Search results for: methods of Lagrange multipliers

Authors: Jorge Anibal Restrepo Morales, Sonia Martín Gómez

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A model based on a logical framework was developed to quantify SMEs' internationalization capacity. To do so, linguistic variables, such as human talent, infrastructure, innovation strategies, FTAs, marketing strategies, finance, etc. were integrated. It is argued that a company’s management of international markets depends on internal factors, especially capabilities and resources available. This study considers internal factors as the biggest business challenge because they force companies to develop an adequate set of capabilities. At this stage, importance and strategic relevance have to be defined in order to build competitive advantages. A fuzzy inference system is proposed to model the resources, skills, and capabilities that determine the success of internationalization. Data: 157 linguistic variables were used. These variables were defined by international trade entrepreneurs, experts, consultants, and researchers. Using expert judgment, the variables were condensed into18 factors that explain SMEs’ export capacity. The proposed model is applied by means of a case study of the textile and clothing cluster in Medellin, Colombia. In the model implementation, a general index of 28.2 was obtained for internationalization capabilities. The result confirms that the sector’s current capabilities and resources are not sufficient for a successful integration into the international market. The model specifies the factors and variables, which need to be worked on in order to improve export capability. In the case of textile companies, the lack of a continuous recording of information stands out. Likewise, there are very few studies directed towards developing long-term plans, and., there is little consistency in exports criteria. This method emerges as an innovative management tool linked to internal organizational spheres and their different abilities.

Keywords: business strategy, exports, internationalization, fuzzy set methods

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Authors: Bindu I. Somarajan, Viney Gupta, Gagandeep Kaur Walia, Jasbir Kaur, Sunil Kumar, Shikha Gupta, Abadh K. Chaurasia, Dinesh Gupa, Abhinav Kaushik, Aditi Mehta, Vipin Gupta, Arundhati Sharma

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Background: Juvenile onset primary open angle glaucoma (JOAG), affects individuals under the age of 40 years. Studies on a few families of JOAG, that led to the discovery of the Myocilin gene, reported the disease to have an autosomal dominant pattern of inheritance. However, sporadic forms of JOAG been seen to be more common in some populations. Most pathological homozygous mutations in the CYP1B1 gene associated with JOAG have been seen among sporadic cases. Given the higher prevalence of sporadic JOAG cases in our population, we aimed to look for common mutations E229K and R368H, the two most common variants in the CYP1B1 gene associated with glaucoma. Objective: To determine the frequency and evaluate genotype phenotype correlation of CYP1B1 E229K and R368H mutations in a cohort of 120 sporadic Juvenile open angle glaucoma patients.Methods: Unrelated JOAG patients whose first degree relatives had been examined and found to be unaffected were included in the study. The patients and their parents were screened for E229K and R368H mutations. The phenotypic characteristics were compared between probands with and with out these mutations by SPSS v16. Results: Out of 120 JOAG patients included in the study, the E229K mutation was seen in 9 probands (7.5%) and R368H in 7 (5.8%). The average age of onset of the disease (p=0.3) and the highest untreated IOP (p=0.4) among those carrying mutations was not significantly different from those who did not have these mutations. The proportion of probands with angle dysgenesis among those with E229K and R368H mutations was 70% (11 out of 16) in comparison to 65% (67 out of 104) of those who did not harbour these mutations (p=0.56). Similarly the probands with moderate to high myopia among those with E229K and R368H mutations was 20% (3 out of 16) in comparison to 18% (18 out of 104) of those who did not harbour these mutations(p=0.59). Conclusion: The frequency of E229K and R368H mutations of the CYP1B1 gene is low even among sporadic JOAG patients. Moreover there is no clinical correlation between the presence of these mutations and disease severity

Keywords: CYP1B1, gene, IOP, JOAG, mutation

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Authors: Reza Vakili, Xiaolei Fan, Alex Walton

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The first near ambient pressure (NAP)-XPS study of CO oxidation over Pt nanoparticles (NPs) incorporated into Zr-based UiO (UiO for Universitetet i Oslo) MOFs was carried out. For this purpose, the MOF-based Catalysts were prepared by wetness impregnation (WI-PtNPs@UiO-67) and linker design (LD-PtNPs@UiO-67) methods along with PtNPs@ZrO₂ as the control catalyst. Firstly, the as-synthesized catalysts were reduced in situ prior to the operando XPS analysis. The existence of Pt(II) species was proved in UiO-67 by observing Pt 4f core level peaks at a high binding energy of 72.6 ± 0.1 eV. However, by heating the WI-PtNPs@UiO-67 catalyst in situ to 200 °C under vacuum, the higher BE components disappear, leaving only the metallic Pt 4f doublet, confirming the formation of Pt NPs. The complete reduction of LD-PtNPs@UiO-67 is achieved at 250 °C and 1 mbar H₂. To understand the chemical state of Pt NPs in UiO-67 during catalytic turnover, we analyzed the Pt 4f region using operando NAP-XPS in the temperature-programmed measurements (100-260 °C) with reference to PtNPs@ZrO₂ catalyst. CO conversion during NAP-XPS experiments with the stoichiometric mixture shows that LD-PtNPs@UiO-67 has a better CO turnover frequency (TOF, 0.066 s⁻¹ at 260 °C) than the other two (ca. 0.055 s⁻¹). Pt 4f peaks only show one chemical species present at all temperatures, but the core level BE shifts change as a function of reaction temperature, i.e., Pt 4f peak from 71.8 eV at T < 200 °C to 71.2 eV at T > 200 °C. As this higher BE state of 71.8 eV was not observed after in situ reductions of the catalysts and only once the CO/O₂ mixture was introduced, we attribute it to the surface saturation of Pt NPs with adsorbed CO. In general, the quantitative analysis of Pt 4f data from the operando NAP-XPS experiments shows that the surface chemistry of the Pt active phase in the two PtNPs@UiO-67 catalysts is the same, comparable to that of PtNPs@ZrO₂. The observed difference in the catalytic activity can be attributed to the particle sizes of Pt NPs, as well as the dispersion of active phase in the support, which are different in the three catalysts.

