Search results for: clinical reasoning

Authors: Yijun Shao, Yan Cheng, Rashmee U. Shah, Charlene R. Weir, Bruce E. Bray, Qing Zeng-Treitler

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Deep neural network (DNN) models are being explored in the clinical domain, following the recent success in other domains such as image recognition. For clinical adoption, outcome prediction models require explanation, but due to the multiple non-linear inner transformations, DNN models are viewed by many as a black box. In this study, we developed a deep neural network model for predicting 1-year mortality of patients who underwent major cardio vascular procedures (MCVPs), using temporal image representation of past medical history as input. The dataset was obtained from the electronic medical data warehouse administered by Veteran Affairs Information and Computing Infrastructure (VINCI). We identified 21,355 veterans who had their first MCVP in 2014. Features for prediction included demographics, diagnoses, procedures, medication orders, hospitalizations, and frailty measures extracted from clinical notes. Temporal variables were created based on the patient history data in the 2-year window prior to the index MCVP. A temporal image was created based on these variables for each individual patient. To generate the explanation for the DNN model, we defined a new concept called impact score, based on the presence/value of clinical conditions’ impact on the predicted outcome. Like (log) odds ratio reported by the logistic regression (LR) model, impact scores are continuous variables intended to shed light on the black box model. For comparison, a logistic regression model was fitted on the same dataset. In our cohort, about 6.8% of patients died within one year. The prediction of the DNN model achieved an area under the curve (AUC) of 78.5% while the LR model achieved an AUC of 74.6%. A strong but not perfect correlation was found between the aggregated impact scores and the log odds ratios (Spearman’s rho = 0.74), which helped validate our explanation.

Keywords: deep neural network, temporal data, prediction, frailty, logistic regression model

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Authors: Farshad Badie

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The central focus of this article is on the fact that knowledge is constructed from an interaction between humans’ experiences and over their conceptions of constructed concepts. Logical characterisation of ‘human inductive learning over human’s constructed concepts’ within terminological systems and providing a logical background for theorising over the Human Concept Learning Problem (HCLP) in terminological systems are the main contributions of this research. This research connects with the topics ‘human learning’, ‘epistemology’, ‘cognitive modelling’, ‘knowledge representation’ and ‘ontological reasoning’.

Keywords: human concept learning, concept construction, knowledge construction, terminological systems

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Authors: Dylan Shiting Lu, Samson Okello, Anita Chunyan Wei, Daniel Xiao Li

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Mammotome vacuum-assisted breast biopsy (MVB) introduced in 1995 can be used for the removal of benign breast lesions. Whether or not MVB is a better option compared to conventional open surgery is inconclusive. We aim to compare the clinical and patient-related outcomes between MVB and open surgery to remove benign breast tumors less than 5 cm in women. We searched English and Chinese electronic databases with the keywords of Mammotome, clinical trial (CT), vacuum-assisted breast biopsy for studies comparing MVB and open surgery until May 2021. We performed a systematic review and random-effects meta-analysis to compare incision size, operation time, intraoperative blood loss, healing time, scar length, patient satisfaction, postoperative hematoma rate, wound infection rate, postoperative ecchymosis, and postoperative sunken skin among those who have Mammotome and those who have surgery. Our analysis included nine randomized CTs with 1155 total patients (575 Mammotome, 580 surgery) and mean age 40.32 years (standard deviation 3.69). We found statistically significant favorable outcomes for Mammotome including blood loss (ml) [standardized mean difference SMD -5.03, 95%CI (-7.30, -2.76)], incision size (cm) [SMD -12.22, 95%CI (-17.40, -7.04)], operation time (min) [SMD -6.66, 95%CI (-9.01, -4.31)], scar length (cm) [SMD -7.06, 95%CI (-10.76, -3.36)], healing time (days) [SMD -6.57, 95%CI (-10.18, -2.95)], and patient satisfaction [relative risk RR 0.38, 95%CI (0.13, 1.08)]. In conclusion, Mammotome vacuum-assisted breast biopsy compared to open surgery shows better clinical and patient-related outcomes. Further studies should be done on whether or not MVB is a better option for benign breast tumors excision.

Keywords: clinical and patient outcomes, open surgery, Mammotome vacuum-assisted breast biopsy, meta-analysis

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Authors: Gianluca Del Rossi

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Sub-concussive impacts occur frequently in collision sports such as American tackle football. Sub-concussive level impacts are defined as hits to the head that do not result in the clinical manifestation of concussion injury. Presently, there is limited information known about the short-term effects of repeated sub-concussive blows to the head. Therefore, the purpose of this investigation was to determine if standard clinical measures could detect acute impairments in neurologic function resulting from the accumulation of sub-concussive impacts throughout a season of high school American tackle football. Simple reaction time using the ruler-drop test, and oculomotor performance using the King-Devick (KD) test, were assessed in 15 athletes prior to the start of the athletic season, then repeated each week of the season, and once following its completion. The mean reaction times and fastest KD scores that were recorded or calculated from each study participant and from each test session were analyzed to assess for change in reaction time and oculomotor performance over the course of the American tackle football season. Analyses of KD data revealed improvements in oculomotor performance from baseline measurements (i.e., decreased time), with most weekly comparisons to baseline being significantly different. Statistical tests performed on the mean reaction times obtained via the ruler-drop test throughout the season revealed statistically significant declines (i.e., increased time) between baseline and weeks 3, 4, 10, and 12 of the athletic season. The inconsistent and contrasting findings between KD data and reaction time demonstrate the need to identify more robust clinical measures to definitively assess if repeated sub-concussive impacts to the head are acutely detrimental to patients.

