Search results for: prolonged resuscitation

Authors: Hsin-Hsin Chang, Jann-Tay Wang, Wang-Huei Sheng

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Background: Hospital-associated infections (HAIs) have significant medical and social resource consumption. In view of medical technology change rapidly and the prolonged average life expectancy, the patients' chances of receiving invasive medical devices have also increased. As well as the potential disease of the patients, the aging, and immune dysfunction makes the disease more serious, raising the risk of HAIs. In our adult intensive care units, catheter-associated urinary tract infections (CAUTIs) have an average of 4.6% in 2014, which is much higher than that of the National Healthcare Safety Network (NHSN). Therefore, we started the intervention of CAUTI bundle care. Methods: This 3-year intervention was conducted in adults’ intensive care units (ICUs) during January 2015 to December 2017. The implementation of CAUTI bundle care in order to reduce invasive catheter-associated infections were built on evidence-based infection control measures. Prospective surveillance was performed on all patients admitted to hospital. The four major directions are 'Leader Engagement', 'Educate Personnel', 'Executive Multidisciplinary Teamwork', 'Innovation and Improvement of Tools'. Results: During the intervention period, there were 167,024 patient-days with a total of 508 episodes of CAUTIs in the entire adult ICUs identified. The incidence of CAUTIs in adult ICU was significantly decreased in the intervention period (from 2015 to 2017), from 4.6 to 3.6 per 1000 catheter days (p=0.05). Conclusion: The necessity for the implementation of CAUTI bundle care in the health care system plays an important role in the quality and policy of infection control. Multidisciplinary teamwork, education, a comprehensive checklist and from time to time audit feedback to improve healthcare workers’ compliance are the keys to success.

Keywords: bundle care, hospital-associated infections, leader engagement, multidisciplinary team work

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Authors: Aprajeeta Jha, Punyadarshini P. Tripathy

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Drying is one of the most critical unit operations for prolonging the shelf-life of food grains in order to ensure global food security. Photovoltaic integrated solar dryers can be a sustainable solution for replacing energy intensive thermal dryers as it is capable of drying in off-sunshine hours and provide better control over drying conditions. But, performance and reliability of PV based solar dryers depend hugely on climatic conditions thereby, drastically affecting process parameters. Therefore, to ensure quality and prolonged shelf-life of paddy, optimization of process parameters for solar dryers is critical. Proper moisture distribution within the grains is most detrimental factor to enhance the shelf-life of paddy therefore; modeling of mass transport can help in providing a better insight of moisture migration. Hence, present work aims at optimizing the process parameters and to develop a 3D finite element model (FEM) for predicting moisture profile in paddy during solar drying. Optimization of process parameters (power level, air velocity and moisture content) was done using box Behnken model in Design expert software. Furthermore, COMSOL Multiphysics was employed to develop a 3D finite element model for predicting moisture profile. Optimized model for drying paddy was found to be 700W, 2.75 m/s and 13% wb with optimum temperature, milling yield and drying time of 42˚C, 62%, 86 min respectively, having desirability of 0.905. Furthermore, 3D finite element model (FEM) for predicting moisture migration in single kernel for every time step has been developed. The mean absolute error (MAE), mean relative error (MRE) and standard error (SE) were found to be 0.003, 0.0531 and 0.0007, respectively, indicating close agreement of model with experimental results. Above optimized conditions can be successfully used to dry paddy in PV integrated solar dryer in order to attain maximum uniformity, quality and yield of product to achieve global food and energy security

Keywords: finite element modeling, hybrid solar drying, mass transport, paddy, process optimization

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Authors: Nazedah Ain Ibrahim, Mohamed Mansor Manan

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Treatment of suspected early onset neonatal sepsis (EONS) in Neonatal Intensive Care Unit (NICU) is essential. However, information regarding EONS pathogens may vary between regions. Global perspectives showed Group B Streptococcal (GBS) as the most common causative pathogens, but the widespread use of intrapartum antibiotics has changed the pathogens pattern towards gram negative microorganisms, especially E. coli. Objective of this study is to describe the pathogens isolated, to assess current treatment and risk of EONS. Records of 899 neonates born in three General Hospitals between 2009 until 2012 were retrospectively reviewed. The inclusion criteria were neonates with blood culture taken prior to empiric antibiotics administration and within 72 hours of life. Of the study group, a total of 734 (82%) cases had documented blood culture that met the inclusion criteria. Proven EONS (as confirmed by positive blood culture) was found in 22 (3%) neonates. The majority was isolated with gram positive organisms, 17 (2.3%). In addition, other common gram positive organism isolated were Coagulase negative staphylococci (7) followed by Bacillus sp. (5) and Streptococcus pneumonia (2), and only one case isolated with GBS, Streptococcus spp. and Enterococcus sp. Meanwhile, only five cases of gram negative organisms [Stenotropomonas (xantho) maltophi (1), Haemophilus influenza (1), Spingomonas paucimobilis (1), Enterobacter gergoviae (1) and E. coli (1)] were isolated. A total of 286 (39%) cases were exposed to intrapartum antibiotics and of those, 157 (21.4%) were administered prior to delivery. All grams positive and most gram negative organisms showed sensitivity to the tested antibiotics. Only two rare gram negative organisms showed total resistant. Male, surfactant, caesarean delivery and prolonged rapture of membrane >18hours were a possible risk of proven EONS. Although proven EONS remains uncommon in Malaysia, nonetheless, the effect of intrapartum antibiotics still required continuous surveillance. However, by analyzing isolated pathogens it can be used as treatment guidance in managing suspected EONS.

Keywords: early onset neonatal sepsis, neonates, pathogens, gram positive, gram negative

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Authors: Waled A. Dawoud, Abdelazim M. Negm, Nasser M. Saleh

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Offshore piling generates underwater sound at level high enough to cause physical damage or hearing impairment to the marine mammals. Several methods can be used to mitigate the effect of underwater noise from offshore pile driving on marine mammals which can be divided into three main approaches. The first approach is to keep the mammal out of the high-risk area by using aversive sound waves produced by acoustic mitigation devices such as playing-back of mammal's natural predator vocalization, alarm or distress sounds, and anthropogenic sound. The second approach is to reduce the amount of underwater noise from pile driving using noise mitigation techniques such as bubble curtains, isolation casing, and hydro-sound dampers. The third approach is to eliminate the overlap of underwater waves by using prolonged construction process. To investigate the effectiveness of different noise mitigation methods; a pile driven with 235 kJ rated energy diesel hammer near Jeddah Coast, Kingdom of Saudi Arabia was used. Using empirical sound exposure model based on Red Sea characteristics and limits of National Oceanic and Atmospheric Administration; it was found that the aversive sound waves should extend to 1.8 km around the pile location. Bubble curtains can reduce the behavioral disturbance area up to 28%; temporary threshold shift up to 36%; permanent threshold shift up to 50%; and physical injury up to 70%. Isolation casing can reduce the behavioral disturbance range up to 12%; temporary threshold shift up to 21%; permanent threshold shift up to 29%; and physical injury up to 46%. Hydro-sound dampers efficiency depends mainly on the used technology and it can reduce the behavioral disturbance range from 10% to 33%; temporary threshold shift from 18% to 25%; permanent threshold shift from 32% to 50%; and physical injury from 46% to 60%. To prolong the construction process, it was found that the single pile construction, use of soft start, and keep time between two successive hammer strikes more than 3 seconds are the most effective techniques.

