Search results for: continuity of supplies

Authors: Aida Raissi, Holly Wong, Elma Raissi

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Background: Connection is a primal need established during infancy and reiterated in many forms of social interaction. When we make connections with others we experience growth, continuity, and gain an understanding of the other’s sense of the world. Feeling socially connected to another individual or community has been shown to increase self-esteem, happiness, and meaning. However, feeling connected to another individual or a specific community may also decrease the motivation to seek connection with more distant individuals or communities. Furthermore, we allow ourselves to interact with those in other communities as apart from us, and in some cases, to dehumanize their existence. Objective: The aim of this project is to bridge the gap between different communities, specifically religious communities and foster feelings of connection as one with all members through the medium of art, specifically photography. Method: Members of all major faiths including Agnosticism, Atheism, Buddhism, Catholicism, Christianity, Ismaili, Jewish, Ja’far Shia, Sunni will be interviewed. Participants will be asked to partake in a brief interview of two parts: A. Answering two questions: 1. What are you most looking forward to in the future, and why? 2. What does religion mean to you? B. Having their picture taken. Our questions aim to elicit individual stories that together, show that we have more in common, than differences, despite our faiths. With the completion of the interviews, the responses will be compiled together and major themes will be identified. Impact: The resulting stories and corresponding individual pictures provide an excellent opportunity to encourage and inspire people to get to know those of other beliefs and values, participate in each other’s communities and develop a sense of oneness within our shared humanity. Knowledge translation: The personal stories, and the common themes they illustrate, will be shared with various audiences, including the general public, academia and targeted groups such as students. This will be done through displaying the photographs and responses at art galleries, conferences, in print and online.

Keywords: social justice, religion, connection, understanding, community

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Authors: G. Tamanza, A. Bossoni

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84 deaf students (from primary school to college) and their families participated in this inclusion project in cooperation with numerous institutions in northern Italy (Brescia-Lombardy). Participants were either congenitally deaf or their deafness was related to other pathologies. This research promoted the integration of deaf students as they pass from primary school to high school to college. Learning methods and processes were studied that focused on encour­aging individual autonomy and socialization. The research team and its collaborators included school teachers, speech ther­apists, psychologists and home tutors, as well as teaching assistants, child neuropsychiatrists and other external authorities involved with deaf persons social inclusion programs. Deaf children and their families were supported, in terms of inclusion, and were made aware of the research team that focused on the Bisogni Educativi Speciali (BES or Special Educational Needs) (L.170/2010 - DM 5669/2011). This project included a diagnostic and evaluative phase as well as an operational one. Results demonstrated that deaf children were highly satisfied and confident; academic performance improved and collaboration in school increased. Deaf children felt that they had access to high school and college. Empowerment for the families of deaf children in terms of networking among local services that deal with the deaf also improved while family satisfaction also improved. We found that teachers and those who gave support to deaf children increased their professional skills. Achieving autonomy, instrumental, communicative and relational abilities were also found to be crucial. Project success was determined by temporal continuity, clear theoretical methodology, strong alliance for the project direction and a resilient team response.

Keywords: autonomy, inclusion, skills, well-being

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Authors: Rachel Koshy, Nazrila Hairizan Bt. Nasir, Samsiah Bt. Awang, Kamaliah Bt. Mohamad Noh

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Malaysia collaborated as a ‘trailblazer’ country with PHCPI (Primary Health Care Performance Initiative) to populate the Primary Health Care (PHC) Vital Signs Profile (VSP) for the country. The PHC VSP provides an innovative snapshot of the primary health care system's performance. Four domains were assessed: system financing, system capacity, system performance, and system equity, and completed in 2019. There were two phases using a mixed method study design. The first phase involved a quantitative study, utilising existing secondary data from national and international sources. In the case of unavailability of data for any indicators, comparable alternative indicators were used. The second phase was a mixed quantitative-qualitative approach to measure the functional capacity based on governance and leadership, population health needs, inputs, population health management, and facility organisation and management. PHC spending constituted 35% of overall health spending in Malaysia, with a per capita PHC spending of $152. The capacity domain was strong in the three subdomains of governance and leadership, information system, and funds management. The two subdomains of drugs & supplies and facility organisation & management had low scores, but the lowest score was in empanelment of the population under the population health management. The PHC system performed with an access index of 98%, quality index of 84%, and service coverage of 62%. In the equity domain, there was little fluctuation in the coverage of reproductive, maternal, newborn, and child health services by mother’s level of education and under-five child mortality between urban and rural areas. The public sector was stronger in the capacity domain as compared to the private sector. This is due to the different financing, organisational structures, and service delivery mechanism. The VSP has identified areas for improvement in the effort to provide high-quality PHC for the population. The gaps in PHC can be addressed through the system approach and the positioning of public and private primary health care delivery systems.

Keywords: primary health care, health system, system domains, vital signs profile

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Authors: Samar Mousa, Galini Mavromatidou, Rebecca Shirley

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Surgeons carry out numerous operations in the busy burns and plastic surgery department daily. Writing an accurate operation note with all the essential information is crucial for communication not only within the plastics team but also to the multi-disciplinary team looking after the patient, including other specialties, nurses and GPs. The Royal college of surgeons of England, in its guidelines of good surgical practice, mentioned that the surgeon should ensure that there are clear (preferably typed) operative notes for every procedure. The notes should accompany the patient into recovery and to the ward and should give sufficient detail to enable continuity of care by another doctor. The notes should include the Date and time, Elective/emergency procedure, Names of the operating surgeon and assistant, Name of the theatre anesthetist, Operative procedure carried out, Incision, Operative diagnosis, Operative findings, Any problems/complications, Any extra procedure performed and the reason why it was performed, Details of tissue removed, added or altered, Identification of any prosthesis used, including the serial numbers of prostheses and other implanted materials, Details of closure technique, Anticipated blood loss, Antibiotic prophylaxis (where applicable), DVT prophylaxis (where applicable), Detailed postoperative care instructions and Signature. Fourteen random days were chosen in December 2021 to assess the accuracy of operative notes and post-operative care. A total of 163 operative notes were examined. The average completion rates in all domains were 85.4%. An electronic operative note template was designed to cover all domains mentioned in the Royal College of surgeons' good surgical practice. It is kept in the hospital drive for all surgeons to use.

