Search results for: persistent atrial fibrillation

Authors: Ratnakar Rao, Subair Khan, Hari Haran

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Posterior cruciate ligament (PCL) avulsion fractures is a rare condition and commonly mismanaged.Surgical reattachment has been shown to produce better result compared with conservative management.Only few techniques are reported in arthroscopic fixation of PCL Avulsion Fracture and they are complex.We describe a new technique in fixation of the PCL Avulsion fracture through a posterior trans septal portal using button fixation device (Mini Tight Rope). Eighteen patients with an isolated posterior cruciate ligament avulsion fracture were operated under arthroscopy. Standard Antero Medial Portal and Antero Lateral portals made and additional Postero Medial and Postero Lateral portals made and trans Septal portal established. Avulsion fracture identified, elevated, prepared. Reduction achieved using PCL Tibial guide (Arthrex) and fixation was achieved using Mini Tight Rope,Arthrex (2 buttons with a suture). Reduction confirmed using probe and Image intensifier. Postoperative assessment made clinically and radiologically. 15 patients had good to excellent results with no posterior sag or instability. The range of motion was normal. No complications were recorded per operatively. 2 patients had communition of the fragment while drilling, for one patient it was managed by suturing technique and the second patient PCL Reconstruction was done. One patient had persistent instability with poor outcome. Establishing trans septal portal helps in better visualization of the posterior compartment of the knee. Assessment of the bony fragment, preparation 0f the bone bed andit protects from injury to posterior neurovascular structures. Fixation using the button with suture (Mini Tight Rope) is stable and easily reproducible for PCL Avulsion fracture with single large fragment.

Keywords: PCL avulsion, arthroscopy, transeptal, minitight rope technique

Procedia PDF Downloads 234

Authors: Elisa K. Schoenell, Cristiano De Oliveira, Luiz R. H. Dos Santos, Alexandre Giacobbo, Andréa M. Bernardes, Marco A. S. Rodrigues

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Water is an indispensable natural resource, which must be preserved to human activities as well the ecosystems. However, the sewage discharge has been contaminating water resources. Conventional treatment, such as physicochemical treatment followed by biological processes, has not been efficient to the complete degradation of persistent organic compounds, such as medicines and hormones. Therefore, the use of advanced technologies to sewage treatment has become urgent and necessary. The aim of this study was to apply Reverse Osmosis (RO) on sewage tertiary treatment from a Waste Water Treatment Plant (WWTP) in south Brazil. It was collected 200 L of sewage pre-treated by wetland with aquatic macrophytes. The sewage was treated in a RO pilot plant, using a polyamide membrane BW30-4040 model (DOW FILMTEC), with 7.2 m² membrane area. In order to avoid damage to the equipment, this system contains a pleated polyester filter with 5 µm pore size. It was applied 8 bar until achieve 5 times of concentration, obtaining 80% of recovery of permeate, with 10 L.min-1 of concentrate flow rate. Samples of sewage pre-treated on WWTP, permeate and concentrate generated on RO was analyzed for physicochemical parameters and by gas chromatography (GC) to qualitative analysis of organic compounds. The results proved that the sewage treated on WWTP does not comply with the limit of phosphorus and nitrogen of Brazilian legislation. Besides this, it was found many organic compounds in this sewage, such as benzene, which is carcinogenic. Analyzing permeate results, it was verified that the RO as sewage tertiary treatment was efficient to remove of physicochemical parameters, achieving 100% of iron, copper, zinc and phosphorus removal, 98% of color removal, 91% of BOD and 62% of ammoniacal nitrogen. RO was capable of removing organic compounds, however, it was verified the presence of some organic compounds on de RO permeate, showing that RO did not have the capacity of removal all organic compounds of sewage. It has to be considered that permeate showed lower intensity of peaks in chromatogram in comparison to the sewage of WWTP. It is important to note that the concentrate generate on RO needs a treatment before its disposal in environment.

Keywords: organic compounds, reverse osmosis, sewage treatment, tertiary treatment

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Authors: Ibrahim Turfanda, Soniya Rai, Karan Vadher

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Objectives— The study aims to compare real-world adherence to and persistence with dulaglutide and liraglutide in patients with type 2 diabetes (T2D) initiating treatment in UAE. Methods— This was a retrospective, non-interventional study (observation period: 01 March 2017–31 August 2019) using the UAE Dubai e-Claims database. Included: adult patients initiating dulaglutide/liraglutide 01 September 2017–31 August 2018 (index period) with: ≥1 claim for T2D in the 6 months before index date (ID); ≥1 claim for dulaglutide/liraglutide during index period; and continuous medical enrolment for ≥6 months before and ≥12 months after ID. Key endpoints, assessed 3/6/12 months after ID: adherence to treatment (proportion of days covered [PDC; PDC ≥80% considered ‘adherent’], per-group mean±standard deviation [SD] PDC); and persistence (number of continuous therapy days from ID until discontinuation [i.e., >45 days gap] or end of observation period). Patients initiating dulaglutide/liraglutide were propensity score matched (1:1) based on baseline characteristics. Between-group comparison of adherence was analysed using the McNemar test (α=0.025). Persistence was analysed using Kaplan–Meier estimates with log-rank tests (α=0.025) for between-group comparisons. This study presents 12-month outcomes. Results— Following propensity score matching, 263 patients were included in each group. Mean±SD PDC for all patients at 12 months was significantly higher in the dulaglutide versus the liraglutide group (dulaglutide=0.48±0.30, liraglutide=0.39±0.28, p=0.0002). The proportion of adherent patients favored dulaglutide (dulaglutide=20.2%, liraglutide=12.9%, p=0.0302), as did the probability of being adherent to treatment (odds ratio [97.5% CI]: 1.70 [0.99, 2.91]; p=0.03). Proportion of persistent patients also favoured dulaglutide (dulaglutide=15.2%, liraglutide=9.1%, p=0.0528), as did the probability of discontinuing treatment 12 months after ID (p=0.027). Conclusions— Based on the UAE Dubai e-Claims database data, dulaglutide initiators exhibited significantly greater adherence in terms of mean PDC versus liraglutide initiators. The proportion of adherent patients and the probability of being adherent favored the dulaglutide group, as did treatment persistence.

Keywords: adherence, dulaglutide, effectiveness, liraglutide, persistence

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Authors: Adèle Hotte-Meunier, Lisa Sarraf, Alan Bougeard, Félicia Bernier, Chloé Voyer, Jiaxuan Deng, Stéphanie El Asmar, Alina Stamate, Marc Corbière, Patrizia Villotti, Geneviève Sauvé

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Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with psychosocial, educational and occupational functioning. Although often conceptualized as a developmental disorder of childhood, 65% of children with ADHD continue to meet full or partial diagnostic criteria for ADHD in adulthood and an estimated 4% of the workforce has a diagnosis of ADHD. Methods: A systematic review was conducted to understand the experiences of people living with ADHD in the workplace. Articles reporting employment outcomes for people living with were identified by a search in eight databases on four separate occasions from June 27, 2022, to June 21, 2023. A risk of bias assessment for each study was performed using the Mixed Methods Appraisal Tool (MMAT). Results: A total of 79 studies were included in this systematic review (nADHD: 68, 216). Results were synthesized into three broad overarching categories: challenges, strengths and adaptations at work. Further, nine themes were included: ADHD symptoms at work, workplace performance, job satisfaction, interpersonal relationships at work, maladaptive work thoughts and behaviors, personal strengths, embracing ADHD, person-environment fit and accommodations and support. Sex differences were highlighted as a tenth subtheme. ADHD confers both strengths and limitations related to employment. Discussion: Workers with ADHD can not only adapt but thrive in employment with the right person-environment fit, accommodations and support. Many challenges related to ADHD can be managed or remodeled as assets in a workplace environment that fosters acceptance, flexible working practices and openness to neurodiversity.

