Search results for: clinical outcome

Authors: N. J. Nawarathna, N. R. Kmarasinghe, D. Chandrasekara, B. M. R. S. Balasooriya, R. A. A. Shaminda, R. J. K. Senevirathne

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Introduction: Thyroid malignancy associated with hyperthyroidism is considered rare. Retrospective studies have shown the incidence of thyroid malignancy in hyperthyroid patients to be low (0.7-8.5%). To assess the clinical relevance of this association, thyroid status in a cohort of patients with thyroid malignancy were analyzed. Method: Thyroid malignancies diagnosed histologically in 56 patients, over a 18 month period beginning from April 2013, in a single surgical unit at Teaching Hospital Kandy were included. Preoperative patient details and progression of thyroid status were asessed with Thyroid Stimulating Hormone, free Thyroxin and free Triiodothyronine levels. Results: Amongst 56 patients Papillary carcinoma was diagnosed in 44(78.6%), follicular carcinomas in 7(12.5%) and 5(8.9%) with medullary and anaplastic carcinomas. 12(21.4%) were males and 44(78.6%) were females. 20(35.7%) were less than 40years, 29(51.8%) were between 40 to 59years and 7(12.5%) were above 59years. Cross tabulation of Type of carcinoma with Gender revealed likelihood ratio of 6.908, Significance p = 0.032. Biochemically 12(21.4%) were hyperthyroid. Out of them 5(41.7%) had primary hyperthyroidism and 7(58.3%) had secondary hyperthyroidism. Mean age of euthyroid patients was 43.77years (SD 10.574) and hyperthyroid patients was 53.25years(SD 16.057). Independent Samples Test t is -2.446, two tailed significance p =0.018. When cross tabulate thyroid status with Age group Likelihood Ratio was 9.640, Significance p = 0.008. Conclusion: Papillary carcinoma is seen more among females. Among the patients with thyroid carcinomas, those with biochemically proven hyperthyroidism were more among the older age group than those who were euthyroid. Hence careful evaluation of elderly hyperthyroid patients to select the most suitable therapeutic approach is justified.

Keywords: age, hyperthyroidism, thyroid malignancy, thyroid status

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Authors: Chethan Purushothama

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Coronary artery disease is one of the major causes of death in developing countries. The coronary arteries show wide range of variations and these variations have not been dealt with different population groups. The present study aims to focus on the pattern and variations of coronary artery in south Indian population. The study was performed to analyze the coronary artery dominance and divisions of main trunk of left coronary artery in 81 isolated adult human cadaveric hearts of South Indian population. The specimens were fixed in 10% formalin and were dissected manually. In our specimens, 74.1% of the hearts were right dominant, 11.1% were left dominant, and 14.8% were co-dominant. Bifurcation, trifurcation, and quadrifurcation of main trunk of left coronary artery were seen in 49.4%, 48.1%, and 2.5% cases respectively. The right dominant hearts had bifurcation, trifurcation and quadrifurcation of main trunk of left coronary artery in 46.7%, 50% and 3.3% hearts respectively. The left dominant hearts had bifurcation and trifurcation of main trunk of left coronary artery in 55.6% and 44.4% cases respectively. The co-dominant hearts had bifurcation and trifurcation of main trunk of left coronary artery in 58.3% and 41.7% respectively. Quadrifurcation of main trunk of left coronary artery were seen only in right dominant hearts. We believe that the data obtained from the present study are important to the interventional cardiologists and radiologists. The details obtained will also be helpful for the clinical anatomists.

Keywords: bifurcation, coronary artery, trifurcation, quadrifurcation

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Authors: Ibtisam Al-Zaru

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Background: Worldwide, depression among coronary artery disease (CAD) patients is considered a serious problem that may cause many complications and negative consequences; particularly serious being increased mortality and morbidity rate. Studying depression among CAD patients in Jordan has not been investigated thoroughly and thus a need for further studies has been a priority. Aims: To assess depression in non-hospitalized Jordanian patients with CAD; to describe the relationship between socio-demographic data, health related factors, and depression; and to examine the best predictors of depression in non-hospitalized Jordanian patients with CAD. Method: A cross-sectional-descriptive design was used to collect data from 174 non-hospitalized Jordanian patients diagnosed with CAD in outpatients’ cardiac clinics, using a self- administered questionnaires and Cardiac Depression Scale. Results: 53.4% of CAD patients reported mild/moderate, and severe depressive symptoms. Significant relationships between depressive symptoms and some demo-clinical characteristics (i.e. being female gender; having of chronic disease and surgical history; being physically inactive, and perceived their sexual activity, physical and psychological as poor). The preceding factors are also found to be statistically significant predictors for depression among this patients’ group. Conclusion: Jordanian patients with CAD had various levels of severity regarding their depressive symptoms. Therefore, health care providers need to introduce depression assessment and treatment in cardiac rehabilitation to control depression and its impact on the patient. Consequently, such control will reduce co-morbidity, mortality, complications and health costs among CAD patients and enhance the quality of their lives.

Keywords: coronary artery disease, predictors, depression, prevalence

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Authors: Asnakew Mulualem Tegegne, Tarun Kumar Lohani, Abunu Atlabachew Eshete

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Groundwater potential delineation is essential for efficient water resource utilization and long-term development. The scarcity of potable and irrigation water has become a critical issue due to natural and anthropogenic activities in meeting the demands of human survival and productivity. With these constraints, groundwater resources are now being used extensively in Ethiopia. Therefore, an innovative convolutional neural network (CNN) is successfully applied in the Gunabay watershed to delineate groundwater potential based on the selected major influencing factors. Groundwater recharge, lithology, drainage density, lineament density, transmissivity, and geomorphology were selected as major influencing factors during the groundwater potential of the study area. For dataset training, 70% of samples were selected and 30% were used for serving out of the total 128 samples. The spatial distribution of groundwater potential has been classified into five groups: very low (10.72%), low (25.67%), moderate (31.62%), high (19.93%), and very high (12.06%). The area obtains high rainfall but has a very low amount of recharge due to a lack of proper soil and water conservation structures. The major outcome of the study showed that moderate and low potential is dominant. Geodetoctor results revealed that the magnitude influences on groundwater potential have been ranked as transmissivity (0.48), recharge (0.26), lineament density (0.26), lithology (0.13), drainage density (0.12), and geomorphology (0.06). The model results showed that using a convolutional neural network (CNN), groundwater potentiality can be delineated with higher predictive capability and accuracy. CNN-based AUC validation platform showed that 81.58% and 86.84% were accrued from the accuracy of training and testing values, respectively. Based on the findings, the local government can receive technical assistance for groundwater exploration and sustainable water resource development in the Gunabay watershed. Finally, the use of a detector-based deep learning algorithm can provide a new platform for industrial sectors, groundwater experts, scholars, and decision-makers.

