Search results for: Natalie Nicholls
41 Trends and Inequalities in Distance to and Use of Nearest Natural Space in the Context of the 20-Minute Neighbourhood: A 4-Wave National Repeat Crosssectional Study, 2013 to 2019
Authors: Jonathan R. Olsen, Natalie Nicholls, Jenna Panter, Hannah Burnett, Michael Tornow, Richard Mitchell
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The 20-minute neighborhood is a policy priority for governments worldwide and a key feature of this policy is providing access to natural space within 800 meters of home. The study aims were to (1) examine the association between distance to nearest natural space and frequent use over time and (2) examine whether frequent use and changes in use were patterned by income and housing tenure over time. Bi-annual Scottish Household Survey data were obtained for 2013 to 2019 (n:42128 aged 16+). Adults were asked the walking distance to their nearest natural space, the frequency of visits to this space and their housing tenure, as well as age, sex and income. We examined the association between distance from home of nearest natural space, housing tenure, and the likelihood of frequent natural space use (visited once a week or more). Two-way interaction terms were further applied to explore variation in the association between tenure and frequent natural space use over time. We found that 87% of respondents lived within 10 minute walk of a natural space, meeting the policy specification for a 20-minute neighbourhood. Greater proximity to natural space was associated with increased use; individuals living a 6 to 10 minute walk and over 10 minute walk were respectively 53% and 78% less likely to report frequent natural space use than those living within a 5 minute walk. Housing tenure was an important predictor of frequent natural space use; private renters and homeowners were more likely to report frequent natural space use than social renters. Our findings provide evidence that proximity to natural space is a strong predictor of frequent use. Our study provides important evidence that time-based access measures alone do not consider deep-rooted socioeconomic variation in use of Natural space. Policy makers should ensure a nuanced lens is applied to operationalising and monitoring the 20-minute neighbourhood to safeguard against exacerbating existing inequalities.Keywords: natural space, housing, inequalities, 20-minute neighbourhood, urban design
Procedia PDF Downloads 12040 Smart Demand Response: A South African Pragmatic, Non-Destructive and Alternative Advanced Metering Infrastructure-Based Maximum Demand Reduction Methodology
Authors: Christo Nicholls
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The National Electricity Grid (NEG) in South Africa has been under strain for the last five years. This overburden of the NEG led Eskom (the State-Owned Entity responsible for the NEG) to implement a blunt methodology to assist them in reducing the maximum demand (MD) on the NEG, when required, called Loadshedding. The challenge of this methodology is that not only does it lead to immense technical issues with the distribution network equipment, e.g., transformers, due to the frequent abrupt off and on switching, it also has a broader negative fiscal impact on the distributors, as their key consumers (commercial & industrial) are now grid defecting due to the lack of Electricity Security Provision (ESP). This paper provides a pragmatic alternative methodology utilizing specific functionalities embedded within direct-connect single and three-phase Advanced Meter Infrastructure (AMI) Solutions deployed within the distribution network, in conjunction with a Multi-Agent Systems Based AI implementation focused on Automated Negotiation Peer-2-Peer trading. The results of this research clearly illustrate, not only does methodology provide a factual percentage contribution towards the NEG MD at the point of consideration, it also allows the distributor to leverage the real-time MD data from key consumers to activate complex, yet impact-measurable Demand Response (DR) programs.Keywords: AI, AMI, demand response, multi-agent
Procedia PDF Downloads 11239 ISIS Resurgence in the Era of COVID-19
Authors: Stacey Pollard, Henry Baraket, Girish Ganesan, Natalie Kim
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One year after U.S.-led coalition operations liberated ISIS-held territories in Iraq and Syria and killed ISIS core leader Abu Bakr al-Baghdadi, ISIS is resurging. Taking a page from its old playbook, the organization is capitalizing on social unrest and a rapidly deteriorating security environment—exacerbated by the COVID-19 pandemic—to reconstitute in permissive areas of Iraq and Syria. This Short examines ISIS’s pandemic-era ground and information operations through the lens of its state- and nation-making efforts to help analysts and decisionmakers better understand the imminence and scope of the threat. ISIS is rapidly overcoming U.S.-supported counterterrorism gains and, without direct pressure to reverse these advances, is poised for recovery.Keywords: Terrorism, COVID-19, Islamic State, Instability, Iraq, Syria, Global, Resurgence
Procedia PDF Downloads 7338 Shear Stress and Effective Structural Stress Fields of an Atherosclerotic Coronary Artery
Authors: Alireza Gholipour, Mergen H. Ghayesh, Anthony Zander, Stephen J. Nicholls, Peter J. Psaltis
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A three-dimensional numerical model of an atherosclerotic coronary artery is developed for the determination of high-risk situation and hence heart attack prediction. Employing the finite element method (FEM) using ANSYS, fluid-structure interaction (FSI) model of the artery is constructed to determine the shear stress distribution as well as the von Mises stress field. A flexible model for an atherosclerotic coronary artery conveying pulsatile blood is developed incorporating three-dimensionality, artery’s tapered shape via a linear function for artery wall distribution, motion of the artery, blood viscosity via the non-Newtonian flow theory, blood pulsation via use of one-period heartbeat, hyperelasticity via the Mooney-Rivlin model, viscoelasticity via the Prony series shear relaxation scheme, and micro-calcification inside the plaque. The material properties used to relate the stress field to the strain field have been extracted from clinical data from previous in-vitro studies. The determined stress fields has potential to be used as a predictive tool for plaque rupture and dissection. The results show that stress concentration due to micro-calcification increases the von Mises stress significantly; chance of developing a crack inside the plaque increases. Moreover, the blood pulsation varies the stress distribution substantially for some cases.Keywords: atherosclerosis, fluid-structure interaction, coronary arteries, pulsatile flow
Procedia PDF Downloads 17237 Public Libraries as Social Spaces for Vulnerable Populations
Authors: Natalie Malone
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This study explores the role of a public library in the creation of social spaces for vulnerable populations. The data stems from a longitudinal ethnographic study of the Anderson Library community, which included field notes, artifacts, and interview data. Thematic analysis revealed multiple meanings and thematic relationships within and among the data sources -interviews, field notes, and artifacts. Initial analysis suggests the Anderson Library serves as a space for vulnerable populations, with the sub-themes of fostering interpersonal communication to create a social space for children and fostering interpersonal communication to create a social space for parents and adults. These findings are important as they illustrate the potential of public libraries to serve as community empowering institutions.Keywords: capital, immigrant families, public libraries, space, vulnerable
Procedia PDF Downloads 15236 Exploring the Meaning of Safety in Acute Mental Health Inpatient Units from the Consumer Perspective
