Search results for: controlled drug delivery
1916 The Development of Nursing Model for Pregnant Women to Prevention of Early Postpartum Hemorrhage
Authors: Wadsana Sarakarn, Pimonpan Charoensri, Baliya Chaiyara
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Objectives: To study the outcomes of the developed nursing model to prevent early postpartum hemorrhage (PPH). Materials and Methods: The analytical study was conducted in Sunpasitthiprasong Hospital during October 1st, 2015, until May 31st, 2017. After review the prevalence, risk factors, and outcomes of postpartum hemorrhage of the parturient who gave birth in Sunpasitthiprasong Hospital, the nursing model was developed under research regulation of Kemmis&McTaggart using 4 steps of operating procedures: 1) analyzing problem situation and gathering 2) creating the plan 3) noticing and performing 4) reflecting the result of the operation. The nursing model consisted of the screening tools for risk factors associated with PPH, the clinical nursing practice guideline (CNPG), and the collecting bag for measuring postpartum blood loss. Primary outcome was early postpartum hemorrhage. Secondary outcomes were postpartum hysterectomy, maternal mortality, personnel’s practice, knowledge, and satisfaction of the nursing model. The data were analyzed by using content analysis for qualitative data and descriptive statistics for quantitative data. Results: Before using the nursing model, the prevalence of early postpartum hemorrhage was under estimated (2.97%). There were 5 cases of postpartum hysterectomy and 2 cases of maternal death due to postpartum hemorrhage. During the study period, there was 22.7% prevalence of postpartum hemorrhage among 220 pregnant women who were vaginally delivered at Sunpasitthiprasong Hospital. No maternal death or postpartum hysterectomy was reported after using the nursing model. Among 16 registered nurses at the delivery room who evaluated using of the nursing model, they reported the high level of practice, knowledge, and satisfaction Conclusion: The nursing model for the prevention of early PPH is effective to decrease early PPH and other serious complications.Keywords: the development of a nursing model, prevention of postpartum hemorrhage, pregnant women, postpartum hemorrhage
Procedia PDF Downloads 991915 Attraction and Retention of Newly Graduated Medical Doctors to Deprived Regions in Ghana: A Qualitative Case Study
Authors: Lily Yarney, Emmanuel M. Y. Seidu, Thomas Chireh Kuusaanu, Belinda Adzimah-Yeboah
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Healthcare delivery is labor-intensive; the role of the health worker is, therefore, indispensable in maintaining and improving individual and population health. In Ghana, doctor-patient ratio is 1:10,450, with a disproportionate tilt in favor of the relatively resource rich southern part of the country. The Upper West Region located in Northern Ghana, is among the poorest regions in the country. The study was aimed at finding out the reasons why medical doctors are unwilling to accept postings to the Upper West Region where their services are needed most despite some efforts to attract, motivate and retain them. Current initiatives by the Ministry of Health and its partners to attract and retain doctors in the region were also examined. Qualitative methodology was employed with an in-depth interview guide to collect data. Sixteen respondents comprising medical doctors, health managers, and other health-related partners purposively selected took part in the study. Data were recorded, transcribed, coded, and categorized into themes in tandem with the objectives of the study. The study found that medical doctors are unwilling to take up appointments in the Upper West Region because of limited opportunities for career and continuing professional development, poor financial inducement, and weak leadership, among other important contextual social and cultural factors. Critical success factors to surmount these challenges include concessions and sponsorship for medical specialization training for doctors and clear implementable national and local policies on postings.Keywords: attraction, retention, medical doctors, deprived regions, Ghana
Procedia PDF Downloads 1101914 A Randomized Controlled Intervention Study of the Effect of Music Training on Mathematical and Working Memory Performances
Authors: Ingo Roden, Stefana Lupu, Mara Krone, Jasmin Chantah, Gunter Kreutz, Stephan Bongard, Dietmar Grube
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The present experimental study examined the effects of music and math training on mathematical skills and visuospatial working memory capacity in kindergarten children. For this purpose, N = 54 children (mean age: 5.46 years; SD = .29) were randomly assigned to three groups. Children in the music group (n = 18) received weekly sessions of 60 min music training over a period of eight weeks, whereas children in the math group (n = 18) received the same amount of training focusing on mathematical basic skills, such as numeracy skills, quantity comparison, and counting objectives. The third group of children (n = 18) served as waiting controls. The groups were matched for sex, age, IQ and previous music experiences at baseline. Pre-Post intervention measurements revealed a significant interaction effect of group x time, showing that children in both music and math groups significantly improved their early numeracy skills, whereas children in the control group did not. No significant differences between groups were observed for the visuospatial working memory performances. These results confirm and extend previous findings on transfer effects of music training on mathematical abilities and visuospatial working memory capacity. They show that music and math interventions are similarly effective to enhance children’s mathematical skills. More research is necessary to establish, whether cognitive transfer effects arising from music interventions might facilitate children’s transition from kindergarten to first-grade.Keywords: music training, mathematical skills, working memory, transfer
Procedia PDF Downloads 2721913 Virtual Simulation as a Teaching Method for Community Health Nursing: An Investigation of Student Performance
Authors: Omar Mayyas
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Clinical decision-making (CDM) is essential to community health nursing (CHN) education. For this reason, nursing educators are responsible for developing these skills among nursing students because nursing students are exposed to highly critical conditions after graduation. However, due to limited exposure to real-world situations, many nursing students need help developing clinical decision-making skills in this area. Therefore, the impact of Virtual Simulation (VS) on community health nursing students' clinical decision-making in nursing education has to be investigated. This study aims to examine the difference in CDM ability among CHN students who received traditional education compared to those who received VS classes, to identify the factors that may influence CDM ability differences between CHN students who received a traditional education and VS classes, and to provide recommendations for educational programs that can enhance the CDM ability of CHN students and improve the quality of care provided in community settings. A mixed-method study will conduct. A randomized controlled trial will compare the CDM ability of CHN students who received 1hr traditional class with another group who received 1hr VS scenario about diabetic patient nursing care. Sixty-four students in each group will randomly select to be exposed to the intervention from undergraduate nursing students who completed the CHN course at York University. The participants will receive the same Clinical Decision Making in Nursing Scale (CDMNS) questionnaire. The study intervention will follow the Medical Research Council (MRC) approach. SPSS and content analysis will use for data analysis.Keywords: clinical decision-making, virtual simulation, community health nursing students, community health nursing education
