Search results for: assessment standards
2718 The Antagonistic/Synergistic Effect of Probiotic Yeast Saccharomyces boulardii on Candida glabrata Adhesion
Authors: Zorica Tomičić, Ružica Tomičić, Peter Raspor
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Growing resistance of pathogenic yeast Candida glabrata to many classes of antifungal drugs has stimulated efforts to discover new agents to combat a rising number of invasive C. glabrata infections, which deserves a great deal of concern due to the high mortality rate in immunocompromised populations. One promising strategy is the use of probiotic microorganisms, which, when administered in adequate amounts, confers a health benefit. A selected number of probiotic organisms, Saccharomyces boulardii among them, have been tested as potential biotherapeutic agents. The aim of this study was to investigate the effect of the probiotic yeast S. boulardii on the adhesion of clinical isolates of C. glabrata at different temperatures, pH values, and in the presence of three clinically important antifungal drugs, such as fluconazole, itraconazole and amphotericin B. The method used to assess adhesion was crystal violet staining. The selection of antimycotics concentrations used in the adhesion assay was based on minimum inhibitory concentrations (MICs) obtained by the preliminarily performed microdilution modification of the Reference method for broth dilution antifungal susceptibility testing of yeast (Clinical and Laboratory Standards Institute (CLSI), standard M27-A2). the results showed that despite the nonadhesiveness of S. boulardii cells, probiotic yeast significantly suppressed the adhesion of C. glabrata strains. Besides, at specific strain ratios, a slight stimulatory effect was observed in some C. glabrata strains, which highlights the importance of strain specificity and opens up further research interests. When environmental conditions are considered, temperature and pH significantly influenced co-culture adhesion of C. glabrata and S. boulardii. The adhesion of C. glabrata strains was relatively equally reduced over all tested temperature range (28°C, 37°C, 39°C and 42°C) in the presence of S. boulardii cells, while the adhesion of a few C. glabrata strains were significantly stimulated at 28°C and suppressed at 42°C. Further, the adhesion was highly dependent on pH, with the highest adherence at pH 4 and lowest at pH 8.5. It was observed that S. boulardii did not manage to suppress the adhesion of C. glabrata strains at high pH. Antimycotics on the other hand showed a greater impact, since S. boulardii failed to affect co-culture adhesion at higher antimycotics concentrations. As expected, exposure to various concentrations of amphotericin B significantly reduced the adherence ability of C.glabrata strains both in a single culture and co-culture with S. boulardii. Therefore, it can be speculated that S. boulardii could substitute the effect of antimycotics in a range concentrations and with specific type of strains. This would certainly change the view on the treatment of yeast infections in the future.Keywords: adhesion, antimycotics, candida glabrata, saccharomyces boulardii
Procedia PDF Downloads 682717 Assessment of Land Surface Temperature Using Satellite Remote Sensing
Authors: R. Vidhya, M. Navamuniyammal M. Sivakumar, S. Reeta
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The unplanned urbanization affects the environment due to pollution, conditions of the atmosphere, decreased vegetation and the pervious and impervious soil surface. Considered to be a cumulative effect of all these impacts is the Urban Heat Island. In this paper, the urban heat island effect is studied for the Chennai city, TamilNadu, South India using satellite remote sensing data. LANDSAT 8 OLI and TIRS DATA acquired on 9th September 2014 were used to Land Surface Temperature (LST) map, vegetation fraction map, Impervious surface fraction, Normalized Difference Water Index (NDWI), Normalized Difference Building Index (NDBI) and Normalized Difference Vegetation Index (NDVI) map. The relationship among LST, Vegetation fraction, NDBI, NDWI, and NDVI was calculated. The Chennai city’s Urban Heat Island effect is significant, and the results indicate LST has strong negative correlation with the vegetation present and positive correlation with NDBI. The vegetation is the main factor to control urban heat island effect issues in urban area like Chennai City. This study will help in developing measures to land use planning to reduce the heat effects in urban area based on remote sensing derivatives.Keywords: land surface temperature, brightness temperature, emissivity, vegetation index
Procedia PDF Downloads 2742716 Assessment of Knowledge, Attitude and Perception of Drug Resistance in Rural Communities of ADA District, Central Ethiopia
Authors: Argaw Amare, Abbuna Fuffa, Stringer Andy
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Improving public knowledge and changing their attitudes towards antibiotic use will be a crucial early strategy to contain Antibiotic resistance. The current study was undertaken from November 2015 to June 2016. A cross-sectional survey using a pretested questionnaire was conducted on 392 residents (330 male and 62 female) aged 18 and above. Participants were selected randomly. Data was analyzed using simple descriptive statistics; the Chi-square test was used to determine any significant difference. The majority of participants (81%) were farmers in their occupation. Most of the respondents (76%) were not able to define the difference between antimicrobials and antibiotics. Furthermore, (61%) of participants were not able to define what antibiotics and for what purpose they are used. Thirty-four percent of participants do not know the names of antibiotics they have used for their animals and for themselves. Nearly 68% have no knowledge about the disease they have been treated for. The majority of participants (73.5%) agree to complete their course of treatment even if they feel better. About 72.5% of participants disagree that antibiotics are safe and can be used to treat different diseases, without prescription. Most of the participants (95%) treat their animals after diagnosis; more than 80% of them agree to not purchase veterinary drugs from local traders. This study showed that the participants have poor knowledge and good attitude, with an average score of 41.3±16.1% and 79.6±16, respectively. Knowledge and attitude are significantly correlated (p<0.01). The participants in this study had a good attitude toward the rational use of antibiotics. Whereas they lack knowledge with regard to the kinds of antibiotics and the diseases they are prescribed for. Therefore, further educational interventions are necessary to improve their understanding of the antibiotics currently available and the major bacterial diseases they are prescribed.Keywords: AMR, knoweledge, attitude, perception
Procedia PDF Downloads 662715 A Quality Improvement Project to Assess the Impact of Orthognathic Surgery on the Quality of Life of Patients: Pre-Operatively versus Post-Operatively
Authors: Fiona Lourenco, William Allen
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Dentofacial deformities are primarily surgically treated via orthognathic surgery. Health-related quality of life is concerned with aspects of quality of life that relate specifically to an individual’s health. Design and Setting: Retrospective analysis of patients who had orthognathic surgery from January 2018 - December 2022 at the trust using the previously validated Orthognathic Quality of Life questionnaire (OQoL). Materials and Methods: 32 Patient questionnaires (which included pre-operative and post-operative separate sections) were obtained via telephone survey. The data was analysed using the two-tailed paired t-test and Wilcoxon signed-rank test. Results: The change in perception post-surgery was highly significant (both tests resulted in p<0.001 for overall analysis as well as for each domain). Overall, a 74% improvement in QoL was seen following orthognathic surgery. Reports of improvement in each domain were as follows: 71% in the social aspect of the deformity domain, 76% in facial aesthetics, 60% in function, and 57% improvement in awareness of facial deformity. Conclusion: The assessment of QoL is becoming progressively imperative in clinical research. The above data shows that orthognathic surgery has a significant improvement in the QoL of patients post-operatively. The results demonstrate improvement in all domains, with perceptions in facial aesthetics seeing the highest change post-operatively.Keywords: dentofacial, oral, facial asymmetry, orthognathic surgery, quality of life
