Soft tissue Reconstruction of Gustilo-Anderson Grade IIIB Open Extra-Articular Tibial Fractures at a Tertiary Hospital in Cape Town, South Africa: A Retrospective Case Series

Introduction: Management of Gustilo-Anderson grade 3b tibia fractures are challenging due to the high rate of complications which includes infection, nonunion and possible amputation. Due to limited soft tissue coverage of the tibia antero-medially, open fractures remain a treatment challenge. Despite many advances, the ideal time delay to definitive soft tissue cover remains controversial. Aim: We aimed to investigate the management strategy and the outcome of soft tissue reconstruction of Gustilo-Anderson grade 3b tibia fractures at a tertiary hospital in Cape Town, South Africa. Methods: A retrospective study was conducted on 22 patients who underwent soft tissue reconstruction for grade 3b tibia fractures from January 2014 to July 2017. Patient demographics, comorbidities, injury characteristics and management practices such as time to debridement, relook time, Negative Pressure Wound Therapy (NPWT), soft tissue coverage and complications were recorded. Results: Most patients were males (n=18; 81.8%) with an average age of 39.3 years. Pedestrian vehicle accidents accounted for 45.4%(n=10), motor-vehicle accidents (n=6; 27.3%) and gunshot wounds (n=2; 9.1%). The commonest site of injury was the middle third of the tibia (n=13; 59.1%), distal third (n=7; 31.8%) and proximal third (n=2; 9.1%). Most patients (n=18; 81.8%) were debrided within 24 hours. The mean times for NPWT prior to cover was 12.5 days and for soft tissue cover 13.7 days (range 2-35), respectively. Fasciocutaneous flaps (n=11; 50%) were predominantly used as cover, then pedicled muscle flaps (n=8; 36.4%), free flaps (n=2) and skin graft(n=1). Most patients (n=13; 59.1%) received satisfactory outcomes. Seven (31.8%) required soft tissue revisions. Three patients (13.6%) suffered complications namely, complete flap loss resulting in amputation, partial skin graft loss and soft tissue infection, respectively. Patients who underwent debridement after 24 hours reported the least complications and there appeared to be better outcomes in the relooks beyond 48 hours. Conclusion: Despite achieving outcomes which concur with other published studies, the BOAST 4 guidelines were not fully reflected in our management strategy. We will require larger numbers in future studies to formulate a standardized management protocol going forward

Using spatiotemporal patterns to qualitatively represent and manage dynamic situations of interest : a cognitive and integrative approach

