Search results for: intra arricular distal humerus fracture

Authors: Pahirangan Sivapatham, Barbara Esser, Andreas Grimmel

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In times of limited public funds and, in particular, an increased social, environmental awareness, as well as the limited availability of construction materials, sustainable and resource-saving pavement management system, is becoming more and more important. Therefore, the knowledge about the condition of the structural substances, particularly bearing capacity and its consideration while planning the maintenance measures of the subordinate network, i.e., state and municipal roads unavoidable. According to the experience, the recommended ride speed of the Traffic Speed Deflectometer (TSD) shall be higher than 40 km/h. Holding of this speed on the intra-urban roads is nearly not possible because of intersections and traffic lights as well as the speed limit. A sufficient background of experience for the evaluation of bearing capacity measurements with TSD in the range of lower speeds is not available yet. The aim of this study is to determine the possible lowest ride speed of the TSD while the bearing capacity measurement on the intra-urban roads. The manufacturer of the TSD used in this study states that the measurements can be conducted at a ride speed of higher than 5 km/h. It is well known that with decreasing ride speed, the viscous fractions in the response of the asphalt pavement increase. This must be taken into account when evaluating the bearing capacity data. In the scope of this study, several measurements were carried out at different speeds between 10 km/h and 60 km/h on the selected intra-urban roads with Pavement-Scanner of the University of Wuppertal, which is equipped with TSD. Pavement-Scanner is able to continuously determine the deflections of asphalt roads in flowing traffic at speeds of up to 80 km/h. The raw data is then aggregated to 10 m mean values so that, as a rule, a bearing capacity characteristic value can be determined for each 10 m road section. By means of analysing of obtained test results, the quality and validity of the determined data rate subject to the riding speed of TSD have been determined. Moreover, the data and pictures of the additional measuring systems of Pavement-Scanners such as High-Speed Road Monitor, Ground Penetration Radar and front cameras can be used to determine and eliminate irregularities in the pavement, which could influence the bearing capacity.

Keywords: bearing capacity measurement, traffic speed deflectometer, inter-urban roads, Pavement-Scanner, structural substance

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Authors: Behzad Behnia, Noah LaRussa-Trott

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In recent years, fibers have been successfully used as an additive to reinforce asphalt concrete materials and to enhance the sustainability and resiliency of transportation infrastructure. Roads covered with fiber-reinforced asphalt concrete (FRAC) require less frequent maintenance and tend to have a longer lifespan. The present work investigates the application of sasobit-coated aramid fibers in asphalt pavements and employs machine learning to develop prediction models to evaluate the cracking performance of FRAC materials. For the experimental part of the study, the effects of several important parameters such as fiber content, fiber length, and testing temperature on fracture characteristics of FRAC mixtures were thoroughly investigated. Two mechanical performance tests, i.e., the disk-shaped compact tension [DC(T)] and indirect tensile [ID(T)] strength tests, as well as the non-destructive acoustic emission test, were utilized to experimentally measure the cracking behavior of the FRAC material in both macro and micro level, respectively. The experimental results were used to train the supervised machine learning approach in order to establish prediction models for fracture performance of the FRAC mixtures in the field. Experimental results demonstrated that adding fibers improved the overall fracture performance of asphalt concrete materials by increasing their fracture energy, tensile strength and lowering their 'embrittlement temperature'. FRAC mixtures containing long-size fibers exhibited better cracking performance than regular-size fiber mixtures. The developed prediction models of this study could be easily employed by pavement engineers in the assessment of the FRAC pavements.

Keywords: fiber reinforced asphalt concrete, machine learning, cracking performance tests, prediction model

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Authors: Alok Srivastava, Vidit Gupta, Aparna Singh, Chandra Sekher Yerramalli

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Carbon-fiber epoxy composites show extremely high modulus and strength in the uniaxial direction. However, they are prone to fail under low load in transverse direction due to the weak nature of the interface between the carbon-fiber and epoxy. In the current study, we have coated graphene nano-platelets (GNPs) on the carbon-fibers in an attempt to strengthen the interface/interphase between the fiber and the matrix. Vacuum Assisted Resin Transfer Moulding (VARTM) has been used to make the laminates of eight cross-woven fabrics. Tensile, flexural and fracture toughness tests have been performed on pristine carbon-fiber composite (P-CF), GNP coated carbon-fiber composite (GNP-CF) and functionalized-GNP coated carbon-fiber composite (F-GNP-CF). The tensile strength and flexural strength values are pretty similar for P-CF and GNP-CF. The micro-structural examination of the GNP coated carbon-fibers, as well as the fracture surfaces, have been carried out using scanning electron microscopy (SEM). The micrographs reveal the deposition of GNPs onto the carbon fibers in transverse and longitudinal direction. Fracture surfaces show the debonding and pull outs of the carbon fibers in P-CF and GNP-CF samples.

Keywords: carbon fiber, graphene nanoplatelets, strength, VARTM, Vacuum Assisted Resin Transfer Moulding

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Authors: Rajendra Kumar Kanojia

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Background; Massive bone gaps are common following road side accidents and injury to the tibia, specially open grade three fractures. It has been seen that the diaphyseal fractures in the tibia are prone to non-union, there are certain reasons known very well, like less soft tissues around the lower third tibia, less vascularity, less options of fixation of the fractures after trauma and prolonged surgical time, operation theatre time and special surgical means. Aim of study; To know the suitability of the ilizarov ring fixators in staged treatment of the fracture of the both bones leg, including tibia, we wish to see the role of ilizarov in management of open grade three fractures which have been operated and debrided, for getting the length use of ilizaorv ring in a tertiary canter is the aim of the study.

