Search results for: inferior tilt

Authors: Vinay Kant Shankhdhar

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Purpose: Maxillary defects are three dimensional and require complex bone and soft tissue reconstruction. Maxillary reconstruction using fibula osteocutaneous flaps in situation requiring orbital floor, orbital wall, palatal defects, and external skin, all at the same time require special planning and multiple osteotomies. We tried to improvise our reconstruction using multiple osteotomies and skin paddle designs for fibula and Flexor Hallucis Longus Muscle. This study aims at discussing the planning and outcome in complex maxillary reconstructions using fibula flaps and soft tissue flaps with or without bone grafts. Material and Methods: From 2011 to 2017 a total of 129 Free fibula flaps were done, 67 required two or more struts, 164 Anterolateral Thigh Flaps, 11 Deep Inferior Epigastric Artery perforator flaps and 3 vertical rectus abdominis muscle flaps with iliac crest bone graft. The age range was 2 to 70 years. The reconstruction was evaluated based on the post-operative rehabilitation including orbital support (prevention of diplopia), oral diet, speech and cosmetic appearance. Results: The follow- up is from 5 years to 1 year. In this series, we observed that the common complications were the de-vascularisation of most distal segment of osteotomised fibula and native skin necrosis. Commonest area of breakdown is the medial canthal region. Plate exposure occurs most commonly at the pyriform sinus. There was extrusion of one non-vascularized bone graft. All these complications were noticed post-radiotherapy. Conclusions: The use of free fibula osteocutaneous flap gives very good results when only alveolar reconstruction is required. The reconstruction of orbital floor with extensive skin loss with post operative radiotherapy has maximum complication rate in long term follow up. A soft tissue flap with non vascularized bone graft may be the best option in such cases.

Keywords: maxilla reconstruction, fibula maxilla, post cancer maxillary reconstruction

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Authors: Mohammed H. Karim, Bestoon M. Faraj

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Introduction: instrument separation is a common challenge in the endodontic field. Various techniques and technologies have been developed to improve the retrieval success rate. This study aimed to compare the effectiveness of a Dynamic Navigation System (DNS) and a three-dimensional microscope in retrieving broken rotary NiTi files when using trepan burs and the extractor system. Materials and Methods: Thirty maxillary first bicuspids with sixty separate roots were split into two comparable groups based on a comprehensive Cone-Beam Computed Tomography (CBCT) analysis of the root length and curvature. After standardised access opening, glide paths, and patency attainment with the K file (sizes 10 and 15), the teeth were arranged on 3D models (three per quadrant, six per model). Subsequently, controlled-memory heat-treated NiTi rotary files (#25/0.04) were notched 4 mm from the tips and fractured at the apical third of the roots. The C-FR1 Endo file removal system was employed under both guidance to retrieve the fragments, and the success rate, canal aberration, treatment time and volumetric changes were measured. The statistical analysis was performed using IBM SPSS software at a significance level of 0.05. Results: The microscope-guided group had a higher success rate than the DNS guidance, but the difference was insignificant (p > 0.05). In addition, the microscope-guided drills resulted in a substantially lower proportion of canal aberration, required less time to retrieve the fragments and caused a minor change in the root canal volume (p < 0.05). Conclusion: Although dynamically guided trephining with the extractor can retrieve separated instruments, it is inferior to three-dimensional microscope guidance regarding treatment time, procedural errors, and volume change.

Keywords: dynamic navigation system, separated instruments retrieval, trephine burs and extractor system, three-dimensional video microscope

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Authors: Ochuko K. Overen, Golden Makaka, Edson L. Meyer, Sampson Mamphweli

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Low-cost housing provided for people with small incomes in South Africa are characterized by poor thermal performance. This is due to inferior craftsmanship with no regard to energy efficient design during the building process. On average, South African households spend 14% of their total monthly income on energy needs, in particular space heating; which is higher than the international benchmark of 10% for energy poverty. Adopting energy efficient passive solar design strategies and superior thermal building materials can create a stable thermal comfort environment indoors. Thereby, reducing energy consumption for space heating. The aim of this study is to analyse the thermal behaviour of a low-cost house integrated with passive solar design features. A low-cost passive solar house with superstructure fly ash brick walls was designed and constructed in Somerset East, South Africa. Indoor and outdoor meteorological parameters of the house were monitored for a period of one year. The ASTM E741-11 Standard was adopted to perform ventilation test in the house. In summer, the house was found to be thermally comfortable for 66% of the period monitored, while for winter it was about 79%. The ventilation heat flow rate of the windows and doors were found to be 140 J/s and 68 J/s, respectively. Air leakage through cracks and openings in the building envelope was 0.16 m3/m2h with a corresponding ventilation heat flow rate of 24 J/s. The indoor carbon dioxide concentration monitored overnight was found to be 0.248%, which is less than the maximum range limit of 0.500%. The prediction percentage dissatisfaction of the house shows that 86% of the occupants will express the thermal satisfaction of the indoor environment. With a good operation of the house, it can create a well-ventilated, thermal comfortable and nature luminous indoor environment for the occupants. Incorporating passive solar design in low-cost housing can be one of the long and immediate solutions to the energy crisis facing South Africa.

Keywords: energy efficiency, low-cost housing, passive solar design, rural development, thermal comfort

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Authors: Naim Izet Kajtazi

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Context: The third ventricle colloid cyst (CC) is a benign growth usually located in the third ventricle and can cause various neurological symptoms, including sudden death. Modern surgical interventions may still result in a wide range of complications and cerebral venous thrombosis (CVT) is among them. Process: A 38-year-old female with an existing diagnosis of diabetes mellitus (DM) and hypothyroidism and a six-month history of headaches, blurred vision, and vomiting presented to our clinic three days after the headaches became excessively severe. Neurological examination on admission revealed bilateral papilledema without any associated focal neurological deficits. Brain computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of a third ventricle colloid cyst and associated non-communicating hydrocephalus involving the lateral ventricles. As a result, the patient underwent emergency bilateral external ventricular drainage (EVD) insertion followed by a third ventricular CC excision under neuronavigation through a right frontal craniotomy. Twelve days post-operatively, the patient developed further headaches, followed by a generalized tonic-clonic seizure that led to no postictal neurological deficits. Nonetheless, computed tomography venography of the brain revealed extensive thrombosis of the superior sagittal sinus, inferior sagittal sinus, right sigmoid sinus, and right internal jugular vein. A newly diagnosed CVT was treated with intravenous heparin. The patient was discharged with warfarin, which was discontinued after 12 months. Ten years after her illness, she remained stable and free from any neurological deficits but still suffered from mild chronic headaches. Outcome: Ten years after her illness, she remained stable and free from any neurological deficits but still suffered from mild chronic headaches. Relevance: A preoperative venous study should be performed in all cases to gain a better understanding of the venous anatomy. We advocate meticulous microsurgical techniques to protect the venous system surrounding the foramen of Monro and reduce the amount of retraction during surgery.

Keywords: CVT, seizures, third ventricle colloid cyst, MRI of brain

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Authors: Stanisław Fic, Danuta Barnat-Hunek, Przemysław Brzyski

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The aim of the study was to evaluate the possibility of applying modified lime binder together with natural flax fibers and straw to the production of wall blocks to the usage in energy-efficient construction industry and the development of proposals for technological solutions. The following laboratory tests were performed: the analysis of the physical characteristics of the tested materials (bulk density, total porosity, and thermal conductivity), compressive strength, a water droplet absorption test, water absorption of samples, diffusion of water vapor, and analysis of the structure by using SEM. In addition, the process of surface hydrophobisation was analyzed. In the paper, there was examined the effectiveness of two formulations differing in the degree of hydrolytic polycondensation, viscosity and concentration, as these are the factors that determine the final impregnation effect. Four composites, differing in composition, were executed. Composites, as a result of the presence of flax straw and fibers showed low bulk density in the range from 0.44 to 1.29 kg/m3 and thermal conductivity between 0.13 W/mK and 0.22 W/mK. Compressive strength changed in the range from 0,45 MPa to 0,65 MPa. The analysis of results allowed observing the relationship between the formulas and the physical properties of the composites. The results of the effectiveness of hydrophobisation of composites after 2 days showed a decrease in water absorption. Depending on the formulation, after 2 days, the water absorption ratio WH of composites was from 15 to 92% (effectiveness of hydrophobization was suitably from 8 to 85%). In practice, preparations based on organic solvents often cause sealing of surface, hindering the diffusion of water vapor from materials but studies have shown good water vapor permeability by the hydrophobic silicone coating. The conducted pilot study demonstrated the possibility of applying flax composites. The article shows that the reduction of CO2 which is produced in the building process can be affected by using natural materials for the building components whose quality is not inferior as compared to the materials which are commonly used.

