Search results for: orthopedic procedure

Authors: Hassan Gholibeigian, Kazem Gholibeigian

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In this paper, our goal is determination of loading versus time in crust. For this goal, we present a computational procedure to propose a cumulative strain energy time profile which can be used to predict the approximate location and time of the next major earthquake (M > 4.5) along a specific fault, which we believe, is more accurate than many of the methods presently in use. In the coming pages, after a short review of the research works presently going on in the area of earthquake analysis and prediction, earthquake mechanisms in both the jerk and sequence earthquake direction is discussed, then our computational procedure is presented using differential equations of equilibrium which govern the nonlinear dynamic response of a system of finite elements, modified with an extra term to account for the jerk produced during the quake. We then employ Von Mises developed model for the stress strain relationship in our calculations, modified with the addition of an extra term to account for thermal effects. For calculation of the strain energy the idea of Pulsating Mantle Hypothesis (PMH) is used. This hypothesis, in brief, states that the mantle is under diurnal cyclic pulsating loads due to unbalanced gravitational attraction of the sun and the moon. A brief discussion is done on the Denali fault as a case study. The cumulative strain energy is then graphically represented versus time. At the end, based on some hypothetic earthquake data, the final results are verified.

Keywords: pulsating mantle hypothesis, inner core’s dislocation, outer core’s bulge, constitutive model, transient hydro-magneto-thermo-mechanical load, diurnal stress, jerk, fault behaviour

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Authors: Radek Doubrava, Roman Ruzek

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Nonstandard tests are necessary for analyses and verification of new developed structural and technological solutions with application of composite materials. One of the most critical primary structural parts of a typical aerospace structure is T-joint. This structural element is loaded mainly in shear, bending, peel and tension. The paper is focused on the shear loading simulations. The aim of the work is to obtain a representative uniform distribution of shear loads along T-joint during the mechanical testing is. A new design of T-joint test procedure, numerical simulation and optimization of representative boundary conditions are presented. The different conditions and inaccuracies both in simulations and experiments are discussed. The influence of different parameters on stress and strain distributions is demonstrated on T-joint made of CFRP (carbon fiber reinforced plastic). A special test rig designed by VZLU (Aerospace Research and Test Establishment) for T-shear test procedure is presented.

Keywords: T-joint, shear, composite, mechanical testing, finite element analysis, methodology

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Authors: Tareq Al Muhareb, Jasper Graham-Jones

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The service quality is a significant element in aviation industry especially in the international airports. Through this paper, the researchers built a model based on Lean six sigma methodologies and applied it in the departure area at KKIA (King Khalid International Airport) in order to assess it. This model characterized with many special features that can become over the cultural differences in aviation industry since it is considered the most critical circumstance in this field. Applying the model of this study is depending on following the DMAIC procedure systemized in lean thinking aspects. This model of Lean-six-sigma as a managerial procedure is mostly focused on the change management culture that requires high level of planning, organizing, modifying, and controlling in order to benefit from strengths as well as revoke weaknesses.

Keywords: lean-six-sigma, service quality, aviation industry, KKIA (King Khalid International Airport), SERVQUAL

Procedia PDF Downloads 384

Authors: K. Allaw, J. Adjizian Gerard, M. Chehayeb, A. Raad, W. Fahs, A. Badran, A. Fakherdin, H. Madi, N. Badaro Saliba

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Population estimation using Geographic Information System (GIS) and remote sensing faces many obstacles such as the determination of permanent residents. A permanent resident is an individual who stays and works during all four seasons in his village. So, all those who move towards other cities or villages are excluded from this category. The aim of this study is to identify the factors affecting the percentage of permanent residents in a village and to determine the attributed weight to each factor. To do so, six factors have been chosen (slope, precipitation, temperature, number of services, time to Central Business District (CBD) and the proximity to conflict zones) and each one of those factors has been evaluated using one of the following data: the contour lines map of 50 m, the precipitation map, four temperature maps and data collected through surveys. The weighting procedure has been done using decision tree method. As a result of this procedure, temperature (50.8%) and percentage of precipitation (46.5%) are the most influencing factors.

Keywords: remote sensing, GIS, permanent residence, decision tree, Lebanon

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Authors: Joao Teotonio Manzi

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Reversibility, irreversibility, equilibrium and steady-state that play a central role in the thermodynamic analysis of processes arising in the context of reactive systems are discussed in this article. Such concepts have generated substantial doubts, even among the most experienced researchers, and engineers, because from the literature, conclusive or definitive statements cannot be extracted. Concepts such as the time-reversibility of irreversible processes seem paradoxical, requiring further analysis. Equilibrium and reversibility, which appear to be of the same nature, have also been re-examined in the light of maximum entropy. The goal of this paper is to revisit and explore these concepts based on classical thermodynamics in order to have a better understanding them due to their impacts on technological advances, as a result, to generate an optimal procedure for designing, monitoring, and engineering optimization. Furthermore, an effective graphic procedure for dimensioning a Plug Flow Reactor has been provided. Thus, to meet the needs of chemical engineering from a simple conceptual analysis but with significant practical effects, a macroscopic approach is taken so as to integrate the different parts of this paper.

