Search results for: patient safety incidents

Authors: Neha P. Amin, Maliha Zainib, Sean Parker, Malcolm Mattes

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Purpose/Objectives: Combination immunotherapy (IT) and radiation therapy (RT) is an actively growing field of clinical investigation due to promising findings of synergistic effects from immune-mediated mechanisms observed in preclinical studies and clinical data from case reports of abscopal effects. While there are many ongoing trials of combined IT-RT, there are still limited data on toxicity and outcome optimization regarding RT dose, fractionation, and sequencing of RT with IT. Nivolumab (NIVO), an anti-PD-1 monoclonal antibody, has been rapidly adopted in the clinic over the past 2 years, resulting in more patients being considered for concurrent RT-NIVO. Knowledge about the toxicity profile of combined RT-NIVO is important for both the patient and physician when making educated treatment decisions. The acute toxicity profile of concurrent RT-NIVO was analyzed in this study. Materials/Methods: A retrospective review of all consecutive patients who received NIVO from 1/2015 to 5/2017 at 4 separate centers within two separate institutions was performed. Those patients who completed a course of RT from 1 day prior to initial NIVO infusion through 1 month after last NIVO infusion were considered to have received concurrent therapy and included in the subsequent analysis. Descriptive statistics are reported for patient/tumor/treatment characteristics and observed acute toxicities within 3 months of RT completion. Results: Among 261 patients who received NIVO, 46 (17.6%) received concurrent RT to 67 different sites. The median f/u was 3.3 (.1-19.8) months, and 11/46 (24%) were still alive at last analysis. The most common histology, RT prescription, and treatment site included non-small cell lung cancer (23/46, 50%), 30 Gy in 10 fractions (16/67, 24%), and central thorax/abdomen (26/67, 39%), respectively. 79% (53/67) of irradiated sites were treated with 3D-conformal technique and palliative dose-fractionation. Grade 3, 4, and 5 toxicities were experienced by 11, 1, and 2 patients, respectively. However all grade 4 and 5 toxicities were outside of the irradiated area and attributed to the NIVO alone, and only 4/11 (36%) of the grade 3 toxicities were attributed to the RT-NIVO. The irradiated site in these cases included the brain [2/10 (20%)] and central thorax/abdomen [2/19 (10.5%)], including one unexpected grade 3 pancreatitides following stereotactic body RT to the left adrenal gland. Conclusions: Concurrent RT-NIVO is generally well tolerated, though with potentially increased rates of severe toxicity when irradiating the lung, abdomen, or brain. Pending more definitive data, we recommend counseling patients on the potentially increased rates of side effects from combined immunotherapy and radiotherapy to these locations. Future prospective trials assessing fractionation and sequencing of RT with IT will help inform combined therapy recommendations.

Keywords: combined immunotherapy and radiation, immunotherapy, Nivolumab, toxicity of concurrent immunotherapy and radiation

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Authors: S. Selman, T. Gout

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Microbial keratitis is a serious complication of contact lens wear that can be vision and eye-threatening. Diverse presentations relating to contact lens wear include dry corneal surface, corneal infiltrate, ulceration, scarring, and complete corneal melt leading to perforation. Contact lens wear is a major risk factor and, as such, is an important consideration in any patient presenting with a red eye in the primary care setting. This paper aims to provide an overview of the risk factors, common organisms, and spectrum of contact lens-associated keratitis (CLAK) complications. It will highlight some of the salient points relevant to the assessment and workup of patients suspected of CLAK in the emergency department based on the recent literature and therapeutic guidelines. An overview of the management principles will also be provided.

Keywords: microbial keratitis, corneal pathology, contact lens-associated complications, painful vision loss

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Authors: Nouha Bouayed Abdelmoula, Rim Louati, Nawel Abdellaoui, Balkiss Abdelmoula, Oldez Kaabi, Walid Smaoui, Samir Aloulou

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Background and Aims: Cardiofaciocutaneous syndrome (CFC) is an autosomal dominant disorder with the vast majority of cases arising by a new mutation of BRAF, MEK1, MEK2, or rarely, KRAS genes. Here, we report a rare Tunisian case of CFC syndrome for whom we identify SOS1 mutation. Methods: Genomic DNA was obtained from peripheral blood collected in an EDTA tube and extracted from leukocytes using the phenol/chloroform method according to standard protocols. High resolution melting (HRM) analysis for screening of mutations in the entire coding sequence of PTPN11 was conducted first. Then, HRM assays to look for hot spot mutations coding regions of the other genes of the RAS-MAPK pathway (RAt Sarcoma viral oncogene homolog Mitogen-Activated Protein Kinases Pathway): SOS1, SHOC2, KRAS, RAF1, KRAS, NRAS, CBL, BRAF, MEK1, MEK2, HRAS, and RIT1, were applied. Results: Heterozygous SOS1 point mutation clustered in exon 10, which encodes for the PH domain of SOS1, was identified: c.1655 G > A. The patient was a 9-year-old female born from a consanguineous couple. She exhibited pulmonic valvular stenosis as congenital heart disease. She had facial features and other malformations of Noonan syndrome, including macrocephaly, hypertelorism, ptosis, downslanting palpebral fissures, sparse eyebrows, a short and broad nose with upturned tip, low-set ears, high forehead commonly associated with bitemporal narrowing and prominent supraorbital ridges, short and/or webbed neck and short stature. However, the phenotype is also suggestive of CFC syndrome with the presence of more severe ectodermal abnormalities, including curly hair, keloid scars, hyperkeratotic skin, deep plantar creases, and delayed permanent dentition with agenesis of the right maxillary first molar. Moreover, the familial history of the patient revealed recurrent brain malignancies in the paternal family and epileptic disease in the maternal family. Conclusions: This case report of an overlapping RASopathy associated with SOS1 mutation and familial history of brain tumorigenesis is exceptional. The evidence suggests that RASopathies are truly cancer-prone syndromes, but the magnitude of the cancer risk and the types of cancer partially overlap.