Keywords: ecological construction, flax fibers, hydrophobisation, lime

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Authors: Claudia Pisano

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The Italian shockumentary Mondo cane (1962), directed by Gualtiero Jacopetti, Paolo Cavara, and Franco Prosperi, has often been criticized for its supposed racist and colonialist stances. Several critics consider it a film that proclaims, without explicitly mentioning it, the superiority of the white Euro-American individual over the people who do not belong to white-western societies. This paper proposes a different interpretation of the way in which Mondo cane engages with the discourse of race. Through an analysis of crucial scenes and of the relationship between images and voice-over, and through a comparison between the representation of non-white societies in Mondo cane and in some popular Italian newsreels of the 50s-60s, such as 'La Settimana Incom' and 'Mondo Libero,' the paper argues that Mondo cane debunks the western-white superiority that, according to some critics, the film would promote. The continuous and rapid alternance of scenes set in the western world, for example in Europe or in the United States, and scenes set in exotic countries inhabited by non-white peoples highlights the commonalities between these far-away realities, rather than pointing out the superiority of the white-western one. In addition, the subtle irony employed by the voice-over distances Mondo cane from the newsreels that it much resembles for its documentary style. Mondo cane’s treatment and representation of race is analyzed in the light of the work of Australian Aboriginal anthropologist Aileen Moreton-Robinson, which is based on key concepts such as whiteness and whiteness invisibility. Whiteness is defined as the invisible and omnipresent norm based on which everything that does not belong to the white world is labeled as an odd and inferior 'other.' To overcome racial discrimination, it is necessary to make whiteness visible; that is to say, to deprive it of that aura of normalcy and unquestionable righteousness that surrounds it. This essay argues that Mondo cane participates in the process of making whiteness visible through the confrontation of the white people with the visible 'other'. Because the film shows that the common features on which this confrontation is based are violence and bestiality, the paper suggests that the film does not support the idea of the white world being superior to the non-white; on the contrary, it underlines that the entire world is characterized by the same shocking savagery.

Keywords: irony, race, shockumentary, whiteness, whiteness invisibility

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Authors: Preetham Shankapal, Jill King, Kori Murray, Corby Martin, Paula Giselman, Jason Hicks, Owen Carmicheal

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Activation of reward and satiety networks in the brain while processing palatable food cues, as well as functional connectivity during rest has been studied using functional Magnetic Resonance Imaging of the brain in various obesity phenotypes. However, functional connectivity within the reward and satiety network during food cue processing is understudied. 14 obese individuals underwent two fMRI scans during viewing of Macronutrient Picture System images. Each scan included two blocks of images of High Sugar/High Fat (HSHF), High Carbohydrate/High Fat (HCHF), Low Sugar/Low Fat (LSLF) and also non-food images. Seed voxels within seven food reward relevant ROIs: Insula, putamen and cingulate, precentral, parahippocampal, medial frontal and superior temporal gyri were isolated based on a prior meta-analysis. Beta series correlation for task-related functional connectivity between these seed voxels and the rest of the brain was computed. Voxel-level differences in functional connectivity were calculated between: first and the second scan; individuals who saw novel (N=7) vs. Repeated (N=7) images in the second scan; and between the HC/HF, HSHF blocks vs LSLF and non-food blocks. Computations and analysis showed that during food image viewing, reward network ROIs showed significant functional connectivity with each other and with other regions responsible for attentional and motor control, including inferior parietal lobe and precentral gyrus. These functional connectivity values were heightened among individuals who viewed novel HS/HF images in the second scan. In the second scan session, functional connectivity was reduced within the reward network but increased within attention, memory and recognition regions, suggesting habituation to reward properties and increased recollection of previously viewed images. In conclusion it can be inferred that Functional Connectivity within reward network and between reward and other brain regions, varies by important experimental conditions during food photography viewing, including habituation to shown foods.

Keywords: fMRI, functional connectivity, task-based, beta series correlation

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Authors: Debora Caetano Dahas

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In ‘Ethics’ and in ‘A Political Treatise’ Spinoza presents his very influential take on natural law and the principles that guide his philosophical work and observations. Spinoza’s ideas about rationalization, God, and ethical behavior are undeniably relevant to many debates in the field of legal theory. In addition, it is important to note that Spinoza's takes on body, mind, and imagination played an important role in building a certain way of understanding the female figure in western societies and of their differences in regards to the male figure. It is important to emphasize that the constant and insistent presentation of women as inferior and irrational beings corroborates the institutionalization of discriminatory public policies and practices legitimized by the legal system that cooperates with the aggravation of gender inequalities. Therefore, his arguments in relation to women and their nature have been highly criticized, especially by feminist theorists during the second half of the 21st century. The questioning of this traditional philosophy –often phallocentric– and its way of describing women as irrational and less capable than men, as well as the attempt to reformulate postulates and concepts, takes place in such a way as to create a deconstruction of classical concepts. Some of the arguments developed by Spinoza, however, can serve as a basis for elucidating in what way and to what extent the social and political construction of the feminine identity served as a basis for gender inequality. Thus, based on to the observations elaborated by Moira Gantes, the present research addresses the relationship between Spinoza and the feminist demands in the juridical and political spheres, elaborating arguments that corroborate the convergence between his philosophy and feminist critical theory. Finally, this research aims to discuss how the feminists' critics of Spinoza’s writings have deconstructed and rehabilitated his principles and, in doing so, can further help to illustrate the importance of his philosophy –and, consequently, of his notes on Natural Law– in understanding gender equality as a vital part of the effective implementation of democratic debate and inclusive political participation and representation. In doing so, philosophical and legal arguments based on the feminist re-reading of Spinoza’s principles are presented and then used to explain the controversial political reform in Brazil, especially in regards to the applicability of the legislative act known as Law n. 9.504/1997 which establishes that at least 30% of legislative seats must be occupied by women.

Keywords: natural law, feminism, politics, gender equality

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Authors: A. Kherraf, M. Bouziane, L. Azzouzi, R. Habbal

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Introduction: Hypocalcaemia is a rare cause of heart failure. We report the clinical case of a young patient with reversible dilated cardiomyopathy secondary to hypocalcaemia in the context of hyperparathyroidism. Clinical case: We report the clinical case of a 23-year-old patient with a history of thyroidectomy for papillary thyroid carcinoma 3 years previously, who presented to the emergency room with a progressive onset dyspnea and edema of the lower limbs. Clinical examination showed hypotension at 90/70 mmHg, tachycardia at 102 bpm, and edema of the lower limbs. The ECG showed a regular sinus rhythm with a prolonged corrected QT interval to 520ms. The chest x-ray showed cardiomegaly. Echocardiography revealed dilated cardiomyopathy with biventricular dysfunction and a left ventricular ejection fraction of 45%, as well as moderate mitral insufficiency by restriction of the posterior mitral leaflet, moderate tricuspid insufficiency, and a dilated inferior vena cava with a pulmonary arterial pressure estimated at 46 mmHg. Blood tests revealed severe hypocalcemia at 38 mg / l with normal albumin and thyroxine levels, as well as hyperphosphatemia and increased TSH. The patient received calcium intake and vitamin D supplementation and was treated with beta blockers, ACE inhibitors, and diuretics with good progress and progressive normalization of cardiac function. Discussion: The cardiovascular manifestations of hypocalcaemia usually appear with deeply low serum calcium levels. This can lead to hypotension, arrhythmias, ventricular fibrillation, prolonged QT interval, or even heart failure. Heart failure is a rare and serious complication of hypocalcemia but most often characterized by complete normalization of myocardial function after treatment. The etiology of the hypocalcaemia, in this case, was probably related to accidental parathyroid removal during thyroidectomy. This is why careful monitoring of calcium levels is recommended after surgery. Conclusion: Hypocalcemic heart failure is rare but reversible heart disease. Systematic monitoring of serum calcium should be performed in all patients after thyroid surgery to avoid any complications related to hypoparathyroidism.

