Search results for: surgery outcome

Authors: Abimbola M. Enitan, J. Adeyemo

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Anaerobic modeling is a useful tool to describe and simulate the condition and behaviour of anaerobic treatment units for better effluent quality and biogas generation. The present investigation deals with the anaerobic treatment of brewery wastewater with varying organic loads. The chemical oxygen demand (COD) and total suspended solids (TSS) of the influent and effluent of the bioreactor were determined at various retention times to generate data for kinetic coefficients. The bio-kinetic coefficients in the modified Stover–Kincannon kinetic and methane generation models were determined to study the performance of anaerobic digestion process. At steady-state, the determination of the kinetic coefficient (K), the endogenous decay coefficient (Kd), the maximum growth rate of microorganisms (µmax), the growth yield coefficient (Y), ultimate methane yield (Bo), maximum utilization rate constant Umax and the saturation constant (KB) in the model were calculated to be 0.046 g/g COD, 0.083 (dˉ¹), 0.117 (d-¹), 0.357 g/g, 0.516 (L CH4/gCODadded), 18.51 (g/L/day) and 13.64 (g/L/day) respectively. The outcome of this study will help in simulation of anaerobic model to predict usable methane and good effluent quality during the treatment of industrial wastewater. Thus, this will protect the environment, conserve natural resources, saves time and reduce cost incur by the industries for the discharge of untreated or partially treated wastewater. It will also contribute to a sustainable long-term clean development mechanism for the optimization of the methane produced from anaerobic degradation of waste in a close system.

Keywords: brewery wastewater, methane generation model, environment, anaerobic modeling

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Authors: Lucia Salvioni, Pietro Giorgio Lovaglio, Valerio Leoni, Miriam Colombo, Luisa Fiandra

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The involvement of plasmatic surfactant protein-D (SP-D) in pulmonary diseases has been long investigated, and over the last two years, more interest has been directed to determine its role as a marker of COVID-19. In this direction, several studies aimed to correlate pulmonary surfactant proteins with the clinical manifestations of the virus indicated SP-D as a prognostic biomarker of COVID-19 pneumonia severity. The present work has performed a retrospective study on a relatively large cohort of patients of Hospital Pio XI of Desio (Lombardia, Italy) with the aim to assess differences in the hematic SP-D concentrations among COVID-19 patients and healthy donors and the role of SP-D as a prognostic marker of severity and/or of mortality risk. The obtained results showed a significant difference in the mean of log SP-D levels between COVID-19 patients and healthy donors, so as between dead and survived patients. SP-D values were significantly higher for both hospitalized COVID-19 and dead patients, with threshold values of 150 and 250 ng/mL, respectively. SP-D levels at admission and increasing differences among follow-up and admission values resulted in the strongest significant risk factors of mortality. Therefore, this study demonstrated the role of SP-D as a predictive marker of SARS-CoV-2 infection and its outcome. A significant correlation of SP-D with patient mortality indicated that it is also a prognostic factor in terms of mortality, and its early detection should be considered to design adequate preventive treatments for COVID-19 patients.

Keywords: SARS-CoV-2 infection, COVID-19, surfactant protein-D (SP-D), mortality, biomarker

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Authors: Aprajita Singh, Anamika Tripathi, Surya P. Dwivedi

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Moradabad is a small town in the Northern area of Uttar Pradesh, India. It is situated on the bank of river Ramganga which is also known as ‘Brass City of India’. There is eventually increase in the environmental pollution due to uncontrolled and inappropriate e-waste burning (recycling) activities which have been reported in many areas of Moradabad. In this paper, analysis of toxic heavy metals, causing pollution to the surrounding environment released from the e-waste burning and much other recycling process. All major e-waste burning sites are situated on the banks of the river which is burned in open environmental conditions. Soil samples were collected from seven (n=3) different sites including control site, after digestion of soil samples using triacid mixture, analysis of different toxic metals (Pb, Ar, Hg, Cd, Cr, Cu, Zn, Fe, and Ni) has been carried out with the help of instrument ICP-AAS. After the study, the outcome is that the soil of those areas contains a relatively high level of the toxic metals in order of Cu>Fe>Pb>Cd>Cr>Zn>Ar>Hg. The concentration of Cd, Pb, Cr, Ar and Zn (the majority of samples experimentally proved) exceeded the maximum standard level of WHO. Sequentially this study showed that uncontrolled e-waste processing operations caused serious pollution to local soil and release of toxic metals in the environment is also causing adverse effect on the health of people living in the nearby areas making them more prone to various harmful diseases.

Keywords: brass city, environment pollution, e-waste, toxic heavy metals

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Authors: Cora Fernandez Dacosta, John A. Posada, Andrea Ramirez

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The biodegradable family of polymers polyhydroxyalkanoates are interesting substitutes for convectional fossil-based plastics. However, the manufacturing and environmental impacts associated with their production via intracellular bacterial fermentation are strongly dependent on the raw material used and on energy consumption during the extraction process, limiting their potential for commercialization. Industrial wastewater is studied in this paper as a promising alternative feedstock for waste valorization. Based on results from laboratory and pilot-scale experiments, a conceptual process design, techno-economic analysis and life cycle assessment are developed for the large-scale production of the most common type of polyhydroxyalkanoate, polyhydroxbutyrate. Intracellular polyhydroxybutyrate is obtained via fermentation of microbial community present in industrial wastewater and the downstream processing is based on chemical digestion with surfactant and hypochlorite. The economic potential and environmental performance results help identifying bottlenecks and best opportunities to scale-up the process prior to industrial implementation. The outcome of this research indicates that the fermentation of wastewater towards PHB presents advantages compared to traditional PHAs production from sugars because the null environmental burdens and financial costs of the raw material in the bioplastic production process. Nevertheless, process optimization is still required to compete with the petrochemicals counterparts.

