Search results for: clinical error

Authors: Amin Salighehdar, Ziwen Ye, Mingzhe Liu, Ionut Florescu, Alan F. Blumberg

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Storm surge is an abnormal water level caused by a storm. Accurate prediction of a storm surge is a challenging problem. Researchers developed various ensemble modeling techniques to combine several individual forecasts to produce an overall presumably better forecast. There exist some simple ensemble modeling techniques in literature. For instance, Model Output Statistics (MOS), and running mean-bias removal are widely used techniques in storm surge prediction domain. However, these methods have some drawbacks. For instance, MOS is based on multiple linear regression and it needs a long period of training data. To overcome the shortcomings of these simple methods, researchers propose some advanced methods. For instance, ENSURF (Ensemble SURge Forecast) is a multi-model application for sea level forecast. This application creates a better forecast of sea level using a combination of several instances of the Bayesian Model Averaging (BMA). An ensemble dressing method is based on identifying best member forecast and using it for prediction. Our contribution in this paper can be summarized as follows. First, we investigate whether the ensemble models perform better than any single forecast. Therefore, we need to identify the single best forecast. We present a methodology based on a simple Bayesian selection method to select the best single forecast. Second, we present several new and simple ways to construct ensemble models. We use correlation and standard deviation as weights in combining different forecast models. Third, we use these ensembles and compare with several existing models in literature to forecast storm surge level. We then investigate whether developing a complex ensemble model is indeed needed. To achieve this goal, we use a simple average (one of the simplest and widely used ensemble model) as benchmark. Predicting the peak level of Surge during a storm as well as the precise time at which this peak level takes place is crucial, thus we develop a statistical platform to compare the performance of various ensemble methods. This statistical analysis is based on root mean square error of the ensemble forecast during the testing period and on the magnitude and timing of the forecasted peak surge compared to the actual time and peak. In this work, we analyze four hurricanes: hurricanes Irene and Lee in 2011, hurricane Sandy in 2012, and hurricane Joaquin in 2015. Since hurricane Irene developed at the end of August 2011 and hurricane Lee started just after Irene at the beginning of September 2011, in this study we consider them as a single contiguous hurricane event. The data set used for this study is generated by the New York Harbor Observing and Prediction System (NYHOPS). We find that even the simplest possible way of creating an ensemble produces results superior to any single forecast. We also show that the ensemble models we propose generally have better performance compared to the simple average ensemble technique.

Keywords: Bayesian learning, ensemble model, statistical analysis, storm surge prediction

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Authors: Jade Fersterer, Tristan Snell, Mark Rickinson

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This paper is designed to provide a review of the literature concerning the impact of natural environments on student learning and wellbeing in Australia. Specific areas of interest include how child-led and teacher-led pedagogies differ in outdoor learning settings, and the impact of each approach on children’s well-being, behavior, relationships with others as well as educational outcomes. The review will include links to possibilities for future research, including a Ph.D. currently being undertaken in Australia, which aims to fulfill a considerable gap in psychological, educational and outdoor learning research, regarding how natural environments are being used by teachers to improve learning and wellbeing among primary school students. The proposed study aims to understand if children’s experience of learning, 1. in a natural environment, and 2. in a child-led way, can support and strengthen their skills across several areas of development, including those required for positive educational outcomes. Data will be collected from a sample of primary school students and teachers via both quantitative and qualitative methods, including a pre- and post-questionnaire, direct observation, and semi-structured interviews. The study will have valuable implications for the provision of quality education as well as the promotion of good health and wellbeing. The implications of the research will be useful not only for teachers and parents but also for Psychologists working with children and young people in both a school and clinical setting. Understanding the impacts and implications of child-led learning and exposure to natural environments provides the opportunity to build on the current school curriculum. The inclusion of child-led experiences in nature may provide a simple way to build enthusiasm for school and learning, cultivating skills for life and relationships as well as meeting current curriculum requirements and building capacity for ongoing academic pursuits. In addition, understanding the impact of learning in a natural environment on wellbeing will assist in the development and dissemination of an educational model that could help mitigate the negative health outcomes associated with reduced physical activity and decreasing contact with nature among children.

Keywords: child-led learning, educational outcomes, natural environments, wellbeing

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Authors: Esabelle Lo Yan Yam, Pheak Chhoun, Sovannary Tuot, Emily Lancsar, Siyan Yi

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Persons living with HIV (PLHIV) need lifelong antiretroviral treatment (ART) to keep their viral load suppressed to an undetectable level, maintain a healthy immune system, and reduce the risk of transmitting HIV to others. However, many factors affect PLHIV's adherence to ART, including access to antiretrovirals (ARV), stigma, lack of social support, and the burden of seeking lifelong care. Community-based care has been shown to be instrumental in the experience of PLHIV in many countries, including Cambodia. In this study based in Cambodia, a community-based ART delivery (CAD) intervention involving community action workers (CAWs) who are PLHIVs was introduced. These workers collect pre-packaged ARVs from the ART clinics and dispense them to PLHIVs in the communities. The quasi-experimental study involved approximately 2000 stable PLHIV in the intervention arm and another 2000 PLHIV in the control arm (receiving usual care). A cost-effectiveness analysis is currently conducted to complement the clinical effectiveness of the CAD intervention on the care continuum and treatment outcomes for stable PLHIV, as well as the operational effectiveness in increasing the efficiency of the ART clinics and the health system. The analysis will consider health system and societal perspectives based on primary outcomes, including retention in care, viral load suppression, and adherence to ART. Additionally, a consultation with the National Centre for HIV/AIDS, Dermatology, and STD under the Cambodia Ministry of Health will be done to discuss the conduct of a budget impact analysis that can quantify the financial impact on the government's budget when adopting the CAD intervention at the provincial and national levels. The budget impact analysis will take into consideration various scaling-up scenarios for the interventions in the country. The research will assess the cost-effectiveness of the CAD intervention to support national stakeholders in Cambodia to make an informed decision on the adoption and scaling up of the intervention in Cambodia. The results are currently being analyzed and will be available at the time of the conference.

Keywords: Cambodia, community intervention, economic evaluation, global health, HIV/AIDs, implementation research

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Authors: Atitallah Sofien, Bouyahia Olfa, Krifi farah, Missaoui Nada, Ben Rabeh Rania, Yahyaoui Salem, Mazigh Sonia, Boukthir Samir

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Introduction: Subcutaneous fat necrosis of the newborn (SCFN) is a rare acute hypodermatitis characterized by skin lesions in the form of infiltrated, hard plaques and subcutaneous nodules, with a purplish-red color, occurring between the first and sixth week of life. SCFN is generally a benign condition that spontaneously regresses without sequelae, but it can be complicated by severe hypercalcemia. Methodology: This is a retrospective case report of neonatal subcutaneous fat necrosis complicated with severe hypercalcemia and nephrocalcinosis. Results: This is a case of a female newborn with a family history of a hypothyroid mother on Levothyrox, born to non-consanguineous parents and from a well-monitored pregnancy. The newborn was delivered by cesarean section at 39 weeks gestation due to severe preeclampsia. She was admitted to the Neonatal Intensive Care Unit at 1 hour of life for the management of grade 1 perinatal asphyxia and immediate neonatal respiratory distress related to transient respiratory distress. Hospitalization was complicated by a healthcare-associated infection, requiring intravenous antibiotics for ten days, with a good clinical and biological response. On the 20th day of life, she developed skin lesions in the form of indurated purplish-red nodules on the back and on both arms. A SCFN was suspected. A calcium level test was conducted, which returned a result of 3 mmol/L. The rest of the phosphocalcic assessment was normal, with early signs of nephrocalcinosis observed on renal ultrasound. The diagnosis of SCFN complicated by nephrocalcinosis associated with severe hypercalcemia was made, and the condition improved with intravenous hydration and corticosteroid therapy. Conclusion: SCFN is a rare and generally benign hypodermatitis in newborns with an etiology that is still poorly understood. Despite its benign nature, SCFN can be complicated by hypercalcemia, which can sometimes be life-threatening. Therefore, it is important to conduct a thorough skin examination of newborns, especially those with risk factors, to detect and correct any potential hypercalcemia.

