Search results for: the success of therapy

Authors: Adama NS Bah

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Background: Loss of teeth has a negative influence on essential oral functions such as phonetics, mastication, and aesthetics. Dentists treat people with prosthodontic rehabilitation to recover essential oral functions. The oral health quality of life inventory reflects the success of prosthodontic rehabilitation. In many countries, the current conventional care delivered to replace missing teeth for adult patients involves the provision of removable partial dentures. Aim: The aim of this systematic review and meta-analysis is to gather the best available evidence to determine patients’ oral health-related quality of life improvement after treatment with partial dentures. Methods: We searched electronic databases from January 2010 to September 2019, including PubMed, ProQuest, Science Direct, Scopus and Google Scholar. In this paper, studies were included only if the average age was 30 years and above and also published in English. Two reviewers independently screened and selected all the references based on inclusion criteria using the PRISMA guideline, and assessed the quality of the included references using the Joanna Briggs Institute quality assessment tools. Data extracted were analyzed in RevMan 5.0 software, the heterogeneity between the studies was assessed using Forest plot, I2 statistics and chi-square test with a statistical P value less than 0.05 to indicate statistical significance. Random effect models were used in case of moderate or high heterogeneity. Four studies were included in the systematic review and three studies were pooled for meta-analysis. Results: Four studies included in the systematic review and three studies included in the meta-analysis with a total of 285 patients comparing the improvement in oral health-related quality of life before and after rehabilitation with partial denture, the pooled results showed a better improvement of oral health-related quality of life after treatment with partial dentures (mean difference 5.25; 95% CI [3.81, 6.68], p < 0.00001) favoring the wearing of partial dentures. In order to ascertain the reliability of the included studies for meta-analysis risk of bias was assessed and found to be low in all included studies for meta-analysis using the Cochrane collaboration tool for risk of bias assessment. Conclusion: There is high evidence that rehabilitation with partial dentures can improve the patient’s oral health-related quality of life measured with Oral Health Impact Profile 14. This review has clinical evidence value for dentists treating the expanding vulnerable adult population.

Keywords: meta-analysis, oral health impact profile, partial dentures, systematic review

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Authors: Maryam Firouzmandi, Moosa Miri

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Common reasons for early tooth loss are trauma, extraction due to caries or periodontal disease and congenital missing. The remaining space after tooth loss may cause functional and esthetic problems. Therefore restorative dentists should attempt to manage these spaces using conservative methods. The goal is to restore the lost esthetic and function, prevent phonetic, self-esteem and personality problems and tongue habits. Preserving alveolar bone is also of great importance during the growth stage. Purpose: When deciding about the management of the missing tooth, space implants are contradicted until the completion of dentoalveolar development. Even in adulthood, due to systemic or periodontal problems or biological and economic issues, the implant might not be indicated. In this article, the alternative conservative restorative methods of space maintenance are going to be discussed. Essix retainers are made chair-side as easy as forming a custom bleaching tray with some modifications. They are esthetically acceptable and not expensive. These temporaries provide support for the lips but could not be used during function. Mini-screw-supported temporaries are another option for maintaining the space, especially after orthodontic treatment when there is a time lag between the termination of orthodontic treatment and definitive restoration. Two techniques will be presented for this kind of restoration: Denture tooth pontic or a composite crown. The benefits are alveolar bone preservation, Physiologic pressure on the alveolar ridge to increase its density and even can be retained until the completion of the definitive treatment. Bonded fixed partial denture includes Maryland bridge, fiber-reinforced composite bridge, resin-bonded bridge, and ceramic bonded bridge. These types of bridges are recommended to be used after a pubertal growth spurt and a recent meta-analysis considered their clinical success similar to conventional FDPs and implant-supported crowns. However, they have several advantages that are going to be discussed by presenting some clinical examples. Practical instruction on how to construct an FRC bridge and a novel chair-side Maryland bridge will be given by means of clinical cases. Clinical relevance: minimally invasive options should always be considered and destruction of healthy enamel and dentin during the preparation phase should be avoided as much as possible.

Keywords: tooth missing, fiber-reinforced composite, Maryland, Essix retainers, screw-retained restoration

Procedia PDF Downloads 183

Authors: Ramoshweu Melvin Sethobya, Emmanuel Chirenje, Mihlali Hobo, Simon Sebothoma

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The recent surge in residential infrastructure development around the metropolitan areas of South Africa has necessitated conditions for thorough geotechnical assessments to be conducted prior to site developments to ensure human and infrastructure safety. This paper appraises the success in the application of multi-method geophysical techniques for the delineation of sinkhole vulnerability in a residential landscape. Geophysical techniques ERT, MASW, VES, Magnetics and gravity surveys were conducted to assist in mapping sinkhole vulnerability, using an existing sinkhole as a constraint at Venterspost town, West of Johannesburg city. A combination of different geophysical techniques and results integration from those proved to be useful in the delineation of the lithologic succession around sinkhole locality, and determining the geotechnical characteristics of each layer for its contribution to the development of sinkholes, subsidence and cavities at the vicinity of the site. Study results have also assisted in the determination of the possible depth extension of the currently existing sinkhole and the location of sites where other similar karstic features and sinkholes could form. Results of the ERT, VES and MASW surveys have uncovered dolomitic bedrock at varying depths around the sites, which exhibits high resistivity values in the range 2500-8000ohm.m and corresponding high velocities in the range 1000-2400 m/s. The dolomite layer was found to be overlain by a weathered chert-poor dolomite layer, which has resistivities between the range 250-2400ohm.m, and velocities ranging from 500-600m/s, from which the large sinkhole has been found to collapse/ cave in. A compiled 2.5D high resolution Shear Wave Velocity (Vs) map of the study area was created using 2D profiles of MASW data, offering insights into the prevailing lithological setup conducive for formation various types of karstic features around the site. 3D magnetic models of the site highlighted the regions of possible subsurface interconnections between the currently existing large sinkhole and the other subsidence feature at the site. A number of depth slices were used to detail the conditions near the sinkhole as depth increases. Gravity surveys results mapped the possible formational pathways for development of new karstic features around the site. Combination and correlation of different geophysical techniques proved useful in delineation of the site geotechnical characteristics and mapping the possible depth extend of the currently existing sinkhole.

Keywords: resistivity, magnetics, sinkhole, gravity, karst, delineation, VES

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Authors: David Sinfield, Thomas Cochrane, Marcos Steagall

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While there is much hype around the potential and development of mobile virtual reality (VR), the two key critical success factors are the ease of user experience and the development of a simple user-generated content ecosystem. Educational technology history is littered with the debris of over-hyped revolutionary new technologies that failed to gain mainstream adoption or were quickly superseded. Examples include 3D television, interactive CDROMs, Second Life, and Google Glasses. However, we argue that this is the result of curriculum design that substitutes new technologies into pre-existing pedagogical strategies that are focused upon teacher-delivered content rather than exploring new pedagogical strategies that enable student-determined learning or heutagogy. Visual Communication design based learning such as Graphic Design, Illustration, Photography and Design process is heavily based on the traditional forms of the classroom environment whereby student interaction takes place both at peer level and indeed teacher based feedback. In doing so, this makes for a healthy creative learning environment, but does raise other issue in terms of student to teacher learning ratios and reduced contact time. Such issues arise when students are away from the classroom and cannot interact with their peers and teachers and thus we see a decline in creative work from the student. Using AR and VR as a means of stimulating the students and to think beyond the limitation of the studio based classroom this paper will discuss the outcomes of a student project considering the virtual classroom and the techniques involved. The Atelier learning environment is especially suited to the Visual Communication model as it deals with the creative processing of ideas that needs to be shared in a collaborative manner. This has proven to have been a successful model over the years, in the traditional form of design education, but has more recently seen a shift in thinking as we move into a more digital model of learning and indeed away from the classical classroom structure. This study focuses on the outcomes of a student design project that employed Augmented Reality and Virtual Reality technologies in order to expand the dimensions of the classroom beyond its physical limits. Augmented Reality when integrated into the learning experience can improve the learning motivation and engagement of students. This paper will outline some of the processes used and the findings from the semester-long project that took place.

