Search results for: rural surgery

Authors: Neha Toppo

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Plans and programs for successful secondary education are incomplete without the inclusion of teaching English as an important area. Even after sixteen years of the formation of Jharkhand as a separate state, the students are still struggling to achieve quality education of English. This paper intends to account the present condition of teaching English in Jharkhand board secondary level schools through discussion on various issues of English language teaching, language need and learning challenges of its students. The study is to analyze whether the learning environment, teaching methods and materials, teaching resources, goals of language curriculum are appropriately convincing for the students of the board or require to be reanalyzed and also to provide appropriate suggestions for improvement. Immediate attention must be drawn towards the problem for benefitting those students, who despite their knowledge and talent are lagging behind in numerous fields only due to the lack of proficiency in English. The data and discussion provided are on the basis of a survey, in which semi structured interview with teachers, students and administrators in several schools including both rural and urban area has been taken. Questionnaire, observation and testing were used as important tools. The survey has been conducted in Ranchi district, as it covers large geographical area which includes number of villages and at the same time several towns. The district primarily possesses tribes as well as different class of people including immigrants from all over and outside Jharkhand with their social, economical strata. The observation makes it clear that the English language teaching at the state board is not complementing its context and the whole language teaching system should be re-examined to establish learner oriented environment.

Keywords: material, method, secondary level, teaching resources

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Authors: B. Kulaga, A. Cinti, F. J. Mazzocchini

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Despite the fact that growing academic attention on dark tourism is a fairly recent phenomenon, among the various reasons for travelling death-related ones, are very ancient. Furthermore, the darker side of human nature has always been fascinated and curious regarding death, or at least, man has always tried to learn lessons from death. This study proposes to describe the phenomenon of dark tourism related to the 2016 earthquake in Central Italy, deadly for 302 people and highly destructive for the rural areas of Lazio, Marche, and Umbria Regions. The primary objective is to examine the motivation-experience relationship in a dark tourism site, using the structural equation model, applied for the first time to a dark tourism research in 2016, in a study conducted after the Beichuan earthquake. The findings of the current study are derived from the calculations conducted on primary data compiled from 350 tourists in the areas mostly affected by the 2016 earthquake, including the town of Amatrice, near the epicenter, Castelluccio, Norcia, Ussita and Visso, through conducting a Likert scale survey. Furthermore, we use the structural equation model to examine the motivation behind dark travel and how this experience can influence the motivation and emotional reaction of tourists. Expected findings are in line with the previous study mentioned above, indicating that: not all tourists visit the thanatourism sites for dark tourism purpose, tourists’ emotional reactions influence more heavily the emotional tourist experience than cognitive experiences do, and curious visitors are likely to engage cognitively by learning about the incident or related issues.

Keywords: dark tourism, emotional reaction, experience, motivation, structural equation model

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Authors: R. T. Aggangan

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Woodfuels continue to be a major component of the energy supply mix of the Philippines due to increasing demand for energy that are not adequately met by decreasing supply and increasing prices of fuel oil such as liquefied petroleum gas (LPG) and kerosene. The Development Academy of the Philippines projects the demand of woodfuels in 2016 as 28.3 million metric tons in the household sector and about 105.4 million metric tons combined supply potentials of both forest and non-forest lands. However, the Revised Master Plan for Forestry Development projects a demand of about 50 million cu meters of fuelwood in 2016 but the capability to supply from local sources is only about 28 million cu meters indicating a 44 % deficiency. Household demand constitutes 82% while industries demand is 18%. Domestic household demand for energy is for cooking needs while the industrial demand is for steam power generation, curing barns of tobacco: brick, ceramics and pot making; bakery; lime production; and small scale food processing. Factors that favour increased use of wood-based energy include the relatively low prices (increasing oil-based fuel prices), availability of efficient wood-based energy utilization technology, increasing supply, and increasing population that cannot afford conventional fuels. Moreover, innovations in combustion technology and cogeneration of heat and power from biomass for modern applications favour biomass energy development. This paper recommends policies and strategic directions for the development of the woodfuel industry with the twin goals of sustainably supplying the energy requirements of households and industry.

Keywords: biomass energy development, fuelwood, households and industry, innovations in combustion technology, supply and demand

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Authors: Zanib Nafees, Amir Razaghizad, Ibtisam Mahmoud, Abhinav Sharma, Renzo Cecere

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More than one million surgeries are performed each year in Canada, resulting in more than 100,000 associated serious adverse events (SAEs) per year. These are defined as unintended injuries or complications that adversely affect the well-being of patients. In recent years, there has been a proliferation of digital health interventions that have the potential to assist, monitor, and educate patients—facilitating self-care following post-operative discharge. Among digital health, interventions are interactive-voice response technologies (IVRs), which have been shown to be highly effective in certain medical settings. Although numerous IVR-based interventions have been developed, their effectiveness and utility remain unclear, notably in post-operative settings. To the best of our knowledge, no systematic or scoping reviews have evaluated this topic to date. Thus, the objective of this scoping review protocol is to systematically map and explore the literature and evidence describing and examining IVR tools, implementation, evaluation, outcome, and experience for post-operative patients. The focus will be primarily on the evaluation of baseline performance status, clinical assessment, treatment outcomes, and patient management, including self-management and self-monitoring. The objective of this scoping review is to assess the extent of the literature to direct future research efforts by identifying gaps and limitations in the literature and to highlight relevant determinants of positive outcomes in the emerging field of IVR monitoring for health outcomes in post-operative patients.

