THE EFFECT OF SUPPORT PLATE ON DRILLING-INDUCED DELAMINATION

Delamination is considered as a major problem in drilling of composite materials, which degrades the mechanical properties of these materials. The thrust force exerted by the drill is considered as the major cause of delamination; and one practical approach to reduce delamination is to use a back-up plate under the specimen. In this paper, the effect of exit support plate on delamination in twist drilling of glass fiber reinforced composites is studied. Firstly, two analytical models based on linear fracture mechanics and elastic bending theory of plates are described to find critical thrust forces at the beginning of crack growth for drilling with and without back-up plate. Secondly, two series of experiments are carried out on glass fiber reinforced composites to determine quantitatively the effect of drilling parameters on the amount of delamination. Experimental findings verify a large reduction in the amount of delaminated area when a back-up plate is placed under the specimen

Economic Valuation of Marine Tourism Dutungan Island by Travel Cost Method in Mallusetasi Subdistrict, Barru Regency, South Sulawesi Province

This study aims to determine the factors that influence the intensity of tourist visits to the Dutungan Island, Mallusetasi Sub-district, Barru Regency, South Sulawesi Province and The economic value of the Dutungan Island marine tourism object. This study uses quantitative descriptive and data collection techniques are observation and questionnaires. The population in this study are tourists with the purpose of traveling. The sampling technique used was accidental sampling with a total sample of 43 respondents. This research was conducted in April-May 2021 on Dutungan Island, Mallusetasi Sub-district, Barru Regency, South Sulawesi Province. The data analysis methods used were multiple linear regression analysis and travel cost analysis. The results of this study indicate that the factors that influence the intensity of tourist visits are travel costs, completeness of tourist attraction facilities, distance, accessibility, age and income. The economic value of the Dungan Island marine tourism object is IDR 1,188,895,920

High speed end milling of single crystal silicon using diamond coated tools

Brittle materials are hard to machine while maintaining the surface roughness desired. A brittle material will have little tendency to deform before it fractures when it is subjected to stress. Brittle material is also consider as a material which fails in tension rather than shear and has little or no evidence of plastic deformation before it fails. Thimmaiah et al. [1] specified that brittle materials, silicon by their inherent properties, are difficult to machine while maintaining the desired surface roughness but J. Yan et al. [2] reviewed that silicon is a nominally brittle material that can be deformed plastically in machining, yielding ductile chips under the influence of high hydrostatic pressure. Mariayyah [3] , stated that under certain controlled conditions, it is possible to machine brittle materials in ductile regime so that material removal is by plastic deformation, leaving a damage free surface. Rusnaldy et al. [4] research on the cutting parameters effect. They study about the effect of the depth of cut, feed rate and spindle speed. Rusnaldy et al. [5] showed that the dominant ductile cutting mode was achieved for Ft/Fc>1.0, which indicates that the thrust force is dominant over the cutting force. Cutting to a very small uncut chip thickness can cause ploughing, resulting in a poor surface due to high friction. Siva [6] proposes a predictive model to determine the undeformed chip thickness in micro-machining of single crystal brittle materials, where the mode of chip formation transitions from the ductile to the brittle regime. The proposed model would support the determination of the cutting conditions for the micromachining of a brittle material in ductile manner without resorting to trial and error. Furthermore, Sreejith [7] was able to obtain ductile mode of machining on silicon nitride by using Poly Crystalline Cubic Diamond (PCD) tools. His findings show that there is a maximum value of rake angle which will obtain ductile mode machining. Thimmaiah et al. [1] also did machining on silicon nitride but performed it using single point diamond turning. Their result indicates that small values of feed, small tooltip radius and at high speeds; conditions of pressure and temperature exist that facilitate ductile behaviour during machining. Negative rake angles are more likely to cause brittle to ductile transition when compared with the positive or zero degree rakes. These findings also correspond with Thimmaiah et al. [1] findings which also show that cutting force and thrust force increases as the rake angle becomes negative. The experimentation results differ with a crossover at between thrust force and cutting force at -45º.Furthermore, J. Yan et al (2000) stated that there is no inherent advantage in using rake angle more negative than -40º

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Lingua li Ta'limi al Lughah al Almaniyah (1)

229 hal.; 24 c