Search results for: TS patient selection

Authors: Farnaz Farhangi

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Many people in New Zealand believe that the access to water is inexhaustible, and it comes from a history of virtually unrestricted access to it. For the region like Hamilton which is one of New Zealand’s fastest growing cities, it is crucial for policy makers to know about the future water consumption and implementation of rules and regulation such as universal water metering. Hamilton residents use water freely and they do not have any idea about how much water they use. Hence, one of proposed objectives of this research is focusing on forecasting water consumption using different methods. Residential water consumption time series exhibits seasonal and trend variations. Seasonality is the pattern caused by repeating events such as weather conditions in summer and winter, public holidays, etc. The problem with this seasonal fluctuation is that, it dominates other time series components and makes difficulties in determining other variations (such as educational campaign’s effect, regulation, etc.) in time series. Apart from seasonality, a stochastic trend is also combined with seasonality and makes different effects on results of forecasting. According to the forecasting literature, preprocessing (de-trending and de-seasonalization) is essential to have more performed forecasting results, while some other researchers mention that seasonally non-adjusted data should be used. Hence, I answer the question that is pre-processing essential? A wide range of forecasting methods exists with different pros and cons. In this research, I apply double seasonal ARIMA and Artificial Neural Network (ANN), considering diverse elements such as seasonality and calendar effects (public and school holidays) and combine their results to find the best predicted values. My hypothesis is the examination the results of combined method (hybrid model) and individual methods and comparing the accuracy and robustness. In order to use ARIMA, the data should be stationary. Also, ANN has successful forecasting applications in terms of forecasting seasonal and trend time series. Using a hybrid model is a way to improve the accuracy of the methods. Due to the fact that water demand is dominated by different seasonality, in order to find their sensitivity to weather conditions or calendar effects or other seasonal patterns, I combine different methods. The advantage of this combination is reduction of errors by averaging of each individual model. It is also useful when we are not sure about the accuracy of each forecasting model and it can ease the problem of model selection. Using daily residential water consumption data from January 2000 to July 2015 in Hamilton, I indicate how prediction by different methods varies. ANN has more accurate forecasting results than other method and preprocessing is essential when we use seasonal time series. Using hybrid model reduces forecasting average errors and increases the performance.

Keywords: artificial neural network (ANN), double seasonal ARIMA, forecasting, hybrid model

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Authors: John Yahng, Hansraj Riteesh Bookun

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Objective: This was a retrospective cross-sectional study evaluating the safety of discharge on the first postoperative day following carotid surgery - principally carotid endarterectomy. Methods: Between January 2010 to October 2017, 252 patients with mean age of 72 years, underwent carotid surgery by seven surgeons. Their medical records were consulted and their operative as well as complication timelines were databased. Descriptive statistics were used to analyse pooled responses and our indicator variables. The statistical package used was STATA 13. Results: There were 183 males (73%) and the comorbid burden was as follows: ischaemic heart disease (54%), diabetes (38%), hypertension (92%), stage 4 kidney impairment (5%) and current or ex-smoking (77%). The main indications were transient ischaemic attacks (42%), stroke (31%), asymptomatic carotid disease (16%) and amaurosis fugax (8%). 247 carotid endarterectomies (109 with patch arterioplasty, 88 with eversion and transection technique, 50 with endarterectomy only) were performed. 2 carotid bypasses, 1 embolectomy, 1 thrombectomy with patch arterioplasty and 1 excision of a carotid body tumour were also performed. 92% of the cases were performed under general anaesthesia. A shunt was used in 29% of cases. The mean length of stay was 5.1 ± 3.7days with the range of 2 to 22 days. No patient was discharged on day 1. The mean time from admission to surgery was 1.4 ± 2.8 days, ranging from 0 to 19 days. The mean time from surgery to discharge was 2.7 ± 2.0 days with the of range 0 to 14 days. 36 complications were encountered over this period, with 12 failed repairs (5 major strokes, 2 minor strokes, 3 transient ischaemic attacks, 1 cerebral bleed, 1 occluded graft), 11 bleeding episodes requiring a return to the operating theatre, 5 adverse cardiac events, 3 cranial nerve injuries, 2 respiratory complications, 2 wound complications and 1 acute kidney injury. There were no deaths. 17 complications occurred on postoperative day 0, 11 on postoperative day 1, 6 on postoperative day 2 and 2 on postoperative day 3. 78% of all complications happened before the second postoperative day. Out of the complications which occurred on the second or third postoperative day, 4 (1.6%) were bleeding episodes, 1 (0.4%) failed repair , 1 respiratory complication (0.4%) and 1 wound complication (0.4%). Conclusion: Although it has been common practice to discharge patients on the second postoperative day following carotid endarterectomy, we find here that discharge on the first operative day is safe. The overall complication rate is low and most complications are captured before the second postoperative day. We suggest that patients having an uneventful first 24 hours post surgery be discharged on the first day. This should reduce hospital length of stay and the health economic burden.

Keywords: carotid, complication, discharge, surgery

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Authors: Andreas Aceranti, Simonetta Vernocchi, Marco Colorato, Daniel Zaccariello

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Our study explores the usefulness of implementing facial expression recognition capabilities and using the Facial Action Coding System (FACS) in contexts where the other person is wearing a mask. In the communication process, the subjects use a plurality of distinct and autonomous reporting systems. Among them, the system of mimicking facial movements is worthy of attention. Basic emotion theorists have identified the existence of specific and universal patterns of facial expressions related to seven basic emotions -anger, disgust, contempt, fear, sadness, surprise, and happiness- that would distinguish one emotion from another. However, due to the COVID-19 pandemic, we have come up against the problem of having the lower half of the face covered and, therefore, not investigable due to the masks. Facial-emotional behavior is a good starting point for understanding: (1) the affective state (such as emotions), (2) cognitive activity (perplexity, concentration, boredom), (3) temperament and personality traits (hostility, sociability, shyness), (4) psychopathology (such as diagnostic information relevant to depression, mania, schizophrenia, and less severe disorders), (5) psychopathological processes that occur during social interactions patient and analyst. There are numerous methods to measure facial movements resulting from the action of muscles, see for example, the measurement of visible facial actions using coding systems (non-intrusive systems that require the presence of an observer who encodes and categorizes behaviors) and the measurement of electrical "discharges" of contracting muscles (facial electromyography; EMG). However, the measuring system invented by Ekman and Friesen (2002) - "Facial Action Coding System - FACS" is the most comprehensive, complete, and versatile. Our study, carried out on about 1,500 subjects over three years of work, allowed us to highlight how the movements of the hands and upper part of the face change depending on whether the subject wears a mask or not. We have been able to identify specific alterations to the subjects’ hand movement patterns and their upper face expressions while wearing masks compared to when not wearing them. We believe that finding correlations between how body language changes when our facial expressions are impaired can provide a better understanding of the link between the face and body non-verbal language.

Keywords: facial action coding system, COVID-19, masks, facial analysis

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Authors: M. Naimi, M. B. Khaled

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The aim of the present work was to test in vitro inhibition of food pathogens and spoilage bacteria by crude bacteriocins from autochthonous lactic acid bacteria. Thirty autochthonous lactic acid bacteria isolated previously, belonging to the genera: Lactobacillus, Carnobacterium, Lactococcus, Vagococcus, Streptococcus, and Pediococcus, have been screened by an agar spot test and a well diffusion assay against Gram-positive and Gram-negative harmful bacteria: Bacillus cereus, Bacillus subtilis ATCC 6633, Escherichia coli ATCC 8739, Salmonella typhimurium ATCC 14028, Staphylococcus aureus ATCC 6538, and Pseudomonas aeruginosa under conditions means to reduce lactic acid and hydrogen peroxide effect to select bacteria with high bacteriocinogenic potential. Furthermore, crude bacteriocins semiquantification and heat sensitivity to different temperatures (80, 95, 110°C, and 121°C) were performed. Another exploratory test concerning the response of St. aureus ATCC 6538 to the presence of crude bacteriocins was realized. It has been observed by the agar spot test that fifteen candidates were active toward Gram-positive targets strains. The secondary screening demonstrated an antagonistic activity oriented only against St. aureus ATCC 6538, leading to the selection of five isolates: Lm14, Lm21, Lm23, Lm24, and Lm25 with a larger inhibition zone compared to the others. The ANOVA statistical analysis reveals a small variation of repeatability: Lm21: 0.56%, Lm23: 0%, Lm25: 1.67%, Lm14: 1.88%, Lm24: 2.14%. Conversely, slight variation was reported in terms of inhibition diameters: 9.58± 0.40, 9.83± 0.46, and 10.16± 0.24 8.5 ± 0.40 10 mm for, Lm21, Lm23, Lm25, Lm14and Lm24, indicating that the observed potential showed a heterogeneous distribution (BMS = 0.383, WMS = 0.117). The repeatability coefficient calculated displayed 7.35%. As for the bacteriocins semiquantification, the five samples exhibited production amounts about 4.16 for Lm21, Lm23, Lm25 and 2.08 AU/ml for Lm14, Lm24. Concerning the sensitivity the crude bacteriocins were fully insensitive to heat inactivation, until 121°C, they preserved the same inhibition diameter. As to, kinetic of growth , the µmax showed reductions in pathogens load for Lm21, Lm23, Lm25, Lm14, Lm24 of about 42.92%, 84.12%, 88.55%, 54.95%, 29.97% in the second trails. Inversely, this pathogen growth after five hours displayed differences of 79.45%, 12.64%, 11.82%, 87.88%, 85.66% in the second trails, compared to the control. This study showed potential inhibition to the growth of this food pathogen, suggesting the possibility to improve the hygienic food quality.