Procedia PDF Downloads 671912 Development and Validation Method for Quantitative Determination of Rifampicin in Human Plasma and Its Application in Bioequivalence Test
Authors: Endang Lukitaningsih, Fathul Jannah, Arief R. Hakim, Ratna D. Puspita, Zullies Ikawati
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Rifampicin is a semisynthetic antibiotic derivative of rifamycin B produced by Streptomyces mediterranei. RIF has been used worldwide as first line drug-prescribed throughout tuberculosis therapy. This study aims to develop and to validate an HPLC method couple with a UV detection for determination of rifampicin in spiked human plasma and its application for bioequivalence study. The chromatographic separation was achieved on an RP-C18 column (LachromHitachi, 250 x 4.6 mm., 5μm), utilizing a mobile phase of phosphate buffer/acetonitrile (55:45, v/v, pH 6.8 ± 0.1) at a flow of 1.5 mL/min. Detection was carried out at 337 nm by using spectrophotometer. The developed method was statistically validated for the linearity, accuracy, limit of detection, limit of quantitation, precise and specifity. The specifity of the method was ascertained by comparing chromatograms of blank plasma and plasma containing rifampicin; the matrix and rifampicin were well separated. The limit of detection and limit of quantification were 0.7 µg/mL and 2.3 µg/mL, respectively. The regression curve of standard was linear (r > 0.999) over a range concentration of 20.0 – 100.0 µg/mL. The mean recovery of the method was 96.68 ± 8.06 %. Both intraday and interday precision data showed reproducibility (R.S.D. 2.98% and 1.13 %, respectively). Therefore, the method can be used for routine analysis of rifampicin in human plasma and in bioequivalence study. The validated method was successfully applied in pharmacokinetic and bioequivalence study of rifampicin tablet in a limited number of subjects (under an Ethical Clearance No. KE/FK/6201/EC/2015). The mean values of Cmax, Tmax, AUC(0-24) and AUC(o-∞) for the test formulation of rifampicin were 5.81 ± 0.88 µg/mL, 1.25 hour, 29.16 ± 4.05 µg/mL. h. and 29.41 ± 4.07 µg/mL. h., respectively. Meanwhile for the reference formulation, the values were 5.04 ± 0.54 µg/mL, 1.31 hour, 27.20 ± 3.98 µg/mL.h. and 27.49 ± 4.01 µg/mL.h. From bioequivalence study, the 90% CIs for the test formulation/reference formulation ratio for the logarithmic transformations of Cmax and AUC(0-24) were 97.96-129.48% and 99.13-120.02%, respectively. According to the bioequivamence test guidelines of the European Commission-European Medicines Agency, it can be concluded that the test formulation of rifampicin is bioequivalence with the reference formulation.Keywords: validation, HPLC, plasma, bioequivalence
Procedia PDF Downloads 2901911 Investigating Kinetics and Mathematical Modeling of Batch Clarification Process for Non-Centrifugal Sugar Production
Authors: Divya Vats, Sanjay Mahajani
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The clarification of sugarcane juice plays a pivotal role in the production of non-centrifugal sugar (NCS), profoundly influencing the quality of the final NCS product. In this study, we have investigated the kinetics and mathematical modeling of the batch clarification process. The turbidity of the clarified cane juice (NTU) emerges as the determinant of the end product’s color. Moreover, this parameter underscores the significance of considering other variables as performance indicators for accessing the efficacy of the clarification process. Temperature-controlled experiments were meticulously conducted in a laboratory-scale batch mode. The primary objective was to discern the essential and optimized parameters crucial for augmenting the clarity of cane juice. Additionally, we explored the impact of pH and flocculant loading on the kinetics. Particle Image Velocimetry (PIV) is employed to comprehend the particle-particle and fluid-particle interaction. This technique facilitated a comprehensive understanding, paving the way for the subsequent multiphase computational fluid dynamics (CFD) simulations using the Eulerian-Lagrangian approach in the Ansys fluent. Impressively, these simulations accurately replicated comparable velocity profiles. The final mechanism of this study helps to make a mathematical model and presents a valuable framework for transitioning from the traditional batch process to a continuous process. The ultimate aim is to attain heightened productivity and unwavering consistency in product quality.Keywords: non-centrifugal sugar, particle image velocimetry, computational fluid dynamics, mathematical modeling, turbidity
Procedia PDF Downloads 711910 Biaxial Fatigue Specimen Design and Testing Rig Development
Authors: Ahmed H. Elkholy
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An elastic analysis is developed to obtain the distribution of stresses, strains, bending moment and deformation for a thin hollow, variable thickness cylindrical specimen when subjected to different biaxial loadings. The specimen was subjected to a combination of internal pressure, axial tensile loading and external pressure. Several axial to circumferential stress ratios were investigated in detail. The analytical model was then validated using experimental results obtained from a test rig using several biaxial loadings. Based on the preliminary results obtained, the specimen was then modified geometrically to ensure uniform strain distribution through its wall thickness and along its gauge length. The new design of the specimen has a higher buckling strength and a maximum value of equivalent stress according to the maximum distortion energy theory. A cyclic function generator of the standard servo-controlled, electro-hydraulic testing machine is used to generate a specific signal shape (sine, square,…) at a certain frequency. The two independent controllers of the electronic circuit cause an independent movement to each servo-valve piston. The movement of each piston pressurizes the upper and lower sides of the actuators alternately. So, the specimen will be subjected to axial and diametral loads independent of each other. The hydraulic system has two different pressures: one pressure will be responsible for axial stress produced in the specimen and the other will be responsible for the tangential stress. Changing the two pressure ratios will change the stress ratios accordingly. The only restriction on the maximum stress obtained is the capacity of the testing system and specimen instability due to buckling.Keywords: biaxial, fatigue, stress, testing
Procedia PDF Downloads 1281909 Review and Analysis of Sustainable-Based Risk Management in Humanitarian Supply Chains
Authors: Marinko Maslaric, Maja Jokic
