Search results for: lumber spine

Authors: Welawat Tienpratarn, Chaiyaporn Yuksen, Kasamon Aramvanitch, Karn Suttapanit, Yahya Mankong, Nussareen Yaemluksanalert, Sansanee Meesawad

Abstract:

Introduction : Application of a rigid cervical collar may interfere with the laryngeal view, and potentially lead to failed endotracheal intubation (ETI). This study aimed to compare intubation success rates while performing inline stabilization with and without cervical hard collar. Methods : This randomized prospective comparative study included paramedics working in the Department of Emergency Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand to compare the success rates of endotracheal intubation on manikin using inline stabilization with and without cervical hard collar. Results : 125 participants were evaluated; 63 in the rigid cervical collar and 62 in the non-cervical hard collar group. The rate of successful intubation was significantly higher using manual stabilization without cervical hard collar (61 (96.8%) vs. 55 (88.7%); p=0.048). The time required to successfully perform intubation was also shorter, with manual stabilization only (14.1 ±20.9 vs. 18.9±29.0; p = 0.081). Conclusion : It seems that, removal of the rigid cervical collar during ETI in patients with suspected traumatic spine injury could increase the intubation success rate.

Keywords: ntubation, Intratracheal, Spinal Injuries, Multiple trauma

Procedia PDF Downloads 98

Authors: Rim Sghiri, Samia Al Shouli, Hana Benhassine, Nejla Elamri, Zahid Shakoor, Foued Slama, Adel Almogren, Hala Zeglaoui, Elyes Bouajina, Ramzi Zemni

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Objectives: Little is known about genes predisposing to systemic bone loss (SBL) in rheumatoid arthritis (RA). Therefore, we examined the association between SBL and a variant of CD40 gene, which is known to play a critical role in both immune response and bone homeostasis among patients with RA. Methods: CD40 rs48104850 was genotyped in 176 adult RA patients. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DXA). Results: Low BMD was observed in 116 (65.9%) patients. Among them, 60 (34.1%) had low femoral neck (FN) Z score, 72 (40.9%) had low total femur (TF) Z score, and 105 (59.6%) had low lumbar spine (LS) Z score. CD40 rs4810485 was found to be associated with reduced TF Z score with the CD40 rs4810485 T allele protecting against reduced TF Z score (OR = 0.40, 95% CI = 0.23-0.68, p = 0.0005). This association was confirmed in the multivariate logistic regression analysis (OR=0.31, 95% CI= 0.16-0.59, p=3.84 x 10₋₄). Moreover, median FN BMD was reduced among RA patients with CD40 rs4810485 GG genotype compared to RA patients harbouring CD40 rs4810485 TT and GT genotypes (0.788± 0.136 versus 0.826± 0.146g/cm², p=0.001). Conclusion: This study, for the first time ever, demonstrated an association between a CD40 genetic variant and SBL among patients with RA.

Keywords: rheumatoid arthritis, CD40 gene, bone mineral density, systemic bone loss, rs48104850

Procedia PDF Downloads 426

Authors: Lamia Bouzgarrou, Irtyah Merchaoui, Amira Omrane, Salma Kammoun, Amine Daafa, Neila Chaari

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Backgrounds: Currently, low back pain (LBP) is one of the most prevalent public health problems, which caused severe morbidity among a large portion of the adult population. It is also associated with heavy direct and indirect costs, in particular, related to absenteeism and early retirement. Health care workers are one of most occupational groups concerned by LBP, especially because of biomechanical and psycho-organizational risk factors. Our current study aims to investigate risk factors associated with chronic low back pain among Tunisian caregivers in university-hospitals. Methods: Cross-sectional study conducted over a period of 14 months, with a representative sample of caregivers, matched according to age, sex and work department, in two university-hospitals in Tunisia. Data collection included items related to socio-professional characteristics, the evaluation of the working capacity index (WAI), the occupational stress (Karazek job strain questionnaire); the quality of life (SF12), the musculoskeletal disorders Nordic questionnaire, and the examination of the spine flexibility (distance finger-ground, sit-stand maneuver and equilibrium test). Results: Totally, 293 caregivers were included with a mean age equal to 42.64 ± 11.65 years. A body mass index (BMI) exceeding 30, was noted in 20.82% of cases. Moreover, no regular physical activity was practiced in 51.9% of cases. In contrast, domestic activity equal or exceeding 20 hours per week, was reported by 38.22%. Job strain was noted in 19.79 % of cases and the work capacity was 'low' to 'average' among 27.64% of subjects. During the 12 months previous to the investigation, 65% of caregivers complained of LBP, with pain rated as 'severe' or 'extremely severe' in 54.4% of cases and with a frequency of discomfort exceeding one episode per week in 58.52% of cases. During physical examination, the mean distance finger-ground was 7.10 ± 7.5cm. Caregivers assigned to 'high workload' services had the highest prevalence of LBP (77.4%) compared to other categories of hospital services, with no statistically significant relationship (P = 0.125). LBP prevalence was statistically correlated with female gender (p = 0.01) and impaired work capacity (p < 10⁻³). Moreover, the increase of the distance finger-ground was statistically associated with LBP (p = 0.05), advanced age (p < 10⁻³), professional seniority (p < 10⁻³) and the BMI ≥ 25 (p = 0.001). Furthermore, others physical tests of spine flexibility were underperformed among LBP suffering workers with a statistically significant difference (sit-stand maneuver (p = 0.03); equilibrium test (p = 0.01)). According to the multivariate analysis, only the domestic activity exceeding 20H/week, the degraded quality of physical life, and the presence of neck pain were significantly corelated to LBP. The final model explains 36.7% of the variability of this complaint. Conclusion: Our results highlighted the elevate prevalence of LBP among caregivers in Tunisian public hospital and identified both professional and individual predisposing factors. The preliminary analysis supports the necessity of a multidimensional approach to prevent this critical occupational and public health problem. The preventive strategy should be based both on the improvement of working conditions, and also on lifestyle modifications, and reinforcement of healthy behaviors in these active populations.