Keywords: CO oxidation, heterogeneous catalysis, MOFs, Metal Organic Frameworks, NAP-XPS, Near Ambient Pressure X-ray Photoelectron Spectroscopy

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Authors: Azar Heidarizadi, Mahdieh Salimi, Hossein Mozdarani

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Introduction: As a complex disease, breast cancer results from several genetic and epigenetic changes. Lactoferrin, a member of the transferrin family, is reported to have a number of biological functions, including DNA synthesis, immune responses, iron transport, etc., any of which could play a role in tumor progression. The aim of this study was to investigate the bioinformatics data and experimental assay to find the pattern of promoter methylation and gene expression of LTF in breast cancer in order to study its potential role in cancer management. Material and Methods: In order to evaluate the methylation status of the LTF promoter, we studied the MS-PCR and Real-Time PCR on samples from patients with breast cancer and normal cases. 67 patient samples were conducted for this study, including tumoral, plasma, and normal tissue adjacent samples, as well as 30 plasma from normal cases and 10 tissue breast reduction cases. Subsequently, bioinformatics analyses such as cBioPortal databases, string, and genomatix were conducted to disclose the prognostic value of LTF in breast cancer progression. Results: The analysis of LTF expression showed an inverse relationship between the expression level of LTF and the stages of tissues of breast cancer patients (p<0.01). In fact, stages 1 and 2 had a high expression in LTF, while, in stages 3 and 4, a significant reduction was observable (p < 0.0001). LTF expression frequently alters with a decrease in the expression in ER⁺, PR⁺, and HER2⁺ patients (P < 0.01) and an increase in the expression in the TNBC, LN¯, ER¯, and PR- patients (P < 0.001). Also, LTF expression is significantly associated with metastasis and lymph node involvement factors (P < 0.0001). The sensitivity and specificity of LTF were detected, respectively. A negative correlation was detected between the results of level expression and methylation of the LTF promoter. Conclusions: The altered expression of LTF observed in breast cancer patients could be considered as a promotion in cell proliferation and metastasis even in the early stages of cancer.

Keywords: LTF, expression, methylation, breast cancer

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Authors: Mirnawati, Gita Ciptaan, Ferawati

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Background and Objective: Palm kernel cake (PKC) is a waste of the palm oil industry. Indonesia, as the largest palm oil producer in the world, produced 45-46% palm kernel cake. Palm kernel cake can potentially be used as animal ration but its utilization for poultry is limited. Thus, fermentation process was done in order to increase the utilization PKC in poultry ration. An experiment was conducted to study the effect between Inoculum Doses with Bacillus subtilis and fermentation time to improve the quality and nutrient content of fermented Palm Kernel Cake. Material and Methods: 1) Palm kernel cake derived from Palm Kernel Processing Manufacture of Andalas Agro Industry in Pasaman, West Sumatra. 2) Bacillus subtilis obtained from The Research Center of Applied Chemistry LIPI, Bogor. 3) Preparations nutrient agar medium (NA) produced by Difoo - Becton Dickinson. 4) Rice bran 5) Aquades and mineral standard. The experiment used completely randomize design (CRD) with 3 x 3 factorial and 3 replications. The first factors were three doses of inoculum Bacillus subtilis: (3%), (5%), and (7%). The second factor was fermentation time: (1) 2 day, (2) 4 day, and (3) 6 day. The parameters were crude protein, crude fiber, nitrogen retention, and crude fiber digestibility of fermented palm kernel cake (FPKC). Results: The result of the study showed that there was significant interaction (P<0.01) between factor A and factor B and each factor A and B also showed significant effect (P<0.01) on crude protein, crude fiber, nitrogen retention, and crude fiber digestibility. Conclusion: From this study, it can be concluded that fermented PKC with 7% doses of Bacillus subtilis and 6 days fermentation time provides the best result as seen from 24.65% crude protein, 17.35% crude fiber, 68.47% nitrogen retention, 53.25% crude fiber digestibility of fermented palm kernel cake (FPKC).

Keywords: fermentation, Bacillus Subtilis, inoculum, palm kernel cake, quality, nutrient

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Authors: Mehmet Akköse

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Concern about seismic safety of concrete dams have been growing around the world, partly because the population at risk in locations downstream of major dams continues to expand and also because it is increasingly evident that the seismic design concepts in use at the time most existing dams were built were inadequate. Most of the investigations in the past have been conducted on large dams, typically above 100m high. A large number of concrete dams in our country and in other parts of the world are less than 50m high. Most of these dams were usually designed using pseudo-static methods, ignoring the dynamic characteristics of the structure as well as the characteristics of the ground motion. Therefore, it is important to carry out investigations on seismic behavior this category of dam in order to assess and evaluate the safety of existing dams and improve the knowledge for different high dams to be constructed in the future. In this study, size effects on structural performance of concrete gravity dams subjected to near and far-fault ground motions are investigated including dam-water-foundation interaction. For this purpose, a benchmark problem proposed by ICOLD (International Committee on Large Dams) is chosen as a numerical application. Structural performance of the dam having five different heights is evaluated according to damage criterions in USACE (U.S. Army Corps of Engineers). It is decided according to their structural performance if non-linear analysis of the dams requires or not. The linear elastic dynamic analyses of the dams to near and far-fault ground motions are performed using the step-by-step integration technique. The integration time step is 0.0025 sec. The Rayleigh damping constants are calculated assuming 5% damping ratio. The program NONSAP modified for fluid-structure systems with the Lagrangian fluid finite element is employed in the response calculations.

Keywords: concrete gravity dams, Lagrangian approach, near and far-fault ground motion, USACE damage criterions

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Authors: S. Fahiminiya, J. Nadaf, F. Rauch, L. Jerome-Majewska, J. Majewski

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Background: Sequencing of protein coding regions of human genome (Whole Exome Sequencing; WES), has demonstrated a great success in the identification of causal mutations for several rare genetic disorders in human. Generally, most of WES studies have focused on rare variants in coding exons and splicing-sites where missense substitutions lead to the alternation of protein product. Although focusing on this category of variants has revealed the mystery behind many inherited genetic diseases in recent years, a subset of them remained still inconclusive. Here, we present the result of our WES studies where analyzing only rare variants in coding regions was not conclusive but further investigation revealed the involvement of non-coding variants and copy number variations (CNV) in etiology of the diseases. Methods: Whole exome sequencing was performed using our standard protocols at Genome Quebec Innovation Center, Montreal, Canada. All bioinformatics analyses were done using in-house WES pipeline. Results: To date, we successfully identified several disease causing mutations within gene coding regions (e.g. SCARF2: Van den Ende-Gupta syndrome and SNAP29: 22q11.2 deletion syndrome) by using WES. In addition, we showed that variants in non-coding regions and CNV have also important value and should not be ignored and/or filtered out along the way of bioinformatics analysis on WES data. For instance, in patients with osteogenesis imperfecta type V and in patients with glucocorticoid deficiency, we identified variants in 5'UTR, resulting in the production of longer or truncating non-functional proteins. Furthermore, CNVs were identified as the main cause of the diseases in patients with metaphyseal dysplasia with maxillary hypoplasia and brachydactyly and in patients with osteogenesis imperfecta type VII. Conclusions: Our study highlights the importance of considering non-coding variants and CNVs during interpretation of WES data, as they can be the only cause of disease under investigation.

