Search results for: general surgery

Authors: Meenakshi Barsaul Chauhan, Aastha Chauhan, Shilpa Hurmade, Rajeev Sen, Jyotsna Sen, Monika Dalal

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Introduction: Ovarian masses are common forms of neoplasm in women and represent 2/3rd of gynaecological malignancies. A pre-operative suggestion of malignancy can guide the gynecologist to refer women with suspected pelvic mass to a gynecological oncologist for appropriate therapy and optimized treatment, which can improve survival. In the younger age group preoperative differentiation into benign or malignant pathology can decide for conservative or radical surgery. Imaging modalities have a definite role in establishing the diagnosis. By using International Ovarian Tumor Analysis (IOTA) classification with sonography, costly radiological methods like Magnetic Resonance Imaging (MRI) / computed tomography (CT) scan can be reduced, especially in developing countries like India. Thus, this study is being undertaken to evaluate the role of clinical methods and sonography for diagnosis of the nature of the ovarian tumor. Material And Methods: This prospective observational study was conducted on 40 patients presenting with ovarian masses, in the Department of Obstetrics and Gynaecology, at a tertiary care center in northern India. Functional cysts were excluded. Ultrasonography and color Doppler were performed on all the cases.IOTA rules were applied, which take into account locularity, size, presence of solid components, acoustic shadow, dopper flow etc . Magnetic Resonance Imaging (MRI) / computed tomography (CT) scans abdomen and pelvis were done in cases where sonography was inconclusive. In inoperable cases, Fine needle aspiration cytology (FNAC) was done. The histopathology report after surgery and cytology report after FNAC was correlated statistically with the pre-operative diagnosis made clinically and sonographically using IOTA rules. Statistical Analysis: Descriptive measures were analyzed by using mean and standard deviation and the Student t-test was applied and the proportion was analyzed by applying the chi-square test. Inferential measures were analyzed by sensitivity, specificity, negative predictive value, and positive predictive value. Results: Provisional diagnosis of the benign tumor was made in 16(42.5%) and of the malignant tumor was made in 24(57.5%) patients on the basis of clinical findings. With IOTA simple rules on sonography, 15(37.5%) were found to be benign, while 23 (57.5%) were found to be malignant and findings were inconclusive in 2 patients (5%). FNAC/Histopathology reported that benign ovarian tumors were 14 (35%) and 26(65%) were malignant, which was taken as the gold standard. The clinical finding alone was found to have a sensitivity of 66.6% and a specificity of 90.9%. USG alone had a sensitivity of 86% and a specificity of 80%. When clinical findings and IOTA simple rules of sonography were combined (excluding inconclusive masses), the sensitivity and specificity were 83.3% and 92.3%, respectively. While including inconclusive masses, sensitivity came out to be 91.6% and specificity was 89.2. Conclusion: IOTA's simple sonography rules are highly sensitive and specific in the prediction of ovarian malignancy and also easy to use and easily reproducible. Thus, combining clinical examination with USG will help in the better management of patients in terms of time, cost and better prognosis. This will also avoid the need for costlier modalities like CT, and MRI.

Keywords: benign, international ovarian tumor analysis classification, malignant, ovarian tumours, sonography

Procedia PDF Downloads 78

Authors: Javier Fernandez, Mayte Medina, Rafael Fernandez de Canete, Nuria Alcain, Juan Carlos Ramos-Diaz

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At present, the experimentation of anesthetic drugs on patients requires a regulation protocol, and the response of each patient to several doses of entry drug must be well known. Therefore, the development of pharmacological dose control systems is a promising field of research in anesthesiology. In this paper, it has been developed a non-linear compartmental the pharmacokinetic-pharmacodynamical model which describes the anesthesia depth effect in a sufficiently reliable way over a set of patients with the depth effect quantified by the Bi-Spectral Index. Afterwards, an Artificial Neural Network (ANN) predictive controller has been designed based on the depth of anesthesia model so as to keep the patient in the optimum condition while he undergoes surgical treatment. For the purpose of quantifying the efficiency of the neural predictive controller, a classical proportional-integral-derivative controller has also been developed to compare both strategies. Results show the superior performance of predictive neural controller during BiSpectral Index reference tracking.

Keywords: anesthesia, bi-spectral index, neural network control, pharmacokinetic-pharmacodynamical model

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Authors: Maryam Mousivand

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Subculture is one of the important concepts in social sciences and the field of cultural studies, which falls under the huge concept of culture. In general, subculture is a kind of movement and experience of collective resistance that is manifested by a population as a reaction against the acceptance of official identities approved by custom and society. Subcultures exist in the virtual world in the new era, and they emerged in various forms, such as the emergence of a subculture under common concepts and interests in the form of sites, channels, and groups of virtual space, which will be discussed in this article.

Keywords: subculture, social media, cultural studies, culture

Procedia PDF Downloads 117

Authors: Mustafa El-Halabi

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A general model of wiretap channel with states is considered, where the legitimate receiver and the wiretapper’s observations depend on three states S1, S2 and S3. State S1 is non-causally known to the encoder, S2 is known to the receiver, and S3 remains unknown. A secure coding scheme, based using structured-binning, is proposed, and it is shown to achieve the secrecy capacity when the signal at legitimate receiver is a deterministic function of the input.