Keywords: neurodivergence, occupation, workplace, person-environment fit

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Authors: Denise Muro

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Conflict in Syria, producing over 11 million displaced persons, has incited global attention to displacement. Although neighboring countries have borne the largest part of the displacement burden, due to the influx of refugees into Europe, the so-called ‘refugee crisis’ is taking place on two fronts: Syria’s neighboring countries, with millions of refugees, and Europe, a destination goal for so many that European states face unprecedented challenges. With increasing attention to displacement, forcibly displaced persons are consistently portrayed as either un-agentic victims, or as dangerous free agents. Recognizing that these dominant portrayals involve discourses of power and inequality, this research investigates the extent to which this victim-agent dichotomy affects refugees and organizations that work closely with them during initial integration processes in Berlin, Germany. The research measures initial integration based on German policy measures regarding integration juxtaposed with the way refugees and those who work with them understand integration. Additionally, the study examines day-to-day interactions of refugees in Germany as a way to gauge social integration in a bottom-up approach. This study involved a discourse analysis of portrayals of refugees and participant observation and interviews with refugees and those who work closely with them, which took place during fieldwork in Berlin in the summer of 2016. Germany is unique regarding their migration history and lack of successful integration, in part due to the persistent refrain, ‘Wir sind kein einwanderungsland’ (‘We are not an immigration country’). Still, their accepted asylum seeker population has grown exponentially in the past few years. Findings suggest that the victim-agent dichotomy is present and impactful in the process of refugees entering and integrating into Germany. Integration is hindered due to refugees either being patronized or criminalized to such an extent that, despite being constantly told that they must integrate, they cannot become part of German society.

Keywords: discourse analysis, Germany, integration, refugee crisis

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Authors: Londeka Ngubane

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The use of corporal punishment is not a new phenomenon in the South African education system as it was, for a long time, recognised as a fitting form of punishment for ill-disciplined and disobedient children. The growing recognition that corporal punishment is an act of violence against children has resulted in the abolishment of this form of punishment in society and particularly in schools. However, regardless of criminalising corporal punishment, it appears to be a disciplinary measure that is persistently used by some educators. Historically and currently, the intimate connection between corporal punishment and discipline has not merely been a convention of human thinking, as this practice is given recognition in various definitions in dictionaries. ‘To discipline’ is habitually stated to mean ‘to punish’. The notion of ‘disciplining children’ also comes from entrenched common conceptions about children and their relationship with adults. Corporal punishment has, for a long time, been associated with the rearing and education of children, and this practice thus pervades schooling across nations. In many societies, punishment is a term that is closely linked with the self-perception of teachers who feel that they must be ‘in control’ and have ‘the upper hand’ in order to be respected. This impression of control is evident in the widespread conception of education which is to ‘socialize’ children in ‘desirable ways’ of ‘sitting in a formal classroom’, ‘behaving’ in school, ‘following instructions’ from the teacher, talking only when asked to, and finishing tasks on time. It was against this backdrop that a comprehensive review of relevant literature was undertaken and that individual interviews were conducted with fifty learners from four schools (two junior secondary and two senior secondary schools) in a selected township area in KwaZulu-Natal Province. The main aim of the study was to explore and thus understand learners’ views on the administration of corporal punishment regardless of the fact that it was legally abolished. It was envisaged that the interviews with the learners would elicit rich data that would enhance the researcher’s insight into their perceptions of the persistent use of corporal punishment as a disciplinary measure in their schools. The study was thus premised on the assumption, which had been strengthened by anecdotal and media evidence, that corporal punishment was still administered in some schools in South Africa and in schools in the study area in particular.

Keywords: corporal punishment, ban, school learners, South Africa

Procedia PDF Downloads 127

Authors: Milad Pirali, Sohrab Keyhani, Mohhamad Ali Sanjari, Ali Ashraf Jamshidi

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Purpose: The effect of hamstring antagonist activity on the knee extensors torque of the Anterior Cruciate Ligament reconstruction (ACLR) is not clear and persistent muscle weakness is common after ACLR. Hamstring activation when acting as antagonist is considered very important for knee strengths. Therefore the purpose of this study was to examine hamstring antagonist coactivation during maximal effort of the isokinetic knee extension in ACLR athletes with hamstring autograft. Materials and Methods: We enrolled 20 professional athletes who underwent primary ACLR (hamstring tendon autograft)with 6-24 months postoperative and 20 healthy subjects as control group. Each subjects performed maximal effort isokinetic knee extension and flexion in 60/˚ s and 180/˚ s velocities for the involved and uninvolved limb. Synchronously, surface electromyography (EMG) was recorded of vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF) and biceps femoris (BF). The antagonist integrated EMG (IEMG) values were normalized to the IEMG of the same muscle during maximal isokinetic eccentric effort at the same velocities and ROM. Results: A one-way analysis of variance designs shows significantly greater IEMG coactivation of hamstring and decreased activation of Vm in ACLR when compared to uninvolved and control group leg in 60/˚ s and 180/˚ s velocities. Likewise peak torque to body weight was decreased in ACLR compared to uninvolved and control group during knee extension in both velocities (p < 0.05). Conclusions: Decreased extensors moment caused by decreased quadriceps inhibition and increased hamstring coactivation. In addition, these result indicated to decrease of motor unit recruitment in the VM (as a kinesiologicmonitore of the knee). It is appearing that strengthening of the quadriceps to be an important for rehabilitation program after ACLR for preparation in athletes endeavors. Therefore, we suggest that having more emphasis and focus on quadriceps strength and less emphasis on hamstring following ACLR.