Keywords: cardiofaciocutaneous syndrome, CFC, SOS1, brain cancer, germline mutation

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Authors: J. E. Appel, R. N. Bouwmeester, L. Crombach, K. Georgieva, N. O’Shea, T. I. van Rijssel, L. Wingens

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The Netherlands has a unique and progressive euthanasia law. Even people with advanced neurodegenerative diseases, like dementia, can request euthanasia when an Advanced Euthanasia Directive (AED) was written. Although the law sets some guidelines, in practice many complexities occur. Especially doctors experience difficult situations, as they have to decide whether euthanasia is justified. Research suggests that this leads to an emotional burden for them, due to feelings of isolation, fear of prosecution, as well as pressures from patient, family, or society. Existing literature, however, failed to address problems arising in dementia cases in particular, as well as possible sources of support. In order to investigate these issues, semi-structured in-depth interviews with 20 Dutch general practitioners and elderly care physicians will be conducted. Results are expected to be obtained by the end of December 2017.

Keywords: dementia, euthanasia, general practitioners, elderly care physicians, palliative care

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Authors: Fahad A. Alotaibi

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An increase in salt dissolution rate with continuous water flow is expected to lead to the progressive collapse of the soil structure. Evaluation of the relationship between soil salt dissolution and the variation of sabkha soil permeability in terms of type, rate, and quantity in order to assure construction safety in these environments. The current study investigates the relationship of soil permeability with the rate of dissolution of calcium (Ca2+), sulfate (SO4-2), chloride (CL−1), magnesium (Mg2+), sodium (Na+), and potassium (K+1) ions. Results revealed an increase in sabkha soil permeability with the rate of ions dissolution. This makes the efficiency of using a waterproofing stabilization agent in the reduction of sabkha salts dissolution the main criterion is selecting suitable stabilizing method.

Keywords: sabkha, permeability, salts, dissolution

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Authors: L. Parisi

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Kinematic data wisely correlate vector quantities in space to scalar parameters in time to assess the degree of symmetry between the intact limb and the amputated limb with respect to a normal model derived from the gait of control group participants. Furthermore, these particular data allow a doctor to preliminarily evaluate the usefulness of a certain rehabilitation therapy. Kinetic curves allow the analysis of ground reaction forces (GRFs) to assess the appropriateness of human motion. Electromyography (EMG) allows the analysis of the fundamental lower limb force contributions to quantify the level of gait asymmetry. However, the use of this technological tool is expensive and requires patient’s hospitalization. This research work suggests overcoming the above limitations by applying artificial neural networks.

Keywords: kinetics, kinematics, cyclograms, neural networks, transtibial amputation

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Authors: C. Shih, J. R. Wang, H. C. Chang, S. W. Chen, S. C. Chiang, T. Y. Yu

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After the measurement uncertainty recapture (MUR) power uprates, Kuosheng nuclear power plant (NPP) was uprated the power from 2894 MWt to 2943 MWt. For power upgrade, several codes (e.g., TRACE, RELAP5, etc.) were applied to assess the safety of Kuosheng NPP. Hence, the main work of this research is to establish a RELAP5/MOD3.3 model of Kuosheng NPP with SNAP interface. The establishment of RELAP5/SNAP model was referred to the FSAR, training documents, and TRACE model which has been developed and verified before. After completing the model establishment, the startup test scenarios would be applied to the RELAP5/SNAP model. With comparing the startup test data and TRACE analysis results, the applicability of RELAP5/SNAP model would be assessed.

Keywords: RELAP5, TRACE, SNAP, BWR

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Authors: Sanjay Shukla

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Excessive use of antibiotics is a main problem in the treatment of wounds and other chronic infections and antibiotic treatment is frequently non-curative, thus alternative treatment is necessary. Phage therapy is considered one of the most effective approaches to treat multi-drug resistant bacterial pathogens. Infections caused by Staphylococcus aureus are very efficiently controlled with phage cocktails, containing a different individual phages lysate infecting a majority of known pathogenic S. aureus strains. The aim of current study was to investigate the efficiency of a purified phage cocktail for prophylactic as well as therapeutic application in mouse model and in large animals with chronic septic infection of wounds. A total of 150 sewage samples were collected from various livestock farms. These samples were subjected for the isolation of bacteriophage by double agar layer method. A total of 27 sewage samples showed plaque formation by producing lytic activity against S. aureus in double agar overlay method out of 150 sewage samples. In TEM recovered isolates of bacteriophages showed hexagonal structure with tail fiber. In the bacteriophage (ØVS) had an icosahedral symmetry with the head size 52.20 nm in diameter and long tail of 109 nm. Head and tail were held together by connector and can be classified as a member of the Myoviridae family under the order of Caudovirale. Recovered bacteriophage had shown the antibacterial activity against the S. aureus in vitro. Cocktail (ØVS1, ØVS5, ØVS9 and ØVS 27) of phage lysate were tested to know in vivo antibacterial activity as well as the safety profile. Result of mice experiment indicated that the bacteriophage lysate was very safe, did not show any appearance of abscess formation which indicates its safety in living system. The mice were also prophylactically protected against S. aureus when administered with cocktail of bacteriophage lysate just before the administration of S. aureus which indicates that they are good prophylactic agent. The S. aureus inoculated mice were completely recovered by bacteriophage administration with 100% recovery which was very good as compere to conventional therapy. In present study ten chronic cases of wound were treated with phage lysate and follow up of these cases was done regularly up to ten days (at 0, 5 and 10 d). Result indicated that the six cases out of ten showed complete recovery of wounds within 10 d. The efficacy of bacteriophage therapy was found to be 60% which was very good as compared to the conventional antibiotic therapy in chronic septic wounds infections. Thus, the application of lytic phage in single dose proved to be innovative and effective therapy for treatment of septic chronic wounds.