Keywords: exploratory test, lactic acid bacteria, crude bacteriocins, spoilage, pathogens

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Authors: Sheillah Hlamalani Mboweni, Lufuno Makhado

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Background: The increasing number of people who tested HIV positive and who demand antiretroviral therapy (ART) prompted the National Department of Health to adopt WHO recommendations of task shifting where Professional Nurses(PNs) initiate ART rather than doctors in the hospital. This resulted in the decentralization of services to primary health care(PHC), generating a need to capacitate PNs on NIMART. After years of training, the impact of NIMART was assessed where it was established that even though there was an increased number who accessed ART, the quality of care is of serious concern. The study aims to answer the following question: What are the challenges influencing NIMART implementation in primary health care. Objectives: This study explores challenges influencing NIMART training and implementation and makes recommendations to improve patient and HIV program outcomes. Methods: A qualitative explorative program evaluation research design. The study was conducted in the rural districts of North West province. Purposive sampling was used to sample PNs trained on NIMART. FGDs were used to collect data with 6-9 participants and data was analysed using ATLAS ti. Results: Five FGDs, n=28 PNs and three program managers were interviewed. The study results revealed two themes: inadequacy in NIMART training and the health care system challenges. Conclusion: The deficiency in NIMART training and health care system challenges is a public health concern as it compromises the quality of HIV management resulting in poor patients’ outcomes and retard the goal of ending the HIV epidemic. These should be dealt with decisively by all stakeholders. Recommendations: The national department of health should improve NIMART training and HIV management: standardization of NIMART training curriculum through the involvement of all relevant stakeholders skilled facilitators, the introduction of pre-service NIMART training in institutions of higher learning, support of PNs by district and program managers, plan on how to deal with the shortage of staff, negative attitude to ensure compliance to guidelines. There is a need to develop a conceptual framework that provides guidance and strengthens NIMART implementation in PHC facilities.

Keywords: antiretroviral therapy, nurse initiated management of retroviral therapy, primary health care, professional nurses

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Authors: Marina Aferiba Tandoh, Elsie Odei

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Peptic Ulcer Disease (PUD) is amongst the commonest gastrointestinal problems that require emergency treatment in order to preserve life. The prevalence of PUD is increasing within the Ghanaian population, deepening the need to identify factors that are associated with its occurrence. This cross-sectional study assessed the nutritional status, socioeconomic and lifestyle factors associated with PUD among patients attending the Out-Patient Department of the Tema General Hospital of Ghana. A food frequency questionnaire and a three-day, 24-hour recall were used to assess the dietary intakes of study participants. A standardized questionnaire was used to obtain information on the participants’ socio-demographic characteristics, lifestyle as well as medical history. The data was analyzed using SPSS version 22. The mean age of study participants was 32.8±15.41years. Females were significantly higher (61.4%) than males (38.6%) (p < 0.001). All participants had received some form of education, with tertiary education being the highest (52.6%). The majority of them managed their condition with medications only (86%), while 10.5% managed it with a combination of medications and diet. The rest were either by dietary counseling only (1.8%), or surgery only (1.8%). or herbal medicines (29.3%), which were made from home (7.2%) or bought from a medical store (10.8%). Most of the participants experienced a recurrence of the disease (42.1%). For those who had ever experienced recurrences of the disease, it happened when they ate acidic foods (1.8%), ate bigger portions (1.8%), starved themselves (1.8%), or were stressed (1.8%). Others also had triggers when they took certain medications (1.8%) or ate too much pepper (1.8%). About 49% of the participants were either overweight or obese with a recurrence of PUD (p>0.05). Obese patients had the highest rate of PUD recurrences (41%). Drinking alcohol was significantly associated with the recurrence of PUD (χ2= 5.243, p=0.026). Other lifestyles, such as weed smoking, fasting, and use of herbal medicine and NSAIDs did not have any significant association with the disease recurrence. There was no significant correlation between the various dietary patterns and anthropometric parameters except dietary pattern one (salty snacks, regular soft drinks, milk, sweetened yogurt, ice cream, and cooked vegetables), which had a positive correlation with weight (p=0.002) and BMI (p=0.038). PUD patients should target weight reduction actions and reduce alcohol intake as measures to control the recurrence of the disease. Nutrition Education among this population must be promoted to minimize the recurrence of PUD.

Keywords: Dietary patterns, lifestyle factors, nutritional status, peptic ulcer disease

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Authors: Sebastiano Candamano, Antonio Iorfida, Patrizia Frontera, Anastasia Macario, Fortunato Crea

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Alkali-activated materials are promising binders obtained by an alkaline attack on fly-ashes, metakaolin, blast slag among others. In order to guarantee the highest ecological and cost efficiency, a proper selection of precursors and alkaline activators has to be carried out. These choices deeply affect the microstructure, chemistry and performances of this class of materials. Even if, in the last years, several researches have been focused on mix designs and curing conditions, the lack of exhaustive activation models, standardized mix design and curing conditions and an insufficient investigation on shrinkage behavior, efflorescence, additives and durability prevent them from being perceived as an effective and reliable alternative to Portland. The aim of this study is to develop alkali-activated cements mortars containing high amounts of industrial by-products and waste, such as ground granulated blast furnace slag (GGBFS) and ashes obtained from the combustion process of forest biomass in thermal power plants. In particular, the experimental campaign was performed in two steps. In the first step, research was focused on elucidating how the workability, mechanical properties and shrinkage behavior of produced mortars are affected by the type and fraction of each precursor as well as by the composition of the activator solutions. In order to investigate the microstructures and reaction products, SEM and diffractometric analyses have been carried out. In the second step, their durability in harsh environments has been evaluated. Mortars obtained using only GGBFS as binder showed mechanical properties development and shrinkage behavior strictly dependent on SiO2/Na2O molar ratio of the activator solutions. Compressive strengths were in the range of 40-60 MPa after 28 days of curing at ambient temperature. Mortars obtained by partial replacement of GGBFS with metakaolin and forest biomass ash showed lower compressive strengths (≈35 MPa) and shrinkage values when higher amount of ashes were used. By varying the activator solutions and binder composition, compressive strength up to 70 MPa associated with shrinkage values of about 4200 microstrains were measured. Durability tests were conducted to assess the acid and thermal resistance of the different mortars. They all showed good resistance in a solution of 5%wt of H2SO4 also after 60 days of immersion, while they showed a decrease of mechanical properties in the range of 60-90% when exposed to thermal cycles up to 700°C.

Keywords: alkali activated cement, biomass ash, durability, shrinkage, slag

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Authors: Adrián Esteban Ortiz-Valera, Angélica Lozano

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In developing countries, informal trade is relevant, but it has been little studied in urban freight transport (UFT) context, although it is a challenge due to the non- contemplated demand it produces and the operational limitations it imposes. Hence, UFT operational improvements (initiatives) and freight attraction models must consider informal trade for developing countries. Afour phasesapproach for characterizing the commercial areas in developing countries (considering both formal and informal establishments) is proposed and applied to ten areas in Mexico City. This characterization is required to calculate real freight trip attraction and then select and/or adapt suitable initiatives. Phase 1 aims the delimitation of the study area. The following information is obtained for each establishment of a potential area: location or geographic coordinates, industrial sector, industrial subsector, and number of employees. Phase 2 characterizes the study area and proposes a set of indicators. This allows a broad view of the operations and constraints of UFT in the study area. Phase 3 classifies the study area according to seven indicators. Each indicator represents a level of conflict in the area due to the presence of formal (registered) and informal establishments on the sidewalks and streets, affecting urban freight transport (and other activities). Phase 4 determines preliminary initiatives which could be implemented in the study area to improve the operation of UFT. The indicators and initiatives relation allows a preliminary initiatives selection. This relation requires to know the following: a) the problems in the area (congested streets, lack of parking space for freight vehicles, etc.); b) the factors which limit initiatives due to informal establishments (reduced streets for freight vehicles; mobility and parking inability during a period, among others), c) the problems in the area due to its physical characteristics; and d) the factors which limit initiatives due to regulations of the area. Several differences in the study areas were observed. As the indicators increases, the areas tend to be less ordered, and the limitations for the initiatives become higher, causing a smaller number of susceptible initiatives. In ordered areas (similar to the commercial areas of developed countries), the current techniquesfor estimating freight trip attraction (FTA) can bedirectly applied, however, in the areas where the level of order is lower due to the presence of informal trade, this is not recommended because the real FTA would not be estimated. Therefore, a technique, which consider the characteristics of the areas in developing countries to obtain data and to estimate FTA, is required. This estimation can be the base for proposing feasible initiatives to such zones. The proposed approach provides a wide view of the needs of the commercial areas of developing countries. The knowledge of these needs would allow UFT´s operation to be improved and its negative impacts to be minimized.

