Search results for: endome¬trial receptivity
596 The Effect of Simultaneous Application of Laser Beam and Magnet in Treatment of Intervertebral Disc Herniation
Authors: Alireza Moghtaderi, Negin Khakpour
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Disc Herniation is a common complication in the society and it is one of the main reasons for referring to physical medicine and rehabilitation clinics. Despite of various methods proposed for treatingthis disease, still there is disagreement on success of these methods especially in non-surgical methods, and thus current study aims at determining effect of laser beam and magnet on treatment of Intervertebral Disc Herniation. During a clinical trial study, 80 patients with Intervertebral Disc Herniation underwent a combined package of treatment including magnet, laser beam, PRP and Prolotherapy during 6 months. Average age of patients was 51.25 ± 10.7 with range of 25 – 71 years. 30 men (37.5%) and 50 women (62.5%) took part in the study. average weight of patients was 64.3 ± 7.2 with range of 49 – 79 kg. highest level of Disc Herniation was L5 – S1 with frequency of 17 cases (21.3%). Disc Herniation was severe in 30 cases before treatment, but it reduced to 3 casesafter treatment. This study indicates effect of combined treatment using non-invasive laser beam and magnet therapy on disco genic diseases and mechanical pains of spine is highly effective.Keywords: hallux, valgus, botulinum toxin a, pain
Procedia PDF Downloads 84595 The Efficacy of Psycho-Education in Improving the Emotional Well-Being of Visually Impaired Adolescents in Nigeria
Authors: Janet Tolulope Olaseni
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Emotional well-being in adolescents is an important psychological factor that can enhance positive living, but if it is not well groomed, it can have adverse impacts on their development. Therefore, the present study examined the efficacy of psycho-education on the emotional well-being of adolescents who are visually impaired in Nigeria. A total of twenty-eight (28) participants, which comprisednineteen (19) males and nine (9) females (M=15.82, SD=2.23) from a Nigerian School for the Blind, participated in the quasi-experimental study. Randomized clinical trial designwas used to assigned the participants into three (Complete Psycho-education, Incomplete Psycho-education, and No Psycho-education) groups. Standardized scales were used to gather data from the respondents. The formulated hypotheses were tested using Dependent T-Test and Analysis of Co-Variance. The results showed that there was a significant effect of Psycho-education on the emotional well-being of the Visually Impaired Adolescents. Those who received complete Psycho-educationhad the highest level of emotional well-being compared to those in the other groups. In order to enhance the emotional well-being of the Visually Impaired Adolescents, the study recommended that complete Psycho-education programme should be incorporated into the school activities of the Visually Impaired Adolescents.Keywords: emotional well-being, psycho-education, visually impaired adolescents, Nigeria
Procedia PDF Downloads 99594 Effects of Gross Domestic Product and International Trade on Logistic Performance: An Effect Observation Trial
Authors: Ibrahim Halil Korkmaz, Eren Özceylan, Cihan Çetinkaya
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Logistics function has great potential for increasing sustainable competitive advantage, profitability, productivity, customer satisfaction and decreasing costs in all sectors. The performance of logistics sector, which has such great influence on the overall performance of the economy, attracts more attention of both researchers and sector representatives day by day. The purpose of this study is to determine the effects of research and development expenditures which spent by enterprises operating in the transportation and storage sectors on Turkey’s logistic performance index (LPI). To do so, research and development investment expenditure among the years 2009-2015 of Turkish transportation and storage firms data from the Turkish Statistical Institute and Turkeys country points in the World Bank logistics performance index in the same years data were examined. As the result of the parametric evaluation, it is seen that the research and development expenditures made have a positive effect on the logistic performance of Turkey.Keywords: logistics performance index, R&D investments, transportation, storage, Turkey
Procedia PDF Downloads 319593 Galawaste Meal as Dietary Supplement in Practical Diets for African Giant Catfish Clarias Gariepinus Burchell 1822 Fingerlings
Authors: G. O. Fakunmoju, F. A. Fakunmoju
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The experiment was conducted to evaluate the growth response of African giant catfish (Clarias gariepinus) fed with varying levels of Galawaste based diet, 300 clarias gariepinus fingerlings with mean body weight 10 ± 0.1g were assigned to five (treatment levels in which Gala waste meal replaced maize at 0, 25, 50, 75, 100% respectively in a completely randomized design. The trial fish were fed at 5% body weight daily for a period of 84 days. Data collected showed that body weight gain increased with an increase gala waste meal in the diet (P<0.05). The similar observation was recorded for feed intake but there was no significant (P>0.05) difference in feed conversion ratio among the treatments. All the fish fed the test ingredients performed better than the control groups hence, Gala waste meal could be recommended as a dietary supplement in the diet of African Giant Catfish.Keywords: Galawaste meal, Clarias gariepinus, replacement, growth performance, diets
Procedia PDF Downloads 394592 The Ability of Adipose Derived Mesenchymal Stem Cells for Diabetes Mellitus Type 2 Treatment
Authors: Purwati, Sony Wibisono, Ari Sutjahjo, Askandar T. J., Fedik A. Rantam
