Search results for: clinical error

Authors: Naji Ali Albakay, Abdulrahman Alothaim, Isa Barshushi

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The most common quadrature amplitude modulator (QAM) applies two Mach-Zehnder Modulators (MZM) and one phase shifter to generate high order modulation format. The bias of MZM changes over time due to temperature, vibration, and aging factors. The change in the biasing causes distortion to the generated QAM signal which leads to deterioration of bit error rate (BER) performance. Therefore, it is critical to be able to lock MZM’s Q point to the required operating point for good performance. We propose a technique for automatic bias control (ABC) of QAM transmitter using BER measurements and gradient descent optimization algorithm. The proposed technique is attractive because it uses the pertinent metric, BER, which compensates for bias drifting independently from other system variations such as laser source output power. The proposed scheme performance and its operating principles are simulated using OptiSystem simulation software for 4-QAM and 16-QAM transmitters.

Keywords: automatic bias control, optical fiber communication, optical modulation, optical devices

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Authors: Amulya P. Rao, Prathima S., Sreedevi N.

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Speech sound disorders (SSD) encompass the major concern in younger population of India with highest prevalence rate among the speech disorders. Children with SSD if not identified and rehabilitated at the earliest, are at risk for academic difficulties. This necessitates early identification using screening tools assessing the frequently misarticulated speech sounds. The literature on frequently misarticulated speech sounds is ample in English and other western languages targeting individuals with various communication disorders. Articulation is language specific, and there are limited studies reporting the same in Kannada, a Dravidian Language. Hence, the present study aimed to identify the frequently misarticulated consonants in Kannada and also to examine the error type. A retrospective, descriptive study was carried out using secondary data analysis of 41 participants (34-phonetic type and 7-phonemic type) with SSD in the age range 3-to 12-years. All the consonants of Kannada were analyzed by considering three words for each speech sound from the Kannada Diagnostic Photo Articulation test (KDPAT). Picture naming task was carried out, and responses were audio recorded. The recorded data were transcribed using IPA 2018 broad transcription. A criterion of 2/3 or 3/3 error productions was set to consider the speech sound to be an error. Number of error productions was calculated for each consonant in each participant. Then, the percentage of participants meeting the criteria were documented for each consonant to identify the frequently misarticulated speech sound. Overall results indicated that velar /k/ (48.78%) and /g/ (43.90%) were frequently misarticulated followed by voiced retroflex /ɖ/ (36.58%) and trill /r/ (36.58%). The lateral retroflex /ɭ/ was misarticulated by 31.70% of the children with SSD. Dentals (/t/, /n/), bilabials (/p/, /b/, /m/) and labiodental /v/ were produced correctly by all the participants. The highly misarticulated velars /k/ and /g/ were frequently substituted by dentals /t/ and /d/ respectively or omitted. Participants with SSD-phonemic type had multiple substitutions for one speech sound whereas, SSD-phonetic type had consistent single sound substitutions. Intra- and inter-judge reliability for 10% of the data using Cronbach’s Alpha revealed good reliability (0.8 ≤ α < 0.9). Analyzing a larger sample by replicating such studies will validate the present study results.

Keywords: consonant, frequently misarticulated, Kannada, SSD

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Authors: Aneena Suresh, C. S. Sidharth