Keywords: head injury, mTBI and sport, subclinical head trauma, sub-concussive impacts

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Authors: K. C. Wong, K. L. Siu, S. N. Ng, K. N. Yip, Y. Y. Yuen, K. W. Lee, K. W. Wong, C. C. Li, H. P. Lam

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Background: Occupational injuries among nursing profession were found related to repeated bedside nursing care, such as transfer, lifting and manual handling patients from previous studies. Likewise, undergraduate nursing students are also exposed to potential safety hazard due to their similar work nature of registered nurses. Especially, those students who worked as Temporary undergraduate nursing students (TUNS) which is a part-time clinical job in hospitals in Hong Kong who mainly assisted in providing bedside cares appeared to at high risk of work-related injuries. Several studies suggested the level of compliance with safe work behaviors was highly associated with work-related injuries. Yet, it had been limitedly studied among nursing students. This study was conducted to assess and compare the compliance with safe work behaviors and the levels of awareness of different workplace safety issues between undergraduate nursing students with or without TUNS experiences. Methods: This is a quantitative descriptive study using convenience sampling. 362 undergraduate nursing students in Hong Kong were recruited. The Safe Work Behavior relating to Patient Handling (SWB-PH) was used to assess their compliance of safe-work behaviors and the level of awareness of different workplace safety issues. Results: The results showed that most of the participants (n=250, 69.1%) who were working as TUNS. However, students who worked as TUNS had significantly lower safe-work behaviors compliance (mean SWB-PH score = 3.64±0.54) than those did not worked as TUNS (SWB-PH score=4.21±0.54) (p<0.001). Particularly, these students had higher awareness to seek help and use assistive devices but lower awareness of workplace safety issues and awareness of proper work posture than students without TUNS experiences. The students with TUNS experiences had higher engagement in help-seeking behaviors might be possibly explained by their richer clinical experiences which served as a facilitator to seek help from clinical staff whenever necessary. Besides, these experienced students were more likely to bear risks for occupational injuries and worked alone when no available aid which might be related to the busy working environment, heightened work pressures and high expectations of TUNS. Eventually, students who worked as TUNS might target on completing the assigned tasks and gradually neglecting the occupational safety. Conclusion: The findings contributed to an understanding of the level of compliance with safe work behaviors among nursing students with different clinical experiences. The results might guide the modification of current safety protocols and the introduction of multiple clinical training courses to improve nursing student’s engagement in safe work behaviors.

Keywords: Occupational safety, Safety compliance, Safe-work behavior, Nursing students

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Authors: Sheraz Gul

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The requirements for progressing a compound to clinical trials is well established and relies on the results from in-vitro and in-vivo animal tests to indicate that it is likely to be safe and efficacious when testing in humans. The typical data package required will include demonstrating compound safety, toxicity, bioavailability, pharmacodynamics (potential effects of the compound on body systems) and pharmacokinetics (how the compound is potentially absorbed, distributed, metabolised and eliminated after dosing in humans). If the desired criteria are met and the compound meets the clinical Candidate criteria and is deemed worthy of further development, a submission to regulatory bodies such as the US Food & Drug Administration for an exploratory Investigational New Drug Study can be made. The purpose of this study is to collect data to establish that the compound will not expose humans to unreasonable risks when used in limited, early-stage clinical studies in patients or normal volunteer subjects (Phase I). These studies are also designed to determine the metabolism and pharmacologic actions of the drug in humans, the side effects associated with increasing doses, and, if possible, to gain early evidence on their effectiveness. In order to reach the above goals, we have developed a pre-clinical high throughput Absorption, Distribution, Metabolism and Excretion–Toxicity (ADME–Toxicity) panel of assays to identify compounds that are likely to meet the Lead and Candidate compound acceptance criteria. This panel includes solubility studies in a range of biological fluids, cell viability studies in cancer and primary cell-lines, mitochondrial toxicity, off-target effects (across the kinase, protease, histone deacetylase, phosphodiesterase and GPCR protein families), CYP450 inhibition (5 different CYP450 enzymes), CYP450 induction, cardio-toxicity (hERG) and gene-toxicity. This panel of assays has been applied to multiple compound series developed in a number of projects delivering Lead and clinical Candidates and examples from these will be presented.

Keywords: absorption, distribution, metabolism and excretion–toxicity , drug discovery, food and drug administration , pharmacodynamics

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Authors: Liliana O. Martínez, Juan E. González, Manuel Ramírez-Aranda, Ana Cervantes-Herrera

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In this work, the use of a collection of mathematical challenges and puzzles aimed at students who are starting in algebra is proposed. The selected challenges and puzzles are intended to arouse students' interest in this area of mathematics, in addition to facilitating the teaching-learning process through challenges such as riddles, crossword puzzles, and board games, all in everyday situations that allow them to build themselves the learning. For this, it is proposed to carry out a "Math Rally: algebra" divided into four sections: mathematical reasoning, a hierarchy of operations, fractions, and algebraic equations.

Keywords: algebra, algebraic challenge, algebraic puzzle, math rally

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Authors: Morteza Khorrami

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The logic as an intellectual infrastructure plays an essential role in the Islamic sciences. Hence, there are a few of the verses of the Holy Quran that their interpretation is not possible due to lack of proper logic. In many verses in the Quran, argument and the respondent has requested from the audience that shows the logic rule is in the Quran. The paper which use a descriptive and analytic method, tries to show the role of logic in understanding of the Quran reasoning methods and display some of Quranic statements with mathematical symbols and point that we can help these symbols for interesting and interpretation and answering to some questions and doubts. In this paper, this problem has been mentioned that the Quran did not use two-valued logic (Aristotelian) in all cases, but the fuzzy logic can also be searched in the Quran.