Les situations spatio-temporelles dynamiques sont des situations qui évoluent dans l’espace et dans le temps. L’être humain peut identifier des configurations de situations dans son environnement et les utilise pour prendre des décisions. Ces configurations de situations peuvent aussi être appelées « situations d’intérêt » ou encore « patrons spatio-temporels ». En informatique, les situations sont obtenues par des systèmes d’acquisition de données souvent présents dans diverses industries grâce aux récents développements technologiques et qui génèrent des bases de données de plus en plus volumineuses. On relève un problème important dans la littérature lié au fait que les formalismes de représentation utilisés sont souvent incapables de représenter des phénomènes spatiotemporels dynamiques et complexes qui reflètent la réalité. De plus, ils ne prennent pas en considération l’appréhension cognitive (modèle mental) que l’humain peut avoir de son environnement. Ces facteurs rendent difficile la mise en œuvre de tels modèles par des agents logiciels. Dans cette thèse, nous proposons un nouveau modèle de représentation des situations d’intérêt s’appuyant sur la notion des patrons spatiotemporels. Notre approche utilise les graphes conceptuels pour offrir un aspect qualitatif au modèle de représentation. Le modèle se base sur les notions d’événement et d’état pour représenter des phénomènes spatiotemporels dynamiques. Il intègre la notion de contexte pour permettre aux agents logiciels de raisonner avec les instances de patrons détectés. Nous proposons aussi un outil de génération automatisée des relations qualitatives de proximité spatiale en utilisant un classificateur flou. Finalement, nous proposons une plateforme de gestion des patrons spatiotemporels pour faciliter l’intégration de notre modèle dans des applications industrielles réelles. Ainsi, les contributions principales de notre travail sont : Un formalisme de représentation qualitative des situations spatiotemporelles dynamiques en utilisant des graphes conceptuels. ; Une approche cognitive pour la définition des patrons spatio-temporels basée sur l’intégration de l’information contextuelle. ; Un outil de génération automatique des relations spatiales qualitatives de proximité basé sur les classificateurs neuronaux flous. ; Une plateforme de gestion et de détection des patrons spatiotemporels basée sur l’extension d’un moteur de traitement des événements complexes (Complex Event Processing).Dynamic spatiotemporal situations are situations that evolve in space and time. They are part of humans’ daily life. One can be interested in a configuration of situations occurred in the environment and can use it to make decisions. In the literature, such configurations are referred to as “situations of interests” or “spatiotemporal patterns”. In Computer Science, dynamic situations are generated by large scale data acquisition systems which are deployed everywhere thanks to recent technological advances. Spatiotemporal pattern representation is a research subject which gained a lot of attraction from two main research areas. In spatiotemporal analysis, various works extended query languages to represent patterns and to query them from voluminous databases. In Artificial Intelligence, predicate-based models represent spatiotemporal patterns and detect their instances using rule-based mechanisms. Both approaches suffer several shortcomings. For example, they do not allow for representing dynamic and complex spatiotemporal phenomena due to their limited expressiveness. Furthermore, they do not take into account the human’s mental model of the environment in their representation formalisms. This limits the potential of building agent-based solutions to reason about these patterns. In this thesis, we propose a novel approach to represent situations of interest using the concept of spatiotemporal patterns. We use Conceptual Graphs to offer a qualitative representation model of these patterns. Our model is based on the concepts of spatiotemporal events and states to represent dynamic spatiotemporal phenomena. It also incorporates contextual information in order to facilitate building the knowledge base of software agents. Besides, we propose an intelligent proximity tool based on a neuro-fuzzy classifier to support qualitative spatial relations in the pattern model. Finally, we propose a framework to manage spatiotemporal patterns in order to facilitate the integration of our pattern representation model to existing applications in the industry. The main contributions of this thesis are as follows: A qualitative approach to model dynamic spatiotemporal situations of interest using Conceptual Graphs. ; A cognitive approach to represent spatiotemporal patterns by integrating contextual information. ; An automated tool to generate qualitative spatial proximity relations based on a neuro-fuzzy classifier. ; A platform for detection and management of spatiotemporal patterns using an extension of a Complex Event Processing engine

Measuring Productive Semantic Associational Knowledge of the Most Frequent Words

Associational vocabulary knowledge is associated with writing and speaking skills. These skills are essential for EAP students who express themselves in oral presentations or written assignments. Therefore, diagnostic measurement of associational vocabulary knowledge is of vital importance, especially in regard to the most frequent 1,000 word families that cover 81% and 85% of written and spoken text. This study measured 46 Iranian EAP students’ productive semantic associational knowledge of words at the 1,000 word frequency level. The findings indicate that while participants had productive form-meaning knowledge of the words, they did not seem to have extensive semantic associational knowledge of the same words. This assists in diagnosing area of weakness and the degree to which instructional emphasis on high frequency words might improve their knowledge

