Search results for: young patients

Authors: Yijun Shao, Yan Cheng, Rashmee U. Shah, Charlene R. Weir, Bruce E. Bray, Qing Zeng-Treitler

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Deep neural network (DNN) models are being explored in the clinical domain, following the recent success in other domains such as image recognition. For clinical adoption, outcome prediction models require explanation, but due to the multiple non-linear inner transformations, DNN models are viewed by many as a black box. In this study, we developed a deep neural network model for predicting 1-year mortality of patients who underwent major cardio vascular procedures (MCVPs), using temporal image representation of past medical history as input. The dataset was obtained from the electronic medical data warehouse administered by Veteran Affairs Information and Computing Infrastructure (VINCI). We identified 21,355 veterans who had their first MCVP in 2014. Features for prediction included demographics, diagnoses, procedures, medication orders, hospitalizations, and frailty measures extracted from clinical notes. Temporal variables were created based on the patient history data in the 2-year window prior to the index MCVP. A temporal image was created based on these variables for each individual patient. To generate the explanation for the DNN model, we defined a new concept called impact score, based on the presence/value of clinical conditions’ impact on the predicted outcome. Like (log) odds ratio reported by the logistic regression (LR) model, impact scores are continuous variables intended to shed light on the black box model. For comparison, a logistic regression model was fitted on the same dataset. In our cohort, about 6.8% of patients died within one year. The prediction of the DNN model achieved an area under the curve (AUC) of 78.5% while the LR model achieved an AUC of 74.6%. A strong but not perfect correlation was found between the aggregated impact scores and the log odds ratios (Spearman’s rho = 0.74), which helped validate our explanation.

Keywords: deep neural network, temporal data, prediction, frailty, logistic regression model

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Authors: Andrea J. Kirk-Jenkins

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Women in late adolescence and young adulthood are particularly vulnerable to disordered eating, and prior research indicates that those within the college and sorority communities may be especially susceptible. Research has primarily involved comparing eating disorder symptoms between sorority women and non-sorority members using formal eating disorder assessments. This phenomenological study examined sorority members’ (N = 10) perceptions of and lived experiences with various disordered eating behaviors within the sorority culture. Data from individual interviews and photographs indicated two structural themes and 11 textural themes related to factors associated with disordered eating behaviors. These findings point to the existence of both positive and negative aspects of sorority culture, normalization of disordered eating behaviors, and pressure to attain or maintain an ideal body image. Implications for university stakeholders, including college counselors, health center staff, and extracurricular program leaders, are discussed. Further research on the identified textural themes as well as a longitudinal study exploring how perceptions change from rush to alumnae status is suggested.

Keywords: eating disorders, disorder eating behaviors, sorority women, sorority culture, college women

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Authors: Jongwoo Lee, Dae-Eun Kang, Sang-Young Park

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This study presents a precise relative navigational method for satellites flying in formation using laser-based intermittent measurement data. The measurement data for the relative navigation between two satellites consist of a relative distance measured by a laser instrument and relative attitude angles measured by attitude determination. The relative navigation solutions are estimated by both the Extended Kalman filter (EKF) and unscented Kalman filter (UKF). The solutions estimated by the EKF may become inaccurate or even diverge as measurement outage time gets longer because the EKF utilizes a linearization approach. However, this study shows that the UKF with the appropriate scaling parameters provides a stable and accurate relative navigation solutions despite the long measurement outage time and large initial error as compared to the relative navigation solutions of the EKF. Various navigation results have been analyzed by adjusting the scaling parameters of the UKF.

Keywords: satellite relative navigation, laser-based measurement, intermittent measurement, unscented Kalman filter

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Authors: Zouleykha Belabbes

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Learning foreign languages is sine qua non in the era of globalization, mobility, and communications, which grants access and connectedness to the world. This urgent need is highlighted in monolingual settings, however, in multilingual contexts the case is, to some extent, complicated. In effect, research on bilingualism and multilingualism lead to the issue of Cross Linguistic Influence (CLI) which seeks to explain how and under which conditions prior linguistic knowledge of first language (L1) and / or second language (L2) influences the production, comprehension and development of a third language (L3) or additional language (Ln). Moreover, the issue of age is also one of the persistent topics in the field of language acquisition. This paper aims to scrutinize the effect of age and two previously known languages: Arabic (L1) and French (L2) in acquiring English (L3) phonology in Algerian context. The study consisted of 20 participants of different age range who were presented with recorded samples of English (L3). The findings confirm the results of some previous studies on the issue of Critical Period Hypothesis (CPH) and demonstrate a tendency for the L2 phonological transfer in L3 production at the initial stages of acquisition within young and later learners that for some circumstances diminished as L3 proficiency develop.

