Search results for: patient monitoring

Authors: Naser Shagerdi Esmaeli, Mohsen Hamidpour, Parisa Hasankhani Tehrani

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Background And Objective: Haematopoietic stem cell transplant is a potentially curative treatment option in various benign and malignant haematological diseases. Patients undergoing stem cell transplant procedure require blood transfusion on a daily basis. Currently, there is paucity of data from developing countries on transfusion practices. This audit was undertaken to determine the consumption of packed red blood cells (PRBCs) transfusion in the bone marrow transplant unit of the Shahid Ghazi Tabatabaei Hospital, Tabriz, Iran. Subjects And Methods: A retrospective audit was conducted for packed red cell transfusion ordering practice over a period from March 2017 to march 2018. All consecutive patients admitted for stem cell transplant procedure for various underlying diseases were included. Outcome measures used in this study were (i) cross match to transfusion (C: T) ratio and (ii) transfusion trigger. Results: During the study period, n=13 patients underwent a haematopoietic stem cell transplant. There were n=10 males and n=3 females. One patient was less than 15 years of age, while rests were adults. Median age±SD was 26.5±14.5 years (12∼54 years). The underlying diagnosis included Aplastic anemia (n=4), Thalassemia major (n=1), Multiple Myeloma (n=3), Acute leukemia (n=3), Hodgkin's lymphoma (n=1), PRCA (n=1). Grand total consumption of PRBCs during the study period was 204, while 258 products were crossmatch. The C:T ratio was 1.26. The transfusion trigger was Hb level of less than 8 gr/dl. Conclusion: The results of our BMT unit indicate that the C:T ratio and transfusion trigger is comparable to the international criteria and pioneer country in BMT transplantation. Also, we hope that our blood consumption become less than it is now.

Keywords: blood consumption, C: T ratio, PRBCs, stem cell transplant, tabriz, Iran

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Authors: Peng Guo

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Objective To investigate the clinical characteristics and changes of video-polysomnography (v-PSG) in Parkinson disease (PD) patients accompanied with cognitive impairment. Methods Three hundred and ninety-four patients with PD were enrolled in Beijing Tiantan Hospital, according to CI level, the patients were divided into PD without cognitive impairment (PD-NCI), PD with mild cognitive impairment (PD-MCI), and PD with dementia (PDD) group. Collect patient's demographic data, including gender, onset age, education level and duration. The cognitive function of PD patients was evaluated by Montreal cognitive assessment (MoCA) scale, and the overall cognitive function and cognitive domains of the three groups were compared.Using v-PSG to assess the sleep status of patients. Correlation analysis of MoCA Scale and v-PSG results in PD-CI group. Results 1. In 394 cases of PD, 94 cases (23.86%) in PD-NCI group , 177 cases(44.92%) in PD-MCI group , 123 cases (31.22%) in PDD group. 2.There was no significant difference in gender, age of onset, education level and duration in PD-NCI group, PD-MCI group and PDD group （P＞0.05）. 3. The total score of MoCA scale in PD-NCI group, PD-MCI group and PDD group decreased one by one. In PD-NCI group, PD-MCI group and PDD group, the scores of each cognitive domain in MoCA scale decreased significantly（P<0.05）. 4.Compared with the PD-MCI group, PDD group had lower total sleep time, lower sleep efficiency （P<0.05）. Compared with PD-NCI group, PDD group had lower total sleep time and lower sleep efficiency （P<0.05）.5. The sleep efficiency of PD-CI patients is positively correlated with the total score of MoCA scale, visual spatial function, executive function, delayed recall and attention score（P<0.05). Conclusions The incidence of CI in PD patients was high; The cognitive function and cognitive domains of PD-CI patients were significantly impaired; In patients with PD-CI, total sleep time decreased, sleep efficiency decreased, and it was related to overall cognitive function and partial cognitive impairment.

Keywords: Parkinson disease, cognitive impairment, clinical characteristics, sleep disorders, video-polysomnography

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Authors: Sofia G. Meirinho, Luis G. Dias, António M. Peres, Lígia R. Rodrigues

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The emerging development of electrochemical aptasen sors has enabled the easy and fast detection of protein biomarkers in standard and real samples. Biomarkers are produced by body organs or tumours and provide a measure of antigens on cell surfaces. When detected in high amounts in blood, they can be suggestive of tumour activity. These biomarkers are more often used to evaluate treatment effects or to assess the potential for metastatic disease in patients with established disease. Osteopontin (OPN) is a protein found in all body fluids and constitutes a possible biomarker because its overexpression has been related with breast cancer evolution and metastasis. Currently, biomarkers are commonly used for the development of diagnostic methods, allowing the detection of the disease in its initial stages. A previously described RNA aptamer was used in the current work to develop a simple and sensitive electrochemical aptasensor with high affinity for human OPN. The RNA aptamer was biotinylated and immobilized on a gold electrode by avidin-biotin interaction. The electrochemical signal generated from the aptamer–target molecule interaction was monitored electrochemically using cyclic voltammetry in the presence of [Fe (CN) 6]−3/− as a redox probe. The signal observed showed a current decrease due to the binding of OPN. The preliminary results showed that this aptasensor enables the detection of OPN in standard solutions, showing good selectivity towards the target in the presence of others interfering proteins such as bovine OPN and bovine serum albumin. The results gathered in the current work suggest that the proposed electrochemical aptasensor is a simple and sensitive detection tool for human OPN and so, may have future applications in cancer disease monitoring.

Keywords: osteopontin, aptamer, aptasensor, screen-printed electrode, cyclic voltammetry

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Authors: Oumaima Khlifati, Khadija Baba

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Pavement distress is the main factor responsible for the deterioration of road structure durability, damage vehicles, and driver comfort. Transportation agencies spend a high proportion of their funds on pavement monitoring and maintenance. The auscultation of pavement distress was based on the manual survey, which was extremely time consuming, labor intensive, and required domain expertise. Therefore, the automatic distress detection is needed to reduce the cost of manual inspection and avoid more serious damage by implementing the appropriate remediation actions at the right time. Inspired by recent deep learning applications, this paper proposes an algorithm for automatic road distress detection and classification using on the Deep Convolutional Neural Network (DCNN). In this study, the types of pavement distress are classified as transverse or longitudinal cracking, alligator, pothole, and intact pavement. The dataset used in this work is composed of public asphalt pavement images. In order to learn the structure of the different type of distress, the DCNN models are trained and tested as a multi-label classification task. In addition, to get the highest accuracy for our model, we adjust the structural optimization hyper parameters such as the number of convolutions and max pooling, filers, size of filters, loss functions, activation functions, and optimizer and fine-tuning hyper parameters that conclude batch size and learning rate. The optimization of the model is executed by checking all feasible combinations and selecting the best performing one. The model, after being optimized, performance metrics is calculated, which describe the training and validation accuracies, precision, recall, and F1 score.