Keywords: augmented reality, blogging, design in community, enhanced learning and teaching, graphic design, new technologies, virtual reality, visual communications

Procedia PDF Downloads 227

Authors: Pascale Brasseur, Binu Gurung, Nicholas Halfpenny, James Eaton

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Development of minimally invasive treatments in recent years provides a potential alternative to invasive surgical interventions which are of limited value to patients with spinal metastases due to short life expectancy. A systematic review was conducted to explore the efficacy and safety of radiofrequency ablation (RFA), a minimally invasive treatment in patients with spinal metastases. EMBASE, Medline and CENTRAL were searched from database inception to March 2017 for randomised controlled trials (RCTs) and non-randomised studies. Conference proceedings for ASCO and ESMO published in 2015 and 2016 were also searched. Fourteen studies were included: three prospective interventional studies, four prospective case series and seven retrospective case series. No RCTs or studies comparing RFA with another treatment were identified. RFA was followed by cement augmentation in all patients in seven studies and some patients (40-96%) in the remaining seven studies. Efficacy was assessed as pain relief in 13/14 studies with the use of a numerical rating scale (NRS) or a visual analogue scale (VAS) at various time points. Ten of the 13 studies reported a significant decrease in pain outcome, post-RFA compared to baseline. NRS scores improved significantly at 1 week (5.9 to 3.5, p < 0.0001; 8 to 4.3, p < 0.02 and 8 to 3.9, p < 0.0001) and this improvement was maintained at 1 month post-RFA compared to baseline (5.9 to 2.6, p < 0.0001; 8 to 2.9, p < 0.0003; 8 to 2.9, p < 0.0001). Similarly, VAS scores decreased significantly at 1 week (7.5 to 2.7, p=0.00005; 7.51 to 1.73, p < 0.0001; 7.82 to 2.82, p < 0.001) and this pattern was maintained at 1 month post-RFA compared to baseline (7.51 to 2.25, p < 0.0001; 7.82 to 3.3; p < 0.001). A significant pain relief was achieved regardless of whether patients had cement augmentation in two studies assessing the impact of RFA with or without cement augmentation on VAS pain scores. In these two studies, a significant decrease in pain scores was reported for patients receiving RFA alone and RFA+cement at 1 week (4.3 to 1.7. p=0.0004 and 6.6 to 1.7, p=0.003 respectively) and 15-36 months (7.9 to 4, p=0.008 and 7.6 to 3.5, p=0.005 respectively) after therapy. Few minor complications were reported and these included neural damage, radicular pain, vertebroplasty leakage and lower limb pain/numbness. In conclusion, the efficacy and safety of RFA were consistently positive between prospective and retrospective studies with reductions in pain and few procedural complications. However, the lack of control groups in the identified studies indicates the possibility of selection bias inherent in single arm studies. Controlled trials exploring efficacy and safety of RFA in patients with spinal metastases are warranted to provide robust evidence. The identified studies provide an initial foundation for such future trials.

Keywords: pain relief, radiofrequency ablation, spinal metastases, systematic review

Procedia PDF Downloads 154

Authors: Susanne Ferschl, Peter Holzmüller, Elisabeth Wacker

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Ageing populations, advances in medical sciences and digitalization, diversity and social disparities, as well as the increasing need for skilled healthcare professionals, are challenging healthcare systems around the globe. To address these challenges, future healthcare systems need to center on human needs taking into account the living environments that shape individuals’ knowledge of and opportunities to access healthcare. Moreover, health should be considered as a common good and an integral part of securing livelihoods for all people. Therefore, the adoption of a systems approach, as well as inter-disciplinary and inter-sectoral cooperation among healthcare providers, are essential. Additionally, the active engagement of target groups in the planning and design of healthcare structures is indispensable to understand and respect individuals’ health and livelihood needs. We will present the research project b4 – identifying needs | building bridges | developing health care in the social space, which is situated within this reasoning and accompanies the cross-sectoral cooperation project Brückenschlag (building bridges) in a Bavarian district. Brückenschlag seeks to explore effective ways of health care linking university medicine (Maximalversorgung | maximum care) with regional inpatient, outpatient, rehabilitative, and preventive care structures (Regionalversorgung | regional care). To create advantages for both (potential) patients and the involved cooperation partners, project b4 qualitatively assesses needs and motivations among professionals, population groups, and political stakeholders at individual and collective levels. Besides providing an overview of the project structure as well as of regional population and healthcare characteristics, the first results of qualitative interviews conducted with different health experts will be presented. Interviewed experts include managers of participating hospitals, nurses, medical specialists working in the hospital and registered doctors operating in practices in rural areas. At the end of the project life and based on the identified factors relevant to the success -and also for failure- of participatory cooperation in health care, the project aims at informing other districts embarking on similar systems-oriented and human-centered healthcare projects. Individuals’ health care needs in dependence on the social space in which they live will guide the development of recommendations.

Keywords: cross-sectoral collaboration in health care, human-centered health care, regional health care, individual and structural health conditions

Procedia PDF Downloads 90

Authors: Corinna Zeli, Silvia Calati, Marco Simeoni, Chiara Comastri

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Developmental stuttering affects about 10% of preschool children; although the high percentage of natural recovery, a quarter of them will become an adult who stutters. An effective early intervention should help those children with high persistence risk for the future. The Psicodizione method for early stuttering is an Italian behavior indirect treatment for preschool children who stutter in which method parents act as good guides for communication, modeling their own fluency. In this study, we give a preliminary measure to evaluate the long-term effectiveness of Psicodizione method on stuttering preschool children with a high persistence risk. Among all Italian children treated with the Psicodizione method between 2018 and 2019, we selected 8 kids with at least 3 high risk persistence factors from the Illinois Prediction Criteria proposed by Yairi and Seery. The factors chosen for the selection were: one parent who stutters (1pt mother; 1.5pt father), male gender, ≥ 4 years old at onset; ≥ 12 months from onset of symptoms before treatment. For this study, the families were contacted after an average period of time of 14,7 months (range 3 - 26 months). Parental reports were gathered with a standard online questionnaire in order to obtain data reflecting fluency from a wide range of the children’s life situations. The minimum worthwhile outcome was set at "mild evidence" in a 5 point Likert scale (1 mild evidence- 5 high severity evidence). A second group of 6 children, among those treated with the Piscodizione method, was selected as high potential for spontaneous remission (low persistence risk). The children in this group had to fulfill all the following criteria: female gender, symptoms for less than 12 months (before treatment), age of onset <4 years old, none of the parents with persistent stuttering. At the time of this follow-up, the children were aged 6–9 years, with a mean of 15 months post-treatment. Among the children in the high persistence risk group, 2 (25%) hadn’t had stutter anymore, and 3 (37,5%) had mild stutter based on parental reports. In the low persistency risk group, the children were aged 4–6 years, with a mean of 14 months post-treatment, and 5 (84%) hadn’t had stutter anymore (for the past 16 months on average).62,5% of children at high risk of persistence after Psicodizione treatment showed mild evidence of stutter at most. 75% of parents confirmed a better fluency than before the treatment. The low persistence risk group seemed to be representative of spontaneous recovery. This study’s design could help to better evaluate the success of the proposed interventions for stuttering preschool children and provides a preliminary measure of the effectiveness of the Psicodizione method on high persistence risk children.

Keywords: early treatment, fluency, preschool children, stuttering

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Authors: Abdolrasoul Daneshjoo

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Soccer is a game which draws more attention in different countries especially in Brazil. Kicking among different skills in soccer and soccer players is an excellent role for the success and preference of a team. The way of point gaining in this game is passing the ball over the goal lines which are gained by shoot skill in attack time and or during the penalty kicks.Regarding the above assumption, identifying the effective factors in instep kicking in different distances shoot with maximum force and high accuracy or pass and penalty kick, may assist the coaches and players in raising qualitative level of performing the skill.The aim of the present study was to study of a few kinematical parameters in instep kicking from 5 and 7 meter distance among the male and female elite soccer players.24 right dominant lower limb subjects (12 males and 12 females) among Tehran elite soccer players with average and the standard deviation (22.5 ± 1.5) & (22.08± 1.31) years, height of (179.5 ± 5.81) & (164.3 ± 4.09) cm, weight of (69.66 ± 4.09) & (53.16 ± 3.51) kg, %BMI (21.06 ± .731) & (19.67 ± .709), having playing history of (4 ± .73) & (3.08 ± .66) years respectively participated in this study. They had at least two years of continuous playing experience in Tehran soccer league.For sampling player's kick; Kinemetrix Motion analysis with three cameras with 1000 Hz was used. Five reflective markers were placed laterally on the kicking leg over anatomical points (the iliac crest, major trochanter, lateral epicondyle of femur, lateral malleolus, and lateral aspect of distal head of the fifth metatarsus). Instep kick was filmed, with one step approach and 30 to 45 degrees angle from stationary ball. Three kicks were filmed, one kick selected for further analyses. Using Kinemetrix 3D motion analysis software, the position of the markers was analyzed. Descriptive statistics were used to describe the mean and standard deviation, while the analysis of variance, and independent t-test (P < 0.05) were used to compare the kinematic parameters between two genders.Among the evaluated parameters, the knee acceleration, the thigh angular velocity, the angle of knee proportionately showed significant relationship with consequence of kick. While company performance on 5m in 2 genders, significant differences were observed in internal – external displacement of toe, ankle, hip and the velocity of toe, ankle and the acceleration of toe and the angular velocity of pelvic, thigh and before time contact . Significant differences showed the internal – external displacement of toe, the ankle, the knee and the hip, the iliac crest and the velocity of toe, the ankle and acceleration of ankle and angular velocity of the pelvic and the knee.