Keywords: whole exome sequencing data, non-coding variants, copy number variations, rare diseases

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Authors: T. Goldstein, E. Serok, J. D. Kark

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Background and Aim: The prevalence of obesity is increasing worldwide and in Israel. To meet this challenge, our study tests a new educational approach through a controlled school-based trial to achieve an improvement in eating habits, aerobic activity, and reduced obesity in Grades 2-3. Methods and Design: A cluster randomized controlled trial allocated 4 elementary schools (3rd and 2nd-grade classes each) to intervention or control groups. This allocation was switched with the next cohort of children. Recruitment was in first grade, randomization at the beginning of second grade, evaluation of results at the end of second grade and the beginning of third grade — intervention: 5 joint parent-children classroom activities on health topics and 5 educational workshops for parents only. Alfred Adler's concepts were guiding principles. Subjects: Of 743 children in 23-second grade classes, parents provided informed consent for 508 (68%). Information of retention health habits continued for third grade. Additional parental approvals were required. Parents provided informed consent for third-grade follow-up for 432. Results: At the end of 2nd grade, the amount of aerobic activity increased in the intervention group in comparison with the control group, the difference being marginally statistically significant (p=0.061). There is a significant difference between the groups in the percentage of "no activity being done" reported at the end of second grade when in the experimental group, the percentage is lower than the control. There are differences between genders in the percentage of aerobic activity at the end of second grade (p=0.044) and in the third grade (p < 0.0001). Height increased significantly (p=0.030 ), and waist circumference declined significantly (p=0.021) in the intervention compared with the control group. There were no significant between-group differences in BMI and weight. Conclusion: There were encouraging changes in aerobic activity and in anthropometric measurements. To maintain changes over longer periods, refreshing these nutrition and activity themes annually in school using the model is required.

Keywords: aerobic activity, child obesity, Alfred Adler, schoolchildren

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Authors: Essam A. Makky, Chan Cai Wen, Muna Jalal, Mashitah M. Yusoff

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Termites are considered as important pests that could cause severe wood damage and economic losses in urban, agriculture and forest of Malaysia. The ability of termites to degrade cellulose depends on association of gut cellulolytic microflora or better known as mutual symbionts. With the idea of disrupting the mutual symbiotic association, better pest control practices can be attained. This study is aimed to isolate cellulolytic bacteria from the gut of termites and carry out antibacterial studies for the termite. Confirmation of cellulase activity is done by qualitative and quantitative methods. Impacts of antibiotics and their combinations, as well as heavy metals and disinfectants, are conducted by using disc diffusion method. Effective antibacterial agents are then subjected for termite treatment to study the effectiveness of the agents as termiticides. 24 cellulolytic bacteria are isolated, purified and screened from the gut of termites. All isolates were identified as Gram-negative with either rod or cocci in shape. For antibacterial studies result, isolates were found to be 100% sensitive to 4 antibiotics (rifampicin, tetracycline, gentamycin, and neomycin), 2 heavy metals (cadmium and mercury) and 3 disinfectants (lactic acid, formalin, and hydrogen peroxide). 22 out of 36 antibiotic combinations showed synergistic effect while 15 antibiotic combinations showed an antagonistic effect on isolates. The 2 heavy metals and 3 disinfectants that showed 100% effectiveness, as well as 22 antibiotic combinations, that showed synergistic effect were used for termite control. Among the 27 selected antibacterial agents, 12 of them were found to be effective to kill all the termites within 1 to 6 days. Mercury, lactic acid, formalin and hydrogen peroxide were found to be the most effective termiticides in which all termites were killed within 1 day only. These effective antibacterial agents possess a great potential to be a new application to control the termite pest species in the future.

Keywords: antibacterial, cellulase, termicide, termites

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Authors: Heba Salem

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This paper aims to share the researcher’s experience of using e-Portfolios as an assessment tool to follow up on students’ learning experiences and performance throughout the semester. It also aims at highlighting the importance of students’ self-reflection in the process of language learning. The paper begins by introducing the advanced media course, with its focus on listening and speaking skills, and introduces the students’ profiles. Then it explains the students’ role in the e-portfolio process as they are given the option to choose a listening text they studied throughout the semester and to choose a recorded oral production of their collection of artifacts throughout the semester. Students showcase and reflect on their progress in both listening comprehension and speaking. According to the research, re-listening to work given to them and to their production is a means of reflecting on both their progress and achievement. And choosing the work students want to showcase is a means to promote independent learning as well as self-expression. Students are encouraged to go back to the class learning outcomes in the process of choosing the work. In their reflections, students express how they met the specific learning outcome. While giving their presentations, students expressed how useful the experience of returning and going over what they covered to select one and going over their production as well. They also expressed how beneficial it was to listen to themselves and literally see their progress in both listening comprehension and speaking. Students also reported that they grasped more details from the texts than they did when first having it as an assignment, which coincided with one of the class learning outcomes. They also expressed the fact that they had more confidence speaking as well as they were able to use a variety of vocabulary and idiomatic expressions that students have accumulated. For illustration, this paper includes practical samples of students’ tasks and instructions as well as samples of their reflections. The results of students’ reflections coincide with what the research confirms about the effectiveness of the e-portfolios as a means of assessment. The employment of e-Portfolios has two-folded benefits; students are able to measure the achievement of the targeted learning outcomes, and teachers receive constructive feedback on their teaching methods.

Keywords: e-portfolios, assessment, self assessment, listening and speaking progress, foreign language, reflection, learning out comes, sharing experience

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Authors: Alokananda Ghosh, Shraban Sarkar

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The study aims to identify suitable sites for new hospitals with critical obstetric care facilities in Birbhum, one of the vulnerable and underserved districts of Eastern India, considering six main and 14 sub-criteria, using GIS-based Analytic Hierarchy Process (AHP) and Multi-Attribute Utility Theory (MAUT) approach. The criteria were identified through field surveys and previous literature. After collecting expert decisions, a pairwise comparison matrix was prepared using the Saaty scale to calculate the weights through AHP. On the contrary, objective weighting methods, i.e., Entropy and Criteria Importance through Interaction Correlation (CRITIC), were used to perform the MAUT. Finally, suitability maps were prepared by weighted sum analysis. Sensitivity analyses of AHP were performed to explore the effect of dominant criteria. Results from AHP reveal that ‘maternal death in transit’ followed by ‘accessibility and connectivity’, ‘maternal health care service (MHCS) coverage gap’ were three important criteria with comparatively higher weighted values. Whereas ‘accessibility and connectivity’ and ‘maternal death in transit’ were observed to have more imprint in entropy and CRITIC, respectively. While comparing the predictive suitable classes of these three models with the layer of existing hospitals, except Entropy-MAUT, the other two are pointing towards the left-over underserved areas of existing facilities. Only 43%-67% of existing hospitals were in the moderate to lower suitable class. Therefore, the results of the predictive models might bring valuable input in future planning.

