Search results for: general surgery

Authors: Kuen Ming Shu, Ren Kai Ho

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Ultrasonic horn has the functions of amplifying amplitude and reducing resonant impedance in ultrasonic system. Its primary function is to amplify deformation or velocity during vibration and focus ultrasonic energy on the small area. It is a crucial component in design of ultrasonic vibration system. There are five common design methods for ultrasonic horns: analytical method, equivalent circuit method, equal mechanical impedance, transfer matrix method, finite element method. In addition, the general optimization design process is to change the geometric parameters to improve a single performance. Therefore, in the general optimization design process, we couldn't find the relation of parameter and objective. However, a good optimization design must be able to establish the relationship between input parameters and output parameters so that the designer can choose between parameters according to different performance objectives and obtain the results of the optimization design. In this study, an ultrasonic horn provided by Maxwide Ultrasonic co., Ltd. was used as the contrast of optimized ultrasonic horn. The ANSYS finite element analysis (FEA) software was used to simulate the distribution of the horn amplitudes and the natural frequency value. The results showed that the frequency for the simulation values and actual measurement values were similar, verifying the accuracy of the simulation values. The ANSYS DesignXplorer was used to perform Response Surface optimization, which could shows the relation of parameter and objective. Therefore, this method can be used to substitute the traditional experience method or the trial-and-error method for design to reduce material costs and design cycles.

Keywords: horn, natural frequency, response surface optimization, ultrasonic vibration

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Authors: Francesco Berald, Yunhui Zhao

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The COVID-19 pandemic further extended the multi-year housing boom in advanced economies and emerging markets alike against massive monetary easing during the pandemic. In this paper, we analyze the pricing-out phenomenon in the U.S. residential housing market due to higher house prices associated with monetary easing. We first set up a stylized general equilibrium model and show that although monetary easing decreases the mortgage payment burden, it would raise house prices and lower housing affordability for first-time homebuyers (through the initial housing wealth channel and the liquidity constraint channel that increases repeat buyers’ housing demand), and increase housing wealth inequality between first-time and repeat homebuyers. We then use the U.S. household-level data to quantify the effect of the house price change on housing affordability relative to that of the interest rate change. We find evidence of the pricing-out effect for all homebuyers; moreover, we find that the pricing-out effect is stronger for first-time homebuyers than for repeat homebuyers. The paper highlights the importance of accounting for general equilibrium effects and distributional implications of monetary policy while assessing housing affordability. It also calls for complementing monetary easing with well-targeted policy measures that can boost housing affordability, particularly for first-time and lower-income households. Such measures are also needed during aggressive monetary tightening, given that the fall in house prices may be insufficient or too slow to fully offset the immediate adverse impact of higher rates on housing affordability.

Keywords: pricing-out, U.S. housing market, housing affordability, distributional effects, monetary policy

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Authors: Albert Perez-Bellmunt, Eila Rivera, Aida Valls, Berta Estragues, Sara Ortiz, Roberto Seijas, Pedro Alvarez

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INTRODUCTION: Physical and sports activity on a regular basis present numerous health benefits such as the prevention of cardiovascular and metabolic diseases. Also, there is a relation between sport and the psychological or the cognitive process of children and young people. The objective of the present study is to know if the sports practice has any positive influence on the university academic performance. MATERIALS AND METHODS: The level of the physical activity of 220 students of different degrees in health science was evaluated and compared with the academic results (grades). To assess the level of physical and sports activity, the Global Physical Activity Questionnaire (to calculate the sporting level in a general way) and the International Physical Activity Questionnaire (to estimate the physical activity carried out during the days leading up to the academic exams) were used. RESULTS: The students that realized an average level of sports activity the days before the exam obtained better grades than the rest of their classmate and the result was statistically significant. Controversially, if the sports level was analyzed in a general way, no relationship was observed between academic performance and the level of sport realized. CONCLUSION: A moderate physical activity, on the days leading up to an assessment, can be a positive factor for the university academic performance. Despite the fact that a regular sports activity improves many cognitive and physiological processes, the present study did not observe a direct relationship between sport/physical activity and academic performance.

Keywords: academic performance, academic results, global physical activity questionnaire, physical activity questionnaire, sport, sport practice

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Authors: Natalia Moreira, Trevor Wood-Harper

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The acceptance of sustainable products by the final consumer is still one of the challenges of the industry, which constantly seeks alternative approaches to successfully be accepted in the global market. A large set of methods and approaches have been discussed and analysed throughout the literature. Considering the current need for sustainable development and the current pace of consumption, the need for a combined solution towards the development of new products became clear, forcing researchers in product development to propose alternatives to the previous standard product development models. This paper presents, through a systemic analysis of the literature on product development, eco-design and consumer involvement, a set of alternatives regarding consumer involvement towards the development of sustainable products and how these approaches could help improve the sustainable industry’s establishment in the general market. The initial findings of the research show that the understanding of the benefits of sustainable behaviour lead to a more conscious acquisition and eventually to the implementation of sustainable change in the consumer. Thus this paper is the initial approach towards the development of new sustainable products using the fashion industry as an example of practical implementation and acceptance by the consumers. By comparing the existing literature and critically analysing it this paper concluded that the consumer involvement is strategic to improve the general understanding of sustainability and its features. The use of consumers and communities has been studied since the early 90s in order to exemplify uses and to guarantee a fast comprehension. The analysis done also includes the importance of this approach for the increase of innovation and ground breaking developments, thus requiring further research and practical implementation in order to better understand the implications and limitations of this methodology.