Keywords: aristotelian logic, fuzzy logic, interpretation, Holy Quran

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Authors: M. Ndaw, G. Mendy, S. Ouya

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Information system risk management helps to reduce or eliminate risk by implementing appropriate controls. In this paper, we propose a quantification model of controls impact on information system risks by automatizing the residual criticality estimation step of FMECA which is based on a inductive reasoning. For this, we defined three equations based on type and maturity of controls. For testing, the values obtained with the model were compared to estimated values given by interlocutors during different working sessions and the result is satisfactory. This model allows an optimal assessment of controls maturity and facilitates risk analysis of information system.

Keywords: information system, risk, control, FMECA method

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Authors: Diana Vieira Figueiredo, Rita Ramos Miguel, Maria do Céu Salvador, Luiza Nobre-Lima, Daniel RIjo, Paula Vagos

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Social Anxiety Disorder (SAD) is characterized by a marked and persistent fear of social and/or performance situations in which one may be exposed to the scrutiny of others.  SAD has its usual onset and is highly prevalent during adolescence; if left untreated, it often has a chronic and unremitting course. So, it seems important to understand the psychological processes that might predict the development of SAD. One of these processes may be self-compassion, which has been found to be associated with social anxiety in both adults and adolescents. Self-compassion involves three main components, each with a positive (compassionate behavior) and negative (uncompassionate behavior) pole – self-kindness versus self-judgment, common humanity versus isolation, and mindfulness versus over-identification. The negative indicators of self-compassion (self-judgement, isolation, and over-identification) were found to be more strongly linked to mental health problems than the positive indicators (self-kindness, common humanity, and mindfulness). Additionally, negative associations were found between the positive indicators of self-compassion (self-kindness, common humanity, mindfulness) and psychopathology. The current study aimed to investigate the role of self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification in the likelihood of an adolescent presenting SAD by comparing groups of normative and socially anxious adolescents. The sample consisted of 32 adolescents (Mage = 15.88, SD = .833) of which 23 were girls. Adolescents were assessed through a clinical structured interview that led 17 to be assigned to the clinical group (presenting a primary diagnosis of SAD) and 15 to be assigned to the non-clinical group (presenting no clinical diagnosis). Variables under study were measured through the Self-Compassion Scale for adolescents (SCS-A), which assesses the six indicators of self-compassion presented above. Six separate models were tested, each with one of the subscales of the SCS-A as the independent variable and with the group (clinical versus non-clinical) as the dependent variable. The models considering isolation, over-identification, self-judgement, and self-kindness fitted the data and accurately predicted group belonging for between 75% to 84.4% of cases. Results indicated that the log of the odds of an adolescent presenting SAD was positively related to isolation, over-identification, and self-judgement and negatively associated with self-kindness. Findings provide support for the idea that decreased self-compassion may place adolescents at increased risk for experiencing clinical levels of social anxiety: on the one hand, adolescents with higher levels of isolation, over-identification, and self-judgement seem to be more prone to the development of psychopathological levels of social anxiety; on the other hand, self-kindness may play a protective role in the development of SAD in this developmental phase. So, if focusing on social feared consequences and perceiving to be different from others may be distinctive features of SAD, developing self-kindness may be the antidote to promote diminished levels of social anxiety and more.

Keywords: adolescents, social anxiety disorder, self-compassion, diagnosis odds-ration

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Authors: Hongmeng Su, Luyu Zhao, Yanyan Qian, Hong Fan

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Aim: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors that endanger human health seriously. RNA methylation, especially N6-methyladenosine (m⁶A) and 5-methylcytosine (m⁵C), a crucial epigenetic transcriptional regulatory mechanism, plays an important role in tumorigenesis, progression and prognosis. This research aims to systematically evaluate the prognostic value of m⁶A and m⁵C modulators in HCC patients. Methods: Twenty-four modulators of m⁶A and m⁵C were candidates to analyze their expression level and their contribution to predict the prognosis of HCC. Consensus clustering analysis was applied to classify HCC patients. Cox and LASSO regression were used to construct the risk model. According to the risk score, HCC patients were divided into high-risk and low/medium-risk groups. The clinical pathology factors of HCC patients were analyzed by univariate and multivariate Cox regression analysis. Results: The HCC patients were classified into 2 clusters with significant differences in overall survival and clinical characteristics. Nine-gene risk model was constructed including METTL3, VIRMA, YTHDF1, YTHDF2, NOP2, NSUN4, NSUN5, DNMT3A and ALYREF. It was indicated that the risk score could serve as an independent prognostic factor for patients with HCC. Conclusion: This study constructed a Nine-gene risk model by modulators of m⁶A and m⁵C and investigated its effect on the clinical prognosis of HCC. This model may provide important consideration for the therapeutic strategy and prognosis evaluation analysis of patients with HCC.

Keywords: hepatocellular carcinoma, m⁶A, m⁵C, prognosis, RNA methylation

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Authors: Mariam Matiashvili

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Argumentation is an integral part of our daily communications - formal or informal. Argumentative reasoning, techniques, and language tools are used both in personal conversations and in the business environment. Verbalization of the opinions requires the use of extraordinary syntactic-pragmatic structural quantities - arguments that add credibility to the statement. The study of argumentative structures allows us to identify the linguistic features that make the text argumentative. Knowing what elements make up an argumentative text in a particular language helps the users of that language improve their skills. Also, natural language processing (NLP) has become especially relevant recently. In this context, one of the main emphases is on the computational processing of argumentative texts, which will enable the automatic recognition and analysis of large volumes of textual data. The research deals with the linguistic analysis of the argumentative structures of Georgian political speeches - particularly the linguistic structure, characteristics, and functions of the parts of the argumentative text - claims, support, and attack statements. The research aims to describe the linguistic cues that give the sentence a judgmental/controversial character and helps to identify reasoning parts of the argumentative text. The empirical data comes from the Georgian Political Corpus, particularly TV debates. Consequently, the texts are of a dialogical nature, representing a discussion between two or more people (most often between a journalist and a politician). The research uses the following approaches to identify and analyze the argumentative structures Lexical Classification & Analysis - Identify lexical items that are relevant in argumentative texts creating process - Creating the lexicon of argumentation (presents groups of words gathered from a semantic point of view); Grammatical Analysis and Classification - means grammatical analysis of the words and phrases identified based on the arguing lexicon. Argumentation Schemas - Describe and identify the Argumentation Schemes that are most likely used in Georgian Political Speeches. As a final step, we analyzed the relations between the above mentioned components. For example, If an identified argument scheme is “Argument from Analogy”, identified lexical items semantically express analogy too, and they are most likely adverbs in Georgian. As a result, we created the lexicon with the words that play a significant role in creating Georgian argumentative structures. Linguistic analysis has shown that verbs play a crucial role in creating argumentative structures.