Keywords: CNN, geodetector, groundwater influencing factors, Groundwater potential, Gunabay watershed

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Authors: Nicolas M. Beleski, Gustavo A. G. Lugo

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Robotic agents are taking more and increasingly important roles in society. In order to make these robots and agents more autonomous and efficient, their systems have grown to be considerably complex and convoluted. This growth in complexity has led recent researchers to investigate forms to explain the AI behavior behind these systems in search for more trustworthy interactions. A current problem in explainable AI is the inner workings with the logic inference process and how to conduct a sensibility analysis of the process of valuation and alteration of beliefs. In a social HRI (human-robot interaction) setup, theory of mind is crucial to ease the intentionality gap and to achieve that we should be able to infer over observed human behaviors, such as cases of cognitive dissonance. One specific case inspired in human cognition is the role emotions play on our belief system and the effects caused when observed behavior does not match the expected outcome. In such scenarios emotions can make a person wrongly assume the antecedent P for an observed consequent Q, and as a result, incorrectly assert that P is true. This form of cognitive dissonance where an unproven cause is taken as truth induces changes in the belief base which can directly affect future decisions and actions. If we aim to be inspired by human thoughts in order to apply levels of theory of mind to these artificial agents, we must find the conditions to replicate these observable cognitive mechanisms. To achieve this, a computational architecture is proposed to model the modulation effect emotions have on the belief system and how it affects logic inference process and consequently the decision making of an agent. To validate the model, an experiment based on the prisoner's dilemma is currently under development. The hypothesis to be tested involves two main points: how emotions, modeled as internal argument strength modulators, can alter inference outcomes, and how can explainable outcomes be produced under specific forms of cognitive dissonance.

Keywords: cognitive architecture, cognitive dissonance, explainable ai, sensitivity analysis, theory of mind

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Authors: A. H. Nanher, N. P. Singh, Shashidhar Yadav, Sachin Tyagi

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Agricultural production system is an outcome of a complex interaction of seed, soil, water and agro-chemicals (including fertilizers). Therefore, judicious management of all the inputs is essential for the sustainability of such a complex system. Precision agriculture gives farmers the ability to use crop inputs more effectively including fertilizers, pesticides, tillage and irrigation water. More effective use of inputs means greater crop yield and/or quality, without polluting the environment the focus on enhancing the productivity during the Green Revolution coupled with total disregard of proper management of inputs and without considering the ecological impacts, has resulted into environmental degradation. To evaluate a new approach for site-specific nutrient management (SSNM). Large variation in initial soil fertility characteristics and indigenous supply of N, P, and K was observed among Field- and season-specific NPK applications were calculated by accounting for the indigenous nutrient supply, yield targets, and nutrient demand as a function of the interactions between N, P, and K. Nitrogen applications were fine-tuned based on season-specific rules and field-specific monitoring of crop N status. The performance of SSNM did not differ significantly between high-yielding and low-yielding climatic seasons, but improved over time with larger benefits observed in the second year Future, strategies for nutrient management in intensive rice systems must become more site-specific and dynamic to manage spatially and temporally variable resources based on a quantitative understanding of the congruence between nutrient supply and crop demand. The SSNM concept has demonstrated promising agronomic and economic potential. It can be used for managing plant nutrients at any scale, i.e., ranging from a general recommendation for homogenous management of a larger domain to true management of between-field variability. Assessment of pest profiles in FFP and SSNM plots suggests that SSNM may also reduce pest incidence, particularly diseases that are often associated with excessive N use or unbalanced plant nutrition.

Keywords: nutrient, pesticide, crop, yield

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Authors: Avrokomi Zavitsanou, Spiros Papadopoulos, Theofanis Alexandridis

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This paper presents the research project ‘Colour & Travel’, which is co-funded by the European Union and national resources through the Operational Programme “Competitiveness, Entrepreneurship and Innovation” 2014-2020, under the Single RTDI State Aid Action "RESEARCH - CREATE - INNOVATE". The research project proposes the design of an innovative, playful framework for exploring a variety of travel destinations and creating personalised travel narratives, aiming to entertain, educate, and promote culture and tourism. Gamification of the cultural and touristic environment can enhance its experiential, multi-sensory aspects and broaden the perception of the traveler. The latter's involvement in creating and shaping his personal travel narrations and the possibility of sharing it with others can offer him an alternative, more binding way of getting acquainted with a place. In particular, the paper presents the design of an infrastructure: (a) for the development of interactive travel guides for mobile devices, where sites with specific points of interest will be recommended, with which the user can interact in playful ways and then create his personal travel narratives, (b) for the development of innovative games within virtual reality environment, where the interaction will be offered while the user is moving within the virtual environment; and (c) for an online application where the content will be offered through the browser and the modern 3D imaging technologies (WebGL). The technological products that will be developed within the proposed project can strengthen important sectors of economic and social life, such as trade, tourism, exploitation and promotion of the cultural environment, creative industries, etc. The final applications delivered at the end of the project will guarantee an improved level of service for visitors and will be a useful tool for content creators with increased adaptability, expansibility, and applicability in many regions of Greece and abroad. This paper aims to present the research project by referencing the state of the art and the methodological scheme, ending with a brief reflection on the expected outcome in terms of results.

