Search results for: surgical errors

Authors: Maria Stepankova, Lucie Vistejnova, Pavel Klein, Tereza Blassova, Marketa Slajerova, Radek Sedlacek, Martin Bartos, Jaroslav Chlupac

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Background: Clinical outcome benefits of the segment rib fracture surgical therapy are well known and follow from better stabilization of the chest wall. Despite this, some authors still incline to conservative therapy and point out to possible rib fracture healing failure in connection with the bone vascular supply disturbance caused by metal plate implantation. This suggestion met neither experimental nor clinical verification and remains the object of discussion. In our pilot study we investigated the titanium plate fixation effect on the rib fracture healing in porcine model and its histological, biomechanical and radiological aspects. Materials and Method: Two porcine models (experimental group) underwent the operative chest wall stabilization with a titanium plate implantation after osteotomy. Two other porcine models (control group) were treated conservatively after osteotomy. Three weeks after surgery, all animals were sacrificed, treated ribs were explanted and the histological analysis, µCT imaging and biomechanical testing of the calluses tissue were performed. Results: In µCT imaging, experimental group showed a higher cortical bone volume compared to the control group. Histological analysis using the non-decalcified bone tissue blocks demonstrated more maturated callus with higher newly-formed osseous tissue ratio in experimental group in comparison to controls. In contrast, no significant differences in bone blood vessels supply in both groups were observed. This finding suggests that the bone blood supply in experimental group was not impaired. Biomechanical analysis using 3-point bending test demonstrated significantly higher bending stiffness and the maximum force in experimental group. Conclusion: Based on our observation, it could be concluded, that the titanium plate fixation of the rib fractures leads to faster bone callus maturation whereas does not cause the vascular supply impairment after 3 weeks and thus has a beneficial effect on the rib fracture healing.

Keywords: bone vascular supply, chest wall stabilization, fracture healing, histological analysis, titanium plate implantation

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Authors: Sudha T., Naveen C.

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Dengue is a serious public health issue that causes significant annual economic and welfare burdens on nations. However, enhanced optimization techniques and quantitative modeling approaches can predict the incidence of dengue. By advocating for a data-driven approach, public health officials can make informed decisions, thereby improving the overall effectiveness of sudden disease outbreak control efforts. The National Oceanic and Atmospheric Administration and the Centers for Disease Control and Prevention are two of the U.S. Federal Government agencies from which this study uses environmental data. Based on environmental data that describe changes in temperature, precipitation, vegetation, and other factors known to affect dengue incidence, many predictive models are constructed that use different machine learning methods to estimate weekly dengue cases. The first step involves preparing the data, which includes handling outliers and missing values to make sure the data is prepared for subsequent processing and the creation of an accurate forecasting model. In the second phase, multiple feature selection procedures are applied using various machine learning models and optimization techniques. During the third phase of the research, machine learning models like the Huber Regressor, Support Vector Machine, Gradient Boosting Regressor (GBR), and Support Vector Regressor (SVR) are compared with several optimization techniques for feature selection, such as Harmony Search and Genetic Algorithm. In the fourth stage, the model's performance is evaluated using Mean Square Error (MSE), Mean Absolute Error (MAE), and Root Mean Square Error (RMSE) as assistance. Selecting an optimization strategy with the least number of errors, lowest price, biggest productivity, or maximum potential results is the goal. In a variety of industries, including engineering, science, management, mathematics, finance, and medicine, optimization is widely employed. An effective optimization method based on harmony search and an integrated genetic algorithm is introduced for input feature selection, and it shows an important improvement in the model's predictive accuracy. The predictive models with Huber Regressor as the foundation perform the best for optimization and also prediction.

Keywords: deep learning model, dengue fever, prediction, optimization

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Authors: Shivani Thakur, Jasmin Dominguez Cervantes, Ahmed Zabiba, Fatima Zabiba, Sandhini Agarwal, Kamalpreet Kaur, Hussein Maatouk, Shae Chand, Omar Madriz, Tiffany Huang, Saloni Bansal

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The prevalence of lymphedema in women in rural communities highlights the importance of developing effective treatment and prevention methods. Subjects with secondary lymphedema in California’s Central Valley were surveyed at 6 surgical clinics to assess demographics and symptoms of lymphedema. Additionally, subjects on semaglutide treatment for obesity and/or T2DM were monitored for their diabetes management, weight loss progress, and lymphedema symptoms compared to subjects who were not treated with semaglutide. The subjects were followed for 12 months. Subjects who were treated with semaglutide completed pre-treatment questionnaires and follow-up post-treatment questionnaires at 3, 6, 9, 12 months, along with medical assessment. The untreated subjects completed similar questionnaires. The questionnaires investigated subjective feelings regarding lymphedema symptoms and management using a Likert-scale; quantitative leg measurements were collected, and blood work reviewed at these appointments. Paired difference t-tests, chi-squared tests, and independent sample t-tests were performed. 50 subjects, aged 18-75 years, completed the surveys evaluating secondary lymphedema: 90% female, 69% Hispanic, 45% Spanish speaking, 42% disabled, 57 % employed, 54% income range below 30 thousand dollars, and average BMI of 40. Both treatment and non-treatment groups noted the most common symptoms were leg swelling (x̄=3.2, ▁d= 1.3), leg pain (x̄=3.2, ▁d=1.6 ), loss of daily function (x̄=3, ▁d=1.4 ), and negative body image (x̄=4.4, ▁d=0.54). Subjects in the semaglutide treatment group >3 months of treatment compared to the untreated group demonstrated: 55% subject in the treated group had a 10% weight loss vs 3% in the untreated group (average BMI reduction by 11% vs untreated by 2.5%, p<0.05) and improved subjective feelings about their lymphedema symptoms: leg swelling (x̄=2.4, ▁d=0.45 vs x̄=3.2, ▁d=1.3, p<0.05), leg pain (x̄=2.2, ▁d=0.45 vs x̄= 3.2, ▁d= 1.6, p<0.05), and heaviness (x̄=2.2, ▁d=0.45 vs x̄=3, ▁d=1.56, p<0.05). Improvement in diabetes management was demonstrated by an average of 0.9 % decrease in A1C values compared to untreated 0.1 %, p<0.05. In comparison to untreated subjects, treatment subjects on semaglutide noted 6 cm decrease in the circumference of the leg, knee, calf, and ankle compared to 2 cm in untreated subjects, p<0.05. Semaglutide was shown to significantly improve weight loss, T2DM management, leg circumference, and secondary lymphedema functional, physical and psychosocial symptoms.

Keywords: diabetes, secondary lymphedema, semaglutide, obesity

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Authors: Brandon Knopp, Matthew Harris

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Purpose: Tip-apex distance (TAD) has long been discussed as a metric for determining risk of failure in the fixation of peritrochanteric fractures. TAD measurements over 25 millimeters (mm) have been associated with higher rates of screw cut out and other complications in the first several months after surgery. However, there is limited evidence for the efficacy of this measurement in predicting the long-term risk of negative outcomes following hip fixation surgery. The purpose of our study was to investigate risk factors including TAD for hospital readmission, loss of pre-injury ambulation and development of complications within 1 year after hip fixation surgery. Methods: A retrospective review of proximal hip fractures treated with single screw intramedullary devices between 2016 and 2020 was performed at a 327-bed regional medical center. Patients included had a postoperative follow-up of at least 12 months or surgery-related complications developing within that time. Results: 44 of the 67 patients in this study met the inclusion criteria with adequate follow-up post-surgery. There was a total of 10 males (22.7%) and 34 females (77.3%) meeting inclusion criteria with a mean age of 82.1 (± 12.3) at the time of surgery. The average TAD in our study population was 19.57mm and the average 1-year readmission rate was 15.9%. 3 out of 6 patients (50%) with a TAD > 25mm were readmitted within one year due to surgery-related complications. In contrast, 3 out of 38 patients (7.9%) with a TAD < 25mm were readmitted within one year due to surgery-related complications (p=0.0254). Individual TAD measurements, averaging 22.05mm in patients readmitted within 1 year of surgery and 19.18mm in patients not readmitted within 1 year of surgery, were not significantly different between the two groups (p=0.2113). Conclusions: Our data indicate a significant improvement in hospital readmission rates up to one year after hip fixation surgery in patients with a TAD < 25mm with a decrease in readmissions of over 40% (50% vs 7.9%). This result builds upon past investigations by extending the follow-up time to 1 year after surgery and utilizing hospital readmissions as a metric for surgical success. With the well-documented physical and financial costs of hospital readmission after hip surgery, our study highlights a reduction of TAD < 25mm as an effective method of improving patient outcomes and reducing financial costs to patients and medical institutions. No relationship was found between TAD measurements and secondary outcomes, including loss of pre-injury ambulation and development of complications.

