Search results for: patient safety incidents

Authors: Amina Lyria Deghal Cheridi, Abla Chaker, Ahcene Loubar

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Relap5 system code is one among powerful tools, which is used in the area of design and safety evaluation. This work aims to simulate the behavior of a radiant steam boiler at the steady-state conditions using Relap5 code system. To perform this study, a detailed Relap5 model is built including all the parts of the steam boiler. The control and regulation systems are also considered. To reproduce the most important parameters and phenomena with an acceptable accuracy and fidelity, a strong qualification work is undertaken concerning the facility nodalization. It consists of making a comparison between the code results and the plant available data in steady-state operation mode. Therefore, the model qualification results at the steady-state are in good agreement with the steam boiler experimental data. The steam boiler Relap5 model has proved satisfactory; and the model was capable of predicting the main thermal-hydraulic steady-state conditions of the steam boiler.

Keywords: industrial steam boiler, model qualification, natural circulation, relap5/mod3.2, steady state simulation

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Authors: Maurice Ntahobari, Levin Kuhlmann, Mario Boley, Zhinoos Razavi Hesabi

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For machine learning based epileptic seizure prediction, it is important for the model to be implemented in small implantable or wearable devices that can be used to monitor epilepsy patients; however, current state-of-the-art methods are complex and computationally intensive. We use Shapley Additive Explanation (SHAP) to find relevant intracranial electroencephalogram (iEEG) features and improve the computational efficiency of a state-of-the-art seizure prediction method based on the extra trees classifier while maintaining prediction performance. Results for a small contest dataset and a much larger dataset with continuous recordings of up to 3 years per patient from 15 patients yield better than chance prediction performance (p < 0.004). Moreover, while the performance of the SHAP-based model is comparable to that of the benchmark, the overall training and prediction time of the model has been reduced by a factor of 1.83. It can also be noted that the feature called zero crossing value is the best EEG feature for seizure prediction. These results suggest state-of-the-art seizure prediction performance can be achieved using efficient methods based on optimal feature selection.

Keywords: machine learning, seizure prediction, extra tree classifier, SHAP, epilepsy

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Authors: Jade V. Rushby, Tony Loughland, Tracy L. Durksen, Hoa Nguyen, Robert M. Klassen

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This paper reports a study investigating the development and implementation of an online multi-session ‘scenario-based learning’ (SBL) program administered to preservice teachers in Australia. The transition from initial teacher education to the teaching profession can present numerous cognitive and psychological challenges for early career teachers. Therefore, the identification of additional supports, such as scenario-based learning, that can supplement existing teacher education programs may help preservice teachers to feel more confident and prepared for the realities and complexities of teaching. Scenario-based learning is grounded in situated learning theory which holds that learning is most powerful when it is embedded within its authentic context. SBL exposes participants to complex and realistic workplace situations in a supportive environment and has been used extensively to help prepare students in other professions, such as legal and medical education. However, comparatively limited attention has been paid to investigating the effects of SBL in teacher education. In the present study, the SBL intervention provided participants with the opportunity to virtually engage with school-based scenarios, reflect on how they might respond to a series of plausible response options, and receive real-time feedback from experienced educators. The development process involved several stages, including collaboration with experienced educators to determine the scenario content based on ‘critical incidents’ they had encountered during their teaching careers, the establishment of the scoring key, the development of the expert feedback, and an extensive review process to refine the program content. The 4-part SBL program focused on areas that can be challenging in the beginning stages of a teaching career, including managing student behaviour and workload, differentiating the curriculum, and building relationships with colleagues, parents, and the community. Results from prior studies implemented by the research group using a similar 4-part format have shown a statistically significant increase in preservice teachers’ self-efficacy and classroom readiness from the pre-test to the final post-test. In the current research, professional teaching identity - incorporating self-efficacy, motivation, self-image, satisfaction, and commitment to teaching - was measured over six weeks at multiple time points: before, during, and after the 4-part scenario-based learning program. Analyses included latent growth curve modelling to assess the trajectory of change in the outcome variables throughout the intervention. The paper outlines (1) the theoretical underpinnings of SBL, (2) the development of the SBL program and methodology, and (3) the results from the study, including the impact of the SBL program on aspects of participating preservice teachers’ professional identity. The study shows how SBL interventions can be implemented alongside the initial teacher education curriculum to help prepare preservice teachers for the transition from student to teacher.

Keywords: classroom simulations, e-learning, initial teacher education, preservice teachers, professional learning, professional teaching identity, scenario-based learning, teacher development

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Authors: Mohamed A. Tantawy, Nourelhoda A. Hussein, Moataz A. Mahrous

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New planning and city design theories are continuously debated and optimized for seeking efficiency and adequacy in economic and life quality aspects. Here, we examine the children-city relationship, to reflect on how modern and traditional cities affect the social climate. We adopt children as a proper caliber for urbanism, as for their very young age, they are independent and attached to family. Their fragility offers a chance to gauge how various urban settings directly affect their feeling of safety, containment, and their perception of belonging for home territory. The importance of street play for the child development process is discussed thoroughly. The authority they have on their play (when and what to play) pushes us to our conclusion. A mediocre built environment characterized by spontaneity and human-scale semi-private urban spaces, is irreplaceable by a perfectly designed far away playgrounds. Street play has a huge role in empowering children for a gradual engagement with grown-ups’ urban flow.