Keywords: distress pavement, hyperparameters, automatic classification, deep learning

Procedia PDF Downloads 82

Authors: Sumayya S.

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Making cities adaptive and inclusive is one among the inherent goal and challenge for contemporary cities. This is a serious concern when the urban transformations occur in varying magnitude due to visible and invisible factors. One type of visibly invisible factor is ecommerce and its expanding operation that is understood to cause changes to the conventional spatial structure positively and negatively. With the continued growth in e-commerce activities and its future potential, market analysts, media, and even retailers have questioned the importance of a future presence of traditional Brick-and-mortar stores in cities as a critical element, with some even referring to the repeated announcement of the closure of some store chains as the end of the online shopping era. Essentially this raises the question of how adaptive and inclusive the cities are to the dynamics of transformative changes that are often unseen. People have become more comfortable with seating inside and door delivery systems, and this increased change in usage of public spaces, especially the commercial corridors. Through this research helped in presetting a new approach for planning and designing commercial activities centers and also presents the impact of ecommerce on the urban fabric, such as division and fragmentation of space, showroom syndrome, reconceptualization of space, etc., in a critical way. The changes are understood by analyzing the e-commerce logistic process. Based on the inferences reach at the conclusion for the need of an integrated approach in the field of planning and designing of public spaces for the sustainable omnichannel retailing. This study was carried out with the following objectives Monitoring the impact of e commerce on the traditional shopping space. Explore the new challenges and opportunities faced by the urban form. Explore how adaptive and inclusive our cities are to the dynamics of transformative changes caused by ecommerce.

Keywords: E-commerce, shopping streets, online environment, offline environment, shopping factors

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Authors: Usama Bin Zubair, Syed Azhar Ali

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Introduction: Depression is emerging as a major public health problem in all parts of the world. Developing countries have a unique socioeconomic structure that affects the lives of its inhabitants in several ways. Going abroad for employment is one of the common social problems which have been faced by young males in developing countries. This included both highly qualified individuals as well as the labor class. Objective: To determine the difference in the presence of depressive symptoms among pregnant women with husbands living abroad and those with husbands living with them in Azad Jammu and Kashmir. Methods: The sample population comprised of pregnant women reporting for an antenatal checkup at Amna hospital Rawalakot. Cases constituted the pregnant women with husbands living abroad while controls were the pregnant women with husbands living with them. Patient health questionnaire-9 (PHQ-9) was used to record the presence and severity of depressive symptoms. Age, gestation, parity, rural or urban origin, education, level of family income, daily contact hours on the telephone or what’s app, previous pregnancy loss or complications, number of years abroad and visits to home per year were associated with the presence of depressive symptoms. Findings: The mean age of the study participants was 29.73 ±5.395 years. Sixty-six had significant depression in the case group, while 14 had in the control group (p-value<0.001). Education and rural background had a significant difference between the case and the control group. Less number of visits per year of the husband was strongly linked with the presence of depressive symptoms among the cases. Conclusion: Pregnant women with husbands abroad were found more prone to develop depressive symptoms as compared to those with husbands living with them. Special attention should be paid to the women whose husband had a lesser number of visits to the country.

Keywords: depression, pregnancy, lack of support, war zone

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Authors: Galal Omer, Onisimo Mutanga, Elfatih M. Abdel-Rahman, Elhadi Adam

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Threatened tree species (TTS) play a significant role in ecosystem functioning and services, land use dynamics, and other socio-economic aspects. Such aspects include ecological, economic, livelihood, security-based, and well-being benefits. The development of techniques for mapping and monitoring TTS is thus critical for understanding the functioning of ecosystems. The advent of advanced imaging systems and supervised learning algorithms has provided an opportunity to classify TTS over fragmenting landscape. Recently, vegetation maps have been produced using advanced imaging systems such as WorldView-2 (WV-2) and robust classification algorithms such as support vectors machines (SVM) and artificial neural network (ANN). However, delineation of TTS in a fragmenting landscape using high resolution imagery has widely remained elusive due to the complexity of the species structure and their distribution. Therefore, the objective of the current study was to examine the utility of the advanced WV-2 data for mapping TTS in the fragmenting Dukuduku indigenous forest of South Africa using SVM and ANN classification algorithms. The results showed the robustness of the two machine learning algorithms with an overall accuracy (OA) of 77.00% (total disagreement = 23.00%) for SVM and 75.00% (total disagreement = 25.00%) for ANN using all eight bands of WV-2 (8B). This study concludes that SVM and ANN classification algorithms with WV-2 8B have the potential to classify TTS in the Dukuduku indigenous forest. This study offers relatively accurate information that is important for forest managers to make informed decisions regarding management and conservation protocols of TTS.

Keywords: artificial neural network, threatened tree species, indigenous forest, support vector machines

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Authors: Shaista Meghani, Rozina Karmaliani, Khairulnissa Ajani, Shireen Shahzad, Nadeem Ullah Khan

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Background: The concept of Family Presence During Resuscitation (FPDR) is gradually gaining recognition in western countries, however, it is rarely considered in South Asian countries including Pakistan. Over time, patients’ and families’ rights have gained recognition and healthcare has progressed to become more patient-family centered. Objectives: The objective of this study was to evaluate the impact of an educational program on the Knowledge, Attitude, and Practices (KAP) of healthcare professionals (HCPs) towards FPDR in Emergency Department (ED), at a tertiary care setting, in Karachi, Pakistan. Methods: This was a Pre-test and Post-test study design. A convenient universal sampling was done, and all ED nurses and physicians with more than one year of experience were eligible. The intervention included one-hour training sessions for physicians (three sessions) and nurses (eight sessions), The KAP of nurses and physicians were assessed immediately after (post-test I), and two weeks(post-test II) after the intervention using a pretested questionnaire. Results: The findings of the study revealed that the mean scores of knowledge and attitude of HCPs at both time points were statistically significant (p-value=<0.001), however, an insignificant difference was found on practice of FPDR (p-value=>0.05). Conclusion: The study findings recommend that the educational program on FPDR for HCPs needs to be offered on an ongoing basis. Moreover, training modules need to be developed for the staff, and formal guidelines need to be proposed for FPDR, through a multidisciplinary team approach.