Keywords: phage therapy, phage lysate, antimicrobial resistance, S. aureus

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Authors: Ahmed Emad, Ahmed Salah, Abdelrahman Magdy, Omar Rashid, Mohammed Adel

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This research paper discusses vehicle-to-vehicle technology as an important application of linear algebra. This communication technology represents an efficient and promising application to help to ensure the safety of the drivers by warning them when a crash possibility is close. The major link that combines our topic with linear algebra is the Laplacian matrix. Some main definitions used in the V2V were illustrated, such as VANET and its characteristics. The V2V technology could be applied in different applications with different traffic scenarios and various ways to warn car drivers. These scenarios were simulated programs such as MATLAB and Python to test how the V2V system would respond to the different scenarios and warn the car drivers exposed to the threat of collisions.

Keywords: V2V communication, vehicle to vehicle scenarios, VANET, FCW, EEBL, IMA, Laplacian matrix

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Authors: Yu-Yu Wang, Shih-Hua Hsieh, Ru-Shian Hsieh

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Wishes and choices being respected, and the right to be supported rather than coerced, have been internationally recognized as the human rights of persons with mental illness. In Taiwan, ‘coerced hospitalization’ has become difficult since the revision of the mental health legislation in 2007. Despite trend towards human rights, the real problem families face when their family members are in mental health crisis is the lack of alternative services. This study aims to explore: 1) When is hospitalization seen as the only solution by family members? 2) What are the barriers for arranging hospitalization, and how are they managed? 3) What have family carers learned, in their experiences of caring for their family members with mental illness? To answer these questions, qualitative approach was adopted, and focus group interviews were taken to collect data. This study includes 24 family carers. The main findings of this research include: First, hospital is the last resort for carers in helplessness. Family carers tend to do everything they could to provide care at home for their family members with mental illness. Carers seek hospitalization only when a patient’s behavior is too violent, weird, and/or abnormal, and beyond their ability to manage. Hospitalization, nevertheless, is never an easy choice. Obstacles emanate from the attitudes of the medical doctors, the restricted areas of ambulance service, and insufficient information from the carers’ part. On the other hand, with some professionals’ proactive assistance, access to medical care while in crisis becomes possible. Some family carers obtained help from the medical doctor, nurse, therapist and social workers. Some experienced good help from policemen, taxi drivers, and security guards at the hospital. The difficulty in accessing medical care prompts carers to work harder on assisting their family members with mental illness to stay in stable states. Carers found different ways of helping the ‘person’ to get along with the ‘illness’ and have better quality of life. Taking back ‘the right to control’ in utilizing medication, from passiveness to negotiating with medical doctors and seeking alternative therapies, are seen in many carers’ efforts. Besides, trying to maintain regular activities in daily life and play normal family roles are also experienced as important. Furthermore, talking with the patient as a person is also important. The authors conclude that in order to protect the human rights of persons with mental illness, it is crucial to make the medical care system more flexible and to make the services more humane: sufficient information should be provided and communicated, and efforts should be made to maintain the person’s social roles and to support the family.

Keywords: family carers, independent living, mental health crisis, persons with mental illness

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Authors: Abdul Basit Kiani

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Web development, the art of creating and maintaining websites, has witnessed remarkable advancements. The aim is to provide an overview of some of the cutting-edge developments in the field. Firstly, the rise of responsive web design has revolutionized user experiences across devices. With the increasing prevalence of smartphones and tablets, web developers have adapted to ensure seamless browsing experiences, regardless of screen size. This progress has greatly enhanced accessibility and usability, catering to the diverse needs of users worldwide. Additionally, the evolution of web frameworks and libraries has significantly streamlined the development process. Tools such as React, Angular, and Vue.js have empowered developers to build dynamic and interactive web applications with ease. These frameworks not only enhance efficiency but also bolster scalability, allowing for the creation of complex and feature-rich web solutions. Furthermore, the emergence of progressive web applications (PWAs) has bridged the gap between native mobile apps and web development. PWAs leverage modern web technologies to deliver app-like experiences, including offline functionality, push notifications, and seamless installation. This innovation has transformed the way users interact with websites, blurring the boundaries between traditional web and mobile applications. Moreover, the integration of artificial intelligence (AI) and machine learning (ML) has opened new horizons in web development. Chatbots, intelligent recommendation systems, and personalization algorithms have become integral components of modern websites. These AI-powered features enhance user engagement, provide personalized experiences, and streamline customer support processes, revolutionizing the way businesses interact with their audiences. Lastly, the emphasis on web security and privacy has been a pivotal area of progress. With the increasing incidents of cyber threats, web developers have implemented robust security measures to safeguard user data and ensure secure transactions. Innovations such as HTTPS protocol, two-factor authentication, and advanced encryption techniques have bolstered the overall security of web applications, fostering trust and confidence among users. Hence, recent progress in web development has propelled the industry forward, enabling developers to craft innovative and immersive digital experiences. From responsive design to AI integration and enhanced security, the landscape of web development continues to evolve, promising a future filled with endless possibilities.

Keywords: progressive web applications (PWAs), web security, machine learning (ML), web frameworks, advancement responsive web design

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Authors: Phanumas Khumsat, Chalermchai Janmane

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Low-voltage instrumentation amplifier has been proposed for 3-lead electrocardiogram measurement system. The circuit’s interference rejection technique is based upon common-mode feed-forwarding where common-mode currents have cancelled each other at the output nodes. The common-mode current for cancellation is generated by means of common-mode sensing and emitter or source followers with resistors employing only one transistor. Simultaneously this particular transistor also provides common-mode feedback to the patient’s right/left leg to further reduce interference entering the amplifier. The proposed designs have been verified with simulations in 0.18-µm CMOS process operating under 1.0-V supply with CMRR greater than 80dB. Moreover ECG signals have experimentally recorded with the proposed instrumentation amplifiers implemented from discrete BJT (BC547, BC558) and MOSFET (ALD1106, ALD1107) transistors working with 1.5-V supply.