Keywords: child's psychology, social activity, street play, urban fabric

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Authors: Mehrnaz Mostafavi, Mahtab Shabani, Alireza Azani, Fatemeh Ghafari

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Artificial intelligence (AI) can transform breast cancer diagnosis and therapy by providing sophisticated solutions for screening, imaging interpretation, histopathological analysis, and treatment planning. This literature review digs into the many uses of AI in breast cancer treatment, highlighting the need for collaboration between AI scientists and healthcare practitioners. It emphasizes advances in AI-driven breast imaging interpretation, such as computer-aided detection and diagnosis (CADe/CADx) systems and deep learning algorithms. These have shown significant potential for improving diagnostic accuracy and lowering radiologists' workloads. Furthermore, AI approaches such as deep learning have been used in histopathological research to accurately predict hormone receptor status and categorize tumor-associated stroma from regular H&E stains. These AI-powered approaches simplify diagnostic procedures while providing insights into tumor biology and prognosis. As AI becomes more embedded in breast cancer care, it is crucial to ensure its ethical, efficient, and patient-focused implementation to improve outcomes for breast cancer patients ultimately.

Keywords: breast cancer, artificial intelligence, cancer diagnosis, clinical practice

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Authors: William Whiteley, Jens Gregor

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In recent developments of direct neural network based positron emission tomography (PET) reconstruction, two prominent architectures have emerged for converting measurement data into images: 1) networks that contain fully-connected layers; and 2) networks that primarily use a convolutional encoder-decoder architecture. In this paper, we present a multi-modal direct PET reconstruction method called MDPET, which is a hybrid approach that combines the advantages of both types of networks. MDPET processes raw data in the form of sinograms and histo-images in concert with attenuation maps to produce high quality multi-slice PET images (e.g., 8x440x440). MDPET is trained on a large whole-body patient data set and evaluated both quantitatively and qualitatively against target images reconstructed with the standard PET reconstruction benchmark of iterative ordered subsets expectation maximization. The results show that MDPET outperforms the best previously published direct neural network methods in measures of bias, signal-to-noise ratio, mean absolute error, and structural similarity.

Keywords: deep learning, image reconstruction, machine learning, neural network, positron emission tomography

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Authors: Babak Mirbaha, Mahmoud Saffarzadeh, Atieh Asgari Toorzani

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Pedestrians are the most vulnerable road users since they do not have a protective shell. One of the most common collisions for them is pedestrian-vehicle at intersections. In order to develop appropriate countermeasures to improve safety for them, researches have to be conducted to identify the factors that affect the risk of getting involved in such collisions. More specifically, this study investigates factors such as the influence of walking alone or having a baby while crossing the street, the observable age of pedestrian, the speed of pedestrians and the speed of approaching vehicles on risk perception of pedestrians. A nested logit model was used for modeling the behavioral structure of pedestrians. The results show that the presence of more lanes at intersections and not being alone especially having a baby while crossing, decrease the probability of taking a risk among pedestrians. Also, it seems that teenagers show more risky behaviors in crossing the street in comparison to other age groups. Also, the speed of approaching vehicles was considered significant. The probability of risk taking among pedestrians decreases by increasing the speed of approaching vehicle in both the first and the second lanes of crossings.

Keywords: pedestrians, intersection, nested logit, risk

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Authors: A. Seham A. Elgamal, Reham H. Saleh

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Chronic kidney disease became a global health problem worldwide. Therefore, in order to maintain a patient’s life and improve the survival rate, hemodialysis is essential to replace the function of their kidneys. However, those patients may complain about multiple physical and psychological stressors due to the nature of the disease and the need for frequent hemodialysis sessions. So, those patients use various strategies to cope with the stressors related to their disease and the treatment procedures. Cross-sectional, descriptive study was carried out to achieve the aim of the study. A convenient sample including all adult patients was recruited for this study. Hemodialysis Stressors Scale (HSS) and Jalowiec Coping Scale (JCS) were used to investigate the stressors and coping strategies of 89 hemodialysis patients, at a governmental hospital (King Khalid Hospital-Jeddah). Results of the study revealed that 50.7% experienced physiological stressors and 38% experienced psychosocial stressors. Also, optimistic, fatalistic, and supportive coping strategies were the most common coping strategies used by the patients with mean scores (2.88 + 0.75, 2.87 + 0.75, and 1.82 + 0.71), respectively. In conclusion, being familiar with the types of stressors and the effective coping strategies of hemodialysis patients and their families are important in order to enhance their adaptation with chronic kidney diseases.