Keywords: operative notes, plastic surgery, documentation, electronic

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Authors: K. Tesfamariam, S. Gebreyesus, C. Lachat, P. Kolsteren, S. De Saeger, M. De Boevre, A. Argaw

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Aflatoxins are toxic secondary metabolites produced by Aspergillus fungi, which are ubiquitously present in the food supplies of low- and middle-income countries. Studies of maternal aflatoxin exposure and fetal outcomes are mainly focused on size at birth and the effect on intrauterine fetal growth has not been assessed using repeated longitudinal fetal biometry across gestation. Therefore, this study intends to assess the association between chronic aflatoxin exposure during pregnancy and fetal growth trajectories in a rural Ethiopian setting. In a prospective cohort study, we enrolled 492 pregnant women. A phlebotomist collected 5 mL of a venous blood sample from eligible women before 28 completed weeks of gestation and aflatoxin B1-lysine concentration was determined using liquid chromatography-tandem mass spectrometry. The mean (±SD) gestational age was 19.1 (3.71) weeks at enrollment, and 28.5 (3.51) and 34.5 (2.44) weeks of gestation at the second and third rounds of ultrasound measurements, respectively. Estimated fetal weight was expressed in centiles using the INTERGROWTH-21st reference. We fitted a multivariable linear mixed-effects model to estimate the rate of fetal growth between aflatoxin-exposed (i.e., aflatoxin B1-lysine concentration above or equal to the limit of detection) and non-exposed mothers in the study. Mothers had a mean (±SD) age of 26.0 (4.58) years. The median (P25, P75) serum AFB1-lysine concentration was 12.6 (0.93, 96.9) pg/mg albumin, and aflatoxin exposure was observed in 86.6% of maternal blood samples. Eighty-five percent of the women enrolled provided at least two ultrasound measurements for analysis. On average, the aflatoxin-exposed group had a significantly lower change over time in fetal weight-for-gestational age centile than the unexposed group (ß = -1.01 centiles/week, 95% CI: -1.87, -0.15, p = 0.02). Chronic maternal AF exposure is associated with lower fetal weight gain over time. Our findings emphasize the importance of nutrition-sensitive strategies to mitigate dietary aflatoxin exposure as well as adopting food safety measures in low-income settings, particularly during the fetal period of development.

Keywords: aflatoxin, fetal growth, low-income setting, mycotoxins

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Authors: Debra L. Stanley, Gabriela Wasileski

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Offenders face many challenges as they transition from being incarcerated to the community, ranging from housing and employment needs to long standing problems with addictions and mental health issues. A lack of appropriate behavioral health services in the more remote parts of the United States has led to a significant illegal substance abuse problem, housing instability, and unaddressed mental health and trauma issues. High rates of poverty and unemployment exacerbate the growing behavioral health issues, drug overdoses, co-occurring disorders, and crime that are so prevalent across rural communities. This study examines the challenges of rural jail reentry faced by offenders in a treatment capacity. The client-centered evidence-based program is uniquely designed to provide continuity of care that focuses on issues which affect rural communities. Prior to release from jail, individuals go through comprehensive assessment screenings to measure mental health and substance use disorder as well as trauma and prior crime victimization histories; the assessments help to target client-specific services. The quasi-experimental research design tracks clients throughout their recovery and reintegration into the community. Individuals in a rural program often do not have the benefit of easy access or peer mentoring that is so often found in urban recovery programs. Therefore, much of the support is provided through telehealth and e-services. The goal of this study is to explore the nature of rural reentry programs and measures of recidivism, drug overdoses, and other behavioral health needs and successful reentry to include stable housing and employment.

Keywords: jail reentry, rehabilitation, behavioral health, drug abuse, recidivism

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Authors: Brian Kwok

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Hong Kong is well-known for its name as "the Pearl of the Orient", due to its spectacular night-view with vast amount of decorative neon lights on the streets. Neon signs are first used as the pervasive media of communication for all kinds of commercial advertising, ranging from movie theatres to nightclubs and department stores, and later appropriated by artists as medium of artwork. As a well-established visual language, it displays texts in bilingual format due to British's colonial influence, which are sometimes arranged in an opposite reading order. Research on neon signs as a visual representation is rare but significant because they are part of people’s collective memories of the unique cityscapes which associate the shifting values of people's daily lives and culture identity. Nevertheless, with the current policy to remove abandoned neon signs, their total number dramatically declines recently. The Buildings Department found an estimation of 120,000 unauthorized signboards (including neon signs) in Hong Kong in 2013, and the removal of such is at a rate of estimated 1,600 per year since 2006. In other words, the vernacular cultural values and historical continuity of neon signs will gradually be vanished if no immediate action is taken in documenting them for the purpose of research and cultural preservation. Therefore, the Hong Kong Neon Signs Archive project was established in June of 2015, and over 100 neon signs are photo-documented so far. By content analysis, this project will explore the two components of neon signs – the use of visual languages and vernacular tacit knowledge of neon makers. It attempts to answer these questions about Hong Kong's neon signs: 'What are the ways in which visual representations are used to produce our cityscapes and streetscapes?'; 'What are the visual languages and conventions of usage in different business types?'; 'What the intact knowledge are applied when producing these visual forms of neon signs?'

Keywords: cityscapes, neon signs, tacit knowledge, visual representation

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Authors: Belyayev P. E., Makeyeva I. R., Mastyuk D. A., Pigasov E. E.

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Previously, the phrase ”hydrogen safety” was often used in terms of NPP safety. Due to the rise of interest to “green” and, particularly, hydrogen power engineering, the problem of hydrogen safety at industrial facilities has become ever more urgent. In Russia, the industrial production of hydrogen is meant to be performed by placing a chemical engineering plant near NPP, which supplies the plant with the necessary energy. In this approach, the production of hydrogen involves a wide range of combustible gases, such as methane, carbon monoxide, and hydrogen itself. Considering probable incidents, sudden combustible gas outburst into open space with further ignition is less dangerous by itself than ignition of the combustible mixture in the presence of many pipelines, reactor vessels, and any kind of fitting frames. Even ignition of 2100 cubic meters of the hydrogen-air mixture in open space gives velocity and pressure that are much lesser than velocity and pressure in Chapman-Jouguet condition and do not exceed 80 m/s and 6 kPa accordingly. However, the space blockage, the significant change of channel diameter on the way of flame propagation, and the presence of gas suspension lead to significant deflagration acceleration and to its transition into detonation or quasi-detonation. At the same time, process parameters acquired from the experiments at specific experimental facilities are not general, and their application to different facilities can only have a conventional and qualitative character. Yet, conducting deflagration and detonation experimental investigation for each specific industrial facility project in order to determine safe infrastructure unit placement does not seem feasible due to its high cost and hazard, while the conduction of numerical experiments is significantly cheaper and safer. Hence, the development of a numerical method that allows the description of reacting flows in domains with complex geometry seems promising. The base for this method is the modification of Kuropatenko method for calculating shock waves recently developed by authors, which allows using it in Eulerian coordinates. The current work contains the results of the development process. In addition, the comparison of numerical simulation results and experimental series with flame propagation in shock tubes with orifice plates is presented.