Keywords: biomechanics, kinematics, instep kicking, soccer

Procedia PDF Downloads 487

Authors: Mohammad Afzal Khan, Fatimah Alanazi, Hala Abdalrahman Ahmed, Talal Shamma, Kilian Kelly, Mohammed A. Hammad, Abdullah O. Alawad, Abdullah Mohammed Assiri, Dieter Clemens Broering

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Lung transplantation is a life-saving surgical replacement of diseased lungs in patients with end-stage respiratory malfunctions. Despite the remarkable short-term recovery, long-term lung survival continues to face several significant challenges, including chronic rejection and severe toxic side-effects due to global immunosuppression. Stem cell-based immunotherapy has been recognized as a crucial immunoregulatory regimen in various preclinical and clinical studies. Despite initial therapeutic outcomes, conventional stem cells face key limitations. The Cymerus™ manufacturing facilitates the production of a virtually limitless supply of consistent human induced pluripotent stem cell (iPSC)-derived mesenchymal stem cells, which could play a key role in selective immunosuppression and graft repair during rejection. Here, we demonstrated the impact of iPSC-derived human MSCs on the development of immune-tolerance and long-term graft survival in mouse orthotopic airway allografts. BALB/c→C57BL/6 allografts were reconstituted with iPSC-derived MSCs (2 million/transplant/ at d0), and allografts were examined for regulatory T cells (Tregs), oxygenation, microvascular blood flow, airway epithelium and collagen deposition during rejection. We demonstrated that iPSC-derived MSC treatment leads to significant increase in tissue expression of hTSG-6 protein, followed by an upregulation of mouse Tregs and IL-5, IL-10, IL-15 cytokines, which augments graft microvascular blood flow and oxygenation, and thereby maintained a healthy airway epithelium and prevented the subepithelial deposition of collagen at d90 post-transplantation. Collectively, these data confirmed that iPSC-derived MSC-mediated immunosuppression has potential to establish immune-tolerance and rescue allograft from sustained hypoxic/ischemic phase and subsequently limits long-term airway epithelial injury and collagen progression, which therapeutically warrant a study of Cymerus iPSC-derived MSCs as a potential management option for immunosuppression in transplant recipients.

Keywords: stem cell therapy, immunotolerance, regulatory T cells, hypoxia and ischemia, microvasculature

Procedia PDF Downloads 141

Authors: O. V. Jurieva, O. U. Jurieva, R. H. Yagudin, P. B. Chursin

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In the recent scientific researches on the problems of public service the idea of the use of innovative technologies of management of personnel processes is accurately formulated. Authors made an attempt to analyze the changes in the public service organizations and to understand how the studied situation is interpreted by the government employees themselves. For this purpose the strategy of sociological research was carried out on the basis of application of questionnaire developed by M. Rokich and focus group research. For the research purposes it was necessary to get to microlevel in order to include daily activities of employees of an organization, their life experience and values in the focus of the analysis. Based on P. Bourdieu's methodology, authors investigated the established patterns of consciousness and behavior of officials (doxa) and also analyzed the tendencies of re-thinking (change) of the settled content of values (heterodoxy) by them. The distinctive feature of the conducted research is that the public servants who have different length of service in the public service took part in the research procedure. The obtained data helped to answer the following question: what are the specifics of doxs of the public servants who work in the public civil service more than 7-10 years and what perception of values of civil service have junior experts whose work experience doesn't exceed 3 years. Respondents were presented by two groups: (1) public servants of the level of main positions in the public civil service of the Republic of Tatarstan. (2) Public servants of the level of lower positions in the ministries and departments of the Republic of Tatarstan. For the study of doxa or of the existing values of public servants, the research with use of the questionnaire based on M. Rokich's system is conducted. Two types of values are emphasised: terminal and instrumental, which are united by us in the collective concept doxa. Doxa: the instrument of research of the established patterns of consciousness and behavior which can either resist to changes in the organization or, on the contrary, support their implementation. In the following stage an attempt to deepen our understanding of the essence and specifics of doxa of officials by means of the applied sociological research which is carried out by focus group method is made. Information obtained by authors during the research convinces that for the success of policy of changes in the organizations of public service it is necessary to develop special technologies of informing employees about the essence and inevitability of the developed innovations, to involve them in the process of changes, to train and to develop the younger generation of civil servants, seriously to perceive additional training and retraining of officials.

Keywords: innovative technologies, public service organizations, public servants

Procedia PDF Downloads 257

Authors: Soheila Sadeghi

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In the dynamic landscape of project management, scope changes are an inevitable reality that can significantly impact project performance. These changes, whether initiated by stakeholders, external factors, or internal project dynamics, can lead to cost overruns and schedule delays. Accurately predicting the consequences of these changes is crucial for effective project control and informed decision-making. This study aims to develop predictive models to estimate the impact of scope changes on project cost and schedule using machine learning techniques. The research utilizes a comprehensive dataset containing detailed information on project tasks, including the Work Breakdown Structure (WBS), task type, productivity rate, estimated cost, actual cost, duration, task dependencies, scope change magnitude, and scope change timing. Multiple machine learning models are developed and evaluated to predict the impact of scope changes on project cost and schedule. These models include Linear Regression, Decision Tree, Ridge Regression, Random Forest, Gradient Boosting, and XGBoost. The dataset is split into training and testing sets, and the models are trained using the preprocessed data. Cross-validation techniques are employed to assess the robustness and generalization ability of the models. The performance of the models is evaluated using metrics such as Mean Squared Error (MSE) and R-squared. Residual plots are generated to assess the goodness of fit and identify any patterns or outliers. Hyperparameter tuning is performed to optimize the XGBoost model and improve its predictive accuracy. The feature importance analysis reveals the relative significance of different project attributes in predicting the impact on cost and schedule. Key factors such as productivity rate, scope change magnitude, task dependencies, estimated cost, actual cost, duration, and specific WBS elements are identified as influential predictors. The study highlights the importance of considering both cost and schedule implications when managing scope changes. The developed predictive models provide project managers with a data-driven tool to proactively assess the potential impact of scope changes on project cost and schedule. By leveraging these insights, project managers can make informed decisions, optimize resource allocation, and develop effective mitigation strategies. The findings of this research contribute to improved project planning, risk management, and overall project success.

Keywords: cost impact, machine learning, predictive modeling, schedule impact, scope changes

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Authors: Ying Li, Rui Hu, Shizhen Chen, Xin Zhou, Yunhuang Yang

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Prostate cancer is one of the leading causes of cancer-related death among men. Prostate-specific antigen (PSA), a specific product of prostatic epithelial cells, is an important indicator of prostate cancer. Though PSA is not a specific serum biomarker for the screening of prostate cancer, it is recognized as an indicator for prostate cancer recurrence and response to therapy for patient’s post-prostatectomy. Since radical prostatectomy eliminates the source of PSA production, serum PSA levels fall below 50 pg/mL, and may be below the detection limit of clinical immunoassays (current clinical immunoassay lower limit of detection is around 10 pg/mL). Many clinical studies have shown that intervention at low PSA levels was able to improve patient outcomes significantly. Therefore, ultra-sensitive and precise assays that can accurately quantify extremely low levels of PSA (below 1-10 pg/mL) will facilitate the assessment of patients for the possibility of early adjuvant or salvage treatment. Currently, the commercially available ultra-sensitive ELISA kit (not used clinically) can only reach a detection limit of 3-10 pg/mL. Other platforms developed by different research groups could achieve a detection limit as low as 0.33 pg/mL, but they relied on sophisticated instruments to get the final readout. Herein we report a microfluidic platform for point-of-care (POC) detection of PSA with a detection limit of 0.5 pg/mL and without the assistance of any equipment. This platform is based on a previously reported volumetric-bar-chart chip (V-Chip), which applies platinum nanoparticles (PtNPs) as the ELISA probe to convert the biomarker concentration to the volume of oxygen gas that further pushes the red ink to form a visualized bar-chart. The length of each bar is used to quantify the biomarker concentration of each sample. We devised a long reading channel V-Chip (LV-Chip) in this work to achieve a wide detection window. In addition, LV-Chip employed a unique enzyme-free ELISA probe that enriched PtNPs significantly and owned 500-fold enhanced catalytic ability over that of previous V-Chip, resulting in a significantly improved detection limit. LV-Chip is able to complete a PSA assay for five samples in 20 min. The device was applied to detect PSA in 50 patient serum samples, and the on-chip results demonstrated good correlation with conventional immunoassay. In addition, the PSA levels in finger-prick whole blood samples from healthy volunteers were successfully measured on the device. This completely stand-alone LV-Chip platform enables convenient POC testing for patient follow-up in the physician’s office and is also useful in resource-constrained settings.