Keywords: copying strategies, hemodialysis, physiological stressors, psychological stressors

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Authors: S. K. Subah, R. Tasnim, M. I. Jahan, M. R. Islam

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While talking about how comfortable and convenient Dhaka's bus service is, the minimum emphasis is placed on the female commuters of the Dhaka city. Recognizing the contemporary situation, the supreme focus is to develop experimental model based on statistical methods. SEM has been adopted to quantify passenger satisfaction, which is affected by the perceived service quality. The study deals with 16 observed variables and three latent variables, which were correlated to identify their significance on the regulation of perceived SQ (Service Quality). To calibrate the model, a dataset of 250 responses from female users of local buses has been utilized through survey. A questionnaire structured with SQ variables was prepared in consultation with prevailing literature, practitioners, academicians, and users. The result concludes that the attributes of safe and secured environment have the most significant impact on the overall bus service quality according to the insight of female respondents. The study outcome might be a great help for the policymakers, women's organizations, and NGOs to formulate transport policy that will ensure a women-friendly public bus service.

Keywords: bus service quality, female perception, structural equation modelling, safety-security, women friendly bus

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Authors: Philipp Burger, Jonas Sommer, Haneen Daoud, Franz Hilmer, Uwe Glatzel

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Press-hardened structural components made of coated high-strength steel are an essential part of the automotive industry when it comes to weight reduction, safety, and durability. Alternative heat treatment processes, such as contact heating, have been developed to improve the efficiency of this process. However, contact heating of the steel sheets often results in cracking within the Al-Si-coated layer. Therefore, this paper will address the development of alternative coating compositions based on Al-Si-X, suitable for contact heating. For this purpose, robot-assisted thermal arc spray was applied to coat the high-strength steel sheets. This ensured high reproducibility as well as effectiveness. The influence of the coating parameters and the variation of the nozzle geometry on the microstructure of the developed coatings will be discussed. Finally, the surface and mechanical properties after contact heating and press hardening will be presented.

Keywords: press hardening, hot stamping, thermal spraying, arc spraying, coating compositions

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Authors: G. Anjan Babu, G. Sumana, M. Rajasekhar

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Many inherited diseases and non-hereditary disorders are common in the development of renal cystic diseases. Polycystic kidney disease (PKD) is a disorder developed within the kidneys in which grouping of cysts filled with water like fluid. PKD is responsible for 5-10% of end-stage renal failure treated by dialysis or transplantation. New experimental models, application of molecular biology techniques have provided new insights into the pathogenesis of PKD. Researchers are showing keen interest for developing an automated system by applying computer aided techniques for the diagnosis of diseases. In this paper a multi-layered feed forward neural network with one hidden layer is constructed, trained and tested by applying back propagation learning rule for the diagnosis of PKD based on physical symptoms and test results of urinanalysis collected from the individual patients. The data collected from 50 patients are used to train and test the network. Among these samples, 75% of the data used for training and remaining 25% of the data are used for testing purpose. Furthermore, this trained network is used to implement for new samples. The output results in normality and abnormality of the patient.

Keywords: dialysis, hereditary, transplantation, polycystic, pathogenesis

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Authors: H. K. V. Narayan

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This study was conducted at Tata Memorial Hospital (TMH), Mumbai, India. The study was to evaluate the impact of adapting Smart Card (SC) for clinical and business transactions in order to reduce Lead times and to enforce business rules of the hospital. The objective for implementing the Smart Card was to improve the patient perception of quality in terms of structures process and outcomes and also to improve the productivity of the Institution. The Smart Card was implemented in phases from 2011 and integrated with the Hospital Information System (HIS/EMR). The implementation was a learning curve for all the stake holders as software obviated the need to use hardcopies of transactions. The acceptability to the stake holders was challenge in change management. The study assessed the impact 3 years into the implementation and the observed trends have suggested that it has decreased the lead times for services and increased the no of transactions and thereby the productivity. Patients who used to complain of multiple queues and cumbersome transactions now compliment the administration for effective use of Information and Communication Technology.

Keywords: smart card, high availability of health care information, reduction in potential medical errors due to elimination of transcription errors, reduction in no of queues, increased transactions, augmentation of revenue

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Authors: Si Mon Kueh, Tom J. Kazmierski

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There are about 1% of the world population suffering from the hidden disability known as epilepsy and major developing countries are not fully equipped to counter this problem. In order to reduce the inconvenience and danger of epilepsy, different methods have been researched by using a artificial neural network (ANN) classification to distinguish epileptic waveforms from normal brain waveforms. This paper outlines the aim of achieving massive ANN parallelization through a dedicated hardware using bit-serial processing. The design of this bit-serial Neural Processing Element (NPE) is presented which implements the functionality of a complete neuron using variable accuracy. The proposed design has been tested taking into consideration non-idealities of a hardware ANN. The NPE consists of a bit-serial multiplier which uses only 16 logic elements on an Altera Cyclone IV FPGA and a bit-serial ALU as well as a look-up table. Arrays of NPEs can be driven by a single controller which executes the neural processing algorithm. In conclusion, the proposed compact NPE design allows the construction of complex hardware ANNs that can be implemented in a portable equipment that suits the needs of a single epileptic patient in his or her daily activities to predict the occurrences of impending tonic conic seizures.