Keywords: CFD, reacting flow, DDT, gas explosion

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Authors: P. J. Kagosi, M. Mndolwa, E. Japhate

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The study was conducted to communities adjacent MNR, Lushoto district, Tanzania. The MNR is one of the nine nature reserves in the Eastern Arc Mountains of Tanzania with an area of 8,700ha with high biological diversity. However, biodiversity in MNR have been threatened by increasing human activities for livelihood in 1970s. The AF systems in the study area was practised since 1980s however, no study was conducted on AF impacts. This paper presents the influence of AF on livelihood of communities adjacent MNR and biodiversity conservation. Qualitative and quantitative data were collected using socio-economic survey and botanical surveys. Data were analysed using Statistical Packages for Social Sciences and content analysis. The study found that in 1970s free livestock grazing caused considerable surface runoff, soil erosion and reduction of crop production. Since 1980s, the study area received various interventions based on the land conservations and improved livelihood through practising AF systems. It was further found that the AF farming improved crop productivity, reduced soil erosion, increased firewood (80.2%) and other forest products availability and AF encouraged community members practicing indoor livestock keeping.The dominant agroforestry tree found in the study area is grevillea reported by 74.1% of respondents planting an average of 40 trees. The study found that the AF reduced pressure to MNR as forest products and fodders were obtained from community's farms in turn, currently water flow from MNR has been increased. Thus AF products support livelihood needs and conserve biodiversity. The study recommends continuity education on new AF technology packages.

Keywords: impact of agroforestry, biodiversity management, communities’ livelihoods, Magamba nature reserve

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Authors: S. P. Bansal, Mukesh Kumar Sharma, Ankit Prabhakar

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Luhri Hydroelectric Project Stage-I (210 MW) is a run of the river type development with a dam toe surface powerhouse (122m long, 50.50m wide, and 65.50m high) on the right bank of river Satluj in Himachal Pradesh, India. The project is located in the inner lesser Himalaya between Dhauladhar Range in the south and higher Himalaya in the north in the seismically active region. At the project, the location river is confined within narrow V-shaped valleys with little or no flat areas close to the river bed. Nearly 120m high cut slopes behind the powerhouse are proposed from the powerhouse foundation level of 795m to ± 915m to accommodate the surface powerhouse. The stability of 120m high cut slopes is a prime concern for the reason of risk involved. The slopes behind the powerhouse will be excavated in mainly in augen gneiss, fresh to weathered in nature, and biotite rich at places. The foliation joints are favorable and dipping inside the hill. Two valleys dipping steeper joints will be encountered on the slopes, which can cause instability during excavation. Geological exploration plays a vital role in designing and optimization of cut slopes. SWEDGE software has been used to analyze the geometry and stability of surface wedges in cut slopes. The slopes behind powerhouse have been analyzed in three zones for stability analysis by providing a break in the continuity of cut slopes, which shall provide quite substantial relief for slope stabilization measure. Pseudo static analysis has been carried out for the stabilization of wedges. The results indicate that many large wedges are forming, which have a factor of safety less than 1. The stability measures (support system, bench width, slopes) have been planned so that no wedge failure may occur in the future.

Keywords: cut slopes, geotechnical investigations, Himalayan geology, surface powerhouse, wedge failure

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Authors: Matt S. Van Deren, Michael Papenfus

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Seattle is one of the hundreds of cities in the United States that relies on a combined sewer system to collect and convey municipal wastewater. By design, these systems convey all wastewater, including industrial and commercial wastewater, human sewage, and stormwater runoff, through a single network of pipes. Serious problems arise for combined sewer systems during heavy precipitation events when treatment plants and storage facilities are unable to accommodate the influx of wastewater needing treatment, causing the sewer system to overflow into local waterways through sewer outfalls. CSOs (Combined Sewer Overflows) pose a serious threat to human and environmental health. Principal pollutants found in CSO discharge include microbial pathogens, comprising of bacteria, viruses, parasites, oxygen-depleting substances, suspended solids, chemicals or chemical mixtures, and excess nutrients, primarily nitrogen and phosphorus. While concentrations of these pollutants can vary between overflow events, CSOs have the potential to spread disease and waterborne illnesses, contaminate drinking water supplies, disrupt aquatic life, and effect a waterbody’s designated use. This paper estimates the economic impact of CSOs on residential property values. Using residential property sales data from Seattle, Washington, this paper employs a hedonic valuation model that controls for housing and neighborhood characteristics, as well as spatial and temporal effects, to predict a consumer’s willingness to pay for improved water quality near their homes. Initial results indicate that a 100,000-gallon decrease in the average annual overflow discharged from a sewer outfall within 300 meters of a home is associated with a 0.053% increase in the property’s sale price. For the average home in the sample, the price increase is estimated to be $18,860.23. These findings reveal some of the important economic benefits of improving water quality by reducing the frequency and severity of combined sewer overflows.

Keywords: benefits, hedonic, Seattle, sewer

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Authors: Toka Aly

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Historically, marketplaces were the most important nodes and focal points of cities, where different activities took place. Commercial streets offer more than just spaces for shopping; they also offer choices for social activities and cultural exchange. They are considered the backbone of the city’s vibrancy and vitality. Despite that, the public life in Cairo’s commercial streets has deteriorated, where the shopping activities became reliant mainly on 'planned formal places', mainly in privatized or indoor spaces like shopping malls. The main aim of this paper is to explore the key elements and tools of assessing the successfulness of commercial streets in Cairo. The methodology followed in this paper is based on a case study methodology (multiple cases) that is based on assessing and analyzing the physical and social elements in historical and contemporary commercial streets in El Muiz Street and Baghdad Street in Cairo. The data collection is based on personal observations, photographs, maps and street sections. Findings indicate that the key factors of analyzing commercial streets are factors affecting the sensory experience, factors affecting the social behavior, and general aspects that attract people. Findings also indicate that urban features have clear influence on shopping pedestrian activities in both streets. Moreover, in order for a commercial street to be successful, shopping patterns must provide people with a quality public space that can provide easy navigation and accessibility, good visual continuity, and well-designed urban features and social gathering. Outcomes of this study will be a significant endeavor in providing a good background for urban designers on analyzing and assessing successfulness of commercial streets. The study will also help in understanding the different physical and social pattern of vending activities taking place in Cairo.