Keywords: family presence, cardiopulmonary resuscitation, attitude, education, practices, health care professionals

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Authors: Coulibaly Fatoumata, Gragnon Biego, Aka N. David, Mbari K. Benjamin, Soro Y. René, Ndiaye Jean-louis

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Poultry is nowadays one of the most consumed sources of protein, and its livestock represents one of the few opportunities for savings, investment and protection against risk. It provides income for the most vulnerable sections of society, in particular, women (70%) and children who mainly practice this breeding. A study was conducted in the commune of Korhogo at the level of 52 poultry farms, the objective of which was to know the epidemiological situation of parasitism external and internal poultry in order to contribute to the improvement of the health status of modern poultry farms in the said commune. The method described by OIE (2005), consisting of using the standard formula (n = δ2*p*(1-p) *c /i2), made it possible to calculate the size of the sample. Then, samples of droppings and ectoparasites were taken from the affected farms. After analysis and identification, two (2) species of mallophagous lice, including Menopon gallinae (50%) and Menacanthus stramineus (33%) and a species of bug Cimex lectularius (17%) were highlighted. The laying hens were more infested than broilers. Regarding gastrointestinal parasites, different species (six) have been identified: Trichostrongylus tenuis (17%), Syngamus trachea (19%), Heterakis sp (10%), Ascaridia sp (17%), Raillietina sp (8%) and Eimeria sp (29%). In addition, coccidiosis (Eimeria sp) proved to be the dominant pathology representing 67% of pathologies in broiler farms and 33% in poultry farms. The presence of these parasitoses in these modern farms constitutes a constraint major contribution to productivity and their development In view of all these difficulties, proposals have been made in order to participate in the establishment of a good prophylaxis program (health and medical). In addition, the Ivorian government, with the support of veterinarians, must interfere more in the organization of the health monitoring of traditional chickens and poultry in general through supervision and training in order to preserve public health ( animal, human and environmental health).

Keywords: gastrointestinal parasites, ectoparasites, pathologies, poultry, korhogo.

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Authors: M. Abuqebitah, H. Tanyildizi, N. Yeyin, I. Cavdar, M. Demir, L. Kabasakal

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Aim: Targeted radionuclide therapy (TRT) is an increasingly used treatment modality for wide range of cancers. Presently dosimetry is highly required either to plan treatment or to ascertain the absorbed dose delivered to critical organs during treatment. Methods and Materials: The study comprised 7 patients suffered from prostate cancer with progressive disease and candidate to undergo Lu-177-DOTA-617 therapy following to PSMA- PET/CT imaging for all patients. (5.2±0.3 mCi) was intravenously injected. To evaluate bone marrow absorbed dose 2 cc blood samples were withdrawn in short variable times (3, 15, 30, 60, 180 minutes) after injection. Furthermore, whole body scans were performed using scintillation gama camera in 4, 24, 48, and 120 hours after injection and in order to quantify the activity taken up in the body, kidneys , liver, right parotid, and left parotid the geometric mean of anterior and posterior counts were determined through ROI analysis, after that background subtraction and attenuation correction were applied using patients PSMA- PET/CT images taking in a consideration: organ thickness, body thickness, and Hounsfield unites from CT scan. OLINDA/EXM dosimetry program was used for curve fitting, residence time calculation, and absorbed dose calculations. Findings: Absorbed doses of bone marrow, left kidney, right kidney, liver, left parotid, right parotid, total body were 1.28±0.52, 32.36±16.36, 32.7±13.68, 10.35±3.45, 38.67±21.29, 37.55±19.77, 2.25±0.95 (mGy/mCi), respectively. Conclusion: Our first results clarify that Lu-177-DOTA-617 is safe and reliable therapy as there were no complications seen. In the other hand, the observable variation in the absorbed dose of the critical organs among the patients necessitate patient-specific dosimetry approach to save body organs and particularly highly exposed kidneys and parotid gland.

Keywords: Lu-177-PSMA, prostate cancer, radionuclide therapy

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Authors: Kaznah Alshammari, Thomas Beach, Yacine Rezgui

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Technological advances in the construction sector are helping to make smart cities a reality by means of cyber-physical systems (CPS). CPS integrate information and the physical world through the use of information communication technologies (ICT). An increasingly common goal in the built environment is to integrate building information models (BIM) with the Internet of Things (IoT) and sensor technologies using CPS. Future advances could see the adoption of digital twins, creating new opportunities for CPS using monitoring, simulation, and optimisation technologies. However, researchers often fail to fully consider the security implications. To date, it is not widely possible to assimilate BIM data and cybersecurity concepts, and, therefore, security has thus far been overlooked. This paper reviews the empirical literature concerning IoT applications in the built environment and discusses real-world applications of the IoT intended to enhance construction practices, people’s lives and bolster cybersecurity. Specifically, this research addresses two research questions: (a) how suitable are the current IoT and CPS security stacks to address the cybersecurity threats facing digital twins in the context of smart buildings and districts? and (b) what are the current obstacles to tackling cybersecurity threats to the built environment CPS? To answer these questions, this paper reviews the current state-of-the-art research concerning digital twins in the built environment, the IoT, BIM, urban cities, and cybersecurity. The results of these findings of this study confirmed the importance of using digital twins in both IoT and BIM. Also, eight reference zones across Europe have gained special recognition for their contributions to the advancement of IoT science. Therefore, this paper evaluates the use of digital twins in CPS to arrive at recommendations for expanding BIM specifications to facilitate IoT compliance, bolster cybersecurity and integrate digital twin and city standards in the smart cities of the future.

Keywords: BIM, cybersecurity, digital twins, IoT, urban cities

Procedia PDF Downloads 157

Authors: Ganetsou Evanthia, Koutsikos Emmanouil, Austin Anna Maria

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Information technology has long served the needs of individuals for learning and entertainment, but much less for children in sickness. The aim of the proposed online video game is to provide immersive learning opportunities as well as essential social and emotional scenarios for hospital-bound children with long-term illness. Online self-paced courses on chosen school subjects, including specialised software and multisensory assessments, aim at enhancing children’s academic achievement and sense of inclusion, while doctor minigames familiarise and educate young patients on their medical conditions. Online ethical dilemmas will offer children opportunities to contemplate on the importance of medical procedures and following assigned medication, often challenging for young patients; they will therefore reflect on their condition, reevaluate their perceptions about hospitalisation, and assume greater personal responsibility for their progress. Children’s emotional and psychosocial needs are addressed by engaging in social conventions, such as interactive, daily, collaborative mini games with other hospitalised peers, like virtual competitive sports games, weekly group psychodrama sessions, and online birthday parties or sleepovers. Social bonding is also fostered by having a virtual pet to interact with and take care of, as well as a virtual nurse to discuss and reflect on the mood of the day, engage in constructive dialogue and perspective taking, and offer reminders. Access to the platform will be available throughout the day depending on the patient’s health status. The program is designed to minimise escapism and feelings of exclusion, and can flexibly be adapted to offer post-treatment and a support online system at home.