Keywords: freight initiatives, freight trip attraction, informal trade, urban freight transport

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Authors: Bistra Kunovska, Kremena Ivanova, Jana Djounova, Desislava Djunakova, Zdenka Stojanovska

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The carcinogenic effects of radon as a radioactive noble gas have been studied and show a strong correlation between radon exposure and lung cancer occurrence, even in the case of low radon levels. The major part of the natural radiation dose in humans is received by inhaling radon and its progenies, which originates from the decay chain of U-238. Indoor radon poses a substantial threat to human health when build-up occurs in confined spaces such as homes, mines and caves and the risk increases with the duration of radon exposure and is proportional to both the radon concentration and the time of exposure. Tourist caves are a case of special environmental conditions that may be affected by high radon concentration. Tourist caves are a recognized danger in terms of radon exposure to cave workers (guides, employees working in shops built above the cave entrances, etc.), but due to the sensitive nature of the cave environment, high concentrations cannot be easily removed. Forced ventilation of the air in the caves is considered unthinkable due to the possible harmful effects on the microclimate, flora and fauna. The risks to human health posed by exposure to elevated radon levels in caves are not well documented. Various studies around the world often detail very high concentrations of radon in caves and exposure of employees but without a follow-up assessment of the overall impact on human health. This study was developed in the implementation of a national project to assess the potential health effects caused by exposure to elevated levels of radon in buildings with public access under the National Science Fund of Bulgaria, in the framework of grant No КП-06-Н23/1/07.12.2018. The purpose of the work is to assess the radon level in Bulgarian caves and the exposure of the visitors and workers. The number of caves (sampling size) was calculated for simple random selection from total available caves 65 (sampling population) are 13 caves with confidence level 95 % and confidence interval (margin of error) approximately 25 %. A measurement of the radon concentration in air at specific locations in caves was done by using CR-39 type nuclear track-etch detectors that were placed by the participants in the research team. Despite the fact that all of the caves were formed in karst rocks, the radon levels were rather different from each other (97–7575 Bq/m3). An assessment of the influence of the orientation of the caves in the earth's surface (horizontal, inclined, vertical) on the radon concentration was performed. Evaluation of health hazards and radon risk exposure causing by inhaling the radon and its daughter products in each surveyed caves was done. Reducing the time spent in the cave has been recommended in order to decrease the exposure of workers.

Keywords: tourist caves, radon concentration, exposure, Bulgaria

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Authors: Chor Yi Ng, Christine Kong, Loretta Teo, Stephen Yau, FC Cheung, TL Poon, Francis Lee

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Purpose: Dynamic conformal arc (DCA) and intensity modulated radiotherapy (IMRT) are two treatment techniques commonly used for stereotactic radiosurgery/radiotherapy of cranial lesions. IMRT plans usually give better dose conformity while DCA plans have better dose fall off. Rapid dose fall off is preferred for radiotherapy of cranial lesions, but dose conformity is also important. For certain lesions, DCA plans have good conformity, while for some lesions, the conformity is just unacceptable with DCA plans, and IMRT has to be used. The choice between the two may not be apparent until each plan is prepared and dose indices compared. We described a deviation index (DI) which is a measurement of the deviation of the target shape from a sphere, and test its functionality to choose between the two techniques. Method and Materials: From May 2015 to May 2017, our institute has performed stereotactic radiotherapy for 105 patients treating a total of 115 lesions (64 DCA plans and 51 IMRT plans). Patients were treated with the Varian Clinac iX with HDMLC. Brainlab Exactrac system was used for patient setup. Treatment planning was done with Brainlab iPlan RT Dose (Version 4.5.4). DCA plans were found to give better dose fall off in terms of R50% (R50% (DCA) = 4.75 Vs R50% (IMRT) = 5.242) while IMRT plans have better conformity in terms of treatment volume ratio (TVR) (TVR(DCA) = 1.273 Vs TVR(IMRT) = 1.222). Deviation Index (DI) is proposed to better facilitate the choice between the two techniques. DI is the ratio of the volume of a 1 mm shell of the PTV and the volume of a 1 mm shell of a sphere of identical volume. DI will be close to 1 for a near spherical PTV while a large DI will imply a more irregular PTV. To study the functionality of DI, 23 cases were chosen with PTV volume ranged from 1.149 cc to 29.83 cc, and DI ranged from 1.059 to 3.202. For each case, we did a nine field IMRT plan with one pass optimization and a five arc DCA plan. Then the TVR and R50% of each case were compared and correlated with the DI. Results: For the 23 cases, TVRs and R50% of the DCA and IMRT plans were examined. The conformity for IMRT plans are better than DCA plans, with majority of the TVR(DCA)/TVR(IMRT) ratios > 1, values ranging from 0.877 to1.538. While the dose fall off is better for DCA plans, with majority of the R50%(DCA)/ R50%(IMRT) ratios < 1. Their correlations with DI were also studied. A strong positive correlation was found between the ratio of TVRs and DI (correlation coefficient = 0.839), while the correlation between the ratio of R50%s and DI was insignificant (correlation coefficient = -0.190). Conclusion: The results suggest DI can be used as a guide for choosing the planning technique. For DI greater than a certain value, we can expect the conformity for DCA plans to become unacceptably great, and IMRT will be the technique of choice.

Keywords: cranial lesions, dynamic conformal arc, IMRT, image guided radiotherapy, stereotactic radiotherapy

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Authors: Freja Rydahl Rasmussen, Naja Villadsen, Stig Koust

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Air purifiers have become widely implemented in a wide range of settings, including households, schools, institutions, and hospitals, as they tackle the pressing issue of indoor air pollution. With their ability to enhance indoor air quality and create healthier environments, air purifiers are particularly vital when ventilation options are limited. These devices incorporate a diverse array of technologies, including HEPA filters, active carbon filters, UV-C light, photocatalytic oxidation, and ionizers, each designed to combat specific pollutants and improve air quality within enclosed spaces. However, the safety of air purifiers has not been investigated thoroughly, and many questions still arise when applying them. Certain air purification technologies, such as UV-C light or ionization, can unintentionally generate undesirable byproducts that can negatively affect indoor air quality and health. It is well-established that these technologies can inadvertently generate nanoparticles or convert common gaseous compounds into harmful ones, thus exacerbating air pollution. However, the formation of byproducts can vary across products, necessitating further investigation. There is a particular concern about the formation of the carcinogenic substance formaldehyde from common gases like acetone. Many air purifiers use mechanical filtration to remove particles, dust, and pollen from the air. Filters need to be replaced periodically for optimal efficiency, resulting in an additional cost for end-users. Currently, there are no guidelines for filter lifespan, and replacement recommendations solely rely on manufacturers. A market screening revealed that manufacturers' recommended lifespans vary greatly (from 1 month to 10 years), and there is a need for general recommendations to guide consumers. Activated carbon filters are used to adsorb various types of chemicals that can pose health risks or cause unwanted odors. These filters have a certain capacity before becoming saturated. If not replaced in a timely manner, the adsorbed substances are likely to be released from the filter through off-gassing or losing adsorption efficiency. The goal of this study is to investigate the lifespan of filters as well as investigate the potentially harmful effects of air purifiers. Understanding the lifespan of filters used in air purifiers and the potential formation of harmful byproducts is essential for ensuring their optimal performance, guiding consumers in their purchasing decisions, and establishing industry standards for safer and more effective air purification solutions. At this time, a selection of air purifiers has been chosen, and test methods have been established. In the following 3 months, the tests will be conducted, and the results will be ready for presentation later.