Keywords: offshore pile driving, sound propagation models, noise effects on marine mammals, Underwater noise mitigation

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Authors: Achim Kampker, Heiner H. Heimes, Mathias Ordung, Christoph Lienemann, Ansgar Hollah, Nemanja Sarovic

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Electric cars with their fast innovation cycles and their disruptive character offer a high degree of freedom regarding innovative design for remanufacturing. Remanufacturing increases not only the resource but also the economic efficiency by a prolonged product life time. The reduced power train wear of electric cars combined with high manufacturing costs for batteries allow new business models and even second life applications. Modular and intermountable designed battery packs enable the replacement of defective or outdated battery cells, allow additional cost savings and a prolongation of life time. This paper discusses opportunities for future remanufacturing value chains of electric cars and their battery components and how to address their potentials with elaborate designs. Based on a brief overview of implemented remanufacturing structures in different industries, opportunities of transferability are evaluated. In addition to an analysis of current and upcoming challenges, promising perspectives for a sustainable electric car circular economy enabled by design for remanufacturing are deduced. Two mathematical models describe the feasibility of pursuing a circular economy of lithium ion batteries and evaluate remanufacturing in terms of sustainability and economic efficiency. Taking into consideration not only labor and material cost but also capital costs for equipment and factory facilities to support the remanufacturing process, cost benefit analysis prognosticate that a remanufacturing battery can be produced more cost-efficiently. The ecological benefits were calculated on a broad database from different research projects which focus on the recycling, the second use and the assembly of lithium ion batteries. The results of this calculations show a significant improvement by remanufacturing in all relevant factors especially in the consumption of resources and greenhouse warming potential. Exemplarily suitable design guidelines for future remanufacturing lithium ion batteries, which consider modularity, interfaces and disassembly, are used to illustrate the findings. For one guideline, potential cost improvements were calculated and upcoming challenges are pointed out.

Keywords: circular economy, electric mobility, lithium ion batteries, remanufacturing

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Authors: Ahmed Elwaleed, Huiho Jeong, Ali H. Abdelbagi, Nguyen Thi Quynh, Koji Arizono, Yasuhiro Ishibashi

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Artisanal and small-scale gold mining (ASGM) poses substantial risks to both human health and the environment, particularly through contamination of soil, water, and air. Prolonged exposure to ASGM-contaminated soils can lead to acute or chronic mercury toxicity. This study assesses the human health risks associated with mercury-contaminated soils and tailings in the Alebediah mining community in Sudan. Soil samples were collected from various locations within Alebediah, including ASGM areas, farmlands, and residential areas, along with tailings samples commonly found within ASGM sites. The evaluation of potential health risks to humans included the computation of the estimated daily intake (AvDI), the hazard quotient (HQ), and the hazard index (HI) for both adults and children. The primary exposure route identified as potentially posing a significant health risk was the volatilization of mercury from tailings samples, where mercury concentrations reached up to 25.5 mg/kg. In contrast, other samples within the ASGM area showed elevated mercury levels but did not present significant health risks, with HI values below 1. However, all areas indicated HI values above 1 for the remaining exposure routes. The study observed a decrease in mercury concentration with increasing distance from the ASGM community. Additionally, soil samples revealed elevated mercury levels exceeding background values, prompting an assessment of contamination levels using the enrichment factor (EF). The findings indicated that farmlands and residential areas exhibited depleted EF, while areas surrounding the ASGM community showed none to moderate pollution. In contrast, ASGM areas exhibited significant to extreme pollution. A GIS map was generated to visually depict the extent of mercury pollution, facilitating communication with stakeholders and decision-makers.

Keywords: mercury pollution, artisanal and small-scale gold mining, health risk assessment, hazard index, soil and tailings, enrichment factor

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Authors: Punit Gandhi, J. C. Brezet, Tim Gorter, Uchechi Obinna

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This paper introduces how weather forecasting could help in more efficient energy management for smart homes with the use of Home Energy Management Systems (HEMS). The paper also focuses on educating consumers and helping them make more informed decisions while using the HEMS. A combined approach of technical and user perspective has been selected to develop a novel HEMS-product-service combination in a more comprehensive manner. The current HEMS switches on/off the energy intensive appliances based on the fluctuating electricity tariffs, but with weather forecasting, it is possible to shift the time of use of energy intensive appliances to maximum electricity production from the renewable energy system installed in the house. Also, it is possible to estimate the heating/cooling load of the house for the day ahead demand. Hence, relevant insight is gained in the expected energy production and consumption load for the next day, facilitating better (more efficient, peak shaved, cheaper, etc.) energy management practices for smart homes. In literature, on the user perspective, it has been observed that consumers lose interest in using HEMS after three to four months. Therefore, to further help in better energy management practices, the new system had to be designed in a way that consumers would sustain their interaction with the system on a structural basis. It is hypothesized that, if consumers feel more comfortable with using such system, it would lead to a prolonged usage, including more energy savings and hence financial savings. To test the hypothesis, a survey for the HEMS is conducted, to which 59 valid responses were recorded. Analysis of the survey helped in designing a system which imparts better information about the energy production and consumption to the consumers. It is also found from the survey that, consumers like a variety of options and they do not like a constant reminder of what they should do. Hence, the final system is designed to encourage consumers to make an informed decision about their energy usage with a wide variety of behavioral options available. It is envisaged that the new system will be tested in several pioneering smart energy grid projects in both the Netherlands and India, with a continued ‘design thinking’ approach, combining the technical and user perspective, as the basis for further improvements.

Keywords: weather forecasting, smart grid, renewable energy forecasting, user defined HEMS

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Authors: Larry O. Awo, George N. Duru

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There is growing public and mental health concerns over the availability of gambling platforms and shops in Nigeria and the high level of youth involvement in gambling. Early theorizing maintained that gambling involvement driven by the quest for resource gains. However, evidences show that the economic model of gambling tend to explain the involvement of the gambling business owners (sport lottery operators: SLOs) as most gamblers lose more than they win. This loss, according to the law of effect, ought to discourage decisions to gamble. However, the quest to recover loses has often initiated and prolonged gambling sessions. Therefore, the need to investigate mental contemplations (such as counterfactual reasoning (upward versus downward) of what “would, should, or could” have been, and feeling of the illusion of control; IOC) over gambling outcome as risk or protective factors in gambling decisions became pertinent. The present study sought to understand the differential contributions and conditional effects of upward versus downward counterfactual reasoning as pathways through which the association between IOC and gambling decision of Nigerian youths (N = 120, mean age = 18.05, SD = 3.81) could be explained. The study adopted a randomized group design, and data were obtained by means of stimulus material (the Gambling Episode; GE) and self-report measures of IOC and Gambling Decision. One-way analysis of variance (ANOVA) result showed that participants in the upward counterfactual reasoning group (M = 22.08) differed from their colleagues in the downward counterfactual reasoning group (M = 17.33) on the decision to gamble, and this difference was significant [F(1,112) = 23, P < .01]. HAYES PROCESS macro moderation analysis results showed that 1) IOC and upward counterfactual reasoning were positively associated with the decision to gamble (B = 14.21, t = 6.10, p < .01 and B = 7.22, t = 2.07, p < .01), 3) upward counterfactual reasoning did not moderate the association between IOC and gambling decision (p > .05), and 4) downward counterfactual reasoning negatively moderated the association between IOC and gambling decision (B = 07, t = 2.18, p < .05) such that the association was strong at a low level of downward counterfactual, but wane at high levels of downward counterfactual reasoning. The implication of these findings are that IOC and upward counterfactual reasoning were risk factors and promote gambling behavior, while downward counterfactual reasoning protects individuals from gambling activities. Thus, it is concluded that downward counterfactual reasoning strategies should be included in gambling therapy and treatment packages as it could diminish feelings of both IOC and negative feelings of missed positive outcomes and the urge to gamble.