Keywords: gamification, culture, tourism, AR, VR, applications

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Authors: Ping-Lun Jiang, Hung-Jun Lin, Shen-Fu Lin, Mei-Yin Chien, Ting-Wei Li, Chun-Han Lin, Der-Zen Liu

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Mucosal vaccine induces both mucosal (secretory IgA) and systemic immune responses and it is considered an ideal vaccination strategy for prevention of infectious diseases. One important point to be considered in mucosal vaccination is effective antigen delivery system which can manage effective delivery of antigen to antigen-presenting cells (APCs) of mucosal. In the present study, cationic gelatin nanoparticles were prepared as ideal carriers for more efficient antigen delivery. The average diameter of cationic gelatin nanoparticle was approximate 190 nm, and the zeta potential was about +45 mV, then ovalbumin (OVA) was physically absorbed onto cationic gelatin nanoparticle. The OVA absorption rate was near 95% the zeta potential was about +20 mV. We show that cationic gelatin nanoparticle effectively facilitated antigen uptake by mice bone marrow-derived dendritic cells (mBMDCs) and RAW264.7 cells and induced higher levels of pro-inflammatory cytokines. C57BL/6 mice twice immunized intranasally with OVA-absorbed cationic gelatin nanoparticle induced high levels of OVA-specific IgG in the serum and IgA in their in the nasal and lung wash fluid. These results indicate that nasal administration of cationic gelatin nanoparticles induced both mucosal and systemic immune responses and cationic gelatin nanoparticles might be a potential antigen delivery carrier for further clinical applications.

Keywords: antigen delivery, antigen-presenting cells, gelatin nanoparticle, mucosal vaccine

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Authors: William Thomas Worster

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This paper will highlight the failure of international adjudication to prevent a state from evading an order of provisional measures by simply issuing a diplomatic assurance to the court. This practice changes the positions of the litigants as equals before a court, prevents the court from inquiring into the reliability of the political pledge as it would with assurances from a state to an individual, and diminishes the court’s ability to control its own proceedings in the face of concerns over sovereignty. Both the European Court of Human Rights (ECtHR) and International Court of Justice (ICJ) will entertain these kinds of unilateral pledges, but they consider them differently when the declaration is made between states or between a state and an individual, and when made directly to the court. In short, diplomatic assurances issued between states or to individuals are usually considered not to be legally binding and are essentially questions of fact, but unilateral assurances issued directly to an international court are questions of law, and usually legally binding. At the same time, orders for provisional measures are now understood also to be legally binding, yet international courts will sometimes permit a state to substitute an assurance in place of an order for provisional measures. This emerging practice has brought the nature of a state as a sovereign capable of creating legal obligations into the forum of adjudication where the parties should have equality of arms and permitted states to create legal obligations that escape inquiry into the reliability of the outcome. While most recent practice has occurred at the ICJ in state-to-state litigation, there is some practice potentially extending the practice to human rights courts. Especially where the litigants are factually unequal – a state and an individual – this practice is problematic since states could more easily overcome factual failings in their pledges and evade the control of the court. Consider, for example, the potential for evading non-refoulement obligations by extending the current diplomatic assurances practice from the state-to-state context to the state-to-court context. The dual nature of assurances, as both legal and factual instruments, should be considered as addressed to distinct questions, each with its own considerations, and that we need to be more demanding about their precise legal and factual effects.

Keywords: unilateral, diplomacy, assurances, undertakings, provisional measures, interim measures

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Authors: Akalu Banbeta, Emmanuel Lesaffre, Reynaldo Martina, Joost Van Rosmalen

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Including data from previous studies (historical data) in the analysis of the current study may reduce the sample size requirement and/or increase the power of analysis. The most common example is incorporating historical control data in the analysis of a current clinical trial. However, this only applies when the historical control dataare similar enough to the current control data. Recently, several Bayesian approaches for incorporating historical data have been proposed, such as the meta-analytic-predictive (MAP) prior and the modified power prior (MPP) both for single control as well as for multiple historical control arms. Here, we examine the performance of the MAP and the MPP approaches for the analysis of (over-dispersed) count data. To this end, we propose a computational method for the MPP approach for the Poisson and the negative binomial models. We conducted an extensive simulation study to assess the performance of Bayesian approaches. Additionally, we illustrate our approaches on an overactive bladder data set. For similar data across the control arms, the MPP approach outperformed the MAP approach with respect to thestatistical power. When the means across the control arms are different, the MPP yielded a slightly inflated type I error (TIE) rate, whereas the MAP did not. In contrast, when the dispersion parameters are different, the MAP gave an inflated TIE rate, whereas the MPP did not.We conclude that the MPP approach is more promising than the MAP approach for incorporating historical count data.

Keywords: count data, meta-analytic prior, negative binomial, poisson

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Authors: Awlad Hossain

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Structural weight reduction with improved functionality is one of the targeted desires of engineers, which drives materials and structures to be lighter. One way to achieve this objective is through the replacement of metallic structures with composites. The main advantages of composite materials are to be lightweight and to offer high specific strength and stiffness. Composite materials can be classified in various ways based on the fiber types and fiber orientations. Fiber reinforced composite laminates are prepared by stacking single sheet of continuous fibers impregnated with resin in different orientation to get the desired strength and stiffness. This research aims to understand the effects of Lamina Stacking Sequence (LSS) on the structural response of a symmetric composite laminate, defined by [0/60/-60]s. The Lamina Stacking Sequence (LSS) represents how the layers are stacked together in a composite laminate. The [0/60/-60]s laminate represents a composite plate consists of 6 layers of fibers, which are stacked at 0, 60, -60, -60, 60 and 0 degree orientations. This laminate is also called symmetric (defined by subscript s) as it consists of same material and having identical fiber orientations above and below the mid-plane. Therefore, the [0/60/-60]s, [0/-60/60]s, [60/-60/0]s, [-60/60/0]s, [60/0/-60]s, and [-60/0/60]s represent the same laminate but with different LSS. In this research, the effects of LSS on laminate in-plane and bending moduli was investigated first. The laminate moduli dictate the in-plane and bending deformations upon loading. This research also provided all the setup and techniques for measuring the in-plane and bending moduli, as well as how the stress distribution was assessed. Then, the laminate was subjected to in-plane force load and bending moment. The strain and stress distribution at each ply for different LSS was investigated using the concepts of Macro-Mechanics. Finally, several numerical simulations were conducted using the Finite Element Analysis (FEA) software ANSYS to investigate the effects of LSS on deformations and stress distribution. The FEA results were also compared to the Macro-Mechanics solutions obtained by MATLAB. The outcome of this research helps composite users to determine the optimum LSS requires to minimize the overall deformation and stresses. It would be beneficial to predict the structural response of composite laminates analytically and/or numerically before in-house fabrication.