Keywords: digital healthcare technologies, post-surgery, interactive voice technology, interactive voice response

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Authors: Jennifer Holbein, Maritza Wiedel

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Background: Aging is associated with an increased risk of falls in older adults, and as a result, falls have become public health crises. However, the incidence of falls can be reduced through healthy aging and the implementation of a regular exercise and strengthening program. Public health and healthcare professionals authorize the use of evidence‐based, exercise‐focused fall interventions, but there are major obstacles to translating and disseminating research findings into healthcare practices. The purpose of this study was to assess the feasibility of an intervention, A Matter of Balance, in terms of demand, acceptability, and implementation into current exercise programs. Subjects: Seventy-five participants from rural communities, above the age of sixty, were randomized to an intervention or attention-control of the standardized senior fitness test. Methods: Subject completes the intervention, which combines two components: (1) motivation and (2) fall-reducing physical activities with protocols derived from baseline strength and balanced assessments. Participants (n=75) took part in the program after completing baseline functional assessments as well as evaluations of their personal knowledge, health outcomes, demand, and implementation interventions. After 8-weeks of the program, participants were invited to complete follow-up assessments with results that were compared to their baseline functional analyses. Out of all the participants in the study who complete the initial assessment, approximately 80% are expected to maintain enrollment in the implemented prescription. Furthermore, those who commit to the program should show mitigation of fall risk upon completion of their final assessment.

Keywords: aging population, exercise, falls, functional assessment, healthy aging

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Authors: Chuan Yang, Jing Bie, Zhong Wang, Panagiotis Psimoulis

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Contemporary studies investigating the association between the spatial configuration of the urban network and economic activities at the street level were mostly conducted within space syntax conceptual framework. These findings supported the theory of 'movement economy' and demonstrated the impact of street configuration on the distribution of pedestrian movement and land-use shaping, especially retail activities. However, the effects varied between different urban contexts. In this paper, the relationship between economic activity distribution and the urban configurational characters was examined at the segment level. In the study area, three kinds of neighbourhood types, urban, suburban, and rural neighbourhood, were included. And among all neighbourhoods, three kinds of urban network form, 'tree-like', grid, and organic pattern, were recognised. To investigate the nested effects of urban configuration measured by space syntax approach and urban context, multilevel zero-inflated negative binomial (ZINB) regression models were constructed. Additionally, considering the spatial autocorrelation, spatial lag was also concluded in the model as an independent variable. The random effect ZINB model shows superiority over the ZINB model or multilevel linear (ML) model in the explanation of economic activities pattern shaping over the urban environment. And after adjusting for the neighbourhood type and network form effects, connectivity and syntax centrality significantly affect economic activities clustering. The comparison between accumulative and new established economic activities illustrated the different preferences for economic activity location choice.

Keywords: space syntax, economic activities, multilevel model, Chinese city

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Authors: Ritu Sharma

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In order to be objective, critics must examine the dynamic relationships between the author, the reader, the text, and the outside world. However, it is also crucial to recognize that because the language was created by God, meaning is ingrained in it. Meaning is located in and discovered through literature rather than being limited to the author, reader, text, or the outside world. The link between the author, the reader, and the text is crucial because literature unites an author and a reader through the use of language. Literature is a potent kind of communication, and Ethan Frome's audience is forever changed as a result of the book's language and the language its characters use. The narrative of Ethan Frome and his wife Zeena is presented in Ethan Frome. Ethan's story is told throughout the course of the book, revealed through the eyes of the narrator, an outsider passing through Starkfield, as well as through the insight that the narrator gains from the townspeople and his stay on the Frome farm. The story is set in the rural New England community of Starkfield, Massachusetts. The weather provides the ideal setting for Ethan and the narrator to get to know one another as the narrator gets preoccupied with unraveling the narrative that underlies Ethan's physical anomalies. In addition to telling a gripping tale and capturing human nature as it is, Ethan Frome uses its storyline to achieve something more significant. The book by Edith Wharton supports language. Zeena's deliberate and convincing language challenges relativity and meaninglessness. Ethan and Mattie's effort to effectively use words reflects the complexity of language, and their battle illustrates the influence that language may have if and when it is used. Ethan Frome defends the written word, the foundation upon which it is constructed, as a literary work. Communication is based on language, and as the characters respond to and get involved in disputes throughout the book, Zeena, Ethan, and Mattie, each reflects particular theories of communication that help define their uses of communication within the broader context of language.

Keywords: dynamic relationships, potent, communication, complexity

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Authors: Samira K. Al-Nasser, Siamak Noroozi, Roya Haratian, Adrian Harvey

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A total knee replacement (TKR) is a surgical procedure necessary when there is severe pain and/or loss of function in the knee. Surgeons balance the load in the knee and the surrounding soft tissue by feeling the tension at different ranges of motion. This method can be unreliable and lead to early failure of the joint. The ideal kinematics and load distribution have been debated significantly based on previous biomechanical studies surrounding both TKRs and normal knees. Intraoperative sensors like VERASENSE and eLibra have provided a method for the quantification of the load indicating a balanced knee. A review of the literature written about intraoperative sensors and tension/stability of the knee was done. Studies currently debate the quantification of the load in medial and lateral compartments specifically. However, most research reported that following a TKR the medial compartment was loaded more heavily than the lateral compartment. In several cases, these results were shown to increase the success of the surgery because they mimic the normal kinematics of the knee. In conclusion, most research agrees that an intercompartmental load differential of between 10 and 20 pounds, where the medial load was higher than the lateral, and an absolute load of less than 70 pounds was ideal. However, further intraoperative sensor development could help improve the accuracy and understanding of the load distribution on the surgical outcomes in a TKR. A reduction in early revision surgeries for TKRs would provide an improved quality of life for patients and reduce the economic burden placed on both the National Health Service (NHS) and the patient.

Keywords: intraoperative sensors, joint load forces, kinematics, load balancing, and total knee replacement

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Authors: Martina I. Reinhold, Theresa Bacon-Baguley

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A core challenge of physician assistant education is preparing professionals for lifelong learning. While this conventionally has encompassed scientific advances, students must also embrace new care delivery models and technologies. Telemedicine, the provision of care via two-way audio and video, is an example of a technological advance reforming health care. During a three-semester sequence of Hospital Community Experiences, physician assistant students were assigned experiences with Answer Health on Demand, a telemedicine collaborative. Preceding the experiences, the agency lectured on the application of telemedicine. Students were then introduced to the technology and partnered with a provider. Prior to observing the patient-provider interaction, patient consent was obtained. Afterwards, students completed a reflection paper on lessons learned and the potential impact of telemedicine on their careers. Thematic analysis was completed on the students’ reflection papers (n=13). Preceding the lecture and experience, over 75% of students (10/13) were unaware of telemedicine. Several stated they were 'skeptical' about the effectiveness of 'impersonal' health care appointments. After the experience, all students remarked that telemedicine will play a large role in the future of healthcare and will provide benefits by improving access in rural areas, decreasing wait time, and saving cost. More importantly, 30% of students (4/13) commented that telemedicine is a technology they can see themselves using in their future practice. Initial results indicate that collaborative interaction between students and telemedicine providers enhanced student learning and exposed students to technological advances in the delivery of care. Further, results indicate that students perceived telemedicine more favorably as a viable delivery method after the experience.