Keywords: consumer involvement, products development, sustainability, eco-design

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Authors: Joseph Osodo, Motsa Thobekani Phila

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The study investigated the impact of e-learning on the performance of history learners in Eswatini general certificate of secondary education in the Manzini region of Eswatini. The study was guided by the theory of connectivism. The study had three objectives which were to find out the significance of e-learning during the COVID-19 era in learning History subject; challenges faced by history teachers’ and learners’ in e-learning; and how the challenges were mitigated. The study used a qualitative research approach and descriptive research design. Purposive sampling was used to select eight History teachers and eight History learners from four secondary schools in the Manzini region. Data were collected using face to face interviews. The collected data were analyzed and presented in thematically. The findings showed that history teachers had good knowledge on what e-learning was, while students had little understanding of e-learning. Some of the forms of e-learning that were used during the pandemic in teaching history in secondary schools included TV, radio, computer, projectors, and social media especially WhatsApp. E-learning enabled the continuity of teaching and learning of history subject. The use of e-learning through the social media was more convenient to the teacher and the learners. It was concluded that in some secondary school in the Manzini region, history teacher and learners encountered challenges such as lack of finances to purchase e-learning gadgets and data bundles, lack of skills as well as access to the Internet. It was recommended that History teachers should create more time to offer additional learning support to students whose performance was affected by the COVID-19 pandemic effects.

Keywords: e-learning, performance, COVID-19, history, connectivism

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Authors: Langhit Kurar, Loren Charles

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Introduction: In light of recent BOAST 12 (August 2016) published guidance on management of ankle fractures, the project aimed to highlight key discrepancies throughout the care trajectory from admission to point of discharge at a district general hospital. Wide breadth of data covering three key domains: accident and emergency, radiology, and orthopaedic surgery were subsequently stratified and recommendations on note documentation, and outpatient follow up were made. Methods: A retrospective twelve month audit was conducted reviewing results of ankle fracture management in 37 patients. Inclusion criterion involved all patients seen at Darent Valley Hospital (DVH) emergency department with radiographic evidence of an ankle fracture. Exclusion criterion involved all patients managed solely by nursing staff or having sustained purely ligamentous injury. Medical notes, including discharge summaries and the PACS online radiographic tool were used for data extraction. Results: Cross-examination of the A & E domain revealed limited awareness of the BOAST 12 recent publication including requirements to document skin integrity and neurovascular assessment. This had direct implications as this would have changed the surgical plan for acutely compromised patients. The majority of results obtained from the radiographic domain were satisfactory with appropriate X-rays taken in over 95% of cases. However, due to time pressures within A & E, patients were often left without a post manipulation XRAY in a backslab. Poorly reduced fractures were subsequently left for a long period resulting in swollen ankles and a time-dependent lag to surgical intervention. This had knocked on implications for prolonged inpatient stay resulting in hospital-acquired co-morbidity including pressure sores. Discussion: The audit has highlighted several areas of improvement throughout the disease trajectory from review in the emergency department to follow up as an outpatient. This has prompted the creation of an algorithm to ensure patients with significant fractures presenting to the emergency department are seen promptly and treatment expedited as per recent guidance. This includes timing for X-rays taken in A & E. Re-audit has shown significant improvement in both documentation at time of presentation and appropriate follow-up strategies. Within the orthopedic domain, we are in the process of creating an ankle fracture pathway to ensure imaging and weight bearing status are made clear to the consulting clinicians in an outpatient setting. Significance/Clinical Relevance: As a result of the ankle fracture algorithm we have adapted the BOAST 12 guidance to shape an intrinsic pathway to not only improve patient management within the emergency department but also create a standardised format for follow up.

Keywords: ankle, fracture, BOAST, radiology

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Authors: Nitzan Winograd, Nada Kakabadse

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This study examines whether the hospitality-based social enterprise Ringelblum Café is achieving its stated social goals of developing a sense of self-efficacy among at-risk youth who work in this enterprise and raising levels of recruitment to the Israel Defence Forces (IDF) and National Service (NS) among these young adults. Ringelblum Café was founded in 2009 in Be'er-Sheva in order to provide employment solutions for at-risk youth in the southern district of Israel. Each year, 10 at-risk young adults aged 16–18 are referred to the programme by various welfare agencies. The training programme is approximately a year in duration and includes professional training in the art of cooking. Each young adult is also supported by a social worker. This study is based on the participation of 31 youths who graduated from the Ringelblum Café’s training programme. A convenience sampling model was used with the assistance of the programme's social worker. This study is quantitative in its approach. Data was collected by means of three separate self-reported questionnaires: a personal information questionnaire collected general demographics data; a self-efficacy questionnaire consisted of two parts: general self-efficacy and social self-efficacy; and an IDS/NS recruitment questionnaire. The study uses the theory of change in order to find out whether at-risk youth in the Ringelblum Café programme are taught a profession with future prospects, as well as whether they develop a sense of self-efficacy and raise their chances of recruitment into the IDF/NS. The study found that the sense of self-efficacy of the graduates is relatively high. In addition, there was a significant difference between the importance of recruitment to the IDF/NS among these youth prior to the beginning of the programme and after its completion, indicating that the training programme had a positive effect on motivation for recruitment to the IDF/NS. The study also found that the percentage of recruits to the IDF/NS among youth who graduated from the training programme were not significantly higher than the general recruitment figures in Israel. In conclusion, Ringelblum Café is making sound progress towards achieving its social goals regarding recruitment to the IDF/NS. Moreover, the sense of self-efficacy among the graduates is relatively high, and it can be assumed that the training programme has a positive effect on these young adults, although there is no clear connection between the two. This study is among a few that have been conducted in the field of hospitality-based social enterprises in Israel and can serve as a basis for further research. Moreover, the study results may help improve the perception of at-risk youth and their contribution to society and could increase awareness of the growing trend of social enterprises promoting social goals.

