Search results for: surgical team

Authors: Ghada E. Esheba, Ghadeer F. Alharthi, Duaa A. Alhejaili, Rawan E. Hudairy, Wafaa A. Altaezi, Raghad M. Alhejaili

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Background: Inflammatory bowel disease (IBD) consists of two specific gastrointestinal disorders: ulcerative colitis (UC) and Crohn's disease (CD). Despite their distinct natures, these two diseases share many similar etiologic, clinical and pathological features, as a result, their accurate differential diagnosis may sometimes be difficult. Correct diagnosis is important because surgical treatment and long-term prognosis differ from UC and CD. Aim: This study aims to study the characteristic clinicopathological features which help in the differential diagnosis between UC and CD, and assess the disease activity in ulcerative colitis. Materials and methods: This study was carried out on 50 selected cases. The cases included 27 cases of UC and 23 cases of CD. All the cases were examined using H& E and immunohistochemically for bcl-2 expression. Results: Characteristic features of UC include: decrease in mucous content, irregular or villous surface, crypt distortion, and cryptitis, whereas the main cardinal histopathological features seen in CD were: epitheloid granuloma, transmural chronic inflammation, absence of mucin depletion, irregular surface, or crypt distortion. 3 cases of UC were found to be associated with dysplasia. UC mucosa contains fewer Bcl-2+ cells compared with CD mucosa. Conclusion: This study using multiple parameters such clinicopathological features and Bcl-2 expression as studied by immunohistochemical stain, helped to gain an accurate differentiation between UC and CD. Furthermore, this work spotted the light on the activity and different grades of UC which could be important for the prediction of relapse.

Keywords: Crohn's disease, dysplasia, inflammatory bowel disease, ulcerative colitis

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Authors: A. Elbaz, K. Spang

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Infrastructure projects are often subjected to delays and cost overruns and mistakenly described as unsuccessful projects. These projects have many peculiarities such as public attention, impact on the environment, subjected to special regulations, etc. They also deal with several stakeholders with different motivations and face unique risks. With this in mind we need to reconsider our approach to manage them, define their success factors and implement these success factors. Infrastructure projects are not only lacking a unified meaning of project success or a definition of success factors, but also a clear method to implement these factors. This paper investigates this gap and introduces a concept to implement success factors in an efficient way, taking into consideration the specific characteristics of infrastructure projects. This concept consists of six enablers such as project organization, project team, project management workflow, contract management, communication and knowledge transfer and project documentations. These enablers allow other success factors to be efficiently implemented in projects. In conclusion, this paper provides project managers as well as company managers with a tool to define and implement success factors efficiently in their projects, along with upgrading their assets for the coming projects. This tool consists of processes and validated checklists to ensure the best use of company resources and knowledge. Due to the special features of infrastructure projects this tool will be tested in the German infrastructure market. However, it is meant to be adaptable to other markets and industries.

Keywords: infrastructure projects, operative success factors, project success, success factors, transportation projects

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Authors: Francis Edum-Fotwe, Tony Thorpe, Charles Afetornu

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Risk perception informs the outcome of how issues are responded to in either solving or overcoming a problem or improving a situation. Risk perception is established to be affected by some key factors reflecting in the varying ways in which work is done as well as the level of efficiency achieved. These factors potentially would influence risk perception to different extents. Such that if these factors are said to determine risk perception, how does a change in any affect risk perception. Since the ability to address risk is influenced by risk perception, establishing and developing awareness of that perception should enable construction professionals to make viable decisions. Any act to improve the construction industry cannot be overemphasised, considering its contribution to national development. A survey questionnaire was conducted in Ghana to elicit data that measures the risk perception and the essential factors as well as the necessary demographics of the respondents, who are construction professionals. This study finds out the sensitivity of the critical factors of risk perception. It uses the Relative Importance Index analysis tool to investigate the differential effect of these essential factors on risk perception, such that a slight change in a factor makes a significant change in risk perception, having established that it is influenced by essential factors. The findings can lead to policy formation for employers on the prioritisation factors to undertake to improve the risk perception of employees. Other areas in which this study can be useful in team formation for sensitive and complex projects where efficient risk management is critical.

Keywords: construction industry, risk, risk management, risk perception

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Authors: Natasha Goh, Sebastian Brown

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Purpose: This case report describes an unusual presentation of uveal melanoma. Method: Case notes, imaging, and histopathological specimen were reviewed for this case report. Result: The patient is a 62-year-old lady of Chinese heritage who had been receiving follow-up at the eye clinic of a tertiary hospital. She had a longstanding history of poor vision in her right eye after sustaining trauma to the eye at age 3. She was found to have a carotid-cavernous sinus fistula in the right eye in 2009 and underwent stenting in China. Unfortunately, this was unsuccessful and resulted in a painful blind eye. She had represented with headaches, worsening eye pain, and ptosis in Sydney in 2016. Her CT angiogram showed a calcified vascular structure in the orbit and globe, and she was offered a digital subtraction angiography by the neurosurgical team, which she ultimately declined. She had since been followed up at the eye clinic for the pthisical eye. Due to chronic ocular pain and recurrent conjunctivitis, the decision was made for an evisceration in 2021. The specimen was sent for routine histopathological examination and returned positive for uveal melanoma. The patient was subsequently referred to a melanoma center for further follow-up, which comprised serial imaging and radiotherapy treatment. Conclusion: Clinicians should bear in mind that uveal melanomas may present in a longstanding phthisical eye and in patients with no or little apparent risk factors.

