World Academy of Science, Engineering and Technology

Authors: Kai-Jui Kou, Tzu-Ling Shen, Ying-Fang Wang

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The objectives of the present study are to characterize nanoparticles generated from the different working type in 3D printing room and the stack flue during 3D printing process. The studied laboratory (10.5 m× 7.2 m × 3.2 m) with a ventilation rate of 500 m³/H is installed a 3D metal printing machine. Direct-reading instrument of a scanning mobility particle sizer (SMPS, Model 3082, TSI Inc., St. Paul, MN, USA) was used to conduct static sampling for nanoparticle number concentration and particle size distribution measurements. The SMPS obtained particle number concentration at every 3 minutes, the diameter of the SMPS ranged from 11~372 nm when the aerosol and sheath flow rates were set at 0.6 and 6 L/min, respectively. The concentrations of background, printing process, clearing operation, and screening operation were performed in the laboratory. On the other hand, we also conducted nanoparticle measurement on the 3D printing machine's stack flue to understand its emission characteristics. Results show that the nanoparticles emitted from the different operation process were the same distribution in the form of the uni-modal with number median diameter (NMD) as approximately 28.3 nm to 29.6 nm. The number concentrations of nanoparticles were 2.55×10³ count/cm³ in laboratory background, 2.19×10³ count/cm³ during printing process, 2.29×10³ count/cm³ during clearing process, 3.05×10³ count/cm³ during screening process, 2.69×10³ count/cm³ in laboratory background after printing process, and 6.75×10³ outside laboratory, respectively. We found that there are no emission nanoparticles during the printing process. However, the number concentration of stack flue nanoparticles in the ongoing print is 1.13×10⁶ count/cm³, and that of the non-printing is 1.63×10⁴ count/cm³, with a NMD of 458 nm and 29.4 nm, respectively. It can be confirmed that the measured particle size belongs to easily penetrate the filter in theory during the printing process, even though the 3D printer has a high-efficiency filtration device. Therefore, it is recommended that the stack flue of the 3D printer would be equipped with an appropriate dust collection device to prevent the operators from exposing these hazardous particles.

Keywords: nanoparticle, particle emission, 3D printing, number concentration

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Authors: Shu-Yu Chung, Ying-Fang Wang, Shih-Min Wang

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To conduct long-term exposure assessments are important for workers exposed to chemicals with chronic effects. However, it usually encounters with several constrains, including cost, workers' willingness, and interference to work practice, etc., leading to inadequate long-term exposure data in the real world. In this study, an integrated approach was developed for conducting long-term exposure assessment for welding workers in a shipbuilding factory. A laboratory study was conducted to yield the fume generation rates under various operating conditions. The results and the measured environmental conditions were applied to the near field/far field (NF/FF) model for predicting long term fume exposures via the Monte Carlo simulation. Then, the predicted long-term concentrations were used to determine the prior distribution in Bayesian decision analysis (BDA). Finally, the resultant posterior distributions were used to assess the long-term exposure and serve as basis for initiating control strategies for shipbuilding workers. Results show that the NF/FF model was a suitable for predicting the exposures of metal contents containing in welding fume. The resultant posterior distributions could effectively assess the long-term exposures of shipbuilding welders. Welders' long-term Fe, Mn and Pb exposures were found with high possibilities to exceed the action level indicating preventive measures should be taken for reducing welders' exposures immediately. Though the resultant posterior distribution can only be regarded as the best solution based on the currently available predicting and monitoring data, the proposed integrated approach can be regarded as a possible solution for conducting long term exposure assessment in the field.

Keywords: Bayesian decision analysis, exposure assessment, near field and far field model, shipbuilding industry, welding fume

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Authors: Shan-Hong Ying, Ying-Fang Wang

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A surrogate approach was deployed for assessing exposures of multiple chemicals at the selected working area of coating processes and applied to assess the exposure concentration of similar exposed groups using the same chemicals but different formula ratios. For the selected area, 6 to 12 portable photoionization detector (PID) were placed uniformly in its workplace to measure its total VOCs concentrations (CT-VOCs) for 6 randomly selected workshifts. Simultaneously, one sampling strain was placed beside one of these portable PIDs, and the collected air sample was analyzed for individual concentration (CVOCi) of 5 VOCs (xylene, butanone, toluene, butyl acetate, and dimethylformamide). Predictive models were established by relating the CT-VOCs to CVOCi of each individual compound via simple regression analysis. The established predictive models were employed to predict each CVOCi based on the measured CT-VOC for each the similar working area using the same portable PID. Results show that predictive models obtained from simple linear regression analyses were found with an R2 = 0.83~0.99 indicating that CT-VOCs were adequate for predicting CVOCi. In order to verify the validity of the exposure prediction model, the sampling analysis of the above chemical substances was further carried out and the correlation between the measured value (Cm) and the predicted value (Cp) was analyzed. It was found that there is a good correction between the predicted value and measured value of each measured chemical substance (R2=0.83~0.98). Therefore, the surrogate approach could be assessed the exposure concentration of similar exposed groups using the same chemicals but different formula ratios. However, it is recommended to establish the prediction model between the chemical substances belonging to each coater and the direct-reading PID, which is more representative of reality exposure situation and more accurately to estimate the long-term exposure concentration of operators.

Keywords: exposure assessment, exposure prediction model, surrogate approach, TVOC

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Authors: P. S. Hsi, Y. F. Wang, Y. F. Ho, P. C. Hung

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The aim of the present study was to explore the dermal exposure assessment model of chemicals that have been developed abroad and to evaluate the feasibility of chemical dermal exposure assessment model for manufacturing industry in Taiwan. We conducted and analyzed six semi-quantitative risk management tools, including UK - Control of substances hazardous to health ( COSHH ) Europe – Risk assessment of occupational dermal exposure ( RISKOFDERM ), Netherlands - Dose related effect assessment model ( DREAM ), Netherlands – Stoffenmanager ( STOFFEN ), Nicaragua-Dermal exposure ranking method ( DERM ) and USA / Canada - Public Health Engineering Department ( PHED ). Five types of manufacturing industry were selected to evaluate. The Monte Carlo simulation was used to analyze the sensitivity of each factor, and the correlation between the assessment results of each semi-quantitative model and the exposure factors used in the model was analyzed to understand the important evaluation indicators of the dermal exposure assessment model. To assess the effectiveness of the semi-quantitative assessment models, this study also conduct quantitative dermal exposure results using prediction model and verify the correlation via Pearson's test. Results show that COSHH was unable to determine the strength of its decision factor because the results evaluated at all industries belong to the same risk level. In the DERM model, it can be found that the transmission process, the exposed area, and the clothing protection factor are all positively correlated. In the STOFFEN model, the fugitive, operation, near-field concentrations, the far-field concentration, and the operating time and frequency have a positive correlation. There is a positive correlation between skin exposure, work relative time, and working environment in the DREAM model. In the RISKOFDERM model, the actual exposure situation and exposure time have a positive correlation. We also found high correlation with the DERM and RISKOFDERM models, with coefficient coefficients of 0.92 and 0.93 (p<0.05), respectively. The STOFFEN and DREAM models have poor correlation, the coefficients are 0.24 and 0.29 (p>0.05), respectively. According to the results, both the DERM and RISKOFDERM models are suitable for performance in these selected manufacturing industries. However, considering the small sample size evaluated in this study, more categories of industries should be evaluated to reduce its uncertainty and enhance its applicability in the future.