Keywords: at-risk youth, Israel Defence Forces (IDF), national service, recruitment, self-efficacy, social enterprise

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Authors: M. Devamanalan, K. Pothiraj, M. Sudhan

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In competitive market like India, there is a high demand on the equal contribution on performance and its durability aspect of any system. In General vehicle has multiple sub-systems such as powertrain, BIW, Brakes, Actuations, Suspension and Seats etc., To withstand the market challenges, the contribution of each sub-system is very vital. The malfunction of any one sub system will directly have an impact on the performance of the major system which lead to dis-satisfaction to the end user. The Powertrain system consists of several sub-systems in which clutch is one of the prime sub-systems in MT vehicles which assist for smoother gear shifts with proper clutch dis-engagement and engagement. In general, most of the vehicles will have a mechanical or semi or full hydraulic clutch release system, whereas in small Commercial Vehicles (SCV) the majorly used clutch release system is mechanical cable release system due to its lesser cost and functional requirements. The major bottle neck in the cable type clutch release system is increase in pedal effort due to hysteresis increase and Gear shifting hard due to efficiency loss / cable slackness over the mileage accumulation of the vehicle. This study is to mainly focus on how the efficiency and hysteresis change over the mileage of the vehicle occurs because of the design architecture of outer and inner cable. The study involves several cable design validation results from vehicle level and rig level through the defined cable routing and test procedures. Results are compared to evaluate the suitable cable design architecture based on better efficiency and lower hysteresis parameters at initial and end of the validation.

Keywords: clutch, clutch cable, efficiency, architecture, cable routing

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Authors: Rukhsana Kausar, Khadija Rasheed

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This research explored general concerns, attitudes and perceptions of Pakistani mothers about their children’s vulnerability for sexual abuse and it also examined the effect of education and work status of mothers on their concerns and attitudes about the safety of their children. The sample consisted of 166 mothers comprising of 4 groups i.e. educated-working mothers, uneducated working mothers, educated non-working mothers and uneducated non-working mothers. This research comprised of two studies. Study 1 was carried out to construct two separate scales namely Maternal Concerns and Attitudes Scale for safety of Daughters (MCA-SD) and Maternal Concerns and Attitudes Scale for safety of Sons (MCA-SS) for assessing maternal concerns and attitudes about safety and protection of daughters and sons. These scales were used in study 2 with the objective to explore mothers’ general concerns, attitudes and perceptions of about child vulnerability for sexual abuse. Data were analyzed using two-way analysis of variance and independent-samples t-test. Educated mothers had more sense of responsibility, ensured more safety and provide more information about self-protection to their children as compared to uneducated mothers. Similarly non-working mothers showed more sense of responsibility and provided more information on self-protection to their children as compared to working mothers. Moreover, mothers living in nuclear family system trusted more on their relatives and other people for the protection of their children and ensured more safety of children than those living in joint family system. Findings have very important implications for protecting children from likely sexual abuse.

Keywords: mothers’ concerns, attitudes, perceptions, child vulnerability, child sexual abuse

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Authors: D. Bheenick, M. Young, M.Elmussareh, A.Ali

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Objective: Coronavirus disease 2019 (COVID-19) has had unprecedented effects on the healthcare system in the UK. The pandemic has impacted every service within secondary care, including urology. Our objective is to determine how COVID-19 has influenced acute urology admissions in a busy district general hospital in the UK. Patient and methods: Retrospective data of patients presenting acutely to the urology department was collected between 13th January to 22nd March 2020 (pre-lockdown period) and 23rd March to 31st May 2020 (lockdown period). The nature of referrals, types of admission encountered, and management required in accordance with the new set of protocols established during the lockdown period were analysed and compared to the same data prior to UK lockdown. Results: 1092 patients were included in the study. An overall reduction of 32.5% was seen in the total number of admissions. A marked decrease was seen in non-urological pathology as compared to other categories. Urolithiasis showed the highest proportional increase. Treatment varied proportionately to the diagnosis, with conservative management accounting for the most likely treatment during lockdown. However, the proportion of patients requiring interventions during the lockdown period increased overall. No comparative differences were observed during the two periods in terms of source of referral, length of stay and patient age. Conclusion: The admission rate showed a decrease, with no significant difference in the nature and timing of presentation. Our department was able to continue providing effective management to patients presenting acutely during the COVID-19 outbreak.

Keywords: COVID-19, lockdown, admissions, urology

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Authors: Abdulrahman Abdulrahman

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A side weir is a hydraulic structure set into the side of a channel. This structure is used for water level control in channels, to divert flow from a main channel into a side channel when the water level in the main channel exceeds a specific limit and as storm overflows from urban sewerage system. Computation of water surface over the side weirs is essential to determine the flow rate of the side weir. Analytical solutions for water surface profile along rectangular side weir are available only for the special cases of rectangular and trapezoidal channels considering constant specific energy. In this paper, a rectangular side weir located in a combined (trapezoidal with exponential) channel was considered. Expanding binominal series of integer and fraction powers and the using of reduction formula of cosine function integrals, a general analytical formula was obtained for water surface profile along a side weir in a combined (trapezoidal with exponential) channel. Since triangular, rectangular, trapezoidal and parabolic cross-sections are special cases of the combined cross section, the derived formula, is applicable to triangular, rectangular, trapezoidal cross-sections as analytical solution and semi-analytical solution to parabolic cross-section with maximum relative error smaller than 0.76%. The proposed solution should be a useful engineering tool for the evaluation and design of side weirs in open channel.