Keywords: open fracture, staged management, ilizarov, bone grafting, lengthening

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Authors: Neerja Gupta

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Objective-Reconstruction of large cavities of the breast without contralateral symmetrisation Background- Reconstruction of breast includes a wide spectrum of procedures from displacement to regional and distant flaps. The pedicled Perforator flaps cover a wide spectrum of reconstruction surgery for all quadrants of the breast, especially in patients with comorbidities. These axial flaps singly or adjunct are based on a near constant perforator vessel, a ratio of 2:1 at its entry in a flap is good to maintain vascularity. The perforators of lateral chest wall viz LICAP, LTAP have overlapping perfurosomes without clear demarcation. LTAP is localized in the narrow zone between the lateral breast fold and anterior axillary line,2.5-3.8cm from the fold. MICAP are localized at 1-2 cm from sternum. Being 1-2mm in diameter, a Single perforator is good to maintain the flap. LICAP has a dominant perforator in 6th-11th spaces, while LTAP has higher placed dominant perforators in 4th and 5th spaces. Methodology-Six consecutive patients who underwent reconstruction of the breast with pedicled perforator flaps were retrospectively analysed. Selections of the flap was done based on the size and locations of the tumour, anticipated volume loss, willingness to undergo contralateral symmetrisation, cosmetic expectations, and finances available.3 patients underwent vertical LTAP, the distal limit of the flap being the inframammary crease. 3 patients underwent MICAP, oriented along the axis of rib, the distal limit being the anterior axillary line. Preoperative identification was done using a unidirectional hand held doppler. The flap was raised caudal to cranial, the pivot point of rotation being the vessel entry into the skin. The donor area is determined by the skin pinch. Flap harvest time was 20-25 minutes. Intra operative vascularity was assessed with dermal bleed. The patient immediate pre, post-operative and follow up pics were compared independently by two breast surgeons. Patients were given a breast Q questionnaire (licensed) for scoring. Results-The median age of six patients was 46. Each patient had a hospital stay of 24 hours. None of the patients was willing for contralateral symmetrisation. The specimen dimensions were from 8x6.8x4 cm to 19x16x9 cm. The breast volume reconstructed range was 30 percent to 45 percent. All wide excision had free margins on frozen. The mean flap dimensions were 12x5x4.5 cm. One LTAP underwent marginal necrosis and delayed wound healing due to seroma. Three patients were phyllodes, of which one was borderline, and 2 were benign on final histopathology. All other 3 patients were invasive ductal cancer and have completed their radiation. The median follow up is 7 months the satisfaction scores at median follow of 7 months are 90 for physical wellbeing and 85 for surgical results. Surgeons scored fair to good in Harvard score. Conclusion- Pedicled perforator flaps are a valuable option for 3/8th volume of breast defects. LTAP is preferred for tumours at the Central, upper, and outer quadrants of the breast and MICAP for the inner and lower quadrant. The vascularity of the flap is dependent on the angiosomalterritories; adequate venous and cavity drainage.

Keywords: breast, oncoplasty, pedicled, perforator

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Authors: Aboozar Aghaei

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In the present work, the dissimilar Monel400 and SS316 were joined by friction stir welding (FSW). The applied rotating speed was 400 rpm, whereas the traverse speed varied between 50 and 150 mm/min. At a constant rotating speed, the sound welds were obtained at the welding speeds of 50 and 100 mm/min. However, a groove-like defect was formed when the welding speed exceeded 100 mm/min. The mechanical properties of the joints were evaluated using tensile and fatigue tests. The fatigue strength of dissimilar FSWed specimen was higher than that of both Monel400 and SS316. To study the failure behavior of FSWed specimens, the fracture surfaces were analyzed using scanning electron microscope (SEM). The failure analysis indicates that different mechanisms may contribute to the fracture of welds. This was attributed to the dissimilar characteristics of dissimilar materials exhibiting different failure behaviors.

Keywords: mechanical properties, stainless steel, frictions, monel

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Authors: Peter Park, Alfonso Ayala, Douglas Saeks, Jordan Miller, Carmen Flores, Karen Nelson

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Introduction Hip fractures account for more than 300,000 hospital admissions every year. Many present as fragility fractures in geriatric patients with multiple medical comorbidities. Standardized protocols for the multidisciplinary management of this patient population have been shown to improve patient outcomes. A hip fracture protocol was implemented at a Level I Trauma center with a focus on pre-operative medical optimization and early surgical care. This study evaluates the efficacy of that protocol, including the early transition period. Methods A retrospective review was performed of all patients ages 60 and older with isolated hip fractures who were managed surgically between 2020 and 2022. This included patients 1 year prior and 1 year following the implementation of a hip fracture protocol at a Level I Trauma center. Results 530 patients were identified: 249 patients were treated before, and 281 patients were treated after the protocol was instituted. There was no difference in mean age (p=0.35), gender (p=0.3), or Charlson Comorbidity Index (p=0.38) between the cohorts. Following the implementation of the protocol, there were observed increases in time to surgery (27.5h vs. 33.8h, p=0.01), hospital length of stay (6.3d vs. 9.7d, p<0.001), and ED LOS (5.1h vs. 6.2h, p<0.001). There were no differences in in-hospital mortality (2.01% pre vs. 3.20% post, p=0.39) and complication rates (25% pre vs 26% post, p=0.76). A trend towards improved outcomes was seen after the early transition period but failed to yield statistical significance. Conclusion Early medical management and surgical intervention are key determining factors affecting outcomes following fragility hip fractures. The implementation of a hip fracture protocol at this institution has not yet significantly affected these parameters. This could in part be due to the restrictions placed at this institution during the COVID-19 pandemic. Despite this, the time to OR pre-and post-implementation was quicker than figures reported elsewhere in literature. Further longitudinal data will be collected to determine the final influence of this protocol. Significance/Clinical Relevance Given the increasing number of elderly people and the high morbidity and mortality associated with hip fractures in this population finding cost effective ways to improve outcomes in the management of these injuries has the potential to have enormous positive impact for both patients and hospital systems.