Keywords: subcutaneous fat necrosis, newborn, hypercalcemia, nephrocalcinosis

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Authors: K. Frahtia, I. Mihoubi, S. Picot

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Leishmaniasis is a group of parasitic disease with a varied clinical expression caused by flagellate protozoa of the Leishmania genus. These diseases are transmitted to humans and animals by the sting of a vector insect, the female sandfly. Among the groups of dipteral disease vectors, Phlebotominae occupy a prime position and play a significant role in human pathology, such as leishmaniasis that affects nearly 350 million people worldwide. The vector control operation launched by health services throughout the country proves to be effective since despite the prevalence of the disease remains high especially in rural areas, leishmaniasis appears to be declining in Algeria. In this context, this study mainly concerns molecular detection of Leishmania from the vector. Furthermore, a molecular diagnosis has also been made on skin samples taken from patients in the region of Constantine, located in the North-East of Algeria. Concerning the vector, 5858 sandflies were captured, including 4360 males and 1498 females. Male specimens were identified based on their morphological. The morphological identification highlighted the presence of the Phlebotomus genus with a prevalence of 93% against 7% represented by the Sergentomyia genus. About the identified species, P. perniciosus is the most abundant with 59.4% of the male identified population followed by P. longicuspis with 24.7% of the workforce. P. perfiliewi is poorly represented by 6.7% of specimens followed by P. papatasi with 2.2% and 1.5% S. dreyfussi. Concerning skin samples, 45/79 (56.96%) collected samples were found positive by real-time PCR. This rate appears to be in sharp decline compared to previous years (alert peak of 30,227 cases in 2005). Concerning the detection of Leishmania from sandflies by RT-PCR, the results show that 3/60 PCR performed genus are positive with melting temperatures corresponding to that of the reference strain (84.1 +/- 0.4 ° C for L. infantum). This proves that the vectors were parasitized. On the other side, identification by RT-PCR species did not give any results. This could be explained by the presence of an insufficient amount of leishmanian DNA in the vector, and therefore support the hypothesis of the regression of leishmaniasis in Constantine.

Keywords: Algeria, molecular diagnostic, phlebotomus, real time PCR

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Authors: Kristian Bugeja, Upeshala A. Jayawardena, Clarissa Fenech, Mark Zammit Vincenti

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Introduction: Biliary colic, acute cholecystitis, and gallstone pancreatitis are some of the most common surgical presentations at Gozo General Hospital (GGH). National Institute for Health and Care Excellence (NICE) guidelines advise that suitable patients with acute biliary problems should be offered a laparoscopic cholecystectomy within one week of diagnosis. There has traditionally been difficulty in achieving this mainly due to the reluctance of some surgeons to operate in the acute setting, limited, timely access to MRCP and ERCP, and organizational issues. Methodology: A retrospective study was performed involving all biliary pathology-related admissions to GGH during the two-year period of 2019 and 2020. Patients’ files and electronic case summary (ECS) were used for data collection, which included demographic data, primary diagnosis, co-morbidities, management, waiting time to surgery, length of stay, readmissions, and reason for readmissions. NICE clinical guidance 188 – Gallstone disease were used as the standard. Results: 51 patients were included in the study. The mean age was 58 years, and 35 (68.6%) were female. The main diagnoses on admission were biliary colic in 31 (60.8%), acute cholecystitis in 10 (19.6%). Others included gallstone pancreatitis in 3 (5.89%), chronic cholecystitis in 2 (3.92%), gall bladder malignancy in 4 (7.84%), and ascending cholangitis in 1 (1.97%). Management included laparoscopic cholecystectomy in 34 (66.7%); conservative in 8 (15.7%) and ERCP in 6 (11.7%). The mean waiting time for laparoscopic cholecystectomy for patients with acute cholecystitis was 74 days – range being between 3 and 146 days since the date of diagnosis. Only one patient who was diagnosed with acute cholecystitis and managed with laparoscopic cholecystectomy was done so within the 7-day time frame. Hospital re-admissions were reported in 5 patients (9.8%) due to vomiting (1), ascending cholangitis (1), and gallstone pancreatitis (3). Discussion: Guidelines were not met for patients presenting to Gozo General Hospital with acute biliary pathology. This resulted in 5 patients being re-admitted to hospital while waiting for definitive surgery. The local issues resulting in the delay to surgery need to be identified and steps are taken to facilitate the provision of urgent cholecystectomy for suitable patients.

Keywords: biliary colic, acute cholecystits, laparoscopic cholecystectomy, conservative management

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Authors: Argyris B. Karapetsas, Rozi M. Laskaraki, Aikaterini A. Karapetsa, Maria Bampou, Valentini N. Vamvaka

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The main aim of the current protocol is the contribution of neuropsychology in both assessment and rehabilitation settings for children with dyslexia. Objectives: The purpose of this study was to evaluate the significant role of neuropsychological assessment including both Psychometric and electrophysiological tests as well as to investigate the effectiveness of an Auditory Training program, designed via Music designed for children with Developmental Dyslexia (DD). Materials: In our study, participated 45 third-, and fourth-grade students with DD and a matched control group (n=45). Method: At the first phase of the protocol, children underwent a clinical assessment, including both electrophysiological, i.e. Event Related Potentials (ERPs) esp. P300 waveform, and psychometric tests, being conducted in Laboratory of Neuropsychology, at University of Thessaly, in Volos, Greece. Assessment’s results confirmed statistically significant lower performance for children with DD for all tests, compared to the typical readers of the control group. After evaluation, a subgroup of children with DD participated in a Rehabilitation Program including digitized musical auditory training activities. Results: The electrophysiological recordings after the intervention revealed shorter, almost similar, P300 latency values for children with DD to those of the control group, indicating the beneficial effects of the Intervention, thus enabling children develop reading skills and become successful readers. Discussion: Similar research data confirm the crucial role of neuropsychology in both diagnosis and treatment of common disorders, observed in children. Indeed, as for DD, there is growing evidence that brain activity dysfunction does occur, as it is confirmed by neuropsychological assessment and also musical auditory training may have remedial effects. Conclusions: The outcomes of the current study suggest that due to the neurobiological origin of DD, neuropsychology may give the means in both neuropsychological assessment and rehabilitation, enabling professionals to cope with cerebral dysfunction and recovery more efficiently.

Keywords: diagnosis, dyslexia, ERPs, Music, neuropsychology, rehabilitation

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Authors: L. Nathaniel-Wurie

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The Sellick manoeuvre a.k.a the application of cricoid force (CF), was first described by Brian Sellick in 1961. CF is the application of digital pressure against the cricoid cartilage with the intention of posterior force causing oesophageal compression against the vertebrae. This is designed to prevent passive regurgitation of gastric contents, which is a major cause of morbidity and mortality during emergency airway management inside and outside of the hospital. To the authors knowledge, there is no universally standardised training modality and, therefore, no reliable way to examine if there are appropriate outcomes. If force is not measured during training, how can one surmise that appropriate, accurate, or precise amounts of force are being used routinely. Poor homogeneity in teaching and untested outcomes will correlate with reduced efficacy and increased adverse effects. For this study, the accuracy of force delivery in trained professionals was tested, and outcomes contrasted against a novice control and a novice study group. In this study, 20 operating department practitioners were tested (with a mean experience of 5.3years of performing CF). Subsequent contrast with 40 novice students who were randomised into one of two arms. ‘Arm A’ were explained the procedure, then shown the procedure then asked to perform CF with the corresponding force measurement being taken three times. Arm B had the same process as arm A then before being tested, they had 10, and 30 Newtons applied to their hands to increase intuitive understanding of what the required force equated to, then were asked to apply the equivalent amount of force against a visible force metre and asked to hold that force for 20 seconds which allowed direct visualisation and correction of any over or under estimation. Following this, Arm B were then asked to perform the manoeuvre, and the force generated measured three times. This study shows that there is a wide distribution of force produced by trained professionals and novices performing the procedure for the first time. Our methodology for teaching the manoeuvre shows an improved accuracy, precision, and homogeneity within the group when compared to novices and even outperforms trained practitioners. In conclusion, if this methodology is adopted, it may correlate with higher clinical outcomes, less adverse events, and more successful airway management in critical medical scenarios.