Keywords: counterfactual reasoning, gambling cognition, gambling decision, nigeria, youths

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Authors: Jan C. Droste, Justine Burns, Nithin Narayan

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Introduction: Life-threatening detrimental effects of inappropriate adrenaline (epinephrine) administration, e.g., by giving the wrong dose, in the context of anaphylaxis management is well documented in the medical literature. Half of the fatal anaphylactic reactions in the UK are iatrogenic, and the median time to a cardio-respiratory arrest can be as short as 5 minutes. It is therefore imperative that hospital doctors of all grades have active and accurate knowledge of the correct route, site, and dosage of administration of adrenaline. Given this time constraint and the potential fatal outcome with inappropriate management of anaphylaxis, it is alarming that surveys over the last 15 years have repeatedly shown only a minority of doctors to have accurate knowledge of adrenaline administration as recommended by the UK Resuscitation Council guidelines (2008 updated 2012). This comparison of survey results of the medical workforce over several years in a small NHS District General Hospital was conducted in order to establish the effect of the employment of multiple educational methods regarding adrenaline administration in anaphylaxis in adults. Methods: Between 2010 and 2017, several education methods and tools were used to repeatedly inform the medical workforce (doctors and advanced clinical practitioners) in a single district general hospital regarding the treatment of anaphylaxis in adults. Whilst the senior staff remained largely the same cohort, junior staff had changed fully in every survey. Examples included: (i) Formal teaching -in Grand Rounds; during the junior doctors’ induction process; advanced life support courses (ii) In-situ simulation training performed by the clinical skills simulation team –several ad hoc sessions and one 3-day event in 2017 visiting 16 separate clinical areas performing an acute anaphylaxis scenario using actors- around 100 individuals from multi-disciplinary teams were involved (iii) Hospital-wide distribution of the simulation event via the Trust’s Simulation Newsletter (iv) Laminated algorithms were attached to the 'crash trolleys' (v) A short email 'alert' was sent to all medical staff 3 weeks prior to the survey detailing the emergency treatment of anaphylaxis (vi) In addition, the performance of the surveys themselves represented a teaching opportunity when gaps in knowledge could be addressed. Face to face surveys were carried out in 2010 ('pre-intervention), 2015, and 2017, in the latter two occasions including advanced clinical practitioners (ACP). All surveys consisted of convenience samples. If verbal consent to conduct the survey was obtained, the medical practitioners' answers were recorded immediately on a data collection sheet. Results: There was a sustained improvement in the knowledge of the medical workforce from 2010 to 2017: Answers improved regarding correct drug by 11% (84%, 95%, and 95%); the correct route by 20% (76%, 90%, and 96%); correct site by 40% (43%, 83%, and 83%) and the correct dose by 45% (27%, 54%, and 72%). Overall, knowledge of all components -correct drug, route, site, and dose-improved from 13% in 2010 to 62% in 2017. Conclusion: This survey comparison shows knowledge of the medical workforce regarding adrenaline administration for treatment of anaphylaxis in adults can be considerably improved by employing a variety of educational methods.

Keywords: adrenaline, anaphylaxis, epinephrine, medical education, patient safety

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Authors: Sara Tokhi Arab, Rozo Noguchi, Tofeal Ahamed

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Drought is a natural disaster that occurs in a region due to a lack of precipitation and high temperatures over a continuous period or in a single season as a consequence of climate change. Precipitation deficits and prolonged high temperatures mostly affect the agricultural sector, water resources, socioeconomics, and the environment. Consequently, it causes agricultural product loss, food shortage, famines, migration, and natural resources degradation in a region. Agriculture is the first sector affected by drought. Therefore, it is important to develop an agricultural drought risk and loss assessment to mitigate the drought impact in the agriculture sector. In this context, the main purpose of this study was to assess yield loss using composite drought indices in the drought-affected vineyards. In this study, the CDI was developed for the years 2016 to 2020 by comprising five indices: the vegetation condition index (VCI), temperature condition index (TCI), deviation of NDVI from the long-term mean (NDVI DEV), normalized difference moisture index (NDMI) and precipitation condition index (PCI). Moreover, the quantitative principal component analysis (PCA) approach was used to assign a weight for each input parameter, and then the weights of all the indices were combined into one composite drought index. Finally, Bayesian regularized artificial neural networks (BRANNs) were used to evaluate the yield variation in each affected vineyard. The composite drought index result indicated the moderate to severe droughts were observed across the Kabul Province during 2016 and 2018. Moreover, the results showed that there was no vineyard in extreme drought conditions. Therefore, we only considered the severe and moderated condition. According to the BRANNs results R=0.87 and R=0.94 in severe drought conditions for the years of 2016 and 2018 and the R= 0.85 and R=0.91 in moderate drought conditions for the years of 2016 and 2018, respectively. In the Kabul Province within the two years drought periods, there was a significate deficit in the vineyards. According to the findings, 2018 had the highest rate of loss almost -7 ton/ha. However, in 2016 the loss rates were about – 1.2 ton/ha. This research will support stakeholders to identify drought affect vineyards and support farmers during severe drought.

Keywords: grapes, composite drought index, yield loss, satellite remote sensing

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Authors: Svetlana Guryeva, Inna Kornienko, Andrey Usanov, Dmitry Usanov, Elena Petersen

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Every day cells in our organism are exposed to various factors: chemical agents, reactive oxygen species, ionizing radiation, and others. These factors can cause damage to DNA, cellular membrane, intracellular compartments, and proteins. The fate of cells depends on the exposure intensity and duration. The prolonged and intense exposure causes the irreversible damage accumulation, which triggers the permanent cell cycle arrest (cellular senescence) or cell death programs. In the case of low dose of impacts, it can lead to cell renovation and to cell functional state improvement. Therefore, it is a pivotal question to investigate the factors and doses that result in described positive effects. In order to estimate the influence of different agents, the proliferation index and levels of cell death markers (annexin V/propidium iodide), senescence-associated β-galactosidase, and lipofuscin were measured. The experiments were conducted on primary human fibroblasts of the 8th passage. According to the levels of mentioned markers, these cells were defined as senescent cells. The effect of low-frequency magnetic field was investigated. Different modes of magnetic field exposure were tested. The physical agents were compared with chemical agents: metformin (10 mM) and taurine (0.8 mM and 1.6 mM). Cells were incubating with chemicals for 5 days. The highest decrease in the level of senescence-associated β-galactosidase (21%) and lipofuscin (17%) was observed in the primary senescent fibroblasts after 5 days after double treatments with 48 h intervals with low-frequency magnetic field. There were no significant changes in the proliferation index after magnetic field application. The cytotoxic effect of magnetic field was not observed. The chemical agent taurine (1.6 mM) decreased the level of senescence-associated β-galactosidase (23%) and lipofuscin (22%). Metformin improved the activity of senescence-associated β-galactosidase on 15% and the level of lipofuscin on 19% in this experiment. According to these results, the effect of double treatment with 48 h interval with low-frequency magnetic field and the effect of taurine (1.6 mM) were comparable to the effect of metformin, for which anti-aging properties are proved. In conclusion, this study can become the first step towards creation of the standardized system for the investigation of different effects on senescent cells.

Keywords: biomarkers, magnetic field, metformin, primary fibroblasts, senescence, taurine

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Authors: Qiushi Ning

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The nitrogen (N) is an important limiting factor of various ecosystems, and the N deposition rate is increasing unprecedentedly due to anthropogenic activities. The N deposition altered the microbial growth and activity, and microbial mediated N cycling through changing soil pH, the availability of N and carbon (C). The CO2, CH4 and N2O are important greenhouse gas which threaten the sustainability and function of the ecosystem. With the prolonged and increasing N enrichment, the soil acidification and C limitation will be aggravated, and the microbial biomass will be further declined. The soil acidification and lack of C induced by N addition are argued as two important factors regulating the microbial activity and growth, and the studies combined soil acidification with lack of C on microbial community are scarce. In order to restore the ecosystem affected by chronic N loading, we determined the responses of microbial activity and GHG emssions to lime and glucose (control, 1‰ lime, 2‰ lime, glucose, 1‰ lime×glucose and 2‰ lime×glucose) addition which was used to alleviate the soil acidification and supply C resource into soils with N addition rates 0-50 g N m–2yr–1. The results showed no significant responses of soil respiration and microbial biomass (MBC and MBN) to lime addition, however, the glucose substantially improved the soil respiration and microbial biomass (MBC and MBN); the cumulative CO2 emission and microbial biomass of lime×glucose treatments were not significantly higher than those of only glucose treatment. The glucose and lime×glucose treatments reduced the net mineralization and nitrification rate, due to inspired microbial growth via C supply incorporating more inorganic N to the biomass, and mineralization of organic N was relatively reduced. The glucose addition also increased the CH4 and N2O emissions, CH4 emissions was regulated mainly by C resource as a substrate for methanogen. However, the N2O emissions were regulated by both C resources and soil pH, the C was important energy and the increased soil pH could benefit the nitrifiers and denitrifiers which were primary producers of N2O. The soil respiration and N2O emissions increased with increasing N addition rates in all glucose treatments, as the external C resource improved microbial N utilization. Compared with alleviated soil acidification, the improved availability of C substantially increased microbial activity, therefore, the C should be the main limiting factor in long-term N loading soils. The most important, when we use the organic C fertilization to improve the production of the ecosystems, the GHG emissions and consequent warming potentials should be carefully considered.