Keywords: air purifiers, activated carbon filters, byproducts, clean air, indoor air quality

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Authors: Joanna Wozniak-Holecka, Sylwia Jaruga-Sekowska

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There are 45 statutory spa and treatment areas in Poland, and the demand for spa and treatment services increases year by year. Within each type of spa treatment facilities, nutritional education services are provided. During spa treatment, the patient learns the principles of rational nutrition and applied diet therapy. It should help him develop proper eating habits, which will also follow at home. However, the nutrition education system of spa resort patients should be considered as very imperfect and requiring a definite systemic correction. It has, at the same time, a wide human and infrastructure base, which guarantees to obtain positive reinforcement in the scope of undertaken activities and management. Unfortunately, this advantage is not fully used. The aim of the project was to assess the quality of implemented nutritional education and to assess the diet of patients in spa treatment entities from a nationwide perspective. The material for the study was data obtained as part of an in-depth interview conducted among nutrition department managers (25 interviews) and a survey addressed to patients (600 questionnaires) of a selected group of spa resorts from across the country about the implementation of nutritional education in institutions. Also, decade menus for the basic diet, easily digestible diet and diet with limitation of easily digestible carbohydrates (a total of 1,120 menus) were obtained for the study. Almost 2/3 of respondents (73.2%) were overweight or obese, but only 32.8% decided on an easily digestible or low-energy diet during the treatment. Most of the surveyed patients rated the nutrition in spa resorts as satisfactory. Classes on nutrition education were carried out mainly by a dietitian (65% of meetings), the other educators were doctors and nurses. The meetings (95%) were of a group nature and lasted only 30 minutes on average. The subjects of the classes concerned the principles of proper nutrition and composition of meals, a nutrition pyramid and a diet adapted to a given disease. The assessed menus did not meet the nutrition standards and, therefore, did not provide patients with the correct quality of nutrition. The norm of protein, fat, vitamin A, B12, phosphorus, iron and sodium was exceeded, while vitamin D, folic acid, magnesium and zinc were not enough than recommended. The study allowed to conclude that there is a large discrepancy between the recommendations presented during the nutrition education classes and the quality of diet implemented in the examined institutions. The project may contribute to the development of effective educational tools in nutrition, especially about a specific group of chronically ill patients.

Keywords: diet, management, nutritional education, spa resort

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Authors: Loris Franchi, Daniele Calvi, Sabrina Corpino

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This paper presents a design methodology in which stakeholders are assisted with the exploration of a so-called negotiation space, aiming to the maximization of both group social welfare and single stakeholder’s perceived utility. The outcome results in less design iterations needed for design convergence while obtaining a higher solution effectiveness. During the early stage of a space project, not only the knowledge about the system but also the decision outcomes often are unknown. The scenario is exacerbated by the fact that decisions taken in this stage imply delayed costs associated with them. Hence, it is necessary to have a clear definition of the problem under analysis, especially in the initial definition. This can be obtained thanks to a robust generation and exploration of design alternatives. This process must consider that design usually involves various individuals, who take decisions affecting one another. An effective coordination among these decision-makers is critical. Finding mutual agreement solution will reduce the iterations involved in the design process. To handle this scenario, the paper proposes a design methodology which, aims to speed-up the process of pushing the mission’s concept maturity level. This push up is obtained thanks to a guided negotiation space exploration, which involves autonomously exploration and optimization of trade opportunities among stakeholders via Artificial Intelligence algorithms. The negotiation space is generated via a multidisciplinary collaborative optimization method, infused by game theory and multi-attribute utility theory. In particular, game theory is able to model the negotiation process to reach the equilibria among stakeholder needs. Because of the huge dimension of the negotiation space, a collaborative optimization framework with evolutionary algorithm has been integrated in order to guide the game process to efficiently and rapidly searching for the Pareto equilibria among stakeholders. At last, the concept of utility constituted the mechanism to bridge the language barrier between experts of different backgrounds and differing needs, using the elicited and modeled needs to evaluate a multitude of alternatives. To highlight the benefits of the proposed methodology, the paper presents the design of a CubeSat mission for the observation of lunar radiation environment. The derived solution results able to balance all stakeholders needs and guaranteeing the effectiveness of the selection mission concept thanks to its robustness in valuable changeability. The benefits provided by the proposed design methodology are highlighted, and further development proposed.

Keywords: concurrent engineering, artificial intelligence, negotiation in engineering design, multidisciplinary optimization

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Authors: Pranee Suecharoen, Ratchadaporn Soontornpas, Jaturat Kanpittaya

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Background: Contrast media has an important role for disease diagnosis through detection of pathologies. Contrast media can, however, cause adverse reactions after administration of its agents. Although non-ionic contrast media are commonly used, the incidence of adverse events is relatively low. The most common reactions found (10.5%) were mild and manageable and/or preventable. Pharmacists can play an important role in evaluating adverse reactions, including awareness of the specific preparation and the type of adverse reaction. As most common types of adverse reactions are idiosyncratic or pseudo-allergic reactions, common standards need to be established to prevent and control adverse reactions promptly and effectively. Objective: To measure the effect of using tools for symptom evaluation in order to reduce the severity, or prevent the occurrence, of adverse reactions from contrast media. Methods: Retrospective review descriptive research with data collected on adverse reactions assessment and Naranjo’s algorithm between June 2015 and May 2016. Results: 158 patients (10.53%) had adverse reactions. Of the 1,500 participants with an adverse event evaluation, 137 (9.13%) had a mild adverse reaction, including hives, nausea, vomiting, dizziness, and headache. These types of symptoms can be treated (i.e., with antihistamines, anti-emetics) and the patient recovers completely within one day. The group with moderate adverse reactions, numbering 18 cases (1.2%), had hypertension or hypotension, and shortness of breath. Severe adverse reactions numbered 3 cases (0.2%) and included swelling of the larynx, cardiac arrest, and loss of consciousness, requiring immediate treatment. No other complications under close medical supervision were recorded (i.e., corticosteroids use, epinephrine, dopamine, atropine, or life-saving devices). Using the guideline, therapies are divided into general and specific and are performed according to the severity, risk factors and ingestion of contrast media agents. Patients who have high-risk factors were screened and treated (i.e., prophylactic premedication) for prevention of severe adverse reactions, especially those with renal failure. Thus, awareness for the need for prescreening of different risk factors is necessary for early recognition and prompt treatment. Conclusion: Studying adverse reactions can be used to develop a model for reducing the level of severity and setting a guideline for a standardized, multidisciplinary approach to adverse reactions.

Keywords: role of pharmacist, management of adverse reactions, guideline for contrast media, non-ionic contrast media

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Authors: Orit Baruth, Anat Cohen

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Online courses have become common in many learning programs and various learning environments, particularly in higher education. Social distancing forced in response to the COVID-19 pandemic has increased the demand for these courses. Yet, despite the frequency of use, online learning is not free of limitations and may not suit all learners. Hence, the growth of online learning alongside with learners' diversity raises the question: is online learning, as it currently offered, meets the needs of each learner? Fortunately, today's technology allows to produce tailored learning platforms, namely, personalization. Personality influences learner's satisfaction and therefore has a significant impact on learning effectiveness. A better understanding of personality can lead to a greater appreciation of learning needs, as well to assists educators ensure that an optimal learning environment is provided. In the context of online learning and personality, the research on learning design according to personality traits is lacking. This study explores the relations between personality traits (using the 'Big-five' model) and students' satisfaction with five techno-pedagogical learning solutions (TPLS): discussion groups, digital books, online assignments, surveys/polls, and media, in order to provide an online learning process to students' satisfaction. Satisfaction level and personality identification of 108 students who participated in a fully online learning course at a large, accredited university were measured. Cluster analysis methods (k-mean) were applied to identify learners’ clusters according to their personality traits. Correlation analysis was performed to examine the relations between the obtained clusters and satisfaction with the offered TPLS. Findings suggest that learners associated with the 'Neurotic' cluster showed low satisfaction with all TPLS compared to learners associated with the 'Non-neurotics' cluster. learners associated with the 'Consciences' cluster were satisfied with all TPLS except discussion groups, and those in the 'Open-Extroverts' cluster were satisfied with assignments and media. All clusters except 'Neurotic' were highly satisfied with the online course in general. According to the findings, dividing learners into four clusters based on personality traits may help define tailor learning paths for them, combining various TPLS to increase their satisfaction. As personality has a set of traits, several TPLS may be offered in each learning path. For the neurotics, however, an extended selection may suit more, or alternatively offering them the TPLS they less dislike. Study findings clearly indicate that personality plays a significant role in a learner's satisfaction level. Consequently, personality traits should be considered when designing personalized learning activities. The current research seeks to bridge the theoretical gap in this specific research area. Establishing the assumption that different personalities need different learning solutions may contribute towards a better design of online courses, leaving no learner behind, whether he\ she likes online learning or not, since different personalities need different learning solutions.