Keywords: airway, cricoid, medical education, sellick

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Authors: Lou J. Pino, Mark Campbell, Matthew J. Kennedy, Ashleigh C. Kennedy

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A concussion is complex and nuanced, with cognitive rest being a key component of recovery. Cognitive overexertion during rehabilitation from a concussion is associated with delayed recovery. However, daily living imposes cognitive demands that may be unavoidable and difficult to quantify. Therefore, a portable tool capable of alerting patients before cognitive overexertion occurs could allow patients to maintain their quality of life while preventing symptoms and recovery setbacks. EEG allows for a sensitive measure of cognitive exertion. Clinical 32-lead EEG headsets are not practical for day-to-day concussion rehabilitation management. However, there are now commercially available and affordable portable EEG headsets. Thus, these headsets can potentially be used to continuously monitor cognitive exertion during mental tasks to alert the wearer of overexertion, with the aim of preventing the occurrence of symptoms to speed recovery times. The objective of this study was to test an algorithm for predicting cognitive exertion from EEG data collected from a portable headset. EEG data were acquired from 10 participants (5 males, 5 females). Each participant wore a portable 4 channel EEG headband while completing 10 tasks: rest (eyes closed), rest (eyes open), three levels of the increasing difficulty of logic puzzles, three levels of increasing difficulty in multiplication questions, rest (eyes open), and rest (eyes closed). After each task, the participant was asked to report their perceived level of cognitive exertion using the NASA Task Load Index (TLX). Each participant then completed a second session on a different day. A customized machine learning model was created using data from the first session. The performance of each model was then tested using data from the second session. The mean correlation coefficient between TLX scores and predicted cognitive exertion was 0.75 ± 0.16. The results support the efficacy of the algorithm for predicting cognitive exertion. This demonstrates that the algorithms developed in this study used with portable EEG devices have the potential to aid in the concussion recovery process by monitoring and warning patients of cognitive overexertion. Preventing cognitive overexertion during recovery may reduce the number of symptoms a patient experiences and may help speed the recovery process.

Keywords: cognitive activity, EEG, machine learning, personalized recovery

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Authors: Isomar Lima da Silva, Alcilene Batalha Pontes, Aristeu Jonatas Leite de Oliveira, Roberto Maia Augusto

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Context: Mechanical ventilators are medical devices that help provide oxygen and ventilation to patients with respiratory difficulties. This equipment consists of a manual breathing unit that can be operated by a doctor or nurse and a mechanical ventilator that controls the airflow and pressure in the patient's respiratory system. This type of ventilator is commonly used in emergencies and intensive care units where it is necessary to provide breathing support to critically ill or injured patients. Objective: In this context, this work aims to develop a reliable and low-cost mechanical ventilator to meet the demand of hospitals in treating people affected by Covid-19 and other severe respiratory diseases, offering a chance of treatment as an alternative to mechanical ventilators currently available in the market. Method: The project presents the development of a low-cost auxiliary ventilator with a controlled ventilatory system assisted by integrated hardware and firmware for respiratory cycle control in non-invasive mechanical ventilation treatments using a manual artificial respiration unit. The hardware includes pressure sensors capable of identifying positive expiratory pressure, peak inspiratory flow, and injected air volume. The embedded system controls the data sent by the sensors. It ensures efficient patient breathing through the operation of the sensors, microcontroller, and actuator, providing patient data information to the healthcare professional (system operator) through the graphical interface and enabling clinical parameter adjustments as needed. Results: The test data of the developed mechanical ventilator presented satisfactory results in terms of performance and reliability, showing that the equipment developed can be a viable alternative to commercial mechanical ventilators currently available, offering a low-cost solution to meet the increasing demand for respiratory support equipment.

Keywords: mechanical fans, breathing, medical equipment, COVID-19, intensive care units

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Authors: Seung Chul Lee, Jooyeong Kim, Ki Ok Ahn, Juok Park

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Background: Injuries caused by motorcycle crashes are one of the major public health burdens leading to high mortality, functional disability. The risk of death among motorcyclists is 30 times greater than that among car drivers, with head injuries the leading cause of death. The motorcycle helmet is crucial protective equipment for motorcyclists. Aims: This study aimed to measure the protective effect of motorcycle helmet use on intracranial injury and mortality and to compare the preventive effect in drivers and passengers. Methods: This is a cross-sessional study based on the Emergency Department (ED)–based Injury In-depth Surveillance (EDIIS) database from 23 EDs in Korea. All of the trauma patients injured in motorcycle crashes between January 1, 2013 and December 31, 2016 were eligible, excluding cases with unknown helmet use and outcomes. The primary and secondary outcomes were intracranial injury and in-hospital mortality. We calculated adjusted odds ratios (AORs) of helmet use for study outcomes after adjusting for potential confounders. Using interaction models, we compared the protective effect of helmet use on outcomes across driving status (driver and passenger). Results: Among 17,791 eligible patients, 10,668 (60.0%) patients were wearing helmets at the time of the crash, 2,128 (12.0%) patients had intracranial injuries and 331 (1.9%) patients had in-hospital death. 16,381 (92.1%) patients were drivers and 1410 (7.9%) patients were passengers. 62.6% of drivers and 29.1% of passengers were wearing helmets at the time of the crash. Compared to un-helmeted group, the helmeted group was less likely to have an intracranial injury(8.0% vs. 17.9%, AOR: 0.43 (0.39-0.48)) and in-hospital mortality (1.0% vs. 3.2%, AOR: 0.29 (0.22-0.37)).In the interaction model, AORs (95% CIs) of helmet use for intracranial injury were 0.42 (0.38-0.47) in drivers and 0.61(0.41-0.90) in passengers, respectively. There was a significant preventive effect of helmet use on in-hospital mortality in drivers (AOR: 0.26(0.21–0.34)). Discussion and conclusions: Wearing helmets in motorcycle crashes reduced intracranial injuries and in-hospital mortality. The preventive effect of motorcycle helmet use on intracranial injury was stronger in drivers than in passengers. There was a significant preventive effect of helmet use on in-hospital mortality in driver but not in passengers. Public health efforts to increase motorcycle helmet use are needed to reduce health burden from injuries caused by motorcycle crashes.

Keywords: intracranial injury, helmet, mortality, motorcycle crashes

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Authors: A. Raj Kumar, S. Bilaloglu

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Stroke is a leading cause of adult disability worldwide. We depend on our hands for our activities of daily living(ADL). Although many patients regain the ability to walk, they continue to experience long-term hand motor impairments. As the number of individuals with young stroke is increasing, there is a critical need for effective approaches for rehabilitation of hand function post-stroke. Motor relearning for dexterity requires task-specific kinesthetic, tactile and visual feedback. However, when a stroke results in both sensory and motor impairment, it becomes difficult to ascertain when and what type of sensory substitutions can facilitate motor relearning. In an ideal situation, real-time task-specific data on the ability to learn and data-driven feedback to assist such learning will greatly assist rehabilitation for dexterity. We have found that kinesthetic and tactile information from the unaffected hand can assist patients re-learn the use of optimal fingertip forces during a grasp and lift task. Measurement of fingertip grip force (GF), load forces (LF), their corresponding rates (GFR and LFR), and other metrics can be used to gauge the impairment level and progress during learning. Currently ATI mini force-torque sensors are used in research settings to measure and compute the LF, GF, and their rates while grasping objects of different weights and textures. Use of the ATI sensor is cost prohibitive for deployment in clinical or at-home rehabilitation. A cost effective mechatronic device is developed to quantify GF, LF, and their rates for stroke rehabilitation purposes using off-the-shelf components such as load cells, flexi-force sensors, and an Arduino UNO microcontroller. A salient feature of the device is its integration with an interactive gaming environment to render a highly engaging user experience. This paper elaborates the integration of kinesthetic and tactile sensing through computation of LF, GF and their corresponding rates in real time, information processing, and interactive interfacing through augmented reality for visual feedback.