Keywords: electrocardiogram, common-mode feedback, common-mode feedforward, communication engineering

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Authors: Rajib Husain, Munirujzaman Osmani, Mohammad Shamsal Islam

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Purpose: To compare the safety, efficacy and visual outcome of phacoemulsification vs. manual small-incision cataract surgery (SICS) for the treatment of cataract in Bangladesh. Objectives: 1. To assess the Visual outcome after cataract surgery 2. To understand the post-operative complications and early rehabilitation 3. To identified which surgical procedure more attractive to the patients 4. To identify which surgical procedure is occurred fewer complications. 5. To find out the socio-economic and demographic characteristics of study patients Setting: Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh. Design: Retrospective, randomised comparison of 300 patients with visually significant cataracts. Method: The present study was designed as a retrospective hospital-based research. The sample size was 300 and study period was from July, 2012 to July, 2013 and assigned randomly to receive either phacoemulsification or manual small-incision cataract surgery (SICS). Preoperative and post-operative data were collected through a well designed collection format. Three follow-up were done; i) during discharge ii) 1-3 weeks & iii) 4-11 weeks post operatively. All preoperative and surgical complications, uncorrected and best-corrected visual acuity (BCVA) and astigmatism were taken into consideration for comparison of outcome Result: Nearly 95% patients were more than 40 years of age. About 52% patients were female, and 48% were male. 52% (N=157) patients came to operate their first eye where 48% (N=143) patients were visited again to operate their second eye. Postoperatively, five eyes (3.33%) developed corneal oedema with >10 Descemets folds, and six eyes (4%) had corneal oedema with <10 Descemets folds for Phacoemulsification surgeries. For SICS surgeries, seven eyes (4.66%) developed corneal oedema with >10 Descemets folds and eight eyes (5.33%) had corneal oedema with < 10 descemets folds. However, both the uncorrected and corrected (4-11 weeks) visual acuities were better in the eyes that had phacoemulsification (p=0.02 and p=0.03), and there was less astigmatism (p=0.001) at 4-11 weeks in the eye that had phacoemulsification. Best-corrected visual acuity (BCVA) of final follow-up 95% (N=253) had a good outcome, borderline 3.10% (N=40) and poor outcome was 1.6% (N=7). The individual surgeon outcome were closer, 95% (BCVA) in SICS and 96% (BCVA) in Phacoemulsification at 4-11 weeks follow-up respectively. Conclusion: outcome of cataract surgery both Phacoemulsification and SICS in CEITC was more satisfactory according to who norms. Both Phacoemulsification and manual small-incision cataract surgery (SICS) shows excellent visual outcomes with low complication rates and good rehabilitation. Phacoemulsification is significantly faster, and modern technology based surgical procedure for cataract treatment.

Keywords: phacoemulsification, SICS, cataract, Bangladesh, visual outcome of SICS

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Authors: Saleh Mobasseri, Mohammad Mobasseri

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The article refers to the history of the rise of brake system and described it’s importance in passenger’s lives. The disc brake system performance and ABS are also compared with each other by the kinetic and kinematic analysis of the braking system,and evaluate the impact of each parameters is checked on the vehicle stopping distance. Anti−lock braking system (ABS) is one of the most important features that affect on vehicle safety and for this reason much efforts have been made to improve this system. The objectives of the anti−lock system (ABS) are as follows: Preventing the wheels from locking, achieving maximum technical momentum in terms of braking,stability,reducing stopping distances. In this paper,we study the comparative of ABS brake and disc brake.

Keywords: anti−lock braking System (ABS), stopping distances, booster, car stability, force exerted on the brake pedal

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Authors: Lisseth Rojas Barreto, Carlos Muñoz Hernández

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The COVID-19 pandemic led to many abrupt changes, including a prolonged lockdown, which brought about work and personal challenges to the population worldwide. Among the most affected populations are women who are workers and housewives at the same time, and especially those who are also parenting. These women were faced with the challenge to perform their usual varied roles during the lockdown from the same physical space, which inevitably had strong repercussions for each of them. This paper will present some results of a research study whose main objective was to examine the possible effects that the COVID-19 pandemic lockdown may have caused in the work, social, family, and personal environments of female English teachers who are also housewives and, by extension in the teaching and learning processes that they lead. Participants included five female English language teachers of a public foreign language school, they are all married, and two of them have children. Similarly, we examined some of the coping strategies these teachers used to tackle the pandemic-related challenges in their different roles, especially those used for their language teaching role; coping strategies are understood as a repertoire of behaviors in response to incidents that can be stressful for the subject, possible challenging events or situations that involve emotions with behaviors and decision-making of people which are used in order to find a meaning or positive result (Lazarus &Folkman, 1986) Following a qualitative-case study design, we gathered the data through a survey and a focus group interview with the participant teachers who work at a public language school in southern Colombia. Preliminary findings indicate that the circumstances that emerged as a result of the pandemic lockdown affected the participants in different ways, including financial, personal, family, health, and work-related issues. Among the strategies that participants found valuable to deal with the novel circumstances, we can highlight the reorganization of the household and work tasks and the increased awareness of time management for the household, work, and leisure. Additionally, we were able to evidence that the participants faced the circumstances with a positive view. Finally, in order to cope with their teaching duties, some participants acknowledged their lack of computer or technology literacy in order to deliver their classes online, which made them find support from their students or more knowledgeable peers to cope with it. Others indicated that they used strategies such as self-learning in order to get acquainted and be able to use the different technological tools and web-based platforms available.

Keywords: coping strategies, language teaching, female teachers, pandemic lockdown

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Authors: J. R. Wang, Y. Chiang, W. S. Hsu, S. H. Chen, J. H. Yang, S. W. Chen, C. Shih, Y. F. Chang, Y. H. Huang, B. R. Shen

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In this research, the RASCAL code was used to simulate and analyze the postulated UF₆ fire accident which may occur in the Institute of Nuclear Energy Research (INER). There are four main steps in this research. In the first step, the UF₆ data of INER were collected. In the second step, the RASCAL analysis methodology and model was established by using these data. Third, this RASCAL model was used to perform the simulation and analysis of the postulated UF₆ fire accident. Three cases were simulated and analyzed in this step. Finally, the analysis results of RASCAL were compared with the hazardous levels of the chemicals. According to the compared results of three cases, Case 3 has the maximum danger in human health.