Keywords: acquisition, age effect, cross linguistic influence, L3 phonology

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Authors: Tian Yi Du, Guan Rong Fan, Dong Dong Zou, Di Xue

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Background: The patient satisfaction survey is becoming of increasing importance for hospitals or other providers to get more reimbursement and/or more governmental subsidies. However, when the results of patient satisfaction survey are compared among medical institutions, there are some concerns. The primary objectives of this study were to evaluate patient satisfaction in tertiary hospitals of Shanghai and to compare the satisfaction rating on physician services between patients and observers. Methods: Two hundred outpatients were randomly selected for patient satisfaction survey in each of 28 public tertiary hospitals of Shanghai. Four or five volunteers were selected to observe 5 physicians’ practice in each of above hospitals and rated observed physicians’ practice. The outpatients that the volunteers observed their physician practice also filled in the satisfaction questionnaires. The rating scale for outpatient survey and volunteers’ observation was: 1 (very dissatisfied) to 6 (very satisfied). If the rating was equal to or greater than 5, we considered the outpatients and volunteers were satisfied with the services. The validity and reliability of the measure were assessed. Multivariate regressions for each of the 4 dimensions and overall of patient satisfaction were used in analyses. Paired t tests were applied to analyze the rating agreement on physician services between outpatients and volunteers. Results: Overall, 90% of surveyed outpatients were satisfied with outpatient care in the tertiary public hospitals of Shanghai. The lowest three satisfaction rates were seen in the items of ‘Restrooms were sanitary and not crowded’ (81%), ‘It was convenient for the patient to pay medical bills’ (82%), and ‘Medical cost in the hospital was reasonable’ (84%). After adjusting the characteristics of patients, the patient satisfaction in general hospitals was higher than that in specialty hospitals. In addition, after controlling the patient characteristics and number of hospital visits, the hospitals with higher outpatient cost per visit had lower patient satisfaction. Paired t tests showed that the rating on 6 items in the dimension of physician services (total 14 items) was significantly different between outpatients and observers, in which 5 were rated lower by the observers than by the outpatients. Conclusions: The hospital managers and physicians should use patient satisfaction and observers’ evaluation to detect the room for improvement in areas such as social skills cost control, and medical ethics.

Keywords: patient satisfaction, observation, quality, hospital

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Authors: Elena B. Cherepetskaya, Alexander A.Karabutov, Vladimir A. Makarov, Elena A. Mironova, Ivan A. Shibaev

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In our study, the object of laser ultrasonic testing was plane-parallel plate of shungit (length 41 mm, width 31 mm, height 15 mm, medium exchange density 2247 kg/m3). We used laser-ultrasonic defectoscope with wideband opto-acoustic transducer in our investigation of the velocities of longitudinal and shear elastic ultrasound waves. The duration of arising elastic pulses was less than 100 ns. Under known material thickness, the values of the velocities were determined by the time delay of the pulses reflected from the bottom surface of the sample with respect to reference pulses. The accuracy of measurement was 0.3% in the case of longitudinal wave velocity and 0.5% in the case of shear wave velocity (scanning pitch along the surface was 2 mm). On the base of found velocities of elastic waves, local elastic moduli of shungit (Young modulus, shear modulus and Poisson's ratio) were uniquely determined.

Keywords: laser ultrasonic testing , local elastic moduli, shear wave velocity, shungit

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Authors: Archana Thangavelu, Han-Ik Park, Young-Chul Park, Joon-Hong Park

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In this numerical study, we have proposed a method for evaluation of backward extrusion process of pressure vessel made up of steel. Demand for lighter and stiffer products have been increasing in the last years especially in automobile engineering. Through detailed finite element analysis, effective stress, strain and velocity profile have been obtained with optimal range. The process design of a forward and backward extrusion axe-symmetric part has been studied. Forging is mainly carried out because forged products are highly reliable and possess superior mechanical properties when compared to normal products. Performing computational simulations of 3D hot forging with various dimensions of billet and optimization of weight is carried out using Taguchi Orthogonal Array (OA) Optimization technique. The technique used in this study can be used for newly developed materials to investigate its forgeability for much complicated shapes in closed hot die forging process.

Keywords: backward extrusion, hot forging, optimization, finite element analysis, Taguchi method

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Authors: Ilana Margalith, Adaya Meirowitz, Sigalit Cohavi

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Violence against health professionals by patients and their families have recently become a disturbing phenomenon worldwide, exacting psychological as well as economic tolls. Health workplaces in Israel (e.g. hospitals and H.M.O clinics) provide workshops for their employees, supplying them with coping strategies. However, these workshops do not focus on nursing students, who are also subjected to this violence. Their learning environment is no longer as protective as it used to be. Furthermore, coping with violence was not part of the curriculum for Israeli nursing students. Thus, based on human aggression theories which depict the pivotal role of the professional's correct response in preventing the onset of an aggressive response or the escalation of violence, a workshop was developed for undergraduate nursing students at the Clalit Nursing Academy, Rabin Campus (Dina), Israel. The workshop aimed at reducing students' anxiety vis a vis the aggressive patient or family in addition to strengthening their ability to cope with such situations. The students practiced interpersonal skills, especially relevant to early detection of potential violence, as well as ‘a correct response’ reaction to the violence, thus developing the necessary steps to be implemented when encountering violence in the workplace. In order to assess the efficiency of the workshop, the participants filled out a questionnaire comprising knowledge and self-efficacy scales. Moreover, the replies of the 23 participants in this workshop were compared with those of 24 students who attended a standard course on interpersonal communication. Students' self-efficacy and knowledge were measured in both groups before and after the course. A statistically significant interaction was found between group (workshop/standard course) and time (before/after) as to the influence on students' self-efficacy (p=0.004) and knowledge (p=0.007). Nursing students, who participated in this ‘coping with workplace violence’ workshop, gained knowledge, confidence and a sense of self-efficacy with regard to workplace violence. Early detection of signs of imminent violence amongst patients or families and the prevention of its escalation, as well as the ability to manage the threatening situation when occurring, are acquired skills. Encouraging nursing students to learn and practice these skills may enhance their ability to cope with these unfortunate occurrences.

