Search results for: third stage labour

Authors: T. Holecki, J. Wozniak-Holecka, K. Sobczyk

Abstract:

Development, implementation, and evaluation of the effects of health policy programs, resulting from the identified health needs and health status of residents, is the own task of all local government units in Poland. This is due to the obligation to provide access to healthcare services to all residents and the implementation of tasks in the field of health promotion based on specific legal acts. Until the end of 2016 local governments financed health policy programs only with their own funds. Currently, there are additional resources available from the public health insurance subsidising up to 80% of health policy programs costs in cities with a population under 5 thousand people and up to 40% in bigger cities. Changes in legal provisions do not translate automatically to increased involvement of local government units in the implementation of public health tasks. The main objective of the study was to assess the actual impact of the new legal regulation on financing local health policy programs on the engagement of local administration in this area of public health activity. To achieve this aim, we analyzed difference in the number of local governments developing and implementing health policy programs before and after the new law came into force. The aim of the study was also to estimate the level of expenditures incurred by self-government units and the National Health Fund to cover the costs of health policy programs. In the first stage of the project, legal acts concerning the subject of research and financial data published by the National Health Fund were analyzed. The material for the second, main stage of the study was the detailed financial data obtained from the National Health Fund and data obtained from local government units. The results present the situation in Poland in territorial terms, divided into 16 voivodships.

Keywords: health care system, health policy programs, local self-governments, public health

Procedia PDF Downloads 156

Authors: Yusuf Bala

Abstract:

The last decades of the 20th Centaury witnessed renewed hope about the birth of democracy and development in Africa the interface between democracy and development in Africa has long engaged the sustained interest of scholars and researchers across Africa. The process was actively supported by all segment of society, labour students market women, rural dweller who saw in it, the prospects of reversing the trend of political despair and in disillusionment that hither to characterized political life in Africa. The political tyranny and dictatorship while having it own clientele and beneficiaries had negative and suffocating effect on the majority of the people. The democratic aspiration of the Africa people is not only confined to the Arena of political Democracy of election and granting of civil and political rights, but it involves the demand for economic empowerment better living standards of the people and adequate social welfare indeed, for the majority of the people democracy is meaningful only when it delivers socio-economic goods. However, democracy and development have generated enormous interest no conclusive evidence seems to be shared in Africa. In the course of this research emphasis shall be made on certain issues, such as issues of corruption in democracy in Africa, ethnic conflict and democracy in Africa contribution of women to democratic practice and women participation in political arena, is still very low, democratization process and industrial relation in Africa as factor that hinder the development of Democracy in Africa, a case study of Nigeria.

Keywords: democracy, development, dictatorship, conflict, ethnicity

Procedia PDF Downloads 318

Authors: A. B. A. Ahmed, D. I. Amar, R. M. Taha

Abstract:

This research aims to investigate callus induction, somatic embryogenesis and indirect plant regeneration of Crassula ovata (Mill.) Druce – the famous ornamental plant. Experiment no.1: Callus induction was obtained from leaf and stem explants on Murashige and Skoog (MS) medium supplemented with various plant growth regulators (PGRs). Effects of different PGRs, plant regeneration and subsequent plantlet conversion were also assessed. Indirect plant regeneration was achieved from the callus of stem explants by the addition of 1.5 mg/L Kinetin (KN) alone. Best shoot induction was achieved (6.5 shoots/per explant) after 60 days. For successful rooting, regenerated plantlets were sub-cultured on the same MS media supplemented with 1.5 mg/L KN alone. The rooted plantlets were acclimatized and the survival rate was 90%. Experiment no.2: Results revealed that 0.5 mg/L 2,4-D alone and in combination with 1.0 mg/L 6-Benzyladenine (BA) gave 89.8% callus from the stem explants as compared to leaf explants. Callus proliferation and somatic embryo formation were also evaluated by ‘Double Staining Method’ and different stages of somatic embryogenesis were revealed by scanning electron microscope. Full Strength MS medium produced the highest number (49.6%) of cotyledonary stage somatic embryos (SEs). Mature cotyledonary stage SEs developed into plantlets after 12 weeks of culture. Well-rooted plantlets were successfully acclimatized at the survival rate of 85%. Indirectly regenerated plants did not show any detectable variation in morphological and growth characteristics when compared with the donor plant.

Keywords: callus induction, indirect plant regeneration, double staining, somatic embryogenesis, Crassula ovata

Procedia PDF Downloads 385

Authors: Leona Ondrejikova, Martin Hill, Antonin Parizek

Abstract:

The incidence of gestational diabetes mellitus (GDM) is higher in women predisposed to developing intrahepatic cholestasis of pregnancy (ICP). Both diseases are associated with altered steroidogenesis when compared with none-ICP controls. However, the effect of GDM on circulating steroids in ICP patients remains unclear. The question remains, whether the levels of circulating steroids differ between ICP patients with and without GDM. In total 10 ICP patients without GDM (ICP+GDM-), 7 ICP patients with GDM (ICP+GDM+), and 15 controls (ICP-GDM-) were monitored during late gestation, at labor, and during three periods postpartum (day 5, week 3, and week 6 postpartum) (Šimják et al., 2018). The relationships between steroid profiles and patients’ status were evaluated using the ANOVA model consisting of subject factor, between-subject factors Group (ICP+GDM+, ICP+GDM-, ICP-GDM-), gestational age at the diagnosis of ICP and gestational age at labor, and within-subject factor Stage and ICP × Stage interaction. The levels of the C21 and C19 Δ5 steroids and 5α/β-reduced C19 steroids were highest in ICP+GDM+, while those for the ICP-GDM-, and ICP+GDM- groups were lower. In the C21 Δ4 steroids and their 5α/β-reduced metabolites, the steroid levels were highest in the ICP+GDM-, intermediate in the ICP-GDM- and lowest in the ICP+GDM+ group. This higher concentration in ICP+GDM- group may be of importance as the 5α-pregnane-3α,20α-diol disulfate, is considered as the substance inducing ICP. In general, these data show that the comorbidity with GDM substantially changes the steroidome in ICP patients towards the higher activity of steroid CYP17A1 lyase step in adrenal zona reticularis reduced CYP17A1 hydroxylase step in zona fasciculata. This is consistent with our previously published hypothesis about the critical role of maternal zona reticularis in the pathophysiology of ICP. Our present data also indicate that the comorbidity with GDM might moderate the gravity of the ICP in this way.