Authors: Natalie Cutler, Lorna Moxham, Moira Stephens
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Safety is a priority in mental health services, and no more so than in the acute inpatient setting. Mental health service policies and accreditation frameworks commonly approach safety from a risk reduction or elimination perspective leading to service approaches that are arguably more focused on risk than on safety. An exploration what safety means for people who have experienced admission to an acute mental health inpatient unit is currently under way in Sydney, Australia. Using a phenomenographic research approach, this study is seeking to understand the meaning of safety from the perspective of people who use, rather than those who deliver mental health services. Preliminary findings suggest that the meanings of safety for users of mental health services vary from the meanings inherent in the policies and frameworks that inform how mental health services and mental health practice are delivered. This variance has implications for the physical and environmental design of acute mental health inpatient facilities, the policies and practices, and the education and training of mental health staff in particular nurses, who comprise the majority of the mental health workforce. These variances will be presented, along with their implications for the way quality and safety in mental health services are evaluated.Keywords: acute inpatient, mental health, nursing, phenomenography, recovery, safety
Procedia PDF Downloads 23235 The Effect of Sustainability Reporting on Company Profitability Using Literature Review Method (Asian Sphere)
Authors: Kesya Terinda Natalie, Marcellina Natasha, Rosinta Ria Panggabean
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Purpose: Over the last few years, the company has been implementing sustainability practices to ensure business continuity. However, there are pros and cons regarding the impact of financial reports if companies provide non-financial reports. So this paper aims to prove what the effect of Sustainability Reporting (SR) has on company profitability, as well as things that can be considered as the decision-making of SR disclosure. Methodology: This paper uses the literature review method to describe the results of published articles concerning Sustainability Reporting and Profitability. This study links and analyzes the essence of 50 previous studies related to SR on company profitability, most of which were conducted in Asia. Therefore this research is limited to only 23 studies in Asia. Findings: Sustainability Reporting does not have a significant impact on company profitability because the SR quality of each company varies based on Agency & Legitimacy Theory considerations. Stakeholders are required to focus not only on profitability but also on the long-term of the company. Thus, it is found that SR is used by companies as a sustainable investment, which can improve overall company performance by reducing capital costs and generating positive company value in increasing reputation capital. Value: This paper focuses on how sustainability reporting affects company profitability, as well as things that can be considered as the decision-making of SR disclosure.Keywords: sustainability reporting, profitability, agency theory, legitimacy theory
Procedia PDF Downloads 8934 Growth of Multi-Layered Graphene Using Organic Solvent-PMMA Film as the Carbon Source under Low Temperature Conditions
Authors: Alaa Y. Ali, Natalie P. Holmes, John Holdsworth, Warwick Belcher, Paul Dastoor, Xiaojing Zhou
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Multi-layered graphene has been produced under low temperature chemical vapour deposition (CVD) growth conditions by utilizing an organic solvent and polymer film source. Poly(methylmethacrylate) (PMMA) was dissolved in chlorobenzene solvent and used as a drop-cast film carbon source on a quartz slide. A source temperature (Tsource) of 180 °C provided sufficient carbon to grow graphene, as identified by Raman spectroscopy, on clean copper foil catalytic surfaces. Systematic variation of hydrogen gas (H2) flow rate from 25 standard cubic centimeters per minute (sccm) to 100 sccm and CVD temperature (Tgrowth) from 400 to 800 °C, yielded graphene films of varying quality as characterized by Raman spectroscopy. The optimal graphene growth parameters were found to occur with a hydrogen flow rate of 75 sccm sweeping the 180 °C source carbon past the Cu foil at 600 °C for 1 min. The deposition at 600 °C with a H2 flow rate of 75 sccm yielded a 2D band peak with ~53.4 cm-1 FWHM and a relative intensity ratio of the G to 2D bands (IG/I2D) of 0.21. This recipe fabricated a few layers of good quality graphene.Keywords: graphene, chemical vapor deposition, carbon source, low temperature growth
Procedia PDF Downloads 16533 Writings About Homeland: Palestinian American Poetry
Authors: Laila Shikaki
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‘Writings about Home’ discusses the poetry of Palestinian American female poets, especially ones who write about their homelands, living away from home, as well as their family ties to the land. This is a paper about poetry, but it is also about Palestinian American women who use English to convey issues pertaining to homesickness, family, and language. She study poems by Naomi Shihab Nye and Natalie Hanal. In ‘My Father and the Fig Tree,’ for example, Nye depicts her father’s life away from Palestine and his attachment to a tree that represents his homeland and nostalgia. Nye’s style is diverse and unified, and her attention is to details and images. While her words and imagery are usually simple, they are always rich in meaning. Nathalie Handal’s poetry, on the other hand, has a more complicated, multi-layered, and nuanced style as the poet herself lived in many areas and spoke multiple languages. ‘Bethlehem,’ for instance, depicts her city of origin, recalling her grandfather. Her poem ‘Blue Hours’ illustrates a persona’s difficulty in belonging, switching from one language to the next, and feeling a betrayal in both. This paper pays attention to language and how being bilingual adds another level of exile and pain to those who have fled or were forced to leave Palestine. This paper is very timely as the issue of Palestinian freedom and its right to autonomy and self-determination is the central stage for many Americans, seen in their protests, university encampments, and graduation ceremonies, not forgetting its effect on voters’ decisions for president and elected officials.Keywords: Palestinian American, poetry, homeland, Nye, Handal
Procedia PDF Downloads 2932 Trafficking, Forced Prostitution, and Minors in the Sex Trade in Post-Legalisation New Zealand
Authors: Natalie Thorburn
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New Zealand legalised and regulated prostitution 13 years ago with the hope of eradicating unsafe or exploitative practices in the sex trade, but the extent to which this has been successful has been hotly contested, with the New Zealand Government denying any existence of sex trafficking and evidence generally indicating the success of the 2004 reform. The aim of the research was therefore to establish the circumstances in which sex trafficking may be occurring without using any previously instrumental gatekeepers of the New Zealand sex industry. 14 survivors of gang, family, or intimate partner trafficking (all of whom had first been trafficked prior to the age of 16) were interviewed, as well as several key informants. It was found that there was a perceived lack of commitment by Police to investigate instances of trafficking, and this was considered to be linked to the legal status of prostitution. The lack of recognition at both community and political levels of the existence and prevalence of trafficking also meant that medical and social service practitioners were unaware trafficking was occurring, and would not know who to refer to if it was disclosed. Participants commonly normalised coercion into sex, seeing this as a continuation of prior sexually abusive experiences that were prevalent in their childhood and early adolescent environments. Their experiences with the helping services were typically either negative or non-existent, and they expressed frustration regarding the absence of justice, the lack of awareness, and health and outcomes they suffered in relation to their experiences of having been trafficked. Barriers to engagement and strategies to facilitate meaningful and sustainable engagement with this population group are therefore presented.Keywords: legalisation, regulation, service access, socio-political context