Keywords: hospital site suitability, analytic hierarchy process, multi-attribute utility theory, entropy, criteria importance through interaction correlation, multi-criteria decision analysis

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Authors: Tabin Millo, Khoob Chand, Ashok Kumar Jaiswal

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Introduction: Various kinds of violence and offences are related to alcohol consumption by the offenders. The relationship between alcohol and violence is complex. But its study is important to achieve understanding of violence as well as alcohol related behavior. This study was done to know the blood alcohol concentration in people involved in various offences and its demographic pattern. The study was carried out in the forensic toxicology laboratory, department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India. Material and methods: The blood samples were collected from the arrested people shortly after the commission of the offence by the emergency medical officers in the emergency department and forwarded to the forensic toxicology laboratory through the investigating officer. The blood samples were collected in EDTA vial with sodium fluoride preservative. The samples were analyzed by using gas chromatography with head space (GC-HS), which is ideal for alcohol estimation. The toxicology reports were given within a week. The data of seven years (2011-17) were analyzed for its alcohol concentration, associated crimes and its demographic pattern. Analysis and conclusion: Total 280 samples were analyzed in the period of 2011-2017. All were males except one female who was a bar dancer. The maximum cases were in the age group of 21-30 years (124 cases). The type of offences involved were road traffic accidents (RTA), assault cases, drunken driving, drinking in public place, drunk on duty, sexual offence, bestiality, eve teasing, fall etc. The maximum cases were of assault (75 cases) followed by RTA (64 cases). The maximum cases were in the alcohol concentration range of 101-150mg% (58 cases) followed by 51-100mg% (52 cases). The maximum blood alcohol level detected was 391.51 mg%, belonging to a security guard found unconscious. This study shows that alcohol consumption is associated with various kinds of violence and offences in society.

Keywords: alcohol, crime, toxicology, violence

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Authors: Abolfazl Zaraki, Yoshikatsu Hayashi, Harry Thorpe, Vincent Strong, Gisle-Andre Larsen, William Holderbaum

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Thanks to the high maneuverability of the cable-driven hyper-redundant manipulators (HRMs), this class of robots has shown a superior capability in highly confined and unstructured space applications. Although the large number of degrees of freedom (DOF) of HRMs enhances the motion flexibility and the robot’s reachability range, it highly increases the complexity of the kinematic configuration which makes the kinematic control problem very challenging or even impossible to solve. This paper presents our current progress achieved on the development of a kinematic-based leader-follower control system which is designed to control not only the robot’s body posture but also to control the trajectory of the robot’s movement in a semi-autonomous manner (the human operator is retained in the robot’s control loop). To obtain the forward kinematic model, the coordinate frames are established by the classical Denavit–Hartenburg (D-H) convention for a hyper-redundant serial manipulator which has a controlled cables-driven mechanism. To solve the inverse kinematics of the robot, unlike the conventional methods, a leader-follower mechanism, based on the sequential inverse kinematic, is followed. Using this mechanism, the inverse kinematic problem is solved for all sequential joints starting from the head joint to the base joint of the robot. To verify the kinematic design and simulate the robot motion, the MATLAB robotic toolbox is used. The simulation result demonstrated the promising capability of the proposed leader-follower control system in controlling the robot motion and trajectory in our confined space application.

Keywords: hyper-redundant robots, kinematic analysis, semi-autonomous control, serial manipulators

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Authors: Rong-Yang Lai, Jia-Yu Wu, Chih-Han Chang, Yung-Chung Chen

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The dental bridge is one of the clinical methods of the treatment for missing teeth. The dental bridge is generally designed for two layers, containing the inner layer of the framework(zirconia) and the outer layer of the porcelain-fused to framework restorations. The design of a conventional bridge is generally based on the antagonist tooth profile so that the framework evenly indented by an equal thickness from outer contour. All-ceramic dental bridge made of zirconia have well demonstrated remarkable potential to withstand a higher physiological occlusal load in posterior region, but it was found that there is still the risk of all-ceramic bridge failure in five years. Thus, how to reduce the incidence of failure is still a problem to be solved. Therefore, the objective of this study is to develop mechanical designs for all-ceramic dental bridges framework by reducing the stress and enhancing fracture resistance under given loading conditions by finite element method. In this study, dental design software is used to design dental bridge based on tooth CT images. After building model, Bi-directional Evolutionary Structural Optimization (BESO) Method algorithm implemented in finite element software was employed to analyze results of finite element software and determine the distribution of the materials in dental bridge; BESO searches the optimum distribution of two different materials, namely porcelain and zirconia. According to the previous calculation of the stress value of each element, when the element stress value is higher than the threshold value, the element would be replaced by the framework material; besides, the difference of maximum stress peak value is less than 0.1%, calculation is complete. After completing the design of dental bridge, the stress distribution of the whole structure is changed. BESO reduces the peak values of principle stress of 10% in outer-layer porcelain and avoids producing tensile stress failure.

Keywords: dental bridge, finite element analysis, framework, automatic program

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Authors: Karimeh Alnuaimi, Manal Kassab, Reem Ali, Khitam Mohammad, Kholoud Shattnawi

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Aim: To compare pregnancy outcomes of Syrian refugee women and Jordanian women. Background and introduction: The current conflict in Syria continues to displace thousands to neighboring countries, including Jordan. Pregnant refugee women are therefore facing many difficulties are known to increase the prevalence of poor reproductive health outcomes and antenatal complications. However, there is very little awareness of whether Syrian refugee women have different risks of pregnancy outcomes than Jordanian women. Methods: Using a retrospective cohort design, we examined pregnancy outcomes for Syrian refugee (N = 616) and Jordanian women (N = 644) giving birth at two governmental Hospitals in the north of Jordan, between January 1, 2014, and December 31, 2014. A checklist of 13 variables was utilized. The primary outcome measures were delivery by Caesarean section, maternal complications, low birth weight (< 2500 g), Apgar score and preterm delivery (< 37 weeks' gestational age). Results: Statistical analysis revealed that refugee mothers had a significant increase in the rate of cesarean section and the higher rate of anemia, a lower neonates’ weight, and Apgar scores when compared to their Jordanian counterparts. Discussion and Conclusion: Results were congruent with findings from other studies in the region and worldwide. Minimizing inequalities in pregnancy outcomes between Syrian refugees and Jordan women is a healthcare priority. Implications for nursing and health policy: The findings could guide the planning and development of health policies in Jordan that would help to alleviate the situation regarding refugee populations. The action is required by the policy makers, specifically targeting public and primary health care services, to address the problem of adequately meeting the need for antenatal care of this vulnerable population.