Keywords: physical layer security, interference, side information, secrecy capacity

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Authors: Nkwenti Mbelli Njah

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This research was motivated by a project requested by AXA on the topic of pensions payable under the workers compensation (WC) line of business. There are two types of pensions: the compulsorily recoverable and the not compulsorily recoverable. A pension is compulsorily recoverable for a victim when there is less than 30% of disability and the pension amount per year is less than six times the minimal national salary. The law defines that the mathematical provisions for compulsory recoverable pensions must be calculated by applying the following bases: mortality table TD88/90 and rate of interest 5.25% (maybe with rate of management). To manage pensions which are not compulsorily recoverable is a more complex task because technical bases are not defined by law and much more complex computations are required. In particular, companies have to predict the amount of payments discounted reflecting the mortality effect for all pensioners (this task is monitored monthly in AXA). The purpose of this research was thus to develop a stochastic model for the future mortality of the worker’s compensation pensioners of both the Portuguese market workers and AXA portfolio. Not only is past mortality modeled, also projections about future mortality are made for the general population of Portugal as well as for the two portfolios mentioned earlier. The global model was split in two parts: a stochastic model for population mortality which allows for forecasts, combined with a point estimate from a portfolio mortality model obtained through three different relational models (Cox Proportional, Brass Linear and Workgroup PLT). The one-year death probabilities for ages 0-110 for the period 2013-2113 are obtained for the general population and the portfolios. These probabilities are used to compute different life table functions as well as the not compulsorily recoverable reserves for each of the models required for the pensioners, their spouses and children under 21. The results obtained are compared with the not compulsory recoverable reserves computed using the static mortality table (TD 73/77) that is currently being used by AXA, to see the impact on this reserve if AXA adopted the dynamic tables.

Keywords: compulsorily recoverable, life table functions, relational models, worker’s compensation pensioners

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Authors: Elaine Wong

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This research protocol aims to explore and justify the need for nutrition and physical activity intervention to improve health outcomes among SME (Small Medium Enterprise) employees. It was found that the worksite is an ideal and convenient setting for employees to take charge of their health thru active participation in health programmes since they spent a great deal of time at their workplace. This study will examine the impact of both general or/and targeted health interventions in both SME and non-SME companies utilizing the Workplace Health Promotion (WHP) grant over a 12 months period and assessed the improvement in chronic health disease outcomes in Singapore. Random sampling of both non-SME and SME companies will be conducted to undergo health intervention and statistical packages such as Statistical Package for Social Science (SPSS) 25 will be used to examine the impact of both general and targeted interventions on employees who participate and those who do not participate in the intervention and their effects on blood glucose (BG), blood lipid, blood pressure (BP), body mass index (BMI), and body fat percentage. Using focus groups and interviews, the data results will be transcribed to investigate enablers and barriers to workplace health intervention revealed by employees and WHP coordinators that could explain the variation in the health screening results across the organisations. Dietary habits and physical activity levels of the employees participating and not participating in the intervention will be collected before and after intervention to assess any changes in their lifestyle practices. It makes economic sense to study the impact of these interventions on health screening outcomes across various organizations that are existing grant recipients to justify the sustainability of these programmes by the local government. Healthcare policy makers and employers can then tailor appropriate and relevant programmes to manage these escalating chronic health disease conditions which is integral to the competitiveness and productivity of the nation’s workforce.

Keywords: chronic diseases, health screening, nutrition and fitness intervention , workplace health

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Authors: Mauro Cristeche

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This work begins with a very simple question: How does the State spend? Argentina is witnessing a process of growing nationalization of social life, so it is necessary to find out the explanations of the phenomenon on the specific dynamic of the capitalist mode of production in Argentina and its transformations in the last decades. Then the new question is: what happened in Argentina that could explain this phenomenon? Since the seventies, the capital growth in Argentina faces deep competitive problems. Until that moment the agrarian wealth had worked as a compensation mechanism, but it began to find its limits. In the meantime, some important demographical and structural changes had happened. The strategy of the capitalist class had to become to seek in the cheapness of the labor force the main source of compensation of its weakness. As a result, a tendency to worsen the living conditions and fragmentation of the working class started to develop, manifested by unemployment, underemployment, and the fall of the purchasing power of the salary as a highlighted fact. As a consequence, it is suggested that the role of the State became stronger and public expenditure increased, as a historical trend, because it has to intervene to face the contradictions and constant growth problems posed by the development of capitalism in Argentina. On the one hand, the State has to guarantee the process of buying the cheapened workforce and at the same time the process of reproduction of the working class. On the other hand, it has to help to reproduce the individual capitals but needs to ‘attack’ them in different ways. This is why the role of the State is said to be the general political representative to the national portion of the total social capital. What will be studied is the dynamic of the intervention of the Argentine State in the context of the particular national process of capital growth, and its dynamics in the last decades. What this paper wants to show are the main general causes that could explain the phenomenon of nationalization of the social life and how it has impacted the life conditions of the working class and the system of rights.

Keywords: Argentina, nationalization, public policies, rights, state

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Authors: Maria Ashitko

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The Constitution of the Republic of Belarus is based on the principle of the unity of rights and obligations, including those of the child. The constitutional status of the child is aspecific system of constitutional elements established and guaranteed by the state through the current legislation and regulatory acts that ensure the special legal status of the child, his or her constitutional legal capacity, implementation of the principles of the constitutional and legal status of the child, constitutional rights of the child and their safeguards. Under the principles of the constitutional status of the child, we consider the general, normative, social-volitional rules of behavior established by the Constitution of the Republic of Belarus, laws and other regulatory acts that determine the content and social purpose of the legal status of the child. The constitutional and legal status of the child is characterized by the following special principles, which form a feature of the state legal system:1) Ensuring the interests of the child means providing for the child in accordance with his or her age, state of health, characteristics of development, life experience, family life, cultural traditions, ethnicity. 2) The principle of equal responsibility of both parents or their substitutes characterized by caring for the next generation as one of the priority tasks of the state and society, and all issues related to the implementation of children’s rights should be addressed at the constitutional level. 3) We would like to highlight such a special principle as the subprinciple of safeguards, which is the principle of ensuring the safety of the child. It is also worth noting that in legal studies, there is no relationship between safety and constitutional rights as general safeguards of individual rights and freedoms, and as special safeguards for the right to life. 4) The principle of justice is expressed by the fact that in modern conditions, the quality of life is determined not only by material wealth but also by the ability of the state to ensure the harmonization of social relations and social harmony on the basis of humanism and justice. Thus, the specificity of the constitutional status of the child is the age boundary between adulthood and minority; therefore, we propose to highlight the age characteristics of the child as an additional element. It is advisable to highlight such a special principle as the subprinciple of safeguards, which is the principle of ensuring the safety of the child.