Keywords: online learning, personality traits, personalization, techno-pedagogical learning solutions

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Authors: Cathal Merz, Gareth O’Donnell

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Coil reinforced thin-walled (CRTW) tubes are used in medicine to treat problems affecting blood vessels within the body through minimally invasive procedures. The CRTW tube considered in this research makes up part of such a device and is inserted into the patient via their femoral or brachial arteries and manually navigated to the site in need of treatment. This procedure replaces the requirement to perform open surgery but is limited by reduction of blood vessel lumen diameter and increase in tortuosity of blood vessels deep in the brain. In order to maximize the capability of these procedures, CRTW tube devices are being manufactured with decreasing wall thicknesses in order to deliver treatment deeper into the body and to allow passage of other devices through its inner diameter. This introduces significant stresses to the device materials which have resulted in an observed increase in the breaking of the proximal segment of the device into two separate pieces after it has failed by buckling. As there is currently no international standard for measuring the mechanical properties of these CRTW tube devices, it is difficult to accurately analyze this problem. The aim of the current work is to address this discrepancy in the biomedical device industry by developing a measurement system that can be used to quantify the effect of process and design changes on CRTW tube performance, aiding in the development of better performing, next generation devices. Using materials testing frames, micro-computed tomography (micro-CT) imaging, experiment planning, analysis of variance (ANOVA), T-tests and regression analysis, test methods have been developed for assessing the impact of process and design changes on the device. The major findings of this study have been an insight into the suitability of buckle and three-point bend tests for the measurement of the effect of varying processing factors on the device’s performance, and guidelines for interpreting the output data from the test methods. The findings of this study are of significant interest with respect to verifying and validating key process and design changes associated with the device structure and material condition. Test method integrity evaluation is explored throughout.

Keywords: neurovascular catheter, coil reinforced tube, buckling, three-point bend, tensile

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Authors: Klea Ramaj

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Objectives: There have recently been increasing calls to better understand the intergenerational transmission of adverse childhood experiences (ACEs). In particular, little is known about the links between maternal (ACEs), maternal stress, maternal depression, and child abuse against toddlers in countries in South-East Europe. This paper, therefore, aims to present new descriptive data on the epidemiology of maternal mental well-being and maternal ACEs in the capital of Albania, Tirana. It also aims to advance our understanding of the overlap between maternal stress, maternal depression, maternal exposure to ACEs, and child abuse toward two-to-three-year-old. Methods: This is a cross-sectional study conducted with a representative sample of 328 mothers of two-to-three-year-olds, recruited through public nurseries located in 8 diverse socio-economic and geographical areas in Tirana, Albania. Maternal stress was measured through the perceived stress scale (α = 0.78); maternal depression was measured via the patient health questionnaire (α = 0.77); maternal exposure to ACEs was captured via the ACEs international questionnaire (α = 0.77); and child maltreatment was captured via ISPCAN ICAST-P (α = 0.66). The main outcome examined here will be child maltreatment. The paper will first present estimates of maternal stress, depression, and child maltreatment by demographic groups. It will then use multiple regression to examine associations between child maltreatment and risk factors in the domains of maternal stress, maternal depression, and maternal ACEs. Results: Mothers' mean age was 32.3 (SD = 4.24), 87.5% were married, 51% had one child, and 83.5% had completed higher education. Analyses show high levels of stress and exposure to childhood adversity among mothers in Tirana. 97.5% of mothers perceived stress during the last month, and 89% had experienced at least one childhood adversity as measured by the ACE questionnaire, with 20.2% having experienced 4+ ACEs. Analyses show significant positive associations between maternal ACEs and maternal stress r(325) = 0.25, p = 0.00. Mothers with a high number of ACEs were more likely to abuse their children r(327) = .43, p = 0.00. 32% of mothers have used physical discipline with their 2–3-year-old, 84% have used psychological discipline, and 35% have neglected their toddler at least once or twice. The mothers’ depression levels were also positively and significantly associated with child maltreatment r(327) = .34, p = 0.00. Conclusions: This study provides cross-sectional data on the link between maternal exposure to early adversity, maternal mental well-being, and child maltreatment within the context of Tirana, Albania. The results highlight the importance of establishing policies that encourage maternal support, positive parenting, and family well-being in order to help break the cycle of transgenerational violence.

Keywords: child maltreatment, maternal mental well-being, intergenerational abuse, Tirana, Albania

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Authors: Osama Moustafa Zayed

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Aim of the work: To evaluate the effectiveness of venous glucose, levels of serum lactate and base deficit in polytraumatized patients as simple parameters to predict the mortality in these patients. Compared to the predictive value of Trauma and injury severity (TRISS) and Acute Physiology And Chronic Health Evaluation IV (APACHE IV). Introduction: Trauma is a serious global health problem, accounting for approximately one in 10 deaths worldwide. Trauma accounts for 5 million deaths per year. Prediction of mortality in trauma patients is an important part of trauma care. Several trauma scores have been devised to predict injury severity and risk of mortality. The trauma and injury severity score (TRISS) was most common used. Regardless of the accuracy of trauma scores, is based on an anatomical description of every injury and cannot be assigned to the patients until a full diagnostic procedure has been performed. So we hypothesized that alterations in admission glucose, lactate levels and base deficit would be an early and easy rapid predictor of mortality. Patient and Method: a comparative cross-sectional study. 282 Polytraumatized patients attended to the Emergency Department(ED) of the Suez Canal university Hospital constituted. The period from 1/1/2012 to 1/4/2013 was included. Results: We found that the best cut off value of TRISS probability of survival score for prediction of mortality among poly-traumatized patients is = 90, with 77% sensitivity and 89% specificity using area under the ROC curve (0.89) at (95%CI). APACHE IV demonstrated 67% sensitivity and 95% specificity at 95% CI at cut off point 99. The best cutoff value of Random Blood Sugar (RBS) for prediction of mortality was>140 mg/dl, with 89%, sensitivity, 49% specificity. The best cut off value of base deficit for prediction of mortality was less than -5.6 with 64% sensitivity, 93% specificity. The best cutoff point of lactate for prediction of mortality was > 2.6 mmol/L with 92%, sensitivity, 42% specificity. Conclusion: According to our results from all evaluated predictors of mortality (laboratory and scores) and mortality based on the estimated cutoff values using ROC curves analysis, the highest risk of mortality was found using a cutoff value of 90 in TRISS score while with laboratory parameters the highest risk of mortality was with serum lactate > 2.6 . Although that all of the three parameter are accurate in predicting mortality in poly-traumatized patients and near with each other, as in serum lactate the area under the curve 0.82, in BD 0.79 and 0.77 in RBS.

Keywords: APACHE IV, emergency department, polytraumatized patients, serum lactate

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Authors: Petr Daniel Edward Kovarik, Malcolm Jackson, Charles Kelly, Rahul Patil, Shahid Iqbal

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Introduction: Recognition of the presence of extra capsular spread (ECS) has been a major change in the TNM 8th edition published by the American Joint Committee on Cancer in 2018. Irrespective of the size or number of lymph nodes, the presence of ECS makes N3b disease a stage IV disease. The objective of this retrospective observational study was to conduct a comparative analysis of survival outcomes in patients with lymph node-positive cutaneous head and neck squamous cell carcinoma (CHNSCC) based on their TNM 7th and TNM 8th editions classification. Materials and Methods: From January 2010 to December 2020, 71 patients with CHNSCC were identified from our centre’s database who were treated with radical surgery and adjuvant radiotherapy. All histopathological reports were reviewed, and comprehensive nodal mapping was performed. The data were collected retrospectively and survival outcomes were compared using TNM 7th and 8th editions. Results: The median age of the whole group of 71 patients was 78 years, range 54 – 94 years, 63 were male and 8 female. In total, 2246 lymph nodes were analysed; 195 were positive for cancer. ECS was present in 130 lymph nodes, which led to a change in TNM staging. The details on N-stage as per TNM 7th edition was as follows; pN1 = 23, pN2a = 14, pN2b = 32, pN2c = 0, pN3 = 2. After incorporating the TNM 8th edition criterion (presence of ECS), the details on N-stage were as follows; pN1 = 6, pN2a = 5, pN2b = 3, pN2c = 0, pN3a = 0, pN3b = 57. This showed an increase in overall stage. According to TNM 7th edition, there were 23 patients were with stage III and remaining 48 patients, stage IV. As per TNM 8th edition, there were only 6 patients with stage III as compared to 65 patients with stage IV. For all patients, 2-year disease specific survival (DSS) and overall survival (OS) were 70% and 46%. 5-year DSS and OS rates were 66% and 20% respectively. Comparing the survival between stage III and stage IV of the two cohorts using both TNM 7th and 8th editions, there is an obvious greater survival difference between the stages if TNM 8th staging is used. However, meaningful statistics were not possible as the majority of patients (n = 65) were with stage IV and only 6 patients were stage III in the TNM 8th cohort. Conclusion: Our study provides a comprehensive analysis on lymph node data mapping in this specific patient population. It shows a better differentiation between stage III and stage IV in the TNM 8th edition as compared to TNM 7th however meaningful statistics were not possible due to the imbalance of patients in the sub-cohorts of the groups.