Keywords: CYP17A1, GC-MS, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy

Procedia PDF Downloads 139

Authors: Aziza Al-Sawafi

Abstract:

Introduction: The evidence of family interventions in schizophrenia is robust primarily in high-income settings. However, they have been adapted to other settings and cultures to improve effectiveness and acceptability. In Oman, there is limited integration of psychosocial interventions in the treatment of schizophrenia. Therefore, the adaptation of family intervention to the Omani culture may facilitate its uptake. Most service users in Oman live with their families outside the healthcare system, and nothing is known about their experience, needs, or resources. Furthermore, understanding caregivers' and mental health professionals' preferences, perceptions, and experience is a fundamental element in the process of intervention development. Therefore, this study aims to develop a culturally sensitive, feasible, and acceptable family intervention for relatives living with schizophrenia in Oman. Method: The Medical Research Council's framework for the evaluation of complex health care interventions provided the conceptual structure for the study. The development phase was carried out, which involved three stages: 1) systematically reviewing the available literature regarding culturally adapted family interventions in the Arab world 2) In-depth interviews with caregivers to explore their experience and perceived needs and preferences regarding intervention 3) A focus group study involving health professionals to explore the acceptability and feasibility of delivering the family intervention in the Omani context. Data synthesis determined the design of the proposed intervention according to the findings obtained from the previous stages. Results: Stage one: The systematic review found limited evidence of culturally-adapted family interventions in the Arab region. However, the cultural adaptation process was comprehensive, and the implementation was reported to be feasible and acceptable. Stage two: The experience of family caregivers illuminated four main themes: burden, stigma, violence, and family needs. Burdens of care included objective and subjective burdens, positive feelings, and coping mechanisms. Caregivers gave their opinion about the content and preference of the intervention from their personal experiences. Stage three: mental health professionals discussed the delivery system of the intervention from a clinical standpoint concerning issues and barriers to implementation. They recommended modifications to the components of the intervention to ensure its acceptability and feasibility in the local setting. Data synthesis was carried out, and the intervention was designed. Conclusion: This study provides evidence of the potential applicability and acceptability of a culturally sensitive family intervention for families of individuals with schizophrenia in Oman. However, more work needs to be done to test the feasibility of the study and overcome the practical challenges.

Keywords: cultural-adaptation, family intervention, Oman, schizophrenia

Procedia PDF Downloads 146

Authors: Joanna Bielecka-Prus

Abstract:

In the view of increasing number of labour migrations associated with broadly understood economic crisis, many families experience migration separation. Currently, in the era of globalization, migration movements include an increasing number of families, more and more frequently a new type of family, a transnational family. Accordingly, the functions of the family, family practice of care, and the relationships between members of the group change especially in the case of female migration. Sociologists highlight the emotional aspects of migrants’ family lives: managing emotions, coping with guilt, loneliness and rejection. Not without significance is the fact that today's public discourse often represents migrant women in a negative light. On the one hand, consumption and expanding material resources are assessed positively, on the other hand, deficits emotional and devastation of family life in the transnational families appear. Opinions expressed by different environments: the media, the political environment, etc. do not always take into account the context of mobility and their different effects on family life. The paper will present the analysis of qualitative studies of Polish female migrants’ families left-behind (children, parents, caregivers N = 100) and their coping strategies in different situations in the event of migration separation. The main area of care deficit will be defined and it will be showed who and how help to solve the problems.

Keywords: care, children left behind, female migration, parents left behind

Procedia PDF Downloads 395

Authors: Michael Ayodeji Boyede

Abstract:

Studies have shown that workers’ job performance is very low in Nigeria, especially in the food and beverage industry. This trend had been partially attributed to low workers’ self-efficacy, poor self-knowledge, lack of empathy and poor psychological well-being. The descriptive survey design was adopted. Four factories were purposively selected from three states in Southwestern, Nigeria (Lagos, Ogun and Oyo States). Proportionate random sampling techniques were used in selecting 1,820 junior and supervisory cadre workers in Nestle Plc (369), Coca-Cola Plc (392), Cadbury Plc (443) and Nigeria Breweries (616). The five research instruments used were: Workers’ self-efficacy (r=0.81), Workers’ self-knowledge (r=0.78), Workers’ empathy (r=0.74), Workers’ psychological well-being (r=0.70) and Workers’ performance rating (r=0.72) scales. Quantitative data were analysed using Pearson product moment correlation, Multiple regression at 0.05 level of significance. Findings show that there were significant relationships between Workers’ job performance and self-efficacy (r=.56), self-knowledge (r=.54), Empathy (r=.55) and Psychological Well-being (r=.69) respectively. Self-efficacy, self-knowledge, empathy and psychological well-being jointly predict workers’ job performance (F (4,1815) = 491.05) accounting for 52.0% of its variance. Psychological well-being (B=.52). Self-efficacy (B=.10), self-knowledge (B=.11), empathy (B=. 09) had predictive relative weights on workers’ job performance. Inadequate knowledge and training of the supervisors led to a mismatch of workers thereby reducing workers’ job performance. High self-efficacy, empathy, psychological well-being and good self-knowledge influence workers job performance in the food and beverage industry. Based on the finding employers of labour should provide work environment that would enhance and promote the development of these factors among the workers.

Keywords: self-efficacy, self-knowledge, empathy, psychological well-being, job performance

Procedia PDF Downloads 262

Authors: Yuan-Jye Tseng, Ching-Yen Chen

Abstract:

In the design cycle, a main design task is to determine the external shape of the product. The external shape of a product is one of the key factors that can affect the customers’ preferences linking to the motivation to buy the product, especially in the case of a consumer electronic product such as a mobile phone. The relationship between the external shape and the customer preferences needs to be studied to enhance the customer’s purchase desire and action. In this research, a design for customer preferences model is developed for investigating the relationships between the external shape and the customer preferences of a product. In the first stage, the names of the geometric features are collected and evaluated from the data of the specified internet web pages using the developed text miner. The key geometric features can be determined if the number of occurrence on the web pages is relatively high. For each key geometric feature, the numerical values are explored using the text miner to collect the internet data from the web pages. In the second stage, a cluster analysis model is developed to evaluate the numerical values of the key geometric features to divide the external shapes into several groups. Several design suggestion cases can be proposed, for example, large model, mid-size model, and mini model, for designing a mobile phone. A customer preference index is developed by evaluating the numerical data of each of the key geometric features of the design suggestion cases. The design suggestion case with the top ranking of the customer preference index can be selected as the final design of the product. In this paper, an example product of a notebook computer is illustrated. It shows that the external shape of a product can be used to drive customer preferences. The presented design for customer preferences model is useful for determining a suitable external shape of the product to increase customer preferences.