Keywords: long-term illness, children, hospital, interactive games, cognitive, socioemotional development

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Authors: Daniele Zullino, Gabriel Thorens, Léonice Furtado, Federico Seragnoli, Radu Iuga, Louise Penzenstadler

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Context: Since the start of the 21st century, there has been a resurgence of interest in psychedelics, marked by a renewed focus on scientific investigations into their therapeutic potential. While psychedelic therapy has gained recognition for effectively treating depression and anxiety disorders, notable progress has been made in the clinical development of substances like psilocybin. Moreover, mounting evidence suggests promising applications of Lysergic acid diethylamide (LSD) and psilocybin in the field of addiction medicine. In Switzerland, compassionate treatment with LSD and psilocybin has been permitted since 2014 through exceptional licenses granted by the Federal Office of Public Health. This treatment approach is also available within the Geneva treatment program, extending its accessibility to patients undergoing opioid-assisted treatment involving substances like morphine and diacetylmorphine. The aim of this study is to assess the feasibility of psychedelic-assisted therapy in patients with opioid use disorder who are undergoing opioid-assisted treatment. This study addresses the question of whether psychedelic-assisted therapy can be successfully implemented in patients with opioid use disorder. It also explores the effects of psychedelic therapy on the patient's experiences and outcomes. Methodology: This is an open case series on six patients who have undergone at least one session with either LSD (100-200 micrograms) or psilocybin (20-40 mg). The patients were assessed using the Five Dimensional Altered States of Consciousness (5D-ASC)-Scale. The data were analyzed descriptively to identify patterns and trends in the patients' experiences. Results: The patients experienced substantial positive psychedelic effects during the psychedelic sessions without significant adverse effects. The patients reported positive experiences and improvements in their condition. Conclusion: The findings of this study support the feasibility and potential efficacy of psychedelic-assisted therapy in patients undergoing opioid-assisted treatment.

Keywords: psychedelics, psychedelic-assisted treatment, opioid use disorder, addiction, LSD, psilocybin

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Authors: Po-Ching Chou, Wen-Chen Liang, I. Chen Chen, Jong-Hau Hsu, Yuh-Jyh Jong

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Background：Cardiopulmonary complications seem to cause high morbidity and mortality in patients with neuromuscular diseases (NMD) but so far there is no domestic data reported in Taiwan. We, therefore attempted to analyze the factors to cause the death in NMD patients from our cohort. Methods：From 1998 to 2013, we retrospectively collected the information of the NMD patients treated and followed up in Kaohsiung Medical University Hospital. Forty-two patients with NMD who expired during these fifteen years were enrolled. The medical records of these patients were reviewed and the causes of death and the associated affecting factors were analyzed. Results：Eighteen patients with NMD (mean age=13.3, SD=12.4) with complete medical record and detailed information were finally included in this study, including spinal muscular atrophy (SMA) (n=9, 7/9: type 1), Duchenne muscular dystrophy (n=6), congenital muscular dystrophy (n=1), carnitine acyl-carnitine translocase (CACT) deficiency (n=1) and spinal muscular atrophy with respiratory distress (SMARD)(n=1). The place of death was in ICU (n=11, 61%), emergency room (n=3, 16.6%) or home (n=4, 22.2%). For SMA type 1 patients, most of them (71.4%, 5/7) died in emergency room or home and the other two expired during an ICU admission. The causes of death included acute respiratory failure due to pneumonia (n=13, 72.2 %), ventilator failure or dislocation (n=2, 11.1%), suffocation/choking (n=2, 11.1%), and heart failure with hypertrophic cardiomyopathy (n=1, 5.55%). Among the 15 patients died of respiratory failure or choking, 73.3% of the patients (n=11) received no ventilator care at home. 80% of the patients (n=12) received no cough assist at home. The patient died of cardiomyopathy received no medications for heart failure until the last admission. Conclusion: Respiratory failure and choking are the leading causes of death in NMD patients. Appropriate respiratory support and airway clearance play the critical role to reduce the mortality.

Keywords: neuromuscular disease, cause of death, tertiary care hospital, medical sciences

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Authors: A. D. Zikiryahodjaev, L. V. Bolotina, A. S. Sukhotko

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Purpose. To evaluate the expediency and timeliness of performance of surgical treatment as a component of multi-therapy treatment of patients with stage IV breast cancers. Materials and Methods. This investigation comparatively analyzed the results of complex treatment with or without surgery in patients with metastatic breast cancer. We analyzed retrospectively treatment experience of 196 patients with generalized breast cancer in the department of oncology and breast reconstructive surgery of P.A. Herzen Moscow Cancer Research Institute from 2000 to 2012. The average age was (58±1,1) years. Invasive ductul carcinoma was verified in128 patients (65,3%), invasive lobular carcinoma-33 (16,8%), complex form - 19 (9,7%). Complex palliative care involving drug and radiation therapies was performed in two patient groups. The first group includes 124 patients who underwent surgical intervention as complex treatment, the second group includes 72 patients with only medical therapy. Standard systemic therapy was given to all patients. Results. Overall, 3-and 5-year survival in fist group was 43,8 and 21%, in second - 15,1 and 9,3% respectively [p=0,00002 log-rank]. Median survival in patients with surgical treatment composed 32 months, in patients with only systemic therapy-21. The factors having influencing an influence on the prognosis and the quality of life outcomes for of patients with generalized breast cancer were are also studied: hormone-dependent tumor, Her2/neu hyper-expression, reproductive function status (age, menopause existence). Conclusion.Removing primary breast tumor in patients with generalized breast cancer improve long-term outcomes. Three- and five-year survival increased by 28,7 and 16,3% respectively, and median survival–for 11 months. These patients may benefit from resection of the breast tumor. One explanation for the effect of this resection is that reducing the tumor load influences metastatic growth.