Keywords: analytical solution, combined channel, exponential channel, side weirs, trapezoidal channel, water surface profile

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Authors: Itsaree Padphai, Jiranan Pakpeian, Suksun Niponchai

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This study is a descriptive research which aims to: 1) Compare the difference of knowledge before and after using the e-Learning program entitled “Basic Cardiopulmonary Resuscitation for Students in an Emergency Medical Technician Diploma Program”, and 2) Assess the students’ satisfaction after using the said program. This research is a kind of teaching and learning management supplemented with the e-Learning system; therefore, the purposively selected samples are 44 first-year and class-16 students of an emergency medical technician diploma program who attend the class in a second semester of academic year 2012 in Sirindhorn College of Public Health, Khon Kaen province. The research tools include 1) the questionnaire for general information of the respondents, 2) the knowledge tests before and after using the e-Learning program, and 3) an assessment of satisfaction in using the e-Learning program. The statistics used in data analysis percentage, include mean, standard deviation, and inferential statistics: paired t-test. 1. The general information of the respondents was mostly 37 females representing 84.09 percent. The average age was 19.5 years (standard deviation was 0.81), the maximum age was 21 years, and the minimum age was 19 years respectively. Students (35 subjects) admitted that they preferred the methods of teaching and learning by using the e-Learning systems. This was totally 79.95 percent. 2. A comparison on the difference of knowledge before and after using the e-Learning program showed that the mean before an application was 6.64 (standard deviation was 1.94) and after was 18.84 (standard deviation 1.03), which was higher than the knowledge of students before using the e-Learning program with the statistical significance (P value < 0.001). 3. For the satisfaction after using the e-Learning program, it was found that students’ satisfaction was at a very good level with the mean of 4.93 (standard deviation was 0.11).

Keywords: e-Learning, cardiopulmonary resuscitation, diploma program, Khon Kaen Province

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Authors: Shao Bo Cheng, Yong-Jin Han, Se Young Park, Seong-Bae Park

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Consumer-to-Consumer (C2C) E-commerce has been growing at a very high speed in recent years. Since identical or nearly-same kinds of products compete one another by relying on keyword search in C2C E-commerce, some sellers describe their products with spam keywords that are popular but are not related to their products. Though such products get more chances to be retrieved and selected by consumers than those without spam keywords, the spam keywords mislead the consumers and waste their time. This problem has been reported in many commercial services like e-bay and taobao, but there have been little research to solve this problem. As a solution to this problem, this paper proposes a method to classify whether keywords of a product are spam or not. The proposed method assumes that a keyword for a given product is more reliable if the keyword is observed commonly in specifications of products which are the same or the same kind as the given product. This is because that a hierarchical category of a product in general determined precisely by a seller of the product and so is the specification of the product. Since higher layers of the hierarchical category represent more general kinds of products, a reliable degree is differently determined according to the layers. Hence, reliable degrees from different layers of a hierarchical category become features for keywords and they are used together with features only from specifications for classification of the keywords. Support Vector Machines are adopted as a basic classifier using the features, since it is powerful, and widely used in many classification tasks. In the experiments, the proposed method is evaluated with a golden standard dataset from Yi-han-wang, a Chinese C2C e-commerce, and is compared with a baseline method that does not consider the hierarchical category. The experimental results show that the proposed method outperforms the baseline in F1-measure, which proves that spam keywords are effectively identified by a hierarchical category in C2C e-commerce.

Keywords: spam keyword, e-commerce, keyword features, spam filtering

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Authors: Songul Cinaroglu

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Regional planning in health has gained speed for developing countries in recent years. In Turkey, 89 different Public Hospital Unions (PHUs) were conducted based on provincial levels. In this study technical efficiencies of 89 PHUs were examined by using Data Envelopment Analysis (DEA) and machine learning techniques by dividing them into two clusters in terms of similarities of input and output indicators. Number of beds, physicians and nurses determined as input variables and number of outpatients, inpatients and surgical operations determined as output indicators. Before performing DEA, PHUs were grouped into two clusters. It is seen that the first cluster represents PHUs which have higher population, demand and service density than the others. The difference between clusters was statistically significant in terms of all study variables (p ˂ 0.001). After clustering, DEA was performed for general and for two clusters separately. It was found that 11% of PHUs were efficient in general, additionally 21% and 17% of them were efficient for the first and second clusters respectively. It is seen that PHUs, which are representing urban parts of the country and have higher population and service density, are more efficient than others. Random forest decision tree graph shows that number of inpatients is a determinative factor of efficiency of PHUs, which is a measure of service density. It is advisable for public health policy makers to use statistical learning methods in resource planning decisions to improve efficiency in health care.

Keywords: public hospital unions, efficiency, data envelopment analysis, random forest

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Authors: P. Vosynek, T. Návrat, M. Peč, J. Pořízka, P. Diviš

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Changes of mechanical properties and response behavior of bones is an important external sign of medical problems like osteoporosis, bone remodeling after fracture or surgery, osteointegration, or bone tissue loss of astronauts in space. Measuring of mechanical behavior of bones in physiological and osteoporotic states, quantified by different degrees of protein (collagen) and mineral loss, is thus an important topic in biomechanical research. This contribution deals with the relation between mechanical properties of the turkey long bone–tibia in physiological, demineralized, and deproteinized state. Three methods for comparison were used: densitometry, three point bending and harmonic response analysis. The results help to find correlations between the methods and estimate their possible application in medical practice.

Keywords: bone properties, long bone, osteoporosis, response behavior

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Authors: Jothilakshmy Nagammal