Keywords: composite, lamina, laminate, lamina stacking sequence, laminate moduli, laminate strength

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Authors: Mansour F. Hussein, Mohammed A. Alshaikh, Riyadh S. Al-Jumaah, A. GarelNabi, I. Al-Khalifa, Osama B. Mohammed

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Serum samples from 489 male and female camels were tested for antibodies against C. burnetii using indirect enzyme-linked immunosorbent assay (ELISA). Antibodies to C. burnetii were recorded in sera of 252 (51.64%) camels. Significant differences in prevalence were found between male and female camels, juvenile and adult camels, different ecotypes and different sampling locations. 307 camels were simultaneously tested for C. burnetii antibodies by ELISA and indirect immunofluorescence (IFA). Close agreement was found between the results of the two tests. A high prevalence of C. burnetii antibodies was also recorded in milk samples tested by ELISA. Clinical samples from serologically positive camels were subjected to PCR analysis using primers which amplify the repetitive transposon-like and transposase gene regions of C. burnetii. Positive DNA amplification was obtained from both regions, with highest shedding of C. burnetii in faecal samples (27.59%) followed, in descending order, by urine (23.81%), blood (15.85%) and milk (6.5%). The present results indicate that camels are a major reservoir of C. burnetii in Saudi Arabia. The high prevalence of infection in camels, the poor sanitary standards under which the animals are kept and the consumption of raw camel milk indicate that camels could also be a major source of transmission of Q fever to humans in Saudi Arabia.

Keywords: Arabian camel, Camelus dromedarius, Coxiella brunetii, ELISA, immunofluoresence, PCR

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Authors: Chro Kavian

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The studies conducted show that cancer is a disease caused by populations of microbes, a notion gaining traction as the interaction between the human microbiome and the tumor microenvironment (TME) increasingly shows how environment and microbes dictate the progress and treatment of neoplastic diseases. A person’s human microbiome is defined as a collection of bacteria, fungi, viruses, and other microorganisms whose structure and composition influence biological processes like immune system modulation and nutrient metabolism, which, in turn, affect how susceptible a person is to neoplastic diseases, and response to different therapies. Recent reports demonstrated the influence specific microbiome bacterial populations have on the TME, thereby altering tumoral behaviors and the TME’s contributing factors that impact patients' lives. In addition, gut microbes and their SCFA products are important determinants of the inflammatory landscape of tumors and augment anti-tumor immunity, which can influence immunotherapy outcomes. Studies have also found that dysbiosis, or microbial imbalance, correlates with biological processes such as cancer progression, metastasis, and therapy resistance, leading scientists to explore the use of microbiome deficiencies as adjunctive approaches to chemotherapy and other, more traditional treatments. Nonetheless, mental health practitioners struggling to comprehend the existent gap between cancer patients with pronounced resolutive capabilities and the profound clinical impact Microbiome-targeted cancer therapy has been proven to possess.

Keywords: microbiome, cancer, tumor, immune system

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Authors: Maria Malliarou, Efrossini Lyraraki, Pavlos Sarafis, Theodosios Paralikas, Styliani Kotrotsiou, Evangelia Kotrotsiou, Mairy Gouva

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Women with breast cancer have to adapt to physical malformations, side effects of chemotherapy, emotional insecurity, and changes in social roles. Inability to recognize the co-morbidity of psychiatric conditions can have an aggravating effect on patient compliance in therapeutic interventions, resulting in treatment delays and an impact on overall survival. The purpose of this study was to identify the quality of life of breast cancer patients undergoing external radiation therapy and to correlate it with depression and anxiety. Patients were asked to respond to an anonymous questionnaire with general demographic and clinical questions, followed by the EORTCQLQ-C30 questionnaire for assessing the quality of life of patients with breast cancer. Hospital Anxiety and Depression Scale (HADS) as well as the Depression, Anxiety and Stress Scale (DASS-21) was also administered. The statistical analysis of the data was done in IBM SPSS. Results indicated that the incidence of anxiety and depression in breast cancer patients is high both in HADS (37.5 % with mild to moderate depression and 62.5 % with significant to severe depression) and DASS - 21 (39.2 % mild to moderate depression and 60.8 % significant to severe) scales. The correlation of anxiety and depression with life quality was negative for HADS (r = -, 810, p = .000) as well as for DASS-21 (r = -, 682, p = .000). The psychological impact of breast cancer on patients is important. Its correlation with the quality of life may lead to better tolerance to treatment and better effectiveness of the therapeutic approach.

Keywords: anxiety, breast cancer, depression, quality of life

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Authors: Nazmul Haque, Syeda Tasnuva Maria

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Sheehan's Syndrome (SS), also known as postpartum hypopituitarism, is a rare but potentially serious condition resulting from ischemic necrosis of the pituitary gland, often occurring during or after childbirth. This syndrome is characterized by hypopituitarism, leading to deficiencies in various hormones produced by the pituitary gland. The primary cause is typically severe postpartum hemorrhage, leading to inadequate blood supply and subsequent necrosis of the pituitary tissue. This chronic hypopituitarism sometimes plays the role of premature atherosclerosis, which may lead to cardiovascular disease. This abstract provides a comprehensive overview of Sheehan's Syndrome with ischaemic heart disease, encompassing its pathophysiology, clinical manifestations, and current management strategies. The disorder presents a wide spectrum of symptoms, including chest pain, fatigue, amenorrhea, lactation failure, hypothyroidism, and adrenal insufficiency. Timely diagnosis is crucial, as delayed recognition can lead to complications and long-term health consequences. We herein report a patient complaining of chronic fatigue symptoms, aggressiveness, chest pain, and breathlessness with repeated LOC that were diagnosed with SS with IHD. The patient was treated with antiplatelet, antianginal, steroids, and hormone replacement with marked improvement in his overall condition.