Keywords: early detection of violence, nursing students, patient aggression, self-efficacy, workplace violence

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Authors: Boris Bajer, Andrea Havranova, Miroslav Vlcek, Richard Imrich, Adela Penesova

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Lifestyle interventions can prevent the deterioration of impaired glucose tolerance to manifest type 2 diabetes, and also prevent cardiovascular diseases, as it showed many studies (the Finnish Diabetes Prevention Study, Diabetes Prevention Program (DPP), . the China Da Qing Diabetes Prevention Study, etc.) Therefore the aim of our study was to compare the effect of intensified lifestyle intervention on cardiometabolic parameters. Methods: It is an ongoing randomized interventional clinical study (NCT02325804) focused on the reduction of body weight/fat. Intervention: hypocaloric diet (30% restriction of calories) and physical activity 150 minutes/week. Before and after 8 weeks of intervention all patients underwent complete medical examination (measurement of physical fitness, resting metabolic rate (RMR), body composition analysis, oral glucose tolerance test, parameters of lipid metabolism, and other cardiometabolic risk factors. Results: So far 39 patients finished the intervention. The average reduction of body weight was 6,8 + 4,9 kg (0-15 kg; p=0,0006), accompanied with significant reduction of body fat percentage (p ≤ 0,0001), amount of fat mass (p=0,03), waist circumference (p=0.02). Amount of lean mass and RMR remained unchanged. Heart rate (p=0,02), systolic and diastolic blood pressure was reduced (p=0,01 p=0,02 resp.) as well as insulin sensitivity was improved. Lipid parameters also changed - cholesterol, LDL decreased (p=0,05, p=0,04 resp.), while triglycerides showed tendency to decrease (p=0,055). Liver function improved, alanine aminotrasnferase (ALT) were reduced (p=0,01). Physical fitness significantly improved (as measure VO2 max (p=0,02). Conclusion: Results of our study are in line with previous results about the beneficial effect of intensive lifestyle changes on the reduction of cardiometabolic risk factors and improvement of liver function. Supported by grants APVV 15-0228; VEGA 2/0161/16

Keywords: obesity, weight loss, diet lipids, blood pressure, liver enzymes

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Authors: Sam J. Cooley, Mary L. Quinton, Benjamin J. Parry, Mark J. G. Holland, Richard J. Whiting, Jennifer Cumming

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Practitioners draw attention to people’s character strengths to promote empowerment and well-being. This paper explores the possibility that existing approaches for assessing character strengths (e.g., the Values in Action survey; VIA-IS) could be even more autonomy supportive and empowering when combined with strengths profiling, an ideographic tool informed by personal construct theory (PCT). A PCT approach ensures that: (1) knowledge is co-created (i.e., the practitioner is not seen as the ‘expert’ who leads the process); (2) individuals are not required to ‘fit’ within a prescribed list of characteristics; and (3) individuals are free to use their own terminology and interpretations. A combined Strengths Profiling and VIA approach was used in a sample of homeless youth (aged 16-25) who are commonly perceived as ‘hard-to-engage’ through traditional forms of assessment. Strengths Profiling was completed face-to-face in small groups. Participants (N = 116) began by listing a variety of personally meaningful characteristics. Participants gave each characteristic a score out of ten for how important it was to them (1 = not so important; 10 = very important), their ideal competency, and their current competency (1 = poor; 10 = excellent). A discrepancy score was calculated for each characteristic (discrepancy score = ideal score - current score x importance), whereby a lower discrepancy score indicated greater satisfaction. Strengths Profiling was used at the beginning and end of a 10-week positive youth development programme. Experiences were captured through video diary room entries made by participants and through reflective notes taken by the facilitators. Participants were also asked to complete a pre-and post-programme questionnaire, measuring perceptions of well-being, self-worth, and resilience. All of the young people who attended the strengths profiling session agreed to complete a profile, and the majority became highly engaged in the process. Strengths profiling was found to be an autonomy supportive and empowering experience, with each participant identifying an average of 10 character strengths (M = 10.27, SD = 3.23). In total, 215 different character strengths were identified, each with varying terms and definitions used, which differed greatly between participants and demonstrated the value in soliciting personal constructs. Using the participants’ definitions, 98% of characteristics were categorized deductively into the VIA framework. Bravery, perseverance, and hope were the character strengths that featured most, whilst temperance and courage received the highest discrepancy scores. Discrepancy scores were negatively correlated with well-being, self-worth, and resilience, and meaningful improvements were recorded following the intervention. These findings support the use of strengths profiling as a theoretically-driven and novel way to engage disadvantaged youth in identifying and monitoring character strengths. When young people are given the freedom to express their own characteristics, the resulting terminologies extend beyond the language used in existing frameworks. This added freedom and control over the process of strengths identification encouraged youth to take ownership over their profiles and apply their strengths. In addition, the ability to transform characteristics post hoc into the VIA framework means that strengths profiling can be used to explore aggregated/nomothetic hypotheses, whilst still benefiting from its ideographic roots.