Procedia PDF Downloads 21631 The Effect of Isokinetic Fatigue of Ankle, Knee, and Hip Muscles on the Dynamic Postural Stability Index
Authors: Masoumeh Shojaei, Natalie Gedayloo, Amir Sarshin
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The purpose of the present study was to investigate the effect of Isokinetic fatigue of muscles around the ankle, knee, and hip on the indicators of dynamic postural stability. Therefore, 15 female university students (age 19.7± 0.6 years old, weight 54.6± 9.4 kg, and height 163.9± 5.6 cm) participated in within-subjects design for 5 different days. In the first session, the postural stability indices (time to stabilization after jump-landing) without fatigue were assessed by force plate and in each next sessions, one of muscle groups of the lower limb including the muscles around ankles, knees, and hip was randomly exhausted by Biodex Isokinetic dynamometer and the indices were assessed immediately after the fatigue of each muscle group. The method involved landing on a force plate from a dynamic state, and transitioning balance into a static state. Results of ANOVA with repeated measures indicated that there was no significant difference between the time to stabilization (TTS) before and after Isokinetic fatigue of the muscles around the ankle, knee and hip in medial – lateral direction (p > 0.05), but in the anterior – posterior (AP) direction, the difference was statistically significant (p < 0.05). Least Significant Difference (LSD) post hoc test results also showed that there was significant difference between TTS in knee and hip muscles before and after isokinetic fatigue in AP direction. In the other hand knee and hip muscles group were affected by isokinetic fatigue only in AP surface (p < 0.05).Keywords: dynamic balance, fatigue, lower limb muscles, postural control
Procedia PDF Downloads 23730 Analysing the Permanent Deformation of Cohesive Subsoil Subject to Long Term Cyclic Train Loading
Authors: Natalie M. Wride, Xueyu Geng
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Subgrade soils of railway infrastructure are subjected to a significant number of load applications over their design life. The use of slab track on existing and future proposed rail links requires a reduced maintenance and repair regime for the embankment subgrade, due to restricted access to the subgrade soils for remediation caused by cyclic deformation. It is, therefore, important to study the deformation behaviour of soft cohesive subsoils induced as a result of long term cyclic loading. In this study, a series of oedometer tests and cyclic triaxial tests (10,000 cycles) have been undertaken to investigate the undrained deformation behaviour of soft kaolin. X-ray Computer Tomography (CT) scanning of the samples has been performed to determine the change in porosity and soil structure density from the sample microstructure as a result of the laboratory testing regime undertaken. Combined with the examination of excess pore pressures and strains obtained from the cyclic triaxial tests, the results are compared with an existing analytical solution for long term settlement considering repeated low amplitude loading. Modifications to the analytical solution are presented based on the laboratory analysis that shows good agreement with further test data.Keywords: creep, cyclic loading, deformation, long term settlement, train loading
Procedia PDF Downloads 29929 War and the Battle of Lebanese Television over Gender
Authors: Natalie M. Khazaal
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The effects of the civil war on Lebanese women have been challenging to conceptualize. For some, war is a liberating and empowering force for women, while for others it is one that subjugates women and disempowers them in new ways. Scholars have explored the impact on the Lebanese civil war (1975-1990) on women in the fields of labor history, political activism and literary production. In all these arenas, women’s role and visibility were contested and negotiated in diverse ways. But probably the most visible arena where this contestation took place was television. Dramatized entertainment series were crucial sites where fictional women battled out the gender question, and which reflected and participated in the negotiations of gender politics. Even more stunningly, actual television stations became part of this battle through the plots and portrayals of women that they created. The state-backed Tele-Liban (TL) peddled patriarchal articulations of gender that directly competed with the edgy vision of liberated, independent women on the pirate Lebanese Broadcasting Corporation (LBC). This presentation explores how LBC used gender to distinguish its brand against the retrograde TL programing. Television series are an important medium for creating, testing and reenacting gender politics. They are even more consequential in another way. They are the sites where a dramatic shift in the relationship between Arab television and Arab publics—from benign neglect of public concerns towards engagement with audiences—took place for the first time. As this shift is at the heart of why Arab media was seen as a participant in the Arab uprisings, it is important to explore the roots of the shift in the dramas and comedy series of the mid-1980s Lebanese television. This presentation argues that television battles over gender were consequential and need serious consideration as sites of unexpected meaning.Keywords: gender, Lebanon, television, war, women
Procedia PDF Downloads 63728 Numerical Investigation of a New Two-Fluid Model for Semi-Dilute Polymer Solutions
Authors: Soroush Hooshyar, Mohamadali Masoudian, Natalie Germann
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Many soft materials such as polymer solutions can develop localized bands with different shear rates, which are known as shear bands. Using the generalized bracket approach of nonequilibrium thermodynamics, we recently developed a new two-fluid model to study shear banding for semi-dilute polymer solutions. The two-fluid approach is an appropriate means for describing diffusion processes such as Fickian diffusion and stress-induced migration. In this approach, it is assumed that the local gradients in concentration and, if accounted for, also stress generate a nontrivial velocity difference between the components. Since the differential velocity is treated as a state variable in our model, the implementation of the boundary conditions arising from the derivative diffusive terms is straightforward. Our model is a good candidate for benchmark simulations because of its simplicity. We analyzed its behavior in cylindrical Couette flow, a rectilinear channel flow, and a 4:1 planar contraction flow. The latter problem was solved using the OpenFOAM finite volume package and the impact of shear banding on the lip and salient vortices was investigated. For the other smooth geometries, we employed a standard Chebyshev pseudospectral collocation method. The results showed that the steady-state solution is unique with respect to initial conditions, deformation history, and the value of the diffusivity constant. However, smaller the value of the diffusivity constant is, the more time it takes to reach the steady state.Keywords: nonequilibrium thermodynamics, planar contraction, polymer solutions, shear banding, two-fluid approach
Procedia PDF Downloads 33327 Fluorescent Ph-Sensing Bandage for Point-of-Care Wound Diagnostics
