Search results for: Pediatric intensive care unit

Authors: Dan Kanmegne

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Africa will become the most populated continent by the end of the century, with around 4 billion inhabitants. Food security and climate changes will become continental issues since agricultural practices depend on climate but also contribute to global emissions and land degradation. Agroforestry has been identified as a cost-efficient and reliable strategy to address these two issues. It is defined as the integrated management of trees and crops/animals in the same land unit. Agroforestry provides benefits in terms of goods (fruits, medicine, wood, etc.) and services (windbreaks, fertility, etc.), and is acknowledged to have a great potential for carbon sequestration; therefore it can be integrated into reduction mechanisms of carbon emissions. Particularly in sub-Saharan Africa, the constraint stands in the lack of information about both areas under agroforestry and the characterization (composition, structure, and management) of each agroforestry system at the country level. This study describes and quantifies “what is where?”, earliest to the quantification of carbon stock in different systems. Remote sensing (RS) is the most efficient approach to map such a dynamic technology as agroforestry since it gives relatively adequate and consistent information over a large area at nearly no cost. RS data fulfill the good practice guidelines of the Intergovernmental Panel On Climate Change (IPCC) that is to be used in carbon estimation. Satellite data are getting more and more accessible, and the archives are growing exponentially. To retrieve useful information to support decision-making out of this large amount of data, satellite data needs to be organized so to ensure fast processing, quick accessibility, and ease of use. A new solution is a data cube, which can be understood as a multi-dimensional stack (space, time, data type) of spatially aligned pixels and used for efficient access and analysis. A data cube for Burkina Faso has been set up from the cooperation project between the international service provider WASCAL and Germany, which provides an accessible exploitation architecture of multi-temporal satellite data. The aim of this study is to map and characterize agroforestry systems using the Burkina Faso earth observation data cube. The approach in its initial stage is based on an unsupervised image classification of a normalized difference vegetation index (NDVI) time series from 2010 to 2018, to stratify the country based on the vegetation. Fifteen strata were identified, and four samples per location were randomly assigned to define the sampling units. For safety reasons, the northern part will not be part of the fieldwork. A total of 52 locations will be visited by the end of the dry season in February-March 2020. The field campaigns will consist of identifying and describing different agroforestry systems and qualitative interviews. A multi-temporal supervised image classification will be done with a random forest algorithm, and the field data will be used for both training the algorithm and accuracy assessment. The expected outputs are (i) map(s) of agroforestry dynamics, (ii) characteristics of different systems (main species, management, area, etc.); (iii) assessment report of Burkina Faso data cube.

Keywords: agroforestry systems, Burkina Faso, earth observation data cube, multi-temporal image classification

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Authors: Paul Holmes, Mike N. G.

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Foundation-year doctors face increased stress, pressure and uncertainty when starting new rotations throughout their first years of work. This research questionnaire resulted in an induction cheat sheet and induction video that enhanced the Junior doctor's understanding of how to work effectively within the plastic surgery department at NHS Tayside. The objectives and goals were to improve the transition between cohorts of junior doctors in ward 26 at Ninewells Hospital. Before this quality improvement project, the induction pack was 74 pages long and over eight years old. With the support of consultant Mike Ng a new up-to-date induction was created. This involved a questionnaire and cheat sheet being developed. The questionnaire covered clerking, venipuncture, ward pharmacy, theatres, admissions, specialties on the ward, the cardiac arrest trolley, clinical emergencies, discharges and escalation. This audit has three completed cycles between August 2022 and August 2023. The cheat sheet developed a concise two-page A4 document designed for doctors to be able to reference easily and understand the essentials. The document format is a table containing ward layout; specialty; location; physician associate, shift patterns; ward rounds; handover location and time; hours coverage; senior escalation; nights; daytime duties, meetings/MDTs/board meetings, important bleeps and codes; department guidelines; boarders; referrals and patient stream; pharmacy; absences; rota coordinator; annual leave; top tips. The induction video is a 10-minute in-depth explanation of all aspects of the ward. The video explores in more depth the contents of the cheat sheet. This alternative visual format familiarizes the junior doctor with all aspects of the ward. These were provided to all foundation year 1 and 2 doctors on ward 26 at Ninewells Hospital at NHS Tayside Scotland. This work has since been adopted by the General Surgery Department, which extends to six further wards and has improved the effective handing over of the junior doctor’s role between cohorts. There is potential to further expand the cheat sheet to other departments as the concise document takes around 30 minutes to complete by a doctor who is currently on that ward. The time spent filling out the form provides vital information to the incoming junior doctors, which has a significant possibility to improve patient care.

Keywords: induction, junior doctor, handover, plastic surgery

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Authors: Shusmita Khan, Shams El Arifeen, Kanta Jamil

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Background: Nutrition transition in Bangladesh has progressed across various relevant socio-demographic contextual issues. For a developing country like Bangladesh, its is believed that, overnutrition is less prevalent than undernutrition. However, recent evidence suggests that a rapid shift is taking place where overweight is subduing underweight. With this rapid increase, for Bangladesh, it will be challenging to achieve the global agenda on halting overweight and obesity. Methods: A secondary analysis was performed from six successive national demographic and health surveys to get the trend on undernutrition and overnutrition for women from reproductive age. In addition, national relevant policy papers were reviewed to determine the countries readiness for whole of the systems approach to tackle this epidemic. Results: Over the last decade, the proportion of women with low body mass index (BMI<18.5), an indicator of undernutrition, has decreased markedly from 34% to 19%. However, the proportion of overweight women (BMI ≥25) increased alarmingly from 9% to 24% over the same period. If the WHO cutoff for public health action (BMI ≥23) is used, the proportion of overweight women has increased from 17% in 2004 to 39% in 2014. The increasing rate of obesity among women is a major challenge to obstetric practice for both women and fetuses. In the long term, overweight women are also at risk of future obesity, diabetes, hyperlipidemia, hypertension, and heart disease. These diseases have serious impact on health care systems. Costs associated with overweight and obesity involves direct and indirect costs. Direct costs include preventive, diagnostic, and treatment services related to obesity. Indirect costs relate to morbidity and mortality costs including productivity. Looking at the Bangladesh Health Facility Survey, it is found that the country is bot prepared for providing nutrition-related health services, regarding prevention, screening, management and treatment. Therefore, if this nutrition transition is not addressed properly, Bangladesh will not be able to achieve the target of the NCD global monitoring framework of the WHO. Conclusion: Addressing this nutrition transition requires contending ‘malnutrition in all its forms’ and addressing it with integrated approaches. Whole of the systems action is required at all levels—starting from improving multi-sectoral coordination to scaling up nutrition-specific and nutrition-sensitive mainstreamed interventions keeping health system in mind.