Keywords: circular economy, life cycle assessment, polyhydroxyalkanoates, waste valorization

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Authors: B. W. Kenny, D.Mansour, K. G. Mansour, J. Attia, B. Meads

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There is currently insufficient evidence to make a conclusive statement about safety while immobilized in a short arm cast. There is a paucity of published literature on this topic. The purpose of this study is to specifically evaluate short arm casts and their effect on driving abilities, particularly steering and avoidance of obstacles. The ability to drive safely is extrapolated from this data. In this study, a randomised, controlled, crossover design was used to assess 30 subjects randomised into 2 groups. A Logitech force feedback steering column and simulated driving program with a standardised road course was used. Objective outcome measures were the number of times subjects drove off the track, the number of crashes, time to lap completion and subjective assessment on whether wearing a short arm plaster cast impeded their steering. Recruited subjects had no upper limb pathology. The side of the applied plaster cast was randomised. The mean lap completion time reduced with repetition, the difference being statistically significant. There was no significant difference in mean number of times subjects in casts drove off the track (3 with vs. 3.07 without casts), average number of crashes (1.27 vs 0.97). Steering ability was not reduced whilst a subject was immobilised in a short arm Plaster of Paris cast, despite subject’s own impressions that their steering was impeded. This may help guide doctors in their advice to patients regarding driving in these casts.

Keywords: upper limb, arm injury, plaster cast, splint, driving, automobile, bone fracture

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Authors: Hwang Kwon

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Objective: To assess the efficacy of embryo transfer (ET) of accumulated vitrified embryos and compare pregnancy outcomes between ET of thawed embryos following accumulation of vitrified embryos (frozen ET) and ET of fresh and thawed frozen embryos following accumulation of vitrified embryos (fresh ET + frozen ET). Study design: Patients were poor ovarian responders defined according to the Bologna criteria as well as a subgroup of women whose previous IVF-ET cycle through controlled ovarian stimulation (COS) yielded one or no embryos. Sixty-four frozen ETs were performed following accumulation of vitrified embryos (ACCE )(ACCE Frozen) and 51 fresh + frozen ETs were performed following accumulation of vitrified embryos (ACCE Fresh + Frozen). Positive βhCG rate, clinical pregnancy rate, ongoing pregnancy rate, and good quality embryos (%, ±SD) were compared between two groups. Results: There were more good quality embryos in the ACCE Fresh + Frozen group than in the ACCE Frozen group: 60±34.7 versus 42.9±28.9, respectively (p=0.03). Positive βhCG rate [18/64(28.2%) vs. 13/51(25.5%); p=0.75] and clinical pregnancy rate [12/64 (18.8%) vs. 11/51 (10.9%); p=0.71] were comparable between the two groups. Conclusion: Accumulation of vitrified embryos is an effective method in patients with poor ovarian response who fulfill the Bologna criteria. Pregnancy outcomes were comparable between the two groups.

Keywords: accumulation of embryos, frozen embryo transfer, poor responder, Bologna criteria

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Authors: Donna L. Roberts

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2019 marked 23 years since Purdue Pharma launched its flagship drug, OxyContin, that unleashed an unprecedented epidemic touching both celebrities and common citizens, metropolitan, suburbia and rural areas and all levels of socioeconomic status. From rural Appalachia to East LA individuals, families and communities have been devastated by a trajectory of addiction that often began with the legitimate prescription of a pain killer for anything from a tooth extraction to a sports injury to recovery from surgery or chronic arthritis. Far from being a serendipitous progression of events, the proliferation of this new breed of 'miracle drug' was instead a carefully crafted marketing program aimed at both the medical community and common citizens. This research represents and in-depth investigation of the evolution of the marketing, distribution and promotion of prescription opioids by pharmaceutical companies and its relationship to the propagation of the opioid crisis. Specifically, key components of Purdue Pharma’s aggressive marketing campaign, including its bonus system and sales incentives, were analyzed in the context of the sociopolitical environment that essential created the proverbial 'perfect storm' for the changing manner in which pain is treated in the U.S. The analyses of these series of events clearly indicate their role in first, the increase in prescription of opioids for non-terminal pain relief and subsequently, the incidence of related addiction, overdose, and death. Through this examination of the conditions that facilitated and maintained this drug crisis, perhaps we can begin to chart a course toward its resolution.

Keywords: addiction, opioid, opioid crisis, Purdue Pharma

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Authors: Mohammad Amin Tutunchian, Pedram Roshani, Reza Rezvani, Julio Ángel Infante Sedano

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The highly recommended approach to design, known as the load and resistance factor design (LRFD) method, employs the geotechnical resistance factor (GRF) for shaping pile foundation designs. Within the standard process for designing pile foundations, geotechnical engineers commonly adopt a design strategy rooted in saturated soil mechanics (SSM), often disregarding the impact of unsaturated soil behavior. This oversight within the design procedure leads to the omission of the enhancement in shear strength exhibited by unsaturated soils, resulting in a more cautious outcome in design results. This research endeavors to present a methodology for fine-tuning the GRF used for axially loaded driven piles in Winnipeg, Canada. This is achieved through the application of a well-established probabilistic approach known as the first-order second moment (FOSM) method while also accounting for the influence of unsaturated soil behavior. The findings of this study demonstrate that incorporating the influence of unsaturated conditions yields an elevation in projected bearing capacity and recommends higher GRF values in accordance with established codes. Additionally, a novel factor referred to as phy has been introduced to encompass the impact of saturation conditions in the calculation of pile bearing capacity, as guided by prevalent static analysis techniques.