Authors: Cherifi Katia, Al-Hawat Marie-Lynn, Tricou Leo-Paul, Lamontagne Stephanie, Tran Minh, Ngu Amy Ching Yie, Manrique Gabriela, Guirguis Natalie, Machuca Parra Arturo Israel, Matoori Simon
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Diabetic foot ulcers (DFUs) are a serious and prevalent complication of diabetes. Current diagnostic options are limited to macroscopic wound analysis such as wound size, depth, and infection. Molecular diagnostics promise to improve DFU diagnosis, staging, and assessment of treatment response. Here, we developed a rapid and easy-to-use fluorescent pH-sensing bandage for wound diagnostics. In a fluorescent dye screen, we identified pyranine as the lead compound due to its suitable pH-sensing properties in the clinically relevant pH range of 6 to 9. To minimize the release of this dye into the wound bed, we screened a library of ionic microparticles and found a strong adhesion of the anionic dye to a cationic polymeric microparticle. These dye-loaded microparticles showed a strong fluorescence response in the clinically relevant pH range of 6 to 9 and a dye release below 1% after one day in biological media. The dye-loaded microparticles were subsequently encapsulated in a calcium alginate hydrogel to minimize the interaction of the microparticles with the wound tissue. This pH-sensing diagnostic wound dressing was tested on full-thickness dorsal wounds of mice, and a linear fluorescence response (R2 = 0.9909) to clinically relevant pH values was observed. These findings encourage further development of this pH-sensing system for molecular diagnostics in DFUs.Keywords: wound ph, fluorescence, diagnostics, diabetic foot ulcer, wound healing, chronic wounds, diabetes
Procedia PDF Downloads 8626 Use of a Symptom Scale Based on Degree of Functional Impairment for Acute Concussion
Authors: Matthew T. McCarthy, Sarah Janse, Natalie M. Pizzimenti, Anthony K. Savino, Brian Crosser, Sean C. Rose
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Concussion is diagnosed clinically using a comprehensive history and exam, supported by ancillary testing. Frequently, symptom checklists are used as part of the evaluation of concussion. Existing symptom scales are based on a subjective Likert scale, without relation of symptoms to clinical or functional impairment. This is a retrospective review of 133 patients under age 30 seen in an outpatient neurology practice within 30 days of a probable or definite concussion. Each patient completed 2 symptom checklists at the initial visit – the SCAT-3 symptom evaluation (22 symptoms, 0-6 scale) and a scale based on the degree of clinical impairment for each symptom (22 symptoms, 0-3 scale related to functional impact of the symptom). Final clearance date was determined by the treating physician. 60.9% of patients were male with mean age 15.7 years (SD 2.3). Mean time from concussion to first visit was 6.9 days (SD 6.2), and 101 patients had definite concussions (75.9%), while 32 were diagnosed as probable (24.1%). 94 patients had a known clearance date (70.7%) with mean clearance time of 20.6 days (SD 18.6) and median clearance time of 19 days (95% CI 16-21). Mean total symptom score was 27.2 (SD 22.9) on the SCAT-3 and 14.7 (SD 11.9) for the functional impairment scale. Pearson’s correlation between the two scales was 0.98 (p < 0.001). After adjusting for patient and injury characteristics, an equivalent increase in score on each scale was associated with longer time to clearance (SCAT-3 hazard ratio 0.885, 95%CI 0.835-0.938, p < 0.001; functional impairment scale hazard ratio 0.851, 95%CI 0.802-0.902, p < 0.001). A concussion symptom scale based on degree of functional impairment correlates strongly with the SCAT-3 scale and demonstrates a similar association with time to clearance. By assessing the degree of impact on clinical functioning, this symptom scale reflects a more intuitive approach to rating symptoms and can be used in the management of concussion.Keywords: checklist, concussion, neurology, scale, sports, symptoms
Procedia PDF Downloads 15325 Collagen Deposition in Lung Parenchyma Driven by Depletion of LYVE-1+ Macrophages Protects Emphysema and Loss of Airway Function
Authors: Yinebeb Mezgebu Dagnachew, Hwee Ying Lim, Liao Wupeng, Sheau Yng Lim, Lim Sheng Jie Natalie, Veronique Angeli
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Collagen is essential for maintaining lung structure and function, and its remodeling has been associated with respiratory diseases, including chronic obstructive pulmonary disease (COPD). However, the cellular mechanisms driving collagen remodeling and the functional implications of this process in the pathophysiology of pulmonary diseases remain poorly understood. Using a mouse model of Lyve-1 expressing macrophage depletion, we found that the absence of this subpopulation of tissue-resident macrophage led to the preferential deposition of type I collagen fibers around the alveoli and bronchi in the steady state. Further analysis by polarized light microscopy revealed that the collagen fibers accumulating in the lungs depleted of Lyve-1+ macrophages were thicker and crosslinked. A decrease in MMP-9 gene expression and proteolytic activity, together with an increase in Col1a1, Timp-3 and Lox gene expression, accompanied the collagen alterations. Next, we investigated the effect of the collagen remodeling on the pathophysiology of COPD and airway function in mouse lacking Lyve-1+ macrophage exposed chronically to cigarette smoke (CS), a well-established animal model of COPD. We showed that the deposition of collagen protected mouse against the destruction of alveoli (emphysema) and bronchi thickening after CS exposure and prevented loss of airway function. Thus, we demonstrate that interstitial Lyve-1+ macrophages regulate the composition, amount, and architecture of the collagen network in the lungs and that such collagen remodeling functionally impacts the development of COPD. This study further supports the potential of targeting collagen as a promising approach to treating respiratory diseases.Keywords: lung, extracellular matrix, chronic obstructive pulmonary disease, matrix metalloproteinases, collagen
Procedia PDF Downloads 3724 Methylation Profiling and Validation of Candidate Tissue-Specific Differentially Methylated Regions for Identification of Human Blood, Saliva, Semen and Vaginal Fluid and Its Application in Forensics
Authors: Meenu Joshi, Natalie Naidoo, Farzeen Kader
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Identification of body fluids is an essential step in forensic investigation to aid in crime reconstruction. Tissue-specific differentially methylated regions (tDMRs) of the human genome can be targeted to be used as biomarkers to differentiate between body fluids. The present study was undertaken to establish the methylation status of potential tDMRs in blood, semen, saliva, and vaginal fluid by using methylation-specific PCR (MSP) and bisulfite sequencing (BS). The methylation statuses of 3 potential tDMRS in genes ZNF282, PTPRS, and HPCAL1 were analysed in 10 samples of each body fluid. With MSP analysis, the ZNF282, and PTPRS1 tDMR displayed semen-specific hypomethylation while HPCAL1 tDMR showed saliva-specific hypomethylation. With quantitative analysis by BS, the ZNF282 tDMR showed statistically significant difference in overall methylation between semen and all other body fluids as well as at individual CpG sites (p < 0.05). To evaluate the effect of environmental conditions on the stability of methylation profiles of the ZNF282 tDMR, five samples of each body fluid were subjected to five different forensic simulated conditions (dry at room temperature, wet in an exsiccator, outside on the ground, sprayed with alcohol, and sprayed with bleach) for 50 days. Vaginal fluid showed highest DNA recovery under all conditions while semen had least DNA quantity. Under outside on the ground condition, all body fluids except semen showed a decrease in methylation level; however, a significant decrease in methylation level was observed for saliva. A statistical significant difference was observed for saliva and semen (p < 0.05) for outside on the ground condition. No differences in methylation level were observed for the ZNF282 tDMR under all conditions for vaginal fluid samples. Thus, in the present study ZNF282 tDMR has been identified as a novel and stable semen-specific hypomethylation marker.Keywords: body fluids, bisulphite sequencing, forensics, tDMRs, MSP