Keywords: hypocalcemia, heart failure, thyroid surgery, hypoparathyroidism

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Authors: SeyedKeivan Nateghi, Jan Kaczmarczyk

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People nowadays spend most of their time in buildings. Accordingly, maintaining a good quality of indoor air is very important. New universal matters related to the prevalence of Covid-19 also highlight the importance of indoor air conditioning in reducing the risk of virus infection. Cooling and Heating of a house will provide a suitable zone of air temperature for residents. One of the significant factors in energy demand is energy consumption in the building. In general, building divisions compose more than 30% of the world's fundamental energy requirement. As energy demand increased, greenhouse effects emerged that caused global warming. Regardless of the environmental damage to the ecosystem, it can spread infectious diseases such as malaria, cholera, or dengue to many other parts of the world. With the advent of the Covid-19 phenomenon, the previous instructions to reduce energy consumption are no longer responsive because they increase the risk of virus infection among people in the room. Two problems of high energy consumption and coronavirus infection are opposite. A classroom with 30 students and one teacher in Katowice, Poland, considered controlling two objectives simultaneal. The probability of transmission of the disease is calculated from the carbon dioxide concentration of people. Also, in a certain period, the amount of energy consumption is estimated by EnergyPlus. The effect of three parameters of number, angle, and time or schedule of opening windows on the probability of infection transmission and energy consumption of the class were investigated. Parameters were examined widely to determine the best possible condition for simultaneous control of infection spread and energy consumption. The number of opening windows is discrete (0,3), and two other parameters are continuous (0,180) and (8 AM, 2 PM). Preliminary results show that changes in the number, angle, and timing of window openings significantly impact the likelihood of virus transmission and class energy consumption. The greater the number, tilt, and timing of window openings, the less likely the student will transmit the virus. But energy consumption is increasing. When all the windows were closed at all hours of the class, the energy consumption for the first day of January was only 0.2 megajoules. In comparison, the probability of transmitting the virus per person in the classroom is more than 45%. But when all windows were open at maximum angles during class, the chance of transmitting the infection was reduced to 0.35%. But the energy consumption will be 36 megajoules. Therefore, school classrooms need an optimal schedule to control both functions. In this article, we will present a suitable plan for the classroom with natural ventilation through windows to control energy consumption and the possibility of infection transmission at the same time.

Keywords: Covid-19, energy consumption, building, carbon dioxide, energyplus

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Authors: Babak Sadeghi, Rony Snyders, Marie-Paule.Delplancke-Ogletree

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Nitrogen fixation (NF) is one of the crucial industrial processes. Many attempts have been made in order to artificially fix nitrogen, and among them, the Haber-Bosch’s (H-B) process is widely used. However, it presents two major drawbacks: huge fossil feedstock consumption and noticeable greenhouse gases emission. It is, therefore, necessary to develop alternatives. Plasma technology, as an inherent “green” technology, is considered to have a great potential for reducing the environmental impacts and improving the energy efficiency of the NF process. In this work, we have studied the catalyst assisted microwave plasma for NF application. Heterogeneous catalysts of MoO₃, with various loads 0, 5, 10, 20, and 30 wt%, supported on γ-alumina were prepared by conventional wet impregnation. Crystallinity, surface area, pore size, and microstructure were obtained by X-ray diffraction (XRD), Brunauer–Emmett–Teller (BET) adsorption isotherm, Scanning electron microscopy (SEM), and Transmission electron microscopy (TEM). The XRD patterns of calcined alumina confirm the γ- phase. Characteristic picks of MoO₃ could not be observed for low loads (< 20 wt%), likely indicating a high dispersion of metal oxide over the support. The specific surface area along with pores size are decreasing with increasing calcination temperature and MoO₃ loading. The MoO₃ loading does not modify the microstructure. TEM and SEM results for loading inferior to 20 wt% are coherent with a monolayer of MoO₃ on the support as proposed elsewhere. For loading of 20 wt% and more, TEM and Electron diffraction (ED) show nanocrystalline ₃-D MoO₃ particles. The catalytic performances of these catalysts were investigated in the post-discharge of a microwave plasma for NOx formation from N₂/O₂ mixtures. The plasma is sustained by a surface wave launched in a quartz tube via a surfaguide supplied by a 2.45 GHz microwave generator in pulse mode. In-situ identification and quantification of the products were carried out by Fourier-transform infrared spectroscopy (FTIR) in the post-discharge region. FTIR analysis of the exhausted gas reveal NO and NO₂ bands in presence of catalyst while only NO band were assigned without catalyst. On the other hand, in presence of catalyst, a 10% increase of NOₓ formation and of 20% increase in energy efficiency are observed.

Keywords: γ-Al2O₃-MoO₃, µ-waveplasma, N2 fixation, Plasma-catalysis, Plasma diagnostic

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Authors: M. Haruna, O. O. Onafowokan, G. Holt, K. Anderson, R. G. Middleton

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Background: Requirements for satisfactory outcomes following total hip arthroplasty (THA) include restoration of femoral offset, version, and leg length. Various techniques have been described for restoring these biomechanical parameters, with leg length restoration being the most predominantly described. We describe a “quartered head technique” (QHT) which uses a stepwise series of femoral head osteotomies to identify and preserve the centre of rotation of the femoral head during THA in order to ensure reconstruction of leg length, offset and stem version, such that hip biomechanics are restored as near to normal as possible. This study aims to identify whether using the QHT during hip arthroplasty effectively restores leg length and femoral offset to within acceptable parameters. Methods: A retrospective review of 206 hips was carried out, leaving 124 hips in the final analysis. Power analysis indicated a minimum of 37 patients required. All operations were performed using an anterolateral approach by a single surgeon. All femoral implants were cemented, collarless, polished double taper CPT® stems (Zimmer, Swindon, UK). Both cemented, and uncemented acetabular components were used (Zimmer, Swindon, UK). Leg length, version, and offset were assessed intra-operatively and reproduced using the QHT. Post-operative leg length and femoral offset were determined and compared with the contralateral native hip, and the difference was then calculated. For the determination of leg length discrepancy (LLD), we used the method described by Williamson & Reckling, which has been shown to be reproducible with a measurement error of ±1mm. As a reference, the inferior margin of the acetabular teardrop and the most prominent point of the lesser trochanter were used. A discrepancy of less than 6mm LLD was chosen as acceptable. All peri-operative radiographs were assessed by two independent observers. Results: The mean absolute post-operative difference in leg length from the contralateral leg was +3.58mm. 84% of patients (104/124) had LLD within ±6mm of the contralateral limb. The mean absolute post-operative difference in offset from contralateral leg was +3.88mm (range -15 to +9mm, median 3mm). 90% of patients (112/124) were within ±6mm offset of the contralateral limb. There was no statistical difference noted between observer measurements. Conclusion: The QHT provides a simple, inexpensive yet effective method of maintaining femoral leg length and offset during total hip arthroplasty. Combining this technique with pre-operative templating or other techniques described may enable surgeons to reduce even further the discrepancies between pre-operative state and post-operative outcome.