Keywords: reversibility, equilibrium, steady-state, thermodynamics, reactive system

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

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Revision total hip arthroplasty (THA) is known to be a challenging procedure with potential for poor outcomes. Due to its lack of metaphyseal encroachment, hip resurfacing arthroplasty (HRA) is classified as a bone conserving procedure. Although the literature postulates that this is an advantage at time of revision surgery, there is no evidence to either support or refute this claim. We identified 129 hips that had undergone HRA and 129 controls undergoing first revision THA. We recorded the clinical assessment and survivorship of implants in a multi-surgeon, single centre, retrospective case control series for both arms. These were matched for age and sex. Data collected included demographics, indications for surgery, Oxford Hip Score (OHS), length of surgery, length of hospital stay, blood transfusion, implant complexity and further surgical procedures. Significance was taken as p < 0.05. Mean follow up was 7.5 years (1 to 15). There was a significant 6 point difference in postoperative OHS in favour of the revision resurfacing group (p=0.0001). The revision HRA group recorded 48 minutes less length of surgery (p<0.0001), 2 days less in length of hospital stay (p=0.018), a reduced need for blood transfusion (p=0.0001), a need for less complexity in revision implants (p=0.001) and a reduced probability of further surgery being required (P=0.003). Whilst we acknowledge the limitations of this study our results suggest that, in contrast to THA, the bone conservation element of HRA may make for a less traumatic revision procedure with better functional outcomes. Use of HRA has seen a dramatic decline as a result of concerns regarding metallosis. However, this information remains of relevance when counselling young active patients about their arthroplasty options and may become pertinent in the future if the promise of ceramic hip resurfacing is ever realized.

Keywords: hip resurfacing, metallosis, revision surgery, total hip arthroplasty

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Authors: Farzaneh Bayat

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Successful and effective presence in regional and global markets along with optimal use of available utilities and proper utilization of new sources for offering desirable services based on customer satisfaction is inevitable. Commitment has a significant role in offering optimal services. Offering high quality job and desirable services to the customers are personnel’s commitment. Thus, Shiraz Chamran Hospital which is affiliated with Shiraz Medical School and is one of the orthopedic poles in southern Iran was studied. This hospital has 750 personnel and physicians which a sample of 200 of them were chosen as the statistic society for a 5 month period from June to November 2009. Main variables in this decision are: responsibility and responsiveness, job security, team work, task autonomy, gradation opportunity, information sharing, payments and commitment. The study approach is descriptive-correlative. With applied and segmental nature of the tests and statistic analysis, the 7 hypotheses were approved with 95% of certainty.

Keywords: commitment, information sharing, responsibility and responsiveness, job security, task autonomy

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Authors: Gordon Weight, Hermione Tsoi, Patrick Cutinha, Sanjay Rajpal

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Aim: Greenlight-laser prostatectomy (GLLP) is becoming a popular treatment option for bladder outlet obstruction and lower urinary tract symptoms (LUTS). In this retrospective study, we aim to explore the patient selection, perioperative morbidity, and functional outcomes of GLLP. Methods: Patients who underwent GLLP at a UK tertiary centre between June 2018 and November 2021 were included in this study. Retrospective data covering patient demographics, perioperative parameters and postoperative outcomes were collected using the electronic records systems. Results: 305 patients were included in this study with a mean age of 73 (range 30-90) years. The most common indication (62.6%) for the procedure was patient’s wish to be free from long-term catheters (LTC) or intermittent catheterisation (ISC), followed by failed medical therapy for LUTS (36.4%). 84.6% of patients had an ASA ≥2, and 32.1% took anticoagulant or antiplatelet therapy. Inpatient stays were minimal, with the majority (68.2%) of patients were performed as day case, and only 10.5% of patients requiring more than a single night admission. The 3-month readmission rate was 10.8%, with the most common causes being haematuria and urinary-tract infection. The successful TWOC rate at follow up was 91.2%. Amongst the 19 patients who failed TWOC, 14 had LTC prior to the procedure and 4 had been performing ISC. Conclusions: Our study shows that GLLP is a safe and effective day case treatment and can be suitable for elderly and comorbid patients. Patients requiring LTC or ISC pre-operatively should be counselled carefully about the risk of not being catheter-free post procedure.

