Search results for: surgical assessment unit

Authors: Fayez Hanna, Viet Tran

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A 20 years old lady- primigravida 6 weeks pregnant with unremarkable past history, presented to the emergency department at the Royal Hobart Hospital, Tasmania, Australia, with hyperemesis gravidarum associated with, dehydration and complicated with hematemesis and chest pain resistant. Accordingly, we conducted laboratory investigations which revealed: FBC: WBC 23.9, unremarkable U&E, LFT, lipase and her VBG showed a pH 7.4, pCo2 36.7, cK+ 3.2, cNa+ 142. The decision was made to do a chest X-ray (CXR) after explaining the risks/benefit of performing radiographic investigations during pregnancy and considering the patient's plan for the termination of the pregnancy as she was not ready for motherhood for shared decision-making and consent to look for pneumoperitoneum to suggest perforated viscus that might cause the hematemesis. However, the CXR showed pneumomediastinum but no evidence of pneumoperitoneum or pneumothorax. Consequently, a decision was made to proceed with CT oesophagography with imaging pre and post oral contrast administration to identify a potential oesophageal tear since it could not be excluded using a plain film of the CXR. The CT oesophagography could not find a leak for the administered oral contrast and thus, no oesophageal tear could be confirmed but could not exclude the Mallory-Weiss tear (lower oesophageal tear). Further, the CT oesophagography showed an extensive pneumomediastinum that could not be confirmed to be pulmonary in origin noting the presence of bilateral pulmonary interstitial emphysema and pneumothorax in the apex of the right lung that was small. The patient was admitted to the Emergency Department Inpatient Unit for monitoring, supportive therapy, and symptomatic management. Her hyperemesis was well controlled with ondansetron 8mg IV, metoclopramide 10mg IV, doxylamine 25mg PO, pyridoxine 25mg PO, esomeprazole 40mg IV and oxycodone 5mg PO was given for pain control and 2 litter of IV fluid. The patient was stabilized after 24 hours and discharged home on ondansetron 8mg every 8 hours whereas the patient had a plan for medical termination of pregnancy. Three weeks later, the patient represented with nausea and vomiting complicated by a frank hematemesis. Her observation chart showed HR 117- other vital signs were normal. Pathology showed WBC 14.3 with normal U&E and Hb. The patient was managed in the Emergency Department with the same previous regimen and was discharged home on same previous regimes. Five days later, she presented again with nausea, vomiting and hematemesis and was admitted under obstetrics and gynaecology for stabilization then discharged home with a plan for surgical termination of pregnancy after 3-days rather than the previously planned medical termination of pregnancy to avoid extension of potential oesophageal tear. The surgical termination and follow up period were uneventful. The case is considered rare as pneumomediastinum is a very rare complication of hyperemesis gravidarum where vomiting-induced barotrauma leads to a ruptured oesophagus and air leak into the mediastinum. However no rupture oesophagus in our case. Although the combination of pneumothorax and pneumomediastinum without oesophageal tear was reported only 8 times in the literature, but none of them was due to hyperemesis gravidarum.

Keywords: Pneumothorax, pneumomediastinum, hyperemesis gravidarum, pneumopericardium

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Authors: Shohreh Ghasemi

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Introduction: Managing oral and maxillofacial trauma is a multifaceted challenge, as it can have life-threatening consequences and significant functional and aesthetic impact. Navigation techniques have been introduced to improve surgical precision to meet this challenge. A machine learning algorithm was also developed to support clinical decision-making regarding treating oral and maxillofacial trauma. Given these advances, this systematic meta-analysis aims to assess the efficacy of navigational techniques in treating oral and maxillofacial trauma and explore the impact of machine learning on their management. Methods: A detailed and comprehensive analysis of studies published between January 2010 and September 2021 was conducted through a systematic meta-analysis. This included performing a thorough search of Web of Science, Embase, and PubMed databases to identify studies evaluating the efficacy of navigational techniques and the impact of machine learning in managing oral and maxillofacial trauma. Studies that did not meet established entry criteria were excluded. In addition, the overall quality of studies included was evaluated using Cochrane risk of bias tool and the Newcastle-Ottawa scale. Results: Total of 12 studies, including 869 patients with oral and maxillofacial trauma, met the inclusion criteria. An analysis of studies revealed that navigation techniques effectively improve surgical accuracy and minimize the risk of complications. Additionally, machine learning algorithms have proven effective in predicting treatment outcomes and identifying patients at high risk for complications. Conclusion: The introduction of navigational technology has great potential to improve surgical precision in oral and maxillofacial trauma treatment. Furthermore, developing machine learning algorithms offers opportunities to improve clinical decision-making and patient outcomes. Still, further studies are necessary to corroborate these results and establish the optimal use of these technologies in managing oral and maxillofacial trauma

Keywords: trauma, machine learning, navigation, maxillofacial, management

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Authors: Malab Sana Balouch, Meenakshi Nayar