Keywords: nutrition transition, Bangladesh, health system, undernutrition, overnutrition, obesity

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Authors: Marie-Josee Lavallee

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Adorno’s reputation as an abstract and pessimistic thinker who indulged in a critic of capitalist society and culture without bothering himself with opening prospects for change, and who has no interest in political activism, recently begun to be questioned. This paper, which has a twofold objective, will push revisionist readings a step further by putting forward the thesis that revolutionary praxis has been an enduring concern for Adorno, surfacing throughout his entire work. On the other hand, it will hold that his understanding of the relationships between theory and praxis, which will be explained by referring to Ernst Bloch’s distinction between the warm and cold currents of Marxism, can help to interpret the paralysis of revolutionary practice in our own time under a new light. Philosophy and its tasks have been an enduring topic of Adorno’s work from the 1930s to Negativ Dialektik. The writings in which he develops these ideas stand among his most obscure and abstract so that their strong ties to the political have remained mainly overlooked. Adorno’s undertaking of criticizing and ‘redeeming’ philosophy and metaphysics is inseparable from a care for retrieving the capacity to act in the world and to change it. Philosophical problems are immanent to sociological problems, and vice versa, he underlines in his Metaphysik. Begriff and Problem. The issue of truth cannot be severed from the contingent context of a given idea. As a critical undertaking extracting its contents from reality, which is what philosophy should be from Adorno's perspective, the latter has the potential to fully reveal the reification of the individual and consciousness resulting from capitalist economic and cultural domination, thus opening the way to resistance and revolutionary change. While this project, according to his usual method, is sketched mainly in negative terms, it also exhibits positive contours which depict a socialist society. Only in the latter could human suffering end, and mutilated individuals experiment with reconciliation in an authentic way. That Adorno’s continuous plea for philosophy’s self-critic and renewal hides an enduring concern for revolutionary praxis emerges clearly from a careful philosophical analysis of his writings on philosophy and a selection of his sociological work, coupled with references to his correspondences. This study points to the necessity of a serious re-evaluation of Adorno’s relationship to the political, which will impact on the interpretation of his whole oeuvre, is much needed. In the second place, Adorno's dialectical conception of theory and praxis is enlightening for our own time, since it suggests that we are experiencing a phase of creative latency rather an insurmountable impasse.

Keywords: Frankfurt school, philosophy and revolution, revolutionary praxis, Theodor W. Adorno

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Authors: Ernest Tambo, Ghislaine Madjou, Jeanne Y. Ngogang, Shenglan Tang, Zhou XiaoNong

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Implementing national to community-based 'One Health' surveillance approach for human, animal and environmental consequences mitigation offers great opportunities and value-added in sustainable development and wellbeing. 'One Health' surveillance approach global partnerships, policy commitment and financial investment are much needed in addressing the evolving threats and epidemics crises mitigation in African countries. The paper provides insights onto how China-Africa health development cooperation in promoting “One Health” surveillance approach in response advocacy and mitigation. China-Africa health development initiatives provide new prospects in guiding and moving forward appropriate and evidence-based advocacy and mitigation management approaches and strategies in attaining Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). Early and continuous quality and timely surveillance data collection and coordinated information sharing practices in malaria and other diseases are demonstrated in Comoros, Zanzibar, Ghana and Cameroon. Improvements of variety of access to contextual sources and network of data sharing platforms are needed in guiding evidence-based and tailored detection and response to unusual hazardous events. Moreover, understanding threats and diseases trends, frontline or point of care response delivery is crucial to promote integrated and sustainable targeted local, national “One Health” surveillance and response approach needs implementation. Importantly, operational guidelines are vital in increasing coherent financing and national workforce capacity development mechanisms. Strengthening participatory partnerships, collaboration and monitoring strategies in achieving global health agenda effectiveness in Africa. At the same enhancing surveillance data information streams reporting and dissemination usefulness in informing policies decisions, health systems programming and financial mobilization and prioritized allocation pre, during and post threats and epidemics crises programs strengths and weaknesses. Thus, capitalizing on “One Health” surveillance and response approach advocacy and mitigation implementation is timely in consolidating Africa Union 2063 agenda and Africa renaissance capabilities and expectations.

Keywords: Africa, one health approach, surveillance, response

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Authors: David A. Scott, Michelle G. Scott

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The problem of juvenile crime, school suspensions and oppositional behaviors indicates a need for a wide range of intervention programs for at-risk youth. Juvenile court systems and mental health agencies are examining alternative ways to deal with at-risk youth that will allow the adolescent to live within their home community. The previous trend that treatment away from home is more effective than treatment near one's community has shifted. Research now suggests that treatment be close to home for several reasons, such as increased treatment success, parental involvement, and reduced costs. Treatment options consist of a wide range of interventions, including outpatient, inpatient, and community-based services (therapeutic group homes, foster care and in-home preservation services). The juvenile justice system, families and other mental health agencies continue to seek the most effective treatment for at-risk youth in their communities. This research examines two possible treatment modalities, a multi-systemic outpatient program and a residential program. Research examining effective, evidence- based counseling will be discussed during this presentation. The presenter recently completed a three-year research grant examining effective treatment modalities for at-risk youth participating in a multi-systemic program. The presenter has also been involved in several research activities gathering data on effective techniques used in residential programs. The data and discussion will be broken down into two parts, each discussing one of the treatment modalities mentioned above. Data on the residential programs was collected on both a sample of 740 at- risk youth over a five-year period and also a sample of 63 participants during a one-year period residing in a residential programs. The effectiveness of these residential services was measured in three ways: services are evaluated by primary referral sources; follow-up data is obtained at various intervals after program participation to measure recidivism (what percentage got back into trouble with the Department of Juvenile Justice); and a more sensitive, "Offense Seriousness Score", has been computed and analyzed prior to, during and after treatment in the residential program. Data on the multi-systemic program was gathered over the past three years on 190 participants. Research will discuss pre and post test results, recidivism rates, academic performance, parental involvement, and effective counseling treatment modalities.

Keywords: at-risk youth, group homes, therapeutic group homes, recidivism rates

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Authors: Sevinj Asgarova

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Within the last few decades, major advances in the field of prenatal testing have transpired yet little research regarding the experiences of mothers who chose to continue their pregnancies after prenatally receiving a diagnosis of Down Syndrome (DS) has been undertaken. Using social constructionism and interpretive description, this retrospective research study explores this topic from the point of view of the mothers involved and provides insight as to how the experience could be improved. Using purposive sampling, 23 mothers were recruited from British Columbia (n=11) and Ontario (n=12) in Canada. Data retrieved through semi-structured in-depth interviews were analyzed using inductive, constant comparative analysis, the major analytical techniques of interpretive description. Four primary phases emerged from the data analysis 1) healthcare professional-mothers communications, 2) initial emotional response, 3) subsequent decision-making and 4) an adjustment and reorganization of lifestyle to the preparation for the birth of the child. This study validates the individualized and contextualized nature of mothers’ decisions as influenced by multiple factors, with moral values/spiritual beliefs being significant. The mothers’ ability to cope was affected by the information communicated to them about their unborn baby’s diagnosis and the manner in which that information was delivered to them. Mothers used emotional coping strategies, dependent upon support from partners, family, and friends, as well as from other families who have children with DS. Additionally, they employed practical coping strategies, such as engaging in healthcare planning, seeking relevant information, and reimagining and reorganizing their lifestyle. Over time many families gained a sense of control over their situation and readjusted to the preparation for the birth of the child. Many mothers expressed the importance of maintaining positivity and hopefulness with respect to positive outcomes and opportunities for their children. The comprehensive information generated through this study will also provide healthcare professionals with relevant information to assist them in understanding the informational and emotional needs of these mothers. This should lead to an improvement in their practice and enhance their ability to intervene appropriately and effectively, better offering improved support to parents dealing with a diagnosis of DS for their child.