Keywords: urology, endourology, prostate, bladder outlet obstruction, laser

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Authors: Naoki Saito, Daisuke Kon, Toshiyuki Sato

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This paper describes an underactuated robot hand operated by low-power actuators. It can grasp objects of various shapes using easy operations. This hand is suitable for use as a lightweight prosthetic hand that can grasp various objects using few input channels. To realize operations using a low-power actuator, a cross section deformation spring is proposed. The design procedure of the underactuated robot finger is proposed to realize an adaptive grasping movement. The validity of this mechanism and design procedure are confirmed through an object grasping experiment. Results demonstrate the effectiveness of a cross section deformation spring in reducing the actuator power. Moreover, adaptive grasping movement is realized by an easy operation.

Keywords: robot hand, underactuated mechanism, cross-section deformation spring, prosthetic hand

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Authors: Mohammad Nazri Mustafa, Sh Norliza Sy Salim, Pedram Hatami Abdullah

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Civil and structural assets normally have an average of more than 30 years of design life. Adding to this advantage, the assets are normally subjected to slow degradation process. Due to the fact that repair and strengthening work for these assets are normally not dependent on plant shut down, the maintenance and integrity restoration of these assets are mostly done based on “as required” and “run to failure” basis. However unlike other industries, the exposure in oil and gas environment is harsher as the result of corrosive soil and groundwater, chemical spill, frequent wetting and drying, icing and de-icing, steam and heat, etc. Due to this type of exposure and the increasing level of structural defects and rectification in line with the increasing age of plants, assets integrity assessment requires a more defined scope and procedures that needs to be based on risk and assets criticality. This leads to the establishment of risk based inspection and proactive maintenance procedure for civil and structural assets. To date there is hardly any procedure and guideline as far as integrity assessment and systematic inspection and maintenance of civil and structural assets (onshore) are concerned. Group Technical Solutions has developed a procedure and guideline that takes into consideration credible failure scenario, assets risk and criticality from process safety and structural engineering perspective, structural importance, modeling and analysis among others. Detailed inspection that includes destructive and non-destructive tests (DT & NDT) and structural monitoring is also being performed to quantify defects, assess severity and impact on integrity as well as identify the timeline for integrity restoration. Each defect and its credible failure scenario is assessed against the risk on people, environment, reputation and production loss. This technical paper is intended to share on the established procedure and guideline and their execution in oil & gas plants. In line with the overall roadmap, the procedure and guideline will form part of specialized solutions to increase production and to meet the “Operational Excellence” target while extending service life of civil and structural assets. As the result of implementation, the management of civil and structural assets is now more systematically done and the “fire-fighting” mode of maintenance is being gradually phased out and replaced by a proactive and preventive approach. This technical paper will also set the criteria and pose the challenge to the industry for innovative repair and strengthening methods for civil & structural assets in oil & gas environment, in line with safety, constructability and continuous modification and revamp of plant facilities to meet production demand.

Keywords: assets criticality, credible failure scenario, proactive and preventive maintenance, risk based inspection

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Authors: Chaudhuri Manoj Kumar Swain, Susmita Das

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This paper explores a detailed procedure of predicting a path loss (PL) model and its application in estimating the coverage probability in a WiMAX network. For this a hybrid approach is followed in predicting an empirical PL model of a 2.65 GHz WiMAX network deployed in a suburban environment. Data collection, statistical analysis, and regression analysis are the phases of operations incorporated in this approach and the importance of each of these phases has been discussed properly. The procedure of collecting data such as received signal strength indicator (RSSI) through experimental set up is demonstrated. From the collected data set, empirical PL and RSSI models are predicted with regression technique. Furthermore, with the aid of the predicted PL model, essential parameters such as PL exponent as well as the coverage probability of the network are evaluated. This research work may assist in the process of deployment and optimisation of any cellular network significantly.

Keywords: WiMAX, RSSI, path loss, coverage probability, regression analysis

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Authors: Yang Liu

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Reinforced concrete (RC) shear wall structures are one of the most popular and efficient structural forms for medium- and high-rise buildings to resist the action of earthquake loading. Thus, it is of great significance to evaluate the seismic demands of the RC shear walls. In this paper, the application of the extend spectrum-based pushover analysis (ESPA) method on the seismic evaluation of the shear wall structure is presented. The ESPA method includes a nonlinear consecutive pushover analysis procedure and a linear elastic modal response analysis procedure to consider the combination of modes in both elastic and inelastic cases. It is found from the results of case study that the ESPA method can predict the seismic performance of shear wall structures, including internal forces and deformations very well.