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Diabetes mellitus type 2 (T2DM), also known as hyperglycemia, results from insulin resistance and relative insulin deficiency. Diabetes mellitus is the main cause of premature death, particularly among individuals under the age of 70 years old. Mesenchymal stem cells (MSCs) can release bioactive molecules that promote tissue repair and regeneration. Hence, in this research, we evaluated the potential of autologous adipose-derived mesenchymal stem cells (AD-MSCs) in 40 patients of phase I clinical trial in T2DM with various ages between 30-79 years. AD-MSCs are transferred through catheterization. MSCs were validated by measures of CD105+ and CD34- expression. The result showed that after AD-MSCs transplantation, blood glucose levels (fasting and 2-hour postprandial) and insulin levels were significantly decreasing. Besides that, the level of HbA1c significantly decreased after three months of AD-MSCs injection and increasing level of c-peptide after injection. Thus, we conclude that AD-MSCs injection has the potential for T2DM therapy.Keywords: glucose, hyperglycemia, MSCs, T2DM
Procedia PDF Downloads 73591 Application of Dissolved Air Flotation for Removal of Oil from Wastewater
Authors: Talat Ghomashchi, Zahra Akbari, Shirin Malekpour, Marjan Alimirzaee
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Mixing the waste water of industries with natural water has caused environmental pollution. So researcher try to obtain methods and optimum conditions for waste water treatment. One of important stage in waste water treatment is dissolved air flotation. DAF is used for the removal of suspended solids and oils from waste water. In this paper, the effect of several parameters on flotation efficiency with Cationic polyacrylamide as flocculant, was examined, namely, (a) concentration of cationic flocculants, (b) pH (c) fast mixing time, (d) fast mixing speed,(e) slow mixing time,(f) retention time and temperature. After design of experiment, in each trial turbidity of waste water was measured by spectrophotometer. Results show that contribution of pH and concentration of flocculant on flotation efficiency are 75% and 9% respectively. Cationic polyacrylamide led to a significant increase in the settling speed and effect of temperature is negligible. In the optimum condition, the outcome of the DAF unit is increased and amount of suspended solid and oil in waste water is decreased effectively.Keywords: dissolved air flotation, oil industry, waste water, treatment
Procedia PDF Downloads 523590 Power Supply Feedback Regulation Loop Design Using Cadence PSpice Tool: Determining Converter Stability by Simulation
Authors: Debabrata Das
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This paper explains how to design a regulation loop for a power supply circuit. It also discusses the need of a regulation loop and the improvement of a circuit with regulation loop. A sample design is used to demonstrate how to use PSpice to design feedback loop to control output voltage of a power supply and how to check if the power supply is stable or oscillatory. A sample design is made using a specific Integrated Circuit (IC) available in the PSpice library. A designer can experiment feedback loop design using Cadence Pspice tool. PSpice is easy to use, reliable, and convenient. To test a feedback loop, generally, engineers use trial and error method with the hardware which takes a lot of time and manpower. Moreover, it is expensive because component and Printed Circuit Board (PCB) may go bad. PSpice can be used by designers to test their loop designs without using hardware circuits. A designer can save time, cost, manpower and simulate his/her power supply circuit accurately before making a real hardware using this software package.Keywords: power electronics, feedback loop, regulation, stability, pole, zero, oscillation
Procedia PDF Downloads 341589 Non-Executive Employees’ Psychological Capital and Goal Attainment Development Through Positive Psychology Micro-Coaching Intervention
Authors: Iman Abrishamchi
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The aim of this study is to investigate the effect of Positive psychology micro coaching (PPMC) on nonexecutive employees' psychological capital and the relation between goal-related self-efficacy and goal attainment. This study was in the form of a control trial design for 150 people in the factory over a period of 5 weeks; the intervention method was a strength-based approach. Participants were divided into two experimental groups (EX) and the waiting list group (WL). The measurement methods were a mix of quantitative and qualitative and included the psychological capital measurement questionnaire, a 2X2 ANOVA to analyze the within-subject factors and between-subject factors, t-tests for evaluating the time effect, and data analysis by the SPSS 25.0 statistical program. The results of the study showed that PPMC could increase psychological capital in employees, and goal-related self-efficacy can predict goal attainment, so this contributes to successful organizational outcomes.Keywords: psychological capital, goal attainment, positive psychology, micro-coaching intervention, goal related self-efficacy
Procedia PDF Downloads 71588 Blind Super-Resolution Reconstruction Based on PSF Estimation
Authors: Osama A. Omer, Amal Hamed
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Successful blind image Super-Resolution algorithms require the exact estimation of the Point Spread Function (PSF). In the absence of any prior information about the imagery system and the true image; this estimation is normally done by trial and error experimentation until an acceptable restored image quality is obtained. Multi-frame blind Super-Resolution algorithms often have disadvantages of slow convergence and sensitiveness to complex noises. This paper presents a Super-Resolution image reconstruction algorithm based on estimation of the PSF that yields the optimum restored image quality. The estimation of PSF is performed by the knife-edge method and it is implemented by measuring spreading of the edges in the reproduced HR image itself during the reconstruction process. The proposed image reconstruction approach is using L1 norm minimization and robust regularization based on a bilateral prior to deal with different data and noise models. A series of experiment results show that the proposed method can outperform other previous work robustly and efficiently.Keywords: blind, PSF, super-resolution, knife-edge, blurring, bilateral, L1 norm
Procedia PDF Downloads 358587 Comparative Study of Music-Therapy Types on Anxiety in Early Stage Cancer Patients: A Randomized Clinical Trial
Authors: Farnaz Dehkhoda