Keywords: Artificial Neural Networks (ANN), bit-serial neural processor, FPGA, Neural Processing Element (NPE)

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Authors: Deanna Ruano-Meas, Laura Shenkman

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Variances are seen in the way healthcare personnel (HCP) don and doff PPE risking contamination to self and others. By standardizing practice, variances in technique decrease, and so does the risk of contamination. To implement this change, the Model for Improvement will be used. A system change will be developed that will outline the role of the organizational leader’s support of HCP in the proper donning and doffing of PPE. Interventions will include environmental surveys to assess the safety and work situation ensuring a permissible environment, plan audits to confirm consistency, and the assessment of PPE wear for standardization. The change will also include an educational plan that will involve instruction of the current guidelines recommended by the Centers for Disease Control and Prevention (CDC) to all pertinent HCP, and the incorporation of PPE education in yearly educational training. The goal is a standardized practice and a reduced risk of contamination through education and organizational support. Personal protective equipment has had recent attention with the coming of the SARS-CoV-2. The realization that proper technique is important to decreasing contamination of pathogens has led to the revising of current processes.

Keywords: donning and doffing, HAI, infection control, PPE

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Authors: Sally Shepherd, Richard De Boer, Craig Murphy

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Background: Invasive lobular carcinoma (ILC) can metastasize to atypical sites within the peritoneal cavity, gastrointestinal, or genitourinary tract. Management varies depending on the symptom presentation, extent of disease burden, particularly if the primary disease is occult, and patient wishes. Case Series: 6 patients presented with general surgical presentations of ILC, including incomplete large bowel obstruction, cholecystitis, persistent lower abdominal pain, and faecal incontinence. 3 were diagnosed with their primary and metastatic disease in the same presentation, whilst 3 patients developed metastasis from 5 to 8 years post primary diagnosis of ILC. Management included resection of the metastasis (laparoscopic cholecystectomy), excision of the primary (mastectomy and axillary clearance), followed by a combination of aromatase inhibitors, biologic therapy, and chemotherapy. Survival post diagnosis of metastasis ranged from 3 weeks to 7 years. Conclusion: Metastatic ILC must be considered with any gastrointestinal or genitourinary symptoms in patients with a current or past history of ILC. Management may not be straightforward to chemotherapy if the acute pathology is resulting in a surgically resectable disease.

Keywords: breast cancer, gastrointestinal metastasis, invasive lobular carcinoma, metastasis

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Authors: Leonardo C. Pacheco-Londoño, Nataly J. Galan-Freyle, Lisandro Pacheco-Lugo, Antonio Acosta, Elkin Navarro, Gustavo Aroca-Martínez, Karin Rondón-Payares, Samuel P. Hernández-Rivera

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In our Life Science Research Center of the University Simon Bolivar (LSRC), one of the focuses is the diagnosis and prognosis of different diseases; we have been implementing the use of gold nanoparticles (Au-NPs) for various biomedical applications. In this case, Au-NPs were used for Surface-Enhanced Raman Spectroscopy (SERS) in different diseases' diagnostics, such as Lupus Nephritis (LN), hypertension (H), preeclampsia (PC), and others. This methodology is proposed for the diagnosis of each disease. First, good signals of the different metabolites by SERS were obtained through a mixture of urine samples and Au-NPs. Second, PLS-DA models based on SERS spectra to discriminate each disease were able to differentiate between sick and healthy patients with different diseases. Finally, the sensibility and specificity for the different models were determined in the order of 0.9. On the other hand, a second methodology was developed using machine learning models from all data of the different diseases, and, as a result, a discriminant spectral map of the diseases was generated. These studies were possible thanks to joint research between two university research centers and two health sector entities, and the patient samples were treated with ethical rigor and their consent.

Keywords: SERS, Raman, PLS-DA, diseases

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Authors: Charles Kwaku Oppong

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The research linked urban expansion resulting from urbanization with changing morphology processes happening in peri-urban communities. Two villages of Kumasi City peri-urban were used as a case study. Appropriate analytical framework and methodology (literature review and empirical evidence) were employed to ensure that all pertinent issues of peri-urban interface are brought to light. It was discovered from the study that since peri-urban livelihood is linked with assets base; it has been found that stock of asset, as well as transformation processes, were major factors in the shaping of livelihoods strategies. For that reason, success or failure of household livelihoods was seen to relate to the kind of livelihood strategy employed. With efforts to mitigate for livelihoods failure due to peri-urban development, households' recourse to remittances, land disposal, and other means as an alternative livelihood approach. The study calls for local government policy interventions in regulating peri-urban transformation process and providing safety nets for the vulnerable.

