Search results for: growing patient
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 6129

Search results for: growing patient

1719 Effect of Plasma Radiation on Keratinocyte Cells Involved in the Wound Healing Process

Authors: B. Fazekas, I. Korolov, K. Kutasi

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Plasma medicine, which involves the use of gas discharge plasmas for medical applications is a rapidly growing research field. The use of non-thermal atmospheric pressure plasmas in dermatology to assist tissue regeneration by improving the healing of infected and/or chronic wounds is a promising application. It is believed that plasma can activate cells, which are involved in the wound closure. Non-thermal atmospheric plasmas are rich in chemically active species (such as O and N-atoms, O2(a) molecules) and radiative species such as the NO, N2+ and N2 excited molecules, which dominantly radiate in the 200-500 nm spectral range. In order to understand the effect of plasma species, both of chemically active and radiative species on wound healing process, the interaction of physical plasma with the human skin cells is necessary. In order to clarify the effect of plasma radiation on the wound healing process we treated keratinocyte cells – that are one of the main cell types in human skin epidermis – covered with a layer of phosphate-buffered saline (PBS) with a low power atmospheric pressure plasma. For the generation of such plasma we have applied a plasma needle. Here, the plasma is ignited at the tip of the needle in flowing helium gas in contact with the ambient air. To study the effect of plasma radiation we used a plasma needle configuration, where the plasma species – chemically active radicals and charged species – could not reach the treated cells, but only the radiation. For the comparison purposes, we also irradiated the cells using a UV-B light source (FS20 lamp) with a 20 and 40 mJ cm-2 dose of 312 nm. After treatment the viability and the proliferation of the cells have been examined. The proliferation of cells has been studied with a real time monitoring system called Xcelligence. The results have indicated, that the 20 mJ cm-2 dose did not affect cell viability, whereas the 40 mJ cm-2 dose resulted a decrease in cell viability. The results have shown that the plasma radiation have no quantifiable effect on the cell proliferation as compared to the non-treated cells.

Keywords: UV radiation, non-equilibrium gas discharges (non-thermal plasmas), plasma emission, keratinocyte cells

Procedia PDF Downloads 582
1718 Attracting the North Holidaymaker to Ireland Using Social Media Channels: An Irish Marketing Strategy

Authors: Colm Barcoe, Garvan Whelan

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In tourism, engagement has been found to boost awareness of a destination and subsequently increase visits. Customer engagement in this industry is now facilitated by social media. This phenomenon is not very well researched in relation to Ireland and the North American tourism market. The objective of this paper is to present research findings on two related topics; the first is an investigation into the effectiveness of social media channels as components of a digital marketing campaign when promoting Ireland as a brand in North America. Secondly, this study reveals how Irish marketers have embraced social media platforms and channels with an innovative strategy that has successfully attracted growing numbers of US and Canadian holidaymakers to Ireland. A range of methodological approaches was applied in order to achieve the study’s objective. The methods used were both quantitative and qualitative, and the data was obtained from both Irish marketers and North American holidaymakers. Surveys of these holidaymakers in the pre, during and post-trip phases revealed their attitudes towards social media and Ireland as a destination. Semi-structured interviews with those responsible for implementing relationship marketing strategies for this segment provide insight into the effectiveness of social media when used to capitalise on the cultural link between Ireland and North America. Further analysis involved using Nvivo 11+ software to investigate the activities of the Irish destination marketer (DMO) and the engagement of the US and Canadian audiences through a detailed study of social media platform content. The findings from this investigation will extend an under-researched body of literature pertaining to Ireland as a destination and the successful digital marketing campaigns that have achieved exponential growth in this sector over the past five years. The empirical evidence presented also illustrates how the innovative use of social media has assisted the DMO to engage with the North American holidaymaker as part of an effective digital marketing strategy.

Keywords: channels, digital, engagement, marketing, strategies

Procedia PDF Downloads 132
1717 Impact of Treatment of Fragility Fractures Due to Osteoporosis as an Economic Burden Worldwide: A Systematic Review

Authors: Fabiha Tanzeem

Abstract:

BACKGROUND: Osteoporosis is a skeletal disease that is associated with a reduction in bone mass and microstructures of the bone and deterioration of bone tissue. Fragility fracture due to osteoporosis is the most significant complication of osteoporosis. The increasing prevalence of fragility fractures presents a growing burden on the global economy. There is a rapidly evolving need to improve awareness of the costs associated with these types of fractures and to review current policies and practices for the prevention and management of the disease. This systematic review will identify and describe the direct and indirect costs associated with osteoporotic fragility fractures from a global perspective from the included studies. The review will also find out whether the costs required for the treatment of fragility fractures due to osteoporosis impose an economic burden on the global healthcare system. METHODS: Four major databases were systematically searched for direct and indirect costs of osteoporotic fragility fracture studies in the English Language. PubMed, Cochrane Library, Embase and Google Scholar were searched for suitable articles published between 1990 and July 2020. RESULTS: The original search yielded 1166 papers; from these, 27 articles were selected for this review according to the inclusion and exclusion criteria. In the 27 studies, the highest direct costs were associated with the treatment of pelvic fractures, with the majority of the expenditure due to hospitalization and surgical treatments. It is also observed that most of the articles are from developed countries. CONCLUSION: This review indicates the significance of the economic burden of osteoporosis globally, although more research needs to be done in developing countries. In the treatment of fragility fractures, direct costs were the main reported expenditure in this review. The healthcare costs incurred globally can be significantly reduced by implementing measures to effectively prevent the disease. Raising awareness in children and adults by improving the quality of the information available and standardising policies and planning of services requires further research.

Keywords: systematic review, osteoporosis, cost of illness

Procedia PDF Downloads 143
1716 Effect of Acceptance and Commitment Therapy in Cognitive Function among Breast Cancer Patients in Eastern Country

Authors: Arunima Datta, Prathama Guha Chaudhuri, Ashis Mukhopadhyay

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Background: Acceptance and commitment therapy (ACT) is one of the newer forms (third wave) therapy. This therapy helps a cancer patient to increase acceptance level about their disease as well as their present situation. Breast cancer patients are known to suffer from depression and mild cognitive impairment; both affect their quality of life. Objectives:The present study had assessed effect of structured ACT intervention on cognitive function and acceptance level among breast cancer patients who were undergoing chemotherapy. Method: Data was collected from 123 breast cancer patients those who were undergoing chemotherapy were willing to undergo psychological treatment, with no history of past psychiatric illness. Their baseline of cognitive function and acceptance levels were assessed using validated tools. The effect of sociodemographic factors and clinical factors on cognitive function was determined at baseline.The participants were randomly divided into two groups: experimental (ACT, 4 sessions over 2 months) and control group. Cognitive function and acceptance level were measured during post intervention on 2months follow-up. Appropriate statistical analyses were performed to determine the effect on cognitive function and acceptance level in two groups. Result: At baseline, the factors that significantly influenced slower speed of task performance were ER PR HER2 status; number of chemo cycle, treatment type (Adjuvant and neo-adjuvant) was related with that. Sociodemographic characteristics did not show any significant difference between slow and fast performance. Per and post intervention analysis showed that ACT intervention resulted in significant difference both in terms of speed of cognitive performance and acceptance level. Conclusion: ACT is an effective therapeutic option for treating mild cognitive impairment and improve acceptance level among breast cancer patients undergoing chemotherapy.