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This study was conducted to compare the effectiveness of active and receptive music-therapy on anxiety in cancer patients undergoing chemotherapy or radiotherapy. 184 young adult patients, who were diagnosed with early stage cancer and were undergoing treatment, were divided into three groups. Two groups received music therapy as a parallel treatment and the third group was control group. In active music-therapy, a music specialist helped the patients to play guitar and sing. In the receptive music-therapy, patients preferred pre-recorded music played by MP3 player. The level of anxiety was measured by the Beck Anxiety Inventory as pre-test and post-test. ANCOVA revealed that both types of music-therapy reduced anxiety level of patients and the active music-therapy intervention found to be more effective. The results suggest that music-therapy can be applied as an intervention method contemporary with cancer medical treatment, for improving quality of life in cancer patients by reducing their anxiety.Keywords: Anxiety, Cancer, Chemotherapy, Music-therapy
Procedia PDF Downloads 170586 The Third Islamic Defend Action: The Completeness Model of Islamic Peace Movement in Indonesia
Authors: Husnul Isa Harahap
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On December 2, 2016 occurred mass movements in Indonesia, led by the National Movement of Fatwa Guard, Indonesian Ulema Council (GNPF MUI). This movement is named 212 in accordance with the date, and also called The Third Islamic Defend Action, a continued movement of Islamic defend earlier (November 4, 2016 and October 14, 2016). All three movements have raised the issue of the demand that Basuki Tjahaja Purnama (Jakarta governor) also known as Ahok put on trial for allegedly insulting the Quran. The interesting view of this movement is that: first, the great social movement could emerge from a small but sensitive issues. Second, although this movement followed by radical Islamic groups, that movement known as the largest and most peaceful Islamic Movement in Indonesia. Third, the movement succeeded in answer the doubts of many parties that the social movements with large masses can not maintain security, order, and even the cleanliness of the site action. What causes all this happen? First, the emphasis on the use of basic religious elements that Islam is love for peace. Second, the role of leadership that is trusted and based on religious relationship. Third, this movement is well organized and trying reflect Islamic values.Keywords: Islamic values, social movement, peaceful group, sensitive issue
Procedia PDF Downloads 316585 A Randomized, Controlled Trial to Test Behavior Change Techniques to Improve Low Intensity Physical Activity in Older Adults
Authors: Ciaran Friel, Jerry Suls, Mark Butler, Patrick Robles, Samantha Gordon, Frank Vicari, Karina W. Davidson
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Physical activity guidelines focus on increasing moderate-intensity activity for older adults, but adherence to recommendations remains low. This is despite the fact that scientific evidence supports that any increase in physical activity is positively correlated with health benefits. Behavior change techniques (BCTs) have demonstrated effectiveness in reducing sedentary behavior and promoting physical activity. This pilot study uses a Personalized Trials (N-of-1) design to evaluate the efficacy of using four BCTs to promote an increase in low-intensity physical activity (2,000 steps of walking per day) in adults aged 45-75 years old. The 4 BCTs tested were goal setting, action planning, feedback, and self-monitoring. BCTs were tested in random order and delivered by text message prompts requiring participant engagement. The study recruited health system employees in the target age range, without mobility restrictions and demonstrating interest in increasing their daily activity by a minimum of 2,000 steps per day for a minimum of five days per week. Participants were sent a Fitbit® fitness tracker with an established study account and password. Participants were recommended to wear the Fitbit device 24/7 but were required to wear it for a minimum of ten hours per day. Baseline physical activity was measured by Fitbit for two weeks. In the 8-week intervention phase of the study, participants received each of the four BCTs, in random order, for a two-week period. Text message prompts were delivered daily each morning at a consistent time. All prompts required participant engagement to acknowledge receipt of the BCT message. Engagement is dependent upon the BCT message and may have included recording that a detailed plan for walking has been made or confirmed a daily step goal (action planning, goal setting). Additionally, participants may have been directed to a study dashboard to view their step counts or compare themselves to their baseline average step count (self-monitoring, feedback). At the end of each two-week testing interval, participants were asked to complete the Self-Efficacy for Walking Scale (SEW_Dur), a validated measure that assesses the participant’s confidence in walking incremental distances, and a survey measuring their satisfaction with the individual BCT that they tested. At the end of their trial, participants received a personalized summary of their step data in response to each individual BCT. The analysis will examine the novel individual-level heterogeneity of treatment effect made possible by N-of-1 design and pool results across participants to efficiently estimate the overall efficacy of the selected behavioral change techniques in increasing low-intensity walking by 2,000 steps, five days per week. Self-efficacy will be explored as the likely mechanism of action prompting behavior change. This study will inform the providers and demonstrate the feasibility of an N-of-1 study design to effectively promote physical activity as a component of healthy aging.Keywords: aging, exercise, habit, walking
Procedia PDF Downloads 86584 Determining the Electrospinning Parameters of Poly(ε-Caprolactone)
Authors: M. Kagan Keler, Sibel Daglilar, Isil Kerti, Oguzhan Gunduz