Keywords: urban expansion, peri-urban interface, livelihoods, asset

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Authors: Emad Alenany, M. Adel El-Baz

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In this paper, the flow of different classes of patients into a hospital is modelled and analyzed by using the queueing network analyzer (QNA) algorithm and discrete event simulation. Input data for QNA are the rate and variability parameters of the arrival and service times in addition to the number of servers in each facility. Patient flows mostly match real flow for a hospital in Egypt. Based on the analysis of the waiting times, two approaches are suggested for improving performance: Separating patients into service groups, and adopting different service policies for sequencing patients through hospital units. The separation of a specific group of patients, with higher performance target, to be served separately from the rest of patients requiring lower performance target, requires the same capacity while improves performance for the selected group of patients with higher target. Besides, it is shown that adopting the shortest processing time and shortest remaining processing time service policies among other tested policies would results in, respectively, 11.47% and 13.75% reduction in average waiting time relative to first come first served policy.

Keywords: queueing network, discrete-event simulation, health applications, SPT

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Authors: Peregrine James Dalziel, Philip Vu Tran

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Objective / Introduction: Demand for radiology services from Emergency Departments (ED) continues to increase with greater demands placed on radiology staff providing reports for the management of complex cases. Queuing theory indicates that wide variability of process time with the random nature of request arrival increases the probability of significant queues. This can lead to delays in the time-to-availability of radiology reports (TTA-RR) and potentially impaired ED patient flow. In addition, greater “cognitive workload” of greater volume may lead to reduced productivity and increased errors. We sought to quantify the potential ED flow improvements obtainable from increased radiology providers serving 3 public hospitals in Melbourne Australia. We sought to assess the potential productivity gains, quality improvement and the cost-effectiveness of increased labor inputs. Methods & Materials: The Western Health Medical Imaging Department moved from single resident coverage on weekend days 8:30 am-10:30 pm to a limited period of 2 resident coverage 1 pm-6 pm on both weekend days. The TTA-RR for weekend CT scans was calculated from the PACs database for the 8 month period symmetrically around the date of staffing change. A multivariate linear regression model was developed to isolate the improvement in TTA-RR, between the two 4-months periods. Daily and hourly scan volume at the time of each CT scan was calculated to assess the impact of varying department workload. To assess any improvement in report quality/errors a random sample of 200 studies was assessed to compare the average number of clinically significant over-read addendums to reports between the 2 periods. Cost-effectiveness was assessed by comparing the marginal cost of additional staffing against a conservative estimate of the economic benefit of improved ED patient throughput using the Australian national insurance rebate for private ED attendance as a revenue proxy. Results: The primary resident on call and the type of scan accounted for most of the explained variability in time to report availability (R2=0.29). Increasing daily volume and hourly volume was associated with increased TTA-RR (1.5m (p<0.01) and 4.8m (p<0.01) respectively per additional scan ordered within each time frame. Reports were available 25.9 minutes sooner on average in the 4 months post-implementation of double coverage (p<0.01) with additional 23.6 minutes improvement when 2 residents were on-site concomitantly (p<0.01). The aggregate average improvement in TTA-RR was 24.8 hours per weekend day This represents the increased decision-making time available to ED physicians and potential improvement in ED bed utilisation. 5% of reports from the intervention period contained clinically significant addendums vs 7% in the single resident period but this was not statistically significant (p=0.7). The marginal cost was less than the anticipated economic benefit based assuming a 50% capture of improved TTA-RR inpatient disposition and using the lowest available national insurance rebate as a proxy for economic benefit. Conclusion: TTA-RR improved significantly during the period of increased staff availability, both during the specific period of increased staffing and throughout the day. Increased labor utilisation is cost-effective compared with the potential improved productivity for ED cases requiring CT imaging.

Keywords: workflow, quality, administration, CT, staffing

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Authors: Jake Tempo, Georgina Williams, Iain Robertson, Claire Pascoe, Darren Rama, Richard Cetti

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Introduction: The twelfth rib is commonly used as a landmark for surgery; however, its variability in length has not been formally studied. The highly variable rib length provides a challenge for urologists seeking a consistent landmark for percutaneous nephrolithotomy and retroperitoneoscopic surgery. Methods and materials: We analysed CT scans of 100 adults who had imaging between 23rd March and twelfth April 2020 at an Australian Hospital. We measured the distance from the mid-sagittal line to the twelfth rib tip in the axial plane as a surrogate for true rib length. We also measured the distance from the twelfth rib tip to the kidney, spleen, and liver. Results: Length from the mid-sagittal line to the right twelfth rib tip varied from 46 (percentile 95%CI 40 to 57) to 136mm (percentile 95%CI 133 to 138). On the left, the distances varied from 55 (percentile 95%CI 50 to 64) to 134mm (percentile 95%CI 131 to 135). Twenty-three percent of people had an organ lying between the tip of the twelfth rib and the kidney on the right, and 11% of people had the same finding on the left. Conclusion: The twelfth rib is highly variable in its length. Similar variability was recorded in the distance from the tip to intra-abdominal organs. Due to the frequency of organs lying between the tip of the rib and the kidney, it should not be used as a landmark for accessing the kidney without prior knowledge of an individual patient’s anatomy, as seen on imaging.