Keywords: feedback, gaming, kinesthetic, rehabilitation, tactile

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Authors: Anita Paddy, Millicent Obodai, Lebbaeus Asamani

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The management of sickle cell disease requires a multidisciplinary team for better outcomes. Thus, literature on the application of the biopsychosocial model for the management and explanation of chronic pain in sickle cell disease (SCD) and other chronic diseases abound. However, there is limited research on the use of the biopsychosocial model, together with a spiritual component (biopsychosocial-spiritual model). The study investigated the extent to which healthcare providers utilized the biopsychosocial-spiritual model in the management of chronic pain to improve the quality of life (QoL) of patients with SCD. This study employed the descriptive survey design involving a consecutive sampling of 261 patients with SCD who were between the ages of 18 to 79 years and were accessing hematological services at the Clinical Genetics Department of the Korle Bu Teaching Hospital. These patients willingly consented to participate in the study by appending their signatures. The theory of integrated quality of life, the gate control theory of pain and the biopsychosocial(spiritual) model were tested. An instrument for the biopsychosocial-spiritual model was developed, with a basis from the literature reviewed, while the World Health Organisation Quality of Life BREF (WHOQoLBref) and the spirituality rating scale were adapted and used for data collection. Data were analyzed using descriptive statistics (means, standard deviations, frequencies, and percentages) and partial least square structural equation modeling. The study revealed that healthcare providers had a great leaning toward the biological domain of the model compared to the other domains. Hence, participants’ QoL was not fully improved as suggested by the biopsychosocial(spiritual) model. Again, the QoL and spirituality of patients with SCD were quite high. A significant negative impact of spirituality on QoL was also found. Finally, the biosocial domain of the biopsychosocial-spiritual model was the most significant predictor of QoL. It was recommended that policymakers train healthcare providers to integrate the psychosocial-spiritual component in health services. Also, education on SCD and its resultant impact from the domains of the model should be intensified while health practitioners consider utilizing these components fully in the management of the condition.

Keywords: biopsychosocial (spritual), sickle cell disease, quality of life, healthcare, accra

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Authors: Anna Slupik, Anna Mosiolek, Sebastian Wojtowicz, Dariusz Bialoszewski

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Introduction: Whole-body vibration (WBV) uses high frequency mechanical stimuli generated by a vibration plate and transmitted through bone, muscle and connective tissues to the whole body. Research has shown that long-term vibration-plate training improves neuromuscular facilitation, especially in afferent neural pathways, responsible for the conduction of vibration and proprioceptive stimuli, muscle function, balance and proprioception. Some researchers suggest that the vibration stimulus briefly inhibits the conduction of afferent signals from proprioceptors and can interfere with the maintenance of body balance. The aim of this study was to evaluate the influence of a single set of exercises associated with whole-body vibration on the joint position sense and body balance. Material and methods: The study enrolled 55 people aged 19-24 years. These individuals were randomly divided into a test group (30 persons) and a control group (25 persons). Both groups performed the same set of exercises on a vibration plate. The following vibration parameters: frequency of 20Hz and amplitude of 3mm, were used in the test group. The control group performed exercises on the vibration plate while it was off. All participants were instructed to perform six dynamic exercises lasting 30 seconds each with a 60-second period of rest between them. The exercises involved large muscle groups of the trunk, pelvis and lower limbs. Measurements were carried out before and immediately after exercise. Joint position sense (JPS) was measured in the knee joint for the starting position at 45° in an open kinematic chain. JPS error was measured using a digital inclinometer. Balance was assessed in a standing position with both feet on the ground with the eyes open and closed (each test lasting 30 sec). Balance was assessed using Matscan with FootMat 7.0 SAM software. The surface of the ellipse of confidence and front-back as well as right-left swing were measured to assess balance. Statistical analysis was performed using Statistica 10.0 PL software. Results: There were no significant differences between the groups, both before and after the exercise (p> 0.05). JPS did not change in both the test (10.7° vs. 8.4°) and control groups (9.0° vs. 8.4°). No significant differences were shown in any of the test parameters during balance tests with the eyes open or closed in both the test and control groups (p> 0.05). Conclusions. 1. Deterioration in proprioception or balance was not observed immediately after the vibration stimulus. This suggests that vibration-induced blockage of proprioceptive stimuli conduction can have only a short-lasting effect that occurs only as long as a vibration stimulus is present. 2. Short-term use of vibration in treatment does not impair proprioception and seems to be safe for patients with proprioceptive impairment. 3. These results need to be supplemented with an assessment of proprioception during the application of vibration stimuli. Additionally, the impact of vibration parameters used in the exercises should be evaluated.

Keywords: balance, joint position sense, proprioception, whole body vibration

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Authors: Hami Ashraf, Mohammad Heydarnejad

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Introduction: The landscape of cancer treatment has been revolutionized by immunotherapy, offering novel therapeutic avenues for diverse cancer types. Animal models play a pivotal role in the development and elucidation of these therapeutic modalities. Nevertheless, the manifestation of Graft-versus-Host Disease (GVHD) in such models poses significant challenges, muddling the interpretation of experimental data within the ambit of cancer immunotherapy. This study is dedicated to scrutinizing the role of GVHD as a confounding factor in animal models used for cancer immunotherapy, alongside proposing viable strategies to mitigate this complication. Method: Employing a systematic review framework, this study undertakes a comprehensive literature survey including academic journals in PubMed, Embase, and Web of Science databases and conference proceedings to collate pertinent research that delves into the impact of GVHD on animal models in cancer immunotherapy. The acquired studies undergo rigorous analysis and synthesis, aiming to assess the influence of GVHD on experimental results while identifying strategies to alleviate its confounding effects. Results: Findings indicate that GVHD incidence significantly skews the reliability and applicability of experimental outcomes, occasionally leading to erroneous interpretations. The literature surveyed also sheds light on various methodologies under exploration to counteract the GVHD dilemma, thereby bolstering the experimental integrity in this domain. Conclusion: GVHD's presence critically affects both the interpretation and validity of experimental findings, underscoring the imperative for strategies to curtail its confounding impacts. Current research endeavors are oriented towards devising solutions to this issue, aiming to augment the dependability and pertinence of experimental results. It is incumbent upon researchers to diligently consider and adjust for GVHD's effects, thereby enhancing the translational potential of animal model findings to clinical applications and propelling progress in the arena of cancer immunotherapy.

