Search results for: surgical planning

Authors: Nathaniel Deboever, Malcolm Breeze, Adrian Sheen

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Basic surgical and suturing techniques are a fundamental requirement for all doctors. In order to gain confidence and competence, doctors in training need to obtain sufficient teaching and just as importantly: practice. Young doctors with an apt level of expertise on these simple surgical skills, which are often used in the Emergency Department, can help alleviate some pressure during a busy evening. Unfortunately, learning these skills can be quite difficult during medical school or even during junior doctor years. The aim of this project was to adequately train medical students attending University of Sydney’s Nepean Clinical School through a series of workshops highlighting practical skills, with hopes to further extend this program to junior doctors in the hospital. The sessions instructed basic skills via tutorials, demonstrations, and lastly, the sessions cemented these proficiencies with practical sessions. During such an endeavor, it is fundamental to employ models that appropriately resemble what students will encounter in the clinical setting. The sustainability of workshops is similarly important to the continuity of such a program. To address both these challenges, the authors have developed models including suturing platforms, knot tying, and vessel ligation stations, as well as a shave and punch biopsy models and ophthalmologic foreign body device. The unique aspect of this work is that we utilized hands-on teaching sessions, to address a gap in doctors-in-training and junior doctor curriculum. Presented to you through this poster are our approaches to creating models that do not employ animal products and therefore do not necessitate particular facilities or discarding requirements. Covering numerous skills that would be beneficial to all young doctors, these models are easily replicable and affordable. This exciting work allows for countless sessions at low cost, providing enough practice for students to perform these skills confidently as it has been shown through attendee questionnaires.

Keywords: medical education, surgical models, surgical simulation, surgical skills education

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Authors: Xie Xiaobin, Zhang Yan, Shi Yipeng, Sun Wenying, Chen Shuang, Cai Zhipeng, Zhang Hong, Zhang Lixia, Xie Like

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Objective: The objective of this research is to compare the efficacy of the late in-situ surgical revision augmented with continuous infusion and needle revision on failed trabeculectomy blebs. Methods From December 2018 to December 2021, a prospective randomized controlled trial was performed on 44 glaucoma patients with failed bleb ≥ 6months with medically uncontrolled in Eye Hospital, China Academy of Chinese Medical Sciences. They were randomly divided into two groups. 22 eyes of 22 patients underwent the late in-situ surgical revision with continuous anterior chamber infusion in the study group, and 22 of 22 patients were treated with needle revision in the control group. Main outcome measures include preoperative and postoperative intraocular pressure (IOP), the number of anti-glaucoma medicines, the operation success rate, and the postoperative complications. Results The postoperative IOP values decreased significantly from the baseline in both groups (both P<0.05). IOP was significantly lower in the study group than in the control group at one week, 1, and 3 months postoperatively (all P<0.05). IOP reductions in the study group were substantially more prominent than in the control group at all postoperative time points (all P<0.05). The complete success rate in the study group was significantly higher than in the control group (71.4% vs. 33.3%, P<0.05), while the complete failure rate was significantly lower in the study group (0% vs. 28.5%, P<0.05). According to Cox’s proportional hazards regression analysis, high IOP at baseline was independently associated with increased risks of complete failure (adjusted hazard ratio=1.141, 95% confidence interval=1.021-1.276, P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). Conclusion: Both in-situ surgical and needle revision have acceptable success rates and safety for the late failed trabeculectomy blebs, while the former is likely to have a higher level of efficacy over the latter. Needle revision may be insufficient for eyes with low target IOP.

Keywords: glaucoma, trabeculectomy blebs, in-situ surgical revision, needle revision

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Authors: Hninn Thiri Naing

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In Myanmar, there are many regions that are far away from the national grid. For these areas, isolated regional micro-grids are one of the solutions. The study area in this paper is also operating in such way. The main difficulty in such regions is the high cost of electrical energy. This paper will be approached to cost-effective or cost-optimization by energy planning with renewable energy resources and natural gas. Micro-grid will be set up for performance in the Dawei region since it is economic zone in lower Myanmar and so far from national grids. The required metrological and geographical data collections are done. Currently, the status is electric unit rate is higher than the other. For microgrid planning and optimization, Homer Pro-software is employed in this research.

Keywords: energy planning, renewable energy, homer pro, cost of energy

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Authors: Ozge Celik, Elvan Ender

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With rapidly increasing population growth and industrial revolution in the 1950s, in Turkey migration began to the cities from the countryside. Along the rapid growth of urban population has started to bring many problems. Depending on the uncontrolled urban development, concerns about the protection of natural values has increased day by day. As a result of disturbance on the natural environment, human health has started to be under threat. After all, much urban planning approaches outspread that protecting natural resources by respect to human health and troubleshooting problems emerging with anthropogenic effects. Smart growth concept is one of the chosen methods to resolve the problems in Turkey. In this paper, smart growth concept idea and its criteria will be explained while ecological planning and urban planning problems will be mentioned in Turkey according to the need of concept. Studies, consisting of practical and theoretical smart growth ideas, shows that ecological landscape planning is not included in the urban development process in Turkey. The main idea is to initiate urban development plans considering social and cultural structures of cultural assets and also natural values.