Keywords: point-of-care detection, microfluidics, PSA, ultra-sensitive

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Authors: Denisa Mackova, Andrea Pokorna

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The management of postoperative pain is a meaningful part of quality care. The experience and knowledge of registered nurses in postoperative pain management can be influenced by local know-how. Therefore, the research helps to understand the cultural differences between two countries with the aim of evaluating the management of postoperative pain management among the nurses from the Czech Republic and the Kingdom of Saudi Arabia. Both countries have different procedures on managing postoperative pain and the research will provide an understanding of both the advantages and disadvantages of the procedures and also highlight the knowledge and experience of registered nurses in both countries. Between the Czech Republic and the Kingdom of Saudi Arabia, the expectation is for differing results in the usage of opioid analgesia for the patients postoperatively and in the experience of registered nurses with Patient Controlled Analgesia. The aim is to evaluate the knowledge and awareness of registered nurses and to merge the data with the postoperative pain management in the early postoperative period in the Czech Republic and the Kingdom of Saudi Arabia. Also, the aim is to assess the knowledge and experience of registered nurses by using Patient Controlled Analgesia and epidural analgesia treatment in the early postoperative period. The criteria for those providing input into the study, are registered nurses, working in surgical settings (standard departments, post-anesthesia care unit, day care surgery or ICU’s) caring for patients in the postoperative period. Method: Research is being conducted by questionnaires. It is a quantitative research, a comparative study of registered nurses in the Czech Republic and the Kingdom of Saudi Arabia. Questionnaire surveys were distributed through an electronic Bristol online survey. Results: The collection of the data in the Kingdom of Saudi Arabia has been completed successfully, with 550 respondents, 77 were excluded and 473 respondents were included for statistical data analysis. The outcome of the research is expected to highlight the differences in treatment through Patient Controlled Analgesia, with more frequent use in the Kingdom of Saudi Arabia. A similar assumption is expected for treatment conducted by analgesia. We predict that opioids will be used more regularly in the Kingdom of Saudi Arabia, whilst therapy through NSAID’s being the most common approach in the Czech Republic. Discussion/Conclusion: The majority of respondents from the Kingdom of Saudi Arabia were female registered nurses from a multitude of nations. We are expecting a similar split in gender between the Czech Republic respondents; however, there will be a smaller number of nationalities. Relevance for research and practice: Output from the research will assess the knowledge, experience and practice of patient controlled analgesia and epidural analgesia treatment. Acknowledgement: This research was accepted and affiliated to the project: Postoperative pain management, knowledge and experience registered nurses (Czech Republic and Kingdom of Saudi Arabia) – SGS05/2019-2020.

Keywords: acute postoperative pain, epidural analgesia, nursing care, patient controlled analgesia

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Authors: Haile Nega Mulata, Seifu Daniel, Umeta Melaku, Wendwesson Ergete, Natesan Gnanasekaran

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Background: In Ethiopia, medicinal plants have been used for various human and animal diseases. In this study, we have examined the potential effect of hydroethanolic extract of Calpurnia aurea seed against hepatotoxicity and haematotoxicity induced by Highly Active Antiretroviral Therapy (HAART) drugs in Albino Wistar rats. Methods: We collected Matured dried seeds of Calpurnia aurea from northern Ethiopia (south Tigray and south Gondar) in June 2013. The powder of the dried seed sample was macerated with 70% ethanol and dried using rotavapor. We have investigated the Preliminary phytochemical tests and in-vitro antioxidant properties. Then, we induced toxicity with HAART drugs and gave the experimental animals different doses of the crude extract orally for thirty-five days. On the 35th day, the animals were fasted overnight and sacrificed by cervical dislocation. We collected the blood samples by cardiac puncture. We excised the liver and brain tissues for further histopathological studies. Subsequently, we analysed serum levels of the liver enzymes- Alanine Aminotransferase, Aspartate Aminotransferase, Alkaline Phosphatase, Total Bilirubin, and Serum Albumin, using commercial kits in Cobas Integra 400 Plus Roche Analyzer Germany. We have also assessed the haematological profile using an automated haematology Analyser (Sysmex KX-2IN). Results: A significant (P<0.05) decrease in serum enzymes (ALT and AST) and total bilirubin were observed in groups that received the highest dose (300mg/kg) of the seed extract. And significant (P<0.05) elevation of total red blood cell count, haemoglobin, and hematocrit percentage was observed in the groups that received the seed extract compared to the HAART-treated groups. The WBC count mean values showed a statistically significant increase (p<0.05) in groups that received HAART and 200 and 300mg/kg extract, respectively. The histopathological observations also showed that the oral administration of varying doses of the crude extract of the seed reversed to a normal state. Conclusion: The hydroethanolic extract of the Calpurnia aurea seed lowered the hepatotoxicity and haematotoxicity in a dose-dependent manner. The antioxidant properties of the Calpurnia aurea seed extract may have possible protective effects against the drug's toxicity.

Keywords: calpurnia aurea, hepatotoxicity, haematotoxicity, antioxidant, histopathology, HAART

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Authors: Fernando Araujo, Sandra Cardoso, Fátima Fonseca, Sandra Cavaca

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A debureaucratization strategy for the Portuguese Health Service was assumed by the Executive Board of the SNS, in deep articulation with the Shared Services of the Ministry of Health. Two of the main dimensions were focused on sick leaves (SL), that transform primary health care (PHC) in administrative institutions, limiting access to patients. The self-declaration of illness (SDI) project, through the National Health Service Contact Centre (SNS24), began on May 1, 2023, and has already resulted in the issuance of more than 300,000 SDI without the need to allocate resources from the National Health Service (NHS). This political decision allows each citizen, in a maximum 2 times/year, and 3 days each time, if ill, through their own responsibility, report their health condition in a dematerialized way, and by this way justified the absence to work, although by Portuguese law in these first three days, there is no payment of salary. Using a digital approach, it is now feasible without the need to go to the PHC and occupy the time of the PHC only to obtain an SL. Through this measure, bureaucracy has been reduced, and the system has been focused on users, improving the lives of citizens and reducing the administrative burden on PHC, which now has more consultation times for users who need it. The second initiative, which began on March 1, 2024, allows the SL to be issued in emergency departments (ED) of public hospitals and in the health institutions of the social and private sectors. This project is intended to allow the user who has suffered a situation of acute urgent illness and who has been observed in an ED of a public hospital or in a private or social entity no longer need to go to PHC only to apply for the respective SL. Since March 1, 54,453 SLs have been issued, 242 in private or social sector institutions and 6,918 in public hospitals, of which 134 were in ED and 47,292 in PHC. This approach has proven to be technically robust, allows immediate resolution of problems and differentiates the performance of doctors. However, it is important to continue to qualify the proper functioning of the ED, preventing non-urgent users from going there only to obtain SL. Thus, in order to make better use of existing resources, it was operationalizing this extension of its issuance in a balanced way, allowing SL to be issued in the ED of hospitals only to critically ill patients or patients referred by INEM, SNS24, or PHC. In both cases, an intense public campaign was implemented to explain the way it works and the benefits for patients. In satisfaction surveys, more than 95% of patients and doctors were satisfied with the solutions, asking for extensions to other areas. The administrative simplification agenda of the NHS continues its effective development. For the success of this debureaucratization agenda, the key factors are effective communication and the ability to reach patients and health professionals in order to increase health literacy and the correct use of NHS.