Keywords: acceptance and commitment therapy, breast cancer, quality of life, cognitive function

Procedia PDF Downloads 282
1715 Historical Evolution of Islamic Law and Its Application to the Islamic Finance

Authors: Malik Imtiaz Ahmad

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The prime sources of Islamic Law or Shariah are Quran and Sunnah and is applied to the personal and public affairs of Muslims. Islamic law is deemed to be divine and furnishes a complete code of conduct based upon universal values to build honesty, trust, righteousness, piety, charity, and social justice. The primary focus of this paper was to examine the development of Islamic jurisprudence (Fiqh) over time and its relevance to the field of Islamic finance. This encompassed a comprehensive analysis of the historical context, key legal principles, and their application in contemporary financial systems adhering to Islamic principles. This study aimed to elucidate the deep-rooted connection between Islamic law and finance, offering valuable insights for practitioners and policymakers in the Islamic finance sector. Understanding the historical context and legal underpinnings is crucial for ensuring the compliance and ethicality of modern financial systems adhering to Islamic principles. Fintech solutions are developing fields to accelerate the digitalization of Islamic finance products and services for the harmonization of global investors' mandate. Through this study, we focus on institutional governance that will improve Sharia compliance, efficiency, transparency in decision-making, and Islamic finance's contribution to humanity through the SDGs program. The research paper employed an extensive literature review, historical analysis, examination of legal principles, and case studies to trace the evolution of Islamic law and its contemporary application in Islamic finance, providing a concise yet comprehensive understanding of this intricate relationship. Through these research methodologies, the aim was to provide a comprehensive and insightful exploration of the historical evolution of Islamic law and its relevance to contemporary Islamic finance, thereby contributing to a deeper understanding of this unique and growing sector of the global financial industry.

Keywords: sharia, sequencing Islamic jurisprudence, Islamic congruent marketing, social development goals of Islamic finance

Procedia PDF Downloads 41
1714 Online Dietary Management System

Authors: Kyle Yatich Terik, Collins Oduor

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The current healthcare system has made healthcare more accessible and efficient by the use of information technology through the implementation of computer algorithms that generate menus based on the diagnosis. While many systems just like these have been created over the years, their main objective is to help healthy individuals calculate their calorie intake and assist them by providing food selections based on a pre-specified calorie. That application has been proven to be useful in some ways, and they are not suitable for monitoring, planning, and managing hospital patients, especially that critical condition their dietary needs. The system also addresses a number of objectives, such as; the main objective is to be able to design, develop and implement an efficient, user-friendly as well as and interactive dietary management system. The specific design development objectives include developing a system that will facilitate a monitoring feature for users using graphs, developing a system that will provide system-generated reports to the users, dietitians, and system admins, design a system that allows users to measure their BMI (Body Mass Index), the system will also provide food template feature that will guide the user on a balanced diet plan. In order to develop the system, further research was carried out in Kenya, Nairobi County, using online questionnaires being the preferred research design approach. From the 44 respondents, one could create discussions such as the major challenges encountered from the manual dietary system, which include no easily accessible information of the calorie intake for food products, expensive to physically visit a dietitian to create a tailored diet plan. Conclusively, the system has the potential of improving the quality of life of people as a whole by providing a standard for healthy living and allowing individuals to have readily available knowledge through food templates that will guide people and allow users to create their own diet plans that consist of a balanced diet.

Keywords: DMS, dietitian, patient, administrator

Procedia PDF Downloads 139
1713 Identification and Origins of Multiple Personality: A Criterion from Wiggins

Authors: Brittany L. Kang

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One familiar theory of the origin of multiple personalities focuses on how symptoms of trauma or abuse are central causes, as seen in paradigmatic examples of the condition. The theory states that multiple personalities constitute a congenital condition, as babies all exhibit multiplicity, and that generally alters only remain separated due to trauma. In more typical cases, the alters converge and become a single identity; only in cases of trauma, according to this account, do the alters remain separated. This theory is misleading in many aspects, the most prominent being that not all multiple personality patients are victims of child abuse or trauma, nor are all cases of multiple personality observed in early childhood. The use of this criterion also causes clinical problems, including an inability to identify multiple personalities through the variety of symptoms and traits seen across observed cases. These issues present a need for revision in the currently applied criterion in order to separate the notion of child abuse and to be able to better understand the origins of multiple personalities itself. Identifying multiplicity through the application of identity theories will improve the current criterion, offering a bridge between identifying existing cases and understanding their origins. We begin by applying arguments from Wiggins, who held that each personality within a multiple was not a whole individual, but rather characters who switch off. Wiggins’ theory is supported by observational evidence of how such characters are differentiated. Alters of older ages are seen to require different prescription lens, in addition to having different handwriting. The alters may also display drastically varying styles of clothing, preferences in food, their gender, sexuality, religious beliefs and more. The definitions of terms such as 'personality' or 'persons' also become more distinguished, leading to greater understanding of who is exactly able to be classified as a patient of multiple personalities. While a more common meaning of personality is a designation of specific characteristics which account for the entirety of a person, this paper argues from Wiggins’ theory that each 'personality' is in fact only partial. Clarification of the concept in question will allow for more successful future clinical applications.

Keywords: identification, multiple personalities, origin, Wiggins' theory

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1712 Blockchain-Based Decentralized Architecture for Secure Medical Records Management

Authors: Saeed M. Alshahrani

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This research integrated blockchain technology to reform medical records management in healthcare informatics. It was aimed at resolving the limitations of centralized systems by establishing a secure, decentralized, and user-centric platform. The system was architected with a sophisticated three-tiered structure, integrating advanced cryptographic methodologies, consensus algorithms, and the Fast Healthcare Interoperability Resources (HL7 FHIR) standard to ensure data security, transaction validity, and semantic interoperability. The research has profound implications for healthcare delivery, patient care, legal compliance, operational efficiency, and academic advancements in blockchain technology and healthcare IT sectors. The methodology adapted in this research comprises of Preliminary Feasibility Study, Literature Review, Design and Development, Cryptographic Algorithm Integration, Modeling the data and testing the system. The research employed a permissioned blockchain with a Practical Byzantine Fault Tolerance (PBFT) consensus algorithm and Ethereum-based smart contracts. It integrated advanced cryptographic algorithms, role-based access control, multi-factor authentication, and RESTful APIs to ensure security, regulate access, authenticate user identities, and facilitate seamless data exchange between the blockchain and legacy healthcare systems. The research contributed to the development of a secure, interoperable, and decentralized system for managing medical records, addressing the limitations of the centralized systems that were in place. Future work will delve into optimizing the system further, exploring additional blockchain use cases in healthcare, and expanding the adoption of the system globally, contributing to the evolution of global healthcare practices and policies.

