall to minimise respiratory compromise and minimise pain from the motion around the rib fracture sites. Non-operative management was successful, and the patient was reviewed one month later. The paradoxical sternal movement had abated. Discussion: External vacuum dressing has been trialled for non-operative management of rib fractures with varying success. It provides an external brace to minimise fracture site movement during respiration and coughing, thus minimising pain. This modality should be considered a low-cost, high-reward adjunct to non-operative management of bony thoracic trauma.

Keywords: thoracic surgery, thoracic trauma, rib fractures, negative pressure dressing

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Authors: Adam Aboalkaz, Rana Shamoon, Duncan Meikle, James Lewis

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Background and aims: In orthopaedic theatres, radiological screening during operations is a commonly used and useful technique to visualise and guide the operating surgeon. Within any theatre using ionising radiation, it is imperative that the use of protective equipment and the wearing of a dosimeter at all times. 1. To assess compliance with use of protective equipment during orthopaedic procedures involving ionising radiation. 2. To assess the radiation risk knowledge of staff members regularly present in an orthopaedic theatre of a national major trauma centre, in accordance to the ionising radiation regulation (2000) guidelines. Method: We conducted an Observational study of 21 operations at the University Hospital of Wales, which is a major trauma centre, recording the compliance with use of protective equipment (lead aprons and thyroid shields) and dosimeters. The observations were performed sporadically over a two week period to ensure that all staff in monitored operating theatres were not aware of the ongoing study, as to avoid bias. A questionnaire testing the knowledge of trainees and staff within the orthopaedic department was given following completion of the initial phase of the study, with 19 responses. The questions were based on knowledge of ionising radiation exposure and monitoring. The questions also tested the general staff knowledge of what equipment should be worn and where to locate such equipment. Results: This study found that only 25% of staff members were wearing thyroid protectors when less than 1 meter from the radiation source and only 50% were wearing appropriate lead aprons whilst in this same vicinity. The study also showed that 0% of all staff members used a dosimeter whilst in an area of radiation exposure. From the distributed questionnaires, only 40% of staff understood where to stand whilst radiation was being used, and only 25% of staff knew where to find protective equipment. Conclusion: Overall our audit showed poor compliance with regards to the National and local policies, due to lack of awareness of the policy and lack of basic ionising radiation exposure knowledge. It was evident from the observational study and questionnaire that staff were not fully aware of what equipment should be worn, where to find such equipment and did not appreciate that the distance from the ionising radiation source altered its exposure effect. This lack of knowledge may affect the staff health and safety after long term exposure. Changes to clinical practice: From the outcome of this study, we managed to drastically increase awareness of ionising radiation within the orthopaedic department. A mandatory teaching session on the safety of ionising radiation has been incorporated into the orthopaedic induction week for all staff. The dosimeters have been moved to a visible location within the trauma operating theatre and all staff made aware of where to find protective equipment.

Keywords: audit, ionising radiation, observational study, protection

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Authors: Min-Tao Hsu

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This study aims to explore the lived experiences of women with breast cancer, including their life world of illness and their adaptation to breast cancer. Breast cancer is not only a potentially lethal disease, but also a disease that may lead to many irreversible changes for female patients. Especially, in a culture where the wholeness is pursuit as an essential value, the sickness and/or broken body bring great challenge of life. Based on holism and symbolic interactionism, this study used interpretive ethnography including in-depth interviews and participant observations to collect the narrative of women with breast cancer concerning their illness experience. In addition, this study used Agar’s hermeneutic cycle to analyze data. The average age of 35 participants was 54.2. A total of 15 patients were within 2 years of onset, 5 patients were within 2-5 years of the treatment observation period, and 15 patients suffered from breast cancer for more than 5 years. The average age of onset was 50.4. Result: The main storyline of the life world of illness is ‘breast cancer is a turning point of life.’ Loss of breast was in terms of ‘no more a woman’ in Taiwanese culture. Two young women, one in her newly wedded and another right before marry, were divorced and cancelled wedding right after being diagnosed. All of them addressed that they have a ‘broken body.’ Single women accounted that they won’t marry for not being humiliated and most of married women said they never show female body in front of her husband or partner even in intimacy encounter. Three common themes were discovered: 1) new self and new identity; 2) new social relationships and new me; 3) new body and new life. The intertwining bodies, illness, selves, suffering, and medical treatments of female patients were observed. More, the recovery, of cause, was happened when new self, relationship, and new body were generated. Their identity to be a woman and a wife is shattered and their life is urged into another facet. For helping them to recovery from such situation, building a new identity and new social fabric on the new body need to be included in nursing care plan.

Keywords: breast cancer, illness narrative, world of illness, self-healing, interpretive ethnography

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