Keywords: debureaucratization strategy, self-declaration of illness, sick leaves, SNS24

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Authors: Christine Lassen, Elizabeth Leonard, Matthew Oliver

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The management of trauma is often complex and outcomes dependent on clinical expertise, effective teamwork, and a supported trauma system. The implementation of a statewide trauma education program should be accessible to all clinicians who manage trauma, but this can be challenging due to diverse individual needs, trauma service needs and geography. The NSW Institute of Trauma and Injury Management (ITIM) is a government funded body, responsible for coordinating and supporting the NSW Trauma System. The aim of this presentation is to describe how education initiatives have been implemented across the state. Simulation: In 2006, ITIM developed a Trauma Team Training Course - aimed to educate clinicians on the technical and non-technical skills required to manage trauma. The course is now independently coordinated by trauma services across the state at major trauma centres as well as in regional and rural hospitals. ITIM is currently in the process of re-evaluating and updating the Trauma Team Training Course to allow for the development of new resources and simulation scenarios. Trauma Education Evenings: In 2013, ITIM supported major trauma services to develop trauma education evenings which allowed the provision of free education to staff within the area health service and local area. The success of these local events expanded to regional hospitals. A total of 75 trauma education evenings have been conducted within NSW, with over 10,000 attendees. Wed-Based Resources: Recently, ITIM commenced free live streaming of the trauma education evenings which have now had over 3000 live views. The Trauma App developed in 2015 provides trauma clinicians with a centralised portal for trauma information and works on smartphones and tablets that integrate with the ITIM website. This supports pre-hospital and bedside clinical decisions and allows for trauma care to be more standardised, evidence-based, timely, and appropriate. Online e-Learning modules have been developed to assist clinicians, reduce unwarranted clinical variation and provide up to date evidence based education. The modules incorporate clinically focused education content with summative and formative assessments. Conclusion: Since 2005, ITIM has helped to facilitate the development of trauma education programs for doctors, nurses, pre-hospital and allied health clinicians. ITIM has been actively involved in more than 100 specialized trauma education programs, seminars and clinical workshops - attended by over 12,000 staff. The provision of state-wide trauma education is a challenging task requiring collaboration amongst numerous agencies working towards a common goal – to provide easily accessible trauma education.

Keywords: education, simulation, team-training, trauma

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Authors: Mumtaz Ali, Hamzullah Khan, Khalid Khanzada, Shahid Ayub, Aurangzeb Wazir

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Objective: To analyse the death of patients treated in neuro-surgical ICU for severe head injuries from different perspectives. The evaluation of the data so obtained to help improve the health care delivery to this group of patients in ICU. Study Design: It is a descriptive study based on retrospective analysis of patients presenting to neuro-surgical ICU in Lady Reading Hospital, Peshawar. Study Duration: It covered the period between 1st January 2009 to 31st December 2009. Material and Methods: The Clinical record of all the patients presenting with the clinical radiological and surgical features of severe head injuries, who expired in neuro-surgical ICU was collected. A separate proforma which mentioned age, sex, time of arrival and death, causes of head injuries, the radiological features, the clinical parameters, the surgical and non surgical treatment given was used. The average duration of stay and the demographic and domiciliary representation of these patients was noted. The record was analyzed accordingly for discussion and recommendations. Results: Out of the total 112 (n-112) patients who expired in one year in the neuro-surgical ICU the young adults made up the majority 64 (57.14%) followed by children, 34 (30.35%) and then the elderly age group: 10 (8.92%). Road traffic accidents were the major cause of presentation, 75 (66.96%) followed by history of fall; 23 (20.53%) and then the fire arm injuries; 13 (11.60%). The predominant CT scan features of these patients on presentation was cerebral edema, and midline shift (diffuse neuronal injuries). 46 (41.07%) followed by cerebral contusions. 28 (25%). The correctable surgical causes were present only in 18 patients (16.07%) and the majority 94 (83.92%) were given conservative management. Of the 69 (n=69) patients in which CT scan was repeated; 62 (89.85%) showed worsening of the initial CT scan abnormalities while in 7 cases (10.14%) the features were static. Among the non surgical cases both ventilatory therapy in 7 (6.25%) and tracheostomy in 39 (34.82%) failed to change the outcome. The maximum stay in the neuro ICU leading upto the death was 48 hours in 35 (31.25%) cases followed by 31 (27.67%) cases in 24 hours; 24 (21.42%) in one week and 16 (14.28%) in 72 hours. Only 6 (5.35%) patients survived more than a week. Patients were received from almost all the districts of NWFP except. The Hazara division. There were some Afghan refugees as well. Conclusion: Mortality following the head injuries is alarmingly high despite repeated claims about the professional and administrative improvement. Even places like ICU could not change the out come according to the desired aims and objectives in the present set up. A rethinking is needed both at the individual and institutional level among the concerned quarters with a clear aim at the more scientific grounds. Only then one can achieve the desired results.

Keywords: Glasgow Coma Scale, pediatrics, geriatrics, Peshawar

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Authors: Despoina Mouratidis, Katia Lida Kermanidis

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Machine translation (MT) is a very important task in Natural Language Processing (NLP). MT evaluation is crucial in MT development, as it constitutes the means to assess the success of an MT system, and also helps improve its performance. Several methods have been proposed for the evaluation of (MT) systems. Some of the most popular ones in automatic MT evaluation are score-based, such as the BLEU score, and others are based on lexical similarity or syntactic similarity between the MT outputs and the reference involving higher-level information like part of speech tagging (POS). This paper presents a language-independent machine learning framework for classifying pairwise translations. This framework uses vector representations of two machine-produced translations, one from a statistical machine translation model (SMT) and one from a neural machine translation model (NMT). The vector representations consist of automatically extracted word embeddings and string-like language-independent features. These vector representations used as an input to a multi-layer neural network (NN) that models the similarity between each MT output and the reference, as well as between the two MT outputs. To evaluate the proposed approach, a professional translation and a "ground-truth" annotation are used. The parallel corpora used are English-Greek (EN-GR) and English-Italian (EN-IT), in the educational domain and of informal genres (video lecture subtitles, course forum text, etc.) that are difficult to be reliably translated. They have tested three basic deep learning (DL) architectures to this schema: (i) fully-connected dense, (ii) Convolutional Neural Network (CNN), and (iii) Long Short-Term Memory (LSTM). Experiments show that all tested architectures achieved better results when compared against those of some of the well-known basic approaches, such as Random Forest (RF) and Support Vector Machine (SVM). Better accuracy results are obtained when LSTM layers are used in our schema. In terms of a balance between the results, better accuracy results are obtained when dense layers are used. The reason for this is that the model correctly classifies more sentences of the minority class (SMT). For a more integrated analysis of the accuracy results, a qualitative linguistic analysis is carried out. In this context, problems have been identified about some figures of speech, as the metaphors, or about certain linguistic phenomena, such as per etymology: paronyms. It is quite interesting to find out why all the classifiers led to worse accuracy results in Italian as compared to Greek, taking into account that the linguistic features employed are language independent.

Keywords: machine learning, machine translation evaluation, neural network architecture, pairwise classification

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Authors: A. Poukens, I. Sluyts, A. Krings, J. Swartenbroekx, D. Geeroms, J. Poukens

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Introduction and Objectives: It has been known for many years that with the administration of intravenous medication, a rather significant part of the planned to be administered infusion solution, the residual volume ( the volume that remains in the IV line and or infusion bag), does not reach the patient and is wasted. This could possibly result in under dosage and diminished therapeutic effect. Despite the important impact on the patient, the reduction of residual volume lacks attention. An optimized and clearly stated protocol concerning the reduction of residual volume in an IV line is necessary for each hospital. As described in my Master’s thesis, acquiring the degree of Master in Hospital Pharmacy, administration of intravenous medication can be optimized by reduction of the residual volume. Herewith effectiveness, user-friendliness, cost efficiency and safety were taken into account. Material and Methods: By usage of a literature study and an online questionnaire sent out to all Flemish hospitals and hospitals in the Netherlands (province Limburg), current flush methods could be mapped out. In laboratory research, possible flush methods aiming to reduce the residual volume were measured. Furthermore, a self-developed experimental method to reduce the residual volume was added to the study. The current flush methods and the self-developed experimental method were compared to each other based on cost efficiency, user-friendliness and safety. Results: There is a major difference between the Flemish and the hospitals in the Netherlands (Province Limburg) concerning the approach and method of flushing IV lines after administration of intravenous medication. The residual volumes were measured and laboratory research showed that if flushing was done minimally 1-time equivalent to the residual volume, 95 percent of glucose would be flushed through. Based on the comparison, it became clear that flushing by use of a pre-filled syringe would be the most cost-efficient, user-friendly and safest method. According to laboratory research, the self-developed experimental method is feasible and has the advantage that the remaining fraction of the medication can be administered to the patient in unchanged concentration without dilution. Furthermore, this technique can be applied regardless of the level of the residual volume. Conclusion and Recommendations: It is recommendable to revise the current infusion systems and flushing methods in most hospitals. Aside from education of the hospital staff and alignment on a uniform substantiated protocol, an optimized and clear policy on the reduction of residual volume is necessary for each hospital. It is recommended to flush all IV lines with rinsing fluid with at least the equivalent volume of the residual volume. Further laboratory and clinical research for the self-developed experimental method are needed before this method can be implemented clinically in a broader setting.