Keywords: breast cancer, combination therapy, factors of prognosis, primary tumor

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Authors: Qing Li, Maiko Kobayashi, Shigeyoshi Kumeda, Hiroko Ochiai, Toshiya Ochiai, Takashi Miura, Takahide Kagawa, Michiko Imai, Toshiaki Otsuka, Tomoyuki Kawada

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In the present study, we investigated the effects of a forest bathing program on cardiovascular and metabolic parameters. Nineteen healthy male subjects (mean age: 51.3 ± 8.8 years) were selected after obtaining informed consent. These subjects took day trips to a forest park named Akasawa Shizen Kyuyourin, Agematsu, Nagano Prefecture (situated in central Japan), and to an urban area of Nagano Prefecture as a control in August 2015. On both trips, they walked 2.6 km for 80 min each in the morning and afternoon on Saturdays. Blood and urine were sampled in the morning before and after each trip. Cardiovascular and metabolic parameters were measured. Blood pressure and pulse rate were measured by an ambulatory automatic blood pressure monitor. The Japanese version of the profile of mood states (POMS) test was conducted before, during and after the trips. Ambient temperature and humidity were monitoring during the trips. The forest bathing program significantly reduced pulse rate, and significantly increased the score for vigor and decreased the scores for depression, fatigue, and confusion in the POMS test. The levels of urinary noradrenaline and dopamine after forest bathing were significantly lower than those after urban area walking, suggesting the relaxing effect of the forest bathing program. The level of adiponectin in serum after the forest bathing program was significantly greater than that after urban area walking. There was no significant difference in blood pressure between forest and urban area trips during the trips.

Keywords: ambient temperature, blood pressure, forest bathing, forest therapy, human health, POMS, pulse rate

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Authors: Arkadiusz Zurek

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The potential of using drones is visible in many areas of logistics, especially in terms of their use for monitoring and control of many processes. The technologies implemented in the last decade concern new possibilities for companies that until now have not even considered them, such as warehouse inventories. Unmanned aerial vehicles are no longer seen as a revolutionary tool for Industry 4.0, but rather as tools in the daily work of factories and logistics operators. The research problem is to develop a method for measuring the weight of goods in a selected link of the clothing supply chain by drones. However, the purpose of this article is to analyze the causes of errors in traditional measurements, and then to identify adverse events related to the use of drones for the inventory of a heap of textiles intended for production purposes. On this basis, it will be possible to develop guidelines to eliminate the causes of these events in the measurement process using drones. In a real environment, work was carried out to determine the volume and weight of textiles, including, among others, weighing a textile sample to determine the average density of the assortment, establishing a local geodetic network, terrestrial laser scanning and photogrammetric raid using an unmanned aerial vehicle. As a result of the analysis of measurement data obtained in the facility, the volume and weight of the assortment and the accuracy of their determination were determined. In this article, this work presents how such heaps are currently being tested, what adverse events occur, indicate and describes the current use of photogrammetric techniques of this type of measurements so far performed by external drones for the inventory of wind farms or construction of the station and compare them with the measurement system of the aforementioned textile heap inside a large-format facility.

Keywords: drones, unmanned aerial system, UAS, indoor system, security, process automation, cost optimization, photogrammetry, risk elimination, industry 4.0

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Authors: Amit Syal, Madeline Grade, Alister Martin

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Background: Cross-sectional and longitudinal studies demonstrate an association between health and voting. Furthermore, voting enables populations to support policies that impact their health via social determinants like income, education, housing, and healthcare access. Unfortunately, many barriers exist which disproportionately affect the civic participation of certain minority groups. Health professionals have an important role to play in addressing the civic health of all patients and empowering underrepresented communities. Description: Vot-ER is a non-partisan, nonprofit organization that aims to reduce barriers to civic participation by helping patients register to vote while in healthcare settings. The initial approach involved iPad-based kiosks in the emergency department waiting rooms, allowing patients to register themselves while waiting. After the COVID-19 pandemic began, Vot-ER expanded its touchless digital approaches. Vot-ER provides healthcare workers across the country with “Healthy Democracy Kits” consisting of badge backers, posters, discharge paperwork, and other resources. These contain QR and text codes that direct users to an online platform for registering to vote or requesting a mail-in ballot, available in English or Spanish. Outcomes: From May to November 2020, Vot-ER helped prepare 46,320 people to vote. 13,192 individual healthcare providers across all 50 states signed up for and received Healthy Democracy Kits. 80 medical schools participated in the Healthy Democracy Campaign competition. Over 500 institutions ordered site-based materials. Conclusions: A healthy democracy is one in which all individuals in a community have equal and fair opportunities for their voices to be heard. Healthcare settings, such as hospitals, are appropriate and effective venues for increasing both voter registration and education.

Keywords: civic health, enfranchisement, physician, voting

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Authors: Eunkyo Kang, Jihye Lee, Jiyeon Choo

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Background: Pediatric palliative care has been increasing, and the number of studies has focused on the age at which pediatric patient can be notified their terminal illness, pediatric advanced care planning (ACP) and palliative care. However, there is a lack of research on health professionals’ perception. Aim: We aimed to investigate the perceptions of healthcare professionals about appropriate age disclosing terminal illness, awareness of ACP, and the relationship between ACP knowledge and the preference for palliative care for children. Methods: We administered nationwide questionnaires to 928 physicians from the 12 hospitals and the Korean Medical Association and 1,241 individuals of the general Korean population. We asked about the age at which the pediatric patients could be notified of their terminal illness, by 4 groups; 4 years old or older, 12 years old or older, 15 years old or older, or not. In addition, we surveyed the questionnaires about the knowledge of ACP of the medical staff, the preference of the pediatric hospice palliative care, aggressive treatment, and life-sustaining treatment preference. Results: In the appropriate age disclosing terminal illness, there were more respondents in the physicians than in the general population who thought that it was possible even at a younger age. Palliative care preference in pediatric patients who were expected to expire within months was higher when health care professionals had knowledge of ACPs compared to those without knowledge. The same results were obtained when deaths were expected within weeks or days. The age of the terminal status notification, the health care professionals who thought to be available at a lower age have a higher preference for palliative care and has less preference for aggressive treatment and life-sustaining treatment. Conclusion: Despite the importance of pediatric palliative care, our study confirmed that there is a difference in the preference of the health care professionals for pediatric palliative care according to the ACP knowledge of the medical staff or the appropriate age disclosing terminal illness. Future research should focus on strategies for inducing changes in perceptions of health care professionals and identifying other obstacles for the pediatric palliative care.

