Search results for: surgical innovations

Authors: Sita Lakshmi Thyagarajan

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Nanofibers will leave no field untouched by its scientific innovations; the medical field is no exception. Electrospinning has proven to be an excellent method for the synthesis of nanofibers which, have attracted the interest for many biomedical applications. The formation of biofilms in wounds often leads to chronic infections that are difficult to treat with antibiotics. In order to minimize the biofilms and enhance the wound healing, preparation of potential nanofibers was focused. In this study, siderophore incorporated nanofibers were electrospun using biocompatible polymers onto the collagen scaffold and were fabricated into a biomaterial suitable for the inhibition of biofilm formation. The purified microbial siderophore was blended with Poly-L-lactide (PLLA) and poly (ethylene oxide) PEO in a suitable solvent. Fabrication of siderophore blended nanofibers onto the collagen surface was done using standard protocols. The fabricated scaffold was subjected to physical-chemical characterization. The results indicated that the fabrication processing parameters of nanofiberous scaffold was found to possess the characteristics expected of the potential scaffold with nanoscale morphology and microscale arrangement. The influence of Poly-L-lactide (PLLA) and poly (ethylene oxide) PEO solution concentration, applied voltage, tip-to-collector distance, feeding rate, and collector speed were studied. The optimal parameters such as the ratio of Poly-L-lactide (PLLA) and poly (ethylene oxide) PEO concentration, applied voltage, tip-to-collector distance, feeding rate, collector speed were finalized based on the trial and error experiments. The fibers were found to have a uniform diameter with an aligned morphology. The overall study suggests that the prepared siderophore entrapped nanofibers could be used as a potent tool for wound dressing material for inhibition of biofilm formation.

Keywords: biofilms, electrospinning, nano-fibers, siderophore, tissue engineering scaffold

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Authors: S. Jaramillo, Y. Montoya, W. Agudelo, J. Bustamante

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Cardiovascular diseases (CVD) are related to affectations of the heart and blood vessels, within these are pathologies such as coronary or peripheral heart disease, caused by the narrowing of the vessel wall (atherosclerosis), which is related to the accumulation of Low-Density Lipoproteins (LDL) in the arterial walls that leads to a progressive reduction of the lumen of the vessel and alterations in blood perfusion. Currently, the main therapeutic strategy for this type of alteration is drug treatment with statins, which inhibit the enzyme 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMG-CoA reductase), responsible for modulating the rate of cholesterol production and other isoprenoids in the mevalonate pathway. This enzyme induces the expression of LDL receptors in the liver, increasing their number on the surface of liver cells, reducing the plasma concentration of cholesterol. On the other hand, when the blood vessel presents stenosis, a surgical procedure with vascular implants is indicated, which are used to restore circulation in the arterial or venous bed. Among the materials used for the development of vascular implants are Dacron® and Teflon®, which perform the function of re-waterproofing the circulatory circuit, but due to their low biocompatibility, they do not have the ability to promote remodeling and tissue regeneration processes. Based on this, the present research proposes the development of a hydrolyzed collagen and polyethylene oxide electrospun membrane reinforced with medium and high-intensity statins, so that in future research it can favor tissue remodeling processes from its microarchitecture.

Keywords: atherosclerosis, medium and high-intensity statins, microarchitecture, electrospun membrane

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Authors: Weber-Lewerenz Bianca

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Digitization is developing fast and has become a powerful tool for digital planning, construction, and operations. Its transformation bears high potentials for companies, is critical for success, and thus, requires responsible handling. This study provides an assessment of calls made in the sustainable development goals by the United Nations (SDGs), White Papers on AI by international institutions, EU-Commission and German Government requesting for the consideration and protection of values and fundamental rights, the careful demarcation between machine (artificial) and human intelligence and the careful use of such technologies. The study discusses digitization and the impacts of artificial intelligence (AI) in construction engineering from an ethical perspective by generating data via conducting case studies and interviewing experts as part of the qualitative method. This research evaluates critically opportunities and risks revolving around corporate digital responsibility (CDR) in the construction industry. To the author's knowledge, no study has set out to investigate how CDR in construction could be conceptualized, especially in relation to the digitization and AI, to mitigate digital transformation both in large, medium-sized, and small companies. No study addressed the key research question: Where can CDR be allocated, how shall its adequate ethical framework be designed to support digital innovations in order to make full use of the potentials of digitization and AI? Now is the right timing for constructive approaches and apply ethics-by-design in order to develop and implement a safe and efficient AI. This represents the first study in construction engineering applying a holistic, interdisciplinary, inclusive approach to provide guidelines for orientation, examine benefits of AI and define ethical principles as the key driver for success, resources-cost-time efficiency, and sustainability using digital technologies and AI in construction engineering to enhance digital transformation. Innovative corporate organizations starting new business models are more likely to succeed than those dominated by conservative, traditional attitudes.

Keywords: construction engineering, digitization, digital transformation, artificial intelligence, ethics, corporate digital responsibility, digital innovation

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Authors: Lakmali Anthony, Madeline Gillies

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Purpose: Decreasing mortality has led to increased focus on patient-reported outcomes such as quality of life (QoL) in breast cancer. Breast cancer patients often have decreased QoL even after treatment is complete. This systematic review of the literature aims to identify psychosocial factors associated with decreased QoL in post-treatment breast cancer patients. Methodology: This systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The search was conducted in MEDLINE, EMBASE, and PsychINFO using MeSH headings. The two authors screened studies for relevance and extracted data. Results: Seventeen studies were identified, including 3,150 total participants (mean = 197) with a mean age of 51.9 years. There was substantial heterogeneity in measures of QoL. The most common was the European Organisation for Research and Treatment of Cancer QLQ-C30 (n=7, 41.1%). Most studies (n=12, 70.5%) found that emotional distress correlated with poor QoL, while 3 found no significant association. The most common measure of emotional distress was the Hospital Anxiety and Depression Scale (n=12, 70.5%). Other psychosocial factors associated with QoL were unmet needs, problematic social support, and negative affect. Clinicopathologic determinants included mastectomy without reconstruction, stage IV disease, and adjuvant chemotherapy. Conclusion: This systematic review provides a summary of the psychosocial determinants of poor QoL in post-treatment breast cancer patients, as well as the most commonly reported measures of these. An understanding of these potentially modifiable determinants of poor outcome is pivotal to the provision of quality, patient-centred care in surgical oncology.