Keywords: intravenous medication, infusion therapy, IV flushing, residual volume

Procedia PDF Downloads 113

Authors: I. Bochev, A. Shterev, S. Kyurkchiev

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One of the factors associated with poor success rates in human in vitro fertilization (IVF) is the suboptimal culture conditions in which fertilization and early embryonic growth occur. Co-culture systems with helper cell lines appear to enhance the in vitro conditions and allow embryos to demonstrate improved in vitro development. The co-culture of human embryos with monolayers of autologous endometrial stromal cell (EnSCs) results in increased blastocyst development with a larger number of blastomeres, lower incidence of fragmentation and higher pregnancy rates in patients with recurrent implantation failure (RIF). The aim of the study was to examine the influence of autologous endometrial stromal cell (EnSC) co-culture on day 3 embryo quality by comparing the morphological status of the embryos from the same patients undergoing consecutive IVF/Intracytoplasmic sperm injection (ICSI) cycles without and with EnSC co-culture. This retrospective randomized study (2015-2017) includes 20 couples and a total of 46 IVF/ICSI cycles. Each patient couple included had at least two IVF/ICSI procedures – one with and one without autologous EnSC co-culture. Embryo quality was assessed at 68±1 hours in culture, according to Istanbul consensus criteria (2010). Day 3 embryos were classified into three groups: good – grade 1; fair – grade 2; poor – grade 3. Embryos from all cycles were divided into two groups (A – co-cultivated; B – not co-cultivated) and analyzed. Second, for each patient couple, embryos from matched IVF/ICSI cycles (with and without co-culture) were analyzed separately. When an analysis of co-cultivated day 3 embryos from all cycles was performed (n=137; group A), 43.1% of the embryos were graded as “good”, which was not significantly different from the respective embryo quality rate of 42.2% (p = NS) in group B (n=147) with non-co-cultivated embryos. The proportions of fair and poor quality embryos in group A and group B were similar as well – 11.7% vs 10.2% and 45.2% vs 47.6% (p=NS), respectively. Nevertheless, the separate embryo analysis by matched cycles for each couple revealed that in 65% of the cases the proportion of morphologically better embryos was increased in cycles with co-culture in comparison with those without co-culture. A decrease in this proportion after endometrial stromal cell co-cultivation was found in 30% of the cases, whereas no difference was observed in only one couple. The results demonstrated that there is no marked difference in the overall morphological quality between co-cultured and non-co-cultured embryos on day 3. However, in significantly greater percentage of couples the process of autologous EnSC co-culture could increase the proportion of morphologically improved day 3 embryos. By mimicking the in vivo relationship between embryo and maternal environment, co-culture in autologous EnSC system represents a perspective approach to improve the quality of embryos in cases with elevated risk for development of embryos with impaired morphology.

Keywords: autologous endometrial stromal cells, co-culture, day 3 embryo, morphological quality

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Authors: Wee Tong Liaw, Elaine Wong Yee Sing

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The main objective and focus of this study are to establish the significance of a sustained health promoting workplace on stock and portfolio returns focusing on companies listed on the Singapore stock exchange, using a two-factor model comprising of the single factor CAPM and a 'health promoting workplace' factor. The 'health promoting workplace' factor represents the excess returns derived between two portfolios of component stocks that, when combined, would represent a top tier stock market index in Singapore, namely the STI index. The first portfolio represents companies that are independently assessed by the Singapore’s Health Award, SHA, to have a sustained and comprehensive health promoting workplace (SHA-STI portfolio) and the second portfolio represents companies that had not been independently assessed (Non-SHA STI portfolio). Since 2001, many companies in Singapore have voluntarily participated in the bi-annual Singapore HEALTH Award initiated by the Health Promotion Board of Singapore (HPB). The Singapore HEALTH Award (SHA), is an industry-wide award and assessment process. SHA assesses and recognizes employers in Singapore for implementing a comprehensive and sustainable health promotion programme at their workplaces. When using a ten year holding period instead of a one year holding period, excess returns in the SHA-STI portfolio over Non-SHA STI portfolio were consistently being observed over all test periods, during 2001 to 2013. In addition, when applied to the SHA-STI portfolio, results from the Two Factor Model consistently revealed higher explanatory powers across all test periods for the portfolio as well as all the individual component stocks in SHA-STI portfolio, than the single factor CAPM model. However, with respect to attaining higher level of achievement in the Singapore Health Award, this study did not show any incentive for selecting listed companies that have achieved a higher level of award. Results from this study would give further insights to investors and fund managers alike who intend to consider health promoting workplace as a risk factor in their stock or portfolio selection process, in particular for investors who have a preference for STI’s component stocks and with a longer investment horizon. Key micro factors like management abilities, business development strategies and production capabilities that meet the needs of market would create the demand for a company’s product(s) or service(s) and consequently contribute to its top line and profitability. Thereafter, the existence of a sustainable health promoting workplace would be a key catalytic factor in sustaining a productive workforce needed to support the continued success of a profitable business.

Keywords: asset pricing model, company's performance, stock returns, financial risk factor, sustained health promoting workplace

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Authors: Zohar Manber, Ran Elkon

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Accumulation of somatic mutations (SMs) in the genome is a major driving force of cancer development. Most SMs in the tumor's genome are functionally neutral; however, some cause damage to critical processes and provide the tumor with a selective growth advantage (termed cancer driver mutations). Current research on functional significance of SMs is mainly focused on finding alterations in protein coding sequences. However, the exome comprises only 3% of the human genome, and thus, SMs in the noncoding genome significantly outnumber those that map to protein-coding regions. Although our understanding of noncoding driver SMs is very rudimentary, it is likely that disruption of regulatory elements in the genome is an important, yet largely underexplored mechanism by which somatic mutations contribute to cancer development. The expression of most human genes is controlled by multiple enhancers, and therefore, it is conceivable that regulatory SMs are distributed across different enhancers of the same target gene. Yet, to date, most statistical searches for regulatory SMs have considered each regulatory element individually, which may reduce statistical power. The first challenge in considering the cumulative activity of all the enhancers of a gene as a single unit is to map enhancers to their target promoters. Such mapping defines for each gene its set of regulating enhancers (termed "set of regulatory elements" (SRE)). Considering multiple enhancers of each gene as one unit holds great promise for enhancing the identification of driver regulatory SMs. However, the success of this approach is greatly dependent on the availability of comprehensive and accurate enhancer-promoter (E-P) maps. To date, the discovery of driver regulatory SMs has been hindered by insufficient sample sizes and statistical analyses that often considered each regulatory element separately. In this study, we analyzed more than 2,500 whole-genome sequence (WGS) samples provided by The Cancer Genome Atlas (TCGA) and The International Cancer Genome Consortium (ICGC) in order to identify such driver regulatory SMs. Our analyses took into account the combinatorial aspect of gene regulation by considering all the enhancers that control the same target gene as one unit, based on E-P maps from three genomics resources. The identification of candidate driver noncoding SMs is based on their recurrence. We searched for SREs of genes that are "hotspots" for SMs (that is, they accumulate SMs at a significantly elevated rate). To test the statistical significance of recurrence of SMs within a gene's SRE, we used both global and local background mutation rates. Using this approach, we detected - in seven different cancer types - numerous "hotspots" for SMs. To support the functional significance of these recurrent noncoding SMs, we further examined their association with the expression level of their target gene (using gene expression data provided by the ICGC and TCGA for samples that were also analyzed by WGS).

Keywords: cancer genomics, enhancers, noncoding genome, regulatory elements

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Authors: John Kosmeh

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Introduction – For years, senior health care and skilled nursing facilities have been plagued with the dilemma of not having the necessary tools and equipment to adequately care for senior residents in their communities. This has led to high transport rates to emergency departments and high 30-day readmission rates, costing billions of unnecessary dollars each year, as well as quality assurance issues. Our Senior care telemedicine program is designed to solve this issue. Methods – We conducted a 1-year pilot program using our technology coupled with our 24/7 telemedicine program with skilled nursing facilities in different parts of the United States. We then compared transports rates and 30-day readmission rates to previous years before the use of our program, as well as transport rates of other communities of similar size not using our program. This data was able to give us a clear and concise look at the success rate of reducing unnecessary transport and readmissions as well as cost savings. Results – A 94% reduction nationally of unnecessary out-of-facility transports, and to date, complete elimination of 30-day readmissions. Our virtual platform allowed us to instruct facility staff on the utilization of our tools and system as well as deliver treatment by our ER-trained providers. Delay waiting for PCP callbacks was eliminated. We were able to obtain lung, heart, and abdominal ultrasound imaging, 12 lead EKG, blood labs, auscultate lung and heart sounds, and collect other diagnostic tests at the bedside within minutes, providing immediate care and allowing us to treat residents within the SNF. Are virtual capabilities allowed for loved ones, family members, and others who had medical power of attorney to virtually connect with us at the time of visit, to speak directly with the medical provider, providing increased confidence in the decision to treat the resident in-house. The decline in transports and readmissions will greatly reduce governmental cost burdens, as well as fines imposed on SNF for high 30-day readmissions, reduce the cost of Medicare A readmissions, and significantly impact the number of patients visiting overcrowded ERs. Discussion – By utilizing our program, SNF can effectively reduce the number of unnecessary transports of residents, as well as create significant savings from loss of day rates, transportation costs, and high CMS fines. The cost saving is in the thousands monthly, but more importantly, these facilities can create a higher quality of life and medical care for residents by providing definitive care instantly with ER-trained personnel.