Keywords: cluster analysis, customer preferences, design evaluation, design for customer preferences, product design

Procedia PDF Downloads 191

Authors: Gamaliel Salazar, Adriana Chazaro, Oscar Madrigal

Abstract:

The evolution of Unmanned Aerial Systems (UAS) has made it possible to develop new vehicles capable to perform microgravity experiments which due its cost and complexity were beyond the reach for many institutions. In this study, the aerodynamic behavior of an UAS is studied through its deceleration stage after an initial free fall phase (where the microgravity effect is generated) using Computational Fluid Dynamics (CFD). Due to the fact that the payload would be analyzed under a microgravity environment and the nature of the payload itself, the speed of the UAS must be reduced in a smoothly way. Moreover, the terminal speed of the vehicle should be low enough to preserve the integrity of the payload and vehicle during the landing stage. The UAS model is made by a study pod, control surfaces with fixed and mobile sections, landing gear and two semicircular wing sections. The speed of the vehicle is decreased by increasing the angle of attack (AoA) of each wing section from 2° (where the airfoil S1091 has its greatest aerodynamic efficiency) to 80°, creating a circular wing geometry. Drag coefficients (Cd) and forces (Fd) are obtained employing CFD analysis. A simplified 3D model of the vehicle is analyzed using Ansys Workbench 16. The distance between the object of study and the walls of the control volume is eight times the length of the vehicle. The domain is discretized using an unstructured mesh based on tetrahedral elements. The refinement of the mesh is made by defining an element size of 0.004 m in the wing and control surfaces in order to figure out the fluid behavior in the most important zones, as well as accurate approximations of the Cd. The turbulent model k-epsilon is selected to solve the governing equations of the fluids while a couple of monitors are placed in both wing and all-body vehicle to visualize the variation of the coefficients along the simulation process. Employing a statistical approximation response surface methodology the case of study is parametrized considering the AoA of the wing as the input parameter and Cd and Fd as output parameters. Based on a Central Composite Design (CCD), the Design Points (DP) are generated so the Cd and Fd for each DP could be estimated. Applying a 2nd degree polynomial approximation the drag coefficients for every AoA were determined. Using this values, the terminal speed at each position is calculated considering a specific Cd. Additionally, the distance required to reach the terminal velocity at each AoA is calculated, so the minimum distance for the entire deceleration stage without comprising the payload could be determine. The Cd max of the vehicle is 1.18, so its maximum drag will be almost like the drag generated by a parachute. This guarantees that aerodynamically the vehicle can be braked, so it could be utilized for several missions allowing repeatability of microgravity experiments.

Keywords: microgravity effect, response surface, terminal speed, unmanned system

Procedia PDF Downloads 173

Authors: Jing (Claire) LI

Abstract:

The topic of corporate social responsibility (CSR) is significant for pharmaceutical companies in China at this current stage. This is because, as a rapid growth industry in China in recent years, the pharmaceutical industry in China has been undergone continuous and terrible incidents relating to CSR. However, there is limited research and practice of CSR in Chinese pharmaceutical companies. Also, there is an urgent call for more research in an international context to understand the implications of corporate life cycle on CSR performance. To respond to the research need and research call, this study examines the relationship between corporate life cycle and CSR performance of Chinese listed companies in pharmaceutical industry. This research studies Chinese listed companies in pharmaceutical industry for the period of 2010-2017, where the data is available in database. Following the literature, this study divides CSR performance with regards to CSR dimensions, including shareholders, creditors, employees, customers, suppliers, the government, and the society. This study uses CSR scores of HEXUN database and financial measures of these CSR dimensions to measure the CSR performance. This study performed regression analysis to examine the relationship between corporate life cycle stages and CSR performance with regards to CSR dimensions for pharmaceutical listed companies in China. Using cash flow pattern as proxy of corporate life cycle to classify corporate life cycle stages, this study found that most (least) pharmaceutical companies in China are in maturity (decline) stage. This study found that CSR performance for most dimensions are highest (lowest) in maturity (decline) stage as well. Among these CSR dimensions, performing responsibilities for shareholder is the most important among all CSR responsibilities for pharmaceutical companies. This study is the first to provide important empirical evidence from Chinese pharmaceutical industry on the association between life cycle and CSR performance, supporting that corporate life cycle is a key factor in CSR performance. The study expands corporate life cycle and CSR literatures and has both empirical and theoretical contributions to the literature. From perspective of empirical contributions, the findings contribute to the argument that whether there is a relationship between CSR performance and various corporate life cycle stages in the literature. This study also provides empirical evidence that companies in different corporate life cycles have difference in CSR performance. From perspective of theoretical contributions, this study relates CSR and stakeholders to corporate life cycle stages and complements the corporate life cycle and CSR literature. This study has important implications for managers and policy makers. First, the results will be helpful for managers to have an understanding in the essence of CSR, and their company’s current and future CSR focus over corporate life cycle. This study provides a reference for their actions and may help them make more wise resources allocation decisions of CSR investment. Second, policy makers (in the government, stock exchanges, and securities commission) may consider corporate life cycle as an important factor in formulating future regulations for companies. Future research can explore the "process-based" differences in CSR performance and more industries.

Keywords: China, corporate life cycle, corporate social responsibility, pharmaceutical industry

Procedia PDF Downloads 105

Authors: Mohd Azman Abdul Latif, Erwan Basiron

Abstract:

A flaw or drift from expected operational performance in one component (NAND, PMIC, controller, DRAM, etc.) may affect the reliability of the entire Solid State Drive (SSD) system. Therefore, it is important to ensure the required quality of each individual component through qualification testing specified using standards or user requirements. Qualification testing is time-consuming and comes at a substantial cost for product manufacturers. A highly technical team, from all the eminent stakeholders is embarking on reliability prediction from beginning of new product development, identify critical to reliability parameters, perform full-blown characterization to embed margin into product reliability and establish control to ensure the product reliability is sustainable in the mass production. The paper will discuss a comprehensive development framework, comprehending SSD end to end from design to assembly, in-line inspection, in-line testing and will be able to predict and to validate the product reliability at the early stage of new product development. During the design stage, the SSD will go through intense reliability margin investigation with focus on assembly process attributes, process equipment control, in-process metrology and also comprehending forward looking product roadmap. Once these pillars are completed, the next step is to perform process characterization and build up reliability prediction modeling. Next, for the design validation process, the reliability prediction specifically solder joint simulator will be established. The SSD will be stratified into Non-Operating and Operating tests with focus on solder joint reliability and connectivity/component latent failures by prevention through design intervention and containment through Temperature Cycle Test (TCT). Some of the SSDs will be subjected to the physical solder joint analysis called Dye and Pry (DP) and Cross Section analysis. The result will be feedbacked to the simulation team for any corrective actions required to further improve the design. Once the SSD is validated and is proven working, it will be subjected to implementation of the monitor phase whereby Design for Assembly (DFA) rules will be updated. At this stage, the design change, process and equipment parameters are in control. Predictable product reliability at early product development will enable on-time sample qualification delivery to customer and will optimize product development validation, effective development resource and will avoid forced late investment to bandage the end-of-life product failures. Understanding the critical to reliability parameters earlier will allow focus on increasing the product margin that will increase customer confidence to product reliability.