Keywords: georgian, argumentation schemas, argumentation structures, argumentation lexicon

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Authors: Alexandra McKinzie, Lucy Brown, Sarah Komanapalli, Sarah Swiezy, Caitlin Bernard

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Background: While 25% of US women will seek an abortion before age 45, targeted laws have led to a decline in abortion clinics, subsequently leaving 96% of Indiana counties and the 70% of Hoosier women residing in these counties without access to services they desperately need.1,2 Despite the need for a physician workforce that is educated and able to provide full-spectrum reproductive health care, few medical institutions have a standardized family planning and abortion pre-clinical curriculum. Methods: A Qualtrics survey was disseminated to students from Indiana University School of Medicine (IUSM) to evaluate (1) student interest in curriculum reform, (2) self-assessed preparedness to counsel on contraceptive and pregnancy options, and (3) preferred modality of instruction for family planning and abortion topics. Based on the pre-panel survey feedback, a case-based pregnancy options counseling panel will be implemented in the students’ pre-clinical, didactic course Endocrine, Reproductive, Musculoskeletal, Dermatologic Systems (ERMD) in February 2022. A Qualtrics post-panel survey will be disseminated to evaluate students’ perceived efficacy and quality of the panel, as well as their self-assessed preparedness to counsel on pregnancy options. Results: Participants in the pre-panel survey (n=303) were primarily female (61.72%) and White (74.43%). Across all class levels, many (60.80%) students expected to learn about family planning and abortion in their pre-clinical education. While most (84-88%) participants felt prepared to counsel about common, non-controversial pharmacotherapies (e.g. beta-blockers and diuretics), only 20% of students felt prepared to counsel on abortion options. Overall, 85.67% of students believed that IUSM should enhance its reproductive health coverage in pre-clinical, didactic courses. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. Expected Results: The authors predict that following the panel, students will indicate improved confidence in providing pregnancy options counseling. Additionally, students will provide constructive feedback on the structure and content of the panel for incorporation into future years’ curriculum. Conclusions: IUSM students overwhelmingly expressed interest in expanding their pre-clinical curriculum’s coverage of family planning and abortion topics. To specifically improve students’ self-assessed preparedness to provide pregnancy options counseling and address students’ self-cited learning gaps, a case-based provider panel session will be implemented in response to students’ preferred modality feedback.

Keywords: options counseling, family planning, abortion, curriculum reform, case-based panel

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Authors: Junaid Ahmed, Nandita Shenoy

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Maintaining lifelong knowledge and skills is essential for safe clinical practice. Continuing Professional Development (CPD) is an established method that can facilitate lifelong learning. It focuses on maintaining or developing knowledge, skills and relationships to ensure competent practice.To date, relatively little has been done to comprehensively and systematically synthesize evidence to identify subjects of interest among practising dentist. Hence the aim of our study was to identify areas in clinical practice that would be favourable for continuing professional dental education amongst practicing dentists. Participants of this study consisted of the practicing dental surgeons of Mangalore, a city in Dakshina Kannada, Karnataka. 95% of our practitioners felt that regular updating as a one day program once in 3-6 months is required, to keep them abreast in clinical practice. 60% of subjects feel that CPD programs enrich their theoretical knowledge and helps in patient care. 27% of them felt that CPD programs should be related to general dentistry. Most of them felt that CPD programs should not be charged nominally between one to two thousand rupees. The acronym ‘CPD’ should be seen in a broader view in which professionals continuously enhance not only their knowledge and skills, but also their thinking,understanding and maturity; they grow not only as professionals, but also as persons; their development is not restricted to their work roles, but may also extend to new roles and responsibilities.

Keywords: continuing professional development, competent practice, dental education, practising dentist

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Authors: Clesse C., Lighezzolo-Alnot J., De Lavergne S.

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Considered as the most common surgical procedure worldwide, episiotomy can be defined as an incision around the vulva performed to enlarge it, in the aim of preventing the traumatic rupture of the perineum during childbirth. Rather mediatized, this practice raises many questions in the field of mental health, relayed by different users and health professionals. Today, is topicality is moderately hectic since many queries about the prophylactic exercise of episiotomy are subject to a relative consensus, particularly since WHO advocated in 1996 that only 10% of childbirths should involve an episiotomy. This indicator appeared after the publication of numerous results from randomized clinical trials. Unfortunately, these papers seem mostly centered about somatic impacts of episiotomy. From the side of psychological studies, they mostly integrate a major clinical methodological bias, especially considering that every primiparous woman is identical to the others face to the experience of parturition. In the aim to fill this lack of knowledge, we developed a longitudinal research starting in the 7th month of pregnancy and ending one year after delivery. We are studying in a comparative way different possible psychological consequences inherent to the use of episiotomy. To do this, we use a standardized methodology which combines semi-structured clinical interviews (IRMAG, IRMAN ...), free clinical interviews, a projective test (Rorschach) and five questionnaires (QIC, EPDS, CPQ WOMBLSQ4, SF36). Therefore, we can comprehend with shrewdness the question of psychic impacts of episiotomy in a qualitative and quantitative way by comparing it to other obstetric interventions. In this paper, we will present the first results obtained about a population of twenty-two primiparous women by focusing on body image, sexuality, quality of life, depressive affects, post-traumatic stress disorder and investment of the maternal role. Finally, we will consider the different implications and perspectives of this research which could improve the public health policies in the field of perinatal care.

