Technical and financial feasibility of a chemicals recovery and energy and water production from a dairy wastewater treatment plant.

Due to the high volume of wastewater produced from dairy factories, it is necessary to integrate a water recovery process with the treatment plant. Today, bipolar membrane electrodialysis units (BMEUs) are increasingly developed for wastewater treatment and reutilizing. This article aims to develop and evaluate (technical and cost analyses) a combined BMEU/batch reverse osmosis unit (BROU) process for the recovery of chemicals and water from the dairy wastewater plant. The combined BROU/BMEU process is able to simultaneously produce water and strong base-acid, and reduce power consumption due to the injection of concentrated feed flow into the BMEU. A comprehensive comparative analysis on the performances of two combined and stand-alone BMEU configurations are developed. The proposed combined technology for dairy factory wastewater treatment is designed on a new structure and configuration that can address superior cost analysis compared to similar technologies. Further, the optimal values of permeate flux and current density as two vital and influencing parameters on the performance of the studied dairy wastewater treatment process were calculated and discussed. From the outcomes, the total cost of production in the combined configuration has been reduced by approximately 26% compared to the stand-alone configuration. Increasing the feed concentration rate using the batch reverse osmosis process for the dairy wastewater treatment process can be an ideal solution from an economic point of view. Moreover, point (current density, feed concentration rate, total unit cost) = 328.9 , 7 , 14.37 can be considered as an optimal point for the economic performance of the studied wastewater treatment process.

Missed peroneus longus tendon laceration following plate-glass injury: A pitfall in the emergency department.

A thorough exploration of traumatic wound is critical to accurately assess the severity of the injury. When it comes to glass-related injuries, the diagnosis of a glass foreign body is often prioritized over identifying any underlying damage. The authors report a case of peroneus longus tendon rupture caused by plate-glass accident that was misdiagnosed in the emergency department (ED) as a superficial laceration.

Using shock generator for the fuel mixing of the extruded single 4-lobe nozzle at supersonic combustion chamber.

The importance of the fuel injection configuration on the propulsion efficiency of high-speed vehicles is apparent. In this article, the use of an annular extruded 4-lobe nozzle for the injection of fuel jet in a supersonic combustor of a scramjet engine in the existence of a shock generator is examined. The main aim of this study is to obtain the efficient jet arrangement for efficient fuel mixing inside the engine of hypersonic vehicles. A numerical approach is used to model the supersonic air stream and cross-jet flow with the SST turbulence model. The role of nozzle altitude and internal air jet on the fuel mixing of the hydrogen within the high-speed domain are disclosed. The importance of the horseshoe vortex and counter-rotating vortex on the fuel distribution is also presented. Our results show that the usage of a coaxial jet instead of an annular jet would increase fuel mixing by more than 40% in the combustion chamber.

Quercetin modulates expression of serum exosomal long noncoding RNA NEAT1 to regulate the miR-129-5p/BDNF axis and attenuate cognitive impairment in diabetic mice.

AIMS: Cognitive impairment poses a considerable health challenge in the context of type 2 diabetes mellitus (T2DM), emphasizing the need for effective interventions. This study delves into the therapeutic efficacy of quercetin, a natural flavonoid, in mitigating cognitive impairment induced by T2DM in murine models. MATERIALS AND METHODS: Serum exosome samples were obtained from both T2DM-related and healthy mice for transcriptome sequencing, enabling the identification of differentially expressed mRNAs and long noncoding RNAs (lncRNAs). Subsequent experiments were conducted to ascertain the binding affinity between mmu-miR-129-5p, NEAT1 and BDNF. The structural characteristics and dimensions of isolated exosomes were scrutinized, and the expression levels of exosome-associated proteins were quantified. Primary mouse hippocampal neurons were cultured for in vitro validation, assessing the expression of pertinent genes as well as neuronal vitality, proliferation, and apoptosis capabilities. For in vivo validation, a T2DM mouse model was established, and quercetin treatment was administered. Changes in various parameters, cognitive ability, and the expression of insulin-related proteins, along with pivotal signaling pathways, were monitored. KEY FINDINGS: Analysis of serum exosomes from T2DM mice revealed dysregulation of NEAT1, mmu-miR-129-5p, and BDNF. In vitro investigations demonstrated that NEAT1 upregulated BDNF expression by inhibiting mmu-miR-129-5p. Overexpression of mmu-miR-129-5p or silencing NEAT1 resulted in the downregulation of insulin-related protein expression, enhanced apoptosis, and suppressed neuronal proliferation. In vivo studies validated that quercetin treatment significantly ameliorated T2DM-related cognitive impairment in mice. SIGNIFICANCE: These findings suggest that quercetin holds promise in inhibiting hippocampal neuron apoptosis and improving T2DM-related cognitive impairment by modulating the NEAT1/miR-129-5p/BDNF pathway within serum exosomes.