Keywords: children’s rights, constitutional status, constitutional principles, constitutional rights

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Authors: Ana Mafalda Silva, Rebeca Fontes, Ana Paula Vaz, Carla Carreira, Ana Corte-Real

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Decades of research on the topic of interpersonal violence against minors highlight five main conclusions: 1) it causes harmful effects on children's development and health; 2) it is prevalent; 3) it violates children's rights; 4) it can be prevented and 5) parents are the main aggressors. The child abuse scenario is identified through clinical observation, administrative data and self-reports. The most used instruments are self-reports; however, there are no valid and reliable self-report instruments for minors, which consist of a retrospective interpretation of the situation by the victim already in her adult phase and/or by her parents. Clinical observation and collection of information, namely from the orofacial region, are essential in the early identification of these situations. The management of medical data, such as personal data, must comply with the General Data Protection Regulation (GDPR), in Europe, and with the General Law of Data Protection (LGPD), in Brazil. This review aims to answer the question: In a situation of medical assistance to minors, in the suspicion of interpersonal violence, due to mistreatment, is it necessary for the guardians to provide consent in the registration and sharing of personal data, namely medical ones. A scoping review was carried out based on a search by the Web of Science and Pubmed search engines. Four papers and two documents from the grey literature were selected. As found, the process of identifying and signaling child abuse by the health professional, and the necessary early intervention in defense of the minor as a victim of abuse, comply with the guidelines expressed in the GDPR and LGPD. This way, the notification in maltreatment scenarios by health professionals should be a priority and there shouldn’t be the fear or anxiety of legal repercussions that stands in the way of collecting and treating the data necessary for the signaling procedure that safeguards and promotes the welfare of children living with abuse.

Keywords: child abuse, disease notifications, ethics, healthcare assistance

Procedia PDF Downloads 93

Authors: T. Jayanthi, K. Velusamy, H. Seetha, S. A. V. Satya Murty

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Verification and Validation of Simulated Process Model is the most important phase of the simulator life cycle. Evaluation of simulated process models based on Verification and Validation techniques checks the closeness of each component model (in a simulated network) with the real system/process with respect to dynamic behaviour under steady state and transient conditions. The process of Verification and validation helps in qualifying the process simulator for the intended purpose whether it is for providing comprehensive training or design verification. In general, model verification is carried out by comparison of simulated component characteristics with the original requirement to ensure that each step in the model development process completely incorporates all the design requirements. Validation testing is performed by comparing the simulated process parameters to the actual plant process parameters either in standalone mode or integrated mode. A Full Scope Replica Operator Training Simulator for PFBR - Prototype Fast Breeder Reactor has been developed at IGCAR, Kalpakkam, INDIA named KALBR-SIM (Kalpakkam Breeder Reactor Simulator) wherein the main participants are engineers/experts belonging to Modeling Team, Process Design and Instrumentation and Control design team. This paper discusses the Verification and Validation process in general, the evaluation procedure adopted for PFBR operator training Simulator, the methodology followed for verifying the models, the reference documents and standards used etc. It details out the importance of internal validation by design experts, subsequent validation by external agency consisting of experts from various fields, model improvement by tuning based on expert’s comments, final qualification of the simulator for the intended purpose and the difficulties faced while co-coordinating various activities.

Keywords: Verification and Validation (V&V), Prototype Fast Breeder Reactor (PFBR), Kalpakkam Breeder Reactor Simulator (KALBR-SIM), steady state, transient state

Procedia PDF Downloads 264

Authors: Yang Xiong, Hua Cheng

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In this paper, for the basic problem of wireless sensor network topology control and deployment, the Roesser model in rectangular grid sensor networks is presented. In addition, a general constructive realization procedure will be proposed. The procedure enables a distributed implementation of linear systems on a sensor network. A non-trivial example is illustrated.

Keywords: grid sensor networks, Roesser model, state-space realization, multidimensional systems

Procedia PDF Downloads 654

Authors: Mrinal Jana, Geetanjali Panda

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In this paper a methodology is developed to solve a nonlinear fractional programming problem in which the coefficients of the objective function and constraints are interval parameters. This model is transformed into a general optimization problem and relation between the original problem and the transformed problem is established. Finally the proposed methodology is illustrated through a numerical example.

Keywords: fractional programming, interval valued function, interval inequalities, partial order relation

Procedia PDF Downloads 518

Authors: Rao Muhammad Afzal Khan

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Nano technology is emerging as a useful technology in nearly all areas of Science and Technology. Its role in medical imaging is attracting the researchers towards existing and new imaging modalities and techniques. This presentation gives an overview of the development of the work done throughout the world. Furthermore, it lays an idea into the scope of the future use of this technology for diagnosing different diseases. A comparative analysis has also been discussed with an emphasis to detect diseases, in general, and cancer, in particular.