Keywords: cutaneous head and neck squamous cell carcinoma, extra capsular spread, neck lymphadenopathy, TNM 7th and 8th editions

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Authors: İlknur Gökşin, Sultan Ayaz Alkaya

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Objective: Progressive muscle relaxation (PMR) include the deliberate stretching and relaxation of the major muscle groups of the human body. This study was conducted to evaluate the effect of PMR applied in women on the postpartum depression and general comfort level. Methods: The study population of this quasi-experimental study with pre-test, post-test and control group consisted of primipara women who had vaginal delivery in the obstetric service of a university hospital. The experimental and control groups consisted of 35 women each. The data were collected by questionnaire, the Edinburgh Postnatal Depression Scale (EPDS) and the General Comfort Questionnaire (GCQ). The women were matched according to their age and education level and divided into the experimental and control groups by simple random selection. Postpartum depression risk and general comfort was evaluated at the 2nd and 5th days, 10th and 15th days, fourth week and eighth week after birth. The experimental group was visited at home and PMR was applied. After the first visit, women were asked to apply PMR regularly three times a week for eight weeks. During the application, the researcher called the participants twice a week to follow up the continuity of the application. No intervention was performed in the control group. For data analysis, descriptive statistics such as number, percentage, mean, standard deviation, significance test of difference between two means and ANOVA were used. Approval of the ethics committee and permission of the institution were obtained for the study. Results: There were no significant differences between the women in the experimental and control groups in terms of age, education status and employment status (p>0.05). There was no statistically significant difference between the experimental and control groups in terms of EPDS pre-test, 1st, 2nd and 3rd follow-up mean scores (p>0.05). There was a statistically significant difference between EPDS pre-test and 3rd follow-up scores of the experimental group (p<0.05), whereas there was no such difference in the control group (p>0.05). There was no statistically significant difference between the experimental and control groups in terms of mean GCQ pre-test scores (p>0.05), whereas in the 1st, 2nd and 3rd follow-ups there was a statistically significant difference between the mean GCQ scores (p<0.05). It was found that there was a significant increase in the GCQ physical, psychospiritual and sociocultural comfort sub-scales, relief and relaxation levels of the experimental group between the pre-test and 3rd follow-ups scores (p<0.05). And, a significant decrease was found between pre-test and 3rd follow-up GCQ psychospiritual, environmental and sociocultural comfort sub-scale, relief, relaxation and superiority levels (p<0.05). Conclusion: Progressive muscle relaxation was effective on reducing the postpartum depression risk and increasing general comfort. It is recommended to provide progressive muscle relaxation training to women in the postpartum period as well as ensuring the continuity of this practice.

Keywords: general comfort, postpartum depression, postpartum period, progressive muscle relaxation

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Authors: Tarek K. Jalouta, Jolietta R. Holliman, Kathryn R. Burke, Kathleen M. Bewley-Thomas

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Background: Chronic hepatitis C virus (HCV) infection is one of the leading causes of liver cirrhosis and hepatocellular carcinoma. In the United States, HCV screening awareness, treatment, and linkage to care are under continues ascending progress. However, still millions of people are asymptomatically infected and undiagnosed yet. Through this community mission, we sought to identify the best and the newest strategies to identify those infected people to educate them, link them to care and cure them. Methods: We have identified patients that did not have a prior HCV screening in our Electronic medical record (EMR) including all our different hospital locations (South Suburban Chicago, Northern, Western and Central Indiana). Providing education to all Primary care/Gastroenterology/Infectious diseases providers and staff in the clinic to increase awareness of the HCV screening. Health-related quality of life, chronic clinical complications, and demographics data were collected for each patient. All outcomes of HCV antibody-reactive and HCV RNA–positive results were identified and statistically analyzed. Results: From July 2016 to July 2018 we screened 35,720 individuals of birth cohort in our different Franciscan’s health medical centers. Of the screened population, 986 (2.7%) individuals were HCV AB-reactive. Of those, 319 (1%) patients were HCV RNA-positive, and 264 patients were counseled and linked to providers. 34 patients initiated anti-HCV therapy with successful treatment. Conclusions: Our HCV screening augmentation project considered the largest screening program in the Midwest. Augmenting the HCV screening process through creating a Best Practice Alert (BPA) in the EMR (Epic Sys.) and point of care testing could be helpful. Although continued work is required, our team is working on increase screening through adding HCV test to CBC-Panels in Emergency Department settings, phone calls to all birth cohort individuals through Robo-Calling System aimed to reach 75,000 individuals by 2019. However, a better linkage to care and referral monitoring system to all HCV RNA positive patients is still needed, and access to therapy, especially for uninsured patients, is challenging.

Keywords: chronic hepatitis C, chronic hepatitis C treatment, chronic hepatitis C screening, chronic hepatitis C prevention, liver cancer

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Authors: Agata Chudzicka-Czupała, Nadiya Hapon, Liudmyla Karamushka, Marta żywiołek-Szeja

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Objectives: The study is about the determinants of coping with stress connected with volunteer activity for Russo-Ukrainian war 2022 refugees. We examined the mental health reactions, chosen psychological traits, and motivational functions of volunteers working in Poland and Ukraine in relation to their coping with stress styles. The study was financed with funds from the Foundation for Polish Science in the framework of the FOR UKRAINE Programme. Material and Method: The study was conducted in 2022. The study was a quantitative, questionnaire-based survey. Data was collected through an online survey. The volunteers were asked to assess their propensity to use different styles of coping with stress connected with their activity for Russo-Ukrainian war refugees using The Brief Coping Orientation to Problems Experienced Inventory (Brief-COPE) questionnaire. Depression, anxiety, and stress were measured using the Depression, Anxiety, and Stress (DASS)-21 item scale. Chosen psychological traits, psychological capital and hardiness, were assessed by The Psychological Capital Questionnaire and The Norwegian Revised Scale of Hardiness (DRS-15R). Then The Volunteer Function Inventory (VFI) was used. The significance of differences between the variable means of the samples was tested by the Student's t-test. We used multivariate linear regression to identify factors associated with coping with stress styles separately for each national sample. Results: The sample consisted of 720 volunteers helping war refugees (in Poland, 435 people, and 285 in Ukraine). The results of the regression analysis indicate variables that are significant predictors of the propensity to use particular styles of coping with stress (problem-focused style, emotion-focused style and avoidant coping). These include levels of depression and stress, individual psychological characteristics and motivational functions, different for Polish and Ukrainians. Ukrainian volunteers are significantly more likely to use all three coping with stress styles than Polish ones. The results also prove significant differences in the severity of anxiety, stress and depression, the selected psychological traits and motivational functions studied, which led volunteers to participate in activities for war refugees. Conclusions: The results show that depression and stress severity, as well as psychological capital and hardiness, and motivational factors are connected with coping with stress behavior. The results indicate the need for increased attention to the well-being of volunteers acting under stressful conditions. They also prove the necessity of guiding the selection of people for specific types of volu

Keywords: anxiety, coping with stress styles, depression, hardiness, mental health, motivational functions, psychological capital, resilience, stress, war, volunteer, civil society

Procedia PDF Downloads 66

Authors: Daniel Thompson, Muhammad Peerbux, Sophie Cerutti, Hansraj Riteesh Bookun

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Patients with carotid stenosis, which may be asymptomatic or symptomatic in the form of transient ischaemic attack (TIA), amaurosis fugax, or stroke, often require an endarterectomy to reduce stroke risk. Risks of this procedure include stroke, death, myocardial infarction, and cranial nerve damage. Carotid endarterectomy is most commonly performed under general anaesthetic, however, it can also be undertaken with a regional anaesthetic approach. Our tertiary centre generally performs carotid endarterectomy under regional anaesthetic. Our major tertiary hospital mostly utilises regional anaesthesia for carotid endarterectomy. We completed a cross-sectional analysis of all cases of carotid endarterectomy performed under regional anaesthesia across a 10-year period between January 2010 to March 2020 at our institution. 350 patients were included in this descriptive analysis, and demographic details for patients, indications for surgery, procedural details, length of surgery, and complications were collected. Data was cross tabulated and presented in frequency tables to describe these categorical variables. 263 of the 350 patients in the analysis were male, with a mean age of 71 ± 9. 172 patients had a history of ischaemic heart disease, 104 had diabetes mellitus, 318 had hypertension, and 17 patients had chronic kidney disease greater than Stage 3. 13.1% (46 patients) were current smokers, and the majority (63%) were ex-smokers. Most commonly, carotid endarterectomy was performed conventionally with patch arterioplasty 96% of the time (337 patients). The most common indication was TIA and stroke in 64% of patients, 18.9% were classified as asymptomatic, and 13.7% had amaurosis fugax. There were few general complications, with 9 wound complications/infections, 7 postoperative haematomas requiring return to theatre, 3 myocardial infarctions, 3 arrhythmias, 1 exacerbation of congestive heart failure, 1 chest infection, and 1 urinary tract infection. Specific complications to carotid endarterectomy included 3 strokes, 1 postoperative TIA, and 1 cerebral bleed. There were no deaths in our cohort. This analysis of a large cohort of patients from a major tertiary centre who underwent carotid endarterectomy under regional anaesthesia indicates the safety of such an approach for these patients. Regional anaesthesia holds the promise of less general respiratory and cardiac events compared to general anaesthesia, and in this vulnerable patient group, calls for comparative research between local and general anaesthesia in carotid surgery.