Keywords: PCNL, rib, anatomy, nephrolithotomy

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Authors: Harim Mohsin, Afshan Channa, Beena Saad

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The Kocher Debre Semelaigne Syndrome (KDSS) is known as cretinism muscular hypertrophy. It is an unusual presentation in intellectually deficit children, commonly associated with congenital or iatrogenic hypothyroidism. The creatinine phosphokinase (CPK) is usually elevated and it’s commonly found in males, consanguineous marriage and ages 18 months to 10 years. It might be misdiagnosed without the classical features of hypothyroidism at first presentation. We present a case of 15 year old intellectually deficit female with epilepsy managed on phenytoin. She had rigidity, myxedema, calf muscle hypertrophy and agitation. The patient was managed as Neuroleptic Malignant Syndrome due to raised CPK of 40,680 IU/L and mixed presentation. Nevertheless, no improvement was noticed and thyroid profile was done to exclude alternative resources. Thyroid stimulating hormone (TSH) was 74.5 IU, Free T3 1.22 ng/dl, and Free T4 0.43 ng/dl. Thyroxine was started along with change in antiepileptic leading to recovery. This case report highlights the inconsistent finding of KDSS. The female gender, non-consanguineous marriage, delayed onset with primarily neuromuscular symptoms, and raised CPK is a rare demonstration in KDSS. Additionally, thyroid profile is not routinely done, which can lead to misdiagnosis and mismanagement.

Keywords: cretinism, hypothyroidism, intellectual deficit, KDSS

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Authors: R. Schweighoffer, N. Nagy, E. Reeves, B. Liebig

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Due to aging populations, the need for seamless palliative care provision is of central interest for western societies. An essential aspect of palliative care delivery is the quality of collaboration amongst palliative care providers. Therefore, the current research is based on Bainbridge’s conceptual framework, which provides an outline for the evaluation of palliative care provision. This study is the first one to investigate the predictive validity of spatial distribution on the quantity of interaction amongst various palliative care providers. Furthermore, based on the familiarity principle, we examine whether the extent of collaboration influences the perceived quality of collaboration among palliative care providers in urban versus rural areas of Switzerland. Based on a population-representative survey of Swiss palliative care providers, the results of the current study show that professionals in densely populated areas report higher absolute numbers of interactions and are more satisfied with their collaborative practice. This indicates that palliative care providers who work in urban areas are better embedded into networks than their counterparts in more rural areas. The findings are especially important, considering that efficient collaboration is a prerequisite to achieve satisfactory patient outcomes. Conclusively, measures should be taken to foster collaboration in weakly interconnected palliative care networks.

Keywords: collaboration, healthcare networks, palliative care, Switzerland

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Authors: Yu-Lin Shen, Ming-Kuen Chang

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In addition to a considerable amount of machinery and equipment, intricacies of the transmission pipeline exist in Petrochemical plants. Long term corrosion may lead to pipeline thinning and rupture, causing serious safety concerns. With the advances in non-destructive testing technology, more rapid and long-range ultrasonic detection techniques are often used for pipeline inspection, EMAT without coupling to detect, it is a non-contact ultrasonic, suitable for detecting elevated temperature or roughened e surface of line. In this study, we prepared artificial defects in pipeline for Electromagnetic Acoustic Transducer Testing (EMAT) to survey the relationship between the defect location, sizing and the EMAT signal. It was found that the signal amplitude of EMAT exhibited greater signal attenuation with larger defect depth and length.. In addition, with bigger flat hole diameter, greater amplitude attenuation was obtained. In summary, signal amplitude attenuation of EMAT was affected by the defect depth, defect length and the hole diameter and size.

Keywords: EMAT, artificial defect, NDT, ultrasonic testing

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Authors: Natarajan Venkatachalam, Subrahmanya V. R. K. Rao, Vijay Karthikeyan Dhandapani, Swaminathan Saravanavel

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The quantum communication technology is an evolving design which connects multiple quantum enabled devices to internet for secret communication or sensitive information exchange. In future, the number of these compact quantum enabled devices will increase immensely making them an integral part of present communication systems. Therefore, safety and security of such devices is also a major concern for us. To ensure the customer sensitive information will not be eavesdropped or deciphered, we need a strong authentications and encryption mechanism. In this paper, we propose a mutual authentication scheme between these smart quantum devices and server based on the secure exchange of information through quantum channel which gives better solutions for symmetric key exchange issues. An important part of this work is to propose a secure mutual authentication protocol over the quantum channel. We show that our approach offers robust authentication protocol and further our solution is lightweight, scalable, cost-effective with optimized computational processing overheads.