Keywords: acidification and C limitation, greenhouse gas emission, microbial activity, N deposition

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Authors: Lara Dutil-Fafard, Caroline Rhéaume, Patrick Archambault, Daniel Lafond, Neal W. Pollock

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Improving resources for medical autonomy of astronauts in prolonged space missions, such as a Mars mission, requires not only technology development, but also decision-making support systems. The Advanced Crew Medical System - Medical Condition Requirements study, funded by the Canadian Space Agency, aimed to create knowledge content and a scenario-based query capability to support medical autonomy of astronauts. The key objective of this study was to create a prototype tool for identifying medical infrastructure requirements in terms of medical knowledge, skills and materials. A multicriteria decision-making method was used to prioritize the highest risk medical events anticipated in a long-term space mission. Starting with those medical conditions, event sequence diagrams (ESDs) were created in the form of decision trees where the entry point is the diagnosis and the end points are the predicted outcomes (full recovery, partial recovery, or death/severe incapacitation). The ESD formalism was adapted to characterize and compare possible outcomes of medical conditions as a function of available medical knowledge, skills, and supplies in a given mission scenario. An extensive literature review was performed and summarized in a medical condition database. A PostgreSQL relational database was created to allow query-based evaluation of health outcome metrics with different medical infrastructure scenarios. Critical decision points, skill and medical supply requirements, and probable health outcomes were compared across chosen scenarios. The three medical conditions with the highest risk rank were acute coronary syndrome, sepsis, and stroke. Our efforts demonstrate the utility of this approach and provide insight into the effort required to develop appropriate content for the range of medical conditions that may arise.

Keywords: decision support system, event-sequence diagram, exploration mission, medical autonomy, scenario-based queries, space medicine

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Authors: Jyh-Ping Chen, Chia-Lin Sheu

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In this study, we propose to use electrospinning to fabricate porous nanofibrous membranes as postsurgical anti-adhesion barriers and to improve the properties of current post-surgical anti-adhesion products. We propose to combine FDA-approved biomaterials with anti-adhesion properties, polycaprolactone (PCL), polyethylene glycol (PEG), hyaluronic acid (HA) with silver nanoparticles (Ag) and ibuprofen (IBU), to produce anti-adhesion barrier nanofibrous membranes. For this purpose, PEG/PCL/Ag/HA/IBU core-shell nanofibers were prepared. The shell layer contains PEG + PCL to provide mechanical supports and Ag was added to the outer PEG-PCL shell layer during electrospinning to endow the nanofibrous membrane with anti-bacterial properties. The core contains HA to exert anti-adhesion and IBU to exert anti-inflammation effects, respectively. The nanofibrous structure of the membranes can reduce cell penetration while allowing nutrient and waste transports to prevent postsurgical adhesion. Nanofibers with different core/shell thickness ratio were prepared. The nanofibrous membranes were first characterized for their physico-chemical properties in detail, followed by in vitro cell culture studies for cell attachment and proliferation. The HA released from the core region showed extended release up to 21 days for prolonged anti-adhesion effects. The attachment of adhesion-forming fibroblasts is reduced using the nanofibrous membrane from DNA assays and confocal microscopic observation of adhesion protein vinculin expression. The Ag released from the shell showed burst release to prevent E Coli and S. aureus infection immediately and prevent bacterial resistance to Ag. Minimum cytotoxicity was observed from Ag and IBU when fibroblasts were culture with the extraction medium of the nanofibrous membranes. The peritendinous anti-adhesion model in rabbits and the peritoneal anti-adhesion model in rats were used to test the efficacy of the anti-adhesion barriers as determined by gross observation, histology, and biomechanical tests. Within all membranes, the PEG/PCL/Ag/HA/IBU core-shell nanofibers showed the best reduction in cell attachment and proliferation when tested with fibroblasts in vitro. The PEG/PCL/Ag/HA/IBU nanofibrous membranes also showed significant improvement in preventing both peritendinous and peritoneal adhesions when compared with other groups and a commercial adhesion barrier film.

Keywords: anti-adhesion, electrospinning, hyaluronic acid, ibuprofen, nanofibers

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Authors: L. Musak, J. Valachova, T. Vasicko, O. Osina

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Introduction: Stainless steel is resistant to electrochemical corrosion by passivation. Welders are greatly exposed to welding fumes of toxic metals, which added to this steel. The content of chromium (Cr) in steel was above 11.5%, Ni and Mo from 2 to 6.5%. The aim of the study was the evaluation of occupational exposure to Cr, chromosome analysis and valuation of individual susceptibility polymorphism of gene CCND1 c.870 G>A. Materials and Methods: The exposed group was consisted from 117 welders of stainless steels. The average age was 38.43 years and average exposure time 7.14 years. Smokers represented 40.17%. The control group consisted of 123 non-exposed workers with an average age of 39.74 years and time employment 16.67 years. Smokers accounted for 22.76%. Analysis of Cr in blood and urine was performed by atomic absorption spectrophotometry (AAS Varian SpectraAA 30P) with electrothermal decomposition of the sample in the graphite furnace. For the evaluation of chromosomal aberrations (CA) was used cytogenetic analysis of peripheral blood lymphocytes, gene polymorphism was determined by PCR-RFLP reaction using appropriate primers and restriction enzymes. For statistical analysis was used the Mann-Whitney U-test. Results: The mean Cr level in exposed group was 0.095 mmol/l (0.019 min-max 0.504). No value does exceed the average normal value. The average value Cr in urine was 7.9 mmol/mol creatinine (min 0.026 to max 19.26). The total number of CA was 1.86% in compared to 1.70% controls. (CTA-type 0.90% vs 0.80% and CSA-type 0.96% vs 0.90%). In the number of total CA was observed statistical difference between smokers and non-smokers of exposed group (S-1.57% vs. NS-2.04%, P<0.05). In CCND1 gene polymorphisms was observed the increasing of the total CA with wild-type allele (WT) via heterozygous to the VAR genotype (1.44%<1.82%<2.13%). There was observed a statistically higher incidence of CTA-type aberrations in variant genotypes between exposed and control groups (1.22% vs. 0.59%, P<0.05). Discussion and conclusions: The work place is usually higher source of exposure to harmful factors. Workers need consistently and checked frequently health control. In assessing the risk of adverse effects of metals is important to consider their persistence, behavior and bioavailability. Prolonged exposure to carcinogens may not manifest symptoms of poisoning, but delayed effects may occur, which resulted in a higher incidence of malignant tumors.

Keywords: genotoxicity, chromium, stainless steels, welders

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Authors: M. R. Aher, R. B. Laware, G. S. Asane, B. S. Kuchekar

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Objective: Studies have shown that a new combination therapy with Artemisinin derivatives and curcumin is unique, with potential advantages over known ACTs. In present study an attempt was made to prepare microparticulate drug delivery system of Curcumin-Zn complex and evaluate it in combination with artemether for antimalarial activity. Material and method: Curcumin Zn complex was prepared and encapsulated using sodium alginate. Microparticles thus obtained are further coated with various enteric polymers at different coating thickness to control the release. Microparticles are evaluated for encapsulation efficiency, drug loading and in vitro drug release. Roentgenographic Studies was conducted in rabbits with BaSO 4 tagged formulation. Optimized formulation was screened for antimalarial activity using P. berghei-infected mice survival test and % paracetemia inhibition, alone (three oral dose of 5mg/day) and in combination with arthemether (i.p. 500, 1000 and 1500µg). Curcumin-Zn(II) was estimated in serum after oral administration to rats by using spectroflurometry. Result: Microparticles coated with Cellulose acetate phthalate showed most satisfactory and controlled release with 479 min time for 60% drug release. X-ray images taken at different time intervals confirmed the retention of formulation in GI tract. Estimation of curcumin in serum by spectroflurometry showed that drug concentration is maintained in the blood for longer time with tmax of 6 hours. The survival time (40 days post treatment) of mice infected with P. berghei was compared to survival after treatment with either Curcumin-Zn(II) microparticles artemether combination, curcumin-Zn complex and artemether. Oral administration of Curcumin-Zn(II)-artemether prolonged the survival of P.berghei-infected mice. All the mice treated with Curcumin-Zn(II) microparticles (5mg/day) artemether (1000µg) survived for more than 40 days and recovered with no detectable parasitemia. Administration of Curcumin-Zn(II) artemether combination reduced the parasitemia in mice by more than 90% compared to that in control mice for the first 3 days after treatment. Conclusion: Antimalarial activity of the curcumin Zn-artemether combination was more pronounced than mono therapy. A single dose of 1000µg of artemether in curcumin-Zn combination gives complete protection in P. berghei-infected mice. This may reduce the chances of drug resistance in malaria management.

