Search results for: elderly hip fracture patients

Authors: Sang Koo Jeon, Seung Hoon Nahm, Oh Heon Kwon

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The unit cell of solid oxide fuel cell (SOFC) must be stacked as several layers type to obtain the high power. The most of researcher have concerned about the performance of stacked SOFC rather than the structural stability of stacked SOFC and especially interested how to design for reducing the electrical loss and improving the high efficiency. Consequently, the stacked SOFC able to produce the electrical high power and related parts like as manifold, gas seal, bipolar plate were developed to optimize the stack design. However, the unit cell of SOFC was just layered on the interconnector without the adhesion and the hydrogen and oxygen were injected to the interfacial layer in the high temperature. On the operating condition, the interfacial layer can be the one of the weak point in the stacked SOFC. Therefore the evaluation of the structural safety for the failure is essentially needed. In this study, interfacial adhesion between SOFC and metal adhesive was estimated in the high temperature environment. The metal adhesive was used to strongly connect the unit cell of SOFC with interconnector and provide the electrical conductivity between them. The four point bending test was performed to measure the interfacial adhesion. The unit cell of SOFC and SiO2 wafer were diced and then attached by metal adhesive. The SiO2 wafer had the center notch to initiate a crack from the tip of the notch. The modified stereomicroscope combined with the CCD camera and system for measuring the length was used to observe the fracture behavior. Additionally, the interfacial adhesion was evaluated in the high temperature condition because the metal adhesive was affected by high temperature. Also the specimen was exposed in the furnace during several hours and then the interfacial adhesion was evaluated. Finally, the interfacial adhesion energy was quantitatively determined and compared in the each condition.

Keywords: solid oxide fuel cell (SOFC), metal adhesive, adhesion, high temperature

Procedia PDF Downloads 509

Authors: Khalid Iqbal, Saima Altaf, M. Akram, Muhammad Abdur Rafaye, Saeed Ahmad Buzdar

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Objective: Verification of patient-specific intensity modulated radiation therapy (IMRT) plans using different 2-D detectors has become increasingly popular due to their ease of use and immediate readout of the results. The purpose of this study was to test and compare various 2-D detectors for dosimetric quality assurance (QA) of intensity-modulated radiotherapy (IMRT) with the vision to find alternative QA methods. Material and Methods: Twenty IMRT patients (12 of brain and 8 of the prostate) were planned on Eclipse treatment planning system using Varian Clinac DHX on both energies 6MV and 15MV. Verification plans of all such patients were also made and delivered to Map check2, EPID (Electronic portal imaging device) and Gafchromic EBT3. Gamma index analyses were performed using different criteria to evaluate and compare the dosimetric results. Results: Statistical analysis shows the passing rate of 99.55%, 97.23% and 92.9% for 6MV and 99.53%, 98.3% and 94.85% for 15 MV energy using a criteria of ±5% of 3mm, ±3% of 3mm and ±3% of 2mm respectively for brain, whereas using ±5% of 3mm and ±3% of 3mm gamma evaluation criteria, the passing rate is 94.55% and 90.45% for 6MV and 95.25%9 and 95% for 15 MV energy for the case of prostate using EBT3 film. Map check 2 results shows the passing rates of 98.17%, 97.68% and 86.78% for 6MV energy and 94.87%,97.46% and 88.31% for 15 MV energy respectively for brain using a criteria of ±5% of 3mm, ±3% of 3mm and ±3% of 2mm, whereas using ±5% of 3mm and ±3% of 3mm gamma evaluation criteria gives the passing rate of 97.7% and 96.4% for 6MV and 98.75%9 and 98.05% for 15 MV energy for the case of prostate. EPID 6 MV and gamma analysis shows the passing rate of 99.56%, 98.63% and 98.4% for the brain, 100% and 99.9% for prostate using the same criteria as for map check 2 and EBT 3 film. Conclusion: The results demonstrate excellent passing rates were obtained for all dosimeter when compared with the planar dose distributions for 6 MV IMRT fields as well as for 15 MV. EPID results are better than EBT3 films and map check 2 because it is likely that part of this difference is real, and part is due to manhandling and different treatment set up verification which contributes dose distribution difference. Overall all three dosimeter exhibits results within limits according to AAPM report.120.

Keywords: gafchromic EBT3, radiochromic film dosimetry, IMRT verification, EPID

Procedia PDF Downloads 407

Authors: Hye Kyung Kim, Myung-Gyou Kim, Kang-Hyun Leem

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Postmenopausal osteoporosis is characterized by low bone density which leads to increased bone fragility and greater susceptibility to fracture. Current treatments for osteoporosis are dominated by drugs that inhibit bone resorption although they also suppress bone formation that may contribute to pathogenesis of osteonecrosis. To restore the extensive bone loss, there is a great need for anabolic treatments that induce osteoblasts to build new bone. Pre-osteoblastic cells produce proteins of the extra-cellular matrix, including type I collagen at first, and then to successively produce alkaline phosphatase (ALP) and osteocalcin during differentiation to osteoblasts. Finally, osteoblasts deposit calcium. Present study investigated the effects of egg yolk peptide (EYP) on osteogenic activities and bone matrix gene expressions in human osteoblastic MG-63 cells. The effects of EYP on cell proliferation, alkaline phosphatase (ALP) activity, collagen synthesis, and mineralization were measured. The expression of osteogenic genes including COL1A1 (collagen, type I, alpha 1), ALP, BGLAP (osteocalcin), and SPP1 (secreted phosphoprotein 1, osteopontin) were measured by quantitative realtime PCR. EYP dose-dependently increased MG-63 cell proliferation, ALP activity, collagen synthesis, and calcium deposition. Furthermore, COL1A1, ALP, and SPP1 gene expressions were increased by EYP treatment. Present study suggested that EYP treatment enhanced osteogenic activities and increased bone matrix osteogenicgenes. These results could provide a mechanistic explanation for the bone-strengthening effects of EYP.

Keywords: egg yolk peptide, osteoblastic MG-63 cells, alkaline phosphatase, collagen synthesis, osteogenic genes, COL1A1, osteocalcin, osteopontin

Procedia PDF Downloads 373

Authors: Ibrahim Khan, Waqas Khalid

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The Healthcare sector is known to consume a higher proportion of total energy consumption in the HVAC market owing to an excessive cooling and heating requirement in maintaining human thermal comfort in indoor conditions, catering to patients undergoing treatment in hospital wards, rooms, and intensive care units. The indoor thermal comfort conditions in selected hospitals of Islamabad, Pakistan, were measured on a real-time basis with the collection of first-hand experimental data using calibrated sensors measuring Ambient Temperature, Wet Bulb Globe Temperature, Relative Humidity, Air Velocity, Light Intensity and CO2 levels. The Experimental data recorded was analyzed in conjunction with the Thermal Comfort Questionnaire Surveys, where the participants, including patients, doctors, nurses, and hospital staff, were assessed based on their thermal sensation, acceptability, preference, and comfort responses. The Recorded Dataset, including experimental and survey-based responses, was further analyzed in the development of a correlation between operative temperature, operative relative humidity, and other measured operative parameters with the predicted mean vote and adaptive predicted mean vote, with the adaptive temperature and adaptive relative humidity estimated using the seasonal data set gathered for both summer – hot and dry, and hot and humid as well as winter – cold and dry, and cold and humid climate conditions. The Machine Learning Logistic Regression Algorithm was incorporated to train the operative experimental data parameters and develop a correlation between patient sensations and the thermal environmental parameters for which a new ML-based adaptive thermal comfort model was proposed and developed in our study. Finally, the accuracy of our model was determined using the K-fold cross-validation.