Procedia PDF Downloads 16323 Association of Mir-196a Expression in Esophageal Tissue with Barrett´s Esophagus and Esophageal Adenocarcinoma
Authors: Petra Borilova Linhartova, Michaela Ruckova, Sabina Sevcikova, Natalie Mlcuchova, Jan Bohm, Katerina Zukalova, Monika Vlachova, Jiri Dolina, Lumir Kunovsky, Radek Kroupa, Zdenek Pavlovsky, Zdenek Danek, Tereza Deissova, Lydie Izakovicova Holla, Ondrej Slaby, Zdenek Kala
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Esophageal adenocarcinoma (EAC) is a highly aggressive malignancy that frequently develops from Barrett's esophagus (BE), a premalignant pathologic change occurring in the lower end of the esophagus. Specific microRNAs (miRNAs), small non-coding RNAs that function as posttranscriptional regulators of gene expression, were repeatedly proved to play key roles in the pathogenesis of these diseases. This pilot study aimed to analyze four selected miRNAs in esophageal tissues from healthy controls (HC) and patients with reflux esophagitis (RE)/BE/EAC, as well as to compare expression at the site of Barrett's mucosa/adenocarcinoma and healthy esophageal tissue outside the area of the main pathology in patients with BE/EAC. In this pilot study, 22 individuals (3 HC, 8 RE, 5 BE, 6 EAC) were included and endoscopically examined. RNA was isolated from the fresh-frozen esophageal tissue (stored in the RNAlater™ Stabilization Solution −70°C) using the AllPrep DNA/RNA/miRNA Universal Kit. Subsequent RT-qPCR analysis was performed using selected TaqMan MicroRNA Assays for miR-21, miR-34a, miR-196a, miR-196b, and endogenous control (RNU44). While the expression of miR-21 in the esophageal tissue with the main pathology was decreased in BE and EAC patients in comparison to the group of HC and RE patients (p=0.01), the expression of miR-196a was increased in the BE and EAC patients (p<0.01). Correlations between those miRNAs expression in tissue and severity of diagnosis were observed (p<0.05). In addition, miR-196a was significantly more expressed at the site with the main pathology than in paired adjacent esophageal tissue in BE and EAC patients (p<0.01). In conclusion, our pilot results showed that miR-196a, which regulates the proliferation, invasion, and migration (and was previously associated with esophageal squamous cell carcinoma and marked as a potential therapeutic target), could be a diagnostic tissue biomarker for BE and EAC as well.Keywords: microRNA, barrett´s esophagus, esophageal adenocarcinoma, biomarker
Procedia PDF Downloads 11222 Targeting Mre11 Nuclease Overcomes Platinum Resistance and Induces Synthetic Lethality in Platinum Sensitive XRCC1 Deficient Epithelial Ovarian Cancers
Authors: Adel Alblihy, Reem Ali, Mashael Algethami, Ahmed Shoqafi, Michael S. Toss, Juliette Brownlie, Natalie J. Tatum, Ian Hickson, Paloma Ordonez Moran, Anna Grabowska, Jennie N. Jeyapalan, Nigel P. Mongan, Emad A. Rakha, Srinivasan Madhusudan
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Platinum resistance is a clinical challenge in ovarian cancer. Platinating agents induce DNA damage which activate Mre11 nuclease directed DNA damage signalling and response (DDR). Upregulation of DDR may promote chemotherapy resistance. Here we have comprehensively evaluated Mre11 in epithelial ovarian cancers. In clinical cohort that received platinum- based chemotherapy (n=331), Mre11 protein overexpression was associated with aggressive phenotype and poor progression free survival (PFS) (p=0.002). In the ovarian cancer genome atlas (TCGA) cohort (n=498), Mre11 gene amplification was observed in a subset of serous tumours (5%) which correlated highly with Mre11 mRNA levels (p<0.0001). Altered Mre11 levels was linked with genome wide alterations that can influence platinum sensitivity. At the transcriptomic level (n=1259), Mre11 overexpression was associated with poor PFS (p=0.003). ROC analysis showed an area under the curve (AUC) of 0.642 for response to platinum-based chemotherapy. Pre-clinically, Mre11 depletion by gene knock down or blockade by small molecule inhibitor (Mirin) reversed platinum resistance in ovarian cancer cells and in 3D spheroid models. Importantly, Mre11 inhibition was synthetically lethal in platinum sensitive XRCC1 deficient ovarian cancer cells and 3D-spheroids. Selective cytotoxicity was associated with DNA double strand break (DSB) accumulation, S-phase cell cycle arrest and increased apoptosis. We conclude that pharmaceutical development of Mre11 inhibitors is a viable clinical strategy for platinum sensitization and synthetic lethality in ovarian cancer.Keywords: MRE11; XRCC1, ovarian cancer, platinum sensitization, synthetic lethality
Procedia PDF Downloads 12921 Alternative Ways of Knowing and the Construction of a Department Around a Common Critical Lens
Authors: Natalie Delia
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This academic paper investigates the transformative potential of incorporating alternative ways of knowing within the framework of Critical Studies departments. Traditional academic paradigms often prioritize empirical evidence and established methodologies, potentially limiting the scope of critical inquiry. In response to this, our research seeks to illuminate the benefits and challenges associated with integrating alternative epistemologies, such as indigenous knowledge systems, artistic expressions, and experiential narratives. Drawing upon a comprehensive review of literature and case studies, we examine how alternative ways of knowing can enrich and diversify the intellectual landscape of Critical Studies departments. By embracing perspectives that extend beyond conventional boundaries, departments may foster a more inclusive and holistic understanding of critical issues. Additionally, we explore the potential impact on pedagogical approaches, suggesting that alternative ways of knowing can stimulate alternative way of teaching methods and enhance student engagement. Our investigation also delves into the institutional and cultural shifts necessary to support the integration of alternative epistemologies within academic settings. We address concerns related to validation, legitimacy, and the potential clash with established norms, offering insights into fostering an environment that encourages intellectual pluralism. Furthermore, the paper considers the implications for interdisciplinary collaboration and the potential for cultivating a more responsive and socially engaged scholarship. By encouraging a synthesis of diverse perspectives, Critical Studies departments may be better equipped to address the complexities of contemporary issues, encouraging a dynamic and evolving field of study. In conclusion, this paper advocates for a paradigm shift within Critical Studies departments towards a more inclusive and expansive approach to knowledge production. By embracing alternative ways of knowing, departments have the opportunity to not only diversify their intellectual landscape but also to contribute meaningfully to broader societal dialogues, addressing pressing issues with renewed depth and insight.Keywords: critical studies, alternative ways of knowing, academic department, Wallerstein
Procedia PDF Downloads 7220 Advancing Urban Sustainability through the Integration of Planning Evaluation Methodologies
Authors: Natalie Rosales