Keywords: assessment, episiotomy, mental health, psychical impacts

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Authors: Patrice L. Weiss, Barbara Mazer, Tal Krasovsky, Naomi Gefen

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Knowledge translation (KT) involves the process of applying the most promising research findings to practical settings, ensuring that new technological discoveries enhance healthcare accessibility, effectiveness, and accountability. This perspective paper aims to discuss and provide examples of how the KT process can be implemented during a time of rapid advancement in rehabilitation technologies, which have the potential to greatly influence pediatric healthcare. The analysis is grounded in a comprehensive systematic review of literature, where key studies from the past 34 years were carefully interpreted by four expert researchers in scientific and clinical fields. This review revealed both theoretical and practical insights into the factors that either facilitate or impede the successful implementation of new rehabilitation technologies. By utilizing the Knowledge-to-Action cycle, which encompasses the knowledge creation funnel and the action cycle, we demonstrated its application in integrating advanced technologies into clinical practice and guiding healthcare policy adjustments. We highlighted three successful technology applications: powered mobility, head support systems, and telerehabilitation. Moreover, we investigated emerging technologies, such as brain-computer interfaces and robotic assistive devices, which face challenges related to cost, durability, and usability. Recommendations include prioritizing early and ongoing design collaborations, transitioning from research to practical implementation, and determining the optimal timing for clinical adoption of new technologies. In conclusion, this paper informs, justifies, and strengthens the knowledge translation process, ensuring it remains relevant, rigorous, and significantly contributes to pediatric rehabilitation and other clinical fields.

Keywords: knowledge translation, rehabilitation technology, pediatrics, barriers, facilitators, stakeholders

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Authors: Maggie Hall, Haley O'Neill

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The U.S. faces a severe shortage of abortion providers, exacerbated by the June 2022 Dobbs v. Jackson Women’s Health Organization decision. Midwives, especially certified nurse midwives, are well-positioned to fill this gap in abortion care. However, a lack of clinical education and training prevents midwives from exercising their full scope of practice. National and international organizations that set obstetrics and midwifery education standards, including the International Confederation of Midwives, American College of Obstetricians and Gynecologists, and American Public Health Association, call for expansion of midwifery-managed abortion care through the first trimester. In the U.S., midwifery programs are accredited based on compliance with ACME standards and compliance is a prerequisite for the American Midwifery Certification Board exams. We conducted a literature review of studies in the last five years regarding abortion didactic and clinical education barriers via CINAHL, EBSCO and PubMed database reviews. We gave preference for primary sources within the last five years; however, due to the rapid changes in abortion education and access, we also included literature from 2012-2022. We evaluated ACME-accredited programs in relation to their geography within abortion-protected or restricted states and assessed state-specific barriers to abortion care education and provision as clinical students. There are 43 AMCB-accredited midwifery schools in 28 states across the U.S. Twenty schools (47%) are in the 15 states in which advanced practice clinicians can provide non-surgical abortion care, such as medication abortion and MVA procedures. Twenty-four schools (56%) are in the 16 states in which abortion care provision is restricted to Licensed Physicians and cannot offer in-state clinical training opportunities for midwifery students. Six schools are in the five states in which abortion is completely banned and are geographically concentrated in the southernmost region of the U.S., including Alabama, Kentucky, Louisiana, Tennessee, and Texas. Subsequently, these programs cannot offer in-state clinical training opportunities for midwifery students. Notably, there are seven ACME programs in six states that do not restrict abortion access by gestational age, including Colorado, Connecticut, Washington, D.C., New Jersey, New Mexico, and Oregon. These programs may be uniquely positioned for midwifery involvement in abortion care beyond the first trimester. While the following states don’t house ACME programs, abortion care can be provided by advanced practice clinicians in Rhode Island, Delaware, Hawaii, Maine, Maryland, Montana, New Hampshire, and Vermont, offering clinical placement and/or new ACME program development opportunities. We identify existing barriers to clinical education and training opportunities for midwifery-managed abortion care, which are both geographic and institutional in nature. We recommend expansion and standardization of clinical education and training opportunities for midwifery-managed abortion care in ACME-accredited programs to improve access to abortion care. Midwifery programs and teaching hospitals need to expand education, training, and residency opportunities for midwifery students to strengthen access to midwife-managed abortion care. ACNM and ACME should re-evaluate accreditation criteria and the implications of ACME programs in states where students are not able to learn abortion care in clinical contexts due to state-specific abortion restrictions.

Keywords: midwifery education, abortion, abortion education, abortion access

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Authors: Yaxian Chen, Yeonhee Park

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Driven by evolving FDA recommendations, modern clinical trials demand innovative designs that strike a balance between statistical rigor and ethical considerations. Covariate-adjusted response-adaptive (CARA) designs bridge this gap by utilizing patient attributes and responses to skew treatment allocation in favor of the treatment that is best for an individual patient’s profile. However, existing CARA designs for survival outcomes often hinge on specific parametric models, constraining their applicability in clinical practice. In this article, we address this limitation by introducing a CARA design for survival outcomes (CARAS) based on the Cox model and a variance estimator. This method addresses issues of model misspecification and enhances the flexibility of the design. We also propose a group sequential overlapweighted log-rank test to preserve type I error rate in the context of group sequential trials using extensive simulation studies to demonstrate the clinical benefit, statistical efficiency, and robustness to model misspecification of the proposed method compared to traditional randomized controlled trial designs and response-adaptive randomization designs.