Keywords: predicted mean vote, thermal comfort, energy management, logistic regression, machine learning

Procedia PDF Downloads 44

Authors: Thuraya Ahmed Al Shidhani, Yahya Al Farsi, Alya Al Husni, Samir Al Adawi

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Background: Knee osteoarthritis (knee OA) represents a major public health burden worldwide, particularly among older adults. However, little has been documented from Arabian Gulf countries, which have left an information gap. Objective: This study describes the socio-demographic, clinical risk factors, and use of herbal medicine among men and women seeking consultation for knee OA at two secondary healthcare facilities in Muscat, Oman. Methods: A cross-sectional study was conducted among 213 Omani adults with knee OA attending a referral polyclinic in Muscat, Oman, over 12 months from January to December. Socio-demographic data were collected from the participants who are seeking consultation for knee OA. Results: Among the 213 study participants, 171 were females and 42 males. The females were comparatively older than the males, had lower education and lower-income, and more overweight. The majority of the participants were normal weight or underweight. About one-third of participants reported OA in other joints as well. Most participants recalled that they had knee OA for less than a year. About 12% reported a history of trauma. The majority (63%) concurrently had other chronic illnesses, and 33% reported having at least one complication. About 22% were using herbal medicines. About 77% are using herbal local applications in form of powder and creams. Conclusion: This study, to our knowledge, is the first to explore socio-demographic characteristics, clinical risk factors and use of herbal medicine among sufferers of knee OA in Oman. Knee OA tended to occur among our participants at younger ages than reported elsewhere, while obesity appeared orthogonal to the severity of knee OA. Women were more affected than men. About one quarter of Omani patients are using herbal medicine. More studies are needed to understand the causal factors and development of knee OA in Oman. Targeted health education and rehabilitation programs are needed, particularly among Omani women, to improve their physical quality of life.

Keywords: knee joint, osteoarthritis, herbal medicine, Oman

Procedia PDF Downloads 107

Authors: Amine Rezzoug, Selsabil Rokia Laraba, Mourad Ancer, Said Abdi

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Composite materials are taking center stage in different fields thanks to their mechanical characteristics and their ease of preparation. Environmental constraints have led to the development of composite with natural reinforcements. The sandwich structure has the advantage to have good flexural proprieties for low density, which is why it was chosen in this work. The development of these materials is related to an energy saving strategy and environmental protection. The present work refers to the study of the development and characterization of sandwiches composites based on hybrids laminates with natural reinforcements (Alfa and Jute), a metal fabric was introduced into composite in order to have a compromise between weight and properties. We use different configurations of reinforcements (jute, metallic fabric) to develop laminates in order to use them as thin facings for sandwiches materials. While the core was an epoxy matrix reinforced with Alfa short fibers, a chemical treatment sodium hydroxide was cared to improve the adhesion of the Alfa fibers. The mechanical characterization of our materials was made by the tensile and bending test, to highlight the influence of jute and Alfa. After testing, the fracture surfaces are observed by scanning electron microscopy (SEM). Optical microscopy allowed us to calculate the degree of porosity and to observe the morphology of the individual layers. Laminates based on jute fabric have shown better results in tensile test as well as to bending, compared to those of the metallic fabric (100%, 65%). Sandwich Panels were also characterized in terms of bending test. Results we had provide, shows that this composite has sufficient properties for possible replacing conventional composite materials by considering the environmental factors.

Keywords: bending test, bio-composites, sandwiches, tensile test

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Authors: Matthew Pleshaw, Caroline Lynch, Caleb Eaton, Ali Kiapour

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The problem addressed in this proposal is that of the lacking comfort and safety of inpatient rooms, specifically at Boston Children’s Hospital, with the implementation of a system that will allow inpatient children to feel more comfortable in the unfamiliar environment of a hospital. The focus is that of advancing and enhancing the healing process for children in a long-term inpatient stay at the hospital, though a combination of announcing a clinician or hospital staff’s arrival utilizing RFID (Fig. 1), and improving communication between clinicians, parents/guardians, patients, etc. by integrating a mobile application.

Keywords: Pediatrics, Hospital, RFID, Technology

Procedia PDF Downloads 146

Authors: B. Dejanova, S. Petrovska, L. Todorovska, J. Pluncevic, S. Mancevska, V. Antevska, E. Sivevska, I. Karagjozova

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Introduction: Aging process is mainly related to endothelial function which may be impaired by oxidative stress (OS). Exercise is known to be beneficial to aging process, which may improve health and prevent appearance of chronic diseases in elderly. The aim of the study was to investigate the OS markers related to exercise. Methods: A number of 80 subjects (healthy volunteers) were examined (38 male and 32 female), divided in 3 age groups: group I ≤ 30 years (n=24); group II – 31-50 years (n=24); group III - ≥ 51 year (n=32). Each group was divided to subgroups of sedentary subjects (SS) and subjects who exercise (SE). Group I: SS (n=11), SE (n=13); group II: SS (n=13), SE (n=10); group III: SS (n=23) SE (n=9). Lipid peroxidation (LP) as a fluorimetric method with thiobarbituric acid was used to estimate OS. Antioxidative status was determined by cell antioxidants such as enzymes - superoxide dismutase (SOD), glutathione peroxidase (GPx) and glucose 6 phosphate (G-6-PD); and by extra cell antioxidants such as glutathione reductase (GR), nitric oxide (NO) and total antioxidant capacity (TAC). Results: Increased values of LP were noticed along the aging process: group I – 3.30±0.3 µmol/L; group II – 3.91±0.2 µmol/L; group III – 3.94±0.8 µmol/L (p<0.05), while no statistical significance was found between male and female subjects. Statistical significance for OS was not found between SS and SE in group I as it was found in group II (p<0.05) and in group III (p<0.01). No statistical significance was found for all cell antioxidants and GR within the groups, while NO and TAC showed lower values in SS compared to SE in II (p<0.05) and in group III (p<0.05). Discussion and conclusion: Aging process showed increased OS which may be either due to impaired function of scavengers of free radicals or due to their enormous production. Well balanced exercise might be one of the factors that keep the integrity of blood vessel endothelium which slows down the aging process. Possible mechanism of exercise beneficial influence is shear stress by upregulation of genes coding for nitric oxide bioavailability. Thus, due to obtained results we may conclude that OS is found to be diminished in the subject groups who perform exercise.