Keywords: reinforced concrete shear wall, seismic performance, high mode effect, nonlinear analysis

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Authors: Aldona Kluczek

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Energy efficient process have become a pressing research field in manufacturing. The arguments for having an effective industrial energy efficiency processes are interacted with factors: economic and environmental impact, and energy security. Improvements in energy efficiency are most often achieved by implementation of more efficient technology or manufacturing process. Current processes of electricity production represents the biggest consumption of energy and the greatest amount of emissions to the environment. The goal of this study is to improve the potential energy-savings and reduce greenhouse emissions related to improvement scenarios for the treatment of hardwood lumber produced by an industrial plant operating in the U.S. through the application of green balancing procedure, in order to find the preferable efficient technology. The green procedure for energy is based on analysis of energy efficiency data. Three alternative scenarios of the cogeneration systems plant (CHP) construction are considered: generation of fresh steam, the purchase of a new boiler with the operating pressure 300 pounds per square inch gauge (PSIG), an installation of a new boiler with a 600 PSIG pressure. In this paper, the application of a bottom-down modelling for energy flow to devise a streamlined Energy and Emission Flow Analyze method for the technology of producing electricity is illustrated. It will identify efficiency or technology of a given process to be reached, through the effective use of energy, or energy management. Results have shown that the third scenario seem to be the efficient alternative scenario considered from the environmental and economic concerns for treating hardwood lumber. The energy conservation evaluation options could save an estimated 6,215.78 MMBtu/yr in each year, which represents 9.5% of the total annual energy usage. The total annual potential cost savings from all recommendations is $143,523/yr, which represents 30.1% of the total annual energy costs. Estimation have presented that energy cost savings are possible up to 43% (US$ 143,337.85), representing 18.6% of the total annual energy costs.

Keywords: alternative scenario improvements, cogeneration system, energy and emission flow analyze, energy balancing, green procedure, hardwood lumber manufacturing process

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Authors: Amin Ranjbar, Amir Arsalan Jalili Zolfaghari, Amir Abolfazl Suratgar, Mehrdad Khajavi

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This paper describes two stages of learning-based fault detection procedure in alternators. The procedure consists of three states of machine condition namely shortened brush, high impedance relay and maintaining a healthy condition in the alternator. The fault detection algorithm uses Wigner-Ville distribution as a feature extractor and also appropriate feature classifier. In this work, ANN (Artificial Neural Network) and also SVM (support vector machine) were compared to determine more suitable performance evaluated by the mean squared of errors criteria. Modules work together to detect possible faulty conditions of machines working. To test the method performance, a signal database is prepared by making different conditions on a laboratory setup. Therefore, it seems by implementing this method, satisfactory results are achieved.

Keywords: alternator, artificial neural network, support vector machine, time-frequency analysis, Wigner-Ville distribution

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Authors: Abdulatif Abdulsalam Mohamed Shaban

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This paper states that the art of Procedure Entry Array (PEA) plan with a focus on control system applications. This paper begins with an impression of PEA technology development, followed by an arrangement of design technologies, and the use of programmable description languages and system-level design tools. They allow a practical approach based on a unique model for complete engineering electronics systems. There are three main design rules are implemented in the system. These are algorithm based fine-tuning, modularity, and the control act and the architectural constraints. An overview of contributions and limits of PEAs is also given, followed by a short survey of PEA-based gifted controllers for recent engineering systems. Finally, two complete and timely case studies are presented to illustrate the benefits of a PEA implementation when using the proposed system modelling and devise attitude. These consist of the direct control for training motor drives and the control of a diesel-driven stand-alone generator with the help of logical design.

Keywords: control (DC), engineering electronics systems, training motor drives, procedure entry array

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Authors: Adrian Forca, Simeon Cainday III

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The Electronic Payment Recording with Payment History Retrieval Module is developed intendedly for the College of Science and Technology. This system software innovates the manual process of recording the payments done in the department through the development of electronic payment recording system software shifting from the slow and time-consuming procedure to quick yet reliable and accurate way of recording payments because it immediately generates receipts for every transaction. As an added feature to its software process, generation of recorded payment report is integrated eliminating the manual reporting to a more easy and consolidated report. As an added feature to the system, all recorded payments of the students can be retrieved immediately making the system transparent and reliable payment recording software. Viewing the whole process, the system software will shift from the manual process to an organized software technology because the information will be stored in a logically correct and normalized database. Further, the software will be developed using the modern programming language and implement strict programming methods to validate all users accessing the system, evaluate all data passed into the system and information retrieved to ensure data accuracy and reliability. In addition, the system will identify the user and limit its access privilege to establish boundaries of the specific access to information allowed for the store, modify, and update making the information secure against unauthorized data manipulation. As a result, the System software will eliminate the manual procedure and replace with an innovative modern information technology resulting to the improvement of the whole process of payment recording fast, secure, accurate and reliable software innovations.

Keywords: collection, information system, manual procedure, payment

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Authors: Andressa dos Santos Nicolau, João P. da S.C Algusto, Claudio Márcio do N. A. Pereira, Roberto Schirru

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In case of abnormal situations, the nuclear power plant (NPP) operators must follow written procedures to check the condition of the plant and to classify the type of emergency. In this paper, we proposed a Real Time Expert System in order to improve operator’s performance in case of transient or accident with reactor shutdown. The expert system’s knowledge is based on the sequence of events (SoE) of known accident and two emergency procedures of the Brazilian Pressurized Water Reactor (PWR) NPP and uses two kinds of knowledge representation: rule and logic trees. The results show that the system was able to classify the response of the automatic protection systems, as well as to evaluate the conditions of the plant, diagnosing the type of occurrence, recovery procedure to be followed, indicating the shutdown root cause, and classifying the emergency level.