Keywords: ideographic, nomothetic, positive youth development, VIA-IS, assessment, homeless youth

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Authors: Lizeth Fuentes-Mera, Vanessa Perez-Silos, Nidia K. Moncada-Saucedo, Alejandro Garcia-Ruiz, Alberto Camacho, Jorge Lara-Arias, Ivan Marino-Martinez, Victor Romero-Diaz, Adolfo Soto-Dominguez, Humberto Rodriguez-Rocha, Hang Lin, Victor Pena-Martinez

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Biphasic scaffolds in cartilage tissue engineering have been designed to influence not only the recapitulation of the osteochondral architecture but also to take advantage of the healing ability of bone to promote the implant integration with the surrounding tissue and then bone restoration and cartilage regeneration. This study reports the development and characterization of a biphasic scaffold based on the assembly of a cartilage phase constituted by fibroin biofunctionalized with bovine cartilage matrix; cellularized with differentiated pre-chondrocytes from adipose tissue stem cells (autologous) and well attached to a bone phase (bone bovine decellularized) to mimic the structure of the nature of native tissue and to promote the cartilage regeneration in a model of joint damage in pigs. Biphasic scaffolds were assembled by fibroin crystallization with methanol. The histological and ultrastructural architectures were evaluated by optical and scanning electron microscopy respectively. Mechanical tests were conducted to evaluate Young's modulus of the implant. For the biological evaluation, pre-chondrocytes were loaded onto the scaffolds and cellular adhesion, proliferation, and gene expression analysis of cartilage extracellular matrix components was performed. The scaffolds that were cellularized and matured for 10 days were implanted into critical 3 mm in diameter and 9-mm in depth osteochondral defects in a porcine model (n=4). Three treatments were applied per knee: Group 1: monophasic cellular scaffold (MS) (single chondral phase), group 2: biphasic scaffold, cellularized only in the chondral phase (BS1), group 3: BS cellularized in both bone and chondral phases (BS2). Simultaneously, a control without treatment was evaluated. After 4 weeks of surgery, integration and regeneration tissues were analyzed by x-rays, histology and immunohistochemistry evaluation. The mechanical assessment showed that the acellular biphasic composites exhibited Young's modulus of 805.01 kPa similar to native cartilage (400-800 kPa). In vitro biological studies revealed the chondroinductive ability of the biphasic implant, evidenced by an increase in sulfated glycosaminoglycan (GAGs) and type II collagen, both secreted by the chondrocytes cultured on the scaffold during 28 days. No evidence of adverse or inflammatory reactions was observed in the in vivo trial; however, In group 1, the defects were not reconstructed. In group 2 and 3 a good integration of the implant with the surrounding tissue was observed. Defects in group 2 were fulfilled by hyaline cartilage and normal bone. Group 3 defects showed fibrous repair tissue. In conclusion; our findings demonstrated the efficacy of biphasic and bioactive scaffold based on silk fibroin, which entwined chondroinductive features and biomechanical capability with appropriate integration with the surrounding tissue, representing a promising alternative for osteochondral tissue-engineering applications.

Keywords: biphasic scaffold, extracellular cartilage matrix, silk fibroin, osteochondral tissue engineering

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Authors: Bishoy Abouelsoud Saad Amin

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This paper examines the use of computer and its related health hazard among computer users in South-Western zone of Nigeria. Two hundred and eighteen (218) computer users constituted the population used to evaluate association between posture, extensive computer use and related health hazard. The instruments for the study are a questionnaire on demographics, lifestyle, body features and work ability index while mean rating, standard deviation and t test were used for data analysis. Identified health related hazard include damages to the eyesight, bad posture, arthritis, musculoskeletal disorders, headache, stress and so on. The results showed that factors such as work demand, posture, closeness to computer screen and excessive working hours on computers constitute health hazards in both old and young computer users of various gender. It is therefore recommended that total number of hours spent with computer should be monitored and controlled.

Keywords: computer game, metaphor, middle school students, virtual environments computer auditing, risk, measures to prevent, information management computer-related health hazard, musculoskeletal disorders, computer usage, work ability index

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Authors: Pankaj Kumar

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Despite few works reported about fluoride enrichment in the groundwater, no studies have done on exposure analysis for biological components in Patan district, Gujarat, Western India. Considering its vital importance, this study strives to quantify the bioaccumulation of fluoride in seven different crops and vegetables, viz. Spinach and Mustard leaves, Cauliflower, Wheat grains, Amaranth seed, Radish, and Garlic grown in the potentially fluoride contaminated area. Result shows that the order for fluoride accumulation among different analyzed plants are spinach (63.3 mg/kg) > mustard (48.9 mg/kg) > cauliflower (41.1 mg/kg) > radish (35.7 mg/kg) > garlic (33.2 mg/kg) > amaranth seed (26.7 mg/kg) > wheat (22.5 mg/kg). Fluoride concentration was highest in leafy vegetable, whereas the lowest was in wheat grains. Finally, estimated daily intake (EDI) and hazard index (HI) were calculated for local consumers of different age group, where it was found that young people (4-15 years) are at the highest risk of fluorosis. This study is relevant for better crop management, like substituting crops with woody plants, flowers, and people awareness.