Keywords: oxidative stress, aging process, exercise, endothelial function

Procedia PDF Downloads 373

Authors: Suveen Kumar

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Oral cancer (OC) is the sixth most death causing cancer in world which includes tumour of lips, floor of the mouth, tongue, palate, cheeks, sinuses, throat, etc. Conventionally, the techniques used for OC detection are toluidine blue staining, biopsy, liquid-based cytology, visual attachments, etc., however these are limited by their highly invasive nature, low sensitivity, time consumption, sophisticated instrument handling, sample processing and high cost. Therefore, we developed biosensing chips for non-invasive detection of OC via CYFRA-21-1 biomarker. CYFRA-21-1 (molecular weight: 40 kDa) is secreted in saliva of OC patients which is a non-invasive biological fluid with a cut-off value of 3.8 ng mL-1, above which the subjects will be suffering from oral cancer. Therefore, in first work, 3-aminopropyl triethoxy silane (APTES) functionalized zirconia (ZrO2) nanoparticles (APTES/nZrO2) were used to successfully detect CYFRA-21-1 in a linear detection range (LDR) of 2-16 ng mL-1 with sensitivity of 2.2 µA mL ng-1. Successively, APTES/nZrO2-RGO was employed to prevent agglomeration of ZrO2 by providing high surface area reduced graphene oxide (RGO) support and much wider LDR (2-22 ng mL-1) was obtained with remarkable limit of detection (LOD) as 0.12 ng mL-1. Further, APTES/nY2O3/ITO platform was used for oral cancer bioseneor development. The developed biosensor (BSA/anti-CYFRA-21-1/APTES/nY2O3/ITO) have wider LDR (0.01-50 ng mL-1) with remarkable limit of detection (LOD) as 0.01 ng mL-1. To improve the sensitivity of the biosensing platform, nanocomposite of yattria stabilized nanostructured zirconia-reduced graphene oxide (nYZR) based biosensor has been developed. The developed biosensing chip having ability to detect CYFRA-21-1 biomolecules in the range of 0.01-50 ng mL-1, LOD of 7.2 pg mL-1 with sensitivity of 200 µA mL ng-1. Further, the applicability of the fabricated biosensing chips were also checked through real sample (saliva) analysis of OC patients and the obtained results showed good correlation with the standard protein detection enzyme linked immunosorbent assay (ELISA) technique.

Keywords: non-invasive, oral cancer, nanomaterials, biosensor, biochip

Procedia PDF Downloads 113

Authors: Karolina Siejka, Monika Piekarska, Monika Zbroja, Weronika Cyranka, Maryla Kuczynska, Magdalena Grzegorczyk, Malgorzata Nowakowska, Agnieszka Brodzisz, Magdalena Maria Wozniak

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Crohn’s disease is one of chronic inflammatory bowel diseases. It is increasing in prevalence worldwide, especially with young people. The disease usually occurs in the second to the fourth decade of life. Traditionally is diagnosed by clinical indicates, endoscopic, and histological findings. Magnetic Resonance Enterography (MRE) can demonstrate mural and extramural inflammatory signs and complications, which make it a valuable diagnostic modality. The study included 76 adults and 36 children diagnosed with Crohn’s disease. Each patient underwent MRE with intravenous administration of a contrast agent. All the studies were performed using Siemens Aera 1.5T scanner according to a local study protocol. Whenever applicable, MR Enterography findings were verified with endoscopy. Forty adults and all 36 children had an active phase of Crohn’s disease; five adults had a chronic phase of the disease; one adult had both chronic and active inflammatory features. Thirty adults have no sings of pathology. In both adult and pediatric groups the most commonly observed manifestation of active disease was thickened edematous ileum wall (26 adults and 36 children). Adults had Bauhin’s valve edema in 58% cases (n=23) and mesenteric changes in 34% cases (n=9). To compare, 32 children had Bauhin’s valve edema (89%) and, in 23 cases, was found inflammatory infiltration of the peri-intestinal fat (64%). The involvement of the large intestine was more common among children (100%). Complications of Crohn’s disease were found commonly in adults (40% of adults, 22% of children). There were observed 18 fistulas (14 adults, four children) and six abscesses (2 adults, four children). MRE is a reliable method in the evaluation of Crohn’s disease activity, especially of its complications. The lack of radiations makes MRE well-tolerated modality, which can be often repeated, particularly in young patients. The disease had different medical sings depending on age – children often had a more active inflammatory process, but there were more complications in the adult group.

Keywords: Crohn's disease, diagnostics, inflammatory bowel disease, magnetic resonance enterography, MRE

Procedia PDF Downloads 175

Authors: In Kyong Yi, Yun Jeong Chae, Jihoon Hwang, Sook-Young Lee, Jong-Yeop Kim

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Background: Pentax airway scope (AWS) is a recently developed video laryngoscope for use in both normal and difficult airways, providing a good laryngeal view. The purpose of this randomized noninferior study was to evaluate the efficacy of the Pentax-AWS regarding intubation time, laryngeal view and ease of intubation in pediatric patients with normal airway, compared to Macintosh laryngoscope. Method: A total of 136 pediatric patients aged 1 to 10 with American Society of Anesthesiologists physical status I or II undergoing general anesthesia required orotracheal intubation were randomly allocated into two groups: Macintosh laryngoscope (n =68) and Pentax AWS (n=68). Anesthesia was induced with propofol, rocuronium, and sevoflurane. The primary outcome was intubation time. Cormack-Lehane laryngeal view grade, application of optimal laryngeal external manipulation (OELM), intubation difficulty scale (IDS), intubation failure rate and adverse events were also measured. Result: No significant difference was observed between the two groups regarding intubation time (Macintosh; 23[22-26] sec vs. Pentax; 23.5[22-27.75] sec, p=0.713). As for the laryngeal view grade, the Pentax group showed less number of grade 2a or higher grade cases compared to the Macintosh group (1/2a/2b/3; 52.9%/41.2%/4.4%/1.5% vs. 98.5%/1.5%/0%/0%, p=0.000). No optimal laryngeal external manipulation application was required in the Pentax group (38.2% vs. 0%, p=0.000). Intubation difficulty scale resulted in lower values for Pentax group (0 [0-2] vs. 0 [0-0.55], p=0.001). Failure rate was not different between the two groups (1.5% vs. 4.4%, p=0.619). Adverse event-wise, slightly higher incidence of bleeding (1.5% vs. 5.9%, p=0.172) and teeth injury (0% vs. 5.9%, p=0.042) occurred in the Pentax group. Conclusion: In conclusion, Pentax-AWS provided better laryngeal view, similar intubation time and similar success rate compared with Macintosh laryngoscope in children with normal airway. However, the risk of teeth injury might increase and warrant special attention.