Keywords: breast cancer, quality of life, psychosocial determinants, cancer surgery

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Authors: Gerard Bray, Derek Mao, Arya Bahadori, Sachinka Ranasinghe

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The EAU currently recommends partial nephrectomy as the preferred management for localised cT1 renal tumours, irrespective of surgical approach. With the advent of robotic assisted partial nephrectomy, there is growing evidence that warm ischaemia time may be reduced compared to the traditional laparoscopic approach. There is still no clear differences between the two approaches with regards to other peri-operative and oncological outcomes. Current limitations in the field denote the lack of single surgeon series to compare the two approaches as other studies often include multiple operators of different experience levels. To the best of our knowledge, this study is the first single surgeon series comparing peri-operative outcomes of robotic assisted and laparoscopic PN. The current study aims to reduce intra-operator bias while maintaining an adequate sample size to assess the differences in outcomes between the two approaches. We retrospectively compared patient demographics, peri-operative outcomes, and renal function derangements of all partial nephrectomies undertaken by a single surgeon with experience in both laparoscopic and robotic surgery. Warm ischaemia time, length of stay, and acute renal function deterioration were all significantly reduced with robotic partial nephrectomy, compared to laparoscopic nephrectomy. This study highlights the benefits of robotic partial nephrectomy. Further prospective studies with larger sample sizes would be valuable additions to the current literature.

Keywords: partial nephrectomy, robotic assisted partial nephrectomy, warm ischaemia time, peri-operative outcomes

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Authors: Burdin Louise, Brulez Anne-Catherine, Mazurcyk Radoslaw, Leclercq Jean-louis, Benayoun Stéphane

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By using a biomimetic approach, an investigation was conducted to determine the connections between morphology and wetting. The interest is focused on the Morpho peleides butterfly. This butterfly is already well-known among researchers for its brilliant iridescent color and has inspired numerous innovations. The intricate structure of its wings is responsible for such color. However, this multiscale structure exhibits a multitude of other features, such as hydrophobicity. Given the limited research on the wetting properties of Morpho butterfly, a detailed analysis of its wetting behavior is proposed. Multiscale surface topographies of the Morpho peleides butterfly were analyzed using scanning electron microscope and atomic force microscopy. To understand the relationship between morphology and wettability, a goniometer was employed to measured static and dynamic contact angle. Since several studies have consistently demonstrated that superhydrophobic surfaces can effectively delay freezing, icing delay time the Morpho’s wings was also measured. The results revealed contact angles close to 136°, indicating a high degree of hydrophobicity. Moreover, sliding angles (SA) were measured in different directions, including along and against the rolling-outward direction. The findings suggest anisotropic wetting. Specifically, when the wing was tilted along the rolling outward direction (i.e., away from the insect’s body) SA was about 7°. While, when the wing was tilted against the rolling outward direction, SA was about 29°. This phenomenon is directly linked to the butterfly’s survival strategy. To investigate the exclusive morphological impact on anti-icing properties, PDMS replicas of the Morpho butterfly were obtained. When compared to flat PDMS and microscale textured PDMS, Morpho replications exhibited a longer freezing time. Therefore, this could be a source of inspiration for designing superhydrophobic surfaces with anti-icing applications or functional surfaces with controlled wettability.

Keywords: biomimetic, anisotropic wetting, anti-icing, multiscale roughness

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Authors: Adila Shaukat, Hussam Al Soub, Muna Al Maslamani, Abdullatif Al Khal

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Background: The aim of this study was to assess clinical presentation and antimicrobial susceptibility of Streptococcus (S.) anginosus group infections in Hamad General Hospital, a tertiary care hospital in the state of Qatar, which is a multinational community. The S. anginosus group is a subgroup of viridans streptococci that consist of 3 different species: S. anginosus, S. constellatus, and S. intermedius. Although a part of the human bacteria flora, they have potential to cause suppurative infections. Method: We studied a total of 101 patients with S. anginosus group infections from January 2006 until March 2012 by reviewing medical records and identification of organisms by VITEK 2 and MALDI-TOF. Results: The most common sites of infection were skin and soft tissue, intra-abdominal, and bacteremia (28.7%, 24.8%, and 22.7%, respectively). Abscess formation was seen in approximately 30% of patients. Streptococcus constellatus was the most common isolated species (40%) followed by S. anginosus(30%) and S. intermedius(7%). In 23% of specimens, the species was unidentified. The most common type of specimen for organism isolation was blood followed by pus and tissue (50%, 22%, and 8%, respectively). Streptococcus constellatus was more frequently associated with abdominal and skin and soft tissue infections than the other 2 species, whereas S. anginosus was isolated more frequently from blood. All isolates were susceptible to penicillin, ceftriaxone, and vancomycin. Susceptibility to erythromycin and clindamycin was also good, reaching 91% and 95%, respectively. Forty percent of patients needed surgical drainage along with antibiotic therapy. Conclusions: Identification of S. anginosus group to species level is helpful in clinical practice because different species exhibit different pathogenic potentials.

Keywords: abscess, bacterial infection, bacteremia, Streptococcus anginosus

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Authors: Fikri Turk, Sahika Pinar Akyer, Mevci Ozdemir, Mehmet Bulent Ozdemir, Ilgaz Akdogan

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The complications such as bleeding, thrombosis and air embolism depend on injuries emissary veins is often encountered in surgery. Detailed descriptions of the mastoid foramen, occipital foramen, parietal foramen, posterior condylar canal and foramen vesalius are lacking in the literature. For this reason, the purpose of our study was to explore and represent the morphology and morphometry of these emissary foramina in order to prevent complications and to guide for surgeons. The present study was made on 60 dry human skull in the laboratories of Pamukkale University, Faculty of Medicine Department of Anatomy. After taken photograph of emissary foramens by Canon 650D professional camera, the evaluation and measurement’s these foramens made with Matlab program by computer. The overall prevalence of mastoid foramen was 90.52%, occipital foramen was 72.52%, parietal foramen was 42.85%, posterior condylar canal was 91.25% and foramen vesalius was 78.26%. The mean diameter of the mastoid foramen was 1.81±0.76 mm, occipital foramen was 1.20±0.25 mm, parietal foramen was 1.49±0.46 mm, posterior condylar canal was 2.83±1.33 mm and foramen vesalius was 1.74±0.60 mm. Distances between emissary foramina and fixed bony landmarks were measured. Emissary veins are important in clinic practice and surgical procedures because they act a route of spread of exracranial infection to the intracranial structures and these veins may be a significant bleeding during surgery of the skull and they can be source of thrombosis and air embolism. The detailed anatomical knowledge of these veins and foraminas may help to prevent complications and to guide for surgeons.