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Hemispatial Neglect is a common disorder primarily associated with right hemispheric stroke, in the acute phase of which it can occur up to 82% of the time. Such individuals fail to acknowledge or respond to people and objects in their left field of vision due to deficits in attention and awareness. Persistent hemispatial neglect significantly impedes post-stroke recovery, leading to longer hospital stays post-stroke, increased functional dependency, longer-term disability in ADLs and increased risk of falls. Recently, evidence has emerged for the use of dopamine agonist Rotigotine in neglect. The aim of our Quality Improvement Project (QIP) is to evaluate and better the current protocols and practice in assessment, documentation and management of neglect and rotigotine use at the Neurorehabilitation unit at Charing Cross Hospital (CNRU). In addition, it brings light to rotigotine use in the management of hemispatial neglect and paves the way for future research in the field. Our QIP was based in the CNRU. All patients admitted to the CNRU suffering from a right-sided stroke from 2nd of February 2018 to the 2nd of February 2021 were included in the project. Each patient’s multidisciplinary team report and hospital notes were searched for information, including bio-data, fulfilment of the inclusion criteria (having hemispatial neglect) and data related to rotigotine use. This includes whether or not the drug was administered, any contraindications to drug in patients that did not receive it, and any therapeutic benefits(subjective or objective improvement in neglect) in those that did receive the rotigotine. Data was simultaneously entered into excel sheet and further statistical analysis was done on SPSS 20.0. Out of 80 patients suffering from right sided strokes, 72.5% were infarcts and 27.5% were hemorrhagic strokes, with vast majority of both types of strokes were in the middle cerebral artery territory (MCA). A total of 31 (38.8%) of our patients were noted to have hemispatial neglect, with the highest number of cases being associated with MCA strokes. Almost half of our patients with MCA strokes suffered from neglect. Neglect was more common in male patients. Out of the 31 patients suffering from visuospatial neglect, only 16% actually received rotigotine and 80% of them were noted to have an objective improvement in their neglect tests and 20% revealed subjective improvement. After thoroughly going through neglect-associated documentation, the following recommendations/plans were put in place for the future. We plan to liaise with the occupational therapy team at our rehab unit to set a battery of tests that would be done on all patients presenting with neglect and recommend clear documentation of outcomes of each neglect screen under it. Also to create two proformas; one for the therapy team to aid in systematic documentation of neglect screens done prior to and after rotigotine administration and a second proforma for the medical team with clear documentation of rotigotine use, its benefits and any contraindications if not administered.

Keywords: hemispatial Neglect, right hemispheric stroke, rotigotine, neglect, dopamine agonist

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Authors: Livia Eisler, Cristiane C. B. Alves, Cristina L. F. Ortolani, Kurt Faltin Jr.

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Purpose: This paper proposes a technically simple diagnosis method among orthodontists and maxillofacial surgeons in order to evaluate discrete bone alterations. The methodology consists of a protocol to optimize the diagnosis and minimize the possibility for orthodontic and ortho-surgical retreatment. Materials and Methods: A protocol of image processing and analysis, through ImageJ software and its plugins, was applied to 20 pairs of lateral cephalometric images obtained from cone beam computerized tomographies, before and 1 year after undergoing orthognathic surgery. The optical density of the images was analyzed in the condylar region to determine possible bone alteration after surgical correction. Results: Image density was shown to be altered in all image pairs, especially regarding the condyle contours. According to measures, condyle had a gender-related density reduction for p=0.05 and condylar contours had their alterations registered in mm. Conclusion: A simple, viable and cost-effective technique can be applied to achieve the more detailed image-based diagnosis, not depending on the human eye and therefore, offering more reliable, quantitative results.

Keywords: bone resorption, computer-assisted image processing, orthodontics, orthognathic surgery

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Authors: Thitaporn Thoopputra, Tipaporn Pongmesa, Shuchuen Li

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Aims: To evaluate the application of non-invasive diabetes risk assessment tool in community pharmacy setting. Methods: Thai diabetes risk score was applied to assess individuals at risk of developing type 2 diabetes. Interactive computer-based risk screening (IT) and paper-based risk screening (PT) tools were applied. Participants aged over 25 years with no known diabetes were recruited in six participating pharmacies. Results: A total of 187 clients, mean aged (+SD) was 48.6 (+10.9) years. 35% were at high risk. The mean value of willingness-to-pay for the service fee in IT group was significantly higher than PT group (p=0.013). No significant difference observed for the satisfaction between groups. Conclusions: Non-invasive risk assessment tool, whether paper-based or computerized-based can be applied in community pharmacy to support the enhancing role of pharmacists in chronic disease management. Long term follow up is needed to determine the impact of its application in clinical, humanistic and economic outcomes.

Keywords: community pharmacy, intervention, prevention, risk assessment, type 2 diabetes

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Authors: S. Kaira, S. Mohamed, A. Rahman

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Traditionally, highway infrastructure projects are initiated based on their economic benefits, thereafter environmental, social and governance impacts are addressed discretely for the selected project from a set of pre-determined alternatives. When opting for cost-benefit analysis (CBA), multi-criteria decision-making (MCDM) has been used as the default assessment tool. But this tool has been critiqued as it does not mimic the real-world dynamic environment. Indeed, it is because of the fact that public sector projects like highways have to experience intense exposure to dynamic environments. Therefore, it is essential to appreciate the impacts of various dynamic factors (factors that change or progress with the system) on project performance. Thus, this paper presents various sustainability assessment tools that have been globally developed to determine sustainability performance of infrastructure projects during the design, procurement and commissioning phase. Indeed, identification of the current gaps in the available assessment methods provides a potential to add prominent part of knowledge in the field of ‘road project development systems and procedures’ that are generally used by road agencies.