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When searching for fast and long term responses, sustainable logistics and supply chain applications have developed irrefutable theories and hypotheses towards market requirements. Nevertheless, there are certain misunderstandings on how the implementation of sustainability principles (social, economical, and environmental) and concepts should work in practice, more specifically, within a humanitarian supply chain management context. This paper will focus on the review and analysis of risk management concepts in humanitarian supply chain in order to identify their compliance with sustainable principles. In this direction, the study will look for strategies that suggest: minimization of environmental impacts throughout the reduction of resources consumption, depreciation of logistics costs, including supply chain ones, minimization of transportation and service costs, elaboration of quality performance of supply chain and logistics, and reduction of supply chain delivery time. On the side of meeting all defense, trades and humanitarian logistics needs, the research will be aligned to UN Sustainable Development Goals, standards, and performances. It will start with relevant strategies for identification of risk indicators and it will end with suggestion of valuable strategic approaches for their minimization or total prevention. Finally, a content analysis will propose a suitable methodological structure for the creation of most sustainable strategy in risk management of humanitarian supply chain. Content analysis will accompany thorough, consistent and methodical approach of literature review for potential disaster risk management plan. Thereupon, the propositions of this research will look for contemporary literature gaps, with respect to operate the literature analysis and to suggest the appropriate sustained risk low master plan. The indicated is here to secure the high quality of logistics practices in hazardous events.Keywords: humanitarian logistics, sustainability, supply chain risk, risk management plan
Procedia PDF Downloads 2391908 Method to Find a ε-Optimal Control of Stochastic Differential Equation Driven by a Brownian Motion
Authors: Francys Souza, Alberto Ohashi, Dorival Leao
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We present a general solution for finding the ε-optimal controls for non-Markovian stochastic systems as stochastic differential equations driven by Brownian motion, which is a problem recognized as a difficult solution. The contribution appears in the development of mathematical tools to deal with modeling and control of non-Markovian systems, whose applicability in different areas is well known. The methodology used consists to discretize the problem through a random discretization. In this way, we transform an infinite dimensional problem in a finite dimensional, thereafter we use measurable selection arguments, to find a control on an explicit form for the discretized problem. Then, we prove the control found for the discretized problem is a ε-optimal control for the original problem. Our theory provides a concrete description of a rather general class, among the principals, we can highlight financial problems such as portfolio control, hedging, super-hedging, pairs-trading and others. Therefore, our main contribution is the development of a tool to explicitly the ε-optimal control for non-Markovian stochastic systems. The pathwise analysis was made through a random discretization jointly with measurable selection arguments, has provided us with a structure to transform an infinite dimensional problem into a finite dimensional. The theory is applied to stochastic control problems based on path-dependent stochastic differential equations, where both drift and diffusion components are controlled. We are able to explicitly show optimal control with our method.Keywords: dynamic programming equation, optimal control, stochastic control, stochastic differential equation
Procedia PDF Downloads 1881907 The Instablity of TetM Gene Encode Tetracycline Resistance Gene in Lactobacillus casei FNCC 0090
Authors: Sarah Devi Silvian, Hanna Shobrina Iqomatul Haq, Fara Cholidatun Nabila, Agustin Krisna Wardani
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Bacteria ability to survive in antibiotic is controlled by the presence of gene that encodes the antibiotic resistance protein. The instability of the antibiotic resistance gene can be observed by exposing the bacteria under the lethal dose of antibiotic. Low concentration of antibiotic can induce mutation, which may take a role in bacterial adaptation through the antibiotic concentration. Lactobacillus casei FNCC 0090 is one of the probiotic bacteria that has an ability to survive in tetracycline by expressing the tetM gene. The aims of this study are to observe the possibilities of mutation happened in L.casei FNCC 0090 by exposing in sub-lethal dose of tetracycline and also observing the instability of the tetM gene by comparing the sequence between the wild type and mutant. L.casei FNCC 0090 has a lethal dose in 60 µg/ml, low concentration is applied to induce the mutation, the range from 10 µg/ml, 15 µg/ml, 30 µg/ml, 45 µg/ml, and 50 µg/ml. L.casei FNCC 0090 is exposed to the low concentration from lowest to the highest concentration to induce the adaptation. Plasmid is isolated from the highest concentration culture which is 50 µg/ml by using modified alkali lysis method with the addition of lysozyme. The tetM gene is isolated by using PCR (Polymerase Chain Reaction) method, then PCR amplicon is purified and sequenced. Sequencing is done on both samples, wild type and mutant. Both sequences are compared and the mutations can be traced in the presence of nucleotides changes. The changing of the nucleotides means that the tetM gene is instable.Keywords: L. casei FNCC 0090, probiotic, tetM, tetracycline
Procedia PDF Downloads 1881906 Hope as a Predictor for Complicated Grief and Anxiety: A Bayesian Structural Equational Modeling Study
Authors: Bo Yan, Amy Y. M. Chow
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Bereavement is recognized as a universal challenging experience. It is important to gather research evidence on protective factors in bereavement. Hope is considered as one of the protective factors in previous coping studies. The present study aims to add knowledge by investigating hope at the first month after death to predict psychological symptoms altogether including complicated grief (CG), anxiety, and depressive symptoms at the seventh month. The data were collected via one-on-one interview survey in a longitudinal project with Hong Kong hospice users (sample size 105). Most participants were at their middle age (49-year-old on average), female (72%), with no religious affiliation (58%). Bayesian Structural Equation Modeling (BSEM) analysis was conducted on the longitudinal dataset. The BSEM findings show that hope at the first month of bereavement negatively predicts both CG and anxiety symptoms at the seventh month but not for depressive symptoms. Age and gender are controlled in the model. The overall model fit is good. The current study findings suggest assessing hope at the first month of bereavement. Hope at the first month after the loss is identified as an excellent predictor for complicated grief and anxiety symptoms at the seventh month. The result from this sample is clear, so it encourages cross-cultural research on replicated modeling and development of further clinical application. Particularly, practical consideration for early intervention to increase the level of hope has the potential to reduce the psychological symptoms and thus to improve the bereaved persons’ wellbeing in the long run.Keywords: anxiety, complicated grief, depressive symptoms, hope, structural equational modeling
Procedia PDF Downloads 2041905 Effects of Green Walnut Husk and Olive Pomace Extracts on Growth of Tomato Plants and Root-Knot Nematode (Meloidogyne incognita)
Authors: Yasemin Kavdir, Ugur Gozel