Keywords: Pentax-AWS, pediatric, video laryngoscope, intubation

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Authors: Promise Ufomadu, Edgar Rodriguez, Grace Lee

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Cutaneous Leishmaniasis (CL) is an infection caused by a variety of Leishmania species which are protozoan organisms that are typically carried by sandflies found in tropical regions. The parasite causes skin lesions that may resolve spontaneously but commonly become chronic and therefore necessitate thorough clinical attention. We present a 15-year-old female patient with CL of her bilateral dorsal hands, which resolved after a 28-day course of miltefosine. This case details the significance of compiling a thorough patient history and considering CL as a possible differential in patients from endemic regions.

Keywords: leishmaniasis, infection, immigrant, parasites, pediatrics

Procedia PDF Downloads 66

Authors: Ying Sun, Biao Cheng, Qing Lu, Xuefei Tao, Xiaoyu Lai, Cheng Guo, Dan Wang

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Fibrinogen-like protein 2 (FGL2) has recently been identified to play an important role in inflammatory diseases such as atherosclerosis through a thrombin-dependent manner. Here, a murine monoclonal antibody was raised against the critical residue Ser(89) of FGL2, and the effects of the anti-FGL2 mAb (SPF89) were analyzed in human umbilical vein endothelial cells (HUVECs) and THP-1 cells. Firstly, it was proved that SPF89, which belongs to the IgG1 subtype with a KD value of 44.5 pM, could specifically show the expression levels of protein FGL2 in different cell lines of known target gene status. The lipopolysaccharide (LPS)-mediated endothelial cell proliferation was significantly inhibited with a decline of phosphorylation nuclear factor-κB (NF-κB) in a dose-dependent manner after SPF89 treatment. Furthermore, SPF89 reduced LPS-induced expression of adhesion molecules and inflammatory cytokines such as vascular cell adhesion molecule-1, tumor necrosis factor-α, Matrix metalloproteinase MMP-2, Integrin αvβ3, and interleukin-6 in HUVECs. In macrophage-like THP-1 cells, SPF89 effectively inhibited LPS and low-density lipoprotein-induced foam cell formation. However, these anti-inflammatory and anti-atherosclerotic effects of anti-FGL2 mAb in HUVECs and THP-1 cells were significantly reduced after treatment with an NF-κB inhibitor PDTC. All the above suggest, by efficiently inhibiting LPS-induced pro-inflammatory effects in vascular endothelial cells by attenuating NF-κB dependent pathway, the new anti-FGL2 mAb SPF89 could to be a potential therapeutic candidate for protecting the vascular endothelium against inflammatory diseases such as atherosclerosis. This work was supported by the Program of Sichuan Science and Technology Department (2017FZ0069) and Collaborative Innovation Program of Sichuan for Elderly Care and Health(YLZBZ1511).

Keywords: monoclonal antibody, fibrinogen like protein 2, inflammation, endothelial cells

Procedia PDF Downloads 243

Authors: M. B. Ricardo De Oliveira, A. Borghi-Silva, E. Paravizo, F. Lizarelli, L. Di Thomazzo, D. Braatz

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Prototypes are a critical feature in the product development process, as they help the project team visualize early concept flaws, communicate ideas and introduce an initial product testing. Involving stakeholders, such as consumers and users, in prototype tests allows the gathering of valuable feedback, contributing for a better product and making the design process more participatory. Even though recent studies have shown that user evaluation of prototypes is valuable, few articles provide a method or protocol on how designers should conduct it. This multidisciplinary study (involving the areas of physiotherapy, engineering and computer science) aims to develop an evaluation protocol, using an ergometric step prototype as the product prototype to be assessed. The protocol consisted of performing two tests (the 2 Minute Step Test and the Portability Test) to allow users (patients) and consumers (physiotherapists) to have an experience with the prototype. Furthermore, the protocol contained four Likert-Scale questionnaires (one for users and three for consumers), that inquired participants about how they perceived the design characteristics of the product (performance, safety, materials, maintenance, portability, usability and ergonomics), in their use of the prototype. Additionally, the protocol indicated the need to conduct interviews with the product designers, in order to link their feedback to the ones from the consumers and users. Both tests and interviews were recorded for further analysis. The participation criteria for the study was gender and age for patients, gender and experience with 2 Minute Step Test for physiotherapists and involvement level in the product development project for designers. The questionnaire's reliability was validated using Cronbach's Alpha and the quantitative data of the questionnaires were analyzed using non-parametric hypothesis tests with a significance level of 0.05 (p <0.05) and descriptive statistics. As a result, this study provides a concise evaluation protocol which can assist designers in their development process, collecting quantitative feedback from consumer and users, and qualitative feedback from designers.

Keywords: Product Design, Product Evaluation, Prototypes, Step

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Authors: Yori Gidron, Laura Caton, Irit Ben-Aharon

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Background: Many patients and even certain clinicians attribute cancer development to psychosocial factors. Yet, empirical data supports more the prognostic role, rather than the etiological role, of psychosocial factors in cancer. Part of the inconsistency may result from not considering possible moderating factors in the etiological role of psychosocial factors. One important candidate moderating factor is the vagal nerve, whose activity is indexed by heart-rate variability (HRV). The vagal nerve may prevent cancer since it reduces inflammation on the one hand, and since it increases anti-tumor immunity on the other hand. This study examined the moderating role of the vagus in the relation between life threatening events (LTE) and cancer development. Method: We re-analyzed data from the Lifelines Dutch longitudinal cohort study of over 150,000 people. The present study included 82,751 adults, who initially were cancer-free. We extracted information on background factors (e.g., age, gender, fat consumption), whether they ever experienced LTE, HRV and cancer diagnosis as reported by patients in annual clinic visits. HRV was derived from brief ECGs. Results: Of the full sample, 1011 people developed cancer during a follow-up. In the full sample, LTE significantly predicted cancer development (R.R = 1.063 p < .01) and HRV significantly predicted a reduced risk of cancer development (R.R = .506 p <.001). Importantly, LTE significantly predicted cancer only when HRV was low (R.R = 1.056, 95% CI: 1.007 - 1.108, p < .05) but not when HRV was high (R.R = 1.014; 95% CI: 0.916 - 1.122, p > 0.05), independent of confounders. Conclusions: To the best of our knowledge, this is the first study showing in a large sample that LTE predict cancer development, and that this occurs only when vagal nerve activity (HRV) is relatively low. These results could result from lack of vagal modulation of inflammation and also from lack of vagal modulation of stress responses. Results are in line with the cancer-protective role of the vagus. HRV needs to be routinely monitored in the population and future intervention trials need to examine whether vagal nerve activation can prevent cancer in people with LTE and with other cancer risk factors.