Keywords: leg length discrepancy, technical tip, total hip arthroplasty, operative technique

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Authors: Nayara Torres B. Acioli, José Fernando T. Jucá

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The uncontrolled emission of gases in urban residues' embankment located near urban areas is a social and environmental problem, common in Brazilian cities. Several environmental impacts in the local and global scope may be generated by atmospheric air contamination by the biogas resulted from the decomposition of solid urban materials. In Brazil, the cities of small size figure mostly with 90% of all cities, with the population smaller than 50,000 inhabitants, according to the 2011 IBGE' census, most of the landfill covering layer is composed of clayey, pure soil. The embankments undertaken with pure soil may reach up to 60% of retention of methane, for the other 40% it may be dispersed into the atmosphere. In face of this figures the oxidative covering layer is granted some space of study, envisaging to reduce this perceptual available in the atmosphere, releasing, in spite of methane, carbonic gas which is almost 20 times as less polluting than Methane. This paper exposes the results of studies on the characteristics of the soil used for the oxidative coverage layer of the experimental embankment of Solid Urban Residues (SUR), built in Muribeca-PE, Brazil, supported of the Group of Solid Residues (GSR), located at Federal University of Pernambuco, through laboratory vacuum experiments (determining the characteristics curve), granularity, and permeability, that in soil with saturation over 85% offers dramatic drops in the test of permeability to the air, by little increments of water, based in the existing Brazilian norm for this procedure. The suction was studied, as in the other tests, from the division of prospection of an oxidative coverage layer of 60cm, in the upper half (0.1 m to 0.3 m) and lower half (0.4 m to 0.6 m). Therefore, the consequences to be presented from the lixiviation of the fine materials after 5 years of finalization of the embankment, what made its permeability increase. Concerning its humidity, it is most retained in the upper part, that comprises the compound, with a difference in the order of 8 percent the superior half to inferior half, retaining the least suction from the surface. These results reveal the efficiency of the oxidative coverage layer in retaining the rain water, it has a lower cost when compared to the other types of layer, offering larger availability of this layer as an alternative for a solution for the appropriate disposal of residues.

Keywords: oxidative coverage layer, permeability, suction, saturation

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Authors: Andrew Wee

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As a result of the Italian Independence Wars starting in 1848, Italy began to change through unification. People gradually moved away from some of their traditional practices and values, such as the long-held belief that women were inferior to men, as part of the Risorgimento. Italians began to take interest in opera as a form of emotional release. As opera became more popular and prominent in their culture, it aided in the dissemination of ideas, especially stimulating the spread of imperialism, in the late 19th century, as Italy began extending its presence to other countries. In order to collect the information needed to analyze Italy’s foreign presence, it was necessary to consult texts concerning the culture of the Risorgimento. These texts included primary sources from operatic composers and contemporary recorded accounts. Letters from Giuseppe Verdi, a leader in opera during the Risorgimento, have been scrutinized for indications of popular attitudes of the time. The cultural context of the Risorgimento is essential to understanding the Italian motives and attitudes towards the outside world. On the more political side, research has also entailed the study of historical data of general laws, policies, and their purposes concerning geopolitical boundaries and foreign affairs, such as Edward Said’s thesis on Orientalism. By establishing these two characteristics of Italy, the paper will thoroughly illustrate Italy’s presence in foreign affairs. Texts have been searched with the intent of using information that reveals Italian attitudes toward exotic countries to determine whether their demeanor was positive or condescending. Motives behind sources have been interpreted in context in order to form a complete picture of the Italian sentiment towards foreigners. Additionally, research pertaining to Italian nationalism and imperialism such as song and literature has been used. The primary form of research has been the division of sources that are culturally based and those that are political in nature. Opera had always been developing since its creation in the 17th century, and in the 19th century, the bel canto movement revolutionized opera and its role in Italian society. This paper uses evidence that popular sentiment was influenced by opera to support the belief that the evolution of opera was as a result of the nationalist sentiment, and in turn fueled the cultural movement known as the Risorgimento. In this way, opera proceeded to affect Italian culture by spreading the idea of imperialism.

Keywords: opera, Italian unification, music history, imperialism

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Authors: Wafaa Kamal Isaac

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This paper attempts to shed light upon the stereotypical images of marginalized black women as shown through the poetry of Rita Dove. Meanwhile, it explores how stereotypical images held by the society and public perceptions perpetuate the marginalization of black women. Dove is considered one of the most fundamental African-American poets who devoted her writings to explore the problem of identity that confronted marginalized women in America. Besides tackling the issue of black women’s stereotypical images, this paper focuses upon the psychological damage which the black women had suffered from due to their stripped identity. In ‘Thomas and Beulah’, Dove reflects the black woman’s longing for her homeland in order to make up for her lost identity. This poem represents atavistic feelings deal with certain recurrent images, both aural and visual, like the image of Beulah who represents the African-American woman who searches for an identity, as she is being denied and humiliated one in the newly founded society. In an attempt to protest against the stereotypical mule image that had been imposed upon black women in America, Dove in ‘On the Bus with Rosa Parks’ tries to ignite the beaten spirits to struggle for their own rights by revitalizing the rebellious nature and strong determination of the historical figure ‘Rosa Parks’ that sparked the Civil Rights Movement. In ‘Daystar’, Dove proves that black women are subjected to double-edged oppression; firstly, in terms of race as a black woman in an unjust white society that violates her rights due to her black origins and secondly, in terms of gender as a member of the female sex that is meant to exist only to serve man’s needs. Similarly, in the ‘Adolescence’ series, Dove focuses on the double marginalization which the black women had experienced. It concludes that the marginalization of black women has resulted from the domination of the masculine world and the oppression of the white world. Moreover, Dove’s ‘Beauty and the Beast’ investigates the African-American women’s problem of estrangement and identity crisis in America. It also sheds light upon the psychological consequences that resulted from the violation of marginalized women’s identity. Furthermore, this poem shows the black women’s self-debasement, helplessness, and double consciousness that emanate from the sense of uprootedness. Finally, this paper finds out that the negative, debased and inferior stereotypical image held by the society did not only contribute to the marginalization of black women but also silenced and muted their voices.

Keywords: stereotypical images, marginalized women, Rita Dove, identity

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Authors: Ece Cigdem Mutlu, Burak Alakent

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Maintaining the quality of manufactured products at a desired level depends on the stability of process dispersion and location parameters and detection of perturbations in these parameters as promptly as possible. Shewhart control chart is the most widely used technique in statistical process monitoring to monitor the quality of products and control process mean and variability. In the application of Xbar control charts, sample standard deviation and sample mean are known to be the most efficient conventional estimators in determining process dispersion and location parameters, respectively, based on the assumption of independent and normally distributed datasets. On the other hand, there is no guarantee that the real-world data would be normally distributed. In the cases of estimated process parameters from Phase I data clouded with outliers, efficiency of traditional estimators is significantly reduced, and performance of Xbar charts are undesirably low, e.g. occasional outliers in the rational subgroups in Phase I data set may considerably affect the sample mean and standard deviation, resulting a serious delay in detection of inferior products in Phase II. For more efficient application of control charts, it is required to use robust estimators against contaminations, which may exist in Phase I. In the current study, we present a simple approach to construct robust Xbar control charts using average distance to the median, Qn-estimator of scale, M-estimator of scale with logistic psi-function in the estimation of process dispersion parameter, and Harrell-Davis qth quantile estimator, Hodge-Lehmann estimator and M-estimator of location with Huber psi-function and logistic psi-function in the estimation of process location parameter. Phase I efficiency of proposed estimators and Phase II performance of Xbar charts constructed from these estimators are compared with the conventional mean and standard deviation statistics both under normality and against diffuse-localized and symmetric-asymmetric contaminations using 50,000 Monte Carlo simulations on MATLAB. Consequently, it is found that robust estimators yield parameter estimates with higher efficiency against all types of contaminations, and Xbar charts constructed using robust estimators have higher power in detecting disturbances, compared to conventional methods. Additionally, utilizing individuals charts to screen outlier subgroups and employing different combination of dispersion and location estimators on subgroups and individual observations are found to improve the performance of Xbar charts.

Keywords: average run length, M-estimators, quality control, robust estimators

Procedia PDF Downloads 168

Authors: Kaushal Kishore, Suman Mukhopadhyay, Susovan Das, Manashi Adhikary, Sandip Bhattacharyya

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In integrated steel plants, conveyor belts are widely used for transferring raw materials from one location to another. An output pin bush coupling attached with a conveyor transferring iron ore fines and fluxes failed after two years of service life. This led to an operational delay of approximately 15 hours. This study is focused on failure analysis of the coupling and recommending counter-measures to prevent any such failures in the future. Investigation consisted of careful visual observation, checking of operating parameters, stress calculation and analysis, macro and micro-fractography, material characterizations like chemical and metallurgical analysis and tensile and impact testings. The fracture occurred from an unusually sharp double step. There were multiple corrosion pits near the step that aggravated the situation. Inner contact surface of the coupling revealed differential abrasion that created a macroscopic difference in the height of the component. This pointed towards misalignment of the coupling beyond a threshold limit. In addition to these design and installation issues, material of the coupling did not meet the quality standards. These were made up of grey cast iron having graphite morphology intermediate between random distribution (Type A) and rosette pattern (Type B). This manifested as a marked reduction in impact toughness and tensile strength of the component. These findings corroborated well with the brittle mode of fracture that might have occurred during minor impact loading while loading of conveyor belt with raw materials from height. Simulated study was conducted to examine the effect of corrosion pits on tensile and impact toughness of grey cast iron. It was observed that pitting marginally reduced tensile strength and ductility. However, there was marked (up to 45%) reduction in impact toughness due to pitting. Thus, it became evident that failure of the coupling occurred due to combination of factors like inferior material, misalignment, poor step design and corrosion pitting. Recommendation for life enhancement of coupling included the use of tougher SG 500/7 grade, incorporation of proper fillet radius for the step, correction of alignment and application of corrosion resistant organic coating to prevent pitting.