Keywords: emergence procedure, expert system, operator support, PWR nuclear power plant

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Authors: Anita Yaghobi, Homayoun Ebrahimian

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One of the important tools that can help orthopedic doctors for diagnose diseases is imaging scan. Imaging techniques can help physicians in see different parts of the body, including the bones, muscles, tendons, nerves, and cartilage. During CT scan, a patient must be in the same position from the start to the end of radiation treatment. Patient movements are usually monitored by the technologists through the closed circuit television (CCTV) during scan. If the patient makes a small movement, it is difficult to be noticed by them. In the present work, a simple patient movement monitoring device is fabricated to monitor the patient movement. It uses an electronic sensing device. It continuously monitors the patient’s position while the CT scan is in process. The device has been retrospectively tested on 51 patients whose movement and distance were measured. The results show that 25 patients moved 1 cm to 2.5 cm from their initial position during the CT scan. Hence, the device can potentially be used to control and monitor patient movement during CT scan and Radiography. In addition, an audible alarm situated at the control panel of the control room is provided with this device to alert the technologists. It is an inexpensive, compact device which can be used in any CT scan machine.

Keywords: CT scan, radiology, X Ray, unwanted movement

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Authors: Trad Khodja Rafik, Mahtout Amine, Ghoul Rachid, Benbouali Amine, Boulahlib Amine, Hariza Abdelmalik

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Cranioplasty with custom implant realized using 3D printing technology. Cranioplasty is a surgical act that aims restoring cranial bone losses in order to protect the brain from external aggressions and to improve the patient aesthetic appearance. This objective can be achieved with taking advantage of the current technological development in computer science and biomechanics. The objective of this paper it to present an approach for the realization of high precision biocompatible cranial implants using new 3D printing technologies at the lowest cost. The proposed method is to reproduce the missing part of the skull by referring to its healthy contralateral part. Once the model is validated by the neurosurgeons, a mold is 3D printed for the production of a biocompatible implant in Poly-Methyl-Methacrylate (PMMA) acrylic cement. Using this procedure four patients underwent this procedure with excellent aesthetic results.

Keywords: cranioplasty, cranial bone loss, 3D printing technology, custom-made implants, PMMA

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Authors: Pengfei Liu, Yiyi Xu

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There have been substantial incidents of wind turbine blade fractures and failures due to the lack of systematic blade strength design method incorporated with the aerodynamic forces and power generation efficiency. This research was to develop a methodology and procedure for the wind turbine rotor blade strength taking into account the strength, integration, and aerodynamic performance in terms of power generation efficiency. The wind turbine blade designed using this method and procedure will have a uniform strength across the span to save unnecessary thickness in many blade radial locations and yet to maintain the optimum power generation performance. A turbine rotor code, taking into account both aerodynamic and structural properties, was developed. An existing wind turbine blade was used as an example. For a condition of extreme wind speed of 100 km per hour, the design reduced about 19% of material usage while maintaining the optimum power regeneration efficiency.

Keywords: renewable energy, wind turbine, turbine blade strength, aerodynamics-strength coupled optimization

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Authors: D. Zujur, J. Moret, D. Rodriguez, L. Cruz, J. Lira, L. Gil, E. Dominguez, J. F. Alvarez-Barreto

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In this work, chitosan (CH) has been used to produce a novel coating for Ti6Al4V, the most widely used alloy in orthopedic implants, so as to improve the biological tissue response at the metallic surface. The Ti6Al4V surface was sandblasted with alumina particles and observed by SEM. Chitosan was chemically modified, via crodiimide chemistry, with lactobionic and 4-azidebenzoic acid to make it soluble at physiological pH and photo-crosslinkable, respectively. The reaction was verified by FTIR, NMR, and UV/vis spectroscopy. Ti6Al4V surfaces were coated with solutions of the modified CH and exposed to UV light, causing the polymer crosslinking, and formation of a hydrogel on the surface. The crosslinking reaction was monitored by FTIR at different exposure times. Coating morphology was observed by SEM. The coating´s cytocompatibility was determined in vitro through the culture of rat bone marrow´s mesenchymal stem cells, using an MTT assay. The results show that the developed coating is cytocompatible, easy to apply and could be used for further studies in the encapsulation of bioactive molecules to improve osteogenic potential at the tissue-implant interface.