Keywords: activities, commercial street, marketplace, successful, vending

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Authors: Mariam Shalaby, Kayla Krause, Raisha Ismail, Daniel George

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Introduction: The Pennsylvania State College of Medicine Refugee Initiative is a student-run organization that works with eleven Syrian and Congolese refugee families. Since 2016, it has used grant funding to make weekly produce purchases at a local market, provide tutoring services, and develop trusting relationships. This case study explains how the Refugee Initiative shifted focus to face new challenges due to the COVID-19 pandemic in 2020. Methodology: When refugees who had previously attained stability found themselves unable to pay the bills, the organization shifted focus from food security to direct assistance such as applying for unemployment compensation since many had recently lost jobs. When refugee families additionally struggled to access hygiene supplies, funding was redirected to purchase them. Funds were also raised from the community to provide financial relief from unpaid rent and bills. Findings: Systemic challenges were encountered in navigating federal/state unemployment and social welfare systems, and there was a conspicuous absence of affordable, language-accessible assistance that could help refugees. Finally, as struggling public schools failed to maintain adequate English as a Second Language (ESL) education, the group’s tutoring services were hindered by social distancing and inconsistent access to distance-learning platforms. Conclusion: Ultimately, the pandemic highlighted that a charity-based arrangement is helpful but not sustainable, and challenges persist for refugee families. Based on the Refugee Initiative's experiences over the past year of the COVID-19 pandemic, several needs must be addressed to aid refugee families at this time, including: increased access to affordable and language-accessible social services, educational resources, and simpler options for grant-based financial assistance. Interventions to increase these resources will aid refugee families in need in Central Pennsylvania and internationally

Keywords: COVID-19, health, pandemic, refugees

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Authors: Andre S. de Lima, Alfredo R. de Faria, Jose J. R. Faria

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Accurate prediction of thermal stresses is particularly important for laminated composite structures, as large temperature changes may occur during fabrication and field application. The normal transverse deformation plays an important role in the prediction of such stresses, especially for problems involving thick laminated plates subjected to uniform temperature loads. Bearing this in mind, the present study aims to investigate the thermo-mechanical behavior of laminated composite structures using a new beam element based on global-local superposition, accounting for through-the-thickness effects. The element formulation is based on a global-local superposition in the thickness direction, utilizing a cubic global displacement field in combination with a linear layerwise local displacement distribution, which assures zig-zag behavior of the stresses and displacements. By enforcing interlaminar stress (normal and shear) and displacement continuity, as well as free conditions at the upper and lower surfaces, the number of degrees of freedom in the model is maintained independently of the number of layers. Moreover, the proposed formulation allows for the determination of transverse shear and normal stresses directly from the constitutive equations, without the need of post-processing. Numerical results obtained with the beam element were compared to analytical solutions, as well as results obtained with commercial finite elements, rendering satisfactory results for a range of length-to-thickness ratios. The results confirm the need for an element with through-the-thickness capabilities and indicate that the present formulation is a promising alternative to such analysis.

Keywords: composite beam element, global-local superposition, laminated composite structures, thermal stresses

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Authors: Eteri Kharaishvili

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Introduction. The paper analyzes the main indicators of export and import of Georgian agri-food products; identifies positive and negative trends under the pandemic; based on the revealed problemssubstantiates the need formodernization ofin agri-food sector. It is argued that low production and productivity rates of food products negatively impact achieving the optimal export-to-import ratio; therefore, it leads toincreaseddependence on other countries andreduces the level of food security. Research objectives. The objective of the research is to identify the key challenges based on the analysis of export-import indicators of Georgian food products during the pandemic period and develop recommendations on the possibilities of post-pandemic perspectives. Research methods. Various theoretical and methodological research tools are used in the paper; in particular, a desk research is carried out on the research topic; endogenous and exogenous variables affecting export and import are determined through factor analysis; SWOT and PESTEL analysis are used to identify development opportunities; selection and groupingof data, identification of similarities and differences is carried outby using analysis, synthesis, sampling, induction and other methods; a qualitative study is conducted based on a survey of agri-food experts and exporters for clarifying the factors that impede export-import flows. Contributions. The factors that impede the export of Georgian agri-food products in the short run under COVID-19 pandemic are identified. These are: reduced income of farmers, delays in the supply of raw materials and supplies to the agri-food sectorfrom the neighboring industries, as well as in harvesting, processing, marketing, transportation, and other sectors; increased indirect costs, etc. The factors that impede the export in the long run areas follows loss of public confidence in the industry, risk of losing positions in traditional markets, etc. Conclusions are made on the problems in the field of export and import of Georgian agri-food products in terms of the pandemic; development opportunities are evaluated based on the analysis of the agri-food sector potential. Recommendations on the development opportunities for export and import of Georgian agri-food products in the post-pandemic period are proposed.

Keywords: agri-food products, export, and import, pandemic period, hindering factor, development potential

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Authors: Renato Morbidelli, Carla Saltalippi, Alessia Flammini, Marco Cifrodelli, Corrado Corradini

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The trend of magnitude and frequency of extreme rainfalls seems to be different depending on the investigated area of the world. In this work, the impact of climate change on extreme rainfalls in Umbria, an inland region of central Italy, is examined using data recorded during the period 1921-2015 by 10 representative rain gauge stations. The study area is characterized by a complex orography, with altitude ranging from 200 to more than 2000 m asl. The climate is very different from zone to zone, with mean annual rainfall ranging from 650 to 1450 mm and mean annual air temperature from 3.3 to 14.2°C. Over the past 15 years, this region has been affected by four significant droughts as well as by six dangerous flood events, all with very large impact in economic terms. A least-squares linear trend analysis of annual maximums over 60 time series selected considering 6 different durations (1 h, 3 h, 6 h, 12 h, 24 h, 48 h) showed about 50% of positive and 50% of negative cases. For the same time series the non-parametrical Mann-Kendall test with a significance level 0.05 evidenced only 3% of cases characterized by a negative trend and no positive case. Further investigations have also demonstrated that the variance and covariance of each time series can be considered almost stationary. Therefore, the analysis on the magnitude of extreme rainfalls supplies the indication that an evident trend in the change of values in the Umbria region does not exist. However, also the frequency of rainfall events, with particularly high rainfall depths values, occurred during a fixed period has also to be considered. For all selected stations the 2-day rainfall events that exceed 50 mm were counted for each year, starting from the first monitored year to the end of 2015. Also, this analysis did not show predominant trends. Specifically, for all selected rain gauge stations the annual number of 2-day rainfall events that exceed the threshold value (50 mm) was slowly decreasing in time, while the annual cumulated rainfall depths corresponding to the same events evidenced trends that were not statistically significant. Overall, by using a wide available dataset and adopting simple methods, the influence of climate change on the heavy rainfalls in the Umbria region is not detected.