Keywords: healthcare informatics, blockchain, medical records management, decentralized architecture, data security, cryptographic algorithms

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1711 Synthesis and Characterization of Iron and Aluminum-Containing AFm Phases

Authors: Aurore Lechevallier, Mohend Chaouche, Jerome Soudier, Guillaume Renaudin

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The cement industry accounts for 8% of the global CO₂ emissions, and approximately 60% of these emissions are associated with the Portland cement clinker production from the decarbonization of limestone (CaCO3). Their impact on the greenhouse effect results in growing social awareness. Therefore, CO2 footprint becomes a product selection choice, and substituting Portland cement with a lower CO2-footprint alternative binder is sought. In this context, new hydraulic binders have been studied as a potential Ordinary Portland Cement substitute. Many of them are composed of iron oxides and aluminum oxides, present in the Ca₄Al₂-xFe₂+ₓO₁₀-like phase and forming Ca-LDH (i.e. AFM) as a hydration product. It has become essential to study the possible existence of Fe/Al AFM solid solutions to characterize the hydration process properly. Ca₂Al₂-xFex(OH)₆.X.nH₂O layered AFM samples intercalated with either nitrate or chloride X anions were synthesized based on the co-precipitation method under a nitrogen atmosphere to avoid the carbonation effect.AFM samples intercalated with carbonate anions were synthesized based on the anionic exchange process, using AFM-NO₃ as the source material. These three AFM samples were synthesized with varying Fe/Al molar ratios. The experimental conditions were optimized to make possible the formation of Al-AFM and Fe-AFM using the same parameters (namely pH value and salt concentration). Rietveld refinements were performed to demonstrate the existence of a solid solution between the two trivalent metallic end members. Spectroscopic analyses were used to confirm the intercalation of the targeted anion; secondary electron images were taken to analyze the AFM samples’ morphology, and energy dispersive X-ray spectroscopy (EDX) was carried out to determine the elemental composition of the AFM samples. Results of this study make it possible to quantify the Al/Fe ratio of the AFM phases precipitated in our hydraulic binder, thanks to the determined Vegard's law characteristic to the corresponding solid solutions

Keywords: AFm phase, iron-rich binder, low-carbon cement, solid solution

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1710 Correlation of Serum Apelin Level with Coronary Calcium Score in Patients with Suspected Coronary Artery Disease

Authors: M. Zeitoun, K. Abdallah, M. Rashwan

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Introduction: A growing body of evidence indicates that apelin, a relatively recent member of the adipokines family, has a potential anti-atherogenic effect. An association between low serum apelin state and coronary artery disease (CAD) was previously reported; however, the relationship between apelin and the atherosclerotic burden was unclear. Objectives: Our aim was to explore the correlation of serum apelin level with coronary calcium score (CCS) as a quantitative marker of coronary atherosclerosis. Methods: This observational cross-sectional study enrolled 100 consecutive subjects referred for cardiac multi-detector computed tomography (MDCT) for assessment of CAD (mean age 54 ± 9.7 years, 51 male and 49 females). Clinical parameters, glycemic and lipid profile, high sensitivity CRP (hsCRP), homeostasis model assessment of insulin resistance (HOMA-IR), serum creatinine and complete blood count were assessed. Serum apelin levels were determined using a commercially available Enzyme Immunoassay (EIA) Kit. High-resolution non-contrast CT images were acquired by a 64-raw MDCT and CCS was calculated using the Agatston scoring method. Results: Forty-three percent of the studied subjects had positive coronary artery calcification (CAC). The mean CCS was 79 ± 196.5 Agatston units. Subjects with detectable CAC had significantly higher fasting plasma glucose, HbA1c, and WBCs count than subjects without detectable CAC (p < 0.05). Most importantly, subjects with detectable CAC had significantly lower serum apelin level than subjects without CAC (1.3 ± 0.4 ng/ml vs. 2.8 ± 0.6 ng/ml, p < 0.001). In addition, there was a statistically significant inverse correlation between serum apelin levels and CCS (r = 0.591, p < 0.001); on multivariate analysis this correlation was found to be independent of traditional cardiovascular risk factors and hs-CRP. Conclusion:To the best of our knowledge, this is the first report of an independent association between apelin and CCS in patients with suspected CAD. Apelin emerges as a possible novel biomarker for CAD, but this result remains to be proved prospectively.

Keywords: HbA1c, apelin, adipokines, coronary calcium score (CCS), coronary artery disease (CAD)

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1709 Exchanging Radiology Reporting System with Electronic Health Record: Designing a Conceptual Model

Authors: Azadeh Bashiri

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Introduction: In order to better designing of electronic health record system in Iran, integration of health information systems based on a common language must be done to interpret and exchange this information with this system is required. Background: This study, provides a conceptual model of radiology reporting system using unified modeling language. The proposed model can solve the problem of integration this information system with electronic health record system. By using this model and design its service based, easily connect to electronic health record in Iran and facilitate transfer radiology report data. Methods: This is a cross-sectional study that was conducted in 2013. The student community was 22 experts that working at the Imaging Center in Imam Khomeini Hospital in Tehran and the sample was accorded with the community. Research tool was a questionnaire that prepared by the researcher to determine the information requirements. Content validity and test-retest method was used to measure validity and reliability of questioner respectively. Data analyzed with average index, using SPSS. Also, Visual Paradigm software was used to design a conceptual model. Result: Based on the requirements assessment of experts and related texts, administrative, demographic and clinical data and radiological examination results and if the anesthesia procedure performed, anesthesia data suggested as minimum data set for radiology report and based it class diagram designed. Also by identifying radiology reporting system process, use case was drawn. Conclusion: According to the application of radiology reports in electronic health record system for diagnosing and managing of clinical problem of the patient, provide the conceptual Model for radiology reporting system; in order to systematically design it, the problem of data sharing between these systems and electronic health records system would eliminate.

Keywords: structured radiology report, information needs, minimum data set, electronic health record system in Iran

Procedia PDF Downloads 228
1708 Assessing the Social Impacts of Regional Services: The Case of a Portuguese Municipality

Authors: A. Camões, M. Ferreira Dias, M. Amorim

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In recent years, the social economy is increasingly seen as a viable means to address social problems. Social enterprises, as well as public projects and initiatives targeted to meet social purposes, offer organizational models that assume heterogeneity, flexibility and adaptability to the ‘real world and real problems’. Despite the growing popularity of social initiatives, decision makers still face a paucity in what concerns the available models and tools to adequately assess its sustainability, and its impacts, notably the nature of its contribution to economic growth. This study was carried out at the local level, by analyzing the social impact initiatives and projects promoted by the Municipality of Albergaria-a-Velha (Câmara Municipal de Albergaria-a-Velha -CMA), a municipality of 25,000 inhabitants in the central region of Portugal. This work focuses on the challenges related to the qualifications and employability of citizens, which stands out as one of the key concerns in the Portuguese economy, particularly expressive in the context of small-scale cities and inland territories. The study offers a characterization of the Municipality, its socio-economic structure and challenges, followed by an exploratory analysis of multiple sourced data, collected from the CMA's documental sources as well as from privileged informants. The purpose is to conduct detailed analysis of the CMA's social projects, aimed at characterizing its potential impact for the model of qualifications and employability of the citizens of the Municipality. The study encompasses a discussion of the socio-economic profile of the municipality, notably its asymmetries, the analysis of the social projects and initiatives, as well as of data derived from inquiry actors involved in the implementation of the social projects and its beneficiaries. Finally, the results obtained with the Better Life Index will be included. This study makes it possible to ascertain if what is implicit in the literature goes to the encounter of what one experiences in reality.