Procedia PDF Downloads 802714 An Assessment of Trace Heavy Metal Contamination of Some Edible Oils Regularly Marketed in Benue and Taraba States of Nigeria
Authors: Raphael Odoh, Obida J. Oko, Mary S. Dauda
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The determination of Cd, Cr, Cu, Fe,Mn, Ni, Pb and Zn contents in edible oils (palm oil, ground-nut oil and soybean oil) bought from various markets of Benue and Taraba state were carried out with flame atomic absorption spectrophotometric technique. The method 3031 developed acid digestion of oils for metal analysis by atomic absorption or ICP spectrometry was used in the preparation of the edible oil samples for the determination of total metal content in this study. The overall results (µg/g) in palm oil sample ranged from 0.028-0.076, 0.035-0.092, 1.011-1.955, 2.101-4.892, 0.666-0.922, 0.054-0.095, 0.031-0.068 and 1.987-2.971 for Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn respectively, while in ground-nut oil the overall results ranged from 0.011-0.042, 0.011-0.052, 0.133-0.788, 1.789-2.511, 0.078-0.765, 0.045-0.092, 0.011-0.028 and 1.098-1.997 for Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn respectively. Of the heavy metals considered Cd and Ni showed the highest contamination in the soybean oil sample. The overall results in soybean oil samples ranged from 0.011-0.015, 0.017-0.032, 0.453-0.987, 1.789-2.511, 0.089-0.321, 0.011-0.016, 0.012-0.065 and 1.011-1.997 for Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn respectively. The concentration of Pb was the highest. The degree of contamination by each metal was estimated by the transfer factor. The transfer factors obtained for Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn in edible oils (palm oil, ground-nut oil and soybean oil) were 10.800, 16.500, 16.000, 18.813, 15.115, 14.230, 23.000 and 9.418 for Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn in palm oil, and 7.000, 12.500, 8.880, 11.333, 7.708, 10.833, 15.00 and 6.608 for Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn in ground-nut oil while for soybean oil the transfer factors were 13.000, 11.000, 7.642, 11.578, 4.486, 13.00, 12.333 and 4.412 for Cd, Cr, Cu, Fe, Mn, Ni, Pb and Zn respectively. The inter-element correlation was found among metals in edible oil samples using Pearson’s correlation co-efficient. There were positive and negative correlations among the metals determined. All Metals determined showed degree of contamination but concentrations lower than the USP specification.Keywords: Benue State, contamination, edible oils, heavy metals, markets, Taraba State
Procedia PDF Downloads 3242713 Water Quality in Buyuk Menderes Graben, Turkey
Authors: Tugbanur Ozen Balaban, Gultekin Tarcan, Unsal Gemici, Mumtaz Colak, I. Hakki Karamanderesi
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Buyuk Menderes Graben is located in the Western Anatolia (Turkey). The graben has become the largest industrial and agricultural area with a total population exceeding 3.000.000. There are two big cities within the study areas from west to east as Aydın and Denizli. The study area is very rich with regard to cold ground waters and thermal waters. Electrical production using geothermal potential has become very popular in the last decades in this area. Buyuk Menderes Graben is a tectonically active extensional region and is undergoing a north–south extensional tectonic regime which commenced at the latest during Early Middle Miocene period. The basement of the study area consists of Menderes massif rocks that are made up of high-to low-grade metamorphics and they are aquifer for both cold ground waters and thermal waters depending on the location. Neogene terrestrial sediments, which are mainly composed by alluvium fan deposits unconformably cover the basement rocks in different facies have very low permeability and locally may act as cap rocks for the geothermal systems. The youngest unit is Quaternary alluvium which is the shallow regional aquifer consists of Holocene alluvial deposits in the study area. All the waters are of meteoric origin and reflect shallow or deep circulation according to the 8O, 2H and 3H contents. Meteoric waters move to deep zones by fractured system and rise to the surface along the faults. Water samples (drilling well, spring and surface waters) and local seawater were collected between 2010 and 2012 years. Geochemical modeling was calculated distribution of the aqueous species and exchange processes by using PHREEQCi speciation code. Geochemical analyses show that cold ground water types are evolving from Ca–Mg–HCO3 to Na–Cl–SO4 and geothermal aquifer waters reflect the water types of Na-Cl-HCO3 in Aydın. Water types of Denizli are Ca-Mg-HCO3 and Ca-Mg-HCO3-SO4. Thermal water types reflect generally Na-HCO3-SO4. The B versus Cl rates increase from east to west with the proportion of seawater introduced into the fresh water aquifers and geothermal reservoirs. Concentrations of some elements (As, B, Fe and Ni) are higher than the tolerance limit of the drinking water standard of Turkey (TS 266) and international drinking water standards (WHO, FAO etc).Keywords: Buyuk Menderes, isotope chemistry, geochemical modelling, water quality
Procedia PDF Downloads 5362712 A Risk-Based Modeling Approach for Successful Adoption of CAATTs in Audits: An Exploratory Study Applied to Israeli Accountancy Firms
Authors: Alon Cohen, Jeffrey Kantor, Shalom Levy
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Technology adoption models are extensively used in the literature to explore drivers and inhibitors affecting the adoption of Computer Assisted Audit Techniques and Tools (CAATTs). Further studies from recent years suggested additional factors that may affect technology adoption by CPA firms. However, the adoption of CAATTs by financial auditors differs from the adoption of technologies in other industries. This is a result of the unique characteristics of the auditing process, which are expressed in the audit risk elements and the risk-based auditing approach, as encoded in the auditing standards. Since these audit risk factors are not part of the existing models that are used to explain technology adoption, these models do not fully correspond to the specific needs and requirements of the auditing domain. The overarching objective of this qualitative research is to fill the gap in the literature, which exists as a result of using generic technology adoption models. Followed by a pretest and based on semi-structured in-depth interviews with 16 Israeli CPA firms of different sizes, this study aims to reveal determinants related to audit risk factors that influence the adoption of CAATTs in audits and proposes a new modeling approach for the successful adoption of CAATTs. The findings emphasize several important aspects: (1) while large CPA firms developed their own inner guidelines to assess the audit risk components, other CPA firms do not follow a formal and validated methodology to evaluate these risks; (2) large firms incorporate a variety of CAATTs, including self-developed advanced tools. On the other hand, small and mid-sized CPA firms incorporate standard CAATTs and still need to catch up to better understand what CAATTs can offer and how they can contribute to the quality of the audit; (3) the top management of mid-sized and small CPA firms should be more proactive and updated about CAATTs capabilities and contributions to audits; and (4) All CPA firms consider professionalism as a major challenge that must be constantly managed to ensure an optimal CAATTs operation. The study extends the existing knowledge of CAATTs adoption by looking at it from a risk-based auditing approach. It suggests a new model for CAATTs adoption by incorporating influencing audit risk factors that auditors should examine when considering CAATTs adoption. Since the model can be used in various audited scenarios and supports strategic, risk-based decisions, it maximizes the great potential of CAATTs on the quality of the audits. The results and insights can be useful to CPA firms, internal auditors, CAATTs developers and regulators. Moreover, it may motivate audit standard-setters to issue updated guidelines regarding CAATTs adoption in audits.Keywords: audit risk, CAATTs, financial auditing, information technology, technology adoption models