Keywords: pregnancy, Syrian refugee, Jordanian women, comparative study

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Authors: Tomas Premoli, Sareh Rowlands

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In this study, we investigate the impact of various convolutional neural network (CNN) architectures on the accuracy of diagnosing Alzheimer’s disease (AD) using patient MRI scans. Alzheimer’s disease is a debilitating neurodegenerative disorder that affects millions worldwide. Early, accurate, and non-invasive diagnostic methods are required for providing optimal care and symptom management. Deep learning techniques, particularly CNNs, have shown great promise in enhancing this diagnostic process. We aim to contribute to the ongoing research in this field by comparing the effectiveness of different CNN architectures and providing insights for future studies. Our methodology involved preprocessing MRI data, implementing multiple CNN architectures, and evaluating the performance of each model. We employed intensity normalization, linear registration, and skull stripping for our preprocessing. The selected architectures included VGG, ResNet, and DenseNet models, all implemented using the Keras library. We employed transfer learning and trained models from scratch to compare their effectiveness. Our findings demonstrated significant differences in performance among the tested architectures, with DenseNet201 achieving the highest accuracy of 86.4%. Transfer learning proved to be helpful in improving model performance. We also identified potential areas for future research, such as experimenting with other architectures, optimizing hyperparameters, and employing fine-tuning strategies. By providing a comprehensive analysis of the selected CNN architectures, we offer a solid foundation for future research in Alzheimer’s disease diagnosis using deep learning techniques. Our study highlights the potential of CNNs as a valuable diagnostic tool and emphasizes the importance of ongoing research to develop more accurate and effective models.

Keywords: Alzheimer’s disease, convolutional neural networks, deep learning, medical imaging, MRI

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Authors: David Ssekamate

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The study which is work in progress examines the opportunities and challenges for universities in Africa in addressing climate change issues in their programmes. Specifically, the study attempts to examine the current academic, research and community engagement programmes on climate change implemented by the Universities; the key challenges faced by the implementing units in carrying out these programmes and; the success factors that would support universities to adequately address climate change issues in their programmes. The researcher adopted a qualitative comparative case study design with Makerere University (Uganda) and University of Dar es Salaam (Tanzania) as comparative cases. Data will be collected using semi-structured in-depth interviews, Focus Group Discussions (FDGs) and Document review. A total of 12 semi-structured in-depth interviews and 4 Focus Group Discussions will be undertaken, collecting data from 36 respondents in both Uganda and Tanzania. The data will be analyzed using content and thematic analysis methods with the help of Nvivo software. The findings are envisaged to make a significant contribution to scholarly literature on climate change education and the role of higher education in addressing climate change issues, inform policy making in the sector and development planning to strengthen the academic, research and community engagement programmes on climate change by universities in Africa. The implications of the findings may go beyond the focus on climate change but also other related sustainable development issues incorporated in academic and research programmes of universities in Africa. The results may enable universities to re-think their approaches and practices and also deal with challenges effectively in addressing climate change related issues in their programmes.

Keywords: climate change, climate change education, African universities, challenges

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Authors: Ilma Robo, Saimir Heta, Nedja Hysi, Vera Ostreni

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Introduction: Marginal gingivitis is a disease with considerable frequency among patients who present routinely for periodontal control and treatment. In fact, this disease may not have alarming symptoms in patients and may go unnoticed by themselves when personal hygiene conditions are optimal. The aim of this study was to collect retrograde data on the prevalence of marginal gingiva in the respective group of patients, evaluated according to specific periodontal diagnostic tools. Materials and methods: The study was conducted in two patient groups. The first group was with 34 patients, during December 2019-January 2020, and the second group was with 64 patients during 2010-2018 (each year in the mentioned monthly period). Bacterial plaque index, hemorrhage index, amount of gingival fluid, presence of xerostomia and candidiasis were recorded in patients. Results: Analysis of the collected data showed that susceptibility to marginal gingivitis shows higher values according to retrograde data, compared to cross-sectional ones. Susceptibility to candidiasis and the occurrence of xerostomia, even in the combination of both pathologies, as risk factors for the occurrence of marginal gingivitis, show higher values ​​according to retrograde data. The female are presented with a reduced bacterial plaque index than the males, but more importantly, this index in the females is also associated with a reduced index of gingival hemorrhage, in contrast to the males. Conclusions: Cross-sectional data show that the prevalence of marginal gingivitis is more reduced, compared to retrograde data, based on the hemorrhage index and the bacterial plaque index together. Changes in production in the amount of gingival fluid show a higher prevalence of marginal gingivitis in cross-sectional data than in retrograde data; this is based on the sophistication of the way data are recorded, which evolves over time and also based on professional sensitivity to this phenomenon.

Keywords: marginal gingivitis, cross-sectional, retrograde, prevalence

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Authors: Maatouk Mohamed, Nouira Mariem, Hamdi Kbir Gh, Mahjoubi M. F., Ben Moussa M.

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Background and aim: Preoperative biliary drainage (PBD) has been introduced to lower bilirubin levels and to control the negative effects of obstructive jaundice in patients with malignant obstructive jaundice undergoing pancreaticoduodenectomy (PD). The optimal time interval between PBD and PD is still not clear. Delaying surgery by 4 to 6 weeks is the commonly accepted practice. However, delayed PD has been shown to decrease the rate of resection and adversely affect the tumor grading and prognosis. Thus, the purpose of our systematic review and meta-analysis was to evaluate the optimal period for PBD prior to PD: short or prolonged in terms of postoperative morbidity and survival outcomes. Methods: Trials were searched in PubMed, Science Direct, Google Scholar, and Cochrane Library until November 2022. Studies using PBD in patients with malignant obstructive jaundice that compared short duration group (SDG) (surgery performed within 3-4 weeks) with prolonged duration group (PDG) (at least 3-4 weeks after PBD) were included in this study. The risk of bias was assessed using the Rob v2 and Robins-I tools. The priori protocol was published in PROSPERO (ID: CRD42022381405). Results: Seven studies comprising 1625 patients (SDG 870, PDG 882) were included. All studies were non-randomized, and only one was prospective. No significant differences were observed between the SDG and PDG in mortality (OR= 0.59; 95% CI [0.30, 1.17], p=0.13), major morbidity (Chi² = 30.28, p <0.00001; I² = 87%), pancreatic fistula (Chi² = 6.61, p = 0.25); I² = 24%), post pancreatectomy haemorrhage (OR= 1.16; 95% CI [0.67, 2.01], p=0.59), positive drainage culture (OR= 0.36; 95% CI [0.10, 1.32], p=0.12), septic complications (OR= 0.78; 95% CI [0.23, 2.72], p=0.70), wound infection (OR= 0.08, p=0.07), operative time (MD= 0.21; p=0.21). Conclusion: Early surgery within 3 or 4 weeks after biliary drainage is both safe and effective. Thus, it is reasonable to suggest early surgery following PBD for patients having resectable periampullary cancers.

