Search results for: clinical advice services

Authors: Luljeta Plakolli-Kasumi

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In the digital age, the relationship between traditional property rights and online intellectual property rights is becoming increasingly complex. On the one hand, the internet and advancements in technology have allowed for the widespread distribution and use of digital content, making it easier for individuals and businesses to access and share information. On the other hand, the rise of digital piracy and illegal file-sharing has led to increased concerns about the protection of intellectual property rights. This paper aims to examine the relationship between traditional property rights and online intellectual property rights in the digital age by analyzing the current legal frameworks, key challenges and controversies that arise, and potential solutions for addressing these issues. The paper will look at how traditional property rights concepts such as ownership and possession are being applied in the online context and how they intersect with new and evolving forms of intellectual property such as digital downloads, streaming services, and online content creation. It will also discuss the tension between the need for strong intellectual property protection to encourage creativity and innovation and the public interest in promoting access to information and knowledge. Ultimately, the paper will explore how the legal system can adapt to better balance the interests of property owners, creators, and users in the digital age.

Keywords: intellectual property, traditional property, digital age, digital content

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Authors: Amira Ben Rabeh, Faouzi Benzarti, Hamid Amiri, Mouna Bouaziz

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Alzheimer is a disease that affects the brain. It causes degeneration of nerve cells (neurons) and in particular cells involved in memory and intellectual functions. Early diagnosis of Alzheimer Diseases (AD) raises ethical questions, since there is, at present, no cure to offer to patients and medicines from therapeutic trials appear to slow the progression of the disease as moderate, accompanying side effects sometimes severe. In this context, analysis of medical images became, for clinical applications, an essential tool because it provides effective assistance both at diagnosis therapeutic follow-up. Computer Assisted Diagnostic systems (CAD) is one of the possible solutions to efficiently manage these images. In our work; we proposed an application to detect Alzheimer’s diseases. For detecting the disease in early stage we used the three sections: frontal to extract the Hippocampus (H), Sagittal to analysis the Corpus Callosum (CC) and axial to work with the variation features of the Cortex(C). Our method of classification is based on Support Vector Machine (SVM). The proposed system yields a 90.66% accuracy in the early diagnosis of the AD.

Keywords: Alzheimer Diseases (AD), Computer Assisted Diagnostic(CAD), hippocampus, Corpus Callosum (CC), cortex, Support Vector Machine (SVM)

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Authors: Saurav Dhawan, Sanchit Bansal

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Background T-MACS is a computer-based decision aid that ‘rules in’ and ‘rules out’ ACS using a combination of the presence or absence of six clinical features with only one biomarker measured on arrival: hs-cTnT. T-MACS had 99.3% negative predictive value and 98.7% sensitivity for ACS, ‘ruling out’ ACS in 40% of patients while ‘ruling in’ 5% at the highest risk. We aim at benchmarking the use of T-MACS which could help to conserve healthcare resources, facilitate early discharges, and ensure safe practice. Methodology Randomized retrospective data collection (n=300) was done from ED electronic records across 3 hospital sites within MFT over a period of 2 months. Data was analysed and compared by percentage for the usage of T-MACS, number of admissions/discharges, and in days for length of stay in hospital. Results MRI A&E had the maximum compliance with the use of T-MACS in the trust at 66%, with minimum admissions (44%) and an average length of stay of 1.825 days. NMG A&E had an extremely low compliance rate (8 %), with 75% admission and 3.387 days as the average length of stay. WYT A&E had no TMACS recorded, with a maximum of 79% admissions and the longest average length of stay at 5.07 days. Conclusion All three hospital sites had a RAG rating of ‘RED’ as per the compliance levels. The assurance level was calculated as ‘Very Limited’ across all sites. There was a positive correlation observed between compliance with TMACS and direct discharges from ED, thereby reducing the average length of stay for patients in the hospital.

Keywords: ACS, discharges, ED, T-MACS

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Authors: Yen-Ting Chiu, Chia-Ying Lin, Pei-Hsuan Ho

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New technologies can help solve the problem of labor shortage and the decline of birthrate. Technologies can improve human’s life and reduce the burden on the staff and bring convenience to people. That’s why unmanned retail store X-Store was established in Taiwan to create more valuable services and shopping experiences based on smart retailing. The purpose of this study is to examine the impact of unmanned stores, X-Store, on customers’ behavioral intentions. It uses the Unified theory of acceptance and use of technology (UTAUT) model as a basis and adds a perceived value factor to explain customer willingness to use the X-Store. In addition, the study further divided the sample into gender and age groups to compare behavioral differences between different groups. The study collected 214 valid questionnaires through online questionnaires. Using SPSS as a statistical analysis tool, the results of the study show that effort expectancy, social influence, facilitating conditions, and perceived value have a significant impact on behavioral intention to use X-Store. However, performance expectancy is not significant. This research concludes with managerial implications and suggestions for retail practitioners.