Keywords: continuing affected pregnancy, decision making, disability, down syndrome, eugenic social attitudes, inequalities, life change events, prenatal care, prenatal testing, qualitative research, social change, social justice

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Authors: Louise Ödlund, Danica Djuric Ilic

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From a system perspective, there are several benefits of DH. A possibility to utilize the excess heat from waste incineration and biomass-based combined heat and power (CHP) production (e.g. possibility to utilize the excess heat from electricity production) are two examples. However, in a future sustainable society, the benefits of DH may be less obvious. Due to the climate changes and increased energy efficiency of buildings, the demand for space heating is expected to decrease. Due to the society´s development towards circular economy, a larger amount of the waste will be material recycled, and the possibility for DH production by the energy recovery through waste incineration will be reduced. Furthermore, the benefits of biomass-based CHP production will be less obvious since the marginal electricity production will no longer be linked to high greenhouse gas emissions due to an increased share of renewable electricity capacity in the electricity system. The purpose of the study is (1) to provide an overview of the possible development of other sectors which may influence the DH in the future and (2) to detect new business strategies which would enable for DH to adapt to the future conditions and remain competitive to alternative heat production in the future. A system approach was applied where DH is seen as a part of an integrated system which consists of other sectors as well. The possible future development of other sectors and the possible business strategies for DH producers were searched through a systematic literature review In order to remain competitive to the alternative heat production in the future, DH producers need to develop new business strategies. While the demand for space heating is expected to decrease, the space cooling demand will probably increase due to the climate changes, but also due to the better insulation of buildings in the cases where the home appliances are the heat sources. This opens up a possibility for applying DH-driven absorption cooling, which would increase the annual capacity utilization of the DH plants. The benefits of the DH related to the energy recovery from the waste incineration will exist in the future since there will always be a need to take care of materials and waste that cannot be recycled (e.g. waste containing organic toxins, bacteria, such as diapers and hospital waste). Furthermore, by operating central controlled heat pumps, CHP plants, and heat storage depending on the intermittent electricity production variation, the DH companies may enable an increased share of intermittent electricity production in the national electricity grid. DH producers can also enable development of local biofuel supply chains and reduce biofuel production costs by integrating biofuel and DH production in local DH systems.

Keywords: district heating, sustainable business strategies, sustainable development, system approach

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Authors: Liang Zhang, Gang Xu, Yue Wang, Chen Li, Shao Chong Zhou

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Presently, more and more nuclear power plants are facing the issue of life extension. When a nuclear power plant applies for an extension of life, its condition needs to meet the current design standards, which is not fine for all old reactors, typically for seismic design. Seismic-grade equipment in nuclear power plants are now generally placed separately from the non-seismic-grade equipment, but it was not strictly required before. Therefore, it is very important to study whether non-seismic-grade equipment will affect the seismic-grade equipment when dropped down in an earthquake situation, which is related to the safety of nuclear power plants and future life extension applications. This research was based on the cooling water system with the seismic and non-seismic grade equipment installed together, as an example to study whether the non-seismic-grade equipment such as DN50 fire pipes and ventilation pipes arranged above will damage the DN300 pipes and valves arranged below when earthquakes occur. In the study, the simulation was carried out by ANSYS / LY-DYNA, and Johnson-Cook was used as the material model and failure model. For the experiments, the relative positions of objects in the room were restored by 1: 1. In the experiment, the pipes and valves were filled with water with a pressure of 0.785 MPa. The pressure-holding performance of the pipe was used as a criterion for damage. In addition to the pressure-holding performance, the opening torque was considered as well for the valves. The research results show that when the 10-meter-long DN50 pipe was dropped from the position of 8 meters height and the 8-meter-long air pipe dropped from a position of 3.6 meters height, they do not affect the integrity of DN300 pipe below. There is no failure phenomenon in the simulation as well. After the experiment, the pressure drop in two hours for the pipe is less than 0.1%. The main body of the valve does not fail either. The opening torque change after the experiment is less than 0.5%, but the handwheel of the valve may break, which affects the opening actions. In summary, impacts of the upper pipes and ventilation pipes dropdown on the integrity of the DN300 pipes and valves below in a cooling water system of a typical second-generation nuclear power plant under an earthquake was studied. As a result, the functionality of the DN300 pipeline and the valves themselves are not significantly affected, but the handwheel of the valve or similar articles can probably be broken and need to take care.

Keywords: cooling water system, earthquake, integrity, pipe and valve

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Authors: Imen Soltani, Takoua Soltani, Taoufik Aguili

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Metamaterials crossover classic physical boundaries and gives rise to new phenomena and applications in the domain of beam steering and shaping. Where electromagnetic near and far field manipulations were achieved in an accurate manner. In this sense, 3D imaging is one of the beneficiaries and in particular Denis Gabor’s invention: holography. But, the major difficulty here is the lack of a suitable recording medium. So some enhancements were essential, where the 2D version of bulk metamaterials have been introduced the so-called metasurface. This new class of interfaces simplifies the problem of recording medium with the capability of tuning the phase, amplitude, and polarization at a given frequency. In order to achieve an intelligible wavefront control, the electromagnetic properties of the metasurface should be optimized by means of solving Maxwell’s equations. In this context, integral methods are emerging as an important method to study electromagnetic from microwave to optical frequencies. The method of moment presents an accurate solution to reduce the problem of dimensions by writing its boundary conditions in the form of integral equations. But solving this kind of equations tends to be more complicated and time-consuming as the structural complexity increases. Here, the use of equivalent circuit’s method exhibits the most scalable experience to develop an integral method formulation. In fact, for allaying the resolution of Maxwell’s equations, the method of Generalised Equivalent Circuit was proposed to convey the resolution from the domain of integral equations to the domain of equivalent circuits. In point of fact, this technique consists in creating an electric image of the studied structure using discontinuity plan paradigm and taken into account its environment. So that, the electromagnetic state of the discontinuity plan is described by generalised test functions which are modelled by virtual sources not storing energy. The environmental effects are included by the use of an impedance or admittance operator. Here, we propose a tunable metasurface composed of graphene-based elements which combine the advantages of reflectarrays concept and graphene as a pillar constituent element at Terahertz frequencies. The metasurface’s building block consists of a thin gold film, a dielectric spacer SiO₂ and graphene patch antenna. Our electromagnetic analysis is based on the method of moment combined with generalised equivalent circuit (MoM-GEC). We begin by restricting our attention to study the effects of varying graphene’s chemical potential on the unit cell input impedance. So, it was found that the variation of complex conductivity of graphene allows controlling the phase and amplitude of the reflection coefficient at each element of the array. From the results obtained here, we were able to determine that the phase modulation is realized by adjusting graphene’s complex conductivity. This modulation is a viable solution compared to tunning the phase by varying the antenna length because it offers a full 2π reflection phase control.