Keywords: cancer development, life-events, moderation, vagal nerve

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Authors: Adriane Amend, Leidiene Ferreira Santos, Daniella Pires Nunes

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The experience of assuming or caring for older persons dependents by relatives is a complex task that encompasses or affective involvement, the demand for technical activities and or psychological support. It would be necessary to understand the situations related to the caregiver, the person and the environment, which help the family difficulty, as a caregiver to lead this role. Objective: To identify the forces that drive and restrict the care process of family caregivers of the older adults. Method: Descriptive and exploratory research, with a qualitative approach, which has as a reference the Force Field Theory. Five family caregivers of older adult’s dependents residing in the city of Palmas, Tocantins, Brazil will participate. The data were collected from December 2021 to February 2022, through a semi-structured individual interview, and submitted to content analysis. Results: As forces that drive or process of caring for family caregivers were: the account of compassionate attitudes and patience of the caregiver (I); to the collaboration of the other person to the care and to the body structure of the same (Other); and the supports of other people not cared for and structural, such as adaptations in the room, read and bathroom, as in the presence of air conditioners (Environment). Among the restrictive forces of care we mention difficulties in delegating care to another person, or stress of care and other personal demands (I); imposition of the older person about care and e a transfer from bed to hip (Other); e lack of accessibility of the house and absence of air conditioning and hospital bed (Environment). Conclusion: The results show that there are driving forces with the caregiver's attitude and feelings, a bond as an idol and support for the caregiver and the environment. On the other hand, conflicting ties, absence of physical structure and daily and continuous care shifts, can significantly compromise well-being or the cycle of older adult, caregiver and care.

Keywords: caregivers, frail elderly, perception, geriatric nursing

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Authors: G. H. B. Dilhari, A. A. D. T. Saparamadu

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Sri Lanka is one of the prominent countries for the coir production. The coir is one of the by-products of the coconut and the coir industry is considered to be one of the traditional industries in Sri Lanka. Because of the inherent nature of the coir industry, labourers play a significant role in the coir production process. The study has analyzed the determinants of the income of the household level coir yarn labourers. The study was conducted in the Kumarakanda Grama Niladhari division. Simple random sampling was used to generate a sample of 100 household level coir yarn labourers and structured questionnaire, personal interviews, and discussion were performed to gather the required data. The obtained data were statistically analyzed by using Statistical Package for Social Science (SPSS) software. Mann-Whitney U and Kruskal-Wallis test were performed for mean comparison. The findings revealed that the household level coir yarn industry is dominated by the female workers and it was identified that fewer numbers of workers have engaged in this industry as the main occupation. In addition to that, elderly participation in the industry is higher than the younger participation and most of them have engaged in the industry as a source of extra income. Level of education, the methods of engagement, satisfaction, engagement in the industry by the next generation, support from the government, method of government support, working hours per day, employed as a main job, number of completed units per day, suffering from job related diseases and type of the diseases were related with income level of household level coir yarn laboures. The recommendations as to flourish in future includes, technological transformation for coir yarn production, strengthening the raw material base and regulating the raw material supply, introduction of new technologies, markets and training programmes, the establishment of the labourers’ association, the initiation of micro credit schemes and better consideration about the job oriented diseases.

Keywords: coir yarn, determinants, income, Sri Lanka

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Authors: Meng-Li Lin, Shang-Hsuan Chiu

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Taiwan is a country of diverse ethnic groups, the historical background of each ethnic group is different, and the conflict between them influence on each other, result in Taiwan's multi-culture. The Changhua County in Taiwan is the largest county of Hoklo-Hakka. Hakka people get along with Hoklo people for a long time. There are integration and conflict during that time and makes Hakka people gradually assimilated Hoklo-Hakka people. Today in Changhua Plain area, many Hoklo-Hakka people do not speak Hakka language. Therefore, it has been difficult to find information of Hakka from the Hakka language in the group of Hoklo-Hakka. But in the living space or culture to find relevant historical traces of life could be confirmed in Hakka Culture. In this paper, through the investigation of descent, life field, religion, language and other investigations of the Dacun, Changhua County residents to carry out the analysis of the process of assimilating Hoklo in living cultural landscape. First is through the local literature, the elderly and other oral history stories, to investigate the changes in Dacun field historical. Second, the comparison of collected traditional Hakka culture and the living cultural landscape of Hoklo-Haka are done to explore the differences between the living cultural landscape and the traditional Hakka culture. After analysis Hoklo-Hakka living cultural landscape, the significant differences, we proposed preservation strategy to provide recommendations to save the cultural life of Hoklo-Hakka landscape in future. Changhua Dacun traditional Hakka landscape is disappearing, in this study, we explore and investigate the data of Changhua Dacun Hoklo-Hakka living cultural landscape to analyze and to provide strategic advice to save. Here we have three study purposes. 1. Discuss the Hoklo-Hakka living cultural landscape of Changhua Dacun. 2. Investigate and record the Hoklo-Hakka living cultural landscape. 3. Propose a reserve strategy of the Hoklo-Hakka living cultural landscape in future.

Keywords: Hoklo-Hakka, Dacun, save policy, life Culture

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Authors: Varinder Kaur, Amanjit Kaur, Simran Kaur, Samriti Vaid

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Coating of fabrics with anti-microbial dyes is an adaptable technique of protection from various diseases. Natural dyes, which are known to possess antibacterial properties, can be used for antibacterial finishing of fibers like cotton, wool, bamboo and so many. Dyeing of fabrics with natural dyes normally requires the use of mordants so that dyes can stay on the fabric as well as into interstices of the fabric during multiple washings. In this study, the mordants used are alum and chitosan for ensuring a reasonable color fastness to light and washing. Chitosan is a natural polysaccharide having significant biological and chemical properties such as biodegradability, biocompatibility, bioactivity, microbial activity and polycationicity. The metal ion of alum mordant can act as electron acceptor for electron donor to form coordination bond with the dye molecule, making them insoluble in water. The dyeing of bamboo fabric using a natural dye extracted from turmeric has been studied using conventional dyeing method. Natural dye was extracted using water as solvent by Soxhlet extraction method. The extracted color was characterized by spectroscopic studies like UV/visible and further tested for antimicrobial activity. The effect of mordants on the dyeing outcome in terms of colour depth as well as fastness properties of the dyeing was investigated. It has been found that employing the conventional dyeing technique at 100 oC, the mordanted samples were deeper in depth than their unmordanted counterparts. The results of fastness properties of the dyed fabrics were fair to good. Turmeric extract was found to enhance microbial resistance of bamboo as well as was itself as a good cause of coloration. These textiles dyed with the turmeric as natural dye can be very useful in developing clothing for infants, elderly and infirm people to protect them against common infections. The outcome of this study will provide a new feature to the interface of dyeing and pharmaceutical industry.