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Based on an ethical vision which recognizes the vital role of human rights, shared values, social responsibility and justice, and environmental ethics, planning may be interpreted as a process aimed at reducing inequalities and overcoming marginality. Seen from this sustainability perspective, planning evaluation must utilize critical-evaluative and narrative receptive models which assist different stakeholders in their understanding of urban fabric while trigger reflexive processes that catalyze wider transformations. In this paper, this approach servers as a guide for the evaluation of Mexico´s urban planning systems, and postulates a framework to better integrate sustainability notions into planning evaluation. The paper is introduced by an overview of the current debate on evaluation in urban planning. The state of art presented includes: the different perspectives and paradigms of planning evaluation and their fundamentals and scope, which have focused on three main aspects; goal attainment (did planning instruments do what they were supposed to?); performance and effectiveness of planning (retrospective analysis of planning process and policy analysis assessment); and the effects of process-considering decision problems and contexts rather than the techniques and methods. As well as, methodological innovations and improvements in planning evaluation. This comprehensive literature review provides the background to support the authors’ proposal for a set of general principles to evaluate urban planning, grounded on a sustainability perspective. In the second part the description of the shortcomings of the approaches to evaluate urban planning in Mexico set the basis for highlighting the need of regulatory and instrumental– but also explorative- and collaborative approaches. As a response to the inability of these isolated methods to capture planning complexity and strengthen the usefulness of evaluation process to improve the coherence and internal consistency of the planning practice itself. In the third section the general proposal to evaluate planning is described in its main aspects. It presents an innovative methodology for establishing a more holistic and integrated assessment which considers the interdependence between values, levels, roles and methods, and incorporates different stakeholders in the evaluation process. By doing so, this piece of work sheds light on how to advance urban sustainability through the integration of evaluation methodologies into planning.Keywords: urban planning, evaluation methodologies, urban sustainability, innovative approaches
Procedia PDF Downloads 47619 Promoting Health and Academic Achievement: Mental Health Promoting Online Education
Authors: Natalie Frandsen
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Pursuing post-secondary education is a milestone for many Canadian youths. This transition involves many changes and opportunities for growth. However, this may also be a period where challenges arise. Perhaps not surprisingly, mental health challenges for post-secondary students are common. This poses difficulties for students and instructors. Common mental-health-related symptoms (e.g., low motivation, fatigue, inability to concentrate) can affect academic performance, and instructors may need to provide accommodations for these students without the necessary expertise. ‘Distance education’ has been growing and gaining momentum in Canada for three decades. As a consequence of the COVID-19 pandemic, post-secondary institutions have been required to deliver courses using ‘remote’ methods (i.e., various online delivery modalities). The learning challenges and subsequent academic performance issues experienced by students with mental-health-related disabilities studying online are not well understood. However, we can postulate potential factors drawing from learning theories, the relationship between mental-health-related symptoms and academic performance, and learning design. Identifying barriers and opportunities to academic performance is an essential step in ensuring that students with mental-health-related disabilities are able to achieve their academic goals. Completing post-secondary education provides graduates with more employment opportunities. It is imperative that our post-secondary institutions take a holistic view of learning by providing learning and mental health support while reducing structural barriers. Health-promoting universities and colleges infuse health into their daily operations and academic mandates. Acknowledged in this Charter is the notion that all sectors must take an active role in favour of health, social justice, and equity for all. Drawing from mental health promotion and Universal Design for Learning (UDL) frameworks, relevant adult learning concepts, and critical digital pedagogy, considerations for mental-health-promoting, online learning community development will be summarized. The education sector has the opportunity to create and foster equitable and mental health-promoting learning environments. This is of particular importance during a global pandemic when the mental health of students is being disproportionately impacted.Keywords: academic performance, community, mental health promotion, online learning
Procedia PDF Downloads 13618 Going Viral: Expanding a Student-Run COVID-19 Journal Club to Social Media
Authors: Joseph Dodson, Robert Roth, Alexander Hodakowski, Leah Greenfield, Melissa Porterhouse, Natalie Maltby, Rachel Sadowsky
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Introduction: Throughout the COVID-19 pandemic, countless research publications were released regarding SARS-CoV-2 and its variants, suggested treatments, and vaccine safety and efficacy. Daily publication of research became overwhelming for health professionals and the general public to stay informed. To address this problem, a group of 70 students across the four colleges at Rush University created the “Rush University COVID-19 Journal Club.” To broaden the available audience, the journal club then expanded to social media. Methods: Easily accessible and understandable summaries of the research were written by students and sent to faculty sponsors for feedback. Following the revision, summaries were published weekly on the Rush University COVID-19 Journal Club website for clinicians and students to use for reference. An Instagram page was then created, and information was further condensed into succinct posts to address COVID-19 “FAQs.” Next, a survey was distributed to followers of the Instagram page with questions meant to assess the effectiveness of the platform and gain feedback. A 5-point Likert scale was used as the primary question format. Results: The Instagram page accrued 749 followers and posted 52 unique posts over a 2 year period. Preliminary results from the surveys demonstrate that over 80% of respondents strongly agree that the Instagram posts 1) are an effective platform for the public presentation of factual COVID-19-related information; 2) provide relevant and valuable information; 3) provide information that is clear, concise, and can be easily understood. Conclusion: These results suggest that the Rush COVID-19 Journal Club was able to successfully create a social media presence and convey information without sacrificing scholarly integrity. Other academic institutions may benefit from the application of this model to help students and clinicians with the interpretation and evaluation of research topics with large bodies of evidence.Keywords: SARS-CoV-2, COVID-19, public health, social media, SARS-CoV-2 vaccine, SARS-CoV-2 variants
Procedia PDF Downloads 12817 Effectiveness of Self-Learning Module on the Academic Performance of Students in Statistics and Probability
Authors: Aneia Rajiel Busmente, Renato Gunio Jr., Jazin Mautante, Denise Joy Mendoza, Raymond Benedict Tagorio, Gabriel Uy, Natalie Quinn Valenzuela, Ma. Elayza Villa, Francine Yezha Vizcarra, Sofia Madelle Yapan, Eugene Kurt Yboa