Keywords: unsaturated soils, shear strength, LRFD, FOSM, GRF

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Authors: Raed Hameed Allawi

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Wellbore instability problems are considered the majority challenge for several wells in the Ratawi shale formation. However, it results in non-productive (NPT) time and increased well-drilling expenditures. This work aims to construct an integrated mechanical earth model (MEM) to predict the wellbore failure and design optimum mud weight to improve the drilling efficiency of future wells. The MEM was based on field data, including open-hole wireline logging and measurement data. Several failure criteria were applied in this work, including Modified Lade, Mogi-Coulomb, and Mohr-Coulomb that utilized to calculate the proper mud weight and practical drilling paths and orientations. Results showed that the leading cause of wellbore instability problems was inadequate mud weight. Moreover, some improper drilling practices and heterogeneity of Ratawi formation were additional causes of the increased risk of wellbore instability. Therefore, the suitable mud weight for safe drilling in the Ratawi shale formation should be 11.5-13.5 ppg. Furthermore, the mud weight should be increased as required depending on the trajectory of the planned well. The outcome of this study is as practical tools to reduce non-productive time and well costs and design future neighboring deviated wells to get high drilling efficiency. In addition, the current results serve as a reference for similar fields in that region because of the lacking of published studies regarding wellbore instability problems of the Ratawi Formation in southern Iraqi oilfields.

Keywords: wellbore stability, hole collapse, horizontal stress, MEM, mud window

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Authors: Ssembatya Joseph Mary

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Introduction: Omphalocele, an abdominal wall defect, occurs in 1 out of 4,000 to 6,000 live births. It is characterized by visceral herniation of small and large intestines, liver, and sometimes spleen and gonads are involved. The viscera is always covered by a three-layered sac. The defect in the mesoderm is mainly due to the failure of lateral abdominal wall folds to unite. About 350,000 ventral hernia repairs are done annually in the united states of America. Surgical repair with a mesh is the gold standard surgical method. With conservative management of Omphalocele, children are eventually closed between the age of 1 and 5 years. Herein, we present a late manifestation of ventral hernia following Omphalocele in a female Ugandan. Case presentation: A 56-year-old female with no known chronic illnesses and normal perinatal history presented with an umbilical swelling since birth with no associated symptoms. She is a married woman to one husband and has five children, and all of them are in good general condition with no such symptoms. She had normal vitals with an umbilical defect measuring about 20cm from the xiphoid process and 10 cm from the symphysis pubis. Surgery was done (component separation) on the second inpatient day, and it was uneventful. The patient was discharged on the 4th postoperative day in good general condition with a dry and clean surgical site. Conclusion: Despite adequate literature about Omphalocele and clear management guidelines, there have been reported cases of adult presentation of ventral hernias secondary to Omphalocele.

Keywords: omphalocele, ventral hernia, uganda, late presentation

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Authors: Sibnath Sarkar

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Developing countries are facing many Social problems. In India, too there are several such problems. The problem of street children is one of them. No country or city anywhere in the world today is without the presence of street children, but the problem is most acute in developing countries. Thousands of street children can be seen in our populous cities like Mumbai, Kolkata, Delhi, and Chennai. Most of them are in the age group of 5-15 years. The number of street children is increasing gradually. Poverty, unemployment, rapid urbanization, rural-urban migrations are the root causes of street children. Being deprive from many of their, they have escaped to the street as a safe place for living. Street children always related with the urban spaces in the developing world and it represents a sad outcome of the rapid urbanization process. After coming to the streets, these children have to cope with the new situation every day. They also adopt or develop many complex survival strategies and a variety of different informal or even illegal activities in public space and form supportive social networks in order to survive in street life. Street children use the different suitable urban spaces as their earning, living, entertaining spot. Therefore, the livelihoods of young people on the street should analyze in relation to the spaces they use, as well as their age and length of stay on the streets. This paper tries to explore the livelihood strategies and copping situation of street children in Sealdah station area. One hundred seventy-five street living children are included in the study living in and around the railway station.

Keywords: strategies, street children, survive, urban-space

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Authors: Daniela Salih Khidir, Mohamed G. Al Kuwari, Mercia V. Walt, Izzeldin J. Ibrahim