Keywords: pediatric palliative care, disclosing terminal illness, palliative care, advanced care planning

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Authors: P. Moskal, T. Bednarski, P. Bialas, E. Czerwinski, A. Gajos, A. Gruntowski, D. Kaminska, L. Kaplon, G. Korcyl, P. Kowalski, T. Kozik, W. Krzemien, E. Kubicz, Sz. Niedzwiecki, M. Palka, L. Raczynski, Z. Rudy, P. Salabura, N. G. Sharma, M. Silarski, A. Slomski, J. Smyrski, A. Strzelecki, A. Wieczorek, W. Wislicki, M. Zielinski, N. Zon

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A new concept and results of the performance tests of the TOF-PET detection system developed at the Jagiellonian University will be presented. The novelty of the concept lies in employing long strips of polymer scintillators instead of crystals as detectors of annihilation quanta, and in using predominantly the timing of signals instead of their amplitudes for the reconstruction of Lines-of-Response. The diagnostic chamber consists of plastic scintillator strips readout by pairs of photo multipliers arranged axially around a cylindrical surface. To take advantage of the superior timing properties of plastic scintillators the signals are probed in the voltage domain with the accuracy of 20 ps by a newly developed electronics, and the data are collected by the novel trigger-less and reconfigurable data acquisition system. The hit-position and hit-time are reconstructed by the dedicated reconstruction methods based on the compressing sensing theory and the library of synchronized model signals. The solutions are subject to twelve patent applications. So far a time-of-flight resolution of ~120 ps (sigma) was achieved for a double-strip prototype with 30 cm field-of-view (FOV). It is by more than a factor of two better than TOF resolution achievable in current TOF-PET modalities and at the same time the FOV of 30 cm long prototype is significantly larger with respect to typical commercial PET devices. The Jagiellonian PET (J-PET) detector with plastic scintillators arranged axially possesses also another advantage. Its diagnostic chamber is free of any electronic devices and magnetic materials thus giving unique possibilities of combining J-PET with CT and J-PET with MRI for scanning the same part of a patient at the same time with both methods.

Keywords: PET-CT, PET-MRI, TOF-PET, scintillator

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Authors: William Thomas Worster

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Diplomatic assurances issued by states declaring that they will not mistreat individuals returned to them occupy a strange middle ground between being legal and non-legal obligations. States assert that they are non-binding, yet at other times that they are binding. However, this assertion may not be the end of the discussion. The International Court of Justice and other tribunals have concluded that similar instruments were binding, states have disagreed that certain similar instruments were binding, and the Vienna Convention on the Law of Treaties and its travaux prépératoires do not appear to contemplate non-binding instruments. This paper is a case study of diplomatic assurances but, by necessity, touches on the delicate question of whether certain texts are treaties, promises, or non-binding political statements. International law, and law in general, requires a binary approach to obligation. All communications must be binding or not, even if the fit is not precise. Through this study, we will find that some of the obligations in certain assurances can be understood as legal and some not. We will attempt to state the current methodology for determining which obligations are legal under the law of treaties and law on binding unilateral promises. The paper begins with some background of the legal environment of diplomatic assurances and their use in cases of expulsion. The paper then turns to discuss the legal nature of diplomatic assurances, proceeding to address various possibilities for legal value as treaties and as binding unilateral statements. This paper will not examine the legal value of diplomatic assurances solely under customary international law other than the way in which customary international law might further refine the treaty definition. In order to identify whether any assurances are contained in legal acts, this study identifies a pool of relevant assurances and qualitatively analyzes whether any of those are contained in treaties or binding unilateral statements. To the author’s best knowledge, this study is the first large-scale, qualitative qualitative analysis of assurances as a group of instruments that accounts for their heterogenous nature. It is also the first study to identify the indicators of whether an instrument is a treaty or promise.

Keywords: diplomatic assurances, deportation, extradition, expulsion, non-refoulement, torture, persecution, death penalty, human rights, memorandum of understanding, promises, secret, monitoring, compliance, enforcement

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Authors: L. Angiuli, L. Trizio, R. Giua, A. Digilio, M. Tutino, P. Dambruoso, F. Mazzone, C. M. Placentino

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In the winter of 2014 a series of measurements were performed to evaluate the behavior of real-time PAHs and black carbon analyzers in a coke oven plant located in Taranto, a city of Southern Italy. Data were collected both insides than outside the plant, at air quality monitoring sites. Contemporary measures of PM2.5 and PM1 were performed. Particle-bound PAHs were measured by two methods: (1) aerosol photoionization using an Ecochem PAS 2000 analyzer, (2) PM2.5 and PM1 quartz filter collection and analysis by gas chromatography/mass spectrometry (GC/MS). Black carbon was determined both in real-time by Magee Aethalometer AE22 analyzer than by semi-continuous Sunset Lab EC/OC instrument. Detected PM2.5 and PM1 levels were higher inside than outside the plant while PAHs real-time values were higher outside than inside. As regards PAHs, inside the plant Ecochem PAS 2000 revealed concentrations not significantly different from those determined on the filter during low polluted days, but at increasing concentrations the automated instrument underestimated PAHs levels. At the external site, Ecochem PAS 2000 real-time concentrations were steadily higher than those on the filter. In the same way, real-time black carbon values were constantly lower than EC concentrations obtained by Sunset EC/OC in the inner site, while outside the plant real-time values were comparable to Sunset EC values. Results showed that in a coke plant real-time analyzers of PAHs and black carbon in the factory configuration provide qualitative information, with no accuracy and leading to the underestimation of the concentration. A site specific calibration is needed for these instruments before their installation in high polluted sites.