Keywords: uveal melanoma, pthisical eye, carotid cavernous fistula, uveal melanoma risk factors

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Authors: Mary Butler

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Background: Screening programmes for older drivers in Europe (though not the UK), and in many states in the US and in Australia are based on medical assessment of fitness to drive. These programmes require physicians (including general practitioners) to carry out an assessment of fitness to drive in their offices. In 2006, New Zealand changed from doing on-road driving tests with all older drivers from the age of 80, to a screening programme that uses medical assessment of fitness to drive only. Aim: This study set out to understand the experience of New Zealand GPs as they manage the process of medical assessment of fitness to drive assessments for older people. In particular, it aimed to establish how GPs understand the role of specialist driving assessment and rehabilitation carried out by occupational therapists. Design and setting: The study used an interpretive descriptive approach to analyze data from ten interviews with GPs in New Zealand. Results: The results indicated that GPs lack understanding about how occupational therapists can assist their patients, and tend to refer only when there is a disagreement with the patient. Conclusion: There are problems with the medical assessment of fitness to drive carried out by GPs, and there is a need for a more comprehensive community approach to driving cessation. Patients, families and the multidisciplinary team all have a role in deciding when driving cessation should occur. Occupational therapists have a particular responsibility for strategic leadership in this area of practice.

Keywords: assessment, driving, older people, occupational therapy

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Authors: Mitzi S. Brammer

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Given that the cultural make-up of programs of study in institutions of higher learning is becoming increasingly diverse, much has been written about cultural diversity from a university-level perspective. However, there are little data in the way of specific programs and how they address inclusive practices when teaching and working with marginalized populations. This research study aimed to discover baseline knowledge and attitudes of health sciences faculty, instructional staff, and students related to inclusive teaching/learning and interactions. Quantitative data were collected via an anonymous online survey (one designed for students and another designed for faculty/instructional staff) using a web-based program called Qualtrics. Quantitative data were analyzed amongst the faculty/instructional staff and students, respectively, using descriptive and comparative statistics (t-tests). Additionally, some participants voluntarily engaged in a focus group discussion in which qualitative data were collected around these same variables. Collecting qualitative data to triangulate the quantitative data added trustworthiness to the overall data. The research team analyzed collected data and compared identified categories and trends, comparing those data between faculty/staff and students, and reported results as well as implications for future study and professional practice.

Keywords: inclusion, higher education, pedagogy, equity, diversity

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Authors: Fawaz A. Binsarra, Halim Boussabaine

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The notion of complexity science has been attracting the interest of researchers and professionals due to the need of enhancing the efficiency of understanding complex systems dynamic and structure of interactions. In addition, complexity analysis has been used as an approach to investigate complex systems that contains a large number of components interacts with each other to accomplish specific outcomes and emerges specific behavior. The design process is considered as a complex action that involves large number interacted components, which are ranked as design tasks, design team, and the components of the design process. Those three main aspects of the building design process consist of several components that interact with each other as a dynamic system with complex information flow. In this paper, the goal is to uncover the complex structure of information interactions in building design process. The Investigating of Royal Institute of British Architects Plan Of Work 2013 information interactions as a case study to uncover the structure and building design process complexity using network analysis software to model the information interaction will significantly enhance the efficiency of the building design process outcomes.

Keywords: complexity, process, building desgin, Riba, design complexity, network, network analysis

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Authors: Lakmali Anthony, Madeline Gillies

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Purpose: Long-term survivorship in colorectal cancer (CRC) is increasing as mortality decreases, leading to increased focus on patient-reported outcomes such as quality of life (QoL). CRC patients often have decreased QoL even after treatment is complete. This systematic review of the literature aims to identify psychosocial factors associated with decreased QoL in post-treatment CRC patients. Methodology: This systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The search was conducted in MEDLINE, EMBASE, and PsychINFO using MeSH headings. The two authors screened studies for relevance and extracted data. Results: Seventeen studies were identified, including 6,272 total participants (mean = 392, 58% male) with a mean age of 60.6 years. The European Organisation for Research and Treatment of Cancer QLQ-C30 was the most common measure of QoL (n=14, 82.3%). Most studies (n=15, 88.2%) found that emotional distress correlated with poor global QoL. This was most commonly measured with the Hospital Anxiety & Depression Scale (n=11, 64.7%). Other psychosocial factors associated with QoL were lack of social support, body image, and financial difficulties. Clinicopathologic determinants included presence of stoma and metastasis. Conclusion: This systematic review provides a summary of the psychosocial determinants of poor QoL in post-treatment CRC patients, as well as the most commonly reported measures of these. An understanding of these potentially modifiable determinants of poor outcome is pivotal to the provision of quality, patient-centred care in surgical oncology.