Keywords: health care workers, low back pain, prevention, risk factor

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Authors: Chih-Wei Pai, Rong-Chang Jou

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Using A1 A2 police-reported accident data for years 2003–2010 in Taiwan, the paper examines anatomic injuries and crash characteristics specific to pedestrians in “facing traffic” and “back to traffic” crashes. There were 2768 and 7558 accidents involving pedestrians walking along with/against traffic respectively. Injuries sustained by pedestrians and crash characteristics in these two crash types were compared with those in other crash types (nearside crash, nearside dart-out crash, offside crash, offside dart-out crash). Main findings include that “back to traffic” crashes resulted in more severe injuries, and pedestrians in “back to traffic” crashes had increased head, neck, and spine injuries than those in other crash types; and there was an elevated risk of head injuries in unlit darkness and NBU (non-built-up) roadways. Several crash features (e.g. unlit darkness, overtaking maneuvers, phone use by pedestrians and drivers, intoxicated drivers) appear to be over-involved in “back to traffic” crashes. The implications of the research findings regarding pedestrian/driver education, enforcement, and remedial engineering design are discussed.

Keywords: pedestrian accident, crash characteristics, injury, facing traffic, back to traffic

Procedia PDF Downloads 335

Authors: Jacklynn Walters, Amanda A. Alblas, Linda M. Greyling

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Cervical carcinoma is the second most common cancer found in women. Diagnosis of skeletal metastases is uncommon in cervical cancer patients. The aim of this study was to determine the prevalence of skeletal metastases in in a Western Cape skeletal population. Skeletal samples (n=14) from the Kirsten Skeletal Collection at Stellenbosch University, diagnosed pre-mortem with cervical cancer, were examined. Macroscopic analysis was done using low magnification to examine each skeletal element for signs of disease. Skeletons were also x-rayed using the Lodox® Statscan® Imaging system and the scans evaluated by a musculoskeletal radiologist. Three (21%) of the skeletons showed metastases, with the os coxae and lower vertebral column affected in all three cases. Furthermore, metastases occurred in the scapulae and ribs in two of the cases and in one case the skull, mandible, and long bones were affected. Additionally, three skeletons without evidence of skeletal metastases presented with a periosteal reaction on the os coxae in response to the diseased adjacent soft tissue. Previous studies observed that skeletal metastases are more common than what is diagnosed pre-mortem with the vertebral spine most commonly affected. The findings of this study agree with previous reports and illustrate the effectiveness of the Lodox® scanner in diagnoses of metastases in skeletal material.

Keywords: cancer, cervix, radiology, skeletal metastases

Procedia PDF Downloads 335

Authors: S. Alireza Mirghasemi, Narges Rahimi Gabaran

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Although sacral fractures in children are rare due to the fact that the occurrence of pelvic fracture is not common in childhood. Sacral fractures present a high risk of neurological damage. This kind of fracture is often missed because the routine pelvic X-rays imaging scarcely show this fracture. Also, the treatment is controversial, and it ranges from fine reduction to conservative treatments without any try to reduce the dislocation. In this article, a case of fracture dislocation of S1 and S2 along with a suggested diagnostic test and treatment based on similar cases are presented. The case investigates a 14-year-old boy who entered the hospital one week after a car accident that knocked him to the ground in crawling position and a rack fell down on his body. Pain and tenderness in the sacral region and a fracture in the left leg were notable--we detected incomplete bilateral palsy of L5, S1 and S2 roots. In radiographs of the spine fracture dislocation of S1, the sacral fracture was seen. The treatment included a skeletal traction with a halo over the patient’s head and two femoral pins. After one week, another surgery was performed in order to stabilize and reduce the fracture, and we employed a posterior approach with CD and a pedicular screw. After two years of follow-up, the fracture is completely cured without any loss of reduction.

Keywords: adolescent, fracture in adolescent, fracture dislocation, sacrum

Procedia PDF Downloads 268

Authors: Moustafa Ibrahim Moustafa

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The purpose of this study was to determine the immediate and long term effects of a multimodal program, with the addition of cervical sagittal curve restoration and forward head correction, on severity of dizziness, disability, frequency of dizziness, and severity of cervical pain. 72 patients with cervicogenic dizziness, definite hypolordotic cervical spine, and forward head posture were randomized to experimental or a control group. Both groups received the multimodal program, additionally, the study group received the Denneroll cervical traction. All outcome measures were measured at three intervals. The general linear model indicated a significant group × time effects in favor of experimental group on measures of anterior head translation (F=329.4 P < .0005), cervical lordosis (F=293.7 P < .0005), severity of dizziness (F=262.1 P < .0005), disability (F=248.9 P < .0005), frequency of dizziness (F=53.9 P < .0005), and severity of cervical pain (F=350.1 P < .0005). The addition of Dennroll cervical traction to a multimodal program can positively affect dizziness management outcomes.

Keywords: randomized controlled trial, traction, dizziness, cervical

Procedia PDF Downloads 279

Authors: Pintu Modak

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The core strength is essential not only for athletes but also for everyone to perform everyday's household chores with ease and efficiency. Core strength means to strengthen the muscles deep within the abdomen which connect to the spine and pelvis which control the position and movement of the central portion of the body. Strengthening of core muscles is important for injury prevention (lower back pain) and performance enhancement in sports. The purpose of the study was to review the literature and findings on the effects of Yoga exercise as a part of sports training method and fitness programs. Fifteen papers were found to be relevant for this review. There are five simple yoga poses: Ardha Phalakasana (Low plank), Vasisthasana (side plank), Purvottanasana (inclined plane), Sarvangasana (shoulder stand), and Virabhadrasana (Warrior) are found to be very effective for strengthening core muscles. They are the most effective poses to build core strength and flexibility to the core muscles. The study suggests that sports and fitness trainers should include these yoga exercises in their programs to strengthen core muscles.