Keywords: ischaemic heart disease, Sheehan's syndrome, post-partum haemorrhage, pituitary gland

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Authors: R. C. Barbuti, M. N. Oliveira, N. P. Perina, C. Haro, P. Bosch, C. S. Bogsan, J. N. Eisig, T. Navarro-Rodriguez

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Background: The management of Helicobacter pylori (H. pylori) eradication is still a matter of discussion, full effectiveness is rarely achieved and it has many adverse effects. Probiotics are believed to have a role in eradicating and possibly preventing H. pylori infection as an adjunctive treatment. The present clinical study was undertaken to see the efficacy of a specially designed fermented milk product containing Bifidobacterium lactis B420 on the eradication of H. pylori infection in a prospective, randomized, double-blind, controlled study in humans. Method: Four test products were specially designed fermented milks, counts of viable cells in all products were 1010 Log CFU. 100 mL-1 for Bifidobacterium lactis-Bifidobacterium species 420, and 1011 Log CFU. 100 mL-1 for Streptococcus thermophiles were administered to subjects infected with H. pylori with a previous diagnosis of functional dyspepsia according to the Rome III criteria in a prospective, randomized, double-blind, placebo-controlled study in humans. Results: After FM supplementation, not all subjects showed a reduction in H. pylori colonization. Conclusion: Bifidobacterium lactis B420, administered twice a day for 90 days did not show an increase in H. pylori eradication effectiveness in Brazilian patients with functional dyspepsia.

Keywords: antibacterial therapy, Bifidobacteria fermented milk, Helicobacter pylori, probiotics

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Authors: Deok Hyun Han

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Objective: To explore outcomes of UventaTM metallic ureteral stent between malignant and benign ureteral obstruction. Methods: We reviewed the medical records of 90 consecutive patients who underwent Uventa stent placement for benign or malignant ureteral obstruction from December 2009 to June 2013. We evaluated the clinical outcomes, complications, and reasons and results for unexpected stent removals. Results: The median follow-up was 10.7 (0.9 – 41) months. From a total of 125 ureter units, there were 24 units with benign obstructions and 101 units with malignant obstructions. Initial technical successes were achieved in all patients. The overall success rate was 70.8% with benign obstructions and 84.2% with malignant obstructions. The major reasons for treatment failure were stent migration (12.5%) in benign and tumor progression (11.9%) in malignant obstructions. The overall complication rate was similar between benign and malignant obstructions (58.3% and 42.6%), but severe complications, which are Clavien grade 3 or more, occurred in 41.7% of benign and 6.9% of malignant obstructions. The most common complications were stent migration (25.0%) in benign obstructions and persistent pain (14.9%) in malignant obstructions. The stent removal was done in 16 units; nine units that were removed by endoscopy and seven units were by open surgery. Conclusions: In malignant ureteral obstructions, the Uventa stent showed favorable outcomes with high success rate and acceptable complication rate. However, in benign ureteral obstructions, overall success rate and complication rate were less favorable. Malignant ureteral obstruction seems to be appropriate indication of Uventa stent placement. However, in chronic diffuse benign ureteral obstructions the decision of placement of Uventa stent has to be careful.

Keywords: cause, complication, ureteral obstruction, metal stent

Procedia PDF Downloads 203

Authors: Aizreena Azaman, Mai Ishibashi, Masanori Ishizawa, Shin-Ichiroh Yamamoto

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Sensory input plays an important role to human posture control system to initiate strategy in order to counterpart any unbalance condition and thus, prevent fall. In previous study, joint stiffness was observed able to describe certain issues regarding to movement performance. But, correlation between balance ability and joint stiffness is still remains unknown. In this study, joint stiffening strategy at ankle and hip were observed under different sensory manipulations and its correlation with conventional clinical test (Functional Reach Test) for balance ability was investigated. In order to create unstable condition, two different surface perturbations (tilt up-tilt (TT) down and forward-backward (FB)) at four different frequencies (0.2, 0.4, 0.6 and 0.8 Hz) were introduced. Furthermore, four different sensory manipulation conditions (include vision and vestibular system) were applied to the subject and they were asked to maintain their position as possible. The results suggested that joint stiffness were high during difficult balance situation. Less balance people generated high average joint stiffness compared to balance people. Besides, adaptation of posture control system under repetitive external perturbation also suggested less during sensory limited condition. Overall, analysis of joint stiffening response possible to predict unbalance situation faced by human.

Keywords: balance ability, joint stiffness, sensory, adaptation, dynamic

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Authors: Walid Moudani

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The healthcare environment is generally perceived as being information rich yet knowledge poor. However, there is a lack of effective analysis tools to discover hidden relationships and trends in data. In fact, valuable knowledge can be discovered from application of data mining techniques in healthcare system. In this study, a proficient methodology for the extraction of significant patterns from the coronary heart disease warehouses for heart attack prediction, which unfortunately continues to be a leading cause of mortality in the whole world, has been presented. For this purpose, we propose to enumerate dynamically the optimal subsets of the reduced features of high interest by using rough sets technique associated to dynamic programming. Therefore, we propose to validate the classification using Random Forest (RF) decision tree to identify the risky heart disease cases. This work is based on a large amount of data collected from several clinical institutions based on the medical profile of patient. Moreover, the experts’ knowledge in this field has been taken into consideration in order to define the disease, its risk factors, and to establish significant knowledge relationships among the medical factors. A computer-aided system is developed for this purpose based on a population of 525 adults. The performance of the proposed model is analyzed and evaluated based on set of benchmark techniques applied in this classification problem.