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COVID-19’s rapid spread caused a dramatic change in the nation, especially the educational system. The Department of Education was forced to adopt a practical learning platform without neglecting health, a printed modular distance learning. The Philippines' K–12 curriculum includes Statistics and Probability as one of the key courses as it offers students the knowledge to evaluate and comprehend data. Due to student’s difficulty and lack of understanding of the concepts of Statistics and Probability in Normal Distribution. The Self-Learning Module in Statistics and Probability about the Normal Distribution created by the Department of Education has several problems, including many activities, unclear illustrations, and insufficient examples of concepts which enables learners to have a difficulty accomplishing the module. The purpose of this study is to determine the effectiveness of self-learning module on the academic performance of students in the subject Statistics and Probability, it will also explore students’ perception towards the quality of created Self-Learning Module in Statistics and Probability. Despite the availability of Self-Learning Modules in Statistics and Probability in the Philippines, there are still few literatures that discuss its effectiveness in improving the performance of Senior High School students in Statistics and Probability. In this study, a Self-Learning Module on Normal Distribution is evaluated using a quasi-experimental design. STEM students in Grade 11 from National University's Nazareth School will be the study's participants, chosen by purposive sampling. Google Forms will be utilized to find at least 100 STEM students in Grade 11. The research instrument consists of 20-item pre- and post-test to assess participants' knowledge and performance regarding Normal Distribution, and a Likert scale survey to evaluate how the students perceived the self-learning module. Pre-test, post-test, and Likert scale surveys will be utilized to gather data, with Jeffreys' Amazing Statistics Program (JASP) software being used for analysis.Keywords: self-learning module, academic performance, statistics and probability, normal distribution
Procedia PDF Downloads 11416 Effect of Repellent Coatings, Aerosol Protective Liners, and Lamination on the Properties of Chemical/Biological Protective Textiles
Authors: Natalie Pomerantz, Nicholas Dugan, Molly Richards, Walter Zukas
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The primary research question to be answered for Chemical/Biological (CB) protective clothing, is how to protect wearers from a range of chemical and biological threats in liquid, vapor, and aerosol form, while reducing the thermal burden. Currently, CB protective garments are hot, heavy, and wearers are limited by short work times in order to prevent heat injury. This study demonstrates how to incorporate different levels of protection on a material level and modify fabric composites such that the thermal burden is reduced to such an extent it approaches that of a standard duty uniform with no CB protection. CB protective materials are usually comprised of several fabric layers: a cover fabric with a liquid repellent coating, a protective layer which is comprised of a carbon-based sorptive material or semi-permeable membrane, and a comfort next-to-skin liner. In order to reduce thermal burden, all of these layers were laminated together to form one fabric composite which had no insulative air gap in between layers. However, the elimination of the air gap also reduced the CB protection of the fabric composite. In order to increase protection in the laminated composite, different nonwoven aerosol protective liners were added, and a super repellent coating was applied to the cover fabric, prior to lamination. Different adhesive patterns were investigated to determine the durability of the laminate with the super repellent coating, and the effect on air permeation. After evaluating the thermal properties, textile properties and protective properties of the iterations of these fabric composites, it was found that the thermal burden of these materials was greatly reduced by decreasing the thermal resistance with the elimination of the air gap between layers. While the level of protection was reduced in laminate composites, the addition of a super repellent coating increased protection towards low volatility agents without impacting thermal burden. Similarly, the addition of aerosol protective liner increased protection without reducing water vapor transport, depending on the nonwoven used, however, the air permeability was significantly decreased. The balance of all these properties and exploration of the trade space between thermal burden and protection will be discussed.Keywords: aerosol protection, CBRNe protection, lamination, nonwovens, repellent coatings, thermal burden
Procedia PDF Downloads 36415 The Economic Burden of Mental Disorders: A Systematic Review
Authors: Maria Klitgaard Christensen, Carmen Lim, Sukanta Saha, Danielle Cannon, Finley Prentis, Oleguer Plana-Ripoll, Natalie Momen, Kim Moesgaard Iburg, John J. McGrath
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Introduction: About a third of the world’s population will develop a mental disorder over their lifetime. Having a mental disorder is a huge burden in health loss and cost for the individual, but also for society because of treatment cost, production loss and caregivers’ cost. The objective of this study is to synthesize the international published literature on the economic burden of mental disorders. Methods: Systematic literature searches were conducted in the databases PubMed, Embase, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to 1980 until May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses, (2) diagnosis of at least one mental disorder, (3) samples based on the general population, and (4) outcome in monetary units. 13,640 publications were screened by their title/abstract and 439 articles were full-text screened by at least two independent reviewers. 112 articles were included from the systematic searches and 31 articles from snowball searching, giving a total of 143 included articles. Results: Information about diagnosis, diagnostic criteria, sample size, age, sex, data sources, study perspective, study period, costing approach, cost categories, discount rate and production loss method and cost unit was extracted. The vast majority of the included studies were from Western countries and only a few from Africa and South America. The disorder group most often investigated was mood disorders, followed by schizophrenia and neurotic disorders. The disorder group least examined was intellectual disabilities, followed by eating disorders. The preliminary results show a substantial variety in the used perspective, methodology, costs components and outcomes in the included studies. An online tool is under development enabling the reader to explore the published information on costs by type of mental disorder, subgroups, country, methodology, and study quality. Discussion: This is the first systematic review synthesizing the economic cost of mental disorders worldwide. The paper will provide an important and comprehensive overview over the economic burden of mental disorders, and the output from this review will inform policymaking.Keywords: cost-of-illness, health economics, mental disorders, systematic review
Procedia PDF Downloads 13114 Thinking Differently about Diversity: A Literature Review
Authors: Natalie Rinfret, Francine Tougas, Ann Beaton