Keywords: collaboration, physician assistant education, teaching innovative health care delivery method, telemedicine

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Authors: Iveta Bryjova

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Recording of viscoelastic strain-vs-time curves with the aid of the suction method and a follow-up analysis, resulting into evaluation of standard viscoelastic parameters, is a significant technique for non-invasive contact diagnostics of mechanical properties of skin and assessment of its conditions, particularly in acute burns, hypertrophic scarring (the most common complication of burn trauma) and reconstructive surgery. For elimination of the skin thickness contribution, usable viscoelastic parameters deduced from the strain-vs-time curves are restricted to the relative ones (i.e. those expressed as a ratio of two dimensional parameters), like grosselasticity, net-elasticity, biological elasticity or Qu’s area parameters, in literature and practice conventionally referred to as R2, R5, R6, R7, Q1, Q2, and Q3. With the exception of parameters R2 and Q1, the remaining ones substantially depend on the position of inflection point separating the elastic linear and viscoelastic segments of the strain-vs-time curve. The standard algorithm implemented in commercially available devices relies heavily on the experimental fact that the inflection time comes about 0.1 sec after the suction switch-on/off, which depreciates credibility of parameters thus obtained. Although the Qu’s US 7,556,605 patent suggests a method of improving the precision of the inflection determination, there is still room for nonnegligible improving. In this contribution, a novel method of inflection point determination utilizing the advantageous properties of the Savitzky–Golay filtering is presented. The method allows computation of derivatives of smoothed strain-vs-time curve, more exact location of inflection and consequently more reliable values of aforementioned viscoelastic parameters. An improved applicability of the five inflection-dependent relative viscoelastic parameters is demonstrated by recasting a former study under the new method, and by comparing its results with those provided by the methods that have been used so far.

Keywords: Savitzky–Golay filter, scarring, skin, viscoelasticity

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Authors: Ishwor Paudel, Pratima Gautam, Sandeep Bhattarai

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Bile spillage occurs frequently during laparoscopic cholecystectomy yet its impact on postoperative outcomes remains unknown. It might not be as innocuous as some surgeons tend to believe and in fact, might be associated with post-operative surgical site infections (SSI). It often leads to patient dissatisfaction, emergency department visits, with subsequent readmission and additional procedures. While some authors found no increase in SSI following bile spillage (BS) compared to non-bile spillage cases, others found bile spillage to be associated with SSI. Therefore we sought to examine whether bile spillage is indeed associated with an increased risk of postoperative wound infections after laparoscopic cholecystectomy. I hypothesize that patients who experience BS during operation, have an increased risk of SSI compared to those who do not. This is a prospective observational study conducted in the Department of Surgery, Patan Hospital over a period of one year. Patients undergoing Laparoscopic cholecystectomy were included and bile spillage, if happened was noted. All cases were followed up for 30 days and SSI was diagnosed as per CDC-defined criteria. Fisher’s test was applied to compare SSI in bile spillage versus non-bile spillage cases. A total of 112 patients were included in the final analysis. Bile spillage occurred in 20 cases and was absent in the rest i.e.92 cases. Among bile spillage cases, SSI was found in 4 cases (20%), whereas in nonbile spillage cases, SSI was found in 8 cases (8.7%). However, it was statistically not significant (p-value>0.05). Eleven (92%) cases were superficial SSI and one was an organ-space infection. No mortality or 30-day readmission. Spillage of Gallbladder content does not lead to an increase in SSIs. However as the rate of SSI is still higher, Surgeons should be careful to avoid iatrogenic gallbladder perforation and in case of bile spillage thorough peritoneal irrigation with normal saline should be done.

Keywords: organ space infection, Laparoscopic cholecystectomy, biliary spillage, surgical site infection

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Authors: Chih-Hsien Chen, Yi-Hung Ho, Chih-Wei Wang, Chih-Wei Chang, Yen-Nien Chen, Chih-Han Chang, Chun-Ting Li

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Laminotomy is a spinal decompression surgery compatible with a minimally invasive approach. However, the unilateral laminotomy for bilateral side decompression leads to more perioperative complications than the bilateral laminotomy. Although the unilateral laminotomy removes the least bone tissue among the spinal decompression surgeries, the difference of spinal stability between unilateral and bilateral laminotomy and laminectomy is rarely investigated. This study aims to compare the biomechanical effects of unilateral and bilateral laminotomy and laminectomy on the lumbar spine by finite element (FE) simulation. A three-dimensional FE model of the lumbar spine (L1–L5) was constructed with the vertebral body, discs, and ligaments, as well as the sacrum was constructed. Three different surgical methods, namely unilateral laminotomy, bilateral laminotomy and laminectomy, at L3–L4 and L4–L5 were considered. Partial pedicle and entire ligamentum flavum were removed to simulate bilateral decompression in laminotomy. The entire lamina and spinal processes from the lower L3 to upper L5 were detached in the laminectomy model. Then, four kinds of loadings, namely flexion, extension, lateral bending and rotation, were applied on the lumbar with various decompression conditions. The results indicated that the bilateral and unilateral laminotomy both increased the range of motion (ROM) compared with intact lumbar, while the laminectomy increased more ROM than both laminotomy did. The difference of ROM between the bilateral and unilateral laminotomy was very minor. Furthermore, bilateral laminotomy demonstrated similar poster element stress with unilateral laminotomy. Unilateral and bilateral laminotomy are equally suggested to bilateral decompression of lumbar spine with minimally invasive technique because limited effect was aroused due to more bone remove in the bilateral laminotomy on the lumbar stability. Furthermore, laminectomy is the last option for lumbar decompression.