Keywords: ecological landscape planning, smart growth, Turkey, urban development

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Authors: Mohammed Aljoma

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In this paper, a developed prototype for the scheduling of repetitive activities in height-rise buildings was presented. The activities that describe the behavior of the most of activities in multi-storey buildings are scheduled using the developed approach. The prototype combines three methods to attain the optimized planning. The methods include Critical Path Method (CPM), Gantt and Line of Balance (LOB). The developed prototype; POTER is used to schedule repetitive and non-repetitive activities with respect to all constraints that can be automatically generated using a generic database. The prototype uses the method of genetic algorithms for optimizing the planning process. As a result, this approach enables contracting organizations to evaluate various planning solutions that are calculated, tested and classified by POTER to attain an optimal time-cost equilibrium according to their own criteria of time or coast.

Keywords: planning scheduling, genetic algorithms, repetitive activity, construction management, planning, scheduling, risk management, project duration

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Authors: Wenqian Shi, Xie He, Ziyin Huang, Zi Yu

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The dramatic changes in the global economic situation have produced dramatic changes to companies’ supply chain systems. A variety of opportunities and challenges make the traditional manufacturing industry feel pressured, and the manufacturing industry must seek a new way out as soon as possible. This paper presents a case study of the advanced planning and scheduling technology problem encountered by an electrical and electronics manufacturer. The objective is to seek the minimum cost of production planning and order management. Digitalization is applied to the problem, and the results demonstrate that significant production performances can be achieved in the face of the existing production of each link and order management systems to analyze and optimize. This paper can also provide some practical implications in various manufacturing industries. Finally, future research directions are discussed.

Keywords: advanced planning and scheduling, case study, production planning, supply chain optimization

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Authors: Sophie Mills, Leila L. Touil, Richard Sisson

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Introduction: The TNM classification is the global standard for the staging of head and neck cancers. Accurate clinical-radiological staging of tumours (cTNM) is essential to predict prognosis, facilitate surgical planning and determine the need for other therapeutic modalities. This study aims to determine the accuracy of pre-operative cTNM staging using pathological TNM (pTNM) and consider possible causes of TNM stage migration, noting any variation throughout the COVID-19 pandemic. Materials and Methods: A retrospective cohort study examined records of patients with surgical management of head and neck cancer at a tertiary head and neck centre from November 2019 to November 2020. Data was extracted from Somerset Cancer Registry and histopathology reports. cTNM and pTNM were compared before and during the first wave of COVID-19, as well as with other potential prognostic factors such as tumour site and tumour stage. Results: 119 cases were identified, of which 52.1% (n=62) were male, and 47.9% (n=57) were female with a mean age of 67 years. Clinical and pathological staging differed in 54.6% (n=65) of cases. Of the patients with stage migration, 40.4% (n=23) were up-staged and 59.6% (n=34) were down-staged compared with pTNM. There was no significant difference in the accuracy of cTNM staging compared with age, sex, or tumour site. There was a statistically highly significant (p < 0.001) correlation between cTNM accuracy and tumour stage, with the accuracy of cTNM staging decreasing with the advancement of pTNM staging. No statistically significant variation was noted between patients staged prior to and during COVID-19. Conclusions: Discrepancies in staging can impact management and outcomes for patients. This study found that the higher the pTNM, the more likely stage migration will occur. These findings are concordant with the oncology literature, which highlights the need to improve the accuracy of cTNM staging for more advanced tumours.

Keywords: COVID-19, head and neck cancer, stage migration, TNM staging

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Authors: Meng Wu

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Motion planning is a common task required to be fulfilled by robots. A strategy combining Ant Colony Optimization (ACO) and gravity gradient inversion algorithm is proposed for motion planning of mobile robots. In this paper, in order to realize optimal motion planning strategy, the cost function in ACO is designed based on gravity gradient inversion algorithm. The obstacles around mobile robot can cause gravity gradient anomalies; the gradiometer is installed on the mobile robot to detect the gravity gradient anomalies. After obtaining the anomalies, gravity gradient inversion algorithm is employed to calculate relative distance and orientation between mobile robot and obstacles. The relative distance and orientation deduced from gravity gradient inversion algorithm is employed as cost function in ACO algorithm to realize motion planning. The proposed strategy is validated by the simulation and experiment results.

Keywords: motion planning, gravity gradient inversion algorithm, ant colony optimization

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Authors: Eugene Y. C. Wong, Daniel Y. W. Mo, Cosmo T. Y. Ng, Jessica K. Y. Chan, Leith K. Y. Chan, Henry Y. K. Lau