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This study was conducted to determine the nematicidal activity of green walnut husk (GWH) and olive pomace (OP) extracts against root-knot nematode (Meloidogyne incognita). Aqueous extracts of GWH and OP were mixed with sandy loam soil at the rates of 0, 6,12,18,24, 60 and 120 ml kg-1. All pots were arranged in a randomized complete block design and replicated four times under controlled atmosphere conditions. Tomato seedlings were grown in sterilized soil then they were transplanted to pots. Inoculation was done by pouring the 20 ml suspension including 1000 M. incognita juvenile pot-1 into 3 cm deep hole made around the base of the plant root. Tomato root and shoot growth and nematode populations have been determined. In general, both GWH and OP extracts resulted in better growth parameters compared to the control plants. However, GWH extract was the most effective in improving growth parameters. Applications of 24 ml kg-1 OP extract enhanced plant growth compared to other OP treatments while 60 ml kg-1 application rate had the lowest nematode number and root galling. In this study, applications of GWH and OP extracts reduced the number of Meloidogyne incognita and root galling compared to control soils. Additionally GWH and OP extracts can be used safely for tomato growth. It could be concluded that OP and GWH extracts used as organic amendments showed promising nematicidal activity in the control of M. incognita. This research was supported by TUBİTAK Grant Number 214O422.Keywords: olive pomace, green walnut husk, Meloidogyne incognita, tomato, soil, extract
Procedia PDF Downloads 1821904 Involvement of BCRP/ABCG2 in Protective Mechanisms of Resveratrol against Methotrexate-Induced Renal Damage in Rats
Authors: Mohamed A. Morsy, Azza A. El-Sheikh, Abdulla Y. Al-Taher
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Resveratrol (RES) is a well-known polyphenol antioxidant. We have previously shown that testicular protective effect of RES against the anticancer drug methotrexate (MTX)-induced toxicity involves transporter-mediated mechanisms. Here, we investigated the effect of RES on MTX-induced nephrotoxicity. Rats were administered RES (10 mg/kg/day) for 8 days, with or without a single MTX dose (20 mg/kg i.p.) at day 4 of the experiment. MTX induced nephrotoxicity evident by significantly increase in serum blood urea nitrogen and creatinine compared to control, as well as distortion of kidney microscopic structure. MTX also significantly increased renal nitric oxide level, with induction of inducible nitric oxide synthase expression. MTX also significantly up-regulated fas ligand and caspase 3. Administering RES prior to MTX significantly improved kidney function and microscopic picture, as well as significantly decreased nitrosative and apoptotic markers compared to MTX alone. RES, but not MTX, caused significant increase in expression of breast cancer resistance protein (BCRP), an apical efflux renal transporter that participates in urinary elimination of both MTX and RES. Interestingly, concomitant MTX and RES caused further up-regulation of renal Bcrp compared to RES alone. Using Human BCRP ATPase assay, both RES and MTX exhibited dose-dependent increase in ATPase activity, with Km values of 0.52 ± 0.03 and 30.9 ± 4.2 µM, respectively. Furthermore, combined RES and MTX caused ATPase activity which was significantly less than maximum ATPase activity attained by the positive control; sulfasalazine (12.5 µM). In conclusion, RES exerted nephro-protection against MTX-induced toxicity through anti-nitrosative and anti-apoptotic effects, as well as via up-regulation of renal Bcrp.Keywords: methotrexate, resveratrol, nephrotoxicity, breast cancer resistance protein
Procedia PDF Downloads 2951903 Inter-Specific Differences in Leaf Phenology, Growth of Seedlings of Cork OAK (Quercus suber L.), Zeen Oak (Quercus canariensis Willd.) and Their Hybrid Afares Oak (Quercus afares Pomel) in the Nursery
Authors: S. Mhamdi, O. Brendel, P. Montpied, K. Ben Yahia, N. Saouyah, B. Hasnaoui, E. Dreyer
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Leaf Life Span (LLS) is used to classify trees into two main groups: evergreen and deciduous species. It varies according to the forms of life between taxonomic groups. Co-occurrence of deciduous and evergreen oaks is common in some Mediterranean type climate areas. Nevertheless, in the Tunisian forests, there is no enough information about the functional inter-specific diversity among oak species, especially in the mixed stand marked by the simultaneous presence of Q. suber L., Q. canariensis Willd. and their hybrid (Q. afares), the latter being an endemic oak species threatened with extinction. This study has been conducted to estimate the LLS, the relative growth rate, and the count of different growth flushes of samplings in semi-controlled conditions. Our study took 17 months, with an observation's interval of 4 weeks. The aim is to characterize and compare the hybrid species to the parental ones. Differences were observed among species, both for phenology and growth. Indeed, Q. suber saplings reached higher total height and number of growth flushes then Q. canariensis, while Q. afares showed much less growth flushes than the parental species. The LLS of parental species has exceeded the duration of the experiment, but their hybrid lost all leaves on all cohorts. The short LLSs of hybrid species are in accordance with this phenology in the field, but for Q. canariensis there was a contrast with observations in the field where phenology is strictly annual. This study allowed us to differentiate the hybrid from both parental species.Keywords: leaf life span, growth, hybrid, Q. afares Pomel, Q. suber L., Q.canariensis Willd
Procedia PDF Downloads 3621902 Physical Property Characterization of Adult Dairy Nutritional Products for Powder Reconstitution
Authors: Wei Wang, Martin Chen
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The reconstitution behaviours of nutritional products could impact user experience. Reconstitution issues such as lump formation and white flecks sticking to bottles surfaces could be very unappealing for the consumers in milk preparation. The controlling steps in dissolving instant milk powders include wetting, swelling, sinking, dispersing, and dissolution as in the literature. Each stage happens simultaneously with the others during milk preparation, and it is challenging to isolate and measure each step individually. This study characterized three adult nutritional products for different properties including particle size, density, dispersibility, stickiness, and capillary wetting to understand the relationship between powder physical properties and their reconstitution behaviours. From the results, the formation of clumps can be caused by different factors limiting the critical steps of powder reconstitution. It can be caused by small particle size distribution, light particle density limiting powder wetting, or the rapid swelling and dissolving of particle surface materials to impede water penetration in the capillary channels formed by powder agglomerates. For the grain or white flecks formation in milk preparation, it was believed to be controlled by dissolution speed of the particles after dispersion into water. By understanding those relationship between fundamental powder structure and their user experience in reconstitution, this information provides us new and multiple perspectives on how to improve the powder characteristics in the commercial manufacturing.Keywords: characterization, dairy nutritional powder, physical property, reconstitution