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Electrospinning is a versatile way to occur fibers at nano-scale and polycaprolactone is a biomedical material which has a wide usage in cartilage defects and tissue regeneration. PCL is biocompatible and durable material which can be used in bio-implants. Therefore, electrospinning process was chosen as a fabrication method to get PCL fibers in an effective way because of its significant adjustments. In this research study, electrospinning parameters was evaluated during the producing of polymer tissue scaffolds. Polycaprolactone’s molecular weight was 80.000 Da and was employed as a tissue material in the electrospinning process. PCL was decomposed in dimethylformamid(DMF) and chloroform(CF) with the weight ratio of 1:1. Different compositions (1%, 3%, 5%, 10% and 20 %) of PCL was prepared in the laboratory conditions. All solvents with different percentages of PCL have been taken into the syringe and loaded into the electrospinning system. In electrospinning dozens of trial were applied to get homogeneously uniform scaffold samples. Taylor cone which is crucial point for electrospinning characteristic was occurred and changed in different voltages up to the material compositions’ conductivity. While the PCL percentages were increasing in the electrospinning, structure started to arise with droplets, which was an expressive problem for tissue scaffold. The vertical and horizontal layouts were applied to produce non-woven structures at all.Keywords: tissue engineering, artificial scaffold, electrospinning, biocomposites
Procedia PDF Downloads 345583 Torture, Inhuman and Degrading Treatment in Nigeria: A Time for Legislative Intervention
Authors: Kolawole Oyekan
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Torture, cruel, inhuman and degrading treatment is one of the issues dealt with by the United Nations in its development of human rights standard. Torture and other ill -treatments is banned at all times in all places including in times of war. There is no justification for torture, cruel, inhuman and degrading treatment under any law in Nigeria. All statutes; local, regional and international on human rights prohibits all forms of degrading treatment. This paper examines the definition of torture, inhuman and degrading treatment and the prevalence of confessional statements obtain through torture by security agencies during the interrogation of crime suspects and are mostly relied upon during trial even in cases involving capital punishment. The paper further reviews the Violence against Persons Prohibition Act 2015 which prohibits torture and other forms of ill-treatment. Presently, the Act is applicable only to the federal Federal Capital Territory, Abuja. Consequently, the paper concludes that the Act should be adopted as a matter of urgency by the 36 states of the Federation of Nigeria and in addition, cogent steps must be taken to ensure that the provisions of the Act are strictly complied with in order to eliminate torture, cruel and inhuman degrading treatment in Nigeria.Keywords: confessional statement, human rights, torture, United Nations
Procedia PDF Downloads 300582 Human Rights and Juvenile Justice System: A Case Study of Warangal District, Telangana State, India
Authors: Vijaya Chandra Tenneti
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The juvenile justice delivery system in India suffers from many lacunae at the operational level and ignores many dimensions of human rights guaranteed to the juvenile delinquents. The present study begins with the hypothesis that the existing justice delivery system seemingly ignores the basic tenets of the fair trial and systemic support to the delinquent juveniles in integrating them into the mainstream of society. As per the designed methodology, data has been collected from the unit of the present study, and other stakeholders, namely, Juvenile Justice Board, Observation Homes etc., of Warangal district of Telangana state, India. The study shows that there is the overemphasis on procedural laws. The juvenile integration programs are not effective. The administrators lack training. Juveniles lack formal education. The study indicates the incidents of juvenile crimes is on the rise and that the majority of the juvenile delinquents hold a low socio-economic profile. Another significant observation of the study is that the juvenile justice system lacks a holistic and human rights-centric approach.Keywords: delinquency, human rights, juvenile justice, rehabilitation
Procedia PDF Downloads 130581 Honey: A Remedy Rediscovered in the Treatment of Oral Diseases
Authors: Muhammad Mansoor Majeed, Imtiaz Ahmed
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For centuries, honey has been used for the management and cure of different diseases for the treatment of wound, ulcers, burns, cough, and sore throat, etc. It has also been proved to decrease inflammation, edema, and exudates in different body tissues. This study is performed to find out the effectiveness of honey in the treatment and prevention of gingivitis, gingival bleeding, and accumulation of plaque. Randomized control trial was performed on two subject groups. Honey provided to one subject group to apply on their gums and tooth and then gargle with water and drink. Frequency of the procedure is thrice a day for a month. Another group was given a placebo. Before and after, readings were taken according to Loe and Silness Plaque and Gingival Index. Initially, the mean plaque index, Gingival index and the percentage of sites which were bleeding in the honey group was 0.910, 0.800 and 58.71% respectively which has reduced to 0.313, 0.296 and 27.6% in 30 ± 3 days whereas the control group did not show signs of improvement. Visible changed has observed in the honey group from 0.910 to 0.313 in mean plaque index, 0.800 to 0.296 in Gingival Index, and the percentage of bleeding sited decreased from 58.71% to 27.6%. No significant changes observed in another group. We can conclude that honey reduces the formation/accumulation of plaque and decreases gingival bleeding as well as it has therapeutic effects.Keywords: honey, gingivitis, Pakistan, bleeding gums
Procedia PDF Downloads 125580 The Effects of Xiang Sha Liu Jun Zi Tang to Diarrhea and Growth Performance of Piglets
Authors: Siao-Wei Jiang, Boy-Young Hsieh, Ching-Liang Hsieh, Cheng-Yung Lin