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This research paper deals with the different case studies, where the Form-Based Codes are adopted in general and the different implementation methods in particular are discussed to develop a method for formulating a new planning model. The organizing principle of the Form-Based Codes, the transect is used to zone the city into various context specific transects. An approach is adopted to develop the new planning model, city Specific Planning Model (CSPM), as a tool to achieve sustainability for any city in general. A case study comparison method in terms of the planning tools used, the code process adopted and the various control regulations implemented in thirty two different cities are done. The analysis shows that there are a variety of ways to implement form-based zoning concepts: Specific plans, a parallel or optional form-based code, transect-based code /smart code, required form-based standards or design guidelines. The case studies describe the positive and negative results from based zoning, Where it is implemented. From the different case studies on the method of the FBC, it is understood that the scale for formulating the Form-Based Code varies from parts of the city to the whole city. The regulating plan is prepared with the organizing principle as the transect in most of the cases. The various implementation methods adopted in these case studies for the formulation of Form-Based Codes are special districts like the Transit Oriented Development (TOD), traditional Neighbourhood Development (TND), specific plan and Street based. The implementation methods vary from mandatory, integrated and floating. To attain sustainability the research takes the approach of developing a regulating plan, using the transect as the organizing principle for the entire area of the city in general in formulating the Form-Based Codes for the selected Special Districts in the study area in specific, street based. Planning is most powerful when it is embedded in the broader context of systemic change and improvement. Systemic is best thought of as holistic, contextualized and stake holder-owned, While systematic can be thought of more as linear, generalisable, and typically top-down or expert driven. The systemic approach is a process that is based on the system theory and system design principles, which are too often ill understood by the general population and policy makers. The system theory embraces the importance of a global perspective, multiple components, interdependencies and interconnections in any system. In addition, the recognition that a change in one part of a system necessarily alters the rest of the system is a cornerstone of the system theory. The proposed regulating plan taking the transect as an organizing principle and Form-Based Codes to achieve sustainability of the city has to be a hybrid code, which is to be integrated within the existing system - A Systemic Approach with a Systematic Process. This approach of introducing a few form based zones into a conventional code could be effective in the phased replacement of an existing code. It could also be an effective way of responding to the near-term pressure of physical change in “sensitive” areas of the community. With this approach and method the new Context Specific Planning Model is created towards achieving sustainability is explained in detail this research paper.

Keywords: context based planning model, form based code, transect, systemic approach

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Authors: Abdul Aziz, Muhammad Qamar Masood, Saadia Sattar, Saira Fatima, Najmul Islam

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Introduction: The most common endocrine tumor is thyroid cancer. Follicular Thyroid Carcinoma (FTC) accounts for 5%–10% of all thyroid cancers. Patients with FTC frequently present with more advanced stage diseases and a higher occurrence of distant metastases because of the propensity of vascular invasion. FTC is mainly treated with surgery, while radioactive iodine therapy is the main adjuvant therapy as per ATA guidelines. In many developing countries, surgical facilities and radioactive iodine are in short supply; therefore, understanding follicular thyroid cancer trends may help developing countries plan and use resources more effectively. Methodology: It was a retrospective observational study of FTC patients of age 18 years and above conducted at Aga Khan University Hospital, Karachi, from 1st January 2010 to 31st December 2019. Results: There were 404 patients with thyroid carcinoma, out of which forty (10.1%) were FTC. 50% of the patients were in the 41-60 years age group, and the female to male ratio was 1.5: 1. Twenty-four patients (60%) presented with complain of neck swelling followed by metastasis (20%) and compressive symptoms (20%). The most common site of metastasis was bone (87.5%), followed by lung (12.5%). The pre-operative thyroglobulin level was done in six out of eight metastatic patients (75%) in which it was elevated. This emphasizes the importance of checking thyroglobulin level in unusual presentation (bone pain, fractures) of a patient having neck swelling also to help in establishing the primary source of tumor. There was no complete documentation of ultrasound features of the thyroid gland in all the patients, which is an important investigation done in the initial evaluation of thyroid nodule. On FNAC, 50% (20 patients) had Bethesda category III-IV nodules, while 10% ( 4 patients ) had Bethesda category II. In sixteen patients, FNAC was not done as they presented with compressive symptoms or metastasis. Fifty percent had a total thyroidectomy and 50% had subtotal followed by completion thyroidectomy, plus ten patients had lymph node dissection, out of which seven had histopathological lymph node involvement. On histopathology, twenty-three patients (57.5%) had minimally invasive, while seventeen (42.5%) had widely invasive follicular thyroid carcinoma. The capsular invasion was present in thirty-three patients (82.5%); one patient had no capsular invasion, but there was a vascular invasion. Six patients' histopathology had no record of capsular invasion. In contrast, the lymphovascular invasion was present in twenty-six patients (65%). In this study, 65 % of the patients had clinical stage 1 disease, while 25% had stage 2 and 10% had clinical stage 4. Seventeen patients (42.5%) had received RAI 30-100 mCi, while ten patients (25%) received more than 100 mCi. Conclusion: FTC demographic and clinicopathological presentation are the same in Pakistan as compared to other countries. Surgery followed by RAI is the mainstay of treatment. Thus understanding the trend of FTC and proper planning and utilization of the resources will help the developing countries in effectively treating the FTC.

Keywords: thyroid carcinoma, follicular thyroid carcinoma, clinicopathological features, developing countries

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Authors: Gabriel Hunduma

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Asymptomatic intra-thoracic neurogenic tumours are rare. Tumours arising from the intercostal nerves of the chest wall are exceedingly rare. This paper reports an incidental discovery of a neurogenic intercostal tumour while being investigated for Coronavirus Disease 2019 (COVID-19). A 54-year-old female underwent a thoracotomy and resection for an intercostal tumour. Pre-operative images showed an intrathoracic mass, and the biopsy revealed a schwannoma. The most common presenting symptom recorded in literature is chest pain; however, our case remained asymptomatic despite the size of the mass and thoracic area it occupied. After an extensive search of the literature, COVID-19 was found to have an influence on the development of certain cells in breast cancer. Hence there is a possibility that COVID-19 played a role in progressing the development of the schwannoma cells.

Keywords: thoracic surgery, intercostal schwannoma, chest wall oncology, COVID-19

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Authors: A. Flammini, R. Morbidelli, C. Saltalippi

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The increase of air surface temperature at global scale is a fact, with values around 0.85 ºC since the late nineteen century, as well as a significant change in main features of rainfall regime. Nevertheless, the detected climatic changes are not equally distributed all over the world, but exhibit specific characteristics in different regions. Therefore, studying the evolution of climatic indices in different geographical areas with a prefixed standard approach becomes very useful in order to analyze the existence of climatic trend and compare results. In this work, a methodology to investigate the climatic change and its effects on a wide set of climatic indices is proposed and applied at regional scale in the case study of a Mediterranean area, Umbria region in Italy. From data of the available temperature stations, nine temperature indices have been obtained and the existence of trends has been checked by applying the non-parametric Mann-Kendall test, while the non-parametric Pettitt test and the parametric Standard Normal Homogeneity Test (SNHT) have been applied to detect the presence of break points. In addition, aimed to characterize the rainfall regime, data from 11 rainfall stations have been used and a trend analysis has been performed on cumulative annual rainfall depth, daily rainfall, rainy days, and dry periods length. The results show a general increase in any temperature indices, even if with a trend pattern dependent of indices and stations, and a general decrease of cumulative annual rainfall and average daily rainfall, with a time rainfall distribution over the year different from the past.