Keywords: colorectal cancer, cancer surgery, quality of life, oncology, social determinants

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Authors: Zainal Arifin, Avanti Fontana

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Considering that TOE framework is the most useful instrument for studying technology adoption in firm context, this paper will analyze the influence of technological, organizational and environmental (TOE) factors to the Dynamic capabilities (DCs) associated with technology adoption strategy for improving the firm’s performance. Focusing on the determinant factors of technology adoption at the firm level, the study will contribute to the broader study of resource base view (RBV) and dynamic capability (DC). There is no study connecting directly the TOE factors to the DCs, this paper proposes technology adoption as a functional competence/capability which mediates a relationship between technology adoptions with firm’s performance. The study wants to show a conceptual model of the indirect effects of DCs at the firm level, which can be key predictors of firm performance in dynamic business environment. The results of this research is mostly relevant to top corporate executives (BOD) or top management team (TMT) who seek to provide some supporting ‘hardware’ content and condition such as technological factors, organizational factors, environmental factors, and to improve firm's ‘software ‘ ability such as adaptive capability, absorptive capability and innovative capability, in order to achieve a successful technology adoption in organization. There are also mediating factors which are elaborated at this paper; timing and external network. A further research for showing its empirical results is highly recommended.

Keywords: technology adoption, TOE framework, dynamic capability, resources based view

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Authors: Ziara Carmelli G. Tan, Irene Carmelle S. Tan

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Background: Trichotillomania (TTM) and Major Depressive Disorder (MDD) are two psychiatric conditions that frequently co-occur, presenting a significant challenge for treatment due to their complex interplay. TTM involves repetitive hair-pulling, leading to noticeable hair loss and distress, while MDD is characterized by persistent low mood and loss of interest or pleasure, leading to dysfunctionality. This case report examines the intricate relationship between TTM and MDD in a young adult female, emphasizing the need for a comprehensive, multifaceted therapeutic approach to address both disorders effectively. Case Presentation: The patient is a 21-year-old female college student and youth church leader who presented with chronic hair-pulling and depressive symptoms. Her premorbid personality was marked by low self-esteem and a strong need for external validation. Despite her academic and social responsibilities and achievements, she struggled with managing her emotional distress, which was exacerbated by her family dynamics and her role within her church community. Her hair-pulling and mood symptoms were particularly triggered by self-esteem threats and feelings of inadequacy. She was diagnosed with Trichotillomania, Scalp and Major Depressive Disorder. Intervention/Management: The patient’s treatment plan was comprehensive, incorporating both pharmacological and non-pharmacological interventions. Initial pharmacologic management was Fluoxetine 20mg/day up, titrated to 40mg/day with no improvement; hence, shifted to Escitalopram 20mg/day and started with N-acetylcysteine 600mg/day with noted significant improvement in symptoms. Psychotherapeutic strategies played a crucial role in her treatment. These included supportive-expressive psychodynamic psychotherapy, which helped her explore and understand underlying emotional conflicts. Cognitive-behavioral techniques were employed to modify her maladaptive thoughts and behaviors. Grief processing was integrated to help her cope with significant losses. Family therapy was done to address conflicts and collaborate with the treatment process. Psychoeducation was provided to enhance her understanding of her condition and to empower her in her treatment journey. A suicide safety plan was developed to ensure her safety during critical periods. An interprofessional approach, which involved coordination with the Dermatology service for co-management, was also a key component of her treatment. Outcome: Over the course of 15 therapy sessions, the patient demonstrated significant improvement in both her depressive symptoms and hair-pulling behavior. Her active engagement in therapy, combined with pharmacological support, facilitated better emotional regulation and a more cohesive sense of self. Her adherence to the treatment plan, along with the collaborative efforts of the interprofessional team, contributed to her positive outcomes. Discussion: This case underscores the significance of addressing both TTM and its comorbid conditions to achieve effective treatment outcomes. The intricate interplay between TTM and MDD in the patient’s case highlights the importance of a comprehensive treatment plan that includes both pharmacological and psychotherapeutic approaches. Supportive-expressive psychodynamic psychotherapy, Cognitive-behavioral techniques, and Family therapy were particularly beneficial in addressing the complex emotional and behavioral aspects of her condition. The involvement of an interprofessional team, including dermatology co-management, was crucial in providing holistic care. Future practice should consider the benefits of such a multidisciplinary approach to managing complex cases like this, ensuring that both the psychological and physiological aspects of the disorders are adequately addressed.

Keywords: cognitive-behavioral therapy, interprofessional approach, major depressive disorder, psychodynamic psychotherapy, trichotillomania

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Authors: Evgeniia Surkova, Manal Assaad, Hleb Makeyeu, Juho Makio

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The main objective of STIMEY (Science, Technology, Innovation, Mathematics, Engineering for the Young) project is the delivery of a hybrid learning environment that combines multi-level components such as social media concepts, robotic artefacts, and radio, among others. It is based on a well-researched pedagogical framework to attract European youths to STEM (science, technology, engineering, and mathematics) education and careers. To develop and integrate these various components, STIMEY is executed in iterative research cycles leading to progressive improvements. Scrum was the development methodology of choice in the project, as studies indicated its benefits as an agile methodology in global software development, especially of e-learning and integrated learning projects. This paper describes the project partners’ experience with the Scrum framework, discussing the challenges faced in its implementation and the mitigation practices employed. The authors conclude with exploring user experience tools and principles for future research, as a novel direction in supporting the Scrum development team.