Keywords: ACLR-coactivation, dynamometry, electromyography, isokinetic

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Authors: Adebola Adedugbe

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The challenge of post-harvest losses poses serious threats for food security in Nigeria and the north-eastern part with the country losing about $9billion annually due to postharvest losses in the sector. Post-harvest loss (PHL) is the quantitative and qualitative loss of food in various post-harvest operations. In Nigeria, post-harvest losses (PHL) have been a major challenge to food security and improved farmer’s income. In 2022, the Nigerian government had said over 30 percent of food produced by Nigerian farmers perish during post-harvest. For many in northeast Nigeria, agriculture is the predominant source of livelihood and income. The persistent communal conflicts, flood, decade-old attacks by boko haram and insurgency in this region have disrupted farming activities drastically, with farmlands becoming insecure and inaccessible as communities are forced to abandon ancestral homes, The impact of climate change is also affecting agricultural and fishing activities, leading to shortage of food supplies, acute hunger and loss of livelihood. This has continued to impact negatively on the region and country’s food production and availability making it loose billions of US dollars annually in income in this sector. The root cause of postharvest losses among others in crops, livestock and fisheries are lack of modern post-harvest equipment, chemical and lack of technologies used for combating losses. The 2019 Global Hunger Index showed Nigeria’s case was progressing from a ‘serious to alarming level’. As part of measures to address the problem of post-harvest losses experienced by farmers, the federal government of Nigeria concessioned 17 silos with 6000 metric tonne storage space to private sector to enable farmers to have access to storage facilities. This paper discusses the causes, effects and solutions in handling post-harvest losses and optimize returns on food security in northeast Nigeria.

Keywords: farmers, food security, northeast Nigeria, postharvest loss

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Authors: Shem Ikoojo Ayegba, Ye Qi

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Public-private partnerships (PPPs) can potentially be a transformative mechanism for advancing affordable housing in Nigeria., considering the current housing deficit between 17 – 24 million. Nevertheless, their effectiveness is marred by persistent unethical practices such as corruption and the utilization of subpar materials. Through a comprehensive mixed-methods approach, this study delves into the ethical quandaries within Nigerian housing construction and their cascading effects on the success of PPPs. Semi-structured interviews encompassing seasoned construction professionals and an in-depth content analysis of ongoing housing policies and projects in Nigeria reveal a culture of corruption across the value chain. This malaise is exacerbated by glaring deficiencies in oversight and a lack of transparent practices. A robust statistical survey involving diverse professionals, including engineers, architects, and project managers, echoes these findings, emphasizing that a frail institutional framework facilitates the persistence of substandard material use, professional negligence, and rampant bribery. Such compromised construction standards place residents in potential jeopardy and impede the achievement of broader sustainability objectives. This study propounds a suite of policy interventions to pave the way for thriving affordable housing PPPs: initiating transparent bidding processes, establishing non-negotiable quality benchmarks for construction materials, and incorporating independent third-party audits throughout the building phase. Furthermore, cultivating a culture of professional integrity through targeted ethics training for all construction personnel is imperative. This research furnishes pragmatic strategies that can radically enhance the potency of housing PPPs, thereby ensuring safe, durable, and affordable housing solutions for Nigeria's underserved populace.

Keywords: public-private partnerships, affordable housing, unethical practicies, housing policies, construction ethics

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Authors: Abdulrahman M. Alajlan, Saichao Dang, Qiaoqiang Gan

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Photovoltaic (PV) cells, while pivotal for solar energy harnessing, confront a challenge due to the presence of persistent residual heat. This thermal energy poses significant obstacles to the performance and longevity of PV cells. Mitigating this thermal issue is imperative, particularly in tropical regions where solar abundance coexists with elevated ambient temperatures. In response, a sustainable and economically viable solution has been devised, incorporating water-passive cooling within a Photovoltaic-Thermoelectric (PV-TEG) hybrid system to address PV cell overheating. The implemented system has significantly reduced the operating temperatures of PV cells, achieving a notable reduction of up to 15 °C below the temperature observed in standalone PV systems. In addition, a thermoelectric generator (TEG) integrated into the system significantly enhances power generation, particularly during nighttime operation. The developed hybrid system demonstrates its capability to generate power at a density of 0.5 Wm⁻² during nighttime, which is sufficient to concurrently power multiple light-emitting diodes, demonstrating practical applications for nighttime power generation. Key findings from this research include a consistent temperature reduction exceeding 10 °C for PV cells, translating to a 5% average enhancement in PV output power compared to standalone PV systems. Experimental demonstrations underscore nighttime power generation of 0.5 Wm⁻², with the potential to achieve 0.8 Wm⁻² through simple geometric optimizations. The optimal cooling of PV cells is determined by the volume of water in the heat storage unit, exhibiting an inverse relationship with the optimal performance for nighttime power generation. Furthermore, the TEG output effectively powers a lighting system with up to 5 LEDs during the night. This research not only proposes a practical solution for maximizing solar radiation utilization but also charts a course for future advancements in energy harvesting technologies.

Keywords: photovoltaic-thermoelectric systems, nighttime power generation, PV thermal management, PV cooling

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Authors: K. Sushma Varma, Rajesh Singh

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Non-engineered landfills cause serious environmental damage due to toxic emissions and mobilization of persistent pollutants, organic and inorganic contaminants, as well as soluble metal ions. The available treatment technologies for landfill leachate and solid waste are not effective from an economic, environmental, and social standpoint. The present study assesses the potential of the bioelectrochemical system (BES) integrated with sulfate-reducing bacteria (SRB) in the sustainable treatment and decontamination of landfill wastes. For this purpose, solid waste and landfill leachate collected from different landfill sites were evaluated for long-term treatment using the integrated SRB-BES anaerobic designed bioreactors after pre-treatment. Based on periodic gas composition analysis, physicochemical characterization of the leachate and solid waste, and metal concentration determination, the present system demonstrated significant improvement in volumetric hydrogen production by suppressing methanogenesis. High reduction percentages of Be, Cr, Pb, Cd, Sb, Ni, Cr, COD, and sTOC removal were observed. This mineralization can be attributed to the synergistic effect of ammonia-assisted pre-treatment complexation and microbial sulphide formation. Despite being amended with 0.1N ammonia, the treated leachate level of NO³⁻ was found to be reduced along with SO₄²⁻. This integrated SRB-BES system can be recommended as an eco-friendly solution for landfill reclamation. The BES-treated solid waste was evidently more stabilized, as shown by a five-fold increase in surface area, and potentially useful for leachate immobilization and bio-fortification of agricultural fields. The vector arrangement and magnitude showed similar treatment with differences in magnitudes for both leachate and solid waste. These findings support the efficacy of SRB-BES in the treatment of landfill leachate and solid waste sustainably, inching a step closer to our sustainable development goals. It utilizes low-cost treatment, and anaerobic SRB adapted to landfill sites. This technology may prove to be a sustainable treatment strategy upon scaling up as its outcomes are two-pronged: landfill waste treatment and energy recovery.