Keywords: minimally invasive technique, lumbar decompression, laminotomy, laminectomy, finite element method

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Authors: Mohammad Saleem, Neeta Kumar, Anita Sharma, Sazina Muzammil

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It is observed that some of the dental students in our setting take less interest in medical subjects. Various teaching methods are focus of research interest currently and being tried to generate interest among students. An approach of interactive integrated tutorial was used to assess its feasibility in teaching medical subjects to dental undergraduates. The aim was to generate interest and promote active self-learning among students. The objectives were to (1) introduce the integrated interactive learning method through two departments, (2) get feedback from the students and faculty on feasibility and effectiveness of this method. Second-year students in Bachelor of Dental Surgery course were divided into two groups. Each group was asked to study physiology and pathology of a common and important condition (anemia and hypertension) in a week’s time. During the tutorial, students asked questions on physiology and pathology of that condition from each other in the presence of teachers of both physiology and pathology departments. The teachers acted only as facilitators. After the session, the feedback from students and faculty on this alternative learning method was obtained. Results: Majority of the students felt that this method of learning is enjoyable, helped to develop reasoning skills and ability to correlate and integrate the knowledge from two related fields. Majority of the students felt that this kind of learning led to better understanding of the topic and motivated them towards deep learning. Teachers observed that the study promoted interdepartmental cross-discipline collaboration and better students’ linkages. Conclusion: Interactive integrated tutorial is effective in motivating dental students for better and deep learning of medical subjects.

Keywords: active learning, education, integrated, interactive, self-learning, tutorials

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Authors: Jacob Medupe

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Life as we know it has changed since the global outbreak of Coronavirus Disease 2019 (COVID-19) and business as usual will not continue. The human impact of the COVID-19 crisis is already immeasurable. Moreover, COVID-19 has already negatively impacted economies, livelihoods and disrupted food systems around the world. The disruptive nature of the Corona virus has affected every sphere of life including the culture and teaching and learning. Right now the majority of education research is based around classroom management techniques that are no longer necessary with digital delivery. Instead there is a great need for new data about how to make the best use of the one-on-one attention that is now becoming possible (Diamandis & Kotler, 2014). The COVID-19 pandemic has necessitated an environment where the South African learners are focused to adhere to social distancing in order to minimise the wild spread of the Corona virus. This arrangement forces the student to utilise the online classroom technologies to continue with the lessons. The historical reality is that the country has not made much strides on the closing of the digital divide and this is particularly a common status quo in the deep rural areas. This will prove to be a toll order for most of the learners affected by the Corona Virus to be able to have a seamless access to the online learning facilities. The paper will seek to look deeply into this reality and how the Corona virus has brought us to the reality that South Africa remains a deeply unequal society in every sphere of life. The study will also explore the state of readiness for education system around the online classroom environment.

Keywords: virtual learning, virtual classroom, COVID-19, Corona virus, internet connectivity, blended learning, online learning, distance education, e-learning, self-regulated Learning, pedagogy, digital literacy

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Authors: Aferdita Stroka Koka, Laver Stroka, Juna Musa, Samanda Celaj

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Non-melanoma skin cancers (NMSCs) are the most common human malignancies. About 5.4 million basal and squamous cell skin cancers are diagnosed each year in the US and new cases continue to grow. About eight out of ten of these are basal cell cancers. Squamous cell cancers occur less often. NMSC usually are treatable, but treatment is expensive and can leave scars. In 2019, 167 patients of both sexes suffering from NMSC were treated by traditional medicine. Patients who have been diagnosed with Basal Cell Carcinoma were 122 cases, Squamous Cell Carcinoma 32 cases and both of them 13 cases. Of these,122 cases were ulcerated lesions and 45 unulcerated lesions. All patients were treated with the herbal solution called NILS, which contains extracts of some Albanian plants such as Allium sativum, Jugulans regia and Laurus nobilis. The treatment is done locally, on the surface of the tumor, applying the solution until the tumor mass is destroyed and, after that, giving the necessary time to the wound to make the regeneration that coincides with the complete healing of the wound. We have prepared a collection of photos for each case. Since the first sessions, a shrinkage and reduction of the tumor mass were evident, up to the total disappearance of the lesion at the end of treatment. The normal period of treatment lasted 1 to 2 weeks, depending on the size of the tumor, then take care of it until the closure of the wound, taking the whole process from 1 to 3 months. In 7 patients, the lesion failed to be dominated by treatment and they underwent standard treatment with radiotherapy or surgery, while in 10 patients, the lesion recurred and was treated again. The aim of this survey was to put in evidence the good results obtained by treatment of NMSC with Albanian traditional medicine methods.

Keywords: local treatment, nils, NMSC, traditional medicine

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Authors: André Rui Coelho Fernandes, Mariana Rufino, Divakar Hamal, Amr Sousa, Emma Fossett, Kamalpreet Cheema

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Aim: A single patella tendon rupture is relatively uncommon, but a simultaneous bilateral event is a rare occurrence and has been scarcely reviewed in the literature. This review was carried out to analyse the existing literature on this event, with the aim of proposing a standardised approach to the diagnosis and management of this injury. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three independent reviewers conducted searches in PubMed, OvidSP for Medline and Embase, as well as Cochrane Library using the same search strategy. From a total of 183 studies, 45 were included, i.e. 90 patellas. Results: 46 patellas had a Type 1 Rupture equating to 51%, with Type 3 being the least common, with only 7 patellas sustaining this injury. The mean Insall-Salvio ratio for each knee was 1.62 (R) and 1.60 (L) Direct Primary Repair was the most common surgical technique compared to Tendon Reconstruction, with End to End and Transosseous techniques split almost equally. Brace immobilisation was preferred over cast, with a mean start to weight-bearing of 3.23 weeks post-op. Conclusions: Bilateral patellar tendon rupture is a rare injury that should be considered in patients with knee extensor mechanism disruption. The key limitation of this study was the low number of patients encompassed by the eligible literature. There is space for a higher level of evidence study, specifically regarding surgical treatment choice and methods, as well as post-operative management, which could potentially improve the outcomes in the management of this injury.