Keywords: dynamic impact factors, micro and macro factors, sustainability assessment framework, sustainability performance

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Authors: A. Fathianpour, M. B. Jelodar, S. Wilkinson

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This paper outlines the approaches taken to assess multi-hazard assessments. There is currently confusion in assessing multi-hazard impacts, and so this study aims to determine which of the available options are the most useful. The paper uses an international literature search, and analysis of current multi-hazard assessments and a case study to illustrate the effectiveness of the chosen method. Findings from this study will help those wanting to assess multi-hazards to undertake a straightforward approach. The paper is significant as it helps to interpret the various approaches and concludes with the preferred method. Many people in the world live in hazardous environments and are susceptible to disasters. Unfortunately, when a disaster strikes it is often compounded by additional cascading hazards, thus people would confront more than one hazard simultaneously. Hazards include natural hazards (earthquakes, floods, etc.) or cascading human-made hazards (for example, Natural Hazard Triggering Technological disasters (Natech) such as fire, explosion, toxic release). Multi-hazards have a more destructive impact on urban areas than one hazard alone. In addition, climate change is creating links between different disasters such as causing landslide dams and debris flows leading to more destructive incidents. Much of the prevailing literature deals with only one hazard at a time. However, recently sophisticated multi-hazard assessments have started to appear. Given that multi-hazards occur, it is essential to take multi-hazard risk assessment under consideration. This paper aims to review the multi-hazard assessment methods through articles published to date and categorize the strengths and disadvantages of using these methods in risk assessment. Napier City is selected as a case study to demonstrate the necessity of using multi-hazard risk assessments. In order to assess multi-hazard risk assessments, first, the current multi-hazard risk assessment methods were described. Next, the drawbacks of these multi-hazard risk assessments were outlined. Finally, the improvements to current multi-hazard risk assessments to date were summarised. Generally, the main problem of multi-hazard risk assessment is to make a valid assumption of risk from the interactions of different hazards. Currently, risk assessment studies have started to assess multi-hazard situations, but drawbacks such as uncertainty and lack of data show the necessity for more precise risk assessment. It should be noted that ignoring or partial considering multi-hazards in risk assessment will lead to an overestimate or overlook in resilient and recovery action managements.

Keywords: cascading hazards, disaster assessment, mullti-hazards, risk assessment

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Authors: Oluwabukola Oluwaseyi Oduntan

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The English Language plays a central and strategic role in the school system because almost all the school subjects are taught using the English language. However, students’ achievement in this subject at senior secondary school is not encouraging. Therefore, this study examined the effects of oral-written mode of assessment on senior secondary school students’ achievement in a descriptive essay. It also examined the moderating effects of students’ gender and class on students’ achievement in a descriptive essay. The study adopted a pretest-posttest, control group, quasi-experimental design with a 2x2x3 factorial matrix. The participant consisted of 140 Senior Secondary II students drawn from four intact classes from four schools randomly selected from four Local Government Areas randomly selected from Oyo town in Oyo State. Two schools were assigned each to the treatment group and the control group. The following instruments were used for the study: Descriptive Essay Achievement Test (r = 0.78); Descriptive Achievement Test Marking Scheme; Check List of Oral-Written Assessment and Teachers’ Instructional Guide on Descriptive Essay (r = 0.81). Seven null hypotheses guided the study and tested at 0.05 level of significance. Data were analyzed using Analysis of Covariance, Estimated Marginal Means and Scheffe post-hoc test. The result revealed that treatment had a significant main effect on students’ achievement in descriptive essay (F(1,127) = 25.407, P < .05, η2 = .167). Students exposed to oral-written assessment had a higher achievement scores ((x ) ̅= 36.15) than those exposed to written assessment ((x ) ̅= 28.55). There was no significant main effect of gender on students’ achievement in descriptive essay (F₍₁, ₁₂₇₎ = .349, P > .05, η2 = .003). The result also revealed that the effects of class was not significant on students’ students’ achievement in descriptive essay (F₍₁, ₁₂₇₎ = .679, P > .05, η2 = .006). Oral-written mode of assessment enhanced students’ achievement in a descriptive essay. It is, therefore, recommended that teachers and curriculum developers should adopt the use of oral-written assessment for better improvement of students’ achievement in a descriptive essay.

Keywords: class, gender, oral-written assessment, written assessment

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Authors: Farzad Pargar

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We introduce the preventive maintenance and renewal scheduling problem for a multi-unit system over a finite and discretized time horizon. Given the latest possible time for carrying out the next maintenance and renewal projects after the previous ones and considering several common set-up costs, the introduced scheduling model tries to minimize the cost of projects by grouping them and simultaneously finding the optimal balance between doing maintenance and renewal. We present a 0-1 pure integer linear programming that determines which projects should be performed together on which location and in which period (e.g., week or month). We consider railway track as a case for our study and test the performance of the proposed model on a set of test problems. The experimental results show that the proposed approach performs well.