Keywords: graphene, method of moment combined with generalised equivalent circuit, reconfigurable metasurface, reflectarray, terahertz domain

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Authors: Liane J. Ioannou, Jonathan Serpell, Joanne Dean, Cino Bendinelli, Jenny Gough, Dean Lisewski, Julie Miller, Win Meyer-Rochow, Stan Sidhu, Duncan Topliss, David Walters, John Zalcberg, Susannah Ahern

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Background: The occurrence of thyroid cancer is increasing throughout the developed world, including Australia and New Zealand, and since the 1990s has become the fastest increasing malignancy. Following the success of a number of institutional databases that monitor outcomes after thyroid surgery, the Australian and New Zealand Endocrine Surgeons (ANZES) agreed to auspice the development of a bi-national thyroid cancer registry. Objectives: To establish a bi-national population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand. Patients and Methods: The Australian and New Zealand Thyroid Cancer Registry (ANZTCR) captures clinical data for all patients, over the age of 18 years, diagnosed with thyroid cancer, confirmed by histopathology report, that have been diagnosed, assessed or treated at a contributing hospital. Data is collected by endocrine surgeons using a web-based interface, REDCap, primarily via direct data entry. Results: A multi-disciplinary Steering Committee was formed, and with operational support from Monash University the ANZTCR was established in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 30 sites expected to come on board across Australia and New Zealand in 2018. A modified-Delphi process was undertaken to determine the key quality indicators to be reported by the registry, and a minimum dataset was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery, and 30-day follow up. Conclusion: There are very few established thyroid cancer registries internationally, yet clinical quality registries have shown valuable outcomes and patient benefits in other cancers. The establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand the current practice in the treatment of thyroid cancer and reasons for variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer-term outcome data particularly for patients with the poor prognostic disease will add significant further value to the registry.

Keywords: thyroid cancer, clinical registry, population health, quality improvement

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Authors: Michal Geca, Grzegorz Baranski, Ksenia Siadkowska

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The work is a part of the project which aims at developing innovative power and control systems for the high power aircraft piston engine ASz62IR. Developed electronically controlled ignition system will reduce emissions of toxic compounds as a result of lowered fuel consumption, optimized combustion and engine capability of efficient combustion of ecological fuels. The tested unit is an air-cooled four-stroke gasoline engine of 9 cylinders in a radial setup, mechanically charged by a radial compressor powered by the engine crankshaft. The total engine cubic capac-ity is 29.87 dm3, and the compression ratio is 6.4:1. The maximum take-off power is 1000 HP at 2200 rpm. The maximum fuel consumption is 280 kg/h. Engine powers aircrafts: An-2, M-18 „Dromader”, DHC-3 „OTTER”, DC-3 „Dakota”, GAF-125 „HAWK” i Y5. The main problems of the engine includes the imbalanced work of cylinders. The non-uniformity value in each cylinder results in non-uniformity of their work. In radial engine cylinders arrangement causes that the mixture movement that takes place in accordance (lower cylinder) or the opposite (upper cylinders) to the direction of gravity. Preliminary tests confirmed the presence of uneven workflow of individual cylinders. The phenomenon is most intense at low speed. The non-uniformity is visible on the waveform of cylinder pressure. Therefore two studies were conducted to determine the impact of this phenomenon on the engine performance: simulation and real tests. Simplified simulation was conducted on the element of the intake system coated with fuel film. The study shows that there is an effect of gravity on the movement of the fuel film inside the radial engine intake channels. Both in the lower and the upper inlet channels the film flows downwards. It follows from the fact that gravity assists the movement of the film in the lower cylinder channels and prevents the movement in the upper cylinder channels. Real tests on aircraft engine ASz62IR was conducted in transients condition (rapid change of the excess air in each cylinder were performed. Calculations were conducted for mass of fuel reaching the cylinders theoretically and really and on this basis, the factors of fuel evaporation “x” were determined. Therefore a simplified model of the fuel supply to cylinder was adopted. Model includes time constant of the fuel film τ, the number of engine transport cycles of non-evaporating fuel along the intake pipe γ and time between next cycles Δt. The calculation results of identification of the model parameters are presented in the form of radar graphs. The figures shows the averages declines and increases of the injection time and the average values for both types of stroke. These studies shown, that the change of the position of the cylinder will cause changes in the formation of fuel-air mixture and thus changes in the combustion process. Based on the results of the work of simulation and experiments was possible to develop individual algorithms for ignition control. This work has been financed by the Polish National Centre for Research and Development, INNOLOT, under Grant Agreement No. INNOLOT/I/1/NCBR/2013.

Keywords: radial engine, ignition system, non-uniformity, combustion process

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Authors: Anis Al-Yakhiri

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

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

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Authors: Soroush Pakniyat-Jahromi, Jessica Bucciarelli, Souparno Mitra, Neda Motamedi, Ralph Amazan, Samuel Rothman, Jose Tiburcio, Douglas Reich, Vicente Liz

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Violence is defined as an act of physical force that is intended to cause harm and may lead to physical and/or psychological damage. Violence toward healthcare workers (HCWs) is more common in psychiatric settings, emergency departments, and nursing homes; however, healthcare workers in medical setting are not spared from such events. Workplace violence has a huge burden in the healthcare industry and has a major impact on the physical and mental wellbeing of staff. The purpose of this study is to compare the prevalence of patient agitation and violence in medical-surgical settings in BronxCare Hospital (BCH) Bronx, New York, one year before and during the COVID-19 pandemic. Data collection occurred between June 2021 and August 2021, while the sampling time was from 2019 to 2021. The data were separated into two separate time categories: pre-COVID-19 (03/2019-03/2020) and COVID-19 (03/2020-03/2021). We created frequency tables for 19 variables. We used a chi-square test to determine a variable's statistical significance. We tested all variables against “restraint type”, determining if a patient was violent or became violent enough to restrain. The restraint types were “chemical”, “physical”, or both. This analysis was also used to determine if there was a statistical difference between the pre-COVID-19 and COVID-19 timeframes. Our data shows that there was an increase in incidents of violence in COVID-19 era (03/2020-03/2021), with total of 194 (62.8%) reported events, compared to pre COVID-19 era (03/2019-03/2020) with 115 (37.2%) events (p: 0.01). Our final analysis, completed using a chi-square test, determined the difference in violence in patients between pre-COVID-19 and COVID-19 era. We then tested the violence marker against restraint type. The result was statistically significant (p: 0.01). This is the first paper to systematically review the prevalence of violence in medical-surgical units in a hospital in New York, pre COVID-19 and during the COVID-19 era. Our data is in line with the global trend of increased prevalence of patient agitation and violence in medical settings during the COVID-19 pandemic. Violence and its management is a challenge in healthcare settings, and the COVID-19 pandemic has brought to bear a complexity of circumstances, which may have increased its incidence. It is important to identify and teach healthcare workers the best preventive approaches in dealing with patient agitation, to decrease the number of restraints in medical settings, and to create a less restrictive environment to deliver care.

Keywords: COVID-19 pandemic, patient agitation, restraints, violence

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Authors: B. M. M. D. Mendis, L. I. Rajapaksa, P. S. K. Gunathunga, R. C. Fernando, M. Jayalath