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Background: University-based physical activity interventions aim to establish durable social patterns during the transition to adulthood. This study is a comprehensive evaluation of a 3-year intervention-based program to increase the culture of physical activity (PA) routine in Qatar campuses community, using a holistic approach. Methodology: General assessment methods: formative evaluation-SIH Campuses logic model design, stakeholders’ identification; process evaluation-members’ step counts analyze and qualitative Appreciative Inquiry session (4-D model); daily steps categorized as: ≤5,000, inactive; 5,000-7,499 low active; ≥7,500, physically active; outcome evaluation - records 3 years interventions. Holistic PA interventions methods: walking interventions - pedometers distributions and walking competitions for students and staff; educational interventions - in campuses implementation of bilingual educational materials, lectures, video related to PA in prevention of non-communicable diseases (NCD); articles published online; monthly emails and sms notifications for pedometer use; mass media campaign - radio advertising, yearly pre/post press releases; community stakeholders interventions-biyearly planning/reporting/achievements rewarding/ qualitative meetings; continuous follow-up communication, biweekly steps reports. Findings: Results formative evaluation - SIH in Campuses logic model identified the need of PA awareness and education within universities, resources, activities, health benefits, program continuity. Results process evaluation: walking interventions: Phase 1: 5 universities recruited, 2352 members, 3 months competition; Phase 2: 6 new universities recruited, 1328 members in addition, 4 months competition; Phase 3: 4 new universities recruited in addition, 1210 members, 6 months competition. Results phase 1 and 2: 1,299 members eligible for analyzes: 800 females (62%), 499 males (38%); 86% non-Qataris, 14% Qatari nationals, daily step count 5,681 steps, age groups 18–24 (n=841; 68%) students, 25–64; (n=458; 35.3%) staff; 38% - low active, 37% physically active and 25% inactive. The AI main themes engaging stakeholders: awareness/education - 5 points (100%); competition, multi levels of involvement in SIH, community-based program/motivation - 4 points each (80%). The AI points represent themes’ repetition within stakeholders’ discussions. Results education interventions: 2 videos implementation, 35 000 educational materials, 3 online articles, 11 walking benefits lectures, 40 emails and sms notifications. Results community stakeholders’ interventions: 6 stakeholders meetings, 3 rewarding gatherings, 1 focus meeting, 40 individual reports, 18 overall reports. Results mass media campaign: 1 radio campaign, 7 press releases, 52 campuses newsletters. Results outcome evaluation: overall 2013-2016, the study used: 1 logic model, 3 PA holistic interventions, partnerships 15 universities, registered 4890 students and staff (aged 18-64 years), engaged 30 campuses stakeholders and 14 internal stakeholders; Total registered population: 61.5% female (2999), 38.5% male (1891), 20.2% (988) Qatari nationals, 79.8% (3902) non-Qataris, 55.5% (2710) students aged 18 – 25 years, 44.5% (2180) staff aged 26 - 64 years. Overall campaign 1,558 members eligible for analyzes: daily step count 7,923; 37% - low active, 43% physically active and 20% inactive. Conclusion: The study outcomes confirm program effectiveness and engagement of young campuses community, specifically female, in PA. The authors recommend implementations of 'holistic PA intervention program approach in Qatar' aiming to impact the community at national level for PA guidelines achievement in support of NCD prevention.

Keywords: campuses, evaluation, Qatar, step-count

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Authors: A. Razavykia, A. Esmaeilzadeh, S. Iranmanesh

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Many orthopedic implants like proximal humerus cases require lower surface roughness and almost immediate/short lead time surgery. Thus, rapid response from the manufacturer is very crucial. Tool path strategy of milling process has a direct influence on the surface roughness and lead time of medical implant. High-speed milling as promised process would improve the machined surface quality, but conventional or super-abrasive grinding still required which imposes some drawbacks such as additional costs and time. Currently, many CAD/CAM software offers some different tool path strategies to milling free form surfaces. Nevertheless, the users must identify how to choose the strategies according to cutting tool geometry, geometry complexity, and their effects on the machined surface. This study investigates the effect of different tool path strategies for milling a proximal humerus head during finishing operation on stainless steel 316L. Experiments have been performed using MAHO MH700 S vertical milling machine and four machining strategies, namely, spiral outward, spiral inward, and radial as well as zig-zag. In all cases, the obtained surfaces were analyzed in terms of roughness and dimension accuracy compared with those obtained by simulation. The findings provide evidence that surface roughness, dimensional accuracy, and machining time have been affected by the considered tool path strategy.

Keywords: CAD/CAM software, milling, orthopedic implants, tool path strategy

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Authors: Mostafa Mohammadpour, Christoph Kapeller, Christy Li, Josef Scharinger, Christoph Guger

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Interictal spikes provide valuable information on electrocorticography (ECoG), which aids in surgical planning for patients who suffer from refractory epilepsy. However, the shape and temporal dynamics of these spikes remain unclear. The purpose of this work was to analyze the shape of interictal spikes and measure their distance to the seizure onset zone (SOZ) to use in epilepsy surgery. Thirteen patients' data from the iEEG portal were retrospectively studied. For analysis, half an hour of ECoG data was used from each patient, with the data being truncated before the onset of a seizure. Spikes were first detected and grouped in a sequence, then clustered into interictal epileptiform discharges (IEDs) and non-IED groups using two-step clustering. The distance of the spikes from IED and non-IED groups to SOZ was quantified and compared using the Wilcoxon rank-sum test. Spikes in the IED group tended to be in SOZ or close to it, while spikes in the non-IED group were in distance of SOZ or non-SOZ area. At the group level, the distribution for sharp wave, positive baseline shift, slow wave, and slow wave to sharp wave ratio was significantly different for IED and non-IED groups. The distance of the IED cluster was 10.00mm and significantly closer to the SOZ than the 17.65mm for non-IEDs. These findings provide insights into the shape and spatiotemporal dynamics of spikes that could influence the network mechanisms underlying refractory epilepsy.