Keywords: e-learning, global software development, scrum, STEM education

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Authors: Maha Salah, Hanaa Hashem, Mahmoud M. Alsagheir, Mohammed Salah

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Acute respiratory distress syndrome (ARDS) represents a complex clinical syndrome and carries a high risk for mortality. The severity of the clinical course, the uncertainty of the outcome, and the reliance on the full spectrum of critical care resources for treatment mean that the entire health care team is challenged. Researchers and clinicians have investigated the nature of the pathological process and explored treatment options with the goal of improving outcome. Through this application of research to practice, we know that some previous strategies have been ineffective, and innovations in mechanical ventilation, sedation, nutrition, and pharmacological intervention remain important research initiatives. Developed Clinical pathway is multidisciplinary plans of best clinical practice for this specified groups of patients that aid in the coordination and delivery of high quality care. They are a documented sequence of clinical interventions that help a patient to move, progressively through a clinical experience to a desired outcome. Although there is a lot of heterogeneity in patients with ARDS, this suggested developed clinical pathway with alternatives was built depended on a lot of researches and evidence based medicine and nursing practices which may be helping these patients to improve outcomes, quality of life and decrease mortality.

Keywords: acute respiratory distress syndrome (ARDS), clinical pathway, clinical syndrome

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Authors: Komal Fizza

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All around the world in every field professionals are taking great support from their computers. Computer assisted strategies not only increase the efficiency of the professionals but also in case of healthcare they help in life-saving interventions. The background of this current research is aimed towards two things; first to find out if computer assisted strategies are useful for Pharmacist for not and secondly how much these assist a Pharmacist to do quality interventions. Shifa International Hospital is a 500 bedded hospital, and it is running Antimicrobial Stewardship, during their stewardship rounds pharmacists observed that a lot of wrong doses of antibiotics were coming at times those were being overlooked by the other pharmacist even. So, with the help of MIS team the patients were categorized into adult and peads depending upon their age. Minimum and maximum dose of every single antibiotic present in the pharmacy that could be dispensed to the patient was developed. These were linked to the order entry window. So whenever pharmacist would type any order and the dose would be below or above the therapeutic limit this would give an alert to the pharmacist. Whenever this message pop-up this was recorded at the back end along with the antibiotic name, pharmacist ID, date, and time. From 14th of January 2015 and till 14th of March 2015 the software stopped different users 350 times. Out of this 300 were found to be major errors which if reached to the patient could have harmed them to the greater extent. While 50 were due to typing errors and minor deviations. The pilot study showed that computer assisted strategies can be of great help to the pharmacist. They can improve the efficacy and quality of interventions.

Keywords: antibiotics, computer assisted strategies, pharmacist, stewardship

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Authors: Mohsin Ali Baloch, Saira Baloch

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Objective: To analyze hematological changes in patients of oral cancer with history of smokable and chewable tobacco use, and to compare them with healthy controls. Study Design: Descriptive type of study survey. Setting: This study was conducted at the Department of Oral and Maxillofacial Surgery, LUMHS, Jamshoro. Study Period: One year July, 2013 to July, 2014. Subject and Methods: Histopathologically confirmed hundred cases of oral cancer with the history of smokable and non-smokable tobacco were selected to analyze the hematological variation. Inclusion Criteria: Histopathologically diagnosed patients of oral squamous cell carcinoma, with history of smokable and non-smokable tobacco. Exclusion Criteria: Patient with any systemic medically compromising problem, terminally ill patients, radio or chemotherapeutically treated patients, patients with metastasis to lungs or any distant metastasis, patients with the history of more than one well-defined etiological factor involved. Results: There were 73% patients of oral cancer reported with anemic. Significantly lower values of Hb, platelet, and higher mean values of ESR, TLC, and were observed in both groups of oral cancer patients; tobacco smokers and tobacco chewers as compared to non-smokers healthy controls. There was more decline in the level of haemoglobin and incline in the level of ESR observed in tobacco chewer oral cancer patients as compared to tobacco smokers patients, while TLC was more observed in smokers. Conclusion: Oral cancer patients with a history of chewable/smokable tobacco have likely worse hematological profile, which increases the anesthetic and surgical challenges for maxillofacial surgeons, which have a significant impact on treatment planning as well.

Keywords: oral cancer, hematological variations, tobacco, smokers

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Authors: Chi-Chang Lin, Jiun-Yan Chiu

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Periodontal disease, oral cancer relating trauma is the prominent factor devastating bone tissue that is crucial to reestablishing in clinical. As we know, common symptom, osteoporosis, and infection limiting the ability of the bone tissue to recover cause difficulty before implantation therapy. Regeneration of bone tissue is the fundamental therapy before surgical processes. To promote the growth of bone tissue, many commercial products still have sophisticated problems that need to overcome. Regrettably, there is no available material which is apparently preferable for releasing and controlling of loading dosage, or mitigating inflammation. In our study, a hydrogel-based composite membrane has been prepared by using Gellan gum (GG), gamma-polyglutamic acid (γ-PGA) and glycerol with simple sol-gel method. GG is a natural material that is massively adopted in cartilage. Unfortunately, the strength of pure GG film is a manifest weakness especially under simulating body fluidic conditions. We utilize another biocompatible material, γ-PGA as cross-linker which can form tri-dimension structure that enhancing the strength. Our result indicated the strength of pure GG membrane can be obviously improved by cross-linked with γ-PGA (0.5, 0.6, 0.7, 0.8, 0.9, 1.0 w/v%). Besides, blending with glycerol (0, 1.0, 2.0, 3.0 w/v%) can significantly improve membrane toughness that corresponds to practical use. The innovative composited hydrogel made of GG, γ-PGA, and glycerol is attested with neat results including elongation and biocompatibility that take the advantage of extension covering major trauma. Recommendations are made for treatment to build up the foundation of bone tissue that would help patients to escape from the suffering and shorten the amount of time in recovery.