Keywords: core strength, yoga, injuries, lower back

Procedia PDF Downloads 245

Authors: Eunhwa Jun

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This case report describes the misdiagnosis of a patient who presented with right arm pain as cervical disc herniation. The patient had several underlying conditions, including hypertension, diabetes mellitus, liver cirrhosis, a history of lung cancer with left lower lobe lobectomy, and adjuvant chemoradiotherapy. An external cervical spine MRI revealed central protruding discs at the C4-5-6-7 levels. Despite treatment with medication and epidural blocks, the patient's pain persisted. A C-RACZ procedure was planned, but the patient's pain had worsened before admission. Using ultrasound, a brachial plexus block was attempted, but the brachial plexus eluded clear visualization, hinting at underlying neurological complexities. Chest CT revealed a new, large soft tissue mass in the right supraclavicular region with adjacent right axillary lymphadenopathy, leading to the diagnosis of metastatic squamous cell carcinoma. Palliative radiation therapy and chemotherapy were initiated as part of the treatment plan, and the patient's pain score decreased to 3 out of 10 on the Numeric Rating Scale (NRS), revealing the pain was due to metastatic lung cancer.

Keywords: supraclavicula brachial plexus metastasis, cervical disc herniation, brachial plexus block, metastatic lung cancer

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Authors: Soyeon Kang, Youn-Jee Chung, Jung Namkung

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Objective: This retrospective study investigated the association between uric acid level and bone mineral density (BMD) in the postmenopausal period. Methods: The study included 328 menopausal women (mean age, 57.3 ± 6.5 years; mean serum uric acid level, 4.6 ± 1.0 mg/dL). Patients were divided into three groups by tertile of serum uric acid level. Patients who used hormone treatment (HT), bisphosphonates, or lipid-lowering agents were included. Results: Blood urea nitrogen, serum creatinine, and serum triglyceride levels were significantly higher in the upper uric acid tertiles. No significant difference was found in the mean uric acid levels between medication users and non-users. Distinct HT regimens showed different mean serum uric acid levels. In a cross-sectional analysis, higher serum uric acid levels showed a tendency toward increased BMD in the spine and femoral neck. Longitudinal analysis of 186 women who underwent follow-up examination at a mean interval of 14.6 months revealed a trend toward a smaller reduction in femoral neck BMD in women in the upper serum uric acid tertiles. Conclusion: A positive correlation exists between serum uric acid levels and BMD in menopausal women.

Keywords: menopause, antioxidant, uric acid, bone mineral density

Procedia PDF Downloads 101

Authors: Mian Huang, Chi Ma, Junyu Lin, William Lu

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Introduction: Bone health attracts more attention recently and an intelligent question and answer (QA) chatbot for osteoporosis is helpful for science popularization. With Generative Pretrained Transformer (GPT) technology developing, we build an osteoporosis corpus dataset and then fine-tune LLaMA, a famous open-source GPT foundation large language model(LLM), on our self-constructed osteoporosis corpus. Evaluated by clinical orthopedic experts, our fine-tuned model outperforms vanilla LLaMA on osteoporosis QA task in Chinese. Three-dimensional quantitative computed tomography (QCT) measured bone mineral density (BMD) is considered as more accurate than DXA for BMD measurement in recent years. We develop an automatic Phantom-less QCT(PL-QCT) that is more efficient for BMD measurement since no need of an external phantom for calibration. Combined with LLM on osteoporosis, our PL-QCT provides efficient and accurate BMD measurement for our chatbot users. Material and Methods: We build an osteoporosis corpus containing about 30,000 Chinese literatures whose titles are related to osteoporosis. The whole process is done automatically, including crawling literatures in .pdf format, localizing text/figure/table region by layout segmentation algorithm and recognizing text by OCR algorithm. We train our model by continuous pre-training with Low-rank Adaptation (LoRA, rank=10) technology to adapt LLaMA-7B model to osteoporosis domain, whose basic principle is to mask the next word in the text and make the model predict that word. The loss function is defined as cross-entropy between the predicted and ground-truth word. Experiment is implemented on single NVIDIA A800 GPU for 15 days. Our automatic PL-QCT BMD measurement adopt AI-associated region-of-interest (ROI) generation algorithm for localizing vertebrae-parallel cylinder in cancellous bone. Due to no phantom for BMD calibration, we calculate ROI BMD by CT-BMD of personal muscle and fat. Results & Discussion: Clinical orthopaedic experts are invited to design 5 osteoporosis questions in Chinese, evaluating performance of vanilla LLaMA and our fine-tuned model. Our model outperforms LLaMA on over 80% of these questions, understanding ‘Expert Consensus on Osteoporosis’, ‘QCT for osteoporosis diagnosis’ and ‘Effect of age on osteoporosis’. Detailed results are shown in appendix. Future work may be done by training a larger LLM on the whole orthopaedics with more high-quality domain data, or a multi-modal GPT combining and understanding X-ray and medical text for orthopaedic computer-aided-diagnosis. However, GPT model gives unexpected outputs sometimes, such as repetitive text or seemingly normal but wrong answer (called ‘hallucination’). Even though GPT give correct answers, it cannot be considered as valid clinical diagnoses instead of clinical doctors. The PL-QCT BMD system provided by Bone’s QCT(Bone’s Technology(Shenzhen) Limited) achieves 0.1448mg/cm2(spine) and 0.0002 mg/cm2(hip) mean absolute error(MAE) and linear correlation coefficient R2=0.9970(spine) and R2=0.9991(hip)(compared to QCT-Pro(Mindways)) on 155 patients in three-center clinical trial in Guangzhou, China. Conclusion: This study builds a Chinese osteoporosis corpus and develops a fine-tuned and domain-adapted LLM as well as a PL-QCT BMD measurement system. Our fine-tuned GPT model shows better capability than LLaMA model on most testing questions on osteoporosis. Combined with our PL-QCT BMD system, we are looking forward to providing science popularization and early morning screening for potential osteoporotic patients.