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Drug related problems (DRPs) are common in chronic kidney disease (CKD) patients and end stage patients undergoing hemodialysis. To treat the co-morbid conditions of the patients, more complex therapeutic regimen is required, and it leads to development of DRPs. So, this calls for frequent monitoring of the patients. Due to the busy work schedules, physicians are unable to deliver optimal care to these patients. Addition of a clinical pharmacist in the team will improve the standard of care offered to CKD patients by minimizing DRPs. In India, the role of clinical pharmacists in the improving the health outcomes in CKD patients is poorly recognized. Therefore, this study is conducted to put an insight on the role of clinical pharmacist in improving Drug Related Problems in patients with chronic kidney disease, thereby helping them to achieve desired therapeutic outcomes in the patients. A prospective interventional study was conducted for a year in a 620 bedded tertiary care hospital in India. Data was collected using an unstructured questionnaire, medication charts, etc. DRPs were categorized using Hepler and Strand classification. Relationships between the age, weight, GFR, average no of medication taken, average no of comorbidities, and average length of hospital days with the DRPs were identified using Mann Whitney U test. The study population primarily constituted of patients above the age of 50 years with a mean age of 59.91±13.59. Our study showed that 25% of the population presented with DRPs. On an average, CKD patients are prescribed at least 8 medications for the treatment in our study. This explains the high incidence of drug interactions in patients suffering from CKD (45.65%). The least common DRPs in our study were found to be sub therapeutic dose (2%) and adverse drug reactions (2%). Out of this, 60 % of the DRPs were addressed successfully. In our study, there is an association between the DRPs with the average number of medications prescribed, the average number of comorbidities, and the length of the hospital days with p value of 0.022, 0.004, and 0.000, respectively. In the current study, 86% of the proposed interventions were accepted, and 41 % were implemented by the physician, and only 14% were rejected. Hence, it is evident that clinical pharmacist interventions will contribute significantly to diminish the DRPs in CKD patients, thereby decreasing the economic burden of healthcare costs and improving patient’s quality of life.

Keywords: chronic kidney disease, clinical pharmacist, drug related problem, intervention

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Authors: T. Nishimura, K. Doi, H. Fujimoto, T. Wada

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We conducted perception experiments on tactile symbols to elucidate the impact of the size of these letters on the level of perceptibility. This study was based on the accessible design perspective and aimed at expanding the availability of tactile symbols for the visually impaired who are unable to read Braille characters. In particular, this study targeted people with acquired visual impairments as users of the tactile symbols. The subjects (young and elderly individuals) in this study had normal vision. They were asked to participate in the experiments to identify tactile symbols while unable to see their hand during the experiments. This study investigated the relation between the size and perceptibility of tactile symbols based on an examination using test pieces of these letters in different sizes. The results revealed that the error rates for both young and elderly subjects converged to almost 0% when 12 mm size tactile symbols were used. The findings also showed that the error rate was low and subjects could identify the symbols in 5 s when 16 mm size tactile symbols were introduced.

Keywords: accessible design, tactile sense, tactile symbols, bioinformatic

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Authors: Sheikh Shams Azam, Manoj Raju, Venkatesh Pagidimarri, Vamsi Kasivajjala

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Over the past decade, there has been a steep rise in the data-driven analysis in major areas of medicine, such as clinical decision support system, survival analysis, patient similarity analysis, image analytics etc. Most of the data in the field are well-structured and available in numerical or categorical formats which can be used for experiments directly. But on the opposite end of the spectrum, there exists a wide expanse of data that is intractable for direct analysis owing to its unstructured nature which can be found in the form of discharge summaries, clinical notes, procedural notes which are in human written narrative format and neither have any relational model nor any standard grammatical structure. An important step in the utilization of these texts for such studies is to transform and process the data to retrieve structured information from the haystack of irrelevant data using information retrieval and data mining techniques. To address this problem, the authors present Q-Map in this paper, which is a simple yet robust system that can sift through massive datasets with unregulated formats to retrieve structured information aggressively and efficiently. It is backed by an effective mining technique which is based on a string matching algorithm that is indexed on curated knowledge sources, that is both fast and configurable. The authors also briefly examine its comparative performance with MetaMap, one of the most reputed tools for medical concepts retrieval and present the advantages the former displays over the latter.