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Background / introduction: During the year 2011, 8511 males received services from the sexual health clinics island wide. At present there is only limited information on the risk behaviours of male attendees. Information on risk behaviours related to STI /HIV transmission is helpful in planning suitable prevention interventions. Aim(s)/objectives: The objectives were to determines the sexual partners (other than the marital partner and regular partners) responsible for transmitting STI( Sexually transmitted infections)/ HIV and to understand the practice of safer sex. Methods: Study was a clinic based prospective study conducted for a one year period using an interviewer administered questionnaire. Results: 983 attendees were interviewed. . Mean age was 34.02 years. 75% of the sample had completed GCE O/L (ordinary level examination). Skilled labourers, drivers and forces/police comprised 40% of the sample. 50% admitted sex with a casual female, 12% with a casual male, and 13% with CSW (commercial sex workers) while MSW (male sex workers) exposures were minimal. It was identified that younger males had more contacts with males, and regular female partners while more older males with CSW. Anal sex among males was reported by 11.5%. 20.5% used alcohol frequently and 5.9% used drugs and 1.4% injected. Common STI were genital herpes (7.9%), Non gonococcal urethritis (6.2%) and gonorrhoea (6.2%). Among those who had contacts with FSW 6.7% gonorrhoea (GC), 8.2% non gonococcal urethritis (NGU), 7.5% genital herpes and 0.7% HIV. Non regular partner exposures 3.7% had gonorrhoea, 8.3% NGU, 6.6% genital herpes and 0.8% HIV. Among MSM contacts 10.6% had GC, 4.5% NGU, 5.3% genital herpes, 5.3% secondary syphilis and 0.8% HIV. Only 9.0% used condoms correctly. Friends, doctors, newspapers, internet, and forces were important sources of information on condoms. Non use of condoms were due to worry about satisfaction (24.6%) and faith in the partner (25.6%). Discussion/conclusion: Casual partners for unsafe sex is a concern. MSM and CSW are remained as an important source of infection. Early Syphilis and gonorrhoea infections were mostly seen among MSM exposures. The findings indicate that the male population in the sample had satisfactory education. However, still the unsafe sexual contacts are common. . Newspapers, internet were more important sources of information on condoms. Low condom use remains another concern.. More males contracted STI through casual partners. Therefore strategies used for prevention need to be revisited also emphasizing on general population where casual partners represent. . Increasing awareness of men and women through mass media and primary health care teams may be important strategies that can be used to keep the HIV epidemic in a low level.

Keywords: STI, HIV, Males, safe sex practices

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Authors: Rinat Gabbay-Benziv, Merav Ben-Natan, Ariel Roguin, Benyamine Abbou, Anna Ofir, Adi Klein, Dikla Dahan-Shriki, Mordechai Hallak, Boris Kessel, Mickey Dudkiewicz

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Introduction: Over recent decades, technology has become integral to healthcare, with electronic health records and advanced medical equipment now standard. However, this reliance has made healthcare systems increasingly vulnerable to ransomware attacks. On October 13, 2021, Hillel Yaffe Medical Center experienced a severe ransomware attack that disrupted all IT systems, including electronic health records, laboratory services, and staff communications. The attack, carried out by the group DeepBlueMagic, utilized advanced encryption to lock the hospital's systems and demanded a ransom. This incident caused significant operational and patient care challenges, particularly impacting the obstetrics department. Objective: The objective is to describe the challenges facing the obstetric division following a cyberattack and discuss ways of preparing for and overcoming another one. Methods: A retrospective descriptive study was conducted in a mid-sized medical center. Division activities, including the number of deliveries, cesarean sections, emergency room visits, admissions, maternal-fetal medicine department occupancy, and ambulatory encounters, from 2 weeks before the attack to 8 weeks following it (a total of 11 weeks), were compared with the retrospective period in 2019 (pre-COVID-19). In addition, we present the challenges and adaptation measures taken at the division and hospital levels leading up to the resumption of full division activity. Results: On the day of the cyberattack, critical decisions were made. The media announced the event, calling on patients not to come to our hospital. Also, all elective activities other than cesarean deliveries were stopped. The number of deliveries, admissions, and both emergency room and ambulatory clinic visits decreased by 5%–10% overall for 11 weeks, reflecting the decrease in division activity. Nevertheless, in all stations, there were sufficient activities and adaptation measures to ensure patient safety, decision-making, and workflow of patients were accounted for. Conclusions: The risk of ransomware cyberattacks is growing. Healthcare systems at all levels should recognize this threat and have protocols for dealing with them once they occur.

Keywords: ransomware attack, healthcare cybersecurity, obstetrics challenges, IT system disruption

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Authors: Sarah Atalla, Shubham Gupta, Kim Alipio, Tanya Maric

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Background: Chelsea and Westminster Hospital have introduced the Birmingham Symptom Specific Obstetric Triage System (BSOTS) for patients who present acutely to the Maternity Assessment Suite (MAS) to prioritise care by urgency. The primary objective was to evaluate whether BSOTS was used appropriately to assess patients (defined as a 90% threshold). The secondary objective was to assess whether patients were seen within their designated triaged timeframe (defined as a 90% threshold). Methodology: MAS records were retrospectively reviewed for a randomly selected one-week period of data from 2020 (21/09/2020 - 27/09/2020). 189 patients presented to MAS during this time. Data were collected on the presenting complaint, time of attendance (divided into four time categories), and triage colour code for the urgency of a review by a doctor (red: immediately, orange: within 15 minutes, yellow: within 1 hour, green: within 4 hours). The number of triage waiting times that were breached and the outcome of the attendance was noted. Results: 49% of patients presenting to MAS during this time period were triaged, which therefore did not meet the 90% target. 67% of patients who were triaged were seen within their allocated timeframe as designated by their triage colour code, which therefore did not meet the 90% target. The most frequent reason for patient attendance was reduced fetal movements (30.5% of attendances). The busiest time of day (when most patients presented) was between 06:01-12:00, and this was also when the highest number of patients were not triaged (26 patients or 54% of patients presenting in this time category). The most used triage category (59%) was the green colour code (to be seen by a doctor within 4 hours), followed by orange (24%), yellow (14%), and red (3%). 45% of triaged patients were admitted, whilst 55% were discharged. 62% of patients allocated to the green triage category were discharged, as compared to 56% of yellow category patients, 27% of orange category patients, and 50% of red category patients. The time of patient presentation to the hospital was also associated with the level of urgency and outcome. Patients presenting from 12:01 to 18:00 were more likely to be discharged (72% discharged) compared to 00:01-06:00 where only 12.5% of patients were discharged. Conclusion: The triage system for assessing the urgency of acutely presenting obstetric patients is only being effectively utilised for 49% of patients. There is potential for enhancing the employment of the triage system to enable further efficiency and boost the promotion of patient safety. It is noted that MAS was busiest at 06:01 - 12:00 when there was also the highest number of non-triaged patients – this highlights some areas where we can improve, including higher levels of staffing, better use of BSOTS to triage patients, and patient education.

Keywords: birmingham, BSOTS, maternal, obstetric, pregnancy, specific, symptom, triage

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

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

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

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Authors: Chandra Shekhar Majumder, Orin Sultana Jamie

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

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

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

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

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

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Authors: Binaya Tamang, Buddhi R. Pokharel, Narayan Gautam, Puspa R. Dhakal, Yuresh Twayana