Keywords: perceived value, smart retailing, unmanned store, UTAUT, X-Store

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Authors: Jin-Ming Wu, Te-Wei Ho, Yu-Wen Tien

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Background: The aim of this population-based study was to determine the occurrence of diabetes and exocrine pancreatic insufficiencies (EPI) on non-diabetes subjects receiving distal pancreatectomy (DP). Method: A nationwide cohort study between 2000 and 2010 was collected from the Taiwan National Health Insurance Research Database. Among 3264 DP patients, we identified 1410 non-diabetes and 966 non-diabetes non-EPI. Results. Of 1410 non-diabetes DP subjects, 312 patients (22.1%) developed newly-diagnosed diabetes after PD. On a multiple logistic regression model, co-morbid hyperlipidemia (odds ratio, 1.640; 95% CI, 1.362–2.763; P < 0.001) and pancreatitis (odds ratio, 2.428; 95% CI, 1.889–3.121; P < 0.001) significantly contributed to higher incidences of diabetes after DP. Moreover, 380 subjects (39.3%) developed EPI, and pancreatic cancer is the statistically significant risk factor (odds ratio, 4.663; 95% CI, 2.108–6.085; P < 0.001). Conclusion: The patients with co-morbid hyperlipidemia and chronic pancreatitis had higher rates of newly-diagnosed diabetes after DP, moreover, pancreatic cancer subjects had higher rates of pancreatic exocrine insufficiency after DP. The clinicians should be alert to follow up glucose metabolism and clinical symptoms of fat intolerance for DP patients.

Keywords: distal pancreatectomy, National database, diabetes, exocrine insufficiency

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Authors: Ghoul Rachid Brahim

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Introduction: Tuberculous spondylodiscitis is an infection of the spine by Mycobacterium tuberculosis. Tuberculous spondylodiscitis still remains a topical disease in developing countries and continues to pose a public health problem in endemic countries. Materials and methods: Clinical case: This is a 12-year-old child followed in pediatrics for weight loss and progressively worsening low back pain. The neurological examination found an irritative pyramidal syndrome in both lower limbs with a severe lumbar spinal syndrome. The radiological assessment: (Rx of the spine supplemented by CT and MRI) shows L1L2 spondylodiscitis. Treatment: The child is put on anti-tuberculosis treatment, and the spine is restrained with a corset. Control MRI shows a worsening of the dorsal kyphosis with a backward movement of the posterior wall and spinal cord compression. The child is operated on via the posterior approach (the operative procedure consists of an L1 laminectomy and D11 L3 osteosynthesis). Results: Spinal cord décompression and stabilization of the spine. Conclusion: Tuberculous spondylodiscitis in children remains a rare, aggressive, and progressive condition. The prognosis depends on the diagnosis's precocity and the therapeutic management quality.

Keywords: tuberculous spondylodiscitis, mycobacterium tuberculosis, laminectomy, MRI

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Authors: Charles Shang, Salina Ramirez, Stephen Shang, Maria Estrada, Timothy R. Williams

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Purpose: Over the past decade, proton therapy utilizing pencil beam scanning has emerged as a preferred treatment modality in radiation oncology, particularly for prostate cancer. This retrospective study aims to assess the clinical and radiobiological efficacy of proton scanning beam therapy in the treatment of localized salvage prostate cancer, following initial radiation therapy with a different modality. Despite the previously delivered high radiation doses, this investigation explores the potential of proton reirradiation in controlling recurrent prostate cancer and detrimental quality of life side effects. Methods and Materials: A retrospective analysis was conducted on 45 cases of locally recurrent prostate cancer that underwent salvage proton reirradiation. Patients were followed for 24.6 ± 13.1 months post-treatment. These patients had experienced an average remission of 8.5 ± 7.9 years after definitive radiotherapy for localized prostate cancer (n=41) or post-prostatectomy (n=4), followed by rising PSA levels. Recurrent disease was confirmed by FDG-PET (n=31), PSMA-PET (n=10), or positive local biopsy (n=4). Gross tumor volume (GTV) was delineated based on PET and MR imaging, with the planning target volume (PTV) expanding to an average of 10.9 cm³. Patients received proton reirradiation using two oblique coplanar beams, delivering total doses ranging from 30.06 to 60.00 GyE in 17–30 fractions. All treatments were administered using the ProBeam Compact system with CT image guidance. The International Prostate Symptom Scores (IPSS) and prostate-specific antigen (PSA) levels were evaluated to assess treatment-related toxicity and tumor control. Results and Discussions: In this cohort (mean age: 76.7 ± 7.3 years), 60% (27/45) of patients showed sustained reductions in PSA levels post-treatment, while 36% (16/45) experienced a PSA decline of more than 0.8 ng/mL. Additionally, 73% (33/45) of patients exhibited an initial PSA reduction, though some showed later PSA increases, indicating the potential presence of undetected metastatic lesions. The median post-retreatment IPSS score was 4, significantly lower than scores reported in other treatment studies. Overall, 69% of patients reported mild urinary symptoms, with 96% (43/45) experiencing mild to moderate symptoms. Three patients experienced grade I or II proctitis, while one patient reported grade III proctitis. These findings suggest that regional organs, including the urethra, bladder, and rectum, demonstrate significant radiobiological recovery from prior radiation exposure, enabling tolerance to additional proton scanning beam therapy. Conclusions: This retrospective analysis of 45 patients with recurrent localized prostate cancer treated with salvage proton reirradiation demonstrates favorable outcomes, with a median follow-up of two years. The post-retreatment IPSS scores were comparable to those reported in follow-up studies of initial radiation therapy treatments, indicating stable or improved urinary symptoms compared to the end of initial treatment. These results highlight the efficacy of proton scanning beam therapy in providing effective salvage treatment while minimizing adverse effects on critical organs. The findings also enhance the understanding of radiobiological responses to reirradiation and support proton therapy as a viable option for patients with recurrent localized prostate cancer following previous definitive radiation therapy.