Keywords: bone tissue, gellan gum, regeneration, toughness

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Authors: Emma Carr, Bilal Aslam-Pervez, David Laraway

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Litigation against surgeons and hospitals continues to increase in Western countries. While verbal consent is all that is required legally, it has for a long time been considered that written consent offers proof of discussion and interaction between the surgeon and the patient. Inadequate consenting of patients continues in the United Kingdom leaving surgeons and Health Trusts open to litigation. We present a standardised consent form which improves patient autonomy and engagement. The General Medical Council recommends that all material risks relevant to the patient are discussed and recorded prior to undergoing surgery, regardless of how likely they are to occur. Current literature was reviewed to evaluate complications associated with surgical management of mandible fractures. Analysis of risks on 52 consent forms were analysed within the Glasgow OMFS department, leading to a procedure-specific form being designed and implemented. This audit showed that the documentation of risks on consent forms was extremely variable- with uncommon risks not being recorded. Interestingly, not a single consent form was found which highlighted all the risks associated with mandible fractures. Our re-audit data confirms 100% of risks being discussed when a procedure specific form is utilised. Our hope, is to introduce further forms for inclusion on the BAOMS website and peripheral distribution. The forms are quick and easy to print and leave more time for consultation with the patient. Whilst we are under no illusion that the forms may not decrease the incidence of intended litigation, we feel confident that they will decrease the chances of it being successful.

Keywords: consent, litigation, mandible fracture, surgery

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Authors: Rosa Sobreira, Paula Arriscado

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Marketers are aware that media relations is an important touch point, which is also cheaper, to bring their products and their brands to the consumer. They recognize the role of journalists as moderators and transformers of public opinion, and they realize their influence on brand image. And also, they know that readers, listeners, viewers and internet users "believe" more what they read, hear and see in the news than in an advertisement. The study is focused on the automotive industry and analyses the news published about three brands that share industrial facilities and components. We wanted to understand the role of the information created by the brand`s media team in the journalists’ work, and the impact on management, activation and differentiation of brands and their products` attributes and benefits. Based on a qualitative methodology, the analysis focused on press news, making comparison between media coverage and their “narratives” about the three cars from different brands. The results point to the fact that journalists easily integrate speech from the marks on their products. In the case of this study, we found that apart from the description of the many similarities between the three cars, the average speech also "struggled" for revealing the attributes that differentiate them. This interpretation of the results helps us to understand the "marriage" between branding and media. We believe also this paper let us to understand how journalists, through news, join the speech of the brands.

Keywords: brand management, media relations, differentiation, positioning

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Authors: Matheesha Herath, Ned Kinnear, Bridget Heijkoop, Eliza Bramwell, Alannah Frazetto, Amy Noll, Prajay Patel, Derek Hennessey, Greg Otto, Christopher Dobbins, Tarik Sammour, James Moore

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Background: Important incidental pathology requiring further action is commonly found during appendicectomy, macro- and microscopically. It is unknown whether the acute surgical unit (ASU) model affects the management and disclosure of these findings. Methods: An ASU model was introduced at our institution on 01/08/2012. In this retrospective cohort study, all patients undergoing appendicectomy 2.5 years before (traditional group) or after (ASU group) this date were compared. The primary outcomes were rates of appropriate management of the incidental findings and communication of the findings to the patient and to their general practitioner (GP). Results: 1,214 patients underwent emergency appendicectomy; 465 in the traditional group and 749 in the ASU group. 80 (6.6%) patients (25 and 55 in each respective period) had important incidental findings. There were 24 patients with benign polyps, 15 with neuro-endocrine tumour, 11 with endometriosis, 8 with pelvic inflammatory disease, 8 Enterobius vermicularis infection, 7 with low grade mucinous cystadenoma, 3 with inflammatory bowel disease, 2 with diverticulitis, 2 with tubo-ovarian mass, 1 with secondary appendiceal malignancy and none with primary appendiceal adenocarcinoma. One patient had dual pathologies. There was no difference between the traditional and ASU group with regards to communication of the findings to the patient (p=0.44) and their GP (p=0.27), and there was no difference in the rates of appropriate management (p=0.21). Conclusions: The introduction of an ASU model did not change rates of surgeon-to-patient and surgeon-to-GP communication nor affect rates of appropriate management of important incidental pathology during an appendectomy.