Keywords: hip fracture, geriatric, treatment algorithm, preoperative optimization

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Authors: John Paul Q. Tomas, Mark Wilson L. de los Reyes, Kirsten Joyce P. Vasquez

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The most frequent type of fracture is a wrist fracture, which often makes it difficult for medical professionals to find and locate. In this study, fractures in wrist x-ray pictures were located and identified using deep learning and computer vision. The researchers used image filtering, masking, morphological operations, and data augmentation for the image preprocessing and trained the RetinaNet and Faster R-CNN models with ResNet50 backbones and Adam optimizers separately for each image filtering technique and projection. The RetinaNet model with Anisotropic Diffusion Smoothing filter trained with 50 epochs has obtained the greatest accuracy of 99.14%, precision of 100%, sensitivity/recall of 98.41%, specificity of 100%, and an IoU score of 56.44% for the Posteroanterior projection utilizing augmented data. For the Lateral projection using augmented data, the RetinaNet model with an Anisotropic Diffusion filter trained with 50 epochs has produced the highest accuracy of 98.40%, precision of 98.36%, sensitivity/recall of 98.36%, specificity of 98.43%, and an IoU score of 58.69%. When comparing the test results of the different individual projections, models, and image filtering techniques, the Anisotropic Diffusion filter trained with 50 epochs has produced the best classification and regression scores for both projections.

Keywords: Artificial Intelligence, Computer Vision, Wrist Fracture, Deep Learning

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Authors: B. L. Avanthi Isaka, P. G. Ranjith

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The development of technically-sound enhanced geothermal systems (EGSs) is identified as a viable solution for world growing energy demand with immense potential, low carbon dioxide emission and importantly, as an environmentally friendly option for renewable energy production. The use of supercritical carbon dioxide (ScCO₂) as the working fluid in EGSs by replacing traditional water-based method is promising due to multiple advantages prevail in ScCO₂-injection for underground reservoir stimulation. The evolution of reservoir stimulation using ScCO₂ and the understanding of the flow behavior of a ScCO₂-stimulated geothermal reservoir is vital in applying ScCO₂-EGSs as a replacement for water-based EGSs. The study is therefore aimed to investigate the flow behavior of a ScCO₂-fractured rock medium at in-situ stress and temperature conditions. A series of permeability tests were conducted for ScCO₂ fractured Harcourt granite rock specimens at 90ºC, under varying confining pressures from 5–60 MPa using the high-pressure and high-temperature tri-axial set up which can simulate deep geological conditions. The permeability of the ScCO₂-fractured rock specimens was compared with that of water-fractured rock specimens. The results show that the permeability of the ScCO₂-fractured rock specimens is one order higher than that of water-fractured rock specimens and the permeability exhibits a non-linear reduction with increasing confining pressure due to the stress-induced fracture closure. Further, the enhanced permeability of the ScCO₂-induced fracture with multiple secondary branches was explained by exploring the CT images of the rock specimens. However, a single plain fracture was induced under water-based fracturing.

Keywords: supercritical carbon dioxide, fracture permeability, granite, enhanced geothermal systems

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Authors: Mohammad Reza Zamani Kouhpanji

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Characterizing the fatigue and fracture properties of nanostructures is one of the most challenging tasks in nanoscience and nanotechnology due to lack of a MEMS/NEMS device for generating uniform cyclic loadings at high frequencies. Here, the dynamic response of a recently proposed MEMS/NEMS device under different inputs signals is completely investigated. This MEMS/NEMS device is designed and modeled based on the electromagnetic force induced between paired parallel wires carrying electrical currents, known as Ampere’s Force Law (AFL). Since this MEMS/NEMS device only uses two paired wires for actuation part and sensing part, it represents highly sensitive and linear response for nanostructures with any stiffness and shapes (single or arrays of nanowires, nanotubes, nanosheets or nanowalls). In addition to studying the maximum gains at different resonance frequencies of the MEMS/NEMS device, its dynamical responses are investigated for different inputs and nanostructure properties to demonstrate the capability, usability, and reliability of the device for wide range of nanostructures. This MEMS/NEMS device can be readily integrated into SEM/TEM instruments to provide real time study of the fatigue and fracture properties of nanostructures as well as their softening or hardening behaviors, and initiation and/or propagation of nanocracks in them.

Keywords: MEMS/NEMS devices, paired wire actuators and sensors, dynamical response, fatigue and fracture characterization, Ampere’s force law

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Authors: Suleyman Karabal, Timothy L. Burnett, Egemen Avcu, Andrew H. Sherry, Philip J. Withers

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SA508 Grade 3 steel is widely used in the construction of nuclear pressure vessels, where its fracture toughness plays a critical role in ensuring operational safety and reliability. Understanding the ductile failure mechanisms in this steel grade is crucial for designing robust pressure vessels that can withstand severe nuclear environment conditions. In the present study, round bar specimens of SA508 Grade 3 steel with four distinct notch geometries were subjected to tensile loading while capturing continuous 2D images at 5-second intervals in order to monitor any alterations in their geometries to construct true stress-strain curves of the specimens. 3D reconstructions of X-ray computed tomography (CT) images at high-resolution (a spatial resolution of 0.82 μm) allowed for a comprehensive assessment of the influences of second-phase particles (i.e., manganese sulfide inclusions and cementite particles) on ductile failure initiation as a function of applied plastic strain. Additionally, based on 2D and 3D images, plasticity modeling was executed, and the results were compared to experimental data. A specific ‘two-parameter criterion’ was established and calibrated based on the correlation between stress triaxiality and equivalent plastic strain at failure initiation. The proposed criterion demonstrated substantial agreement with the experimental results, thus enhancing our knowledge of ductile fracture behavior in this steel grade. The implementation of X-ray CT and fractography analysis provided new insights into the diverse roles played by different populations of second-phase particles in fracture initiation under varying stress triaxiality conditions.