Procedia PDF Downloads 1031901 Ethanol Chlorobenzene Dosimetr Usage for Measuring Dose of the Intraoperative Linear Electron Accelerator System
Authors: Mojtaba Barzegar, Alireza Shirazi, Saied Rabi Mahdavi
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Intraoperative radiation therapy (IORT) is an innovative treatment modality that the delivery of a large single dose of radiation to the tumor bed during the surgery. The radiotherapy success depends on the absorbed dose delivered to the tumor. The achievement better accuracy in patient treatment depends upon the measured dose by standard dosimeter such as ionization chamber, but because of the high density of electric charge/pulse produced by the accelerator in the ionization chamber volume, the standard correction factor for ion recombination Ksat calculated with the classic two-voltage method is overestimated so the use of dose/pulse independent dosimeters such as chemical Fricke and ethanol chlorobenzene (ECB) dosimeters have been suggested. Dose measurement is usually calculated and calibrated in the Zmax. Ksat calculated by comparison of ion chamber response and ECB dosimeter at each applicator degree, size, and dose. The relative output factors for IORT applicators have been calculated and compared with experimentally determined values and the results simulated by Monte Carlo software. The absorbed doses have been calculated and measured with statistical uncertainties less than 0.7% and 2.5% consecutively. The relative differences between calculated and measured OF’s were up to 2.5%, for major OF’s the agreement was better. In these conditions, together with the relative absorbed dose calculations, the OF’s could be considered as an indication that the IORT electron beams have been well simulated. These investigations demonstrate the utility of the full Monte Carlo simulation of accelerator head with ECB dosimeter allow us to obtain detailed information of clinical IORT beams.Keywords: intra operative radiotherapy, ethanol chlorobenzene, ksat, output factor, monte carlo simulation
Procedia PDF Downloads 4791900 Exploring the Strategy to Identify Seed-Specific Acyl-Hydrolases from Arabidopsis thaliana by Activity-Based Protein Profiling
Authors: M. Latha, Achintya K. Dolui, P. Vijayaraj
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Vegetable oils mainly triacylglycerol (TAG) are an essential nutrient in the human diet as well as one of the major global commodity. There is a pressing need to enhance the yield of oil production to meet the world’s growing demand. Oil content is controlled by the balance between synthesis and breakdown in the cells. Several studies have established to increase the oil content by the overexpression of oil biosynthetic enzymes. Interestingly the significant oil accumulation was observed with impaired TAG hydrolysis. Unfortunately, the structural, as well as the biochemical properties of the lipase enzymes, is widely unknown, and so far, no candidate gene was identified in seeds except sugar-dependent1 (SDP1). Evidence has shown that SDP1directly responsible for initiation of oil breakdown in the seeds during germination. The present study is the identification of seed-specific acyl-hydrolases by activity based proteome profiling (ABPP) using Arabidopsis thaliana as a model system. The ABPP reveals that around 8 to 10 proteins having the serine hydrolase domain and are expressed during germination of Arabidopsis seed. The N-term sequencing, as well as LC-MS/MS analysis, was performed for the differentially expressed protein during germination. The coding region of the identified proteins was cloned, and lipases activity was assessed with purified recombinant protein. The enzyme assay was performed against various lipid substrates, and we have observed the acylhydrolase activity towards lysophosphatidylcholine and monoacylglycerol. Further, the functional characteristic of the identified protein will reveal the physiological significance the enzyme in oil accumulation.Keywords: lipase, lipids, vegetable oil, triacylglycerol
Procedia PDF Downloads 1871899 Effect of Withania Somnifera in Alloxan Induced Diabetic Rabbits
Authors: Farah Ali, Tehreem Fayyaz, Musadiq Idris
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The present work was undertaken to investigate effects of various extracts of W. somniferafor anti-diabetic activity in alloxan induced diabetic rabbits. Rabbits were acclimatized for a week to standard laboratory temperature. Animals were fed according to a strict schedule (8 am, 3 pm and 10 pm) with green fodder (Medicago sativa) and tap water ad libitum. Animals were divided into nine groups of six rabbits each in a random manner. Body weights and physical activities of all rabbits were recorded before start of experiments. The animals of group 1 and 2 were given lactose (250 mg/kg,p.o) and Withaniasomniferaroot powder (100 mg/kg, p.o) respectively daily from day 1-20. Animals of group 3 were given alloxan (100 mg/kg,i.v) as a single dose on day 1. Powdered root of Withaniasomnifera in the doses of 100, 150, 200 mg/kg and its aqueous and ethanol extracts (equivalent to 200 mg/kg of crude drug) were given to the treated animals (groups 4-8), respectively by oral route for three weeks (day 1-20o.d), along with alloxan (100 mg/kg, i.v) as a single dose on day 1. Group 9 was treated with metformin (200 mg/kg, p.o) daily from day 1-20, along with a single dose of alloxan (100 mg/ kg, i.v) on day 1. Fasting serum glucose concentration in groups 3-9 was increased significantly (p<0.05) on day 3, with a maximum increase (215.3 mg/dl) in animals of toxic control (TC) group (3) on day 21 of the experiment as compared to normal control (NC) group (1). Effects of different doses (100, 150, 200 mg/kg, p.o) of W. somnifera root powder (WS) decreased the fasting serum glucose concentration as compared to toxic control group, with a maximum decrease (88.3 mg/dl) in group 2 (treated control) on day 21 of the experiment. Metformin (200 mg/kg, p.o) (reference control), aqueous extract (AWS) and ethanol extract (EWS) of W. somnifera (equivalent to 100 mg/kg W.somnifera root, p.o) antagonized the effects of alloxan as compared to toxic control group. These results indicate that the W. somnifera possess significant anti –diabetic activity.Keywords: diabetes, serum, glucose, blood, sugar, rabbits
Procedia PDF Downloads 5611898 Womens’ Atti̇tudes and Behavi̇ors towards Breastfeedi̇ng in Publi̇c
Authors: Irem Ozten, Neri̇man Caglayan Keles
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Aim: Breastfeeding is a special process for a mother and her baby, and it is the first feeding option for a baby. However, not every society approves of breastfeeding in public to the same degree. The purpose of this study is to determine the attitudes and behaviors of women living in Türkiye toward breastfeeding in public. Materials and methods: This descriptive study was carried out in December 2023 with 515 women (N=515) who had babies aged 0-5 years and breastfed their babies. Based on the review of the literature, an online (Google Forms) data collection form consisting of 40 questions was created. While 13 of these questions were about sociodemographic and obstetric characteristics, 27 were about breastfeeding in public. It took each participant 5-7 minutes to respond to the data collection form by marking their choices on the form. The responses of the participants were analyzed using the R Core Team statistics program. Results: The mean age of the participants (N=515) was 30.6±4.07 (range: 20-44). According to their statements, 76.1% of the participants had undergraduate university degrees, and 77.1% of them had given