Keywords: brittle fracture, cast iron, coupling, double step, pitting, simulated impact tests

Procedia PDF Downloads 103

Authors: Kaltrina Kusari

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Displaced populations have received increasing attention, yet the experiences of return migrants remain largely hidden within social sciences. Existing research, albeit limited, suggests that policies which impact return migrants, especially those forced to return to their home countries, do not reflect their voices. Specifically, the United Nations Hight Commissioner for Refugees has adopted repatriation as a preferred policy solution, despite research which substantiates that returning to one’s home country is neither durable nor the end of the migration cycle; as many of 80% of returnees decide to remigrate. This one-size-fits-all approach to forced displacement does not recognize the impact of intersecting identity categories on return migration, thus failing to consider how ethnicity, gender, and class, among others, shape repatriation. To address this, this qualitative study examined the repatriation experiences of return migrant women from Kosovo and the role of social workers in facilitating return. In 2015, Kosovars constituted the fourth largest group of asylum seekers in the European Union, yet 96% of them were rejected. Additionally, since 1999 Kosovo has ranked among the top 10 countries of origin for return migrants. Considering that return migration trends are impacted by global power dynamics, this study relied on a postcolonial and transnational feminist framework to contextualize the mobility of displaced peoples in terms of globalization and conceptualize migration as a gendered process. Postcolonial and feminist theories suggest that power is partly operationalized through language, thus, Critical Discourse Analysis was used as a research methodology. CDA is concerned with examining how power, language, and discourses shape social processes and relationships of dominance. Data collection included interviews with 15 return migrant women (eight ethnic minorities and seven Albanian) and 18 service providers in Kosovo. The main findings illustrate that both returnee women and service providers rely on discourses which 1) challenge the voluntariness and sustainability of repatriation; 2) construct Kosovo as inferior to EU countries; and 3) highlight the impact of patriarchy and ethnic racism on return migration. A postcolonial transnational feminist analysis demonstrates that despite Kosovars’ challenges with repatriation, European Union countries use their power to impose repatriation as a preferred solution for Kosovo’s government. These findings add to the body of existing repatriation literature and provide important implications for how return migration might be carried out, not only in Kosovo but other countries as well.

Keywords: migration, gender, repatriation, transnational feminism

Procedia PDF Downloads 54

Authors: Abdullah Mohammadi

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Years of prolong war in Afghanistan has led to one of the largest refugee and migrant populations in the contemporary world. During this continuous unrest which began in 1970s (by military coup, Marxist revolution and the subsequent invasion of USSR), over one-third of the population migrated to neighboring countries, especially Pakistan and Iran. After the Soviet Army withdrawal in 1989, a new wave of conflicts emerged between rival Afghan groups and this led to new refugees. Taliban period, also, created its own refugees. During all these years, I.R. of Iran has been one of the main destinations of Afghan refugees and migrants. At first, due to the political situation after Islamic Revolution, Iran government didn’t restrict the entry of Afghan refugees. Those who came first in Iran received ID cards and had access to education and healthcare services. But in 1990s, due to economic and social concerns, Iran’s policy towards Afghan refugees and migrants changed. The government has tried to identify and register Afghans in Iran and limit their access to some services and jobs. Unfortunately, there are few studies on Afghan refugees and migrants’ situation in Iran and we have a dim and vague picture of them. Of the few studies done on this group, none of them focus on the illegal Afghan migrants’ situation in Iran. Here, we tried to study the social and economic aspects of illegal Afghan migrants’ living in Iran. In doing so, we interviewed 24 illegal Afghan migrants in Iran. The method applied for analyzing the data is thematic analysis. For the interviews, we chose family heads (17 men and 7 women). According to the findings, illegal Afghan migrants’ socio-economic situation in Iran is very undesirable. Its main cause is the marginalization of this group which is resulted from government policies towards Afghan migrants. Most of the illegal Afghan migrants work in unskilled and inferior jobs and live in rent houses on the margins of cities and villages. None of them could buy a house or vehicle due to law. Based on their income, they form one of the lowest, unprivileged groups in the society. Socially, they face many problems in their everyday life: social insecurity, harassment and violence, misuse of their situation by police and people, lack of education opportunity, etc. In general, we may conclude that illegal Afghan migrant have little adaptation with Iran’s society. They face severe limitations compared to legal migrants and refugees and have no opportunity for upward social mobility. However, they have managed some strategies to face these difficulties including: seeking financial and emotional helps from family and friendship networks, sending one of the family members to third country (mostly to European countries), establishing self-administered schools for children (schools which are illegal and run by Afghan educated youth).

Keywords: illegal Afghan migrants, marginalization, social insecurity, upward social mobility

Procedia PDF Downloads 295

Authors: Aylin W Sahin, Alice Jaeger, Laura Nyhan, Gregory Belt, Steffen Münch, Elke K. Arendt

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Our current food systems cause an increase in malnutrition resulting in more people being overweight or obese in the Western World. Additionally, our natural resources are under enormous pressure and the greenhouse gas emission increases yearly with a significant contribution to climate change. Hence, transforming our food systems is of highest priority. Plant-based food products have a lower environmental impact compared to their animal-based counterpart, representing a more sustainable protein source. However, most plant-based protein ingredients, such as soy and pea, are lacking indispensable amino acids and extremely limited in their functionality and, thus, in their food application potential. They are known to have a low solubility in water and change their properties during processing. The low solubility displays the biggest challenge in the development of milk alternatives leading to inferior protein content and protein quality in dairy alternatives on the market. Moreover, plant-based protein ingredients often possess an off-flavour, which makes them less attractive to consumers. EverPro, a plant-protein isolate originated from Brewer’s Spent Grain, the most abundant by-product in the brewing industry, represents the missing piece in the plant protein portfolio. With a protein content of >85%, it is of high nutritional value, including all indispensable amino acids which allows closing the protein quality gap of plant proteins. Moreover, it possesses high techno-functional properties. It is fully soluble in water (101.7 ± 2.9%), has a high fat absorption capacity (182.4 ± 1.9%), and a foaming capacity which is superior to soy protein or pea protein. This makes EverPro suitable for a vast range of food applications. Furthermore, it does not cause changes in viscosity during heating and cooling of dispersions, such as beverages. Besides its outstanding nutritional and functional characteristics, the production of EverPro has a much lower environmental impact compared to dairy or other plant protein ingredients. Life cycle assessment analysis showed that EverPro has the lowest impact on global warming compared to soy protein isolate, pea protein isolate, whey protein isolate, and egg white powder. It also contributes significantly less to freshwater eutrophication, marine eutrophication and land use compared the protein sources mentioned above. EverPro is the prime example of sustainable ingredients, and the type of plant protein the food industry was waiting for: nutritious, multi-functional, and environmentally friendly.