Keywords: chitosan, photo-crosslinking, Ti6Al4V, bioactive coating, hydrogel

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Authors: Virgil Florescu, Lucian Capitanu

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The studies performed by the author and presented here focus mainly on the FE simulation of some relevant phenomena related to stability of orthopedic implants, especially those components of Total Hip Prostheses. The objectives are to study the mechanisms of achieving stability of acetabular prosthetic components and the influence of some characteristic parameters, to evaluate the effect of femoral stem fixation modality on the stability of prosthetic component and to predict long-term behavior, to analyze a critical phenomena which influence the loading transfer mechanism through artificial joints and could lead to aseptic loosening – the wear of joint frictional surfaces. After a theoretical background an application is made considering only three activities: normal walking, stair ascending and stair descending. For each activity, this function is maximized in a different locations: if for normal walking the maxima is in the superior-posterior part of the acetabular cup, for stair descending this maxim value could be located rather in the superior-anterior part, for stair ascending being even closer to the central area of the cup.

Keywords: THA, acetabular stability, FEM simulation, stresses and displacements, wear tests, wear simulation

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Authors: Ashvamedh, Chandra Bhushan Singh, Anil Kumar Sarda

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Introduction: Ileal perforation is a common cause for peritonitis in developing countries. Surgery is the ideal treatment as it eliminates soilage of peritoneal cavity in an effort to lessen the toxaemia and enhance the recovery of the patient. However, there is no uniformity of standardized operative procedure that is most effective for management. Material and method: The study was conducted on 66 patients of perforation peritonitis from November 2013 to February 2015 in Lok Nayak Hospital. Data of each patient were recorded on a pre-determined proforma. The methods used for repair were Primary repair, Resection anastomosis (RA) and Ileostomy. Result: Male preponderance was noticed among the patients with majority in their third decade. Of all perforations 40.9% were tubercular and 34.8% were typhoid. Amongst operated cases 27.3% underwent primary repair, RA was performed in 45.5%, Ileostomy in 27.3%patients. The average time taken for RA and ileostomy was more than primary repair. The type of repair bear no significance to size or no of perforation but was significant statistically for distance from I/C valve(P=.005) and edema of bowel wall(p=.002) when analysed for post op complications. Wound infection, dehiscence, intra-abdominal collections were complications observed bearing no significance to type of repair. Ileostomy per se has its own complications peristomal skin excoriation seen in 83.3%, electrolyte imbalance in 33.3%, duration for closure averaged 188 days (median 150 days, range 85-400 days). Conclusion: Primary closure is preferable in patients with single, small perforations. RA is advocated in patients with multiple or large perforation, perforation proximal to stricture. Ileostomy should not be considered as primary definitive procedure and reserved only for moribund patients as a lifesaving procedure. It has more morbidity and requires a second surgery for closure increasing the cost of treatment as well.

Keywords: ileal perforation, ileostomy, perforation peritonitis, typhoid perforation management

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Authors: Yasemin Kaya, Ahmet N. Eraslan

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In this study, the thermoelastic behavior of a long tube is studied by taking into account the temperature dependency of all mechanical and thermal properties. As the tube is heated slowly, an uncoupled solution procedure is adopted under free and radially constrained boundary conditions. The nonlinear heat conduction equation is solved by a finite element collocation procedure and the corresponding distributions of stress and strain are computed by shooting iterations. The computational model is verified in comparison to the analytical solution by shutting down the temperature dependency of physical properties. In the analysis, experimental data available in the literature is used to describe the coefficient of thermal expansion $\alpha$, the thermal conductivity $k$, the modulus of rigidity $G$, the yield strength $\sigma_{0}$, and the Poisson's ratio $\nu$ of Nickel. Results of the analysis are presented in comparison to those having constant physical properties. As a result of the calculations, the temperature dependency of the material properties should be taken into account at higher temperature ranges.

Keywords: thermoelasticity, long tube, temperature-dependent properties, internal heating

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Authors: László Schmidt

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In the context of artificial intelligence, we need to pay primary and particular attention to ethical principles not only in the design process but also during the application process. According to the European Commission's Ethical Guidelines, AI must have three main characteristics: it must be legal, ethical and stabil. We must never lose sight of the ethical principles because we risk that this new technology will not help democratic decision-making under the rule of law, but will, on the contrary, destroy it. The rapid spread and use of artificial intelligence poses an enormous challenge to both lawmaking and law enforcement. On legislation because AI permeates many areas of our daily lives that the legislator must regulate. We can see how challenging it is to regulate e.g., selfdriving cars/taxis/vans etc. Not to mention, more recently, cryptocurrencies and Chat GPT, the use of which also requires legislative intervention, from copyright to scientific use and even law of succession. Artificial intelligence also poses an extraordinary challenge to law enforcement. In criminal cases, police and prosecutors can make great use of AI in investigations, e.g. in forensics, DNA samples, reconstruction, identification, etc. But it can also be of great help in the detection of crimes committed in cyberspace. In criminal or civil court proceedings, AI can also play a major role in the evaluation of evidence and proof. For example, a photo or video or audio recording could be immediately revealed as genuine or fake. Likewise, the authenticity or falsification of a document could be determined much more quickly and cheaply than with current procedure (expert witnesses). Neither the current Hungarian Civil Procedure Act nor the Criminal Procedure Act allows the use of artificial intelligence in the evidentiary process. However, this should be changed. To use this technology in court proceedings would be very useful. The procedures would be faster, simpler, and therefore cheaper. Artificial intelligence could also replace much of the work of expert witnesses. Its introduction into judicial procedures would certainly be justified, but with due respect for human rights, the right to a fair trial and other democratic and rule of law guarantees.