Keywords: climate changes, rainfall extremes, rainfall magnitude and frequency, central Italy

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Authors: Markus Meyer, Bastian Maucher, Rolf Witzmann

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The ever increasing amount of distributed generation in low voltage distribution grids (mainly PV and micro-CHP) can lead to reverse load flows from low to medium/high voltage levels at times of high feed-in. Reverse load flow leads to rising voltages that may even exceed the limits specified in the grid codes. Furthermore, the share of electrical loads connected to low voltage distribution grids via switched power supplies continuously increases. In combination with inverter-based feed-in, this results in high harmonic levels reducing overall power quality. Especially high levels of third-order harmonic currents can lead to neutral conductor overload, which is even more critical if lines with reduced neutral conductor section areas are used. This paper illustrates a possible concept for smart grids in order to increase the feed-in capacity, improve power quality and to ensure safe operation of low voltage distribution grids at all times. The key feature of the concept is a hierarchically structured control strategy that is run on a superordinated controller, which is connected to several distributed grid analyzers and inverters via broad band powerline (BPL). The strategy is devised to ensure both quick response time as well as the technically and economically reasonable use of the available inverters in the grid (PV-inverters, batteries, stepless line voltage regulators). These inverters are provided with standard features for voltage control, e.g. voltage dependent reactive power control. In addition they can receive reactive power set points transmitted by the superordinated controller. To further improve power quality, the inverters are capable of active harmonic filtering, as well as voltage balancing, whereas the latter is primarily done by the stepless line voltage regulators. By additionally connecting the superordinated controller to the control center of the grid operator, supervisory control and data acquisition capabilities for the low voltage distribution grid are enabled, which allows easy monitoring and manual input. Such a low voltage distribution grid can also be used as a virtual power plant.

Keywords: distributed generation, distribution grid, power quality, smart grid, virtual power plant, voltage control

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Authors: Y. P. Wang, J. K. Chen, C. H. Lee, G. H. Huang, M. C. Wang, S. W. Chen, Y. T. Kuan, H. C. Lin, C. Y. Huang, W. H. Liang, W. C. Lin, H. C. Yu

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The hi-tech industries in the Science Park at southern Taiwan were heavily damaged by a strong earthquake early 2016. The financial loss in this event was attributed primarily to the automated stocker system handling fully processed products, and recovery of the automated stocker system from the aftermath proved to contribute major lead time. Therefore, development of effective means for protection of stockers against earthquakes has become the highest priority for risk minimization and business continuity. This study proposes to mitigate the seismic response of the stockers by introducing viscous fluid dampers in between the ceiling and the top of the stockers. The stocker is expected to vibrate less violently with a passive control force on top. Linear damper is considered in this application with an optimal damping coefficient determined from a preliminary parametric study. The damper is small in size in comparison with those adopted for building or bridge applications. Component test of the dampers has been carried out to make sure they meet the design requirement. Shake table tests have been further conducted to verify the proposed scheme under realistic earthquake conditions. Encouraging results have been achieved by effectively reducing the seismic responses of up to 60% and preventing the FOUPs from falling off the shelves that would otherwise be the case if left unprotected. Effectiveness of adopting a viscous fluid damper for seismic control of the stocker on top against the ceiling has been confirmed. This technique has been adopted by Macronix International Co., LTD for seismic retrofit of existing stockers. Demonstrative projects on the application of the proposed technique are planned underway for other companies in the display industry as well.

Keywords: hi-tech industries, seismic protection, automated stocker system, viscous fluid damper

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Authors: Lara Dutil-Fafard, Caroline Rhéaume, Patrick Archambault, Daniel Lafond, Neal W. Pollock

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Improving resources for medical autonomy of astronauts in prolonged space missions, such as a Mars mission, requires not only technology development, but also decision-making support systems. The Advanced Crew Medical System - Medical Condition Requirements study, funded by the Canadian Space Agency, aimed to create knowledge content and a scenario-based query capability to support medical autonomy of astronauts. The key objective of this study was to create a prototype tool for identifying medical infrastructure requirements in terms of medical knowledge, skills and materials. A multicriteria decision-making method was used to prioritize the highest risk medical events anticipated in a long-term space mission. Starting with those medical conditions, event sequence diagrams (ESDs) were created in the form of decision trees where the entry point is the diagnosis and the end points are the predicted outcomes (full recovery, partial recovery, or death/severe incapacitation). The ESD formalism was adapted to characterize and compare possible outcomes of medical conditions as a function of available medical knowledge, skills, and supplies in a given mission scenario. An extensive literature review was performed and summarized in a medical condition database. A PostgreSQL relational database was created to allow query-based evaluation of health outcome metrics with different medical infrastructure scenarios. Critical decision points, skill and medical supply requirements, and probable health outcomes were compared across chosen scenarios. The three medical conditions with the highest risk rank were acute coronary syndrome, sepsis, and stroke. Our efforts demonstrate the utility of this approach and provide insight into the effort required to develop appropriate content for the range of medical conditions that may arise.