Keywords: emissary foramina, mastoid foramen, occipital foramen, parietal foramen, posterior condylar canal, foramen vesalius, morphology, morphometry

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Authors: Symbat Moldabekova

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This research explores the practice of decision-making in commercial banks in Kazakhstan. It focuses on recent technologies, such as contactless payments and QR code, and uses interviews with bank executives and industry practitioners to gain an understanding of how decisions are made and the role of financial assessment methods. The aim of the research is (1) to study the importance of financial techniques to evaluate IT investments; (2) to understand the role of different expert groups; (3) to explore how market trends and industry features affect decisions on IT; (4) to build a model that defines the real practice of decision-making on IT in commercial banks in Kazakhstan. The theoretical framework suggests that decision-making on IT is a socially constructed process, where actor groups with different background interact and negotiate with each other to develop a shared understanding of IT and to make more effective decisions. Theory and observations suggest that the more parties involved in the process of decision-making, the higher the possibility of disagreements between them. As each actor group has their views on the rational decision on an IT project, it is worth exploring how the final decision is made in practice. Initial findings show that the financial assessment methods are used as a guideline and do not play a big role in the final decision. The commercial banks of Kazakhstan tend to study experience of neighboring countries before adopting innovation. Implementing contactless payments is widely regarded as pinnacle success factor due to increasing competition in the market. First-to-market innovations are considered as priorities therefore, such decisions can be made with exemption of some certain actor groups from the process. Customers play significant role and they participate in testing demo versions of the products before bringing innovation to the market. The study will identify the viewpoints of actors in the banking sector on a rational decision, and the ways decision-makers from a variety of disciplines interact with each other in order to make a decision on IT in retail banks.

Keywords: actor groups, decision making, technology investment, retail banks

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Authors: Vignesh Ratnaraj, Jaewon Chang

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Background: Frailty is associated with poorer outcomes in cardiac surgery, but the heterogeneity in frailty assessment tools makes it difficult to ascertain its true impact in cardiac surgery. Slow gait speed is a simple, validated, and reliable marker of frailty. We performed a systematic review and meta-analysis to examine the effect of slow gait speed on postoperative cardiac surgical patients. Methods: PubMED, MEDLINE, and EMBASE databases were searched from January 2000 to August 2021 for studies comparing slow gait speed and “normal” gait speed. The primary outcome was in-hospital mortality. Secondary outcomes were composite mortality and major morbidity, AKI, stroke, deep sternal wound infection, prolonged ventilation, discharge to a healthcare facility, and ICU length of stay. Results: There were seven eligible studies with 36,697 patients. Slow gait speed was associated with an increased likelihood of in-hospital mortality (risk ratio [RR]: 2.32; 95% confidence interval [CI]: 1.87–2.87). Additionally, they were more likely to suffer from composite mortality and major morbidity (RR: 1.52; 95% CI: 1.38–1.66), AKI (RR: 2.81; 95% CI: 1.44–5.49), deep sternal wound infection (RR: 1.77; 95% CI: 1.59–1.98), prolonged ventilation >24 h (RR: 1.97; 95% CI: 1.48–2.63), reoperation (RR: 1.38; 95% CI: 1.05–1.82), institutional discharge (RR: 2.08; 95% CI: 1.61–2.69), and longer ICU length of stay (MD: 21.69; 95% CI: 17.32–26.05). Conclusion: Slow gait speed is associated with poorer outcomes in cardiac surgery. Frail patients are twofold more likely to die during hospital admission than non-frail counterparts and are at an increased risk of developing various perioperative complications.

Keywords: cardiac surgery, gait speed, recovery, frailty

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Authors: Paul Lam, Chi Him Chan, Alan Tse

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Language laboratories have been widely used in language learning, starting in the middle of the last century as one of the earliest forms of educational technology. They are designed to assist students’ language learning with technological innovations. Traditional language laboratories provide individual workstations that allow students to access multimedia language resources. In this type of facility, students can train their listening and speaking abilities, and teachers can also assess the performance of an individual student. Although such a setting promotes a student-centered pedagogy by encouraging students to work at their own pace and according to their own needs, it still favours a traditional, behaviourist language learning pedagogy which focuses on repetitive drilling. The change of pedagogies poses challenges to both the teachers and the facilities. The peer-learning pedagogy advocates that language learning should focus on the social aspect, which emphasizes the importance of everyday communication in language learning. The self-access, individual workstation language laboratories may not be able to provide the flexibility for interaction in the new pedagogies. Modern advancement in technology is another factor that drove our language laboratory renovation. In particular, mobile and wireless technology enabled the use of smaller and more flexible devices, making possible much clever use of space. The Chinese University of Hong Kong (CUHK) renovated nine existing language laboratories to provide lighter and more advanced equipment, movable tables, and round desks. These facilities allow more flexibility and encourage students’ interaction. It is believed that the renovated language laboratories can serve different peer learning activities and thus support peer-learning pedagogies in language teaching and learning. A survey has been conducted to collect comments from the teachers who have used the renovated language laboratories and received forty-four response. The teachers’ comments reveal that they experienced different challenges in using the renovated language laboratories, and there is a need to provide guidance to teachers during the technological and pedagogical transition. For example, teachers need instruction on using the newly installed devices such as touch-monitor and visualizer. They also need advice on planning new teaching and learning activities. Nevertheless, teachers appreciated that the renovated language laboratories are flexible and provide more spaces for different learning activities.