Keywords: artificial intelligence, judiciary, Hungarian, court practice

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Authors: K. N. Dinesh Babu

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In this paper, the protection of a complicated bus arrangement with a dual bus coupler and bus sectionalizer using low impedance differential protection applicable for very high voltages like 220kV and 400kV is discussed. In many power generation stations, several operational procedures are implemented to utilize the transfer bus as the main bus and to facilitate the maintenance of circuit breakers and current transformers (in each section) without shutting down the bay(s). Owing to this fact, the complications in operational philosophy have thrown challenges for the bus bar protection implementation. Many bus topologies allow any one of the main buses available in the station to be used as an auxiliary bus. In such a system, pre-defined precautions and procedures are made as guidelines, which are followed before assigning any bus as an auxiliary bus. The procedure involves shifting of links, changing rotary switches, insertion of test block, and so on, thereby causing unreliable operation. This kind of unreliable operation or inadvertent procedural lapse may result in the isolation of the bus bar from the grid due to the unpredictable operation of the bus bar protection relay, which is a commonly occurring phenomenon due to manual mistakes. With the sophisticated configuration and implementation of logic in modern intelligent electronic devices, the operator is free to select the transfer arrangement without sacrificing the protection required by a bus differential system for a reliable operation, and labor-intensive processes are completely eliminated. This paper deals with the procedure to test the security logic for such special scenarios using Megger make SMRT, bus bar protection relay to assure system stability and get rid of all the specific operational precautions/procedure.

Keywords: bus bar protection, by-pass isolator, blind spot, breaker failure, intelligent electronic device, end fault, bus unification, directional principle, zones of protection, breaker re-trip, under voltage security, smart megger relay tester

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Authors: Adya H. Uluwita, Fernando B. D. S. Pedrosa, Georgi M. Georgiev, Raoul Masterson

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CERN is an international organisation funded by 23 countries which provides the particle physics community with excellence in particle accelerators and other related facilities. Founded in 1954, CERN has a wide range of accelerators that allow groundbreaking science to be conducted. Accelerators bring particles to high levels of energy and make them collide with each other or with fixed targets, creating specific conditions that are of high interest to physicists. A chain of accelerators is used to ramp up the energy of particles and eventually inject them into the largest and most recent one of them: the Large Hadron Collider (LHC). Among this chain of machines is, for instance, the Proton Synchrotron, which was started in 1959 and is still in operation. These machines, called "injectors”, keep evolving over time, as well as the related infrastructure. Massive decommissioning of obsolete cables started in 2015 at CERN in the frame of the so-called "injectors de-cabling project phase 1". Its goal was to replace aging cables and remove unused ones, freeing space for new cables necessary for upgrades and consolidation campaigns. To proceed with the de-cabling, a project coordination team was assembled. The start of this project phase led to the investigation of legacy cables throughout the organisation. The identification of cables stacked during half a century proved to be arduous. Phase 1 of the injectors de-cabling was implemented for three years with success after overcoming some difficulties. Phase 2, which started 3 years later, focused on improving safety and structure with the introduction of a quality assurance procedure. This paper discusses the implementation of this quality assurance procedure throughout phase 2 of the project and the transition between the two phases. Over hundreds of kilometres of cable were removed in the injectors complex at CERN from 2015 to 2023.

Keywords: CERN, de-cabling, injectors, quality assurance procedure

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Authors: Amrit Vasdev, Edwin Rho, Gurinder Vasdev