Keywords: prostate salvage radiotherapy, proton therapy, biological radiation tolerance, radiobiology of organs

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Authors: Mohammad Obeidat

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In recent years, social media has revolutionized the way businesses market their products and services. Platforms such as Instagram, Facebook, YouTube, and TikTok have become powerful tools for reaching large audiences and engaging with consumers in real-time. These platforms allow businesses to create visually appealing content, interact with customers, and leverage user-generated content to enhance brand visibility and credibility. Recent statistics indicate that businesses that actively participate in social media marketing see improvements in brand visibility, customer engagement, and revenue generation. For example, several studies reveal that 70% of business-to-consumer marketers have gained customers through Facebook. This study aims to contribute to the academic literature on social media marketing and consumer behavior, specifically within the context of the fitness industry in the UAE. The findings will provide valuable insights for gym and fitness center managers, marketers, and social media strategists looking to enhance their engagement with potential customers. By understanding the impact of social media on purchasing decisions, businesses can tailor their marketing efforts to meet consumer expectations better and drive membership growth.

Keywords: social media, consumer behavior, digital native, influencer

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Authors: Vahid Nademi

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In response to widely used wearable medical devices equipped with a continuous glucose monitor (CGM) and insulin pump, the advanced control methods are still demanding to get the full benefit of these devices. Unlike costly clinical trials, implementing effective insulin-glucose control strategies can provide significant contributions to the patients suffering from chronic diseases such as diabetes. This study deals with a key role of two-layer insulin-glucose regulator based on model-predictive-control (MPC) scheme so that the patient’s predicted glucose profile is in compliance with the insulin level injected through insulin pump automatically. It is achieved by iterative optimization algorithm which is called an integrated perturbation analysis and sequential quadratic programming (IPA-SQP) solver for handling uncertainties due to unexpected variations in glucose-insulin values and body’s characteristics. The feasibility evaluation of the discussed control approach is also studied by means of numerical simulations of two case scenarios via measured data. The obtained results are presented to verify the superior and reliable performance of the proposed control scheme with no negative impact on patient safety.

Keywords: blood glucose monitoring, insulin pump, predictive control, optimization

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Authors: Agnieszka Misztal

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The popularity of the quality management system models continues to grow despite the transitional crisis in 2008. Their development is associated with the demands of the new requirements for entrepreneurs, such as risk analysis projects and more emphasis on supervision of outsourced processes. In parallel appropriate to focus attention on the selection of companies aspiring to quality management system. This is particularly important in the automotive supplier industry, where requirements transferred to the levels in the supply chain should be clear, transparent and fairly satisfied. The author has carried out series of researches aimed at finding the factors that allow for the effective implementation of the quality management system in automotive companies. The research was focused on four groups of companies: 1) manufacturing (parts and assemblies for the purpose of sale or for vehicle manufacturers), 2) service (repair and maintenance of the car), 3) services for the transport of goods or people, 4) commercial (auto parts and vehicles). Identified determinants were divided in two types of criteria into: internal and external, as well as: hard and soft. The article presents hard - technical factors that automotive company must meet in order to achieve the goal of the quality management system implementation.

Keywords: automotive industry, quality management system, automotive technology, automotive company

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Authors: Kailin K. Zhang, Anne W. Thompson

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Electronic learning for continuing professional education (CPE) and interprofessional education (IPE) in healthcare have been shown to improve learners’ satisfaction, attitudes, and performance. Yet, their impact on behavior change in healthcare professionals through continuing interprofessional education (CIPE) is less known. A scoping review of 32 articles from 2010 to 2020 was conducted using the Arksey and O’Malley framework across all healthcare settings. It focused on evaluating the effectiveness of CIPE on behavior change of healthcare professionals, as well as identifying course features of electronic CIPE programs facilitating behavior change. Eight different types of electronic learning methods, including online programs, tele-education, and social media, were identified as interventions. More than 35,542 healthcare professionals participated in the interventions. Electronic learning for CIPE led to positive behavior outcomes in 30 out of 32 studies, especially through a change in patient care practices. The most successful programs provided interactive and authentic learning experiences tailored to learners’ needs while promoting the direct application of what was learned in their clinical settings. Future research should include monitoring of sustained behavior changes and their resultant patient outcomes.

Keywords: behavior change, continuing interprofessional education, distance learning, electronic learning

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Authors: D. Suman, B. Nikitha, J. Sarvani, V. Archana

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Histological slides provide clinical diagnostic information about the subjects from the ancient times. Even with the advent of high resolution imaging cameras the image tend to have some background noise which makes the analysis complex. A study of the histological slides is done by using a nonlinear transfer function based image enhancement method. The method processes the raw, color images acquired from the biological microscope, which, in general, is associated with background noise. The images usually appearing blurred does not convey the intended information. In this regard, an enhancement method is proposed and implemented on 50 histological slides of human tissue by using nonlinear transfer function method. The histological image is converted into HSV color image. The luminance value of the image is enhanced (V component) because change in the H and S components could change the color balance between HSV components. The HSV image is divided into smaller blocks for carrying out the dynamic range compression by using a linear transformation function. Each pixel in the block is enhanced based on the contrast of the center pixel and its neighborhood. After the processing the V component, the HSV image is transformed into a colour image. The study has shown improvement of the characteristics of the image so that the significant details of the histological images were improved.