Keywords: climatic change, temperature, rainfall regime, trend analysis

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Authors: Yemane Hailu Fissuh, Zhongzhan Zhang

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An estimating equation technique is an alternative method of the widely used maximum likelihood methods, which enables us to ease some complexity due to the complex characteristics of time-varying covariates. In the situations, when both the time-varying covariates and left-truncation are considered in the model, the maximum likelihood estimation procedures become much more burdensome and complex. To ease the complexity, in this study, the modified estimating equations those have been given high attention and considerations in many researchers under semiparametric transformation model was proposed. The purpose of this article was to develop the modified estimating equation under flexible and general class of semiparametric transformation models for left-truncated and right censored survival data with time-varying covariates. Besides the commonly applied Cox proportional hazards model, such kind of problems can be also analyzed with a general class of semiparametric transformation models to estimate the effect of treatment given possibly time-varying covariates on the survival time. The consistency and asymptotic properties of the estimators were intuitively derived via the expectation-maximization (EM) algorithm. The characteristics of the estimators in the finite sample performance for the proposed model were illustrated via simulation studies and Stanford heart transplant real data examples. To sum up the study, the bias for covariates has been adjusted by estimating density function for the truncation time variable. Then the effect of possibly time-varying covariates was evaluated in some special semiparametric transformation models.

Keywords: EM algorithm, estimating equation, semiparametric transformation models, time-to-event outcomes, time varying covariate

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Authors: Moses Aron, Elias Mwakilama, Jimmy Namangale

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Spending more time on long queues for a basic service remains a common challenge to most developing countries, including Malawi. For health sector in particular, Out-Patient Department (OPD) experiences long queues. This puts the lives of patients at risk. However, using queuing analysis to under the nature of the problems and efficiency of service systems, such problems can be abated. Based on a kind of service, literature proposes different possible queuing models. However, unlike using generalized assumed models proposed by literature, use of real time case study data can help in deeper understanding the particular problem model and how such a model can vary from one day to the other and also from each case to another. As such, this study uses data obtained from one urban HC for BP, Pediatric and General OPD cases to investigate an average queuing time for patients within the system. It seeks to highlight the proper queuing model by investigating the kind of distributions functions over patient’s arrival time, inter-arrival time, waiting time and service time. Comparable with the standard set values by WHO, the study found that patients at this HC spend more waiting times than service times. On model investigation, different days presented different models ranging from an assumed M/M/1, M/M/2 to M/Er/2. As such, through sensitivity analysis, in general, a commonly assumed M/M/1 model failed to fit the data but rather an M/Er/2 demonstrated to fit well. An M/Er/3 model seemed to be good in terms of measuring resource utilization, proposing a need to increase medical personnel at this HC. However, an M/Er/4 showed to cause more idleness of human resources.

Keywords: health care, out-patient department, queuing model, sensitivity analysis

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Authors: Disha Batra

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With the advent of economic reforms in India in 1992, economic journalism in India has undergone a sea change along with the rise in the Indian economy. Squeezing out of economic news stories (economy-in-general) over business (individual corporate stories) and financial (financial and equity markets) news stories have been done and are still underway. The objective of the study is to explore how economic journalism – news stories about macroeconomic issues or economy-in-general has changed over the past three decades with the emergence of LPG (Liberalisation, Privatisation, and Globalisation) policies in India. The purpose of the study is to examine to what extent business and financial news are constricting economic news which is done by analysing news stories and content of business papers. The study is based on the content analyses of the top three Indian business dailies as per IRS (Indian Readership Survey) 2017. The parametric analysis of the different parameters (source of information, sub-topic, a dominant source in economic news, layout and framing, etc.) has been done in order to come across with the distinct adaptations and modifications by these dailies. The paper significantly dwells upon the thematic analysis of these newspapers in order to explore and find out the coverage given to various sub-themes of EBF (economic, business, and financial) journalism. The study revealed that stories concerning broader issues about the economy which are likely to be of public concern had been dropped. The paper further indicates an upward trend for the stories concerning individual corporate, equity, and financial markets. Findings of the study raise concern over the indicated disparity between economic and business news stories which may further limit the information that people need in order to make well-versed decisions.

Keywords: business-papers, business news, economic news, financial news

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Authors: Dara Singh, Keikhosrow Firouzbakhsh, Mohammad Taghi Ahmadian

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In this paper, conventional laser Keratoplasty surgeries in the human eye are studied. For this purpose, a validated 3D finite volume model of the human eye is introduced. In this model the fluid flow has also been considered. The discretized domain of the human eye incorporates a bio-heat transfer equation coupled with a Boussinesq equation. Both continuous and pulsed lasers have been modeled and the results are compared. Moreover, two different conventional surgical positions that are upright and recumbent are compared for these laser therapies. The simulation results show that in these conventional surgeries, the temperature rises above the critical values at the laser insertion areas. However, due to the short duration and the localized nature, the potential damages are restricted to very small regions and can be ignored. The conclusion is that the present day lasers are acceptably safe to the human eye.