Keywords: information retrieval, unified medical language system, syntax based analysis, natural language processing, medical informatics

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Authors: Hendri Purwadi, Christine McCloud

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Triage is a complex decision-making process that aims to categorize a victim’s level of acuity and the need for medical assistance. Two common triage systems have been widely used in Mass Casualty Incidents (MCIs) and disaster situation are START (Simple triage algorithm and rapid treatment) and SALT (sort, asses, lifesaving, intervention, and treatment/transport). There is currently controversy regarding the effectiveness of SALT over START triage system. This systematic review aims to investigate and compare the effectiveness between SALT and START triage system in disaster and MCIs setting. Literatures were searched via systematic search strategy from 2009 until 2019 in PubMed, Cochrane Library, CINAHL, Scopus, Science direct, Medlib, ProQuest. This review included simulated-based and medical record -based studies investigating the accuracy and applicability of SALT and START triage systems of adult and children population during MCIs and disaster. All type of studies were included. Joana Briggs institute critical appraisal tools were used to assess the quality of reviewed studies. As a result, 1450 articles identified in the search, 10 articles were included. Four themes were identified by review, they were accuracy, under-triage, over-triage and time to triage per individual victim. The START triage system has a wide range and inconsistent level of accuracy compared to SALT triage system (44% to 94. 2% of START compared to 70% to 83% of SALT). The under-triage error of START triage system ranged from 2.73% to 20%, slightly lower than SALT triage system (7.6 to 23.3%). The over-triage error of START triage system was slightly greater than SALT triage system (START ranged from 2% to 53% compared to 2% to 22% of SALT). The time for applying START triage system was faster than SALT triage system (START was 70-72.18 seconds compared to 78 second of SALT). Consequently; The START triage system has lower level of under-triage error and faster than SALT triage system in classifying victims of MCIs and disaster whereas SALT triage system is known slightly more accurate and lower level of over-triage. However, the magnitude of these differences is relatively small, and therefore the effect on the patient outcomes is not significance. Hence, regardless of the triage error, either START or SALT triage system is equally effective to triage victims of disaster and MCIs.

Keywords: disaster, effectiveness, mass casualty incidents, START triage system, SALT triage system

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Authors: Ebrahim Ghanbari, Mohammad Reza Nematollahi

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Integrating deterministic and probabilistic safety assessment (IDPSA) is one of the most commonly used issues in the field of safety analysis of power plant accident. It has also been recognized today that the role of human error in creating these accidents is not less than systemic errors, so the human interference and system errors in fault and event sequences are necessary. The integration of these analytical topics will be reflected in the frequency of core damage and also the study of the use of water resources in an accident such as the loss of all electrical power of the plant. In this regard, the SBO accident was simulated for the pressurized water reactor in the deterministic analysis issue, and by analyzing the operator's behavior in controlling the accident, the results of the combination of deterministic and probabilistic assessment were identified. The results showed that the best performance of the plant operator would reduce the risk of an accident by 10%, as well as a decrease of 6.82 liters/second of the water sources of the plant.