Keywords: hip fractures, hip reductions, readmission rates, open reduction internal fixation

Procedia PDF Downloads 127

Authors: Isalira Peroba Ramos, Cherley Borba Vieira de Andrade, Grazielle Suhett, Camila Salata, Paulo Cesar Canary, Guilherme Visconde Brasil, Antonio Carlos Campos de Carvalho, Regina Coeli dos Santos Goldenberg

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Background: The therapeutic options for patients with cancer now include increasingly complex combinations of medications, radiation therapy (RT), and surgical intervention. Many of these treatments have important potential adverse cardiac effects and are likely to have significant effects on patient outcomes. Cell therapy appears to be promising for the treatment of chronic and degenerative diseases, including cardiomyopathy induced by RT, as the current therapeutic options are insufficient. Aims: To evaluate the potential of bone marrow mesenchymal cells (BMMCs) in radioinduced cardiac damage Methods: Female Wistar rats, 3 months old (Ethics Committee 054/14), were divided into 2 groups, non-treated irradiated group (IR n=15) and irradiated and BMMC treated (IRT n=10). Echocardiography was performed to evaluate heart function. After euthanasia, 3 months post treatment; the left ventricle was removed and prepared for RT-qPCR (VEGF and Pro Collagen I) and histological (picrosirius) analysis. Results: In both groups, 45 days after irradiation, ejection fraction (EF) was in the normal range for these animals (> 70%). However, the BMMC treated group had EF (83.1%±2.6) while the non-treated IR group showed a significant reduction (76.1%±2.6) in relation to the treated group. In addition, we observed an increase in VEGF gene expression and a decrease in Pro Collagen I in IRT when compared to IR group. We also observed by histology that the collagen deposition was reduced in IRT (10.26%±0.83) when compared to IR group (25.29%±0.96). Conclusions: Treatment with BMMCs was able to prevent ejection fraction reduction and collagen deposition in irradiated animals. The increase of VEGF and the decrease of pro collagen I gene expression might explain, at least in part, the cell therapy benefits. All authors disclose no financial or personal relationships with individuals or organizations that could be perceived to bias their work. Sources of funding: FAPERJ, CAPES, CNPq, MCT.

Keywords: mesenchymal cells, radioation, cardiotoxicity, bone marrow

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Authors: Nateepat Srivarom, Weng Jingnong, Serm Chinnarat

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Precise Point Positioning (PPP) technique is use to improve accuracy by using precise satellite orbit and clock correction data, but this technique is complicated methods and high costs. Currently, there are several online processing service providers which offer simplified calculation. In the first part of this research, we compare the efficiency and precision of four software. There are three popular online processing service providers: Australian Online GPS Processing Service (AUSPOS), CSRS-Precise Point Positioning and CenterPoint RTX post processing by Trimble and 1 offline software, RTKLIB, which collected data from 10 the International GNSS Service (IGS) stations for 10 days. The results indicated that AUSPOS has the least distance root mean square (DRMS) value of 0.0029 which is good enough to be calculated for monitoring the movement of tectonic plates. The second, we use AUSPOS to process the data of geodetic network of Thailand. In December 26, 2004, the earthquake occurred a 9.3 MW at the north of Sumatra that highly affected all nearby countries, including Thailand. Earthquake effects have led to errors of the coordinate system of Thailand. The Royal Thai Survey Department (RTSD) is primarily responsible for monitoring of the crustal movement of the country. The difference of the geodetic network movement is not the same network and relatively large. This result is needed for survey to continue to improve GPS coordinates system in every year. Therefore, in this research we chose the AUSPOS to calculate the magnitude and direction of movement, to improve coordinates adjustment of the geodetic network consisting of 19 pins in Thailand during October 2013 to November 2017. Finally, results are displayed on the simulation map by using the ArcMap program with the Inverse Distance Weighting (IDW) method. The pin with the maximum movement is pin no. 3239 (Tak) in the northern part of Thailand. This pin moved in the south-western direction to 11.04 cm. Meanwhile, the directional movement of the other pins in the south gradually changed from south-west to south-east, i.e., in the direction noticed before the earthquake. The magnitude of the movement is in the range of 4 - 7 cm, implying small impact of the earthquake. However, the GPS network should be continuously surveyed in order to secure accuracy of the geodetic network of Thailand.

Keywords: precise point positioning, online processing service, geodetic network, inverse distance weighting

Procedia PDF Downloads 168

Authors: Kamil Ganaev, Elina Vlasova, Andrei Shiryaev, Renat Akchurin

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De novo atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is a common complication. To date, there are no data on the possible effect of diffuse lesions of coronary arteries on the incidence of postoperative AF complications. Methods. Patients operated on-pump under hypothermic conditions during the calendar year (2020) were studied. Inclusion criteria - isolated CABG and achievement of complete myocardial revascularization. Patients with a history of AF moderate and severe valve dysfunction, hormonal thyroid pathology, initial CHF(Congestive heart failure), as well as patients with developed perioperative complications (IM, acute heart failure, massive blood loss) and deceased were excluded. Thus 227 patients were included; mean age 65±9 years; 69% were men. 89% of patients had a 3-vessel lesion of the coronary artery; the remainder had a 2-vessel lesion. Mean LV size: 3.9±0.3 cm, indexed LV volume: 29.4±5.3 mL/m2. Two groups were considered: D (n=98), patients with diffuse coronary heart disease, and L (n=129), patients with local coronary heart disease. Clinical and demographic characteristics in the groups were comparable. Rhythm assessment: continuous bedside ECG monitoring up to 5 days; ECG CT at 5-7 days after CABG; daily routine ECG registration. Follow-up period - postoperative hospital period. Results. The Median follow-up period was 9 (7;11) days. POFP (Postoperative atrial fibrillation) was detected in 61/227 (27%) patients: 34/98 (35%) in group D versus 27/129 (21%) in group L; p<0.05. Moreover, the values of revascularization index in groups D and L (3.9±0.7 and 3.8±0.5, respectively) were equal, and the mean time Cardiopulmonary bypass (CPB) (107±27 and 80±13min), as well as the mean ischemic time (67±17 and 55±11min) were significantly longer in group D (p<0.05). However, a separate analysis of these parameters in patients with and without developed AF did not reveal any significant differences in group D (CPB time 99±21.2 min, ischemic time 63±12.2 min), or in group L (CPB time 88±13.1 min, ischemic time 58.7±13.2 min). Conclusion. With the diffuse nature of coronary lesions, the incidence of AF in the hospital period after isolated CABG definitely increases. To better understand the role of severe coronary atherosclerosis in the development of POAF, it is necessary to distinguish the influence of organic features of atrial and ventricular myocardium (as a consequence of chronic coronary disease) from the features of surgical correction in diffuse coronary lesions.

Keywords: atrial fibrillation, diffuse coronary artery disease, coronary artery bypass grafting, local coronary artery disease

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Authors: Kamal Ahmed, Othman Ayman, Refat Mostafa

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The post-construction phase represents a critical milestone in the project lifecycle. This is because design errors and omissions, as well as construction defects, are examined during this phase. The traditional procurement approaches that are commonly adopted in construction projects separate design from construction, which ultimately inhibits contractors, suppliers and other parties from providing the design team with constructive comments and feedback to improve the project design. As a result, a lack of considering maintainability aspects during the design process results in increasing maintenance and operation costs as well as reducing building performance. This research aims to investigate the role of Early Supplier Involvement (ESI) in the design process as an approach to enhancing building maintainability. In order to achieve this aim, a research methodology consisting of a literature review, case studies and a survey questionnaire was designed to accomplish four objectives. Firstly, a literature review was used to examine the concepts of building maintenance, maintainability, the design process and ESI. Secondly, three case studies were presented and analyzed to investigate the role of ESI in enhancing building maintainability during the design process. Thirdly, a survey questionnaire was conducted with a representative sample of Architectural Design Firms (ADFs) in Egypt to investigate their perception and application of ESI towards enhancing building maintainability during the design process. Finally, the research developed a framework to facilitate ESI in the design process in ADFs in Egypt. Data analysis showed that the ‘Difficulty of trusting external parties and sharing information with transparency’ was ranked the highest challenge of ESI in ADFs in Egypt, followed by ‘Legal competitive advantage restrictions’. Moreover, ‘Better estimation for operation and maintenance costs’ was ranked the highest contribution of ESI towards enhancing building maintainability, followed by ‘Reduce the number of operation and maintenance problems or reworks’. Finally, ‘Innovation, technical expertise, and competence’ was ranked the highest supplier’s selection criteria, while ‘paying consultation fees for offering advice and recommendations to the design team’ was ranked the highest form of supplier’s remuneration. The proposed framework represents a synthesis that is creative in thought and adds value to the knowledge in a manner that has not previously occurred.