Procedia PDF Downloads 682711 Assessment of Aflatoxins in Marketed Fish: A Potential Forgotten Risk in Cameroon
Authors: Evelyne Nguegwouo, Raoul Fonkem Sonfack Tsakem, Abel Wade, Gabriel Nama Medoua, Kamgaing Theophile
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Fresh and smoked fish are widely consumed in Cameroon. The traditional nature of smoking, the lack of hygiene in production, the poor preservation of stocks and the long storage time for certain types of fish considerably favor the contamination of products by molds, which secrete toxic molecules called mycotoxins. Today there are more than 400 types of mycotoxins, Aflatoxins being the most formidable. These toxins are considered carcinogenic in humans. It is in this perspective that we proposed to evaluate the total Aflatoxins in the fish marketed and consumed by the populations of the city of Yaoundé in Cameroon. On the one hand, it was a question of conducting a survey of fish consumers and sellers in points of sale, sampling fish of three species [Marquereau (Scomber scombrus), Cod (Gadus morhua) and Bifaka (Ethmalosa fimbriata)], randomly in some markets of the city to evaluate the total Aflatoxins contents (B1, B2, G1, G2) by the quantitative ELISA method and finally to estimate the level of exposure of the populations. It emerges from this study that of the 30 samples analyzed, 96.1% contained total Aflatoxins and two samples had total Aflatoxins levels above the standard, which is 20 ppb. These first results show that the risk is present in Cameroon and in order to improve the quality of marketed fish in terms of mycotoxins, a more thorough control must be done from the production chain to the consumer.Keywords: aflatoxins, evaluation, exposure, mycotoxins, fish
Procedia PDF Downloads 792710 Air Pollution and Respiratory-Related Restricted Activity Days in Tunisia
Authors: Mokhtar Kouki Inès Rekik
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This paper focuses on the assessment of the air pollution and morbidity relationship in Tunisia. Air pollution is measured by ozone air concentration and the morbidity is measured by the number of respiratory-related restricted activity days during the 2-week period prior to the interview. Socioeconomic data are also collected in order to adjust for any confounding covariates. Our sample is composed by 407 Tunisian respondents; 44.7% are women, the average age is 35.2, near 69% are living in a house built after the 1980, and 27.8% have reported at least one day of respiratory-related restricted activity. The model consists on the regression of the number of respiratory-related restricted activity days on the air quality measure and the socioeconomic covariates. In order to correct for zero-inflation and heterogeneity, we estimate several models (Poisson, Negative binomial, Zero inflated Poisson, Poisson hurdle, Negative binomial hurdle and finite mixture Poisson models). Bootstrapping and post-stratification techniques are used in order to correct for any sample bias. According to the Akaike information criteria, the hurdle negative binomial model has the greatest goodness of fit. The main result indicates that, after adjusting for socioeconomic data, the ozone concentration increases the probability of positive number of restricted activity days.Keywords: bootstrapping, hurdle negbin model, overdispersion, ozone concentration, respiratory-related restricted activity days
Procedia PDF Downloads 2572709 Volume Estimation of Trees: An Exploratory Study on Rosewood Logging Within Forest Transition and Savannah Ecological Zones of Ghana
Authors: Albert Kwabena Osei Konadu
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One of the endemic forest species of the savannah transition zones enlisted by the Convention of International Treaty for Endangered Species (CITES) in Appendix II is the Rosewood, also known as Pterocarpus erinaceus or Krayie. Its economic viability has made it increasingly popular and in high demand. Ghana’s forest resource management regime for these ecozones is mainly on conservation and very little on resource utilization. Consequently, commercial logging management standards are at teething stage and not fully developed, leading to a deficiency in the monitoring of logging operations and quantification of harvested trees volumes. Tree information form (TIF); a volume estimation and tracking regime, has proven to be an effective sustainable management tool for regulating timber resource extraction in the high forest zones of the country. This work aims to generate TIF that can track and capture requisite parameters to accurately estimate the volume of harvested rosewood within forest savannah transition zones. Tree information forms were created on three scenarios of individual billets, stacked billets and conveying vessel basis. The study was limited by the usage of regulators assigned volume as benchmark and also fraught with potential volume measurement error in the stacked billet scenario due to the existence of spaces within packed billets. These TIFs were field-tested to deduce the most viable option for the tracking and estimation of harvested volumes of rosewood using the smallian and cubic volume estimation formula. Overall, four districts were covered with individual billets, stacked billets and conveying vessel scenarios registering mean volumes of 25.83m3,45.08m3 and 32.6m3, respectively. These adduced volumes were validated by benchmarking to assigned volumes of the Forestry Commission of Ghana and known standard volumes of conveying vessels. The results did indicate an underestimation of extracted volumes under the quotas regime, a situation that could lead to unintended overexploitation of the species. The research revealed conveying vessels route is the most viable volume estimation and tracking regime for the sustainable management of the Pterocarpous erinaceus species as it provided a more practical volume estimate and data extraction protocol.Keywords: cubic volume formula, smallian volume formula, pterocarpus erinaceus, tree information form, forest transition and savannah zones, harvested tree volume
Procedia PDF Downloads 442708 Process Improvement and Redesign of the Immuno Histology (IHC) Lab at MSKCC: A Lean and Ergonomic Study
Authors: Samantha Meyerholz