Keywords: HSV space, histology, enhancement, image

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Authors: Ahmad Javid Habib, Tetsuo Kidokoro

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There is an increasing demand for developing urban land to provide better living conditions for all citizens in Afghanistan. Most of the development will involve the acquisition of land. And the current land acquisition method practiced by central government is expropriation, which is a cash-based transaction method that imposes heavy fiscal burden on local municipalities and central government, and it does not protect ownership rights and social equity of landowners besides it relocates the urban poor to remote areas with limited access to jobs and public services. The questionnaire analysis, backed by observations of different case studies in countries where land readjustment is used as a collaborative land development tool indicates that the method plays a key role in valuing landowners’ rights, giving other community members and stakeholders the opportunity to collaboratively implement urban development projects. The practice of the method is reducing the heavy fiscal burden on the local and central governments and is a better option to deal with the current development challenges in Afghanistan.

Keywords: collaboration, land readjustment, master plan, expropriation

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Authors: Kazuhiro Tateda, Elisa Gonzalez, Shuhei Ito, Kirstin Heinrich, Kevin Sweetland, Pingping Zhang, Catia Ferreira, Michael Pride, Jennifer Moisi, Sharon Gray, Bennett Lee, Fred Angulo

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Clostridium difficile (C. difficile) is the most common cause of antibiotic-associated diarrhea and infectious diarrhea in healthcare settings. Japan has an aging population; the elderly are at increased risk of hospitalization, antibiotic use, and C. difficile infection (CDI). Little is known about the population-based incidence and disease burden of CDI in Japan although limited hospital-based studies have reported a lower incidence than the United States. To understand CDI disease burden in Japan, CLOUD (Clostridium difficile Infection Burden of Disease in Adults in Japan) was developed. CLOUD will derive population-based incidence estimates of the number of CDI cases per 100,000 population per year in Ota-ku (population 723,341), one of the districts in Tokyo, Japan. CLOUD will include approximately 14 of the 28 Ota-ku hospitals including Toho University Hospital, which is a 1,000 bed tertiary care teaching hospital. During the 12-month patient enrollment period, which is scheduled to begin in November 2018, Ota-ku residents > 50 years of age who are hospitalized at a participating hospital with diarrhea ( > 3 unformed stools (Bristol Stool Chart 5-7) in 24 hours) will be actively ascertained, consented, and enrolled by study surveillance staff. A stool specimen will be collected from enrolled patients and tested at a local reference laboratory (LSI Medience, Tokyo) using QUIK CHEK COMPLETE® (Abbott Laboratories). which simultaneously tests specimens for the presence of glutamate dehydrogenase (GDH) and C. difficile toxins A and B. A frozen stool specimen will also be sent to the Pfizer Laboratory (Pearl River, United States) for analysis using a two-step diagnostic testing algorithm that is based on detection of C. difficile strains/spores harboring toxin B gene by PCR followed by detection of free toxins (A and B) using a proprietary cell cytotoxicity neutralization assay (CCNA) developed by Pfizer. Positive specimens will be anaerobically cultured, and C. difficile isolates will be characterized by ribotyping and whole genomic sequencing. CDI patients enrolled in CLOUD will be contacted weekly for 90 days following diarrhea onset to describe clinical outcomes including recurrence, reinfection, and mortality, and patient reported economic, clinical and humanistic outcomes (e.g., health-related quality of life, worsening of comorbidities, and patient and caregiver work absenteeism). Studies will also be undertaken to fully characterize the catchment area to enable population-based estimates. The 12-month active ascertainment of CDI cases among hospitalized Ota-ku residents with diarrhea in CLOUD, and the characterization of the Ota-ku catchment area, including estimation of the proportion of all hospitalizations of Ota-ku residents that occur in the CLOUD-participating hospitals, will yield CDI population-based incidence estimates, which can be stratified by age groups, risk groups, and source (hospital-acquired or community-acquired). These incidence estimates will be extrapolated, following age standardization using national census data, to yield CDI disease burden estimates for Japan. CLOUD also serves as a model for studies in other countries that can use the CLOUD protocol to estimate CDI disease burden.

Keywords: Clostridium difficile, disease burden, epidemiology, study protocol

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Authors: Sabiha Sahin, Kursad Bora Carman, Coskun Yarar

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Introduction: Measuring the diameter of the optic nerve sheath is a noninvasive and easy to use imaging technique to predict intracranial pressure in children and adults. The aim was to measure the diameter of the optic nerve sheath in pediatric head trauma. Methods: The study group consisted of 40 children with healthy and 40 patients with head trauma. Transorbital sonographic measurement of the optic nerve sheath diameter was performed. Conclusion: The mean diameters of the optic nerve sheath of right and left eyes were 0.408 ± 0.064 mm and 0.417 ± 0.065 mm, respectively, in the trauma group. These results were higher in patients than in control group. There was a negative correlation between optic nerve sheath diameters and Glasgow Coma Scales in patients with head trauma (p < 0.05). There was a positive correlation between optic nerve sheath diameters and positive CT findings, systolic blood pressure in patients with head trauma. The clinical status of the patients at admission, blood pH and lactate level were related to the optic nerve sheath diameter. Conclusion: Measuring the diameter of the optic nerve sheath is not an invasive technique and can be easily used to predict increased intracranial pressure and to prevent secondary brain injury.