Keywords: maintenance, building maintainability, building life cycle cost (ICC), material supplier

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Authors: Ibrahim Mohamed Ibrahim Hassanin, Hany Hassan Mostafa, Mona Mohamed Shaban, Ahlam El Said Kamel

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Background: New so-called minimally invasive devices have been developed to limit groin pain after sling placement for treatment of stress urinary incontinence (SUI) to minimize the risk of postoperative pain and organ perforation. A new generation of suburethral slings was described that avoided skin incision to pull out and tension the sling. Evaluation of this device through prospective short-term series has shown controversial results compared with other tension-free techniques. The aim of this study is to compare success rates and complications for tension-free vaginal tape secur (TVT secur) and trans-obturator sub urethral tape inside-out technique (TVT-O) for treatment of stress urinary incontinence (SUI). Materials and Methods: Fifty patients with genuine SUI were divided into two groups: group S (n=25) were operated upon using (TVT secur) and group O (n=25) were operated upon using trans-obturator suburethral tape inside-out technique (TVT-O). Success rate, quality of life and postoperative complications such as groin pain, urgency, urine retention and vaginal tape erosion were reported in both groups at one, three, and six months after surgery. Results: As regards objective cure rate at one, three, six months intervals; there was a significant difference between group S (56%, 64%, and 60%), and group O (80%, 88%, and 88%) respectively (P <0.05). As regards subjective cure rate at one, three, six months intervals; there was a significant difference between group S (44%, 44%, and 48%), and group O (76%, 80%, and 80%) respectively (P <0.05). Quality of life (QoL) parameters improved significantly in cured patients with no difference between both groups. As regards complications, group O had a higher frequency of complications than group S; groin pain (12% vs 12% p= 0.05), urgency (4% (1 case) vs 0%), urine retention (8% (2 cases) vs 0%), vaginal tape erosion (4% (1 case) vs 0%). No cases were complicated with wound infection. Conclusion: Compared to TVT secur, TVT-O showed higher subjective and objective cure rates after six months but higher rate of complications. Both techniques were comparable as regards improvement of quality of life after surgery.

Keywords: stress urinary incontinence, trans-vaginal tape-obturator, TVT Secur, TVT-O

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Authors: Choon Seong Ng, P. Petrick, C. L. Lau

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Background: Carbapenem-resistant isolates have been increasingly reported recently. Carbapenem stewardship is designed to optimize its usage particularly among medical wards with high prevalence of carbapenem prescriptions to combat such emerging resistance. Carbapenem stewardship programmes (CSP) can reduce antibiotic use but clinical outcome of such measures needs further evaluation. We examined this in a prospective manner using feedback mechanism. Methods: Our single-center prospective cohort study involved all carbapenem prescriptions across the medical wards (including medical patients admitted to intensive care unit) in a tertiary university hospital setting. The impact of such stewardship was analysed according to the accepted and the rejected groups. The primary endpoint was safety. Safety measure applied in this study was the death at 1 month. Secondary endpoints included length of hospitalisation and readmission. Results: Over the 19 months’ period, input from 144 carbapenem prescriptions was analysed on the basis of acceptance of our CSP recommendations on the use of carbapenems. Recommendations made were as follows : de-escalation of carbapenem; stopping the carbapenem; use for a short duration of 5-7 days; required prolonged duration in the case of carbapenem-sensitive Extended Spectrum Beta-Lactamases bacteremia; dose adjustment; and surgical intervention for removal of septic foci. De-escalation, shorten duration of carbapenem and carbapenem cessation comprised 79% of the recommendations. Acceptance rate was 57%. Those who accepted CSP recommendations had no increase in mortality (p = 0.92), had a shorter length of hospital stay (LOS) and had cost-saving. Infection-related deaths were found to be higher among those in the rejected group. Moreover, three rejected cases (6%) among all non-indicated cases (n = 50) were found to have developed carbapenem-resistant isolates. Lastly, Pitt’s bacteremia score appeared to be a key element affecting the carbapenem prescription’s behaviour in this trial. Conclusions: Carbapenem stewardship program in the medical wards not only saves money, but most importantly it is safe and does not harm the patients with added benefits of reducing the length of hospital stay. However, more time is needed to engage the primary clinical teams by formal clinical presentation and immediate personal feedback by senior Infectious Disease (ID) personnel to increase its acceptance.

Keywords: audit and feedback, carbapenem stewardship, medical wards, university hospital

Procedia PDF Downloads 172

Authors: S. Cencek, A. Markun

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Noise assessment methods are regularly used in scope of Environmental Impact Assessments for planned projects to assess (predict) the expected noise emissions of these projects. Different noise assessment methods could be used. In recent years, we had an opportunity to collaborate in some noise assessment procedures where noise assessments of different laboratories have been performed simultaneously. We identified some significant differences in noise assessment results between laboratories in Slovenia. We estimate that despite good input Georeferenced Data to set up acoustic model exists in Slovenia; there is no clear consensus on methods for predictive noise methods for planned projects. We analyzed input data, methods and results of predictive noise methods for two planned industrial projects, both were done independently by two laboratories. We also analyzed the data, methods and results of two interlaboratory collaborative noise models for two existing noise sources (railway and motorway). In cases of predictive noise modelling, the validations of acoustic models were performed by noise measurements of surrounding existing noise sources, but in varying durations. The acoustic characteristics of existing buildings were also not described identically. The planned noise sources were described and digitized differently. Differences in noise assessment results between different laboratories have ranged up to 10 dBA, which considerably exceeds the acceptable uncertainty ranged between 3 to 6 dBA. Contrary to predictive noise modelling, in cases of collaborative noise modelling for two existing noise sources the possibility to perform the validation noise measurements of existing noise sources greatly increased the comparability of noise modelling results. In both cases of collaborative noise modelling for existing motorway and railway, the modelling results of different laboratories were comparable. Differences in noise modeling results between different laboratories were below 5 dBA, which was acceptable uncertainty set up by interlaboratory noise modelling organizer. The lessons learned from the study were: 1) Predictive noise calculation using formulae from International standard SIST ISO 9613-2: 1997 is not an appropriate method to predict noise emissions of planned projects since due to complexity of procedure they are not used strictly, 2) The noise measurements are important tools to minimize noise assessment errors of planned projects and should be in cases of predictive noise modelling performed at least for validation of acoustic model, 3) National guidelines should be made on the appropriate data, methods, noise source digitalization, validation of acoustic model etc. in order to unify the predictive noise models and their results in scope of Environmental Impact Assessments for planned projects.