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MSKCC offers patients cutting edge cancer care with the highest quality standards. However, many patients and industry members do not realize that the operations of the Immunology Histology Lab (IHC) are the backbone for carrying out this mission. The IHC lab manufactures blocks and slides containing critical tissue samples that will be read by a Pathologist to diagnose and dictate a patient’s treatment course. The lab processes 200 requests daily, leading to the generation of approximately 2,000 slides and 1,100 blocks each day. Lab material is transported through labeling, cutting, staining and sorting manufacturing stations, while being managed by multiple techs throughout the space. The quality of the stain as well as wait times associated with processing requests, is directly associated with patients receiving rapid treatments and having a wider range of care options. This project aims to improve slide request turnaround time for rush and non-rush cases, while increasing the quality of each request filled (no missing slides or poorly stained items). Rush cases are to be filled in less than 24 hours, while standard cases are allotted a 48 hour time period. Reducing turnaround times enable patients to communicate sooner with their clinical team regarding their diagnosis, ultimately leading faster treatments and potentially better outcomes. Additional project goals included streamlining tech and material workflow, while reducing waste and increasing efficiency. This project followed a DMAIC structure with emphasis on lean and ergonomic principles that could be integrated into an evolving lab culture. Load times and batching processes were analyzed using process mapping, FMEA analysis, waste analysis, engineering observation, 5S and spaghetti diagramming. Reduction of lab technician movement as well as their body position at each workstation was of top concern to pathology leadership. With new equipment being brought into the lab to carry out workflow improvements, screen and tool placement was discussed with the techs in focus groups, to reduce variation and increase comfort throughout the workspace. 5S analysis was completed in two phases in the IHC lab, helping to drive solutions that reduced rework and tech motion. The IHC lab plans to continue utilizing these techniques to further reduce the time gap between tissue analysis and cancer care.Keywords: engineering, ergonomics, healthcare, lean
Procedia PDF Downloads 2232707 Supporting the ESL Student in a Tertiary Setting: Carrot and Stick
Authors: Ralph Barnes
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The internationalization and globalization of education are now a huge, multi-million dollar industry. The movement of international students across the globe has provided a rich vein of revenue for universities and institutions of higher learning to exploit and harvest. A concerted effort has been made by universities worldwide to court students from overseas, with some countries relying up to one-third of student fees, coming from international students. Australian universities and English Language Centres are coming under increased government scrutiny in respect to such areas as the academic progression of international students, management and understanding of student visa requirements and the design of higher education courses and effective assessment regimes. As such, universities and other higher education institutions are restructuring themselves more as service providers rather than as strictly education providers. In this paper, the high-touch, tailored academic model currently followed by some Australian educational institutions to support international students, is examined and challenged. Academic support services offered to international students need to be coordinated, sustained and reviewed regularly, in order to assess their effectiveness. Maintaining the delivery of high-quality educational programs and learning outcomes for this high income-generating student cohort is vital, in order to continue the successful academic and social engagement by international students across the Australian university and higher education landscape.Keywords: ESL, engagement, tertiary, learning
Procedia PDF Downloads 2032706 Jeddah’s Hydraulic Protection Systems and the Management of Flood: An Assessment
Authors: Faouzi Ameur, Atef Belhaj Ali
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Located in the South-west of Saudi Arabia, Jeddah is more than a harbor. It is a big city of the Red Sea and the second town of Saudi Arabia, after Riyadh the capital. Jeddah profits from several economic assets due especially to its transit position towards the high sacred places of Islam like Mecca and Medina. During summer, this metropolis is transformed into a political capital and a tourist resort for foreigners and Saudis alike. The city of Jeddah was affected by serious sudden floods; two great ones took place in 2009, and in 2011. The human and material tools were considerable, since these events caused the death to hundreds of people, damaged thousands of buildings built on basins slopes, which, however had the authorizations necessary. To cope with these natural disasters, several urban hydraulic measures were undertaken like building dams and canals to collect surface waters. These urban measures aimed at the protection of inhabitants and belongings against the risks of floods as well as the interception and the drainage of streams. Although these protection measures are important, expensive, and effective, they are no longer enough or effective to cope with the evolution of the natural disasters that the city of Jeddah is constantly exposed to. These protective hydraulic measures did not make it possible to reach risk zero situations. They transferred the damages towards other zones. This paper purports to study the protection network systems in Jeddah and to understand their various impacts during floods on the city and on its inhabitants.Keywords: Jeddah, Saudi Arabia, urbanization, hydraulic protection
Procedia PDF Downloads 2502705 Anti-Methicillin-Resistant Staphylococcus aureus (MRSA) Compounds from Bauhinia kockiana Korth and Their Mechanism of Antibacterial Activity
Authors: Yik Ling Chew, Adlina Maisarah Mahadi, Joo Kheng Goh
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Bauhinia kockiana originates from Peninsular Malaysia, and it is grown as a garden ornamental plant. However, it is used as medicinal plant by Malaysia ‘Kelabit’ ethic group in treating various diseases and illnesses. This study focused on the assessment of the antibacterial activity of B. kockiana towards MRSA, to purify and identify the antibacterial compounds, and to determine the mechanism of antibacterial activity. Antibacterial activity of B. kockiana flower is evaluated qualitatively and quantitatively using disc diffusion assay and microbroth dilution method to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of extracts. Phytochemical analysis is performed to determine the classes of phytochemicals in the extracts. Bioactivity-guided isolation is performed to purify the antibacterial agents and identified the chemical structures via various spectroscopy methods. Scanning electron microscopy (SEM) technique is adopted to evaluate the antibacterial mechanism of extract and compounds isolated. B. kockiana flower is found to exhibit fairly strong antibacterial activity towards both strains of MRSA bacteria. Gallic acid and its ester derivatives are purified from ethyl acetate extract and the antibacterial activity is evaluated. SEM has revealed the mechanism of the extracts and compounds isolated.Keywords: alkyl gallates, Bauhinia kockiana, MRSA, scanning electron microscopy
Procedia PDF Downloads 3702704 The Role of Vitamin D Supplementation in Augmenting IFN-γ Production in Response to Mycobacterium Tuberculosis Infection: A Randomized Controlled Trial
Authors: Muhammad Imran Hussain, Ramisha Ibtisam, Tayyaba Fatima, Huba Khalid, Ayesha Aziz, Khansa, Adan Sitara, Anam Shahzad, Aymen Jabeen
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Vitamin D supports the immune system fight TB by inhibiting Interferon-gamma (IFN-γ) and lowering host inflammation. The purpose of the research was to see if giving the vitamin D supplements to TB patients affected their prognosis. A randomized placebo control study of 200 TB patients was performed among which 106 received 400,000 IU of injectable vitamin D3 and 94 received placebo for 2 doses. Assessment was carried out at the end of every month for 3 months. IFN-γ responses to whole blood stimulation generated by the Mycobacterium tuberculosis sonicate (MTBs) antigen and early secreted and T cell activated 6 kDa (ESAT6) were assessed at 0 and 12 weeks. The statistical analysis used descriptive statistics (mean and standard deviation), Friedman's test and Fisher's test. The vitamin D group gained significantly more weight (+3.90 pounds) and had less persistent lung disease on imaging (1.33 zones vs. 1.84 zones). They also had a 50% decrease in cavity size. Additionally, patients with low baseline serum concentrations of 25-(OH)D had a significant increase in MTB-induced IFN-γ production after taking vitamin D supplements. Vitamin D administration in large amounts can hasten the recovery of TB patients. The findings point is a therapeutically useful activity of Vitamin D's in the management for tuberculosis.Keywords: tuberculosis, vitamin D, interferon gamma, protein, infection