Keywords: medical imaging, cancer detection, diagnosis, nano-imaging, nanotechnology

Procedia PDF Downloads 477

Authors: Khemnath Kharel

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Forest itself is a factory as well as product. It supplies tangible and intangible goods and services. It supplies timber, fuel wood, fodder, grass leaf litter as well as non timber edible goods and medicinal and aromatic products additionally provides environmental services. These environmental services are of local, national, or even global importance. In Nepal more than 19 thousands community forests are providing environmental service in less economic benefit than actual efficiency. There is a risk of cost of management of those forest exceeds benefits and forests get converted to open access resources in future. Most of the environmental goods and services don’t have markets which mean no prices at which they are available to the consumers therefore the valuation of these services goods and services establishment of paying mechanism for such services and insure the benefit to community is more relevant in local as well as global scale. There are few examples of carbon trading in domestic level to meet the country wide emission goal. In this contest the study aims to explore the public attitude towards carbon offsetting and their responsibility over service providers. This study helps in promotion of environment service awareness among general people and service provider; community forest. The research helps to unveil the carbon pool scenario in community forest and willingness to pay for carbon offsetting of people who are consuming more energy than general people and emitting relatively more carbon in atmosphere. The study has assessed the carbon pool status in two community forest. In the study in two community forests carbon pools were assessed following the guideline “Forest Carbon Inventory Guideline 2010” prescribed by Ministry of Forest and soil Conservation, Nepal. Final out comes of analysis in intensively managed area of Hokse CF recorded as 103.58 tons C /ha with 6173.30 tons carbon stock. Similarly in Hariyali CF carbon density was recorded 251.72 mg C /ha. The total carbon stock of intensively managed blocks in Hariyali CF is 35839.62 tons carbon.

Keywords: carbon, offsetting, sequestration, valuation

Procedia PDF Downloads 321

Authors: Esengül Elibol, Arzu Kader Harmancı Seren

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Individuals' reasons to choose a profession, profession image perceptions and future plans related to that profession affect their success in their future work lives. For nursing profession, this situation at the same time is important in terms of the health and safety of patients. The purpose of this study is to determine why medical vocational high school students in İstanbul choose nursing profession, their nursing image perceptions and future plans related to the profession. Descriptive and cross-sectional design are used. The study was carried out in four medical vocational high school in İstanbul. All third and fourth grade students who are attending to nursing programs and voluntary for participation were included in the study. In collecting data, two questionnaires that aim to learn about socio-demographic characteristics, profession choice reasons and future plans of nursing students and ‘Nursing Image Scale’ were used. Scale consisted of 28 items including individuals' opinions on nursing profession image and three sub-categories ‘General View,’ ‘Communication,’ and ‘Vocational-Educational Qualities.’ Analyzing profession choice reasons and future plans of participants, it is determined that majority chose nursing for easily finding a job (46.9%) and that majority had a dream profession other than nursing (65.8%). Analyzing nursing image perception of participants, it is determined that average of general view sub-category total scores was 9.75±2.27, average of communication sub-category total scores was8.68±2.86, and average of vocational-educational qualities sub-category total score was 21.18±3.96. In the perception score averages, meaningful differences were found according to independent variables. In conclusion, it was determined that majority of the participant students chose nursing for easily finding a job, perceived profession image negatively, and had a dream profession other than nursing.

Keywords: nursing image, medical vocational health school, perception, profession, student nurse

Procedia PDF Downloads 273

Authors: R. V. Dahibhate, A. B. Deoghare, P. M. Padole

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Maintaining natural integrity of biosystem is paramount significant for orthopedic surgeon while performing surgery. Restoration is challenging task to rehabilitate trauma patient. Drilling is an inevitable procedure to fix implants. The task leads to rise in temperature at the contact site which intends to thermal necrosis. A precise monitoring can avoid thermal necrosis. To accomplish it, data acquiring instrument is integrated with the drill bit. To contemplate it, electronic feedback system is developed. It not only measures temperature without any physical contact in between measuring device and target but also visualizes the site and monitors correct movement of tool path. In the current research work an infrared thermometer data acquisition system is used which monitors variation in temperature at the drilling site and a camera captured movement of drill bit advancement. The result is presented in graphical form which represents variations in temperature, drill rotation and time. A feedback system helps in keeping drill speed in threshold limit.

Keywords: thermal necrosis, infrared thermometer, drilling tool, feedback system

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Authors: Aiydh Aljeddani

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Sustainable learning is an emerging concept that aims at enhancing sustainability literacy and competency in educational contexts. Mobile learning is one of the means increasingly used in sustainable development education nowadays. Studies which have explored this issue in the Saudi educational context so far are rare. Therefore, the current study attempted to explore the current situation of the usage of mobile learning in the Saudi elementary and secondary schools as a means of promoting sustainable learning. It also focused on how mobile learning has been implemented in those schools to promote sustainable learning and what factors have contributed to the success/failure of the implementation of mobile learning and possible ways to improve the current practice. An interpretive approach was followed in this study to gain a thorough understanding of the explored issue in the Saudi educational context using the activity theory as a lens to do so. A qualitative case study methodology in which semi-structured interviews, documents analysis and nominal group were used to gather the data for this study. Two hundred and twenty-nine participants representing several main stakeholders in the educational system took part in this study. Those included six general education schools, head teachers, teachers, students’ parents, educational supervisors, one curriculum designer and academic curriculum specialists. Through the lens of activity theory, the results of the study showed that there were contradictions in the current practice between the elements of the activity system and within each of its elements. Furthermore, several sociocultural factors have influenced both the division of labour and the community's members. These have acted as obstacles which have impeded the usage of mobile learning to promote sustainable learning in this context. It was found that shifting from the current practice to sustainable learning via the usage of mobile learning requires appropriate interrelationship between the different elements of the activity system. The study finally offers a number of recommendations to improve on the current practices and suggests areas for further studies.