Keywords: measurement, municipalities, social economy, social impact

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1707 Effectiveness of Gamified Virtual Physiotherapy Patients with Shoulder Problems

Authors: A. Barratt, M. H. Granat, S. Buttress, B. Roy

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Introduction: Physiotherapy is an essential part of the treatment of patients with shoulder problems. The focus of treatment is usually centred on addressing specific physiotherapy goals, ultimately resulting in the improvement in pain and function. This study investigates if computerised physiotherapy using gamification principles are as effective as standard physiotherapy. Methods: Physiotherapy exergames were created using a combination of commercially available hardware, the Microsoft Kinect, and bespoke software. The exergames used were validated by mapping physiotherapy goals of physiotherapy which included; strength, range of movement, control, speed, and activation of the kinetic chain. A multicenter, randomised prospective controlled trial investigated the use of exergames on patients with Shoulder Impingement Syndrome who had undergone Arthroscopic Subacromial Decompression surgery. The intervention group was provided with the automated sensor-based technology, allowing them to perform exergames and track their rehabilitation progress. The control group was treated with standard physiotherapy protocols. Outcomes from different domains were used to compare the groups. An important metric was the assessment of shoulder range of movement pre- and post-operatively. The range of movement data included abduction, forward flexion and external rotation which were measured by the software, pre-operatively, 6 weeks and 12 weeks post-operatively. Results: Both groups show significant improvement from pre-operative to 12 weeks in elevation in forward flexion and abduction planes. Results for abduction showed an improvement for the interventional group (p < 0.015) as well as the test group (p < 0.003). Forward flexion improvement was interventional group (p < 0.0201) with the control group (p < 0.004). There was however no significant difference between the groups at 12 weeks for abduction (p < 0.118067) , forward flexion (p < 0.189755) or external rotation (p < 0.346967). Conclusion: Exergames may be used as an alternative to standard physiotherapy regimes; however, further analysis is required focusing on patient engagement.

Keywords: shoulder, physiotherapy, exergames, gamification

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1706 Single-Molecule Optical Study of Cholesterol-Mediated Dimerization Process of EGFRs in Different Cell Lines

Authors: Chien Y. Lin, Jung Y. Huang, Leu-Wei Lo

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A growing body of data reveals that the membrane cholesterol molecules can alter the signaling pathways of living cells. However, the understanding about how membrane cholesterol modulates receptor proteins is still lacking. Single-molecule tracking can effectively probe into the microscopic environments and thermal fluctuations of receptor proteins in a living cell. In this study we applies single-molecule optical tracking on ligand-induced dimerization process of EGFRs in the plasma membranes of two cancer cell lines (HeLa and A431) and one normal endothelial cell line (MCF12A). We tracked individual EGFR and dual receptors, diffusing in a correlated manner in the plasma membranes of live cells. We developed an energetic model by integrating the generalized Langevin equation with the Cahn-Hilliard equation to help extracting important information from single-molecule trajectories. From the study, we discovered that ligand-bound EGFRs move from non-raft areas into lipid raft domains. This ligand-induced motion is a common behavior in both cancer and normal cells. By manipulating the total amount of membrane cholesterol with methyl-β-cyclodextrin and the local concentration of membrane cholesterol with nystatin, we further found that the amount of cholesterol can affect the stability of EGFR dimers. The EGFR dimers in the plasma membrane of normal cells are more sensitive to the local concentration changes of cholesterol than EGFR dimers in the cancer cells. Our method successfully captures dynamic interactions of receptors at the single-molecule level and provides insight into the functional architecture of both the diffusing EGFR molecules and their local cellular environment.

Keywords: membrane proteins, single-molecule tracking, Cahn-Hilliard equation, EGFR dimers

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1705 Seroprevalence of Toxoplasmosis among Hemato-Oncology Patients in Tertiary Hospital of East Cost Malaysia

Authors: Aisha Khodijah Kholib Jati, Suharni Mohamad, Azlan Husin, Wan Suriana Wan Ab Rahman

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Introduction: Toxoplasmosis is caused by an obligate intracellular parasite, Toxoplasma gondii (T. gondii). It is commonly asymptomatic in normal individual, but it can be fatal to immunocompromised patients as it can lead to severe complications such as encephalitis, chorioetinitis and myocarditis. Objective: The aim of the study was to determine the seroprevalence of toxoplasmosis and its association with socio-demographic and behavioral characteristics among hemato-oncology patients in Hospital USM. Methods: In this cross-sectional study, 56 hemato-oncology patients were screened for immunoglobulin M (IgM) antibodies, immunoglobulin G (IgG) antibodies, and IgG avidity of T. gondii by using ELISA Kit (BioRad, USA). For anti-T. gondii IgG antibody, titer ≥ 9 IU/ml was considered as recent infection, while for IgM, ratio ≥ 1.00 was considered as reactive for the anti-T. gondii IgM antibodies. Low avidity index is considered as recent infection within 20 weeks while high avidity considered as past infection. T. gondii exposure, socio-demographic and behavioral characteristics was assessed by a questionnaire and interview. Results: A total of 28 (50.0%) hemato-oncology patients were seropositive for T. gondii antibodies. Out of that total, 27 (48.21%) patients were IgG+/IgM- and one patient (1.79%) was IgG+/IgM+ with high avidity index. Univariate analysis showed that age, gender, ethnicity, marital status, educational level, employment status, stem cell transplant, blood transfusion, close contact with cats, water supply, and consumption of undercooked meat were not significantly associated with Toxoplasma seropositivity rate. Discussion: The seropositivity rate of IgG anti-T. gondii was high among hemato-oncology patients in Hospital USM. With impaired immune system, these patients might have a severe consequence if the infection reactivated. Therefore, screening for anti-T. gondii may be considered in the future. Moreover, health programme towards healthy food and good hygiene practice need to be implemented.