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The real-time planning visualisation, precise allocation and loading optimisation in air cargo load planning operations are increasingly important as more considerations are needed on dangerous cargo loading, locations of lithium batteries, weight declaration and limited aircraft capacity. The planning of the unit load devices (ULD) can often be carried out only in a limited number of hours before flight departure. A dynamic air cargo load planning system is proposed with the optimisation of cargo load plan and visualisation of planning results in virtual reality systems. The system aims to optimise the cargo load planning and visualise the simulated loading planning decision on air cargo terminal operations. Adopting simulation tools, Cave Automatic Virtual Environment (CAVE) and virtual reality technologies, the results of planning with reference to weight and balance, Unit Load Device (ULD) dimensions, gateway, cargo nature and aircraft capacity are optimised and presented. The virtual reality system facilities planning, operations, education and training. Staff in terminals are usually trained in a traditional push-approach demonstration with enormous manual paperwork. With the support of newly customized immersive visualization environment, users can master the complex air cargo load planning techniques in a problem based training with the instant result being immersively visualised. The virtual reality system is developed with three-dimensional (3D) projectors, screens, workstations, truss system, 3D glasses, and demonstration platform and software. The content will be focused on the cargo planning and loading operations in an air cargo terminal. The system can assist decision-making process during cargo load planning in the complex operations of air cargo terminal operations. The processes of cargo loading, cargo build-up, security screening, and system monitoring can be further visualised. Scenarios are designed to support and demonstrate the daily operations of the air cargo terminal, including dangerous goods, pets and animals, and some special cargos.

Keywords: air cargo load planning, optimisation, virtual reality, weight and balance, unit load device

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Authors: Shpetim Rezniqi

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Over the years has increased, and increasingly has become necessary to make audit of financial statements. An auditor to perform an audit, should plan its audit in order to provide a high-quality audit and to be performed in an economic, efficient, effective and timely. This phase of the audit is also important stages of reach to the final goal of an audit to be professional and based in Kosovo and International Standards on Auditing. Always considering Kosovo as a new state and once out of war, where everything in its entrepreneurship started from the lowest stage of economic development and aim at development and regional and European integration, planning and performing audit becomes even more important.

Keywords: control, accounting, planning, analysis

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Authors: Ioannis Kavouras, Eftychios Protopapadakis, Emmanuel Sardis, Anastasios Doulamis

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In this paper, we investigate the appropriateness and usability of three different free and open-source rendering tools for urban planning visualizations. The process involves the selection of a map area, the 3D rendering transformation, the addition of nature-based solution placement, and the evaluation and assessment of the suggested applied interventions. The manuscript uses a case study involved at Dilaveri Coast, Piraeus region, Greece. Research outcomes indicate that a Blender-OSM implementation is an appropriate tool capable of supporting high-fidelity urban planning, with quick and accurate visibility of related results for end users and involved in NBS transformations.

Keywords: urban planning, nature based solution, 3D gaming tools, game engine, free and open source

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Authors: Sharon Baoas, Toni Beninato, Michael Zenilman, Gokhan Ozuner

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Background An enhanced recovery after surgery (ERAS) protocol was implemented to improve quality and cost effectiveness of surgical care in elective colorectal procedures. Results A total of 109 patients, 55 (pre-ERAS) and 54 (post-ERAS) are included in the final analysis. There were no differences in complications were recorded (p = 0.37) and 30-day readmissions (p = 0.785). The mean hospital stay was 5.89 ± 2.62 days in pre-ERAS and 4.94 ± 2.27 days in post-ERAS group which was statistically significant (p = 0.047). Conclusions An ERAS protocol for colorectal surgery harmonised perioperative care and decreased length of stay.

Keywords: 30-day readmission, lenght of stay, Enhanced Recovery after surgery, Surgical site infection

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Authors: Utsamani Cintyamena, Sandra Frans Olivia, Shita Lisyadewi, Ariane Utomo

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Family planning is one of fundamental aspects in preventing maternal morbidity and mortality. However, the prevalence rate of Indonesia’s married women in choosing contraception is low. This study purpose to assess opportunities and challenges in family planning. Methodology: We conducted a qualitative study in Banyumas District which has huge reduction of maternal mortality rate from 2013 to 2015. Four focus group discussions and four small group discussions were conducted to assess knowledge and attitude of women in using contraceptive and their method of choice, as well as in-depth interview to four health workers and two family planning field officers as triangulation. Thematic content analysis was done manually. Results: Key themes emerge across interviews including (1) first choice of contraception is the one that they previously had, provided that they did not encountered problems with it, (2) rumor and fear of side effect affected their method of choice, (3) selection of contraceptive method was influenced by approval of husband, believes, and role model in community. Conclusion: Collaboration of health worker, family planning field officers, community, as well as support from stakeholder, must be increased to socializing family planning.

Keywords: attitude, challenge, chance, family planning, knowledge

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Authors: Abdelsalam Omran Gebril

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Pollution and solid waste are the most important environmental problems plaguing the city of Benghazi as well as other cities and towns in Libya. These problems are caused by the lack of environmental planning and sound environmental management. Environmental planning is very important at present for the development of projects that preserve the environment, therefore, the planning process should be prioritized over the management process. Pollution caused by poor planning and environmental management exists not only in Benghazi but also in all other Libyan cities. This study was conducted through various field visits to several neighborhoods and areas within Benghazi as well as its neighboring regions. Follow-ups in these areas were conducted from March 2013 to October 2013 and documented by photographs. The existing methods of waste collection and means of transportation were investigated. Interviews were conducted with relevant authorities, including the Environment Public Authority in Benghazi and the Public Service Company of Benghazi. The objective of this study is to determine the causes of solid waste pollution in Benghazi City and its surrounding areas. Results show that solid waste pollution in Benghazi and its surrounding areas is the result of poor planning and environmental management, population growth, and the lack of hardware and equipment for the collection and transport of waste from the city to the landfill site. One of the most important recommendations in this study is the development of a complete and comprehensive plan that includes environmental planning and environmental management to reduce solid waste pollution.