Keywords: senior care, long term care, telemedicine, technology, senior care communities

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Authors: Martin Juckel

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Probably no other field of inorganic chemistry has undergone such a rapid development in the past two decades than the low oxidation state chemistry of main group elements. This rapid development has only been possible by the development of new bulky ligands. In case of our research group, super-bulky monodentate amido ligands and β-diketiminate ligands have been used to a great success. We first synthesized the unprecedented magnesium(I) dimer [ᴹᵉˢNacnacMg]₂ (ᴹᵉˢNacnac = [(ᴹᵉˢNCMe)₂CH]-; Mes = mesityl, which has since been used both as reducing agent and also for the synthesis of new metal-magnesium bonds. In case of the zinc bromide precursor [L*ZnBr] (L*=(N(Ar*)(SiPri₃); (Ar* = C₆H₂{C(H)Ph₂}₂Me-2,6,4, the reduction with [ᴹᵉˢNacnacMg]₂ led to such a metal-magnesium bond. This [L*ZnMg(ᴹᵉˢNacnac)] compound can be seen as an ‘inorganic Grignard reagent’, which can be used to transfer the metal fragment onto other functional groups or other metal centers; just like the conventional Grignard reagent. By simple addition of (TBoN)GeCl (TBoN = N(SiMe₃){B(DipNCH)₂) to the aforesaid compound, we were able to transfer the amido-zinc fragment to the Ge center of the germylene starting material and to synthesize the first example of a germanium(II)-zinc bond: [:Ge(TBoN)(ZnL*)]. While these reactions typically led to complex product mixture, [:Ge(TBoN)(ZnL*)] could be isolated as dark blue crystals in a good yield. This new compound shows interesting reactivity towards small molecules, especially dihydrogen gas. This is of special interest as dihydrogen is one of the more difficult small molecules to activate, due to its strong (BDE = 108 kcal/mol) and non-polar bond. In this context, the interaction between H₂ σ-bond with the tetrelylene p-Orbital (LUMO), with concomitant donation of the tetrelylene lone pair (HOMO) into the H₂ σ* orbital are responsible for the activation of dihydrogen gas. Accordingly, the narrower the HOMO-LUMO gap of tertelylene, the more reactivity towards H₂ it typically is. The aim of a narrow HOMO-LUMO gap was reached by transferring electropositive substituents respectively metal substituents with relatively low Pauling electronegativity (zinc: 1.65) onto the Ge center (here: the zinc-amido fragment). In consideration of the unprecedented reactivity of [:Ge(TBoN)(ZnL*)], a computational examination of its frontier orbital energies was undertaken. The energy separation between the HOMO, which has significant Ge lone pair character, and the LUMO, which has predominantly Ge p-orbital character, is narrow (40.8 kcal/mol; cf.∆S-T= 24.8 kcal/mol), and comparable to the HOMO-LUMO gaps calculated for other literature known complexes). The calculated very narrow HOMO-LUMO gap for the [:Ge(TBoN)(ZnL*)] complex is consistent with its high reactivity, and is remarkable considering that it incorporates a π-basic amide ligand, which are known to raise the LUMO of germylenes considerably.

Keywords: activation of dihydrogen gas, narrow HOMO-LUMO gap, first germanium(II)-zinc bond, inorganic Grignard reagent

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Authors: Rudainah Alkhazam, Özlem Yaşar Uğurlu

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Immigrant entrepreneurship arises from the start of entrepreneurial activity by immigrants in the country they relocate to. The future prosperity and stability of the refugee-hosting countries depends on the mutual social and economic benefits between the residents and the refugees. Syrian refugees and workers in host countries necessitate efforts to assist their residents and refugees in meeting their daily needs, contributing lawfully to local and possibly regional economies through trade, and instilling hope in their future. This study investigates the effects of Syrian refugee entrepreneurs on host communities' business sectors, focusing on Turkey. Specifically, we examine entrepreneurship in general and its role in the country's economy. Because Turkey is the most popular resettlement destination for Syrian refugees, this study will shed light on the challenges of successful migrant entrepreneurship in Turkey and their role in the business sector. The research relies on a mixed-method approach which helps identify recurring themes, favorable results, and conflicting results across methods, allowing us to draw accurate conclusions. The study will adopt a quantitative method in collecting numerical data from Syrian refugees in Turkey. The self-administered survey would be translated into Arabic to ensure that the respondents understood the questions and possible replies. The research will use survey questionnaires to gather the majority of the data. These surveys would have closed-ended questions with nominal ratio and Likert scales. The data will be analyzed using linear regression and the Statistical Package for Social Sciences (SPSS) to ascertain the role of Syrian entrepreneurs in the business sectors of Turkey. The research will use the findings to make future recommendations. Syrian entrepreneurs, among the migrant entrepreneurs, contribute to the labor market, the majority of whom are young people. This research noted the significant participation of Syrian immigrant women in the entrepreneurship sector. The previous experience of Syrians in the field of trade and running their own business plays a vital role in the success of their business in the host countries. The study shows that Syrian entrepreneurs could integrate effectively into the various Turkish business sectors and could rely on themselves, open and manage their projects, and market them in the Turkish market. Syrian entrepreneurs consider that the investment and labor laws, commercial arrangements, and facilities for obtaining financial resources in Turkey need to be more flexible and available to immigrant entrepreneurs.

Keywords: entrepreneurship, immigration, Syrian, Turkey, refugees, investors, socio-economic benefits, unemployment

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Authors: Kamal Kumar Gupta, Sunil Kayesth

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Dysdercus koenigii is serious pest of cotton and other malvaceous crop. Present research work aimed at ecofriendly approach for management of pest by plant extracts. The impact of Ocimum sanctum was studied on reproductive performance of Dysdercus koenigii. The hexane extract of Ocimum leaves was prepared by ‘cold extraction method’. The newly emerged fifth instar nymphs were exposed to the extract of concentrations ranging from 0.1% to 0.00625% by ‘thin film residual method’ for a period of 24h. Reproductive fitness of the adults emerged from the treated nymphs was evaluated by assessing their courtship behaviour, oviposition behaviour, and fertility. The studies indicated that treatment of Dysdercus with the hexane extract of Ocimum altered their courtship behaviour. Consequently, the treated males exhibited less sexual activity, performed fewer mounting attempts, increased time to mate and showed decreased percent successful mating. The females often rejected courting treated male by shaking the abdomen. Similarly, the treated females in many cases remained non-receptive to the courting male. Premature termination of mating in the mating pairs prior to insemination further decreased the mating success of the treated adults. Maximum abbreviation of courtship behaviour was observed in the experimental set up where both the males and the females were treated. Only females which mate successfully were observed for study of oviposition behaviour. The treated females laid lesser number of egg batches and eggs in their life span. The eggs laid by these females were fertile indicating insemination of the female. However, percent hatchability was lesser than control. The effects of hexane extract were dose dependent. Treatment with 0.1% and 0.05% extract altered courtship behaviour. Doses of concentrations less than 0.05% did not affect courtship behaviour but altered the oviposition behaviour and fertility. Significant reduction in the fecundity and fertility was observed in the treatments at concentration as low as 0.00625%. The GCMS analysis of the extract revealed a plethora of phytochemicals including juvenile hormone mimics, and the intermediates of juvenile hormone biosynthesis. Therefore, some of these compounds individually or synergistically impair reproductive behaviour of Dysdercus. Alteration of courtship behaviour and suppression of fecundity and fertility with the help of plant extracts has wide potentials in suppression of pest population and ‘integrated pest management’.