Keywords: acute care surgery, appendicitis, appendicectomy, incidental

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Authors: A. M. Prasad

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Knowledge of variations of nerves of gluteal region is important for clinicians administering intramuscular injections, for orthopedic surgeons dealing with the hip surgeries, possibly for physiotherapists managing the painful conditions and paralysis of this region. Herein, we report multiple variations of the nerves of gluteal region. In the current case, the sciatic nerve was absent. The common peroneal and tibial nerves arose from sacral plexus and reached the gluteal region through greater sciatic foramen above and below piriformis respectively. The common peroneal nerve gave a muscular branch to the gluteus maximus. The inferior gluteal nerve and posterior cutaneous nerve of the thigh arose from a common trunk. The common trunk was formed by three roots. Upper and middle roots arose from sacral plexus and entered gluteal region through greater sciatic foramen respectively above and below piriformis. The lower root arose from the pudendal nerve and joined the common trunk. These variations were seen in the right gluteal region of an adult male cadaver aged approximately 70 years. Innervation of gluteus maximus by common peroneal nerve and presence of a common trunk of inferior gluteal nerve and posterior cutaneous nerve of the thigh make this case unique. The variant nerves may be subjected to iatrogenic injuries during surgical approach to the hip. They may also get compressed if there is a hypertrophy of the piriformis syndrome. Hence, the knowledge of these variations is of importance to clinicians, orthopedic surgeons and possibly for physiotherapists.

Keywords: gluteal region, multiple variations, nerve injury, sciatic nerve

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Authors: Leon Pan

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The first programming course within post-secondary education has long been recognized as a challenging endeavor for both educators and students alike. Historically, these courses have exhibited high failure rates and a notable number of dropouts. Instructors often lament students' lack of effort in their coursework, and students often express frustration that the teaching methods employed are not effective. Drawing inspiration from the successful principles of Extreme Programming, this study introduces an approach—the Extremes-based teaching model — aimed at enhancing the teaching of introductory programming courses. To empirically determine the effectiveness of the model, a comparison was made between a section taught using the extreme-based model and another utilizing traditional teaching methods. Notably, the extreme-based teaching class required students to work collaboratively on projects while also demanding continuous assessment and performance enhancement within groups. This paper details the application of the extreme-based model within the post-secondary online classroom context and presents the compelling results that emphasize its effectiveness in advancing the teaching and learning experiences. The extreme-based model led to a significant increase of 13.46 points in the weighted total average and a commendable 10% reduction in the failure rate.

Keywords: extreme-based teaching model, innovative pedagogical methods, project-based learning, team-based learning

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Authors: Isaac Benning

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Using technology to expand the learning space is critical for a productive mathematical discourse. This is a case study of two teachers who developed and enacted GeoGebra-based mathematics lessons following their engagement in a two-year professional development. The didactical and semiotic affordance of GeoGebra in widening the learning space for a productive mathematical discourse was explored. The approach of thematic analysis was used for lesson artefact, lesson observation, and interview data. The results indicated that constructing tools in GeoGebra provided a didactical milieu where students used them to explore mathematical concepts with little or no support from their teacher. The prompt feedback from the GeoGebra motivated students to practice mathematical concepts repeatedly in which they privately rethink their solutions before comparing their answers with that of their colleagues. The constructing tools enhanced self-discovery, team spirit, and dialogue among students. With regards to the semiotic construct, the tools widened the physical and psychological atmosphere of the classroom by providing animations that served as virtual concrete to enhance the recording, manipulation, testing of a mathematical idea, construction, and interpretation of geometric objects. These findings advance the discussion of widening the classroom for a productive mathematical discourse within the context of the mathematics curriculum of Ghana and similar Sub-Saharan African countries.

Keywords: GeoGebra, theory of didactical situation, semiotic mediation, mathematics laboratory, mathematical discussion

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Authors: Kwasi Dartey-Baah, Mias De Klerk

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Project complexity has been cited as one of the essential areas of project management. It can be observed from environmental, social, technological, and organisational viewpoints, and its handling is critical to project success. Conceptualised in varied industries, this paper seeks to ascertain the meaning and understanding of project complexity within the Ghanaian construction industry based on the three dimensions of complexities (faith, fact, and interaction) using experts' opinions. Taking the form of a focus group discussion, the paper sought to gain an in-depth understanding of project complexity issues in Ghana’s construction industry. The method use obtained data from experts (a purposely selected group) comprising project leaders and project management academics. The findings indicated that the experts broadly agreed with the complexity items but offered varied reasons for their agreement. In the composite assessment of the complexity dimensions of (faith, fact, and interaction), it emerged that there was some agreement with the complexity dimensions of fact and interaction within Ghana’s construction industry. On the other hand, with the dimension for complexity by faith, it was noted that the experts in Ghana’s construction construed complexity by faith, not as the absence of evidence but the evidence that hinges on at least a member of the project team. It is expected that other researches on project complexity will focus on other industries to enhance the knowledge of the same within the field of project management.