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Background and Objective: Microalbuminuria is often regarded as a sign of end-organ damage due to hypertension, with an increased risk for renal diseases. The present study was designed to find the prevalence of microalbuminuria in hypertensive patients by determining albumin creatinine ratio (ACR) and the association of ACR and microalbuminuria status with different stages and duration of hypertension (HTN). Also, to establish the correlation of systolic and diastolic blood pressure (SBP and DBP) with various parameters viz; ACR, urinary microalbumin (UMA), estimated glomerular filtration rate (eGFR), urinary creatinine (Ucreat), serum creatinine (Screat), and find out their significance among HTN and ACR status. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Biochemistry in collaboration with the Department of Internal Medicine, UCMS, Bhairahawa, Nepal from April 2019 to September 2019 after obtaining ethical approval from institutional review committee (IRC), UCMS. A total of 120 hypertensive patients were enrolled whose blood, and spot urine samples were taken. eGFR was calculated by using Cockcroft-Gault formula after determining Screat while ACR was calculated after measuring Ucreat and UMA from the spot urine sample. Creatinine was estimated from modified jaffes’ reaction, whereas urinary micro albumin was done by Mispa i3 analyzer. Data were analyzed by using SPSS. 20 using p-value ≤ 0.05 as statistically significant. Results: In our study, the highest enrolled were grade II HTN (36.7%) followed by normal (33.3%), grade I (20.8%) and grade III (9.2%). Evaluating the ACR status, 19.2% were microalbuminuria, and the rest were normal. Though the ACR status (normal and microalbuminuria) was not statistically significant with HTN status (P=0.860) and the duration of HTN status (P=0.165), 5 (45.5%) out of 11 grade III HTN were microalbuminuria and the prevalence was also higher for longer duration .i.e., more than 10 years. In microalbuminuria, both the SBP (p=0.023, r=0.471) and DBP (P=0.034, r= 0.444) were strongly and positively correlated with Screat, in contrast to eGFR, which was negatively but weakly correlated. With the significant difference between the HTN group, the mean ACR (P=0.047) and UMA (P=0.02) were found to be highest among grade III patients, i.e., 84.3 ± 113.3 mg/gm. and 88.4 ± 83.9 mg/l respectively. The mean eGFR (64.2 ± 24.8 vs 77.2 ± 18.1 ml/min) was considerably lower in microalbuminuria ( p=0.026) than the normal in contrast to the SBP (160 ± 33.7 vs. 146.6 ± 19.5 mm of Hg) which was significantly higher (P=0.008). Among the different BMI category, the mean ACR was found to be significantly different (P= 0.01) with the highest value in underweight (115.2 ± 51.5 mg/gm.) and lowest in overweight (31.8 ± 4.3 mg/gm.). Conclusion: The study recommends that the microalbuminuria can be a very useful and imperative predictor of deranged kidney functions in hypertensive patients. The high value of ACR and UMA in hypertensive patients along with significant increased Screat, SBP whereas decreased eGFR in microalbuminuria patients explicitly supports the above statement.

Keywords: albumin creatinine ratio, hypertension, microalbuminuria, renal disease

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Authors: Cledinaldo A. Dias, Isabela C. Santos, Marcus V. S. Siqueira

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In the contemporary globalization, the competitiveness generated in the search of new markets aiming at the growth of productivity and, consequently, of profits, implies the redefinition of productive processes and new forms of work organization. As a result of this structuring, unemployment, labor force turnover and the increase in outsourcing and informal work occur. Considering the different relationships and working conditions of outsourced employees, this study aims to identify the most present stressors among outsourced service providers from a Federal Institution of Higher Education in Brazil. To reach this objective, a descriptive exploratory study with a quantitative approach was carried out. The qualitative approach was chosen to provide an in-depth analysis of the occupational conditions of outsourced workers since this method seeks to focus on the social as a world of investigated meanings and the language or speech of each subject as the object of this approach. The survey was conducted in the city of Montes Claros - Minas Gerais (Brazil) and involved eighty workers from companies hired by the institution, including armed security guards, porters, cleaners, drivers, gardeners, and administrative assistants. The choice of professionals obeyed non-probabilistic criteria for convenience or accessibility. Data collection was performed by means of a structured questionnaire composed of sixty questions, in a Likert-type frequency interval scale format, in order to identify potential organizational stressors. The results obtained evidence that the stress factors pointed out by the workers are, in most cases, a determining factor due to the low productive performance at work. Amongst the factors associated with stress, the ones that stood out most were those related to organizational communication failures, the incentive to competition, lack of expectations of professional growth, insecurity and job instability. Based on the results, the need for greater concern and organizational responsibility with the well-being and mental health of the outsourced worker and the recognition of their physical and psychological limitations, and care that goes beyond the functional capacity for the work. Specifically for the preservation of mental health, physical and quality of life, it is concluded that it is necessary for the professional to be inserted in the external world that favors it internally since this set is complemented so that the individual remains in balance and obtain satisfaction in your work.

Keywords: occupational health, outsourced, organizational studies, stressors

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Authors: Teagan Fink, Lynn Chong, Michael Hii, Brett Knowles

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Background: Telemedicine is a rapidly advancing field providing healthcare to patients at a distance from their treating clinician. There is a paucity of high-quality evidence detailing the safety and acceptability of telemedicine for postoperative outpatient follow-up. This randomized controlled trial – conducted prior to the COVID 19 pandemic – aimed to assess patient satisfaction and safety (as determined by readmission, reoperation and complication rates) of telephone compared to face-to-face clinic follow-up after uncomplicated general surgical procedures. Methods: Patients following uncomplicated laparoscopic appendicectomy or cholecystectomy and laparoscopic or open umbilical or inguinal hernia repairs were randomized to a telephone or face-to-face outpatient clinic follow-up. Data points including patient demographics, perioperative details and postoperative outcomes (eg. wound healing complications, pain scores, unplanned readmission to hospital and return to daily activities) were compared between groups. Patients also completed a Likert patient satisfaction survey following their consultation. Results: 103 patients were recruited over a 12-month period (21 laparoscopic appendicectomies, 65 laparoscopic cholecystectomies, nine open umbilical hernia repairs, six laparoscopic inguinal hernia repairs and two laparoscopic umbilical hernia repairs). Baseline patient demographics and operative interventions were the same in both groups. Patient or clinician-reported concerns on postoperative pain, use of analgesia, wound healing complications and return to daily activities at clinic follow-up were not significantly different between the two groups. Of the 58 patients randomized to the telemedicine arm, 40% reported high and 60% reported very high patient satisfaction. Telemedicine clinic mean consultation times were significantly shorter than face-to-face consultation times (telemedicine 10.3 +/- 7.2 minutes, face-to-face 19.2 +/- 23.8 minutes, p-value = 0.014). Rates of failing to attend clinic were not significantly different (telemedicine 3%, control 6%). There was no increased rate of postoperative complications in patients followed up by telemedicine compared to in-person. There were no unplanned readmissions, return to theatre, or mortalities in this study. Conclusion: Telemedicine follow-up of patients undergoing uncomplicated general surgery is safe and does not result in any missed diagnosis or higher rates of complications. Telemedicine provides high patient satisfaction and steps to implement this modality in inpatient care should be undertaken.

Keywords: general surgery, telemedicine, patient satisfaction, patient safety

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Authors: Masoume Ehsani, Ning Zhu, Huu Doan, Ali Lohi, Amira Abdelrasoul