Keywords: spike propagation, spike pattern, clustering, SOZ

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Authors: Samson Olasunkanmi Oluga, Teh Chee Send, Gerard Sagaya Raj Rajo

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It is ironical that the national anthems of many nations that are in the forefront of the global condemnation of violence of all forms have portions or expressions that propagate various forms of linguistic violence which advocate attacking opponents, going to war, shedding blood and sacrificing lives. These diametrically contradict contemporary yearnings for global tranquility and the ideals of the United Nations established for the maintenance of international peace and harmony aimed at making the world a safe haven for all and sundry. The linguistic violence of many national anthems is manipulatively constructed /presented via the instrumentality of the figurative or rhetorical language. This helps to linguistically embellish the violent ideas communicated and makes them sound somehow better or logical to the target audience with the intention of cognitively manipulating them to accept or rationalize such violent ideas. This paper, therefore, presents the outcome of a linguistic exploration/examination of national anthems which reveals elements or cases manipulative figurative linguistic violence in the anthems of twenty-one (21) nations. The paper details a Socio-Cognitive Critical Discourse Analysis of the manipulative figures of comparison, contrast, indirectness, association and sound used to convey the linguistic violence of the identified national anthems. Finally, the paper advocates the need for linguistic overhaul of affected anthems so that the language of anthems which epitomize nations can be pacific and in tandem with contemporary global trends.

Keywords: national anthems, linguistic violence, figurative language, cognitive, manipulation, CDA

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Authors: Muhamad Badri Bin Othman

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As a role model and leading country in the world that establishes and promotes Islamic banking and finance, Malaysia has set up and come up with a set of standards and frameworks to govern its Shari’ah function towards implementing the desired outcome of Islamic banking and finance as new source of wealth creation. This paper, examines and highlights, at the very minimum, the importance and application of Shari’ah governance in Islamic banking and finance in Malaysia as a leading country in Islamic banking and finance. This paper also, compares on Shari’ah governance, which is being adopted between Malaysia and other selected countries namely, Pakistan, Bahrain, Kuwait, United Arab Emirates (UAE) and Qatar. This paper also, aims at highlighting the current challenges and issues faced by the scholars in Shari’ah Supervisory Board (SSB) in deliberating their opinions and fatwa towards the implementation of new products in Islamic banking industry to promote innovation among the industry players. The author of this paper will highlight the major challenges and issues faced by the SSB members of Islamic banks in Malaysia, taking into account the complexity of the operation wise and products of Islamic banking, and how they overcome those challenges and issues identified. This will be done through a series of face-to-face interview sessions which will be conducted with a few prominent figures of Islamic banking and finance scholars in Malaysia to highlight the issues and challenges they are facing towards Islamic financial innovation and subsequently finding solutions for the identified issues and challenges.

Keywords: Shari’ah governance, Shari’ah supervisory board (SSB), Issues and challenges, Islamic financial innovation

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Authors: Greg Fetzer

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One of the fundamental tensions of creative work is between the need to be passionate and persistent in advancing novel and risky ideas and the need to be flexible, revising, or even abandoning ideas in favor of others. The tension becomes fraught in part because of the attachment that creators have toward their ideas. Idea attachment is defined here as a multifaceted concept referring to affection, passion, and connection toward a target—in this case, one’s projects or ideas. Yet feeling attached can make creators resistant to feedback, making them less flexible and leading them to escalate commitment. Despite a growing understanding of how attachment develops and evolves in response to project changes, feedback, and creative jolts, we still know relatively little about the organizational dynamics that may shape idea attachment. Through a qualitative, inductive study of early-stage R&D scientists in the pharmaceutical industry, this research finds that scientists develop bounded attachment, a mindset that limits emotional attachment to ideas while still fostering engagement in idea development. This research develops a process model of how bounded attachment is developed and enacted across three stages of the creative process, idea generation, idea evaluation, and outcome assessment, as well as the role that organizational practices and professional identity play in shaping this process: these collective practices provided structures to ensure ideas were evaluated in a rational (i.e. non-emotional way) while also providing socioemotional support in the face of setbacks. Together, this process led to continued creative engagement across ideas in a portfolio and helped scientists construct a sense of meaningful work despite a high likelihood (and frequency) of failure.

Keywords: creativity, innovation, organizational practices, qualitative, attachment

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Authors: Parveen Kundu, Nitika Chawla, Ruchi Agarwal, Swaran Kaur

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Background: Mature cystic teratoma is a benign, most common tumor of the ovary occurring mostly in young and middle-aged females. This study consists of 19 cases of mature cystic teratomas which were received in the Department Of Pathology over a period of two years. There were malignant transformations observed in three cases, which makes it very important for pathologists to thoroughly examine the entire specimen of mature cystic teratomas. Material and Methods: Nineteen reported cases of mature cystic teratomas were received in Deptt. Of Pathology, BPS GMC Khanpur Kalan, Sonepat, over a two-year period from November 2020 to October 2022 and reviewed retrospectively. Data regarding age, size, laterality, gross, morphological features, and surgery performed were retrieved from pathological archives. Results: In our study, the most common age of presentation was the 20-40 year age group. The most common presenting complaint was fullness in the abdomen or abdominal distension. Four out of 19 cases studied cases presented with bilateral ovarian cysts. Tumor size ranged from 6 to 20 cm in diameter. In seven cases, cysts were greater than or equal to 10 cm in diameter. Three cases showed malignant transformation. Conclusion: It is very important to thoroughly examine the contralateral ovary to rule out bilateral presentation. A furthermost thorough examination is advised in tumors of size >10 cm and in tumors with solid areas to rule out any malignant transformation.