Keywords: project complexity, complexity by faith, complexity by fact, complexity by interaction, construction industry, Ghana

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Authors: Reza Farahmand Rad, Farnad Imani, Azadeh Emami, Reza Salehi, Ali Reza Ghavamy, Ali Nima Shariat

Abstract:

Background: One of the methods of pain control after pediatric surgical procedures is regional techniques, including caudal block, despite their limitations. Objectives: In this study, the pain score and complications of caudal tramadol were evaluated in pediatrics following lower abdom- inal surgery. Methods: In this study, 46 children aged 3 to 10 years were allocated into two equal groups (R and TR) for performing caudal anal- gesia after lower abdominal surgery. The injectate contained 0.2% ropivacaine 1 mL/kg in the R group (control group) and tramadol (2 mg/kg) and ropivacaine in the TR group. The pain score, duration of pain relief, amount of paracetamol consumption, hemody- namic alterations, and possible complications at specific times (1, 2, and 6 hours) were evaluated in both groups. Results: No considerable difference was observed in the pain score between the groups in the first and second hours (P > 0.05). However, in the sixth hour, the TR group had a significantly lower pain score than the R group (P < 0.05). Compared to the R group, the TR group had a longer period of analgesia and lower consumption of analgesic drugs (P < 0.05). Heart rate and blood pressure differences were not significant between the two groups (P > 0.05). Similarly, the duration of operation and recovery time were not remarkably different between the two groups (P > 0.05). Complications had no apparent differences between these two groups, as well (P > 0.05). Conclusions: In this study, the addition of tramadol to caudal ropivacaine in pediatric lower abdominal surgery promoted pain relief without complications.

Keywords: tramadol, ropivacaine, caudal block, pediatric, lower abdominal surgery, postoperative pain

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Authors: Abderrahman Hassi, Omar Bacadi, Khaoula Zitouni

Abstract:

Abdelkader El Mouaziz is a Moroccan long-distance runner with a career-best time of 2:06:46 in the Chicago Marathon. El Mouaziz is a winner of the Madrid Marathon in 1994, the London Marathon in 1999 and 2001, as well as the New York Marathon in 2001. While he was playing for the Moroccan national team, he used to train in the Ifrane-Azrou region owing to its altitude, fresh forests, non-polluted air and quietness. After winning so many international competitions and retiring, he left his native Casablanca and went back to the Ifrane-Azrou region and started a business that employs ten people. In March 2010, El Mouaziz opened a bed and breakfast called Tourtite with a nice view on the mountain near the city of Ifrane in the way to Azrou. He wanted to give back to the region that helped him become a sport legend. His management style is not different than his sport style: performance and competitiveness combined with fair play. The objective of the present case study is to further enhance the understanding of the dynamics of transferring athletic championship-winning principles to entrepreneurial activities. The case study is a real-life situation and experience designed to provoke and stimulate reflections about a particular approach of management, especially for start-up businesses.

Keywords: sport, winning principles, entrepreneurship, Abdelkader El Mouaziz

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Authors: Hansraj Riteesh Bookun, Emily Maree Stevens, Jarryd Leigh Solomon, Anthony Chan

Abstract:

Objective: This was a retrospective cross-sectional study evaluating the safety and efficacy of femoral endarterectomy using the eversion technique with transection as opposed to the conventional endarterectomy technique with either vein or synthetic patch arterioplasty. Methods: Between 2010 to mid 2017, 19 patients with mean age of 75.4 years, underwent eversion femoral endarterectomy with transection by a single surgeon. There were 13 males (68.4%), and the comorbid burden was as follows: ischaemic heart disease (53.3%), diabetes (43.8%), stage 4 kidney impairment (13.3%) and current or ex-smoking (73.3%). The indications were claudication (45.5%), rest pain (18.2%) and tissue loss (36.3%). Results: The technical success rate was 100%. One patient required a blood transfusion following bleeding from intraoperative losses. Two patients required blood transfusions from low post operative haemogloblin concentrations – one of them in the context of myelodysplastic syndrome. There were no unexpected returns to theatre. The mean length of stay was 11.5 days with two patients having inpatient stays of 36 and 50 days respectively due to the need for rehabilitation. There was one death unrelated to the operation. Conclusion: The eversion technique with transection is safe and effective with low complication rates and a normally expected length of stay. It poses the advantage of not requiring a synthetic patch. This technique features minimal extraneous dissection as there is no need to harvest vein for a patch. Additionally, future endovascular interventions can be performed by puncturing the native vessel. There is no change to the femoral bifurcation anatomy after this technique. We posit that this is a useful adjunct to the surgeon’s panoply of vascular surgical techniques.

Keywords: endarterectomy, eversion, femoral, vascular

Procedia PDF Downloads 199

Authors: Sarah Werner, Michael J. Pritchard

Abstract:

From pilots to engineers, the skills development within the aerospace industry is exceptionally broad. Employers often struggle with finding the right mixture of qualified skills to fill their organizational demands. This effort to find qualified talent is further complicated by the industrial delineation between two key areas: aviation and aerospace. In a broad sense, the aerospace industry overlaps with the aviation industry. In turn, the aviation industry is a smaller sector segment within the context of the broader definition of the aerospace industry. Furthermore, it could be conceptually argued that -in practice- there is little distinction between these two sectors (i.e., aviation and aerospace). However, through our unstructured text analysis of over 6,000 job listings captured, our team found a clear delineation between aviation-related jobs and aerospace-related jobs. Using techniques in natural language processing, our research identifies an integrated workforce skill pattern that clearly breaks between these two sectors. While the aviation sector has largely maintained its need for pilots, mechanics, and associated support personnel, the staffing needs of the aerospace industry are being progressively driven by integrative engineering needs. Increasingly, this is leading many aerospace-based organizations towards the acquisition of 'system level' staffing requirements. This research helps to better align higher educational institutions with the current industrial staffing complexities within the broader aerospace sector.