Keywords: decision support system, event-sequence diagram, exploration mission, medical autonomy, scenario-based queries, space medicine

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Authors: H. Shokouhmand, M. Tajerian

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A numerical investigation of laminar forced convection flows through a square cross section micro heat pipe by applying electrohydrodynamic (EHD) field has been studied. In the present study, pentane is selected as working fluid. Temperature and velocity profiles and heat transfer enhancement in the micro heat pipe by using EHD field at the two-dimensional and single phase fluid flow in steady state regime have been numerically calculated. At this model, only Coulomb force is considered. The study has been carried out for the Reynolds number 10 to 100 and EHD force field up to 8 KV. Coupled, non-linear equations governed on the model (continuity, momentum, and energy equations) have been solved simultaneously by CFD numerical methods. Steady state behavior of affecting parameters, e.g. friction factor, average temperature, Nusselt number and heat transfer enhancement criteria, have been evaluated. It has been observed that by increasing Reynolds number, the effect of EHD force became more significant and for smaller Reynolds numbers the rate of heat transfer enhancement criteria is increased. By obtaining and plotting the mentioned parameters, it has been shown that the EHD field enhances the heat transfer process. The numerical results show that by increasing EHD force field the absolute value of Nusselt number and friction factor increases and average temperature of fluid flow decreases. But the increasing rate of Nusselt number is greater than increasing value of friction factor, which makes applying EHD force field for heat transfer enhancement in micro heat pipes acceptable and applicable. The numerical results of model are in good agreement with the experimental results available in the literature.

Keywords: micro heat pipe, electrohydrodynamic force, Nusselt number, average temperature, friction factor

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Authors: Sewe Silvanus Odhiambo

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Globally, many governments have publicly recognized private security firms as essential services providers. The private security firms face a lot of challenges, but the COVID-19 situation also has exacerbated them to another level. This paper locates its relevance in the post-coronavirus era. The COVID-19 pandemic has redefined the world operation, which shows a higher impact on the security field. Accordingly, the purpose of the study was to examine the role of corporate governance on the performance of private security firms in a post-covid pandemic era in Kenya. The study employed a descriptive research design, which included a quantitative approach and secondary data. The study was carried in the month of July 2021 from the registered private security firms. After targeting all private security firms, only 54 firms had disclosed their annual report by the time of conducting the study. The results depicted that pandemic has affected the performance of private security firms measures unfavorably. Further, boards of directors show a positive association with security firm performance. The study recommends that there is need board of directors to enhance management’s risk assessments in the midst of COVID-19; ensure that there are business continuity plans; there is organizational resilience; there is need for the development of new digital strategies; enabling the digital workforce in the firms and have effective communication plans with both internal and external stakeholders to deal with uncertainties and develop more post-COVID practices for boards of directors to improve performance of private security firms in Kenya. The practical implications of the study are that the research outcomes might assist regulatory bodies, investors, policymakers, and the security sector in general in their formulation of public and corporate governance strategies concerning future emergency preparedness and responses. This study also provides a unique contribution to the literature of COVID-19 and security firm performance in emerging economies context.

Keywords: COVID-19, corporate governance, firm performance, private security firms

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Authors: Jamie Sundvall, Lisa Jennings

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A decline in writing skills and abilities of students entering graduate school has become a focus for university systems within the United States. This decline has become a national trend that requires reflection on the intervention strategies used to address the deficit and unintended consequences as outcomes in the profession. Social work faculty is challenged to increase written scholarship within the academic setting. However, when a large number of students in each course have writing deficits, there is a shift from focus on content, ability to demonstrate competency, and application of core social work concepts. This qualitative study focuses on the experiences of online faculty who support increasing scholarship through writing and are following best practices preparing students academically to see improvements in written presentation in classroom work. This study outlines best practices to improve written academic presentation, especially in an online setting. The research also highlights how a student’s ability to show competency and application of concepts may be overlooked in the online setting. This can lead to new social workers who are prepared academically, but may unable to effectively advocate and document thought presentation in their writing. The intended progression of writing across all levels of higher education moves from summary, to application, and into abstract problem solving. Initial findings indicate that it is important to reflect on practices used to address writing deficits in terms of academic writing, competency, and application. It is equally important to reflect on how these methods of intervention impact a student post-graduation. Specifically, for faculty, it is valuable to assess a social worker’s ability to engage in continuity of documentation and advocacy at micro, mezzo, macro, and international levels of practice.

Keywords: intervention, professional impact, scholarship, writing

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Authors: Dalia Kubiliūtė

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Lithuania is known as a trusted location for global business institutions, and it attracts investors with it’s competitive environment for financial service providers. Along with the aspiration to offer a strong results-oriented and innovations-driven environment for financial service providers, Lithuanian regulatory authorities consistently implement the European Union's high regulatory standards for financial activities, including sustainability-related disclosures. Since European Union directed its policy towards transition to a climate-neutral, green, competitive, and inclusive economy, additional regulatory requirements for financial market participants are adopted: disclosure of sustainable activities, transparency, prevention of greenwashing, etc. The financial sector is one of the key factors influencing the implementation of sustainability objectives in European Union policies and mitigating the negative effects of climate change –public funds are not enough to make a significant impact on sustainable investments, therefore directing public and private capital to green projects may help to finance the necessary changes. The topic of the study is original and has not yet been widely analyzed in Lithuanian legal discourse. There are used quantitative and qualitative methodologies, logical, systematic, and critical analysis principles; hence the aim of this study is to reveal the problem of the implementation of the regulation on sustainability in the Lithuanian financial sector. Additional regulatory requirements could cause serious changes in financial business operations: additional funds, employees, and time have to be dedicated in order for the companies could implement these regulations. Lack of knowledge and data on how to implement new regulatory requirements towards sustainable reporting causes a lot of uncertainty for financial market participants. And for some companies, it might even be an essential point in terms of business continuity. It is considered that the supervisory authorities should find a balance between financial market needs and legal regulation.

Keywords: financial, legal, regulatory, sustainability

Procedia PDF Downloads 76

Authors: M. Mutoti, J. Gumbo, A. Jideani

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Cyanobacteria or blue green algae have been part of the human diet for thousands of years. Cyanobacteria can multiply quickly in surface waters and form blooms when favorable conditions prevail, such as high temperature, intense light, high pH, and increased availability of nutrients, especially phosphorous and nitrogen, artificially released by anthropogenic activities. Consumption of edible cyanotoxins such as Spirulina may reduce risks of cataracts and age related macular degeneration. Sulfate polysaccharides exhibit antitumor, anticoagulant, anti-mutagenic, anti-inflammatory, antimicrobial, and even antiviral activity against HIV, herpes, and hepatitis. In humans, exposure to cyanotoxins can occur in various ways; however, the oral route is the most important. This is mainly through drinking water, or by eating contaminated foods; it may even involve ingesting water during recreational activities. This paper seeks to present a review on cyanobacteria/cyanotoxin contamination of water and food and implications for human health. In particular, examining the water quality used during maize seed that passes through mill grinding processes. In order to fulfil the objective, this paper starts with the theoretical framework on cyanobacteria contamination of food that will guide review of the present paper. A number of methods for decontaminating cyanotoxins in food is currently available. Therefore, physical, chemical, and biological methods for treating cyanotoxins are reviewed and compared. Furthermore, methods that are utilized for detecting and identifying cyanobacteria present in water and food were also informed in this review. This review has indicated various routes through which humans can be exposed to cyanotoxins. Accumulation of cyanotoxins, mainly microcystins, in food has raised an awareness of the importance of food as microcystins exposure route to human body. Therefore, this review demonstrates the importance of expanding research on cyanobacteria/cyanotoxin contamination of water and food for water treatment and water supply management, with focus on examining water for domestic use. This will help providing information regarding the prevention or minimization of contamination of water and food, and also reduction or removal of contamination through treatment processes and prevention of recontamination in the distribution system.