Keywords: environmental noise assessment, predictive noise modelling, spatial planning, noise measurements, national guidelines

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Authors: Karen Boaz, C. R. Charan

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Background: The infiltration of tumour stroma by eosinophils, Tumor-Associated Tissue Eosinophilia (TATE), is known to modulate the progression of Oral Squamous Cell Carcinoma (OSCC). Eosinophils have direct tumoricidal activity by release of cytotoxic proteins and indirectly they enhance permeability into tumor cells enabling penetration of tumoricidal cytokines. Also, eosinophils may promote tumor angiogenesis by production of several angiogenic factors. Identification of eosinophils in the inflammatory stroma has been proven to be an important prognosticator in cancers of mouth, oesophagus, larynx, pharynx, breast, lung, and intestine. Therefore, the study aimed to correlate TATE with clinical and histopathological variables, and blood eosinophil count to assess the role of TATE as a prognosticator in Oral Squamous Cell Carcinoma (OSCC). Methods: Seventy two biopsy-proven cases of OSCC formed the study cohort. Blood eosinophil counts and TNM stage were obtained from the medical records. Tissue sections (5µm thick) were stained with Haematoxylin and Eosin. The eosinophils were quantified at invasive tumour front (ITF) in 10HPF (40x magnification) with an ocular grid. Bryne’s grading of ITF was also performed. A subset of thirty cases was also assessed for association of TATE with recurrence, involvement of lymph nodes and surgical margins. Results: 1) No statistically significant correlation was found between TATE and TNM stage, blood eosinophil counts and most parameters of Bryne’s grading system. 2) Statistically significant relation of intense degree of TATE was associated with the absence of distant metastasis, increased lympho-plasmacytic response and increased survival (diseasefree and overall) of OSCC patients. 3) In the subset of 30 cases, tissue eosinophil counts were higher in cases with lymph node involvement, decreased survival, without margin involvement and in cases that did not recur. Conclusion: While the role of eosinophils in mediating immune responses seems ambiguous as eosinophils support cell-mediated tumour immunity in early stages while inhibiting the same in advanced stages, TATE may be used as a surrogate marker for determination of prognosis in oral squamous cell carcinoma.

Keywords: tumour-associated tissue eosinophilia, oral squamous cell carcinoma, prognosticator, tumoral immunity

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Authors: T. Rakhi, Thrivikram Shenoy

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Esophageal atresia is a disorder of maldevelopment of esophagus with or without a connection to the trachea. Radiological reviews are needed in consultation with the pediatric surgeon and neonatologist and we report a rare case of esophageal atresia associated with atrial septal defect-patent ductus arteriosus complex. A 2-day old female baby born at term, weighing 3.010kg, admitted to the Neonatal Intensive Care Unit with respiratory distress and excessive oral secretions. On examination, continuous murmur and cyanosis were seen. Esophageal atresia was suspected, after a failed attempt to pass a nasogastric tube. Chest radiograph showed coiling of the nasogastric tube and absent gas shadow in the abdomen. Echocardiography confirmed Patent Ductus Arteriosus with Atrial Septal Defect not in failure and was diagnosed with esophageal atresia with suspected fistula posted for surgical repair. After preliminary management with oxygenation, suctioning in prone position and antibiotics, investigations revealed Hb 17gms serum biochemistry, coagulation profile and C-Reactive Protein Test normal. The baby was premedicated with 5mcg of fentanyl and 100 mcg of midazolam and a rapid awake laryngoscopy was done to rule out difficult airway followed by induction with o2 air, sevo and atracurium 2 mg. Placement of a 3.5 tube was uneventful at first attempt and after confirming bilateral air entry positioned in the lateral position for Right thoracotomy. A pulse oximeter, Echocardiogram, Non-invasive Blood Pressure, temperature and a precordial stethoscope in left axilla were essential monitors. During thoracotomy, both the ends of the esophagus and the fistula could not be located after thorough search suggesting an on table finding of type A esophageal atresia. The baby was repositioned for gastrostomy, and cervical esophagostomy ventilated overnight and extubated uneventful. Absent gas shadow was overlooked and the purpose of this presentation is to create an awareness between the neonatologist, pediatric surgeons and anesthesiologist regarding variation of typing of Tracheoesophageal fistula pre and intraoperatively. A need for imaging modalities warranted for a definitive diagnosis in the presence of a gasless stomach.

Keywords: anesthetic, atrial septal defects, esophageal atresia, patent ductus arteriosus, perioperative, chest x-ray

Procedia PDF Downloads 154

Authors: Grace Fangmin Tan, Elaine Yiling Tay, Elizabeth Huiwen Tham, Andrea Wei Ching Yeo

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Background: While accidental poisonings in children may seem unavoidable, knowledge of circumstances surrounding such incidents and identification of risk factors is important in the development of secondary prevention strategies. Some risk factors include age of the child, lack of adequate supervision and improper storage of substances. The aim of this study is to assess risk factors and circumstances influencing outcomes in these children. Methodology: A retrospective medical record review of all accidental poisoning cases presenting to the Children’s Emergency at National University Hospital (NUH), Singapore between January 2014 and December 2015 was conducted. Information on demographics, poisoning circumstances and clinical outcomes were collected. Results: Ninety-nine of a total of 186 poisoning cases were accidental ingestions, with a mean age of 4.7 (range 0.4 to 18.3 years). The gender distribution is rather equal with 52(52.5%) females and 47(47.5%) males. Seventy-nine (79.8%) were self-administered by the child and in 20 cases (20.2%), the substance was administered erroneously by caregivers 12/20 (60.0%) of whom were given the wrong drug dose while 8/20 (40.0%) were given the wrong substance. Self-administration was associated with presentation to the ED within 12 hours (p=0.027, OR 6.65, 95% CI 1.24-35.72). Notably, 94.9% of the cases involved substances kept within reach of the child. Sixty-nine (82.1%) had the substance kept in the original container, 3(3.6%) in food containers, 8(9.5%) in other containers and 4(4.8%) without a container. Of the 50 cases with information on labelling, 40/50(80.0%) were accurately labelled, 2/50 (4.0%) wrongly labelled, and 8/50 (16.0%) were unlabelled. Implicated substances included personal care products (11.1%), household cleaning products (3.0%), and different classes of drugs such as paracetamol (22.2%), antihistamines (17.2%) and sympathomimetics (8.1%). Children < 3 years of age were 4.8 times more likely to be poisoned by household substances than children >3 years of age (p=0.009, 95% CI 1.48-15.77). Prehospital interventions were more likely to have been done in poisoning with household substances (p=0.005, OR 6.12 95% CI 1.73-21.68). Fifty-nine (59.6%) were asymptomatic, 34 (34.3%) had a Poisoning Severity Score (PSS) grade of 1 (minor) and 6 (6.1%) grade 2 (moderate). Older children were 9.3 times more likely to be symptomatic (p<0.001, 95% CI 3.15-27.25). Thirty (32%) required admission. Conclusion: A significant proportion of accidental poisoning cases were due to medication administration errors by caregivers, which should be preventable. Risk factors for accidental poisoning included lack of adequate caregiver supervision, improper labelling and young age of the child. There is an urgent need to improve caregiver counselling during medication dispensing as well as to educate caregivers on basic child safety measures in the home to prevent future accidental poisonings.

Keywords: accidental, caregiver, paediatrics, poisoning

Procedia PDF Downloads 186

Authors: Gwendolyn Royal-Smith

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Cocaine ranks as one of the world’s most addictive and commonly abused stimulant drugs. Recent evidence indicates that the abuse of cocaine has risen so quickly among females that this group now accounts for about 40 percent of all users in the United States. Neuropsychological studies have demonstrated that specific neural activation patterns carry higher risks for neurocognitive and executive function in cocaine addicted females thereby increasing their vulnerability for poorer treatment outcomes and more frequent post-treatment relapse when compared to males. This study examined secondary data with a convenience sample of 164 cocaine addicted male and females to assess neurocognitive and executive function. The principal objective of this study was to assess whether individual performance on the Stroop Word Color Task is predictive of treatment success by gender. A second objective of the study evaluated whether individual performance employing neurocognitive measures including the Stroop Word-Color task, the Rey Auditory Verbal Learning Test (RALVT), the Iowa Gambling Task, the Wisconsin Card Sorting Task (WISCT), the total score from the Barratte Impulsiveness Scale (Version 11) (BIS-11) and the total score from the Frontal Systems Behavioral Scale (FrSBE) test demonstrated differences in neurocognitive and executive function performance by gender. Logistic regression models were employed utilizing a covariate adjusted model application. Initial analyses of the Stroop Word color tasks indicated significant differences in the performance of males and females, with females experiencing more challenges in derived interference reaction time and associate recall ability. In early testing including the Rey Auditory Verbal Learning Test (RALVT), the number of advantageous vs disadvantageous cards from the Iowa Gambling Task, the number of perseverance errors from the Wisconsin Card Sorting Task (WISCT), the total score from the Barratte Impulsiveness Scale (Version 11) (BIS-11) and the total score from the Frontal Systems Behavioral Scale, results were mixed with women scoring lower in multiple indicators in both neurocognitive and executive function.