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The problems of multiple drug resistance in the pig farming industry have been emphasized in recent years. Diarrhea syndrome is common in weaning piglets and often treated with antibiotics as a feed additive, leading to the rapid spread of antibiotic resistance and posing high health risks to humans. The study aimed to alleviate diarrhea syndrome with traditional herbal medicine, Xiang Sha Liu Jun Zi Tang, whose effects enhanced digestive function. Piglets at 4 weeks old with stool classified to Bristol stool classification type 6 or type 7 were randomly divided into the control group, group A (1% of Xiang Sha Liu Jun Zi Tang) and group B (0.1% Colistin). The piglets were administrated for 7 days, and their weight, feed intake, and stool score were recorded daily before and after the trial. The results showed that the diarrhea index score in group A and group B improved significantly compared to the control group, indicating that Xiang Sha Liu Jun Zi Tang may have the same effect on alleviating diarrhea syndrome as Colistin, and it may be another replacement for antibiotics.Keywords: pig, diarrhea, herbal medicine, Xiang Sha Liu Jun Zi Tang
Procedia PDF Downloads 45579 Alternating Electric fields-Induced Senescence in Glioblastoma
Authors: Eun Ho Kim
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Innovations have conjured up a mode of treating GBM cancer cells in the newly diagnosed patients in a period of 4.9 months at an improved median OS, which brings along only a few minor side effects in the phase III of the clinical trial. This mode has been termed the Alternating Electric Fields (AEF). The study at hand is aimed at determining whether the AEF treatment is beneficial in sensitizing the GBM cancer cells through the process of increasing the AEF –induced senescence. The methodology to obtain the findings for this research ranged across various components, such as obtaining and testing SA-β-gal staining, flow cytometry, Western blotting, morphology, and Positron Emission Tomography (PET) / Computed Tomography (CT), immunohistochemical staining and microarray. The number of cells that displayed a senescence-specific morphology and positive SA-ß-Gal activity gradually increased up to 5 days. These results suggest that p16, p21 and p27 are essential regulators of AEF -induced senescence via NF-κB activation. The results showed that the AEF treatment is functional in enhancing the AEF –induced senescence in the GBM cells via an apoptosis- independent mechanism. This research concludes that this mode of treatment is a trustworthy protocol that can be effectively employed to overcome the limitations of the conventional mode of treatment on GBM.Keywords: alternating electric fields, senescence, glioblastoma, cell death
Procedia PDF Downloads 81578 Effect of Whole-Body Vibration Training on Self-Reported Physical Disability in Employees with Chronic Low-Back Pain: A Randomized Controlled Trial
Authors: Tobias Stephan Kaeding, Rebecca Schwarz, Momme Kück, Lothar Stein
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Introduction: The goal of this randomized and controlled study is to examine whether whole-body vibration (WBV) training is able to reduce self-reported physical disability in office employees with chronic low-back pain. Materials and methods: 41 subjects (68.3% female/mean age 45.5 ± 9.1 years/mean BMI 26.6 ± 5.2) were randomly allocated to an intervention group (INT (n= 21)) or a control group (CON (n=20). The INT participated in WBV training 2.5 times per week for 3 months. The primary outcome was the change in the Roland and Morris disability questionnaire (RMQ) score over the study period. In addition, secondary outcomes included changes in the Oswestry Disability Index (ODI). Results: The compliance with the intervention in the INT reached a mean of 81.1% ± 31.2% with no long-lasting unwanted side effects. We found significant positive effects of 3 months of WBV training in the INT compared to the CON regarding the RMQ (p=0.027) and the ODI (p=0.002). Conclusions: WBV training seems to be an effective, safe and suitable intervention for the reduction of the self-reported physical disability in seated working employees with chronic low-back pain.Keywords: back pain, exercise, occupational health management, vibration training
Procedia PDF Downloads 292577 Competing Risk Analyses in Survival Trials During COVID-19 Pandemic
Authors: Ping Xu, Gregory T. Golm, Guanghan (Frank) Liu
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In the presence of competing events, traditional survival analysis may not be appropriate and can result in biased estimates, as it assumes independence between competing events and the event of interest. Instead, competing risk analysis should be considered to correctly estimate the survival probability of the event of interest and the hazard ratio between treatment groups. The COVID-19 pandemic has provided a potential source of competing risks in clinical trials, as participants in trials may experienceCOVID-related competing events before the occurrence of the event of interest, for instance, death due to COVID-19, which can affect the incidence rate of the event of interest. We have performed simulation studies to compare multiple competing risk analysis models, including the cumulative incidence function, the sub-distribution hazard function, and the cause-specific hazard function, to the traditional survival analysis model under various scenarios. We also provide a general recommendation on conducting competing risk analysis in randomized clinical trials during the era of the COVID-19 pandemic based on the extensive simulation results.Keywords: competing risk, survival analysis, simulations, randomized clinical trial, COVID-19 pandemic
Procedia PDF Downloads 179576 Prevalence, Median Time, and Associated Factors with the Likelihood of Initial Antidepressant Change: A Cross-Sectional Study
Authors: Nervana Elbakary, Sami Ouanes, Sadaf Riaz, Oraib Abdallah, Islam Mahran, Noriya Al-Khuzaei, Yassin Eltorki