Keywords: bio-electrochemical system, leachate /solid waste treatment, landfill leachate, sulfate-reducing bacteria

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Authors: Hajar Zarei, AliAkbar Zarenejadatashgah, Vuk Uskoković, Hiroshi Watabe

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The reactive oxygen species (ROS) generated by radiation in nuclear diagnostic imaging and radiotherapy could damage the structure of the proteins in noncancerous cells surrounding the tumor. The critical factor in many age-related diseases, such as Alzheimer, Parkinson, or Huntington diseases, is the oxidation of proteins by the ROS as molecular triggers of the given pathologies. Our studies by spectroscopic experiments showed doses close to therapeutic ones (1 to 5 Gy) could lead to changes of secondary and tertiary structures in BSA protein macromolecule as a protein model as well as the aggregation of polypeptide chain but without the fragmentation. For this reason, we investigated the radioprotective effects of natural (vitamin C and E) and synthetic materials (CNPs and FIOMPs) on the structural changes in BSA protein induced by gamma irradiation at a therapeutic dose (3Gy). In the presence of both vitamins and synthetic materials, the spectroscopic studies revealed that irradiated BSA was protected from the structural changes caused by ROS, according to in vitro research. The radioprotective property of CNPs and FIOMPs arises from enzyme mimetic activities (catalase, superoxide dismutase, and peroxidase) and their antioxidant capability against hydroxyl radicals. In the case of FIOMPs, a porous structure also leads to increased ROS recombination with each other in the same radiolytic track and subsequently decreased encounters with BSA. The hydrophilicity of vitamin C resulted in the major scavenging of ROS in the solvent, whereas hydrophobic vitamin E localized on the nonpolar patches of the BSA surface, where it did not only neutralize them thanks to the moderate BSA binding constant but also formed a barrier for diffusing ROS. To the best of our knowledge, there has been a persistent lack of studies investigating the radioactive effect of mentioned materials on proteins. Therefore, the results of our studies can open a new widow for application of these common dietary ingredients and new synthetic NPs in improving the safety of radiotherapy.

Keywords: reactive oxygen species, spectroscopy, bovine serum albumin, gamma radiation, radioprotection

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Authors: Djeddi Khaled, Houssou Hind, Miloudi Abdelatif, Rabah Siham

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Camels play a vital role as multipurpose animals, providing milk meat and serving as a means of transportation. They serve as a financial reserve for pastoralists and hold significant cultural and social value. Camel milk, known for its exceptional nutritional properties, is considered a valuable substitute for human milk. However, udder infections, particularly mastitis, pose significant challenges to camel farming. Clinical and subclinical mastitis can lead to substantial economic losses. Mastitis, especially the subclinical form, is a persistent and prevalent condition affecting milk hygiene and quality in dairy camels. This review offers insights into the prevalence and risk factors associated with subclinical mastitis in camels. The prevalence of subclinical mastitis in dairy camels was found to range from 9.28% to 87.78%. Major pathogens responsible for camel mastitis include Staphylococcus aureus, Coagulase-negative Staphylococcus, Streptococcus agalactiae, Streptococcus dysgalactiae, Escherichia coli, Micrococcus spp, Pasteurella haemolytica and Corynebacterium spp. The study outlines key risk factors contributing to camel mastitis, emphasizing factors such as severe tick infestation, age, stage of lactation, parity, body condition score, skin lesion on the teats or udders, anti-suckling devices, previous history of the udder, conformation of the udder, breed, unhygienic milking practices, production system, amongst others have been reported to be important in the prevalence of subclinical mastitis. This comprehensive overview provides valuable insights into the multifaceted aspects of camel mastitis, encompassing prevalent bacterial pathogens and diverse risk factors. The findings underscore the importance of holistic management practices, emphasizing hygiene, health monitoring, and targeted interventions to ensure the well-being and productivity of camels in various agro-pastoral contexts.

Keywords: bacterial pathogens, camel, mastitis, risk factors

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Authors: Madhuri Goswami

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The matrix of power establishes the hegemonic dominance and supremacy of one group through exercising repression and relegation upon the other. However, the injustice done to any race, ethnicity, or caste has instigated the protest and resistance through various modes -social campaigns, political movements, literary expression and so on. Consequently, the search for identity, the means of claiming it and strive for recognition have evolved as the persistent phenomena all through the world. In the discourse of protest and minority literature, these two discourses -African American and Indian Dalit- surprisingly, share wrath and anger, hope and aspiration, and quest for identity and struggle for self-assertion. African American and Indian Dalit are two geographically and culturally apart communities that stand together on a single platform. This paper has sought to comprehend the form and investigate the formation of identity in general and in the literary work of Toni Morrison and Indian Dalit writing, particular, i.e., Black identity and Dalit identity. The study has speculated two types of identity, namely, individual or self and social or collective identity in the literary province of these marginalized literature. Morrison’s work outsources that self-identity is not merely a reflection of an inner essence; it is constructed through social circumstances and relations. Likewise, Dalit writings too have a fair record of discovery of self-hood and formation of identity, which connects to the realization of self-assertion and worthiness of their culture among Dalit writers. Bama, Pawar, Limbale, Pawde, and Kamble investigate their true self concealed amid societal alienation. The study has found that the struggle for recognition is, in fact, the striving to become the definer, instead of just being defined; and, this striving eventually, leads to the introspection among them. To conclude, Morrison as well as Indian marginalized authors, despite being set quite distant, communicate the relation between individual and community in the context of self-consciousness, self-identification and (self) introspection. This research opens a scope for further research to find out similar phenomena and trace an analogy in other world literatures.

Keywords: identity, introspection, self-access, struggle for recognition

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Authors: Tuji Jemal Ahmed

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Food security and utilization are critical aspects of ensuring the well-being and prosperity of a nation. This paper examines the current state of food security and utilization in Ethiopia, focusing on the challenges, opportunities, and strategies employed to address the issue. Ethiopia, a country in East Africa, has made significant progress in recent years to improve food security and utilization for its population. However, persistent challenges such as recurrent droughts, limited access to resources, and low agricultural productivity continue to pose obstacles to achieving sustainable food security. The paper begins by providing an overview of the concept of food security, emphasizing its multidimensional nature and the importance of access, availability, utilization, and stability. It then explores the specific factors influencing food security and utilization in Ethiopia, including natural resources, climate variability, agricultural practices, infrastructure, and socio-economic factors. Furthermore, the paper highlights the initiatives and interventions implemented by the Ethiopian government, non-governmental organizations, and international partners to enhance food security and utilization. These efforts include agricultural extension programs, irrigation projects, investments in rural infrastructure, and social safety nets to protect vulnerable populations. The study also examines the role of technology and innovation in improving food security and utilization in Ethiopia. It explores the potential of sustainable agricultural practices, such as conservation agriculture, improved seed varieties, and precision farming techniques. Additionally, it discusses the role of digital technologies in enhancing access to market information, financial services, and agricultural inputs for smallholder farmers. Finally, the paper discusses the importance of collaboration and partnerships between stakeholders, including government agencies, development organizations, research institutions, and communities, in addressing food security and utilization challenges. It emphasizes the need for integrated and holistic approaches that consider both production and consumption aspects of the food system.