Keywords: quantum cryptography, quantum key distribution, wireless quantum communication, authentication protocol, quantum enabled device, trusted third party

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Authors: Farha Lakhani, Michael J. Pont

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There are two main architectures used to develop software for modern embedded systems: these can be labelled as “event-triggered” (ET) and “time-triggered” (TT). The research presented in this paper is concerned with the issues involved in migration between these two architectures. Although TT architectures are widely used in safety-critical applications they are less familiar to developers of mainstream embedded systems. The research presented in this paper began from the premise that–for a broad class of systems that have been implemented using an ET architecture–migration to a TT architecture would improve reliability. It may be tempting to assume that conversion between ET and TT designs will simply involve converting all event-handling software routines into periodic activities. However, the required changes to the software architecture are, in many cases rather more profound. The main contribution of the work presented in this paper is to identify ways in which the significant effort involved in migrating between existing ET architectures and “equivalent” (and effective) TT architectures could be reduced. The research described in this paper has taken an innovative step in this regard by introducing the use of ‘Design patterns’ for this purpose for the first time.

Keywords: embedded applications, software architectures, reliability, pattern

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Authors: Cindy de Frias, Erum Whyne

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Objectives: The current study examined whether the link between stress and health-related quality of life was buffered by protective factors, namely mindfulness, in a sample of middle-aged and older adults. Method: In this cross-sectional study, 134 healthy, community-dwelling adults (aged 50–85 years) were recruited from Dallas, Texas. The participants were screened for depressive symptoms and severity (using the Patient Health Questionnaire [PHQ-9]). All participants completed measures of self-reported health status (i.e., SF-36v2: mental and physical health composites), life stress (using the Elder’s Life Stress Inventory [ELSI]), and trait mindfulness (i.e., Mindful Attention Awareness Scale). Results: Hierarchical regressions (covarying for age, gender, and education) showed that life stress was inversely related to physical and mental health. Mindfulness was positively related to mental health. The negative effect of life stress on mental health was weakened for those individuals with greater trait mindfulness. Discussion: The results suggest that mindfulness is a powerful, adaptive strategy that may protect middle-aged and older adults from the well-known harmful effects of stress on healthy aging.

Keywords: health, stress, mindfulness, aging

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Authors: Jong Yeop Kim, Jong Bum Choi, Hyun Jeong Kwak, Sook Young Lee

Abstract:

Background: Each supraglottic airway requires different anesthetic depth because it has a specific structure and different compressive force in the oropharyngeal cavity. We designed the study to investigate remifentanil effect-site concentration (Ce) in 50% of patients (EC50) for successful insertion of i- gel, and to compare it with that for laryngeal mask airway (LMA) insertion during propofol target-controlled infusion (TCI). Methods: Forty-one female patients were randomized to the i-gel group (n=20) or the LMA group (n=21). Anesthesia induction was performed using propofol Ce of 5 μg/ml and the predetermined remifentanil Ce, and i-gel or LMA insertion was attempted 5 min later. The remifentanil Ce was estimated by modified Dixon's up-and-down method (initial concentration: 3.0 ng/ml, step size: 0.5 ng/ml). The patient’s response to device insertion was classified as either ‘success (no movement)’ or ‘failure (movement)’. Results: Using the Dixon’s up and down method, EC50 of remifentanil Ce for i-gel (1.58 ± 0.41 ng/ml) was significantly lower than that for LMA (2.25 ± 0.55 ng/ml) (p=0.038). Using isotonic regression, EC50 (83% CI) of remifentanil in the i-gel group [1.50 (1.37-1.80) ng/ml] was statistically lower than that in the LMA group [2.00 (1.82-2.34) ng/ml]. EC95 (95% CI) of remifentanil in the i-gel group [2.38 (1.48-2.50) ng/ml] was statistically lower than that in the LMA group [3.35 (2.58-3.48) ng/ml]. Conclusion: We found that EC50 of remifentanil Ce for i-gel insertion (1.58 ng/ml) was significantly lower than that for LMA insertion (2.25 ng/ml), in female patients during propofol TCI without neuromuscular blockade.