Keywords: GPT, phantom-less QCT, large language model, osteoporosis

Procedia PDF Downloads 36

Authors: Yavuz Unal, Kemal Polat, H. Erdinc Kocer

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In this study, a decision support system comprising three stages has been proposed to detect the disc abnormalities of the lumbar region. In the first stage named the feature extraction, T2-weighted sagittal and axial Magnetic Resonance Images (MRI) were taken from 55 people and then 27 appearance and shape features were acquired from both sagittal and transverse images. In the second stage named the feature weighting process, k-means clustering based feature weighting (KMCBFW) proposed by Gunes et al. Finally, in the third stage named the classification process, the classifier algorithms including multi-layer perceptron (MLP- neural network), support vector machine (SVM), Naïve Bayes, and decision tree have been used to classify whether the subject has lumbar disc or not. In order to test the performance of the proposed method, the classification accuracy (%), sensitivity, specificity, precision, recall, f-measure, kappa value, and computation times have been used. The best hybrid model is the combination of k-means clustering based feature weighting and decision tree in the detecting of lumbar disc disease based on both sagittal and axial MR images.

Keywords: lumbar disc abnormality, lumbar MRI, lumbar spine, hybrid models, hybrid features, k-means clustering based feature weighting

Procedia PDF Downloads 496

Authors: Manoj Deepak, N. Mathivanan, K. Venkatachalam

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Nerve root stenosis is one of the main cause for back pain. There are many methods both conservative and surgical to treat this disease. It is pertinent to decompress the spine to a proper extent so as to avoid the recurrence of symptoms. But too much of an aggressive approach also has its disadvantages. We present one of the methods to effectively decompress the nerve with better results. Our study was carried out in 52 patients with foramina stenosis between 2008 to 2011.We carried out the surgical procedure of shaving off the medial part of the facet joint so as to decompress the root. We selected those patients who had symptoms of claudication for more than 2 years. They had no signs of instability and they underwent conservative treatment for a period of 2 months before the procedure. Oswersty scoring was used to record the functional level of the patient before and after the procedure. All patients were followed up for a period of minimum 2.5 years. After evaluation for a minimum of 2.5 years, 34 patients had no evidence of recurrence of symptoms with improvement in the functional level.7 patients complained of minimal pain but their functional quality had improved postop. Six patients had symptoms of lumbar canal disease which reduced with conservative treatment. 5 patients required spinal fusion surgeries in the later period. Conclusion: Thus, we can effectively conclude that our procedure is safe and effective in reducing the symptoms in those patients with neurogenic claudication.

Keywords: facetectoemy, stenosis, decompression, Lumbar Foraminal Stenosis, hemi-facetectomy

Procedia PDF Downloads 319

Authors: Azadeh Jafari, Mohammad Taghi Karimi, Azadeh Nadi

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Background: Scoliosis is the lateral curvature of the spine which may influence the abilities of the subjects during standing and walking. Most of the scoliotic subjects use orthosis to reduce the curve and to decrease the risk of curve progression. There was lack of information regarding the effects of orthosis on kinematic and joint contact force. Therefore, this research was done to highlight the effects of orthosis on the aforementioned parameters. Method: 5 scoliotic subjects were recruited in this study, with single curve less than 40 (females with age 13.2 ± 1.7). They were asked to walk with and without orthosis. The kinematic of the joints, force applied on the legs, moments transmitted through the joints and joint contact forces were evaluated in this study. Moreover, the lengths of muscles were determined by use of computer muscle control approach in OpenSim. Results: There was a significant difference between the second peak of vertical ground reaction force while walking with and without orthosis (p-value < 0.05). There was no difference between spatiotemporal gait parameters while walking with and without orthosis (P-value > 0.05). The mean values of joint contact forces (vertical component) increased by the use of orthosis, but the difference was not significant (p-value > 0.05). Conclusion: Although the kinematic of most of the body joints was not influenced by the use of orthosis, the joint contact force may be increased by orthosis. The increase in joint contact force may be due to the performance of orthosis which restricts the motions of pelvic and increases compensatory mechanism used by the subjects to decrease the side effects of the orthosis.

Keywords: scoliosis, joint contact force, kinetic, kinematic

Procedia PDF Downloads 180

Authors: Li-Ting Kung, Hui-Zhu Chen, Hsin-Tzu Lee, Wan-Yin Hsu

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Patients with spinal cord injury combined with diabetic nephropathy may under a lot of painful conditions due to complications related to the illness itself or treatments, such as recurrent pressure ulcers, autonomic and peripheral neuropathy, as well as dialysis, for long term. This case report illustrated the nursing experience of transferring a spine cord injure patient who received hemodialysis due to adverse lifestyle-induced diabetic nephropathy to the hospice ward. Nursing care was provided in this patient from July 25th to August 30th, 2015. The tool of 'Gordon’s 11-item functional health assessment' and clinical observation, interviews as well as physical examination were used as data collections. Based on results of health assessment as above, the patient’s health problems were identified as the following: impaired skin integrity, chronic pain, and hopeless. Besides to relieve the symptom of pain due to disease or the treatment of hemodialysis and provide wound care, the first author also played a role to assist the patient to achieve his goal of receiving the hospice palliative care. Finally, with much effort of nurses to communicate with medical teams between the surgical and hospice wards, the patient was transferred to the hospice ward to have fulfilled his last wish of having a good death. We hope this nursing experience can be applied to other similar cases in the future.

Keywords: diabetic nephropathy, hospice care, palliative care, spinal cord injury

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Authors: Shirin Jalili, Ramin Ghasemi

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Lumbar microdiscectomy is the most commonly performed spinal surgery strategy; it is regularly performed to lighten the indications and signs of sciatica within the lower back and leg caused by a lumbar disc herniation. This surgery aims to progress leg pain, reestablish function, and enable a return to ordinary day-by-day exercises. Rates of lumbar disc surgery show critical geographic varieties recommending changing treatment criteria among working specialists. Few population-based considers have investigated the hazard of reoperation after disc surgery, and regional or inter specialty varieties within the reoperations are obscure. The conventional approach to recouping from lumbar microdiscectomy has been to restrain bending, lifting, or turning for a least 6 weeks in arrange to anticipate the disc from herniating once more. Traditionally, patients were exhorted to limit post-operative action, which was accepted to decrease the hazard of disc herniation and progressive insecurity. In modern hone, numerous specialists don't limit understanding of postoperative action due to the discernment this practice is pointless. There's a need of thinks about highlighting the result by distinctive scores or parameters after surgery for repetitive circle herniations of the lumbar spine at the starting herniation location. This study will evaluate the quality of life after surgical treatment of recurrent herniations with distinctive standardized approved result instruments.