Keywords: food security, utilization, Ethiopia, challenges

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Authors: Tuji Jemal Ahmed

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Food security and utilization are critical aspects of ensuring the well-being and prosperity of a nation. This paper examines the current state of food security and utilization in Ethiopia, focusing on the challenges, opportunities, and strategies employed to address the issue. Ethiopia, a country in East Africa, has made significant progress in recent years to improve food security and utilization for its population. However, persistent challenges such as recurrent droughts, limited access to resources, and low agricultural productivity continue to pose obstacles to achieving sustainable food security. The paper begins by providing an overview of the concept of food security, emphasizing its multidimensional nature and the importance of access, availability, utilization, and stability. It then explores the specific factors influencing food security and utilization in Ethiopia, including natural resources, climate variability, agricultural practices, infrastructure, and socio-economic factors. Furthermore, the paper highlights the initiatives and interventions implemented by the Ethiopian government, non-governmental organizations, and international partners to enhance food security and utilization. These efforts include agricultural extension programs, irrigation projects, investments in rural infrastructure, and social safety nets to protect vulnerable populations. The study also examines the role of technology and innovation in improving food security and utilization in Ethiopia. It explores the potential of sustainable agricultural practices, such as conservation agriculture, improved seed varieties, and precision farming techniques. Additionally, it discusses the role of digital technologies in enhancing access to market information, financial services, and agricultural inputs for smallholder farmers. Finally, the paper discusses the importance of collaboration and partnerships between stakeholders, including government agencies, development organizations, research institutions, and communities, in addressing food security and utilization challenges. It emphasizes the need for integrated and holistic approaches that consider both production and consumption aspects of the food system.

Keywords: food security, utilization, Ethiopia, challenges

Procedia PDF Downloads 62

Authors: Hanaa M. M. El-Khayat, Hoda Abdel-Hamid, Kadria M. A. Mahmoud, Hanan S. Gaber, Hoda, M. A. Abu Taleb, Hassan E. Flefel

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Snails are considered as suitable diagnostic organisms for heavy metal–contaminated sites. Biomphalaria alexandrina snails are used in this work as pollution bioindicators after exposure to chemical mixtures consisted of heavy metals (HM); zinc (Zn), copper (Cu) and lead (Pb); and persistent organic pollutants; Decabromodiphenyl ether 98% (D) and Aroclor 1254 (A). The impacts of these tested chemicals, individual and mixtures, on liver and kidney functions, antioxidant enzymes, complete blood picture, and tissue histology were studied. Results showed that Cu was proved to be the highly toxic against snails than Zn and Pb where LC₅₀ values were 1.362, 213.198 and 277.396 ppm, respectively. Also, B. alexandrina snails exposed to the mixture of HM (¼ LC₅ Cu, Pb and Zn) showed the highest bioaccumulation of Cu and Zn in their whole tissue, the most significant increase in AST, ALT & ALP activities and the highest significant levels of total protein, albumin and globulin. Results showed significant alterations in CAT activity in snail tissue extracts while snail samples exposed to most experimental tests showed significant increase in GST activity. Snail samples that exposed to HM mixtures showed a significant decrease in total hemocytes count while snail samples that exposed to mixtures containing A & D showed a significant increase in total hemocytes and Hyalinocytes. Histopathological alterations in snail samples exposed to individual HM and their mixtures for 4 weeks showed degeneration, edema, hyper trophy and vaculation in head-foot muscle, degeneration and necrotic changes in the digestive gland and accumulation in most tested organs. Also, the hermaphrodite gland showed mature ova with irregular shape and reduction in sperm number. In conclusion, the resulted damage and alterations in B. alexandrina studied parameters can be used as bioindicators to the presence of pollutants in its habitats.

Keywords: Biomphalaria, Zn, Cu, Pb, AST, ALT, ALP, total protein albumin, globulin, CAT, histopathology

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Authors: Naijin Wu, Peizhong Li, Haijian Wang, Wenxia Wei, Yun Song

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Chlorinated aliphatic hydrocarbons (CAHs) pollution poses a severe threat to human health and is persistent in groundwater. Although chemical reduction or bioremediation is effective, it is still hard to achieve their complete and rapid dechlorination. Recently, the combination of zero-valent iron and biostimulation has been considered to be one of the most promising strategies, but field studies of this technology are scarce. In a typical site contaminated by various types of CAHs, basic physicochemical parameters of groundwater, CAHs and their product concentrations, and microbial abundance and diversity were monitored after a remediation slurry containing both micron zero-valent iron (mZVI) and biostimulation components were directly injected into the aquifer. Results showed that groundwater could form and keep low oxidation-reduction potential (ORP), a neutral pH, and anoxic conditions after different degrees of fluctuations, which was benefit for the reductive dechlorination of CAHs. The injection also caused an obvious increase in the total organic carbon (TOC) concentration and sulfate reduction. After 253 days post-injection, the mean concentration of total chlorinated ethylene (CEE) from two monitoring wells decreased from 304 μg/L to 8 μg/L, and total chlorinated ethane (CEA) decreased from 548 μg/L to 108 μg/L. Occurrence of chloroethane (CA) suggested that hydrogenolysis dechlorination was one of the main degradation pathways for CEA, and also hints that biological dechlorination was activated. A significant increase of ethylene at day 67 post-injection indicated that dechlorination was complete. Additionally, the total bacterial counts increased by 2-3 orders of magnitude after 253 days post-injection. And the microbial species richness decreased and gradually changed to anaerobic/fermentative bacteria. The relative abundance of potential degradation bacteria increased corresponding to the degradation of CAHs. This work demonstrates that mZVI and biostimulation can be combined to achieve the efficient removal of various CAHs from contaminated groundwater sources.

Keywords: chlorinated aliphatic hydrocarbons, groundwater, field study, zero-valent iron, biostimulation

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Authors: K. Sakthivel

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With the continuous increase in population worldwide, stress increased among agricultural peoples, so it is necessary to increase the yield of agro-products. But it is not possible to meet fully with the traditionally adopted ways of using pesticides and herbicides. Today, agriculture and horticulture has realized the need of tomorrow and opting for various technologies to get higher overall yield, quality agro-products. Most of today’s synthetic polymers are produced from petrochemical bi-products and are not biodegradable. Persistent polymers generate significant sources of environmental pollution, harming wildlife when they are disposed in nature. The disposal of non degradable plastic bags adversely affects human and wild life. Moreover incineration of plastic waste presents environmental issues as well, since it yields toxic emissions. Material incineration is also limited due to the difficulties to find accurate and economically viable outlets. In addition plastic recycling shows a negative eco balance due to the necessity in nearly all cases to wash the plastic waste as well as the energy consumption during the recycling process phases. As plastics represent a large part of the waste collection at the local regional and national levels institutions are aware of the significant savings that compostable or biodegradable materials would generate. Polylactic acid (PLA), which is one of the most important biocompatible polyesters that are derived from annually renewable biomass such as corn and wheat, has attracted much attention for automotive parts and also can be applied in agro textiles. The manufacturing method of PLA is the ring-opening polymerization of the dimeric cyclic ester of lactic acid, lactide. For the stereo complex PLA, we developed by the four unit processes, fermentation, separation, lactide conversion, and polymerization. Then the polymer is converted into mulching film and applied in agriculture field. PLA agro textiles have better tensile strength, tearing strength and with stand from UV rays than polyester agro textile and polypropylene-based products.