Keywords: plant-based protein, upcycled, brewers' spent grain, low environmental impact, highly functional ingredient

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Authors: Naima Jannat, Ariful Islam, Sharafat Hossain

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Due to the involvement of the large target volume, Craniospinal Irradiation makes it challenging to achieve a uniform dose, and it requires different isocenters. This isocentric junction needs to shift after every five fractions to overcome the possibility of hot and cold spots. This study aims to evaluate the Planning Target Volume coverage & sparing Organ at Risk between two techniques and shows that the Field Alignment Technique does not need replanning and resetting. Planning method for Craniospinal Irradiation by Eclipse treatment planning system Field Alignment and Extended Source to Surface Distance technique was developed where 36 Gy in 20 Fraction at the rate of 1.8 Gy was prescribed. The patient was immobilized in the prone position. In the Field Alignment technique, the plan consists of half beam blocked parallel opposed cranium and a single posterior cervicospine field was developed by sharing the same isocenter, which obviates divergence matching. Further, a single field was created to treat the remaining lumbosacral spine. Matching between the inferior diverging edge of the cervicospine field and the superior diverging edge of a lumbosacral field, the field alignment option was used, which automatically matches the field edge divergence as per the field alignment rule in Eclipse Treatment Planning System where the couch was set to 2700. In the Extended Source to Surface Distance technique, two parallel opposed fields were created for the cranium, and a single posterior cervicospine field was created where the Source to Surface Distance was from 120-140 cm. Dose Volume Histograms were obtained for each organ contoured and for each technique used. In all, the patient’s maximum dose to Planning Target Volume is higher for the Extended Source to Surface Distance technique to Field Alignment technique. The dose to all surrounding structures was increased with the use of a single Extended Source to Surface Distance when compared to the Field Alignment technique. The average mean dose to Eye, Brain Steam, Kidney, Oesophagus, Heart, Liver, Lung, and Ovaries were respectively (58% & 60 %), (103% & 98%), (13% & 15%), (10% & 63%), (12% & 16%), (33% & 30%), (14% & 18%), (69% & 61%) for Field Alignment and Extended Source to Surface Distance technique. However, the clinical target volume at the spine junction site received a less homogeneous dose with the Field Alignment technique as compared to Extended Source to Surface Distance. We conclude that, although the use of a single field Extended Source to Surface Distance delivered a more homogenous, but its maximum dose is higher than the Field Alignment technique. Also, a huge advantage of the Field Alignment technique for Craniospinal Irradiation is that it doesn’t need replanning and resetting up of patients after every five fractions and 95% prescribed dose was received by more than 95% of the Planning Target Volume in all the plane with the acceptable hot spot.

Keywords: craniospinalirradiation, cranium, cervicospine, immobilize, lumbosacral spine

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Authors: D. Pogliana, A. Maso, N. Milani, D. Panzin, S. Rivaroli, J. Konin

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This case aims to identify the role of movement quality during the final stage of return to sport (RTS) in a male amateur football player 13 years old after passing the acute phase of the bilateral Osgood-Schlatter disease (OSD). The patient, after a year from passing the acute phase of OSD with the abstention of physical activity, reports bilateral anterior knee pain at the beginning of the football sport activity. Interventions: After the orthopedist check, who recommended physiotherapy sessions for the correction of motor patterns and the isometric reinforcement of the muscles of the quadriceps, the rehabilitation intervention was developed in 7 weeks through 14 sessions of neuro-motor training (NMT) with a frequency of two weekly sessions and six sessions of muscle-strengthening with a frequency of one weekly session. The sessions of NMT were carried out through free body exercises (or with overloads) with visual bio-feedback with the help of two cameras (one with anterior vision and one with lateral vision of the subject) and a big touch screen. The aim of these sessions of NMT was to modify the dysfunctional motor patterns evaluated by the 2D motion analysis test. The test was carried out at the beginning and at the end of the rehabilitation course and included five movements: single-leg squat (SLS), drop jump (DJ), single-leg hop (SLH), lateral shuffle (LS), and change of direction (COD). Each of these movements was evaluated through the video analysis of dynamic valgus knee, pelvic tilt, trunk control, shock absorption, and motor strategy. A free image analysis software (Kinovea) was then used to calculate scores. Results: Baseline assessment of the subject showed a total score of 59% on the right limb and 64% on the left limb (considering an optimal score above 85%) with large deficits in shock absorption capabilities, the presence of dynamic valgus knee, and dysfunctional motor strategies defined “quadriceps dominant.” After six weeks of training, the subject achieved a total score of 80% on the right limb and 86% on the left limb, with significant improvements in shock absorption capabilities, the presence of dynamic knee valgus, and the employment of more hip-oriented motor strategies on both lower limbs. The improvements shown in dynamic knee valgus, greater hip-oriented motor strategies, and improved shock absorption identified through six weeks of the NMT program can help a teenager amateur football player to manage the anterior knee pain during sports activity. In conclusion, NMT was a good choice to help a 13 years old male amateur football player to return to performance without pain after OSD and can also be used with all this type of athletes of the other teams' sports.

Keywords: movement analysis, neuro-motor training, knee pain, movement strategies

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Authors: Laura Kupers, Julie Piérard, Niki Cauberg

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The use of exposed concrete (sometimes referred to as architectural concrete), keeps gaining popularity. Exposed concrete has the advantage to combine the structural properties of concrete with an aesthetic finish. However, for a successful aesthetic finish, much attention needs to be paid to the execution (formwork, release agent, curing, weather conditions…), the concrete composition (choice of the raw materials and mix proportions) as well as to its fresh properties. For the latter, a simple on-site pass/fail test could halt the casting of concrete not suitable for architectural concrete and thus avoid expensive repairs later. When architects opt for an exposed concrete, they usually want a smooth, uniform and nearly blemish-free surface. For this choice, a standard ‘construction’ concrete does not suffice. An aesthetic surface finishing requires the concrete to contain a minimum content of fines to minimize the risk of segregation and to allow complete filling of more complex shaped formworks. The concrete may neither be too viscous as this makes it more difficult to compact and it increases the risk of blow holes blemishing the surface. On the other hand, too much bleeding may cause color differences on the concrete surface. An easy pass/fail test, which can be performed on the site just before the casting, could avoid these problems. In case the fresh concrete fails the test, the concrete can be rejected. Only in case the fresh concrete passes the test, the concrete would be cast. The pass/fail tests are intended for a concrete with a consistency class S4. Five tests were selected as possible onsite pass/fail test. Two of these tests already exist: the K-slump test (ASTM C1362) and the Bauer Filter Press Test. The remaining three tests were developed by the BBRI in order to test the segregation resistance of fresh concrete on site: the ‘dynamic sieve stability test’, the ‘inverted cone test’ and an adapted ‘visual stability index’ (VSI) for the slump and flow test. These tests were inspired by existing tests for self-compacting concrete, for which the segregation resistance is of great importance. The suitability of the fresh concrete mixtures was also tested by means of a laboratory reference test (resistance to segregation) and by visual inspection (blow holes, structure…) of small test walls. More than fifteen concrete mixtures of different quality were tested. The results of the pass/fail tests were compared with the results of this laboratory reference test and the test walls. The preliminary laboratory results indicate that concrete mixtures ‘suitable’ for placing as exposed concrete (containing sufficient fines, a balanced grading curve etc.) can be distinguished from ‘inferior’ concrete mixtures. Additional laboratory tests, as well as tests on site, will be conducted to confirm these preliminary results and to set appropriate pass/fail values.