Procedia PDF Downloads 522703 Prevalence and Risk Factors of Economic Toxicity in Gynecologic Malignancies: A Systematic Review
Authors: Dongliu Li
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Objective: This study systematically evaluates the incidence and influencing factors of economic toxicity in patients with gynecological malignant tumors. Methods: Literature on economic toxicity of gynecological malignancies were comprehensively searched in Pubmed, The Cochrane Library, Web of Science, Embase, CINAHL, CNKI, Wanfang Database, Chinese Biomedical Literature database and VIP database. The search period is up to February 2024. Stata 17 software was used to conduct a single-group meta-analysis of the incidence of economic toxicity in gynecological malignant tumors, and descriptive analysis was used to analyze the influencing factors. Results: A total of 11 pieces of literature were included, including 6475 patients with gynecological malignant tumors. The results of the meta-analysis showed that the incidence of economic toxicity in gynecological malignant tumors was 40% (95%CI 31%—48%). The influencing factors of economic toxicity in patients with gynecological malignant tumors include social demographic factors, medical insurance-related factors and disease-related factors. Conclusion: The incidence of economic toxicity in patients with gynecological malignant tumors is high, and medical staff should conduct early screening of patients according to relevant influencing factors, personalized assessment of patients' economic status, early prevention work and personalized intervention measures.Keywords: gynecological malignancy, economic toxicity, the incidence rate, influencing factors, systematic review
Procedia PDF Downloads 302702 Efficacy of Educational Program on the Performance of Internship Nursing Students Regarding Electronic Fetal Monitoring
Authors: Aida Abd El-Razek, Alyaa Salman Madian, Gamila Gaber Ayoub
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Background: Electronic fetal monitoring is an obstetric technology that helps to record any changes in fetal heart rate and uterine activity. The aim of this study was to determine the efficacy of educational programs on the performance of internship nursing students regarding electronic fetal monitoring in obstetrics and gynecology departments. Design: A quasi-experimental research design (pre- and post-test) was used. Sample: A convenient sample of all internship nursing students (180 internship nursing students) from the Faculty of Nursing at Menoufia University during the academic year 2022-2023). The instruments of this study were a structured, self-administered interview questionnaire consisting of two parts: the socio-demographic characteristics of the study participants and an assessment of internship nursing students’ knowledge regarding electronic fetal monitoring (pre- and post-test). Observational checklist to assess internship nursing students’ performance regarding EFM. Results: There were highly statistically significant differences between the internship nurses' students’ knowledge and performance on the pretest and posttest. Conclusion: An educational program on electronic fetal monitoring carries a vital value for enhancing internship nursing students’ knowledge and performance, which ultimately leads to improved maternal and fetal outcomes. Recommendation: Regular educational programs and workshops about electronic fetal monitoring should be encouraged for all maternity nurses and internship nursing students.Keywords: educational program, internship nursing students, performance, efficacy
Procedia PDF Downloads 532701 Comparing the Efficacy of Quantitative Electroencephalogram-Based Neurofeedback Therapy Program versus Organizational Skills Training Program to Reduce the Core Symptoms among Children Group of ADHD
Authors: Radwa R. El-Saadany , Medhat Abu Zeid, Tarek Omar, Marwa S. Maqsoud
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Attention deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders characterized by attention deficit, hyperactivity, and impulsivity. Neurofeedback (NF) is one of the neurotherapy treatments that cause brain wave changes. Method: The current pseudo-experimental study with a pre–post-test design was conducted on a population of children with attention deficit hyperactivity disorder (ADHD).The sample size comprised of (30) children selected by random sampling method and assigned to two therapeutic groups: First therapeutic group received a neurofeedback program. Based on QEEG, it reached (10) children. The second therapeutic group received an organization skills training program, it reached (10) and the control group that did not receive programs, it reached (10) children. Results: There are significant differences between pre- and post-assessments among therapeutic groups in reducing the three core symptoms of ADHD in favor of post measurement. There are no significant differences between post-assessment and follow up measurement of the therapeutic groups.Keywords: QEEG-based neurofeedback therapy program, organizational skills training program, attention deficit hyperactivity disorder
Procedia PDF Downloads 772700 Assessment of Ultra-High Cycle Fatigue Behavior of EN-GJL-250 Cast Iron Using Ultrasonic Fatigue Testing Machine
Authors: Saeedeh Bakhtiari, Johannes Depessemier, Stijn Hertelé, Wim De Waele
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High cycle fatigue comprising up to 107 load cycles has been the subject of many studies, and the behavior of many materials was recorded adequately in this regime. However, many applications involve larger numbers of load cycles during the lifetime of machine components. In this ultra-high cycle regime, other failure mechanisms play, and the concept of a fatigue endurance limit (assumed for materials such as steel) is often an oversimplification of reality. When machine component design demands a high geometrical complexity, cast iron grades become interesting candidate materials. Grey cast iron is known for its low cost, high compressive strength, and good damping properties. However, the ultra-high cycle fatigue behavior of cast iron is poorly documented. The current work focuses on the ultra-high cycle fatigue behavior of EN-GJL-250 (GG25) grey cast iron by developing an ultrasonic (20 kHz) fatigue testing system. Moreover, the testing machine is instrumented to measure the temperature and the displacement of the specimen, and to control the temperature. The high resonance frequency allowed to assess the behavior of the cast iron of interest within a matter of days for ultra-high numbers of cycles, and repeat the tests to quantify the natural scatter in fatigue resistance.Keywords: GG25, cast iron, ultra-high cycle fatigue, ultrasonic test
Procedia PDF Downloads 1762699 A pilot Study of Umbilical Cord Mini-Clamp
Authors: Seng Sing Tan