Keywords: RASCAL, UF₆, safety, hydrogen fluoride

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Authors: L. Onal

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The aim of this study is to optimize manufacturing process for thermoplastic sandwich composite structures for the pedestrian safety of automobiles subjected to collision condition. In particular, cost-effective manufacturing techniques for sandwich structures with commingled GF/PP skins and low-density foam cores are being investigated. The performance of these structures under bending load is being studied. Samples are manufactured using compression moulding technique. The relationship of this performance to processing parameters such as mould temperature, moulding time, moulding pressure and sequence of the layers during moulding is being investigated. The results of bending tests are discussed in the light of the moulding conditions and conclusions are given regarding optimum set of processing conditions using the compression moulding route

Keywords: twintex, flexural properties, automobile composites, sandwich structures

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Authors: Priscilla Echeverria

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This paper addresses initial teacher formation as a formative space in which pedagogy students develop a pedagogical agency capacity to contribute to social justice, considering ethical, political, and epistemic dimensions. This paper is structured by discussing first the concepts of agency, pedagogical interaction, and social justice from a critical perspective; and continues offering preliminary results on the capacity of pedagogical agency in novice teachers after the analysis of critical incidents as a research methodology. This study is motivated by the concern that responding to the current neoliberal scenario, many initial teacher formation (ITF) programs have reduced the meaning of education to instruction, and pedagogy to methodology, favouring the formation of a technical professional over a reflective or critical one. From this concern, this study proposes that the restitution of the subject is an urgent task in teacher formation, so it is essential to enable him in his capacity for action and advance in eliminating institutionalized oppression insofar as it affects that capacity. Given that oppression takes place in human interaction, through this work, I propose that initial teacher formation develops sensitivity and educates the gaze to identify oppression and take action against it, both in pedagogical interactions -which configure political, ethical, and epistemic subjectivities- as in the hidden and official curriculum. All this from the premise that modelling democratic and dialogical interactions are basic for any program that seeks to contribute to a more just and empowered society. The contribution of this study lies in the fact that it opens a discussion in an area about which we know little: the impact of the type of interactions offered by university teaching at ITF on the capacity of future teachers to be pedagogical agents. For this reason, this study seeks to gather evidence of the result of this formation, analysing the capacity of pedagogical agency of novice teachers, or, in other words, how capable the graduates of secondary pedagogies are in their first pedagogical experiences to act and make decisions putting the formative purposes that they are capable of autonomously defining before technical or bureaucratic issues imposed by the curriculum or the official culture. This discussion is part of my doctoral research, "The importance of developing the capacity for ethical-political-epistemic agency in novice teachers during initial teacher formation to contribute to social justice", which I am currently developing in the Educational Research program of the University of Lancaster, United Kingdom, as a Conicyt fellow for the 2019 cohort.

Keywords: initial teacher formation, pedagogical agency, pedagogical interaction, social justice, hidden curriculum

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Authors: S. Hatamikia, A. Biguri, H. Furtado, G. Kronreif, J. Kettenbach, W. Birkfellner

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Nowadays, three dimensional Cone Beam CT (CBCT) has turned into a widespread clinical routine imaging modality for interventional radiology. In conventional CBCT, a circular sourcedetector trajectory is used to acquire a high number of 2D projections in order to reconstruct a 3D volume. However, the accumulated radiation dose due to the repetitive use of CBCT needed for the intraoperative procedure as well as daily pretreatment patient alignment for radiotherapy has become a concern. It is of great importance for both health care providers and patients to decrease the amount of radiation dose required for these interventional images. Thus, it is desirable to find some optimized source-detector trajectories with the reduced number of projections which could therefore lead to dose reduction. In this study we investigate some source-detector trajectories with the optimal arbitrary orientation in the way to maximize performance of the reconstructed image at particular regions of interest. To achieve this approach, we developed a box phantom consisting several small target polytetrafluoroethylene spheres at regular distances through the entire phantom. Each of these spheres serves as a target inside a particular region of interest. We use the 3D Point Spread Function (PSF) as a measure to evaluate the performance of the reconstructed image. We measured the spatial variance in terms of Full-Width-Half-Maximum (FWHM) of the local PSFs each related to a particular target. The lower value of FWHM shows the better spatial resolution of reconstruction results at the target area. One important feature of interventional radiology is that we have very well-known imaging targets as a prior knowledge of patient anatomy (e.g. preoperative CT) is usually available for interventional imaging. Therefore, we use a CT scan from the box phantom as the prior knowledge and consider that as the digital phantom in our simulations to find the optimal trajectory for a specific target. Based on the simulation phase we have the optimal trajectory which can be then applied on the device in real situation. We consider a Philips Allura FD20 Xper C-arm geometry to perform the simulations and real data acquisition. Our experimental results based on both simulation and real data show our proposed optimization scheme has the capacity to find optimized trajectories with minimal number of projections in order to localize the targets. Our results show the proposed optimized trajectories are able to localize the targets as good as a standard circular trajectory while using just 1/3 number of projections. Conclusion: We demonstrate that applying a minimal dedicated set of projections with optimized orientations is sufficient to localize targets, may minimize radiation.

Keywords: CBCT, C-arm, reconstruction, trajectory optimization

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Authors: Nina Robson, Kenneth John Faller II, Vishalkumar Ahir, Arthur Ricardo Deps Miguel Ferreira, John Buchanan, Amarnath Banerjee

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This paper describes the development of a virtual-reality system ARWED, which will be used in physical rehabilitation of patients with reduced upper extremity mobility to increase limb Active Range of Motion (AROM). The ARWED system performs a symmetric reflection and real-time mapping of the patient’s healthy limb on to their most affected limb, tapping into the mirror neuron system and facilitating the initial learning phase. Using the ARWED, future experiments will test the extension of the action-observation priming effect linked to the mirror-neuron system on healthy subjects and then stroke patients.