Keywords: maintenance, renewal, scheduling, mathematical programming model

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Authors: João Madureira, Ricardo Lagido, Inês Sousa, Fraunhofer Portugal

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Surf is an increasingly popular sport and its performance evaluation is often qualitative. This work aims at using a smartphone to collect and analyze the GPS and inertial sensors data in order to obtain quantitative metrics of the surfing performance. Two approaches are compared for detection of wave rides, computing the number of waves rode in a surfing session, the starting time of each wave and its duration. The first approach is based on computing the velocity from the Global Positioning System (GPS) signal and finding the velocity thresholds that allow identifying the start and end of each wave ride. The second approach adds information from the Inertial Measurement Unit (IMU) of the smartphone, to the velocity thresholds obtained from the GPS unit, to determine the start and end of each wave ride. The two methods were evaluated using GPS and IMU data from two surfing sessions and validated with similar metrics extracted from video data collected from the beach. The second method, combining GPS and IMU data, was found to be more accurate in determining the number of waves, start time and duration. This paper shows that it is feasible to use smartphones for quantification of performance metrics during surfing. In particular, detection of the waves rode and their duration can be accurately determined using the smartphone GPS and IMU.

Keywords: inertial measurement unit (IMU), global positioning system (GPS), smartphone, surfing performance

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Authors: Mehdi Attia, Sana Ben Fadhel, Lamjed Bettaieb

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Mobile technology has become a part of our daily lives and assist learners (despite their level and age) in their leaning process using various apparatus and mobile devices (laptop, tablets, etc.). This paper presents a new learning framework based on tablets. This solution has been developed and tested in ESPRIT “Ecole Supérieure Privée d’Igénieurie et de Technologies”, a Tunisian school of engineering. This application is named ESSF: Esprit Smart School Framework. In this work, the main features of the proposed solution are listed, particularly its impact on the learners’ evaluation process. Learner’s assessment has always been a critical component of the learning process as it measures students’ knowledge. However, traditional evaluation methods in which the learner is evaluated once or twice each year cannot reflect his real level. This is why a continuous assessment (CA) process becomes necessary. In this context we have proved that ESSF offers many important features that enhance and facilitate the implementation of the CA process.

Keywords: continuous assessment, mobile learning, tablet based learning, smart school, ESSF

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Authors: Mehtap Dursun, Zeynep Şener

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Supplier selection is considered as one of the most critical issues encountered by operations and purchasing managers to sharpen the company’s competitive advantage. In this paper, a novel fuzzy multi-criteria group decision making approach integrating quality function deployment (QFD) and decision making trial and evaluation laboratory (DEMATEL) method is proposed for supplier selection. The proposed methodology enables to consider the impacts of inner dependence among supplier assessment criteria. A house of quality (HOQ) which translates purchased product features into supplier assessment criteria is built using the weights obtained by DEMATEL approach to determine the desired levels of supplier assessment criteria. Supplier alternatives are ranked by a distance-based method.

Keywords: DEMATEL, group decision making, QFD, supplier selection

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Authors: Emine Feyza Şükür, Mevlüt Türköz, Murat Dilmeç, Hüseyin Selçuk Halkacı

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In this study, a warm bulge test system was designed, built and experimentally validated to perform warm bulge tests with all necessary systems. In addition, performance of each sub-system is validated through repeated production and/or test runs as well as through part quality measurements. Validation and performance tests were performed to characterize the repeatability of the system. As a result of these tests, the desired temperature distribution on the sheet metal was obtained by the heating systems and the good repeatability of the bulge tests was obtained. Consequently, this study is expected to provide other researchers and manufacturer with a set of design and process guidelines to develop similar systems.

Keywords: design, test unit, warm bulge test unit, validation test

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Authors: Yanuarti Retnaningrum, Cendrawasih A. Farmasyanti, Kuswahyuning

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Orthodontists find challenges in treating patients who have cases of macroglossia and multiple tooth agenesis because difficulties in determining the causes, formulating a diagnosis and the potential for relapse after treatment. Definition of macroglossia is a tongue enlargement due to muscle hypertrophy, tumor or an endocrine disturbance. Macroglossia may cause many problems such as anterior proclination of upper and lower incisors, development of general diastema and anterior and/ or posterior open bite. Treatment for such patients with multiple tooth agenesis and macroglossia can be complex and must consider orthodontic and/or surgical interventions. This article discusses an orthodontic non surgical approach to a patient with a general diastema in both maxilla and mandible associated with multiple tooth agenesis and macroglossia. Fixed orthodontic therapy with straightwire appliance was used for space closure in anterior region of maxilla and mandible, also to create a space suitable for future prosthetic restoration. After 12 months treatment, stable and functional occlusal relationships was achieved, although still have edentulous area in both maxilla and mandible. At the end of the orthodontic treatment was obtained with correct overbite and overjet values. After removal of the brackets, a maxillary and mandibular removable retainer combine with artificial tooth were placed for retention.