Keywords: black carbon, coke oven plant, PAH, PAS, aethalometer

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Authors: V. Veeraprathap, G. S. Harish, G. Narendra Kumar

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Uncontrolled growth of abnormal cells in the lung in the form of tumor can be either benign (non-cancerous) or malignant (cancerous). Patients with Lung Cancer (LC) have an average of five years life span expectancy provided diagnosis, detection and prediction, which reduces many treatment options to risk of invasive surgery increasing survival rate. Computed Tomography (CT), Positron Emission Tomography (PET), and Magnetic Resonance Imaging (MRI) for earlier detection of cancer are common. Gaussian filter along with median filter used for smoothing and noise removal, Histogram Equalization (HE) for image enhancement gives the best results without inviting further opinions. Lung cavities are extracted and the background portion other than two lung cavities is completely removed with right and left lungs segmented separately. Region properties measurements area, perimeter, diameter, centroid and eccentricity measured for the tumor segmented image, while texture is characterized by Gray-Level Co-occurrence Matrix (GLCM) functions, feature extraction provides Region of Interest (ROI) given as input to classifier. Two levels of classifications, K-Nearest Neighbor (KNN) is used for determining patient condition as normal or abnormal, while Artificial Neural Networks (ANN) is used for identifying the cancer stage is employed. Discrete Wavelet Transform (DWT) algorithm is used for the main feature extraction leading to best efficiency. The developed technology finds encouraging results for real time information and on line detection for future research.

Keywords: artificial neural networks, ANN, discrete wavelet transform, DWT, gray-level co-occurrence matrix, GLCM, k-nearest neighbor, KNN, region of interest, ROI

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Authors: Ya-Ching Fu, An-Kuo Chou, Boon-Fatt Tan, Chi-Nien Chen, Wen-Chien Yang, Pou-Leng Cheong

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Blind oro-/naso-pharyngeal suction and feeding tube placement are very common practices in neonatal intensive care unit. Though esophageal perforation is a rare complication of these instrumentations, its prevalence is highest in extremely premature neonates. Due to its association with significant morbidity (including respiratory deterioration, pneumothorax, and sepsis) and even mortality, it is an important issue to prevent this iatrogenic complication in the field of premature care. We demonstrate an esophageal perforation in an extreme-low-birth-weight neonate after oro-gastric tube placement. This female baby weighing 680 grams was delivered by caesarean section at 25 weeks of gestational age. She initially received oro-tracheal intubation with mechanical ventilation which was smoothly weaned to non-invasive positive-pressure ventilation at 7-day-old. However, after insertion of a 5-French oro-gastric tube, the baby’s condition suddenly worsened with apnea requiring mechanical ventilation. Her chest radiogram showed the oro-gastric tube in right pleural space, and thus another oro-gastric tube was replaced, and its position was radiographically confirmed. The malpositioned tube was then removed. The baby received 2-week course of intravenous antibiotics for her esophageal perforation. Feeding was then reintroduced and increased to full feeds in a smooth course. She was discharged at 107-day-old. Esophageal perforation in newborn is very rare. Sudden respiratory deterioration in a neonate after naso-/oro-gastric tube placement should alarm us to consider esophageal perforation, and further radiological investigation is required for the diagnosis. Tube materials, patient condition, and age are major risk factors of esophageal perforation. The use of softer tube material, such as silicone, in extreme premature baby might prevent this fetal complication.

Keywords: esophageal perforation, preterm, newborn, feeding tube

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Authors: Swati Kapoor, Rajeev Upreti, Monica Mahajan, Abhaya Indrayan, Dinesh Srivastava

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Enteric Fever is caused by gram negative bacilli Salmonella typhi and paratyphi. It is associated with high morbidity and mortality worldwide. Timely initiation of treatment is a crucial step for prevention of any complications. Cultures of body fluids are diagnostic, but not always conclusive or practically feasible in most centers. Moreover, the results of cultures delay the treatment initiation. Serological tests lack diagnostic value. The blood counts can offer a promising option in diagnosis. A retrospective study to find out the relevance of leucopenia and eosinopenia was conducted on 203 culture proven enteric fever patients and 159 culture proven non-enteric fever patients in a tertiary care hospital in New Delhi. The patient details were retrieved from the electronic medical records section of the hospital. Absolute eosinopenia was considered as absolute eosinophil count (AEC) of less than 40/mm³ (normal level: 40-400/mm³) using LH-750 Beckman Coulter Automated machine. Leucopoenia was defined as total leucocyte count (TLC) of less than 4 X 10⁹/l. Blood cultures were done using BacT/ALERT FA plus automated blood culture system before first antibiotic dose was given. Case and control groups were compared using Pearson Chi square test. It was observed that absolute eosinophil count (AEC) of 0-19/mm³ was a significant finding (p < 0.001) in enteric fever patients, whereas leucopenia was not a significant finding (p=0.096). Using Receiving Operating Characteristic (ROC) curves, it was observed that patients with both AEC < 14/mm³ and TCL < 8 x 10⁹/l had 95.6% chance of being diagnosed as enteric fever and only 4.4% chance of being diagnosed as non-enteric fever. This result was highly significant with p < 0.001. This is a very useful association of AEC and TLC found in enteric fever patients of this study which can be used for the early initiation of treatment in clinically suspected enteric fever patients.

Keywords: absolute eosinopenia, absolute eosinophil count, enteric fever, leucopenia, total leucocyte count

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Authors: A. Yakub AbdurRaheem

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Urban violence in the form of ethnic and religious conflicts have been on the increase in many African cities in the recent years of which most of them are the result of intense and bitter competition for political power, the control of limited economic, social and environmental resources. In Nigeria, the emergence of the Boko Haram insurgency in most parts of the northeastern parts have ignited violence, bloodshed, refugee exodus and internal migration. Not only do the persistent attacks of the sect create widespread insecurity and fear, but it has also stifled normal processes of trade and investments most especially real property investment which is acclaimed to accelerate the economic cycle, thus the need to evolve strategies for an improved property market in such areas. This paper, therefore, examines the impact of this social crisis on effective and efficient utilization of real properties as a resource towards the development of the economy, using a descriptive analysis approach where particular emphasis was based on trends in residential housing values; volume of estimated property transactions and real estate investment decisions by affected individuals. Findings indicate that social crisis in the affected areas have been a clog on the wheels of property development and investment as properties worth hundreds of millions have been destroyed thereby having great impact on property values. Based on these findings, recommendations were made to include the need to strategically continue investing in property during such times, the need for Nigerian government to establish an active conflict monitoring and management unit for the prompt response, encourage community and neighborhood policing to ameliorate security challenges in Nigeria.