Keywords: formulation, microparticulate drug delivery, antimalarial, pharmaceutics

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Authors: S. Pathak, R. Lazarus

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A 25-year-old male HIV patient (CD4 cells 20/µL and HIV viral load 14200000 copies/ml) with a past medical history of duodenal ulcer, pneumocystis carinii pneumonia, oesophageal candidiasis presented with fever and a seizure to hospital. The only recent travel had been a religious pilgrimage from Singapore to Malaysia 5 days prior; during the trip he sustained skin abrasions. The patient had recently started highly active antiretroviral therapy 2 months prior. Clinical examination was unremarkable other than a temperature of 38.8°C and perianal warts. Laboratory tests showed a leukocyte count 12.5x109 cells/L, haemoglobin 9.4 g/dL, normal biochemistry and a C-reactive protein 121 mg/L. CT head and MRI head were unremarkable and cerebrospinal fluid analysis performed after a delay (due to technical difficulties) of 11 days was unremarkable. Blood cultures (three sets) taken on admission showed Gram-negative rods in the anaerobic bottles only at the end of incubation with culture result confirmed by molecular sequencing showing Helicobacter cinaedi. The patient was treated empirically with ceftriaxone for seven days and this was converted to oral co-amoxiclav for a further seven days after the blood cultures became positive. A Transthoracic echocardiogram was unremarkable. The patient made a full recovery. Helicobacter cinaedi is a gram-negative anaerobic fastidious organism affecting patients with comorbidity. Infection may manifest as cellulitius, colitis or as in this case as bloodstream infection – the latter is often attributed to faeco-oral infection. Laboratory identification requires prolonged culture. Therapeutic options may be limited by resistance to macrolides and fluoroquinolones. The likely pathogen inoculation routes in the case described include gastrointestinal translocation due to proctitis at the site of perianal warts, or breach of the skin via abrasions occurring during the pilgrimage. Such organisms are increasing in prevalence as our patient population ages and patients have multiple comorbidities including HIV. It may be necessary in patients with unexplained fever to prolong incubation of sterile sites including blood in order to identify this unusual fastidious organism.

Keywords: fastidious, Helicobacter cinaedi, HIV, immunocompromised

Procedia PDF Downloads 358

Authors: Chang Yu Chuan

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Background and Aim: Pressure sore is not only the consequence of any gradual damage of the skin leading to tissue defects but also an important indicator of clinical care. If hospitalized patients develop pressure sores without proper care, it would result in delayed healing, wound infection, increase patient physical pain, prolonged hospital stay and even death, which would have a negative impact on the quality of care and also increase nursing manpower and medical costs. This project is aimed at decreasing the incidence of pressure sore in one ward of internal medicine. Our data showed 53 cases (0.61%) of pressure sore in 2015, which exceeded the average (0.5%) of Taiwan Clinical Performance Indicator (TCPI) for medical centers. The purpose of this project is to reduce the incidence rate of pressure sore in the ward. After data collection and analysis from January to December 2016, the reasons of developing pressure sore were found: 1. Lack of knowledge to prevent pressure among nursing staffs; 2. No relevant courses about preventing pressure ulcers and pressure wound care being held in this unit; 3. Low complete rate of pressure sore care education that family members should receive from nursing staffs; 4. Decompression equipment is not enough; 5. Lack of standard procedures for body-turning and positioning care. After team members brainstorming, several strategies were proposed, including holding in-service education, pressure sore care seed training, purchasing decompression mattress and memory pillows, designing more elements of health education tools, such as health education pamphlet, posters and multimedia films of body-turning and positioning demonstration, formulation and promotion of standard operating procedures. In this way, nursing staffs can understand the body-turning and positioning guidelines for pressure sore prevention and enhance the quality of care. After the implementation of this project, the pressure sore density significantly decreased from 0.61%(53 cases) to 0.45%(28 cases) in this ward. The project shows good results and good example for nurses working at the ward and helps to enhance quality of care.

Keywords: body-turning and positioning, incidence density, nursing, pressure sore

Procedia PDF Downloads 246

Authors: Faizah Asiri, Mohammed Fathy, Saeed Alghamdi, Nahlah Ayoub, Faisal Asiri

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Background: - The strategies for this study were based on the toxic effect of long-term inhalation of Benzene on hormones and liver enzymes and various parameters related to it. The following databases were searched: benzene, hepatotoxic, benzene metabolism, hormones, testosterone, hemotoxic, and prolonged exposure. A systematic strategy is designed to search the literature that links benzene with the multiplicity and different types of intoxication or the medical abbreviations of diseases relevant to benzene exposure. Evidence suggests that getting rid of inhaled gasoline is by exhalation. Absorbed benzene is metabolized by giving phenolic acid as well as meconic acid, followed by urinary excretion of conjugate sulfates and glucuronides. Materials and Methods :- This work was conducted in the Al-Khadra laboratory in Taif 2020/2021 and aimed to measure some of the possible endocrinal and liver toxicities associated with benzene's long-term exposure in Saudi Arabia at the station workers who are considered the most exposed category to gasoline. One hundred ten station workers were included in this study. They were divided into four patient groups according to the chronic exposure rate to benzene, one control group, and three other groups of exposures. As follows: patient Group 1 (controlled group), patient Group 2 (exposed less than 1y), patient Group 3 (exposed 1-5 y), patient Group 4 (more than 5). Each group is compared with blood sample parameters (ALT, FSH and Testosterone, TSH). Blood samples were drawn from the participants, and statistical tests were performed. Significant change (p≤0.05) was examined compared to the control group. Workers' exposure to benzene led to a significant change in hematological, hormonal, and hepatic factors compared to the control group. Results:- The results obtained a relationship between long-term exposure to benzene and a decrease in the level of testosterone and FSH hormones, including that it poses a toxic risk in the long term (p≤0.05) when compared to the control. We obtained results confirming that there is no significant coloration between years of exposure and TSH level (p≤0.05) when compared to the control. Conclusion:- We conclude that some hormones and liver enzymes are affected by chronic doses of benzene through inhalation after our study was on the group most exposed to benzene, which is gas station workers.

Keywords: toxicities, benzene, hormones, station workers

Procedia PDF Downloads 63

Authors: Desalegn Feyissa Desu

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Drug therapy problem is a significant challenge to provide high quality health care service for the patients. It is associated with morbidity, mortality, increased hospital stay, and reduced quality of life. Moreover, pediatric patients are quite susceptible to drug therapy problems. Thus this study aimed to assess drug therapy problem and its contributing factors among pediatric patients diagnosed with infectious disease admitted to pediatric ward of Jimma university medical center, from April 1 to June 30, 2018. Prospective observational study was conducted among pediatric patients with infectious disease admitted from April 01 to June 30, 2018. Drug therapy problems were identified by using Cipolle’s and strand’s drug related problem classification method. Patient’s written informed consent was obtained after explaining the purpose of the study. Patient’s specific data were collected using structured questionnaire. Data were entered into Epi data version 4.0.2 and then exported to statistical software package version 21.0 for analysis. To identify predictors of drug therapy problems occurrence, multiple stepwise backward logistic regression analysis was done. The 95% CI was used to show the accuracy of data analysis and statistical significance was considered at p-value < 0.05. A total of 304 pediatric patients were included in the study. Of these, 226(74.3%) patients had at least one drug therapy problem during their hospital stay. A total of 356 drug therapy problems were identified among two hundred twenty six patients. Non-compliance (28.65%) and dose too low (27.53%) were the most common type of drug related problems while disease comorbidity [AOR=3.39, 95% CI= (1.89-6.08)], Polypharmacy [AOR=3.16, 95% CI= (1.61-6.20)] and more than six days stay in hospital [AOR=3.37, 95% CI= (1.71-6.64) were independent predictors of drug therapy problem occurrence. Drug therapy problems were common in pediatric patients with infectious disease in the study area. Presence of comorbidity, polypharmacy and prolonged hospital stay were the predictors of drug therapy problem in study area. Therefore, to overcome the significant gaps in pediatric pharmaceutical care, clinical pharmacists, Pediatricians, and other health care professionals have to work in collaboration.