Keywords: graft-versus-host disease, cancer immunotherapy, animal models, preclinical model

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Authors: Erna Judith Roach, Nalini Bhaskaranand

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Background & Significance: Asthma is the most common chronic disease among children. Education is the cornerstone of management of asthma to help the affected children. In India there are about 1.5- 3.0 million asthmatic children in the age group of 5-11 years. Many parents face management dilemmas in administration of medications to their children. Mothers being primary caregivers of children are often responsible for administering medications to them. The purpose of the study was to develop an educational package on techniques of drug administration for mothers of asthmatic children and determine its effectiveness in terms of improvement in skill in drug administration. Methodology: A quasi- experimental time series pre-test post -test control group design was used. Mothers of asthmatic children attending paediatric outpatient departments of selected hospitals along with their children between 5 and 12 years were included. Sample size consisted of 40 mothers in the experimental and 40 mothers in the control groups. Block randomization was used to assign samples to both the groups. The data collection instruments used were Baseline Proforma, Clinical Proforma, Daily asthma drug intake and symptoms diary and Observation Rating Scales on technique of using a metered dose inhaler with spacer; metered dose inhaler with facemask; metered dose inhaler alone and dry powder inhaler. The educational package consisted of a video and booklet on techniques of drug administration. Data were collected at baseline, 1, 3 and 6 months. Findings: The mean post-test scores in techniques of drug administration were higher than the mean pre-test scores in the experimental group in all techniques. The Friedman test (p < 0.01), Wilcoxon Signed Rank test (p < 0.008) and Mann Whitney U (p < 0.01) showed statistically significant difference in the experimental group than the control group. There was significant decrease in the average number of symptom days (11 Vs. 4 days/ month) and hospital visits (5 to 1 per month) in the experimental group when compared to the control group. Conclusion: The educational package was found to be effective in improving the skill of mothers in drug administration in all the techniques, especially with using the metered dose inhaler with spacer.

Keywords: childhood asthma, drug administration, mothers of children, inhaler

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Authors: Noorulain Khalid, Unsaar Hayat, Muhammad Chaudhary, Christos Iosifidis, Felipe Dhawahir-Scala, Fiona Carley

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Dry eye disease (DED) is a common condition seen in the emergency eye department (EED) at Manchester Royal Eye Hospital (MREH). However, there is variability in the prescription of lubricating eye drops among different healthcare providers. The aim of this study was to develop an up-to-date, standardized algorithm for the prescription of lubricating eye drops in the EED at MREH based on international and national guidelines. The study also aimed to assess the impact of implementing the guideline on the rate of inappropriate lubricant prescriptions. Primarily, the impact was to be assessed in the form of the appropriateness of prescriptions for patients’ DED. The impact was secondary to be assessed through analysis of the cost to the hospital. Data from 845 patients who attended the EED over a 3-month period were analyzed, and 157 patients met the inclusion and exclusion criteria. After conducting a review of the literature and collaborating with the corneal team, an algorithm for the prescription of lubricants in the EED was developed. Three plan-do-study-act (PDSA) cycles were conducted, with interventions such as emails, posters, in-person reminders, and education for incoming trainees. The appropriateness of prescriptions was evaluated against the guidelines. Data were collected from patient records and analyzed using statistical methods. The appropriateness of prescriptions was assessed by comparing them to the guidelines and by clinical correlation with a specialized registrar. The study found a substantial improvement in the number of appropriate prescriptions, with an increase from 55% to 93% over the three PDSA cycles. There was additionally a 51% reduction in expenditure on lubricant prescriptions, resulting in cost savings for the hospital (approximate saving of £50/week). Theoretical importance: Appropriate prescription of lubricating eye drops improves disease management for patients and reduces costs for the hospital. The development and implementation of a standardized guideline facilitate the achievement of these goals. Conclusion: This study highlights the inconsistent management of DED in the EED and the potential lack of training in this area for healthcare providers. The implementation of a standardized, easy-to-follow guideline for lubricating eye drops can help to improve disease management while also resulting in cost savings for the hospital.

Keywords: lubrication, dry eye disease, guideline, prescription

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Authors: Emanuela Zilli, Antonio Madia, Milvia Marchiori, Paola Anello, Chiara Cabbia, Emanuela Velo, Delia Campagnolo, Michele Scomazzon, Emanuela Salvatico, S. Tikvina, Antonio Miotti

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Hepatitis C is an inflammation of the liver caused by the hepatitis C virus (HCV). Antiviral medicines can cure more than 95% of cases of hepatitis C infection, but access to diagnosis and treatment remains low. The ULSS 6 Euganea – Health Trust has implemented a campaign to eradicate hepatitis C in the province of Padua (North-East of Italy), which can be subdivided into three areas: North (300.000 inhabitants), Centre (400.000) and South (300.000). In September 2021, the project was launched in the Northern area; a set of brochures was distributed in outpatient services, general practitioners’ clinics and offices, community pharmacy services, social health districts, and through social networks. The Hepatology Service contacted 460 patients selected by the Clinical Laboratory (positivity for HCV antibodies): 83 patients (18.0%) had been already cured of HCV infection, missing or deceased; 377 patients (82.0%) met the criteria to be eligible for HCV eradication therapy and were therefore included in a Day Service specific agenda and followed by a multidisciplinary team of healthcare professionals, with a dedicated telephone line. Haemato-chemical tests, general medical check-ups and ultrasound tests with fibroscan were performed. Patients were tested for Sars-CoV-2 positivity; those not yet vaccinated against Covid-19 were encouraged to complete the vaccination scheme. All 377 patients (100%) received HCV eradication therapy at the community pharmacy service; a detailed explanation of how to take their medication was provided. At the end of the first phase, Covid-19 vaccination rate was 100% (377/377), including patients already vaccinated and new-vaccinated. Check-up appointments were arranged after 2 or 3 months, according to the treatment plan. The awareness campaign and the organization of HCV eradication therapy service by ULSS 6 Euganea are proving to be effective; the project is now going to be applied to Central and Southern areas of the province (1.132 patients).

Keywords: public health, HCV-eradication, Covid-19 emergency, health communication strategies

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Authors: Franca De Sarno, Alfonso Maria Ponsiglione, Enza Torino

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Recent advances in diagnostic imaging technology have significantly contributed to a better understanding of specific changes associated with diseases progression. Among different imaging modalities, Magnetic Resonance Imaging (MRI) represents a noninvasive medical diagnostic technique, which shows low sensitivity and long acquisition time and it can discriminate between healthy and diseased tissues by providing 3D data. In order to improve the enhancement of MRI signals, some imaging exams require intravenous administration of contrast agents (CAs). Recently, emerging research reports a progressive deposition of these drugs, in particular, gadolinium-based contrast agents (GBCAs), in the body many years after multiple MRI scans. These discoveries confirm the need to have a biocompatible system able to boost a clinical relevant Gd-chelate. To this aim, several approaches based on engineered nanostructures have been proposed to overcome the common limitations of conventional CAs, such as the insufficient signal-to-noise ratios due to relaxivity and poor safety profile. In particular, nanocarriers, labeling or loading with CAs, capable of carrying high payloads of CAs have been developed. Currently, there’s no a comprehensive understanding of the thermodynamic contributions enable of boosting the efficacy of conventional CAs by using biopolymers matrix. Thus, considering the importance of MRI in diagnosing diseases, here it is reported a successful example of the next generation of these drugs where the commercial gadolinium chelate is incorporate into a biopolymer nanostructure, formed by cross-linked hyaluronic acid (HA), with improved relaxation properties. In addition, they are highlighted the basic principles ruling biopolymer-CA interactions in the perspective of their influence on the relaxometric properties of the CA by adopting a multidisciplinary experimental approach. On the basis of these discoveries, it is clear that the main point consists in increasing the rigidification of readily-available Gd-CAs within the biopolymer matrix by controlling the water dynamics, the physicochemical interactions, and the polymer conformations. In the end, the acquired knowledge about polymer-CA systems has been applied to develop of Gd-based HA nanoparticles with enhanced relaxometric properties.