Keywords: preoperative biliary drainage, pancreatic cancer, pancreatic surgery, complication

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Authors: Claudia Matassa, Matthias Hohne, Dominic Ormerod, Yamini Satyawali

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Chiral amines integrate the backbone of several active pharmaceutical ingredients (APIs) used in modern medicine for the treatment of a vast range of diseases. Despite the demand, their synthesis remains challenging. Besides a range of chemicals and enzymatical methods, chiral amine synthesis using transaminases (EC 2.6.1.W) represents a useful alternative to access this important class of compounds. Even though transaminases exhibit excellent stereo and regioselectivity and the potential for high yield, the reaction suffers from a number of challenges, including the thermodynamic equilibrium, product inhibition, and low substrate solubility. In this work, we demonstrate a membrane assisted strategy for addressing these challenges. It involves the use of high molecular weight (HMW) amine donors for the transaminase-catalyzed synthesis of 4-phenyl-2-butylamine in both aqueous and organic solvent media. In contrast to common amine donors such as alanine or isopropylamine, these large molecules, provided in excess for thermodynamic equilibrium shifting, are easily retained by commercial nanofiltration membranes; thus a selective permeation of the desired smaller product amine is possible. The enzymatic transamination in aqueous media, combined with selective product removal shifted the equilibrium enhancing substrate conversion by an additional 25% compared to the control reaction. Along with very efficient amine product removal, there was undesirable loss of ketone substrate and low product concentration was achieved. The system was therefore further improved by performing the reaction in organic solvent (n-heptane). Coupling the reaction system with membrane-assisted product removal resulted in a highly concentrated and relatively pure ( > 97%) product solution. Moreover, a product yield of 60% was reached, compared to 15% without product removal.

Keywords: amine donor, chiral amines, in situ product removal, transamination

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Authors: Parsa Keyvani, Alistair Phillips, David Warwick

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Background: The current process for gaining patient consent for hand and wrist surgery at University Hospital Southampton (UHS) is paper-based and makes use of generic forms provided by the NHS and no patient information leaflet is available relating to hand and wrist surgery. Aims: To evaluate the process of obtaining clinical consent and suggest ways in which the service can be improved. Methods: A log-book review of four orthopaedic surgeons at UHS was carried out over a three-month period in order to identify the 10 most common types of elective hand and wrist surgeries performed. A literature review was carried out to identify the complications of these surgeries. The surgeries were then divided into 6 types: nerve, bone, ligament, joint, tendon and dupuytren’s surgery. A digitised consent form was created covering the complications of all 6 surgery types. Finally, the surgeons at the orthopaedic department of UHS were asked whether they prefer the old paper-based or the digitised consent form. Results: All of the surgeons felt that the procedure type-based form was easier to read, use and understand. Conclusion: This research highlights a number of problems related to the use of current NHS consent forms. The proposed solution is to use a set of digitised, procedure type-based consent forms. Digital consent forms can be filled in in advance and sent to the patient electronically along with any relevant information leaflets, thus giving them time to absorb the information and come up with any questions before they have their pre-procedure discussion with their doctor. This would allow the doctor to focus the consultation on the patient rather than writing out the consent form and would ultimately be a step forward in making the NHS a global digital leader and fully embrace the opportunity offered by technology.

Keywords: digitised consent form, elective surgery, hand surgery complications, informed consent, procedure type-based consent form

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Authors: Kiyanoush Ghalavand

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Aquaculture production is inherently a risky business, and farmers face a variety of weather, pest, disease, inptut supply, and market related risks. There are many factors out farmers control and unpredictable. Insurance has an important role in aquaculture production and is a tool to support farmers against threats. Investigation of factors affecting aquaculture farmers' adoption of aquaculture insurance strategy was the objective of this study. The purpose of this study was determining the related factors to adoption of insurance by aquaculture farmers in Khuzestan province, Iran. The research design was a descriptive and correlation surveying method. Aquaculture farmers in Khuzestan province were the target population for this study. A random sample of aquaculture selected (N=1830, n =139). The main result of the study reveled that exist correlation between the level of education, knowledge about purpose of insurance, participation in extension course, visit with insurance organization, and contact with extension agents to the adoption of insurance by aquaculture farmers were significantly positive. By using Bartlett's test and KMO test, determine whether research variables are appropriate for factor analysis (Sig = 0.000, Bartlett test = 0.9724, KMO = 0.74). The number of factors was determined using a split plot, eigenvalue, and percent of variance. An examination of the items and their factors loadings was used to understand the nature of the nine factors. To reduce subjectivity, items with factor loading equal to or greater than 0.5 were considered most important when factors were labeled. The nine factors were labeled (1) Extension and education activities, (2) Economical characteristics, (3) Governmental support, (4) communicational channel, (5) local leaders, (6) Facilitate in given damage (7) Motivation establishing, (8) Given damage in appropriate methods and (9) Appropriate activities by insurance organization. The results obtained from the factors analysis reveal that the nine factors explain percentage75 of the variation of the adoption of insurance of the adoption of insurance by aquaculture farmers in Khuzestan province.