Keywords: IDPSA, human error, SBO, risk

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Authors: Lik Hang Gary Wong

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Background: Practice learning is crucial for preparing the healthcare profession to meet the real challenge upon graduation. Students are required to demonstrate their competence in managing interpersonal challenges, such as teamwork with other professionals and communicating well with the service users, during the placement. Such competence precedes clinical practice, and it may eventually affect students' actual performance in a clinical context. Unfortunately, there were limited studies investigating how such competence affects students' performance in practice learning. Objectives: The aim of this study is to investigate how self-rated interpersonal competence affects students' actual performance during clinical placement. Methods: 40 occupational therapy students from Hong Kong were recruited in this study. Prior to the clinical placement (level two or above), they completed an online survey that included the Interpersonal Communication Competence Scale (ICCS) measuring self-perceived competence in interpersonal communication. Near the end of their placement, the clinical educator rated students’ performance with the Student Practice Evaluation Form - Revised edition (SPEF-R). The SPEF-R measures the eight core competency domains required for an entry-level occupational therapist. This study adopted the cross-sectional observational design. Pearson correlation and multiple regression are conducted to examine the relationship between students' interpersonal communication competence and their actual performance in clinical placement. Results: The ICCS total scores were significantly correlated with all the SPEF-R domains, with correlation coefficient r ranging from 0.39 to 0.51. The strongest association was found with the co-worker communication domain (r = 0.51, p < 0.01), followed by the information gathering domain (r = 0.50, p < 0.01). Regarding the ICCS total scores as the independent variable and the rating in various SPEF-R domains as the dependent variables in the multiple regression analyses, the interpersonal competence measures were identified as a significant predictor of the co-worker communication (R² = 0.33, β = 0.014, SE = 0.006, p = 0.026), information gathering (R² = 0.27, β = 0.018, SE = 0.007, p = 0.011), and service provision (R² = 0.17, β = 0.017, SE = 0.007, p = 0.020). Moreover, some specific communication skills appeared to be especially important to clinical practice. For example, immediacy, which means whether the students were readily approachable on all social occasions, correlated with all the SPEF-R domains, with r-values ranging from 0.45 to 0.33. Other sub-skills, such as empathy, interaction management, and supportiveness, were also found to be significantly correlated to most of the SPEF-R domains. Meanwhile, the ICCS scores correlated differently with the co-worker communication domain (r = 0.51, p < 0.01) and the communication with the service user domain (r = 0.39, p < 0.05). It suggested that different communication skill sets would be required for different interpersonal contexts within the workplace. Conclusion: Students' self-perceived interpersonal communication competence could predict their actual performance during clinical placement. Moreover, some specific communication skills were more important to the co-worker communication but not to the daily interaction with the service users. There were implications on how to better prepare the students to meet the future challenge upon graduation.

Keywords: interpersonal competence, clinical education, healthcare professional education, occupational therapy, occupational therapy students

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Authors: P. Venu, Joeju M. Issac

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Quality Function Deployment (QFD) is a systematic technique that creates a platform where the customer responses can be positively converted to design attributes. The accuracy of a QFD process heavily depends on the data that it is handling which is captured from customers or QFD team members. Customized computer programs that perform Quality Function Deployment within a stipulated time have been used by various companies across the globe. These programs heavily rely on storage and retrieval of the data on a common database. This database must act as a perfect source with minimum missing values or error values in order perform actual prioritization. This paper introduces a missing/error data handler module which uses Genetic Algorithm and Fuzzy numbers. The prioritization of customer requirements of sesame oil is illustrated and a comparison is made between proposed data handler module-based deployment and manual deployment.

Keywords: hybrid data handler, QFD, prioritization, module-based deployment

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Authors: Paramjit Kaur, Harish Kundra

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In the recent years, swarm intelligence based firefly algorithm has become a great focus for the researchers to solve the real time optimization problems. Here, firefly algorithm is used for the application of satellite image classification. For experimentation, Alwar area is considered to multiple land features like vegetation, barren, hilly, residential and water surface. Alwar dataset is considered with seven band satellite images. Firefly Algorithm is based on the attraction of less bright fireflies towards more brightener one. For the evaluation of proposed concept accuracy assessment parameters are calculated using error matrix. With the help of Error matrix, parameters of Kappa Coefficient, Overall Accuracy and feature wise accuracy parameters of user’s accuracy & producer’s accuracy can be calculated. Overall results are compared with BBO, PSO, Hybrid FPAB/BBO, Hybrid ACO/SOFM and Hybrid ACO/BBO based on the kappa coefficient and overall accuracy parameters.

Keywords: image classification, firefly algorithm, satellite image classification, terrain classification