Keywords: general diastema, macroglossia, space closure, tooth agenesis

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Authors: Nicholas Bayfield, Liam Bibo, Kaushelandra Rathore, Lucas Sanders, Mark Newman

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INTRODUCTION: Surgical pulmonary embolectomy is an established therapy for acute pulmonary embolism causing right heart dysfunction and haemodynamic instability. Massive intraoperative airway haemorrhage is a rare complication of pulmonary embolectomy. We present our institutional experience with massive airway haemorrhage complicating pulmonary embolectomy and discuss optimal therapeutic strategies. METHODS: A retrospective review of emergent surgical pulmonary embolectomy patients was undertaken. Cases complicated by massive intra-operative airway haemorrhage were identified. Intra- and peri-operative management strategies were analysed and discussed. RESULTS: Of 76 patients undergoing emergent or salvage pulmonary embolectomy, three cases (3.9%) of massive intraoperative airway haemorrhage were identified. Haemorrhage always began on weaning from cardiopulmonary bypass. Successful management strategies involved intraoperative isolation of the side of bleeding, occluding the affected airway with an endobronchial blocker, institution of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) and reversal of anticoagulation. Running the ECMO without heparinisation allows coagulation to occur. Airway haemorrhage was controlled within 24 hours of operation in all patients, allowing re-institution of dual lung ventilation and decannulation from ECMO. One case in which positive end-expiratory airway pressure was trialled initially was complicated by air embolism. Although airway haemorrhage was controlled successfully in all cases, all patients died in-hospital for reasons unrelated to the airway haemorrhage. CONCLUSION: Massive intraoperative airway haemorrhage during pulmonary embolectomy is a rare complication with potentially catastrophic outcomes. Re-perfusion alveolar and capillary injury is the likely aetiology. With a systematic approach to management, airway haemorrhage can be well controlled intra-operatively and often resolves within 24 hours. Stopping blood flow to the pulmonary arteries and support of oxygenation by the institution of VA ECMO is important. This management has been successful in our 3 cases.

Keywords: pulmonary embolectomy, cardiopulmonary bypass, cardiac surgery, pulmonary embolism

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

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

Keywords: zaleplon, alprazolam, premedication, abdominal surgery

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Authors: Ching-Yuan Chen, Lung-Kwang Pan

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Objective: Back pain is a major health problem costing billions of health budgets annually in Taiwan. Thousands of back pain surgeries are performed annually with up to 40% of patients complaining of back pain at time of post-surgery causing failed back surgery syndrome (FBSS), although diagnosis in these patients may be complex. The aim of study is to assess the feasibility of using bone SPECT-CT imaging to localize the active lesions causing persistent, recurrent or new backache after spine surgery. Materials and Methods: Bone SPECT-CT imaging was performed after the intravenous injection of 20 mCi of 99mTc-MDP for all the patients with diagnosis of FBSS. Patients were evaluated using status of subjectively pain relief, functional improvement and degree of satisfaction by reviewing the medical records and questionnaires in a 2 more years’ follow-up. Results: We enrolled a total of 16 patients were surveyed in our hospital from Jan. 2015 to Dec. 2016. Four people on SPEC/CT imaging ensured significant lesions were undergone a revised surgery (surgical treatment group). The mean visual analogue scale (VAS) decreased 5.3 points and mean Oswestry disability index (ODI) improved 38 points in the surgical group. The remaining 12 on SPECT/CT imaging were diagnosed as no significant lesions then received drug treatment (medical treatment group). The mean VAS only decreased 2 .1 point and mean ODI improved 12.6 points in the medical treatment group. In the posttherapeutic evaluation, the pain of the surgical treatment group showed a satisfactory improvement. In the medical treatment group, 10 of the 12 were also satisfied with the symptom relief while the other 2 did not improve significantly. Conclusions: Findings on SPECT-CT imaging appears to be easily explained the patients' pain. We recommended that SPECT/CT imaging was a feasible and useful clinical tool to improve diagnostic confidence or specificity when evaluating patients with FBSS.

Keywords: failed back surgery syndrome, oswestry disability index, SPECT-CT imaging, 99mTc-MDP, visual analogue scale

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Authors: Taleb Hosni Abderrahmane, Berga Abdelmadjid

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The development of numerical analysis and its application to geomechanics problems have provided geotechnical engineers with extremely powerful tools. One of the most important problems in geotechnical engineering is the slope stability assessment. It is a very difficult task due to several aspects such the nature of the problem, experimental consideration, monitoring, controlling, and assessment. The main objective of this paper is to perform a comparative numerical study between the following methods: The Limit Equilibrium (LEM), Finite Element (FEM), Limit Analysis (LAM) and Distinct Element (DEM). The comparison is conducted in terms of the safety factors and the critical slip surfaces. Through the results, we see the feasibility to analyse slope stability by many methods.

Keywords: comparison, factor of safety, geomechanics, numerical methods, slope analysis, slip surfaces

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Authors: Modupe C. Alasa

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One of the major parameters for ensuring a country’s economic growth and development is the extent to which the citizens are involved in agriculture. The general objective of this study is to determine the assessment of vocational rehabilitation of visually impaired persons in poultry farming at blind center, Ogbomoso, Nigeria. A total number of 70 students will be selected randomly through the use of structured questionnaire out of the total number of students which is 120. Data will be collected from the farmers’ personal characteristics and other specific objectives related to the work. The results will be analyzed with the use of simple statistical tools as frequency, percentage, means and standard deviations. Conclusion and recommendations will be suggested based on result findings of the study.