Keywords: trauma and orthopaedic surgery, bilateral patella, tendon rupture, trauma

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Authors: Thidathit Prachanukool, Chaiyaporn Yuksen, Welawat Tienpratarn, Sorravit Savatmongkorngul, Panvilai Tangkulpanich, Chetsadakon Jenpanitpong, Yuranan Phootothum, Malivan Phontabtim, Promphet Nuanprom

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Background: Ruptured appendicitis has a high morbidity and mortality and requires immediate surgery. The Alvarado Score is used as a tool to predict the risk of acute appendicitis, but there is no such score for predicting rupture. This study aimed to developed the prediction score to determine the likelihood of ruptured appendicitis in an Asian population. Methods: This study was diagnostic, retrospectively cross-sectional and exploratory model at the Emergency Medicine Department in Ramathibodi Hospital between March 2016 and March 2018. The inclusion criteria were age >15 years and an available pathology report after appendectomy. Clinical factors included gender, age>60 years, right lower quadrant pain, migratory pain, nausea and/or vomiting, diarrhea, anorexia, fever>37.3°C, rebound tenderness, guarding, white blood cell count, polymorphonuclear white blood cells (PMN)>75%, and the pain duration before presentation. The predictive model and prediction score for ruptured appendicitis was developed by multivariable logistic regression analysis. Result: During the study period, 480 patients met the inclusion criteria; of these, 77 (16%) had ruptured appendicitis. Five independent factors were predictive of rupture, age>60 years, fever>37.3°C, guarding, PMN>75%, and duration of pain>24 hours to presentation. A score > 6 increased the likelihood ratio of ruptured appendicitis by 3.88 times. Conclusion: Using the Ramathibodi Welawat Ruptured Appendicitis Score. (RAMA WeRA Score) developed in this study, a score of > 6 was associated with ruptured appendicitis.

Keywords: predictive model, risk score, ruptured appendicitis, emergency room

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Authors: Jiajia Peng, Danni Cheng, Jianqing Qiu, Yufang Rao, Minzi Mao, Ke Qiu, Junhong Li, Fei Chen, Feng Liu, Jun Liu, Xiaosong Mu, Wenxin Yu, Wei Zhang, Wei Xu, Yu Zhao, Jianjun Ren

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Background: Currently, primary B-cell non-Hodgkin lymphoma (B-NHL) and T/NK-cell non-Hodgkin lymphoma (NKT-NHL) originated from the nasal cavity (NC), nasopharynx (NP) and nasal sinus (NS) distinguished unclearly in the clinic. Objective: We sought to compare the clinical and survival differences of B-NHL and NKT-NHL that occurred in NC, NP, and NS, respectively. Methods: Retrospective data of patients diagnosed with nasal cavity lymphoma (NCL), nasopharyngeal lymphoma (NPL), and nasal sinus lymphoma (NSL) between 1975 and 2017 from the Surveillance, Epidemiology, and End Results (SEER) database were collected. We identified the B/NKT-NHL patients based on the histological type and performed univariate, multivariate, and Kaplan-Meier analyses to investigate the survival rates. Results: Of the identified 3,101 B-NHL and 738 NKT-NHL patients, those with B-NHL in NP were the majority (43%) and had better cancer-specific survival than those in NC and NS from 2010 to 2017 (5-year-CSS, NC vs. NP vs. NS: 81% vs. 83% vs. 82%). In contrast, most of the NKT-NHL originated from NC (68%) and had the highest CSS rate in the recent seven years (2010-2017, 5-year-CSS: 63%). Additionally, the survival outcomes of patients with NKT-NHL-NP (HR: 1.34, 95% CI: 0.62-2.89, P=0.460) who had received surgery were much worse than those of patients with NKT-NHL-NC (HR: 1.07, 95% CI: 0.75-1.52, P=0.710) and NKT-NHL-NS (HR: 1.11, 95% CI: 0.59-2.07, P=0.740). NKT-NHL-NS patients who had radiation performed (HR: 0.38, 95% CI: 0.19-0.73, P=0.004) showed the highest survival rates, while chemotherapy performed (HR: 1.01, 95% CI: 0.43-2.37, P=0.980) presented opposite results. Conclusions: Although B-NHL and NKT-NHL originating from NC, NP and NS had similar anatomical locations, their clinical characteristics, treatment therapies, and prognoses were different in this study. Our findings may suggest that B-NHL and NKT-NHL in NC, NP, and NS should be treated as different diseases in the clinic.

Keywords: nasopharyngeal lymphoma, nasal cavity lymphoma, nasal sinus lymphoma, B-cell non-Hodgkin lymphoma, T/NK-cell non-Hodgkin lymphoma

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Authors: Murad Gasanov, Shagen Danielyan, Ali Gasanov, Yuri Teterin, Peter Yartsev

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Background: Despite the advances made in modern surgery, the treatment of patients with esophageal injuries remains one of the most topical and complex issues. In recent years, high-technology minimally invasive methods, such as endoscopic vacuum therapy (EVT) in the treatment of esophageal injuries. The effectiveness of EVT has been sufficiently studied in case of failure of esophageal anastomoses, however the application of this method in case of mechanical esophageal injuries is limited by a small series of observations, indicating the necessity of additional study. Aim: The aim was to аnalyzed of own experience in the use of endoscopic vacuum therapy (EVT) in a comprehensive examination of patients with esophageal injuries. Methods: We analyzed the results of treatment of 24 patients with mechanical injuries of the esophagus for the period 2019-2021. Complex treatment of patients included the use of minimally invasive technologies, including percutaneous endoscopic gastrostomy (PEG), EVT and video-assisted thoracoscopic debridement. Evaluation of the effectiveness of treatment was carried out using multislice computed tomography (MSCT), endoscopy and laboratory tests. The duration of inpatient treatment and the duration of EVT, the number of system replacements, complications and mortality were taken into account. Result: EVT in patients with mechanical injuries of the esophagus allowed to achieve epithelialization of the esophageal defect in 21 patients (87.5%) in the form of linear scar on the site of perforation or pseudodiverticulum. Complications were noted in 4 patients (16.6%), including bleeding (2) and and esophageal stenosis in the perforation area (2). Lethal outcome was in one observation (4.2%). Conclusion. EVT may be the method of choice in complex treatment in patients with esophageal lesions.