Keywords: e2e reliability prediction, SSD, TCT, solder joint reliability, NUDD, connectivity issues, qualifications, characterization and control

Procedia PDF Downloads 174

Authors: Mrinal Mukherjee, Gargi Seal, Bitopan Mazumdar, Prakhar Agarwal

Abstract:

The central sector of Palghat-Cauvery Shear zone Tamil Nadu, India, had been studied with reference to development, mode of occurrence, interrelationship and variation of structural elements. The litho assemblages of the study area include gneisses migmatites granites and bear signature of multistage deformation patterns. The early deformation D1 is characterized in migmatites and gneisses by the development of tight to isoclinal, recumbent to reclined folds within the compositional bands that are refolded subsequently to produce D2 deformation structures ranging from type-II to type-III superposed geometry. The granite, in general, is undeformed, save a few places where strong mylonitic foliation developed with stretching lineation on it. The D1-D2 structures of gneisses and migmatites were affected by a D3 stage- E-W trending shear zone (Palghat-Cauvery Shear zone) that dips steeply towards north. The shear zone is characterized by the development of mylonite zone with stretching lineation on foliation, shear band structures, modification of geometry and orientation of earlier folds and foliations within the shear zone and development of shear induced folds and foliations. Several anastomosing lenses of shear zones define the larger Palghat-Cauvery Shear zone. The orientation of the shear induced folds and foliations and deflections of earlier foliation and folds within the Palghat-Cauvery shear zone indicate an oblique-slip thrust-shear with north-towards-east sense of displacement. The E-W trending shear zone is further openly folded along N-S in the D4 stage of deformation.

Keywords: deformation, migmatites, mylonites, shear zones

Procedia PDF Downloads 190

Authors: Erica Cochran Hameen, Bobuchi Ken-Opurum, Mounica Guturu

Abstract:

The United Stated (U.S.) populous spends the majority of their time indoors in spaces where building codes and voluntary sustainability standards provide clear Indoor Environmental Quality (IEQ) metrics. The existing sustainable building standards and codes are aimed towards improving IEQ, health of occupants, and reducing the negative impacts of buildings on the environment. While they address the post-occupancy stage of buildings, there are fewer standards on the pre-occupancy stage thereby placing a large labor population in environments much less regulated. Construction personnel are often exposed to a variety of uncomfortable and unhealthy elements while on construction sites, primarily thermal, visual, acoustic, and air quality related. Construction site power generators, equipment, and machinery generate on average 9 decibels (dBA) above the U.S. OSHA regulations, creating uncomfortable noise levels. Research has shown that frequent exposure to high noise levels leads to chronic physiological issues and increases noise induced stress, yet beyond OSHA no other metric focuses directly on the impacts of noise on contractors’ well-being. Research has also associated natural light with higher productivity and attention span, and lower cases of fatigue in construction workers. However, daylight is not always available as construction workers often perform tasks in cramped spaces, dark areas, or at nighttime. In these instances, the use of artificial light is necessary, yet lighting standards for use during lengthy tasks and arduous activities is not specified. Additionally, ambient air, contaminants, and material off-gassing expelled at construction sites are one of the causes of serious health effects in construction workers. Coupled with extreme hot and cold temperatures for different climate zones, health and productivity can be seriously compromised. This research evaluates the impact of existing green building metrics on construction and risk management, by analyzing two codes and nine standards including LEED, WELL, and BREAM. These metrics were chosen based on the relevance to the U.S. construction industry. This research determined that less than 20% of the sustainability context within the standards and codes (texts) are related to the pre-occupancy building sector. The research also investigated the impact of construction personnel’s health and well-being on construction management through two surveys of project managers and on-site contractors’ perception of their work environment on productivity. To fully understand the risks of limited Environmental and Health Quality metrics for contractors (EHQ) this research evaluated the connection between EHQ factors such as inefficient lighting, on construction workers and investigated the correlation between various site coping strategies for comfort and productivity. Outcomes from this research are three-pronged. The first includes fostering a discussion about the existing conditions of EQH elements, i.e. thermal, lighting, ergonomic, acoustic, and air quality on the construction labor force. The second identifies gaps in sustainability standards and codes during the pre-occupancy stage of building construction from ground-breaking to substantial completion. The third identifies opportunities for improvements and mitigation strategies to improve EQH such as increased monitoring of effects on productivity and health of contractors and increased inclusion of the pre-occupancy stage in green building standards.

Keywords: construction contractors, health and well-being, environmental quality, risk management

Procedia PDF Downloads 132

Authors: Marco Sewald

Abstract:

WWSE School Development (Wahrnehmungs- und wertorientierte Schulentwicklung) contains surveys on pupils, teachers and parents and enables schools to align the development to the requirements mentioned by these three stakeholders. WWSE includes a derivative set of questions for Christian schools, meeting their specific needs. The conducted research on WWSE is reflecting contemporary questions on school development, questioning the quality of the implementation of the results of past surveys, delivered by WWSE School Development in Christian schools in Germany. The research focused on questions connected to organizational development, including leadership and change management. This is done contoured to the two other areas of WWSE: human resources development and development of school teaching methods. The chosen research methods are: (1) A quantitative triangulation on three sets of data. Data from a past evaluation taken in 2011, data from a second evaluation covering the same school conducted in 2014 and a structured survey among the teachers, headmasters and members of the school board taken within the research. (2) Interviews with teachers and headmasters have been conducted during the research as a second stage to fortify the result of the quantitative first stage. Results: WWSE is supporting modern school development. While organizational development, leadership, and change management are proofed to be important for modern school development, these areas are widespread underestimated by teachers and headmasters. Especially in comparison to the field of human resource development and to an even bigger extent in comparison to the area of development of school teaching methods. The research concluded, that additional efforts in the area of organizational development are necessary to meet modern demands and the research also shows which areas are the most important ones.

Keywords: school as a social organization, school development, school leadership, WWSE, Wahrnehmungs- und wertorientierte Schulentwicklung

Procedia PDF Downloads 226

Authors: Ahmed Abdallatif

Abstract:

Background: Patients with malignant germ cell tumors have age distribution in two peaks, with the first one during infancy and the second after the onset of puberty. Gonadal germ cell tumors are the most common malignant ovarian tumor in females aged below twenty years. Sacrococcygeal and retroperitoneal abdominal tumors usually presents in a large size before the onset of symptoms. Methods: Patients with pediatric germ cell tumors presenting to Children’s Cancer Hospital Egypt and National Cancer Institute Egypt from January 2008 to June 2011 Patients underwent stratification according to risk into low, intermediate and high risk groups according to children oncology group classification. Objectives: Assessment of the clinicopathologic features of all cases of pediatric germ cell tumors and classification of malignant cases according to their stage, and the primary site to low, intermediate and high risk patients. Evaluation of surgical management in each group of patients focusing on surgical approach, the extent of surgical resection according to each site, ability to achieve complete surgical resection and perioperative complications. Finally, determination of the three years overall and disease-free survival in different groups and the relation to different prognostic factors including the extent of surgical resection. Results: Out of 131 cases surgically explored only 26 cases had re exploration with 8 cases explored for residual disease 9 cases for remote recurrence or metastatic disease and the other 9 cases for other complications. Patients with low risk kept under follow up after surgery, out of those of low risk group (48 patients) only 8 patients (16.5%) shifted to intermediate risk. There were 20 patients (14.6%) diagnosed as intermediate risk received 3 cycles of compressed (Cisplatin, Etoposide and Bleomycin) and all high risk group patients 69patients (50.4%) received chemotherapy. Stage of disease was strongly and significantly related to overall survival with a poorer survival in late stages (stage IV) as compared to earlier stages. Conclusion: Overall survival rate at 3 three years was (76.7% ± 5.4, 3) years EFS was (77.8 % ±4.0), however 3 years DFS was much better (89.8 ± 3.4) in whole study group with ovarian tumors had significantly higher Overall survival (90% ± 5.1). Event Free Survival analysis showed that Male gender was 3 times likely to have bad events than females. Patients who underwent incomplete resection were 4 times more than patients with complete resection to have bad events. Disease free survival analysis showed that Patients who underwent incomplete surgery were 18.8 times liable for recurrence compared to those who underwent complete surgery, and patients who were exposed to re-excision were 21 times more prone to recurrence compared to other patients.