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Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4–12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Most patients with MDD in the mental health setting have been labeled incorrectly as treatment-resistant where in fact they have not been subjected to an adequate trial of guideline-recommended therapy. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. Avoiding irrational practices such as subtherapeutic doses of IAD, premature switching between the ADs, and refraining from unjustified polypharmacy can help the disease to go into a remission phase We aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the predictors that were associated with IAD change. This was a retrospective cross- sectional study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated predictors were examined using two unadjusted and adjusted cox regression models. A total of 487 patients met the inclusion criteria of the study. The average age for participants was 39.1 ± 12.3 years. Patients with first experience MDD episode 255 (52%) constituted a major part of our sample comparing to the relapse group 206(42%). About 431 (88%) of the patients had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44–53%]) had their IAD changed less than or equal to 30 days. Switching was consistently more common than combination or augmentation at any timepoint. The median time to IAD change was 43 days with 95% CI [33.2–52.7]. Five independent variables (age, bothersome side effects, un-optimization of the dose before any change, comorbid anxiety, first onset episode) were significantly associated with the likelihood of IAD change in the unadjusted analysis. The factors statistically associated with higher hazard of IAD change in the adjusted analysis were: younger age, un-optimization of the IAD dose before any change, and comorbid anxiety. Because almost half of the patients in this study changed their IAD as early as within the first month, efforts to avoid treatment failure are needed to ensure patient-treatment targets are met. The findings of this study can have direct clinical guidance for health care professionals since an optimized, evidence-based use of AD medication can improve the clinical outcomes of patients with MDD; and also, to identify high-risk factors that could worsen the survival time on IAD such as young age and comorbid anxietyKeywords: initial antidepressant, dose optimization, major depressive disorder, comorbid anxiety, combination, augmentation, switching, premature discontinuation
Procedia PDF Downloads 145575 WHO Surgical Safety Checklist in a Rural Ugandan Hospital, Barriers and Drivers to Implementation
Authors: Lucie Litvack, Malaz Elsaddig, Kevin Jones
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There is strong evidence to support the efficacy of the World Health Organization (WHO) Surgical Safety Checklist in improving patient safety; however, its use can be associated with difficulties. This study uses qualitative data collected in Kitovu Healthcare Complex, a rural Ugandan hospital, to identify factors that may influence the use of the checklist in a low-income setting. Potential barriers to and motivators for the hospital’s use of this checklist are identified and explored through observations of current patient safety practices; semi-structured interviews with theatre staff; a focus group with doctors; and trial implementation of the checklist. Barriers identified include the institutional context; knowledge and understanding; patient safety culture; resources and checklist contents. Motivators for correct use include prior knowledge; team attitudes; and a hospital advocate. Challenges are complex and unique to this socioeconomic context. Stepwise change to improve patient safety practices, local champions, whole team training, and checklist modification may assist the implementation and sustainable use of the checklist in an effective way.Keywords: anaesthesia, patient safety, Uganda, WHO surgical safety checklist
Procedia PDF Downloads 350574 A Randomized, Controlled Trial To Test Behavior Change Techniques (BCTS) To Improve Low Intensity Physical Activity In Older Adults
Authors: Ciaran Friel, Jerry Suls, Patrick Robles, Frank Vicari, Joan Duer-Hefele, Karina W. Davidson
Abstract:
Physical activity guidelines focus on increasing moderate intensity activity for older adults, but adherence to recommendations remains low. This is despite the fact that scientific evidence supports that any increase in physical activity is positively correlated with health benefits. Behavior change techniques (BCTs) have demonstrated effectiveness in reducing sedentary behavior and promoting physical activity. This pilot study uses a Personalized Trials (N-of-1) design to evaluate the efficacy of using four BCTs to promote an increase in low-intensity physical activity (2,000 steps of walking per day) in adults aged 45-75 years old. The 4 BCTs tested were goal setting, action planning, feedback, and self-monitoring. BCTs were tested in random order and delivered by text message prompts requiring participant response. The study recruited health system employees in the target age range, without mobility restrictions and demonstrating interest in increasing their daily activity by a minimum of 2,000 steps per day for a minimum of five days per week. Participants were sent a Fitbit Charge 4 fitness tracker with an established study account and password. Participants were recommended to wear the Fitbit device 24/7, but were required to wear it for a minimum of ten hours per day. Baseline physical activity was measured by the Fitbit for two weeks. Participants then engaged with a clinical research coordinator to review comprehension of the text message content and required actions for each of the BCTs to be tested. Participants then selected a consistent daily time in which they would receive their text message prompt. In the 8 week intervention phase of the study, participants received each of the four BCTs, in random order, for a two week period. Text message prompts were delivered daily at a time selected by the participant. All prompts required an interactive response from participants and may have included recording their detailed plan for walking or daily step goal (action planning, goal setting). Additionally, participants may have been directed to a study dashboard to view their step counts or compare themselves with peers (self-monitoring, feedback). At the end of each two week testing interval, participants were asked to complete the Self-Efficacy for Walking Scale (SEW_Dur), a validated measure that assesses the participant’s confidence in walking incremental distances and a survey measuring their satisfaction with the individual BCT that they tested. At the end of their trial, participants received a personalized summary of their step data in response to each individual BCT. Analysis will examine the novel individual-level heterogeneity of treatment effect made possible by N-of-1 design, and pool results across participants to efficiently estimate the overall efficacy of the selected behavioral change techniques in increasing low-intensity walking by 2,000 steps, 5 days per week. Self-efficacy will be explored as the likely mechanism of action prompting behavior change. This study will inform the providers and demonstrate the feasibility of N-of-1 study design to effectively promote physical activity as a component of healthy aging.Keywords: aging, exercise, habit, walking