Keywords: antimicrobial activity, bamboo fabric, natural dye, turmeric

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Authors: Manushi Srivastava

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Introduction: Doctor’s role, and relation with respect to patient care is at the core of medical ethics. The rapid pace of medical advances along with increasing consumer awareness about their rights and hike in cost of effective health care demand a robust, transparent and patient-friendly medical care system. However, doctors’ role performance is still in the frame of activity-passivity model of Doctor-Patient Relationship (DPR) where doctors act as parent and use to instruct their patients, without their consensus that is not going to help in the 21st century. Thus the current situation is a new challenge for traditional doctor-patient relationship after the introduction of Consumer Protection Act (CPA) in medical profession and the same is evidenced by increasing cases of medical litigation. To strengthen this system of medical services, the doctor plays a vital role, and the same should be reviewed in the present context. Objective: To understand the opinion of consultants regarding medical negligence and effect of Consumer Protection Act in terms of current practices of patient care. Method: This is a cross-sectional study in which both quantitative and qualitative methods are applied. Total 69 consultants were selected from multi-specialty hospitals of densely populated Varanasi city catering a population of about 1.8 million. Two-stage sampling was used for selection of respondents. At the first stage, selection of major wards (Medicine, Surgery, Ophthalmology, Gynaecology, Orthopaedics, and Paediatrics) was carried out, which are more susceptible to medical negligence. At the second stage, selection of consultants from the respective wards was carried out. In-depth Interviews were conducted with the help of semi-structured schedule. Two case studies of medical negligence were also carried out as part of the qualitative study. Analysis: Data were analyzed with the help of SPSS software (21.0 trial version). Semi-structured research tool was used to know consultant’s opinion about the pattern of medical negligence cases, litigations and claims made by patient community and inclusion of government medical services in CPA. Statistical analysis was done to describe data, and non-parametric test was used to observe the association between the variables. Analysis of Verbatim was used in case-study. Findings and Conclusion: Majority (92.8%) of consultants felt changes in the behaviour of community (patient) after implementation of CPA, as it had increased awareness about their rights. Less than half of the consultants opined that Medical Negligence is an Unintentional act of doctors and generally occurs due to communication gap and behavioural problem between doctor and patients. Experienced consultants ( > 10 years) pointed out that unethical practice by doctors and mal-intention of patient to harass doctors were additional reasons of Medical Negligence. In-depth interview revealed that now patients’ community expects more transparency and hence they demand cafeteria approach in diagnosis and management of cases. Thus as study results, we propose ‘Agreement Model’ of DPR to re-ensure ethical practice in medical profession.

Keywords: doctors, communication, consumer protection act (CPA), medical error

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Authors: Kana Matsuyanagi

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Anorexia Nervosa (AN) is a psychiatric disorder characterized by a relentless pursuit of thinness and strict restriction of food. The current therapeutic approaches for AN predominantly revolve around outpatient psychotherapies, which create significant financial barriers for the majority of affected patients, hindering their access to treatment. Nonetheless, AN exhibit one of the highest mortality and relapse rates among psychological disorders, underscoring the urgent need to provide patients with an affordable self-treatment tool, enabling those unable to access conventional medical intervention to address their condition autonomously. To this end, a neurofeedback software, termed RelaxNeuron, was developed with the objective of providing an economical and portable means to aid individuals in self-managing AN. Electroencephalography (EEG) was chosen as the preferred modality for RelaxNeuron, as it aligns with the study's goal of supplying a cost-effective and convenient solution for addressing AN. The primary aim of the software is to ameliorate the negative emotional responses towards food stimuli and the accompanying aberrant eye-tracking patterns observed in AN patient, ultimately alleviating the profound fear towards food an elemental symptom and, conceivably, the fundamental etiology of AN. The core functionality of RelaxNeuron hinges on the acquisition and analysis of EEG signals, alongside an electrocardiogram (ECG) signal, to infer the user's emotional state while viewing dynamic food-related imagery on the screen. Moreover, the software quantifies the user's performance in accurately tracking the moving food image. Subsequently, these two parameters undergo further processing in the subsequent algorithm, informing the delivery of either negative or positive feedback to the user. Preliminary test results have exhibited promising outcomes, suggesting the potential advantages of employing RelaxNeuron in the treatment of AN, as evidenced by its capacity to enhance emotional regulation and attentional processing through repetitive and persistent therapeutic interventions.

Keywords: Anorexia Nervosa, fear conditioning, neurofeedback, BCI

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Authors: Fatima Meirkhankyzy Shaizadina, Alua Oralovna Omarova, Praskovya Mikhailovna Britskaya, Nessipkul Oryntayevna Alysheva

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In recent years in the Republic of Kazakhstan there have been registered outbreaks of measles among the population. The objective of work was the analysis of outbreak of measles in 2014 among the population of North-Kazakhstan region of the Republic of Kazakhstan. For the analysis of the measles outbreak descriptive and analytical research, techniques were used and threshold levels of morbidity were calculated. The increase of incidence was noted from March to July. The peak was registered in May and made 9.0 per 100000 population. High rates were registered in April – 5.7 per 100000 population, and in June and July they made 5.7 and 3.1 respectively. Duration of the period of increase made 5 months. The analysis of monthly incidence of measles revealed spring and summer seasonality. Across the territory it was established that 69.2% of cases were registered in the city, 29.1% in rural areas and 1.7% of cases were brought in from other regions of Kazakhstan. The registered cases and threshold values of measles during the outbreak revealed that from 12 to 24 week, and also during the 40th week the cases exceeding the threshold levels are registered. Thus, for example, for the analyzed 1 week the number of the revealed patients made 4, which exceeds the calculated threshold value (3) by 33.3%. The data exceeding the threshold values confirm the emergence of a disease outbreak or the beginning of epidemic rise in morbidity. Epidemic rise in incidence of the population of North-Kazakhstan region was observed throughout 2014. The risk group includes 0-4 year-old children, who made 22.7%, 15-19 year-olds – 25.6%, 20-24 year-olds – 20.9%. The analysis of measles cases registration by gender revealed that women are registered 1.1 times more often than men. The ratio of women to men made 1:0.87. In social and professional groups often ill are unorganized children – 23.3% and students – 19.8%. Studying clinical manifestations of measles in the hospitalized patients, the typical beginning of a disease with expressed intoxication symptoms – weakness, sickliness was established. In individual cases expressed intoxication symptoms, hemorrhagic and dyspeptic syndromes, complications in the form of overlay of a secondary bacterial infection, which defined high severity of the illness, were registered both in adults and in children. The average duration of stay of patients in the hospital made 6.9 days. The average duration of time between date of getting the disease and date of delivery of health care made 3.6 days. Thus, the analysis of monthly incidence of measles revealed spring and summer seasonality, the peak of which was registered in May. Urban dwellers are ill more often (69.2%), while in rural areas people are ill more rarely (29.1%). Throughout 2014 an epidemic rise in incidence of the population of North-Kazakhstan region was observed. Risk group includes: children under 4 – 22.7%, 15-19 year-olds – 25.6%, 20-24 year-olds – 20.9%. The ratio of women and men made 1:0.87. The typical beginning of a disease in all hospitalized with the expressed intoxication symptoms – weakness, sickliness was established.