Measuring Productive Depth of Vocabulary Knowledge of the Most Frequent Words

Productive depth of vocabulary knowledge (PDVK) is associated with writing and speaking skills (Laufer & Goldstein, 2004). These skills are essential for English for Academic Purposes (EAP) students, who have difficulties with expressing themselves in oral presentations or written assignments (Evans & Green, 2007). As a result, diagnostic measurement of PDVK is of vital importance, especially in regard to the most frequent 1,000 word families because these word families cover 81% of written text and 85% of spoken text (Nation, 2006). Depth of vocabulary knowledge has been investigated and measured in various studies (see Chen & Truscatt, 2010; Pigada & Schmitt, 2006; Schmitt & Meara, 1997; Schmitt, 1998, 1999; Webb, 2005, 2007a, 2007b, 2007c, 2009a, 2009b) leading to successful multi-dimensional batteries of tests for its measurement. However, no study, to date, has productively measured the depth (and strength) of knowledge of the most frequent words. Nation’s (2013) conception of vocabulary knowledge—the proposition that vocabulary knowledge has three main aspects of Form, Meaning, and Use—structured the current study. Considering that the development of a test battery to measure all aspects of vocabulary knowledge outlined by Nation (2013) was impractical (Ishii & Schmitt, 2009), the current Ph.D. project focused on four aspects of vocabulary knowledge: (a) word parts, (b) associations, (c) collocations, and (d) form and meaning. The study measured 46 Iranian university EAP students’ productive vocabulary knowledge of the words at the 1,000 word frequency level. One productive test of word parts, two productive tests of semantic associations (synonym & antonym, and superordination & subordination tests), one productive test of collocation, and four corresponding productive tests of form-meaning connection for the aforementioned tests were developed for the present research. The results showed that while the participants had a strong performance on form-meaning connection and superordination and subordination, their knowledge of collocations was considerably lower. The results also showed that the participants’ performance on synonymy and antonymy, on association as a general term (synonym and antonym, superordination and subordination, and collocation altogether), and on word parts was not as strong as expected and was considerably lower than the maximum possible performance. Together the findings indicate that while Iranian university students had the productive Meaning knowledge of the words at 1,000 level, they did not seem to have extensive Form knowledge of the same words, and their Use knowledge was limited. This assists in diagnosing areas of weakness and the degree to which instructional emphasis on high frequency words might improve their knowledge

The Effect of Exchange Rate Uncertainty on Import of Medical and Pharmaceutical Products in Iran

Background: The field of medicine and medical equipment are partially dependent on the exchange rate. The aim of this study was to investigate the effect of real exchange rate uncertainty on the import of medical and pharmaceutical products during 1971-2012. Methods: In this longitudinal study, the related data were collected from the World Bank, the Central Bank of the Islamic Republic of Iran and Iran customs office during 1971-2012. Generalized Autoregressive Conditional Heteroskedastic (GARCH) model was used for modelling the real exchange rate. In order to evaluate the impact of real exchange rate uncertainty on import of medical and pharmaceutical products, the exchange rate uncertainty index and other variables such as gross domestic product (GDP), oil revenues (OILR) and private sector health expenditure (PRI) were applied in the import model. Finally, VAR model was estimated using Eviews software version 6. Results: Estimation of medical and pharmaceutical products import model using Johansson test showed a significant negative coefficient for the exchange rate uncertainty variable. Error correction factor in this study was -0.039. Results show that in each period, 3.9 percent of the shocks in the short term can be adjusted to long-run equilibrium values. Conclusion: The exchange rate uncertainty had a significant negative impact on imports of medical and pharmaceutical products. This issue is very important for policy makers of the health field and health economists

Refashioning Language: Arabic Literature in the New Millennium

In this paper I explore two contemporary Egyptian literary works, Nisāʾ il- Karantīna and the graphic novel Fī Shiqqat Bāb al-Lūq, showing that the language varieties and registers that exist within them make the dualistic category of Fuṣḥā and ʿAmmiyyah no longer sufficient. Using affective stance theory, I analyse the language and to what affect it is used in the novels, showing that the new millennium writers are refashioning a new poetics for the language that aims to unsettle previously held notions of power in all its guises, including the lingustic.Middle Eastern Studie