Keywords: anaesthesia, carotid endarterectomy, stroke, carotid stenosis

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Authors: Perizat Aitmaganbet, Kerbez Kimatova, Gulmira Umarova

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As a result of medical check-up conducted in the framework of this research study an evaluation of the health status of the population living in the oil-producing regions, namely Sarkul and Kenkiyak villages in Aktobe was examined. With the help of the Spearman correlation, the connection between the level of hazard chemical elements in the atmosphere and the health of population living in the regions of oil and gas industry was estimated. Background & Objective. The oil and gas resource-extraction industries play an important role in improving the economic conditions of the Republic of Kazakhstan, especially for the oil-producing administrative regions. However, environmental problems may adversely affect the health of people living in that area. Thus, the aim of the study is to evaluate the exposure to negative environmental factors of the adult population living in Sarkul and Kenkiyak villages, the oil and gas producing areas in the Aktobe region. Methods. After conducting medical check-up among the population of Sarkul and Kenkiyak villages. A single cross-sectional study was conducted. The population consisted of randomly sampled 372 adults (181 males and 191 females). Also, atmospheric air probes were taken to measure the level of hazardous chemical elements in the air. The nonparametric method of the Spearman correlation analysis was performed between the mean concentration of substances exceeding the Maximum Permissible Concentration and the classes of newly diagnosed diseases. Selection and analysis of air samples were carried out according to the developed research protocol; the qualitative-quantitative analysis was carried out on the Gas analyzer HANK-4 apparatus. Findings. The medical examination of the population identified the following diseases: the first two dominant were diseases of the circulatory and digestive systems, in the 3rd place - diseases of the genitourinary system, and the nervous system and diseases of the ear and mastoid process were on the fourth and fifth places. Moreover, significant pollution of atmospheric air by carbon monoxide (MPC-5,0 mg/m3), benzapyrene (MPC-1mg/m3), dust (MPC-0,5 mg/m3) and phenol (МРС-0,035mg/m3) were identified in places. Correlation dependencies between these pollutants of air and the diseases of the population were established, as a result of diseases of the circulatory system (r = 0,7), ear and mastoid process (r = 0,7), nervous system (r = 0,6) and digestive organs(r = 0,6 ); between the concentration of carbon monoxide and diseases of the circulatory system (r = 0.6), the digestive system(r = 0.6), the genitourinary system (r = 0.6) and the musculoskeletal system; between nitric oxide and diseases of the digestive system (r = 0,7) and the circulatory system (r = 0,6); between benzopyrene and diseases of the digestive system (r = 0,6), the genitourinary system (r = 0,6) and the nervous system (r = 0,4). Conclusion. The positive correlation was found between air pollution and the health of the population living in Sarkul and Kenkiyak villages. To enhance the reliability of the results we are going to continue this study further.

Keywords: atmospheric air, chemical substances, oil and gas, public health

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Authors: Nisa Mohan

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Adverse drug event (ADE) related hospital admissions are common among older people. The first step in prevention is accurately estimating the prevalence of ADE admissions. Clinical coding is an efficient method to estimate the prevalence of ADE admissions. The objective of the study is to estimate the rate of under-coding of ADE admissions in older people in New Zealand and to explore how clinical coders decide whether or not to code an admission as an ADE. There has not been any research in New Zealand to explore these areas. This study is done using a mixed-methods approach. Two common and serious ADEs in older people, namely bleeding and hypoglycaemia were selected for the study. In study 1, eight hundred medical records of people aged 65 years and above who are admitted to hospital due to bleeding and hypoglycemia during the years 2015 – 2016 were selected for quantitative retrospective medical records review. This selection was made to estimate the proportion of ADE-related bleeding and hypoglycemia admissions that are not coded as ADEs. These files were reviewed and recorded as to whether the admission was caused by an ADE. The hospital discharge data were reviewed to check whether all the ADE admissions identified in the records review were coded as ADEs, and the proportion of under-coding of ADE admissions was estimated. In study 2, thirteen clinical coders were selected to conduct qualitative semi-structured interviews using a general inductive approach. Participants were selected purposively based on their experience in clinical coding. Interview questions were designed in a way to investigate the reasons for the under-coding of ADE admissions. The records review study showed that 35% (Cl 28% - 44%) of the ADE-related bleeding admissions and 22% of the ADE-related hypoglycemia admissions were not coded as ADEs. Although the quality of clinical coding is high across New Zealand, a substantial proportion of ADE admissions were under-coded. This shows that clinical coding might under-estimate the actual prevalence of ADE related hospital admissions in New Zealand. The interviews with the clinical coders added that lack of time for searching for information to confirm an ADE admission, inadequate communication with clinicians, along with coders’ belief that an ADE is a small thing might be the potential reasons for the under-coding of the ADE admissions. This study urges the coding policymakers, auditors, and trainers to engage with the unconscious cognitive biases and short-cuts of the clinical coders. These results highlight that further work is needed on interventions to improve the clinical coding of ADE admissions, such as providing education to coders about the importance of ADEs, education to clinicians about the importance of clear and confirmed medical records entries, availing pharmacist service to improve the detection and clear documentation of ADE admissions and including a mandatory field in the discharge summary about external causes of diseases.

Keywords: adverse drug events, bleeding, clinical coders, clinical coding, hypoglycemia

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Authors: Remi Szauer

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Introductory, Background, and Importance of the Study: For many years, religiosity in Poland remained at a stable level of religious practice. When the symptoms of secularization and privatization processes appeared in Poland, it was not clearly felt but rather related to the decline in compulsory practices carried out in public, the growing distance of respondents to catholic ethic, and the lack of acceptance regarding the intervention of the Church in legislation and policy. The basic indicators observed over the years kept the picture: more religious women - less religious men. By carrying out own research in the field of religious and moral attitudes in 2019-2021, it was noticed that a reversal of the trend preserved over the years could be observed. The data showed that women under 40 are radically different in their responses than women older than them - especially those over 50: in terms of practices or ties with the Church and many more specific aspects. This became the basis for a careful examination of the responses in the under 40 age cohorts among women. This study is significant because it shows completely new perspectives of women's perception of religiosity and allows us to notice clearly the aspects of social changes mapped in the minds of the surveyed women. Research Methodology: The original survey was carried out using the quantitative method among 2,346 respondents in northern Poland, 1,349 of whom were women. The findings from these observations led to deepening the topic of beliefs of women under 40 compared to other age cohorts of women. Hence, studies were carried out on the general population of women in Poland, which constituted a comparative sample. These were panel studies. The selection of the sample among women was random, respecting the age amounts so that the two statistical groups could be compared. The designated research parameters included: declarations of religious faith, declarations of religious practice, bond with the Church, acceptance of Mariological dogmas, attitude towards the image of women in the Church, and acceptance of selected issues in Catholic ethics. Main Research Findings: Among women under 40, the decline in declarations not only concerning compulsory public practices but also private practices and declarations of religious faith is more pronounced. Not only is the range of indifferent religious attitudes increasing, but also attitudes directly declaring religious disbelief, for which there are important justifications. Women under 40 years of age strongly distance themselves from the institutions of the Church and from accepting Mariological dogmas. Moreover, they note that the image of a woman is marked by stereotyping, favoring the intensification of violence against women, as well as disregarding her potential and agency. Concluding Statement: By analyzing the answers of the female respondents and the data obtained in the research, it can be observed a reevaluation of women's beliefs, which opens the perspective of analyzing the role of religion and the Church in Poland as well as religious socialization.