vaginal birth in their last delivery. While 68.3% of the participants stated that they had heard about the concept of breastfeeding in public, 47.4% said they comfortably breastfed their babies in public, but 33.6% said they breastfed their babies for a shorter period than usual. It was determined that 40% of the participants were embarrassed about being seen by someone while breastfeeding their babies in public, 38.6% were afraid of men while breastfeeding, and 89.7% looked for a suitable place to breastfeed their babies. Among the participants, 93.6% stated that they covered their breasts with a cloth while breastfeeding, 49.5% thought a mother should breastfeed her baby in a place where she can be alone with her baby, and 29.1% thought a mother should breastfeed her baby in private. Conclusion: According to the results of the study, although most women had heard of the concept of breastfeeding in public, and some were comfortable breastfeeding in public, some breastfed their baby in public for a shorter period than usual, they covered their breasts with a cloth while breastfeeding their babies, they were embarrassed about being seen by someone while breastfeeding, and they were afraid of men while breastfeeding. Therefore, awareness should be raised about breastfeeding in public, and environments where mothers can conveniently breastfeed their babies should be created.Keywords: breastfeeding in public, breastfeeding, breastfeeding attitudes, breastfeeding bahaviors
Procedia PDF Downloads 951897 The Effect of Exercise, Reflexology and Chrome on Metabolic Syndrome
Authors: F. Arslan, S.D. Guven, A. Özcan, H. Vatansev, Ö. Taşgin
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Weight, hypertension and dyslipidemia control and increased physical activity are required for the treatment of metabolic syndrome (METS). The purpose of this study was to investigate the effect of core exercise, reflexology and intake chrome picolinate on METS. This study comprised a twelve-week randomized controlled trial. A total of 25 university workers with metabolic risk factors participated in this study voluntarily. They were randomly divided into three groups: Those undertaking a core exercise program (n=7), reflexology intervention group (n=8) and intake chrome group (n=10). The subjects took part in a core exercise program for one hour per day, three days a week and a reflexology interfered for thirty minutes per day, one days a week and chrome group took chrome picolinate every day in week for twelve weeks. The components of metabolic syndrome were analyzed before and after the completion of all the intervention. There were significant differences at pre-prandial blood glucose in the core exercise group and at systolic blood pressure in chrome group after the twelve week interventions (p < 0.005). While High Density Lipoprotein (HDL) excluding the components of METS decreased after the interventions on the all groups; levels of HDL and the other components of METS decreased in reflexology group. There was a clear response to the twelve-week interventions in terms of METS control. Besides, the reflexology intervention should not be applied to individuals with low HDL levels and core exercise and intake chrome picolinate suggested to improve the components of METS.Keywords: blood pressure, body mass index, exercise, METS, pre-prandial blood glucose
Procedia PDF Downloads 4431896 From Comfort to Safety: Assessing the Influence of Car Seat Design on Driver Reaction and Performance
Authors: Sabariah Mohd Yusoff, Qamaruddin Adzeem Muhamad Murad
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This study investigates the impact of car seat design on driver response time, addressing a critical gap in understanding how ergonomic features influence both performance and safety. Controlled driving experiments were conducted with fourteen participants (11 male, 3 female) across three locations chosen for their varying traffic conditions to account for differences in driver alertness. Participants interacted with various seat designs while performing driving tasks, and objective metrics such as braking and steering response times were meticulously recorded. Advanced statistical methods, including regression analysis and t-tests, were employed to identify design factors that significantly affect driver response times. Subjective feedback was gathered through detailed questionnaires—focused on driving experience and knowledge of response time—and in-depth interviews. This qualitative data was analyzed thematically to provide insights into driver comfort and usability preferences. The study aims to identify key seat design features that impact driver response time and to gain a deeper understanding of driver preferences for comfort and usability. The findings are expected to inform evidence-based guidelines for optimizing car seat design, ultimately enhancing driver performance and safety. The research offers valuable implications for automotive manufacturers and designers, contributing to the development of seats that improve driver response time and overall driving safety.Keywords: car seat design, driver response time, cognitive driving, ergonomics optimization
Procedia PDF Downloads 241895 Speech Detection Model Based on Deep Neural Networks Classifier for Speech Emotions Recognition
Authors: Aisultan Shoiynbek, Darkhan Kuanyshbay, Paulo Menezes, Akbayan Bekarystankyzy, Assylbek Mukhametzhanov, Temirlan Shoiynbek
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Speech emotion recognition (SER) has received increasing research interest in recent years. It is a common practice to utilize emotional speech collected under controlled conditions recorded by actors imitating and artificially producing emotions in front of a microphone. There are four issues related to that approach: emotions are not natural, meaning that machines are learning to recognize fake emotions; emotions are very limited in quantity and poor in variety of speaking; there is some language dependency in SER; consequently, each time researchers want to start work with SER, they need to find a good emotional database in their language. This paper proposes an approach to create an automatic tool for speech emotion extraction based on facial emotion recognition and describes the sequence of actions involved in the proposed approach. One of the first objectives in the sequence of actions is the speech detection issue. The paper provides a detailed description of the speech detection model based on a fully connected deep neural network for Kazakh and Russian. Despite the high results in speech detection for Kazakh and Russian, the described process is suitable for any language. To investigate the working capacity of the developed model, an analysis of speech detection and extraction from real tasks has been performed.Keywords: deep neural networks, speech detection, speech emotion recognition, Mel-frequency cepstrum coefficients, collecting speech emotion corpus, collecting speech emotion dataset, Kazakh speech dataset
Procedia PDF Downloads 261894 Beneficial Effect of Chromium Supplementation on Glucose, HbA1C and Lipid Variables in Individuals with Newly Onset Type-2 Diabetes
Authors: Baljinder Singh, Navneet Sharma