Is Subtle Cavovarus a Problem for Athletes?

Cavovarus or high-arched foot is a common foot deformity that occurs due to the disruption of the foot-driven equilibrium between the first metatarsal, fifth metatarsal, and the heel. This imbalance leads to an increase in the foot's normal plantar concavity. Cavovarus deformity ranges from a mild and flexible malalignment to a fixed, complex, and severe deformation. Subtle cavovarus foot, the mild form of the cavus foot, was first described by Manoli and colleagues.

Accuracy of Intraarticular Injections: Blind vs. Image Guided Techniques-A Review of Literature.

Intra-articular injections are widely used for diagnostic and therapeutic purposes of joint pathologies throughout the body. These injections can be performed blind by utilizing anatomical landmarks or with the use of imaging modalities to directly visualize the joint space during injections. This review of the literature aims to comprehensively identify differences in the accuracy of intra-articular injections via palpation vs. image guidance in the most commonly injected joints in the upper and lower extremities. To our knowledge, there are no such comprehensive reviews available. A narrative literature review was performed using PubMed and Google Scholar databases to identify studies focusing on the accuracy of blind or image-guided intra-articular injections for each joint. A total of 75 articles was included in this review, with blind and image-guided strategies being discussed for the most commonly injected joints of the upper and lower extremities. Varying ranges of accuracy with blind and image-guided modalities were found throughout the literature, though an improvement in accuracy was seen in nearly all joints when using image guidance. Differences are pronounced, particularly in deep joints such as the hip or in the small joints such as those in the hand or foot. Image guidance is a useful adjunct for most intra-articular injections, if available. Though there is an increase in accuracy in nearly all joints, minor differences in accuracy seen in large, easily accessed joints, such as the knee, may not warrant image guidance.

Comparison of Dynamic Hip Screw and Proximal Femoral Nailing Techniques in Stable Intertrochanteric Fractures.

Introduction Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) are two well-accepted modes of surgical treatments for intertrochanteric (IT) hip fractures. While studies have extensively explored the efficacy of one over the other in unstable fractures, the comparison is sparsely available for stable fractures. The main aim of this study is to compare DHS or PFN corrective surgeries in cases of stable IT fractures operated at the Hamad General Hospital, Doha, Qatar, between 2016 and 2018. Methods We conducted a retrospective data review of all stable IT fractures operated at the Hamad General Hospital, Doha, Qatar, between 2016 and 2018. Data were extracted from electronic medical CERNER records, including demographics, clinical notes, operative reports, radiographs, and imaging reports. Data review was followed by prospective data collection via phone about the current post-operative functional status of all cases. Data analysis was done on SPSS v.23. Study was approved by Medical Research Center (MRC) and Institutional Review Board (IRB) at Hamad Medical Corporation (HMC). Study Protocol ID: MRC-01-19-108 Results Out of 62 stable IT fractures operated at our center during the study period, 42 underwent DHS correction, while 20 had PFN. The mean age of the studied cohort was 66.56 years (± 15.95). Males were twice more than females. The mean duration of surgery was 83.73 minutes for DHS and 120.25 minutes for PFN. This difference was statistically significant (p < 0.001). Differences in intraoperative blood loss, duration between fracture and surgery, and length of hospital stay were all statistically insignificant. Patients who underwent PFN showed a higher frequency of return to ambulation (assisted and unassisted), while the number of patients with DHS was less for the functional outcome. Similarly, more post-PFN radiographs displayed union than post-DHS radiographs (55% and 38%, respectively). This difference was statistically insignificant. Conclusion Our study showed promising results for stable IT fractures treated with PFN. However, more data and prospective observational studies are required to establish more statistically significant results.