Keywords: biopolymers, MRI, nanoparticles, contrast agent

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Authors: Rossana Taravella, Gilberto M. Cellura, Giuseppe Cirrincione, Salvatore Asciutto, Marco Caruso, Massimo Benedetto, Renato Ciofalo, Giuliana Pace, Salvatore Novo

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Objectives: This retrospective analysis sought to evaluate 1-month outcomes and therapy effectiveness of a population of patients treated with MitraClip therapy. We describe in this article the preliminary results of primary effectiveness endpoint. Background: Percutaneous Mitral Repair is being developed to treat severe mitral regurgitation (MR), with increasing real-world cases of functional MR (FMR). In the EVEREST (Endovascular Valve Edge-to-Edge Repair Study)II trial, the percutaneous device showed superior safety but less reduction in MR at 1year. 4-year outcomes from EVEREST II trial showed no difference in the prevalence of moderate-severe and severe MR or mortality at 4years between surgical mitral repair and percutaneous approach. Methods: We analysed retrospectively collected data from one center experience in Italy enrolled from January 2011 to December 2016. The study included 62 patients [mean age 74±11years, 43 men (69%)] with MR of at least grade3+. Most of the patients had functional MR, were in New York Heart Association (NYHA) functional class III or IV, with a large portion (78%) of mild-to-moderate Tricuspid Regurgitation (TR). One or more clips were implanted in 67 procedures (62 patients). Results and Conclusions: Severity of MR was reduced in all successfully treated patients,54(90%) were discharged with MR≤2+ (primary effectiveness endpoint). Clinical 1-month follow-up data showed an improvement in NYHA functional class (42 patients (70%) in NYHA class I-II). 60 of 62 (97 %) successfully treated patients were free from death and mitral valve surgery at 1-month follow-up. MitraClip therapy reduces functional MR with acute MR reduction to <2+ in the great majority of patients, with a large freedom from death, surgery or recurrent MR in a great portion of patients.

Keywords: MitraClip, mitral regurgitation, heart valves, catheter-based therapy

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Authors: Renu Pattanshetty

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The aim of this narrative review is to highlight the impact of menopause on osteoporosis and weight gain. The review also aims to summarize physiotherapeutic strategies to combat the same.A thorough literature search was conducted using electronic databases like MEDline, PUBmed, Highwire Press, PUBmed Central for English language studies that included search terms like menopause, osteoporosis, obesity, weight gain, exercises, physical activity, physiotherapy strategies from the year 2000 till date. Out of 157 studies that included metanalyses, critical reviews and randomized clinical trials, a total of 84 were selected that met the inclusion criteria. Prevalence of obesity is increasing world - wide and is reaching epidemic proportions even in the menopausal women. Prevalence of abdominal obesity is almost double than that general obesity with rates in the US with 65.5% in women ages 40-59 years and 73.8 in women aged 60 years or more. Physical activities and exercises play a vital role in prevention and treatment of osteoporosis and weight gain related to menopause that aim to boost the general well-being and any symptoms brought about by natural body changes. Endurance exercises lasting about 30 minutes /day for 5 days/ week has shown to decrease weight and prevent weight gain. In addition, strength training with at least 8 exercises of 8-12 repetitions working for whole body and for large muscle groups has shown to result positive outcomes. Hot flashes can be combatted through yogic breathing and relaxation exercises. Prevention of fall strategies and resistance training are key to treat diagnosed cases of osteoporosis related to menopause. One to three sets with five to eight repetitions of four to six weight bearing exercises have shown positive results. Menopause marks an important time for women to evaluate their risk of obesity and osteoporosis. It is known fact that bone benefit from exercises are lost when training is stopped, hence, practicing bone smart habits and strict adherence to recommended physical activity programs are recommended which are enjoyable, safe and effective.

Keywords: menopause, osteoporosis, obesity, weight gain, exercises, physical activity, physiotherapy strategies

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Authors: Masato Koizumi, Yuya Oshio, Ikkoh Funaki

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Magnetoplasma Sail (MPS) is a future spacecraft propulsion that generates high levels of thrust by inducing an artificial magnetosphere to capture and deflect solar wind charged particles in order to transfer momentum to the spacecraft. By injecting plasma in the spacecraft’s magnetic field region, the ring current azimuthally drifts on the equatorial plane about the dipole magnetic field generated by the current flowing through the solenoid attached on board the spacecraft. This ring current results in magnetosphere inflation which improves the thrust performance of MPS spacecraft. In this present study, the ring current was experimentally measured using three Rogowski Current Probes positioned in a circular array about the laboratory model of MPS spacecraft. This investigation aims to determine the detailed structure of ring current through physical experimentation performed under two different magnetic field strengths engendered by varying the applied voltage on the solenoid with 300 V and 600 V. The expected outcome was that the three current probes would detect the same current since all three probes were positioned at equal radial distance of 63 mm from the center of the solenoid. Although experimental results were numerically implausible due to probable procedural error, the trends of the results revealed three pieces of perceptive evidence of the ring current behavior. The first aspect is that the drift direction of the ring current depended on the strength of the applied magnetic field. The second aspect is that the diamagnetic current developed at a radial distance not occupied by the three current probes under the presence of solar wind. The third aspect is that the ring current distribution varied along the circumferential path about the spacecraft’s magnetic field. Although this study yielded experimental evidence that differed from the original hypothesis, the three key findings of this study have informed two critical MPS design solutions that will potentially improve thrust performance. The first design solution is the positioning of the plasma injection point. Based on the implication of the first of the three aspects of ring current behavior, the plasma injection point must be located at a distance instead of at close proximity from the MPS Solenoid for the ring current to drift in the direction that will result in magnetosphere inflation. The second design solution, predicated by the third aspect of ring current behavior, is the symmetrical configuration of plasma injection points. In this study, an asymmetrical configuration of plasma injection points using one plasma source resulted in a non-uniform distribution of ring current along the azimuthal path. This distorts the geometry of the inflated magnetosphere which minimizes the deflection area for the solar wind. Therefore, to realize a ring current that best provides the maximum possible inflated magnetosphere, multiple plasma sources must be spaced evenly apart for the plasma to be injected evenly along its azimuthal path.

Keywords: Magnetoplasma Sail, magnetosphere inflation, ring current, spacecraft propulsion

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Authors: Mardiana Madjid, Nurpudji Astuti Taslim, Suryani As'ad, Haerani Rasyid, Agussalim Bukhari

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The high level of Urine Urea Nitrogen (UUN) indicates hypercatabolism occurs in hospitalized patients. High levels of Total Lymphocyte Count (TLC) indicates the immune system condition, adequate wound healing, and limit complication. Adequate dietary intake affects to decrease of hypercatabolism status in treated patient’s hospitals. Nitrogen Balance (NB) is simply the difference between nitrogen (N₂) intake and output. If more N₂ intake than output, then positive NB or anabolic will occur. This study aims to evaluate the effect of dietary intake in influencing balance nitrogen and total lymphocyte count. Method: A total of 43 patients admitted to a Wahidin Sudirohusodo Hospital between 2018 and 2019 for 10 days' treats are included. The inclusion criteria were patients who were treated for 10 days and receives food from the hospital orally. Patients did not experience gastrointestinal disorders such as vomiting and diarrhea and experience impair kidney function and liver function and expressed approval to participate in this study. During hospitalization, food intake, UUN, albumin serum, balance nitrogen, and TLC was assessed twice on day 1 and day 10. There is no Physician Clinical Nutritional intervention to correct food intake. UUN is 24 hours of urine collected on the second day after admission and the tenth day. Statistical analysis uses SPSS 24 with observational cohort methods. Result: The Forty-three participants completed the follow-up (27 men and 18 women). The age of fewer than 4 years is 22 people, 45 to 60 years is 16 people, and over 60 years is 4 people. The result of the study on day 1 obtained SGA score A, SGA score B, SGA score C are 8, 32, 3 until day 10 are 8, 31, 4, respectively. According to 24h dietary recalls, the energy intake during observation was from 522.5 ± 400.4 to 1011.9 ± 545.1 kcal/day P < 0.05, protein intake from 20.07 ± 17.2 to 40.3 ± 27.3 g/day P < 0.05, carbohydrates from 92.5 ± 71.6 to 184.8 ± 87.4 g/day, and fat from 5.5 ± 3.86 to 13.9 ± 13.9 g/day. The UUN during the observation was from 6.6 ± 7.3 to 5.5 ± 3.9 g/day, TLC decreased from 1622.9 ± 897.2 to 1319.9 ± 636.3/mm³ value target 1800/mm³, albumin serum from 3.07 ± 0.76 to 2.9 ± 0.57 g/day, and BN from -7.5 ± 7.2 to -3.1 ± 4.86. Conclusion: The high level of UUN needs to correct adequate dietary intake to improve NB and TLC status on hospitalized patients.