Keywords: head trauma, intracranial pressure, optic nerve, sonography

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Authors: Joaquim de Almeida Dultra, Daiana Cristina Pereira Santana, Fátima Karoline Alves Araújo Dultra, Liliane Akemi Kawano Shibasaki, Mariana Machado Mendes de Carvalho, Ieda Margarida Crusoé Rocha Rebello

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Defects originating from mandibular resections can cause significant functional impairment and facial disharmony, and they have complex rehabilitation. The aim of this report is to demonstrate the authors' experience facing challenging rehabilitation after mandibular resection in a patient with ameloblastoma. Clinical and surgical steps are described simultaneously, highlighting the adaptation of the final fixed prosthesis, reported in an unprecedented way in the literature. A 37-year-old male patient was seen after a sports accident, where a pathological fracture in the symphysis and left mandibular body was identified, where a large radiolucent lesion was found. The patient underwent resection, bone graft, distraction osteogenesis, rehabilitation with dental implants, prosthesis, and finally, orofacial harmonization, in an interval of six years. Rehabilitation should consider the patient's needs individually and should have as the main objective to provide similar aesthetics and function to that present before the disease. We also emphasize the importance of interdisciplinary work during the course of rehabilitation.

Keywords: ameloblastoma, mandibular reconstruction, distraction osteogenesis, dental implants. dental prosthesis, implant-supported, treatment outcome

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Authors: Ismial A. Raji, Blessing Egbezieme Oladejo, Babatunde Kasim Oladele

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The study investigated the influence of leadership succession and tenure on goal attainment in the University of Ibadan. Leadership styles, tenure politics, organization succession, leadership succession, goal attainment in terms of research, teaching and public services were considered. The study adopted a descriptive survey design. The population of the study was 250 consisting 90 academic staff, 100 Senior Non-Teaching Staff and 60 Junior Non-Teaching Staff. Questionnaire was the instrument used to collect data. The instrument reliability coefficient was 0.88. Data collected were analysed with descriptive statistics. The result revealed that a significant relationship exist between leadership succession, tenure and goal attainment (r= .648, 0.466 and 0.479p< .0.5) Also, There was no statistical significant interaction between the effects of leadership tenure and leadership succession on goal attainment, F (38, 131) = 1.356, p = .104. The main influence of the independent variables on goal attainment were significant at F (24, 131) = 1.682, p=.034 and F (26, 131) = 2.182, p=.002. The study concluded that leadership succession and tenure are key factors for goal attainment in the University of Ibadan. The study recommended that an effective leadership succession and tenure processes should be maintained and sustained by higher institutions of learning.

Keywords: leadership tenure, style, succession, institutional goal

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Authors: Sharlene Fernandes

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Literature has shed light on the challenges of mothers of children with ASD, one of which involves sacrificing their professional jobs to fulfill the demands of their caregiving roles. However, the voices of the mothers who pursue employment along with caregiving roles have been overlooked. This study aimed to address this issue by exploring the narratives of Employed Mothers of Children with Autism Spectrum Disorder using the Narrative approach to inquiry. Through the view of Feminist Standpoint Theory, this study attempted to understand the role of sociocultural and systemic factors in shaping the lives of mothers. By employing the theoretical lens of Ethics of Care, this study explored how mothers balance care with their employment responsibilities, which are expected to be balanced seamlessly. Through narrative interviews, the study addressed the mothers' narratives on navigating work and caregiving, delving into their interpretations regarding expectations of care. The study gained valuable insights into the nuanced dynamics of employment, caregiving, and gender roles among mothers of children with Autism in the Indian context, implicating the urgent need for organizational policies, enhanced support systems, better quality therapeutic services, and inclusive school developments.

Keywords: Autism Spectrum Disorder, Caregivers, Employed Mothers, India, Narratives

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Authors: Siti Nurma Hanim Hadie, Asma’ Hassan, Zul Izhar Ismail, Ahmad Fuad Abdul Rahim, Mohd. Zarawi Mat Nor, Hairul Nizam Ismail

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Anatomy is a medical subject, which contributes to high cognitive load during learning. Despite its complexity, anatomy remains as the most important basic sciences subject with high clinical relevancy. Although anatomy knowledge is required for safe practice, many medical students graduated without having sufficient knowledge. In fact, anatomy knowledge among the medical graduates was reported to be declining and this had led to various medico-legal problems. Applying cognitive load theory (CLT) in anatomy teaching particularly lecture would be able to address this issue since anatomy information is often perceived as cognitively challenging material. CLT identifies three types of loads which are intrinsic, extraneous and germane loads, which combine to form the total cognitive load. CLT describe that learning can only occur when the total cognitive load does not exceed human working memory capacity. Hence, managing these three types of loads with the aim of optimizing the working memory capacity would be beneficial to the students in learning anatomy and retaining the knowledge for future application.

Keywords: cognitive load theory, intrinsic load, extraneous load, germane load

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Authors: Cristiane C. B. Alves, Livia Eisler, Gustavo Mota, Kurt Faltin Jr., Cristina L. F. Ortolani

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The correct positioning of the brackets is essential for the success of orthodontic treatment. Indirect bracket placing technique has the main objective of eliminating the positioning errors, which commonly occur in the technique of direct system of brackets. The objective of this study is to demonstrate that the exact positioning of the brackets is of extreme relevance for the success of the treatment. The present work shows a case report of an adult female patient who attended the clinic with the complaint of being in orthodontic treatment for more than 5 years without noticing any progress. As a result of the intra-oral clinical examination and documentation analysis, a class III malocclusion, an anterior open bite, and absence of all third molars and first upper and lower bilateral premolars were observed. For the treatment, the indirect bonding technique with self-ligating ceramic braces was applied. The preparation of the trays was done after the intraoral digital scanning and printing of models with a 3D printer. Brackets were positioned virtually, using a specialized software. After twelve months of treatment, correction of the malocclusion was observed, as well as the closing of the anterior open bite. It is concluded that the adequate and precise positioning of brackets is necessary for a successful treatment.