Keywords: dermal exposure, risk management, quantitative estimation, feasibility evaluation

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Authors: Lena Lapidot, Amir Amnon, Rita Nosenko, Veitsman Ella, Cohen-Ezra Oranit, Davidov Yana, Segev Shlomo, Koren Omry, Safran Michal, Ben-Ari Ziv

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Introduction: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related mortality worldwide. Liver Cirrhosis is the main predisposing risk factor for the development of HCC. The factor(s) influencing disease progression from Cirrhosis to HCC remain unknown. Gut microbiota has recently emerged as a major player in different liver diseases, however its association with HCC is still a mystery. Moreover, there might be an important association between the gut microbiota, nutrition, life style and the progression of Cirrhosis and HCC. The aim of our study was to characterize the gut microbial signature in association with life style and nutrition of patients with Cirrhosis, HCC-Cirrhosis and healthy controls. Design: Stool samples were collected from 95 individuals (30 patients with HCC, 38 patients with Cirrhosis and 27 age, gender and BMI-matched healthy volunteers). All participants answered lifestyle and Food Frequency Questionnaires. 16S rRNA sequencing of fecal DNA was performed (MiSeq Illumina). Results: There was a significant decrease in alpha diversity in patients with Cirrhosis (qvalue=0.033) and in patients with HCC-Cirrhosis (qvalue=0.032) compared to healthy controls. The microbiota of patients with HCC-cirrhosis compared to patients with Cirrhosis, was characterized by a significant overrepresentation of Clostridium (pvalue=0.024) and CF231 (pvalue=0.010) and lower expression of Alphaproteobacteria (pvalue=0.039) and Verrucomicrobia (pvalue=0.036) in several taxonomic levels: Verrucomicrobiae, Verrucomicrobiales, Verrucomicrobiaceae and the genus Akkermansia (pvalue=0.039). Furthermore, we performed an analysis of predicted metabolic pathways (Kegg level 2) that resulted in a significant decrease in the diversity of metabolic pathways in patients with HCC-Cirrhosis (qvalue=0.015) compared to controls, one of which was amino acid metabolism. Furthermore, investigating the life style and nutrition habits of patients with HCC-Cirrhosis, we found significant correlations between intake of artificial sweeteners and Verrucomicrobia (qvalue=0.12), High sugar intake and Synergistetes (qvalue=0.021) and High BMI and the pathogen Campylobacter (qvalue=0.066). Furthermore, overweight in patients with HCC-Cirrhosis modified bacterial diversity (qvalue=0.023) and composition (qvalue=0.033). Conclusions: To the best of the our knowledge, we present the first report of the gut microbial composition in patients with HCC-Cirrhosis, compared with Cirrhotic patients and healthy controls. We have demonstrated in our study that there are significant differences in the gut microbiome of patients with HCC-cirrhosis compared to Cirrhotic patients and healthy controls. Our findings are even more pronounced because the significantly increased bacteria Clostridium and CF231 in HCC-Cirrhosis weren't influenced by diet and lifestyle, implying this change is due to the development of HCC. Further studies are needed to confirm these findings and assess causality.

Keywords: Cirrhosis, Hepatocellular carcinoma, life style, liver disease, microbiome, nutrition

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Authors: Majid Forghani, Michael Khachay

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In genetics, the impact of neighboring amino acids on a target site is referred as the nearest-neighbor effect or simply neighbor effect. In this paper, a new method called wavelet particle decomposition representing the one-dimensional neighbor effect using wavelet packet decomposition is proposed. The main idea lies in known dependence of wavelet packet sub-bands on location and order of neighboring samples. The method decomposes the value of a signal sample into small values called particles that represent a part of the neighbor effect information. The results have shown that the information obtained from the particle decomposition can be used to create better model variables or features. As an example, the approach has been applied to improve the correlation of test and reference sequence distance with titer in the hemagglutination inhibition assay.

Keywords: antigenic variants, neighbor effect, wavelet packet, wavelet particle decomposition

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Authors: Ramesh Kumar Behera, Md. Izhar Hassan

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Accident investigation and analysis are useful to identify deficiencies in plant, process, and management practices and formulate preventive strategies for injury elimination. In India and other parts of the world, industrial accidents are investigated to know the causes and also to fulfill legal compliances. However, findings of investigation are seldom used appropriately to strengthen Occupational Safety and Health (OSH) in expected lines. The mineral rich state of Odisha in eastern coast of India; known as a hub for Iron and Steel industries, witnessed frequent accidents during 2005-2009. This article based on study of 982 fatal ‘factory-accidents’ occurred in Odisha during the period 2001-2016, discusses the ‘turnaround-story’ resulting in reduction of fatal accident from 122 in 2009 to 45 in 2016. This paper examines various factors causing incidents; accident pattern in steel and chemical sector; role of climate and harsh weather conditions on accident causation. Software such as R, SQL, MS-Excel and Tableau were used for analysis of data. It is found that maximum fatality is caused due to ‘fall from height’ (24%); steel industries are relatively more accident prone; harsh weather conditions of summer increase chances of accident by 20%. Further, the study suggests that enforcement of partial work-restriction around lunch time during peak summer, screening and training of employees reduce accidents due to fall from height. The study indicates that learning from accident investigation and analysis can be used as a method to reduce work related accidents in the journey towards ‘Vision Zero’.

Keywords: accident investigation and analysis, fatal accidents in India, fall from height, vision zero

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Authors: Vanessa G. P. Severino, Eliangela Cristina Candida Costa, Nubia Alves Mariano Teixeira Pires Gomides, Lucilia Kato, Afif Felix Monteiro, Maria Anita Lemos Vasconcelos Ambrosio, Carlos Henrique Gomes Martins

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One of the biomes present in Brazil is known as Cerrado, which is a vast tropical savanna ecoregion, particularly in the states of Goiás, Mato Grosso do Sul, Mato Grosso, Tocantins and Minas Gerais. Many species of plants are characterized as endemic and they have therapeutic value for a large part of the population, especially to the rural communities. Given that, the southeastern region of the state of Goiás contains about 21 rural communities, which present a form of organization based on the use of natural resources available. One of these rural communities is named of Coqueiros, where the knowledge about the medicinal plants was very important to this research. Thus, this study focuses on the ethnobotanical survey of this community on the use of Kielmeyera coriacea to treat diseases. From the 37 members interviewed, 76% indicated this species for the treatment of intestinal infection, leukemia, anemia, gastritis, gum pain, toothache, cavity, arthritis, arthrosis, healing, vermifuge, rheumatism, antibiotic, skin problems, mycoses and all kinds of infections. The medicinal properties attributed during the interviews were framed in the body system (disease categories), adapted from ICD 10; thus, 20 indications of use were obtained, among five body systems. Therefore, the root of this species was select to chemical and biological (antioxidant and antimicrobial) studies. From the liquid-liquid extraction of ethanolic extract of root (EER), the hexane (FH), ethyl acetate (FAE), and hydro alcoholic (FHA) fractions were obtained. The chemical profile study of these fractions was performed by LC-MS, identifying major compounds such as δ-tocotrienol, prenylated acylphoroglucinol, 2-hydroxy-1-methoxyxanthone and quercitrin. EER, FH, FAE and FHA were submitted to biological tests. FHA presented the best antioxidant action (EC50 201.53 μg mL-1). EER inhibited the bacterial growth of Streptococcus pyogenes and Pseudomonas aeruginosa, microorganisms associated with rheumatism, at Minimum Inhibitory Concentration (MIC) of 6.25 μg mL-1. In addition, the FH-10 subfraction, obtained from FH fractionation, presented MIC of 1.56 μg mL-1 against S. pneumoniae; EER also inhibited the fungus Candida glabrata (MIC 7.81 μg mL- 1). The FAE-4.7.3 fraction, from the fractionation of FAE, presented MIC of 200 μg mL-1 against Lactobacillus casei, which is one of the causes of caries and oral infections. By the correlation of the chemical and biological data, it is possible to note that the FAE-4.7.3 and FH-10 are constituted 4-hydroxy-2,3-methylenedioxy xanthone, 3-hydroxy-1,2-dimethoxy xanthone, lupeol, prenylated acylphoroglucinol and quercitrin, which could be associated with the biological potential found. Therefore, this study provides an important basis for further investigations regarding the compounds present in the active fractions of K. coriacea, which will permit the establishment of a correlation between ethnobotanical survey and bioactivity.