Keywords: drug therapy problem, pediatric, infectious disease, Ethiopia

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Authors: Larry O. Awo, George N. Duru

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There are growing public and mental health concerns over the availability of gambling platforms and shops in Nigeria and the high level of youth involvement in gambling. Early theorizing maintained that gambling involvement was driven by a quest for resource gains. However, evidence shows that the economic model of gambling tends to explain the involvement of the gambling business owners (sport lottery operators: SLOs) as most gamblers lose more than they win. This loss, according to the law of effect, ought to discourage decisions to gamble. However, the quest to recover losses has often initiated prolonged gambling sessions. Therefore, the need to investigate mental contemplations (such as counterfactual reasoning (upward versus downward) of what “would, should, or could” have been, and feeling of the illusion of control; IOC) over gambling outcomes as risk or protective factors in gambling decisions became pertinent. The present study sought to understand the differential contributions and conditional effects of upward versus downward counterfactual reasoning as pathways through which the association between IOC and gambling decisions of Nigerian youths (N = 120, mean age = 18.05, SD = 3.81) could be explained. The study adopted a randomized group design, and data were obtained by means of stimulus material (the Gambling Episode; GE) and self-report measures of IOC and Gambling Decision. One-way analysis of variance (ANOVA) result showed that participants in the upward counterfactual reasoning group (M = 22.08) differed from their colleagues in the downward counterfactual reasoning group (M = 17.33) on the decision to gamble, and this difference was significant [F(1,112) = 23, P < .01]. HAYES PROCESS macro moderation analysis results showed that 1) IOC and upward counterfactual reasoning were positively associated with the decision to gamble (B = 14.21, t = 6.10, p < .01 and B = 7.22, t = 2.07, p <.05, respectively), 2) downward counterfactual reasoning was negatively associated with the decision to gamble more to recover losses (B = 10.03, t = 3.21, p < .01), 3) upward counterfactual reasoning did not moderate the association between IOC and gambling decision (p > .05), and 4) downward counterfactual reasoning negatively moderated the association between IOC and gambling decision (B = 07, t = 2.18, p < .05) such that the association was strong at the low level of downward counterfactual, but wane at high levels of downward counterfactual reasoning. The implication of these findings is that IOC and upward counterfactual reasoning were risk factors and promoted gambling behavior, while downward counterfactual reasoning protects individuals from gambling activities. Thus, it is concluded that downward counterfactual reasoning strategies should be included in gambling therapy and treatment packages as it could diminish feelings of both IOC and negative feelings of missed positive outcomes and the urge to gamble.

Keywords: counterfactual reasoning, gambling cognition, gambling decision, Nigeria, youths

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Authors: Ali Baker, Russel Krawitz

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This paper describes a rare occurrence where a potentially fatal complication of COVID-19 infection (MIS-A) was misdiagnosed as an acute abdomen. As most patients with this syndrome present with fever and gastrointestinal symptoms, they may inadvertently fall under the care of the surgical unit. However, unusual imaging findings and a poor response to anti-microbial therapy should prompt clinicians to suspect a non-surgical etiology. More than half of MIS-A patients require ICU admission and vasopressor support. Prompt referral to a physician is key, as the cornerstone of treatment is IVIG and corticosteroid therapy. A 32 year old woman presented with right sided abdominal pain and fevers. She had also contracted COVID-19 two months earlier. Abdominal examination revealed generalised right sided tenderness. The patient had raised inflammatory markers, but other blood tests were unremarkable. CT scan revealed extensive lymphadenopathy along the ileocolic chain. The patient proved to be a diagnostic dilemma. She was reviewed by several surgical consultants and discussed with several inpatient teams. Although IV antibiotics were commenced, the right sided abdominal pain, and fevers persisted. Pan-culture returned negative. A mild cholestatic derangement developed. On day 5, the patient underwent preparation for colonoscopy to assess for a potential intraluminal etiology. The following day, the patient developed sinus tachycardia and hypotension that was refractory to fluid resuscitation. That patient was transferred to ICU and required vasopressor support. Repeat CT showed peri-portal edema and a thickened gallbladder wall. On re-examination, the patient was Murphy’s sign positive. Biliary ultrasound was equivocal for cholecystitis. The patient was planned for diagnostic laparoscopy. The following morning, a marked rise in cardiac troponin was discovered, and a follow-up echocardiogram revealed moderate to severe global systolic dysfunction. The impression was post-COVID MIS with myocardial involvement. IVIG and Methylprednisolone infusions were commenced. The patient had a great response. Vasopressor support was weaned, and the patient was discharged from ICU. The patient continued to improve clinically with oral prednisolone, and was discharged on day 17. Although MIS following COVID-19 infection is well-described syndrome in children, only recently has it come to light that it can occur in adults. The exact incidence is unknown, but it is thought to be rare. A recent systematic review found only 221 cases of MIS-A, which could be included for analysis. Symptoms vary, but the most frequent include fever, gastrointestinal, and mucocutaneous. Many patients progress to multi-organ failure and require vasopressor support. 7% succumb to the illness. The pathophysiology of MIS is only partly understood. It shares similarities with Kawasaki disease, macrophage activation syndrome, and cytokine release syndrome. Importantly, by definition, the patient must have an absence of severe respiratory symptoms. It is thought to be due to a dysregulated immune response to the virus. Potential mechanisms include reduced levels of neutralising antibodies and autoreactive antibodies that promote inflammation. Further research into MIS-A is needed. Although rare, this potentially fatal syndrome should be considered in the unwell surgical patient who has recently contracted COVID-19 and poses a diagnostic dilemma.

Keywords: acute-abdomen, MIS, COVID-19, ICU

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Authors: Arulselvi Subramanian, Albert Venencia, Sanjeev Bhoi

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Coagulopathy of trauma is an early endogenous coagulation abnormality that occurs shortly resulting in high mortality. In emergency trauma situations, viscoelastic tests may be better in identifying the various phenotypes of coagulopathy and demonstrate the contribution of platelet function to coagulation. We aimed to determine thrombin generation and clot strength, by estimating a ratio of Maximum amplitude and R-time (MA-R ratio) for identifying trauma coagulopathy and predicting subsequent mortality. Methods: We conducted a prospective cohort analysis of acutely injured trauma patients of the adult age groups (18- 50 years), admitted within 24hrs of injury, for one year at a Level I trauma center and followed up on 3rd day and 5th day of injury. Patients with h/o coagulation abnormalities, liver disease, renal impairment, with h/o intake of drugs were excluded. Thromboelastography was done and a ratio was calculated by dividing the MA by the R-time (MA-R). Patients were further stratified into sub groups based on the calculated MA-R quartiles. First sampling was done within 24 hours of injury; follow up on 3rd and 5thday of injury. Mortality was the primary outcome. Results: 100 acutely injured patients [average, 36.6±14.3 years; 94% male; injury severity score 12.2(9-32)] were included in the study. Median (min-max) on admission MA-R ratio was 15.01(0.4-88.4) which declined 11.7(2.2-61.8) on day three and slightly rose on day 5 13.1(0.06-68). There were no significant differences between sub groups in regard to age, or gender. In the lowest MA-R ratios subgroup; MA-R1 (<8.90; n = 27), injury severity score was significantly elevated. MA-R2 (8.91-15.0; n = 23), MA-R3 (15.01-19.30; n = 24) and MA-R4 (>19.3; n = 26) had no difference between their admission laboratory investigations, however slight decline was observed in hemoglobin, red blood cell count and platelet counts compared to the other subgroups. Also significantly prolonged R time, shortened alpha angle and MA were seen in MA-R1. Elevated incidence of mortality also significantly correlated with on admission low MA-R ratios (p 0.003). Temporal changes in the MA-R ratio did not correlated with mortality. Conclusion: The MA-R ratio provides a snapshot of early clot function, focusing specifically on thrombin burst and clot strength. In our observation, patients with the lowest MA-R time ratio (MA-R1) had significantly increased mortality compared with all other groups (45.5% MA-R1 compared with <25% in MA-R2 to MA-R3, and 9.1% in MA-R4; p < 0.003). Maximum amplitude and R-time may prove highly useful to predict at-risk patients early, when other physiologic indicators are absent.