Keywords: epidemiological analysis, measles, morbidity, outbreak

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Authors: Sina Alimohammadi, Mahnaz Banihashemi, Maryam Poursharif

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Demodex is a mandatory parasite of pilosebaceous. D. folliculorum lives as a single parasite or as a number of parasites in hair follicles, and D. brevis as a single parasite living in sebaceous glands. Transmission of Demodex from one person to another requires direct skin contact; it also has a greater density in the forehead, cheeks, nose, and nasolabial folds. Demodex can cause some clinical symptoms such as follicular pityriasis, rosacea-like demodicosis, postural folliculitis, papules, seborrheic dermatitis, blepharitis, dermatitis around the lips, and hyperpigmented spots. In this study, the prevalence of Demodex species in patients referred to the dermatology department of Sayad Shirazi Hospital Gorgan, Iran, in the years 2019-2020 was investigated. Material and Methods: The study population consisted of 242 samples taken from the people referred to the dermatology department of Sayad Shirazi Hospital during the years 2019-2020, which were sampled by adhesive tape. All of the participants completed the questionnaires. The samples were examined microscopically for the presence of Demodex. Results: Out of 242 participants, 67 (27.68%) were infected with Demodex. Most cases of infection were observed in the group of 21 to 30 years (28 people; 11.57%) and then in the group of 31 to 40 years (21 people; 8.67%). Also, in the group of people under 10 years and over 60 years, no positive cases (0%) of Demodex were observed in microscopic examinations. Out of 11 variables, there was a statistically significant difference in relation to the three variables of age (P = 0.000003), use of cleansing solutions (P = 0.002), and the presence of acne (P = 0.0013). Conclusion: According to the results of this study, it was found that the incidence of Demodex in one group of acne patients is higher than in others, which emphasizes the possible role of Demodex in the pathogenesis of acne. In this study, there was an inverse relationship between the incidence of Demodex and the use of skin cleansing solutions. Also, the prevalence of Demodex is higher in the group of 20-30 years, and its prevalence does not increase with age. Due to the possibility of drug resistance in the future, regular studies on genotyping and drug resistance are recommended.

Keywords: acne, demodex, mite, prevalence

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Authors: Daly M. J, Condron C, Mulhall C, Eppich W, O'Neill J.

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Introduction: In contemporary clinical cardiology, comprehensive and holistic bedside evaluation including accurate cardiac auscultation is in decline despite having positive effects on patients and their outcomes. Methods: Scripted histories and scoring checklists for three clinical scenarios in cardiology were co-created and refined through iterative consensus by a panel of clinical experts; these were then paired with recordings of auscultatory findings from three actual patients with known valvular heart disease. A wearable vest with embedded pressure-sensitive panel speakers was developed to transmit these recordings when examined at the standard auscultation points. RCSI medical students volunteered for a series of three formative long case examinations in cardiology (LC1 – LC3) using this hybrid simulation. Participants were randomised into two groups: Group 1 received individual teaching from an expert trainer between LC1 and LC2; Group 2 received the same intervention between LC2 and LC3. Each participant’s long case examination performance was recorded and blindly scored by two peer participants and two RCSI examiners. Results: Sixty-eight participants were included in the study (age 27.6 ± 0.1 years; 74% female) and randomised into two groups; there were no significant differences in baseline characteristics between groups. Overall, the median total faculty examiner score was 39.8% (35.8 – 44.6%) in LC1 and increased to 63.3% (56.9 – 66.4%) in LC3, with those in Group 1 showing a greater improvement in LC2 total score than that observed in Group 2 (p < .001). Using the novel checklist, intraclass correlation coefficients (ICC) were excellent between examiners in all cases: ICC .994 – .997 (p < .001); correlation between peers and examiners improved in LC2 following peer grading of LC1 performances: ICC .857 – .867 (p < .001). Conclusion: Hybrid simulation and quantitative grading improve learning, standardisation of assessment, and direct comparisons of both performance and acumen in clinical cardiology.

Keywords: cardiology, clinical skills, long case examination, hybrid simulation, checklist

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Authors: Avik Banerjee, Kavita Saggar

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Infections of the nervous system and adjacent structures are often life-threatening conditions. Despite the recent advances in neuroimaging evaluation, the diagnosis of unclear infectious CNS disease remains a challenge. Our aim is to evaluate the typical and atypical neuro-imaging features of the various routinely encountered CNS infected patients so as to form guidelines for their imaging recognition and differentiation from tumoral, vascular and other entities that warrant a different line of therapy.

Keywords: central nervous system (CNS), Cerebro Spinal Fluid (Csf), Creutzfeldt Jakob Disease (CJD), progressive multifocal leukoencephalopathy (PML)

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Authors: Reza Safdari, Goli Arji, Robab Abdolkhani Maryam zahmatkeshan

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Background and purpose: Cardiovascular diseases are among the most common diseases in all societies. The most important step in minimizing myocardial infarction and its complications is to minimize its risk factors. The amount of medical data is increasingly growing. Medical data mining has a great potential for transforming these data into information. Using data mining techniques to generate predictive models for identifying those at risk for reducing the effects of the disease is very helpful. The present study aimed to collect data related to risk factors of heart infarction from patients’ medical record and developed predicting models using data mining algorithm. Methods: The present work was an analytical study conducted on a database containing 350 records. Data were related to patients admitted to Shahid Rajaei specialized cardiovascular hospital, Iran, in 2011. Data were collected using a four-sectioned data collection form. Data analysis was performed using SPSS and Clementine version 12. Seven predictive algorithms and one algorithm-based model for predicting association rules were applied to the data. Accuracy, precision, sensitivity, specificity, as well as positive and negative predictive values were determined and the final model was obtained. Results: five parameters, including hypertension, DLP, tobacco smoking, diabetes, and A+ blood group, were the most critical risk factors of myocardial infarction. Among the models, the neural network model was found to have the highest sensitivity, indicating its ability to successfully diagnose the disease. Conclusion: Risk prediction models have great potentials in facilitating the management of a patient with a specific disease. Therefore, health interventions or change in their life style can be conducted based on these models for improving the health conditions of the individuals at risk.

Keywords: decision trees, neural network, myocardial infarction, Data Mining

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Authors: Sílvia Pereira Mello, Eliane Rodrigues, Maria de Lourdes Andrade, Marcelo Pereira, Giselle Dias, Jose Seixas Filho

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Frog meat is a highly digestible food and its use is recommended in diets aimed at fighting cholesterol, obesity, and arterial hypertension, as well as for treating gastrointestinal disorders. In this study, the soups were developed with frog meat in addition to other ingredients which did not present allergenic potential. The carcasses of the thawed frogs went through bleaching and deboning, and other ingredients (vegetables and condiments) were then added to the separated meat. After the process of cooking, the soups were cooled and later on frozen at -40° C for 3 hours and then taken to the LS 3000 B lyophilizer for 24 hours. The soups were submitted to microbiological analysis: enumeration of total coliforms and Bacillus cereus; identification of coagulase positive Staphylococcus; isolation and identification of Salmonella spp.; and physical-chemical analysis; application of micro-Kjeldahl method for protein, Soxhlet method for lipids, use of a heating chamber at 105ºC for moisture, incineration method (500-550°C) for ash, and Decagon's Pawkit equipment for determining water activity. Acceptance test was performed with 50 elderly people, all between 60 and 85 years of age. The degree of acceptance was demonstrated using a seven points structured hedonic scale in which the taster expressed their impression towards the product. Results of the microbiological analysis showed that all samples met the standards established by the National Health Surveillance Agency of Brazil (ANVISA). Results of the acceptance test indicated that all the soups were accepted considering overall impression and intended consumption. In addition to its excellent nutritional quality, the dehydrated soups made with frog meat are presented as a solution for consumers due to convenience in preparation, consumption and storage.