Keywords: biological activity, ethnobotanical survey, Kielmeyera coriacea Mart., LC-MS profile

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Authors: Chi Wu, Dean Wu, Wen-Te Liu, Cheng-Yu Tsai, Shin-Mei Hsu, Yin-Tzu Lin, Ru-Yin Yang

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Background: The results of previous studies compared the benefits and risks of receiving insomnia medication. However, the effects between hypnotic drugs used and enhancement of sleep quality were still unclear. Objective: The aim of this study is to establish a prediction model for hypnotic drugs' dosage used for insomnia subjects and associated the relationship between sleep stage ratio change and drug types. Methodologies: According to American Academy of Sleep Medicine (AASM) guideline, sleep stages were classified and transformed to hypnogram via the polysomnography (PSG) in a hospital in New Taipei City (Taiwan). The subjects with diagnosis for insomnia without receiving hypnotic drugs treatment were be set as the comparison group. Conversely, hypnotic drugs dosage within the past three months was obtained from the clinical registration for each subject. Furthermore, the collecting subjects were divided into two groups for training and testing. After training convolution neuron network (CNN) to predict types of hypnotics used and dosages are taken, the test group was used to evaluate the accuracy of classification. Results: We recruited 76 subjects in this study, who had been done PSG for transforming hypnogram from their sleep stages. The accuracy of dosages obtained from confusion matrix on the test group by CNN is 81.94%, and accuracy of hypnotic drug types used is 74.22%. Moreover, the subjects with high ratio of wake stage were correctly classified as requiring medical treatment. Conclusion: CNN with hypnogram was potentially used for adjusting the dosage of hypnotic drugs and providing subjects to pre-screening the types of hypnotic drugs taken.

Keywords: convolution neuron network, hypnotic drugs, insomnia, polysomnography

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Authors: Preet Shah, Om Shrivastav

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Introduction : In India, Leishmania donovani is the only parasite causing Leishmaniasis. The parasite infects the reticuloendothelial system and is found in the bone marrow, spleen and liver. Treatment of choice is amphotericin-B with sodium stibogluconate being an alternative. Miltefosine is useful in refractory cases. In our case, Leishmaniasis occurred in a person residing in western India (which is quite rare) and it failed to respond to two different drugs (again an uncommon feature) before it finally responded to a third one. Description: A 50 year old lady, a resident of western India, with no history of recent travel, presented with an ulcer on the left side of the nose since 8 months. She was apparently alright 8 months back, when she noticed a small ulcerated lesion on the left ala of the nose which was immediately biopsied. The biopsy revealed amastigotes of Leishmania for which she was administered intra-lesional sodium stibogluconate for 1 month (4 doses every 8 days).Despite this, there was no regression of the ulcer and hence she presented to us for further management. On examination, her vital parameters were normal. Barring an ulcer on the left side of the nose, rest of the examination findings were unremarkable. Complete blood count was normal. Ultrasound abdomen showed hepatomegaly. PET-CT scan showed increased metabolic activity in left ala of nose, hepatosplenomegaly and increased metabolic activity in spleen and bone marrow. Bone marrow biopsy was done which showed hypercellular marrow with erythroid preponderance. Considering a diagnosis of leishmaniasis which had so far been unresponsive to sodium stibogluconate, she was started on liposomal amphotericin-B. At the time of admission, her creatinine level was normal, but it started rising with the administration of liposomal amphotericin-B, hence the dose was reduced. Despite this, creatinine levels did not improve, and she started developing hypokalemia and hypomagnesemia as side effects of the drug, hence further reductions in the dosage were made. Despite a total of 3 weeks of liposomal amphotericin-B, there was no improvement in the ulcer. As had so far failed to respond to sodium stibogluconate and liposomal amphotericin-B, it was decided to start her on miltefosine. She received the miltefosine for a total of 12 weeks. At the end of this duration, there was a marked regression of the cutaneous lesion. Conclusion: Refractoriness to amphotericin-B in leishmaniasis may be seen in up to 5 % cases. Here, an alternative drug such as miltefosine is useful and hence we decided to use it, to which she responded adequately. Furthermore, although leishmaniasis is common in the eastern part of India, it is a relatively unknown entity in the western part of the country with the occurrence being very rare. Because of these 2 reasons, we consider our case to be a unique one.

Keywords: amphotericin-b, leishmaniasis, miltefosine, tropical diseases

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Authors: Cheng-Yu Tsai, Wen-Te Liu, Shin-Mei Hsu, Yin-Tzu Lin, Chi Wu

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Background: Obstructive Sleep apnea syndrome (OSAS) is a common respiratory disorder during sleep. In addition, Body parameters were identified high predictive importance for OSAS severity. However, the effects of body parameters on OSAS severity remain unclear. Objective: In this study, the objective is to establish a prediction model for OSAS by using body parameters and investigate the effects of body parameters in OSAS. Methodologies: Severity was quantified as the polysomnography and the mean hourly number of greater than 3% dips in oxygen saturation during examination in a hospital in New Taipei City (Taiwan). Four levels of OSAS severity were classified by the apnea and hypopnea index (AHI) with American Academy of Sleep Medicine (AASM) guideline. Body parameters, including neck circumference, waist size, and body mass index (BMI) were obtained from questionnaire. Next, dividing the collecting subjects into two groups: training and testing groups. The training group was used to establish the random forest (RF) to predicting, and test group was used to evaluated the accuracy of classification. Results: There were 3330 subjects recruited in this study, whom had been done polysomnography for evaluating severity for OSAS. A RF of 1000 trees achieved correctly classified 79.94 % of test cases. When further evaluated on the test cohort, RF showed the waist and BMI as the high import factors in OSAS. Conclusion It is possible to provide patient with prescreening by body parameters which can pre-evaluate the health risks.

Keywords: apnea and hypopnea index, Body parameters, obstructive sleep apnea syndrome, Random Forest

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Authors: Tzu-Hao Li, Yen-Ying Kung, Chang-Youh Tsai

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Oral dryness is a common chief complaint among patients with Sjőgren syndrome (SS), which is a disorder currently known as autoantibodies production; however, to author’s best knowledge, there has been no satisfying pharmacy to relieve the associated symptoms. Hence the effectiveness of other non-pharmacological interventions such as acupuncture should be accessed. We conducted a meta-analysis of randomized clinical trials (RCTs) which evaluated the effectiveness of xerostomia in SS. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Chongqing Weipu Database (CQVIP), China Academic Journals Full-text Database, AiritiLibrary, Chinese Electronic Periodicals Service (CEPS), China National Knowledge Infrastructure (CNKI) Database were searches through May 12, 2018 to select studies. Data for evaluation of subjective and objective xerostomia was extracted and was assessed with random-effects meta-analysis. After searching, a total of 541 references were yielded and five RCTs were included, covering 340 patients dry mouth resulted from SS, among whom 169 patients received acupuncture and 171 patients were control group. Acupuncture group was associated with higher subjective response rate (odds ratio 3.036, 95% confidence interval [CI] 1.828 – 5.042, P < 0.001) and increased salivary flow rate (weighted mean difference [WMD] 3.066, 95% CI 2.969 – 3.164, P < 0.001), as an objective marker. In addition, two studies examined IgG levels, which were lower in the acupuncture group (WMD -166.857, 95% CI -233.138 - -100.576, P < 0.001). Therefore, in the present meta-analysis, acupuncture improves both subjective and objective markers of dry mouth with autoantibodies reduction in patients with SS and is considered as an option of non-pharmacological treatment for SS.