Keywords: esophagus injuries, damage to the esophagus, perforation of the esophagus, spontaneous perforation of the esophagus, mediastinitis, endoscopic vacuum therapy

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Authors: Gwani M., Umar M. Kangiwa, Bello A. Umar, Gado A. Abubakar

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The increasing demand for sustainable energy solutions has driven significant interest in the development of innovative designs of wind turbines. The horizontal axis wind turbine (HAWT) and the vertical axis wind turbine (VAWT) are the dominant type of wind turbine used for power generation. However, these turbines have their respective merits and demerits, which affect their performance. This study introduces a Hybrid Cross Axis Wind Turbine (HCAWT), which integrates the blades of both horizontal axis wind turbines (HAWTs) and vertical axis wind turbines (VAWTs) in a cross-axis configuration with a Savonius rotor to form a hybrid system. The HCAWT combines the self-starting capabilities of Savonius rotors with the high-efficiency characteristics of Darrieus rotors and HAWT, aiming to optimize performance across a range of wind conditions. The performance of the HCAWT was tested and evaluated against a cross-axis wind turbine (CAWT) and a conventional VAWT under similar experimental conditions. The study’s results indicate that the HCAWT outperformed both the CAWT and the conventional VAWT. The power coefficient (Cp) of the HCAWT increases by 83% and 132% compared to that of the CAWT and conventional VAWT, respectively. The findings show that the HCAWT offers better start-up performance and maintains higher efficiency at lower wind speeds compared to CAWT and conventional VAWT. The findings suggest that the HCAWT offers significant improvements in energy capture, particularly in turbulent wind conditions, and greater adaptability to changing wind conditions, making it a viable option for both urban and rural energy applications.

Keywords: renewable energy, hybrid, cross axis wind turbine, energy efficiency

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Authors: Betty Chiyangwa

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This paper explores the complexities surrounding second-generation Mozambican migrant youth’s identity and sense of belonging in post-apartheid South Africa, Bushbuckridge. Established in 1884, Bushbuckridge is one of the earliest districts to accommodate first-generation Mozambicans who migrated to South Africa in the 1970s. This is a single case study informed by data from 24 semi-structured interviews and narratives with migrant youth (18-34 years) born and raised in South Africa to Mozambican parent(s) living in Bushbuckridge. Drawing from Sen’s Capability and Crenshaw’s Intersectionality approaches, this paper contributes to the existing body of knowledge on South to South migration by demonstrating how the role of participants’ identity status influences their agency and capability. The subject of youth migrants is often under-researched in the context of migration in South African thus, their opinions and views have often been marginalized in sociology. Through exploring participants’ experiences, this paper reveals that lack of identity status was described to be a huge hindrance to participants to identify as South Africans and they explained that is a constant distortion of their sense of belonging. Un-documentation status restricts participants and threatens their mobility and hinders their agency to access human rights and perpetuates social inequalities as well as hampering future aspirations. This paper concludes there is a strong association between identity status and levels of social integration. The development of a multi-layered comprehensive model in enhancing participants’ identity is recommended. This model encourages a collaborative effort from multiple stakeholders in enhancing and harnessing migrant youth capabilities in host societies.

Keywords: migrant youth, mozambique, second-generation, south africa

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Authors: Kathy Stein, Mariola Lysson, Anja Schmidt, Beatrix Schumak, Sabine Specht, Hicham Bouabe, Jürgen Heesemann, Axel Roers, Joerg C. Kalff, Sven Wehner

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Objective: Postoperative ileus (POI) is a common complication of abdominal surgery. Monocyte infiltration is a hallmark of POI. The polarization of macrophages/monocytes in this process is not well understood. We aimed to investigate if and how M2 macrophage/monocyte differentiation is involved in POI pathogenesis. Design: POI was induced by intestinal manipulation (IM). C57Bl/6, CCR2-/-, IL-10 reporter (ITIB), IL-10-/- and LysMcre/IL-10fl/fl mice underwent IM. At various points in time leukocyte influx, gene and protein expression of cytokines, chemokines and M2 differentiation markers and intestinal motility were analyzed. Results: IM induced the postoperative expression of the M2 markers Arginase-1 and YM-1, predominantly in F4/80+Ly6C+ monocytes. Gene expression analyses indicated an IL-10-dependent, IL-4-independent M2 polarization of these monocytes. IL-10 dependency of M2 differentiation was confirmed in IL-10 deficient mice. Leukocytes, in the order of infiltrating monocytes, neutrophils, and resident macrophages were the main IL-10 producers during POI. IL-10 producing monocytes as well as M2 marker expression were almost absent in CCR2-deficient mice. However, postoperative IL-10 expression was not altered in CCR2-/- mice. The loss of M2 polarized monocytes neither protected CCR2-/- mice from nor affected resolution of POI. In contrast, IL-10 deficiency reduced postoperative neutrophil numbers and ameliorated POI. IL-10Ra expression was strongly induced in neutrophils but not in monocytes. Conclusion: We conclude that IL-10 counteracts POI resolution by activating IL-10Ra-expressing neutrophils in the late phase of disease while IL-10-dependent M2 differentiation is not pivotal to POI manifestation and resolution.