Keywords: solid waste, pollution, environmental planning, management, Benghazi, Libya

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Authors: Rene Hellmuth, Jorg Frohnmayer

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The requirements of the factory planning and the building concerned have changed in the last years. Factory planning has the task of designing products, plants, processes, organization, areas, and the building of a factory. Regular restructuring gains more importance in order to maintain the competitiveness of a factory. Even today, the methods and process models used in factory planning are predominantly based on the classical planning principles of Schmigalla, Aggteleky and Kettner, which, however, are not specifically designed for reorganization. In addition, they are designed for a largely static environmental situation and a manageable planning complexity as well as for medium to long-term planning cycles with a low variability of the factory. Existing approaches already regard factory planning as a continuous process that makes it possible to react quickly to adaptation requirements. However, digital factory models are not yet used as a source of information for building data. Approaches which consider building information modeling (BIM) or digital factory models in general either do not refer to factory conversions or do not yet go beyond a concept. This deficit can be further substantiated. A method for factory conversion planning using a current digital building model is lacking. A corresponding approach must take into account both the existing approaches to factory planning and the use of digital factory models in practice. A literature review will be conducted first. In it, approaches to classic factory planning and approaches to conversion planning are examined. In addition, it will be investigated which approaches already contain digital factory models. In the second step, an approach is presented how digital factory models based on building information modeling can be used as a basis for augmented reality tablet applications. This application is suitable for construction sites and provides information on the costs and time required for conversion variants. Thus a fast decision making is supported. In summary, the paper provides an overview of existing factory planning approaches and critically examines the use of digital tools. Based on this preliminary work, an approach is presented, which suggests the sensible use of digital factory models for decision support in the case of conversion variants of the factory building. The augmented reality application is designed to summarize the most important information for decision-makers during a reconstruction process.

Keywords: augmented reality, digital factory model, factory planning, restructuring

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Authors: Youping Huang, Yang Liu

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Mountainous cities have unique landscape relationship, topography and urban spatial pattern different from plain cities, which put forward different requirements for greenway system planning strategy. Taking the greenway planning of Chengkou County in Chongqing as an example, this paper discusses the greenway system planning strategy of mountainous cities based on urban and rural green space, urban landscape resources, human resources and other factors. Through multi-angle maintenance of landscape pattern, multi-objective integration of urban resources, multi-level construction of greenway network, and multi-interactive development control, the sustainable development of mountain city landscape resources is realized, the new urban ecology is constructed, and the quality of life of urban and rural residents is improved.

Keywords: greenway planning, mountain city, landscape pattern, cultural resources, chongqing

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Authors: Chidiebere Joy Nwankwo, Benjamin S. C. Uzochukwu, Florence T. Sibeudu

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Background: Family planning is one of the most cost-effective ways to prevent maternal, infant, and child mortality. It can decrease maternal mortality by reducing the number of unintended pregnancies, the number of abortions, and the proportion of births at high risk. It has been seen to improve the health and economic well-being of families and communities and ensures women’s planned childbearing in order to achieve education and career goals which could raise family income thereby reducing poverty. The choice and use of a particular family planning method and their sources vary globally. Rural Communities often face significant challenges in accessing and utilizing family planning services. Aim: This study set out to assess Access and Utilization of Family Planning Services among Women of Reproductive Age in a Rural Community of Enugu state, Nigeria. Rural communities were chosen for this study because past demographic surveys have shown that women in urban areas are more likely to accept and practice family planning compared to those in rural areas. Method: A Descriptive Cross-sectional Research design was employed to achieve the aim and objectives of the study. Data collected from 177 consenting participants using interviewer-administered questionnaires was analysed using Descriptive statistics to summarize the Socio-demographic characteristics of the participants and Access and Utilization of Family Planning Services among the participants including Reasons for using different Family Planning Methods and Barriers encountered in Access and Utilization of these services. A Cross-tabulation between Socio-demographic Characteristics of respondents and the use of Family Planning services was carried out. Result: The findings of this study revealed that majority of the participants (72.9%) have not utilized any family planning service. Out of those (27.1%) that have used any family planning service, majority of them are still currently using a form of family planning service and have access to them in health facilities, patent medicine vendors and others based on multiple responses. Male condoms were the most utilized modern family planning service. Based on multiple responses, inaccessibility, personal beliefs and partner’s objection were the most identified barriers encountered in accessing family planning services. Conclusion: Access and uptake of family planning services in rural communities is lower than the national average. Increasing access to family planning is an urgent priority for rural areas Interventions that will scale up Access and Utilization of family planning services in rural communities should be intensified.