Keywords: biodegradation, environment, mulching film, PLA, technical textiles

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Authors: Ching-Yuan Chen, Lung-Kwang Pan

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Objective: Back pain is a major health problem costing billions of health budgets annually in Taiwan. Thousands of back pain surgeries are performed annually with up to 40% of patients complaining of back pain at time of post-surgery causing failed back surgery syndrome (FBSS), although diagnosis in these patients may be complex. The aim of study is to assess the feasibility of using bone SPECT-CT imaging to localize the active lesions causing persistent, recurrent or new backache after spine surgery. Materials and Methods: Bone SPECT-CT imaging was performed after the intravenous injection of 20 mCi of 99mTc-MDP for all the patients with diagnosis of FBSS. Patients were evaluated using status of subjectively pain relief, functional improvement and degree of satisfaction by reviewing the medical records and questionnaires in a 2 more years’ follow-up. Results: We enrolled a total of 16 patients were surveyed in our hospital from Jan. 2015 to Dec. 2016. Four people on SPEC/CT imaging ensured significant lesions were undergone a revised surgery (surgical treatment group). The mean visual analogue scale (VAS) decreased 5.3 points and mean Oswestry disability index (ODI) improved 38 points in the surgical group. The remaining 12 on SPECT/CT imaging were diagnosed as no significant lesions then received drug treatment (medical treatment group). The mean VAS only decreased 2 .1 point and mean ODI improved 12.6 points in the medical treatment group. In the posttherapeutic evaluation, the pain of the surgical treatment group showed a satisfactory improvement. In the medical treatment group, 10 of the 12 were also satisfied with the symptom relief while the other 2 did not improve significantly. Conclusions: Findings on SPECT-CT imaging appears to be easily explained the patients' pain. We recommended that SPECT/CT imaging was a feasible and useful clinical tool to improve diagnostic confidence or specificity when evaluating patients with FBSS.

Keywords: failed back surgery syndrome, oswestry disability index, SPECT-CT imaging, 99mTc-MDP, visual analogue scale

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Authors: Zou Xuan, Liu Hongchen

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The ideal dentin desensitizing agent should not only have good biological safety, simple clinical operation mode, the superior treatment effect, but also should have a durable effect to resist the oral environmental temperature change and oral mechanical abrasion, so as to achieve a persistent desensitization effect. Also, when using desensitizing agent to prevent the post-operative hypersensitivity, we should not only prevent it from affecting crowns’ retention, but must understand its effects on bond strength of dentin adhesives. There are various of desensitizers and dentin adhesives in clinical treatment. They have different chemical or physical properties. Whether the use of desensitizing agent would affect the bond strength of dentin adhesives still need further research. In this in vitro study, we built the hypersensitive dentin model and post-operative dentin model, to evaluate the sealing effects and durability on exposed tubule by three different dentin desensitizers and to evaluate the sealing effects and the bond strength of dentin adhesives after using three different dentin desensitizers on post-operative dentin. The result of this study could provide some important references for clinical use of dentin desensitizing agent. 1. As to the three desensitizers, the hypersensitive dentin model was built to evaluate their sealing effects on exposed tubule by SEM observation and dentin permeability analysis. All of them could significantly reduce the dentin permeability. 2. Test specimens of three groups treated by desensitizers were subjected to aging treatment with 5000 times thermal cycling and toothbrush abrasion, and then dentin permeability was measured to evaluate the sealing durability of these three desensitizers on exposed tubule. The sealing durability of three groups were different. 3. The post-operative dentin model was built to evaluate the sealing effects of the three desensitizers on post-operative dentin by SEM and methylene blue. All of three desensitizers could reduce the dentin permeability significantly. 4. The influences of three desensitizers on the bonding efficiency of total-etch and self-etch adhesives were evaluated with the micro-tensile bond strength study and bond interface morphology observation. The dentin bond strength for Green or group was significantly lower than the other two groups (P<0.05).

Keywords: dentin, desensitizer, dentin permeability, thermal cycling, micro-tensile bond strength

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Authors: Manuela Nayantara Jeyaraj, Senuri Sucharitharathna, Chathurika Senarath, Yasanthy Kanagaraj, Indraka Udayakumara

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PostgreSQL is an Object Relational Database Management System (ORDBMS) that has been in existence for a while. Despite the superior features that it wraps and packages to manage database and data, the database community has not fully realized the importance and advantages of PostgreSQL. Hence, this research tends to focus on provisioning a better environment of development for PostgreSQL in order to induce the utilization and elucidate the importance of PostgreSQL. PostgreSQL is also known to be the world’s most elementary SQL-compliant open source ORDBMS. But, users have not yet resolved to PostgreSQL due to the facts that it is still under the layers and the complexity of its persistent textual environment for an introductory user. Simply stating this, there is a dire need to explicate an easy way of making the users comprehend the procedure and standards with which databases are created, tables and the relationships among them, manipulating queries and their flow based on conditions in PostgreSQL to help the community resolve to PostgreSQL at an augmented rate. Hence, this research under development within the context tends to initially identify the dominant features provided by PostgreSQL over its competitors. Following the identified merits, an analysis on why the database community holds a hesitance in migrating to PostgreSQL’s environment will be carried out. These will be modulated and tailored based on the scope and the constraints discovered. The resultant of the research proposes a system that will serve as a designing platform as well as a learning tool that will provide an interactive method of learning via a visual editor mode and incorporate a textual editor for well-versed users. The study is based on conjuring viable solutions that analyze a user’s cognitive perception in comprehending human computer interfaces and the behavioural processing of design elements. By providing a visually draggable and manipulative environment to work with Postgresql databases and table queries, it is expected to highlight the elementary features displayed by Postgresql over any other existent systems in order to grasp and disseminate the importance and simplicity offered by this to a hesitant user.

Keywords: cognition, database, PostgreSQL, text-editor, visual-editor

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Authors: Kofi Nkonkonya Mpuangnan, Samantha Govender, Hlengiwe Romualda Mhlongo

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In recent years, a noticeable and worrisome pattern has emerged in numerous developing nations which is a steady and persistent rise in unemployment rates. This escalation of economic struggles has become a cause of great concern for parents who, having invested significant resources in their children's education, harboured hopes of achieving economic prosperity and stability for their families through secure employment. To effectively tackle this pressing unemployment issue, it is imperative to adopt a holistic approach, and a pivotal aspect of this approach involves incorporating entrepreneurial education seamlessly into the entire educational system. In this light, the authors explored approaches to integrating entrepreneurial education into school curriculum focusing on the following questions. How can an entrepreneurial mindset among learners be promoted in school? And how far have pedagogical approaches improved entrepreneurship in schools? To find answers to these questions, a systematic literature review underpinned by Human Capital Theory was adopted. This method was supported by the three stages of guidelines like planning, conducting, and reporting. The data were specifically sought from publishers with expansive coverage of scholarly literature like Sage, Taylor & Francis, Emirate, and Springer, covering publications from 1965 to 2023. The search was supported by two broad terms such as promoting entrepreneurial mindset in learners and pedagogical strategies for enhancing entrepreneurship. It was found that acquiring an entrepreneurial mindset through an innovative classroom environment, resilience, and guest speakers and industry experts. Also, teachers can promote entrepreneurial education through the adoption of pedagogical approaches such as hands-on learning and experiential activities, role-playing, business simulation games and creative and innovative teaching. It was recommended that the Ministry of Education should develop tailored training programs and workshops aimed at empowering educators with the essential competencies and insights to deliver impactful entrepreneurial education.