Keywords: acupuncture, meta-analysis, Sjogren syndrome, xerostomia

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Authors: Prashant Verma, K. K. Singh, Anjali Singh, Ujjaval Srivastava

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Contraceptive policies have been derived to achieve desired reductions in the growth rate and also, applied to the data of Uttar-Pradesh, India for illustration. Using the Lotka’s integral equation for the stable population, expressions for the proportion of contraceptive users at different ages have been obtained. At the age of 20 years, 42% of contraceptive users is imperative to reduce the present annual growth rate of 0.036 to 0.02, assuming that 40% of the contraceptive users discontinue at the age of 25 years and 30% again continue contraceptive use at age 30 years. Further, presuming that 75% of women start using contraceptives at the age of 23 years, and 50% of the remaining women start using contraceptives at the age of 28 years, while the rest of them start using it at the age of 32 years. If we set a minimum age of marriage as 20 years, a reduction of 0.019 in growth rate will be obtained. This study describes how the level of contraceptive use at different age groups of women reduces the growth rate in the state of Uttar Pradesh. The article also promotes delayed marriage in the region.

Keywords: child bearing, contraceptive devices, contraceptive policies, population growth, stable population

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Authors: Prashant Verma, Prafulla K. Swain, K. K. Singh, Mukti Khetan

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Objective: In India, around 20,000 women die every year due to abortion-related complications. In the modelling of count variables, there is sometimes a preponderance of zero counts. This article concerns the estimation of various count regression models to predict the average number of spontaneous abortion among women in the Punjab state of India. It also assesses the factors associated with the number of spontaneous abortions. Materials and methods: The study included 27,173 married women of Punjab obtained from the DLHS-4 survey (2012-13). Poisson regression (PR), Negative binomial (NB) regression, zero hurdle negative binomial (ZHNB), and zero-inflated negative binomial (ZINB) models were employed to predict the average number of spontaneous abortions and to identify the determinants affecting the number of spontaneous abortions. Results: Statistical comparisons among four estimation methods revealed that the ZINB model provides the best prediction for the number of spontaneous abortions. Antenatal care (ANC) place, place of residence, total children born to a woman, woman's education and economic status were found to be the most significant factors affecting the occurrence of spontaneous abortion. Conclusions: The study offers a practical demonstration of techniques designed to handle count variables. Statistical comparisons among four estimation models revealed that the ZINB model provided the best prediction for the number of spontaneous abortions and is recommended to be used to predict the number of spontaneous abortions. The study suggests that women receive institutional Antenatal care to attain limited parity. It also advocates promoting higher education among women in Punjab, India.

Keywords: count data, spontaneous abortion, Poisson model, negative binomial model, zero hurdle negative binomial, zero-inflated negative binomial, regression

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Authors: Risikat Oladoyin S. Dauda, Onyebuchi Iwegbu

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This study investigates the response of human development outcomes to selected macroeconomic indicators in Nigeria. Human development outcomes is measured by human development index while the selected macroeconomic variables are inflation rate, real interest rate, government capital expenditure, real exchange rate, current account balance, and savings. Structural Vector Autoregression (SVAR) technique is employed in examining the response of human development index to the macroeconomic shocks. The result from the forecast error variance decomposition and Impulse-Response analysis reveals that fiscal policy (government capital expenditure) shock is the greatest determinant of human development outcomes. This result reiterates the role which the government plays in improving the welfare of the citizenry. The fiscal policy tool is pivotal in human development which comes in the form of investment in education, health, housing, and infrastructure. Further conclusion drawn from this study is that human development outcome positively and significantly responds to shocks from real interest rate, a monetary policy transmission variable and is felt greatly in the short run period. The policy implication of this study is that if capital budget implementation falls below expectations, human development will be engendered. Hence, efforts should be made to ensure that full implementation and appraisal of government capital expenditure is taken sacrosanct as any shock from such plan, engenders human development outcome.

Keywords: human development outcome, macroeconomic outcomes, structural vector autoregression, SVAR

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Authors: Loai AbdAllah, Mahmoud Kaiyal

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Missing values in real-world datasets are a common problem. Many algorithms were developed to deal with this problem, most of them replace the missing values with a fixed value that was computed based on the observed values. In our work, we used a distance function based on Bhattacharyya distance to measure the distance between objects with missing values. Bhattacharyya distance, which measures the similarity of two probability distributions. The proposed distance distinguishes between known and unknown values. Where the distance between two known values is the Mahalanobis distance. When, on the other hand, one of them is missing the distance is computed based on the distribution of the known values, for the coordinate that contains the missing value. This method was integrated with Wikaya, a digital health company developing a platform that helps to improve prevention of chronic diseases such as diabetes and cancer. In order for Wikaya’s recommendation system to work distance between users need to be measured. Since there are missing values in the collected data, there is a need to develop a distance function distances between incomplete users profiles. To evaluate the accuracy of the proposed distance function in reflecting the actual similarity between different objects, when some of them contain missing values, we integrated it within the framework of k nearest neighbors (kNN) classifier, since its computation is based only on the similarity between objects. To validate this, we ran the algorithm over diabetes and breast cancer datasets, standard benchmark datasets from the UCI repository. Our experiments show that kNN classifier using our proposed distance function outperforms the kNN using other existing methods.

Keywords: missing values, incomplete data, distance, incomplete diabetes data

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Authors: Aritra Das, Tanmay Mahapatra, Prabir Maharana, Sridhar Srikantiah

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In the absence of adequate well-equipped neonatal-care facilities serving rural Bihar, India, the practice of essential home-based newborn-care remains critically important for reduction of neonatal and infant mortality, especially among pre-term and small-for-gestational-age (Low-birth-weight) newborns. To improve the child health parameters in Bihar, ‘Very-Low-Birth-Weight (vLBW) Tracking’ intervention is being conducted by CARE India, since 2015, targeting public facility-delivered newborns weighing ≤2000g at birth, to improve their identification and provision of immediate post-natal care. To assess the effectiveness of the intervention, 200 public health facilities were randomly selected from all functional public-sector delivery points in Bihar and various outcomes were tracked among the neonates born there. Thus far, one pre-intervention (Feb-Apr’2015-born neonates) and three post-intervention (for Sep-Oct’2015, Sep-Oct’2016 and Sep-Oct’2017-born children) follow-up studies were conducted. In each round, interviews were conducted with the mothers/caregivers of successfully-tracked children to understand outcome, service-coverage and care-seeking during the neonatal period. Data from 171 matched facilities common across all rounds were analyzed using SAS-9.4. Identification of neonates with birth-weight ≤ 2000g improved from 2% at baseline to 3.3%-4% during post-intervention. All indicators pertaining to post-natal home-visits by frontline-workers (FLWs) improved. Significant improvements between baseline and post-intervention rounds were also noted regarding mothers being informed about ‘weak’ child – at the facility (R1 = 25 to R4 = 50%) and at home by FLW (R1 = 19%, to R4 = 30%). Practice of ‘Kangaroo-Mother-Care (KMC)’– an important component of essential newborn care – showed significant improvement in postintervention period compared to baseline in both facility (R1 = 15% to R4 = 31%) and home (R1 = 10% to R4=29%). Increasing trend was noted regarding detection and birth weight-recording of the extremely low-birth-weight newborns (< 1500 g) showed an increasing trend. Moreover, there was a downward trend in mortality across rounds, in each birth-weight strata (< 1500g, 1500-1799g and >= 1800g). After adjustment for the differential distribution of birth-weights, mortality was found to decline significantly from R1 (22.11%) to R4 (11.87%). Significantly declining trend was also observed for both early and late neonatal mortality and morbidities. Multiple regression analysis identified - birth during immediate post-intervention phase as well as that during the maintenance phase, birth weight > 1500g, children of low-parity mothers, receiving visit from FLW in the first week and/or receiving advice on extra care from FLW as predictors of survival during neonatal period among vLBW newborns. vLBW tracking was found to be a successful and sustainable intervention and has already been handed over to the Government.