Keywords: coagulopathy, trauma, thromboelastography, mortality

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Authors: Matheus Madureira Matos, Alexandre Rodrigues Farias

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Magnetic Resonance Imaging (MRI) is a vital imaging technique used in both clinical and pre-clinical areas to obtain detailed anatomical and functional information. However, MRI scans can be expensive, time-consuming, and often require the use of anesthetics to keep animals still during the imaging process. Anesthetics are commonly administered to animals undergoing MRI scans to ensure they remain still during the imaging process. However, prolonged or repeated exposure to anesthetics can have adverse effects on animals, including physiological alterations and potential toxicity. Minimizing the duration and frequency of anesthesia is, therefore, crucial for the well-being of research animals. In recent years, various sampling trajectories have been investigated to reduce the number of MRI measurements leading to shorter scanning time and minimizing the duration of animal exposure to the effects of anesthetics. Compressed sensing (CS) and sampling trajectories, such as cartesian, spiral, and radial, have emerged as powerful tools to reduce MRI data while preserving diagnostic quality. This work aims to apply CS and cartesian, spiral, and radial sampling trajectories for the reconstruction of MRI of the abdomen of mice sub-sampled at levels below that defined by the Nyquist theorem. The methodology of this work consists of using a fully sampled reference MRI of a female model C57B1/6 mouse acquired experimentally in a 4.7 Tesla MRI scanner for small animals using Spin Echo pulse sequences. The image is down-sampled by cartesian, radial, and spiral sampling paths and then reconstructed by CS. The quality of the reconstructed images is objectively assessed by three quality assessment techniques RMSE (Root mean square error), PSNR (Peak to Signal Noise Ratio), and SSIM (Structural similarity index measure). The utilization of optimized sampling trajectories and CS technique has demonstrated the potential for a significant reduction of up to 70% of image data acquisition. This result translates into shorter scan times, minimizing the duration and frequency of anesthesia administration and reducing the potential risks associated with it.

Keywords: compressed sensing, magnetic resonance, sampling trajectories, small animals

Procedia PDF Downloads 45

Authors: Jhiamluka Zservando Solano Velasquez, Raul Palma, Alejandro Calderon, Servio Paguada, Erick Marin, Kellyn Funes, Hana Sandoval, Oscar Hernandez

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Background: Screening cardiac conditions in primary care in developing countries can be challenging, and Honduras is not the exception. One of the main limitations is the underfunding of the Healthcare System in general, causing conventional ECG acquisition to become a secondary priority. Objective: Development of a low-cost ECG to improve screening of arrhythmias in primary care and communication with a specialist in secondary and tertiary care. Methods: Design a portable, pocket-size low-cost 3 lead ECG (Handy EKG). The device is autonomous and has Wi-Fi/Bluetooth connectivity options. A mobile app was designed which can access online servers with machine learning, a subset of artificial intelligence to learn from the data and aid clinicians in their interpretation of readings. Additionally, the device would use the online servers to transfer patient’s data and readings to a specialist in secondary and tertiary care. 50 randomized patients volunteer to participate to test the device. The patients had no previous cardiac-related conditions, and readings were taken. One reading was performed with the conventional ECG and 3 readings with the Handy EKG using different lead positions. This project was possible thanks to the funding provided by the National Autonomous University of Honduras. Results: Preliminary results show that the Handy EKG performs readings of the cardiac activity similar to those of a conventional electrocardiograph in lead I, II, and III depending on the position of the leads at a lower cost. The wave and segment duration, amplitude, and morphology of the readings were similar to the conventional ECG, and interpretation was possible to conclude whether there was an arrhythmia or not. Two cases of prolonged PR segment were found in both ECG device readings. Conclusion: Using a Frugal innovation approach can allow lower income countries to develop innovative medical devices such as the Handy EKG to fulfill unmet needs at lower prices without compromising effectiveness, safety, and quality. The Handy EKG provides a solution for primary care screening at a much lower cost and allows for convenient storage of the readings in online servers where clinical data of patients can then be accessed remotely by Cardiology specialists.

Keywords: low-cost hardware, portable electrocardiograph, prototype, remote healthcare

Procedia PDF Downloads 153

Authors: E. Ghoneim, C. Narron, I. Iqbal, I. Hassan, E. Hammam

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The scarcity of water is becoming a more prominent threat, especially in areas that are already arid in nature. Although the Kingdom of Saudi Arabia (KSA) is an arid country, its southwestern region offers a high variety of botanical landscapes, many of which are wooded forests, while the eastern and northern regions offer large areas of groundwater irrigated farmlands. At present, some parts of KSA, including forests and farmlands, have witnessed protracted and severe drought due to change in rainfall pattern as a result of global climate change. Such prolonged drought that last for several consecutive years is expected to cause deterioration of forested and pastured lands as well as cause crop failure in the KSA (e.g., wheat yield). An analysis to determine vegetation drought vulnerability and severity during the growing season (September-April) over a fourteen year period (2000-2014) in KSA was conducted using MODIS Terra imagery. The Vegetation Condition Index (VCI), derived from the Normalized Difference Vegetation Index (NDVI), and the Temperature Condition Index (TCI), derived from the Land Surface Temperature (LST) data was extracted from MODIS Terra Images. The VCI and TCI were then combined to compute the Vegetation Health Index (VHI). The VHI revealed the overall vegetation health for the area under investigation. A preliminary outcome of the modeled VHI over KSA, using averaged monthly vegetation data over a 14-year period, revealed that the vegetation health condition is deteriorating over time in both naturally vegetated areas and irrigated farmlands. The derived drought map for KSA indicates that both extreme and severe drought occurrences have considerably increased over the same study period. Moreover, based on the cumulative average of drought frequency in each governorate of KSA it was determined that Makkah and Jizan governorates to the east and southwest, witness the most frequency of extreme drought, whereas Tabuk to the northwest, exhibits the less extreme drought frequency. Areas where drought is extreme or severe would most likely have negative influences on agriculture, ecosystems, tourism, and even human welfare. With the drought risk map the kingdom could make informed land management decisions including were to continue with agricultural endeavors and protect forested areas and even where to develop new settlements.

Keywords: drought, vegetation health condition, TCI, Saudi Arabia

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Authors: Getahun Nigusie Demise

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Background; antiretroviral treatment reduce HIV-related morbidity, and prolonged survival of patients however, there is lack of up-to-date information concerning the treatment long term effect on the survival of HIV positive children especially in the study area. Objective: The aim of this study is to assess the incidence and predictors of mortality among HIV positive children on antiretroviral therapy (ART) in public hospitals of Harer town who were enrolled from 2011 to 2021. Methodology: Institution based retrospective cohort study was conducted among 429 HIV positive children enrolled in ART clinic from January 1st 2011 to December30th 2021. Data were collected from medical cards by using a data extraction form, Descriptive analyses were used to Summarized the results, and life table was used to estimate survival probability at specific point of time after introduction of ART. Kaplan Meier survival curve together with log rank test was used to compare survival between different categories of covariates, and Multivariate Cox-proportional hazard regression model was used to estimate adjusted Hazard rate. Variables with p-values ≤0.25 in bivariable analysis were candidates to the multivariable analysis. Finally, variables with p-values < 0.05 were considered as significant variables. Results: The study participants had followed for a total of 2549.6 child-years (30596 child months) with an overall mortality rate of 1.5 (95% CI: 1.1, 2.04) per 100 child-years. Their median survival time was 112 months (95% CI: 101–117). There were 38 children with unknown outcome, 39 deaths, and 55 children transfer out to different facility. The overall survival at 6, 12, 24, 48 months were 98%, 96%, 95%, 94% respectively. being in WHO clinical Stage four (AHR=4.55, 95% CI:1.36, 15.24), having anemia(AHR=2.56, 95% CI:1.11, 5.93), baseline low absolute CD4 count (AHR=2.95, 95% CI: 1.22, 7.12), stunting (AHR=4.1, 95% CI: 1.11, 15.42), wasting (AHR=4.93, 95% CI: 1.31, 18.76), poor adherence to treatment (AHR=3.37, 95% CI: 1.25, 9.11), having TB infection at enrollment (AHR=3.26, 95% CI: 1.25, 8.49),and no history of change their regimen(AHR=7.1, 95% CI: 2.74, 18.24), were independent predictors of death. Conclusion: more than half of death occurs within 2 years. Prevalent tuberculosis, anemia, wasting, and stunting nutritional status, socioeconomic factors, and baseline opportunistic infection were independent predictors of death. Increasing early screening and managing those predictors are required.