Procedia PDF Downloads 124573 The Effect of Exercise Therapy and Electroacupuncture on Some Clinical Outcomes in People with Post Total Hip Arthroplasty
Authors: Marzieh Yassin, Masoud Rashed, Soheil Mansour Sohani, Reza Salehi
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Background: Hip arthroplasty is one of the surgical methods to improve symptoms in patients with hip osteoarthritis. The use of electroacupuncture and TENS reduces pain, increases range of motion and improves performance. Methods: In this clinical trial study, 30 patients after hip arthroplasty were randomly divided into two groups: electroacupuncture (n=16) with exercise therapy and TENS with exercise therapy (n=14). Severity of pain, quality of life, range of motion, edema and function were evaluated in two groups before and after the interventions. Interventions of 10 sessions (three sessions per week) were conducted for two groups. The significance level in all tests was below 0.05. Results: The results showed that both groups improved all of the symptoms after the intervention (p≤0.05), although there was no statistically significant difference between the two groups in terms of effectiveness (p≥0.05). Conclusion: The results showed that both methods improve symptoms in patients after surgery. According to this study, electroacupuncture is suggested as a new method effective for the treatment of people with post-Total Hip Arthroplasty.Keywords: electroacupuncture, physical performance, total hip arthroplasty, TENS
Procedia PDF Downloads 73572 The Design of a Phase I/II Trial of Neoadjuvant RT with Interdigitated Multiple Fractions of Lattice RT for Large High-grade Soft-Tissue Sarcoma
Authors: Georges F. Hatoum, Thomas H. Temple, Silvio Garcia, Xiaodong Wu
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Soft Tissue Sarcomas (STS) represent a diverse group of malignancies with heterogeneous clinical and pathological features. The treatment of extremity STS aims to achieve optimal local tumor control, improved survival, and preservation of limb function. The National Comprehensive Cancer Network guidelines, based on the cumulated clinical data, recommend radiation therapy (RT) in conjunction with limb-sparing surgery for large, high-grade STS measuring greater than 5 cm in size. Such treatment strategy can offer a cure for patients. However, when recurrence occurs (in nearly half of patients), the prognosis is poor, with a median survival of 12 to 15 months and with only palliative treatment options available. The spatially-fractionated-radiotherapy (SFRT), with a long history of treating bulky tumors as a non-mainstream technique, has gained new attention in recent years due to its unconventional therapeutic effects, such as bystander/abscopal effects. Combining single fraction of GRID, the original form of SFRT, with conventional RT was shown to have marginally increased the rate of pathological necrosis, which has been recognized to have a positive correlation to overall survival. In an effort to consistently increase the pathological necrosis rate over 90%, multiple fractions of Lattice RT (LRT), a newer form of 3D SFRT, interdigitated with the standard RT as neoadjuvant therapy was conducted in a preliminary clinical setting. With favorable results of over 95% of necrosis rate in a small cohort of patients, a Phase I/II clinical study was proposed to exam the safety and feasibility of this new strategy. Herein the design of the clinical study is presented. In this single-arm, two-stage phase I/II clinical trial, the primary objectives are >80% of the patients achieving >90% tumor necrosis and to evaluation the toxicity; the secondary objectives are to evaluate the local control, disease free survival and overall survival (OS), as well as the correlation between clinical response and the relevant biomarkers. The study plans to accrue patients over a span of two years. All patient will be treated with the new neoadjuvant RT regimen, in which one of every five fractions of conventional RT is replaced by a LRT fraction with vertices receiving dose ≥10Gy while keeping the tumor periphery at or close to 2 Gy per fraction. Surgical removal of the tumor is planned to occur 6 to 8 weeks following the completion of radiation therapy. The study will employ a Pocock-style early stopping boundary to ensure patient safety. The patients will be followed and monitored for a period of five years. Despite much effort, the rarity of the disease has resulted in limited novel therapeutic breakthroughs. Although a higher rate of treatment-induced tumor necrosis has been associated with improved OS, with the current techniques, only 20% of patients with large, high-grade tumors achieve a tumor necrosis rate exceeding 50%. If this new neoadjuvant strategy is proven effective, an appreciable improvement in clinical outcome without added toxicity can be anticipated. Due to the rarity of the disease, it is hoped that such study could be orchestrated in a multi-institutional setting.Keywords: lattice RT, necrosis, SFRT, soft tissue sarcoma
Procedia PDF Downloads 54571 O-(2-18F-Fluoroethyl)-L-Tyrosine Positron Emission Tomography/Computed Tomography in Patients with Suspicious Recurrent Low and High-Grade Glioma
Authors: Mahkameh Asadi, Habibollah Dadgar
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The precise definition margin of high and low-grade glioma is crucial for choosing best treatment approach after surgery and radio-chemotherapy. The aim of the current study was to assess the O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) positron emission tomography (PET)/computed tomography (CT) in patients with low (LGG) and high grade glioma (HGG). We retrospectively analyzed 18F-FET PET/CT of 10 patients (age: 33 ± 12 years) with suspicious for recurrent LGG and HGG. The final decision of recurrence was made by magnetic resonance imaging (MRI) and registered clinical data. While response to radio-chemotherapy by MRI is often complex and sophisticated due to the edema, necrosis, and inflammation, emerging amino acid PET leading to better interpretations with more specifically differentiate true tumor boundaries from equivocal lesions. Therefore, integrating amino acid PET in the management of glioma to complement MRI will significantly improve early therapy response assessment, treatment planning, and clinical trial design.Keywords: positron emission tomography, amino acid positron emission tomography, magnetic resonance imaging, low and high grade glioma