Keywords: physical rehabilitation, mirror neuron, virtual reality, stroke therapy

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Authors: Dêivisson Alves Anjos, Blenda Fonseca Aires Teles, Queitiane Castro Costa

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Fire is one of the biggest dangers for factories, warehouses, mills, among other places, causing unimaginable damage, because besides the material damage also directly affects the lives of workers who are likely to suffer death or very serious consequences. This protection of the lives of these people should be taken seriously, always seeking safety. Thus investment in security and monitoring equipment must be high, so you can prevent or reduce the impacts of a possible fire. Our device, made in PIC micro controller monitors the temperature and the presence of gas in the environment, it sends the data via Bluetooth device to a developed in LabVIEW interface saves these data continuously and alert if the temperature exceeds the allowed or some gas is detected. Currently the device is in operation and can perform several tests, as well as use in different areas for which you need anti-fire protection.

Keywords: pic, bluetooth, fire, temperature, gas, LabVIEW

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Authors: Boukhatem Mohammed Belkaid, Lahdir Mourad

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In this paper, we propose a new encryption system for security issues medical images. The hybrid encryption scheme is based on AES and RSA algorithms to validate the three security services are authentication, integrity, and confidentiality. Privacy is ensured by AES, authenticity is ensured by the RSA algorithm. Integrity is assured by the basic function of the correlation between adjacent pixels. Our system generates a unique password every new session of encryption, that will be used to encrypt each frame of the medical image basis to strengthen and ensure his safety. Several metrics have been used for various tests of our analysis. For the integrity test, we noticed the efficiencies of our system and how the imprint cryptographic changes at reception if a change affects the image in the transmission channel.

Keywords: AES, RSA, integrity, confidentiality, authentication, medical images, encryption, decryption, key, correlation

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Authors: Rizvi Hasan

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Male factor infertility due to abnormalities in prolactin levels is encountered in a significant proportion. This was a case-control study carried out to determine the effects of prolactin abnormalities in normal males with infertility, recruiting 297 male infertile patients with informed written consent. All underwent a Basic Seminal Fluid Analysis (BSA) and endocrine profiles of FSH, LH, testosterone and prolactin (PRL) hormones using the random access chemiluminescent immunoassay method (normal range 2.5-17ng/ml). Age, weight, and height matched voluntary controls were recruited for comparison. None of the cases had anatomical, medical or surgical disorders related to infertility. Among the controls; mean age 33.2yrs ± 5.2, BMI 21.04 ± 1.39kgm-2, BSA 34×106, a number of children fathered 2±1, PRL 6.78 ± 2.92ng/ml. Of the 297 patients, 28 were hyperprolactinaemic while one was hypoprolactinaemic. All the hyperprolactinaemic patients had oligoasthenospermia, abnormal morphology and decreased viability. The serum testosterone levels were markedly lowered in 26 (92.86%) of the hyperprolactinaemic subjects. In the other 2 hyperprolactinaemic subjects and the single hypoprolactinaemic subject, the serum testosterone levels were normal. FSH and LH were normal in all patients. The 29 male patients with abnormalities in their serum PRL profiles were followed up for 12 months. The 28 patients suffering from hyperprolactinaemia were treated with oral bromocriptine in a dose of 2.5 mg twice daily. The hypoprolactinaemic patient defaulted treatment. From the follow-up, it was evident that 19 (67.86%) of the treated patients responded after 3 months of therapy while 4 (14.29%) showed improvement after approximately 6 months of bromocriptine therapy. One patient responded after 1 year of therapy while 2 patients showed improvements although not up to normal levels within the same period. Response to treatment was assessed by improvement in their BSA parameters. Prolactin abnormalities affect the male reproductive system and semen parameters necessitating further studies to ascertain the exact role of prolactin on the male reproductive tract. A parallel study was carried out incorporating 200 male white rats that were grouped and subjected to variations in their serum PRL levels. At the end of 100 days of treatment, these rats were subjected to morphological studies of their male reproductive tracts.Varying morphological changes depending on the levels of PRL changes induced were evident. Notable changes were arrest of spermatogenesis at the spermatid stage, a reduced testicular cellularity, a reduction in microvilli of the pseudostratified epithelial lining of the epididymis, while measurement of the tubular diameter showed a 30% reduction compared to normal tissue. There were no changes in the vas deferens, seminal vesicles, and the prostate. It is evident that both hyperprolactinaemia and hypoprolactinaemia have a direct effect on the morphology and function of the male reproductive tract. The morphological studies carried out on the groups of rats who were subjected to variations in their PRL levels could be the basis for infertility in male human beings.

Keywords: male factor infertility, morphological studies, prolactin, seminal fluid analysis

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Authors: Somayeh Nezami

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The management of financial and human resources of police in metropolitans requires many information and exact plans to reduce a rate of crime and increase the safety of the society. Geographical Information Systems have an important role in providing crime maps and their analysis. By using them and identification of crime hot spots along with spatial presentation of the results, it is possible to allocate optimum resources while presenting effective methods for decision making and preventive solutions. In this paper, we try to explain and compare between some of the methods of hot spots analysis such as Mode, Fuzzy Mode and Nearest Neighbour Hierarchical spatial clustering (NNH). Then the spots with the highest crime rates of drug smuggling for one province in Iran with borderline with Afghanistan are obtained. We will show that among these three methods NNH leads to the best result.

Keywords: GIS, Hot spots, nearest neighbor hierarchical spatial clustering, NNH, spatial analysis of crime

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Authors: Mohamed Abo El Nasr, Mohamed Shoeib, Abdelhamid Abdelkhalik, Amro Serag