Keywords: eye, heat-transfer, keratoplasty laser, surgery

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Authors: Eric Tardif, Nicolas Meylan

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Recent studies suggest that the consolidation of episodic memory is better achieved through repeated retrieval than with the use of concept mapping or repeated study. Although such laboratory results highly appeal to educationalists, it remains to be shown whether they can be directly used in a classroom setting. Forty-five college students (42 girls; mean age 16.1 y/o) were asked to remember pairs of biology-related words (e.g. mitochondria-energy) in two configurations. The first configuration consisted of a three-minute study of pairs of words followed by a final one-minute test in which the first word of a pair was shown and the subject asked to write down the second associated word. This procedure was repeated three times. The second configuration consisted of a one-minute study of a list of pairs of words, which was immediately followed by a one-minute test. This procedure was repeated 6 times. Subjects filled out a small questionnaire assessing their general mood, level of fatigue, stress and motivation to do the exercise. One week later, subjects were given a final test using the same words. A total of 8 lists of words were studied and tested during the semester. Results showed that subjects recalled more correct words when using the second configuration, both within the study period and one week later, confirming laboratory findings. However, the general performance (mean items recalled) as well as the motivation to do the exercise gradually decreased during the semester. Motivation was positively correlated with performance (r=0.77, p<0.05). The results suggest that laboratory findings may provide some applications in education but other variables inherent to the classroom setting must also be considered.

Keywords: long-term, episodic memory, consolidation, retrieval, school setting

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Authors: Vahid Asadzadeh, Amin Ataee

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Since the advent of social media, there has been a wave of optimism among researchers and civic activists about the influence of virtual networks on the democratization process, which has gradually waned. One of the lesser-known concerns is how to increase the possibility of hearing the voices of different minorities. According to the theory of media logic, the media, using their technological capabilities, act as a structure through which events and ideas are interpreted. Social media, through the use of the learning machine and the use of algorithms, has formed a kind of structure in which the voices of minorities and less popular topics are lost among the commotion of the trends. In fact, the recommended systems and algorithms used in social media are designed to help promote trends and make popular content more popular, and content that belongs to minorities is constantly marginalized. As social networks gradually play a more active role in politics, the possibility of freely participating in the reproduction and reinterpretation of structures in general and political structures in particular (as Laclau‎ and Mouffe had in mind‎) can be considered as criteria to democracy in action. The point is that the media logic of virtual networks is shaped by the rule and even the tyranny of the majority, and this logic does not make it possible to design a self-foundation and self-revolutionary model of democracy. In other words, today's social networks, though seemingly full of variety But they are governed by the logic of homogeneity, and they do not have the possibility of multiplicity as is the case in immanent radical democracies (influenced by Gilles Deleuze). However, with the emergence and increasing popularity of Clubhouse as a new social media, there seems to be a shift in the social media space, and that is the diminishing role of algorithms and systems reconditioners as content delivery interfaces. This has led to the fact that in the Clubhouse, the voices of minorities are better heard, and the diversity of political tendencies manifests itself better. The purpose of this article is to show, first, how social networks serve the elimination of minorities in general, and second, to argue that the media logic of social networks must adapt to new interpretations of democracy that give more space to minorities and human rights. Finally, this article will show how the Clubhouse serves the new interpretations of democracy at least in a minimal way. To achieve the mentioned goals, in this article by a descriptive-analytical method, first, the relation between media logic and postmodern democracy will be inquired. The political economy popularity in social media and its conflict with democracy will be discussed. Finally, it will be explored how the Clubhouse provides a new horizon for the concepts embodied in radical democracy, a horizon that more effectively serves the rights of minorities and human rights in general.

Keywords: algorithmic tyranny, Clubhouse, minority rights, radical democracy, social media

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Authors: G. M. Contessa, L. Lepore, G. Gandolfo, C. Poggi, N. Cherubini, R. Remetti, S. Sandri

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Practical guidelines are provided in this work for the safe use of a portable d-t Thermo Scientific MP-320 neutron generator producing pulsed 14.1 MeV neutron beams. The neutron generator’s emission was tested experimentally and reproduced by MCNPX Monte Carlo code. Simulations were particularly accurate, even generator’s internal components were reproduced on the basis of ad-hoc collected X-ray radiographic images. Measurement campaigns were conducted under different standard experimental conditions using an LB 6411 neutron detector properly calibrated at three different energies, and comparing simulated and experimental data. In order to estimate the dose to the operator vs. the operating conditions and the energy spectrum, the most appropriate value of the conversion factor between neutron fluence and ambient dose equivalent has been identified, taking into account both direct and scattered components. The results of the simulations show that, in real situations, when there is no information about the neutron spectrum at the point where the dose has to be evaluated, it is possible - and in any case conservative - to convert the measured value of the count rate by means of the conversion factor corresponding to 14 MeV energy. This outcome has a general value when using this type of generator, enabling a more accurate design of experimental activities in different setups. The increasingly widespread use of this type of device for industrial and medical applications makes the results of this work of interest in different situations, especially as a support for the definition of appropriate radiation protection procedures and, in general, for risk analysis.

Keywords: instrumentation and monitoring, management of radiological safety, measurement of individual dose, radiation protection of workers

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Authors: Lazzat M. Zhamaliyeva, Nurgul A. Abenova, Gauhar S. Dilmagambetova, Ziyash Zh. Tanbetova, Moldir B. Ahmetzhanova, Tatyana P. Ostretcova, Aliya A. Yegemberdiyeva