Keywords: aerospace industry, job demand, text mining, workforce development

Procedia PDF Downloads 272

Authors: Muhammad Zikril Hakim Md. Azizi, Norhafizan Ahmad, Raja Ariffin Raja Ghazilla

Abstract:

Postural stability, attention level of the archer and particularly the vibrations of the bow itself plays a prominent role in determining the athletes performance. Many techniques and systems had been developing to monitor the parameters of the archers during training. In Malaysia, archery coaches tend to use non-scientific ways that they are familiar with, to evaluate archer performance. An approach that provides more affordable yet accurate systems to the masses and relatively easy system deployment procedure need to be proposed. Hence, this project will address to fulfil the needs. Three area of the archer parameter were included for data monitoring sensors. Attention level can be measured using EEG sensor, centre of mass linked to the postural stability can be measured by foot pressure sensor, and the bow vibrations in three axis will be relayed by the vibrations sensors placed directly on the bow using wireless sensors. Arduino based microcontroller used to relay all the data back to the interfacing systems. Interface systems will be using Python language and C++ framework for user interface and hardware interfacing systems. All sensor data can be observed in real time using the in-house applications, and each sessions can be saved to common files so that coach and the team can have a further discussion and comparisons.

Keywords: archery, graphical user interface, microcontroller, wireless sensor, monitoring system

Procedia PDF Downloads 299

Authors: Ioannis Boutas, Vasilios Pergialiotis, Nicolaos Salakos, George Agrogiannis, Panagiotis Konstantopoulos, Laskarina-Maria Korou, Theodoros Kalampokas, Odysseas Gregoriou, George Creatsas, Despina Perrea

Abstract:

Introduction: The effect of third generation aromatase inhibitors in the lipid profile among women with breast cancer, present diversities. It has been also shown that low levels of estrogens affect liver metabolism in mice in numerous ways, such as lipid accumulation and hepatic steatosis. Materials and Methods: Forty-five female Wistar rats underwent surgical ovariectomy. The animals were anesthetized with a combination of ketamine (75 mg/kg) and xylazine (10 mg/kg) which were administered intraperitoneally. After the ovariectomy, the operated animals were randomized in three groups. The first group did not receive any drug regimen (ovariectomized control group). The second group received Anastrazole and the third group received Letrozole. Four months after the initiation of the study, the animals were euthanized and livers were dissected immediately for further histopathological analysis. The histological features were grouped into 4 broad categories: steatosis, ballooning, portal inflammation and lobular activity. A score from 0 (absence) to 3 (severe) was assigned to each parameter. Results: The liver pathology analysis revealed significant differences among groups with favored mild steatosis and ballooning among animals that received Anastrazole or Letrozole. Conclusion: The effect of Anastrazole and Letrozole on liver function have not yet been clarified. In our study mild histological liver alterations seem also to occur and these alterations should be taken in mind in future clinical studies

Keywords: anastrazole, letrozole, liver, rats

Procedia PDF Downloads 352

Authors: Bhagwant Singh, Sikander Singh Cheema

Abstract:

This paper examines firewall mechanisms routinely implemented for network security in depth. A firewall can't protect you against all the hazards of unauthorized networks. Consequently, many kinds of infrastructure are employed to establish a secure network. Firewall strategies have already been the subject of significant analysis. This study's primary purpose is to avoid unnecessary connections by combining the capability of the firewall with the use of additional firewall mechanisms, which include packet filtering and NAT, VPNs, and backdoor solutions. There are insufficient studies on firewall potential and combined approaches, but there aren't many. The research team's goal is to build a safe network by integrating firewall strength and firewall methods. The study's findings indicate that the recommended concept can form a reliable network. This study examines the characteristics of network security and the primary danger, synthesizes existing domestic and foreign firewall technologies, and discusses the theories, benefits, and disadvantages of different firewalls. Through synthesis and comparison of various techniques, as well as an in-depth examination of the primary factors that affect firewall effectiveness, this study investigated firewall technology's current application in computer network security, then introduced a new technique named "tight coupling firewall." Eventually, the article discusses the current state of firewall technology as well as the direction in which it is developing.

Keywords: firewall strategies, firewall potential, packet filtering, NAT, VPN, proxy services, firewall techniques

Procedia PDF Downloads 101

Authors: Shameka Stanford

Abstract:

This presentation will discuss how cognitive and communication disorders in the areas of executive functioning, receptive and expressive language can impact the problem-solving and decision making of individuals with such impairments. More specifically, this presentation will discuss approaches the legal defense team of capital case lawyers can add to their experience when servicing individuals who have a history of educational decline, special education, and limited intervention and treatment. The objective of the research is to explore and identify the correlations between impaired executive function skills and decision making and competency for individuals facing death penalty charges. To conduct this research, experimental design, randomized sampling, qualitative analysis was employed. This research contributes to the legal and criminal justice system related to how they view, defend, and characterize, and judge individuals with documented cognitive and communication disorders who are eligible for capital case charges. More importantly, this research contributes to the increased ability of death penalty lawyers to successfully defend clients with a history of academic difficulty, special education, and documented disorders that impact educational progress and academic success.

Keywords: cognitive impairments, communication disorders, death penalty, executive function

Procedia PDF Downloads 156