Keywords: fluoride, bioaccumulation, health risk, water

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Authors: Ramzi Shawahna

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Background: Neonatal intensive care units are high-risk settings where medication errors can occur and cause harm to this fragile segment of patients. This multicenter qualitative study was conducted to describe medication errors that occurred in neonatal intensive care units in Palestine from the perspectives of healthcare providers. Methods: This exploratory multicenter qualitative study was conducted and reported in adherence to the consolidated criteria for reporting qualitative research checklist. Semi-structured in-depth interviews were conducted with healthcare professionals (4 pediatricians/neonatologists and 11 intensive care unit nurses) who provided care services for patients admitted to neonatal intensive care units in Palestine. An interview schedule guided the semi-structured in-depth interviews. The qualitative interpretive description approach was used to thematically analyze the data. Results: The total duration of the interviews was 282 min. The healthcare providers described their experiences with 41 different medication errors. These medication errors were categorized under 3 categories and 10 subcategories. Errors that occurred while preparing/diluting/storing medications were related to calculations, using a wrong solvent/diluent, dilution errors, failure to adhere to guidelines while preparing the medication, failure to adhere to storage/packaging guidelines, and failure to adhere to labeling guidelines. Errors that occurred while prescribing/administering medications were related to inappropriate medication for the neonate, using a different administration technique from the one that was intended and administering a different dose from the one that was intended. Errors that occurred after administering the medications were related to failure to adhere to monitoring guidelines. Conclusion: In this multicenter study, pediatricians/neonatologists and neonatal intensive care unit nurses described medication errors occurring in intensive care units in Palestine. Medication errors occur in different stages of the medication process: preparation/dilution/storage, prescription/administration, and monitoring. Further studies are still needed to quantify medication errors occurring in neonatal intensive care units and investigate if the designed strategies could be effective in minimizing medication errors.

Keywords: medication errors, pharmacist, pharmacology, neonates

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Authors: Umamaheswari Shanmugam, Silvia Ronchi

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Software, artificial intelligence, and machine learning can improve healthcare through innovative and advanced technologies that can use the large amount and variety of data generated during healthcare services every day; one of the significant advantages of these new technologies is the ability to get experience and knowledge from real-world use and to improve their performance continuously. Healthcare systems and institutions can significantly benefit because the use of advanced technologies improves the efficiency and efficacy of healthcare. Software-defined as a medical device, is stand-alone software that is intended to be used for patients for one or more of these specific medical intended uses: - diagnosis, prevention, monitoring, prediction, prognosis, treatment or alleviation of a disease, any other health conditions, replacing or modifying any part of a physiological or pathological process–manage the received information from in vitro specimens derived from the human samples (body) and without principal main action of its principal intended use by pharmacological, immunological or metabolic definition. Software qualified as medical devices must comply with the general safety and performance requirements applicable to medical devices. These requirements are necessary to ensure high performance and quality and protect patients' safety. The evolution and the continuous improvement of software used in healthcare must consider the increase in regulatory requirements, which are becoming more complex in each market. The gap between these advanced technologies and the new regulations is the biggest challenge for medical device manufacturers. Regulatory requirements can be considered a market barrier, as they can delay or obstacle the device's approval. Still, they are necessary to ensure performance, quality, and safety. At the same time, they can be a business opportunity if the manufacturer can define the appropriate regulatory strategy in advance. The abstract will provide an overview of the current regulatory framework, the evolution of the international requirements, and the standards applicable to medical device software in the potential market all over the world.

Keywords: artificial intelligence, machine learning, SaMD, regulatory, clinical evaluation, classification, international requirements, MDR, 510k, PMA, IMDRF, cyber security, health care systems

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Authors: WooYoung Jung, V. Sim

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This paper presents numerical analysis in terms of buckling resistance strength of polymer matrix composite (PMC) infill panels system under the influence of temperature on the foam core. Failure mode under in-plane compression is investigated by means of numerical analysis with ABAQUS platform. Parameters considered in this study are contact length and both the type of foam for core and the variation of its Young's Modulus under the thermal influence. Variation of temperature is considered in static cases and only applied to core. Indeed, it is shown that the effect of temperature on the panel system mechanical properties is significance. Moreover, the variations of temperature result in the decrements of the system strength. This is due to the polymeric nature of this material. Additionally, the contact length also displays the effect on performance of infill panel. Their significance factors are based on type of polymer for core. Hence, by comparing difference type of core material, the variation can be reducing.

Keywords: buckling, contact length, foam core, temperature dependent

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Authors: Ayman K. El Essawy, Amal M. Hosny, Hala M. Abu Shady

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The rapid detection of TB and drug resistance, both optimizes treatment and improves outcomes. In the current study, respiratory specimens were collected from 155 patients. Conventional susceptibility testing and MIC determination were performed for rifampicin (RIF) and isoniazid (INH). Genotype MTBDRplus assay, which is a molecular genetic assay based on the DNA-STRIP technology and specific gene sequencing with primers for rpoB, KatG, and mab-inhA genes were used to detect mutations associated with resistance to rifampicin and isoniazid. In comparison to other categories, most of rifampicin resistant (61.5%) and isoniazid resistant isolates (47.1%) were from patients relapsed in treatment. The genotypic profile (using Genotype MTBDRplus assay) of multi-drug resistant (MDR) isolates showed missing of katG wild type 1 (WT1) band and appearance of mutation band katG MUT2. For isoniazid mono-resistant isolates, 80% showed katG MUT1, 20% showed katG MUT1, and inhA MUT1, 20% showed only inhA MUT1. Accordingly, 100% of isoniazid resistant strains were detected by this assay. Out of 17 resistant strains, 16 had mutation bands for katG distinguished high resistance to isoniazid. The assay could clearly detect rifampicin resistance among 66.7% of MDR isolates that showed mutation band rpoB MUT3 while 33.3% of them were considered as unknown. One mono-resistant rifampicin isolate did not show rifampicin mutation bands by Genotype MTBDRplus assay, but it showed an unexpected mutation in Codon 531 of rpoB by DNA sequence analysis. Rifampicin resistance in this strain could be associated with a mutation in codon 531 of rpoB (based on molecular sequencing), and Genotype MTBDRplus assay could not detect the associated mutation. If the results of Genotype MTBDRplus assay and sequencing were combined, this strain shows hetero-resistance pattern. Gene sequencing of eight selected isolates, previously tested by Genotype MTBDRplus assay, could detect resistance mutations mainly in codon 315 (katG gene), position -15 in inhA promotes gene for isoniazid resistance and codon 531 (rpoB gene) for rifampicin resistance. Genotyping techniques allow distinguishing between recurrent cases of reinfection or reactivation and supports epidemiological studies.