Keywords: cocaine addiction, gender, neuropsychology, neurocognitive, executive function

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Authors: Qi En Han, Si En Wai, Eugene Quek

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As one of the two Academic Medical Centres (AMCs) in Singapore, SingHealth Duke-NUS AMC strives to improve patients’ lives through excellent clinical care, research and education. These efforts are enhanced with the establishment of Academic Clinical Programmes (ACPs). Each ACP brings together specialists in a particular discipline from different institutions to maximize the power of shared knowledge and resources. Initiated by Surgery ACP, the student research mentorship programme is a programme designed to facilitate engagement between medical students and the surgical faculty. The programme offers mentors not only the opportunity to supervise research but also to nurture future clinician scientists. In turn, medical students acquire valuable research experience which may be useful in their future careers. The programme typically lasts one year, depending on the students’ commitment. Surgery ACP matches students’ research interests with the mentor's area of expertise whenever possible. Surgery ACP organizes informal tea sessions to bring students and prospective mentors together. Once a match is made, the pair is required to submit a project proposal which includes the title, proposed start and end dates, ethical and biosafety considerations and project details. The mentees either think of their own research question with guidance from the mentors or join an existing project. The mentees may participate in data collection, data analysis, manuscript writing and conference presentation. The progress of each research project is monitored through half-yearly progress report. The mentees report problems encountered or changes made to existing proposal on top of the progress made. A total of 18 mentors were successfully paired with 36 mentees since 2013. Currently, there are 23 on-going and 13 completed projects. The mentees are encouraged to present their projects at conferences and to publish in peer-reviewed journals. Six mentees have presented their completed projects at local or international conferences and one mentee has her work published. To further support student research, Surgery ACP organized a Research Day in 2015 to recognize their research efforts and to showcase their wide-range of research. Surgery ACP recognizes that early exposure of medical students to research is important in developing them into clinician scientists. As interest in research take time to develop and are usually realized during various research attachments, it is crucial that programmes such as the student research mentorship programme exist. Surgery ACP will continue to build on this programme.

Keywords: academic clinical programme, clinician scientist, medical student, mentoring

Procedia PDF Downloads 191

Authors: K. Larysz, E. Grochowska-Niedworok, M. Kardas, K. Brukalo, B. Calyniuk, R. Polaniak

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Eating behaviours and habits are one of the main factors affecting health. Abnormal nutritional status is a growing problem related to nutritional errors. The number of adolescents presenting excess body weight is also rising. The body's demand for all nutrients increases in the period of intensive development, i.e., during puberty. A varied, well-balanced diet and elimination of unhealthy habits are two of the key factors that contribute to the proper development of a young body. The aim of the study was to assess the nutritional status and selected eating behaviours/habits in adolescents attending middle school. An original questionnaire including 24 questions was conducted. A total of 401 correctly completed questionnaires were qualified for the assessment. Body mass index (BMI) was calculated. Furthermore, the frequency of breakfast consumption, the number of meals per day, types of snacks and sweetened beverages, as well as the frequency of consuming fruit and vegetables, dairy products and fast-foods were assessed. The obtained results were analysed statistically. The study showed that malnutrition was more of a problem than overweight or obesity among middle school students. More than 71% of middle school students have breakfast, whereas almost 30% of adolescents skip this meal. Up to 57.6% of respondents most often consume sweets at school. A total of 37% of adolescents consume sweetened beverages daily or almost every day. Most of the respondents consume an optimal number of meals daily. Only 24.7% of respondents consume fruit and vegetables more than once daily. The majority of respondents (49.40%) declared that they consumed fast food several times a month. Satisfactory frequency of consuming dairy products was reported by 32.7% of middle school students. Conclusions of our study: 1. Malnutrition is more of a problem than overweight or obesity among middle school students. They consume excessive amounts of sweets, sweetened beverages, and fast foods. 2. The consumption of fruit and vegetables was too low in the study group. The intake of dairy products was also low in some cases. 3. A statistically significant correlation was found between the frequency of fast food consumption and the intake of sweetened beverages. A low correlation was found between nutritional status and the number of meals per day. The number of meals consumed by these individuals decreased with increasing nutritional status.

Keywords: adolescent, malnutrition, nutrition, nutritional status, obesity

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Authors: Sadam Elayah

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Background: One of the most critical competencies in advanced dentistry is alveolar ridge preservation after exodontia. The aim of this clinical trial was to assess the impact of autologous concentrated growth factor (CGF) as a socket-filling material and its ridge preservation properties following the lower third molar extraction. Materials and Methods: A total of 60 sides of 30 participants who had completely symmetrical bilateral impacted lower third molars were enrolled. The short-term outcome variables were wound healing, swelling and pain, clinically assessed at different time intervals (1st, 3rd & 7th days). While the long-term outcome variables were bone height & width, bone density and socket surface area in the coronal section. Cone beam computed tomography images were obtained immediately after surgery and three months after surgery as a temporal measure. Randomization was achieved by opaque, sealed envelopes. Follow-up data were compared to baseline using Paired & Unpaired t-tests. Results: The wound healing index was significantly better in the test sides (P =0.001). Regarding the facial swelling, the test sides had significantly fewer values than the control sides, particularly on the 1st (1.01±.57 vs 1.55 ±.56) and 3rd days (1.42±0.8 vs 2.63±1.2) postoperatively. Nonetheless, the swelling disappeared within the 7th day on both sides. The pain scores of the visual analog scale were not a statistically significant difference between both sides on the 1st day; meanwhile, the pain scores were significantly lower on the test sides compared with the control sides, especially on the 3rd (P=0.001) and 7th days (P˂0.001) postoperatively. Regarding long-term outcomes, CGF sites had higher values in height and width when compared to Control sites (Buccal wall 32.9±3.5 vs 29.4±4.3 mm, Lingual wall 25.4±3.5 vs 23.1±4 mm, and Alveolar bone width 21.07±1.55vs19.53±1.90 mm) respectively. Bone density showed significantly higher values in CGF sites than in control sites (Coronal half 200±127.3 vs -84.1±121.3, Apical half 406.5±103 vs 64.2±158.6) respectively. There was a significant difference between both sites in reducing periodontal pockets. Conclusion: CGF application following surgical extraction provides an easy, low-cost, and efficient option for alveolar ridge preservation. Thus, dentists may encourage using CGF during dental extractions, particularly when alveolar ridge preservation is required.

Keywords: platelet, extraction, impacted teeth, alveolar ridge, regeneration, CGF

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Authors: Sabyasachi Mukhopadhyay, Joseph Ogutu, Gundula Bartzke, Hans-Peter Piepho

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Rainfall is a critical component of climate governing vegetation growth and production, forage availability and quality for herbivores. However, reliable rainfall measurements are not always available, making it necessary to predict rainfall values for particular locations through time. Predicting rainfall in space and time can be a complex and challenging task, especially where the rain gauge network is sparse and measurements are not recorded consistently for all rain gauges, leading to many missing values. Here, we develop a flexible Bayesian model for predicting rainfall in space and time and apply it to Narok County, situated in southwestern Kenya, using data collected at 23 rain gauges from 1965 to 2015. Narok County encompasses the Maasai Mara ecosystem, the northern-most section of the Mara-Serengeti ecosystem, famous for its diverse and abundant large mammal populations and spectacular migration of enormous herds of wildebeest, zebra and Thomson's gazelle. The model incorporates geographical and meteorological predictor variables, including elevation, distance to Lake Victoria and minimum temperature. We assess the efficiency of the model by comparing it empirically with the established Gaussian process, Kriging, simple linear and Bayesian linear models. We use the model to predict total monthly rainfall and its standard error for all 5 * 5 km grid cells in Narok County. Using the Monte Carlo integration method, we estimate seasonal and annual rainfall and their standard errors for 29 sub-regions in Narok. Finally, we use the predicted rainfall to predict large herbivore biomass in the Maasai Mara ecosystem on a 5 * 5 km grid for both the wet and dry seasons. We show that herbivore biomass increases with rainfall in both seasons. The model can handle data from a sparse network of observations with many missing values and performs at least as well as or better than four established and widely used models, on the Narok data set. The model produces rainfall predictions consistent with expectation and in good agreement with the blended station and satellite rainfall values. The predictions are precise enough for most practical purposes. The model is very general and applicable to other variables besides rainfall.