Keywords: immunocompromised, seroprevalence, socio-demographic, toxoplasmosis

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1704 Drug Therapy Problems and Associated Factors among Patients with Heart Failure in the Medical Ward of Arba Minch General Hospital, Ethiopia

Authors: Debalke Dale, Bezabh Geneta, Yohannes Amene, Yordanos Bergene, Mohammed Yimam

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Background: A drug therapy problem (DTP) is an event or circumstance that involves drug therapies that actually or potentially interfere with the desired outcome and requires professional judgment to resolve. Heart failure is an emerging worldwide threat whose prevalence and health loss burden constantly increase, especially in the young and in low-to-middle-income countries. There is a lack of population-based incidence and prevalence of heart failure (HF) studies in sub-Saharan African countries, including Ethiopia. Objective: The aim of this study was designed to assess drug therapy problems and associated factors among patients with HF in the medical ward of Arba Minch General Hospital(AGH), Ethiopia, from June 5 to August 20, 2022. Methods: A retrospective cross-sectional study was conducted among 180 patients with HF who were admitted to the medical ward of AGH. Data were collected from patients' cards by using questionnaires. The data were categorized and analyzed by using SPSS version 25.0 software, and data were presented in tables and words based on the nature of the data. Result: Out of the total, 85 (57.6%) were females, and 113 (75.3%) patients were aged over fifty years. Of the 150 study participants, 86 (57.3%) patients had at least one DTP identified, and a total of 116 DTPs were identified, which is 0.77 DTPs per patient. The most common types of DTP were unnecessary drug therapy (32%), followed by the need for additional drug therapy (36%), and dose too low (15%). Patients who used polypharmacy were 5.86 (AOR) times more likely to develop DTPs than those who did not (95% CI = 1.625–16.536, P = 0.005), and patients with more co-morbid conditions developed 3.68 (AOR) times more DTPs than those who had fewer co-morbidities (95% CI = 1.28–10.5, P = 0.015). Conclusion: The results of this study indicated that drug therapy problems were common among medical ward patients with heart failure. These problems are adversely affecting the treatment outcomes of patients, so it requires the special attention of healthcare professionals to optimize them.

Keywords: heart failure, drug therapy problems, Arba Minch general hospital, Ethiopia

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1703 The Electrophysiology Study Results in Patients with Guillain Barre Syndrome (GBS): A Retrospective Study in a TertiaryHospital in Cebu City, Philippines

Authors: Dyna Ann C. Sevilles, Noel J. Belonguel, Jarungchai Anton S. Vatanagul, Mary Jeanne O. Flordelis, Grace G. Anota

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Guillain Barre syndrome is an acute inflammatory polyradiculoneuropathy causing progressive symmetrical weakness which can be debilitating to the patient. Early diagnosis is important especially in the acute phase when treatment favors good outcome and reduces the incidence of the need for mechanical ventilation. Electrodiagnostic studies aid in the evaluation of patients suspected with GBS. However, the characteristic electrical changes may not be evident until after several weeks. Thus, studies performed early in the course may give unclear results. The aim of this study is to associate the symptom onset of patients diagnosed with Guillain Barre syndrome with the EMG NCV results and determine the earliest time when there is evident findings supporting the diagnosis. This is a retrospective descriptive chart review study involving patients of >/= 18 years of age with GBS written on their charts in a Tertiaty hospital in Cebu City, Philippines from January 2000 to July 2014. Twenty patients showed electrodiagnostic findings suggestive of GBS. The mean day of illness when EMG NCV was carried out was 7 days. The earliest with suggestive findings was done on day 2 (10%) of illness. Moreover, the highest frequency with positive results was done on day 3 (20%) of illness. Based on the Dutch Guillain Barre Study group criteria, the most frequent variables noted were: prolonged distal motor latency in both median and ulnar nerves(65%) and both peroneal and tibial nerves (71%); and reduced CMAP in both median and ulnar nerves (65%) and both tibial and peroneal nerves (71%). The EMG NCV findings showed majority of demyelinating type (59%). Electrodiagnostic studies are helpful in aiding the physician in the diagnosis and treatment of the disease in the early stage. Based on this study, neurophysiologic evidence of GBS can be seen in as early as day 2 of clinical illness.

Keywords: Acute Inflammatory Demyelinating Polyneuropathy, electrophysiologic study, EMG NCV, Guillain Barre Syndrome

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1702 The Distribution, Productivity and Conservation of Camphor Tree, Dryobalanops Aromatica in West Coast of Sumatra, Indonesia

Authors: Aswandi Anas Husin, Cut Rizlani Kholibrina

Abstract:

Harvesting camphor resin has been carried out since the beginning of civilization on the west coast of Sumatra. Oil or crystals that containing borneol are harvested from the camphor tree (Dryobalanops aromatica). Non-timber forest products are utilized for the manufacture of fragrances, antiseptics, anti-inflammatory, analgesic as well as effective for the treatment of blocked arteries. Based on exploration on the west coast of Sumatra, these endemic tree species were found remaining growing in groups on small spots in the lowlands to the hills. Some populations are found at an altitude of 700 meters above sea level in Kadabuhan, Jongkong and Sultan Daulat in Subulussalam district, Singkohor and Lake Paris in Aceh Singkil district, and Sirandorung and Manduamas in the north of Barus, Central Tapanuli district. These multi-purpose tree species was also identified as being able to adapt to the Singkil Peat Swamp. The decline in tree population has a direct impact on reducing their productivity. Conventionally, the crystals are harvested by cutting and splitting the stem into wooden blocks. In this way about 1.5-2.5 kg of crystals are obtained with various qualities. Camphor retrieval can also be done by making a notch on a standing tree trunk and collecting liquid resin (ombil) that is removed from the injured resin channel. Twigs and leaves also contain borneol. The aromatic content in this section opens opportunities for the supply of borneol through the distillation process. Vegetative propagation technology is needed to overcome the limitations of available seeds. This breeding strategy for vulnerable species starts with gathering genetic material from various provenances which are then used to support the provision of basic populations, breeding populations, multiplication populations and production populations for extensive development of camphor tree plantations

Keywords: camphor, conservation, natural borneol, productivity, vulnerable species

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1701 Molecular Genetic Purity Test Using SSR Markers in Pigeon Pea

Authors: Rakesh C. Mathad, G. Y. Lokesh, Basavegowda

Abstract:

In agriculture using quality seeds of improved varieties is very important to ensure higher productivity thereby food security and sustainability. To ensure good productivity, seeds should have characters as described by the breeder. To know whether the characters as described by the breeder are expressing in a variety such as genuineness or genetic purity, field grow out test (GOT) is done. In pigeon pea which is long durational crop, conducting a GOT may take very long time and expensive also. Since in pigeon pea flower character is a most distinguishing character from the contaminants, conducting a field grow out test require 120-130 days or till flower emergence, which may increase cost of storage and seed production. This will also delay the distribution of seed inventory to the pigeon pea growing areas. In this view during 2014-15 with financial support of Govt. of Karnataka, India, a project to develop a molecular genetic test for newly developed variety of pigeon pea cv.TS3R was commissioned at Seed Unit, UAS, Raichur. A molecular test was developed with the help SSR markers to identify pure variety from possible off types in newly released pigeon pea variety TS3R. In the investigation, 44 primer pairs were screened to identify the specific marker associated with this variety. Pigeon pea cv. TS3R could be clearly identified by using the primer CCM 293 based on the banding pattern resolved on gel electrophoresis and PCR reactions. However some of the markers like AHSSR 46, CCM 82 and CCM 57 can be used to test other popular varieties in the region like Asha, GRG-811 and Maruti respectively. Further to develop this in to a lab test, the seed sample size was standardized to 200 seeds and a grow out matrix was developed. This matrix was used to sample 12 days old leaves to extract DNA. The lab test results were validated with actual field GOT test results and found variations within the acceptable limit of 1%. This molecular method can now be employed to test the genetic purity in pigeon pea cv TS3R which reduces the time and can be a cheaper alternative method for field GOT.