Keywords: extragonadal, germ cell tumors, gonadal, pediatric

Procedia PDF Downloads 218

Authors: Neeraj Gupta, Jitendra Mahakud

Abstract:

The banking system plays a major role in the Indian economy. Banking system is the payment gateway of most of the financial transactions. Banking has gone a major transition that is still in progress. Recent banking reforms after liberalization in 1991 have led to the establishment of the foreign banks in the country. The foreign banks are not listed in the Indian stock markets and have increased the competition leading to the capture of the significant share in the revenue from the public sector banks which are still the major players in the Indian banking sector. The performance of the banking sector depends on the internal (bank specific) as well as the external (market specific and macroeconomic) factors. Profitability in banking sector is affected by numerous factors which can be internal or external. The present study examines these internal and external factors which are likely to effect the profitablilty of the Indian banks. The sample consists of a panel dataset of 64 commercial banks in India, consisting of 1088 observations over the years from 1998 to 2016. The GMM dynamic panel estimation given by Arellano and Bond has been used. The study revealed that the variables capital adequacy ratio, deposit, age, labour productivity, non-performing asset, inflation and concentration have significant effect on performance measured.

Keywords: banks in India, bank performance, bank productivity, banking management

Procedia PDF Downloads 272

Authors: Pakize Neslihan Taslı, Alev Cumbul, Gul Merve Yalcın, Fikrettin Sahin

Abstract:

A key experimental trial in the regeneration of large oral and craniofacial defects is the neogenesis of osseous and ligamentous interfacial structures. Currently, oral regenerative medicine strategies are unpredictable for repair of tooth supporting tissues destroyed as a consequence of trauma, chronic infection or surgical resection. A different approach combining the gel-casting method with Hydroxy Apatite HA-based scaffold and different cell lineages as a hybrid system leads to successively mimic the early stage of tooth development, in vitro. HA is widely accepted as a bioactive material for guided bone and tooth regeneration. In this study, it was reported that, HA porous scaffold preparation, characterization and evaluation of structural and chemical properties. HA is the main factor that exists in tooth and it is in harmony with structural, biological, and mechanical characteristics. Here, this study shows mimicking immature tooth at the late bell stage design and construction of HA scaffolds for cell transplantation of human Adipose Stem Cells (hASCs), human Bone Marrow Stem Cells (hBMSCs) and Gingival Epitelial cells for the formation of human tooth dentin-pulp-enamel complexes in vitro. Scaffold characterization was demonstrated by SEM, FTIR and pore size and density measurements. The biological contraction of dental tissues against each other was demonstrated by mRNA gene expressions, histopatologic observations and protein release profile by ELISA tecnique. The tooth shaped constructs with a pore size ranging from 150 to 300 µm arranged by gathering right amounts of materials provide interconnected macro-porous structure. The newly formed tissue like structures that grow and integrate within the HA designed constructs forming tooth cementum like tissue, pulp and bone structures. These findings are important as they emphasize the potential biological effect of the hybrid scaffold system. In conclusion, this in vitro study clearly demonstrates that designed 3D scaffolds shaped as a immature tooth at the late bell stage were essential to form enamel-dentin-pulp interfaces with an appropriate cell and biodegradable material combination. The biomimetic architecture achieved here is providing a promising platform for dental tissue engineering.

Keywords: tooth regeneration, tissue engineering, adipose stem cells, hydroxyapatite tooth engineering, porous scaffold

Procedia PDF Downloads 233

Authors: Luísa P. Cruz-Lopes, Hugo Costa e Silva, Idalina Domingos, José Ferreira, Luís Teixeira de Lemos, Bruno Esteves

Abstract:

The liquefaction process of cork based tree barks has led to an increase of interest due to its potential innovation in the lumber and wood industries. In this particular study the bark of Quercus cerris (Turkish oak) is used due to its appreciable amount of cork tissue, although of inferior quality when compared to the cork provided by other Quercus trees. This study aims to optimize alkaline catalysis liquefaction conditions, regarding several parameters. To better comprehend the possible chemical characteristics of the bark of Quercus cerris, a complete chemical analysis was performed. The liquefaction process was performed in a double-jacket reactor heated with oil, using glycerol and a mixture of glycerol/ethylene glycol as solvents, potassium hydroxide as a catalyst, and varying the temperature, liquefaction time and granulometry. Due to low liquefaction efficiency resulting from the first experimental procedures a study was made regarding different washing techniques after the filtration process using methanol and methanol/water. The chemical analysis stated that the bark of Quercus cerris is mostly composed by suberin (ca. 30%) and lignin (ca. 24%) as well as insolvent hemicelluloses in hot water (ca. 23%). On the liquefaction stage, the results that led to higher yields were: using a mixture of methanol/ethylene glycol as reagents and a time and temperature of 120 minutes and 200 ºC, respectively. It is concluded that using a granulometry of <80 mesh leads to better results, even if this parameter barely influences the liquefaction efficiency. Regarding the filtration stage, washing the residue with methanol and then distilled water leads to a considerable increase on final liquefaction percentages, which proves that this procedure is effective at liquefying suberin content and lignocellulose fraction.

Keywords: liquefaction, Quercus cerris, polyalcohol liquefaction, temperature

Procedia PDF Downloads 332

Authors: Ajay Agrawal, Pravin Shah, Shailaja Chhetri, Pappu Rijal

Abstract:

Background and Objectives: Postpartum hemorrhage (PPH) is a common and occasionally life-threatening complication of labour. Cesarean section (CS) is associated with more blood loss than vaginal delivery. There is a trend for increasing CS rates in both developed and developing countries. This could increase the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of Intravenous Tranexamic Acid (TA) on blood loss during and after elective CS delivery. Materials and Methods: It is a prospective, randomized controlled study. 160 eligible pregnant women of 37 or more POG planned for CS were randomized into two groups either to receive 10ml(1gm) of tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation. Results: The mean estimated blood loss was significantly lower in women treated with TA compared with women in the placebo group (392.13 ml ± 10.06 versus 498.69 ml ± 15.87, respectively; p < 0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the tranexamic acid group than in the control group (0.31 ± 0.18 versus 0.79 ± 0.23, respectively; p < 0.001). Conclusion: Pre-operative use of tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where PPH is a major threat to the life of the mothers, it seems to be a promising option.