Keywords: access, family planning, rural community, utilization

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Authors: C. M. Williams, R. English, P. King, I. M. Brown

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Introduction: Pseudoangiomatous Stromal Hyperplasia (PASH) is a benign fibrous proliferation of breast stroma affecting predominantly premenopausal women with no significant increased risk of breast cancer. Informal recommendations for management have continued to evolve over recent years from surgical excision to observation, although there are no specific national guidelines. This study assesses the safety of a non-surgical approach to PASH management by review of cases at a single centre. Methods: Retrospective case series review (January 2011 – August 2016) was conducted on consecutive PASH cases. Diagnostic classification (clinical, radiological and histological), management outcomes, and breast cancer incidence were recorded. Results: 43 patients were followed up for median of 25 months (3-64) with 75% symptomatic at presentation. 12% of cases (n=5) had a radiological score (BIRADS MMG or US) ≥ 4 of which 3 were confirmed malignant. One further malignancy was detected and proven radiologically occult and contralateral. No patients were diagnosed with a malignancy during follow-up. Treatment evolved from 67% surgical in 2011 to 33% in 2016. Conclusions: The management of PASH has transitioned in line with other published experience. The preliminary findings suggest this appears safe with no evidence of missed malignancies; however, longer follow up is required to confirm long-term safety. Recommendations: PASH with suspicious radiological findings ( ≥ U4/R4) warrants multidisciplinary discussion for excision. In the absence of histological or radiological suspicion of malignancy, PASH can be safely managed without surgery.

Keywords: benign breast disease, conservative management, malignancy, pseudoangiomatous stromal hyperplasia, surgical excision

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Authors: Soheila Zhaeentan, Anders Von Heijne, Elisabet Hagert, André Stark, Björn Salomonsson

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Recommended treatment for traumatic rotator cuff tear (TRCT) is surgery within a few weeks after injury if the diagnosis is made early, especially if a functional impairment of the shoulder exists. This may lead to the assumption that a poor outcome then can be expected in delayed surgical treatment, when the patient is diagnosed at a later stage. The aim of this study was to investigate if a surgical repair later than three months after injury may result in successful outcomes and patient satisfaction. There is evidence in literature that good results of treatment can be expected up to three months after the injury, but little is known of later treatment with cuff repair. 73 patients (75 shoulders), 58 males/17 females, mean age 59 (range 34-­‐72), who had undergone surgical intervention for TRCT between January 1999 to December 2011 at our clinic, were included in this study. Patients were assessed by MRI investigation, clinical examination, Western Ontario Rotator Cuff index (WORC), Oxford Shoulder Score, Constant-­‐Murley Score, EQ-­‐5D and patient subjective satisfaction at follow-­‐up. The patients treated surgically within three months ( < 12 weeks) after injury (39 cases) were compared with patients treated more than three months ( ≥ 12 weeks) after injury (36 cases). WORC was used as the primary outcome measure and the other variables as secondary. A senior consultant radiologist, blinded to patient category and clinical outcome, evaluated all MRI-­‐images. Rotator cuff integrity, presence of arthritis, fatty degeneration and muscle atrophy was evaluated in all cases. The average follow-­‐up time was 56 months (range 14-­‐149) and the average time from injury to repair was 16 weeks (range 3-­‐104). No statistically significant differences were found for any of the assessed parameters or scores between the two groups. The mean WORC score was 77 (early group, range 25-­‐ 100 and late group, range 27-­‐100) for both groups (p= 0.86), Constant-­‐Murley Score (p= 0.91), Oxford Shoulder Score (p= 0.79), EQ-­‐5D index (p= 0.86). Re-­‐tear frequency was 24% for both groups, and the patients with re-­‐tear reported less satisfaction with outcome. Discussion and conclusion: This study shows that surgical repair of TRCT performed later than three months after injury may result in good functional outcomes and patient satisfaction. However, this does not motivate an intentional delay in surgery when there is an indication for surgical repair as that delay may adversely affect the possibility to perform a repair. Our results show that surgeons may safely consider surgical repair even if a delay in diagnosis has occurred. A retrospective cohort study on 75 shoulders shows good functional result after traumatic rotator cuff tear (TRCT) treated surgically up to one year after the injury.

Keywords: traumatic rotator cuff injury, time to surgery, surgical outcome, retrospective cohort study

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Authors: Samira Alvandi

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In the context of the circular economy, production planning aims to eliminate waste and emissions and maximize resource efficiency. Historically production planning is challenged through arrays of uncertainty and complexity arising from the interdependence and variability of products, processes, and systems. Manufacturers worldwide are facing new challenges in tackling various environmental issues such as climate change, resource depletion, and land degradation. In managing the inherited complexity and uncertainty and yet maintaining profitability, the manufacturing sector is in need of a holistic framework that supports energy efficiency and carbon emission reduction schemes. The proposed framework addresses the current challenges and integrates simulation modeling with optimization for finding optimal machine-job allocation to maximize throughput and total energy consumption while minimizing lead time. The aluminium refinery facility in western Sydney, Australia, is used as an exemplar to validate the proposed framework.