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Chromium is an essential nutrient involved in normal carbohydrate and lipid metabolism. It influences glucose metabolism by potentiating the action as taking part in insulin signal amplification mechanism. A placebo-controlled single blind, prospective study was carried out to investigate the effect of chromium supplementation on blood glucose, HbA1C and lipid profile in newly onset patients with type-2 diabetes. Total 40 newly onset type-2 diabetics were selected and after one month stabilization further randomly divided into two groups viz. study group and placebo group. The study group received 9 gm brewer’s yeast (42 μ Cr) daily and the other placebo group received yeast devoid of chromium for 3 months. Subjects were instructed not to change their normal eating and living habits. Fasting blood glucose, HbA1C and lipid profile were analyzed at beginning and completion of the study. Results revealed that fasting blood glucose level significantly reduced in the subjects consuming yeast supplemented with chromium (197.65±6.68 to 103.68±6.64 mg/dl; p<0.001). HbA1C values improved significantly from 9.51±0.26% to 6.86±0.28%; p<0.001 indicating better glycaemic control. In experimental group total cholesterol, TG and LDL levels were also significantly reduced from 199.66±3.11 to 189.26±3.01 mg/dl; p<0.02, 144.94±8.31 to 126.01±8.26; p<0.05 and 119.19±1.71 to 99.58±1.10; p<0.001 respectively. These data demonstrate beneficial effect of chromium supplementation on glycaemic control and lipid variables in subjects with newly onset type-2 diabetes.Keywords: type-2 diabetes, chromium, glucose, HbA1C
Procedia PDF Downloads 2421893 Audit of TPS photon beam dataset for small field output factors using OSLDs against RPC standard dataset
Authors: Asad Yousuf
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Purpose: The aim of the present study was to audit treatment planning system beam dataset for small field output factors against standard dataset produced by radiological physics center (RPC) from a multicenter study. Such data are crucial for validity of special techniques, i.e., IMRT or stereotactic radiosurgery. Materials/Method: In this study, multiple small field size output factor datasets were measured and calculated for 6 to 18 MV x-ray beams using the RPC recommend methods. These beam datasets were measured at 10 cm depth for 10 × 10 cm2 to 2 × 2 cm2 field sizes, defined by collimator jaws at 100 cm. The measurements were made with a Landauer’s nanoDot OSLDs whose volume is small enough to gather a full ionization reading even for the 1×1 cm2 field size. At our institute the beam data including output factors have been commissioned at 5 cm depth with an SAD setup. For comparison with the RPC data, the output factors were converted to an SSD setup using tissue phantom ratios. SSD setup also enables coverage of the ion chamber in 2×2 cm2 field size. The measured output factors were also compared with those calculated by Eclipse™ treatment planning software. Result: The measured and calculated output factors are in agreement with RPC dataset within 1% and 4% respectively. The large discrepancies in TPS reflect the increased challenge in converting measured data into a commissioned beam model for very small fields. Conclusion: OSLDs are simple, durable, and accurate tool to verify doses that delivered using small photon beam fields down to a 1x1 cm2 field sizes. The study emphasizes that the treatment planning system should always be evaluated for small field out factors for the accurate dose delivery in clinical setting.Keywords: small field dosimetry, optically stimulated luminescence, audit treatment, radiological physics center
Procedia PDF Downloads 3271892 A Single Stage Rocket Using Solid Fuels in Conventional Propulsion Systems
Authors: John R Evans, Sook-Ying Ho, Rey Chin
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This paper describes the research investigations orientated to the starting and propelling of a solid fuel rocket engine which operates as combined cycle propulsion system using three thrust pulses. The vehicle has been designed to minimise the cost of launching small number of Nano/Cube satellites into low earth orbits (LEO). A technology described in this paper is a ground-based launch propulsion system which starts the rocket vertical motion immediately causing air flow to enter the ramjet’s intake. Current technology has a ramjet operation predicted to be able to start high subsonic speed of 280 m/s using a liquid fuel ramjet (LFRJ). The combined cycle engine configuration is in many ways fundamentally different from the LFRJ. A much lower subsonic start speed is highly desirable since the use of a mortar to obtain the latter speed for rocket means a shorter launcher length can be utilized. This paper examines the means and has some performance calculations, including Computational Fluid Dynamics analysis of air-intake at suitable operational conditions, 3-DOF point mass trajectory analysis of multi-pulse propulsion system (where pulse ignition time and thrust magnitude can be controlled), etc. of getting a combined cycle rocket engine use in a single stage vehicle.Keywords: combine cycle propulsion system, low earth orbit launch vehicle, computational fluid dynamics analysis, 3dof trajectory analysis
Procedia PDF Downloads 1911891 The Suitability of Agile Practices in Healthcare Industry with Regard to Healthcare Regulations
Authors: Mahmood Alsaadi, Alexei Lisitsa
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Nowadays, medical devices rely completely on software whether as whole software or as embedded software, therefore, the organization that develops medical device software can benefit from adopting agile practices. Using agile practices in healthcare software development industries would bring benefits such as producing a product of a high-quality with low cost and in short period. However, medical device software development companies faced challenges in adopting agile practices. These due to the gaps that exist between agile practices and the requirements of healthcare regulations such as documentation, traceability, and formality. This research paper will conduct a study to investigate the adoption rate of agile practice in medical device software development, and they will extract and outline the requirements of healthcare regulations such as Food and Drug Administration (FDA), Health Insurance Portability and Accountability Act (HIPAA), and Medical Device Directive (MDD) that affect directly or indirectly on software development life cycle. Moreover, this research paper will evaluate the suitability of using agile practices in healthcare industries by analyzing the most popular agile practices such as eXtream Programming (XP), Scrum, and Feature-Driven Development (FDD) from healthcare industry point of view and in comparison with the requirements of healthcare regulations. Finally, the authors propose an agile mixture model that consists of different practices from different agile methods. As result, the adoption rate of agile practices in healthcare industries still low and agile practices should enhance with regard to requirements of the healthcare regulations in order to be used in healthcare software development organizations. Therefore, the proposed agile mixture model may assist in minimizing the gaps existing between healthcare regulations and agile practices and increase the adoption rate in the healthcare industry. As this research paper part of the ongoing project, an evaluation of agile mixture model will be conducted in the near future.Keywords: adoption of agile, agile gaps, agile mixture model, agile practices, healthcare regulations
Procedia PDF Downloads 2361890 Silica Nanofibres – Promising Material for Regenerative Medicine
Authors: Miroslava Rysová, Zdena Syrová, Tomáš Zajíc, Petr Exnar