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Authors: Yi-Hsiu Lai

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The present study aimed to elucidate the lexical-semantic processing for Chinese as second language (CSL) learners. Twenty L1 speakers of Chinese and twenty CSL learners in Taiwan participated in a picture naming task and a category fluency task. Based on their Chinese proficiency levels, these CSL learners were further divided into two sub-groups: ten CSL learners of elementary Chinese proficiency level and ten CSL learners of intermediate Chinese proficiency level. Instruments for the naming task were sixty black-and-white pictures: thirty-five object pictures and twenty-five action pictures. Object pictures were divided into two categories: living objects and non-living objects. Action pictures were composed of two categories: action verbs and process verbs. As in the naming task, the category fluency task consisted of two semantic categories – objects (i.e., living and non-living objects) and actions (i.e., action and process verbs). Participants were asked to report as many items within a category as possible in one minute. Oral productions were tape-recorded and transcribed for further analysis. Both error types and error frequency were calculated. Statistical analysis was further conducted to examine these error types and frequency made by CSL learners. Additionally, category effects, pictorial effects and L2 proficiency were discussed. Findings in the present study helped characterize the lexical-semantic process of Chinese naming in CSL learners of different Chinese proficiency levels and made contributions to Chinese vocabulary teaching and learning in the future.

Keywords: lexical-semantic processing, Mandarin Chinese, naming, category effects

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Authors: Jee-Young Lee, Joaquim J. Ferreira, Hyeo-il Ma, José-Francisco Rocha, Beomseok Jeon

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The effective management of wearing-off is a key driver of medication changes for patients with Parkinson’s disease (PD) treated with levodopa (L-DOPA). While L-DOPA is well tolerated and efficacious, its clinical utility over time is often limited by the development of complications such as dyskinesia. Still, common first-line option includes adjusting the daily L-DOPA dose followed by adjunctive therapies usually counting for the L-DOPA equivalent daily dose (LEDD). The LEDD conversion formulae are a tool used to compare the equivalence of anti-PD medications. The aim of this work is to compare the effects of opicapone (OPC) 50 mg, a catechol-O-methyltransferase (COMT) inhibitor, and an additional 100 mg dose of L-DOPA in reducing the off time in PD patients with early motor fluctuations receiving different daily L-DOPA doses. OPC was found to be well tolerated and efficacious in advanced PD population. This work utilized patients' home diary data from a 4-week Phase 2 pharmacokinetics clinical study. The Korean ADOPTION study randomized (1:1) patients with PD and early motor fluctuations treated with up to 600 mg of L-DOPA given 3–4 times daily. The main endpoint was change from baseline in off time in the subgroup of patients receiving 300–400 mg/day L-DOPA at baseline plus OPC 50 mg and in the subgroup receiving >300 mg/day L-DOPA at baseline plus an additional dose of L-DOPA 100 mg. Of the 86 patients included in this subgroup analysis, 39 received OPC 50 mg and 47 L-DOPA 100 mg. At baseline, both L-DOPA total daily dose and LEDD were lower in the L-DOPA 300–400 mg/day plus OPC 50 mg group than in the L-DOPA >300 mg/day plus L-DOPA 100 mg. However, at Week 4, LEDD was similar between the two groups. The mean (±standard error) reduction in off time was approximately three-fold greater for the OPC 50 mg than for the L-DOPA 100 mg group, being -63.0 (14.6) minutes for patients treated with L-DOPA 300–400 mg/day plus OPC 50 mg, and -22.1 (9.3) minutes for those receiving L-DOPA >300 mg/day plus L-DOPA 100 mg. In conclusion, despite similar LEDD, OPC demonstrated a significantly greater reduction in off time when compared to an additional 100 mg L-DOPA dose. The effect of OPC appears to be LEDD independent, suggesting that caution should be exercised when employing LEDD to guide treatment decisions as this does not take into account the timing of each dose, onset, duration of therapeutic effect and individual responsiveness. Additionally, OPC could be used for keeping the L-DOPA dose as low as possible for as long as possible to avoid the development of motor complications which are a significant source of disability.

Keywords: opicapone, levodopa, pharmacokinetics, off-time

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Authors: Othman Saleh Al-Razgan

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Obesity establishes an epidemic along with an array of comorbidities and this call for careful clinical assessment, to identify causal factors and comprehensive management. In Kuwait, this epidemic reflects the progressive, socio-economic and age-related issues, along with the shift of nutrition from traditional to modern-style. The current research attempts to narrate the obesity and related health issues in Kuwait, with a special emphasis on the magnitude of the issue in Kuwait, nutrition transition over the past three decades, change in life-style, and possible solution for this issue.