Keywords: ductile fracture, two-parameter criterion, x-ray computed tomography, stress triaxiality

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Authors: Hygreeva Kiran Namburi, Anna Hojna, Edita Lecianova, Fencl Zdenek

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Irradiation Assisted Stress Corrosion Cracking [IASCC] is one of the most significant environmental degradation in the internal components made from Austenitic stainless steel. This mechanism is still not fully understood and there are no suitable criteria for prediction of the damage during operation. In this work, core basket material 08Ch18N10T austenitic stainless steel acquired from decommissioned NPP Nord / Greifswald Unit 1, VVER 440-230 type, operated for 15 years and irradiated at 5.2 dpa is studied. This material was tensile tested at two different test temperatures and strain rates in air and at the elevated temperature under the water environment. SEM observations of the fracture surface documented ductile fracture of the samples tested in air, but areas of IASCC tested in water. This paper emphasizes on the microscopic examination results from the mechanically tested samples to determine the underlying IASCC physical damage process. TEM observations of thin foils made from the gauge sections that are closer to the fractured surface of the specimen aimed to find variances in interaction of dislocations and grain boundaries owing to different test conditions.

Keywords: irradiation assisted stress corrosion cracking, core basket material, SEM observations of the fracture surface, microscopic examination results

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Authors: Farid Saeidi, Serkan Dag

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In this study, fracture analysis of a fibrous composite laminate with variable fiber spacing is carried out using Jk-integral method. The laminate is assumed to be under thermal loading. Jk-integral is formulated by using the constitutive relations of plane orthotropic thermoelasticity. Developed domain independent form of the Jk-integral is then integrated into the general purpose finite element analysis software ANSYS. Numerical results are generated so as to assess the influence of variable fiber spacing on mode I and II stress intensity factors, energy release rate, and T-stress. For verification, some of the results are compared to those obtained using displacement correlation technique (DCT).

Keywords: Jk-integral, Variable Fiber Spacing, Thermoelasticity, T-stress, Finite Element Method, Fibrous Composite.

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Authors: Arthi Ganapathy, Arithra Banerjee, Saroj Kaler

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Abdominal aorta is the sole purveyor of all organs in the abdomen. Anomalies of its main trunk or its branches are to be meticulously observed as it effects the perfusion of an organ. Varying patterns of the testicular artery is one of them. The origin and course of testicular arteries have to be identified carefully during various surgical procedures like renal transplant, intra abdominal surgeries and even in orthopedic surgery like spine surgery. With the advent of new intra-abdominal therapeutic and diagnostic techniques, the anatomy of testicular arteries has assumed much more significance. Though the variations of the testicular vein are well documented, the variations of the testicular artery are not so frequent in incidence. We report a case of the bilateral aberrant origin of the testicular artery from polar renal arteries. We also discuss its developmental basis. Such anomalies if left unnoticed will lead to serious intraoperative complications during procedures on retroperitoneal organs. Any damage to testicular arteries will compromise the function of the gonads.

Keywords: cadaver, gonadal, renal, surgery

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Authors: Iftikhar Ahmad, Abulhakim Almajid

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Alumina (Al2O3) is an attractive structural ceramic however; brittleness turns Al2O3 down for advanced applications. Development of multi-phase phase ceramics systems is promising to curtail the brittleness and the incorporation of strong/elastic graphene, as third phase, into dual phase (Al2O3-SiC) is striking for mechanical upgrading purpose. Thin graphene nanosheets (GNS) were prepared by thermal exfoliation process and reinforced into dual phase ceramic system. The hybrid nanocomposite was consolidated by novel HF-IH (high-frequency induction heating) sintering furnace at 1500 °C under 50 MPa in vacuum conditions. Structural features and grain size of the resulting nanocomposite were analyzed by SEM and TEM whilst the mechanical properties were assessed by microhardness and nanoindentation techniques. The fracture toughness of the hybrid nanocomposites was appraised by direct crack measurement method. Electron microscopic investigations confirmed the preparation of thin (< 10 nm) graphene nanosheets (GNS). HF-IH sintering route condensed the three-phase (GNS-Al2O3-SiC) hybrid nanocomposite system to > 99% relative densities. SEM of the hybrid nanocomposites fractured surfaces revealed even distribution of the nanocomposite constituents and changed in fracture-mode. Structurally, 88% grain reduction into hybrid nanocomposite was also obtained. Mechanically, enhanced fracture toughness (50%) and hardness (53%) were also achieved for hybrid nanocomposites were attained against bench marked monolithic Al2O3.