Keywords: language laboratories, language learning, peer-learning, student interaction

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Authors: Abidemi C. Adegboye, Samuel Iweriebor

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The primary link between financial institutions and economic performance is the provision of resources by these institutions to businesses in order to drive enterprise expansion, sustainability, and development. In this study, the role of access to finance in driving innovations and productivity in Nigerian SMEs is investigated using the World Bank Enterprise Survey (ES) dataset. Innovation is defined based on the ES analysis using five compositions including product, method, organisational, use of foreign-licensed technology, and spending on R&D. The study considers finance in terms of source in meeting investment needs and in terms of access. Moreover, finance access is categorized as external and internal to a firm with each having different implications. The research methodology adopted a survey analysis based on the 2014 World Bank Enterprise Survey of 19 states in Nigeria. The survey comprised over 10,000 manufacturing and services firms, both at the small scale and medium scale levels. The logit estimation technique is used to estimate the relationships in the study. The results from the empirical analysis show that in general, access to finance drives SME innovation in Nigeria. In particular, ease of accessing bank loans and credit is shown to be the strongest positive force in driving all types of innovation among SMEs in Nigeria. In the same vein, the type of finance source for investment matters in terms of how it affects innovation: it is shown that both internal and external sources improve investment in product, process, and organisational innovation, but only external financing has effect on R&D spending and use of foreign licensed technology. Overall spending on R&D is only driven by access to external finance by the SMEs. For productivity, the results show that while structure of financing investment improves productivity, increased access to finance may actually lead to productivity decline among SMEs in Nigeria. There is a need for the financial system to evolve structures to increase fund availability to SMEs in Nigeria, especially for the purpose of innovation investment.

Keywords: access to finance, financing investment, innovation, productivity, SMEs

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Authors: Mostafa Mabrouk, Basma E. Abdel-Ghany, Mona Moaness, Bothaina M. Abdel-Hady, Hanan H. Beherei

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Tissue engineering became a promising field for bone repair and regenerative medicine in which cultured cells, scaffolds and osteogenic inductive signals are used to regenerate tissues. The annual cost of treating bone defects in Egypt has been estimated to be many billions, while enormous costs are spent on imported bone grafts for bone injuries, tumors, and other pathologies associated with defective fracture healing. The current study is aimed at developing a more strategic approach in order to speed-up recovery after bone damage. This will reduce the risk of fatal surgical complications and improve the quality of life of people affected with such fractures. 3D scaffolds loaded with cheap nano-particles that possess an osteogenic effect were prepared by nano-electrospinning. The Microstructure and morphology characterizations of the 3D scaffolds were monitored using scanning electron microscopy (SEM). The physicochemical characterization was investigated using X-ray diffractometry (XRD) and infrared spectroscopy (IR). The Physicomechanical properties of the 3D scaffold were determined by a universal testing machine. The in vitro bioactivity of the 3D scaffold was assessed in simulated body fluid (SBF). The bone-bonding ability of novel 3D scaffolds was also evaluated. The obtained nanofibrous scaffolds demonstrated promising microstructure, physicochemical and physicomechanical features appropriate for enhanced bone regeneration. Therefore, the utilized nanomaterials loaded with the drug are greatly recommended as cheap alternatives to growth factors.

Keywords: bone regeneration, cheap scaffolds, nanomaterials, active molecules

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Authors: Hannah Nagel, Hayley Lang, Albert Sole Guitart, Natasha Lean, Rachel Allavena, Cleide Sprohnie-Barrera, Alex Young

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Aggressive neoplasia of the hoof is a rare occurrence in horses and has been only sporadically described in the literature. In the few cases reported intra-hoof wall, aggressive neoplasia has been documented radiographically and has been described with variable imaging characteristics. These include a well-defined osteolytic area, a smoothly outlined semi-circular defect, an extensive draining tract beneath the hoof wall, as well as an additional large area of osteolysis or an extensive central lytic region. A 20-year-old Quarterhorse gelding and a 10-year-old Thoroughbred gelding were both presented for chronic reoccurring lameness in the left forelimb and left hindlimb, respectively. Both of the cases displayed radiographic lesions that have been previously described but also displayed osteoproliferative expansile regions of additional bone formation. Changes associated with hoof neoplasia are often non-specific due to the nature and capacity of bone to react to pathological insult, which is either to proliferate or be absorbed. Both cases depict and describe imaging findings seen on radiography, contrast radiography, computed tomography, and magnetic resonance imaging before reaching a histological diagnosis of malignant melanoma and squamous cell carcinoma. Although aggressive hoof wall neoplasia is rare, there are some imaging features which may raise our index of suspicion for an aggressive hoof wall lesion. This case report documents two horses with similar imaging findings who underwent multiple assessments, surgical interventions, and imaging modalities with a final diagnosis of malignant neoplasia.

Keywords: horse, hoof, imaging, radiography, neoplasia

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Authors: Ilana Margalith, Yaron Niv

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One of the most important factors of professional health treatment is teamwork, in which each discipline contributes its expert knowledge, thus ensuring quality and a high standard of care as well as efficient communication (one of the International Patient Safety Goals). However, in most countries, students are educated separately by each health discipline. They are exposed to teamwork only during their clinical experience, which in some cases is short and skill-oriented. In addition, health organizations in most countries are hierarchical and although changes have occurred in the hierarchy of the medical system, there are still disciplines that underrate the unique contributions of other health professionals, thus, young graduates of health professions develop and base their perception of their peers from other disciplines on insufficient knowledge. In order to establish a wide-ranging perception among nursing students as to the contribution of different health professionals to the health of their patients, students at the Clalit Nursing Academy, Rabin Campus (Dina), Israel, participated in an interdisciplinary clinical discussion with students from several different professions, other than nursing, who were completing their clinical experience at Rabin Medical Center in medicine, health psychology, social work, audiology, physiotherapy and occupational therapy. The discussion was led by a medical-surgical nursing instructor. Their tutors received in advance, a case report enabling them to prepare the students as to how to present their professional theories and interventions regarding the case. Mutual stimulation and acknowledgment of the unique contribution of each part of the team enriched the nursing students' understanding as to how their own nursing interventions could be integrated into the entire process towards a safe and speedy recovery of the patient.