Keywords: exposed concrete, testing fresh concrete, segregation resistance, bleeding, consistency

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Authors: Qing Wu, Xuchun Ye, Kirsten Corazzini

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Objective: It is increasingly recognized that patients’ rational and meaningful engagement in healthcare could make important contributions to their health care and safety management. However, recent evidence indicated that patients' actual roles in healthcare didn’t match their desired roles, and many patients reported a less active role than desired, which suggested that patient engagement in healthcare may be influenced by various factors. This study aimed to analyze influencing factors on patient engagement and explore the influence mechanism, which will be expected to contribute to the strategy development of patient engagement in healthcare. Methods: On the basis of analyzing the literature and theory study, the research framework was developed. According to the research framework, a cross-sectional survey was employed using the behavior and willingness of patient engagement in healthcare questionnaire, Chinese version All Aspects of Health Literacy Scale, Facilitation of Patient Involvement Scale and Wake Forest Physician Trust Scale, and other influencing factor related scales. A convenience sample of 580 patients was recruited from 8 general hospitals in Shanghai, Jiangsu Province, and Zhejiang Province. Results: The results of the cross-sectional survey indicated that the mean score for the patient engagement behavior was (4.146 ± 0.496), and the mean score for the willingness was (4.387 ± 0.459). The level of patient engagement behavior was inferior to their willingness to be involved in healthcare (t = 14.928, P ＜ 0.01). The influencing mechanism model of patient engagement in healthcare was constructed by the path analysis. The path analysis revealed that patient attitude toward engagement, patients’ perception of facilitation of patient engagement and health literacy played direct prediction on the patients’ willingness of engagement, and standard estimated values of path coefficient were 0.341, 0.199, 0.291, respectively. Patients’ trust in physician and the willingness of engagement played direct prediction on the patient engagement, and standard estimated values of path coefficient were 0.211, 0.641, respectively. Patient attitude toward engagement, patients’ perception of facilitation and health literacy played indirect prediction on patient engagement, and standard estimated values of path coefficient were 0.219, 0.128, 0.187, respectively. Conclusions: Patients engagement behavior did not match their willingness to be involved in healthcare. The influencing mechanism model of patient engagement in healthcare was constructed. Patient attitude toward engagement, patients’ perception of facilitation of engagement and health literacy posed indirect positive influence on patient engagement through the patients’ willingness of engagement. Patients’ trust in physician and the willingness of engagement had direct positive influence on the patient engagement. Patient attitude toward engagement, patients’ perception of physician facilitation of engagement and health literacy were the factors influencing the patients’ willingness of engagement. The results of this study provided valuable evidence on guiding the development of strategies for promoting patient rational and meaningful engagement in healthcare.

Keywords: healthcare, patient engagement, influencing factor, the mechanism

Procedia PDF Downloads 127

Authors: Tin Yee Ling, Kavita Maravar, Ruzica Ardalic

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Background: Uterine torsion (UT) in pregnancy of more than 45-degree along the longitudinal axis is a rare occurrence, and the aetiology remains unclear. Case: A 34-year-old G2P1 woman with a history of one previous caesarean section presented at 36+2 weeks with sudden onset lower abdominal pain, syncopal episode, and tender abdomen on examination. She was otherwise haemodynamically stable. Cardiotocography showed a pathological trace with initial prolonged bradycardia followed by a subsequent tachycardia with reduced variability. An initial diagnosis of uterine dehiscence was made, given the history and clinical presentation. She underwent an emergency caesarean section which revealed a 180-degree UT along the longitudinal axis, with oedematous left round ligament lying transverse anterior to the uterus and a segment of large bowel inferior to the round ligament. Detorsion of uterus was performed prior to delivery of the foetus, and anterior uterine wall was intact with no signs of rupture. There were no anatomical uterine abnormalities found other than stretched left ovarian and round ligaments, which were repaired. Delivery was otherwise uneventful, and she was discharged on day 2 postpartum. Discussion: UT is rare as the number of reported cases is within the few hundreds worldwide. Generally, the uterus is supported in place by uterine ligaments, which limit the mobility of the structure. The causes of UT are unknown, but risk factors such as uterine abnormalities, increased uterine ligaments’ flexibility in pregnancy, and foetal malposition has been identified. UT causes occlusion of uterine vessels, which can lead to ischaemic injury of the placenta causing premature separation of the placenta, preterm labour, and foetal morbidity and mortality if delivery is delayed. Diagnosing UT clinically is difficult as most women present with symptoms similar to placenta abruption or uterine rupture (abdominal pain, vaginal bleeding, shock), and one-third are asymptomatic. The management of UT involves surgical detorsion of the uterus and delivery of foetus via caesarean section. Extra vigilance should be taken to identify the anatomy of the uterus experiencing torsion prior to hysterotomy. There have been a few cases reported with hysterotomy on posterior uterine wall for delivery of foetus as it may be difficult to identify and reverse a gravid UT when foetal well-being is at stake. Conclusion: UT should be considered a differential diagnosis of acute abdominal pain in pregnancy. It is crucial that the torsion is addressed immediately as it is associated with maternal and foetal morbidity and mortality.

Keywords: uterine torsion, pregnancy complication, abdominal pain, torted uterus

Procedia PDF Downloads 127

Authors: Prateek Bhattacharya

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The definition of 'control' in India is a rapidly evolving concept, owing to varying rights attached to varying securities. Shares with differential voting rights (DVRs) provide the holder with differential rights as to voting, as compared to ordinary equity shareholders of the company. Such DVRs can amount to both superior voting rights and inferior voting rights, where DVRs with superior voting rights amount to providing the holder with golden shares in the company. While DVRs are not a novel concept in India having been recognized since 2000, they were placed on a back burner by the Securities and Exchange Board of India (SEBI) in 2010 after issuance of DVRs with superior voting rights was restricted. In June 2019, the SEBI rekindled the ebbing fire of DVRs, keeping mind the fast-paced nature of the global economy, the government's faith that India’s ‘new age technology companies’ (i.e., Start-Ups) will lead the charge in achieving its goal of India becoming a $5 trillion dollar economy by 2024, and recognizing that the promoters of such Start-Ups seek to raise capital without losing control over their companies. DVRs with superior voting rights guarantee promoters with up to 74% shareholding in Start-Ups for a period of 5 years, meaning that the holder of such DVRs can exercise sole control and material influence over the company for that period. This manner of control has the potential of causing both pro-competitive and anti-competitive effects in the markets where these companies operate. On the one hand, DVRs will allow Start-Up promoters/founders to retain control of their companies and protect its business interests from foreign elements such as private/public investors – in a scenario where such investors have multiple investments in firms engaged in associated lines of business (whether on a horizontal or vertical level) and would seek to influence these firms to enter into potential anti-competitive arrangements with one another, DVRs will enable the promoters to thwart such scenarios. On the other hand, promoters/founders who themselves have multiple investments in Start-Ups, which are in associated lines of business run the risk of influencing these associated Start-Ups to engage in potentially anti-competitive arrangements in the name of profit maximisation. This paper shall be divided into three parts: Part I shall deal with the concept of ‘control’, as deliberated upon and decided by the SEBI and the Competition Commission of India (CCI) under both company/securities law and competition law; Part II shall review this definition of ‘control’ through the lens of DVRs, and Part III shall discuss the aforementioned potential pro-competitive and anti-competitive effects caused by the DVRs by examining the current Indian Start-Up scenario. The paper shall conclude by providing suggestions for the CCI to incorporate a clearer and more progressive concept of ‘control’.

Keywords: competition law, competitive effects, control, differential voting rights, DVRs, investor shareholding, merger control, start-ups

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Authors: Taurino S. R. Neto, Epitácio D. S. Neto, Flávio Signorelli, Gustavo G. M. Balbi, Alex H. Higashi, Mário Luiz R. Monteiro, Eloisa Bonfá, Danieli C. O. Andrade, Leandro C. Zacharias

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Purpose: To perform a multimodal evaluation, including the use of Optical Coherence Angiotomography (OCTA), in patients with primary antiphospholipid syndrome (PAPS) without ocular complaints and to compare them with healthy individuals. Methods: A complete structural and functional ophthalmological evaluation using OCTA and microperimetry (MP) exam in patients with PAPS, followed at a tertiary rheumatology outpatient clinic, was performed. All ophthalmologic manifestations were recorded and then statistical analysis was performed for comparative purposes; p <0.05 was considered statistically significant. Results: 104 eyes of 52 subjects (26 patients with PAPS without ocular complaints and 26 healthy individuals) were included. Among PAPS patients, 21 were female (80.8%) and 21 (80.8%) were Caucasians. Thrombotic PAPS was the main clinical criteria manifestation (100%); 65.4% had venous and 34.6% had arterial thrombosis. Obstetrical criteria were present in 34.6% of all thrombotic PAPS patients. Lupus anticoagulant was present in all patients. 19.2% of PAPS patients presented ophthalmologic findings against none of the healthy individuals. The most common retinal change was paracentral acute middle maculopathy (PAMM) (3 patients, 5 eyes), followed by drusen-like deposits (1 patient, 2 eyes) and pachychoroid pigment epitheliopathy (1 patient, 1 eye). Systemic hypertension and hyperlipidaemia were present in 100% of the PAPS patients with PAMM, while only six patients (26.1%) with PAPS without PAMM presented these two risk factors together. In the quantitative OCTA evaluation, we found significant differences between PAPS patients and controls in both the superficial vascular complex (SVC) and deep vascular complex (DVC) in the high-speed protocol, as well as in the SVC in the high-resolution protocol. In the analysis of the foveal avascular zone (FAZ) parameters, the PAPS group had a larger area of FAZ in the DVC using the high-speed method compared to the control group (p=0.047). In the quantitative analysis of the MP, the PAPS group had lower central (p=0.041) and global (p<0.001) retinal sensitivity compared to the control group, as well as in the sector analysis, with the exception of the inferior sector. In the quantitative evaluation of fixation stability, there was a trend towards worse stability in the PAPS subgroup with PAMM in both studied methods. Conclusions: PAMM was observed in 11.5% of PAPS patients with no previous ocular complaints. Systemic hypertension concomitant with hyperlipidemia was the most commonly associated risk factor for PAMM in patients with PAPS. PAPS patients present lower vascular density and retinal sensitivity compared to the control group, even in patients without PAMM.