Keywords: alumina, graphene, hybrid nanocomposites, rapid sintering

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Authors: Jie Chen, Chris Cheng, Kai Zhang

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Polycrystalline diamond compact (PDC) cutters with a polycrystalline diamond (PCD) table supported by a cemented tungsten carbide substrate have been widely used for earth-drilling tools in the oil and gas industry. Both wear and impact resistances are key figure of merits of PDC cutters, and they are closely related to the microstructure of the PCD table. As oil and gas exploration enters deeper, harder, and more complex formations, plus increasing requirement of accelerated downhole drilling speed and drilling cost reduction, current PDC cutters face unprecedented challenges for maintaining a longer drilling life than ever. Excessive wear on uneven hard formations, spalling, chipping, and premature fracture due to impact loads are common failure modes of PDC cutters in the field. Tailoring microstructure of the PCD table is one of the effective approaches to improve the wear and impact resistances of PDC cutters, along with other factors such as cutter geometry and bit design. In this research, cross-sectional microstructure, fracture surface, wear surface, and elemental composition of PDC cutters were analyzed using scanning electron microscopy (SEM) with both backscattered electron and secondary electron detectors, and energy dispersive X-ray spectroscopy (EDS). The microstructure and elemental composition were further correlated with the wear and impact resistances of corresponding PDC cutters. Wear modes and impact toughening mechanisms of state-of-the-art PDCs were identified. Directions to further improve the wear and impact resistances of PDC cutters were proposed.

Keywords: fracture surface, microstructure, polycrystalline diamond, PDC, wear surface

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Authors: Asma Poursoroush

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Solid-supported lipid bilayers are often used as a simple model for studies of biological membranes. The presence of a solid substrate that interacts attractively with lipid head-groups is expected to affect the phase behavior of the supported bilayer. Molecular dynamics simulations of a coarse-grained model are thus performed to investigate the phase behavior of supported one-component lipid bilayer membranes. Our results show that the attraction of the lipid head groups to the substrate leads to a phase behavior that is different from that of a free standing lipid bilayer. In particular, we found that the phase behaviors of the two leaflets are decoupled in the presence of a substrate. The proximal leaflet undergoes a clear gel-to-fluid phase transition at a temperature lower than that of a free standing bilayer, and that decreases with increasing strength of the substrate-lipid attraction. The distal leaflet, however, undergoes a change from a homogeneous liquid phase at high temperatures to a heterogeneous state consisting of small liquid and gel domains, with the average size of the gel domains that increases with decreasing temperature. While the chain order parameter of the proximal leaflet clearly shows a gel-fluid phase transition, the chain order parameter of the distal leaflet does not exhibit a clear phase transition. The decoupling in the phase behavior of the two leaflets is due to a non-symmteric lipid distribution in the two leaflets resulting from the presence of the substrate.

Keywords: membrane, substrate, molecular dynamics, simulation

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Authors: Tyler D. Cesarone, Tatiana M. Wugalter

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The movement of patients from the Global North to the Global South in pursuit of inexpensive healthcare and touristic experiences dominates the academic discourse on international medical travel (IMT). However, medical travel exists in higher numbers between Global South countries as patients who lack trust in, and feel disenfranchised by, their national healthcare systems seek treatment in nearby countries. Through a review of the existing literature, this paper examines patterns of IMT in the Middle East, Southeast Asia, and Southern Africa, distinguishing North-South medical tourism from South-South intra-regional medical mobility (IRMM). Evidence from these case studies demonstrates that notions of medical distrust and disenfranchisement, rooted in low-resourced and poor quality healthcare systems, are key drivers of IRMM in the Global South. The movement of patients from lower income to proximate higher income countries not only reveals tensions between patients and their healthcare systems but widens gaps in the quality of healthcare between departing and destination countries. In analyzing these cross-regional similarities, the paper moves beyond the current literature’s focus on singular case studies to expose global patterns of South-South IRMM. This presents a shift from the traditional focus on North-South medical tourism, demonstrating how disparities in healthcare systems both influence and are influenced by IRMM.

Keywords: global South, healthcare quality, international medical travel (IMT), intra-regional medical mobility (IRMM), medical disenfranchisement, medical distrust, medical tourism

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Authors: F. Christie, M. Staber

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Malnutrition is a predictor of poor clinical outcome in the elderly. Up to 60% of hip fracture patients are clinically malnourished on admission. This study assessed the perioperative nutritional state of patients admitted with a proximal femoral fracture and examined if adequate nutritional support was achieved. Methods: Prospective, the observational audit of 30 patients, admitted with a proximal femoral fracture, over a one-month period. We recorded: patient demographics; surgical delay; nutritional state on admission; documentation of Malnutrition Universal Screening Tool (MUST) score; dietician input and daily calorie intake through food charts. The nutritional state was re-assessed weekly and at discharge. The outcome was measured by the length of hospital stay and thirty-day mortality. Results: Mean age 87, M:F 1:2 and all patients were ASA three or four. Five patients (17%) had a prolonged ( >24 hours) fasting period. All patients had a MUST score completed on admission, 27% were underweight and 30% were high risk for malnutrition. Twenty-six patients (87%) were appropriately assessed for dietician referral. Thirteen patients had food charts; on average, hospital meals provided 1500kcal daily. No patient achieved > 75% of the provided calories with 69% of patients achieving 50% or less. Only three patients were started on nutritional supplements. Twenty-three patients (77%) lost weight, averaging 6% weight loss during admission. Mean length of stay (LOS) was 23 days and 30-day mortality 9%. Four patients (13%) gained weight, their mean LOS was 17 days and 30-day mortality 0%. Discussion: Malnutrition in the elderly originates in the community. Following major trauma it’s difficult to reverse nutritional deficits in hospitals. It’s therefore concerning that no high-risk patient achieved their recommended calorie intake. Perioperative optimisation needs to include early nutritional intervention, early anaesthetic review and adjusted anaesthetic techniques to support feeding.