Keywords: i-gel, laryngeal mask airway, propofol, remifentanil

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Authors: C. C. Igwe, C. E. Ogbuadike

Abstract:

Bryophyllum pinnatum is a tropical plant used by the indigenous people of South-East Nigeria as a medicinal plant for the treatment of skin ulcer and is being explored for the production of topical herbal skin ointments. This preliminary study involves the extraction and characterization of bioactive compounds from this plant for anti-skin ulcer, antimicrobial, and antioxidant activity, as well as formulating topical herbal medications for skin ulcer. Thus extraction, percentage yield, moisture content analysis, solvent-solvent fractionation and GC-MS has been carried out on processed leaves sample of B. pinnatum. GC-MS analysis revealed the presence of seven compounds, namely: 1-Octene, 3, 7-dimethyl, 1-Tridecene, E-14-Hexadecenal, 3-Eicosene (E)-, 11-Tricosene, 1-Tridecyn-4-ol and Butanamide. Standardized herbal products have been produced from B. pinnatum extracts. The products are being evaluated for safety and efficacy tests to ascertain their toxicity (if any), anti-ulcer, antibiotic and antioxidant properties. Further work is on-going to characterize the bioactive principles present in the plant extracts.

Keywords: anti-microbial, bioactive compounds, bryophyllum pinnatum, skin ulcer

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Authors: Aryati Yashadhana, Ted Fields Jnr., Wendy Fernando, Kelvin Brown, Godfrey Blitner, Francis Hayes, Ruby Stanley, Brian Donnelly, Bridgette Jerrard, Anthea Burnett, Anthony B. Zwi

Abstract:

Indigenous Australians experience some of the worst health outcomes globally, with life expectancy being significantly poorer than those of non-Indigenous Australians. This is largely attributed to preventable diseases such as diabetes (prevalence 39% in Indigenous Australian adults > 55 years), which is attributed to a raised risk of diabetic visual impairment and cataract among Indigenous adults. Our study aims to explore the interface between structural and sociocultural determinants and human agency, in order to understand how they impact (1) accessibility of eye health and chronic disease services and (2) the potential for Indigenous patients to achieve positive clinical eye health outcomes. We used Participatory Action Research methods, and aimed to privilege the voices of Indigenous people through community collaboration. Semi-structured interviews (n=82) and patient focus groups (n=8) were conducted by Indigenous Community-Based Researchers (CBRs) with diabetic Indigenous adults (> 40 years) in four remote communities in Australia. Interviews (n=25) and focus groups (n=4) with primary health care clinicians in each community were also conducted. Data were audio recorded, transcribed verbatim, and analysed thematically using grounded theory, comparative analysis and Nvivo 10. Preliminary analysis occurred in tandem with data collection to determine theoretical saturation. The principal investigator (AY) led analysis sessions with CBRs, fostering cultural and contextual appropriateness to interpreting responses, knowledge exchange and capacity building. Identified themes were conceptualised into three spheres of influence: structural (health services, government), sociocultural (Indigenous cultural values, distrust of the health system, ongoing effects of colonialism and dispossession) and individual (health beliefs/perceptions, patient phenomenology). Permeating these spheres of influence were three core determinants: economic disadvantage, health literacy/education, and cultural marginalisation. These core determinants affected accessibility of services, and the potential for patients to achieve positive clinical outcomes at every level of care (primary, secondary, tertiary). Our findings highlight the clinical realities of institutionalised and structural inequities, illustrated through the lived experiences of Indigenous patients and primary care clinicians in the four sampled communities. The complex determinants surrounding inequity in health for Indigenous Australians, are entrenched through a longstanding experience of cultural discrimination and ostracism. Secure and long term funding of Aboriginal Community Controlled Health Services will be valuable, but are insufficient to address issues of inequity. Rather, working collaboratively with communities to build trust, and identify needs and solutions at the grassroots level, while leveraging community voices to drive change at the systemic/policy level are recommended.

Keywords: indigenous, Australia, culture, public health, eye health, diabetes, social determinants of health, sociology, anthropology, health equity, aboriginal and Torres strait islander, primary care

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Authors: Jiří Kubásek, Peter Minárik, Klára Hosová, Stanislav Šašek, Jozef Veselý, Jitka Stráská, Drahomír Dvorský, Dalibor Vojtěch, Miloš Janeček

Abstract:

Mg-2Y-2Gd-1Ca and Mg-4Y-4Gd-2Ca alloys were processed by extrusion or equal channel angular pressing (ECAP) to analyse the effect of the microstructure on ignition temperature, mechanical properties and corrosion resistance. The alloys are characterized by good mechanical properties and exceptionally high ignition temperature, which is a critical safety measure. The effect of extrusion and ECAP on the microstructure, mechanical properties and ignition temperature was studied. The obtained results indicated a substantial effect of the processing conditions on the average grain size, the recrystallized fraction and texture formation. Both alloys featured a high strength, depending on the composition and processing condition, and a high ignition temperature of ≈1100 °C (Mg-4Y-4Gd-2Ca) and ≈950 °C (Mg-2Y-2Gd-1Ca), which was attributed to the synergic effect of Y, Gd and Ca oxides, with the dominant effect of Y₂O₃. The achieved combination of enhanced mechanical properties and the ignition temperature makes these alloys a prominent candidate for aircraft applications.

Keywords: magnesium alloys, enhanced ignition temperature, mechanical properties, ECAP

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