Keywords: antiphospholipid syndrome, optical coherence angio tomography, optical coherence tomography, retina

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Authors: Ngoc Nguyen

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There is large plantation of Eucalyptus globulus established which has been grown to produce pulpwood. This resource is not suitable for the production of decorative products, principally due to low grades of wood and “dull” appearance but many trials have been already undertaken for the production of veneer and veneer-based engineered wood products, such as plywood and laminated veneer lumber (LVL). The manufacture of veneer-based products has been recently identified as an unprecedented opportunity to promote higher value utilisation of plantation resources. However, many uncertainties remain regarding the impacts of inferior wood quality of young plantation trees on product recovery and value, and with respect to optimal processing techniques. Moreover, the quality of veneer and veneer-based products is far from optimal as trees are young and have small diameters; and the veneers have the significant colour variation which affects to the added value of final products. Developing production methods which would enhance appearance of low-quality veneer would provide a great potential for the production of high-value wood products such as furniture, joinery, flooring and other appearance products. One of the methods of enhancing appearance of low quality veneer, developed in Italy, involves the production of multilaminar veneer, also named “reconstructed veneer”. An important stage of the multilaminar production is colouring the veneer which can be achieved by dyeing veneer with dyes of different colours depending on the type of appearance products, their design and market demand. Although veneer dyeing technology has been well advanced in Italy, it has been focused on poplar veneer from plantation which wood is characterized by low density, even colour, small amount of defects and high permeability. Conversely, the majority of plantation eucalypts have medium to high density, have a lot of defects, uneven colour and low permeability. Therefore, detailed study is required to develop dyeing methods suitable for colouring eucalypt veneers. Brown reactive dye is used for veneer colouring process. Veneers from sapwood and heartwood of two moisture content levels are used to conduct colouring experiments: green veneer and veneer dried to 12% MC. Prior to dyeing, all samples are treated. Both soaking (dipping) and vacuum pressure methods are used in the study to compare the results and select most efficient method for veneer dyeing. To date, the results of colour measurements by CIELAB colour system showed significant differences in the colour of the undyed veneers produced from heartwood part. The colour became moderately darker with increasing of Sodium chloride, compared to control samples according to the colour measurements. It is difficult to conclude a suitable dye solution used in the experiments at this stage as the variables such as dye concentration, dyeing temperature or dyeing time have not been done. The dye will be used with and without UV absorbent after all trials are completed using optimal parameters in colouring veneers.

Keywords: Eucalyptus globulus, veneer colouring/dyeing, multilaminar veneer, reactive dye

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Authors: Ryan A. Black, Stacey A. McCaffrey

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Over the past few decades, great strides have been made towards improving the science in the measurement of psychological constructs. Item Response Theory (IRT) has been the foundation upon which statistical models have been derived to increase both precision and accuracy in psychological measurement. These models are now being used widely to develop and refine tests intended to measure an individual's level of academic achievement, aptitude, and intelligence. Recently, the field of clinical psychology has adopted IRT models to measure psychopathological phenomena such as depression, anxiety, and addiction. Because advances in IRT measurement models are being made so rapidly across various fields, it has become quite challenging for psychologists and other behavioral scientists to keep abreast of the most recent developments, much less learn how to employ and decide which models are the most appropriate to use in their line of work. In the same vein, IRT measurement models vary greatly in complexity in several interrelated ways including but not limited to the number of item-specific parameters estimated in a given model, the function which links the expected response and the predictor, response option formats, as well as dimensionality. As a result, inferior methods (a.k.a. Classical Test Theory methods) continue to be employed in efforts to measure psychological constructs, despite evidence showing that IRT methods yield more precise and accurate measurement. To increase the use of IRT methods, this study endeavors to provide a comprehensive overview of binary IRT models; that is, measurement models employed on test data consisting of binary response options (e.g., correct/incorrect, true/false, agree/disagree). Specifically, this study will cover the most basic binary IRT model, known as the 1-parameter logistic (1-PL) model dating back to over 50 years ago, up until the most recent complex, 4-parameter logistic (4-PL) model. Binary IRT models will be defined mathematically and the interpretation of each parameter will be provided. Next, all four binary IRT models will be employed on two sets of data: 1. Simulated data of N=500,000 subjects who responded to four dichotomous items and 2. A pilot analysis of real-world data collected from a sample of approximately 770 subjects who responded to four self-report dichotomous items pertaining to emotional consequences to alcohol use. Real-world data were based on responses collected on items administered to subjects as part of a scale-development study (NIDA Grant No. R44 DA023322). IRT analyses conducted on both the simulated data and analyses of real-world pilot will provide a clear demonstration of how to construct, evaluate, and compare binary IRT measurement models. All analyses will be performed using the new IRT procedure in SAS 9.4. SAS code to generate simulated data and analyses will be available upon request to allow for replication of results.

Keywords: instrument development, item response theory, latent trait theory, psychometrics

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Authors: Nurgul A. Abenova, Gaukhar S. Dilmagambetova, Lazzat M. Zhamaliyeva

Abstract:

Professionalism is a core competency that all medical students must achieve throughout their studies. Clinical knowledge, good communication skills and an understanding of ethics form the basis of professionalism. Patients, medical societies and accrediting organizations expect future specialists to be professionals in their field, which in turn leads to the best clinical results. Currently, there are no studies devoted to the study of medical professionalism in the Republic of Kazakhstan. As a result, medical education in the Kazakhstani system has a limited perception of the concept of professionalism compared to many Western medical schools. Thus, the primary purpose of this study is to analyze the perception of medical professionalism among residents and teachers of family medicine at the West Kazakhstan Marat Ospanov Medical University. А qualitative research method was used based on the content analysis methodology. A focus group discussion was held with 60 residents and 12 family medicine teachers to gather participants' views and experiences in the field of medical professionalism. The received information was processed using the MAXQDA-2020 software package. Respondents were selected for the study based on their age, gender, and educational level. The results of the conducted survey confirmed the respondents’ acknowledgment of the basic attributes of professionalism, such as medical knowledge and skills (more than 40% of the answers), personal and moral qualities of the doctor (more than 25% of the answers), respect for the interests of the patient (15% of the answers), the relationship between the doctor and the patient and among professionals themselves (15% of responses). Another important discovery of the survey was that residents are five times more likely to define the relationship between a doctor and a patient in a model “respect for the interests of the patient” in comparison with teachers of family medicine, who primarily reported responsibility and collegiality to be the basis for the development of professionalism and traditionally view doctor-patient relationship to be formed on the basis of paternalism defined by a high degree of control over patients. This significant difference demonstrates a rift among specialists in the field of family medicine, which causes a lot of problems. For example, nowadays, professional family doctors regularly face burnout problem due to many reasons and factors that force them to abandon their jobs. In addition to that, elements of professionalism such as reflective skills, time management and feedback collection were presented to the least extent (less than 1%) by both groups, which differs from the perception of the Western medical school and is a significant issue that needs to be solved. The qualitative nature of our study provides a detailed understanding of medical professionalism in the context of the Central Asian healthcare system, revealing many aspects that are inferior to the Western medical school counterparts and provides a solution, which is to teach the attributes and skills required for medical professionalism at all stages of medical education of family doctors.

Keywords: family medicine, family doctors, medical professionalism, medical education

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