Keywords: religiosity, morality, gender, feminism, social change

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Authors: Sharon Milberger, Jane Turner, Denise White-Perkins

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Michigan shares the overall U.S. national need for more highly qualified professionals who have knowledge and experience in the use of evidence-based practices to meet the special health care needs of children, adolescents, and adults with neurodevelopmental disabilities including autism spectrum disorder (DD/ASD). The Michigan Leadership Education in Neurodevelopmental Disabilities (MI-LEND) program is a consortium of six universities that spans the state of Michigan and serves more than 181,800 undergraduate, graduate, and professional students. The purpose of the MI LEND program is to improve the health of infants, children and adolescents with disabilities in Michigan by training individuals from different disciplines to assume leadership roles in their respective fields and work across disciplines. The MI-LEND program integrates “L.I.F.E.” perspectives into all training components. L.I.F.E. is an acronym for Leadership, Interdisciplinary, Family-Centered and Equity perspectives. This paper will describe how L.I.F.E. perspectives are embedded into all aspects of the MI-LEND training program including the application process, didactic training, community and clinical experiences, discussions, journaling and projects. Specific curriculum components will be described including content from a training module dedicated to Equity. Upon completion of the Equity module, trainees are expected to be able to: 1) Use a population health framework to identify key social determinants impacting families and children; 2) Explain how addressing bias and providing culturally appropriate linguistic care/services can influence patient/client health and wellbeing; and 3) Describe the impact of policy and structural/institutional factors influencing care and services for children with DD/ASD and their families. Each trainee completes two self-assessments: the Cultural and Linguistic Competence Health Practitioner Assessment and the other assessing social attitudes/implicit bias. Trainees also conduct interviews with a family with a child with DD/ASD. In addition, interdisciplinary Equity-related group activities are incorporated into face-to-face training sessions. Each MI-LEND trainee has multiple ongoing opportunities for self-reflection through discussion and journaling and completion of a L.I.F.E. project as a culminating component of the program. The poster will also discuss the challenges related to teaching and measuring successful outcomes related to diversity/equity perspectives.

Keywords: disability, diversity, equity, training

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Authors: Diana Cunha, Catarina Coelho, Ana Paula Relvas, Elisabeth Kastenholz

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Context: Tourist experiences have a recognized impact on the well-being of individuals. However, studies on the specific benefits of tourist experiences for families are scattered across different disciplines. This study aims to systematically review the literature to synthesize the evidence on the benefits of tourist experiences for families. Research Aim: The main objective is to systematize the evidence in the literature regarding the benefits of tourist experiences for families. Methodology: A systematic literature review was conducted using Nvivo, analyzing 33 scientific studies obtained from various databases. The search terms used were "family"/ "couple" and "tourist experience". The studies included quantitative, qualitative, mixed methods, and literature reviews. All works prior to the year 2000 were excluded, and the search was restricted to full text. A language filter was also used, considering articles in Portuguese, English, and Spanish. For NVivo analysis, information was coded based on both deductive and inductive perspectives. To minimize the subjectivity of the selection and coding process, two of the authors discussed the process and agreed on criteria that would make the coding more objective. Once the coding process in NVivo was completed, the data relating to the identification/characterization of the works were exported to the Statistical Package for the Social Sciences (SPPS), to characterize the sample. Findings: The results highlight that tourist experiences have several benefits for family systems, including the strengthening of family and marital bonds, the creation of family memories, and overall well-being and life satisfaction. These benefits contribute to both immediate relationship quality improvement and long-term family identity construction and transgenerational transmission. Theoretical Importance: This study emphasizes the systemic nature of the effects and relationships within family systems. It also shows that no harm was reported within these experiences, with only some challenges related to positive outcomes. Data Collection and Analysis Procedures: The study collected data from 33 scientific studies published predominantly after 2013. The data were analyzed using Nvivo, employing a systematic review approach. Question Addressed: The study addresses the question of the benefits of tourist experiences for families and how these experiences contribute to family functioning and individual well-being. Conclusion: Tourist experiences provide opportunities for families to enhance their interpersonal relationships and create lasting memories. The findings suggest that formal interventions based on evidence could further enhance the potential benefits of these experiences and be a valuable preventive tool in therapeutic interventions.

Keywords: family systems, individual and family well-being, marital satisfaction, tourist experiences

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Authors: Bechir Hbibi, Lamine Mili

Abstract:

Understanding the condition of comatose patients can be difficult, but it is crucial to their optimal treatment. Consequently, numerous scoring systems have been developed around the world to categorize patient states based on physiological assessments. Although validated and widely adopted by medical communities, these scores still present numerous limitations and obstacles. Even with the addition of additional tests and extensions, these scoring systems have not been able to overcome certain limitations, and it appears unlikely that they will be able to do so in the future. On the other hand, physiological tests are not the only way to extract ideas about comatose patients. EEG signal analysis has helped extensively to understand the human brain and human consciousness and has been used by researchers in the classification of different levels of disease. The use of EEG in the ICU has become an urgent matter in several cases and has been recommended by medical organizations. In this field, the EEG is used to investigate epilepsy, dementia, brain injuries, and many other neurological disorders. It has recently also been used to detect pain activity in some regions of the brain, for the detection of stress levels, and to evaluate sleep quality. In our recent findings, our aim was to use multifractal analysis, a very successful method of handling multifractal signals and feature extraction, to establish a state of awareness scale for comatose patients based on their electrical brain activity. The results show that this score could be instantaneous and could overcome many limitations with which the physiological scales stock. On the contrary, multifractal analysis stands out as a highly effective tool for characterizing non-stationary and self-similar signals. It demonstrates strong performance in extracting the properties of fractal and multifractal data, including signals and images. As such, we leverage this method, along with other features derived from EEG signal recordings from comatose patients, to develop a scale. This scale aims to accurately depict the vigilance state of patients in intensive care units and to address many of the limitations inherent in physiological scales such as the Glasgow Coma Scale (GCS) and the FOUR score. The results of applying version V0 of this approach to 30 patients with known GCS showed that the EEG-based score similarly describes the states of vigilance but distinguishes between the states of 8 sedated patients where the GCS could not be applied. Therefore, our approach could show promising results with patients with disabilities, injected with painkillers, and other categories where physiological scores could not be applied.

Keywords: coma, vigilance state, EEG, multifractal analysis, feature extraction

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Authors: T. Mcgraw, F. N. Morin, N. Desai

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Background: Antimicrobial resistance is a critical issue in global health care and a significant contributor to increased patient morbidity and mortality. Suspected urinary tract infection (UTI) is a key area of inappropriate antibiotic prescription in pediatrics. Management patterns of infectious diseases have been shown to vary by provider type within a single setting. The aim of this study was to assess compliance with national UTI management guidelines by nurse practitioners in a pediatric emergency department (ED). Methods: This was a post-hoc analysis of a retrospective cohort study to review and evaluate visits to a tertiary care freestanding pediatric emergency department. Patients were included if they were 60 days to 36 months old and discharged with a diagnosis of UTI or ‘rule-out UTI’ between July 2015 and July 2020. Primary outcome measure was proportion of visits seen by Nurse Practitioners (NP) which were associated with national guideline compliance in the diagnosis and treatment of suspected UTI. We performed descriptive statistics and comparative analyses to determine differences in practice patterns between NPs, and physicians. Results: A total of 636 charts were reviewed, of which 402 patients met inclusion criteria. 17 patients were treated by NPs, 385 were treated by either Pediatric Emergency Medicine physicians (PEM) or non-PEM physicians. Overall, the proportion of infants receiving guideline-compliant care was 25.9% (21.8-30.4%). Of those who were prescribed antibiotics, 79.6% (74.7-83.8%) received first line guideline recommended therapy and 58.9% (53.8-63.8%) received fully compliant therapy with respect to age, dose, duration, and frequency. In patients treated by NPs, 16/17 (94%(95% CI:73.0-99.0)) required antibiotics, 15/16 (93%(95% CI: 71.7-98.9)) were treated with first line agent (cephalexin), 8/16 (50%(95% CI:28-72)) were guideline compliant of dose and duration. 5/8 (63%(95% CI:30.6-86.3)) were noncompliant for dose being too high. There was no difference in receiving guideline compliant empiric antibiotic therapy between physicians and nurse practitioners (OR: 0.837 CI: 0.302-2.69). Conclusion: In this post-hoc analysis, guideline noncompliance by nurse practitioners is common in children tested and treated for UTIs in a pediatric emergency department. Care by a Nurse Practitioner was not associated with greater rate of noncompliance than care by a Pediatric Emergency Medicine physician. Future appropriately powered studies may focus on confirming these results.

Keywords: antibiotic stewardship, infectious disease, nurse practitioner, urinary tract infection

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