Keywords: teratoma, ovary, malignant, transformation

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Authors: Takudzwa C. Taruza, Carel B. Schoeman, Ilse M. Schoeman

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The proliferation of informal settlements remains one of the major planning challenges in democratic South Africa. In spite of the various local, national and international initiatives to promote the creation of sustainable human settlements, informal settlements continue to exist as spatially marginalised societies characterised by poverty, unemployment, squalor conditions and disaster risks. It is argued that, in practice, intervention is mainly directed at achieving set quantitative targets and goals rather than improving the lives of the inhabitants. The relevant planning instruments do not adequately address the integration of informal settlements into the broader planning framework. This paper is based on the analysis of the informal settlement intervention within the North West Province. Financial constraints, bureaucracy in housing delivery and lack of horizontal and vertical integration in spatial planning and programme implementation are amongst the major factors that caused stagnation in some of the upgrading programmes which in turn hindered the attainment of the target set as part of the Outcome 8 Delivery Agreement. Moreover, the absence of distinct indicators for the assessment of the qualitative progress of upgrading programmes indicates shortcomings in the intervention policies and programmes to promote the creation of sustainable human settlements. Thus, this paper seeks to proffer an assessment toolkit as well as a framework for the implementation of a Sustainable Informal Settlement Programme.

Keywords: formalization of informal settlements, planning intervention, sustainable formalization indicators, sustainable human settlements

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Authors: Jake Tempo, Jack Crozier, Huay Ann Chia, Philip Tan

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Purpose: A prospective study was performed to determine whether temporary ureteric catheterization should be eliminated as a prophylactic method for preventing ureteric obstruction after uncomplicated ureteropyeloscopic lithotripsy. Material and Methods: From 2010 to 2014, 227 patients underwent uncomplicated ureteroscopic and/or pyeloscopic lithotripsy. Three patient-groups based on postoperative drainage method were analysed: temporary uretericcatheter (TUC), -ureteric JJ stent, and no-stent groups. Exclusion criteria included urosepsis, ureteric injury, and non-surgical complications delaying hospital-discharge. Outcome measures included parenteral analgesic requirements, prolonged hospitalization ≥2 days due to postoperative-pain, and readmissions rate. Results: Delayed discharge was reported in 14.5%(9 of 62) patients in the TUC group compared to 3.4%(4 of 119) in theureteric JJ stent group and 8.7%(4 of 46) in the no-drainage-group (p=0.02). Odds ratio for delayed-discharge between catheter- versus-ureteric JJ stent is 4.9 (95% CI = 1.6-15.0; p < 0.01). Parenteral analgesic requirements in the TUC group (12.9%) was also significantly higher than theureteric JJ stent group (1.7%; p=0.003). Readmissions were negligible between groups. Conclusions: Patients with ureteric catheters after uncomplicated ureteroscopy have a prolonged hospital stay with increased pain and parenteral analgesic requirements. There is a 7.6-fold increased requirement for parenteral analgesia and a 4.2-fold increased risk of delayed-discharge compared to a patient with a ureteric JJ stent.

Keywords: ureteric catheter, ureteric stent, ureteroscopy, pyeloscopy

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Authors: Mehrdad Taghipour, Mina Rostami, Mahdi Eskandarlou

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Partial-thickness skin graft is the cornerstone for scalp defect repair. Given the potential side effects following harvesting from these sites, this study aimed to compare the outcomes of graft harvesting from scalp and lower limb. This clinical trial was conducted among a sample number of 40 partial thickness graft candidates (20 case and 20 control group) with scalp defect presenting to Plastic Surgery Clinic at Besat Hospital, Hamadan, Iran during 2018-2019. Sampling was done by simple randomization using random digit table. The donor site in case group and control group was scalp and lower limb respectively. Overall, 28 patients (70%) were male and 12 (30%) were female. Basal cell carcinoma (BCC) and trauma were the most common etiology for the defects. There was a statistically meaningful relationship between two groups regarding the etiology of defect (P=0.02). The mean diameter of defect was 24.28±45.37 mm for all of the patients. The difference between diameters of defect in both groups were statistically meaningful while no such difference between graft diameters was seen. The graft “Take” was completely successful in both groups according to evaluations. The level of postoperative pain was lower in the case group compared to the control according to VAS scale and the satisfaction was higher in them per Likert scale. Scalp can safely be used as donor site for skin graft to be used for scalp defects associated with better results and lower complication rates compared to other donor sites.

Keywords: donor site, graft, scalp, partial thickness

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Authors: R. Hassan, J. Duncombe, E. Darke, A. Dias, K. Anderson, R. G. Middleton

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Background: NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studiesare shortcoming on individual patient experience. The aim of this study was to assess the patient’ssatisfaction and outcomes with woodcast used in the conservative management of distal radius fractures. Methods: For all patients managed with woodcast in our unit, we undertook a structured questionnairethat included the Patient Rated Wrist Evaluation (PRWE) score, The EQ-5D-5L score, and the pain numerical score at the time of injury and six weeks after. Results: 30 patients were initially managed with woodcast.80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less. Conclusion: For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good. However, we acknowledged 20% of patients in our series were not able to tolerate woodacst, Therefore, we suggest a comparison between the widely used synthetic plaster of Pariscasting and woodcast to come in order.