Keywords: post-operative activity, disc, quality of life, treatment, movements

Procedia PDF Downloads 55

Authors: Tarik Ozmen

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The soccer players need good dynamic balance and jumping performance for dribbling, crossing rival, and to be effective in high balls during soccer game. The quadriceps angle (Q-angle) is used to assess biomechanics of the patellofemoral joint in the musculoskeletal medicine. The Q angle is formed by the intersection of two lines drawing from the anterior superior iliac spine to the centre of the patella and to the midline of the tibia tuberosity. Studies have shown that the Q angle is inversely associated with quadriceps femoris strength. The purpose of this study was to investigate relationship between dynamic balance, jumping performance and Q-angle in soccer players. Thirty male soccer players (mean ± SD: age, 15.23 ± 0.56 years, height, 170 ± 8.37 cm, weight, 61.36 ± 6.04 kg) participated as volunteer in this study. Dynamic balance of the participants were evaluated at directions of anterior (A), posteromedial (PM) and posterolateral (PL) with Star Excursion Balance Test (SEBT). Each participant was instructed to reach as far as with the non-dominant leg in each of the 3 directions while maintaining dominant leg stance. Leg length was used to normalize excursion distances by dividing the distance reached by leg length and then multiplying the result by 100. The jumping performance was evaluated by squat jump using a contact mat. A universal (standard) goniometer was used to measure the Q angle in standing position. The Q angle was not correlated with directions of SEBT (A: p = 0.32, PM: p = 0.06, PL: p = 0.37). The squat jump height was not correlated with Q-angle (p = 0.21). The findings of this study suggest that there are no significant relationships between dynamic balance, jumping performance and Q-angle in soccer players. Further studies should investigate relationship between balance ability, athletic performance and Q-angle with larger sample size in soccer players.

Keywords: balance, jump height, Q angle, soccer

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Authors: B. Kenny, M. Dixon, A. Boshell

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The use of alcoholic surgical prep was recently introduced into the Royal Newcastle Center for elective procedures. In the past 3 months there have been a significant number of burns believed to be related to ‘pooling’ of this surgical prep in patients undergoing procedures where they are placed in the lateral position with hip bolsters. The aim of the audit was to determine the reason for the burns, analyze what pre-existing factors may contribute to the development of the burns and what can be changed to prevent further burns occurring. All patients undergoing a procedure performed on the hip who were placed in the lateral position with sacral and anterior, superior iliac spine (ASIS) support with ‘bolsters’ were included in the audit. Patients who developed a ‘burn’ were recorded, details of the surgery, demographics, surgical prep used and length of surgery were obtained as well as photographs taken to document the burn. Measures were then taken to prevent further burns and the efficacy was documented. Overall 14 patients developed burns over the ipsilateral ASIS. Of these, 13 were Total Hip Arthroplasty (THA) and 1 was a removal of femoral nail. All patients had Chlorhexidine 0.5% in Alcohol 70% Tinted Red surgical preparation or Betadine Alcoholic Skin Prep (70% etoh). Patients were set up in the standard lateral decubitus position with sacral and bilateral ASIS bolsters with a valband covering. 86% of patients were found to have pre-existing hypersensitivities to various substances. There is very little literature besides a few case reports on surgical prep-related burns. The case reports that do exist are related to the use of tourniquet-related burns and there is no mention in the literature examining ‘bolster’ related burns. The burns are hypothesized to be caused by pooling of the alcoholic solution which is amplified by the use of Valband.

Keywords: arthroplasty, chemical burns, wounds, rehabilitation

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Authors: Manikandan S. P., Sharmila N.

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Pain in the neck, intermediate and anterior, and even low back may occur in one or more locations. Numerous factors can lead to back discomfort, which can manifest into sensations in the other parts of your body. Up to 80% of people will have low back problems at a certain stage of their lives, making spine-related pain a highly prevalent ailment. Roughly twice as commonly as neck pain, low back discomfort also happens about as often as knee pain. According to current studies, using digital devices for extended periods of time and poor sitting posture are the main causes of neck and low back pain. There are numerous monitoring techniques provided to enhance the sitting posture for the aforementioned problems. A sophisticated technique to monitor the extended sitting position is suggested in this research based on this problem. The system is made up of an inertial measurement unit, a T-shirt, an Arduino board, a buzzer, and a mobile app with cloud services. Based on the anatomical position of the spinal cord, the inertial measurement unit was positioned on the inner back side of the T-shirt. The IMU (inertial measurement unit) sensor will evaluate the hip position, imbalanced shoulder, and bending angle. Based on the output provided by the IMU, the data will be analyzed by Arduino, supplied through the cloud, and shared with a mobile app for continuous monitoring. The buzzer will sound if the measured data is mismatched with the human body's natural position. The implementation and data prediction with design to identify balanced and unbalanced posture using a posture monitoring t-shirt will be further discussed in this research article.

Keywords: IMU, posture, IOT, textile

Procedia PDF Downloads 48

Authors: Walid Abouzeid, Mohamed Shadad, Mostafa Farid, Magdy El Hawary

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The most frequent treatable vascular abnormality of the spinal canal is spinal dural arteriovenous fistulae (SDAVFs), which cause progressive para- or quadriplegia mostly affecting elderly males. SDAVFs are present in the thoracolumbar region. The main goal of treatment must be to obliterate the shunting zone via superselective embolization with the usage of a liquid embolic agent. This study aims to evaluate endovascular technique as a safe and efficient approach for the treatment SDAVFs, especially with long-term follow-up clinical outcomes. Study Design: A retrospective clinical case study. From May 2010 to May 2017, 15 patients who had symptoms attributed to SDAVFs underwent the operation in the Departments of Neurosurgery in Suhag, Tanta, and Al-Azhar Universities and Interventional Radiology, Ain Shams University. All the patients had varying degrees of progressive spastic paraparesis with and without sphincteric disturbances. Endovascular embolization was used in all cases. Fourteen were males, with ages ranging from 45 to 74 years old. After the treatment, good outcome was found in five patients (33.3%), a moderate outcome was delineated in six patients (40 %), and four patients revealed a poor outcome (26.7%). Spinal AVF could be treated safely and effectively by the endovascular approach. Generally, there is no correlation between the disappearance of MRI abnormalities and significant clinical improvement. The preclinical state of the patient is directly proportional to the clinical outcome. Due to unexpected responses, embolization should be attempted even the patient is in a bad clinical condition.