Keywords: multi-classifier decisions tree, features reduction, dynamic programming, rough sets

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Authors: Farah Naja, Mohamad Alameddine

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Background: The difficulty of compliance to therapeutic and lifestyle management of type 2 diabetes mellitus (T2DM) encourages patients to use complementary and alternative medicine (CAM) therapies. Little is known about the prevalence and mode of CAM use among diabetics in the Eastern Mediterranean Region in general and Lebanon in particular. Objective: To assess the prevalence and modes of CAM use among patients with T2DM residing in Beirut, Lebanon. Methods: A cross-sectional survey of T2DM patients was conducted on patients recruited from two major referral centers - a public hospital and a private academic medical center in Beirut. In a face-to-face interview, participants completed a survey questionnaire comprised of three sections: socio-demographic, diabetes characteristics and types and modes of CAM use. Descriptive statistics, univariate and multivariate logistic regression analyses were utilized to assess the prevalence, mode and correlates of CAM use in the study population. The main outcome in this study (CAM use) was defined as using CAM at least once since diagnosis with T2DM. Results: A total of 333 T2DM patients completed the survey (response rate: 94.6%). Prevalence of CAM use in the study population was 38%, 95% CI (33.1-43.5). After adjustment, CAM use was significantly associated with a “married” status, a longer duration of T2DM, the presence of disease complications, and a positive family history of the disease. Folk foods and herbs were the most commonly used CAM followed by natural health products. One in five patients used CAM as an alternative to conventional treatment. Only 7 % of CAM users disclosed the CAM use to their treating physician. Health care practitioners were the least cited (7%) as influencing the choice of CAM among users. Conclusion: The use of CAM therapies among T2DM patients in Lebanon is prevalent. Decision makers and care providers must fully understand the potential risks and benefits of CAM therapies to appropriately advise their patients. Attention must be dedicated to educating T2DM patients on the importance of disclosing CAM use to their physicians especially patients with a family history of diabetes, and those using conventional therapy for a long time.

Keywords: nutritional supplements, type 2 diabetes mellitus, complementary and alternative medicine (CAM), conventional therapy

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Authors: Bharti Arora, Michael Chen, Steven Lun

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Plasmacytoid urothelial carcinoma (PUC) of the bladder is a rare and aggressive subtype of urothelial carcinoma that usually presents at an advanced clinical stage, has a predilection for early metastatic potential and is associated with poor prognosis. The first reported case of PUC was in 1991 and approximately 100 cases were reported in the literature worldwide. We present a case of a 43 year old female presenting with a 3-month history of urgency and frequency. Failing medical management of her urinary symptoms with anticholinergic medication, she underwent a diagnostic cystoscopy which revealed an erythematous and indurated bladder. Bladder biopsies of these regions revealed plasmacytoid urothelial carcinoma. Pre-operative staging scans were clear of any metastatic disease and the patient subsequently underwent a radical cystectomy and pelvic clearance with the formation of ileal conduit for urinary diversion. Histology confirmed plasmacytoid urothelial carcinoma with involvement of right upper vagina and focally positive margins in soft tissue at right and left sides of bladder. She received adjuvant chemotherapy but passed away within a year from disease progression. PUC can present atypically and our case highlights the role of cystoscopy in patients with persistent urinary symptoms. By reviewing the literature on PUC, we aim to raise awareness and improve understanding of this rare bladder cancer subtype amongst urologists.

Keywords: urology, bladder cancer, plasmacytoid urothelial cancer, literature review

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Authors: Yuguang Gao, Qiang Yang, Yanpeng Zhang, Mingtao Deng

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To enhance the safety, quality and efficiency of healthcare services provided by surgical doctors, we propose a comprehensive approach to the performance evaluation of individual doctors by incorporating insights from performance data as well as views of different stakeholders in the hospital. Exploratory factor analysis was first performed on collective multidimensional performance data of surgical doctors, where key factors were extracted that encompass assessment of professional experience and service performance. A two-level indicator system was then constructed, for which we developed a weighted interval-valued spherical fuzzy analytic hierarchy process to analyze the relative importance of the indicators while handling subjectivity and disparity in the decision-making of multiple parties involved. Our analytical results reveal that, for the key factors identified as instrumental for evaluating surgical doctors’ performance, the overall importance of clinical workload and complexity of service are valued more than capacity of service and professional experience, while the efficiency of resource consumption ranks comparatively the lowest in importance. We also provide a retrospective case study to illustrate the effectiveness and robustness of our quantitative evaluation model by assigning meaningful performance ratings to individual doctors based on the weights developed through our approach.

Keywords: analytic hierarchy processes, factor analysis, fuzzy logic, performance evaluation

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Authors: Aniket Kumar, Jacob Peedicayil

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Major depressive disorder (MDD) is a common and important psychiatric disorder. Several clinical features of MDD suggest an epigenetic basis for its pathogenesis. Since epigenetics (heritable changes in gene expression not involving changes in DNA sequence) may underlie the pathogenesis of MDD, epigenetic drugs such as DNA methyltransferase inhibitors (DNMTi) and histone deactylase inhibitors (HDACi) may be useful for treating MDD. The available literature indexed in Pubmed on preclinical drug trials of epigenetic drugs for the treatment of MDD was investigated. The search terms we used were ‘depression’ or ‘depressive’ and ‘HDACi’ or ‘DNMTi’. Among epigenetic drugs, it was found that there were 3 preclinical trials using HDACi and 3 using DNMTi for the treatment of MDD. All the trials were conducted on rodents (mice or rats). The animal models of depression that were used were: learned helplessness-induced animal model, forced swim test, open field test, and the tail suspension test. One study used a genetic rat model of depression (the Flinders Sensitive Line). The HDACi that were tested were: sodium butyrate, compound 60 (Cpd-60), and valproic acid. The DNMTi that were tested were: 5-azacytidine and decitabine. Among the three preclinical trials using HDACi, all showed an antidepressant effect in animal models of depression. Among the 3 preclinical trials using DNMTi also, all showed an antidepressant effect in animal models of depression. Thus, epigenetic drugs, namely, HDACi and DNMTi, may prove to be useful in the treatment of MDD and merit further investigation for the treatment of this disorder.