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Background: Early assessment of severity of chest trauma, either blunt or penetrating is of critical importance in prediction of patient outcome. Different trauma scoring systems are widely available and are based on anatomical or physiological parameters to expect patient morbidity or mortality. Up till now, there is no ideal, universally accepted trauma score that could be applied in all trauma centers and is suitable for assessment of severity of chest trauma patients. Aim: Our aim was to compare various trauma scoring systems regarding their predictability of morbidity and mortality in chest trauma patients. Patients and Methods: This study was a prospective study including 400 patients with chest trauma who were managed at Tanta University Emergency Hospital, Egypt during a period of 2 years (March 2014 until March 2016). The patients were divided into 2 groups according to the mode of trauma: blunt or penetrating. The collected data included age, sex, hemodynamic status on admission, intrathoracic injuries, and associated extra-thoracic injuries. The patients outcome including mortality, need of thoracotomy, need for ICU admission, need for mechanical ventilation, length of hospital stay and the development of acute respiratory distress syndrome were also recorded. The relevant data were used to calculate the following trauma scores: 1. Anatomical scores including abbreviated injury scale (AIS), Injury severity score (ISS), New injury severity score (NISS) and Chest wall injury scale (CWIS). 2. Physiological scores including revised trauma score (RTS), Acute physiology and chronic health evaluation II (APACHE II) score. 3. Combined score including Trauma and injury severity score (TRISS ) and 4. Chest-Specific score Thoracic trauma severity score (TTSS). All these scores were analyzed statistically to detect their sensitivity, specificity and compared regarding their predictive power of mortality and morbidity in blunt and penetrating chest trauma patients. Results: The incidence of mortality was 3.75% (15/400). Eleven patients (11/230) died in blunt chest trauma group, while (4/170) patients died in penetrating trauma group. The mortality rate increased more than three folds to reach 13% (13/100) in patients with severe chest trauma (ISS of >16). The physiological scores APACHE II and RTS had the highest predictive value for mortality in both blunt and penetrating chest injuries. The physiological score APACHE II followed by the combined score TRISS were more predictive for intensive care admission in penetrating injuries while RTS was more predictive in blunt trauma. Also, RTS had a higher predictive value for expectation of need for mechanical ventilation followed by the combined score TRISS. APACHE II score was more predictive for the need of thoracotomy in penetrating injuries and the Chest-Specific score TTSS was higher in blunt injuries. The anatomical score ISS and TTSS score were more predictive for prolonged hospital stay in penetrating and blunt injuries respectively. Conclusion: Trauma scores including physiological parameters have a higher predictive power for mortality in both blunt and penetrating chest trauma. They are more suitable for assessment of injury severity and prediction of patients outcome.

Keywords: chest trauma, trauma scores, blunt injuries, penetrating injuries

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Authors: Mohammad Ali Tabibi, Farzad Nazemi, Nasrin Salimian

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Background: Peritoneal dialysis (PD) is a prevalent renal replacement therapy for patients with end-stage renal disease. Despite its benefits, PD patients often experience reduced physical activity and physical function, which can negatively impact dialysis adequacy and overall health outcomes. Despite the known benefits of maintaining physical activity in chronic disease management, the specific interplay between physical inactivity, physical function, and dialysis adequacy in PD patients remains underexplored. Understanding this relationship is essential for developing targeted interventions to enhance patient care and outcomes in this vulnerable population. This study aims to assess the impact of physical inactivity on dialysis adequacy and functional health in PD patients. Methods: This cross-sectional study included 135 peritoneal dialysis patients from multiple dialysis centers. Physical inactivity was measured using the International Physical Activity Questionnaire (IPAQ), while physical function was assessed using the Short Physical Performance Battery (SPPB). Dialysis adequacy was evaluated using the Kt/V ratio. Additional variables such as demographic data, comorbidities, and laboratory parameters were collected to control for potential confounders. Statistical analyses were performed to determine the relationships between physical inactivity, physical function, and dialysis adequacy. Results: The study cohort comprised 70 males and 65 females with a mean age of 55.4 ± 13.2 years. A significant proportion of the patients (65%) were categorized as physically inactive based on IPAQ scores. Inactive patients demonstrated significantly lower SPPB scores (mean 6.2 ± 2.1) compared to their more active counterparts (mean 8.5 ± 1.8, p < 0.001). Dialysis adequacy, as measured by Kt/V, was found to be suboptimal (Kt/V < 1.7) in 48% of the patients. There was a significant positive correlation between physical function scores and Kt/V values (r = 0.45, p < 0.01), indicating that better physical function is associated with higher dialysis adequacy. Also, there was a significant negative correlation between physical inactivity and physical function (r = -0.55, p < 0.01). Additionally, physically inactive patients had lower Kt/V ratios compared to their active counterparts (1.3 ± 0.3 vs. 1.8 ± 0.4, p < 0.05). Multivariate regression analysis revealed that physical inactivity was an independent predictor of reduced dialysis adequacy (β = -0.32, p < 0.01) and poorer physical function (β = -0.41, p < 0.01) after adjusting for age, sex, comorbidities, and dialysis vintage. Conclusion: This study underscores the critical role of physical activity and physical function in maintaining adequate dialysis in peritoneal dialysis patients. These findings highlight the need for targeted interventions to promote physical activity in this population to improve their overall health outcomes. Future research should focus on developing and evaluating exercise programs tailored for PD patients to enhance their physical function and dialysis adequacy. The findings suggest that interventions aimed at increasing physical activity and improving physical function may enhance dialysis adequacy and overall health outcomes in this population. Further research is warranted to explore the mechanisms underlying these associations and to develop targeted strategies for enhancing patient care.

Keywords: inactivity, physical function, peritoneal dialysis, dialysis adequacy

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Authors: Rino Gubiani, Gianfranco Pergher

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The work focused on the statistical analysis of accidents in the forestry sector (2000-2020) in Friuli-Venezia Giulia region, located in the North-East of Italy. The aim of the work was to analyse the evolution of the casualties throughout time and to evaluate possible improvements in the sector. It was shown that even nowadays the rate of accidents in forestry work is higher compared with all the other sectors, including agriculture; moreover, it was highlighted that some accidents remained present throughout the whole analysed range, such as slipping on the soil, being hit by trees and falling down from the plants. The results showed that an increase in forestry exploitation could even increase the total number of accidents, if advanced technological machines, such as cable cranes, would not implemented, given the fact that there is also a significant number of old people (above 50 years old) working in the sector.