Keywords: spine, arteriovenous, fistula, endovascular, embolization

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Authors: Rajnarayan Damor, Gayatri Swarnakar

Abstract:

Fasciola gigantica are present in the biliary ducts of liver and gall bladder of domestic buffaloes. They are very harmful and causes significant lose to live stock owners, on account of poor growth and lower productivity of domestic buffaloes. Synthetic veterinary drugs have been used to eliminate parasites from cattle but these drugs are unaffordable and inaccessible for poor cattle farmers. The in vitro anthelmintic effect of Citrullus colocynthis fruit extract against Fasciola gigantica parasites were observed by light and scanning electron microscopy. Fruit extracts of C. colocynthis exhibit highest mortality 100% at 50 mg/ml in 15th hour of exposure. The oral and ventral sucker appeared to be slightly more swollen than control and synthetic drug albendazole. The tegument showed submerged spines by the swollen tegument around them. The tegument of the middle region showed deep furrows, folding and submerged spines which either lied very flat against the surface or had become submerged in the tegument by the swollen tegument around them leaving deep furrows. Posterior region showed with deep folding in the tegument, completely disappearance of spines and swelling of the tegument led to completely submerged spines leaving spine socket. The present study revealed that fruit extracts of Citrullus colocynthis found to be potential sources for novel anthelmintic and justify their ethno-veterinary use.

Keywords: anthelmintic, buffalo, Citrullus colocynthis, Fasciola gigantica, mortality, tegument

Procedia PDF Downloads 211

Authors: Haley Gershon

Abstract:

The transition from using fossil fuel-based building material to formulating eco-friendly and biobased building materials plays a key role in sustainable building. The growing demand on a global level for biobased materials in the building and construction industries heightens the importance of carbon-14 testing, an analytical method used to determine the percentage of biobased content that comprises a material’s ingredients. This presentation will focus on the use of carbon-14 analysis within the building materials sector. Carbon-14, also known as radiocarbon, is a weakly radioactive isotope present in all living organisms. Any fossil material older than 50,000 years will not contain any carbon-14 content. The radiocarbon method is thus used to determine the amount of carbon-14 content present in a given sample. Carbon-14 testing is performed according to ASTM D6866, a standard test method developed specifically for biobased content determination of material in solid, liquid, or gaseous form, which requires radiocarbon dating. Samples are combusted and converted into a solid graphite form and then pressed onto a metal disc and mounted onto a wheel of an accelerator mass spectrometer (AMS) machine for the analysis. The AMS instrument is used in order to count the amount of carbon-14 present. By submitting samples for carbon-14 analysis, manufacturers of building materials can confirm the biobased content of ingredients used. Biobased testing through carbon-14 analysis reports results as percent biobased content, indicating the percentage of ingredients coming from biomass sourced carbon versus fossil carbon. The analysis is performed according to standardized methods such as ASTM D6866, ISO 16620, and EN 16640. Products 100% sourced from plants, animals, or microbiological material are therefore 100% biobased, while products sourced only from fossil fuel material are 0% biobased. Any result in between 0% and 100% biobased indicates that there is a mixture of both biomass-derived and fossil fuel-derived sources. Furthermore, biobased testing for building materials allows manufacturers to submit eligible material for certification and eco-label programs such as the United States Department of Agriculture (USDA) BioPreferred Program. This program includes a voluntary labeling initiative for biobased products, in which companies may apply to receive and display the USDA Certified Biobased Product label, stating third-party verification and displaying a product’s percentage of biobased content. The USDA program includes a specific category for Building Materials. In order to qualify for the biobased certification under this product category, examples of product criteria that must be met include minimum 62% biobased content for wall coverings, minimum 25% biobased content for lumber, and a minimum 91% biobased content for floor coverings (non-carpet). As a result, consumers can easily identify plant-based products in the marketplace.

Keywords: carbon-14 testing, biobased, biobased content, radiocarbon dating, accelerator mass spectrometry, AMS, materials

Procedia PDF Downloads 133

Authors: Ngoc Nguyen

Abstract:

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

Procedia PDF Downloads 316

Authors: Marcel Duh, Jadranka Stricevic, David Halozan, Dusan Celan

Abstract:

Back pain is not only the result of structural or biomechanical abnormalities of the spine but is also associated with cognitive and behavioral aspects of pain and thus represents biopsychosocial problem. Stressors are not only interpersonal conflicts, negative life events, and dangerous situations but also noise. Effects of noise on human beings are psychological (excitement, stress), sensory, and physiological. The harmful effects of noise can be seen in the 40-65 dB range and are manifested as fatigue, irritability, poor sleep and psychological discomfort of the worker. Within 65-90 dB range, body metabolism increases, oxygen consumption is higher, tachycardia and hypertension appear, and the tone of skeletal muscles increases. The purpose of the study was to determine whether the stress caused by noise at the work place increases the incidence of back pain. Measurements of noise levels were carried out in three different wards of social care institution. The measurement on each ward was repeated 3 times (total of 9 measurements) for 8 hours during the morning shift. The device was set up in the room where clients spent most of the day. The staff on the ward replied to the questionnaire consisting of closed type questions about basic demographic information and information about back pain. We find that noise levels as measured in our study had no statistically significant effect on the incidence of back pain (p = 0.90). We also find that health care workers who perceive their work as stressful, have more back pain than those who perceive their job as unstressful, but correlation is statistically insignificant (p = 0.682). With our study, we have proven findings of other authors, that noise level below 65 dB does not have a significant influence on the incidence of back pain.