Keywords: DNA methylation, drug discovery, epigenetics, major depressive disorder

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Authors: A. Fordham, A. Hudson

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Background: Studies have suggested 16-25% of normotensive trauma patients with no clinical signs of shock have abnormal lactate and BD readings evidencing shock; a phenomenon known as occult hypoperfusion (OH). In light of the scarce quantity of evidence currently documenting OH, this study aimed to identify the prevalence of OH in the pre-hospital setting and explore ways to improve its identification and management. Methods: A quantitative retrospective data analysis was carried out on 75 sets of patient records for trauma patients treated by Kent Surrey Sussex Air Ambulance Trust between November 2013 and October 2014. The KSS HEMS notes and subsequent ED notes were collected. Trends between patients’ SBP on the scene, whether or not they received PRBCs on the scene as well as lactate and BD readings in the ED were assessed. Patients’ KSS HEMS notes written by the HEMS crew were also reviewed and recorded. Results: -Suspected OH was identified in 7% of the patients who did not receive PRBCs in the pre-hospital phase. -SBP heavily influences the physicians’ decision of whether or not to transfuse PRBCs in the pre-hospital phase. Preliminary conclusions: OH is an under-studied and underestimated phenomenon. We suggest a prospective trial is carried out to evaluate whether detecting trauma patients’ tissue perfusion status in the pre-hospital phase using portable devices capable of measuring serum BD and/or lactate could aid more accurate detection and management of all haemorrhaging trauma patients, including patients with OH.

Keywords: occult hypoperfusion, PRBC transfusion, point of care testing, pre-hospital emergency medicine, trauma

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Authors: Katie Emerson, Sara Perez-Ojalvo, Jim Komorowski, Danielle Greenberg

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The purpose of this study was to evaluate arginase activity levels in response to combinations of an inositol-stabilized arginine silicate (ASI; Nitrosigine®), L-arginine, and Inositol. Arginine acts as a vasodilator that promotes increased blood flow resulting in enhanced delivery of oxygen and nutrients to the brain and other tissues. ASI alone has been shown to improve performance on cognitive tasks. Arginase, found in human serum, catalyzes the conversion of arginine to ornithine and urea, completing the last step in the urea cycle. Decreasing arginase levels maintains arginine and results in increased nitric oxide production. This study aimed to determine the most effective combination of ASI, L-arginine and inositol for minimizing arginase levels and therefore maximize ASI’s effect on cognition. Serum was taken from untreated healthy donors by separation from clotted factors. Arginase activity of serum in the presence or absence of test products was determined (QuantiChrom™, DARG-100, Bioassay Systems, Hayward CA). The remaining ultra-filtrated serum units were harvested and used as the source for the arginase enzyme. ASI alone or combined with varied levels of Inositol were tested as follows: ASI + inositol at 0.25 g, 0.5 g, 0.75 g, or 1.00 g. L-arginine was also tested as a positive control. All tests elicited changes in arginase activity demonstrating the efficacy of the method used. Adding L-arginine to serum from untreated subjects, with or without inositol only had a mild effect. Adding inositol at all levels reduced arginase activity. Adding 0.5 g to the standardized amount of ASI led to the lowest amount of arginase activity as compared to the 0.25g 0.75g or 1.00g doses of inositol or to L-arginine alone. The outcome of this study demonstrates an interaction of the pairing of inositol with ASI on the activity of the enzyme arginase. We found that neither the maximum nor minimum amount of inositol tested in this study led to maximal arginase inhibition. Since the inhibition of arginase activity is desirable for product formulations looking to maintain arginine levels, the most effective amount of inositol was deemed preferred. Subsequent studies suggest this moderate level of inositol in combination with ASI leads to cognitive improvements including reaction time, executive function, and concentration.

Keywords: arginine, inositol, arginase, cognitive benefits

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Authors: Kholoud Abdulaziz, Kholoud Al-Najdi, Abdullah Kadri, Konstantinos E. Kakosimos

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The Middle East area is highly affected by air pollution induced by anthropogenic and natural phenomena. There is evidence that air pollution, especially particulates, greatly affects the population health. Many studies have raised a warning of the high concentration of particulates and their affect not just around industrial and construction areas but also in the immediate working and living environment. One of the methods to study air quality is continuous and periodic monitoring using active or passive samplers. Active monitoring and sampling are the default procedures per the European and US standards. However, in many cases they have been inefficient to accurately capture the spatial variability of air pollution due to the small number of installations; which eventually is attributed to the high cost of the equipment and the limited availability of users with expertise and scientific background. Another alternative has been found to account for the limitations of the active methods that is the passive sampling. It is inexpensive, requires no continuous power supply, and easy to assemble which makes it a more flexible option, though less accurate. This study aims to investigate and evaluate the use of passive sampling for particulate matter pollution monitoring in dry tropical climates, like in the Middle East. More specifically, a number of field measurements have be conducted, both indoors and outdoors, at Qatar and the results have been compared with active sampling equipment and the reference methods. The samples have been analyzed, that is to obtain particle size distribution, by applying existing laboratory techniques (optical microscopy) and by exploring new approaches like the white light interferometry to. Then the new parameters of the well-established model have been calculated in order to estimate the atmospheric concentration of particulates. Additionally, an extended literature review will investigate for new and better models. The outcome of this project is expected to have an impact on the public, as well, as it will raise awareness among people about the quality of life and about the importance of implementing research culture in the community.