Keywords: cox model, log-rank test, optimal allocation ratio, overlap weight, survival outcome

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Authors: Ng Yen, Shafii Khamis, Rehir Bin Dahalan

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Cyclotrons in the energy range 10-30 MeV are widely used for the production of clincally relevant radiosiotopes used in positron emission tomography (PET) nuclear imaging. Positron emmision tomography is a powerful nuclear imaging tool that produces high quality 3-dimentional images of functional processes of body. The advantage of PET among all other imaging devices is that it allows the study of an impressive array of discrete biochemical and physiologic processes, within a single imaging session. The number of PET scanner increases every year globally due to high clinical demand. However, not all PET centers can afford a cyclotron, due to the expense associated with operation of an in-house cyclotron. Therefore, current research has also focused on the development of parent/daughter generators that can reliably provide PET nuclides. These generators (68Ge/68Ga generator, 62Zn/62Cu, 82Sr/82Rb, etc) can provide even short-lived radionuclides at any time on demand, without the need of an ‘in-house cyclotron’. The parent isotope is produced at a cyclotron/reactor facility, and can be shipped to remote clinical sites (regionally/overseas), where the daughter isotope is eluted, a model similar to the 99Mo/99mTc generator system. The specific aim for this presentation is to talk about the potential for both of the cyclotron and generator-produced PET radiopharmaceuticals used in clinical imaging.

Keywords: positron emission tomography, radiopharmaceutical, cyclotron, generator

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Authors: Célia Barreto Carvalho, Carolina da Motta, Marina Sousa, Joana Cabral, Ana Luísa Carvalho, Ermelindo Peixoto

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The aim of the current study was to develop and validate a Response to Stressful Situations Scale (RSSS) for the Portuguese population. This scale assesses the degree of stress experienced in scenarios that can constitute positive, negative and more neutral stressors, and also describes the physiological, emotional and behavioral reactions to those events according to their intensity. These scenario include typical stressor scenarios relevant to patients with schizophrenia, which are currently absent from most scale, assessing specific risks that these stressors may bring on subjects, which may prove useful in non-clinical and clinical populations (i.e. patients with mood or anxiety disorders, schizophrenia). Results from Principal Components Analysis and Confirmatory Factor Analysis of on two adult samples from general population allowed to confirm a three-factor model with good fit indices: χ2 (144)= 370.211, p = 0.000; GFI = 0.928; CFI = 0.927; TLI = 0.914, RMSEA = 0.055, P( rmsea ≤ 0.005) = 0.096; PCFI = 0.781. Further data analysis on the scale revealed that RSSS is an adequate assessment tool of stress response in adults to be used in further research and clinical settings, with good psychometric characteristics, adequate divergent and convergent validity, good temporal stability and high internal consistency.

Keywords: assessment, stress events, stress response, stress vulnerability

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Authors: Yutong Wan, John N. Wood

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Introduction: SCN9A encoded Nav1.7 is an ideal therapeutic target with minimal side effects for the pharmaceutical industry because SCN9A variants can cause both human gains of function pain-related mutations and loss of function pain-free mutations. This study reviews the clinical effectiveness of existing Nav1.7 inhibitors, which theoretically should be powerful analgesics. Methods: A systematic review is conducted on the effectiveness of current Nav1.7 blockers undergoing clinical trials. Studies were mainly extracted from PubMed, U.S. National Library of Medicine Clinical Trials, World Health Organization International Clinical Trials Registry, ISRCTN registry platform, and Integrated Research Approval System by NHS. Only studies with full text available and those conducted using double-blinded, placebo controlled, and randomised designs and reporting at least one analgesic measurement were included. Results: Overall, 61 trials were screened, and eight studies covering PF 05089771 (Pfizer), TV 45070 (Teva & Xenon), and BIIB074 (Biogen) met the inclusion criteria. Most studies were excluded because results were not published. All three compounds demonstrated insignificant analgesic effects, and the comparison between PF 05089771 and pregabalin/ibuprofen showed that PF 05089771 was a much weaker analgesic. All three drug candidates only have mild side effects, indicating the potentials for further investigation of Nav1.7 antagonists. Discussion: The failure of current Nav1.7 small molecule inhibitors might attribute to ignorance of the key role of endogenous systems in Nav1.7 null mutants, the lack of selectivity and blocking potency, and central impermeability. The synergistic combination of analgesic drugs, a recent UCL patent, combining a small dose of Nav1.7 blockers and opioids or enkephalinase inhibitors dramatically enhanced the analgesic effects. Conclusion: The current clinical testing Nav1.7 blockers are generally disappointing. However, the newer generation of Nav1.7 targeting analgesics has overcome the major constraints of its predecessors.

Keywords: chronic pain, Nav1.7 blockers, SCN9A, systematic review

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Authors: Mousa Saleh Daoud

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Rickets is a condition that affects the development of bones in children. It causes soft bones, which can become bowed or curved, this bending and curvature is evident in the age of Walking. The most common cause of rickets is dietary deficiency of vitamin D or Lack of exposure to sunlight or both together. The link between vitamin D and rickets has been known for many years and is well understood by doctors and scientists. If a child does not get enough of the vitamin D, the bones cannot form hard outer shells. This is why they become soft and weak. This study was conducted on children who reviewed by our medical clinic between the years 2011-2013. The study included 400 children, aged between one and six years. 11 children had clear clinical manifestations of rickets of varying degrees and all of them due to lack of vitamin D except for one case of rickets resistant to vitamin D. 389 cases ranged between natural and deficiency in vitamin D without clinical manifestations of Rickets.