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Membrane fouling poses severe challenges in membrane-based wastewater treatment applications. Ultrasound (US) has been considered an effective fouling remediation technique in filtration processes. Bubble cavitation in the liquid medium results from the alternating rarefaction and compression cycles during the US irradiation at sufficiently high acoustic pressure. Cavitation microbubbles generated under US irradiation can cause eddy current and turbulent flow within the medium by either oscillating or discharging energy to the system through microbubble explosion. Turbulent flow regime and shear forces created close to the membrane surface cause disturbing the cake layer and dislodging the foulants, which in turn improve the cleaning efficiency and filtration performance. Therefore, the number, size, velocity, and oscillation pattern of the microbubbles created in the liquid medium play a crucial role in foulant detachment and permeate flux recovery. The goal of the current study is to gain in depth understanding of the influence of the US power intensity and frequency on the microbubble dynamics and its characteristics generated under US irradiation. In comparison with other imaging techniques, the synchrotron in-line Phase Contrast Imaging technique at the Canadian Light Source (CLS) allows in-situ observation and real-time visualization of microbubble dynamics. At CLS biomedical imaging and therapy (BMIT) polychromatic beamline, the effective parameters were optimized to enhance the contrast gas/liquid interface for the accuracy of the qualitative and quantitative analysis of bubble cavitation within the system. With the high flux of photons and the high-speed camera, a typical high projection speed was achieved; and each projection of microbubbles in water was captured in 0.5 ms. ImageJ software was used for post-processing the raw images for the detailed quantitative analyses of microbubbles. The imaging has been performed under the US power intensity levels of 50 W, 60 W, and 100 W, in addition to the US frequency levels of 20 kHz, 28 kHz, and 40 kHz. For the duration of 2 seconds of imaging, the effect of the US power and frequency on the average number, size, and fraction of the area occupied by bubbles were analyzed. Microbubbles’ dynamics in terms of their velocity in water was also investigated. For the US power increase of 50 W to 100 W, the average bubble number and the average bubble diameter were increased from 746 to 880 and from 36.7 µm to 48.4 µm, respectively. In terms of the influence of US frequency, a fewer number of bubbles were created at 20 kHz (average of 176 bubbles rather than 808 bubbles at 40 kHz), while the average bubble size was significantly larger than that of 40 kHz (almost seven times). The majority of bubbles were captured close to the membrane surface in the filtration unit. According to the study observations, membrane cleaning efficiency is expected to be improved at higher US power and lower US frequency due to the higher energy release to the system by increasing the number of bubbles or growing their size during oscillation (optimum condition is expected to be at 20 kHz and 100 W).

Keywords: bubble dynamics, cavitational bubbles, membrane fouling, ultrasonic cleaning

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Authors: Neeraj Vij, Christian Leber, Kenneth Schmidt

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

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

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Authors: Óscar Muñoz Garrigós, José Manuel Bernabeu Aubán

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Time-sensitive services are the base of the cloud services industry. Keeping low service saturation is essential for controlling response time. All auto-scalable services make use of reactive auto-scaling. However, reactive auto-scaling has few in-depth studies. This presentation shows a model for reactive auto-scaling methodologies with a MAPE-k architecture. Queuing theory can compute different properties of static services but lacks some parameters related to the transition between models. Our model uses queuing theory parameters to relate the transition between models. It associates MAPE-k related times, the sampling frequency, the cooldown period, the number of requests that an instance can handle per unit of time, the number of incoming requests at a time instant, and a function that describes the acceleration in the service's ability to handle more requests. This model is later used as a solution to horizontally auto-scale time-sensitive services composed of microservices, reevaluating the model’s parameters periodically to allocate resources. The solution requires limiting the acceleration of the growth in the number of incoming requests to keep a constrained response time. Business benefits determine such limits. The solution can add a dynamic number of instances and remains valid under different system sizes. The study includes performance recommendations to improve results according to the incoming load shape and business benefits. The exposed methodology is tested in a simulation. The simulator contains a load generator and a service composed of two microservices, where the frontend microservice depends on a backend microservice with a 1:1 request relation ratio. A common request takes 2.3 seconds to be computed by the service and is discarded if it takes more than 7 seconds. Both microservices contain a load balancer that assigns requests to the less loaded instance and preemptively discards requests if they are not finished in time to prevent resource saturation. When load decreases, instances with lower load are kept in the backlog where no more requests are assigned. If the load grows and an instance in the backlog is required, it returns to the running state, but if it finishes the computation of all requests and is no longer required, it is permanently deallocated. A few load patterns are required to represent the worst-case scenario for reactive systems: the following scenarios test response times, resource consumption and business costs. The first scenario is a burst-load scenario. All methodologies will discard requests if the rapidness of the burst is high enough. This scenario focuses on the number of discarded requests and the variance of the response time. The second scenario contains sudden load drops followed by bursts to observe how the methodology behaves when releasing resources that are lately required. The third scenario contains diverse growth accelerations in the number of incoming requests to observe how approaches that add a different number of instances can handle the load with less business cost. The exposed methodology is compared against a multiple threshold CPU methodology allocating/deallocating 10 or 20 instances, outperforming the competitor in all studied metrics.

Keywords: reactive auto-scaling, auto-scaling, microservices, cloud computing

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Authors: Rohit Kothari

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Background: Leprosyis a chronic granulomatous diseasecaused by Mycobacterium leprae (M. Lepra). Reactions may interrupt its usual chronic course.Type-1 (T1R)and type-2 lepra reaction(T2R) are acute events and signifytype-IV and type-III hypersensitivity responses, respectively. Various chemokines like CCL3, 5, 11, and CCL24 may be increased during the course of leprosy or during reactions and may serve as markers of early diagnosis, response to therapy, and prognosis. Objective: To find correlation of CCL3, 5, 11, and CCL24 in leprosy patients on multidrug therapy and their family contacts after ruling out active disease during leprosy treatment and during periods of lepra reactions. Methodology: This randomized control trial was conducted in 50 clinico-histopathologically diagnosed cases of leprosy in a tertiary care hospital in Bengaluru, India. 50 of their family contacts were adequately examined and investigated should the need be to rule out active disease. The two study-groups comprised of leprosy cases, and the age, sex, and area of residence matched healthy contactswho were given single-dose rifampicin prophylaxis, respectively. Blood samples were taken at baseline, six months, and after one yearin both the groups (on completion of MDT in leprosy cases)and also during periods of reaction if occurred in leprosy cases. Results: Our study found that at baseline, CCL5, 11, and 24 were higher in leprosy cases as compared to the healthy contacts, and the difference was statistically significant.CCL3 was also found to be higherat baseline in leprosy cases, however, the difference was not statistically significant. At six months and one year, the levels of CCL 5, 11, and 24 reduced, and the difference was statistically significant in leprosy cases, whereas it remained almost static in all the healthy contacts. Twenty patients of leprosy developed lepra reaction during the course of one year, and during reaction, the increase in CCL11 and 24 was statistically significant from baseline, whereas CCL3 and 5 did not rise significantly. One of the healthy contacts developed signs of leprosy in the form of hypopigmented numb patch and was clinico-histopathologically, and CCL11 and 24 were found to be higher with a statistically significant difference from the baseline values. Conclusion: CCL5, 11, and 24 are sensitive markers of diagnosing leprosy, response to MDT, and prognosis and are not increased in healthy contacts. CCL11 and 24 are sensitive markers of lepra reactions and may serve as one of the early diagnostic modalities for identifying lepra reaction and also leprosy in healthy contacts. To the best of our knowledge, this is the first study to evaluate these biomarkers in leprosy cases and their healthy contacts with a follow-up of upto one year with one of them developing the disease, and the same was confirmed based on these biomarkers as well.