Keywords: weak newborn tracking, very low birth weight babies, newborn care, community response

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Authors: Aboli Gore, Aritra Das, Sunil Sonthalia, Tanmay Mahapatra, Sridhar Srikantiah, Hemant Shah

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AMANAT is an initiative, taken in collaboration with the Government of Bihar, aimed at improving the Quality of Maternal and Neonatal care services at Bihar’s public health facilities – those offering either the Basic Emergency Obstetric and Neonatal care (BEmONC) or Comprehensive Emergency Obstetric and Neonatal care (CEmONC) services. The effectiveness of this program is evaluated by conducting cross-sectional assessments at the concerned facilities prior to (baseline) and following completion (endline) of intervention. Direct Observation of Delivery (DOD) methodology is employed for carrying out the baseline and endline assessments – through which key obstetric and neonatal care practices among the Health Care Providers (especially the nurses) are assessed quantitatively by specially trained nursing professionals. Assessment of vitals prior to delivery improved during all three phases of BEmONC and all four phases of CEmONC training with statistically significant improvement noted in: i) pulse measurement in BEmONC phase 2 (9% to 68%), 3 (4% to 57%) & 4 (14% to 59%) and CEmONC phase 2 (7% to 72%) and 3 (0% to 64%); ii) blood pressure measurement in BEmONC phase 2 (27% to 84%), 3 (21% to 76%) & 4 (36% to 71%) and CEmONC phase 2 (23% to 76%) and 3 (2% to 70%); iii) fetal heart rate measurement in BEmONC phase 2 (10% to 72%), 3 (11% to 77%) & 4 (13% to 64%) and CEmONC phase 1 (24% to 38%), 2 (14% to 82%) and 3 (1% to 73%); and iv) abdominal examination in BEmONC phase 2 (14% to 59%), 3 (3% to 59%) & 4 (6% to 56%) and CEmONC phase 1 (0% to 24%), 2 (7% to 62%) & 3 (0% to 62%). Regarding infection control, wearing of apron, mask and cap by the delivery conductors improved significantly in all BEmONC phases. Similarly, the practice of handwashing improved in all BEmONC and CEmONC phases. Even on disaggregation, the handwashing showed significant improvement in all phases but CEmONC phase-4. Not only the positive practices related to handwashing improved but also negative practices such as turning off the tap with bare hands declined significantly in the aforementioned phases. Significant decline was also noted in negative maternal care practices such as application of fundal pressure for hastening the delivery process and administration of oxytocin prior to delivery. One of the notable achievement of AMANAT is an improvement in active management of the third stage of labor (AMTSL). The overall AMTSL (including administration of oxytocin or other uterotonics uterotonic in proper dose, route and time along with controlled cord traction and uterine massage) improved in all phases of BEmONC and CEmONC mentoring. Another key area of improvement, across phases, was in proper cutting/clamping of the umbilical cord. AMANAT mentoring also led to improvement in important immediate newborn care practices such as initiation of skin-to-skin care and timely initiation of breastfeeding. The next phase of the mentoring program seeks to institutionalize mentoring across the state that could potentially perpetuate improvement with minimal external intervention.

Keywords: capacity building, nurse-mentoring, quality of care, pregnancy, newborn care

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Authors: Mireille Canal-Raffin, Nadege Lepage, Antoine Villa

Abstract:

Context: Most antineoplastic drugs (AD) have a potential carcinogenic, mutagenic and/or reprotoxic effect and are classified as 'hazardous to handle' by National Institute for Occupational Safety and Health Their handling increases with the increase of cancer incidence. AD contamination from workers who handle AD and/or care for treated patients is, therefore, a major concern for occupational physicians. As part of the process of evaluation and prevention of chemical risks for professionals exposed to AD, Biological Monitoring of Occupational Exposure (BMOE) is the tool of choice. BMOE allows identification of at-risk groups, monitoring of exposures, assessment of poorly controlled exposures and the effectiveness and/or wearing of protective equipment, and documenting occupational exposure incidents to AD. This work aims to make proposals for the practical implementation of the BMOE for AD. The proposed strategy is based on the French good practice recommendations for BMOE, issued in 2016 by 3 French learned societies. These recommendations have been adapted to occupational exposure to AD. Results: AD contamination of professionals is a sensitive topic, and the BMOE requires the establishment of a working group and information meetings within the concerned health establishment to explain the approach, objectives, and purpose of monitoring. Occupational exposure to AD is often discontinuous and 2 steps are essential upstream: a study of the nature and frequency of AD used to select the Biological Exposure Indice(s) (BEI) most representative of the activity; a study of AD path in the institution to target exposed professionals and to adapt medico-professional information sheet (MPIS). The MPIS is essential to gather the necessary elements for results interpretation. Currently, 28 urinary specific BEIs of AD exposure have been identified, and corresponding analytical methods have been published: 11 BEIs were AD metabolites, and 17 were AD. Results interpretation is performed by groups of homogeneous exposure (GHE). There is no threshold biological limit value of interpretation. Contamination is established when an AD is detected in trace concentration or in a urine concentration equal or greater than the limit of quantification (LOQ) of the analytical method. Results can only be compared to LOQs of these methods, which must be as low as possible. For 8 of the 17 AD BEIs, the LOQ is very low with values between 0.01 to 0.05µg/l. For the other BEIs, the LOQ values were higher between 0.1 to 30µg/l. Results restitution by occupational physicians to workers should be individual and collective. Faced with AD dangerousness, in cases of workers contamination, it is necessary to put in place corrective measures. In addition, the implementation of prevention and awareness measures for those exposed to this risk is a priority. Conclusion: This work is a help for occupational physicians engaging in a process of prevention of occupational risks related to AD exposure. With the current analytical tools, effective and available, the (BMOE) to the AD should now be possible to develop in routine occupational physician practice. The BMOE may be complemented by surface sampling to determine workers' contamination modalities.