Keywords: trauma, nutrition, neck of femur fracture

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Authors: Mahmoud Hassanin, Roshan Thawale, Kiran Yelamati

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Background: During current practice, intraoperative regular endotracheal cuff pressure monitoring is not routine, despite the significant number of clinicians interested in checking it after intubation to ensure a good seal and adequate ventilation. Aims and objectives: to highlight that the current practice has no guidance related to regular intra-operative monitoring of the endotracheal tube cuff pressure, which can improve patient safety and post-operative experience. Methods: local department survey was done targeting anaesthetists' current practice, measuring their knowledge and problem awareness to improve patient satisfaction and change the current approach. Results: The participants were not using the manometer, despite their interest in ensuring that the cuff pressure was high enough and there was a proper seal. More than 50% of the participant don't know the ideal range of the endotracheal tube cuff pressure range, and 32% don't know whether it is available or not in the theatre. Despite the previous finding, 100% of the participants used different methods to ensure adequate cuff pressure. The collected data revealed that at least 26% of the participant confirmed that they had seen patients having post-intubation complications. Conclusion: There is an increasing importance placed on quality assurance. Clinical practice varies widely among practitioners, with the only consistency being the omission of cuff manometers during routine intra-operative management, despite their proven benefit and efficacy. Encourage the anaesthetists and ODPs to use cuff pressure manometers. The availability of portable pressure manometers can help to maintain safe cuff pressures in patients requiring endotracheal intubation.

Keywords: endotracheal cuff pressure, intra-operative monitoring, current practice, patient satisfaction

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Authors: Karina Oborune

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International student mobility involves a unique spatio-temporal context and exploring the various aspects of mobile students’ experience can lead to new findings within identity studies. The previous studies have mainly focused on student mobility within Europe and its impact on European identity arguing that students who participate in intra-European mobility already feel European before exchange. Contrary to previous studies, in this paper student mobility is analyzed from different point of view. In order to see whether a true Europeanization of identities is taking place, it is necessary to contrast European identity with alternative supranational identity which could similarly result from student mobility and in particular a global identity. Besides, in the paper there is explored whether geographical constellation (host country continental location during mobility- Europe vs. outside of Europe) plays a role. Based on newly developed model of multicultural, social and socio-demographic variables there is argued that after intra-European mobility only global identity of students could be increased (H1), but the mobility to countries outside of Europe causes changes in European identity (H2). The quantitative study (survey, n=1440, 22 higher education institutions, experimental group of former and future/potential mobile students and control group of non-mobile students) was held in Switzerland where is equally high number of students who participate in intra-European and outside of Europe mobility. The results of multivariate linear regression showed that students who participate in exchange in Europe increase their European identity due to having close friends from Europe, as well as due to length of the mobility experience had impact, but students who participate in exchange outside of Europe increase their global identity due to having close friends from outside of Europe and proficiency in foreign languages.

Keywords: student mobility, European identity, global identity, global identity

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Authors: Gabi N. Nehme

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Below-knee amputees commonly experience asymmetrical gait patterns. It is generally believed that ischemia is related to the formation of pressure sores due to uneven distribution of forces. Micro-vascular responses can reveal local malnutrition. Changes in local skin blood supply under various external loading conditions have been studied for a number of years. Radionuclide clearance, photo-plethysmography, trans-cutaneous oxygen tension along with other studies showed that the blood supply would be influenced by the epidermal forces, and the rate and the amount of blood supply would decrease with increased epidermal loads being shear forces or normal forces. Several cases of socket designs were investigated using Finite Element Model (FEM) and Design of Experiment (DOE) to increase flexibility and minimize the pressure at the limb/socket interface using ultra high molecular weight polyethylene (UHMWPE) and polyamide 6 (PA6) or Duraform. The pressure reliefs at designated areas where reducing thickness is involved are seen to be critical in determination of amputees’ comfort and are very important to clinical applications. Implementing a hole between the Patellar Tendon (PT) and Distal Tibia (DT) would decrease stiffness and increase prosthesis range of motion where flexibility is needed. In addition, displacement and prosthetic energy storage increased without compromising mechanical efficiency and prosthetic design integrity.

Keywords: patellar tendon, distal tibia, prosthetic socket relief areas, hole implementation

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Authors: P. Vosynek, T. Návrat, M. Peč, J. Pořízka, P. Diviš

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Changes of mechanical properties and response behavior of bones is an important external sign of medical problems like osteoporosis, bone remodeling after fracture or surgery, osteointegration, or bone tissue loss of astronauts in space. Measuring of mechanical behavior of bones in physiological and osteoporotic states, quantified by different degrees of protein (collagen) and mineral loss, is thus an important topic in biomechanical research. This contribution deals with the relation between mechanical properties of the turkey long bone–tibia in physiological, demineralized, and deproteinized state. Three methods for comparison were used: densitometry, three point bending and harmonic response analysis. The results help to find correlations between the methods and estimate their possible application in medical practice.

Keywords: bone properties, long bone, osteoporosis, response behavior

Procedia PDF Downloads 462

Authors: Jehnming Lin

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The effects of the contact ball-lens on the soda lime glass in laser thermal cleavage with a cw Nd-YAG laser were investigated in this study. A contact ball-lens was adopted to generate a bending force on the crack formation of the soda-lime glass in the laser cutting process. The Nd-YAG laser beam (wavelength of 1064 nm) was focused through the ball-lens and transmitted to the soda-lime glass, which was coated with a carbon film on the surface with a bending force from a ball-lens to generate a tensile stress state on the surface cracking. The fracture was controlled by the contact ball-lens and a straight cutting was tested to demonstrate the feasibility. Experimental observations on the crack propagation from the leading edge, main section and trailing edge of the glass sheet were compared with various mechanical and thermal loadings. Further analyses on the stress under various laser powers and contact ball loadings were made to characterize the innovative technology. The results show that the distributions of the side crack at the leading and trailing edges are mainly dependent on the boundary condition, contact force, cutting speed and laser power. With the increase of the mechanical and thermal loadings, the region of the side cracks might be dramatically reduced with proper selection of the geometrical constraints. Therefore, the application of the contact ball-lens is a possible way to control the fracture in laser cleavage with improved cutting qualities.