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Clamping of the umbilical cord after birth is widely practiced as a part of labor management. Further improvements were proposed to produce a smaller, lighter and more comfortable clamp while still maintaining current standards of clamping. A detachable holder was also developed to facilitate the clamping process. This pilot study on the efficacy of the mini-clamp was conducted to evaluate a tightness of the seal and a firm grip of the clamp on the umbilical cord. The study was carried out at National University Hospital, using 5 sets of placental cord. 18 samples of approximate 10 cm each were harvested. The test results showed that the mini-clamp was able to stop the flow through the cord after clamping without rupturing the cord. All slip tests passed with a load of 0.2 kg. In the pressure testing, 30kPa of saline was exerted into the umbilical veins. Although there was no physical sign of fluid leaking through the end secured by the mini-clamp, the results showed the pressure was not able to sustain the pressure set during the tests. 12 out of the 18 test samples have more than 7% of pressure drop in 30 seconds. During the pressure leak test, it was observed on several samples that when pressurized, small droplets of saline were growing on the outer surface of the cord lining membrane. It was thus hypothesized that the pressure drop was likely caused by the perfusion of the injected saline through the Wharton’s jelly and the cord lining membrane. The average pressure in the umbilical vein is roughly 2.67kPa (20 mmHg), less than 10% of 30kPa (~225mmHg), set for the pressure testing. As such, the pressure set could be over-specified, leading to undesirable outcomes. The development of the mini-clamp was an attempt to increase the comfort of newly born babies while maintaining the usability and efficacy of hospital grade umbilical cord clamp. The pressure leak in this study would be unfair to fully attribute it to the design and efficacy of the mini-clamp. Considering the unexpected leakage of saline through the umbilical membrane due to over-specified pressure exerted on the umbilical veins, improvements can definitely be made to the existing experimental setup to obtain a more accurate and conclusive outcome. If proven conclusive and effective, the mini-clamp with a detachable holder could be a smaller and potentially cheaper alternative to existing umbilical cord clamps. In addition, future clinical trials could be conducted to determine the user-friendliness of the mini-clamp and evaluate its practicality in the clinical setting by labor ward clinicians. A further potential improvement could be proposed on the sustainability factor of the mini-clamp. A biodegradable clamp would revolutionise the industry in this increasingly environmentally sustainability world.Keywords: leak test, mini-clamp, slip test, umbilical cord
Procedia PDF Downloads 1322698 Well-Being in the Workplace: Do Christian Leaders Behave Differently?
Authors: Mariateresa Torchia, Helene Cristini, Hannele Kauppinen
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Leadership plays a vital role in organizations. Leaders provide directions and facilitate the processes that enable organizations to achieve their goals and objectives. However, while productivity and financial objectives are often given the greatest emphasis, leaders also have the responsibility for instituting standards of ethical conduct and moral values that guide the behavior of employees. Leaders’ behaviors such as support, empowerment and a high-quality relationship with their employees might not only prevent stress, but also improve employees’ stress coping meanwhile contributing to their affective well-being. Stemming from Girard’s Mimetic Theory, this study aims at understanding how leaders can foster well-being in organizations. To do so, we explore which is the role leaders play in conflict management, resentment management and negative emotions dissipation. Furthermore, we examine whether and to what extent religiosity impacts the way in which leaders operate in relation to employees’ well-being. Indeed, given that organizational values are crucial to ethical behavior and firms’ values may be steeled by a deep sense of spirituality and religious identification, there is a need to take a closer look at the role religion and spirituality play in influencing the way leaders impact employees’ well-being. Thus, religion might work as an overarching logic that provides a set of principles guiding leaders’ everyday practices and relations with employees. We answer our research questions using a qualitative approach. We interviewed 27 Christian leaders (members of the Christian Entrepreneurs and Leaders Association – EDC, a non-profit organization created in 1926 including 3,000 French Christian Leaders & Entrepreneurs). Our results show that well-being can have a different meaning in relation to the type of companies, size, culture, country of analysis. Moreover the values and believes of leaders influence the way they see and foster well-being among employees. Furthermore, leaders can have both a positive or negative impact on well-being. Indeed on the one side, they could increase well-being in the company while on the other hand, they could be the source of resentment and conflicts among employees. Finally, we observed that Christian leaders possess characteristics that are sometimes missing in leaders (humility, inability to compare with others, attempt to be coherent with their values and beliefs, interest in the common good instead of the personal interest, having tougher dilemmas, collectively undertaking the firm). Moreover the Christian leader believes that the common good should come before personal interest. In other words, to them, not only short –termed profit shouldn’t guide strategical decisions but also leaders should feel responsible for their employees’ well-being. Last but not least, the study is not an apologia of Christian, yet it discusses the implications of these values through the light of Girard’s mimetic theory for both theory and practice.Keywords: Christian leaders, employees well-being, leadership, mimetic theory
Procedia PDF Downloads 1212697 Groundwater Quality in the Rhiss-Nekor Plain, Morocco: Impacts of Human Activities
Authors: Ali Ait Boughrous, Said Benyoussef, Hossain El Ouarghi, Moulay Abdelazize Aboulhassan, Samah Aitbnichou, Said Benguamra
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The Rhiss-Nekor aquifer represents a primary water source for the central Rif region. Many operating structures were built for irrigation and drinking water supply. Because of the vulnerability of this aquifer, a thorough knowledge of the environment is needed to evaluate and protect resources. This work aims at the quality assessment of the water table of the plain Ghiss-Nekor and determination of pollution sources in order to establish a map of the web. The plain-Rhiss Nekor, with an area of 100 km2, is located on the Mediterranean coast of Morocco. It has a particular geological structure resulting from the opening of a graben at the end of the Tertiary, which is filled by the accumulation of hundreds of meters of sediment, generating considerable heterogeneity in deposits. This heterogeneity gives various hydrodynamic properties within the aquifer of the plain. The analysis of the water quality of twenty water points, well distributed over the plain, showed high natural salinity linked to the geological nature of the area. This salinity increases in the littoral area by the seawater intrusion phenomenon. This is accentuated by overexploitation of the ground water due to the growing demand. Some wells, located inland, are characterized by organic pollution caused by wastewater seepage from septic tanks and lost wells widespread in the region.Keywords: anthropogenic factors, groundwater quality, marine intrusion, Rhiss-Nekor aquifer
Procedia PDF Downloads 1412696 Physiochemical Parameters Assessment and Evaluation of the Quality of Drinking Water in Some Parts of Lagos State
Authors: G. T. Mudashiru, Mayowa P. Ibitola