Keywords: aquaculture farmers, insurance, factorial analysis, Khuzestan province, risks

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Authors: Eric Fang, Robert Chen, Ghim Song Chia, Bien Soo Tan

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Objective and Rationale: Training of radiology residents hinges on practical, on-the-job training in all facets and modalities of diagnostic radiology. Although residency is structured to be comprehensive, clinical exposure depends on the case mix available locally and during the posting period. To supplement clinical training, there are several e-learning resources available to allow for greater exposure to radiological cases. The objective of this study was to survey residents and faculty on the usefulness of these e-learning resources. Methods: E-learning resources were shortlisted with input from radiology residents, Google search and online discussion groups, and screened by their purported focus. Twelve e-learning resources were found to meet the criteria. Both radiology residents and experienced radiology faculty were then surveyed electronically. The e-survey asked for ratings on breadth, depth, testing capability and user-friendliness for each resource, as well as for rankings for the top 3 resources. Statistical analysis was performed using SAS 9.4. Results: Seventeen residents and fifteen faculties completed an e-survey. Mean response rate was 54% ± 8% (Range: 14- 96%). Ratings and rankings were statistically identical between residents and faculty. On a 5-point rating scale, breadth was 3.68 ± 0.18, depth was 3.95 ± 0.14, testing capability was 2.64 ± 0.16 and user-friendliness was 3.39 ± 0.13. Top-ranked resources were STATdx (first), Radiopaedia (second) and Radiology Assistant (third). 9% of responders singled out R-ITI as potentially good but ‘prohibitively costly’. Statistically significant predictive factors for higher rankings are familiarity with the resource (p = 0.001) and user-friendliness (p = 0.006). Conclusion: A good e-learning system will complement on-the-job training with a broad case base, deep discussion and quality trainee evaluation. Based on our study on twelve e-learning resources, no single program fulfilled all requirements. The perception and use of radiology e-learning resources depended more on familiarity and user-friendliness than on content differences and testing capability.

Keywords: e-learning, medicine, radiology, survey

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Authors: Anna Strakowska, Marian Zaborski

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This abstract focuses an overview of the methods used to create self-healing silicone composites. It has been shown how incorporating of polyhedral oligomeric silsesquioxanes (POSS) molecules with acid and basic groups to silicone rubber affects the barrier properties, mechanical properties in room and reduced temperature or the influence on relaxation rates of the methylvinylsilicone rubber vulcanizates. Moreover, the presence of silsesquioxanes, their content and the way of composites preparing affect the amount of ionic bonds, as indicated by dynamic - mechanical thermal analysis (DMTA) as well as measurements of equilibrium swelling in toluene. The aim of this work was to study the influence of concentration and different functional groups types selected silsesquioxanes compounds on self-healing effect of silicone rubber and obtain elastomers with good barrier and mechanical properties. Composites based on the methylvinylsilicone rubber with fumed silica as the fillers were manufactured and studied. To obtain self-healing effect various silsesquioxanes with amino and acid groups were used. Every tested sample demonstrated the ability to the self-treatment. The most significant effect was observed for system containing amic-acid isobytyl POSS/ aminopropylisobutyl POSS. Composite with this silsesquioxanes was exhibited the best improvement of gas permeability after heal. Moreover, the addition of POSS with acid and basic groups clearly affects the mechanical properties of the vulcanizates. The most significant effect was observed for the composite material consisting of amic-acid isobytyl POSS / aminoethylaminopropylisobutyl POSS, which tensile strength was even greater than the reference vulcanizate with fumed silica. The development of autonomous self-healing materials could have an enormous influence on all industry branches from motorization to power industry. Self-repairing materials would have a massive impact on lengthening product lifetimes, increasing safety, and lowering product costs by reducing maintenance requirements.

Keywords: barrier properties, mechanical properties, POSS, self-healing composites

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Authors: Luke Power, Paul O'Leary

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Research has long described the enhancement of student engagement as a fundamental aim of delivering a consistent, lifelong benefit to student success across the multitude of dimensions a quality HE (higher education) experience offers. Engagement may take many forms, with Universities and Institutes across the world attempting to define the parameters which constitutes a successful student engagement framework and implementation strategy. These efforts broadly include empowering students, encouraging involvement, and the transfer of decision-making power through a variety of methods with the goal of obtaining a meaningful partnership between students and staff. As the Republic of Ireland continues to observe an increasing population transferring directly from secondary education to HE institutions, it falls on these institutions to research and develop effective strategies which insures the growing student population have every opportunity to engage with their education, research community, and staff. This research systematically reviews SPAs (student partnership agreements) which are currently in the process of being defined, and/or have been adopted at HE institutions, worldwide. Despite the demonstrated importance of a student-staff partnership to the overall student engagement experience, there is no obvious framework or model by which to begin this process. This work will therefore provide a novel analysis of student-staff agreements which will focus on examining the factors of success common to each and builds towards a workable and applicable framework using critical review, analysis of the key words, phraseology, student involvement, and the broadly applicable HE traits and values. Following the analysis, this work proposes SPA ‘toolkit’ with input from key stakeholders such as students, staff, faculty, and alumni. The resulting implications for future research and the lessons learned from the development and implementation of the SPA will aid the systematic implementation of student-staff agreements in Ireland and beyond.

Keywords: student engagement, student partnership agreements, student-staff partnerships, higher education, systematic review, democratising students, empowering students, student unions

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Authors: Sandrine Cardinal, Jean-Marc Pelletier, Guang Xie, Florian Mercier, Florent Delmas

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Bulk metallic glasses exhibit several superior properties, compared to their corresponding crystalline counterpart, such as high strength, high elastic limit or good corrosion resistance. Therefore they can be considered as good candidates for structural applications in many sectors. However, they are generally brittle and do not exhibit plastic deformation at room temperature. These materials are mainly obtained by rapid cooling from a liquid state to prevent crystallization, which limits their size. To overcome these two drawbacks: fragility and limited dimensions, composite metallic glass matrix reinforced by a second phase whose role is to slow crack growth are developed. Concerning the limited size of the pieces, the proposed solution is to get the material from amorphous powders by densifying under load. In this study, Cu50Zr45Al5 bulk metallic glassy matrix composites (MGMCs) containing different volume fraction (Vf) of Zr crystalline particles were manufactured by spark plasma sintering (SPS). Microstructure, thermal stability and mechanical properties of the MGMCs were investigated. Matrix of the composites remains a fully amorphous phase after consolidation at 420°C under 600 MPa. A good dispersion of the particles in the glassy matrix is obtained. Results show that the compressive strength decreases with Vf : 1670 MPa (Vf=0%) to 1300MPa (Vf=30%), the elastic modulus decreases but only slighty respectively 97.3GPa and 94.5 GPa and plasticity is improved from 0 to 4%. Fractographic investigation indicates a good bonding between amorphous and crystalline particles. In conclusion, present study has demonstrated that SPS method is useful for the synthesis of the bulk glassy composites. Large controlled microstructure specimens with interesting ductility can be obtained compared with others methods.