Keywords: clinical assessment, comorbidities, obesity, socio-economic

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Authors: Muhammad Ilyas, Awais Khan, Syed Ali Raza Shah

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DC motors are widely used in industries to provide mechanical power in speed and torque. The position and speed control of DC motors is getting the interest of the scientific community in robotics, especially in the robotic arm, a flexible joint manipulator. The current research work is based on position control of DC motors using experimental investigations in LabVIEW. The linear control strategy is applied to track the position and speed of the DC motor with comparative analysis in the LabVIEW platform and simulation analysis in MATLAB. The tracking error in hardware setup based on LabVIEW programming is slightly greater than simulation analysis in MATLAB due to the inertial load of the motor during steady-state conditions. The controller output shows the input voltage applied to the dc motor varies between 0-8V to ensure minimal steady error while tracking the position and speed of the DC motor.

Keywords: DC motor, labview, proportional integral derivative control, position tracking, speed tracking

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Authors: Ju-Hong Lee, Ching-Wei Liao

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Adaptive beamforming using antenna array of sensors is useful in the process of adaptively detecting and preserving the presence of the desired signal while suppressing the interference and the background noise. For conventional adaptive array beamforming, we require a prior information of either the impinging direction or the waveform of the desired signal to adapt the weights. The adaptive weights of an antenna array beamformer under a steered-beam constraint are calculated by minimizing the output power of the beamformer subject to the constraint that forces the beamformer to make a constant response in the steering direction. Hence, the performance of the beamformer is very sensitive to the accuracy of the steering operation. In the literature, it is well known that the performance of an adaptive beamformer will be deteriorated by any steering angle error encountered in many practical applications, e.g., the wireless communication systems with massive antennas deployed at the base station and user equipment. Hence, developing effective signal processing techniques to deal with the problem due to steering angle error for array beamforming systems has become an important research work. In this paper, we present an effective signal processing technique for constructing an adaptive beamformer against the steering angle error. The proposed array beamformer adaptively estimates the actual direction of the desired signal by using the presumed steering vector and the received array data snapshots. Based on the presumed steering vector and a preset angle range for steering mismatch tolerance, we first create a matrix related to the direction vector of signal sources. Two projection matrices are generated from the matrix. The projection matrix associated with the desired signal information and the received array data are utilized to iteratively estimate the actual direction vector of the desired signal. The estimated direction vector of the desired signal is then used for appropriately finding the quiescent weight vector. The other projection matrix is set to be the signal blocking matrix required for performing adaptive beamforming. Accordingly, the proposed beamformer consists of adaptive quiescent weights and partially adaptive weights. Several computer simulation examples are provided for evaluating and comparing the proposed technique with the existing robust techniques.

Keywords: adaptive beamforming, robustness, signal blocking, steering angle error

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Authors: Muhammad nor Farhan Sa'At, Xin Y. Lim, Terence Y. C. Tan, Siti Hajar M. Rosli, Syazwani S. Ali, Ami F. Syed Mohamed

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INTRODUCTION: Hemp (Cannabis sativa subsp. sativa), commonly used for industrial purposes, differs from marijuana by containing lower levels of delta-9-tetrahydronannabidiol- the principal psychoactive constituent in cannabis. Due to its non-psychoactive nature, there has been growing interest in hemp’s therapeutic potential, which has been investigated through pre-clinical and clinical study modalities. OBJECTIVE: To provide an overview of the current landscape of hemp research, through recent scientific findings specific to the pharmacological effects of the medicinal hemp plant and its derived compounds. METHODS: This review was conducted through a systematic search strategy according to the preferred reporting items for systematic review and meta-analysis-ScR (PRISMA-ScR) checklist on electronic databases including MEDLINE, OVID (OVFT, APC Journal Club, EBM Reviews), Cochrane Library Central and Clinicaltrials.gov. RESULTS: From 65 primary articles reviewed, there were 47 pre-clinical studies related to medicinal hemp. Interestingly, the hemp derivatives showed several potential activities such as anti-oxidative, anti-hypertensive, anti-inflammatory, anti-diabetic, anti-neuroinflammatory, anti-arthritic, anti-acne, and anti-microbial activities. Renal protective effects and estrogenic properties were also exhibited in vitro. CONCLUSION: Medicinal hemp possesses various pharmacological effects tested in vitro and in vivo. Information provided in this review could be used as tool to strengthen the study design of future clinical trial research.