Keywords: chemokine profile, healthy contacts, leprosy, lepra reactions

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Authors: Qianxi Lv, Junying Liang

Abstract:

Among the various modes of interpreting, simultaneous interpreting (SI) is regarded as a ‘complex’ and ‘extreme condition’ of cognitive tasks while consecutive interpreters (CI) do not have to share processing capacity between tasks. Given that SI exerts great cognitive demand, it makes sense to posit that the output of SI may be more compromised than that of CI in the linguistic features. The bulk of the research has stressed the varying cognitive demand and processes involved in different modes of interpreting; however, related empirical research is sparse. In keeping with our interest in investigating the quantitative linguistic factors discriminating between SI and CI, the current study seeks to examine the potential lexical simplification, syntactic complexity and sequential organization mechanism with a self-made inter-model corpus of transcribed simultaneous and consecutive interpretation, translated speech and original speech texts with a total running word of 321960. The lexical features are extracted in terms of the lexical density, list head coverage, hapax legomena, and type-token ratio, as well as core vocabulary percentage. Dependency distance, an index for syntactic complexity and reflective of processing demand is employed. Frequency motif is a non-grammatically-bound sequential unit and is also used to visualize the local function distribution of interpreting the output. While SI is generally regarded as multitasking with high cognitive load, our findings evidently show that CI may impose heavier or taxing cognitive resource differently and hence yields more lexically and syntactically simplified output. In addition, the sequential features manifest that SI and CI organize the sequences from the source text in different ways into the output, to minimize the cognitive load respectively. We reasoned the results in the framework that cognitive demand is exerted both on maintaining and coordinating component of Working Memory. On the one hand, the information maintained in CI is inherently larger in volume compared to SI. On the other hand, time constraints directly influence the sentence reformulation process. The temporal pressure from the input in SI makes the interpreters only keep a small chunk of information in the focus of attention. Thus, SI interpreters usually produce the output by largely retaining the source structure so as to relieve the information from the working memory immediately after formulated in the target language. Conversely, CI interpreters receive at least a few sentences before reformulation, when they are more self-paced. CI interpreters may thus tend to retain and generate the information in a way to lessen the demand. In other words, interpreters cope with the high demand in the reformulation phase of CI by generating output with densely distributed function words, more content words of higher frequency values and fewer variations, simpler structures and more frequently used language sequences. We consequently propose a revised effort model based on the result for a better illustration of cognitive demand during both interpreting types.

Keywords: cognitive demand, corpus-based, dependency distance, frequency motif, interpreting types, lexical simplification, sequential units distribution, syntactic complexity

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Authors: Ana Carolina Felizardo Da Silva

Abstract:

People with disabilities are those who have limitations of a physical, mental, intellectual or sensory nature and who, therefore, should not be excluded or marginalized. In Brazil, the Brazilian Law for the Inclusion of People with Disabilities defines that people with disabilities have the right to culture, sport, tourism and leisure on an equal basis with other people. Sport for people with disabilities, in its genesis, had a character aimed at rehabilitating men and soldiers, that is, the male figure who returned wounded from war and needed care. By gaining practitioners, the marketing issue emerges and, successively, high performance, what we call Paralympic sport. We found that sport for people with disabilities was designed for men, corroborating the social idea that sport is a masculine and masculinizing environment. In this way, the inclusion of women with disabilities in sports becomes a double challenge because they are women and have a disability. From data collected from official documents of the International Paralympic Committee, it is found that the first report on the participation of women in the Paralympic Games was in 1948, in England, in Stoke Mandeville, a championship considered the firstborn of the games, later, became called the “Paralympic Games”. However, due to the lack of information, the return of the appearance of women participating in the Paralympics took place after long 40 years, in 1984, which demonstrates a large gap of records on the official website referring to women in the games. Despite the great challenge, the number of women has been growing substantially. When collecting data from participants of all 16 editions of the Paralympic Games, in its last edition, held in Tokyo, out of 4,400 competing athletes, 1,853 were women, which represents 42% of the total number of athletes. In this same edition, we had the largest delegation of Brazilian women, represented by 96 athletes out of a total of 260 Brazilian athletes. It is estimated that in the next edition, to be taken place in Paris in 2024, the participation of women will equal or surpass that of men. The certain invisibility of women participating in the Paralympic Games is noticed when we access the database of the Brazilian Paralympic Committee website. It is possible to identify all women medalists of a given edition. On the other side, participating female athletes who did not medal are not registered on the site. Regarding the participation of Brazilian women in the Paralympics, there was a considerable growth in the last two editions, in 2012 there were only 69 women participating, going to 102 in 2016 and 96 in 2021. The same happened in relation to the medalists, going from 8 Brazilians in 2012 to 33 in 2016 and 27 in 2021. In this sense, the present study, aims to analyze how Brazilian women participate in the Paralympics, giving visibility and voice to female athletes. Structured interviews are being carried out with the participants of the games, identifying the difficulties and potentialities of participating with athletes in the competition. The analysis will be carried out through Bardin’s content analysis.

Keywords: paralympics, sport for people with disabilities, woman, woman in sport

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Authors: Amesh P, Suneesh A S, Venkatesan K A

Abstract:

The magnetic solid-phase extraction is a relatively new method among the other solid-phase extraction techniques for the separating of metal ions from aqueous solutions, such as mine water and groundwater, contaminated wastes, etc. However, the bare magnetic particles (Fe3O4) exhibit poor selectivity due to the absence of target-specific functional groups for sequestering the metal ions. The selectivity of these magnetic particles can be remarkably improved by covalently tethering the task-specific ligands on magnetic surfaces. The magnetic particles offer a number of advantages such as quick phase separation aided by the external magnetic field. As a result, the solid adsorbent can be prepared with the particle size ranging from a few micrometers to the nanometer, which again offers the advantages such as enhanced kinetics of extraction, higher extraction capacity, etc. Conventionally, the magnetite (Fe3O4) particles were prepared by the hydrolysis and co-precipitation of ferrous and ferric salts in aqueous ammonia solution. Since the covalent linking of task-specific functionalities on Fe3O4 was difficult, and it is also susceptible to redox reaction in the presence of acid or alkali, it is necessary to modify the surface of Fe3O4 by silica coating. This silica coating is usually carried out by hydrolysis and condensation of tetraethyl orthosilicate over the surface of magnetite to yield a thin layer of silica-coated magnetite particles. Since the silica-coated magnetite particles amenable for further surface modification, it can be reacted with task-specific functional groups to obtain the functionalized magnetic particles. The surface area exhibited by such magnetic particles usually falls in the range of 50 to 150 m2.g-1, which offer advantage such as quick phase separation, as compared to the other solid-phase extraction systems. In addition, the magnetic (Fe3O4) particles covalently linked on mesoporous silica matrix (MCM-41) and task-specific ligands offer further advantages in terms of extraction kinetics, high stability, longer reusable cycles, and metal extraction capacity, due to the large surface area, ample porosity and enhanced number of functional groups per unit area on these adsorbents. In view of this, the present paper deals with the synthesis of uranium specific diethylenetriamine ligand (DETA) ligand anchored on silica-coated magnetite (Fe-DETA) as well as on magnetic mesoporous silica (MCM-Fe-DETA) and studies on the extraction of uranium from aqueous solution spiked with uranium to mimic the mine water or groundwater contaminated with uranium. The synthesized solid-phase adsorbents were characterized by FT-IR, Raman, TG-DTA, XRD, and SEM. The extraction behavior of uranium on the solid-phase was studied under several conditions like the effect of pH, initial concentration of uranium, rate of extraction and its variation with pH and initial concentration of uranium, effect of interference ions like CO32-, Na+, Fe+2, Ni+2, and Cr+3, etc. The maximum extraction capacity of 233 mg.g-1 was obtained for Fe-DETA, and a huge capacity of 1047 mg.g-1 was obtained for MCM-Fe-DETA. The mechanism of extraction, speciation of uranium, extraction studies, reusability, and the other results obtained in the present study suggests Fe-DETA and MCM-Fe-DETA are the potential candidates for the extraction of uranium from mine water, and groundwater.

Keywords: diethylenetriamine, magnetic mesoporous silica, magnetic solid-phase extraction, uranium extraction, wastewater treatment

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