Keywords: health care workers, musculoskeletal disorder, noise, sick leave

Procedia PDF Downloads 97

Authors: R. Unnikrishnan, K. Shankar

Abstract:

In the case of high-speed fighter aircrafts, seat ejection is designed mainly for the safety of the pilot in case of an emergency. Strong windblast due to the high velocity of flight is one main difficulty in clearing the tail of the aircraft. Excessive G-forces generated, immobilizes the pilot from escape. In most of the cases, seats are ejected out of the aircrafts by explosives or by rocket motors attached to the bottom of the seat. Ejection forces are primarily in the vertical direction with the objective of attaining the maximum possible velocity in a specified period of time. The safe ejection parameters are studied to estimate the critical time of ejection for various geometries and velocities of flight. An equivalent analytical 2-dimensional biomechanical model of the human spine has been modelled consisting of vertebrae and intervertebral discs with a lumped mass approach. The 24 vertebrae, which consists of the cervical, thoracic and lumbar regions, in addition to the head mass and the pelvis has been designed as 26 rigid structures and the intervertebral discs are assumed as 25 flexible joint structures. The rigid structures are modelled as mass elements and the flexible joints as spring and damper elements. Here, the motions are restricted only in the mid-sagittal plane to form a 26 degree of freedom system. The equations of motions are derived for translational movement of the spinal column. An ejection force with a linearly increasing acceleration profile is applied as vertical base excitation on to the pelvis. The dynamic vibrational response of each vertebra in time-domain is estimated.

Keywords: biomechanical model, lumped mass, seat ejection, vibrational response

Procedia PDF Downloads 198

Authors: Alex Kiselyov, Suehyun Cho, Darrell Harrington; Florent Cros, Olin Palmer, John Caputo, Michael Kardosh, Eran Oren, William Loudon, Michael Shpigelmacher

Abstract:

Despite the most aggressive surgical and adjuvant therapeutic strategies, treatment of both pediatric and adult brainstem tumors remains problematic. Novel strategies, including targeted biologics, immunotherapy, and specialized delivery systems such as convection-enhanced delivery (CED), have been proposed. While some of these novel treatments are entering phase I trials, the field is still in need of treatment(s) that exhibits dramatically enhanced potency with optimal therapeutic ratio. Bionaut Labs has developed a modular microrobotic platform for performing localized delivery of diverse therapeutics in vivo. Our biocompatible particles (Bionauts™) are externally propelled and visualized in real-time. Bionauts™ are specifically designed to enhance the effect of radiation therapy via anatomically precise delivery of a radiosensitizing agent, as exemplified by temozolomide (TMZ) and Avastin™ to the brainstem gliomas of diverse origin. The treatment protocol is designed to furnish a better therapeutic outcome due to the localized (vs systemic) delivery of the drug to the neoplastic lesion(s) for use as a synergistic combination of radiation and radiosensitizing agent. In addition, the procedure is minimally invasive and is expected to be appropriate for both adult and pediatric patients. Current progress, including platform optimization, selection of the lead radiosensitizer as well as in vivo safety studies of the Bionauts™ in large animals, specifically the spine and the brain of porcine and ovine models, will be discussed.

Keywords: Bionaut, brainstem, glioma, local delivery, micro-robot, radiosensitizer

Procedia PDF Downloads 136

Authors: S. M. Ismail, H-H Yen, C. M. Murray, H. M. S. Davies

Abstract:

A recent study reported a 33% incidence of complete sacrocaudal fusion in greyhounds compared to a 3% incidence in other dogs. In the dog, the median sacral crest is formed by the fusion of sacral spinous processes. Separation of the 1st spinous process from the median crest of the sacrum in the dog has been reported as a diagnostic tool of type one lumbosacral transitional vertebra (LTV). LTV is a congenital spinal anomaly, which includes either sacralization of the caudal lumbar part or lumbarization of the most cranial sacral segment of the spine. In this study, the absence or reduction of fusion (presence of separation) between the 1st and 2ndspinous processes of the median sacral crest has been identified in association with sacrocaudal fusion in the greyhound, without any feature of LTV. In order to provide quantitative data on the absence or reduction of fusion in the median sacral crest between the 1st and 2nd sacral spinous processes, in association with sacrocaudal fusion. 204 dog sacrums free of any pathological changes (192 greyhound, 9 beagles and 3 labradors) were grouped based on the occurrence and types of fusion and the presence, absence, or reduction in the median sacral crest between the 1st and 2nd sacral spinous processes., Sacrums were described and classified as follows: F: Complete fusion (crest is present), N: Absence (fusion is absent), and R: Short crest (fusion reduced but not absent (reduction). The incidence of sacrocaudal fusion in the 204 sacrums: 57% of the sacrums were standard (3 vertebrae) and 43% were fused (4 vertebrae). Type of sacrum had a significant (p < .05) association with the absence and reduction of fusion between the 1st and 2nd sacral spinous processes of the median sacral crest. In the 108 greyhounds with standard sacrums (3 vertebrae) the percentages of F, N and R were 45% 23% and 23% respectively, while in the 84 fused (4 vertebrae) sacrums, the percentages of F, N and R were 3%, 87% and 10% respectively and these percentages were significantly different between standard (3 vertebrae) and fused (4 vertebrae) sacrums (p < .05). This indicates that absence of spinous process fusion in the median sacral crest was found in a large percentage of the greyhounds in this study and was found to be particularly prevalent in those with sacrocaudal fusion – therefore in this breed, at least, absence of sacral spinous process fusion may be unlikely to be associated with LTV.