Keywords: adequate dietary intake, balance nitrogen, total lymphocyte count, urine urea nitrogen

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Authors: E. Nakamachi, S. Tanaka, K. Yamamoto, Y. Morita

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In this study, we developed a three-dimensional (3D) direct current electric field (DCEF) stimulation bio-reactor for axonal outgrowth enhancement to generate the neural network of the central nervous system (CNS). By using our newly developed 3D DCEF stimulation bio-reactor, we cultured the rat pheochromocytoma cells (PC12) and investigated the effects on the axonal extension enhancement and network generation. Firstly, we designed and fabricated a 3D bio-reactor, which can load DCEF stimulation on PC12 cells embedded in the collagen gel as extracellular environment. The connection between the electrolyte and the medium using salt bridges for DCEF stimulation was introduced to avoid the cell death by the toxicity of metal ion. The distance between the salt bridges was adopted as the design variable to optimize a structure for uniform DCEF stimulation, where the finite element (FE) analyses results were used. Uniform DCEF strength and electric flux vector direction in the PC12 cells embedded in collagen gel were examined through measurements of the fabricated 3D bio-reactor chamber. Measurement results of DCEF strength in the bio-reactor showed a good agreement with FE results. In addition, the perfusion system was attached to maintain pH 7.2 ~ 7.6 of the medium because pH change was caused by DCEF stimulation loading. Secondly, we disseminated PC12 cells in collagen gel and carried out 3D culture. Finally, we measured the morphology of PC12 cell bodies and neurites by the multiphoton excitation fluorescence microscope (MPM). The effectiveness of DCEF stimulation to enhance the axonal outgrowth and the neural network generation was investigated. We confirmed that both an increase of mean axonal length and axogenesis rate of PC12, which have been exposed 5 mV/mm for 6 hours a day for 4 days in the bioreactor. We found following conclusions in our study. 1) Design and fabrication of DCEF stimulation bio-reactor capable of 3D culture nerve cell were completed. A uniform electric field strength of average value of 17 mV/mm within the 1.2% error range was confirmed by using FE analyses, after the structure determination through the optimization process. In addition, we attached a perfusion system capable of suppressing the pH change of the culture solution due to DCEF stimulation loading. 2) Evaluation of DCEF stimulation effects on PC12 cell activity was executed. The 3D culture of PC 12 was carried out adopting the embedding culture method using collagen gel as a scaffold for four days under the condition of 5.0 mV/mm and 10mV/mm. There was a significant effect on the enhancement of axonal extension, as 11.3% increase in an average length, and the increase of axogenesis rate. On the other hand, no effects on the orientation of axon against the DCEF flux direction was observed. Further, the network generation was enhanced to connect longer distance between the target neighbor cells by DCEF stimulation.

Keywords: PC12, DCEF stimulation, 3D bio-reactor, axonal extension, neural network generation

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Authors: Xue Li, Hui Xu

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Mild cognitive impairment (MCI) is a clinical stage that occurs between normal aging and dementia. Although MCI increases the risk of developing dementia, individuals with MCI may maintain stable cognitive function and even recover to a typical cognitive state. An intervention to prevent or delay the progression to dementia in individuals with MCI may involve promoting social engagement. Social participation is the engagement in socially relevant social exchanges and meaningful activities. Older adults with MCI may encounter restricted cognitive abilities, mood changes, and behavioral difficulties during social participation, influencing their willingness to engage. Therefore, this study aims to employ qualitative research methods to gain an in-depth comprehension of the authentic social participation experiences of older adults with mild cognitive impairment, which will establish a foundation for designing appropriate intervention programs. A phenomenological research was conducted. The study participants were selected using the purposive sampling method in combination with the maximum differentiation sampling strategy. Face-to-face semistructured interviews were conducted among 12 elderly individuals suffering from mild cognitive impairment in a community in Zhengzhou City from May to July 2023. Colaizzi 7-step method was used to analyze the data and extract the theme. The real experience of social participation in older adults with mild cognitive impairment can be summarized into 3 themes: (1) a single social relationship but a strong desire to participate, (2) a dual experience of social participation with both positive and negative aspects, (3) multiple barriers to social participation, including impaired memory capacity, heavy family responsibilities and lack of infrastructure. The study found that elderly individuals with mild cognitive impairment and one social interaction display an increased desire to engage in society. To improve social participation levels and reduce cognitive function decline, healthcare providers should work with relevant government agencies and the community to create a comprehensive social participation system. It is important for healthcare providers to note the social participation status of the elderly with mild cognitive impairment.

Keywords: mild cognitive impairment, the elderly, social participation, qualitative research

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Authors: Abdul-Dahiru El-Yuguda, Saka Saheed Baba, Tawa Monilade Adisa, Mustapha Bala Abubakar

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Background: Chikungunya (CHIK) virus, a previously anecdotally described arbovirus, is now assuming a worldwide public health burden. The CHIK virus infection is characterized by potentially life threatening and debilitating arthritis in addition to the high fever, arthralgia, myalgia, headache and rash. Method: Three hundred and seventy (370) serum samples were collected from outpatients with febrile illness attending University of Maiduguri Teaching Hospital, Nigeria, and was used to detect for Chikungunya (CHIK) virus IgG and IgM antibodies using the Enzyme Linked Immunosorbent Assays (ELISAs). Result: Out of the 370 sera tested, 39 (10.5%) were positive for presence of CHIK virus antibodies. A total of 24 (6.5%) tested positive for CHIK virus IgM only while none (0.0%) was positive for presence of CHIK virus IgG only and 15 (4.1%) of the serum samples were positive for both IgG and IgM antibodies. A significant difference (p<0.0001) was observed in the distribution of CHIK virus antibodies in relation to gender. The males had prevalence of 8.5% IgM antibodies as against 4.6% observed in females. On the other hand 4.6% of the females were positive for concurrent CHIK virus IgG and IgM antibodies when compared to a prevalence of 3.4% observed in males. Only the age groups ≤ 60 years and the undisclosed age group were positive for presence of CHIK virus IgG and/or IgM antibodies. No significant difference (p>0.05) was observed in the seasonal prevalence of CHIK virus antibodies among the study subjects Analysis of the prevalence of CHIK virus antibodies in relation to clinical presentation (as observed by Clinicians) of the patients revealed that headache and fever were the most frequently encountered ailments. Conclusion: The CHIK virus IgM and concurrent IgM and IgG antibody prevalence rates of 6.5% and 4.1% observed in this study indicates a current infection and the lack of IgG antibody alone observed shows that the infection is not endemic but sporadic. Recommendation: Further studies should be carried to establish the seasonal prevalence of CHIK virus infection vis-à-vis vector dynamics in the study area. A comprehensive study need to be carried out on the molecular characterization of the CHIK virus circulating in Nigeria with a view to developing CHIK virus vaccine.