Salvage of Hindfoot Charcot with Osteomyelitis and Ulceration: A Case Report.

Diabetic Charcot arthropathy of the ankle, due to the presence of multiplanar deformities, and associated medical comorbidities, poses a challenge for treating physicians. The situation becomes more complicated when accompanied by ulceration and osteomyelitis, leaving limited salvage options. We present a case of advanced Charcot ankle arthropathy with osteomyelitis and ulcerated hindfoot. It was managed by talectomy and antibiotic-impregnated cement beads, followed by hindfoot arthrodesis using a retrograde intramedullary nail six weeks later. This two-stage reconstruction approach resulted in an ulcer-free, stable, plantigrade foot at one-year postoperative follow-up.

Calcaneus Fracture Fixation in Prone Position: A Novel Technique and Case Series.

INTRODUCTION: Calcaneus is one of the most commonly fractured tarsal bones. The use of computed tomography (CT) has enabled more accurate fracture configuration and classification of fractures. The outcomes of operative versus nonoperative treatment of these fractures have been extensively debated with variable results. Significant complications following intra-articular fractures have been reported in the literature despite management by experienced surgeons. This article will discuss the treatment of calcaneus fractures by open reduction and internal fixation in a prone position with a calcaneal traction pin, and assess the outcomes following this novel technique. METHODS: Fifty-three patients with 58 acute displaced intra-articular calcaneal closed fractures (Sanders type II and III), presented to one tertiary center, were treated by open reduction and internal fixation in a distracted prone position through an extensile lateral approach by a single surgeon and assessed for postoperative wound and soft tissue complications. The primary outcome measure was postoperative wound complications. Secondary outcome measures were postoperative ankle and subtalar range of motion and return to work. Radiological assessment of anatomical reduction by measuring preoperative and postoperative Bohler's angle, Gissane angle, and posterior facet joint depression was conducted. A comparison was made with paired sample t-test with a confidence interval of 95%. RESULTS: Fifty-three patients with 58 calcaneus fractures were treated surgically. Three cases (5.6%) developed postoperative wound infection, of which only one needed surgical intervention. The reoperation rate was 5.6% in our study. Half of the patients (50%) were able to be followed up long-term, and the radiographs showed significant restoration of Bohler's angle and posterior facet joint depression in 24 patients. Return to full duties was achieved in an average of 5.6 months for 16 of 22 patients, who were available for follow-up questions with regard to return-to-work status. CONCLUSION: Operative treatment of calcaneus fracture by open reduction and internal fixation in the novel distracted prone position technique has shown a low rate of the wound and soft tissue complications and can be considered as an alternative approach in treating these fractures.

Olecranon Fracture in an Older Adult Treated With Locking Plate Osteosynthesis.

Although olecranon fractures are not uncommon in the geriatric population, there has been a considerable difference of opinion between surgical and nonsurgical treatments. Surgical treatment is usually deferred in the elderly, even for displaced olecranon fractures, because of inherent risks associated with poor bone quality and soft tissues, which often necessitate further surgeries. However, nonoperative treatment frequently results in an inability to regain full extension strength of the elbow, which can be disabling in select older adults with higher functional demands. We present an active older adult with a displaced olecranon fracture, who achieved a satisfactory result after open reduction and internal fixation (ORIF) using a low-profile locking plate.

Impact of universal home visits on child health in Bauchi State, Nigeria: a stepped wedge cluster randomised controlled trial.