Keywords: assessment, impair, poultry, rehabilitation, vocational

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Authors: Ahmed Gendia, Waseem Kamran

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Objective: Total Laparoscopic hysterectomy (TLH) remains a common approach among laparoscopic surgeons. However, this approach depends on the use of uterine manipulator to facilitate the surgery. Although many studies reported the effectiveness of TLH with uterine manipulator, only few reported TLH without the use of any uterine or vaginal manipulation. the aim of this report is to demonstrate our Technique (kamran's TLH) in performing TLH without the use of any uterine or vaginal manipulation in benign conditions and report our intra- and post-operative outcomes. Methodology : surgical technique will be demonstrated through a short video highlighting the easy and safe to learn surgical steps. Additionally, the data of 86 patients who underwent KTLH for benign condition were retrospectively analyzed. the data included intra- and postoperative finding and complications. Results : A total of 86 hysterectomies were performed utilizing the Kamran's TLH ( KTHL). Mean age was 52.2 (±11) years old and BMI was 28.2(±7). Mean operative time was 64.7(±27.9) minutes and estimated bloods loss was 46.2(±54.6) ml. No intraoperative complications were recorded and there was no conversion to open surgery. Only one patient required readmission and surgery for vaginal vault dehiscence. Conclusion & Significance: Uterine manipulator is a key component in performing laparoscopic hysterectomy. However, our approach demonstrated that TLH can be safely performed without the use of any uterine or vaginal manipulation.

Keywords: laparoscopic hystrectomy, TLH, uterine manipulator, surgery

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Authors: Vadood Mobini, Mansoreh Agazadeh Shahrivar, Parvin Hashemi Gelenjkhanlo, Hassan Vazifah

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Seed number is a function of dry matter accumulation, crop growth rate (CGR), photothermal quotient (PTQ) and temperature during a critical developmental period, which is around flowering in canola (Brassica napus L.). The objective of this experiment was to determine factors such as dry matter, CGR, temperature, and PTQ around flowering which affect seed number. The experiment was conducted at Agricultural Research Station of Gonbad, Iran, between 2005 and 2007. Two cultivars of canola (Hyola401 and RGS003), as subplots were grown at 5 sowing dates as main plots, spaced approximately 30 days apart, to obtain different environmental conditions during flowering. The experiment was arranged in two conditions, i.e., supplemental irrigation and rainfed. Seed number per unit area was a key factor for increasing seed yield. Late sowing dates made the critical period of flowering coincide with high temperatures, decreased days to the flowering, seed number per unit area and seed yield. Seed number was driven by the availability of carbohydrates around flowering. Seed number per unit area was maximized for the cultivars when exposed to the highest PTQ, and to the lowest temperature between the beginning of flowering to that of seed filling. The relationship of seed number with aboveground dry matter, CGR, temperature, and PTQ around flowering, over different environmental conditions, showed these variables were generally applicable to seed number determination.

Keywords: flowering, cultivar, seed filling, environmental conditions, seed yield

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Authors: Sunghyoun Lee, Byeongkee Yu, Chanjung Lee, Yeongtaek Lim

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Oyster mushrooms are one of the ingredients that Koreans prefer. The oyster mushroom cultivation house has multiple layers in order to increase the mushroom production per unit area. However, the growing shelves in the house act as obstacles and hinder the circulation of the interior air, which leads to the difference of cultivation environment between the upper part and lower part of the growing shelves. Due to this difference of environments, growth distinction occurs according to the area of the growing shelves. It is known that minute air circulation around the mushroom cap facilitates the metabolism of mushrooms and improves its quality. This study has utilized the computational fluid dynamics (CFD) program, that is, FLUENT R16, in order to analyze the improvement of the internal environment uniformity of the oyster mushroom cultivation house. The analyzed factors are velocity distribution, temperature distribution, and humidity distribution. In order to maintain the internal environment uniformity of the oyster mushroom cultivation house, it appeared that installing circulation fan at the upper part of the working passage towards the ceiling is effective. When all the environmental control equipment – unit cooler, inlet fan, outlet fan, air circulation fan, and humidifier - operated simultaneously, the RMS figure on the growing shelves appeared as follows: velocity 28.23%, temperature 30.47%, humidity 7.88%. However, when only unit cooler and air circulation fan operated, the RMS figure on the growing shelves appeared as follows: velocity 22.28%, temperature 0.87%, humidity 0.82%. Therefore, in order to maintain the internal environment uniformity of the mushroom cultivation house, reducing the overall operating time of inlet fan, outlet fan, and humidifier is needed, and managing the internal environment with unit cooler and air circulation fan appropriately is essential.

Keywords: air circulation fan, computational fluid dynamics, multi-layered shelves cultivation, oyster mushroom cultivation house