Keywords: M. tuberculosis, rpoB, KatG, inhA, genotype MTBDRplus

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Authors: Jai Myung Yang, Na Young Kim, Sung Ho Shin

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The adverse reactions of current live smallpox vaccines and potential use of smallpox as a bioterror weapon have heightened the development of new effective vaccine for this infectious disease. In the present study, DNA vaccine vector was produced which was optimized for expression of the vaccinia virus L1 antigen in the mouse model. A plasmid IgM-tL1R, which contains codon-optimized L1R gene, was constructed and fused with an IgM signal sequence under the regulation of a SV40 enhancer. The expression and secretion of recombinant L1 protein was confirmed in vitro 293 T cell. Mice were administered the DNA vaccine by electroporation and challenged with vaccinia virus. We observed that immunization with IgM-tL1R induced potent neutralizing antibody responses and provided complete protection against lethal vaccinia virus challenge. Isotyping studies reveal that immunoglobulin G2 (IgG2) antibody predominated after the immunization, indicative of a T helper type 1 response. Our results suggest that an optimized DNA vaccine, IgM-tL1R, can be effective in stimulating anti-vaccinia virus immune response and provide protection against lethal orthopoxvirus challenge.

Keywords: DNA vaccine, electroporation, L1R, vaccinia virus

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Authors: Sandeep Kumar Agrawal, Aditi Bhattacharya, Janvie Manhas, Krushna Bhatt, Yatin Kholakiya, Nupur Khera, Ajoy Roychoudhury, Sudip Sen

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Autologous cultured explants of human oral mucosal epithelial cells (OMEC) are a potential therapeutic modality for limbal stem cell deficiency (LSCD). Injury or inflammation of the ocular surface in the form of burns, chemicals, Stevens Johnson syndrome, ocular cicatricial pemphigoid etc. can lead to destruction and deficiency of limbal stem cells. LSCD manifests in the form of severe ocular surface diseases (OSD) characterized by persistent and recurrent epithelial defects, conjuntivalisation and neovascularisation of the corneal surface, scarring and ultimately opacity and blindness. Most of the cases of OSD are associated with severe dry eye pertaining to diminished mucin and aqueous secretion. Mycophenolate mofetil (MMF) has been shown to upregulate the mucin expression in conjunctival goblet cells in vitro. The aim of this study was to evaluate the effects of MMF on mucin expression in primary cultures of oral mucosal epithelial cells. With institutional ethics committee approval and written informed consent, thirty oral mucosal epithelial tissue samples were obtained from patients undergoing oral surgery for non-malignant conditions. OMEC were grown on human amniotic membrane (HAM, obtained from expecting mothers undergoing elective caesarean section) scaffold for 2 weeks in growth media containing DMEM & Ham’s F12 (1:1) with 10% FBS and growth factors. In vitro dosage of MMF was standardised by MTT assay. Analysis of stem cell markers was done using RT-PCR while mucin mRNA expression was quantified using RT-PCR and q-PCR before and after treating cultured OMEC with graded concentrations of MMF for 24 hours. Protein expression was validated using immunocytochemistry. Morphological studies revealed a confluent sheet of proliferating, stratified oral mucosal epithelial cells growing over the surface of HAM scaffold. The presence of progenitor stem cell markers (p63, p75, β1-Integrin and ABCG2) and cell surface associated mucins (MUC1, MUC15 and MUC16) were elucidated by RT-PCR. The mucin mRNA expression was found to be upregulated in MMF treated primary cultures of OMEC, compared to untreated controls as quantified by q-PCR with β-actin as internal reference gene. Increased MUC1 protein expression was validated by immunocytochemistry on representative samples. Our findings conclude that OMEC have the ability to form a multi-layered confluent sheet on the surface of HAM similar to a cornea, which is important for the reconstruction of the damaged ocular surface. Cultured OMEC has stem cell properties as demonstrated by stem cell markers. MMF can be a novel enhancer of mucin production in OMEC. It has the potential to improve dry eye in patients undergoing OMEC transplantation for bilateral OSD. Further clinical trials are required to establish the role of MMF in patients undergoing OMEC transplantation.

Keywords: limbal stem cell deficiency, mycophenolate mofetil, mucin, ocular surface disease

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Authors: Jae Hee Choi, Seung Il Ahn, Sae Kyul Kim, Byung Wook Yang, Bong Sun Park, Hwan Sup Kim, Young Tae Hahm

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The root of Panax ginseng C. A. MEYER, commonly known as Korean ginseng, has several physiologic effects as a cure-all or a panacea. Among the ginseng, ginseng berry can be obtained from 3 or 4-year-old ginseng plant. Ginseng berry contains the high amount of ginsenoside Re, compared with other ginsenosides. Ginseng berry wine was manufactured with berry extract. The concentration of ginsenoside in ginseng berry extract obtained from Anseong Ginseng Nonghyup was 3.6 mg/g. Ethanol content of ginseng berry wine was 15.00±1.00%. Total polyphenol content was 1.62±0.12 mg/ml. In analysis of organic acids, acetic acid was high in ginseng berry extract whereas malic acid in ginseng berry wine was high.Ginseng berry rice wine was manufactured with berry extract with traditional nuruk (yeast). When the ginseng berry rice wine was manufactured, ginseng berry extract was diluted into 5% of total volume of wine. pH values and total acidity were 3.30±0.03 and 1.28±0.0 %, respectively. Residual sugar content was 8.8 ± 0.0 °Brix and ethanol content was 14.00 %. Any residual pesticides were not detected over acceptable range. Overall, the ginseng berry extract were valuable food stuffs for the manufacture of new ginseng product.