The Effect of Health Care Financing on Income Distribution in Iran: 2008- 2010

Background: Inequality in income distribution leads to the incidence of poverty and increase of the gap between social classes. Evidences suggest that policymakers in many developed and developing countries are concerned about the effects of health care financing on income distribution. The aim of this study was to investigate the effects of paying for health care on the distribution of income in rural and urban households in Iran. Methods: This descriptive- analytical, retrospective study was composed of a 3-year time series. Data were collected from the household income and expenditure survey of the Statistical Centre of Iran. To measure the inequality in the distribution of resources, Lorenze Curve and Gini index estimations were used. Data were analyzed using Stata11 software. Results: Gini coefficient for prepayment income, for the years 2008 to 2011, was respectively 0.367, 0.348 and 0.369 for urban households and 0.404, 0.362, 0.396, for rural households. The values of this index for post payment income in urban households were 0.300, 0.286 and 0.302 and 0.324, 0.300, 0.320 for rural households respectively. According to the results, paying for health care services has led to a significant reduction in the Gini coefficient and increase of equity. Conclusion: The results showed that paying for health care had a significant relationship with income distribution; it means that paying for health care and households’ contribution in health care financing reduced the Gini coefficient and improved income distribution. Keywords: Health care payment, Income distribution, Gini coefficient, Ira

PCR identification of Mycobacterium tuberculosis complex in a clinical sample from a patient with symptoms of tuberculous spondylodiscitis

A 42-year-old male complaining of thoracic spine pain was admitted to the hospital for evaluation. An X-ray and computer tomography of the thoracic spine showed spondylodiscitis of the L3 lumbar and L2-L3 intervertebral disk. The tuberculin skin test (PPD) was strongly positive. A radioscopy-guided fine needle aspirate of the affected area was cultured but did not reveal the cause of the disease. Two biopsy attempts failed to reveal the cause of the disease by culturing or by acid-fast-resistant staining (Ziehl Neelsen) of the specimens. A third biopsy also failed to detect the infectious agent by using microbiological procedures, but revealed the presence of a 245-bp amplicon characteristic of the Mycobacterium tuberculosis complex after PCR of the sample. The result demonstrates the efficacy of PCR for the identification of M. tuberculosis in situations in which conventional diagnosis by culturing techniques or direct microscopy is unable to detect the microorganism. Following this result the patient was treated with the antituberculous cocktail composed by rifampicin, pirazinamide and isoniazid during a six-month period. At the end of the treatment the dorsalgia symptoms had disappeared

Microstructural investigation and hole quality evaluation in S2/FM94 glass-fibre composites under dry and cryogenic conditions

International audienceS2/FM94 glass fibre reinforced epoxy is an aerospace-grade composite currently bonded with aluminium alloys and installed in parts of the Airbus A380 fuselage. In addition to its abrasive and hard nature, S2/FM94 glass fibre is sensitive to thermal effects developed during the drilling process, and therefore using coolants becomes necessary. However, conventional oil and water-based coolants are not suitable for drilling of composites. Cryogenic coolants on the other hand are an attractive choice for machining composites and are environmentally friendly. In this study, a new environmentally friendly cryogenic cooling technique in a liquid nitrogen bath was used for the drilling of S2/FM94 glass fibre reinforced epoxy composite. The aim was to investigate the effect of drilling parameters and cryogenic cooling on cutting forces, surface roughness, hardness and delamination factor at hole entry and exit sides. The workpiece was drilled within a cryogenic bath. In this way, both cryogenic workpiece cooling and tool cooling were obtained. In addition, the drill geometry is fixed and only the cutting parameters (i.e. spindle speed and the feed rate) are varied under dry and cryogenic conditions. The results indicate that the spindle speed and cryogenic cooling had the most significant influence on the cutting forces and surface roughness parameters (R a and R z ), while the use of cryogenic cooling had the most significant influence on increasing the hardness and size of delamination at entry and exit sides of the holes