Keywords: antineoplastic drugs, urine, occupational exposure, biological monitoring of occupational exposure, biological exposure indice

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Authors: Antoine Villa, Moustapha Mohamedou, Florence Pilliere, Catherine Verdun-Esquer, Mathieu Molimard, Mohamed Sidatt Cheikh El Moustaph, Mireille Canal-Raffin

Abstract:

Context: In Mauritania, the activity of the National Center of Oncology (NCO) has steadily risen leading to an increase in the handling of antineoplastic drugs (AD) by healthcare professionals. In this context, the AD contamination of those professionals is a major concern for occupational physicians. It has been evaluated using biological monitoring of occupational exposure (BMOE). Methods: The intervention took place in 2015, in 2 care units, and evaluated nurses preparing and/or infusing AD and agents in charge of hygiene. Participants provided a single urine sample, at the end of the week, at the end of their shift. Five molecules were sought using specific high sensitivity methods (UHPLC-MS/MS) with very low limits of quantification (LOQ) (cyclophosphamide (CP), Ifosfamide (IF), methotrexate (MTX): 2.5ng/L; doxorubicin (Doxo): 10ng/L; α-fluoro-β-alanine (FBAL, 5-FU metabolite): 20ng/L). A healthcare worker was considered as 'contaminated' when an AD was detected at a urine concentration equal to or greater than the LOQ of the analytical method or at trace concentration. Results: Twelve persons participated (6 nurses, 6 agents in charge of hygiene). Twelve urine samples were collected and analyzed. The percentage of contamination was 66.6% for all participants (n=8/12), 100% for nurses (6/6) and 33% for agents in charge of hygiene (2/6). In 62.5% (n=5/8) of the contaminated workers, two to four of the AD were detected in the urine. CP was found in the urine of all contaminated workers. FBAL was found in four, MTX in three and Doxo in one. Only IF was not detected. Urinary concentrations (all drugs combined) ranged from 3 to 844 ng/L for nurses and from 3 to 44 ng/L for agents in charge of hygiene. The median urinary concentrations were 87 ng/L, 15.1 ng/L and 4.4 ng/L for FBAL, CP and MTX, respectively. The Doxo urinary concentration was found 218ng/L. Discussion: There is no current biological exposure index for the interpretation of AD contamination. The contamination of these healthcare professionals is therefore established by the detection of one or more AD in urine. These urinary contaminations are higher than the LOQ of the analytical methods, which must be as low as possible. Given the danger of AD, the implementation of corrective measures is essential for the staff. Biological monitoring of occupational exposure is the most reliable process to identify groups at risk, tracing insufficiently controlled exposures and as an alarm signal. These results show the necessity to educate professionals about the risks of handling AD and/or to care for treated patients.

Keywords: antineoplastic drugs, Mauritania, biological monitoring of occupational exposure, contamination

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Authors: Benoit Atge, Alice Dhersin, Oscar Da Silva Cacao, Beatrice Martinez, Dominique Ducint, Catherine Verdun-Esquer, Isabelle Baldi, Mathieu Molimard, Antoine Villa, Mireille Canal-Raffin

Abstract:

Introduction: Healthcare workers' exposure to antineoplastic drugs (AD) is a burning issue for occupational medicine practitioners. Biological monitoring of occupational exposure (BMOE) is an essential tool for assessing AD contamination of healthcare workers. In addition to BMOE, surface sampling is a useful tool in order to understand how workers get contaminated, to identify sources of environmental contamination, to verify the effectiveness of surface decontamination way and to ensure monitoring of these surfaces. The objective of this work was to develop a complete tool including a kit for surface sampling and a quantification analytical method for AD traces detection. The development was realized with the three following criteria: the kit capacity to sample in every professional environment (healthcare services, veterinaries, etc.), the detection of very low AD traces with a validated analytical method and the easiness of the sampling kit use regardless of the person in charge of sampling. Material and method: AD mostly used in term of quantity and frequency have been identified by an analysis of the literature and consumptions of different hospitals, veterinary services, and home care settings. The kind of adsorbent device, surface moistening solution and mix of solvents for the extraction of AD from the adsorbent device have been tested for a maximal yield. The AD quantification was achieved by an ultra high-performance liquid chromatography method coupled with tandem mass spectrometry (UHPLC-MS/MS). Results: With their high frequencies of use and their good reflect of the diverse activities through healthcare, 15 AD (cyclophosphamide, ifosfamide, doxorubicin, daunorubicin, epirubicin, 5-FU, dacarbazin, etoposide, pemetrexed, vincristine, cytarabine, methothrexate, paclitaxel, gemcitabine, mitomycin C) were selected. The analytical method was optimized and adapted to obtain high sensitivity with very low limits of quantification (25 to 5000ng/mL), equivalent or lowest that those previously published (for 13/15 AD). The sampling kit is easy to use, provided with a didactic support (online video and protocol paper). It showed its effectiveness without inter-individual variation (n=5/person; n= 5 persons; p=0,85; ANOVA) regardless of the person in charge of sampling. Conclusion: This validated tool (sampling kit + analytical method) is very sensitive, easy to use and very didactic in order to control the chemical risk brought by AD. Moreover, BMOE permits a focal prevention. Used in routine, this tool is available for every intervention of occupational health.

Keywords: surface contamination, sampling kit, analytical method, sensitivity

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Authors: Vanessa De Carvalho, Chad MacPherson, Julien Tremblay, Julie Champagne, Stephanie-Anne Girard

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Background: The interactions between bacteria and fungi in the human vaginal microbiome are fundamental to the concept of health and disease. The means by which the microbiota and mycobiota interact is still poorly understood and further studies are necessary to properly characterize this complex ecosystem. The aim of this study was to select a DNA extraction method capable of recovering high qualities of fungal and bacterial DNA from a single vaginal swab. Methods: 11 female volunteers ( ≥ 20 to < 55 years old) self-collected vaginal swabs in triplicates. Three commercial extraction kits: Masterpure Yeast Purification kit (Epicenter), PureLink™ Microbiome DNA Purification kit (Invitrogen), and Quick-DNA™ Fecal/Soil Microbe Miniprep kit (Zymo) were evaluated on the ability to recover fungal and bacterial DNA simultaneously. The extraction kits were compared on the basis of recovery, yield, purity, and the community richness of bacterial (16S rRNA - V3-V4 region) and fungal (ITS1) microbiota composition by Illumina MiSeq amplicon sequencing. Results: Recovery of bacterial DNA was achieved with all three kits while fungal DNA was only consistently recovered with Masterpure Yeast Purification kit (yield and purity). Overall, all kits displayed similar microbiota profiles for the top 20 OTUs; however, Quick-DNA™ Fecal/Soil Microbe Miniprep kit (Zymo) showed more species richness than the other two kits. Conclusion: In the present study, Masterpure Yeast purification kit proved to be a good candidate for purification of high quality fungal and bacterial DNA simultaneously. These findings have potential benefits that could be applied in future vaginal microbiome research. Whilst the use of a single extraction method would lessen the burden of multiple swab sampling, decrease laboratory workload and off-set costs associated with multiple DNA extractions, thoughtful consideration must be taken when selecting an extraction kit depending on the desired downstream application.

Keywords: bacterial vaginosis, DNA extraction, microbiota, mycobiota, vagina, vulvovaginal candidiasis, women’s health

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Authors: Kun Chen, Yan Wang, Yangyu Zhao, Shufang Li, Lian Chen, Xiaoyue Guo, Jue Zhang, Jing Fang

Abstract:

The coupling strength between uterine electromyography (UEMG) and Fetal heart rate (FHR) signals during peripartum reflects the fetal biophysical activities. Therefore, UEMG-FHR coupling characterization is instructive in assessing placenta function. This study introduced a physiological marker named elevated frequency of UEMG-FHR coupling (E-UFC) and explored its predictive value for pregnancies complicated by pre-eclampsia and small for gestational age (SGA). Placental insufficiency patients (n=12) and healthy volunteers (n=24) were recruited and participated. UEMG and FHR were recorded non-invasively by a trans-abdominal device in women at term with singleton pregnancy (32-37 weeks) from 10:00 pm to 8:00 am. The product of the wavelet coherence and the wavelet cross-spectral power between UEMG and FHR was used to weight these two effects in order to quantify the degree of the UEMG-FHR coupling. E-UFC was exacted from the resultant spectrogram by calculating the mean value of the high-coherence (r > 0.5) frequency band. Results showed the high-coherence between UEMG and FHR was observed in the frequency band (1/512-1/16Hz). In addition, E-UFC in placental insufficiency patients was weaker compared to healthy controls (p < 0.001) at group level. These findings suggested the proposed approach could be used to quantitatively characterize the fetal biophysical activities, which is beneficial for early detection of placental insufficiency and reduces the occurrence of adverse pregnancy.