Keywords: smart production planning, simulation-optimisation, energy aware capacity planning, energy intensive industries

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Authors: Shammael Selorfia

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The Quality improvement project aimed to improve junior doctors and nurses’ knowledge and confidence in diagnosing and managing delirium on inpatient surgical wards in a tertiary hospital. The study aimed to develop a standardised assessment and management checklist for all staff working with patients who were presenting with signs of delirium. The aim of the study was to increase confidence of staff at dealing with delirium and improve the quality of referrals that were being sent to the Mental Health Liaison team over a 6-month period. A significant proportion of time was being spent by the Mental Health Liaison triage nurses on referrals for delirium. Data showed 28% of all delirium referrals from surgical teams were being closed at triage reflecting a poor standard of quality of those referrals. A qualitative survey of junior doctors in 6 surgical specialties in a UK tertiary hospital was conducted. These specialties include general surgery, vascular, plastic, urology, neurosurgery, and orthopaedics. The standardised checklist was distributed to all surgical wards. A comparison was made between the Mental health team caseload of delirium before intervention was compared and after. A Qualitative survey at end of 3-month cycle and compare overall caseload on Mental Health Liaison team to pre-QIP data with aim to improve quality of referrals and reduce workload on Mental Health Liaison team. At the end of the project cycle, we demonstrated an improvement in the quality of referrals with a decrease in the percentage of referrals being closed at triage by 8%. Our surveys also indicated an increase in the knowledge of official trust delirium guidelines and confidence at managing the patients. This project highlights that a new approach to delirium using multi-component interventions is needed, where the diagnosis of delirium is shared amongst medical and nursing staff, and everyone plays role in management. The key is improving awareness of delirium and encouraging the use of recognized diagnostic tools and official guidelines. Recommendations were made to the trust on how to implement a long-lasting change.

Keywords: delirium, surgery, quality, improvement

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Authors: A. Arjomand Kermani, N. Charbgoo, M. Alalhesabi

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In the situation of great acceleration of changes and the need for new developments in the cities on one hand and conservation and regeneration approaches on the other hand, place identity and its relation with heritage context have taken on new importance. This relation is generally mutual and complex one. The significant point in this relation is that the process of identifying something as heritage rather than just historical  phenomena, brings that which may be inherited into the realm of identity. In planning and urban design as well as environmental psychology and phenomenology domain, place identity and its attributes and components were studied and discussed. However, the relation between physical environment (especially heritage) and identity has been neglected in the planning literature. This article aims to review the knowledge on this field and develop a model on the influence and relation of these two major concepts (heritage and identity). To build this conceptual model, we draw on available literature in environmental psychology as well as planning on place identity and heritage environment using a descriptive-analytical methodology to understand how they can inform the planning strategies and governance policies. A cross-disciplinary analysis is essential to understand the nature of place identity and heritage context and develop a more holistic model of their relationship in order to be employed in planning process and decision making. Moreover, this broader and more holistic perspective would enable both social scientists and planners to learn from one another’s expertise for a fuller understanding of community dynamics. The result indicates that a combination of these perspectives can provide a richer understanding—not only of how planning impacts our experience of place, but also how place identity can impact community planning and development.

Keywords: heritage, inter-disciplinary study, place identity, planning

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Authors: Caner Koc, Dilara Gerdan Koc, Mustafa Vatandas

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The fundamental components of autonomous agricultural robot design, such as having a working understanding of coordinates, correctly constructing the desired route, and sensing environmental elements, are the most important. A variety of sensors, hardware, and software are employed by agricultural robots to find these systems.These enable the fully automated driving system of an autonomous vehicle to simulate how a human-driven vehicle would respond to changing environmental conditions. To calculate the vehicle's motion trajectory using data from the sensors, this automation system typically consists of a sophisticated software architecture based on object detection and driving decisions. In this study, the software architecture of an autonomous agricultural vehicle is compared to the trajectory planning techniques.

Keywords: agriculture 5.0, computational intelligence, motion planning, trajectory planning

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Authors: Agata Krawczyk-Ozog, Mateusz K. Holda, Mateusz Koziej, Danuta Sorysz, Zbigniew Siudak, Wieslawa Klimek-Piotrowska, Dariusz Dudek

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Introduction: Rapid development of the surgical and less-invasive percutaneous mitral valve repair procedures greatly increase the interest of the mitral valve anatomy. The aim of this study was to characterize morphological variability of the mitral valve leaflets and to provide the size of their particular parts. Materials and Methods: In the study, we included 200 autopsied human hearts from Caucasian individuals (25% females) with mean age 47.5 (±17.9) without any valvular diseases. The morphology of the mitral valve was evaluated. The intercommissural and aorto-mural diameters of the mitral annulus were measured. All leaflets and their scallops were identified. The base and the height of the posteromedial commissure (PM-C), anterolateral commissure (AL-C), anterior leaflet (AL) and posterior leaflet (PL) with their scallops were measured. Results: The intercommissural diameter was 28.0±4.8 mm, the aorto-mural diameter 19.7±4.8 mm, circumference of the mitral annulus 89.9±12.6 mm and the area of the mitral valve 485.4±171.4 mm2. Classical mitral valves (AL+AL-C+PL(P1,P2,P3)+PM-C) were found in 141 (70.5%) specimens. In classical type, the mean AL base and height were 30.8±4.9 mm and 20.6±4.2 mm, while mean PL base and height 45.1±8.2 mm 12.9±2.8 mm respectively. The mean ratio of the AL base to PL base was 0.7±0.2. Variations in PL were found in 55 (27.5%) and in AL in 5 (2.5%) hearts. The most common variations were: valve with one accessory scallop (AcS) between P3 and PM-C (7%); AcS between P1 and AL-C (4%); connections of P2 and P3 scallops (4%); connections of P1 and P2 scallops (3%); AcS in AL (2.5%). All AcS were smaller than the main PL scallops. The mean intertrigonal distance was 21.9±3.8 mm. Conclusions: In all cases, the mitral valve is built by two main leaflets with possible variants in secondary to leaflets scallops (29.5%). The variations are largely associated with PL and are mostly related to the presence of AcS. Anatomically the AL is not divided into scallops, and it occupies 34.5% of the mitral annulus circumference. Understanding the anatomy of the mitral valve leaflets helps to planning and performing mitral valve repair procedures.