Keywords: safety, forestry work, accidents, risk analysis, casualties, statistical analysis

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Authors: Wu Liching

Abstract:

Aim This case aims to discuss the pathogenesis, clinical manifestations and medical treatment of strokes caused by mitochondrial gene mutations. Methods Diagnosis of ischemic stroke caused by mitochondrial gene defect by means of "next-generation sequencing mitochondrial DNA gene variation detection", imaging examination, neurological examination, and medical history; this study took samples from the neurology ward of a medical center in northern Taiwan cases diagnosed with acute cerebral infarction as the research objects. Result This case is a 49-year-old married woman with a rare disease, mitochondrial gene mutation inducing ischemic stroke. She has severe hearing impairment and needs to use hearing aids, and has a history of diabetes. During the patient’s hospitalization, the blood test showed that serum Lactate: 7.72 mmol/L, Lactate (CSF) 5.9 mmol/L. Through the collection of relevant medical history, neurological evaluation showed changes in consciousness and cognition, slow response in language expression, and brain magnetic resonance imaging examination showed subacute bilateral temporal lobe infarction, which was an atypical type of stroke. The lineage DNA gene has m.3243A>G known pathogenic mutation point, and its heteroplasmic level is 24.6%. This pathogenic point is located in MITOMAP and recorded as Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes (MELAS) , Leigh Syndrome and other disease-related pathogenic loci, this mutation is located in ClinVar and recorded as Pathogenic (dbSNP: rs199474657), so it is diagnosed as a case of stroke caused by a rare disease mitochondrial gene mutation. After medical treatment, there was no more seizure during hospitalization. After interventional rehabilitation, the patient's limb weakness, poor language function, and cognitive impairment have all improved significantly. Conclusion Mitochondrial disorders can also be associated with abnormalities in psychological, neurological, cerebral cortical function, and autonomic functions, as well as problems with internal medical diseases. Therefore, the differential diagnoses cover a wide range and are not easy to be diagnosed. After neurological evaluation, medical history collection, imaging and rare disease serological examination, atypical ischemic stroke caused by rare mitochondrial gene mutation was diagnosed. We hope that through this case, the diagnosis of rare disease mitochondrial gene variation leading to cerebral infarction will be more familiar to clinical medical staff, and this case report may help to improve the clinical diagnosis and treatment for patients with similar clinical symptoms in the future.

Keywords: acute stroke, MELAS, lactic acidosis, mitochondrial disorders

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Authors: F. O’Dowd, G. Murphy, M. Roche, E. Shudell, F. Keane, M. O’Kane

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Intoduction: Apremilast (Otezla®) is an oral phosphodiesterase-4 (PDE4) inhibitor indicated for treatment of adult patients with moderate to severe plaque psoriasis who have contraindications to have failed or intolerant of standard systemic therapy and/or phototherapy; and adult patients with active psoriatic arthritis. Apremilast influences intracellular regulation of inflammatory mediators. Two randomized, placebo-controlled trials evaluating apremilast in 1426 patients with moderate to severe plague psoriasis (ESTEEM 1 and 2) demonstrated that the commonest adverse reactions (AE’s) leading to discontinuation were nausea (1.6%), diarrhoea (1.0%), and headaches (0.8%). The overall proportion of subjects discontinuing due to adverse reactions was 6.1%. At week 16 these trials demonstrated significant more apremilast-treated patients (33.1%) achieved the primary end point PASI-75 than placebo (5.3%). We began prescribing apremilast in July 2015. Aim: To evaluate efficacy and tolerability of apremilast in an Irish teaching hospital psoriasis population. Methods: A proforma documenting clinical evaluation parameters, prior treatment experience and AE’s; was completed prospectively on all patients commenced on apremilast since July 2015 – July 2017. Data was collected at week 0,6,12,24,36 and week 52 with 20/71 patients having passed week 52. Efficacy was assessed using Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI). AE’s documented included GI effects, infections, changes in weight and mood. Retrospective chart review and telephone review was utilised for missing data. Results: A total of 71 adult subjects (38 male, 33 female; age range 23-57), with moderate to severe psoriasis, were evaluated. Prior treatment: 37/71 (52%) were systemic/biologic/phototherapy naïve; 14/71 (20%) has prior phototherapy alone;20/71 (28%) had previous systemic/biologic exposure; 12/71 (17%) had both psoriasis and psoriatic arthritis. PASI responses: mean baseline PASI was 10.1 and DLQI was 15.Week 6: N=71, n=15 (21%) achieved PASI 75. Week 12: N= 48, n=6 (13%) achieved a PASI 100%; n=16 (34.5%) achieved a PASI 75. Week 24: N=40, n=10 (25%) achieved a PASI 100; n=15 (37.5%) achieved a PASI 75. Week 52: N= 20, n=4 (20%) achieved a PASI 100; n= 16 (80%) achieved a PASI 75. (N= number of pts having passed the time point indicated, n= number of pts (out of N) achieving PASI or DLQI responses at that time). DLQI responses: week 24: N= 40, n=30 (75%) achieved a DLQI score of 0; n=5 (12.5%) achieved a DLQI score of 1; n=1 (2.5%) achieved a DLQI score of 10 (due to lack of efficacy). Adverse Events: The proportion of patients that discontinued treatment due to AE’s was n=7 (9.8%). One patient experienced nausea alleviated by dose reduction; another developed significant dysgeusia for certain foods, both continued therapy. Two patients lost 2-3 kg. Conclusion: Initial Irish patient experience of Apremilast appears comparable to that observed in trials with good efficacy and tolerability.

Keywords: Apremilast, introduction, Ireland, clinical audit

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Authors: Ragy Raafat Gaber Attaalla

Abstract:

Background: The research begins with a summary of the state of pharmacy practice research, both now and in the future. The concerns that are relevant to practice research are then covered in this research to set the stage. These concerns include shifts in the demography of the population, technological advancements, the institutional function of pharmacies, consumer behavior, and the pharmacy profession itself. It also describes the significant changes in pharmacy practice research, such as interprofessional collaboration and patient teaming, the description and measurement of intervention results, and the cultural diversity of patients. Methods: It would be most frequently employed in the next pharmacy practice research are highlighted in the conclusion. They cover the cultural diversity of patients, documenting and assessing the results of interventions, and interdisciplinary communication and partnership with patients. Results: The rise of large and complicated data sets, the handling of electronic health records, and the use of a wide range of mixed techniques by pharmacy practice researchers are a few potential future methodological obstacles.

Keywords: pharmacy, practice, research, significant changes

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