Keywords: blood loss, cesarean section, postpartum hemorrhage, tranexamic acid

Procedia PDF Downloads 271

Authors: Abu Hasan, Rochmadi, Hary Sulistyo, Suharto Honggokusumo

Abstract:

This research purpose is to study the effect of Ingredients mixing sequence in rubber compounding onto the formation of bound rubber and cross link density of natural rubber and also the relationship of bound rubber and cross link density. Analysis of bound rubber formation of rubber compound and cross link density of rubber vulcanizates were carried out on a natural rubber formula having masticated and mixing, followed by curing. There were four methods of mixing and each mixing process was followed by four mixing sequence methods of carbon black into the rubber. In the first method of mixing sequence, rubber was masticated for 5 min and then rubber chemicals and carbon black N 330 were added simultaneously. In the second one, rubber was masticated for 1 min and followed by addition of rubber chemicals and carbon black N 330 simultaneously using the different method of mixing then the first one. In the third one, carbon black N 660 was used for the same mixing procedure of the second one, and in the last one, rubber was masticated for 3 min, carbon black N 330 and rubber chemicals were added subsequently. The addition of rubber chemicals and carbon black into masticated rubber was distinguished by the sequence and time allocated for each mixing process. Carbon black was added into two stages. In the first stage, 10 phr was added first and the remaining 40 phr was added later along with oil. In the second one to the fourth one, the addition of carbon black in the first and the second stage was added in the phr ratio 20:30, 30:20, and 40:10. The results showed that the ingredients mixing process influenced bound rubber formation and cross link density. In the three methods of mixing, the bound rubber formation was proportional with crosslink density. In contrast in the fourth one, bound rubber formation and cross link density had contradictive relation. Regardless of the mixing method operated, bound rubber had non linear relationship with cross link density. The high cross link density was formed when low bound rubber formation. The cross link density became constant at high bound rubber content.

Keywords: bound-rubber, cross-link density, natural rubber, rubber mixing process

Procedia PDF Downloads 411

Authors: Sepideh Mohammadi

Abstract:

Iran is a country that boasts of ethnic diversity, comprising various groups such as Turks, Lors, Arabs, Baluchs, Persians, Kurds, Gliks, Azaris, and Tabaris. The majority of people in Iran are Persians and as such, the Persian language is the official language of the country. However, it is also a common language among different ethnic groups. It is worth noting that there is a longstanding history of coexistence and cultural relations between the Turkic and Lor ethnic groups. The purpose of this article is to study the range of intercultural sensitivities of Turks and Lor peoples to identify the state of intercultural competence and reduce conflicts in the direction of cultural policy. It is important to gain insight into the mutual perceptions of Lor and Turkic people towards each other. Understanding these perceptions can greatly aid in fostering stronger relationships and promoting effective communication between the two ethnic groups. The study employed a qualitative content analysis approach to gather data using a semi-structured interview tool. The participants consisted of ten individuals from the Lor ethnic and ten individuals from the Turk ethnic. According to Milton Bennett's six-stage model, our findings reveal that the Turkish and Lor ethnic groups tend to exhibit higher intercultural sensitivity in the second stage, which consists of defense against differences. Both groups tend to emphasize the differences between them, and the notion of "us and the other" holds significant importance for them. It is important to acknowledge that both the Turk and Lor ethnicities consist of various clans, which significantly shape intercultural relations between them. A common stereotype in this regard is that the Turks of Tabriz province often do not recognize the Turks of other provinces of the country as their own. Moreover, our study indicates that an increase in interaction and communication between the Lor and Turk ethnic groups may lead to a reduction in cultural sensitivities between them.

Keywords: intercultural communication, intercultural sensitivity, Iran, Lor, Turk

Procedia PDF Downloads 47

Authors: Catherine Chua, Kashif Raza

Abstract:

Work-integrated learning (WIL) has been heightened in the last few years across countries. With a specific attention on working adults, the key objective is to integrate work experiences with academic studies so that they will be given more opportunities to advance, gather relevant skills and credentials to enable them to contribute more positively to the labour market. In Singapore, developing talent through WIL aims to develop specialist and enduring skills for the industries. Collaborating with the institutes of higher education in Singapore, the Integrated Work Study Programs (IWSP) seek to harmonize classroom learning with practical work experiences so that adult students can develop skills and knowledge that are needed in the existing and future workplaces. Local higher education institutions will also work closely with industry partners, and design courses that support these students to deepen their skills. Using Critical Discourse Analysis, this paper examines the Singapore government policies in WIL and argues that despite the various supports and interventions provided by the government, it is equally important to create a ‘space’ in the society whereby there is a greater recognition for WIL as a valuable education approach, i.e., “continuous meritocracy”. This is especially so in Singapore where academic excellence and conventional front-loaded approach to education are valued.

Keywords: work-integrated learning, adult learners, continuous meritocracy, skillsfuture singapore

Procedia PDF Downloads 65

Authors: Sitalakshmi Venkatraman, Fiona Wahr, Anthony de Souza-Daw, Samuel Kaspi

Abstract:

There is a growing emphasis on generic skills in higher education to match the changing skill-set requirements of the labour market. However, researchers and policy makers have not arrived at a consensus on the generic skills that actually contribute towards workplace employability and performance that complement and/or underpin discipline-specific graduate attributes. In order to strengthen the qualifications framework, a range of ‘generic’ learning outcomes have been considered for students undergoing higher education programs and among them it is necessary to have the fundamental generic skills such as literacy and numeracy at a level appropriate to the qualification type. This warrants for curriculum design approaches to contextualise the form and scope of these fundamental generic skills for supporting both students’ learning engagement in the course, as well as the graduate attributes required for employability and to progress within their chosen profession. Little research is reported in integrating such generic skills into discipline-specific learning outcomes. This paper explores the literature of the generic skills required for graduates from the discipline of Information Technology (IT) in relation to an Australian higher education institution. The paper presents the rationale of a proposed Bachelor of IT curriculum designed to contextualize the learning of these generic skills within the students’ discipline studies.