Keywords: accessory scallop, commissure, connected scallops, human heart, mitral leaflets, mitral valve

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Authors: Saidasanov Saidazal Shokhmurodovich, Topolnickiy Orest Zinovyevich, Afaunova Olga Arturovna

Abstract:

Relevance: Bilateral congenital cleft is one of the most complex forms of all clefts, which makes it difficult to choose a surgical method of treatment. During primary operations to close the hard and soft palate, there is a shortage of soft tissues and their lack during standard uranoplasty, and these factors aggravate the period of rehabilitation of patients. Materials and methods: The results of surgical treatment of children with bilateral cleft, who underwent uranoplasty using a flap from the tongue, were analyzed. The study used methods: clinical and statistical, which allowed us to solve the tasks, based on the principles of evidence-based medicine. Results and discussion: in our study, 15 patients were studied, who underwent surgical treatment in the following volume: uranoplasty using a flap from the tongue in two stages. Of these, 9 boys and 6 girls aged 2.5 to 6 years. The first stage was surgical treatment in the volume: veloplasty. The second stage was a surgical intervention in volume: uranoplasty using a flap from the tongue. In all patients, the width of the cleft ranged from 1.6-2.8 cm. All patients in this group were orthodontically prepared. Using this method, the surgeon can achieve the following results: maximum narrowing of the palatopharyngeal ring, long soft palate, complete closure of the hard palate, alveolar process, and the mucous membrane of the nasal cavity is also sutured, which creates good conditions for the next stage of osteoplastic surgery. Based on the result obtained, patients have positive results of working with a speech therapist. In all patients, the dynamics were positive without complications. Conclusions: Based on our observation, tongue flap uranoplasty is one of the effective techniques for patients with wide clefts of the hard and soft palate. The use of a flap from the tongue makes it possible to reduce the number of repeated reoperations and improve the quality of social adaptation of this group of patients, which is one of the important stages of rehabilitation. Upon completion of the stages of rehabilitation, all patients had the maximum improvement in functional, anatomical and social indicators.

Keywords: congenital cleft lips and palate, bilateral cleft, child surgery, maxillofacial surgery

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Authors: M. M. Akhmediev, J. R. Ashrapov, T. M. Akhmediev

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Hydrocephalus frequently occurs with spina bifida, and up to 80% of such patients need to be shunted. Objective: It’s sought to improve the results of the surgical treatment of hydrocephalus in children with spina bifida. Methods: We have analyzed the results of the surgical treatment of 80 patients aged between 1 month and 1,5-year-old with hydrocephalus and myelomeningocele. All patients underwent surgery in the period of 2013-2018. Results: In all patients, spina bifida was associated with hydrocephalus with a predominant extension of the posterior horns of the lateral ventricles in the form of colpocephaly, Chiari malformation type 2. Based on the method “Choose right shunt” the determination of the point of critical deformation of the ventricular system was established, 47 (58.8%) patients for the 1st stage underwent ventriculoperitoneal (VP) shunt surgery with a low-pressure valve, 28 (35.0%) patients with medium pressure and 5 (6.2%) with high-pressure valve. Under or over drainage complications were not observed in the postoperative period. The 2nd stage of surgery for myelomeningocele repair was planned in 1-2 months with the follow-up head ultrasonography and electromyography study. Conclusion: The implantable shunt systems parameters chosen before surgery in the surgical management of hydrocephalus in children with myelomeningocele are important in the causes of under or over drainage states, cerebrospinal fluid leakage from the myelomeningocele sac. Management of hydrocephalus should be performed by considering myelomeningocele affecting craniospinal compliance.

Keywords: hydrocephalus, spina bifida, myelomeningocele, ventriculoperitoneal (VP) shunt

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Authors: Neal Rupani

Abstract:

Background: A surgical trainee has limited learning opportunities in the operating room in order to gain an ever-increasing standard of surgical skill, competency, and proficiency. These opportunities continue to decline due to numerous factors such as the European Working Time Directive and increasing requirement for service provision. It is therefore imperative to obtain the highest educational value from each educational opportunity. A measure that has yet to be validated in England on surgical trainees called the Operating Room Educational Environment Measure (OREEM) has been developed to identify and evaluate each component of the educational environment with a view to steer future change in optimising educational events in theatre. Aims: The aims of the study are to assess the reliability of the OREEM within England and to evaluate the surgical trainee’s objective perspective of the current operating room educational environment within one region within England. Methods: Using a quantitative study approach, data was collected over one month from surgical trainees within Health Education Thames Valley (Oxford) using an online questionnaire consisting of demographic data, the OREEM, a global satisfaction score. Results: 140 surgical trainees were invited to the study, with an online response of 54 participants (response rate = 38.6%). The OREEM was shown to have good internal consistency (α = 0.906, variables = 40) and unidimensionality, along with all four of its subgroups. The mean OREEM score was 79.16%. The areas highlighted for improvement predominantly focused on improving learning opportunities (average subscale score = 72.9%) and conducting pre- and post-operative teaching (average score = 70.4%). The trainee perception is most satisfactory for the level of supervision and workload (average subscale score = 82.87%). There was no differences found between gender (U = 191.5, p = 0.535) or type of hospital (U = 258.0, p = 0.099), but the learning environment was favoured towards senior trainees (U = 223.5, p = 0.017). There was strong correlation between OREEM and the global satisfaction score (r = 0.755, p<0.001). Conclusions: The OREEM was shown to be reliable in measuring the educational environment in the operating room. This can be used to identify potentially modifiable components for improvement and as an audit tool to ensure high standards are being met. The current perception of the education environment in Health Education Thames Valley is satisfactory, and modifiable internal and external factors such as reducing service provision requirements, empowering trainees to plan lists, creating a team-working ethic between all personnel, and using tools that maximise learning from each operation have been identified to improve learning in the future. There is a favourable attitude to use of such improvement tools, especially for those currently dissatisfied.