Keywords: anterior open-bite, CAD/CAM, orthodontics, malocclusion, angle class III

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Authors: Dimas Tri Anantyo, Zsa-Zsa Ayu Laksmi, Adhie Nur Radityo, Arsita Eka Rini, Gatot Irawan Sarosa

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A six-point-two-magnitude earthquake rocked Mamuju District, West Sulawesi Province, Indonesia, on 15 January 2021, causing significant health issues for the affected community, particularly among vulnerable populations such as neonates and children. The aim of this study is to examine and describe the diseases diagnosed in the pediatric population in Mamuju 14 days after the earthquake. This study uses a prospective observational study of the pediatric population presenting at West Sulawesi Regional Hospital, Mamuju Regional Public Hospital, and Bhayangkara Hospital for the period of 14 days after the earthquake. Demographic and clinical information were recorded. One hundred and fifty-three children were admitted to the health center. Children younger than six years old were the highest proportion (78%). Out of 153 children, 82 of them were male (54%). The most frequently diagnosed disease during the first and second weeks after the earthquake was respiratory problems, followed by gastrointestinal problems that showed an increase in incidence in the second week. This study found that age has a correlation with frequent disease in children after an earthquake. Respiratory and gastrointestinal problems were found to be the most common diseases among the pediatric population in Mamuju after the earthquake.

Keywords: health outcomes, pediatric population, earthquake, Mamuju

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Authors: Maureen Gibney

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The examination of narrative in psychology has a long tradition, starting with psychoanalytic theory and embracing over time cognitive, social, and personality psychology, among others. Narrative use has been richly detailed as well in medicine, nursing, and social service. One aspect of narrative that has ready utility in higher education and in clinical work is the exploration of suffering and its meaning. Because it is such a densely examined topic, suffering provides a window into identity, sense of purpose, and views of humanity and of the divine. Storytelling analysis permits an exploration of a host of specific manifestations of suffering such as pain and illness, moral injury, and the impact of prolonged suffering on love and relationships. This presentation will review the origins and current understandings of narrative theory in general, and will draw from psychology, medicine, ethics, nursing, and social service in exploring the topic of suffering in particular. It is suggested that the use of narrative themes such as meaning making, agency and communion, generativity, and loss and redemption allows for a finely grained analysis of common and more atypical sources of suffering, their resolution, and the acceptance of their continuation when resolution is not possible. Such analysis, used in professional work and in higher education, can enrich one’s empathy and one’s sense of both the fragility and strength of everyday life.

Keywords: meaning making, narrative theory, suffering, teaching

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Authors: Kalin Ivanov, Stanislava Ivanova

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Actoprotectors are substances with hight performance enchasing potential and hight antioxidant activity. Most of these drugs have been developed in USSR for military medicine purposes. Based on their chemical composition actoprotectors could be classified into three categories: benzimidazole derivatives (ethomersol, bemitil); adamantane derivatives (bromantane), other chemical classes. First data for intake of actoprotectors from professional athletes is from 1980. The daily intake of actoprotectors demonstrate many benefits for athletes like: positive effect on the efficiency of physical work, antihypoxic effects, antioxidant effects, nootropic effects, rapid recovery. Since 1997, bromantane is considered as doping. This is a result of Summer Olympic Games in Athlanta (1996) when several Russian athletes tested positive for bramantane. Even the drug is safe for athletes health its use is considered as violation of anti- doping rules. More than 37 years bemetil has been used by professional athletes with no risk but currently it is included in WADA monitoring programme for 2018. Current perspectives are that most used actoprotectors would be considered as doping. Many clinical studies have confirmed that intake of bemitil and bromantan demonstrate positive influence on the physical work capacity but data for other actoprotectors like chlodantane, ademol, ethomersol is limited.

Keywords: actoprotector, sport, doping, bemitil

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Authors: Zakieh Rostamzadeh Khameneh, Nariman Sepehrvand, Khalkhali-Zahra Shirmohamadi

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Background: Although the hepatitis E virus mostly causes a self-limited disease in general population, the disease is more severe in pregnant women. Hepatitis E accounts for about 10% of pregnancy-associated deaths in southern Asia. Methods: 136 pregnant women who referred to urban health centers of Urmia for pursuing pregnancy-related health services were selected randomly and enrolled in a descriptive, cross-sectional study. Each subject was tested for the presence of anti-HEV IgG antibody using an enzyme-linked immunosorbent assay (ELISA, Dia.Pro). Results: The mean age among 136 pregnant women was 25.12±4.91 years old (range of 14-39 years). Only five cases (3.6%) among all 136 subjects were demonstrated to be seropositive for anti-HEV IgG using ELISA method. There was no significant difference between age (P=0.88), income level (P=0.19) of two seropositive and seronegative groups. All seropositive cases were from urban areas. Conclusion: The seroprevalence of anti-HEV IgG is low in the population of pregnant women in Urmia, Iran. Because of limited sample size in this study, we recommend to perform further studies with larger sample size in other regions of Iran in order to be able to systematically generalize the findings of studies to the population of Iranian pregnant women.