Keywords: uterine electromyography, fetal heart rate, coupling analysis, wavelet analysis

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Authors: Eun Jeong Yu, Inn Soo Kang, Tae Ki Yoon, Mi Kyoung Koong

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Advanced female age is associated with higher cycle cancelation rates, lower clinical pregnancy rate, increased miscarriage and aneuploidy rates in IVF (In Vitro Fertilization) cycles. This retrospective cohort study was conducted at a Cha Fertility Center, Seoul Station. All fresh non-donor IVF cycles performed in women aged 40 years and above from January 2016 to December 2016 were reviewed. Donor/recipient treatment, PGD/PGS (Preimplantation Genetic Diagnosis/ Preimplantation Genetic Screening) were excluded from analysis. Of the 1,166 cycles from 753 women who completed ovulation induction, 1,047 were appropriate for the evaluation according to inclusion and exclusion criterion. IVF cycles were categorized according to age and grouped into the following 1-year age groups: 40, 41, 42, 43, 44, 45 and > 46. The mean age of patients was 42.4 ± 1.8 years. The median AMH (Anti-Mullerian Hormone) level was 1.2 ± 1.5 ng/mL. The mean number of retrieved oocytes was 4.9 ± 4.3. The clinical pregnancy rate and live birth rate in women > 40 years significantly decreased with each year of advancing age (p < 0.001). The clinical pregnancy rate decreased from 21% at the age of 40 years to 0% at ages above 45 years. Live birth rate decreased from 12.3% to 0%, respectively. There were no clinical pregnancy outcomes among 95 patients aged above 45 years of age. The overall miscarriage rate was 40.7% (range, 36.7%-70%). The transfer of at least one good quality embryo was associated with about 4-9% increased chance of a clinical pregnancy rate. Therefore, IVF in old age women less than 46 had a reasonable chance for successful pregnancy outcomes especially when good quality embryo is transferred.

Keywords: advanced maternal age, in vitro fertilization, pregnancy rate, live birth rate

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Authors: Udaykumar R., M. S. Ganachari

Abstract:

In order to engage community pharmacies in Tuberculosis care, a survey has been conducted in Belgaum city, Karnataka state, India. After the survey divided into two groups one is control group and another one is intervention group. One is dispensing of anti-tuberculosis drugs, and another one is non-availability of anti-tuberculosis drugs. Those community pharmacists who are voluntarily interesting for becoming DOTS (Directly observed treatment short course) provider and RNTCP (Revised national tuberculosis control programme) objectives. Structured training is conducted for community pharmacist who are dispensing anti-tuberculosis drugs. The training module includes record maintaining, reporting to the RNTCP, Medication adherence etc. In case of non-availability of anti-tuberculosis drugs, the district RNTCP has been given training for community pharmacist by providing free of drugs to the community pharmacies. So, community pharmacies can dispense anti-tuberculosis drugs to the patients. The target of this study is Private community pharmacies. A simple random sampling method is used and 550 private community pharmacy shops has been involved in Belgaum city of Karnataka state, India. Significance of the Study: This study mainly focused on training of DOTS (Directly observed treatment short course) to the private community pharmacist. Indian Govt. Considers Private Providers as Assets for TB Control and Care to Achieve National Strategic Plan for TB Elimination 2017-2025. The Govt. has not fully tapped the Potential of Private Pharmacies to Fight TB. Providing DOTS as per patient’s convenience through community DOT Providers with periodic monitoring may reduce the treatment Default. We explore RNTCP objectives interventions that can have directly managed by private community pharmacy shop. Objectives: Survey of anti-tuberculosis drugs in Community pharmacy shop in Belgaum city. Interested community pharmacist who are willing to become DOTS (Directly observed treatment short course) Provider. Major Findings:Most of the community pharmacist are dispensing anti-tuberculosis drugs without having knowledge of DOTS therapy and RNTCP objectives. No community pharmacist is aware of RNTCP and Tuberculosis burden in India. Most of the Pharmacist agreed to come for RNTCP Training module for the community pharmacist. Some of the community pharmacist not dispensing anti-tuberculosis drugs and they agreed to become official DOTS provider. Concluding Statement: Awareness of role of community pharmacist on tuberculosis control and care has been neglected. More than 50% of tuberculosis patients seeking treatments from privatesector. In this study finds the major gap between government and private sector on tuberculosis treatment.

Keywords: community pharmacist, directly observed treatment short course(DOTS), revised national tuberculosis control programme (RNTCP), private pharmacies, anti-tuberculosis drugs

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Authors: C. M. Choi, H. C. Tsang, W. K. Fong, Y. K. Cheng, T. K. Chui, L. Y. Chan, K. W. Lee, C. K. Yuen, P. W. Lau, Y. L. To, K. C. Chow

Abstract:

Six-minute walk test (6MWT) is a sub-maximal exercise test to assess aerobic capacity and exercise tolerance of patients with chronic respiratory disease and heart failure. This has been proven to be a reliable and valid tool and commonly used in clinical situations. Traditional 6MWT is labour-intensive and time-consuming especially for patients who require assistance in ambulation and oxygen use. When performing the test with these patients, one staff will assist the patient in walking (with or without aids) while another staff will need to manually record patient’s oxygen saturation, heart rate and walking distance at every minute and/or carry oxygen cylinder at the same time. Physiotherapist will then have to document the test results in bed notes in details. With the use of electronic 6MWT (E-6MWT), patients wear a wireless oximeter that transfers data to a tablet PC via Bluetooth. Real-time recording of oxygen saturation, heart rate, and distance are displayed. No manual work on recording is needed. The tablet will generate a comprehensive report which can be directly attached to the patient’s bed notes for documentation. Data can also be saved for later patient follow up. This study was carried out in North District Hospital. Patients who followed commands and required 6MWT assessment were included. Patients were assigned to study or control groups. In the study group, patients adopted the E-6MWT while those in control group adopted the traditional 6MWT. Manpower and time consumed were recorded. Physiotherapists also completed a questionnaire about the use of E-6MWT. Total 12 subjects (Study=6; Control=6) were recruited during 11-12/2017. An average number of staff required and time consumed in traditional 6MWT were 1.67 and 949.33 seconds respectively; while in E-6MWT, the figures were 1.00 and 630.00 seconds respectively. Compared to traditional 6MWT, E-6MWT required 67.00% less manpower and 50.10% less in time spent. Physiotherapists (n=7) found E-6MWT is convenient to use (mean=5.14; satisfied to very satisfied), requires less manpower and time to complete the test (mean=4.71; rather satisfied to satisfied), has better data management (mean=5.86; satisfied to very satisfied) and is recommended to be used clinically (mean=5.29; satisfied to very satisfied). It is proven that E-6MWT requires less manpower input with higher efficiency and better data management. It is welcomed by the clinical frontline staff.