Keywords: genuineness, grow-out matrix, molecular genetic purity, SSR markers

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1700 Changing the Dynamics of the Regional Water Security in the Mekong River Basin: An Explorative Study Understanding the Cooperation and Conflict from Critical Hydropolitical Perspective

Authors: Richard Grünwald, Wenling Wang, Yan Feng

Abstract:

The presented paper explores the changing dynamics of regional water security in the Mekong River Basin and examines the contemporary water-related challenges from a critical hydropolitical perspective. By drawing on the Lancang-Mekong Cooperation and Conflict Database (LMCCD) recording more than 3000 water-related events within the basin in the last 30 years, we identified several trends changing the dynamics of the regional water security in the Mekong River Basin. Firstly, there is growing politicization of water that is no longer interpreted as abundant. While some scientists blame the rapid basin development, particularly in upstream countries, other researchers consider climate change and cumulative environmental impacts of various water projects as the main culprit for changing the water flow. Secondly, there is an increasing securitization of large-scale hydropower dams with questionable outcomes. Despite hydropower dams raise many controversies, many riparian states push the development at all cost. Such water security dilemma can be especially traced to Laos and Cambodia, which highly invest in the hydropower sector even at the expense of the local environment and good relations with neighbouring countries situated lower on the river. Thirdly, there is a lack of accountable transboundary water governance that will effectively face a looming water crisis. To date, most of the existing cooperation mechanisms are undermined by the geopolitical interests of foreign donors and increasing mistrust to scientific approaches dealing with water insecurity. Our findings are beneficial for the policy-makers and other water experts who want to grasp the broader hydropolitical context in the Mekong River Basin and better understand the new water security threats, including misinterpretation of the hydrological data and legitimization of the pro-development narratives.

Keywords: critical hydropolitics, mekong river, politicization of science, water governance, water security

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1699 Undersea Communications Infrastructure: Risks, Opportunities, and Geopolitical Considerations

Authors: Lori W. Gordon, Karen A. Jones

Abstract:

Today’s high-speed data connectivity depends on a vast global network of infrastructure across space, air, land, and sea, with undersea cable infrastructure (UCI) serving as the primary means for intercontinental and ‘long-haul’ communications. The UCI landscape is changing and includes an increasing variety of state actors, such as the growing economies of Brazil, Russia, India, China, and South Africa. Non-state commercial actors, such as hyper-scale content providers including Google, Facebook, Microsoft, and Amazon, are also seeking to control their data and networks through significant investments in submarine cables. Active investments by both state and non-state actors will invariably influence the growth, geopolitics, and security of this sector. Beyond these hyper-scale content providers, there are new commercial satellite communication providers. These new players include traditional geosynchronous (GEO) satellites that offer broad coverage, high throughput GEO satellites offering high capacity with spot beam technology, low earth orbit (LEO) ‘mega constellations’ – global broadband services. And potential new entrants such as High Altitude Platforms (HAPS) offer low latency connectivity, LEO constellations offer high-speed optical mesh networks, i.e., ‘fiber in the sky.’ This paper focuses on understanding the role of submarine cables within the larger context of the global data commons, spanning space, terrestrial, air, and sea networks, including an analysis of national security policy and geopolitical implications. As network operators and commercial and government stakeholders plan for emerging technologies and architectures, hedging risks for future connectivity will ensure that our data backbone will be secure for years to come.

Keywords: communications, global, infrastructure, technology

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1698 Alcohol Rituals and Active Ageing: A Thematic Analysis of Semi-Structured Interviews with Retirees in the West of Scotland

Authors: Deborah Nicholson, Fiona McCormack, Pete Seaman, Karen Bell

Abstract:

This paper explores alcohol consumption amongst retirees in the West of Scotland in the context of active and healthy ageing discourses. The public health consequences of alcohol use are well documented and of growing concern to policy makers in Scotland and elsewhere. However, alcohol occupies a prominent position in a range of cultural and social practices and has associated meanings for users related to conviviality, leisure, sociability, and inclusion- features closely tied to active and healthy ageing. These perceived positive and negative meanings place alcohol in an ambiguous and contradictory position in relation to the Scottish Government’s key health policy initiatives aimed at healthy ageing and the reduction of alcohol-related ill-health. This paper explores these positive and negative associations through an examination of the meanings which retirees attach to alcohol and the routines and rituals they develop to navigate wider health concerns. Methods: participants were recruited from the West of Scotland area using a quota sampling design based around gender, age, and socioeconomic position. Forty participants were interviewed using a semi-structured interview schedule and qualitative techniques. The interviews were transcribed and thematic analysis of the data was conducted. Results: Alcohol use amongst retirees in Scotland was widely varied with marked differences noted in terms of gender and age group, but with less clear variance by socioeconomic position. A range of strategies was employed to limit alcohol use by time, context, location and/or volume and these strategies clearly drew on a perception of alcohol use in retirement as potentially more problematic than at earlier stage of life. Thus, the retirees in the sample used these limiting strategies to navigate the positive and negative meanings they attached to alcohol use.

Keywords: alcohol, health, retirement, routines

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1697 Perception of Quality of Life and Self-Assessed Health in Patients Undergoing Haemodialysis

Authors: Magdalena Barbara Kaziuk, Waldemar Kosiba

Abstract:

Introduction: Despite the development of technologies and improvements in the interior of dialysis stations, dialysis remains an unpleasant procedure, difficult to accept by the patients (who undergo it 2 to 3 times a week, a single treatment lasting several hours). Haemodialysis is one of the renal replacement therapies, in Poland most commonly used in patients with chronic or acute kidney failure. Purpose: An attempt was made to evaluate the quality of life in haemodialysed patients using the WHOQOL-BREF questionnaire. Material and methods: The study covered 422 patients (200 women and 222 men, aged 60.5 ± 12.9 years) undergoing dialysis at three selected stations in Poland. The patients were divided into 2 groups, depending on the duration of their dialysis treatment. The evaluation was conducted with the WHOQOL-BREF questionnaire containing 26 questions analysing 4 areas of life, as well as the perception of the quality of life and health self-assessment. A 5-point scale is used to answer them. The maximum score in each area is 20 points. The results in individual areas have a positive direction. Results: In patients undergoing dialysis for more than 3 years, a reduction in the quality of life was found in the physical area and in their environment versus a group of patients undergoing dialysis for less than 3 years, where a reduced quality of life was found in the areas of social relations and mental well-being (p < 0.05). A significant correlation (p < 0.01) between the two groups was found in self-perceived general health, while no significant differences were observed in the general perception of the quality of life (p > 0.05). Conclusions: The study confirmed that in patients undergoing dialysis for more than three years, the quality of life is especially reduced in their environment (access to and quality of healthcare, financial resources, and mental and physical safety). The assessment of the quality of life should form a part of the therapeutic process, in which the role of the patient in chronic renal care should be emphasised, reflected in the quality of services provided by dialysis stations.