Keywords: interleukin-10, macrophages, neutrophils, postoperative ileus

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Authors: Skander Ben Mami

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Despite its particular patterns and historical importance, the remote region of the Pamir Hindu Kush still lacks public recognition, as well as scientific substance, because of the abundance of classical state-centred geopolitical studies, the resilience of (inter)national narratives, and the political utility of the concepts of 'Central Asia' and 'South Asia'. However, this specific region of about 100 million inhabitants and located at the criss-cross of four geopolitical areas (Indian, Iranian, Chinese and Russian) over a territory of half a million square kilometres features a string of patterns that set it apart from the neighbouring areas of the Fergana, the Gansu and Punjab. Moreover, the Pamir Hindu Kush undergoes a series of parallel social and economic transformations that deserve scrutiny for their strong effect on the people’s lifestyle, particularly in three major urban centres (Aksu in China, Bukhara in Uzbekistan and Islamabad in Pakistan) and their immediate rural surroundings. While the involvement of various public and private stakeholders (States, NGOs, civil movements, private firms…) has undeniably resulted in positive elements (economic growth, connectivity, higher school attendance), it has in the same time generated a collection of negative effects (radicalizing, inequalities, pollution, territorial divide) that need to be addressed to strengthen regional and international security. This paper underscores the region’s strategical importance as the major hotbed and engine of insecurity and violence in Asia, notably in the context of Afghanistan’s enduring violence. It introduces the inner structures of the region, the different sources of violence as well as the governments’ responses to address it.

Keywords: geography, security, terrorism, urbanisation

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Authors: Uttam Kumar Sahoo, K. Lalhmingsangi, J. H. Lalremruati

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Non-timber forest resources particularly the high-value, low volume NTFPs has drawn interest as an activity all over the world during the past three decades that could raise standards of living for the rural folks while being compatible with forest conservation. This is particularly true for the people living in and around or fringes of protected areas. However, the economics that plays between resources’ stock and its utilization by the humans is yet to be validated and evaluated logistically. A study was therefore designed to understand the linkages between resource (especially NTFPs) availability and their utilization, existing threats to this biodiversity conservation and the role of NTFPs within the livelihood systems of those households that are most directly involved in creating conservation threats. About 25% of the households were sampled from the two sites ‘resource-rich’ and ‘resource poor’ area of Dampa Tiger Reserve (Western boundary). Our preliminary findings suggest that the collection of relatively high-volume and low value NTFPs such as fuelwood, fodder has caused degradation of forest resources while the low-volume and high-value NTFPs such as wild edible mushrooms, vegetables, other specialty food products, inputs to crafts, medicinal plants have resulted into species promotion/conservation through their domestication in traditional agroforestry systems including home gardens and/or collateral protection of the Tiger Reserve. It is thus suggested that proper assessment of these biodiversities, their direct and indirect valuation, market and non-market profits etc be carried out in greater details which would result in prescribing effective management plans around the park.

Keywords: household economy, livelihood strategies, non-timber forest products, species conservation

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Authors: Gorazd Karer

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When performing a diagnostic procedure or surgery in general anesthesia (GA), a proper introduction and dosing of anesthetic agents are one of the main tasks of the anesthesiologist. However, depth of anesthesia (DoA) also seems to be a suitable process for closed-loop control implementation. To implement such a system, one must be able to acquire the relevant signals online and in real-time, as well as stream the calculated control signal to the infusion pump. However, during a procedure, patient monitors and infusion pumps are purposely unable to connect to an external (possibly medically unapproved) device for safety reasons, thus preventing closed-loop control. The paper proposes a conceptual solution to the aforementioned problem. First, it presents some important aspects of contemporary clinical practice. Next, it introduces the closed-loop-control-system structure and the relevant information flow. Focusing on transferring the data from the patient to the computer, it presents a non-invasive image-based system for signal acquisition from a patient monitor for online depth-of-anesthesia assessment. Furthermore, it introduces a UDP-based communication method that can be used for transmitting the calculated anesthetic inflow to the infusion pump. The proposed system is independent of a medical device manufacturer and is implemented in Matlab-Simulink, which can be conveniently used for DoA control implementation. The proposed scheme has been tested in a simulated GA setting and is ready to be evaluated in an operating theatre. However, the proposed system is only a step towards a proper closed-loop control system for DoA, which could routinely be used in clinical practice.

Keywords: closed-loop control, depth of anesthesia (DoA), modeling, optical signal acquisition, patient state index (PSi), UDP communication protocol

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Authors: Falak Nawaz

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The Climate Change Vulnerability and Capacity Assessment carried out in the coastal regions of Thatta and Malir districts underscore the potential risks and challenges associated with climate change affecting water resources. This study was conducted by the author using participatory rural appraisal tools, with a greater focus on conducting focus group discussions, direct observations, key informant interviews, and other PRA tools. The assessment delves into the specific impacts of climate change along the coastal belt, concentrating on aspects such as rising sea levels, depletion of freshwater, alterations in precipitation patterns, fluctuations in water table levels, and the intrusion of saltwater into rivers. These factors have significant consequences for the availability and quality of water resources in coastal areas, manifesting in frequent migration and alterations in agriculture-based livelihood practices. Furthermore, the assessment assesses the adaptive capacity of communities and organizations in these coastal regions to effectively confront and alleviate the effects of climate change on water resources. It considers various measures, including infrastructure enhancements, water management practices, adjustments in agricultural approaches, and disaster preparedness, aiming to bolster adaptive capacity. The study's findings emphasize the necessity for prompt actions to address identified vulnerabilities and fortify the adaptive capacities of Sindh's coastal areas. This calls for comprehensive strategies and policies promoting sustainable water resource management, integrating climate change considerations, and providing essential resources and support to vulnerable communities.