Keywords: distal radius fractures, ecological cast, sustainability, woodcast

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Authors: Nouf Al Harthi

Abstract:

Venous thromboembolism (VTE) is one of the most common causes of hospital-related deaths in critically ill patients. Guidelines recommended VTE prophylaxis with standardized, fixed doses for most patients. The underweight population has limited data to guide the appropriate drug and dosing regimen. The aim of this study was to describe the pattern of VTE prophylaxis dose regimens for underweighted critically ill adult patients and the prevalence of associated VTE and bleeding. This study is a retrospective cohort study, conducted in King Abdulaziz Medical City, Saudi Arabia. It included all critical patients admitted to the intensive care units and were above 14 years old with weight less than 50 kg or BMI of 18.5 kg/m2 or less and were on heparin as VTE prophylaxis for more than 72 hours from January 2016 until January 2020. After screening 270 patients, only 40 patients were included in this study according to our inclusion and exclusion criteria. Only 6 patients (15%) received VTE prophylaxis as an adjusted dose of heparin 2500 U Q12, while the rest of the patients were taking standard dosing of heparin, 5000 U Q12 was given to 21 (52.50%) patients and 5000 U Q8 was given to 13 (32.50%) patients. None of the adjusted doses developed any complications such as VTE or bleeding. There was no significant difference compared with the standard dose group. This study focused on describing the pattern of heparin doses as VTE prophylaxis in underweight patients. We also compared the standard dosing and adjusted dosage of VTE prophylaxis on underweight patients and any complications. There was no significant difference in the complication’s outcome or benefits between the two groups.

Keywords: venous thromboembolism prophylaxis, heparin, underweight patients, adult, critical care units

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Authors: T. C. Ng, R. Radzi, T. K. Ng, H. C. Chen

Abstract:

The analgesic effects of lidocaine-bupivacaine block in cats undergoing routine orchiectomy were determined in this controlled, randomized, and blinded study. Twelve cats were randomly assigned to two groups. Cats in local block group received subcutaneous infiltration of 1 mg/kg of 2% lidocaine and 1 mg/kg of 0.5% bupivacaine into the scrotal sac. Cats in control group received equivolume of saline. Both groups were induced with mixture of ketamine (15 mg/kg) and acepromazine (0.1 mg/kg) intramuscularly and maintained on sevoflurane via facemask. Non-invasive blood pressures (BP), heart (HR), and respiratory rate (RR) were measured intra-operatively at specific events. Post-operatively, all cats received meloxicam, 0.2 mg/kg subcutaneously. Pain scores were determined at 4, 8, and 24 hours postoperatively. Mechanical pressure thresholds (MPT) at the perineum and metatarsus were determined at 2, 4, 8, and 24 hours postoperatively. Intra-operatively, the BP and HR tended to be higher in the control group. The increment in HR peaked during traction and autoligation of the spermatic cord in the control group. There was no treatment difference in RR. Post-operatively, pain scores in the group given local blocks were lower than the control group at 4 hour post-operation. There was no treatment difference in the post-operative HR, RR, BP and MPT values. In conclusion, subcutaneous infiltration of lidocaine-bupivacaine into the scrotal sac before orchiectomy improved intra-operative hemodynamic stability and provided better analgesia up to 4 hours post-surgery.

Keywords: analgesia, bupivacaine, cat, lidocaine, local block, orchiectomy

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Authors: Siti Ayu Ningsih

Abstract:

This study aims to find the differences outcomes in learning reading comprehension with text and film as media on Indonesian Language for foreign speaker (BIPA) learning at intermediate level. By using quantitative and qualitative research methods, the respondent of this study is a single respondent from D'Royal Morocco Integrative Islamic School in grade nine from secondary level. Quantitative method used to calculate the learning outcomes that have been given the appropriate action cycle, whereas qualitative method used to translate the findings derived from quantitative methods to be described. The technique used in this study is the observation techniques and testing work. Based on the research, it is known that the use of the text media is more effective than the film for intermediate level of Indonesian Language for foreign speaker learner. This is because, when using film the learner does not have enough time to take note the difficult vocabulary and don't have enough time to look for the meaning of the vocabulary from the dictionary. While the use of media texts shows the better effectiveness because it does not require additional time to take note the difficult words. For the words that are difficult or strange, the learner can immediately find its meaning from the dictionary. The presence of the text is also very helpful for Indonesian Language for foreign speaker learner to find the answers according to the questions more easily. By matching the vocabulary of the question into the text references.

Keywords: Indonesian language for foreign speaker, learning outcome, media, reading comprehension

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Authors: H. Noureddine, P. Rao, R. Guru, A. Chandratreya

Abstract:

The nice guidance for elective total knee replacements states that patients should be given mechanical thrombo-prophylaxis, and if no contraindications chemical thromboprophylaxis in the form of Dabigatran etexilate, Rivaroxiban, UFH, LMWH, or Fondaparinux sodium (CG92, 1.5.14, January 2010). In Practice administering oral agents has been the dominant practice as it reduces the nursing needs, and shortens hospital stay and is generally received better by patients. However, there are well documented associated bleeding risks, and their effects are difficult to reverse in case of major bleeding. Our experience with oral factor 10 inhibitors used for thromboprophylaxis was marked with several patients developing complications necessitating return to the theatre for wound washouts. This has led us to try a different protocol for thromboprophylaxis that we applied on our patients undergoing total and unicondylar knee replacements. We applied mechanical thromboprophylaxis in the form of intermittent pneumatic pressure devices, and chemical thromboprophylaxis in the form of a dose of prophylactic LMWH pre-op, then 150 mg of Aspirin to start 24 hours after the surgery and to continue for 6 weeks, alongside GI cover with PPIs or antihistamines. We also administered local anaesthetics intra-operatively in line with the ERAS protocol thus encouraging early mobilization. We have identified a cohort of 133 patients who underwent one of the aforementioned procedures in the same trust, and by the same surgeon, where this protocol was applied and examined their medical notes retrospectively with a mean follow-up period of 14 months, to identify the rate and percentage of patients who had thrombo-embolic events in the post-operative period.