Keywords: haemodialysis, perception of quality of life, quality of services provided, dialysis station

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1696 Phytotechnologies for Use and Reconstitution of Contaminated Sites

Authors: Olga Shuvaeva, Tamara Romanova, Sergey Volynkin, Valentina Podolinnaya

Abstract:

Green chemistry concept is focused on the prevention of environmental pollution caused by human activity. However, there are a lot of contaminated areas in the world which pose a serious threat to ecosystems in terms of their conservation. Therefore in accordance with the principles of green chemistry, it should not be forgotten about the need to clean these areas. Furthermore, the waste material often contains the valuable components, the extraction of which by traditional wet chemical technologies is inefficient both from the economic and environmental protection standpoint. Wherein, the plants may be successfully used to ‘scavenge’ a range of metals from polluted land sites in an approach allowing to carry out both of these processes – phytoremediation and phytomining in conjunction. The goal of the present work was to study bioaccumulation ability of floating macrophytes such as water hyacinth and pondweed toward Hg, Ba, Cd, Mo and Pb as pollutants in aquatic medium and terrestrial plants (birch, reed, and cane) towards gold and silver as valuable components. The peculiarity of ongoing research was that the plants grew under extreme conditions (pH of drainage and pore waters was about 2.5). The study was conducted at the territory of Ursk tailings (Southwestern Siberia, Russia) formed as a result of primary polymetallic ores cyanidation. The waste material is mainly presented (~80%) by pyrite (FeS₂) and barite (BaSO₄), the raw minerals included FeAsS, HgS, PbS, Ag₂S as minor ones. It has been shown that water hyacinth demonstrates high ability to accumulate different metals, and what is especially important – to remove mercury from polluted waters with BCF value more than 1000. As for the gold, its concentrations in reed and cane growing near the waste material were estimated as 500 and 900 μg∙kg⁻¹ respectively. It was also found that the plants can survive under extreme conditions of acidic environment and hence we can assume that there is a principal opportunity to use them for the valuable substances extraction from an area of the mining waste dumps burial.

Keywords: bioaccumulation, gold, heavy metals, mine tailing

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1695 HCl-Based Hydrometallurgical Recycling Route for Metal Recovery from Li-Ion Battery Wastes

Authors: Claudia Schier, Arvid Biallas, Bernd Friedrich

Abstract:

The demand for Li-ion-batteries owing to their benefits, such as; fast charging time, high energy density, low weight, large temperature range, and a long service life performance is increasing compared to other battery systems. These characteristics are substantial not only for battery-operated portable devices but also in the growing field of electromobility where high-performance energy storage systems in the form of batteries are highly requested. Due to the sharp rising production, there is a tremendous interest to recycle spent Li-Ion batteries in a closed-loop manner owed to the high content of valuable metals such as cobalt, manganese, and lithium as well as regarding the increasing demand for those scarce applied metals. Currently, there are just a few industrial processes using hydrometallurgical methods to recover valuable metals from Li-ion-battery waste. In this study, the extraction of valuable metals from spent Li-ion-batteries is investigated by pretreated and subsequently leached battery wastes using different precipitation methods in a comparative manner. For the extraction of lithium, cobalt, and other valuable metals, pelletized battery wastes with an initial Li content of 2.24 wt. % and cobalt of 22 wt. % is used. Hydrochloric acid with 4 mol/L is applied with 1:50 solid to liquid (s/l) ratio to generate pregnant leach solution for subsequent precipitation steps. In order to obtain pure precipitates, two different pathways (pathway 1 and pathway 2) are investigated, which differ from each other with regard to the precipitation steps carried out. While lithium carbonate recovery is the final process step in pathway 1, pathway 2 requires a preliminary removal of lithium from the process. The aim is to evaluate both processes in terms of purity and yield of the products obtained. ICP-OES is used to determine the chemical content of leach liquor as well as of the solid residue.

Keywords: hydrochloric acid, hydrometallurgy, Li-ion-batteries, metal recovery

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1694 Using of the Fractal Dimensions for the Analysis of Hyperkinetic Movements in the Parkinson's Disease

Authors: Sadegh Marzban, Mohamad Sobhan Sheikh Andalibi, Farnaz Ghassemi, Farzad Towhidkhah

Abstract:

Parkinson's disease (PD), which is characterized by the tremor at rest, rigidity, akinesia or bradykinesia and postural instability, affects the quality of life of involved individuals. The concept of a fractal is most often associated with irregular geometric objects that display self-similarity. Fractal dimension (FD) can be used to quantify the complexity and the self-similarity of an object such as tremor. In this work, we are aimed to propose a new method for evaluating hyperkinetic movements such as tremor, by using the FD and other correlated parameters in patients who are suffered from PD. In this study, we used 'the tremor data of Physionet'. The database consists of fourteen participants, diagnosed with PD including six patients with high amplitude tremor and eight patients with low amplitude. We tried to extract features from data, which can distinguish between patients before and after medication. We have selected fractal dimensions, including correlation dimension, box dimension, and information dimension. Lilliefors test has been used for normality test. Paired t-test or Wilcoxon signed rank test were also done to find differences between patients before and after medication, depending on whether the normality is detected or not. In addition, two-way ANOVA was used to investigate the possible association between the therapeutic effects and features extracted from the tremor. Just one of the extracted features showed significant differences between patients before and after medication. According to the results, correlation dimension was significantly different before and after the patient's medication (p=0.009). Also, two-way ANOVA demonstrates significant differences just in medication effect (p=0.033), and no significant differences were found between subject's differences (p=0.34) and interaction (p=0.97). The most striking result emerged from the data is that correlation dimension could quantify medication treatment based on tremor. This study has provided a technique to evaluate a non-linear measure for quantifying medication, nominally the correlation dimension. Furthermore, this study supports the idea that fractal dimension analysis yields additional information compared with conventional spectral measures in the detection of poor prognosis patients.