Keywords: bacteriological quality, lithobates catesbeianus, instant soup, proximate composition, sensory analysis

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Authors: Chalachew Gashu, Yoseph Kassa, Habtamu Geremew, Mengestie Mulugeta

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Background and Aims: Severe acute malnutrition remains a significant health challenge, particularly in low‐ and middle‐income countries. The aim of this study was to determine the survival time of under‐five children with severe acute malnutrition. Methods: A retrospective cohort study was conducted at a hospital, focusing on under‐five children with severe acute malnutrition. The study included 322 inpatients admitted to the Chiro hospital in Chiro, Ethiopia, between September 2019 and August 2020, whose data was obtained from medical records. Survival functions were analyzed using Kaplan‒Meier plots and log‐rank tests. The survival time of severe acute malnutrition was further analyzed using the Cox proportional hazards model and Bayesian parametric survival models, employing integrated nested Laplace approximation methods. Results: Among the 322 patients, 118 (36.6%) died as a result of severe acute malnutrition. The estimated median survival time for inpatients was found to be 2 weeks. Model selection criteria favored the Bayesian Weibull accelerated failure time model, which demonstrated that age, body temperature, pulse rate, nasogastric (NG) tube usage, hypoglycemia, anemia, diarrhea, dehydration, malaria, and pneumonia significantly influenced the survival time of severe acute malnutrition. Conclusions: This study revealed that children below 24 months, those with altered body temperature and pulse rate, NG tube usage, hypoglycemia, and comorbidities such as anemia, diarrhea, dehydration, malaria, and pneumonia had a shorter survival time when affected by severe acute malnutrition under the age of five. To reduce the death rate of children under 5 years of age, it is necessary to design community management for acute malnutrition to ensure early detection and improve access to and coverage for children who are malnourished.

Keywords: Bayesian analysis, severe acute malnutrition, survival data analysis, survival time

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Authors: Ting Lu, Ya-Ru Diao, Fei Fan, Ye Xue, Lei Shi, Xian-e Tang, Meng-jun Zhan, Zhen-hua Deng

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Accurate adult age estimation (AAE) is a significant and challenging task in forensic and archeology fields. Attempts have been made to explore optimal adult age metrics, and the rib is considered a potential age marker. The traditional way is to extract age-related features designed by experts from macroscopic or radiological images followed by classification or regression analysis. Those results still have not met the high-level requirements for practice, and the limitation of using feature design and manual extraction methods is loss of information since the features are likely not designed explicitly for extracting information relevant to age. Deep learning (DL) has recently garnered much interest in imaging learning and computer vision. It enables learning features that are important without a prior bias or hypothesis and could be supportive of AAE. This study aimed to develop DL models for AAE based on CT images and compare their performance to the manual visual scoring method. Chest CT data were reconstructed using volume rendering (VR). Retrospective data of 2500 patients aged 20.00-69.99 years were obtained between December 2019 and September 2021. Five-fold cross-validation was performed, and datasets were randomly split into training and validation sets in a 4:1 ratio for each fold. Before feeding the inputs into networks, all images were augmented with random rotation and vertical flip, normalized, and resized to 224×224 pixels. ResNeXt was chosen as the DL baseline due to its advantages of higher efficiency and accuracy in image classification. Mean absolute error (MAE) was the primary parameter. Independent data from 100 patients acquired between March and April 2022 were used as a test set. The manual method completely followed the prior study, which reported the lowest MAEs (5.31 in males and 6.72 in females) among similar studies. CT data and VR images were used. The radiation density of the first costal cartilage was recorded using CT data on the workstation. The osseous and calcified projections of the 1 to 7 costal cartilages were scored based on VR images using an eight-stage staging technique. According to the results of the prior study, the optimal models were the decision tree regression model in males and the stepwise multiple linear regression equation in females. Predicted ages of the test set were calculated separately using different models by sex. A total of 2600 patients (training and validation sets, mean age=45.19 years±14.20 [SD]; test set, mean age=46.57±9.66) were evaluated in this study. Of ResNeXt model training, MAEs were obtained with 3.95 in males and 3.65 in females. Based on the test set, DL achieved MAEs of 4.05 in males and 4.54 in females, which were far better than the MAEs of 8.90 and 6.42 respectively, for the manual method. Those results showed that the DL of the ResNeXt model outperformed the manual method in AAE based on CT reconstruction of the costal cartilage and the developed system may be a supportive tool for AAE.

Keywords: forensic anthropology, age determination by the skeleton, costal cartilage, CT, deep learning

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Authors: Shohreh Ghasemi

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Introduction: Managing oral and maxillofacial trauma is a multifaceted challenge, as it can have life-threatening consequences and significant functional and aesthetic impact. Navigation techniques have been introduced to improve surgical precision to meet this challenge. A machine learning algorithm was also developed to support clinical decision-making regarding treating oral and maxillofacial trauma. Given these advances, this systematic meta-analysis aims to assess the efficacy of navigational techniques in treating oral and maxillofacial trauma and explore the impact of machine learning on their management. Methods: A detailed and comprehensive analysis of studies published between January 2010 and September 2021 was conducted through a systematic meta-analysis. This included performing a thorough search of Web of Science, Embase, and PubMed databases to identify studies evaluating the efficacy of navigational techniques and the impact of machine learning in managing oral and maxillofacial trauma. Studies that did not meet established entry criteria were excluded. In addition, the overall quality of studies included was evaluated using Cochrane risk of bias tool and the Newcastle-Ottawa scale. Results: Total of 12 studies, including 869 patients with oral and maxillofacial trauma, met the inclusion criteria. An analysis of studies revealed that navigation techniques effectively improve surgical accuracy and minimize the risk of complications. Additionally, machine learning algorithms have proven effective in predicting treatment outcomes and identifying patients at high risk for complications. Conclusion: The introduction of navigational technology has great potential to improve surgical precision in oral and maxillofacial trauma treatment. Furthermore, developing machine learning algorithms offers opportunities to improve clinical decision-making and patient outcomes. Still, further studies are necessary to corroborate these results and establish the optimal use of these technologies in managing oral and maxillofacial trauma

Keywords: trauma, machine learning, navigation, maxillofacial, management

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