Keywords: aspirin, heparin, knee arthroplasty, thromboprophylaxis

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Authors: Erika Humphreys

Abstract:

The effectiveness of treating anxiety with Reiki is explored within ten quantitative studies. The methodology utilized for a critical appraisal and systematic review of the literature is explained with inclusion and exclusion criteria. The theoretical framework for the project is grounded in the work of Hildegard Peplau, whose nursing theory based on the therapeutic use of self is foundational for Reiki implementation. A thorough critique of the literature is conducted for key components of robustness and believability. This critique is conducted using a structured guide addressing synthesized strengths and weaknesses of the body of literature. A synthesis of the literature explores the findings of the studies. This synthesis reports on Reiki’s effectiveness in treating anxiety within a variety of patient settings and populations, its effect on subscales of anxiety, physiological manifestations of anxiety, and pain associated with anxiety. Cultural considerations affecting Reiki’s potential effectiveness are discussed. Gaps in the literature are examined, including the studies’ narrow sample population, lack of participant exclusionary factors for controlled outcome data, and the lack of studies across time. Implications for future research are discussed with recommendations for expanded research that includes a broader variety of settings, age groups, and patient diagnoses, including anxiety disorders, for research data that is transferable. Implications for further practice for the advanced practice registered nurse (APRN) are explored, with the potential benefits for both providers and patients, including improved patient satisfaction and expansion of provider treatment modalities.

Keywords: Reiki, anxiety, complementary alternative medicine, pandemic

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Authors: Christos Theoharatos, Dimitris Tsourounis, Spiros Oikonomou, Andreas Makedonas

Abstract:

This paper focuses on the problem of visually inspecting and recognizing the road conditions in front of moving vehicles, targeting automotive scenarios. The goal of road inspection is to identify whether the road is slippery or not, as well as to detect possible anomalies on the road surface like potholes or body bumps/humps. Our work is based on an artificial intelligence methodology for real-time monitoring of road conditions in autonomous driving scenarios, using state-of-the-art deep convolutional neural network (CNN) techniques. Initially, the road and ego lane are segmented within the field of view of the camera that is integrated into the front part of the vehicle. A novel classification CNN is utilized to identify among plain and slippery road textures (e.g., wet, snow, etc.). Simultaneously, a robust detection CNN identifies severe surface anomalies within the ego lane, such as potholes and speed bumps/humps, within a distance of 5 to 25 meters. The overall methodology is illustrated under the scope of an integrated application (or system), which can be integrated into complete Advanced Driver-Assistance Systems (ADAS) systems that provide a full range of functionalities. The outcome of the proposed techniques present state-of-the-art detection and classification results and real-time performance running on AI accelerator devices like Intel’s Myriad 2/X Vision Processing Unit (VPU).

Keywords: deep learning, convolutional neural networks, road condition classification, embedded systems

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Authors: Lukman Thalib, Luis Furuya-Kanamori, Rachel Walker, Brigid Gillespie, Suhail Doi

Abstract:

Background and objectives: There are many topical treatments available for Pressure Injury (PI) treatment, yet there is a lack of evidence with regards to the most effective treatment. The objective of this study was to compare the effect of various topical treatments and identify the best treatment choice(s) for PI healing. Methods: Network meta-analysis of published randomized controlled trials that compared the two or more of the following dressing groups: basic, foam, active, hydroactive, and other wound dressings. The outcome complete healing following treatment and the generalised pair-wise modelling framework was used to generate mixed treatment effects against hydroactive wound dressing, currently the standard of treatment for PIs. All treatments were then ranked by their point estimates. Main Results: 40 studies (1,757 participants) comparing 5 dressing groups were included in the analysis. All dressings groups ranked better than basic (i.e. saline gauze or similar inert dressing). The foam (RR 1.18; 95%CI 0.95-1.48) and active wound dressing (RR 1.16; 95%CI 0.92-1.47) ranked better than hydroactive wound dressing in terms of healing of PIs when the latter was used as the reference group. Conclusion & Recommendations: There was considerable uncertainty around the estimates, yet, the use of hydroactive wound dressings appear to perform better than basic dressings. Foam and active wound dressing groups show promise and need further investigation. High-quality research on clinical effectiveness of the topical treatments are warranted to identify if foam and active wound dressings do provide advantages over hydroactive dressings.

Keywords: Net work Meta Analysis, Pressure Injury, Dresssing, Pressure Ulcer

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Authors: Zahra Bakhtiari

Abstract:

Middle East countries confront a multitude of main environmental challenges which are inevitable. The unstable economic and political structure which dominates numerous middle East countries makes it difficult to react effectively to unfavorable climate change impacts. This study applies a qualitative methodology and relies on secondary literature aimed to investigate how countries in the Middle East are balancing economic security and climatic security in terms of budgeting, infrastructure investment, political engagement (domestically through discourses or internationally in terms of participation in international organizations or bargaining, etc.) There has been provided an outline of innovative measures in both economic and environmental fields that are in progress in the Middle East countries and what capacity they have for economic development and environmental adaptation, as well as what has already been performed. The primary outcome is that countries that rely more on infrastructure investment such as negative emissions technologies (NET) through green social capital enterprises and political engagement, especially nationally determined contributions (NDCs) commitments and United Nations Framework Convention on Climate Change (UNFCCC), experience more economic and climatological security balance in the Middle East. Since implementing these measures is not the same in all countries in the region, we see different levels of balance between climate security and economic security. The overall suggestion is that the collaboration of both the bottom-up and top-down approaches helps create strategic environmental strategies which are in line with the economic circumstances of each country and creates the desired balance.

Keywords: climate change, economic growth, sustainability, the Middle East, green economy, renewable energy

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