Keywords: air pollution, passive samplers, interferometry, indoor, outdoor

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Authors: Zuzana Chaloupková, Zdeňka Marková, Václav Ranc, Radek Zbořil

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Prostate cancer is now one of the most serious oncological diseases in men with an incidence higher than that of all other solid tumors combined. Diagnosis of prostate cancer usually involves detection of related genes or detection of marker proteins, such as PSA. One of the new potential markers is PSMA (prostate specific membrane antigen). PSMA is a unique membrane bound glycoprotein, which is considerably overexpressed on prostate cancer as well as neovasculature of most of the solid tumors. Commonly applied methods for a detection of proteins include techniques based on immunochemical approaches, including ELISA and RIA. Magnetically assisted surface enhanced Raman spectroscopy (MA-SERS) can be considered as an interesting alternative to generally accepted approaches. This work describes a utilization of MA-SERS in a detection of PSMA in human blood. This analytical platform is based on magnetic nanocomposites Fe3O4@Ag, functionalized by a low-molecular selector labeled as JB303. The system allows isolating the marker from the complex sample using application of magnetic force. Detection of PSMA is than performed by SERS effect given by a presence of silver nanoparticles. This system allowed us to analyze PSMA in clinical samples with limits of detection lower than 1 ng/mL.

Keywords: diagnosis, cancer, PSMA, MA-SERS, Ag nanoparticles

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Authors: Hanna Gulema, Meaza Demissie, Alemayehu Worku, Tesfaye Assebe Yadeta, Yemane Berhane

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Background: In patriarchal societies, female caregivers decide on food allocation within a family based on prevailing gender and age norms, which may lead to inequality that does not favor young adolescent girls. This study evaluated the effect of a community-based social norm intervention involving female caregivers in West Hararghe, Ethiopia. The intervention was engaging female caregivers along with other adult influential community members to deliberate and act on food allocation social norms in a process referred to as Social Analysis and Action (SAA). Method: We used data from a large quasi-experimental study to compare family eating practices between those who participated in the Social Analyses and Action intervention and those who did not. The respondents were female caregivers in households with young adolescent girls (ages 13 and 14 years). The study’s outcome was the practice of family eating together from the same dish. The difference in difference (DID) analysis with the Mixed effect logistic regression model was used to examine the effect of the intervention. Result: The results showed improved family eating practices in both groups, but the improvement was greater in the intervention group. The DID analysis showed an 11.99 percentage points greater improvement in the intervention arm than in the control arm. The mixed-effect regression produced an adjusted odds ratio of 2.08 (95% CI [1.06–4.09]) after controlling selected covariates, p-value 0.033. Conclusions: The involvement of influential adult community members significantly improves the family practice of eating together in households where adolescent girls are present in our study. The intervention has great potential to minimize household food allocation inequalities and thus improve the nutritional status of young adolescents. Further studies are necessary to evaluate the effectiveness of the intervention in different social norm contexts to formulate policy and guidelines for scale-up.

Keywords: family eating practice, social norm intervention, adolescence girls, caregiver

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Authors: Arlene Caney, Linda Fellag

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To counter the adverse effect of Covid-19 on college student success, two faculty members at a US community college have used web-based assessment data to improve curricula and, thus, student outcomes. This case study exemplifies how “closing the loop” by analyzing outcome assessments in real time can improve student learning for academically underprepared students struggling during the pandemic. The purpose of the study was to develop ways to mitigate the negative impact of Covid-19 on student success of underprepared college students. Using the Assessment, Evaluation, Feedback and Intervention System (AEFIS) and other assessment tools provided by the college’s Office of Institutional Research, an English professor and a Music professor collected data in skill areas related to their curricula over four semesters, gaining insight into specific course sections and learners’ performance across different Covid-driven course formats—face-to-face, hybrid, synchronous, and asynchronous. Real-time data collection allowed faculty to shorten and close the assessment loop, and prompted faculty to enhance their curricula with engaging material, student-centered activities, and a variety of tech tools. Frequent communication, individualized study, constructive criticism, and encouragement were among other measures taken to enhance teaching and learning. As a result, even while student success rates were declining college-wide, student outcomes in these faculty members’ asynchronous and synchronous online classes improved or remained comparable to student outcomes in hybrid and face-to-face sections. These practices have demonstrated that even high-risk students who enter college with remedial level language and mathematics skills, interrupted education, work and family responsibilities, and language and cultural diversity can maintain positive outcomes in college across semesters, even during the pandemic.

Keywords: AEFIS, assessment, distance education, institutional research center

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Authors: Kristin Thooft

Abstract:

— Increasing pressure to manage healthcare costs has resulted in shifting care towards ambulatory settings and is driving a focus on cost transparency. There are few nurse staffing to workload models developed for ambulatory settings, less for multi-specialty clinics. Of the existing models, few have been evaluated against outcomes to understand any impact. This evaluation took place after the AWARD model for nurse staffing to workload was implemented in a multi-specialty clinic at a regional healthcare system in the Midwest. The multi-specialty clinic houses 26 medical and surgical specialty practices. The AWARD model was implemented in two specialty practices in October 2020. Donabedian’s Structure-Process-Outcome (SPO) model was used to evaluate outcomes based on changes to the structure and processes of care provided. The AWARD model defined and quantified the processes, recommended changes in the structure of day-to-day nurse staffing. Cost of care per patient visit, total visits, a total nurse performed visits used as structural and process measures, influencing the outcomes of cost of care and access to care. Independent t-tests were used to compare the difference in variables pre-and post-implementation. The SPO model was useful as an evaluation tool, providing a simple framework that is understood by a diverse care team. No statistically significant changes in the cost of care, total visits, or nurse visits were observed, but there were differences. Cost of care increased and access to care decreased. Two weeks into the post-implementation period, the multi-specialty clinic paused all non-critical patient visits due to a second surge of the COVID-19 pandemic. Clinic nursing staff was re-allocated to support the inpatient areas. This negatively impacted the ability of the Nurse Manager to utilize the AWARD model to plan daily staffing fully. The SPO framework could be used for the ongoing assessment of nurse staffing performance. Additional variables could be measured, giving a complete picture of the impact of nurse staffing. Going forward, there must be a continued focus on the outcomes of care and the value of nursing

Keywords: ambulatory, clinic, evaluation, outcomes, staffing, staffing model, staffing to workload

Procedia PDF Downloads 173