Keywords: activity theory, mobile learning, sustainability competency, sustainability literacy, sustainable learning

Procedia PDF Downloads 240

Authors: Keng H. Kong, Louis C. Tan, Wing L. Aw, Kay Y. Tay

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Background: Fatigue is a common problem in patients with Parkinson's disease, with reported prevalence of up to 70%. Fatigue can be disabling and has adverse effects on patients' quality of life. There is currently no satisfactory treatment of fatigue. Acupuncture is effective in the treatment of fatigue, especially that related to cancer. Its role in Parkinson's disease-related fatigue is uncertain. Aims: To evaluate the clinical efficacy of acupuncture treatment in Parkinson's disease-related fatigue. Hypothesis: We hypothesize that acupuncture is effective in alleviating Parkinson's disease-related fatigue. Design: A single center, randomized, controlled study with two parallel arms. Participants: Forty participants with idiopathic Parkinson's disease will be enrolled. Interventions: Participants will be randomized to receive verum (real) acupuncture or placebo acupuncture. The retractable non-invasive sham needle will be used in the placebo group. The intervention will be administered twice a week for five weeks. Main outcome measures: The primary outcome will be the change in general fatigue score of the multidimensional fatigue inventory at week 5. Secondary outcome measures include other subscales of the multidimensional fatigue inventory, movement disorders society-unified Parkinson's disease rating scale, Parkinson's disease questionnaire-39 and geriatric depression scale. All outcome measures will be assessed at baseline (week 0), completion of intervention (week 5) and 4 weeks after completion of intervention (week 9). Results: To date, 23 participants have been recruited and nine have completed the study. The mean age is 63.5±14.2 years, mean duration of Parkinson’s disease is 6.4±1.8 years and mean MDS-UPDRS score is 8.3±2.8. The mean general fatigue score of the multidimensional fatigue inventory is 13.5±4.6. No significant adverse event related to acupuncture is noted. Potential significance: If the results are as expected, this study will provide preliminary scientific evidence for the efficacy of acupuncture in Parkinson's Disease-related fatigue, and opens the door for a larger multicentre trial to be performed. In the longer term, it may lead to the integration of acupuncture in the care of patients with Parkinson's disease.

Keywords: acupuncture, fatigue, Parkinson's disease, trial

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Authors: Shaival Dalal, Nilesh Shah, Dinshaw Pardiwala, David Rajan, Satyen Sanghavi, Charul Bhanji

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Autologous Chondrocyte Implantation (ACI) is used worldwide since 1998 to treat cartilage defect. GEL based ACI is a new tissue-engineering technique to treat full thickness cartilage defect with fibrin and thrombin as scaffold for chondrocytes. Purpose of this study is to see safety and efficacy of gel based ACI for knee cartilage defect in multiple centres with different surgeons. Gel-based Autologous Chondrocyte Implantation (GACI) has shown effectiveness in treating isolated cartilage defect of knee joint. Long term results are still needed to be studied. This study was followed-up up to two years and showed benefit to patients. All enrolled patients with a mean age of 28.5 years had an average defect size of3 square centimeters, and were grade IV as per ICRS grading. All patients were followed up several times and at several intervals at 6th week, 8th week, 11th week, 17th week, 29th week, 57th week after surgery. The outcomes were measured based on the IKDC (subjective and objective) and MOCART scores.

Keywords: knee, chondrocyte, autologous chondrocyte implantation, fibrin gel based

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Authors: Suegnet Smit

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Prior to 1994, special education in South Africa was marginalized and fragmented. Moving away from a Medical model approach to special education, the Government, after 1994, promoted an Inclusive approach, as a means to transform education in general, and special education in particular. This transformation, however, is moving at too a slow pace for learners with barriers to learning and development to benefit fully from their education. The goal of the Department of Basic Education is to minimize, remove, and prevent barriers to learning and development in the educational setting, by attending to the unique needs of the individual learner. However, the implementation of Inclusive education is problematic, and general education remains poor. This paper highlights the historical development of special education in South Africa, underpinned by a bio-ecological perspective. Problematic areas within the systemic levels of the education system are highlighted in order to indicate how the interactive processes within the systemic levels affect special needs learners on the personal dimension of the bio-ecological approach. As part of the methodology, thorough document analysis was conducted on information collected from a large body of research literature, which included academic articles, reports, policies, and policy reviews. Through a qualitative analysis, data were grouped and categorized according to the bio-ecological model systems, which revealed various successes and challenges within the education system. The challenges inhibit change, growth, and development for the child, who experience barriers to learning. From these findings, it is established that special education in South Africa has been, and still is, on a bumpy road. Sadly, the transformation process of change, envisaged by implementing Inclusive education, is still yet a dream, not fully realized. Special education seems to be stuck at what is, and the education system has not moved forward significantly enough to reach what special education should and could be. The gap that exists between a vision of Inclusive quality education for all, and the current reality, is still too wide. Problems encountered in all the education system levels, causes a funnel-effect downward to learners with special educational needs, with negative effects for the development of these learners.

Keywords: bio-ecological perspective, education systems, inclusive education, special education

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Authors: Miroslav Dumbrovsky

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The paper deals with positive impacts of land consolidation on decreasing soil degradation with the main emphasis on soil and water conservation in the landscape. The importance of land degradation is very high because of its impact on crop productivity and many other adverse effects. Soil degradation through soil erosion is causing losses in crop productivity and quality of the environment, through decreasing quality of soil and water (especially water resources). Negative effects of conventional farming practices are increased water erosion, as well as crusting and compaction of the topsoil and subsoil. Soil erosion caused by water destructs the soil’s structure, reduces crop productivity due to deterioration in soil physical and chemical properties such as infiltration rate, water holding capacity, loss of nutrients needed for crop production, and loss of soil carbon. Recently, a new process of complex land consolidation in the Czech Republic has provided a unique opportunity for improving the quality of the environment and sustainability of the crop production by means a better soil and water conservation. The present process of the complex land consolidation is not only a reallocation of plots, but this system consists of a new layout of plots within a certain territory, aimed at establishing the integrated land-use economic units, based on the needs of individual landowners and land users. On the other hand, the interests of the general public and the environmental protection have to be solved, too. From the general point of view, a large part of the Czech landscape shall be reconstructed in the course of complex land consolidation projects. These projects will be based on new integrated soil-economic units, spatially arranged in a designed multifunctional system of soil and water conservation measures, such as path network and a territorial system of ecological stability, according to structural changes in agriculture. This new approach will be the basis of a rational economic utilization of the region which will comply with the present ecological and aesthetic demands at present.