Keywords: laser cleavage, stress analysis, crack visualization, laser

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Authors: Waseem Al-Talalwah

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The superior vesical artery usually arises directly from the anterior division of the internal iliac artery. It may arise from the umbilical artery as three or four branches to supply the upper and middle parts of bladder. Current study focuses on the different origins of the superior vesical artery to provide a sufficient data for surgeons to disease iatrogenic fault. The superior vesical artery arises directly from the anterior division of the internal iliac artery in 24.5% whereas it arises indirectly as from umbilical artery in 83.7%. Further, it may arise from any branch of the anterior division as from the utrine and obturator arteries in 6.1% and in 6.3% respectively. It also shares the origin of the internal pudendal and inferior glutyeal artery as it arises from the gluteopudendal trunk in 4.1%. The superior vesical artery arises as a single, double, triple and quadruple in 69.4%, 20.4%, 8.2% and 2% respectively. In case of cystectomy for bladder cancer, surgeons have to be aware of the origin variability of superior vesical artery to prevent post-surgical complication such as intra-pelvic bleeding. Also, the as intra-pelvic bleeding has to be expected in case of hysterectomy therefore a great caution of the vesical branches arising from uterine artery has to be considered. In case of aneurysm resection of inferior gluteal artery arising from the gluteopudendal trunk, the surgeons have to be careful of the vascular supply of urinary bladder coming from above and below this common trunk as from superior and inferior vesical arteries respectively. Therefore, present study increases the awareness of clinical significance of superior vesical artery origin for surgeons to minimise the iatroginc errors.

Keywords: superior vesical artery, anterior division, internal iliac, internal pudendal, inferior glutyeal, intra-pelvic bleeding, hysterectomy, cystectomy

Procedia PDF Downloads 362

Authors: A. Elrefaei

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The possibility of having sheets with different thicknesses and materials in one assembly facilitates the optimal material distribution within the final product and reduces the weight of the structure. Ability of joining process to assembly these different material combinations is always a challenge to the designer. In this study, 0.6 mm thick 6061-T6 and 2 mm thick 5182-O were robot CMT welded using ER5356 and ER4043 filler metals. The thermal effect of welding resulted in a loss of hardness in the 6061 HAZ. Joints welded by ER5356 filler metal were much higher in fracture load than joints welded by ER4043 and the elongation of joints welded by ER5356 was almost double its corresponding joints welded by ER4043 filler. Owing to the big difference in formability and thickness of base metals, the fracture in forming test occurred in the softened 6061 HAZ out from the weld centerline.

Keywords: aluminum, CMT, mechanical, welding

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Authors: Ramin Khamedi, Isa Ahmadi

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In this study acoustic emission (AE) signals obtained during deformation and fracture of two types of ferrite-martensite dual phase steels (DPS) specimens have been analyzed in frequency domain. For this reason two low carbon steels with various amounts of carbon were chosen, and intercritically heat treated. In the introduced method, identifying the mechanisms of failure in the various phases of DPS is done. For this aim, AE monitoring has been used during tensile test of several DPS with various volume fraction of the martensite (VM) and attempted to relate the AE signals and failure mechanisms in these steels. Different signals, which referred to 2-3 micro-mechanisms of failure due to amount of carbon and also VM have been seen. By Fast Fourier Transformation (FFT) of signals in distinct locations, an excellent relationship between peak frequencies in these areas and micro-mechanisms of failure were seen. The results were verified by microscopic observations (SEM).

Keywords: acoustic emission, dual phase steels, deformation, failure, fracture

Procedia PDF Downloads 371

Authors: George Zhou, Yunchan Chen, Candace Chien

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Kidney replacement therapy is the current standard of care for end-stage renal diseases. In-center or home hemodialysis remains an integral component of the therapeutic regimen. Arteriovenous fistulas (AVF) make up the vascular circuit through which blood is filtered and returned. Naturally, AVF patency determines whether adequate clearance and filtration can be achieved and directly influences clinical outcomes. Our aim was to build a deep learning model for automated AVF stenosis screening based on the sound of blood flow through the AVF. A total of 311 patients with AVF were enrolled in this study. Blood flow sounds were collected using a digital stethoscope. For each patient, blood flow sounds were collected at 6 different locations along the patient’s AVF. The 6 locations are artery, anastomosis, distal vein, middle vein, proximal vein, and venous arch. A total of 1866 sounds were collected. The blood flow sounds are labeled as “patent” (normal) or “stenotic” (abnormal). The labels are validated from concurrent ultrasound. Our dataset included 1527 “patent” and 339 “stenotic” sounds. We show that blood flow sounds vary significantly along the AVF. For example, the blood flow sound is loudest at the anastomosis site and softest at the cephalic arch. Contextualizing the sound with location metadata significantly improves classification performance. How to encode and incorporate categorical metadata is an active area of research1. Herein, we study ordinal (i.e., integer) encoding schemes. The numerical representation is concatenated to the flattened feature vector. We train a vision transformer (ViT) on spectrogram image representations of the sound and demonstrate that using scalar multiples of our integer encodings improves classification performance. Models are evaluated using a 10-fold cross-validation procedure. The baseline performance of our ViT without any location metadata achieves an AuROC and AuPRC of 0.68 ± 0.05 and 0.28 ± 0.09, respectively. Using the following encodings of Artery:0; Arch: 1; Proximal: 2; Middle: 3; Distal 4: Anastomosis: 5, the ViT achieves an AuROC and AuPRC of 0.69 ± 0.06 and 0.30 ± 0.10, respectively. Using the following encodings of Artery:0; Arch: 10; Proximal: 20; Middle: 30; Distal 40: Anastomosis: 50, the ViT achieves an AuROC and AuPRC of 0.74 ± 0.06 and 0.38 ± 0.10, respectively. Using the following encodings of Artery:0; Arch: 100; Proximal: 200; Middle: 300; Distal 400: Anastomosis: 500, the ViT achieves an AuROC and AuPRC of 0.78 ± 0.06 and 0.43 ± 0.11. respectively. Interestingly, we see that using increasing scalar multiples of our integer encoding scheme (i.e., encoding “venous arch” as 1,10,100) results in progressively improved performance. In theory, the integer values do not matter since we are optimizing the same loss function; the model can learn to increase or decrease the weights associated with location encodings and converge on the same solution. However, in the setting of limited data and computation resources, increasing the importance at initialization either leads to faster convergence or helps the model escape a local minimum.