Procedia PDF Downloads 185

Authors: Fauziah Aziz, Mohd.fadzil Arshad, Hazrina Mansor, Sedat Kömürcü

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Masonry is an isotropic and heterogeneous material due to the presence of the different components within the assembly process. Normally the mortar plays a significant role in the compressive behavior of the traditional masonry structures. Biaxial interlocking concrete block is a masonry unit that comes out with the interlocking concept. This masonry unit can improve the quality of the construction process, reduce the cost of labor, reduce high skill workmanship, and speeding the construction time. Normally, the interlocking concrete block masonry unit in the market place was designed in a way interlocking concept only either x or y-axis, shorter in length, and low compressive strength value. However, the biaxial interlocking concrete block is a dry-stack concept being introduced in this research, offered the specialty compared to the normal interlocking concrete available in the market place due to its length and the geometry of the groove and tongue. This material can be used as a non-load bearing wall, or load-bearing wall depends on the application of the masonry. But, there is a lack of technical data that was produced before. This paper presents a finding on the compressive resistance of the biaxial interlocking concrete block masonry wall compared to the other traditional masonry walls. Two series of biaxial interlocking concrete block masonry walls, namely M1 and M2, a series of solid concrete block and cement sand brick walls M3, and M4 have tested the compressive resistance. M1 is the masonry wall of a hollow biaxial interlocking concrete block meanwhile; M2 is the grouted masonry wall, M3 is a solid concrete block masonry wall, and M4 is a cement sand brick masonry wall. All the samples were tested under static compressive load. The results examine that M2 is higher in compressive resistance compared to the M1, M3, and M4. It shows that the compressive strength of the concrete masonry units plays a significant role in the capacity of the masonry wall.

Keywords: interlocking concrete block, compressive resistance, concrete masonry unit, masonry

Procedia PDF Downloads 152

Authors: Evangelos G. Ilias, Panagiotis G. Ilias, Vasileios T. Popotas

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The United Kingdom has one of the oldest railway networks in the world dating back to 1825 when the world’s first passenger railway was opened. The network has some 40,000 bridges of various construction types using a wide range of materials including masonry, steel, cast iron, wrought iron, concrete and timber. It is commonly accepted that the successful operation of the network is vital for the economy of the United Kingdom, consequently the cost effective maintenance of the existing infrastructure is a high priority to maintain the operability of the network, prevent deterioration and to extend the life of the assets. Every bridge on the railway network is required to be assessed every eighteen years and a structured approach to assessments is adopted with three main types of progressively more detailed assessments used. These assessment types include Level 0 (standardized spreadsheet assessment tools), Level 1 (analytical hand calculations) and Level 2 (generally finite element analyses). There is a degree of conservatism in the first two types of assessment dictated to some extent by the relevant standards which can lead to some structures not achieving the required load rating. In these situations, a Level 2 Assessment is often carried out using finite element analysis to uncover ‘latent strength’ and improve the load rating. If successful, the more sophisticated analysis can save on costly strengthening or replacement works and avoid disruption to the operational railway. This paper presents the ‘strengthening by assessment’ achieved by Level 2 analyses. The use of more accurate analysis assumptions and the implementation of non-linear modelling and functions (material, geometric and support) to better understand buckling modes and the structural behaviour of historic construction details that are not specifically covered by assessment codes are outlined. Metallic bridges which are susceptible to loss of section size through corrosion have largest scope for improvement by the Level 2 Assessment methodology. Three case studies are presented, demonstrating the effectiveness of the sophisticated Level 2 Assessment methodology using finite element analysis against the conservative approaches employed for Level 0 and Level 1 Assessments. One rail overbridge and two rail underbridges that did not achieve the required load rating by means of a Level 1 Assessment due to the inadequate restraint provided by U-Frame action are examined and the increase in assessed capacity given by the Level 2 Assessment is outlined.

Keywords: assessment, bridges, buckling, finite element analysis, non-linear modelling, strengthening

Procedia PDF Downloads 294

Authors: Pirom Thangchitpianpol, Suttipong Jumroonrut

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This research investigates the distribution of food demand for animal food and the optimum amount of that food production at minimum cost. The data consist of customer purchase orders for the food of laying hens, price of food for laying hens, cost per unit for the food inventory, cost related to food of laying hens in which the food is out of stock, such as fine, overtime, urgent purchase for material. They were collected from January, 1990 to December, 2013 from a factory in Nakhonratchasima province. The collected data are analyzed in order to explore the distribution of the monthly food demand for the laying hens and to see the rate of inventory per unit. The results are used in a stochastic linear programming model for aggregate planning in which the optimum production or minimum cost could be obtained. Programming algorithms in MATLAB and tools in Linprog software are used to get the solution. The distribution of the food demand for laying hens and the random numbers are used in the model. The study shows that the distribution of monthly food demand for laying has a normal distribution, the monthly average amount (unit: 30 kg) of production from January to December. The minimum total cost average for 12 months is Baht 62,329,181.77. Therefore, the production planning can reduce the cost by 14.64% from real cost.

Keywords: animal food, stochastic linear programming, aggregate planning, production planning, demand uncertainty

Procedia PDF Downloads 361

Authors: I-Ling Chang, Jer-An Chen

Abstract:

The elastic properties and fracture of two-dimensional graphene were calculated purely from the atomic bonding (stretching and bending) based on molecular mechanics method. Considering the representative unit cell of graphene under various loading conditions, the deformations of carbon bonds and the variations of the interlayer distance could be realized numerically under the geometry constraints and minimum energy assumption. In elastic region, it was found that graphene was in-plane isotropic. Meanwhile, the in-plane deformation of the representative unit cell is not uniform along armchair direction due to the discrete and non-uniform distributions of the atoms. The fracture of graphene could be predicted using fracture criteria based on the critical bond length, over which the bond would break. It was noticed that the fracture behavior were directional dependent, which was consistent with molecular dynamics simulation results.