Keywords: soil degradation, land consolidation, soil erosion, soil conservation

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Authors: Abdelmaguid Ramzy, Mohamed Bahaa

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Introduction: The effects of ovarian endometrioma on fertility outcomes with IVF have been always related to poor outcomes. Objective: To evaluate the effect of unilateral unoperated ovarian endometrioma < 2cm on the number of developing follicles and compare them with the contralateral ovary as a control. Design: Retrospective case control study. Setting: KasrEl-Aini IVF center. Patient(s): We studied 32 women with unilateral endometrioma who underwent their first IVF cycle. Methods: 32 Patients aged between 20-35 years selected for IVF who were diagnosed with one unilateral endometrioma (diameter <2 cm) and who did not undergo previous ovarian surgery were retrospectively identified. The number of follicles > 17 mm during folliculometry on the day of HCG trigger in the ovary that contained endometrioma were compared with those from the contralateral ovary. They were all hyperstimulated using long protocol with (225-300 IU) gonadotrophins. Primary outcome: The number of follicles > 17 mm during folliculometry on the day of HCG trigger. Result(s): The mean ± SD age, Day 3 serum FSH and LH were 27± 3.7 years, 5.8 ± 1.6 IU/ml and 4.5 ± 1.7 IU/ml respectively. There was no significant difference in the number of follicles > 17 mm on the day of HCG trigger in the ovary that contained endometrioma (4.4 ±2.5) and in the opposite ovary (4.5 ± 2.8) (P= 0.48). Conclusion: The presence of ovarian endometrioma in a controlled ovarian hyperstimulation cycle for IVF treatment is not associated with a reduced number of follicles > 17 mm during folliculometry on the day of HCG trigger.

Keywords: endometrioma, folliculometry, hyperstimulation, fertility

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Authors: Munaza Mubeen

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The colonial Urdu literature has played a significant role in uplifting the overall status of the Indians. Taking example of the Bhopal State, the contribution of the Royal ladies holds no match in the contemporary age. Similarly, the efforts of the Begamat-e-Bhopal in the field of education had been acknowledged across the Sub-continent. It had been noticed that with the downfall of the Mughal Empire at the hands of the British Raj, the local culture in the Indian sub-continent in general and in Bhopal State in proper got deteriorated. This led to uncertainty, chaos and an anti-British sentiment which created hatred against them in the entire sub-continent. Likely, in Bhopal State, the role of women in field of education also vanished. However, this change was felt by the ladies in the Royal Household where they struggled for restoration of the status quo with their personal efforts. The prominent contributors from the Royal household included Qudseya Begum, Nawab Sikander Begum, Nawab Shah Jahan Begum and Nawab Sultan Johan-they are known as Begamat-i-Bhopal. They established schools, colleges and universities to impart formal and non-formal education respectively. Their systematic approach and continued efforts constituted a dynamic aspect of women’ empowerment. Focused on the female education, however, one of the by-products of their efforts was an introduction of socio-cultural and politico-religious awareness among the middle class womenfolk. Unfortunately, the role of these Bagamat-i-Bhopal has been left untouched or ignored by the academic scholars. This study critically analyzed the role of Beghamat-i-Bhopal regarding female education in Hindustan in general and in Bhopal in particular. Similarly, the contribution of the contemporary writers in development of female education in Bhopal has also been discussed in this paper. This paper is based on the 'historico-textual' approach following structural reason which has established a justifiable argument. The researcher, therefore, has taken into consideration all the chronological nuances in order to accord greater visibility to the contents. The data has been described, analyzed and interpreted inclusively and in generalized manner.

Keywords: colonialism, Begamaat e Bhopal, female education, State of Bhopal

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Authors: Yael Neumann

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Attention deficits are common in people with aphasia (PWA). Two treatment approaches address these deficits: domain-general methods like Play Attention, which focus on cognitive functioning, and domain-specific methods like Language-Specific Attention Treatment (L-SAT), which use linguistically based tasks. Research indicates that L-SAT can improve both attentional deficits and functional language skills, while Play Attention has shown success in enhancing attentional capabilities among school-aged children with attention issues compared to standard cognitive training. This study employed a randomized controlled cross-over single-subject design to evaluate the effectiveness of these two attention treatments over 25 weeks. Four PWA participated, undergoing a battery of eight standardized tests measuring language and cognitive skills. The treatments were counterbalanced. Play Attention used EEG sensors to detect brainwaves, enabling participants to manipulate items in a computer game while learning to suppress theta activity and increase beta activity. An algorithm tracked changes in the theta-to-beta ratio, allowing points to be earned during the games. L-SAT, on the other hand, involved hierarchical language tasks that increased in complexity, requiring greater attention from participants. Results showed that for language tests, Participant 1 (moderate aphasia) aligned with existing literature, showing L-SAT was more effective than Play Attention. However, Participants 2 (very severe) and 3 and 4 (mild) did not conform to this pattern; both treatments yielded similar outcomes. This may be due to the extremes of aphasia severity: the very severe participant faced significant overall deficits, making both approaches equally challenging, while the mild participant performed well initially, leaving limited room for improvement. In attention tests, Participants 1 and 4 exhibited results consistent with prior research, indicating Play Attention was superior to L-SAT. Participant 2, however, showed no significant improvement with either program, although L-SAT had a slight edge on the Visual Elevator task, measuring switching and mental flexibility. This advantage was not sustained at the one-month follow-up, likely due to the participant’s struggles with complex attention tasks. Participant 3's results similarly did not align with prior studies, revealing no difference between the two treatments, possibly due to the challenging nature of the attention measures used. Regarding participation and ecological tests, all participants showed similar mild improvements with both treatments. This limited progress could stem from the short study duration, with only five weeks allocated for each treatment, which may not have been enough time to achieve meaningful changes affecting life participation. In conclusion, the performance of participants appeared influenced by their level of aphasia severity. The moderate PWA’s results were most aligned with existing literature, indicating better attention improvement from the domain-general approach (Play Attention) and better language improvement from the domain-specific approach (L-SAT).