Keywords: pregnancy, hepatitis E, women, ELISA

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Authors: Joserra Díez, Ainhoa Meñika, Iñaki Sanz-Azkue, Arritokieta Ortuzar

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Biodiversity provides humans with a great range of ecosystemic services; it is therefore an indispensable resource and a legacy to coming generations. However, in the last decades, the increasing exploitation of the Planet has caused a great loss of biodiversity and its acquaintance has decreased remarkably; especially in urbanized areas, due to the decreasing attachment of humans to nature. Yet, the Primary Education curriculum primes the identification of flora and fauna to guarantee the knowledge of children on their surroundings, so that they care for the environment as well as for themselves. In order to produce effective didactic material that meets the needs of both teachers and pupils, it is fundamental to diagnose the current situation. In the present work, the knowledge on biodiversity of 3^rd cycle Primary Education students in Biscay (n=98) and its relation to the size of the town/city of their school is discussed. Two tests have been used with such aim: one for tree identification and the other one so that the students enumerated the species of trees and animals they knew. Results reveal that knowledge of students on tree identification is scarce regardless the size of the city/town and of their school. On the other hand, animal species are better known than tree species.

Keywords: biodiversity, population, tree identification, animal identification

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Authors: Elena Parmentier, Henrik Endeman

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Introduction: Large mediastinal masses often present with diagnostic and clinical challenges due to compression of the respiratory and hemodynamic system. We present a case of a mediastinal mass with symptomatic mechanical compression of the trachea, resulting in challenging airway management. Methods: We present a case of 66-year-old male, complaining of progressive dysphagia. Initial esophagogastroscopy revealed a stenosis secondary to external compression, biopsies were inconclusive. Additional CT scan showed a large mediastinal mass of unknown origin, situated between the vertebrae and esophagus. Symptoms progressed and patient developed dyspnea and stridor. A new CT showed quick growth of the mass with compression of the trachea, subglottic to just above the carina. A tracheal covered stent was successfully placed. Endobronchial ultrasound revealed a large irregular mass without tracheal invasion, biopsies were taken. 4 days after stent placement, the patients’ condition deteriorated with worsening of stridor, dyspnea and desaturation. Migration of the tracheal stent into the right main bronchus was seen on chest X ray, with obstruction of the left main bronchus and secondary atelectasis. Different methods have been described in the literature for tracheobronchial stent removal (surgical, endoscopic, fluoroscopyguided), our first choice in this case was flexible bronchoscopy. However, this revealed tracheal compression above the migrated stent and passage of the scope occurred impossible. Patient was admitted to the ICU, high-flow nasal oxygen therapy was started and the situation stabilized, giving time for extensive assessment and preparation of the airway management approach. Close cooperation between the intensivist, pulmonologist, anesthesiologist and otorhinolaryngologist was essential. Results: In case of sudden deterioration, a protocol for emergency situations was made. Given the increased risk of additional tracheal compression after administration of neuromuscular blocking agents, an approach with awake fiberoptic intubation maintaining spontaneous ventilation was proposed. However, intubation without retrieval of the tracheal stent was found undesirable due to expected massive shunting over the left atelectatic lung. As rescue option, assistance of extracorporeal circulation was considered and perfusionist was kept on standby. The patient stayed stable and was transferred to the operating theatre. High frequency jet ventilation under general anesthesia resulted in desaturations up to 50%, making rigid bronchoscopy impossible. Subsequently an endotracheal tube size 8 could be placed successfully and the stent could be retrieved via bronchoscopy over (and with) the tube, after which the patient was reintubated. Finally, a tracheostomy (Shiley™ Tracheostomy Tube With Cuff, size 8) was placed, fiberoptic control showed a patent airway. Patient was readmitted to the ICU and could be quickly weaned of the ventilator. Pathology was positive for rhabdomyosarcoma, without indication for systemic therapy. Extensive surgery (laryngectomy, esophagectomy) was suggested, but patient refused and palliative care was started. Conclusion: Due to meticulous planning in an interdisciplinary team, we showed a successful airway management approach in this complicated case of critical airway compression secondary to a rare rhabdomyosarcoma, complicated by tracheal stent migration. Besides presenting our thoughts and considerations, we support exploring other possible approaches of this specific clinical problem.

Keywords: airway management, rhabdomyosarcoma, stent displacement, tracheal stenosis

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Authors: João Coutinho-Rodrigues, Nuno Sousa, Luís Alçada-Almeida