Keywords: ginseng berry, ginseng berry wine, ginsenoside, panax ginseng

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Authors: Olga Lasaga, Carmen Parra

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Within the EU 'New Skills for New Jobs' initiative, the art and music sector is considered one of the most vulnerable. Its graduates are faced with the threat of the dole or of not finding work in the sector in which they trained. In this regard, an increasing number of students are graduating every year from European Conservatories and Fine Arts Centres, while the number of job opportunities in this sector has stagnated or decreased. Moreover, the traditional teaching of these institutes does not favour the acquisition of basic skills, such as team building, entrepreneurship, marketing, website design and the design of events, which are among the most important facets of project management and are precisely those aspects that are often most related to the improvement of employability in the art world. To remedy this situation, the results of the European Erasmus+ OMEGA project (Opening More Employment Gates for Art and Music Students) are presented. The OMEGA project aims to increase the employability of art and music students by equipping them with additional skills needed for the search for work. As a result of this project, a manual has been created, a pilot course has been designed and taught, and a comparative study has been conducted on the state of play of the participating countries.

Keywords: artists, employability, entrepreneurship, musicians, skills

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Authors: Hanh Thi My Nguyen, Phuong Thu Dinh

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People with intellectual disability are at high risk for sexual abuse. The reasons may originate from their communication skills deficits, lack of skills and knowledge to protect themselves from sexual abuse, or limited access to sexual abuse prevention programs. This article aims to present a systematic review about strategies for preventing sexual abuse for young people with intellectual disability. A range of articles in 10 years from 2009 to 2018 are searched by using online database. 5 papers are included for the final review. The results of this comprehensive literature review showed that there are two main strategies used: programs designed for people with intellectual, including evaluation on sex education programs; and sexual education program for parents of children with intellectual disability. However, none of the papers were conducted in low-and middle-income countries. Therefore, cautions should be taken when it comes to interpret these findings. The findings of studies showed that participants increased their awareness and skills for protecting themselves from sexual abuse after participating in the programs. It is also recommended that more effective evidence-based programs should be developed.

Keywords: intellectual disability, prevention, sexual abuse, sexual education program

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Authors: Woei-Shyan Lee, Shuo-Ling Chang

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The nanoindentation behaviour and phase transformation of annealed single-crystal silicon wafers are examined. The silicon specimens are annealed at temperatures of 250, 350 and 450ºC, respectively, for 15 minutes and are then indented to maximum loads of 30, 50 and 70 mN. The phase changes induced in the indented specimens are observed using transmission electron microscopy (TEM) and micro-Raman scattering spectroscopy (RSS). For all annealing temperatures, an elbow feature is observed in the unloading curve following indentation to a maximum load of 30 mN. Under higher loads of 50 mN and 70 mN, respectively, the elbow feature is replaced by a pop-out event. The elbow feature reveals a complete amorphous phase transformation within the indented zone, whereas the pop-out event indicates the formation of Si XII and Si III phases. The experimental results show that the formation of these crystalline silicon phases increases with an increasing annealing temperature and indentation load. The hardness and Young’s modulus both decrease as the annealing temperature and indentation load are increased.

Keywords: nanoindentation, silicon, phase transformation, amorphous, annealing

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Authors: Myung Ho Lee, Hee Seung Lim, Young Jae Maeng, Chang Hoon Lee

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This study presents an automatic sequential extraction device for Pu and Am isotopes in radioactive waste samples from the nuclear power plant with anion exchange resin and TRU resin. After radionuclides were leached from the radioactive waste samples with concentrated HCl and HNO₃, the sample was allowed to evaporate to dryness after filtering the leaching solution with 0.45 micron filter. The Pu isotopes were separated in HNO₃ medium with anion exchange resin. For leaching solution passed through the anion exchange column, the Am isotopes were sequentially separated with TRU resin. Automatic sequential extraction device built-in software information of separation for Pu and Am isotopes was developed. The purified Pu and Am isotopes were measured by alpha spectrometer, respectively, after the micro-precipitation of neodymium. The data of Pu and Am isotopes in radioactive waste with an automatic sequential extraction device developed in this study were validated with the ICP-MS system.

Keywords: automatic sequential extraction device, Pu isotopes, Am isotopes, alpha spectrometer, radioactive waste samples, ICP-MS system

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Authors: Kadir Özsoy

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Creating a moderately competitive learning environment is believed to have positive effects on student interest and motivation. The best way today to attract young learners to get involved in a fun, competitive learning experience is possible through mobile applications as these learners mostly rely on games and applications on their phones and tablets to have fun, communicate, look for information and study. In this study, a mobile application called ‘QuizUp’ is used to create a specific game topic for elementary level students at Anadolu University Preparatory School. The topic is specially designed with weekly-added questions in accordance with the course syllabus. Students challenge their classmates or randomly chosen opponents to answer questions related to their course subjects. They also chat and post on the topic’s wall in English. The study aims at finding out students’ perceptions towards the use of the application as a classroom and extra-curricular activity through a survey. The study concludes that educational games boost students’ motivation, lead to increased effort, and positively change their studying habits.