Keywords: arteriovenous fistula, blood flow sounds, metadata encoding, deep learning

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Authors: Ayhan Eymirli, Sila N. Usta

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The aim of this study is the comparison of the cyclic fatigue resistance of EndoArt Gold (EAG, Inci Dental, Istanbul, Turkey), EndoArt Blue (EAB, Inci Dental, Istanbul, Turkey), ProTaper Universal (PTU, Dentsply Tulsa Dental Specialties), and ProTaper Gold (PTG, Dentsply Tulsa Dental Specialties) files at body temperature. Twelve instruments of each EAG, EAB, PTU, PTG file system were included in this study. All selected files were rotated in the artificial canals, which have a 60° angle and a 5-mm radius of curvature until fracture occurred. The time to fracture (Ttf) was measured in seconds by a chronometer in the control panel that presents in the cyclic fatigue testing device when a fracture was detected visually and/or audibly. The lengths of the fractured fragments (FL) were also measured with a digital microcaliper. The data of Ttf and FL were analyzed using Kruskal-Wallis, one-way ANOVA and post hoc Bonferroni tests at the 5% significance level. There was a statistically significant difference among the file systems (p < 0.05). EAB had the statistically highest fatigue resistance, and PTU had the statistically lowest fatigue resistance (p < 0.05). PTG system had a statistically higher FL means than EAB and PTU file systems (p < 0.05). EAB had the greatest cyclic fatigue resistance amongst the other file systems. It can be stated that heat treatments may be a factor that increases fatigue resistance.

Keywords: cyclic fatigue resistance, Endo art blue, Endo art gold, pro taper gold, pro taper universal

Procedia PDF Downloads 106

Authors: Mark McGuire, Eric Shannon, John Parmigiani

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Timber harvesting increasingly involves mechanized equipment. This has increased the efficiency of harvesting, but has also introduced worker-safety concerns. One such concern arises from the use of harvesters. During operation, harvesters subject saw chain to large dynamic mechanical stresses. These stresses can, under certain conditions, cause the saw chain to fracture. The high speed of harvester saw chain can cause the resulting open chain loop to fracture a second time due to the dynamic loads placed upon it as it travels through space. If a second fracture occurs, it can result in a projectile consisting of one-to-several chain links. This projectile is referred to as a chain shot. It has speeds similar to a bullet but typically has greater mass and is a significant safety concern. Numerous examples exist of chain shots penetrating bullet-proof barriers and causing severe injury and death. Improved harvester-cab barriers can help prevent injury however a comprehensive scientific understanding of chain shot is required to consistently reduce or prevent it. Obtaining this understanding requires a test machine with the capability to cause chain shot to occur under carefully controlled conditions and accurately measure the response. Worldwide few such test machine exist. Those that do focus on validating the ability of barriers to withstand a chain shot impact rather than obtaining a scientific understanding of the chain shot event itself. The purpose of this paper is to describe the design, fabrication, and use of a test machine capable of a comprehensive scientific investigation of chain shot. The capabilities of this machine are to test all commercially-available saw chains and bars at chain tensions and speeds meeting and exceeding those typically encountered in harvester use and accurately measure the corresponding key technical parameters. The test machine was constructed inside of a standard shipping container. This provides space for both an operator station and a test chamber. In order to contain the chain shot under any possible test conditions, the test chamber was lined with a base layer of AR500 steel followed by an overlay of HDPE. To accommodate varying bar orientations and fracture-initiation sites, the entire saw chain drive unit and bar mounting system is modular and capable of being located anywhere in the test chamber. The drive unit consists of a high-speed electric motor with a flywheel. Standard Ponsse harvester head components are used to bar mounting and chain tensioning. Chain lubrication is provided by a separate peristaltic pump. Chain fracture is initiated through ISO standard 11837. Measure parameters include shaft speed, motor vibration, bearing temperatures, motor temperature, motor current draw, hydraulic fluid pressure, chain force at fracture, and high-speed camera images. Results show that the machine is capable of consistently causing chain shot. Measurement output shows fracture location and the force associated with fracture as a function of saw chain speed and tension. Use of this machine will result in a scientific understanding of chain shot and consequently improved products and greater harvester operator safety.

Keywords: chain shot, safety, testing, timber harvesters

Procedia PDF Downloads 124