Keywords: Preclinical, Herbal Medicine, Hemp, Cannabis

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Authors: Sabah Mohammed, Jinan Fiaidhi, Darien Sawyer

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Describing clinical cases according to a clinical charting standard that enforces interoperability and enables connected care services can save lives in the event of a medical emergency or provide efficient and effective interventions for the benefit of the patients through the integration of bedside and bench side clinical research. This article presented a multi-tenant extension to the problem-oriented medical record that we have prototyped previously upon using the GraphQL Application Programming Interface to represent the notion of a problem list. Our implemented extension enables physicians and patients to collaboratively describe the patient case via using multi chatbots to collaboratively describe the patient case using the SOAP charting standard. Our extension also connects the described SOAP patient case with the HL7 FHIR (Health Interoperability Resources) medical record for connecting the patient case to the bench data.

Keywords: problem-oriented medical record, graphQL, chatbots, SOAP

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Authors: Cecilia Moreira, Rita Paiva, Daniela Macedo, Leonor Ribeiro, Isabel Fernandes, Luis Costa

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Background: Head and neck paragangliomas are a rare group of tumors with a large spectrum of clinical manifestations. The approach to evaluate and treat these lesions has evolved over the last years. Surgery was the standard for the approach of these patients, but nowadays new techniques of imaging and radiation therapy changed that paradigm. Despite advances in treating, the growth potential and clinical outcome of individual cases remain largely unpredictable. Objectives: Characterization of our institutional experience with clinical management of these tumors. Methods: This was a cross-sectional study of patients followed in our institution between 01 January and 31 December 2017 with paragangliomas of the head and neck and cranial base. Data on tumor location, catecholamine levels, and specific imaging modalities employed in diagnostic workup, treatment modality, tumor control and recurrence, complications of treatment and hereditary status were collected and summarized. Results: A total of four female patients were followed between 01 January and 31 December 2017 in our institution. The mean age of our cohort was 53 (± 16.1) years. The primary locations were at the level of the tympanic jug (n=2, 50%) and carotid body (n=2, 50%), and only one of the tumors of the carotid body presented pulmonary metastasis at the time of diagnosis. None of the lesions were catecholamine-secreting. Two patients underwent genetic testing, with no mutations identified. The initial clinical presentation was variable highlighting the decrease of visual acuity and headache as symptoms present in all patients. In one of the cases, loss of all teeth of the lower jaw was the presenting symptomatology. Observation with serial imaging, surgical extirpation, radiation, and stereotactic radiosurgery were employed as treatment approaches according to anatomical location and resectability of lesions. As post-therapeutic sequels the persistence of tinnitus and disabling pain stands out, presenting one of the patients neuralgia of the glossopharyngeal. Currently, all patients are under regular surveillance with a median follow up of 10 months. Conclusion: Ultimately, clinical management of these tumors remains challenging owing to heterogeneity in clinical presentation, the existence of multiple treatment alternatives, and potential to cause serious detriment to critical functions and consequently interference with the quality of life of the patients.