Keywords: biofilm, cyanobacteria, cyanotoxin, food contamination

Procedia PDF Downloads 131

Authors: Suman Dutta, Manish Agrawal, C. S. Jog

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Accurate computation of hydrodynamic forces on floating structures and their deformation finds application in the ocean and naval engineering and wave energy harvesting. This manuscript presents a monolithic, finite element strategy for fluid-structure interaction involving hyper-elastic solids partly submerged in an incompressible fluid. A velocity-based Arbitrary Lagrangian-Eulerian (ALE) formulation has been used for the fluid and a displacement-based Lagrangian approach has been used for the solid. The flexibility of the ALE technique permits us to treat the free surface of the fluid as a Lagrangian entity. At the interface, the continuity of displacement, velocity and traction are enforced using the mortar method. In the mortar method, the constraints are enforced in a weak sense using the Lagrange multiplier method. In the literature, the mortar method has been shown to be robust in solving various contact mechanics problems. The time-stepping strategy used in this work reduces to the generalized trapezoidal rule in the Eulerian setting. In the Lagrangian limit, in the absence of external load, the algorithm conserves the linear and angular momentum and the total energy of the system. The use of monolithic coupling with an energy-conserving time-stepping strategy gives an unconditionally stable algorithm and allows the user to take large time steps. All the governing equations and boundary conditions have been mapped to the reference configuration. The use of the exact tangent stiffness matrix ensures that the algorithm converges quadratically within each time step. The robustness and good performance of the proposed method are demonstrated by solving benchmark problems from the literature.

Keywords: ALE, floating body, fluid-structure interaction, monolithic, mortar method

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Authors: Inna Vinokurova, N. Savvina

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The goal of research: to study the organization of multi-field hospital’s work environment in the Republic of Sakha (Yakutia), Autonomous public health care institution of Republic of Sakha (Yakutia) - Republican Hospital No. 1 - National Center of Medicine. Results: Autonomous public health care institution of Republic of Sakha (Yakutia) - Republican Hospital No. 1 - National Center of Medicine is a multidisciplinary, specialized hospital complex that provides specialized and high-tech medical care to children and adults in the Republic of Sakha (Yakutia) of the Russian Federation. There are 5 diagnostic and treatment centers (advisory and diagnostic, clinical, pediatric, perinatal, Republican cardiologic dispensary) with 45 clinical specialized departments with 727 cots, 5 resuscitation departments, 20 operating rooms and out-patient department with 905 visits in alternation in the National Center of Medicine. Annually more than 20,000 patients receive treatment in the hospital of the Republican Hospital of the Republic of Sakha (Yakutia), more than 70,000 patients visit out-patient sections, more than 2 million researches are done, more than 12,000 surgeries are performed, more than 2 thousand babies are delivered. National Center of Medicine has a great influence with such population’s health indicators as total mortality, birth rate, maternal, infant and perinatal mortality, circulatory system incidence. The work environment of the Republican Hospital of the Republic of Sakha (Yakutia) is represented by the following structural departments: pharmacy, blood transfusion department, sterilization department, laundry, dietetic department, infant-feeding centre, material and technical supply. More than 200 employees work in this service. The main function of these services is to provide on-time and fail-safe supply with all necessary: wear parts, medical supplies, donated blood and its components, foodstuffs, hospital linen , sterile instruments, etc. Thus, the activity of medical organization depends on the work environment, including quality health care, so it is a main part of multi-field hospital activity.

Keywords: organization of multi-field hospital’s, work environment, quality health care, pharmacy, blood transfusion department, sterilization department

Procedia PDF Downloads 221

Authors: Mariia Timofeeva, Andrew Ooi, Eric K. W. Poon, Peter Barlis

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Atherosclerotic plaque build-up, commonly known as stenosis, limits blood flow and hence oxygen and nutrient supplies to the heart muscle. Thus, assessment of its severity is of great interest to health professionals. Numerical simulation of the fractional flow reserve (FFR) has proved to be well correlated with invasively measured FFR used for physiological assessment of the severity of coronary stenosis in arteries. Atherosclerosis may impact the diseased artery in several locations causing serial stenoses, which is a complicated subset of coronary artery disease that requires careful treatment planning. However, hemodynamic of the serial sequential stenoses in coronary arteries has not been extensively studied. The hemodynamics of the serial stenoses is complex because the stenoses in the series interact and affect the flow through each other. To address this, serial stenoses in a 3.4 mm left anterior descending (LAD) artery are examined in this study. Two diameter stenoses (DS) are considered, 30 and 50 percent of the reference diameter. Serial stenoses configurations are divided into three groups based on the order of the stenoses in the series, spacing between them, and deviation of the stenoses’ symmetry (eccentricity). A patient-specific pulsatile waveform is used in the simulations. Blood flow within the stenotic artery is assumed to be laminar, Newtonian, and incompressible. Results for the FFR are reported. Based on the simulation results, it can be deduced that the larger drop in pressure (smaller value of the FFR) is expected when the percentage of the second stenosis in the series is bigger. Varying the distance between the stenoses affects the location of the maximum drop in the pressure, while the minimal FFR in the artery remains unchanged. Eccentric serial stenoses are characterized by a noticeably larger decrease in pressure through the stenoses and by the development of the chaotic flow downstream of the stenoses. The largest drop in the pressure (about 4% difference compared to the axisymmetric case) is obtained for the serial stenoses, where both the stenoses are highly eccentric with the centerlines deflected to the different sides of the LAD. In conclusion, varying configuration of the sequential serial stenoses results in a different distribution of FFR through the LAD. Results presented in this study provide insight into the clinical assessment of the severity of the coronary serial stenoses, which is proved to depend on the relative position of the stenoses and the deviation of the stenoses’ symmetry.