Keywords: education, entrepreneurship, school curriculum, pedagogical approaches, integration

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Authors: Afrouz Yousefi, Mohtada Sadrzadeh

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The widespread presence of poly- and perfluoroalkyl substances (PFAS) poses a significant concern due to their ability to accumulate in living organisms and their persistence in the environment, thanks to their robust carbon-fluorine (C-F) bonds, which require substantial energy to break (485 kJ/mol). The prevalence of toxic PFAS compounds can be highly detrimental to ecosystems, wildlife, and human health. Ongoing efforts are dedicated to investigating methods for fully breaking down and eliminating PFAS from the environment. Among the various techniques employed, advanced oxidation processes have shown promise in completely breaking down emerging contaminants in wastewater. However, the drawback lies in the relatively slow reaction rates of these processes and the substantial energy input required, which currently impedes their widespread commercial adoption. We developed a hybrid process, comprising electro-Fenton as an advanced oxidation process and membrane distillation, to simultaneously degrade organic PFAS pollutants and extract pure water from the mixture. In this study, environmentally persistent perfluorooctanoic acid (PFOA), as an emerging contaminant, was used to study the effectiveness of the electro-Fenton/membrane distillation hybrid system. The PFOA degradation studies were conducted in two modes: electro-Fenton and electro-Fenton coupled with membrane distillation. High-performance liquid chromatography with ultraviolet detection (HPLC-UV), ion-chromatography (measuring fluoride ion concentration), total organic carbon (TOC) decay, mineralization current efficiency (MCE), and specific energy consumption (SEC) were evaluated for a single EF and hybrid EF-MD processes. In contrast to a single EF reaction, TOC decay improved significantly in the EF-MD process. Overall, the MCE of hybrid processes surpassed 100% while it remained under 50% for a single EF reaction. Calculations of specific energy consumption (SEC) demonstrated a substantial decrease of nearly one-third in energy usage when integrating the EF reaction with the MD process.

Keywords: water treatment, PFAS, membrane distillation, electro-Fenton, advanced oxidation

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Authors: Su-Lin Yu

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Coalition politics has been one of feminists’ persistent concerns. Following recent feminist discussion on new modes of affiliation across difference, she will explore how the process of female subject formation depends on alliances across different cultural locations. First, she will examine how coalition politics is reformulated across difference in contemporary feminist literature. In particular, the paper will identify the particular contexts and locations in which coalition building both enables and constrains the female subject. She will attempt to explore how contemporary feminist literature highlights the possibilities and limitations for solidarity and affiliations. To understand coalition politics in contemporary feminist works, she will engage in close readings of two texts: Rebecca Walker’s Black, White and Jewish: Memoir of a Shifting Self and Danzy Senna’s Caucasia. Both Walker and Senna have articulated the complex nodes of identity that are staged by a politics of location as they refuse to be boxed into simplistic essentialist positions. Their texts are characterized by the characters’ racial ambiguity and their social and geographical mobility of life in the contemporary United States. Their experiences of living through conflictual and contradictory relationships never fully fit the boundaries of racial categorization. Each of these texts demonstrates the limits as well as the possibilities of working with diversity among and within persons and groups, thus, laying the ground for complex alliance formation. Because each of the protagonists must negotiate a set of contradictions, they will have to constantly shift their affiliations. Rather than construct a static alliance, they describe a process of moving ‘beyond boundaries,’ an embracing of multiple locations. As self-identified third wavers, Rebecca Walker and Danzy Senna have been identified and marked with the status of ‘leader’ by the feminist establishment and by mainstream U.S. media. Their texts have captured both mass popularity and critical attention in the feminist and, often, the non-feminist literary community. By analyzing these texts, she will show how contemporary American feminist literature reveals coalition politics which is fraught with complications and unintended consequences. Taken as a whole, then, these works provide an important examination not only of coalition politics of American feminism, but also a snapshot of a central debate among feminist critique of coalition politics as a whole.

Keywords: coalition politics, contemporary women’s literature, identity, female subject

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Authors: Jolanta Uszko, Tomasz Wloch, Aneta Pirowska, Roman Nowobilski

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Introduction: Phantom phenomena are often reported by subjects who have undergone limb amputation. Mostly, patients feel the amputated part of the limb as if it was still attached to the body. Two types of phantom phenomena: painless (phantom sensation) and painful (phantom pain) were described. Triggers of phantom sensations and phantom pain, as well as fully effective treatment, have not been clearly described yet. Purpose: To assess the influence of psychosocial factors and some clinical conditions on the occurrence of phantom phenomena in amputee athletes. Subjects: 21 men (age: 31 years, SD = 7.5 years) after lower or upper extremity amputation, who regularly performed high-intensity sports (Amp Football Team Players) were included to the study. Method and equipment: In the research, the following method and tools were used: Questionnaire [Pirowska] adapted for athletes with disabilities, Numerical Rating Scale (NRS) - for phantom pain assessment, McGill Pain Assessment Questionnaire (short version), Beck's Depression Inventory (BDI), State Trait Anxiety Inventory (STAI): X-1 and X-2, shortened version of The World Health Organization Quality of Life (WHOQOLBREFF). Results: In the study group, the lower leg amputations with traumatic etiology were predominant. Phantom sensations were present in all subjects. Half of the respondents claimed to experience phantom sensations at least once a day, paroxysmally. There was a prevalence of phantom sensations characterized as incomplete, immobile limb. Phantom pain was reported by over 85% of respondents. The nature of phantom pain was frequently described as stabbing, squeezing, shooting, pulsing, tiring. There was a significant correlation between phantom pain intensity and anxiety, quality of life, depressive tendencies, perception of phantom pain as the obstacle in daily functioning and intensity of the limb pain before amputation. Conclusions: The etiology of phantom phenomena is complex. Psychological factors seem to have a significant influence on the intensity of the phantom pain. Particular attention should be paid to patients who complain about persistent limb pain before the amputation. These are patients with an increased risk of the phantom pain of relatively high intensity.