Keywords: Chikungunya virus, IgM and IgG antibodies, febrile patients, enzyme linked immunosorbent assay

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Authors: Yu Yoshihara, Chika Tada, Moe Takada, Nyam-Osor Purevdorj, Khorolmaa Chimedtseren, Yutaka Nakai

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Water pollution from animal waste and its influence on grazing animals is a current concern regarding Mongolian grazing lands. We allocated 32 free-grazing lambs to four groups and provided each with water from a different source (upper stream, lower stream, well, and pond) for 49 days. We recorded the amount of water consumed by the lambs, as well as their body weight, behavior, white blood cell count, acute phase (haptoglobin) protein level, and fecal condition. We measured the chemical and biological qualities of the four types of water, and we detected enteropathogenic and enterohemorrhagic Escherichia coli in fecal samples by using a genetic approach. Pond water contained high levels of nitrogen and minerals, and well water contained high levels of bacteria. The odor concentration index decreased in order from pond water to upper stream, lower stream, and well. On day 15 of the experiment, the following parameters were the highest in lambs drinking water from the following sources: water intake (pond or lower stream), body weight gain (pond), WBC count (lower stream), haptoglobin concentration (well), and enteropathogenic E. coli infection rate (lower stream). Lambs that drank well water spent more time lying down and less time grazing than the others, and lambs that drank pond water spent more time standing and less time lying down. Lambs given upper or lower stream water exhibited more severe diarrhea on day 15 of the experiment than before the experiment. Mongolian sheep seemed to adapt to chemically contaminated water: their productivity benefited the most from pond water, likely owing to its rich mineral content. Lambs that drank lower stream water showed increases in enteropathogenic E. coli infection, clinical diarrhea, and WBC count. Lambs that drank well water, which was bacteriologically contaminated, had increased serum acute phase protein levels and poor physical condition; they were thus at increased risk of negative health and production effects.

Keywords: DNA, Escherichia coli, fecal sample, lower stream, well water

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Authors: Richa Sinha, Mohammad Irfan Javed, Sanjay Singh

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Introduction: Good antimicrobial prescribing reduces length of stay in hospital, risk of adverse events, antimicrobial resistance, and unnecessary hospital expenditure. The aim of this prospective audit was to identify any problems with antimicrobial prescribing including documentation of the relevant aspects as well as appropriateness of antibiotics use. The audit was conducted on the surgical wards in a teaching hospital in the UK. Methods: Standards included the indication, duration, choice, and prescription of antibiotic should be in line with current Regional Guidelines and should be clearly documented on the prescription chart. There should be an entry in each patients’ medical record of the diagnosis and indication for each acute antibiotic prescription issued. All prescriptions should clearly document the route, frequency and dose of antibiotic. Data collection was done for 2 weeks in the month of March 2014. A proforma including all the questions above was completed for all the patients. The results were analysed using Excel. Results: 35 patients in total were selected for the audit. 85.7% of patients had indication of antibiotic documented on the prescription chart and 68.5% of patients had indication documented in the notes. The antibiotic used was in line with hospital guidelines in 45.7% of patients, however, in a further 28.5% of patients the reason for the antibiotic prescription was microbiology approved. Therefore, in total 74.2% of patients had been prescribed appropriate antibiotics. The duration of antibiotic was documented in 68.6% of patients and the antibiotic was reviewed in 37.1% of patients. The dose, frequency and route was documented clearly in 100% of patients. Conclusion: Overall, prescribing can be improved on the surgical wards in this hospital. Only 37.1% of patients had clear documentation of a review of antibiotics. It may be that antibiotics have been reviewed but this should be clearly highlighted on the prescription chart or the notes. Failure to review antibiotics can lead to poor patient care and antimicrobial resistance and therefore it is important to address this. It is also important to address the appropriateness of antibiotics as inappropriate antibiotic prescription can lead to failure of treatment as well as antimicrobial resistance. The good points from the audit was that all patients had clear documentation of dose, route and frequency which is extremely important in the administration of antibiotics. Recommendations from this audit included to emphasize good antimicrobial prescribing at induction (twice yearly), an antimicrobial handbook for junior doctors, and re-audit in 6 months time.

Keywords: prescribing, antimicrobial, indication, duration

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Authors: Regis Pochon, Nicolas Stefaniak, Veronique Baltazart, Pamela Gobin

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Anxiety is known to have an impact on working memory. In reasoning or memory tasks, individuals with anxiety tend to show longer response times and poorer performance. Furthermore, there is a memory bias for negative information in anxiety. Given the crucial role of working memory in lexical learning, anxious students may encounter more difficulties in learning to read and spell. Anxiety could even affect an earlier learning, that is the activation of phonological representations, which are decisive for the learning of reading and writing. The aim of this study is to compare the access to phonological representations of beginning readers and writers according to their level of anxiety, using an auditory lexical decision task. Eighty students of 6- to 9-years-old completed the French version of the Revised Children's Manifest Anxiety Scale and were then divided into four anxiety groups according to their total score (Low, Median-Low, Median-High and High). Two set of eighty-one stimuli (words and non-words) have been auditory presented to these students by means of a laptop computer. Stimuli words were selected according to their emotional valence (positive, negative, neutral). Students had to decide as quickly and accurately as possible whether the presented stimulus was a real word or not (lexical decision). Response times and accuracy were recorded automatically on each trial. It was anticipated a) longer response times for the Median-High and High anxiety groups in comparison with the two others groups, b) faster response times for negative-valence words in comparison with positive and neutral-valence words only for the Median-High and High anxiety groups, c) lower response accuracy for Median-High and High anxiety groups in comparison with the two others groups, d) better response accuracy for negative-valence words in comparison with positive and neutral-valence words only for the Median-High and High anxiety groups. Concerning the response times, our results showed no difference between the four groups. Furthermore, inside each group, the average response times was very close regardless the emotional valence. Otherwise, group differences appear when considering the error rates. Median-High and High anxiety groups made significantly more errors in lexical decision than Median-Low and Low groups. Better response accuracy, however, is not found for negative-valence words in comparison with positive and neutral-valence words in the Median-High and High anxiety groups. Thus, these results showed a lower response accuracy for above-median anxiety groups than below-median groups but without specificity for the negative-valence words. This study suggests that anxiety can negatively impact the lexical processing in young students. Although the lexical processing speed seems preserved, the accuracy of this processing may be altered in students with moderate or high level of anxiety. This finding has important implication for the prevention of reading and spelling difficulties. Indeed, during these learnings, if anxiety affects the access to phonological representations, anxious students could be disturbed when they have to match phonological representations with new orthographic representations, because of less efficient lexical representations. This study should be continued in order to precise the impact of anxiety on basic school learning.

Keywords: anxiety, emotional valence, childhood, lexical access

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Authors: Timmis W., Simms M., Thomas C.

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This case discusses the management of two floors of mouth (FOM) Squamous Cell Carcinomas (SCC) not identified upon initial biopsy. A 51 year-old male presented with right FOM erythroleukoplakia. Relevant medical history included alcoholic dependence syndrome and alcoholic liver disease. Relevant drug therapy encompassed acamprosate, folic acid, hydroxocobalamin and thiamine. The patient had a 55.5 pack-year smoking history and alcohol dependence from age 14, drinking 16 units/day. FOM incisional biopsy and histopathological analysis diagnosed Carcinoma in situ. Treatment involved wide local excision. Specimen analysis revealed two separate foci of pT1 moderately differentiated SCCs. Carcinoma staging scans revealed no pathological lymphadenopathy, no local invasion or metastasis. SCCs had been excised in completion with narrow margins. MDT discussion concluded that in view of the field changes it would be difficult to identify specific areas needing further excision, although techniques such as Lugol’s Iodine were considered. Further surgical resection, surgical neck management and sentinel lymph node biopsy was offered. The patient declined intervention, primary management involved close monitoring alongside alcohol and smoking cessation referral. Narrow excisional margins can increase carcinoma recurrence risk. Biopsy failed to identify SCCs, despite sampling an area of clinical concern. For gross field change multiple incisional biopsies should be considered to increase chance of accurate diagnosis and appropriate treatment. Coupling of tobacco and alcohol has a synergistic effect, exponentially increasing the relative risk of oral carcinoma development. Tobacco and alcoholic control is fundamental in reducing treatment‑related side effects, recurrence risk and second primary cancer development.

Keywords: alcohol dependence, biopsy, oral carcinoma, tobacco

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