Keywords: non-stationary covariance function, gaussian process, ungulate biomass, MCMC, maasai mara ecosystem

Procedia PDF Downloads 260

Authors: Ali K. M. Al-Nasrawi, Uday A. Al-Hamdany, Sarah M. Hamylton, Brian G. Jones, Yasir M. Alyazichi

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Surface elevation dynamics have always responded to disturbance regimes. Creating Digital Elevation Models (DEMs) to detect surface dynamics has led to the development of several methods, devices and data clouds. DEMs can provide accurate and quick results with cost efficiency, in comparison to the inherited geomatics survey techniques. Nowadays, remote sensing datasets have become a primary source to create DEMs, including LiDAR point clouds with GIS analytic tools. However, these data need to be tested for error detection and correction. This paper evaluates various DEMs from different data sources over time for Apple Orchard Island, a coastal site in southeastern Australia, in order to detect surface dynamics. Subsequently, 30 chosen locations were examined in the field to test the error of the DEMs surface detection using high resolution global positioning systems (GPSs). Results show significant surface elevation changes on Apple Orchard Island. Accretion occurred on most of the island while surface elevation loss due to erosion is limited to the northern and southern parts. Concurrently, the projected differential correction and validation method aimed to identify errors in the dataset. The resultant DEMs demonstrated a small error ratio (≤ 3%) from the gathered datasets when compared with the fieldwork survey using RTK-GPS. As modern modelling approaches need to become more effective and accurate, applying several tools to create different DEMs on a multi-temporal scale would allow easy predictions in time-cost-frames with more comprehensive coverage and greater accuracy. With a DEM technique for the eco-geomorphic context, such insights about the ecosystem dynamic detection, at such a coastal intertidal system, would be valuable to assess the accuracy of the predicted eco-geomorphic risk for the conservation management sustainability. Demonstrating this framework to evaluate the historical and current anthropogenic and environmental stressors on coastal surface elevation dynamism could be profitably applied worldwide.

Keywords: DEMs, eco-geomorphic-dynamic processes, geospatial Information Science, remote sensing, surface elevation changes,

Procedia PDF Downloads 247

Authors: Vishwanath Mali, Hemant Warhatkar, Raju Pawade

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Drilling of bone has been always challenging for surgeons due to the adverse effect it may impart to bone tissues. Force has to be applied manually by the surgeon while performing conventional bone drilling which may lead to permanent death of bone tissues and nerves. During bone drilling the temperature of the bone tissues increases to higher values above 47 ⁰C that causes thermal osteonecrosis resulting into screw loosening and subsequent implant failures. An attempt has been made here to study the input drilling parameters and surgical drill bit geometry affecting bone health during bone drilling. A One Factor At a Time (OFAT) method is used to plan the experiments. Input drilling parameters studied include spindle speed and feed rate. The drill bit geometry parameter studied include point angle and helix angle. The output variables are drilling thrust force and bone temperature. The experiments were conducted on goat femur bone at room temperature 30 ⁰C. For measurement of thrust forces KISTLER cutting force dynamometer Type 9257BA was used. For continuous data acquisition of temperature NI LabVIEW software was used. Fixture was made on RPT machine for holding the bone specimen while performing drilling operation. Bone specimen were preserved in deep freezer (LABTOP make) under -40 ⁰C. In case of drilling parameters, it is observed that at constant feed rate when spindle speed increases, thrust force as well as temperature decreases and at constant spindle speed when feed rate increases thrust force as well as temperature increases. The effect of drill bit geometry shows that at constant helix angle when point angle increases thrust force as well as temperature increases and at constant point angle when helix angle increase thrust force as well as temperature decreases. Hence it is concluded that as the thrust force increases temperature increases. In case of drilling parameter, the lowest thrust force and temperature i.e. 35.55 N and 36.04 ⁰C respectively were recorded at spindle speed 2000 rpm and feed rate 0.04 mm/rev. In case of drill bit geometry parameter, the lowest thrust force and temperature i.e. 40.81 N and 34 ⁰C respectively were recorded at point angle 70⁰ and helix angle 25⁰ Hence to avoid thermal necrosis of bone it is recommended to use higher spindle speed, lower feed rate, low point angle and high helix angle. The hard nature of cortical bone contributes to a greater rise in temperature whereas a considerable drop in temperature is observed during cancellous bone drilling.

Keywords: bone drilling, helix angle, point angle, thrust force, temperature, thermal necrosis

Procedia PDF Downloads 286

Authors: Michael Hast

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Within their first year, infants can differentiate between objects based on their weight. By at least 5 years children hold consistent weight-related misconceptions about the physical world, such as that heavy things fall faster than lighter ones because of their weight. Such misconceptions are seen as a challenge for science education since they are often highly resistant to change through instruction. Understanding the time point of emergence of such ideas could, therefore, be crucial for early science pedagogy. The paper thus discusses two studies that jointly address the issue by examining young children’s search behaviour in hidden displacement tasks under consideration of relative object weight. In both studies, they were tested with a heavy or a light ball, and they either had information about one of the balls only or both. In Study 1, 88 toddlers aged 2 to 3½ years watched a ball being dropped into a curved tube and were then allowed to search for the ball in three locations – one straight beneath the tube entrance, one where the curved tube lead to, and one that corresponded to neither of the previous outcomes. Success and failure at the task were not impacted by weight of the balls alone in any particular way. However, from around 3 years onwards, relative lightness, gained through having tactile experience of both balls beforehand, enhanced search success. Conversely, relative heaviness increased search errors such that children increasingly searched in the location immediately beneath the tube entry – known as the gravity bias. In Study 2, 60 toddlers aged 2, 2½ and 3 years watched a ball roll down a ramp and behind a screen with four doors, with a barrier placed along the ramp after one of four doors. Toddlers were allowed to open the doors to find the ball. While search accuracy generally increased with age, relative weight did not play a role in 2-year-olds’ search behaviour. Relative lightness improved 2½-year-olds’ searches. At 3 years, both relative lightness and relative heaviness had a significant impact, with the former improving search accuracy and the latter reducing it. Taken together, both studies suggest that between 2 and 3 years of age, relative object weight is increasingly taken into consideration in navigating naïve physical concepts. In particular, it appears to contribute to the early emergence of misconceptions relating to object weight. This insight from developmental psychology research may have consequences for early science education and related pedagogy towards early conceptual change.

Keywords: conceptual development, early science education, intuitive physics, misconceptions, object weight

Procedia PDF Downloads 175

Authors: Moustafa Osman Mohammed

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The photocurrent generations are influencing ultra-high efficiency solar cells based on self-assembled quantum dot (QD) nanostructures. Nanocrystal quantum dots (QD) provide a great enhancement toward solar cell efficiencies through the use of quantum confinement to tune absorbance across the solar spectrum enabled multi-exciton generation. Based on theoretical predictions, QDs have potential to improve systems efficiency in approximate regular electrons excitation intensity greater than 50%. In solar cell devices, an intermediate band formed by the electron levels in quantum dot systems. The spatial architecture is exploring how can solar cell integrate and produce not only high open circuit voltage (> 1.7 eV) but also large short-circuit currents due to the efficient absorption of sub-bandgap photons. In the proposed QD system, the structure allows barrier material to absorb wavelengths below 700 nm while multi-photon processes in the used quantum dots to absorb wavelengths up to 2 µm. The assembly of the electronic model is flexible to demonstrate the atoms and molecules structure and material properties to tune control energy bandgap of the barrier quantum dot to their respective optimum values. In terms of energy virtual conversion, the efficiency and cost of the electronic structure are unified outperform a pair of multi-junction solar cell that obtained in the rigorous test to quantify the errors. The milestone toward achieving the claimed high-efficiency solar cell device is controlling the edge causes of energy bandgap between the barrier material and quantum dot systems according to the media design limits. Despite this remarkable potential for high photocurrent generation, the achievable open-circuit voltage (Voc) is fundamentally limited due to non-radiative recombination processes in QD solar cells. The orientation of voltage recovery system is compared theoretically with experimental Voc variation in mediation upper–limit obtained one diode modeling form at the cells with different bandgap (Eg) as classified in the proposed spatial architecture. The opportunity for improvement Voc is valued approximately greater than 1V by using smaller QDs through QD solar cell recovery systems as confined to other micro and nano operations states.