BACKGROUND: Nigeria is the second biggest contributor to global child mortality. Infectious diseases continue to be major killers. In Bauchi State, Nigeria, a stepped wedge cluster randomised controlled trial tested the health impacts of universal home visits to pregnant women and their spouses. We present here the findings related to early child health. METHODS: The home visits took place in eight wards in Toro Local Government Authority, randomly allocated into four waves with a delay of 1 year between waves. Female and male home visitors visited all pregnant women and their spouses every 2 months during pregnancy, with a follow up visit 12-18 months after the birth. They presented and discussed evidence about household prevention and management of diarrhoea and immunisation. We compared outcomes among children 12-18 months old born to mothers visited during the first year of intervention in each wave (intervention group) with those among children 12-18 months old pre-intervention in subsequent waves (control group). Primary outcomes included prevalence and management of childhood diarrhoea and immunisation status, with intermediate outcomes of household knowledge and actions. Generalised Estimating Equations (GEE), with an exchangeable correlation matrix and ward as cluster, tested the significance of differences in outcomes. RESULTS: The analysis included 1796 intervention and 5109 control children. In GEE models including other characteristics of the children, intervention children were less likely to have suffered diarrhoea in the last 15 days (Odds Ratio (OR) 0.40, 95% confidence interval (CI) 0.30-0.53) and more likely to have received increased fluids and continued feeding in their last episode of diarrhoea (OR 6.06, 95% CI 2.58-14.20). Mothers of intervention children were more likely to identify lack of hygiene as a cause of diarrhoea (OR 2.24, 95% CI 1.27-3.95) and their households had better observed hygiene (OR 3.29, 95% CI 1.45-7.45). Intervention children were only slightly more likely to be fully immunised (OR 1.67, 95% CI 0.78-3.57). CONCLUSIONS: Evidence-based home visits to both parents stimulated household actions that improved prevention and management of childhood diarrhoea. Such visits could help to improve child health even in settings with poor access to quality health services. TRIAL REGISTRATION: ISRCTN82954580 . Date: 11/08/2017. Retrospectively registered.

An experimental comparison of different hierarchical self-tuning regulatory control procedures for under-actuated mechatronic systems.

This paper presents an experimental comparison of four different hierarchical self-tuning regulatory control procedures in enhancing the robustness of the under-actuated systems against bounded exogenous disturbances. The proposed hierarchical control procedure augments the ubiquitous Linear-Quadratic-Regulator (LQR) with an online reconfiguration block that acts as a superior regulator to dynamically adjust the critical weighting-factors of LQR's quadratic-performance-index (QPI). The Algebraic-Riccati-Equation (ARE) uses these updated weighting-factors to re-compute the optimal control problem, after every sampling interval, to deliver time-varying state-feedback gains. This article experimentally compares four state-of-the-art rule-based online adaptation mechanisms that dynamically restructure the constituent blocks of the ARE. The proposed hierarchical control procedures are synthesized by self-adjusting the (i) controller's degree-of-stability, (ii) the control-weighting-factor of QPI, (iii) the state-weighting-factors of QPI as a function of "state-error-phases", and (iv) the state-weighting-factors of QPI as a function of "state-error-magnitudes". Each adaptation mechanism is formulated via pre-calibrated hyperbolic scaling functions that are driven by state-error-variations. The implications of each mechanism on the controller's behaviour are analyzed in real-time by conducting credible hardware-in-the-loop experiments on the QNET Rotary-Pendulum setup. The rotary pendulum is chosen as the benchmark platform owing to its under-actuated configuration and kinematic instability. The experimental outcomes indicate that the latter self-adaptive controller demonstrates superior adaptability and disturbances-rejection capability throughout the operating regime.

Control Plane Optimisation for an SDN-Based WBAN Framework to Support Healthcare Applications.

Software-Defined Networking (SDN) offers an abstract view of the network and assists network operators to control the network traffic and the associated network resources more effectively. For the past few years, SDN has shown a lot of merits in diverse fields of applications, an important one being the Wireless Body Area Network (WBAN) for healthcare services. With the amalgamation of SDN with WBAN (SDWBAN), the patient monitoring and management system has gained much more flexibility and scalability compared to the conventional WBAN. However, the performance of the SDWBAN framework largely depends on the controller which is a core element of the control plane. The reason is that an optimal number of controllers assures the satisfactory level of performance and control of the network traffic originating from the underlying data plane devices. This paper proposes a mathematical model to determine the optimal number of controllers for the SDWBAN framework in healthcare applications. To achieve this goal, the proposed mathematical model adopts the convex optimization method and incorporates three critical SDWBAN factors in the design process: number of controllers, latency and number of SDN-enabled switches (SDESW). The proposed analytical model is validated by means of simulations in Castalia 3.2 and the outcomes indicate that the network achieves high level of Packet Delivery Ratio (PDR) and low latency for optimal number of controllers as derived in the mathematical model.