Keywords: correlation dimension, non-linear measure, Parkinson’s disease, tremor

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1693 The Impact of Australia's Skilled Migrant Selection System: A Case Study of Japanese Skilled Migrants and Their Families

Authors: Iori Hamada

Abstract:

Australia's skilled migrant selection system is constantly changing its target skills and criteria according to the labour market demands. The government's intention to employ this highly selective market-driven selection system is to better target the skills needed in the economy, enable skilled migrants to be employed in industries that have the highest need, and consequently boost the economy and population. However, migration scholars have called this intention into question, arguing that the system is not making the best use of skilled migrants. This paper investigates the impact of recent reforms in Australian skilled migration system on skilled migrants' employment and related life conditions. Drawing on semi-structured qualitative interviews with Japanese skilled migrants in Australia, it argues that Australia’s skilled migrant selection system guarantees neither skilled migrants' employment nor successful transfer of their skills to the labour market. The findings show that Japanese skilled migrants are often unemployed or under-employed, although they intend to achieve upward occupational mobility. The interview data also reveal that male unemployment or under-employment status prompts some Japanese men to leave Australia and find a job that better matches their skills and qualifications in a new destination. Further, it finds that Japanese male skilled migrants who experience downward occupational mobility tend to continue to take a primary breadwinner role, which affects the distribution of paid and unpaid work within their families. There is a growing body of research investigating skilled migrants’ downward career mobility. However, little has been written on skilled Japanese migrants. Further, the work-family intersection is a 'hot public policy topic' in Australia and elsewhere. Yet, the existing studies focus almost exclusively on non-migrant families. This calls attention to the urgency of assessing the work-family lives of skilled migrants. This study fills these gaps, presenting additional insight into Japanese skilled migrants’ work and family in and beyond Australia.

Keywords: Australia, employment, family, Japanese skilled migrants

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1692 A Theoretical Study on Pain Assessment through Human Facial Expresion

Authors: Mrinal Kanti Bhowmik, Debanjana Debnath Jr., Debotosh Bhattacharjee

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A facial expression is undeniably the human manners. It is a significant channel for human communication and can be applied to extract emotional features accurately. People in pain often show variations in facial expressions that are readily observable to others. A core of actions is likely to occur or to increase in intensity when people are in pain. To illustrate the changes in the facial appearance, a system known as Facial Action Coding System (FACS) is pioneered by Ekman and Friesen for human observers. According to Prkachin and Solomon, a set of such actions carries the bulk of information about pain. Thus, the Prkachin and Solomon pain intensity (PSPI) metric is defined. So, it is very important to notice that facial expressions, being a behavioral source in communication media, provide an important opening into the issues of non-verbal communication in pain. People express their pain in many ways, and this pain behavior is the basis on which most inferences about pain are drawn in clinical and research settings. Hence, to understand the roles of different pain behaviors, it is essential to study the properties. For the past several years, the studies are concentrated on the properties of one specific form of pain behavior i.e. facial expression. This paper represents a comprehensive study on pain assessment that can model and estimate the intensity of pain that the patient is suffering. It also reviews the historical background of different pain assessment techniques in the context of painful expressions. Different approaches incorporate FACS from psychological views and a pain intensity score using the PSPI metric in pain estimation. This paper investigates in depth analysis of different approaches used in pain estimation and presents different observations found from each technique. It also offers a brief study on different distinguishing features of real and fake pain. Therefore, the necessity of the study lies in the emerging fields of painful face assessment in clinical settings.

Keywords: facial action coding system (FACS), pain, pain behavior, Prkachin and Solomon pain intensity (PSPI)

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1691 Contour Defects of Face with Hyperpigmentation

Authors: Afzaal Bashir, Sunaina Afzaal

Abstract:

Background: Facial contour deformities associated with pigmentary changes are of major concern for plastic surgeons, both being important and difficult in treating such issues. No definite ideal treatment option is available to simultaneously address both the contour defect as well as related pigmentation. Objectives: The aim of the current study is to compare the long-term effects of conventional adipose tissue grafting and ex-vivo expanded Mesenchymal Stem Cells enriched adipose tissue grafting for the treatment of contour deformities with pigmentary changes on the face. Material and Methods: In this study, eighty (80) patients with contour deformities of the face with hyperpigmentation were recruited after informed consent. Two techniques i.e., conventional fat grafting (C-FG) and fat grafts enriched with expanded adipose stem cells (FG-ASCs), were used to address the pigmentation. Both techniques were explained to patients, and enrolled patients were divided into two groups i.e., C-FG and FG-ASCS, per patients’ choice and satisfaction. Patients of the FG-ASCs group were treated with fat grafts enriched with expanded adipose stem cells, while patients of the C-FGs group were treated with conventional fat grafting. Patients were followed for 12 months, and improvement in face pigmentation was assessed clinically as well as measured objectively. Patient satisfaction was also documented as highly satisfied, satisfied, and unsatisfied. Results: Mean age of patients was 24.42(±4.49), and 66 patients were females. The forehead was involved in 61.20% of cases, the cheek in 21.20% of cases, the chin in 11.20% of cases, and the nose in 6.20% of cases. In the GF-ASCs group, the integrated color density (ICD) was decreased (1.08×10⁶ ±4.64×10⁵) as compared to the C-FG group (2.80×10⁵±1.69×10⁵). Patients treated with fat grafts enriched with expanded adipose stem cells were significantly more satisfied as compared to patients treated with conventional fat grafting only. Conclusion: Mesenchymal stem cell-enriched autologous fat grafting is a preferred option for improving the contour deformities related to increased pigmentation of face skin.

Keywords: hyperpigmentation, color density, enriched adipose tissue graft, fat grafting, contour deformities, Image J

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1690 Effect of Foot Reflexology Treatment on Arterial Blood Gases among Mechanically Ventilated Patients

Authors: Maha Salah Abdullah Ismail, Manal S. Ismail, Amir M. Saleh

Abstract:

Reflexology treatment is a method for enhancing body relaxation. It is a widely recognized as an alternative therapy, effective for many health conditions. This study aimed to evaluate the effect of reflexology treatment on arterial blood gases among mechanically ventilated patients. A quasi-experimental (pre and post-test) research design was used. Research hypothesis was mechanically ventilated patients who will receive the reflexology treatment will have improvement in their arterial blood gases than those who will not. The current study was carried out in different Intensive Care Units at the Cairo University Hospitals. A purposeful sample of 100 adults’ mechanically ventilated patients was recruited over a period of three months of data collection. The participants were divided into two equally matched groups; (1) The study group who has received the routine care, in addition, two reflexology sessions on the feet, (2) The control group who has received only the routine care. One tool was utilized to collect data pertinent to the study; mechanically ventilated patients' data sheet that consists of demographic and medical data. Result: Majority (58% of the study group and 82% of the control group) were males, with mean age of 50.9 years in both groups. Patients who received the reflexology treatment significantly increase in the oxygen saturation pre second session (t=5.15, p=.000), immediate post sessions (t=4.4, p=.000) and post two hours (t= 4.7, p= .000). The study group was more likely to have lower PaO2 (F=5.025, p=.015), PaCo2 (F=4.952, p=.025) and higher HCo3 (F=15.211, p=.000) than the control group. Conclusion: This study results support the positive effect of reflexology treatment in improving some arterial blood gases among mechanically ventilated patients’ with the conventional therapy as in the study group there was increase in the oxygen saturation. In differences between groups there decrease PaO2, PaCo2 and increase HCo3 in the study group. Recommendation: Nurses should be trained how to demonstrate the foot reflexology among mechanically ventilated patients.

Keywords: arterial blood gases, foot, mechanical ventilated patient, reflexology

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