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Robotic surgery has enabled a new spectrum of minimally invasive breast reconstruction by improving visualization, surgeon posturing, and improved patient outcomes.1 The DaVinci robot system can be utilized in nipple sparing mastectomies and reconstructions. The process involves the insufflation of the subglandular space and a dissection of the mammary gland with a combination of cautery and blunt dissection. This case outlines a 35-year-old woman who has a long-standing family history of breast cancer and a diagnosis of a deleterious BRCA2 genetic mutation. She has decided to proceed with bilateral nipple sparing mastectomies with implants. Her perioperative mammogram and MRI were negative for masses, however, her left internal mammary lymph node was enlarged. She has taken oral contraceptive pills for 3-5 years and denies DES exposure, radiation therapy, human replacement therapy, or prior breast surgery. She does not smoke and rarely consumes alcohol. During the procedure, the patient received a standardized anesthetic for out-patient surgery of propofol infusion, succinylcholine, sevoflurane, and fentanyl. Aprepitant was given as an antiemetic and preoperative Tylenol and gabapentin for pain management. Concerns for the patient during the procedure included CO2 insufflation into the subcutaneous space. With CO2 insufflation, there is a potential for rapid uptake leading to severe acidosis, embolism, and subcutaneous emphysema.2To mitigate this, it is important to hyperventilate the patient and reduce both the insufflation pressure and the CO2 flow rate to the minimal acceptable by the surgeon. For intraoperative monitoring during this 6-9 hour long procedure, it has been suggested to utilize an Arterial-Line for end-tidal CO2 monitoring. However, in this case, it was not necessary as the patient had excellent cardiovascular reserve, and end-tidal CO2 was within normal limits for the duration of the procedure. A BIS monitor was also utilized to reduce anesthesia burden and to facilitate a prompt discharge from the PACU. Minimal Invasive Robotic Surgery will continue to evolve, and anesthesiologists need to be prepared for the new challenges ahead. Based on our limit number of patients, robotic mastectomy appears to be a safe alternative to open surgery with the promise of clearer tissue demarcation and better cosmetic results.

Keywords: anesthesia, mastectomies, robotic, hypercarbia

Procedia PDF Downloads 71

Authors: H. Akhloufi, M. Hulscher, J. M. Prins, I. H. Van Der Sijs, D. Melles, A. Verbon

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Background: A timely switch from intravenous to oral antibiotic therapy has many advantages, such as reduced incidence of IV-line related infections, a decreased hospital length of stay and less workload for healthcare professionals with equivalent patient safety. Additionally, numerous studies have demonstrated significant decreases in costs of a timely intravenous to oral antibiotic therapy switch, while maintaining efficacy and safety. However, a considerable variation in iv to oral antibiotic switch therapy criteria has been described in literature. Here, we report the development of a set of iv to oral switch criteria that are generally applicable in all hospitals. Material/methods: A RAND-modified Delphi procedure, which was composed of 3 rounds, was used. This Delphi procedure is a widely used structured process to develop consensus using multiple rounds of questionnaires within a qualified panel of selected experts. The international expert panel was multidisciplinary and composed out of clinical microbiologists, infectious disease consultants and clinical pharmacists. This panel of 19 experts appraised 6 major intravenous to oral antibiotic switch therapy criteria and operationalized these criteria using 41 measurable conditions extracted from the literature. The procedure to select a concise set of iv to oral switch criteria included 2 questionnaire rounds and a face-to-face meeting. Results: The procedure resulted in the selection of 16 measurable conditions, which operationalize 6 major intravenous to oral antibiotic switch therapy criteria. The following 6 major switch therapy criteria were selected: (1) Vital signs should be good or improving when bad. (2) Signs and symptoms related to the infection have to be resolved or improved. (3) The gastrointestinal tract has to be intact and functioning. (4) The oral route should not be compromised. (5) Absence of contra-indicated infections. (6) An oral variant of the antibiotic with good bioavailability has to exist. Conclusions: This systematic stepwise method which combined evidence and expert opinion resulted in a feasible set of 6 major intravenous to oral antibiotic switch therapy criteria operationalized by 16 measurable conditions. This set of early antibiotic iv to oral switch criteria can be used in daily practice in all adult hospital patients. Future use in audits and as rules in computer assisted decision support systems will lead to improvement of antimicrobial steward ship programs.

Keywords: antibiotic resistance, antibiotic stewardship, intravenous to oral, switch therapy

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Authors: Mohammed Hussein Ahmed, Bahar Mohammed Kareem

Abstract:

This study is concerned with the pragmatic discoursal study of hedging constructions in English language. Hedging is a mitigated word used to lessen the impact of the utterance uttered by the speakers. Hedging could be either adverbs, adjectives, verbs and sometimes it may consist of clauses. It aims at finding out the extent to which speakers and participants of the discourse use hedging constructions during their conversations. The study also aims at finding out whether or not there are any significant differences in the types and functions of the frequency of hedging constructions employed by male and female. It is hypothesized that hedging constructions are frequent in English discourse more than any other languages due to its formality and that the frequency of the types and functions are influenced by the gender of the participants. To achieve the aims of the study, two types of procedures have been followed: theoretical and practical. The theoretical procedure consists of presenting a theoretical background of hedging topic which includes its definitions, etymology and theories. The practical procedure consists of selecting a sample of texts and analyzing them according to an adopted model. A number of conclusions will be drawn based on the findings of the study.

Keywords: hedging, pragmatics, politeness, theoretical

Procedia PDF Downloads 531