Keywords: computational fluid dynamics, coronary artery, fractional flow reserve, serial stenoses

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Authors: Hanna Salminen

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Due to the large societal changes in working life, such as retirement reforms, globalization and technological changes, careers are becoming longer, more varied and unpredictable than before. Similar to other new career concepts, such as protean and boundaryless career, a sustainable career concept emphasizes an individual’s active role and agency in managing his/her own career in changing working life. However, the sustainable career concept also underlines the importance of safeguarding and developing human capital over time and thereby fostering continuity. Especially, the theoretical discussion around sustainable careers stresses flexible career choices that meet an individual’s own personal needs, allow work-family balance and promotes continuous learning. Although sustainable careers concern employees at all ages, this study focuses on older employees (aged 50+). So far, the changing nature of careers has been mainly investigated among younger generations, and the changing and prolonging late career phase has received less attention among career scholars. In other words, there is lack of knowledge regarding what constitutes a sustainable career in the late career phase and how the individual, organizational, and societal levels of sustainable career ecosystem are interconnected. The theoretical discussion around sustainable careers is closely linked to the sustainable management of human resources in organizations. In the field of human resource management (HRM), sustainable HRM has received more attention in recent years and it has been seen as a step forward from strategic HRM approach. As a concept, sustainable HRM stresses the long-term focus on organizations’ social, economic, and ecological resources, and the benefits of HRM practices for employees, organizations, and the society at large. However, some HRM scholars argue that the ecological and financial matters have overshadowed the social aspect of sustainability. In this study, the sustainable career and sustainable HRM literature are combined. As a result of an integrative literature review, this study provides new insight, how sustainable late career phase has been understood and conceptualized in sustainable career and sustainable HRM literature.

Keywords: sustainability, career, human resource management, ageing

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Authors: S. D. Kadir

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Background: Antibiotics have always been at the centrum of the revolution of modern microbiology. Micro-organisms and its pathogenicity, resistant organisms, inappropriate or over usage of various types of antibiotic agents are fuelled multidrug-resistant pathogenic organisms. Our present time review report mainly focuses on the therapeutic condition of antibiotic resistance and the possible roots behind the development of antibiotic resistance in Bangladesh in 2019. Methodology: The systemic review has progressed through a series of research analyses on various manuscripts published on Google Scholar, PubMed, Research Gate, and collected relevant information from established popular healthcare and diagnostic center and its subdivisions all over Bangladesh. Our research analysis on the possible assurance of antibiotic resistance been ensured by the selective medical reports and on random assay on the extent of individual antibiotic in 2019. Results: 5 research articles, 50 medical report summary, and around 5 patients have been interviewed while going through the estimation process. We have prioritized research articles where the research analysis been performed by the appropriate use of the Kirby-Bauer method. Kirby-Bauer technique is preferred as it provides greater efficiency, ensures lower performance expenditure, and supplies greater convenience and simplification in the application. In most of the reviews, clinical and laboratory standards institute guidelines were strictly followed. Most of our reports indicate significant resistance shown by the Beta-lactam drugs. Specifically by the derivatives of Penicillin's, Cephalosporin's (rare use of the first generation Cephalosporin and overuse of the second and third generation of Cephalosporin and misuse of the fourth generation of Cephalosporin), which are responsible for almost 67 percent of the bacterial resistance. Moreover, approximately 20 percent of the resistance was due to the fact of drug pumping from the bacterial cell by tetracycline and sulphonamides and their derivatives. Conclusion: 90 percent of the approximate antibiotic resistance is due to the usage of relative and true broad-spectrum antibiotics. The environment has been created by the following circumstances where; the excessive usage of broad-spectrum antibiotics had led to a condition where the disruption of native bacteria and a series of anti-microbial resistance causing a disturbance of the surrounding environments in medium, leading to a state of super-infection.

Keywords: antibiotics, antibiotic resistance, Kirby Bauer method, microbiology

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Authors: Doran C. Kalmin

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The descending genicular artery (DGA) perforator free flap provides an alternative to free flap reconstruction based on a review of the literature detailing both anatomical and clinical studies. The descending genicular artery (DGA) supplies skin, muscle, tendon, and bone located around the medial aspect of the knee that has been used in several pioneering reports in reconstructing defects located in various areas throughout the body. After the success of the medial femoral condyle flap in early studies, a small number of studies have been published detailing the use of the DGA in free flap reconstruction. Despite early success in the use of the DGA flap, acceptance within the Plastic and Reconstructive Surgical community has been limited due primarily to anatomical variations of the pedicle. This literature review is aimed at detailing the progression of the DGA perforator free flap and its variations as an alternative and reliable free flap for reconstruction of composite defects with an exploration into both anatomical and clinical studies. A literature review was undertaken, and the progression of the DGA flap is explored from the early review by Acland et al. pioneering the saphenous free flap to exploring modern changes and studies of the anatomy of the DGA. An extensive review of the literature was undertaken that details the anatomy and its variations, approaches to harvesting the flap, the advantages, and disadvantages of the DGA perforator free flap as well as flap outcomes. There are 15 published clinical series of DGA perforator free flaps that incorporate cutaneous, osteoperiosteal, cartilage, osteocutaneous, osteoperiosteal and muscle, osteoperiosteal and subcutaneous and tendocutatenous. The commonest indication for using a DGA free flap was for non-union of bone, particularly that of the scaphoid whereby the medial femoral condyle could be used. In the case series, a success rate of over 90% was established, showing that these early studies have had good success with a wide range of tissue transfers. The greatest limitation is the anatomical variation of the DGA and therefore, the challenges associated with raising the flap. Despite the variation in anatomy and around 10-15% absence of the DGA, the saphenous artery can be used as well as the superior medial genicular artery if the vascular bone is required as part of the flap. Despite only a handful of anatomical and clinical studies describing the DGA perforator free flap, it ultimately provides a reliable flap that can include a variety of composite structure used for reconstruction in almost any area throughout the body. Although it has limitations, it provides a reliable option for free flap reconstruction that can routinely be performed as a single-stage procedure.

Keywords: anatomical study, clinical study, descending genicular artery, literature review, perforator free flap reconstruction

Procedia PDF Downloads 121