Keywords: health professions' students, interdisciplinary clinical discussion, nursing education, patient safety

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Authors: O. O. Onafowokan, K. Anderson, M. R. Norton, R. G. Middleton

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Revision total hip arthroplasty (THA) is known to be a challenging procedure with potential for poor outcomes. Due to its lack of metaphyseal encroachment, hip resurfacing arthroplasty (HRA) is classified as a bone conserving procedure. Although the literature postulates that this is an advantage at time of revision surgery, there is no evidence to either support or refute this claim. We identified 129 hips that had undergone HRA and 129 controls undergoing first revision THA. We recorded the clinical assessment and survivorship of implants in a multi-surgeon, single centre, retrospective case control series for both arms. These were matched for age and sex. Data collected included demographics, indications for surgery, Oxford Hip Score (OHS), length of surgery, length of hospital stay, blood transfusion, implant complexity and further surgical procedures. Significance was taken as p < 0.05. Mean follow up was 7.5 years (1 to 15). There was a significant 6 point difference in postoperative OHS in favour of the revision resurfacing group (p=0.0001). The revision HRA group recorded 48 minutes less length of surgery (p<0.0001), 2 days less in length of hospital stay (p=0.018), a reduced need for blood transfusion (p=0.0001), a need for less complexity in revision implants (p=0.001) and a reduced probability of further surgery being required (P=0.003). Whilst we acknowledge the limitations of this study our results suggest that, in contrast to THA, the bone conservation element of HRA may make for a less traumatic revision procedure with better functional outcomes. Use of HRA has seen a dramatic decline as a result of concerns regarding metallosis. However, this information remains of relevance when counselling young active patients about their arthroplasty options and may become pertinent in the future if the promise of ceramic hip resurfacing is ever realized.

Keywords: hip resurfacing, metallosis, revision surgery, total hip arthroplasty

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Authors: Harshit Vallecha, Prabha Bhola

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‘Energy for all’, is a global issue of concern for the past many years. Despite the number of technological advancements and innovations, significant numbers of people are living without access to electricity around the world. India, an emerging economy, tops the list of nations having the maximum number of residents living off the grid, thus raising global attention in past few years to provide clean and sustainable energy access solutions to all of its residents. It is evident from developed economies that centralized planning and electrification alone is not sufficient for meeting energy security. Implementation of off-grid and consumer-driven energy models like Decentralized Renewable Energy (DRE) systems have played a significant role in meeting the national energy demand in developed nations. Cases of DRE systems have been reported in developing countries like India for the past few years. This paper attempts to profile the status of DRE projects in the Indian context with their scope and relevance to ensure universal electrification. Diversified cases of DRE projects, particularly solar, biomass and micro hydro are identified in different Indian states. Critical factors affecting the sustainability of DRE projects are extracted with their interlinkages in the context of developers, beneficiaries and promoters involved in such projects. Socio-techno-economic indicators are identified through similar cases in the context of DRE projects. Exploratory factor analysis is performed to evaluate the critical sustainability factors followed by regression analysis to establish the relationship between the dependent and independent factors. The generated EFA-Regression model provides a basis to develop the sustainability and replicability framework for broader coverage of DRE projects in developing nations in order to attain the goal of universal electrification with least carbon emissions.

Keywords: climate change, decentralized generation, electricity access, renewable energy

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Authors: Chih-Hsien Chen, Yi-Hung Ho, Chih-Wei Wang, Chih-Wei Chang, Yen-Nien Chen, Chih-Han Chang, Chun-Ting Li

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Laminotomy is a spinal decompression surgery compatible with a minimally invasive approach. However, the unilateral laminotomy for bilateral side decompression leads to more perioperative complications than the bilateral laminotomy. Although the unilateral laminotomy removes the least bone tissue among the spinal decompression surgeries, the difference of spinal stability between unilateral and bilateral laminotomy and laminectomy is rarely investigated. This study aims to compare the biomechanical effects of unilateral and bilateral laminotomy and laminectomy on the lumbar spine by finite element (FE) simulation. A three-dimensional FE model of the lumbar spine (L1–L5) was constructed with the vertebral body, discs, and ligaments, as well as the sacrum was constructed. Three different surgical methods, namely unilateral laminotomy, bilateral laminotomy and laminectomy, at L3–L4 and L4–L5 were considered. Partial pedicle and entire ligamentum flavum were removed to simulate bilateral decompression in laminotomy. The entire lamina and spinal processes from the lower L3 to upper L5 were detached in the laminectomy model. Then, four kinds of loadings, namely flexion, extension, lateral bending and rotation, were applied on the lumbar with various decompression conditions. The results indicated that the bilateral and unilateral laminotomy both increased the range of motion (ROM) compared with intact lumbar, while the laminectomy increased more ROM than both laminotomy did. The difference of ROM between the bilateral and unilateral laminotomy was very minor. Furthermore, bilateral laminotomy demonstrated similar poster element stress with unilateral laminotomy. Unilateral and bilateral laminotomy are equally suggested to bilateral decompression of lumbar spine with minimally invasive technique because limited effect was aroused due to more bone remove in the bilateral laminotomy on the lumbar stability. Furthermore, laminectomy is the last option for lumbar decompression.

Keywords: minimally invasive technique, lumbar decompression, laminotomy, laminectomy, finite element method

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Authors: Waseem Al-Talalwah

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The superior vesical artery usually arises directly from the anterior division of the internal iliac artery. It may arise from the umbilical artery as three or four branches to supply the upper and middle parts of bladder. Current study focuses on the different origins of the superior vesical artery to provide a sufficient data for surgeons to disease iatrogenic fault. The superior vesical artery arises directly from the anterior division of the internal iliac artery in 24.5% whereas it arises indirectly as from umbilical artery in 83.7%. Further, it may arise from any branch of the anterior division as from the utrine and obturator arteries in 6.1% and in 6.3% respectively. It also shares the origin of the internal pudendal and inferior glutyeal artery as it arises from the gluteopudendal trunk in 4.1%. The superior vesical artery arises as a single, double, triple and quadruple in 69.4%, 20.4%, 8.2% and 2% respectively. In case of cystectomy for bladder cancer, surgeons have to be aware of the origin variability of superior vesical artery to prevent post-surgical complication such as intra-pelvic bleeding. Also, the as intra-pelvic bleeding has to be expected in case of hysterectomy therefore a great caution of the vesical branches arising from uterine artery has to be considered. In case of aneurysm resection of inferior gluteal artery arising from the gluteopudendal trunk, the surgeons have to be careful of the vascular supply of urinary bladder coming from above and below this common trunk as from superior and inferior vesical arteries respectively. Therefore, present study increases the awareness of clinical significance of superior vesical artery origin for surgeons to minimise the iatroginc errors.