Keywords: nanotechnology, photovoltaic solar cell, quantum systems, renewable energy, environmental modeling

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Authors: Joana PaScoa Pinheiro, David Goncalves Ferreira, Filipe Ramos, Joaquim Soares Do Brito, Samuel Martins, Marco Sarmento

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Introduction: The SARS-CoV-2 (COVID-19) pandemic was identified in January 2020 in China, in the city of Wuhan. The increase in the number of cases over the following months was responsible for the restructuring of hospitals and departments in order to accommodate admissions related to COVID-19. Essential services, such as trauma, had to readapt to maintain their functionality and thus guarantee quick and safe access in case of an emergency. Objectives: This study describes the impact of COVID-19 on a Level III Trauma Center and particularly on the clinical management of hospitalized patients with spine injuries. Study Design & Methods: This is a retrospective cohort study whose results were obtained through the medical records of patients with spine injuries who underwent surgical intervention in the years 2019 and 2020 (period from March 1st to December 31st). A comparison between the two groups was made. In the study patients with injuries in the context of trauma were included who underwent surgery in the periods previously described. Patients hospitalized with a spine injury in a non-traumatic context and/or were not surgically treated were excluded. Results: In total, 137 patients underwent trauma spine surgery of which 71 in 2019 (51.8%) were without significant differences in intergroup comparisons. The most frequent injury mechanism in 2019 was motor vehicle crash (47.9%) compared to 2020 which was of a person falling from a height between 2-4 meters (37.9%). Cervical trauma was reported to be the most frequent spine injury in both years. There was a significant decrease in the need for intensive care in 2020, 51.4% vs 30.3%, p = .015 and the number of complications was also lower in 2020 (1.35% vs 0.98%), including the number of deaths, being the difference marginally significant. There were no significant differences regarding time for presentation to surgery or in the total days of hospitalization. Conclusions: The restructuring made in the trauma unit at a Level III Trauma Center in the context of the current COVID-19 pandemic was effective, with no significant differences between the years of 2019 vs 2020 when compared with the time for presentation to surgery or the number of days of hospitalization. It was also found that lockdown rules in 2020 were probably responsible for the decrease in the number of road traffic accidents, which justifies a significant decrease in the need for intensive care as well as in the number of complications in patients hospitalized in the context of spine trauma.

Keywords: trauma, spine, impact, covid-19

Procedia PDF Downloads 223

Authors: Hong Je Kang, Young Chae Choi, Jin Sung Park, Isac Kim

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Purpose: Osteoporotic fractures are an important among postmenopausal women. When osteoporotic distal radial fractures occur, osteoporosis must be treated to prevent the hip and spine fractures. Intravenous injection of Zoledronic acid is expected to improve preventing osteoporotic fractures. Many articles reported the effect of intravenous Zoledronic acid to BMD of the hip and spine fracture or non-fracture patients with low BMD. However, that with distal radial fractures has rarely been reported. Therefore, the authors decided to study the effect of Zoledronic acid in BMD score, bone union, and bone turnover markers in the patients who underwent volar plating due to osteoporotic distal radial fractures. Materials: From April 2018 to May 2022, postmenopausal women aged 55 years or older who had osteoporotic distal radial fractures and who underwent surgical treatment using volar plate fixation were included. Zoledronic acid (5mg) was injected intravenously between 3 and 5 days after surgery. BMD scores after 1 year of operation were compared with the initial scores. Bone turnover markers were measured before surgery, after 3 months, and after 1 year. Radiological follow-up was performed every 2 weeks until the bone union and at 1 year postoperatively. Clinical outcome indicators were measured one year after surgery, and the occurrence of side effects was observed. Result: Total of 23 patients were included, with a lumbar BMD T score of -2.89±0.2 before surgery to -2.27±0.3 one year after surgery (p=0.012) and a femoral neck BMD T score of -2.45±0.3 before surgery to -2.36±0.3 (p=0.041) after one year, and all were statistically significant. Measured as bone resorption markers, serum CTX-1 was 337.43±10.4 pg/mL before surgery, 160.86±8.7 pg/mL (p=0.022) after three months, and 250.12±12.7 pg/mL (p=0.031) after one year. Urinary NTX-1 was 39.24±2.2 ng/mL before surgery, 24.46±1.2 ng/mL (p=0.014) after three months and 30.35±1.6 ng/mL (p=0.042) after one year. Measured as bone formation markers, serum osteocalcin was 13.04±1.1 ng/mL before surgery, 8.84±0.7 ng/mL (p=0.037) after 3 months and 11.1±0.4 ng/mL (p=0.026) after one year. Serum bone-specific ALP was 11.24±0.9 IU/L before surgery, 8.25±0.9 IU/L (p=0.036) after three months, and 10.2±0.9 IU/L (p=0.027) after one year. All were statistically significant. All cases showed bone union within an average of 6.91±0.3 weeks without any signs of failure. Complications were found in 5 out of 23 cases (21.7%), such as headache, nausea, muscle pain, and fever. Conclusion: When Zoledronic acid was used, BMD was improved in both the spine and femoral neck. This may reduce the likelihood and subsequent morbidity of additional osteoporotic fractures. This study is meaningful in that there was no difference in the duration of bone union and radiological characteristics in patients with distal radial fractures administrated with intravenous BP early after the fractures, and improvement in BMD and bone turnover indicators was measured.

Keywords: zeoldreonic acid, BMD, osteoporosis, distal radius

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Authors: Nishant Shrivastava, D. K. Sehgal

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In Finite Element Technique nodal stresses are calculated through displacement as nodes. In this process, the displacement calculated at nodes is sufficiently good enough but stresses calculated at nodes are not sufficiently accurate. Therefore, the accuracy in the stress computation in FEM models based on the displacement technique is obviously matter of concern for computational time in shape optimization of engineering problems. In the present work same is focused to find out unique points within the element as well as the boundary of the element so, that good accuracy in stress computation can be achieved. Generally, major optimal stress points are located in domain of the element some points have been also located at boundary of the element where stresses are fairly accurate as compared to nodal values. Then, it is subsequently concluded that there is an existence of unique points within the element, where stresses have higher accuracy than other points in the elements. Therefore, it is main aim is to evolve a generalized procedure for the determination of the optimal stress location inside the element as well as at the boundaries of the element and verify the same with results from numerical experimentation. The results of quadratic 9 noded serendipity elements are presented and the location of distinct optimal stress points is determined inside the element, as well as at the boundaries. The theoretical results indicate various optimal stress locations are in local coordinates at origin and at a distance of 0.577 in both directions from origin. Also, at the boundaries optimal stress locations are at the midpoints of the element boundary and the locations are at a distance of 0.577 from the origin in both directions. The above findings were verified through experimentation and findings were authenticated. For numerical experimentation five engineering problems were identified and the numerical results of 9-noded element were compared to those obtained by using the same order of 25-noded quadratic Lagrangian elements, which are considered as standard. Then root mean square errors are plotted with respect to various locations within the elements as well as the boundaries and conclusions were drawn. After numerical verification it is noted that in a 9-noded element, origin and locations at a distance of 0.577 from origin in both directions are the best sampling points for the stresses. It was also noted that stresses calculated within line at boundary enclosed by 0.577 midpoints are also very good and the error found is very less. When sampling points move away from these points, then it causes line zone error to increase rapidly. Thus, it is established that there are unique points at boundary of element where stresses are accurate, which can be utilized in solving various engineering problems and are also useful in shape optimizations.