Keywords: climate, climate change adaptation, disaster reselience, vulnerability, capacity, assessment

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Authors: Akudo Ejelonu, Sarah Willig, J. Anthony Sauder, Heather Murphy, Frances Shofer

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Background: The high prevalence of diarrheal diseases in the village of Tzununá, Guatemala is linked to lack of sanitation facilities and handwashing practices. Diarrheal diseases are preventable and improved access to latrines, hygiene education and clean water may improve sanitation by reducing the spread of disease. Objective: Between May 2015-January 2017, the University of Pennsylvania Chapter of Engineers Without Border (PennEWB) and local partners designed an intervention to reduce diarrheal disease by building pour flush latrines in 50 individual households and providing education on the importance of handwashing practice. Design/Methods: Through convenient sampling, we surveyed 45 households to evaluate the community’s knowledge of diarrheal disease, handwashing practices, and maintenance of the latrines. Results: 92% of the study participants experienced decrease of new cases of diarrheal disease after receiving a latrine. Only 11% washed their hands after defecating in the latrine. There was gap in understanding the health outcome of latrine sanitation and handwashing education. The respondents did not connect the reduction of diarrheal disease with latrine use and maintenance. Instead, they associated their motivation for latrine use with aesthetics, proximity to their home, ease and comfort, and reduction of shame. We recommend that PennEWB adopt UNICEF or WHO education on hand washing practice. Conclusion: Social interaction and social pressure drove the household use of latrines. The latrines are being valued and cleaned. The education that the residents received did not target norms and behaviors. Latrines could be used to create a new social norm that supports behavioral change.

Keywords: diarrheal disease, latrine, open defecation, water, sanitation and hygiene

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Authors: Fairuz A. Ulinnuha, Bimo K. Fuadi

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The world’s population continues to grow resulting in steady migration from rural to urban areas. Increased numbers of people and cities hand in hand with greater exploitation of world’s resource. Every year, more cities are feeling the devastating of this impact of this situation. During the 1970’s, some of eco-concept were applied to urban settings, one of them is Ecological Cities. A non-profit organization, Urban Ecology, was founded in California in 1975 to 'rebuild cities in balance with nature'. Efforts to synthesize ecological and urban planning approaches were slowed somewhat in the 1980s, but useful refinements were made. Consideration of social impact acknowledges that the ecological design is not just about ecology itself. It is also about questioning and redefining our understanding of the ecology. When ecologist did recognize the existence of cities, they were usually concerned with resource flows. One popular approach was to study the flow and transformation of energy through urban ecosystem. This research method is descriptive method, following LEED Certification which is the international standard of the sustainable building, is more widely applied. But there remains problem that the moral imperative of sustainability and by implication of sustainable design, tends to supplant the disciplinary contribution. Sustainable design is not always seen as design excellence or design innovation. This can provoke the skepticism and cause the tension those who promote disciplinary knowledge and those who push for sustainability. The challenges of rapid urbanization and limited of global resources has become more pressing. So, there is a need to find an alternative design approaches. The urban, as the site of complex relation (economy, political, social, cultural), need a complex problem solving that can solve current and future condition. The aim of this study is to discussed about conjoining of ecology such as public park and sustainable design.

Keywords: ecology, cities, urban, sustainability

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Authors: S. O. Obasa, J. A. Soaga, O. I. Afolabi, N. A. Bamidele, O. E. Babalola

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Attempt to improve the income of the rural population is a welcome development in Nigeria. Integrated fish-crop farming has been suggested as a means of raising farm income, reducing wastage and mitigating the risk component in production through the complementarity gain. A feeding trial was carried out to investigate the replacement of maize with fermented unripe plantain (Musa paradisiaca) peel meal in the diet of Nile tilapia, Oreochromis niloticus. The economics of the integrated enterprise was assessed using budgetary analysis techniques. The analysis incorporated the material and labour costs as well as the returns from sale of matured fish and plantain. A total of 60 fingerlings of Nile tilapia (1.70±0.1 g) were stocked at 10 per plastic tank. Two iso-nitrogenous diets containing 35% crude protein in which maize meal was replaced by fermented unripe plantain peel meal at 0% (FUP0/Control diet), and 100% (FUP100) were formulated and prepared. The fingerlings were fed at 5% body weight per day for 56 days. Lowest feed conversion ratio of 1.39 in fish fed diet FUP100 was not significantly different (P > 0.05) from the highest 1.42 of fish fed the Control diet. The highest percentage profit of 88.85% in fish fed diet FUP100 was significantly higher than 66.68% in fish fed diet FUP0, while the profit index of 1.89 in fish fed diet FUP100 was significantly different from 1.67 in fish fed diet FUP0. Therefore, fermented unripe plantain peel meal can completely replace maize in the diet of O. niloticus fingerlings. Profitability assessment shows that the net income from the integration was ₦ 463,000 per hectare and the integration resulted to an increase of ₦ 87,750.00 representing a 12.2% increase than in separate production.

Keywords: fish-crop, income, Nile tilapia, waste management

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Authors: Hamidreza Hoshyarmanesh, Benjamin Durante, Alex Irwin, Sanju Lama, Kourosh Zareinia, Garnette R. Sutherland

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This study reports on a proposed method to evaluate the accuracy and precision of Excalibur I, a neurosurgery-specific haptic hand controller, designed and developed at Project neuroArm. Having an efficient and successful robot-assisted telesurgery is considerably contingent on how accurate and precise a haptic hand controller (master/local robot) would be able to interpret the kinematic indices of motion, i.e., position and orientation, from the surgeon’s upper limp to the slave/remote robot. A proposed test rig is designed and manufactured according to standard ASTM F2554-10 to determine the accuracy and precision range of Excalibur I at four different locations within its workspace: central workspace, extreme forward, far left and far right. The test rig is metrologically characterized by a coordinate measuring machine (accuracy and repeatability < ± 5 µm). Only the serial linkage of the haptic device is examined due to the use of the Structural Length Index (SLI). The results indicate that accuracy decreases by moving from the workspace central area towards the borders of the workspace. In a comparative study, Excalibur I performs on par with the PHANToM PremiumTM 3.0 and more accurate/precise than the PHANToM PremiumTM 1.5. The error in Cartesian coordinate system shows a dominant component in one direction (δx, δy or δz) for the movements on horizontal, vertical and inclined surfaces. The average error magnitude of three attempts is recorded, considering all three error components. This research is the first promising step to quantify the kinematic performance of Excalibur I.

Keywords: accuracy, advanced metrology, hand controller, precision, robot-assisted surgery, tele-operation, workspace

Procedia PDF Downloads 336