Keywords: composite, mechanical properties, metallic glasses, spark plasma sintering

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Authors: Joyce Joas Kahembe

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The implementation of education assessment reforms in developing countries has been claimed to be problematic and difficult. The socio-economic teaching and learning environment has pointed to constraints in the education reform process. Nevertheless, there are existing assessment practices that if enhanced, can have potential to foster formative assessment practices in those contexts. The present study used the sociocultural perspective to explore teachers’ assessment practices and factors influencing them in Tanzania. Specifically, the sociocultural perspective helped to trace social, economic and political histories imparted to teachers’ assessment practices. The ethnographic oriented methods like interviews, observations and document reviews was used in this exploration. Teachers used assessment practices, such as questioning and answering, tests, assignments and examinations, for evaluating, monitoring and diagnosing students’ understanding, achievement and performance and standards and quality of instruction practices. The obtained assessment information functioned as feedback for improving students’ understanding, performance, and the standard and quality of teaching instruction and materials. For example, teachers acknowledged, praised, approved, disapproved, denied, graded, or marked students’ responses to give students feedback and aid learning. Moreover, teachers clarified and corrected or repeated students’ responses with worded/added words to improve students’ mastery of the subject content. Teachers’ assessment practices were influenced by the high demands of passing marks in the high stakes examinations and the contexts of the social economic teaching environment. There is a need to ally education assessment reforms with existing socio-economic teaching environments and society and institutional demands of assessment to make assessment reforms meaningful and sustainable. This presentation ought to contribute on ongoing strategies for contextualizing assessment practices for formative uses.

Keywords: assessment, feedback, practices, formative assessment

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Authors: Hiroko Komatsu, Kaori Yagasaki

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Background: Cancer-related cognitive impairment is a common problem seen in cancer patients undergoing chemotherapy. Physical activity may show beneficial effects on the cognitive function in such patients. Therefore, we have developed a self-directed home yoga program for cancer patients with cognitive symptoms during chemotherapy. This program involves a DVD presenting a combination of yoga courses based on patient preferences to be practiced at home. This study was performed to examine the feasibility of this program. In addition, we also examined changes in cognitive function and quality of life (QOL) in these patients participating in the program. Methods: This prospective feasibility study was conducted in a 500-bed general hospital in Tokyo, Japan. The study population consisted of breast cancer patients undergoing chemotherapy as the initial therapy. This feasibility study used a convenience sample with estimation of recruitment rate in a single facility with the availability of trained nurses and physicians to ensure safe yoga intervention. The aim of the intervention program was to improve cognitive function by means of both physical and mental activation via yoga, consisting of physical practice, breathing exercises, and meditation. Information on the yoga program was provided as a booklet, with an instructor-guided group yoga class during the orientation, and a self-directed home yoga program on DVD with yoga logs. Results: The recruitment rate was 44.7%, and the study population consisted of 18 women with a mean age of 43.9 years. This study showed high rates of retention, adherence, and acceptability of the yoga program. Improvements were only observed in the cognitive aspects of fatigue, and there were serious adverse events during the program. Conclusion: The self-directed home yoga program discussed here was both feasible and safe for breast cancer patients showing cognitive symptoms during chemotherapy. The patients also rated the program as useful, interesting, and satisfactory. Participation in the program was associated with improvements in cognitive fatigue but not cognitive function.

Keywords: yoga, cognition, breast cancer, chemotherapy, quality of life

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Authors: Nosratollah Hedayatpour, Hamid Reza Taheri, Mehrdad Fathi

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Introduction: Quadriceps femoris muscle is frequently involved in various movements e.g., jumping, landing) during sport and/or daily activities. During ballistic movement when individuals are faced with unexpected knee perturbation, fast twitch muscle fibers contribute to force production to stabilize knee joint. Fast twitch muscle fiber is more susceptible to fatigue and therefor may reduce the ability of the quadriceps muscle to stabilize knee joint during fast perturbation. Aim: The aim of this study was to investigate the effect of fatigue on postural response of the knee extensor muscles to fast and slow perturbations. Methods: Fatigue was induced to the quadriceps muscle using a KinCom Isokinetic Dynamometer (Chattanooga, TN). Bipolar surface electromyography (EMG) signals were simultaneously recorded from quadriceps components (vastus medialis, rectus femoris, and vastus lateralis) during pre- and post-fatigue postural perturbation performed at two different velocities of 120 ms and 250 mes. Results: One-way ANOVA showed that maximal voluntary knee extension force and time to task failure, and associated EMG activities were significantly reduced after fatiguing knee exercise (P< 0.05). Two-ways ANOVA also showed that ARV of EMG during backward direction was significantly larger than forward direction (P< 0.05), and during fast-perturbation it was significantly higher than slow-perturbation (P< 0.05). Moreover, ARV of EMG was significantly reduced during post fatigue perturbation, with the largest reduction identified for fast-perturbation compared with slow perturbation (P< 0.05). Conclusion: A larger reduction in muscle activity of the quadriceps muscle was observed during post fatigue fast-perturbation to stabilize knee joint, most likely due to preferential recruitment of fast twitch muscle fiber which are more susceptible to fatigue. This may partly explain that why knee injuries is common after fast ballistic movement.

Keywords: electromyography, fast-slow perturbations, fatigue, quadriceps femoris muscle

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Authors: Jamal Alasiri, Naif Hakeem, Saoud Almaslmani

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Background: Patients with humeral shaft fractures have two different treatment options. Surgical therapy has lesser risks of non-union, mal-union, and re-intervention than non-surgical therapy. These positive clinical outcomes of the surgical approach make it a preferable treatment option despite the risks of radial nerve palsy and additional surgery-related risk. We aimed to evaluate patients’ outcomes and return to work after surgical vs. non-surgical management of shaft humeral fracture. Methods: We used databases, including PubMed, Medline, and Cochrane Register of Controlled Trials, from 2010 to January 2022 to search for potential randomised controlled trials (RCTs) and cohort studies comparing the patients’ related outcome measures and return to work between surgical and non-surgical management of humerus fracture. Results: After carefully evaluating 1352 articles, we included three RCTs (232 patients) and one cohort study (39 patients). The surgical intervention used plate/nail fixation, while the non-surgical intervention used a splint or brace procedure to manage shaft humeral fracture. The pooled DASH effects of all three RCTs at six (M.D: -7.5 [-13.20, -1.89], P: 0.009) I2:44%) and 12 months (M.D: -1.32 [-3.82, 1.17], p:0.29, I2: 0%) were higher in patients treated surgically than in non-surgical procedures. The pooled constant Murley score at six (M.D: 7.945[2.77,13.10], P: 0.003) I2: 0%) and 12 months (M.D: 1.78 [-1.52, 5.09], P: 0.29, I2: 0%) were higher in patients who received non-surgical than surgical therapy. However, pooled analysis for patients returning to work for both groups remained inconclusive. Conclusion: Altogether, we found no significant evidence supporting the clinical benefits of surgical over non-surgical therapy. Thus, the non-surgical approach remains the preferred therapeutic choice for managing shaft humeral fractures due to its lesser side effects.

Keywords: shaft humeral fracture, surgical treatment, Patient-related outcomes, return to work, DASH

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