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Introduction: There are many reasons for the weak training of family doctors in Kazakhstan: the unified national educational program is not focused on competencies, the role of a general practitioner (GP) is not clear, poor funding for the health care and education system, outdated teaching and assessment methods, inefficient management. We highlight two issues in particular. Firstly, academic teachers of family medicine (FM) in Kazakhstan do not practice as family doctors; most of them are narrow specialists (pediatricians, therapists, surgeons, etc.); they usually hold one-time consultations; clinical mentors from practical healthcare (non-academic teachers) do not have the teaching competences, and the vast majority of them are also narrow specialists. Secondly, clinical sites (polyclinics) are unprepared for general practice and do not follow the principles of family medicine; residents do not like to be in primary health care (PHC) settings due to the chaos that is happening there, as well as due to the lack of the necessary equipment for mastering and consolidating practical skills. Aim: We present the concept of the family physicians’ training office (FPTO), which is being created as a friendly learning environment for young general practitioners and for the involvement of academic teachers of family medicine in the practical work and innovative development of PHC. Methodology: In developing the conceptual framework and identifying practical activities, we drew on literature and expert input, and interviews. Results: The goal of the FPTO is to create a favorable educational and clinical environment for the development of the FM residents’ competencies, in which the residents with academic teachers and clinical mentors could understand and accept the principles of family medicine, improve clinical knowledge and skills, and gain experience in improving the quality of their practice in scientific basis. Three main areas of office activity are providing primary care to the patients, improving educational services for FM residents and other medical workers, and promoting research in PHC and innovations. The office arranges for residents to see outpatients at least 50% of the time, and teachers of FM departments at least 1/4 of their working time conduct general medical appointments next to residents. Taking into account the educational and scientific workload, the number of attached population for one GP does not exceed 500 persons. The equipment of the office allows FPTO workers to perform invasive and other manipulations without being sent to other clinics. In the office, training for residents is focused on their needs and aimed at achieving the required level of competence. International methodologies and assessment tools are adapted to local conditions and evaluated for their effectiveness and acceptability. Residents and their faculty actively conduct research in the field of family medicine. Conclusions: We propose to change the learning environment in order to create teams of like-minded people, to unite residents and teachers even more for the development of family medicine. The offices will also invest resources in developing and maintaining young doctors' interest in family medicine.

Keywords: educational environment, family medicine residents, family physicians’ training office, primary care research

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Authors: Sara De Pelsmaeker, Catarina Ferreira da Silva, Janne Prawit

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Recent studies show that enzymatically hydrolysed collagen is absorbed and distributed to joint tissues, where it has analgesic and active anti-inflammatory properties. Reviews of the associated relevant literature also support this theory. However, these studies are all using hydrolyzed collagen from animal hide or skin. This study looks into the effect of daily supplementation of hydrolyzed cartilage collagen (HCC), which has a different composition. A consumer study was set up using a double-blind placebo-controlled design with a control group using twice a day 0.5gr of maltodextrin and an experimental group using twice 0.5g of HCC, over a trial period of 12 weeks. A follow-up phase of 4 weeks without supplementation was taken into the experiment to investigate the ‘wash-out’ phase. As this consumer study was conducted during the lockdown periods, a specific app was designed to follow up with the participants. The app had the advantage that in this way, the motivation of the participants was enhanced and the drop-out range of participants was lower than normally seen in consumer studies. Participants were recruited via various sports and health clubs across the UK as we targeted a general population of people that considered themselves in good health. Exclusion criteria were ‘not experiencing any medical conditions’ and ‘not taking any prescribed medication’. A minimum requirement was that they regularly engaged in some level of physical activity. The participants had to log the type of activity that they conducted and the duration of the activity. Weekly, participants were providing feedback on their joint health and subjective pain using the validated pain measuring instrument Visual Analogue Scale (VAS). The weekly repoAbstract Public Health and Wellbeing Conferencerting section in the app was designed with simplicity and based on the accuracy demonstrated in previous similar studies to track subjective pain measures of participants. At the beginning of the trial, each participant indicated their baseline on joint pain. The results of this consumer study indicated that HCC significantly improved joint health and subjective pain scores compared to the placebo group. No significant differences were found between different demographic groups (age or gender). The level of activity, going from high intensive training to regular walking, did not significantly influence the effect of the HCC. The results of the wash-out phase indicated that when the participants stopped the HCC supplementation, their subjective pain scores increased again to the baseline. In conclusion, the results gave a positive indication that the daily supplementation of HCC can contribute to the overall mobility and wellbeing of a general active population

Keywords: VAS-score, food supplement, mobility, joint health

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Authors: Adam Kurnicki, Bartłomiej Stanczyk, Bartosz Kania

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This paper presents development of the light-weight manipulator with series elastic actuation for medical telediagnostics (USG examination). General structure of realized impedance control algorithm was shown. It was described how to perform force measurements based mainly on elasticity of manipulator links.

Keywords: telediagnostics, elastic manipulator, impedance control, force measurement

Procedia PDF Downloads 473

Authors: E. Asadollahi-Yazdi, J. Gardan, P. Lafon

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Nowadays, manufactures are encountered with production of different version of products due to quality, cost and time constraints. On the other hand, Additive Manufacturing (AM) as a production method based on CAD model disrupts the design and manufacturing cycle with new parameters. To consider these issues, the researchers utilized Design For Manufacturing (DFM) approach for AM but until now there is no integrated approach for design and manufacturing of product through the AM. So, this paper aims to provide a general methodology for managing the different production issues, as well as, support the interoperability with AM process and different Product Life Cycle Management tools. The problem is that the models of System Engineering which is used for managing complex systems cannot support the product evolution and its impact on the product life cycle. Therefore, it seems necessary to provide a general methodology for managing the product’s diversities which is created by using AM. This methodology must consider manufacture and assembly during product design as early as possible in the design stage. The latest approach of DFM, as a methodology to analyze the system comprehensively, integrates manufacturing constraints in the numerical model in upstream. So, DFM for AM is used to import the characteristics of AM into the design and manufacturing process of a hybrid product to manage the criteria coming from AM. Also, the research presents an integrated design method in order to take into account the knowledge of layers manufacturing technologies. For this purpose, the interface model based on the skin and skeleton concepts is provided, the usage and manufacturing skins are used to show the functional surface of the product. Also, the material flow and link between the skins are demonstrated by usage and manufacturing skeletons. Therefore, this integrated approach is a helpful methodology for designer and manufacturer in different decisions like material and process selection as well as, evaluation of product manufacturability.

Keywords: additive manufacturing, 3D printing, design for manufacturing, integrated design, interoperability

Procedia PDF Downloads 313