The psychological impact of COVID-19 pandemic on health care workers in a MERS-CoV endemic country.

BACKGROUND: The global pandemic of coronavirus disease of 2019 (COVID-19) has led to unprecedented psychological stress on health workers (HCWs). We aimed to assess the psychological impact of COVID-19 on HCWs in comparison to the stress brought on by the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic in Saudi Arabia. METHOD: Between February 5th and 16th, 2020, 811 health-care workers (HCWs) of a tertiary care teaching hospital were invited to fill a questionnaire regarding concerns and worries about the novel coronavirus pandemic, along with Generalized Anxiety Disorder (GAD-7) Anxiety Severity screening tool. RESULTS: Out of 582 HCWs who completed the survey questionnaire (response rate of 71.8%), about 40% were exposed previously to MERS-CoV infected or suspected patients during a previous hospital outbreak. While there were no COVID-19 cases reported yet in Saudi Arabia at the time of data collection, still, the anxiety level from COVID-19 was significantly higher than that from MERS-CoV or seasonal influenza: 41.1% were more worried about COVID-19, 41.4% were similarly worried about both MERS-CoV and COVID-19, and 17.5% were more stressed by the previous MERS-CoV hospital outbreak. The most frequent concern was transmitting the infection to family and friends (2.71/5) than to themselves only (2.57/5). CONCLUSION: Pandemic and epidemic infectious diseases such as COVID-19 or MERS-CoV impose a significant level of anxiety and stress on healthcare workers who are caring of infected patients, with their main concern being the risk of transmitting the infection to their families or to acquire it themselves. Therefore, optimizing the compliance of healthcare workers with the proper infection prevention and control measures is paramount during the infectious disease outbreak, to ensure their safety, to decrease the likelihood of getting infected or transmitting the infection to others, and consequently to alleviate their psychological stress and anxiety.

Benign Bone Tumors When They Coexist with Common Orthopaedic Conditions.

Benign and malignant bone tumors around the knee can be encountered with concomitant orthopaedic disease. As such, it is important to recognize these oncologic processes that may impact or alter the routine treatment of more common orthopaedic processes. Frequently, these rare oncologic conditions are discovered only through the evaluation of acute injuries as in the setting of fractures or sports injuries. Other times, they are encountered when evaluating chronic entities, such as arthroplasty. This article aims to provide general guidelines and management strategies for benign bone tumors when they coincide with common orthopaedic conditions around the knee.

Epidemiology of acetabular fractures in Qatar.

OBJECTIVES: This study aimed to review the epidemiological aspects of acetabular fractures treated at Hamad Medical Corporation in Qatar. The study is the first orthopaedic trauma epidemiological study in Qatar and will provide a platform to advance high-level clinical research. METHODS: We obtained data for 103 patients who presented to our level I trauma centre from 2008 to 2010 with a diagnosis of acetabular fracture. Age, sex, the cause of injury, fracture classification, mode of treatment, associated nerve injuries, and other complications were analyzed. RESULTS: The incidence of acetabular fracture was 2/100,000/year. Males (93.2%) predominated. The mean age at injury time was 36 years, and the most common cause of injury was motor vehicle collisions (49.5%). Injuries were mostly primary acetabular fractures (73.6%) in comparison to (26.4%) for associated fractures. Posterior wall fractures were the most common pattern (25.2%). Associated posterior hip dislocation occurred in 21.3% of cases. Data revealed a lower incidence of post-traumatic sciatic nerve palsy (7%) that was present at the time of injury. There were no cases of reported mortality. CONCLUSION: Acetabular fractures are uncommon injuries with motor vehicle collision being the most common cause of injury. Posterior wall fracture was the most frequent pattern, and most of the patients were males. The incidence of post-traumatic sciatic nerve palsy and the proportion of injured women were lower than those reported in literature. Well-trained surgeons and specialized centres for treating these injuries are recommended.