Keywords: superior vesical artery, anterior division, internal iliac, internal pudendal, inferior glutyeal, intra-pelvic bleeding, hysterectomy, cystectomy

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Authors: Yamina Boukari, Nashiru Billa, Andrew Morris, Stephen Doughty, Kevin Shakesheff

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Poly (lactic-co-glycolic) acid (PLGA) is a synthetic polymer that can be used in bone tissue engineering with the aim of creating a scaffold in order to support the growth of cells. The formation of microspheres from this polymer is an attractive strategy that would allow for the development of an injectable system, hence avoiding invasive surgical procedures. The aim of this study was to develop a microsphere delivery system for use as an injectable scaffold in bone tissue engineering and evaluate various formulation parameters on its properties. Porous and lysozyme-containing PLGA microspheres were prepared using the double emulsion solvent evaporation method from various molecular weights (MW). Scaffolds were formed by sintering to contain 1 -3mg of lysozyme per gram of scaffold. The mechanical and physical properties of the scaffolds were assessed along with the release of lysozyme, which was used as a model protein. The MW of PLGA was found to have an influence on microsphere size during fabrication, with increased MW leading to an increased microsphere diameter. An inversely proportional relationship was displayed between PLGA MW and mechanical strength of formed scaffolds across loadings for low, intermediate and high MW respectively. Lysozyme release from both microspheres and formed scaffolds showed an initial burst release phase, with both microspheres and scaffolds fabricated using high MW PLGA showing the lowest protein release. Following the initial burst phase, the profiles for each MW followed a similar slow release over 30 days. Overall, the results of this study demonstrate that lysozyme can be successfully incorporated into porous PLGA scaffolds and released over 30 days in vitro, and that varying the MW of the PLGA can be used as a method of altering the physical properties of the resulting scaffolds.

Keywords: bone, microspheres, PLGA, tissue engineering

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Authors: Fares Mahdi

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Background: Infection control is an important concern for all health care professionals, especially nurses. Nurses have a higher risk for both self-acquiring and transmitting infections to other patients. Aim of this study: to assess nurses' knowledge regarding infection control for wound care. Methodology: a descriptive research design was used in the study. The total number studied sample was 200 nurses, were conducting in Amran Public Hospitals in Amran City- Yemen. The study covered sample nurses in the hospital according to the study population; a standard closed-ended questionnaire was used to collect the data. Results: The results showed less than half (37.5 %) of nurses were from 22 May Hospital, also followed by (62.5%) of them were from Maternal and Child Hospital. Also according to the department name. Most (22.5%) of nurses worked in an intensive care unit, followed by (20%) of them were working in the pediatric world, also about (19%) of them were working in the surgical department. While in finally, only about (8.5%) of them worked from another department. According to course training, The results showed about (21%) of nurses had course training in wound care management. At the same time, others (79%) of them have not had course training in wound care management. According to the total nurse's knowledge of infection control for wound care, that find more than two-thirds (68%) of nurses had fair knowledge according to total all of nurse's knowledge of infection control wound care. Conclusion:The results showed that more than two-thirds (68%) of nurses had fair knowledge according to total all of the nurse's knowledge of infection control for wound care. Recommendations: There should be providing training program about infection control masseurs and it's important for new employees of nurses. Providing continuing refreshment training courses about infection control programs and about evidence-based practice in infection control for all health care teams.

Keywords: assessment, knowledge, infection control, wound care, nurses, amran hospitals

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Authors: Nashed Atef Nashed Farag

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Introduction: Reporting adverse events following vaccination remains a challenge. WHO has mandated pharmacovigilance centers around the world to submit Adverse Events Following Immunization (AEFI) reports from different countries to a large electronic database of adverse drug event data called Vigibase. Despite sufficient information about AEFIs on Vigibase, they are not available to the general public. However, the WHO has an alternative website called VigiAccess, an open-access website that serves as an archive for reported adverse reactions and AEFIs. The aim of the study was to establish a reporting model for a number of commonly used vaccines in the VigiAccess system. Methods: On February 5, 2018, VigiAccess comprehensively searched for ESSI reports on the measles vaccine, oral polio vaccine (OPV), yellow fever vaccine, pneumococcal vaccine, rotavirus vaccine, meningococcal vaccine, tetanus vaccine, and tuberculosis vaccine (BCG). These are reports from all pharmacovigilance centers around the world since they joined the WHO Drug Monitoring Program. Results: After an extensive search, VigiAccess found 9,062 AEFIs from the measles vaccine, 185,829 AEFIs from the OPV vaccine, 24,577 AEFIs from the yellow fever vaccine, 317,208 AEFIs from the pneumococcal vaccine, 73,513 AEFIs from the rotavirus vaccine, and 145,447 AEFIs from meningococcal cal vaccine, 22,781 EI FI vaccines against tetanus and 35,556 BCG vaccines against AEFI. Conclusion: The study found that among the eight vaccines examined, pneumococcal vaccines were associated with the highest number of AEFIs, while measles vaccines were associated with the fewest AEFIs.

Keywords: surgical approach, anatomical approach, decompression, axillary nerve, quadrangular space adverse events following immunization, cameroon, COVID-19 vaccines, nOPV, ODK vaccines, adverse reactions, VigiAccess, adverse event reporting

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Authors: Bahador Bardshiri, Omid Moradi, Amir Komeilian, Nima Panahifar

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Formation of a conjunctival membrane over the corneal surface is a condition unique to rabbits that has been labeled aberrant corneal occlusion or pseudopterygium. In the summer of 2013, a five years old male Standard Chinchilla rabbit were presented to Karaj Central Veterinary hospital and the owner complained that his rabbit shows degrees of blindness and there were opacities on both eyes of the presented rabbit. Ophthalmic examination of the affected eyes revealed a conjunctival fold stretching over the cornea of both eyes. The fold originated from limbus and it was vascularized and centrally thickened. There were no attachments to the corneal epithelium and the fold could be easily lifted. Surgery was performed under general anesthesia. The conjunctival fold was incised centrifugally up to its attachment at the limbus and the lid margin using small scissors. The central rim of the segment was then replaced to its normal position in the fornix and fixed with mattress sutures (7/0) passing through outside skin. After the surgery, eye drops containing dexamethasone, gentamicin and polymixin were applied twice daily up to 3 weeks. Within the observation period (8 months) no recurrence was noted. "Pseudo" in the term pseudopterygium refers to the fact that the conjunctival membrane is not adhering to the underlying cornea, but growing over it. In rare cases, the membrane may be loosely attached to the cornea, but can be easily separated without causing damage. It can cover only a small part of the cornea with an annular peripheral opacification of the cornea, or cover it almost fully, leading to blindness. Ethiopathogenesis remains unclear and recurrence of the problem is very likely. The surgical technique that used here decreases probability of recurrence of conjunctival fold.