Keywords: competitive learning, educational application, effort, motivation 'QuizUp', study habits

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Authors: Lovro Štefan

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Background: The main purpose of the present study was to explore the correlations between physical activity and peak plantar pressure in dynamic mode. Methods: Participants were one hundred forty-six first-year university students (30.8% girls). Plantar pressure generated under each region of the foot (forefoot, midfoot, and heel) was measured by using Zebris dynamometric platform (Isny, Germany). The level of physical activity (PA) was calculated with the International Physical Activity questionnaire (IPAQ - short form). Results: In boys, forefoot peak plantar pressure was correlated with moderate PA (MPA; r=-0.21), vigorous PA (VPA; r=-0.18), and moderate-to-vigorous PA (MVPA; r=-0.28). No significant correlations with other foot regions (p>0.05) were observed. In girls, forefoot peak plantar pressure was correlated with MPA (r =-0.30), VPA (r=-0.39) and MVPA (r=-0.38). Also, heel peak pressure was significantly correlated with MPA (r=-0.33), while no significant correlations with VPA (r=0.05) and MVPA (r=-0.15) were observed. Conclusion: This study shows that different intensities of PA were mostly correlated with forefoot peak plantar pressure in both boys and girls. Therefore, strategies that reduce plantar pressure through a more active lifestyle should be implemented within the education system.

Keywords: pedobarography, youth, exercise, associations

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Authors: Oluwatofunmi Otobo

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This paper presents a review of the challenges of e-learning and e-learning technologies in tertiary institutions. This review is based on the researchers observations of the challenges of making use of ICT for learning in Nigeria using Adeyemi College of Education as a case study; this is in comparison to tertiary institutions in the UK, US and other more developed countries. In Nigeria and probably Africa as a whole, power is the major challenge. Its inconsistency and fluctuations pose the greatest challenge to making use of online education inside and outside the classroom. Internet and its supporting infrastructures in many places in Nigeria are slow and unreliable. This, in turn, could frustrate any attempt at making use of online education and e-learning technologies. Lack of basic knowledge of computer, its technologies and facilities could also prove to be a challenge as many young people up until now are yet to be computer literate. Personal interest on both the parts of lecturers and students is also a challenge. Many people are not interested in learning how to make use of technologies. This makes them resistant to changing from the ancient methods of doing things. These and others were reviewed by this paper, suggestions, and recommendations were proffered.

Keywords: education, e-learning, Nigeria, tertiary institutions

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Authors: Masoud Swalehe, Semra Günay

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Developed countries are losing many lives to non-communicable diseases as compared to their developing counterparts. The effects of these diseases are mostly sudden and manifest at a very short time prior to death or a dangerous attack and this has consolidated the significance of emergency medical system (EMS) as one of the vital areas of healthcare service delivery. The primary objective of this research is to reduce ambulance response times (RT) of Eskişehir province EMS since a number of studies have established a relationship between ambulance response times and survival chances of patients especially out of hospital cardiac arrest (OHCA) victims. It has been found out that patients who receive out of hospital medical attention in few (4) minutes after cardiac arrest because of low ambulance response times stand higher chances of survival than their counterparts who take longer times (more than 12 minutes) to receive out of hospital medical care because of higher ambulance response times. The study will make use of geographic information systems (GIS) technology to dynamically reallocate ambulance resources according to demand and time so as to reduce ambulance response times. Geospatial-time distribution of ambulance calls (demand) will be used as a basis for optimal ambulance deployment using system status management (SSM) strategy to achieve much demand coverage with the same number of ambulance resources to cause response time reduction. Drive-time polygons will be used to come up with time specific facility coverage areas and suggesting additional facility candidate sites where ambulance resources can be moved to serve higher demands making use of network analysis techniques. Emergency Ambulance calls’ data from 1st January 2014 to 31st December 2014 obtained from Eskişehir province health directorate will be used in this study. This study will focus on the reduction of ambulance response times which is a key Emergency Medical Services performance indicator.

Keywords: emergency medical services, system status management, ambulance response times, geographic information system, geospatial-time distribution, out of hospital cardiac arrest

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Authors: Marina Sartor Hoffer

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The multicultural composition of today's societies poses new challenges to educational contexts. Schools are therefore called first to develop dialogic aptitudes and communicative skills adapted to the complex reality of post-modern societies. It is indispensable for educators and for young people to learn theoretical and practical tools during their scholastic path, in order to allow the knowledge of themselves and of the others with the aim of recognizing the value of the others regardless of their culture. Dialogic Skills help to understand and manage individual differences by allowing the solution of problems and preventing conflicts. The Educational Sector of Eric Berne’s Transactional Analysis offers a range of methods and techniques for this purpose. Educational Transactional Analysis is firmly anchored in the Personalist Philosophy and deserves to be promoted as a theoretical frame suitable to face the challenges of contemporary education. The goal of this paper is therefore to outline some conceptual and methodological signposts for the education to dialogue by drawing concepts and methodologies from educational transactional analysis.

Keywords: dialogic process, education to dialogue, educational transactional analysis, personalism, the good of the relationship

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

Abstract:

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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