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Transportation infrastructure systems are fundamental in modern society and economy. However, they need modernizing, maintaining, and reinforcing interventions which require large investments. In many countries, accumulated intervention delays arise from aging and intense use, being magnified by financial constraints of the past. The decision problem of managing the renewal of large backlogs is common to several types of important transportation infrastructures (e.g., railways, roads). This problem requires considering financial aspects as well as operational constraints under a multidimensional framework. The present research introduces a linear programming multiobjective model for managing railway infrastructure asset renewal. The model aims at minimizing three objectives: (i) yearly investment peak, by evenly spreading investment throughout multiple years; (ii) total cost, which includes extra maintenance costs incurred from renewal backlogs; (iii) priority delays related to work start postponements on the higher priority railway sections. Operational constraints ensure that passenger and freight services are not excessively delayed from having railway line sections under intervention. Achieving a balanced annual investment plan, without compromising the total financial effort or excessively postponing the execution of the priority works, was the motivation for pursuing the research which is now presented. The methodology, inspired by a real case study and tested with real data, reflects aspects of the practice of an infrastructure management company and is generalizable to different types of infrastructure (e.g., railways, highways). It was conceived for treating renewal interventions in infrastructure assets, which is a railway network may be rails, ballasts, sleepers, etc.; while a section is under intervention, trains must run at reduced speed, causing delays in services. The model cannot, therefore, allow for an accumulation of works on the same line, which may cause excessively large delays. Similarly, the lines do not all have the same socio-economic importance or service intensity, making it is necessary to prioritize the sections to be renewed. The model takes these issues into account, and its output is an optimized works schedule for the renewal project translatable in Gantt charts The infrastructure management company provided all the data for the first test case study and validated the parameterization. This case consists of several sections to be renewed, over 5 years and belonging to 17 lines. A large instance was also generated, reflecting a problem of a size similar to the USA railway network (considered the largest one in the world), so it is not expected that considerably larger problems appear in real life; an average of 25 years backlog and ten years of project horizon was considered. Despite the very large increase in the number of decision variables (200 times as large), the computational time cost did not increase very significantly. It is thus expectable that just about any real-life problem can be treated in a modern computer, regardless of size. The trade-off analysis shows that if the decision maker allows some increase in max yearly investment (i.e., degradation of objective ii), solutions improve considerably in the remaining two objectives.

Keywords: transport infrastructure, asset renewal, railway maintenance, multiobjective modeling

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Authors: R. Stevens, W.L. Bryden

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The objective of this study was to determine the efficacy of zeolite in preventing the adverse effects of aflatoxin B1 (AFB1) in broilers. A total of 540 one-day-old Ross chicks were randomly divided into nine treatments, with four replicate pens per treatment and 15 chicks per pen. The treatments included 3 Levels of AFB1 (0,1and 2 mg/kg diet) and 3 levels of zeolite (0, 1.5 and 3 %) in a 3 ×3 factorial arrangement. The experimental treatments commenced on d 7 post-hatch. A starter diet was provided from d 1 to 14, a grower diet from d 15 to 28 and a finisher diet from d 29 to d 49. Diets were based on corn and soybeans and formulated to meet the bird's requirements. The evaluated parameters were as follows: Bodyweight, daily gain, feed intake (FI), feed conversion (FC), relative weights of organs (carcass, liver, heart and abdominal fat) and clinical biochemistry parameters: alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Bodyweight, daily gain and FC were significantly (P<0.05) impaired by aflatoxin. Relative weights of the liver and heart were also affected. The addition of zeolite (1.5 and 3 %) to the contaminated diets ameliorated the effects of aflatoxin, especially at the higher level of inclusion. These data demonstrate that this specific sorbent (zeolite) can protect against the toxicity of AFB1in young broiler chicks.

Keywords: aflatoxin, broiler, toxicity, zeolite

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Authors: Jackson Ishara, Ariel Buzera, Gustave N. Mushagalusa, Ahmed R. A. Hammam, Judith Munga, Paul Karanja, John Kinyuru

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Numerous mushroom bioactive metabolites, including polysaccharides, eritadenine, lignin, chitosan, mevinolin, and astrakurkurone have been studied in life-threatening conditions and diseases such as diabetes, cardiovascular, hypertension, cancer, DNA damage, hypercholesterolemia, and obesity attempting to identify natural therapies. These bioactive metabolites have shown potential as antiviral and immune system strengthener natural agents through diverse cellular and physiological pathways modulation with no toxicity evidence, widely available, and affordable. In light of the emerging literature, this paper compiles the most recent information describing the molecular mechanisms that underlie the nutraceutical potentials of these mushroom metabolites suggesting their effectiveness if combined with existing drug therapies. The findings raise hope that these mushroom bioactive metabolites may be utilized as natural therapies considering their therapeutic potential while anticipating further research designing clinical trials and developing new drug therapies while encouraging their consumption as a natural adjuvant in preventing and controlling life-threatening conditions and diseases.

Keywords: bioactive metabolites, food functionality, health-threatening conditions, mushrooms, nutraceutical

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Authors: Sayna Bahraini, Wendy Gifford, Ian Graham, Liquaa Wazni, Suzettee Bremault-Phillips, Rebekah Hackbusch, Catrine Demers, Mary Egan

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Objective: Guidelines for palliative and spiritual care emphasize the importance of screening patients for spiritual suffering. The aim of this review was to synthesize the research evidence on the accuracy of measures used to screen adults for spiritual suffering. Methods: A systematic review has been conducted. We searched five scientific databases to identify relevant articles. Two independent reviewers screened extracted data and assessed study methodological quality. Results: We identified five articles that yielded information on 24 spiritual screening measures. Among all identified measures, the 2-item Meaning/Joy & Self-Described Struggle has the highest sensitivity (82-87%), and the revised Rush protocol has the highest specificity (81-90%). The methodological quality of all included studies was low. Significance of Results: While most of the identified spiritual screening measures are brief (comprise 1 to 12 number of items), few have sufficient accuracy to effectively screen patients for spiritual suffering. We advise clinicians to use their critical appraisal skills and clinical judgment when selecting and using any of the identified measures to screen for spiritual suffering.

Keywords: screening, suffering, spirituality, diagnostic test accuracy, systematic review

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