Keywords: rabbit, cornea, aberrant corneal occlusion, pseudopterygium

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Authors: Yu-Shun Elisa Pong

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American composer John Cage (1912-1992) is an influential figure in musical, visual and performing arts after World War II and has also been claimed as a forerunner of the western avant-garde in the artistic field. However, the crucial factors contributed to his highly acclaimed achievements include the Zen enlightenment, which he mainly got from Japanese Zen master D. T. Suzuki (1870-1966). As a kind of reflection and afterthought of the Zen inspiration, John Cage created various forms of arts in which visual arts have recently attracted more and more attention and discussion, especially from the perspectives of Zen. John Cage had started to create visual art works since he was 66 years old and the activity had lasted until his death. The quality and quantity of the works are worthy of in-depth study— the 667 pieces of print, 114 pieces of water color, and about 150 pieces of sketch. Cage’s stylistic changes during the 14 years of creation are quite obvious, and the Zen elements in the later works seem to be omnipresent. Based on comparative artistic study, a historical and conceptual view of Zen art that was formed initially in the traditional Chinese and Japanese visual arts will be discussed. Then, Chinese and Japanese representative Zen works will be mentioned, and the technique aspect, as well as stylistic analysis, will be revealed. Finally, a comprehensive comparison of the original Oriental Zen works with John Cage’s works and focus on the influence, and art transformation will be addressed. The master pieces from Zen tradition by Chinese artists like Liang Kai (d. 1210) and Ma Yuan (1160-1225) from Southern Sung Dynasty, the Japanese artists like Sesshū (1420-1506), Miyamoto Musashi (1584-1645) and some others would be discussed. In the current study, these art works from different periods of historical development in Zen will serve as the basis of analogy, interpretation, and criticism to Cage's visual art works. Through the perspectives of the Zen authenticity from Asia, we see how John Cage appropriated the eastern culture to his innovation, which changed the art world forever. And it is believed that through a transition from inter-, cross-, toward trans-cultural inspiration, John Cage set up a unique pathway of art innovations.

Keywords: John Cage, Chinese Zen art, Japanese Zen art, visual art

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Authors: Nelson Igaba, C. Onaga, S. Hlongwane

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Background: Medical Male Circumcision (MMC) is part of a comprehensive HIV prevention strategy. The quality of MMC done at Right To Care (RtC) sites is maintained by Continuous Quality Improvement (CQI) based on findings of assessments by internal and independent external assessors who evaluate such parameters as the quality of the surgical procedure, infection control, etc. There are 12 RtC MMC teams in Mpumalanga, two of which are headed by Medical Officers and 10 by Clinical Associates (Clin A). Objectives: To compare the quality (i) of care rendered at doctor headed sites (DHS) versus Clin A headed sites (CHS); (ii) of CQI assessments (external versus internal). Methodology: A retrospective review of data from RightMax™ (a novel RtC data management system) and CQI reports (external and internal) was done. CQI assessment scores of October 2015 and October 2016 were taken as the baseline and latest respectively. Four sites with 745-810 circumcisions per annum were purposively selected; the two DHS (group A) and two CHS (group B). Statistical analyses were conducted using R (2017 version). Results: There were no significant difference in latest CQI scores between the two groups (DHS and CHS) (Anova, F = 1.97, df = 1, P = 0.165); between internal and external CQI assessment scores (Anova, F = 2.251, df = 1, P = 0.139) or among the individual sites (Anova, F = 1.095, df = 2, P = 0.341). Of the total of 16 adverse events reported by the four sites in the 12 months reviewed (all were infections), there was no statistical evidence that the documented severity of the infection was different for DHS and CHS (Fisher’s exact test, p-value = 0.269). Conclusion: At RtC VMMC sites in Mpumalanga, internal and external/independent CQI assessments are comparable, and quality of care of VMMC is standardized with the performance of well-supervised clinical associates comparing well with those of medical officers.

Keywords: adverse events, Right to Care, male medical circumcision, continuous quality improvement

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Authors: Shlomit Hon-Snir, Shosh Shahrabai, Sharon Teitler Regev, Anabel Friedlander-Lifszyc

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Today, online travel sites account for a large share of the orders for tourism services, leading to the expectation that many traditional travel agencies will become redundant in the future. Technological changes are offering customers a wider variety and better prices, and the improved competition in the industry has increased customer well-being significantly. Therefore, the question is whether all customers can enjoy this change, specifically whether different groups in the Israeli population enjoy the changes similarly. The purpose of this study is to identify the factors that affect the collection of data and the purchase of tourism products online and in particular to identify the barriers and limitations of technology usage among the population. The results of the current research are of great importance both economically and socially. The theory of Reasoned Action assumes that actual behavior is based on intention. Volitional behavior is predicted by individuals' attitudes to that behavior and by the way they think other people will look at them. Two cognitive variables regarding the use of technology are: perceived usefulness and perceived ease-of-use. Moreover, early adopters of innovations have different characteristics than people that adopt an innovation at a later stage. In the study, we analyze four groups of factors: Customer characteristics, internet usage, technology acceptance and product characteristics. Some of the parameters are gender, age, income level, frequency and type of internet use, proficiency in English, traveler type, number of trips abroad, perceived ease of use, perceived usefulness, perceived risk, perceived trust and product type. We investigate online purchasing and online information search separately. Data will be collected using an online questionnaire distributed among a representative sample of 600 citizens in Israel. Some of the research questions will be based on previous research studies (that underwent reliability and validity testing). Those questions will be translated into Hebrew and adjusted for the tested population.