Keywords: education environment, surgery, post-graduate education, OREEM

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Authors: Tomaz Oliveira, Rui Medeiros, André Lacerda

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Introduction: Cleft lip and/or palate are the most frequent forms of congenital craniofacial anomalies, affecting mainly the middle third of the face and manifesting by functional and aesthetic changes. Bilateral cleft lip represents a reconstructive surgical challenge, not only for the labial component but also for the associated nasal deformation. Recently, the paradigm of the approach to this pathology has changed, placing the focus on muscle reconstruction and anatomical repositioning of the nasal cartilages in order to obtain the best aesthetic and functional results. The aim of this study is to carry out a systematic review of the surgical approach to bilateral cleft lip, retrospectively analyzing the case series of Plastic Surgery Service at Hospital Santa Maria (Lisbon, Portugal) regarding this pathology, the global assessment of the characteristics of the operated patients and the study of the different surgical approaches and their complications in the last 20 years. Methods: The present work demonstrates a retrospective and descriptive study of patients who underwent at least one reconstructive surgery for cleft lip and/or palate, in the CPRE service of the HSM, in the period between January 1 of 1997 and December 31 of 2017, in which the data relating to 361 individuals were analyzed who, after applying the exclusion criteria, constituted a sample of 212 participants. The variables analyzed were the year of the first surgery, gender, age, type of orofacial cleft, surgical approach, and its complications. Results: There was a higher overall prevalence in males, with cleft lip and cleft palate occurring in greater proportion in males, with the cleft palate being more common in females. The most frequently recorded malformation was cleft lip and palate, which is complete in most cases. Regarding laterality, alterations with a unilateral labial component were the most commonly observed, with the left lip being described as the most affected. It was found that the vast majority of patients underwent primary intervention up to 12 months of age. The surgical techniques used in the approach to this pathology showed an important chronological variation over the years. Discussion: Cleft lip and/or palate is a medical condition associated with high aesthetic and functional morbidity, which requires early treatment in order to optimize the long-term outcome. The existence of a nasolabial component and its respective surgical correction plays a central role in the treatment of this pathology. The high rates of post-surgical complications and unconvincing aesthetic results have motivated an evolution of the surgical technique, increasingly evident in recent years, allowing today to achieve satisfactory aesthetic results, even in bilateral cleft lip with high deformation complexity. The introduction of techniques that favor nasolabial reconstruction based on anatomical principles has been producing increasingly convincing results. The analyzed sample shows that most of the results obtained in this study are, in general, compatible with the results published in the literature. Conclusion: This work showed that the existence of small variations in the surgical technique can bring significant improvements in the functional and aesthetic results in the treatment of bilateral cleft lip.

Keywords: cleft lip, palate lip, congenital abnormalities, cranofacial malformations

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Authors: Ulrike Dowie, Ralph Grothmann

Abstract:

Rational planning decisions are based upon forecasts. Precise forecasting has, therefore, a central role in business. The prediction of customer demand is a prime example. This paper introduces recurrent neural networks to model customer demand and combines the forecast with uncertainty measures to derive decision support of the demand planning department. It identifies and describes the keys to the successful implementation of an AI-based solution: bringing together data with business knowledge, AI methods, and user experience, and applying agile software development practices.

Keywords: agile software development, AI project success factors, deep learning, demand forecasting, forecast uncertainty, neural networks, supply chain management

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Authors: Siyamthanda Makhwabe

Abstract:

Tourism development and spatial planning within the broader spectrum of the Eastern Cape needs to be strategically integrated to give effectiveness to development planning within the province. Tourism was severely affected and limited by policies of the previous regime. Tourism development in the Eastern Cape has been identified as one of the underdeveloped sectors that have the potential to improve the province’s local economic development trajectory The proposed study reviews literature on tourism development in an urban/rural and regional context in the Eastern Cape province. The proposed study will therefore offer an in-depth literature review on issues pertaining to spatial planning, land use management policies and tourism development within the Eastern Cape using the scoping review method. The intention of the proposed study is to identify synergies between the intertwined municipalities within the Wild Coast region in order to create a tourism belt that would yield benefit from Coffee Bay to East London.

Keywords: development, Eastern Cape, policies, spatial planning, tourism

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