Keywords: rickts, bone metabolic diseases, vitamin D, child

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Authors: Bhavani Veasuvalingam

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Case-based learning (CBL) is a popular instructional method aimed to bridge theory to clinical practice. This study aims to explore CBL mixed modality curriculum in influencing students’ learning styles and strategies that support learning. An explanatory sequential mixed method study was employed with initial phase, 44-itemed Felderman’s Index of Learning Style (ILS) questionnaire employed across year one medical students (n=142) using convenience sampling to describe the preferred learning styles. The qualitative phase utilised three focus group discussions (FGD) to explore in depth on the multimodal learning style exhibited by the students. Most students preferred combination of learning stylesthat is reflective, sensing, visual and sequential i.e.: RSVISeq style (24.64%) from the ILS analysis. The frequency of learning preference from processing to understanding were well balanced, with sequential-global domain (66.2%); sensing-intuitive (59.86%), active- reflective (57%), and visual-verbal (51.41%). The qualitative data reported three major themes, namely Theme 1: CBL mixed modalities navigates learners’ learning style; Theme 2: Multimodal learners active learning strategies supports learning. Theme 3: CBL modalities facilitating theory into clinical knowledge. Both quantitative and qualitative study strongly reports the multimodal learning style of the year one medical students. Medical students utilise multimodal learning styles to attain the clinical knowledge when learning with CBL mixed modalities. Educators’ awareness of the multimodal learning style is crucial in delivering the CBL mixed modalities effectively, considering strategic pedagogical support students to engage and learn CBL in bridging the theoretical knowledge into clinical practice.

Keywords: case-based learning, learnign style, medical students, learning

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Authors: Mohamed Aly, Aliaa Rehan Youssef, Emad Sawerees, Mounir Guirgis

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Relevance: Osteoarthritis (OA) is the most common degenerative disease seen in all populations. It causes disability and substantial socioeconomic burden. Evidence supports that exercise are the most effective conservative treatment for patients with OA. Therapists experience and clinical judgment play major role in exercise prescription and scientific evidence for this regard is lacking. The development of clinical prediction rules to identify patients who are most likely benefit from exercise may help solving this dilemma. Purpose: This study investigated whether body mass index and functional ability at baseline can predict patients’ response to a selected exercise program. Approach: Fifty-six patients, aged 35 to 65 years, completed an exercise program consisting of open kinetic chain strengthening and passive stretching exercises. The program was given for 3 sessions per week, 45 minutes per session, for 6 weeks Evaluation: At baseline and post treatment, pain severity was assessed using the numerical pain rating scale, whereas functional ability was being assessed by step test (ST), time up and go test (TUG) and 50 feet time walk test (50 FTW). After completing the program, global rate of change (GROC) score of greater than 4 was used to categorize patients as successful and non-successful. Thirty-eight patients (68%) had successful response to the intervention. Logistic regression showed that BMI and 50 FTW test were the only significant predictors. Based on the results, patients with BMI less than 34.71 kg/m2 and 50 FTW test less than 25.64 sec are 68% to 89% more likely to benefit from the exercise program. Conclusions: Clinicians should consider the described strengthening and flexibility exercise program for patents with BMI less than 34.7 Kg/m2 and 50 FTW faster than 25.6 seconds. The validity of these predictors should be investigated for other exercise.

Keywords: clinical prediction rule, knee osteoarthritis, physical therapy exercises, validity

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Authors: Alexander Denzler, Marcel Wehrle, Andreas Meier

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A knowledge base stores facts and rules about the world that applications can use for the purpose of reasoning. By applying the concept of granular computing to a knowledge base, several advantages emerge. These can be harnessed by applications to improve their capabilities and performance. In this paper, the concept behind such a construct, called a granular knowledge cube, is defined, and its intended use as an instrument that manages to cope with different data types and detect knowledge domains is elaborated. Furthermore, the underlying architecture, consisting of the three layers of the storing, representing, and structuring of knowledge, is described. Finally, benefits as well as challenges of deploying it are listed alongside application types that could profit from having such an enhanced knowledge base.

Keywords: granular computing, granular knowledge, hierarchical structuring, knowledge bases

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Authors: Shu Hwang Ang, Choo Yee Yu, Geik Yong Ang, Yean Yean Chan, Yatimah Binti Alias, And Sook Mei Khor

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With the high prevalence of Type 2 diabetes mellitus across the world, the morbidities and mortalities associated with Type 2 diabetes have significant impact on the production line for a nation. With routine scheduled clinical visits to manage Type 2 diabetes, diabetic patients with hectic lifestyles can have low clinical compliance. Hence, it often decreases the effectiveness of diabetic management personalized for each diabetic patient. Here, we report a useful developed point-of-care (POC) device that detect glycated hemoglobin (HbA1c, biomarker for long-term Type 2 diabetic management). In fact, the established POC devices certified to be used in clinical setting are not only expensive ($ 8 to $10 per test), they also require skillful practitioners to perform sampling and interpretation. As a paper-based biosensor, the developed HbA1c biosensor utilized lateral flow principle to offer an alternative for cost-effective (approximately $2 per test) and end-user friendly device for household testing. Requiring as little as 2 L of finger-picked blood, the test can be performed at the household with just simple dilution and washings. With visual interpretation of numbers of test lines shown on the developed biosensor, it can be interpreted as easy as a urine pregnancy test, aided with scale of intensity provided. In summary, the developed HbA1c immunosensor has been tested to have high selectivity towards HbA1c, and is stable with reasonably good performance in clinical testing. Therefore, our developed HbA1c immunosensor has high potential to be an effective diabetic management tool to increase patient compliance and thus contain the progression of the diabetes.