Keywords: energy minimization, fracture, graphene, molecular mechanics

Procedia PDF Downloads 383

Authors: Murat Gunduz, Mustafa Ozdemir

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In this research, a framework is to be proposed to model the safety performance in construction sites. Determinants of safety performance are to be defined through extensive literature review and a multidimensional safety performance model is to be developed. In this context, a questionnaire is to be administered to construction companies with sites. The collected data through questionnaires including linguistic terms are then to be defuzzified to get concrete numbers by using fuzzy set theory which provides strong and significant instruments for the measurement of ambiguities and provides the opportunity to meaningfully represent concepts expressed in the natural language. The validity of the proposed safety performance model, relationships between determinants of safety performance are to be analyzed using the structural equation modeling (SEM) which is a highly strong multi variable analysis technique that makes possible the evaluation of latent structures. After validation of the model, a safety performance index assessment tool is to be proposed by the help of software. The proposed safety performance assessment tool will be based on the empirically validated theoretical model.

Keywords: Fuzzy set theory, safety performance assessment, safety index, structural equation modeling (SEM), construction sites

Procedia PDF Downloads 499

Authors: Alisher Agzamov, Hanan Al Harbi

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BACKGROUND: The timely assessment and treatment of ICU Surgical and Medical Oncology patients is important for Oncology surgeons and Medical Oncologists and Intensivists. We hypothesized that the use of Robot Physician’s (RP - 7) ICU management and care in ICU can improve ICU physician rapid response to unstable ICU Oncology patients. METHODS: This is a prospective study using a before-after, cohort-control design to test the effectiveness of RP. We have used RP to make multidisciplinary ICU rounds in the ICU and for Emergency cases. Data concerning several aspects of the RP interaction including the latency of the response, the problem being treated, the intervention that was ordered, and the type of information gathered using the RP were documented. The effect of RP on ICU length of stay and cost was assessed. RESULTS: The use of RP was associated with a reduction in latency of attending physician face-to-face response for routine and urgent pages compared to conventional care (RP: 10.2 +/- 3.3 minutes vs conventional: 220 +/- 80 minutes). The response latencies to Oncology Emergency (8.0 +/- 2.8 vs 150 +/- 55 minutes) and for Respiratory Failure (12 +/- 04 vs 110 +/- 45 minutes) were reduced (P < .001), as was the LOS for patients with AML (5 days) and ARDS (10 day). There was an increase in ICU occupancy by 20 % compared with the prerobot era, and there was an ICU cost savings of KD2.5 million attributable to the use of RP. CONCLUSION: The use of RP enabled rapid face-to-face ICU Intensivist - physician response to unstable ICU Oncology patients and resulted in decreased ICU cost and LOS.

Keywords: robot physician, oncology patients, rp - 7 in icu management, cost and icu occupancy

Procedia PDF Downloads 61

Authors: Argaw T. Gurmu, Muhammad N. Mahmood

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The objective of this research is to identify the architecture and construction management students’ learning challenges of the building measurement. This research used the survey data obtained collected from the students who completed the building measurement unit. NVivo qualitative data analysis software was used to identify relevant themes. The analysis of the qualitative data revealed the major learning difficulties such as inadequacy of practice questions for the examination, inability to work as a team, lack of detailed understanding of the prerequisite units, insufficiency of the time allocated for tutorials and incompatibility of lecture and tutorial schedules. The output of this research can be used as a basis for improving the teaching and learning activities in construction measurement units.

Keywords: building measurement, construction management, learning challenges, evaluate survey

Procedia PDF Downloads 123

Authors: Leonore Robieux, Franck Zenasni, Marc Pocard, Clarisse Eveno

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Empirical data in health psychology studies show the necessity to consider the doctor-patient communication and its positive impact on outcomes such as patients’ satisfaction, treatment adherence, physical and psychological wellbeing. In this line, the present research aims to define the role and determinants of an effective doctor–patient communication during the treatment of patients with serious illness (peritoneal carcinomatosis). We carried out a prospective longitudinal study including patients treated for peritoneal carcinomatosis of various origins. From November 2016, to date, data were collected using validated questionnaires at two times of evaluation: one month before the surgery (T0) and one month after (T1). Thus, patients reported their (a) anxiety and depression levels, (b) standardized and individualized quality of life and (c) how they perceived communication, attitude and empathy of the surgeon. 105 volunteer patients (Mean age = 58.18 years, SD = 10.24, 62.2% female) participated to the study. PC arose from rare diseases (14%), colorectal (38%), eso-gastric (24%) and ovarian (8%) cancer. Three groups are defined according to the severity of their pathology and the treatment offered to them: (1) important surgical treatment with the goal of healing (53%), (2) repeated palliative surgical treatment (17%), and (3) the patients recused for surgical treatment, only palliative approach (30%). Results are presented according to Baron and Kenny recommendations. The regressions analyses show that only depression and anxiety are sensitive to the communication and empathy of surgeon. The main results show that a good communication and high level of empathy at T0 and T1 limit depression and anxiety of the patients in T1. Results also indicate that the severity of the disease modulates this positive impact of communication: better is the communication the less are the level of depression and anxiety of the patients. This effect is higher for patients treated for the more severe disease. These results confirm that, even in the case severe disease a good communication between patient and physician remains a significant factor in promoting the well-being of patients. More specific training need to be developed to promote empathic care.

Keywords: clinical empathy, determinants, healthcare, psychological wellbeing

Procedia PDF Downloads 111