Keywords: curriculum, employability, generic skills, graduate attributes, higher education, information technology

Procedia PDF Downloads 256

Authors: Mohamed Yousef, Magdy Samuel, Maha El-Meligy, Taher El-Bitar

Abstract:

The present work is dealing with 2% Si-steel alloy. The alloy contains 0.05% C as well as 0.85% Al. The alloy under investigation would be used for electrical transformation purposes. A heating (expansion) - cooling (contraction) dilation investigation was executed to detect the a, a+g, and g transformation temperatures at the inflection points of the dilation curve. On heating, primary a  was detected at a temperature range between room temperature and 687 ^oC. The domain of a+g was detected in the range between 687 ^oC and 746 ^oC. g phase exists in the closed g region at the range between 746 ^oC and 1043 ^oC. The domain of a phase appears again at a temperature range between 1043 and 1105 ^oC, and followed by secondary a at temperature higher than 1105 ^oC. A physical simulation of thermo-mechanical processing on the as-cast alloy was carried out. The simulation process took into consideration the hot flat rolling pilot plant parameters. The process was executed on the thermo-mechanical simulator (Gleeble 3500). The process was designed to include seven consecutive passes. The 1^st pass represents the roughing stage, while the remaining six passes represent finish rolling stage. The whole process was executed at the temperature range from 1100 ^oC to 900 ^oC. The amount of strain starts with 23.5% at the roughing pass and decreases continuously to reach 7.5 % at the last finishing pass. The flow curve of the alloy can be abstracted from the stress-strain curves representing simulated passes. It shows alloy hardening from a pass to the other up to pass no. 6, as a result of decreasing the deformation temperature and increasing of cumulative strain. After pass no. 6, the deformation process enhances the dynamic recrystallization phenomena to appear, where the z-parameter would be high.

Keywords: si- steel, hot deformability, critical transformation temperature, physical simulation, thermo-mechanical processing, flow curve, dynamic softening.

Procedia PDF Downloads 245

Authors: Alexis Naranjo

Abstract:

In the current global stage, a new sense and mix feelings against the globalization has started to take shape thanks to events such as Brexit and the 2016 US election. The perceptions towards the globalization have started to focus in a resistance movement called the 'anti-globalization movement'. This paper examines the current global stage vs. leadership decisions in a time when market integrations are not longer seeing as an opportunity for an economic growth buster. The biggest economy in the world the United States of America has started to face a new beginning of something called 'anti-globalization', in the current global stage starting with the United Kingdom to the United States a new strategy to help local economies has started to emerge. A new nationalist movement has started to focus on their local economies which now represents a direct threat to the globalization, trade agreements, wages and free markets. Business leaders of multinationals now in our days face a new dilemma, how to address the feeling that globalization and outsourcing destroy and take away jobs from local economies. The initial perception of the literature and data rebels that companies in Western countries like the US sees many risks associate with outsourcing, however, saving cost associated with outsourcing is greater than the firm’s local reputation. Starting with India as a good example of a supplier of IT developers, analysts and call centers we can start saying that India is an industrialized nation which has not yet secured its spot and title. India has emerged as a powerhouse in the outsource industry, which makes India hold the number one spot in the world to outsource IT services. Thanks to the globalization of economies and markets around the globe that new ideas to increase productivity at a lower cost has been existing for years and has started to offer new ideas and options to businesses in different industries. The economic growth of the information technology (IT) industry in India is an example of the power of the globalization which in the case of India has been tremendous and significant especially in the economic arena. This research paper concentrates in understand the behavior of business leaders: First, how multinational’s leaders will face the new challenges and what actions help them to lead in turbulent times. Second, if outsourcing or withdraw from a market is an option what are the consequences and how you communicate and negotiate from the business leader perspective. Finally, is the perception of leaders focusing on financial results or they have a different goal? To answer these questions, this study focuses on the most recent data available to outline and present the findings of the reason why outsourcing is and option and second, how and why those decisions are made. This research also explores the perception of the phenomenon of outsourcing in many ways and explores how the globalization has contributed to its own questioning.

Keywords: anti-globalization, globalization, leadership, outsourcing

Procedia PDF Downloads 194

Authors: Aghamolaei Teamur, Hosseini Zahra, Ghanbarnejad Amin

Abstract:

Introduction: A diet rich in fruits and vegetables, especially for adolescents is of a great importance due to the need for nutrients and the rapid growth of this age group. The aim of this study was to investigate the relationship between decisional balance and self-efficacy with stages of change for fruit and vegetable consumption in high school students in Bandar Abbas, Iran. Methods: In this descriptive-analytical study, the data were collected from 345 students studying in 8 high schools of Bandar Abbas were selected through multistage sampling. To collect data, separate questionnaires were designed for evaluating each of the variables including the stages of change, perceived benefits, perceived barriers, and self-efficacy of fruit and vegetable consumption. Decisional balance was estimated by subtracting the perceived benefits and barriers. The data were analyzed using SPSS19 and one-way ANOVA. Results: The results of this study indicated that individuals’ progress along the stages of change from pre-contemplation to maintenance level was associated with a significant increase in their decisional balance and self-efficacy for fruit and vegetable consumption. (P < 0.001). The lowest level of decisional balance and self-efficacy regarding for fruit showed up in the pre-contemplation stage, and the highest level of decisional balance and self-efficacy was in the maintenance stage. The same trends were observed in the case of vegetable consumption. Conclusion: Decisional balance and self-efficacy should be considered in designing interventions to increase consumption of fruits and vegetables. There needs to be more emphasis in educational programs based on the Trans-theoretical Model (TTM) on the enhancement of perceived benefits and elimination of perceived barriers regarding consumption of fruits and vegetables.

Keywords: fruit, vegetable, decision balance, self-efficacy, trans-theoretical model

Procedia PDF Downloads 294

Authors: Mary-Luz Olivares-Tenorio, Ruud Verkerk, Matthijs Dekker, Martinus A. J. S. van Boekel

Abstract:

Cape gooseberry, the fruit of the plant Physalis peruviana L. has gained interest in research given its contents of promising health-promoting compounds like contents. The presence of carotenoids, ascorbic acid, minerals, polyphenols, vitamins and antioxidants. This project aims to study thermal stability of β-carotene, ascorbic acid, catechin and epicatechin and antioxidant activity in the matrix of the Cape Gooseberry. Fruits were obtained from a Colombian field in Cundinamarca. Ripeness stage was 4 (According to NTC 4580, corresponding to mature stage) at the moment of the experiment. The fruits have been subjected to temperatures of 40, 60, 80, 100 and 120°C for several times. β-Carotene, ascorbic acid, catechin and epicatechin content were assessed with HPLC and antioxidant activity with the DPPH method. β-Carotene was stable upon 100°C, and showed some degradation at 120°C. The same behavior was observed for epicatechin. Catechin increased during treatment at 40°C, at 60°C it remained stable and it showed degradation at 80°C, 100°C and 120°C that could be described by a second order kinetic model. Ascorbic acid was the most heat-sensitive of the analyzed compounds. It showed degradation at all studied temperatures, and could be described by a first order model. The activation energy for ascorbic acid degradation in cape gooseberry was 46.0 kJ/mol and its degradation rate coefficient at 100 °C was 6.53 x 10-3 s-1. The antioxidant activity declined for all studied temperatures. Results from this study showed that cape gooseberry is an important source of different health-promoting compounds and some of them are stable to heat. That makes this fruit a suitable raw material for processed products such as jam, juices and dehydrated fruit, giving the consumer a good intake of these compounds.