Keywords: blood, glycated hemoglobin (HbA1c), lateral flow, type 2 diabetes mellitus

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Authors: Swati Arun

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The present paper argues that Balance of Power (BOP) needs to conjugate with certain contingencies like geography. It is evident that sea powers (‘insular’ for better clarity) are not balanced (if at all) in the same way as land powers. Its apparent that artificial insularity that the US has achieved reduces the chances of balancing (constant) and helps it maintain preponderance (variable). But how precise is this approach in assessing the dynamics between China’s rise and reaction of other powers and US. The ‘evolved’ theory can be validated by putting China and US in the equation. Systemic Relation between the nations was explained through the Balance of Power theory much before the systems theory was propounded. The BOP is the crux of functionality of ‘power relation’ dynamics which has played its role in the most astounding ways leading to situations of war and peace. Whimsical; but true that, the BOP has remained a complicated and indefinable concepts since Hans. Morganthau to Kenneth Waltz. A challenge of the BOP, however remains; “ that it has too many meanings”. In the recent times it has become evident that the myriad of expectations generated by BOP has not met the practicality of the current world politics. It is for this reason; the BoP has been replaced by Preponderance Theory (PT) to explain prevailing power situation. PT does provide an empirical reasoning for the success of this theory but fails in a abstract logical reasoning required for making a theory universal. Unipolarity clarifies the current system as one where balance of power has become redundant. It seems to reach beyond the contours of BoP, where a superpower does what it must to remain one. The centrality of this arguments pivots around - an exception, every time BOP fails to operate, preponderance of power emerges. PT does not sit well with the primary logic of a theory because it works on an exception. The evolution of such a pattern and system where BOP fails and preponderance emerges is absent. The puzzle here is- if BOP really has become redundant or it needs polishing. The international power structure changed from multipolar to bipolar to unipolar. BOP was looked at to provide inevitable logic behind such changes and answer the dilemma we see today- why US is unchecked, unbalanced? But why was Britain unchecked in 19th century and why China was unbalanced in 13th century? It is the insularity of the state that makes BOP reproduce “imbalance of power”, going a level up from off-shore balancer. This luxury of a state to maintain imbalance in the region of competition or threat is the causal relation between BOP’s and geography. America has applied imbalancing- meaning disequilibrium (in its favor) to maintain the regional balance so that over time the weaker does not get stronger and pose a competition. It could do that due to the significant parity present between the US and the rest.

Keywords: balance of power, china, preponderance of power, US

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Authors: Dipo Dunsin, Mohamed C. Ghanem, Karim Ouazzane

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Digital investigators often have a hard time spotting evidence in digital information. It has become hard to determine which source of proof relates to a specific investigation. A growing concern is that the various processes, technology, and specific procedures used in the digital investigation are not keeping up with criminal developments. Therefore, criminals are taking advantage of these weaknesses to commit further crimes. In digital forensics investigations, artificial intelligence is invaluable in identifying crime. It has been observed that an algorithm based on artificial intelligence (AI) is highly effective in detecting risks, preventing criminal activity, and forecasting illegal activity. Providing objective data and conducting an assessment is the goal of digital forensics and digital investigation, which will assist in developing a plausible theory that can be presented as evidence in court. Researchers and other authorities have used the available data as evidence in court to convict a person. This research paper aims at developing a multiagent framework for digital investigations using specific intelligent software agents (ISA). The agents communicate to address particular tasks jointly and keep the same objectives in mind during each task. The rules and knowledge contained within each agent are dependent on the investigation type. A criminal investigation is classified quickly and efficiently using the case-based reasoning (CBR) technique. The MADIK is implemented using the Java Agent Development Framework and implemented using Eclipse, Postgres repository, and a rule engine for agent reasoning. The proposed framework was tested using the Lone Wolf image files and datasets. Experiments were conducted using various sets of ISA and VMs. There was a significant reduction in the time taken for the Hash Set Agent to execute. As a result of loading the agents, 5 percent of the time was lost, as the File Path Agent prescribed deleting 1,510, while the Timeline Agent found multiple executable files. In comparison, the integrity check carried out on the Lone Wolf image file using a digital forensic tool kit took approximately 48 minutes (2,880 ms), whereas the MADIK framework accomplished this in 16 minutes (960 ms). The framework is integrated with Python, allowing for further integration of other digital forensic tools, such as AccessData Forensic Toolkit (FTK), Wireshark, Volatility, and Scapy.

Keywords: artificial intelligence, computer science, criminal investigation, digital forensics

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Authors: Druzhinenko-Silhan Daria, Metz Claire

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In this paper, we introduce the findings of the "Conjugal violence: mothers' parenting and court decisions" (VIC-PADEJ) study, focusing on the motherhood experiences of domestic violence victims. Utilizing a longitudinal research protocol that encompassed clinical interviews, projective methods, and various questionnaires, we detail the outcomes derived from seven clinical interviews with mothers alongside a comprehensive analysis. The findings reveal a pronounced decline in security and an imperative need for structuring both social and internal realities. The convergence of these findings indicates that parenting, post-experiencing domestic violence, may become an unattainable task due to the deficiency of internal resources.

Keywords: domestic violence, parenthood, mothers victims, projective methods, longitudinal research, alceste analysis

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Authors: Milind D. Meshram

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Ascarids are the most frequent worm parasite of dogs and cats. There are two species that commonly infect dogs: Toxocara canis and Toxascaris leonina. Adult roundworms live in the stomach and intestines and can grow to 7 inches (18 cm) long. A female may lay 200,000 eggs in a day. The eggs are protected by a hard shell. They are extremely hardy and can live for months or years in the soil. A dog aged about 6 years, from Satara was referred to Teaching Veterinary Clinical Complex (TVCC) with a complaint of abdominal pain, anorexia, loss of condition and dull body coat with mucous pale membrane. The clinical examination revealed Anaemia, palpation of abdomen revealed enlargement of liver, slimy feel of the intestine loop, diarrhea.

Keywords: therapeutic management, Toxocara canis, induced hepatitis, dogs

Procedia PDF Downloads 585