Keywords: attention, language, cognitive rehabilitation, neurofeedback

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Authors: Elena Parmentier, Henrik Endeman

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Introduction: Large mediastinal masses often present with diagnostic and clinical challenges due to compression of the respiratory and hemodynamic system. We present a case of a mediastinal mass with symptomatic mechanical compression of the trachea, resulting in challenging airway management. Methods: We present a case of 66-year-old male, complaining of progressive dysphagia. Initial esophagogastroscopy revealed a stenosis secondary to external compression, biopsies were inconclusive. Additional CT scan showed a large mediastinal mass of unknown origin, situated between the vertebrae and esophagus. Symptoms progressed and patient developed dyspnea and stridor. A new CT showed quick growth of the mass with compression of the trachea, subglottic to just above the carina. A tracheal covered stent was successfully placed. Endobronchial ultrasound revealed a large irregular mass without tracheal invasion, biopsies were taken. 4 days after stent placement, the patients’ condition deteriorated with worsening of stridor, dyspnea and desaturation. Migration of the tracheal stent into the right main bronchus was seen on chest X ray, with obstruction of the left main bronchus and secondary atelectasis. Different methods have been described in the literature for tracheobronchial stent removal (surgical, endoscopic, fluoroscopyguided), our first choice in this case was flexible bronchoscopy. However, this revealed tracheal compression above the migrated stent and passage of the scope occurred impossible. Patient was admitted to the ICU, high-flow nasal oxygen therapy was started and the situation stabilized, giving time for extensive assessment and preparation of the airway management approach. Close cooperation between the intensivist, pulmonologist, anesthesiologist and otorhinolaryngologist was essential. Results: In case of sudden deterioration, a protocol for emergency situations was made. Given the increased risk of additional tracheal compression after administration of neuromuscular blocking agents, an approach with awake fiberoptic intubation maintaining spontaneous ventilation was proposed. However, intubation without retrieval of the tracheal stent was found undesirable due to expected massive shunting over the left atelectatic lung. As rescue option, assistance of extracorporeal circulation was considered and perfusionist was kept on standby. The patient stayed stable and was transferred to the operating theatre. High frequency jet ventilation under general anesthesia resulted in desaturations up to 50%, making rigid bronchoscopy impossible. Subsequently an endotracheal tube size 8 could be placed successfully and the stent could be retrieved via bronchoscopy over (and with) the tube, after which the patient was reintubated. Finally, a tracheostomy (Shiley™ Tracheostomy Tube With Cuff, size 8) was placed, fiberoptic control showed a patent airway. Patient was readmitted to the ICU and could be quickly weaned of the ventilator. Pathology was positive for rhabdomyosarcoma, without indication for systemic therapy. Extensive surgery (laryngectomy, esophagectomy) was suggested, but patient refused and palliative care was started. Conclusion: Due to meticulous planning in an interdisciplinary team, we showed a successful airway management approach in this complicated case of critical airway compression secondary to a rare rhabdomyosarcoma, complicated by tracheal stent migration. Besides presenting our thoughts and considerations, we support exploring other possible approaches of this specific clinical problem.

Keywords: airway management, rhabdomyosarcoma, stent displacement, tracheal stenosis

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Authors: Luciano Tarantino

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Gas gangrene is a rare, severe infection with a very high mortality rate caused by Clostridium species. The infection causes a non-suppurative localized producing gas lesion from which harmful toxins that impair the inflammatory response cause vessel damage and multiple organ failure. Gas gangrene of the liver is very rare and develops suddenly, often as a complication of abdominal surgery and liver transplantation. The present paper deals with a case of gas gangrene of the liver that occurred after percutaneous MW ablation of hepatocellular carcinoma, resulting in progressive liver necrosis and multi-organ failure in spite of specific antibiotics administration. The patient was successfully treated with percutaneous Radiofrequency ablation. Case report: Female, 76 years old, Child A class cirrhosis, treated with synchronous insertion of 3 MW antennae for large HCC (5.5 cm) in the VIII segment. 24 hours after treatment, the patient was asymptomatic and left the hospital . 2 days later, she complained of fever, weakness, abdominal swelling, and pain. Abdominal US detected a 2.3 cm in size gas-containing area, eccentric within the large (7 cm) ablated area. The patient was promptly hospitalized with the diagnosis of anaerobic liver abscess and started antibiotic therapy with Imipenem/cilastatine+metronidazole+teicoplanine. On the fourth day, the patient was moved to the ICU because of dyspnea, congestive heart failure, atrial fibrillation, right pleural effusion, ascites, and renal failure. Blood tests demonstrated severe leukopenia and neutropenia, anemia, increased creatinine and blood nitrogen, high-level FDP, and high INR. Blood cultures were negative. At US, unenhanced CT, and CEUS, a progressive enlargement of the infected liver lesion was observed. Percutaneous drainage was attempted, but only drops of non-suppurative brownish material could be obtained. Pleural and peritoneal drainages gave serosanguineous muddy fluid. The Surgeon and the Anesthesiologist excluded any indication of surgical resection because of the high perioperative mortality risk. Therefore, we asked for the informed consent of the patient and her relatives to treat the gangrenous liver lesion by percutaneous Ablation. Under conscious sedation, percutaneous RFA of GG was performed by double insertion of 3 cool-tip needles (Covidien LDT, USA ) into the infected area. The procedure was well tolerated by the patient. A dramatic improvement in the patient's condition was observed in the subsequent 24 hours and thereafter. Fever and dyspnea disappeared. Normalization of blood tests, including creatinine, was observed within 4 days. Heart performance improved, 10 days after the RFA the patient left the hospital and was followed-up with weekly as an outpatient for 2 months and every two months thereafter. At 18 months follow-up, the patient is well compensated (Child-Pugh class B7), without any peritoneal or pleural effusion and without any HCC recurrence at imaging (US every 3 months, CT every 6 months). Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients non-responder to antibiotics and when surgery and liver transplantation are not feasible. A fast and early indication is needed in case of rapid worsening of patient's conditions.