Keywords: electronic, physiotherapy, six-minute walk test, 6MWT

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Authors: K. W. Lee, C. M. Choi, H. C. Tsang, W. K. Fong, Y. K. Cheng, L. Y. Chan, C. K. Yuen, P. W. Lau, Y. L. To, K. C. Chow

Abstract:

QR (Quick Response) Code is a matrix barcode. It enables users to open websites, photos and other information with mobile devices by just snapping the code. In usual Long Term Oxygen Therapy arrangement, piles of LTOT related information like leaflets from different oxygen service providers are given to patients to choose an appropriate plan according to their needs. If these printed materials are transformed into electronic format (QR Code), it would be more environmentally-friendly. More importantly, electronic materials including LTOT equipment operation and dyspnoea relieving techniques also empower patients in long-term disease management. The objective to this study is to investigate the effect of QR code in patient education on new LTOT users. This study was carried out in medical wards of North District Hospital. Adult patients and relatives who followed commands, were able to use smartphones with internet services and required LTOT arrangement on hospital discharge were recruited. In LTOT arrangement, apart from the usual LTOT education booklets which included patients’ personal information (e.g. oxygen titration and six-minute walk test results etc.), extra leaflets consisted of 1. QR codes of LTOT plans from different oxygen service providers, 2. Education materials of dyspnoea management and 3. Instructions on LTOT equipment operation were given. Upon completion of LTOT arrangement, a questionnaire about the use of QR code on patient education was filled in by patients or relatives. A total of 10 new LTOT users were recruited from November 2017 to January 2018. Initially, 70% of them did not know anything about the QR code, but all of them understood its operation after a simple demonstration. 70% of them agreed that it was convenient to use (20% strongly agree, 40% agree, 10% somewhat agree). 80% of them agreed that QR code could facilitate the retrieval of more LTOT related information (10% strongly agree, 70% agree) while 90% agreed that we should continue delivering QR code leaflets to new LTOT users in the future (30% strongly agree, 40% agree, 20% somewhat agree). It is proven that QR code is a convenient and environmentally-friendly tool to deliver information. It is also relatively easy to be introduced to new users. It has received welcoming feedbacks from current users.

Keywords: long-term oxygen therapy, physiotherapy, patient education, QR code

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Authors: Pawel Kiper, Alfonc Baba, Mahmoud Alhelou, Giorgia Pregnolato, Michela Agostini, Andrea Turolla

Abstract:

Impairment of cervical spine mobility is often related to pain triggered by musculoskeletal disorders or direct traumatic injuries of the spine. To date, these disorders are assessed with goniometers and inclinometers, which are the most popular devices used in clinical settings. Nevertheless, these technologies usually allow measurement of no more than two-dimensional range of motion (ROM) quotes in static conditions. Conversely, the wide use of motion tracking systems able to measure 3 to 6 degrees of freedom dynamically, while performing standard ROM assessment, are limited due to technical complexities in preparing the setup and high costs. Thus, motion tracking systems are primarily used in research. These systems are an integral part of virtual reality (VR) technologies, which can be used for measuring spine mobility. To our knowledge, the accuracy of VR measure has not yet been studied within virtual environments. Thus, the aim of this study was to test the reliability of a protocol for the assessment of sensorimotor function of the cervical spine in a population of healthy subjects and to compare whether using immersive or non-immersive VR for visualization affects the performance. Both VR assessments consisted of the same five exercises and random sequence determined which of the environments (i.e. immersive or non-immersive) was used as first assessment. Subjects were asked to perform head rotation (right and left), flexion, extension and lateral flexion (right and left side bending). Each movement was executed five times. Moreover, the participants were invited to perform head reaching movements i.e. head movements toward 8 targets placed along a circular perimeter each 45°, visualized one-by-one in random order. Finally, head repositioning movement was obtained by head movement toward the same 8 targets as for reaching and following reposition to the start point. Thus, each participant performed 46 tasks during assessment. Main measures were: ROM of rotation, flexion, extension, lateral flexion and complete kinematics of the cervical spine (i.e. number of completed targets, time of execution (seconds), spatial length (cm), angle distance (°), jerk). Thirty-five healthy participants (i.e. 14 males and 21 females, mean age 28.4±6.47) were recruited for the cervical spine assessment with immersive and non-immersive VR environments. Comparison analysis demonstrated that: head right rotation (p=0.027), extension (p=0.047), flexion (p=0.000), time (p=0.001), spatial length (p=0.004), jerk target (p=0.032), trajectory repositioning (p=0.003), and jerk target repositioning (p=0.007) were significantly better in immersive than non-immersive VR. A regression model showed that assessment in immersive VR was influenced by height, trajectory repositioning (p<0.05), and handedness (p<0.05), whereas in non-immersive VR performance was influenced by height, jerk target (p=0.002), head extension, jerk target repositioning (p=0.002), and by age, head flex/ext, trajectory repositioning, and weight (p=0.040). The results of this study showed higher accuracy of cervical spine assessment when executed in immersive VR. The assessment of ROM and kinematics of the cervical spine can be affected by independent and dependent variables in both immersive and non-immersive VR settings.

Keywords: virtual reality, cervical spine, motion analysis, range of motion, measurement validity

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Authors: Saira Mehnaz, Ali Jafar Abedi, Shazia Farooq Fazli, Sakeena Mushfiq, Zulfia Khan, M. Athar Ansari

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Introduction: Public health spending is a necessity in an underdeveloped country like India. The people are already suffering from poverty and that clubbed with out of pocket expenditure leads them to a very catastrophic situation, reducing the overall access to healthcare. Objectives: This study was designed to determine the usual source of medical care opted, the illness pattern, the expenditure incurred on illness and its source of procurement by the study population. It also intended to assess this expenditure as a determinant of access to health care. Methodology: Cities like Aligarh, which are classified as B grade cities in India are thought to be ripe sites for getting livelihood and hence are almost half filled with migrants living in urban slums. A cross sectional study was done to study the newer slum pockets. 3409 households with a population of 16,978 were studied with the help of pretested questionnaire; SPSS 20 was used for statistical analysis. Results and Conclusions: In our study, we found that almost all the households suffered from catastrophic health expenditure. The study population, which was already vulnerable owing to their low socio-economic and migrant status was further being forced with into poverty and indebtedness on account of expenditure on illness. This lead to a significant decrease in access to health. National health financing systems should be designed to protect households from financial catastrophe, by reducing out-of-pocket spending.

Keywords: access to healthcare, catastrophic health expenditure, new urban slums, out of pocket expenditure

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Authors: Arsalan Ghaderi

Abstract:

Introduction: Inactivity is one of the most important risk factors for cardiovascular disease. According to the study prevalence of inactivity in Iran, about 67.5% and in the staff, and especially nurses, are similar. The inflammatory index (HS-CRP) is highly predictive of the progression of these diseases. Physical activity education is very important in preventing these diseases. One of the modern educational methods is web-based theory-based education. Methods: This is a semi-experimental interventional study which was conducted in Isfahan and Kurdistan universities of medical sciences in two stages. A cross-sectional study was done to determine the status of physical activity and its predictive factors. Then, intervention was performed, and six months later the data were retrieved. The data was collected using a demographic questionnaire, an integrative model of behavior prediction constructs, a standard physical activity questionnaire and (HS-CRP) test. Data were analyzed by SPSS software. Results: Physical activity was low in 66.6% of nurses, 25.4% were moderate and 8% severe. According to Pearson correlation matrix, the highest correlation was found between behavioral intention and skill structures (0.553**), subjective norms (0.222**) and self-efficacy (0.198**). The relationship between age and physical activity in the first study was reverse and significant. After intervention, there was a significant change in attitudes, self-efficacy, skill and behavioral intention in the intervention group. This change was significant in attitudes, self-efficacy and environmental conditions of the control group. HS-CRP index decreased significantly after intervention in both groups, but there was not a significant relationship between inflammatory index and physical activity score. The change in physical activity level was significant only in the control group. Conclusion: Despite the effect of educational intervention on attitude, self-efficacy, skill, and behavioral intention, the results showed that if factors such as environmental factors are not corrected, training and changing structures cannot lead to physical activity behavior. On the other hand, no correlation between physical activity and HS-CRP showed that this index can be influenced by other factors, and this should be considered in any intervention to reduce the HS-CRP index.

Keywords: HS-CRP, integrative model of behavior prediction, physical activity, nurses, web-based education

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