Keywords: amputation, phantom pain, phantom sensations, adaptive sports

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Authors: Phill-Seung Jung, Dae-Yeon Kim

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Objectives: In young, especially nulliparous women, it is not easy to decide on excisional therapy for cervical intraepithelial neoplasia (CIN). We aimed to evaluate how effective topical imiquimod is in the treatment of high-grade CIN so that excisional therapy can be avoided in young women. Methods: Patients with CIN were allocated to this pilot study. They did not want excisional therapy and agreed with topical imiquimod therapy, which required once-a-week hospital visit for 8 weeks for the application of imiquimod to the cervix by a gynecologic oncologist. If the lesion got worse during treatment, it was decided to convert imiquimod therapy to excisional therapy. Results: A total of 36 patients with a median age of 29 years (range, 22–41 years) agreed to receive topical imiquimod therapy. Of these, 32 patients (88.9%) were positive for high-risk human papillomavirus (HR HPV). Twenty-five patients (69.4%) had low-grade squamous intraepithelial lesion (LSIL), and 11 (30.6%) had high-grade squamous intraepithelial lesion (HSIL) on their initial LBC. Twenty-eight patients underwent punch biopsy, which showed CIN 1 in 7 (19.4%), CIN 2 in 11 (30.6%), and CIN 3 in 10 (27.8%) patients. Twenty patients finished the 8-week imiquimod therapy. Among them, 14 patients had CIN 2 or 3, and 6 patients had CIN 1. HR HPV was positive in 12 patients. On the last examination, 14 patients (70.0%) had negative intraepithelial lesions, 3 (15.0%) had atypical squamous cells of undetermined significance, and 1 (5.0%) had LSIL. Two patients had persistent HSIL: 1 patient underwent loop electrosurgical excision procedure, resulting in CIN 3 with positive resection margin, and the other patient underwent punch biopsy, resulting in intermediate cells and restarted imiquimod therapy. Only 7 patients were negative for HR HPV. Conclusions: This study showed that topical imiquimod therapy was effective for the treatment of high-grade CIN, with a histologic regression rate of 85.7% (14/20) and HPV eradication rate of 25.0% (8/32). Based on our findings, topical imiquimod therapy might have a successful therapeutic effect in young women with CIN 2-3 so that they can avoid excisional therapy. In addition, it could be a more reassuring treatment option for CIN 1 than just follow-up after few months. To confirm its efficacy, a phase II study with larger cohort would be needed.

Keywords: Imiquimod, Cervical Intraepthelial Neoplasia, Cervical Dysplasia, Human Papillomavirus

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Authors: Geum Yeon Sim, Tyler Pigott, Julio Vasquez

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A 38-year-old obese female with no apparent past medical history presented with left knee pain. Six months ago, she sustained a left knee dislocation in a motor vehicle accident that was managed with a skin graft over the left lower extremity without any reconstructive surgery. She developed persistent pain and stiffness in her left knee that worsened with walking and stair climbing. Examination revealed healed extensive skin graft over the left lower extremity, including the left knee. Palpation showed moderate tenderness along the superior border of the patella, exquisite tenderness over MCL, and mild tenderness on the tibial tuberosity. There was normal sensation, reflexes, and strength in her lower extremities. There was limited active and passive range of motion of her left knee during flexion. There was instability noted upon the valgus stress test of the left knee. Left knee magnetic resonance imaging showed high-grade (grade 2-3) injury of the proximal superficial fibers of the MCL and diffuse thickening and signal abnormality of the cruciate ligaments, as well as edema-like subchondral marrow signal change in the anterolateral aspect of the lateral femoral condyle weight-bearing surface. There was also notable extensive scarring and edema of the skin, subcutaneous soft tissues, and musculature surrounding the knee. The patient was managed with left knee immobilization for five months, which was complicated by limited knee flexion. Physical therapy consisting of quadriceps, hamstrings, gastrocnemius stretching and strengthening, range of motion exercises, scar/soft tissue mobilization, and gait training was given with marked improvement in pain and range of motion. The patient experienced a further reduction in pain as well as an improvement in function with home exercises consisting of continued strengthening and stretching.

Keywords: ligamentous injury, trauma, rehabilitation, knee pain

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Authors: José Luis Gallizo, Pilar Gargallo, Ramon Saladrigues, Manuel Salvador

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This study offers an exploratory statistical analysis of the persistence of annual profits across a sample of firms from different European Union (EU) countries. To this end, a hierarchical Bayesian dynamic model has been used which enables the annual behaviour of those profits to be broken down into a permanent structural and a transitory component, while also distinguishing between general effects affecting the industry as a whole to which each firm belongs and specific effects affecting each firm in particular. This breakdown enables the relative importance of those fundamental components to be more accurately evaluated by country and sector. Furthermore, Bayesian approach allows for testing different hypotheses about the homogeneity of the behaviour of the above components with respect to the sector and the country where the firm develops its activity. The data analysed come from a sample of 23,293 firms in EU countries selected from the AMADEUS data-base. The period analysed ran from 1999 to 2007 and 21 sectors were analysed, chosen in such a way that there was a sufficiently large number of firms in each country sector combination for the industry effects to be estimated accurately enough for meaningful comparisons to be made by sector and country. The analysis has been conducted by sector and by country from a Bayesian perspective, thus making the study more flexible and realistic since the estimates obtained do not depend on asymptotic results. In general terms, the study finds that, although the industry effects are significant, more important are the firm specific effects. That importance varies depending on the sector or the country in which the firm carries out its activity. The influence of firm effects accounts for around 81% of total variation and display a significantly lower degree of persistence, with adjustment speeds oscillating around 34%. However, this pattern is not homogeneous but depends on the sector and country analysed. Industry effects depends also on sector and country analysed have a more marginal importance, being significantly more persistent, with adjustment speeds oscillating around 7-8% with this degree of persistence being very similar for most of sectors and countries analysed.

Keywords: dynamic models, Bayesian inference, MCMC, abnormal returns, persistence of profits, return on assets

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Authors: H. N. Alyaseen, S. E. Alalawi, T. Cordoba, É. Delisle, C. Cordoba, A. Odobescu

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Sternal dehiscence is defined as the persistent separation of sternal bones that are often complicated with mediastinitis. Etiologies that lead to sternal dehiscence vary, with cardiovascular and thoracic surgeries being the most common. Early diagnosis in susceptible patients is crucial to the management of such cases, as they are associated with high mortality rates. A recent meta-analysis of more than four hundred thousand patients concluded that deep sternal wound infections were the leading cause of mortality and morbidity in patients undergoing cardiac procedures. Long-term complications associated with sternal dehiscence include increased hospitalizations, cardiac infarctions, and renal and respiratory failures. Numerous osteosynthesis methods have been described in the literature. Surgical materials offer enough rigidity to support the sternum and can be flexible enough to allow physiological breathing movements of the chest; however, these materials fall short when managing patients with extensive bone loss, osteopenia, or general poor bone quality, for such cases, flaps offer a better closure system. Early utilization of flaps yields better survival rates compared to delayed closure or to patients treated with sternal rewiring and closed drainage. The utilization of pectoralis major flaps, rectus abdominus, and latissimus muscle flaps have all been described in the literature as great alternatives. Flap selection depends on a variety of factors, mainly the size of the sternal defect, infection, and the availability of local tissues. Free fibular flaps are commonly harvested flaps utilized in reconstruction around the body. In cases regarding sternal reconstruction with free fibular flaps, the literature exclusively discussed the flap applied vertically to the chest wall. We present a different technique applying the free fibular triple barrel flap oriented in a transverse manner, in parallel to the ribs. In our experience, this method could have enhanced results and improved prognosis as it contributes to the normal circumferential shape of the chest wall.

Keywords: sternal dehiscence, management, free fibular flaps, novel surgical techniques

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