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Investigation was carried out at Ikorodu North local council development area of Lagos state using physiochemical parameters to study the quality drinking water. It was ascertained that the human functions and activities were dependent on the continuous and availability of good drinking water. Six water samples were collected at six different boreholes from various outlets and homes in Ikorodu North local council development area. Lagos state Nigeria. Analysis was carried out to determine the purity of water for domestic use. Physicochemical properties evaluation was adapted using standard chemical methods. A number of parameters such as PH, turbidity, conductivity, total dissolved solids, color, chloride, sulphate, nitrate, hardness were determined. Heavy metals such as Zn, Mg, Fe, Pb, Hg, and Mn as well as total coliform counts were observed. The resulted values of each parameter were justified with World Health Organization (WHO) and Lagos state water regulatory commission LSWRC standard values for quantitative comparison. The result reveals that all the water had pH value well below the WHO maximum permissible level for potable water. Other physicochemical parameters were within the safe limit of WHO standard showing the portability nature of the water. It can be concluded that though the water is potable, there should be a kind of treatment of the water before consumption to prevent outbreak of diseases.Keywords: drinking water, physiology, boreholes, heavy metals, domestic
Procedia PDF Downloads 2202695 Sleep Quality and Burnout, Mental and Physical Health of Polish Healthcare Workers
Authors: Maciej Bialorudzki, Zbigniew Izdebski, Alicja Kozakiewicz, Joanna Mazur
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The quality of sleep is extremely important for physical and mental health, especially among professional groups exposed to the suffering of the people they serve. The aim of the study is to assess sleep quality and various aspects of physical and mental health. A nationwide cross-sectional survey conducted in the first quarter of 2022 included 2227 healthcare professionals from 114 Polish hospitals and specialized outpatient clinics. The following distribution for each professional group was obtained (22% doctors; 52.6% nurses; 7.3% paramedics; 10.1% other medical professionals; 7.9% other non-medical professionals). The mean age of the respondents was 46.24 (SD=11.53). The Jenkins Sleep Scale with four items (JSS-4) was used to assess sleep quality, yielding a mean value of 5.35 (SD=5.20) in the study group and 13.7% of subjects with poor sleep quality using the cutoff point of the mean JSS-4 sum score as >11. More often, women than men reported poorer sleep quality (14,8% vs. 9,1% p=0,002). Respondents with poor sleep quality were more likely to report occupational burnout as measured by the BAT-12 (43.1% vs. 12.9% p<0.001) and high levels of stress as measured by the PSS-4 (72.5% vs. 27.5% p<0.001). In addition, those who declare experiencing a traumatic event compared to those who have not experienced it has an almost two times higher risk of poorer sleep quality (OR:1.958; 95% CI:1.509-2.542; p<0.001). In contrast, those with occupational burnout had more than five times the risk of those without occupational burnout (OR:5.092; 95% CI: 3.763-6.889; p<0.001). Sleep quality remains an important predictor of stress levels, job burnout, and quality of life assessment.Keywords: quality of sleep, medical staff, mental health, physical health, occupational burnout, stress
Procedia PDF Downloads 742694 Perceived Organizational Justice, Trust and Employee Engagement in Bank Managers
Authors: Seemal Mazhar Khan, Tahira Mubashar
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The present research aimed to investigate the relationship in perceived organizational justice, organizational trust and employee engagement in bank employees. It was hypothesized: there is likely to be a relationship in perceived organizational justices, organizational trust and employee engagement; perceived organizational justice and organizational trust are likely to predict employee engagement; there is likely to be effect of bank type and designation on perceived organizational justice, organizational trust and employee engagement. The sample consisted of 150 bank employees (50 from government, 50 from private and 50 from privatized banks) selected from different banks in Lahore, Pakistan. Correlational research design was used to conduct this study. Perceived Organizational Justices Questionnaire, Organizational Trust Questionnaire and Employee Engagement Scale were used for assessment. Pearson product moment correlation, hierarchical regression and multivariate analysis of covariance were applied. Results showed a positive significant relationship in perceived organizational justice and organizational engagement and there were also a positive significant relation between organizational trust and job and organizational engagement. Results showed that organizational trust predicts organizational engagement after controlling the effect of age, marital status and socio-economic status and there is a significant interaction effect of bank type and designation level on organizational trust in bank employees. The findings of the research can serve as a platform for the awareness of important antecedents of employee engagement and organizations can inculcate trust for better and improved engagement of its employees, thereby, enhancing the productivity of their employees.Keywords: bank employees, organizational engagement, perceived organizational justice, trust
Procedia PDF Downloads 3982693 Evaluating Effectiveness of Training and Development Corporate Programs: The Russian Agribusiness Context
Authors: Ekaterina Tikhonova
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This research is aimed to evaluate the effectiveness of T&D (Training and Development) on the example of two T&D programs for the Executive TOP Management run in 2012, 2015-2016 in Komos Group. This study is commissioned to research the effectiveness of two similar corporate T&D programs (within one company) in two periods of time (2012, 2015-2016) through evaluating the programs’ effectiveness using the four-level Kirkpatrick’s model of evaluating T&D programs and calculating ROI as an instrument for T&D program measuring by Phillips’ formula. The research investigates the correlation of two figures: the ROI calculated and the rating percentage scale per the ROI implementation (Wagle’s scale). The study includes an assessment of feedback 360 (Kirkpatrick's model) and Phillips’ ROI Methodology that provides a step-by-step process for collecting data, summarizing and processing the collected information. The data is collected from the company accounting data, the HR budgets, MCFO and the company annual reports for the research periods. All analyzed data and reports are organized and presented in forms of tables, charts, and graphs. The paper also gives a brief description of some constrains of the research considered. After ROI calculation, the study reveals that ROI ranges between the average implementation (65% to 75%) by Wagle’s scale that can be considered as a positive outcome. The paper also gives some recommendations how to use ROI in practice and describes main benefits of ROI implementation.Keywords: ROI, organizational performance, efficacy of T&D program, employee performance
Procedia PDF Downloads 2502692 Empowering Youth Through Pesh Poultry: A Transformative Approach to Addressing Unemployment and Fostering Sustainable Livelihoods in Busia District, Uganda
Authors: Bisemiire Anthony,