Keywords: human immunodeficiency virus-positive children, anti-retroviral therapy, survival, treatment, Ethiopia

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Authors: Anna Tokajuk, Agnieszka Zakrzeska, Ewa Chabielska, Halina Car

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Whey is a by-product generated mainly in the production of cheese and casein. Powder forms of whey are used widely in the food industry as well as a high-protein food for infants, for convalescents, by athletes and especially by bodybuilders to increase muscle mass during exercise. Whey protein concentrate-80 (WPC-80) is a source of bioactive peptides with beneficial effects on the cardiovascular system. It is known that whey proteins health beneficial properties include antidiabetic, blood pressure lowering, improving cardiovascular system function, antibacterial, antiviral and other effects. To study its influence on the development of thrombosis, venous thrombosis model was performed according to the protocol featured by Reyers with modification by Chabielska and Gromotowicz. Male Wistar-Crl: WI (Han) rats from researched groups were supplemented with two doses of WPC-80 (0.3 or 0.5 g/kg) for 7, 14 or 21 days and after these periods, one-hour venous thrombosis model was performed. Control group received 0.9 % NaCl solution and was sham operated. The statistical significance of results was computed by Mann – Whitney’s test. We observed that thrombus weight was decreased in animals obtaining WPC-8080 and that was statistically significant in 14 and 21-day supplemented groups. Blood count parameters did not differ significantly in rats with and without thrombosis induction whether they were fed with WPC-80 or not. Moreover, the number of platelets (PLT) was within the normal range in each group. The examined coagulation parameters in rats of the control groups were within normal limits. After WPC-80 supplementation there was the tendency to prolonged activated partial thromboplastin time (aPTT), but in comparison, the results did not turn out significant. In animals that received WPC-80 0.3 g·kg-1 for 21 days with and without induced thrombosis, prothrombin time (PT) and an international normalized ratio (INR) was somewhat decreased, remaining within the normal range, but the nature and significance of this observation are beyond the framework of the current study. Additionally, fibrinogen and thrombin time (TT) did not differ significantly between groups. Therefore the exact effect of WPC-80 on coagulation system is still elusive and requires further thorough research including mechanisms of action. Determining the potential clinical application of WPC-80 requires the selection of the optimal dose and duration of supplementation.

Keywords: antithrombotic, rats, venous thrombosis, WPC-80

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Authors: M. Y. Maila, H. P. Makhubele

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Roasting is one of the oldest preservation method used in foods such as nuts and seeds. It is a process by which heat is applied to dry foodstuffs without the use of oil or water as a carrier. Groundnut seeds, also known as peanuts when sun dried or roasted, are among the oldest oil crops that are mostly consumed as a snack, after roasting in many parts of South Africa. However, roasting can denature proteins, destroy amino acids, decrease nutritive value and induce undesirable chemical changes in the final product. The aim of this study, therefore, was to evaluate the effect of various roasting times on the food value of the runner groundnut seeds. A constant temperature of 160 °C and various time-intervals (20, 30, 40, 50 and 60 min) were used for roasting groundnut seeds in an oven. Roasted groundnut seeds were then cooled and milled to flour. The milled sundried, raw groundnuts served as reference. The proximate analysis (moisture, energy and crude fats) was performed and the results were determined using standard methods. The antioxidant content was determined using HPLC. Mineral (cobalt, chromium, silicon and iron) contents were determined by first digesting the ash of sundried and roasted seed samples in 3M Hydrochloric acid and then determined by Atomic Absorption Spectrometry. All results were subjected to ANOVA through SAS software. Relative to the reference, roasting time significantly (p ≤ 0.05) reduced moisture (71%–88%), energy (74%) and crude fat (5%–64%) of the runner groundnut seeds, whereas the antioxidant content was significantly (p ≤ 0.05) increased (35%–72%) with increasing roasting time. Similarly, the tested mineral contents of the roasted runner groundnut seeds were also significantly (p ≤ 0.05) reduced at all roasting times: cobalt (21%–83%), chromium (48%–106%) and silicon (58%–77%). However, the iron content was significantly (p ≤ 0.05) unaffected. Generally, the tested runner groundnut seeds had higher food value in the raw state than in the roasted state, except for the antioxidant content. Moisture is a critical factor affecting the shelf life, texture and flavor of the final product. Loss of moisture ensures prolonged shelf life, which contribute to the stability of the roasted peanuts. Also, increased antioxidant content in roasted groundnuts is essential in other health-promoting compounds. In conclusion, the overall reduction in the proximate and mineral contents of the runner groundnuts seeds due to roasting is sufficient to suggest influences of roasting time on the food value of the final product and shelf life.

Keywords: dry roasting, legume, oil source, peanuts

Procedia PDF Downloads 259

Authors: Kirill M. Dubovikov, Ekaterina S. Marchenko, Gulsharat A. Baigonakova

Abstract:

NiTi alloys are widely used as implants in medicine due to their unique properties such as superelasticity, shape memory effect and biocompatibility. However, despite these properties, one of the major problems is the release of nickel after prolonged use in the human body under dynamic stress. This occurs due to oxidation and cracking of NiTi implants, which provokes nickel segregation from the matrix to the surface and release into living tissues. As we know, nickel is a toxic element and can cause cancer, allergies, etc. One of the most popular ways to solve this problem is to create a corrosion resistant coating on NiTi. There are many coatings of this type, but not all of them have good biocompatibility, which is very important for medical implants. Coatings based on calcium phosphate phases have excellent biocompatibility because Ca and P are the main constituents of the mineral part of human bone. This fact suggests that a Ca-P coating on NiTi can enhance osteogenesis and accelerate the healing process. Therefore, the aim of this study is to investigate the structure of Ca-P coating on NiTi substrate. Plasma assisted radio frequency (RF) sputtering was used to obtain this film. This method was chosen because it allows the crystallinity and morphology of the Ca-P coating to be controlled by the sputtering parameters. It allows us to obtain three different NiTi samples with Ca-P coating. XRD, AFM, SEM and EDS were used to study the composition, structure and morphology of the coating phase. Scratch tests were carried out to evaluate the adhesion of the coating to the substrate. Wettability tests were used to investigate the hydrophilicity of the different coatings and to suggest which of them had better biocompatibility. XRD showed that the coatings of all samples were hydroxyapatite, but the matrix was represented by TiNi intermetallic compounds such as B2, Ti2Ni and Ni3Ti. The SEM shows that the densest and defect-free coating has only one sample after three hours of sputtering. Wettability tests show that the sample with the densest coating has the lowest contact angle of 40.2° and the largest free surface area of 57.17 mJ/m2, which is mostly disperse. A scratch test was carried out to investigate the adhesion of the coating to the surface and it was shown that all coatings were removed by a cohesive mechanism. However, at a load of 30N, the indenter reached the substrate in two out of three samples, except for the sample with the densest coating. It was concluded that the most promising sputtering mode was the third, which consisted of three hours of deposition. This mode produced a defect-free Ca-P coating with good wettability and adhesion.

Keywords: biocompatibility, calcium phosphate coating, NiTi alloy, radio frequency sputtering.

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