Procedia PDF Downloads 166570 The Effects of Phenolic Compounds in Brown Iranian Propolis Extracts on Ruminal Nitrogen Ammonia Concentration in in Vitro
Authors: Alireza Vakili, Shahab Ehtesham, Mohsen Danesh Mesgaran, Mahdi Paktinat
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The goal of this study is to determine the chemical compounds of brown Iranian propolis(BIP) extracts and to show flavonoids and phenol effects on nitrogen ammonia (NH3-N) in in vitro. Experimental samples were including two diets with different concentrate: forage ratio (80:20 and 60:40) with eight treatments (1:Control diet 60:40 without BIP,2: 60:40 diet with 25% BIP, 3:60:40 diet with 50% BIP, 4: 60:40 diet with 75% BIP,5: Control diet 80:20 without BIP,6: 80:20 diet with 25% BIP,7: 80:20 diet with 50% BIP and 8: 80:20 diet with 75% BIP) and eight repeats. The trial was analyzed considering a completely randomized design by the GLM procedure of SAS 9.1. Means among treatment were compared by Tukey test. The results of this study showed that in food with 80:20 (concentrate: forage), adding BIP 25% did not statistically change NH3-N (p > 0.05) compared to the control treatment but there was a significant difference (p < 0.05) between the effect of BIP 50% on NH3-N compared to the BIP 25% and the control. In diet with 60:40 (concentrate: forage), there was no significant difference between the effect of BIP 25% on NH3-N and the control, nor was there a significant difference between the effect of BIP 50% and 75%, while a significant difference (p < 0.05) between BIP 50% and 75% and the rest was observed. The propolis extract makes nitrogen ammonia decrease. This may help the nitrogen retain longer in ruminants.Keywords: brown Iranian propolis, in vitro, nitrogen ammonia, ruminant
Procedia PDF Downloads 477569 Effects of Vitexin on Scopolamine-Induced Memory Impairment in Rats
Authors: Mehdi Sheikhi, Marjan Nassiri-Asl, Esmail Abbasi, Mahsa Shafiee
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Various synthetic derivatives of natural flavonoids are known to have neuroactive properties. The present study aimed to investigate the effects of vitexin (5, 7, 4-trihydroxyflavone-8-glucoside), a flavonoid found in such plants as tartary buckwheat sprouts, wheat leaves phenolome, Mimosa pudica Linn and Passiflora spp, on scopolamine-induced memory impairment in rats. To achieve this goal, we assessed the effects of vitexin on memory retrieval in the presence or absence of scopolamine using a step-through passive avoidance trial. In the first part of the study, vitexin (25, 50, and 100 μM) was administered intracerebroventricularly (i.c.v.) before acquisition trials. In the second part, vitexin, at the same doses, was administered before scopolamine (10 μg, i.c.v.) and before the acquisition trials. During retention tests, vitexin (100 μM) in the absence of scopolamine significantly increased the stepthrough latencies compared to scopolamine. In addition, vitexin (100 μM) significantly reversed the shorter step-through latencies induced by scopolamine (P < 0.05). These results indicate that vitexin has a potential role in enhancing memory retrieval. A possible mechanism is modulation of cholinergic receptors; however, other mechanisms may be involved in its effects in acute exposure.Keywords: flavonoid, memory retrieval, passive avoidance, scopolamine, vitexin
Procedia PDF Downloads 345568 Undercasts in Fracture Care: A Randomized Control Study
Authors: B. Kenny
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There is currently no literature comparing undercasts in fracture care. This study is a randomised trial comparing the 4 commonly used undercasts in Australia. These are Webril, Sofban, Goretech and Delta-dry. The ideal undercast should be comfortable for the patient and not cause itchiness. It should be durable enough to withstand daily activities. The clinician/technician should find the undercast easy to apply and remove. It should provide adequate padding without compromising cast mouldability to obtain a good cast index and air index. 18 volunteering medical students were randomly allocated to receive 4 angular casts, one over each elbow and ankle(total of 72 casts). They were blinded to cast type. After an hour their casts were stressed by pouring 20ml Normal Saline onto the skin beneath. Each student filled a questionnaire about comfort, itchiness, weight and water resistance. Subsequently they ranked each cast 1 to 4 based on preference. Our preliminary results show Delta-dry is the most preferred undercast followed by Webril, Sofban and Goretech in that order. Underlay selection is important component of patient care with long immobilsation. Webril or Deltra-dry are by far the most preferred undercasts in our study.Keywords: casts, fracture, treatment modality, patient compliance
Procedia PDF Downloads 308567 An Evaluation of the MathMates Program Implemented in Andrew Hamilton Public School as Part of College-Community Initiatives
Authors: Haofei Li
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To support academic growth and foster love of learning, MathMates has been introduced for grade 6-8 students at Andrew Hamilton public school in 2022. The program is targeted at students from diverse backgrounds, particularly those underperforming in Pennsylvania System of School Assessment (PSSA) exams. Then, this study aims to evaluate the efficacy of MathMates by comparing student performance on the PSSA test, before and after the intervention. Through a randomized control trial, the study will collect associated costs using the ingredients method and measure the effectiveness for cost-effectiveness analysis. Text messages will be sent to parents/guardians as a reminder of the program and to encourage student participation. The findings of this study will provide valuable insights for funding organizations seeking to understand the impact and costs of math tutoring interventions on student academic achievement, which also emphasizes the importance of the collaborative efforts between higher education and local public schools.Keywords: mathematics education, mathematics tutoring, college-community initiative, middle schools, Philadelphia public schools, after-school program, PSSA
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