Keywords: goldenberry, health-promoting compounds, phytochemical, processing, heat treatment

Procedia PDF Downloads 452

Authors: Tae Bo Jeon

Abstract:

Korean air force is undertaking a big project to replace prevailing hundreds of old air fighters such as F-4, F-5, KF-16 etc. The task is to develop and produce domestic fighters equipped with 2 complete-type engines each. A large number of engines, however, will be purchased as products from a foreign engine maker. In addition to the fighters themselves, secure the proper number of spare engines serves a significant role in maintaining combat readiness and effectively managing the national defense budget due to high cost. In this paper, we presented a model dynamically updating spare engine requirements. Currently, the military administration purchases all the fighters, engines, and spare engines at acquisition stage and does not have additional procurement processes during the life cycle, 30-40 years. With the assumption that procurement procedure during the operational stage is established, our model starts from the initial estimate of spare engine requirements based on limited information. The model then performs military missions and repair/maintenance works when necessary. During operation, detailed field information - aircraft repair and test, engine repair, planned maintenance, administration time, transportation pipeline between base, field, and depot etc., - should be considered for actual engine requirements. At the end of each year, the performance measure is recorded and proceeds to next year when it shows higher the threshold set. Otherwise, additional engine(s) will be bought and added to the current system. We repeat the process for the life cycle period and compare the results. The proposed model is seen to generate far better results appropriately adding spare engines thus avoiding possible undesirable situations. Our model may well be applied to future air force military operations.

Keywords: DMSMS, operational availability, METRIC, PRS

Procedia PDF Downloads 172

Authors: Paul Licina, Emma M. Johnston, David Lisle, Mark Young, Chris Brady

Abstract:

Background: Lumbar pars pathology is a common cause of pain in the growing spine. It can be seen in young athletes participating in at-risk sports and can affect sporting performance and long-term health due to its resistance to traditional management. There is a current lack of consensus of classification and treatment for pars injuries. Previous systems used CT to stage pars defects but could not assess early stress reactions. A modified classification is proposed that considers findings on MRI, significantly improving early treatment guidance. The treatment protocol is designed for patients aged 5 to 19 years. Method: Clinical screening identifies patients with a low, medium, or high index of suspicion for lumbar pars injury using patient age, sport participation and pain characteristics. MRI of the at-risk cohort enables augmentation of existing CT-based classification while avoiding ionising radiation. Patients are classified into five categories based on MRI findings. A type 0 lesion (stress reaction) is present when CT is normal and MRI shows high signal change (HSC) in the pars/pedicle on T2 images. A type 1 lesion represents the ‘early defect’ CT classification. The group previously referred to as a 'progressive stage' defect on CT can be split into 2A and 2B categories. 2As have HSC on MRI, whereas 2Bs do not. This distinction is important with regard to healing potential. Type 3 lesions are terminal stage defects on CT, characterised by pseudarthrosis. MRI shows no HSC. Results: Stress reactions (type 0) and acute fractures (1 and 2a) can heal and are treated in a custom-made hard brace for 12 weeks. It is initially worn 23 hours per day. At three weeks, patients commence basic core rehabilitation. At six weeks, in the absence of pain, the brace is removed for sleeping. Exercises are progressed to positions of daily living. Patients with continued pain remain braced 23 hours per day without exercise progression until becoming symptom-free. At nine weeks, patients commence supervised exercises out of the brace for 30 minutes each day. This allows them to re-learn muscular control without rigid support of the brace. At 12 weeks, bracing ceases and MRI is repeated. For patients with near or complete resolution of bony oedema and healing of any cortical defect, rehabilitation is focused on strength and conditioning and sport-specific exercise for the full return to activity. The length of this final stage is approximately nine weeks but depends on factors such as development and level of sports participation. If significant HSC remains on MRI, CT scan is considered to definitively assess cortical defect healing. For these patients, return to high-risk sports is delayed for up to three months. Chronic defects (2b and 3) cannot heal and are not braced, and rehabilitation follows traditional protocols. Conclusion: Appropriate clinical screening and imaging with MRI can identify pars pathology early. In those with potential for healing, we propose hard bracing and appropriate rehabilitation as part of a multidisciplinary management protocol. The validity of this protocol will be tested in future studies.

Keywords: adolescents, MRI classification, pars interticularis, treatment protocol

Procedia PDF Downloads 153

Authors: Jenee Gooden, Kevin Vasquez-monterroso, Lady Paula Dejesus, Sandra Wainwright, Daniel Kim, Mackenzie Walker

Abstract:

Introduction: Pyoderma gangrenosum (PG) is a rare, rapidly progressive, neutrophilic ulcerative colitis condition with an incidence of 3 to 10 cases per year ¹ ². Due to the similar appearance, PG is often misdiagnosed as a diabetic ulcer in diabetic patients. Though they may clinically appear similar in appearance, the treatment protocol and diagnostic criteria differ. Also, end-stage renal disease (ESRD) is often a condition seen in diabetic patients, which can have a significant impact on wound healing due to the wide range of uremic toxins³. This case study demonstrates a multidisciplinary team and multimodal treatment approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine for an uncontrolled diabetic with pyoderma gangrenosum of a significant circumferential wound, covering almost the entire right lower extremity. Methods:56 y.o male presents with multiple PG ulcerations, including the chest, right posterior lower extremity and sacrum. All ulcerations were previously managed by the same wound care specialist. His chief complaint was worsening PG ulcerations accompanied by a fever of 103 °F . This case study focuses on the wound to his RLE. Past medical history significant for diabetes mellitus type 2 with hemoglobin A1c of 10% and end stage renal disease (ESRD) on hemodialysis. A multidisciplinary team approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine was successfully used to perform right lower extremity limb salvage. The patient was managed by rheumatology for the continuation of prior medication, as well as the mutual agreement with wound care for the addition of dapsone. A coronary CT angiogram was performed by interventional cardiology, but no significant disease was noted, and no further vascular workup was necessary. Multiple surgical sharp wide excisional debridements with application of allografts and split thickness skin grafts for the circumferential ulceration that encompassed almost the entire right lower extremity were performed by both podiatric surgery and general surgery. Wound cultures and soft tissue biopsies were performed, and infectious disease managed antibiotic therapy. Hyperbaric oxygen therapy and wound vac therapy by wound care were also completed as adjunct management. Results: Prevention of leg amputation by limb salvage of the RLE was accomplished by a multidisciplinary team approach, with the wound size decreasing over a total of 29 weeks from 600 cm² to 12.0 x 3.5 x 0.2 cm. Our multidisciplinary team included podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine. Discussion: Wound healing, in general, can have its challenges, and those challenges are only magnified when accompanied by multiple systemic illnesses. Though the negative impact of diabetes on wound healing is well known, the compound impact of being a diabetic with ESRD and having pyoderma gangrenosum is not. This case demonstrates the necessity for a multidisciplinary team approach with a wide array of treatment modalities to optimize wound healing and perform limb salvage with prevention of lower extremity amputation.

Keywords: diabetes, podiatry, pyoderma gangrenosum, end stage renal disease

Procedia PDF Downloads 74