Keywords: social crisis, economy, resources, property market

Procedia PDF Downloads 233

Authors: Izabel Cristina Zattar, Gilberto Passos Lima, Guilherme Schünemann de Oliveira

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In Brazil, there are several institutions committed to the development of new businesses based on product innovation. Among them are business incubators, universities and science institutes. Business incubators can be defined as nurseries for new companies, which may be in the technology segment, discussed in this article. Business incubators provide services related to infrastructure, such as physical space and meeting rooms. Besides these services, incubators also offer assistance in the form of information and communication, access to finance, relationship networks and business monitoring and mentoring processes. Business incubators support not all technology companies. One of the business incubators tasks is to assess the nature and feasibility of new business proposals. To assist in this goal, this paper proposes a methodology for evaluating new business using the Analytic Hierarchy Process (AHP). This paper presents the concepts used in the assessing methodology application for new business, concepts that have been tested with positive results in practice. This study counts on three main steps: first, a hierarchy was built, based on new business manuals used by the business incubators. These books and manuals relate business selection requirements, such as the innovation status and other technological aspects. Then, a questionnaire was generated, in order to guide incubator experts in the parity comparisons at all hierarchy levels. The weights of each requirement are calculated from information obtained from the questionnaire responses. Finally, the proposed method was applied to evaluate five new business proposals, which were applying to be part of a company incubator. The main result is the classification of these new businesses, which helped the incubator experts to decide what companies were more eligible to work with. This classification may also be helpful to the decision-making process of business incubators in future selection processes.

Keywords: Analytic Hierarchy Process (AHP), Brazilian companies incubators, technology companies, incubator

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Authors: Benjamin L. Freidman, Sally L. Gras, Ian Snape, Geoff W. Stevens, Kathryn A. Mumford

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Increasing transportation and storage of petroleum hydrocarbons in Antarctic and sub-Antarctic regions have resulted in frequent accidental spills. Migrating petroleum hydrocarbon spills can have a significant impact on terrestrial and marine ecosystems in cold regions, as harsh environmental conditions result in heightened sensitivity to pollution. This migration of contaminants has led to the development of Permeable Reactive Barriers (PRB) for application in cold regions. PRB’s are one of the most practical technologies for on-site or in-situ groundwater remediation in cold regions due to their minimal energy, monitoring and maintenance requirements. The Main Power House site has been used as a fuel storage and power generation area for the Macquarie Island research station since at least 1960. Soil analysis at the site has revealed Total Petroleum Hydrocarbon (TPH) (C9-C28) concentrations as high as 19,000 mg/kg soil. Groundwater TPH concentrations at this site can exceed 350 mg/L TPH. Ongoing migration of petroleum hydrocarbons into the neighbouring marine ecosystem resulted in the installation of a ‘funnel and gate’ PRB in November 2014. The ‘funnel and gate’ design successfully intercepted contaminated groundwater and analysis of TPH retention and biodegradation on PRB media are currently underway. Installation of the PRB facilitates research aimed at better understanding the contribution of particle attached biofilms to the remediation of groundwater systems. Bench-scale PRB system analysis at The University of Melbourne is currently examining the role biofilms play in petroleum hydrocarbon degradation, and how controlled release nutrient media can heighten the metabolic activity of biofilms in cold regions in the presence of low temperatures and low nutrient groundwater.

Keywords: groundwater, petroleum, Macquarie island, funnel and gate

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Authors: Kristina Jansen, Maximilian Lennartz, Patrick Lebok, Guido Sauter, Ronald Simon, David Dum, Stefan Steurer

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DOG1 (Discovered on GIST1) is a voltage-gated calcium-activated chloride and bicarbonate channel that is highly expressed in interstitial cells of Cajal and in gastrointestinal stromal tumors (GIST) derived from Cajal cells. To systematically determine in what tumor entities and normal tissue types DOG1 may be further expressed, a tissue microarray (TMA) containing 15,965 samples from 121 different tumor types and subtypes as well as 608 samples of 76 different normal tissue types were analyzed by immunohistochemistry. DOG1 immunostaining was found in 67 tumor types, including GIST (95.7%), esophageal squamous cell carcinoma (31.9%), pancreatic ductal adenocarcinoma (33.6%), adenocarcinoma of the Papilla Vateri (20%), squamous cell carcinoma of the vulva (15.8%) and the oral cavity (15.3%), mucinous ovarian cancer (15.3%), esophageal adenocarcinoma (12.5%), endometrioid endometrial cancer (12.1%), neuroendocrine carcinoma of the colon (11.1%) and diffuse gastric adenocarcinoma (11%). Low level-DOG1 immunostaining was seen in 17 additional tumor entities. DOG1 expression was unrelated to histopathological parameters of tumor aggressiveness and/or patient prognosis in cancers of the breast (n=1,002), urinary bladder (975), ovary (469), endometrium (173), stomach (233), and thyroid gland (512). High DOG1 expression was linked to estrogen receptor expression in breast cancer (p<0.0001) and the absence of HPV infection in squamous cell carcinomas (p=0.0008). In conclusion, our data identify several tumor entities that can show DOG1 expression levels at similar levels as in GIST. Although DOG1 is tightly linked to a diagnosis of GIST in spindle cell tumors, the differential diagnosis is much broader in DOG1 positive epithelioid neoplasms.

Keywords: biomarker, DOG1, immunohistochemistry, tissue microarray

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Authors: M. Deligianni, P. Voultsos, E. Tsamadou

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Background/Introduction: Moral distress is a common occurrence for health professionals working in neonatal critical care. Despite a growing number of critically ill neonatal and pediatric patients, only a few articles related to moral distress as experienced by neonatal physicians have been published over the last years. Objectives/Aims: The aim of this study was to define and identify barriers to and facilitators of moral distress based on the perceptions and experiences of neonatal physicians working in neonatal intensive care units (NICUs). This pilot study is a part of a larger nationwide project. Methods: A multicenter qualitative descriptive study using focus group methodology was conducted. In-depth interviews lasting 45 to 60 minutes were audio-recorded. Once data were transcribed, conventional content analysis was used to develop the definition and categories, as well as to identify the barriers to and facilitators of moral distress. Results: Participants defined moral distress broadly in the context of neonatal critical care. A wide variation of definitions was displayed. The physicians' responses to moral distress included different feelings and other situations. The overarching categories that emerged from the data were patient-related, family-related, and physician-related factors. Moreover, organizational factors may constitute major facilitators of moral distress among neonatal physicians in NICUs. Note, however, that moral distress may be regarded as an essential component to caring for neonates in critical care. The present study provides further insight into the moral distress experienced by physicians working in Greek NICUs. Discussion/Conclusions: Understanding how neonatal and pediatric critical care nurses define moral distress and what contributes to its development is foundational to developing targeted strategies for mitigating the prevalence of moral distress among neonate physicians in the context of NICUs.

Keywords: critical care, moral distress, neonatal physician, neonatal intensive care unit, NICU

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