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Conventions No. 100 and 111 of the International Labor Organization, passed in 1951 and 1958 respectively, established the principles of equal pay for men and women for work of equal value and freedom from discrimination in employment. Governments of different countries followed suit. For example, in 1964, the Civil Rights Act was passed in the United States and in 1972, Canada ratified Convention 100. Thus, laws were enacted and programs were implemented to combat discrimination in the workplace and, over time, more than 90% of the member countries of the International Labour Organization have ratified these conventions by implementing programs such as employment equity in Canada aimed at groups recognized as being discriminated against in the labor market, including women. Although legislation has been in place for several decades, employment discrimination has not gone away. In this study, we pay particular attention to the hidden side of the effects of employment discrimination. This is the emergence of subtle forms of discrimination that often fly under the radar but nevertheless, have adverse effects on the attitudes and behaviors of members of targeted groups. Researchers have identified two forms of racial and gender bias. On the one hand, there are traditional prejudices referring to beliefs about the inferiority and innate differences of women and racial minorities compared to White men. They have the effect of confining these two groups to job categories suited to their perceived limited abilities and can result in degrading, if not violent and hateful, language and actions. On the other hand, more subtle prejudices are more suited to current social norms. However, this subtlety harbors a conflict between values of equality and remnants of negative beliefs and feelings toward women and racial minorities. Our literature review also takes into account an overlooked part of the groups targeted by the programs in place, senior workers, and highlights the quantifiable and observable effects of prejudice and discriminatory behaviors in employment. The study proposes a hybrid model of interventions, taking into account the organizational system (employment equity practices), discriminatory attitudes and behaviors, and the type of leadership to be advocated. This hybrid model includes, in the first instance, the implementation of initiatives aimed at both promoting employment equity and combating discrimination and, in the second instance, the establishment of practices that foster inclusion, the full and complete participation of all, including seniors, in the mission of their organization.Keywords: employment discrimination, gender bias, the hybrid model of interventions, senior workers
Procedia PDF Downloads 22113 Effective Service Provision and Multi-Agency Working in Service Providers for Children and Young People with Special Educational Needs and Disabilities: A Mixed Methods Systematic Review
Authors: Natalie Tyldesley-Marshall, Janette Parr, Anna Brown, Yen-Fu Chen, Amy Grove
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It is widely recognised in policy and research that the provision of services for children and young people (CYP) with Special Educational Needs and Disabilities (SEND) is enhanced when health and social care, and education services collaborate and interact effectively. In the UK, there have been significant changes to policy and provisions which support and improve collaboration. However, professionals responsible for implementing these changes face multiple challenges, including a lack of specific implementation guidance or framework to illustrate how effective multi-agency working could or should work. This systematic review will identify the key components of effective multi-agency working in services for CYP with SEND; and the most effective forms of partnership working in this setting. The review highlights interventions that lead to service improvements; and the conditions in the local area that support and encourage success. A protocol was written and registered with PROSPERO registration: CRD42022352194. Searches were conducted on several health, care, education, and applied social science databases from the year 2012 onwards. Citation chaining has been undertaken, as well as broader grey literature searching to enrich the findings. Qualitative, quantitative, mixed methods studies and systematic reviews were included, assessed independently, and critically appraised or assessed for risk of bias using appropriate tools based on study design. Data were extracted in NVivo software and checked by a more experienced researcher. A convergent segregated approach to synthesis and integration was used in which the quantitative and qualitative data were synthesised independently and then integrated using a joint display integration matrix. Findings demonstrate the key ingredients for effective partnership working for services delivering SEND. Interventions deemed effective are described, and lessons learned across interventions are summarised. Results will be of interest to educators and health and social care professionals that provide services to those with SEND. These will also be used to develop policy recommendations for how UK healthcare, social care, and education services for CYP with SEND aged 0-25 can most effectively collaborate and achieve service improvement. The review will also identify any gaps in the literature to recommend areas for future research. Funding for this review was provided by the Department for Education.Keywords: collaboration, joint commissioning, service delivery, service improvement
Procedia PDF Downloads 10712 Getting It Right Before Implementation: Using Simulation to Optimize Recommendations and Interventions After Adverse Event Review
Authors: Melissa Langevin, Natalie Ward, Colleen Fitzgibbons, Christa Ramsey, Melanie Hogue, Anna Theresa Lobos
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Description: Root Cause Analysis (RCA) is used by health care teams to examine adverse events (AEs) to identify causes which then leads to recommendations for prevention Despite widespread use, RCA has limitations. Best practices have not been established for implementing recommendations or tracking the impact of interventions after AEs. During phase 1 of this study, we used simulation to analyze two fictionalized AEs that occurred in hospitalized paediatric patients to identify and understand how the errors occurred and generated recommendations to mitigate and prevent recurrences. Scenario A involved an error of commission (inpatient drug error), and Scenario B involved detecting an error that already occurred (critical care drug infusion error). Recommendations generated were: improved drug labeling, specialized drug kids, alert signs and clinical checklists. Aim: Use simulation to optimize interventions recommended post critical event analysis prior to implementation in the clinical environment. Methods: Suggested interventions from Phase 1 were designed and tested through scenario simulation in the clinical environment (medicine ward or pediatric intensive care unit). Each scenario was simulated 8 times. Recommendations were tested using different, voluntary teams and each scenario was debriefed to understand why the error was repeated despite interventions and how interventions could be improved. Interventions were modified with subsequent simulations until recommendations were felt to have an optimal effect and data saturation was achieved. Along with concrete suggestions for design and process change, qualitative data pertaining to employee communication and hospital standard work was collected and analyzed. Results: Each scenario had a total of three interventions to test. In, scenario 1, the error was reproduced in the initial two iterations and mitigated following key intervention changes. In scenario 2, the error was identified immediately in all cases where the intervention checklist was utilized properly. Independently of intervention changes and improvements, the simulation was beneficial to identify which of these should be prioritized for implementation and highlighted that even the potential solutions most frequently suggested by participants did not always translate into error prevention in the clinical environment. Conclusion: We conclude that interventions that help to change process (epinephrine kit or mandatory checklist) were more successful at preventing errors than passive interventions (signage, change in memory aids). Given that even the most successful interventions needed modifications and subsequent re-testing, simulation is key to optimizing suggested changes. Simulation is a safe, practice changing modality for institutions to use prior to implementing recommendations from RCA following AE reviews.Keywords: adverse events, patient safety, pediatrics, root cause analysis, simulation
Procedia PDF Downloads 152