Keywords: courtship behaviour, Dysdercus koenigii, Ocimum sanctum, oviposition behaviour

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Authors: Christi Jackson, Chuka Onaga

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Introduction: We report a case of delayed diagnosis of extra-pulmonary INH-mono-resistant Tuberculosis (TB) in a South African patient with drug-resistant HIV. Case Presentation: A 36-year old male was initiated on 1st line (NNRTI-based) anti-retroviral therapy (ART) in September 2009 and switched to 2nd line (PI-based) ART in 2011, according to local guidelines. He was following up at the outpatient wellness unit of a public hospital, where he was diagnosed with Protease Inhibitor resistant HIV in March 2016. He had an HIV viral load (HIVVL) of 737000 copies/mL, CD4-count of 10 cells/µL and presented with complaints of productive cough, weight loss, chronic diarrhoea and a septic buttock wound. Several investigations were done on sputum, stool and pus samples but all were negative for TB. The patient was treated with antibiotics and the cough and the buttock wound improved. He was subsequently started on a 3rd-line ART regimen of Darunavir, Ritonavir, Etravirine, Raltegravir, Tenofovir and Emtricitabine in May 2016. He continued losing weight, became too weak to stand unsupported and started complaining of abdominal pain. Further investigations were done in September 2016, including a urine specimen for Line Probe Assay (LPA), which showed M. tuberculosis sensitive to Rifampicin but resistant to INH. A lymph node biopsy also showed histological confirmation of TB. Management and outcome: He was started on Rifabutin, Pyrazinamide and Ethambutol in September 2016, and Etravirine was discontinued. After 6 months on ART and 2 months on TB treatment, his HIVVL had dropped to 286 copies/mL, CD4 improved to 179 cells/µL and he showed clinical improvement. Pharmacy supply of his individualised drugs was unreliable and presented some challenges to continuity of treatment. He successfully completed his treatment in June 2017 while still maintaining virological suppression. Discussion: Several laboratory-related factors delayed the diagnosis of TB, including the unavailability of urine-lipoarabinomannan (LAM) and urine-GeneXpert (GXP) tests at this facility. Once the diagnosis was made, it presented a treatment dilemma due to the expected drug-drug interactions between his 3rd-line ART regimen and his INH-resistant TB regimen, and specialist input was required. Conclusion: TB is more difficult to diagnose in patients with severe immunosuppression, therefore additional tests like urine-LAM and urine-GXP can be helpful in expediting the diagnosis in these cases. Patients with non-standard drug regimens should always be discussed with a specialist in order to avoid potentially harmful drug-drug interactions.

Keywords: drug-resistance, HIV, line probe assay, tuberculosis

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Authors: Scott Snyder

Abstract:

Grading approaches in higher education have not changed meaningfully in over 100 years. While there is variation in the types of grades assigned across countries, most use approaches based on simple ordinal scales (e.g, letter grades). While grades are generally viewed as an indication of a student's performance, challenges arise regarding the clarity, validity, and reliability of letter grades. Research about grading in higher education has primarily focused on grade inflation, student attitudes toward grading, impacts of grades, and benefits of plus-minus letter grade systems. Little research is available about alternative approaches to grading, varying approaches used by faculty within and across colleges, and faculty attitudes toward grades and alternative approaches to grading. To begin to address these gaps, a survey was conducted of faculty in a sample of departments at three diverse colleges in a southeastern state in the US. The survey focused on faculty experiences with and attitudes toward grading, the degree to which faculty innovate in teaching and grading practices, and faculty interest in alternatives to the point system approach to grading. Responses were received from 104 instructors (21% response rate). The majority reported that teaching accounted for 50% or more of their academic duties. Almost all (92%) of respondents reported using point and percentage systems for their grading. While all respondents agreed that grades should reflect the degree to which objectives were mastered, half indicated that grades should also reflect effort or improvement. Over 60% felt that grades should be predictive of success in subsequent courses or real life applications. Most respondents disagreed that grades should compare students to other students. About 42% worried about their own grade inflation and grade inflation in their college. Only 17% disagreed that grades mean different things based on the instructor while 75% thought it would be good if there was agreement. Less than 50% of respondents felt that grades were directly useful for identifying students who should/should not continue, identify strengths/weaknesses, predict which students will be most successful, or contribute to program monitoring of student progress. Instructors were less willing to modify assessment than they were to modify instruction and curriculum. Most respondents (76%) were interested in learning about alternative approaches to grading (e.g., specifications grading). The factors that were most associated with willingness to adopt a new grading approach were clarity to students and simplicity of adoption of the approach. Follow-up studies are underway to investigate implementations of alternative grading approaches, expand the study to universities and departments not involved in the initial study, examine student attitudes about alternative approaches, and refine the measure of attitude toward adoption of alternative grading practices within the survey. Workshops about challenges of using percentage and point systems for determining grades and workshops regarding alternative approaches to grading are being offered.

Keywords: alternative approaches to grading, grades, higher education, letter grades

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Authors: Ghiwa Dandach

Abstract:

By challenging the anti-failure bias and contributing to the theoretical territory of the attribution theory, this thesis develops a comprehensive process for entrepreneurial learning from failure. The practical implication of the findings suggests assisting entrepreneurs (current, failing, and nascent) in effectively anticipating and reflecting upon failure. Additionally, the process is suggested to enhance the level of institutional and private (accelerators and financers) support provided to entrepreneurs, the implications of which may improve future opportunities for entrepreneurial success. Henceforth, exploring learning from failure is argued to impact the potential survival of future ventures, subsequently revitalizing the economic contribution of entrepreneurship. This learning process can be enhanced with the cognitive development of causal ascriptions for failure, which eventually impacts learning outcomes. However, the mechanism with which entrepreneurs make sense of failure, reflect on the journey, and transform experience into knowledge is still under-researched. More specifically, the cognitive process of failure attribution is under-explored, majorly in the context of developing economies, calling for a more insightful understanding on how entrepreneurs ascribe failure. Responding to the call for more thorough research in such cultural contexts, this study expands the understanding of the dimensions of failure attributions as perceived by entrepreneurs and the impact of these dimensions on learning outcomes in the Lebanese context. The research adopted the exploratory interpretivism paradigm and collected data from interviews with industry experts first, followed by narratives of entrepreneurs using the qualitative multimethod approach. The holistic and categorical content analysis of narratives, preceded by the thematic analysis of interviews, unveiled how entrepreneurs ascribe failure by developing minor and major dimensions of each failure attribution. The findings have also revealed how each dimension impacts the learning from failure when accompanied by emotional resilience. The thesis concludes that exploring in-depth the dimensions of failure attributions significantly determines the level of learning generated. They are moving beyond the simple categorisation of ascriptions as primary internal or external unveiled how learning may occur with each attribution at the individual, venture, and ecosystem levels. This has further accentuated that a major internal attribution of failure combined with a minor external attribution generated the highest levels of transformative and double-loop learning, emphasizing the role of personal blame and responsibility on enhancing learning outcomes.

Keywords: attribution, entrepreneurship, reflection, sense-making, emotions, learning outcomes, failure, exit

Procedia PDF Downloads 200

Authors: Janice Keener, Christine Houlihan

Abstract:

Over the last several years, there has been an increase in children identified as having Autism Spectrum Disorder (ASD). Specialists across several disciplines: mental health and medical professionals have been tasked with ensuring accurate and timely evaluations for children with suspected ASD. Due to the nature of the ASD symptom presentation, an interdisciplinary assessment and treatment approach best addresses the needs of the whole child. During the unprecedented COVID-19 Pandemic, clinicians were faced with how to continue with interdisciplinary assessments in a telehealth arena. Instruments that were previously used to assess ASD in-person were no longer appropriate measures to use due to the safety restrictions. For example, The Autism Diagnostic Observation Schedule requires examiners and children to be in very close proximity of each other and if masks or face shields are worn, they render the evaluation invalid. Similar issues arose with the various cognitive measures that are used to assess children such as the Weschler Tests of Intelligence and the Differential Ability Scale. Thus the need arose to identify measures that are able to be safely and accurately administered using safety guidelines. The incidence of ASD continues to rise over time. Currently, the Center for Disease Control estimates that 1 in 59 children meet the criteria for a diagnosis of ASD. The reasons for this increase are likely multifold, including changes in diagnostic criteria, public awareness of the condition, and other environmental and genetic factors. The rise in the incidence of ASD has led to a greater need for diagnostic and treatment services across the United States. The uncertainty of the diagnostic process can lead to an increased level of stress for families of children with suspected ASD. Along with this increase, there is a need for diagnostic clarity to avoid both under and over-identification of this condition. Interdisciplinary assessment is ideal for children with suspected ASD, as it allows for an assessment of the whole child over the course of time and across multiple settings. Clinicians such as Psychologists and Developmental Pediatricians play important roles in the initial evaluation of autism spectrum disorder. An ASD assessment may consist of several types of measures such as standardized checklists, structured interviews, and direct assessments such as the ADOS-2 are just a few examples. With the advent of telehealth clinicians were asked to continue to provide meaningful interdisciplinary assessments via an electronic platform and, in a sense, going to the family home and evaluating the clinical symptom presentation remotely and confidently making an accurate diagnosis. This poster presentation will review the benefits, limitations, and interpretation of these various instruments. The role of other medical professionals will also be addressed, including medical providers, speech pathology, and occupational therapy.

Keywords: Autism Spectrum Disorder Assessments, Interdisciplinary Evaluations , Tele-Assessment with Autism Spectrum Disorder, Diagnosis of Autism Spectrum Disorder

Procedia PDF Downloads 194