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Currently, attention of tissue engineers has been attracted to novel nanofibrous materials having advanced properties and ability to mimic extracellular matrix (ECM) by structure which makes them interesting candidates for application in regenerative medicine as scaffolding and/or drug delivering material. Throughout the last decade, more than 200 synthetic and natural polymers have been successfully electrospun leading to the formation of nanofibres with a wide range of chemical, mechanical and degradation properties. In this family, inorganic nanofibres represent very specific group offering an opportunity to manufacture inert to body, well degradable and in properties tunable material. Aim of this work, was to reveal unique properties of silica (SiO2, CAS 7631-86-9) nanofibres and their potential in field of regenerative medicine. Silica nanofibres were prepared by sol-gel method from tetraethyl orthosilicate (TEOS, CAS 78-10-4) as a precursor and subsequently manufactured by needleless electrospinning on NanospiderTM device. Silica nanofibres thermally stabilized under 200°C were confirmed to be fully biodegradable and soluble in several simulated body fluids. In vitro cytotoxicity tests of eluate (ES ISO 10993-5:1999) and in direct contact (ES ISO 10993-5:2009) showed no toxicity - e.g. cell viabilities reached values exceeding 80%. Those results were obtained equally from two different cell lines (Vero, 3T3). Non-toxicity of silaca nanofibres´ eluate was additionally confirmed in real time by testing on xCelligence (ACEA Biosciences, Inc.) device. Both cell types also showed good adhesion to material. To conclude, all mentioned results lead to resumption that silica nanofibres have a potential as material for regenerative medicine which opens door to further research.Keywords: cytotoxicity, electrospinning, nanofibres, silica, tissue engineering
Procedia PDF Downloads 4291889 Application of Bacteriophages as Natural Antibiotics in Aquaculture
Authors: Chamilani Nikapitiya, Mahanama De Zoysa, Jehee Lee
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Most of the bacterial diseases are associated with high mortalities in aquaculture species and causing huge economic losses. Different approaches have been taken to prevent or control of bacterial diseases including use of vaccines, probiotics, chemotherapy, water quality management, etc. Antibiotics are widely applying as chemotherapy to control bacterial diseases, however, it has been shown that frequent use of antibiotics is favored to develop multi-drug resistance bacteria. Therefore, phages and phage encoded lytic proteins are known to be one of the most promising alternatives for antibiotics to avoid the emergence of antibiotic-resistant bacteria. We isolated and characterized the two lytic phages, namely pAh-1 and pAs-1 against pathogenic Aeromonas hydrophila and Aeromonas salmonicida, respectively. Morphological characteristics were analyzed by Transmission electron microscopy (TEM) and host strain specificities were tested with Aeromonas and other closely related bacterial strains. TEM analysis revealed that both pAh-1 and pAsm-1 are composed of an icosahedral head and a segmented tail, and we suggest that, they are new members of Myoviridae family. Genome sizes of isolated phages were estimated by restriction enzyme digestion of genomic DNA using selected endonucleases followed by agarose gel electrophoresis. Estimated genome size of pAh-1 and pAs-1 were approximately 64 Kbp and 120 Kbp, respectively. Both pAh-1 and pAs-1 have shown narrow host specificity. Moreover, protective effects of phage therapy against fish pathogenic A. hydrophila were investigated in zebrafish model. The survival rate was 40% higher when zebrafish received intra-peritoneal injection (i.p.) of pAh-1 were simultaneously challenge A. hydrophila (2 x 106 CFU/fish) compared to that without phage treatment. Overall results suggest that both pAh-1 and pAs-1 can be used as a potential phage therapy to control Aeromonas infections in aquaculture.Keywords: Aeromonas infections, antibiotic resistance, bacteriophage, bio-control, lytic phage
Procedia PDF Downloads 1931888 Dual-Actuated Vibration Isolation Technology for a Rotary System’s Position Control on a Vibrating Frame: Disturbance Rejection and Active Damping
Authors: Kamand Bagherian, Nariman Niknejad
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A vibration isolation technology for precise position control of a rotary system powered by two permanent magnet DC (PMDC) motors is proposed, where this system is mounted on an oscillatory frame. To achieve vibration isolation for this system, active damping and disturbance rejection (ADDR) technology is presented which introduces a cooperation of a main and an auxiliary PMDC, controlled by discrete-time sliding mode control (DTSMC) based schemes. The controller of the main actuator tracks a desired position and the auxiliary actuator simultaneously isolates the induced vibration, as its controller follows a torque trend. To determine this torque trend, a combination of two algorithms is introduced by the ADDR technology. The first torque-trend producing algorithm rejects the disturbance by counteracting the perturbation, estimated using a model-based observer. The second torque trend applies active variable damping to minimize the oscillation of the output shaft. In this practice, the presented technology is implemented on a rotary system with a pendulum attached, mounted on a linear actuator simulating an oscillation-transmitting structure. In addition, the obtained results illustrate the functionality of the proposed technology.Keywords: active damping, discrete-time nonlinear controller, disturbance tracking algorithm, oscillation transmitting support, position control, stability robustness, vibration isolation
Procedia PDF Downloads 1011887 Big Data and Cardiovascular Healthcare Management: Recent Advances, Future Potential and Pitfalls
Authors: Maariyah Irfan
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Intro: Current cardiovascular (CV) care faces challenges such as low budgets and high hospital admission rates. This review aims to evaluate Big Data in CV healthcare management through the use of wearable devices in atrial fibrillation (AF) detection. AF may present intermittently, thus it is difficult for a healthcare professional to capture and diagnose a symptomatic rhythm. Methods: The iRhythm ZioPatch, AliveCor portable electrocardiogram (ECG), and Apple Watch were chosen for review due to their involvement in controlled clinical trials, and their integration with smartphones. The cost-effectiveness and AF detection of these devices were compared against the 12-lead ambulatory ECG (Holter monitor) that the NHS currently employs for the detection of AF. Results: The Zio patch was found to detect more arrhythmic events than the Holter monitor over a 2-week period. When patients presented to the emergency department with palpitations, AliveCor portable ECGs detected 6-fold more symptomatic events compared to the standard care group over 3-months. Based off preliminary results from the Apple Heart Study, only 0.5% of participants received irregular pulse notifications from the Apple Watch. Discussion: The Zio Patch and AliveCor devices have promising potential to be implemented into the standard duty of care offered by the NHS as they compare well to current routine measures. Nonetheless, companies must address the discrepancy between their target population and current consumers as those that could benefit the most from the innovation may be left out due to cost and access.Keywords: atrial fibrillation, big data, cardiovascular healthcare management, wearable devices
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