Keywords: finite elements, Lagrangian, optimal stress location, serendipity

Procedia PDF Downloads 88

Authors: Belyihun Muchie

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This study investigates the low English oral communication skills of 5 second-year English major students at Debark University. It aims to identify the key factors contributing to their weaknesses and propose effective interventions to improve their spoken English proficiency. Mixed-methods research will be employed, utilizing observations, questionnaires, and semi-structured interviews to gather data from the participants. To clearly identify these factors, structured and informal observations will be employed; the former will be used to identify their fluency, pronunciation, vocabulary use, and grammar accuracy, and the later will be suited to observe the natural interactions and communication patterns of learners in the classroom setting. The questionnaires will assess their self-perceptions of their skills, perceived barriers to fluency, and preferred learning styles. Interviews will also delve deeper into their experiences and explore specific obstacles faced in oral communication. Data analysis will involve both quantitative and qualitative responses. The structured observation and questionnaire will be analyzed quantitatively, whereas the informal observation and interview transcripts will be analyzed thematically. Findings will be used to identify the major causes of low oral communication skills, such as limited vocabulary, grammatical errors, pronunciation difficulties, or lack of confidence. They are also helpful to develop targeted solutions addressing these causes, such as intensive pronunciation practice, conversation simulations, personalized feedback, or anxiety-reduction techniques. Finally, the findings will guide designing an intervention plan for implementation during the action research phase. The study's outcomes are expected to provide valuable insights into the challenges faced by English major students in developing oral communication skills, contribute to the development of evidence-based interventions for improving spoken English proficiency in similar contexts, and offer practical recommendations for English language instructors and curriculum developers to enhance student learning outcomes. By addressing the specific needs of these students and implementing tailored interventions, this research aims to bridge the gap between theoretical knowledge and practical speaking ability, equipping them with the confidence and skills to flourish in English communication settings.

Keywords: oral communication skills, mixed-methods, evidence-based interventions, spoken English proficiency

Procedia PDF Downloads 26

Authors: Shujon Mohammed Alazzam, Sarah Saad Alamer, Omar Hassan Kasule, Lama Suliman Aleid, Mohammad Abdulaziz Alakeel, Boshra Mosleh Alanazi, Abdullah Abdulelah Altowairqi, Yahya Ali Al-Asiri

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Background: Interventional radiology (IR) is a specialized field within radiology that diagnose and treat several conditions through a minimally invasive surgical procedure that involves the use of various radiological techniques. In the last few years, the role of IR has expanded to include a variety of organ systems which have been led to an increase in demand for these Specialties. The level of knowledge regarding IR is relatively low in general. In this study, we aimed to investigate the perceptions of interventional radiology (IR) as a specialty among medical students and medical interns in Riyadh, Saudi Arabia. Methodology: This study was a cross section. The target population is medical students in January 2023 in Riyadh city, KSA. We used the questionnaire for face-to-face interviews with voluntary participants to assess their knowledge of Interventional radiology. Permission was taken from participants to use their information. Assuring them that the data in this study was used only for scientific purposes. Results: According to the inclusion criteria, a total of 314 students participated in the study. (49%) of the participants were in the preclinical years, and (51%) were in the clinical years. The findings indicate more than half of the students think that they had good information about IR (58%), while (42%) reported that they had poor information and knowledge about IR. Only (28%) of students were planning to take an elective and radiology rotation, (and 27%) said they would consider a career in IR. (73%) of the participants who would not consider a career in IR, the highest reasons in order were due to "I do not find it interesting" (45%), then "Radiation exposure" (14%). Around half (48%) thought that an IRs must complete a residency training program in both radiology and surgery, and just (36%) of the students believe that an IRs must finish training in radiology. Our data show the procedures performed by IRs that (66%) lower limb angioplasty and stenting (58%) Cardiac angioplasty or stenting. (68%) of the students were familiar with angioplasty. When asked about the source of exposure to angioplasty, the majority (46%) were from a cardiologist, (and 16%) were from the interventional radiologist. Regarding IR career prospects, (78%) of the students believe that IRs have good career prospects. In conclusion, our findings reveal that the perception and exposure to IR among medical students and interns are generally poor. This has a direct influence on the student's decision regarding IR as a career path. Recommendations to attract medical students and promote IR as a career should be increased knowledge among medical students and future physicians through early exposure to IR, and this will promote the specialty's growth; also, involvement of the Saudi Interventional Radiology Society and Radiological Society of Saudi Arabia is essential.

Keywords: knowledge, medical students, perceptions, radiology, interventional radiology, Saudi Arabia

Procedia PDF Downloads 59

Authors: Yi-Fung Lin, Shiow-Ching Shun, Wen-Yu Hu

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Background: A skill mix model is regarded as one of the most effective methods of reducing nursing shortages, as well as easing nursing staff workloads and labor costs. Although this model shows several benefits for the health workforce, the relationship between the optimal model of skill mix and the patient mortality rate remains to be discovered. Objectives: This review aimed to explore the relationship between the skill mix model and patient mortality rate in acute care hospitals. Data Sources: A systematic search of the PubMed, Web of Science, Embase, and Cochrane Library databases and researchers retrieved studies published between January 1986 and March 2022. Review methods: Two independent reviewers screened the titles and abstracts based on selection criteria, extracted the data, and performed critical appraisals using the STROBE checklist of each included study. The studies focused on adult patients in acute care hospitals, and the skill mix model and patient mortality rate were included in the analysis. Results: Six included studies were conducted in the USA, Canada, Italy, Taiwan, and European countries (Belgium, England, Finland, Ireland, Spain, and Switzerland), including patients in medical, surgical, and intensive care units. There were both nurses and nursing assistants in their skill mix team. This main finding is that three studies (324,592 participants) show evidence of fewer mortality rates associated with hospitals with a higher percentage of registered nurse staff (range percentage of registered nurse staff 36.1%-100%), but three articles (1,122,270 participants) did not find the same result (range of percentage of registered nurse staff 46%-96%). However, based on appraisal findings, those showing a significant association all meet good quality standards, but only one-third of their counterparts. Conclusions: In light of the limited amount and quality of published research in this review, it is prudent to treat the findings with caution. Although the evidence is not insufficient certainty to draw conclusions about the relationship between nurse staffing level and patients' mortality, this review lights the direction of relevant studies in the future. The limitation of this article is the variation in skill mix models among countries and institutions, making it impossible to do a meta-analysis to compare them further.

Keywords: nurse staffing level, nursing assistants, mortality, skill mix

Procedia PDF Downloads 88

Authors: Nahush Modak, Meena Pangarkar, Anand Pathak, Ankita Tamhane

Abstract:

Background: Breast cancer is the prominent cause of cancer and mortality among women. This study was done to show the statistical analysis of a cohort of over 250 patients detected with breast cancer diagnosed by oncologists using Immunohistochemistry (IHC). IHC was performed by using ER; PR; HER2; Ki-67 antibodies. Materials and methods: Formalin fixed Paraffin embedded tissue samples were obtained by surgical manner and standard protocol was followed for fixation, grossing, tissue processing, embedding, cutting and IHC. The Ventana Benchmark XT machine was used for automated IHC of the samples. Antibodies used were supplied by F. Hoffmann-La Roche Ltd. Statistical analysis was performed by using SPSS for windows. Statistical tests performed were chi-squared test and Correlation tests with p<.01. The raw data was collected and provided by National Cancer Insitute, Jamtha, India. Result: Luminal B was the most prevailing molecular subtype of Breast cancer at our institute. Chi squared test of homogeneity was performed to find equality in distribution and Luminal B was the most prevalent molecular subtype. The worse prognostic indicator for breast cancer depends upon expression of Ki-67 and her2 protein in cancerous cells. Our study was done at p <.01 and significant dependence was observed. There exists no dependence of age on molecular subtype of breast cancer. Similarly, age is an independent variable while considering Ki-67 expression. Chi square test performed on Human epidermal growth factor receptor 2 (HER2) statuses of patients and strong dependence was observed in percentage of Ki-67 expression and Her2 (+/-) character which shows that, value of Ki depends upon Her2 expression in cancerous cells (p<.01). Surprisingly, dependence was observed in case of Ki-67 and Pr, at p <.01. This shows that Progesterone receptor proteins (PR) are over-expressed when there is an elevation in expression of Ki-67 protein. Conclusion: We conclude from that Luminal B is the most prevalent molecular subtype at National Cancer Institute, Jamtha, India. There was found no significant correlation between age and Ki-67 expression in any molecular subtype. And no dependence or correlation exists between patients’ age and molecular subtype. We also found that, when the diagnosis is Luminal A, out of the cohort of 257 patients, no patient shows >14% Ki-67 value. Statistically, extremely significant values were observed for dependence of PR+Her2- and PR-Her2+ scores on Ki-67 expression. (p<.01). Her2 is an important prognostic factor in breast cancer. Chi squared test for Her2 and Ki-67 shows that the expression of Ki depends upon Her2 statuses. Moreover, Ki-67 cannot be used as a standalone prognostic factor for determining breast cancer.

Keywords: breast cancer molecular subtypes , correlation, immunohistochemistry, Ki-67 and HR, statistical analysis

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