Keywords: customer characteristics, online travel sites, technology acceptance, tourism

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Authors: Andriati Nadhilah Widyarini, Ezra Margareth

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Introduction: Rhegmatogenous retinal detachment is a condition where there’s a break in the retina, which allows the vitreous to directly enter the subretinal space. Proliferative vitreoretinopathy (PVR) may develop due to this condition and can result in a new break, which could cause traction on the previously detached retina. Various methods of therapy can be done to treat this complication. Case: This case series involved 2 eyes of 2 patients who had total retinal detachment with advanced PVR. Pars plana vitrectomy was performed, and a 360-degree retinectomy procedure with perfluorocarbon liquid usage was done. This was followed by endo laser retinopexy to surround the border of retinectomy. 5000 cs silicone oil was used in 1 eye, whereas 12% of perfluoropropane gas was used in the other eye as a tamponade. These procedures were performed with meticulous attention to prevent any fluid from entering the subretinal space. Postoperative examination showed attachment of the retina and improvement of the patient’s visual acuity. Both eyes’ intraocular pressure was in the normal range. One eye developed retinal displacement, but no other complications occurred. Discussion: Rhegmatogenous retinal detachment with advanced PVR is a complex situation for vitreoretinal surgeons. PVR is characterized by the growth and migration of preretinal or subretinal membranes. PVR is the most common cause of retinal reattachment failure. A 360-degree retinectomy is an alternative surgical method to overcome this condition. Objectives of this procedure are releasing retinal traction caused by PVR, reducing the recurrence rate of PVR, and reattaching the retina to the pigment epithelial surface. Conclusion: 360-degree retinectomy provides satisfactory retinal reattachment and visual outcome improvement in rhegmatogenous retinal detachment with advanced PVR.

Keywords: RRD, retinectomy, pars plana, advanced PVR

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Authors: Juland D. Salayo

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With numerous innovations introduced in the Philippine educational system, the country’s struggle of materializing its national goal of transforming lives ends with great loss. Many agree that the failure to emerge the integral values of the program, framework and the implementers impedes realization. Employing a descriptive-correlational method, it aimed to determine the value clusters of the Grade 9 teachers as assessed by themselves and by the students, the significant difference of the assessed values and the significant difference on the values based on their profile. Respondents were composed of sixty-nine (69) teachers and three hundred forty (340) students using simple random sampling. Through a survey-questionnaire, the study revealed that the teachers have high regards on their self-reliance, honesty and trustworthiness, obedience, politeness and respect and self-discipline and spirituality. In contrast, they have ranked the following values fairly: justice and fairness, courage, responsibility and punctuality and nationalism and patriotism. Having assessed by the students, they have highly regarded their teachers’ self-reliance, responsibility and punctuality, obedience, politeness and respect and fair play and sportsmanship. On the other hand, the student-respondents made a low assessment on the level of the teachers’ justice and fairness, nationalism and patriotism, honesty and trustworthiness and excellence. Using t-test, it showed that there is a significant difference between the assessments of the respondents. Finally, among the demographic profiles, only civil status and age rejected the hypothesis. The following were recommended: provide educators value-enhancement trainings and conferences, organize value-oriented organizations and activities, and make intensive value-campaigns heightening the low-assessed values. Thus, a Revised Values Education Program (RVEP) was made to further meet the objectives of the program, address the needs of its clienteles, and responding to the demands of both education and society towards excellence in service, social and economic revolution, and constructive national goals which are based from integral values.

Keywords: values, value clusters, values education program, values education, teachers' assessed values

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Authors: Ae Ra Han, Seoung Eun Huh, Ji Yeon Kim, Joanne Kwak-Kim, Sung Ki Lee

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Objective: Prevalence of osteoporosis, cardiovascular disorders, and Alzheimer's disease rapidly increase after menopause. Immune activation and inflammation are suggested as an important pathogenesis of these serious diseases. Several pro-inflammatory cytokines are increased in women with surgical or natural menopause. However, the little is known about IL-17 producing T cells and Foxp3+ regulatory T (Treg) cells in post-menopause. Methods: A total of 34 postmenopausal women, who had no active cardiovascular, endocrine and infectious disorders were recruited as study group and healthy premenopausal women participated as controls. Peripheral blood mononuclear cells were isolated. Immuno-morphologic (CD3, CD4, CD8, CD19, CD56/CD16), intracellular cytokine (TNF-alpha, IFN-gamma, IL-10, IL-17), and Treg cell (Foxp3) studies were carried out using flow cytometry. The proportion of peripheral lymphocytes, including IL-17 producing and Foxp3+ Treg cells immune cell in each group were statistically analyzed. Results: The proportion of NK cells was significantly increased in menopausal women as compared to that of controls (P=.005). The ratios of TNF-alpha/IL-10 producing CD3+CD4+ T cells were increased in postmenopausal women. CD3+IL-17+ T cell level was higher in postmenopausal women and CD4+ Foxp3+ Treg cells was lower than that of controls. The ratios of CD3+IL-17+ T cell to CD3+Foxp3+ and to CD4+Foxp3+ Treg cells were significantly increased in postmenopausal women (P=.001). Conclusions: We found enhanced innate immunity and Th1- and Th17-mediated adaptive immunity in postmenopausal women. This may explain increasing prevalence of chronic inflammatory diseases after menopause. Further studies are needed to elucidate what factors contribute to this inflammatory shift in the postmenopause.

Keywords: inflammation, immune cell, menopause, Th17, regulatory T cell

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Authors: Sereen Itani

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As the world aspires for technological innovation, Innovative Robotics Technology-Supported Pedagogic Models in STEAM Education (Science, Technology, Engineering, Arts, and Mathematics) are critical in our global education system to build and enhance the next generation 21st century skills. Thus, diverse international schools endeavor in attempts to construct an integrated robotics and technology enhanced curriculum based on interdisciplinary subjects. Accordingly, it is vital that the globe remains resilient in STEAM fields by equipping the future learners and educators with Innovative Technology Experiences through robotics to support such fields. A variety of advanced teaching methods is employed to learn about Robotics Technology-integrated pedagogic models. Therefore, it is only when STEAM and innovations in Robotic Technology becomes integrated with real-world applications that transformational learning can occur. Robotics STEAM education implementation faces major challenges globally. Moreover, STEAM skills and concepts are communicated in separation from the real world. Instilling the passion for robotics and STEAM subjects and educators’ preparation could lead to the students’ majoring in such fields by acquiring enough knowledge to make vital contributions to the global STEAM industries. Thus, this necessitates the establishment of Pedagogic models such as Innovative Robotics Technologies to enhance STEAM education and develop students’ 21st-century skills. Moreover, an ICT innovative supported robotics classroom will help educators empower and assess students academically. Globally, the Robotics Design System and platforms are developing in schools and university labs creating a suitable environment for the robotics cross-discipline STEAM learning. Accordingly, the research aims at raising awareness about the importance of robotics design systems and methodologies of effective employment of robotics innovative technology-supported pedagogic models to enhance and develop (STEAM) education globally and enhance the next generation 21st century skills.

Keywords: education, robotics, STEAM (Science, Technology, Engineering, Arts and Mathematics Education), challenges

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