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PESH Poultry is a business project proposed specifically to solve unemployment and income-related problems affecting the youths in the Busia district. The project is intended to transform the life of the youth in terms of economic, social and behavioral, as well as the domestic well-being of the community at large. PESH Poultry is a start-up poultry farm that will be engaged in the keeping of poultry birds, broilers and layers for the production of quality and affordable poultry meat and eggs respectively and other poultry derivatives targeting consumers in eastern Uganda, for example, hotels, restaurants, households and bakeries. We intend to use a semi-intensive system of farming, where water and some food are provided in a separate nighttime shelter for the birds; our location will be in Lumino, Busia district. The poultry project will be established and owned by Bisemiire Anthony, Nandera Patience, Naula Justine, Bwire Benjamin and other investors. The farm will be managed and directed by Nandera Patience, who has five years of work experience and business administration knowledge. We will sell poultry products, including poultry eggs, chicken meat, feathers and poultry manure. We also offer consultancy services for poultry farming. Our eggs and chicken meat are hygienic, rich in protein and high quality. We produce processes and packages to meet the standard organization of Uganda and international standards. The business project shall comprise five (5) workers on the key management team who will share various roles and responsibilities in the identified business functions such as marketing, finance and other related poultry farming activities. PESH Poultry seeks 30 million Ugandan shillings in long-term financing to cover start-up costs, equipment, building expenses and working capital. Funding for the launch of the business will be provided primarily by equity from the investors. The business will reach positive cash flow in its first year of operation, allowing for the expected repayment of its loan obligations. Revenue will top UGX 11,750,000, and net income will reach about UGX115 950,000 in the 1st year of operation. The payback period for our project is 2 years and 3 months. The farm plans on starting with 1000 layer birds and 1000 broiler birds, 20 workers in the first year of operation.Keywords: chicken, pullets, turkey, ducks
Procedia PDF Downloads 952691 Charting the Course: Using group Charters to Enhance Engagement and Learning Outcomes
Authors: Angela Knox
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Student diversity in postgraduate classes puts major challengesoneducatorsseekingtoencouragestudentengagementand desired learning outcomes. This paper outlines the impact of a set of teaching initiatives aimed at addressing challenges associated with teaching and learning in an environment characterized by diversity in the student cohort. The study examines postgraduate students completing the core capstone unit within a specialized business degree. Although relatively small, the student cohort is highly diverse in terms of cultural backgrounds represented, prior learning and/or qualifications,aswellasdurationandtypeofworkexperiencerelevant to the degree being completed. The wide range of cultures, existing knowledge, and experience create enormous challenges with respect to students’ learning needs and outcomes. Subsequently, a suite of teaching innovations has been adopted to enhance curriculum content/delivery and the design of assessments. This paperexplores the impact of formalized group charters on students’ learning outcomes. Data from surveys and focus groups are used to assess the effectiveness of these practices. The results highlight the effectiveness of formalizedgroup charters in addressing diverse student needs and enhancing student engagement and learning outcomes. Thesefindings suggest that such practices would benefit students’ learning in environments marked by diversity in the student cohort. Specific recommendationsareofferedforothereducatorsworkingwithdiverse classes.Keywords: assessment design, curriculum content, curriculum delivery, group charter, student diversity
Procedia PDF Downloads 1352690 Groundwater Contamination Assessment and Mitigation Strategies for Water Resource Sustainability: A Concise Review
Authors: Khawar Naeem, Adel Elomri, Adel Zghibi
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Contamination leakage from municipal solid waste (MSW) landfills is a serious environmental challenge that poses a threat to interconnected ecosystems. It not only contaminates the soil of the saturated zone, but it also percolates down the earth and contaminates the groundwater (GW). In this concise literature review, an effort is made to understand the environmental hazards posed by this contamination to the soil and groundwater, the type of contamination, and possible solutions proposed in the literature. In the study’s second phase, the MSW management practices are explored as the landfill site dump rate and type of MSW into the landfill site directly depend on the MSW management strategies. Case studies from multiple developed and underdeveloped countries are presented, and the complex MSW management system is investigated from an operational perspective to minimize the contamination of GW. One of the significant tools used in the literature was found to be Systems Dynamic Modeling (SDM), which is a simulation-based approach to study the stakeholder’s approach. By employing the SDM approach, the risk of GW contamination can be reduced by devising effective MSW management policies, ultimately resulting in water resource sustainability and regional sustainable development.Keywords: groundwater contamination, environmental risk, municipal solid waste management, system dynamic modeling, water resource sustainability, sustainable development
Procedia PDF Downloads 772689 ‘Doctor Knows Best’: Reconsidering Paternalism in the NICU
Authors: Rebecca Greenberg, Nipa Chauhan, Rashad Rehman
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Paternalism, in its traditional form, seems largely incompatible with Western medicine. In contrast, Family-Centred Care, a partial response to historically authoritative paternalism, carries its own challenges, particularly when operationalized as family-directed care. Specifically, in neonatology, decision-making is left entirely to Substitute Decision Makers (most commonly parents). Most models of shared decision-making employ both the parents’ and medical team’s perspectives but do not recognize the inherent asymmetry of information and experience – asking parents to act like physicians to evaluate technical data and encourage physicians to refrain from strong medical opinions and proposals. They also do not fully appreciate the difficulties in adjudicating which perspective to prioritize and, moreover, how to mitigate disagreement. Introducing a mild form of paternalism can harness the unique skillset both parents and clinicians bring to shared decision-making and ultimately work towards decision-making in the best interest of the child. The notion expressed here is that within the model of shared decision-making, mild paternalism is prioritized inasmuch as optimal care is prioritized. This mild form of paternalism is known as Beneficent Paternalism and justifies our encouragement for physicians to root down in their own medical expertise to propose treatment plans informed by medical expertise, standards of care, and the parents’ values. This does not mean that we forget that paternalism was historically justified on ‘beneficent’ grounds; however, our recommendation is that a re-integration of mild paternalism is appropriate within our current Western healthcare climate. Through illustrative examples from the NICU, this paper explores the appropriateness and merits of Beneficent Paternalism and ultimately its use in promoting family-centered care, patient’s best interests and reducing moral distress. A distinctive feature of the NICU is the fact that communication regarding a patient’s treatment is exclusively done with substitute decision-makers and not the patient, i.e., the neonate themselves. This leaves the burden of responsibility entirely on substitute decision-makers and the clinical team; the patient in the NICU does not have any prior wishes, values, or beliefs that can guide decision-making on their behalf. Therefore, the wishes, values, and beliefs of the parent become the map upon which clinical proposals are made, giving extra weight to the family’s decision-making responsibility. This leads to why Family Directed Care is common in the NICU, where shared decision-making is mandatory. However, the zone of parental discretion is not as all-encompassing as it is currently considered; there are appropriate times when the clinical team should strongly root down in medical expertise and perhaps take the lead in guiding family decision-making: this is just what it means to adopt Beneficent Paternalism.Keywords: care, ethics, expertise, NICU, paternalism
Procedia PDF Downloads 145