Keywords: liver tumor ablation, interventional ultrasound, liver infection, gas gangrene, radiofrequency ablation

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Authors: Neelesh Papineni

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Aim: Piezosurgery is a relatively new technique for osteotomy and osteoplasty that uses ultrasonic vibration. The conventional method of treating periodontal cases are by conventional surgeries. However, in this advancing field the use of motor-driven instruments is being considered less invasive. Out of these motor-driven instruments, piezo-electric device has been introduced to the field of periodontics and oral implantology. This article discusses about the wide range of application of piezo-electric device in periodontology, its advantages over conventional surgical therapies and other motor-driven instruments. Results: Piezo- electric has shown better results in aspect of osteotomy, osteoplasty, implants, and any procedure which includes conserving the bone. Also piezo-electric does not cause any kind of damage to the surrounding soft tissue and eliminates the risk of bone necrosis which is a risk factor in other motor driven instruments. Conclusion: In this era of modern dentistry , a successful periodontal and implant surgery requires a sound osseous support. This review gives a pictorial representation about the wide range of application of piezo-electric device in periodontology.

Keywords: piezo-electric, osteotomy, osteoplasty, implantology

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Authors: Aniya Everette

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In June of 1971, President Richard Nixon made his first public declaration regarding the “War on Drugs,” deeming it America’s number one public enemy. Since then, the drug war has been a divisive topic in the US. Black and brown children have been unfairly targeted and imprisoned at alarming rates as a result of this policy, which has had a negative effect on them. Black and Latino youth have faced significant obstacles that have impacted their educational opportunities, employment prospects, and general quality of life due to harsh mandatory sentences, aggressive policing tactics, and racial profiling.

Keywords: war, drugs, crime, racial profiling

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Authors: Ali Arazeem Abdullahi, Mariam Seedat-Khan, Bamidele S. Akanni

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Background: Like the rest of the world, cancer of the breast is a life-threatening disease to Nigerian women. The utilization of mammography is however very poor among the general population. Whereas, there strong indications that women who engage in the regular screening of breast cancer using mammography are more likely to have a lower risk of developing and dying from advanced breast cancer compared to unscreened women. This study examined knowledge of breast cancer and utilization of mammography among undergraduate female students at the University of Ilorin, Nigeria. Health Belief Model (HBM) was deployed to guide the conduct of the study. Method: Self-administered questionnaire was used to collect data from 292 undergraduate female students from the faculties of Social and Management Sciences of the University. A simple random sampling technique was used to select the respondents. Data was analyzed using both descriptive and inferential statistics. Results: The study found that apart from high knowledge of breast cancer and mammography, perceived threat, perceived susceptibility and perceived seriousness of breast cancer were equally high. However, the uptake of mammography was very poor largely due to perceived barriers including being single and young and poor history of breast cancer in families (cues to action). The test of hypotheses showed that there is a weak relationship of about 6.8% between knowledge of breast cancer and utilization of mammography (p-value= 0.244) at 0.05 level of significance. However, 64.4% of the respondents were willing to utilize mammography in the future if the opportunity arises. While the study found a significant statistical relationship between the perceived benefits of mammography and its utilization among the respondents, no significant statistical association was found between the socio-demographic characteristics of the respondents and the uptake of mammography. Recommendations: Findings highlight the need for health education interventions to promote breast cancer screening and the utilization mammography, while addressing barriers to the uptake of mammography among female undergraduate students of the University of Ilorin and Nigeria in general.

Keywords: cancer of the breast, mammography, female undergraduate students, health belief model, University of Ilorin

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Authors: Harjyot Khosa

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In India and south Asia, stigma and discrimination against transgender community remain disproportionately high. Lack of mental health care restricts effective treatment and care for both physical and mental health. Knowledge assessment of 80 counsellors across India reflected that only 28% counsellors knew about the transgender community. Whereas, only 6% of them felt, that transgender community require a specific mental health support, considering the stigma they face in day to day life. Lastly, 62% did agree that they require specific training to address unmet needs of transgender community. A robust counselling module was developed with focus on technical counselling skills and strategies, specific counselling issues, identity and sexuality, disclosure, hormone therapy and sex reassignment surgery. Mental health related support should be an integral part of government and non-government programs for the overall well-being of transgender community who face stigma and discrimination at every level. Needs based capacity building and technical assistance is required towards providing mental health support for transgender populations and their partners.

Keywords: identity and sexuality, mental health, stigma, transgender

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