Keywords: greyhound, median sacral crest, sacrocaudal fusion, sacral spinous process

Procedia PDF Downloads 416

Authors: Bintou Jobe

Abstract:

Musculo-skeletal disorders (MSDs) are injuries or disorders of the spine disc, muscle strains, and low back injuries. It remains a major cause of occupational illness. Findings: Due to poor grips during handling, it is possible for neck, shoulder, arm, knees, ankle, fingers, waist, lower back injuries, and other muscle joints to be affected. Pregnant women are more prone to physical and hormonal changes, which lead to the relaxation of supporting ligaments. MSD continues to pose a global concern due to its impact on workers worldwide. The prevalence of the disorder is high, according to research into the workforce in Europe and developing countries. The causes are characterized by long working hours, insufficient rest breaks, poor posture, repetitive motion, poor manual handling techniques, psychological stress, and poor nutrition. To prevent MSD, the design mainly involves avoiding and assessing the risk. However, clinical solutions, policy governance, and minimizing manual labour are also an alternative. In addition, eating a balanced diet and teamwork force are key to elements in minimising the risk. This review aims to raise awareness and promote cost effectiveness prevention and understanding of MSD through research and identify proposed solutions to recognise the underlying causes of MSDs in the construction sectors. The methodology involves a literature review approach, engaging with the policy landscape of MSD, synthesising publications on MSD and a wider range of academic publications. In conclusion, training on effective manual handling techniques should be considered, and Personal Protective Equipment should be a last resort. The implementation of training guidelines has yielded significant benefits.

Keywords: musculoskeletal disorder work related, MSD, manual handling, work hazards

Procedia PDF Downloads 32

Authors: Md Tanvir Rahman, Mahbube Subhani, Mahmud Ashraf, Paul Kremer

Abstract:

Cross-laminated timber (CLT) is made from layers of timber boards orthogonally oriented in the thickness direction, and due to this, CLT can withstand bi-axial bending in contrast with most other engineered wood products such as laminated veneer lumber (LVL) and glued laminated timber (GLT). Wood is cylindrically anisotropic in nature and is characterized by significantly lower elastic modulus and shear modulus in the planes perpendicular to the fibre direction, and is therefore classified as orthotropic material and is thus characterized by 9 elastic constants which are three elastic modulus in longitudinal direction, tangential direction and radial direction, three shear modulus in longitudinal tangential plane, longitudinal radial plane and radial tangential plane and three Poisson’s ratio. For simplification, timber materials are generally assumed to be transversely isotropic, reducing the number of elastic properties characterizing it to 5, where the longitudinal plane and radial planes are assumed to be planes of symmetry. The validity of this assumption was investigated through numerical modelling of CLT with both orthotropic mechanical properties and transversely isotropic material properties for three softwood species, which are Norway spruce, Douglas fir, Radiata pine, and three hardwood species, namely Victorian ash, Beech wood, and Aspen subjected to uniformly distributed loading under simply supported boundary condition. It was concluded that assuming the timber to be transversely isotropic results in a negligible error in the order of 1 percent. It was also observed that along with longitudinal elastic modulus, ratio of longitudinal shear modulus (GL) and rolling shear modulus (GR) has a significant effect on a deflection for CLT panels of lower span to depth ratio. For softwoods such as Norway spruce and Radiata pine, the ratio of longitudinal shear modulus, GL to rolling shear modulus GR is reported to be in the order of 12 to 15 times in literature. This results in shear flexibility in transverse layers leading to increased deflection under out-of-plane loading. The rolling shear modulus of hardwoods has been found to be significantly higher than those of softwoods, where the ratio between longitudinal shear modulus to rolling shear modulus as low as 4. This has resulted in a significant rise in research into the manufacturing of CLT from entirely from hardwood, as well as from a combination of softwood and hardwoods. The commonly used beam theory to analyze the performance of CLT panels under out-of-plane loads are the Shear analogy method, Gamma method, and k-method. The shear analogy method has been found to be the most effective method where shear deformation is significant. The effect of the ratio of longitudinal shear modulus and rolling shear modulus of cross-layer on the deflection of CLT under uniformly distributed load with respect to its length to depth ratio was investigated using shear analogy method. It was observed that shear deflection is reduced significantly as the ratio of the shear modulus of the longitudinal layer and rolling shear modulus of cross-layer decreases. This indicates that there is significant room for improvement of the bending performance of CLT through developing hybrid CLT from a mix of softwood and hardwood.

Keywords: rolling shear modulus, shear deflection, ratio of shear modulus and rolling shear modulus, timber

Procedia PDF Downloads 95

Authors: Moustafa Elwan, Sohier Shehata, Fatma Sedek, Manar Hussine

Abstract:

One of the most risky factors that lead to a foot injury during physical activities are both high and low arched feet. Normally the medial longitudinal arch of the foot develops in the first 10 years of life, so flexible flat foot has an inversely relationship with age in the first decade, all over the world, the prevalence of flat foot is increasing. In approximately 15% of foot deformities cases, the deformity does not disappear and remains throughout adulthood, 90% of the clinical cases are complaining from foot problems are due to flatfoot. Flatfoot creates subtalar over pronation, which creates tibial and femoral medial rotation, and that is accompanied with increases of pelvic tilting anteriorly, which may influence the lumbar vertebrae alignment by increasing muscle tension and rotation. Objective: To study the impact of the flexible flatfoot on lumbosacral angle (angle of Ferguson). Methods: This experiment included 40 volunteers (14 females &26 males) gathered from the Faculty of Physical Therapy, Modern University of Technology and Information, Cairo, Egypt, for each participant, four angles were measured in the foot( talar first metatarsal angle, lateral talocalcaneal angle, , Calcaneal first metatarsal angle, calcaneal inclination angle) and one angle in the lumbar region (lumbosacral angle). Measurement of these angles was conducted by using Surgimap Spine software (version 2.2.9.6). Results: The results demonstrated that there was no significant correlation betweenFerguson angle and lateral talocalcaneal (r=0.164, p=0.313). Also, there was no significant correlation between Ferguson angle and talo first metatarsal “Meary’s angle" (r=0.007, p=0.968). Moreover, there was no significant correlation between Ferguson angle and calcaneal-first metatarsal angle (r=0.083, p=0.612). Also, there was no significant correlation between Ferguson angle and calcaneal inclination angle (r= 0.032, p= 0.846). Conclusion: It can be concluded that there is no significant correlation between the flexible flat foot and lumbosacral angle So, more study should be conducted in large sample and different ages and conditions of foot problems.

Keywords: calcaneal first metatarsal, calcaneal inclination, flatfoot, ferguson’s angle, lateral talocalcaneal angle, lumbosacral angle, and talar first metatarsal angle

Procedia PDF Downloads 101