Keywords: clinical outcomes, head and neck, management, paragangliomas

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Authors: Emad A. Mohammed

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The concept of hydraulic flow units (HFU) has been used for decades in the petroleum industry to improve the prediction of permeability. This concept is strongly related to the flow zone indicator (FZI) which is a function of the reservoir rock quality index (RQI). Both indices are based on reservoir porosity and permeability of core samples. It is assumed that core samples with similar FZI values belong to the same HFU. Thus, after dividing the porosity-permeability data based on the HFU, transformations can be done in order to estimate the permeability from the porosity. The conventional practice is to use the power law transformation using conventional HFU where percentage of error is considerably high. In this paper, neural network technique is employed as a soft computing transformation method to predict permeability instead of power law method to avoid higher percentage of error. This technique is based on HFU identification where Amaefule et al. (1993) method is utilized. In this regard, Kozeny and Carman (K–C) model, and modified K–C model by Hasan and Hossain (2011) are employed. A comparison is made between the two transformation techniques for the two porosity-permeability models. Results show that the modified K-C model helps in getting better results with lower percentage of error in predicting permeability. The results also show that the use of artificial intelligence techniques give more accurate prediction than power law method. This study was conducted on a heterogeneous complex carbonate reservoir in Oman. Data were collected from seven wells to obtain the permeability correlations for the whole field. The findings of this study will help in getting better estimation of permeability of a complex reservoir.

Keywords: permeability, hydraulic flow units, artificial intelligence, correlation

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Authors: Fakhr Eddin Alnaal, Angela Dahdal, Duaa Aladib, Sabeen Ibrahim, Ibrahim Ghoraibi, Bissan Ahmed

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Dementia is one of the diseases which had several stages and Alzheimer’s term was selected in respect for the first doctor Alzheimer who defined the first symptoms of this diseases in a woman whom was well treated by him. The fact that this is a type of a silent disease on which you have a long-term process of neurological degradation and suddenly gives symptoms which are most often irreversible, on clinical level likely we can consider it as a malignancy, one in terms of that it is sudden shocking irreversible and on the level of behavior and some mortality beside the lack of early detection tools for diagnosis. Therefore, the goal of our project is to test the concept of the ability of Statin in prevention of such disease and we investigated that both on experimental level and most importantly on clinical one, the clinical part was performed in a recognized house of aged people who had accidently a high cholesterol and were for years given Statin to treat that elevation, however after the symptoms of Alzheimer’s appeared and when diagnosed, they were well treated and rapidly recovered compared to Alzheimer’s patients in the same house who did not receive Statin had a mild improvement in their symptoms after the therapy, on the other hand we confirmed such observation by a well-organized experimental work.

Keywords: Alzheimer's, dementia, silent disease, statin

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Authors: Ergin Toros, Manar Aslan

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This study was planned as a descriptive study in order to learn the opinions of the students who are studying in nursing undergraduate program about their theoretical/practical lessons and departments. The education in the undergraduate nursing programs has great importance because it contains the knowledge and skills to prepare student nurses to the clinic in the future. In order to provide quality-nursing services in the future, the quality of nursing education should be measured, and opinions of student nurses about education should be taken. The research population was composed of students educated in a university with 1-4 years of theoretical and clinical education (N=550), and the sample was composed of 460 students that accepted to take part in the study. It was reached to 83.6% of target population. Data collected through a survey developed by the researchers. Survey consists of 48 questions about sociodemographic characteristics (9 questions), theoretical courses (9 questions), laboratory applications (7 questions), clinical education (14 questions) and services provided by the faculty (9 questions). It was determined that 83.3% of the nursing students found the nursing profession to be suitable for them, 53% of them selected nursing because of easy job opportunity, and 48.9% of them stayed in state dormitory. Regarding the theoretical courses, 84.6% of the students were determined to agree that the question ‘Course schedule is prepared before the course and published on the university web page.’ 28.7% of them were determined to do not agree that the question ‘Feedback is given to students about the assignments they prepare.’. It has been determined that 41,5% of the students agreed that ‘The time allocated to laboratory applications is sufficient.’ Students said that physical conditions in laboratory (41,5%), and the materials used are insufficient (44.6%), and ‘The number of students in the group is not appropriate for laboratory applications.’ (45.2%). 71.3% of the students think that the nurses view in the clinics the students as a tool to remove the workload, 40.7% of them reported that nurses in the clinic area did not help through the purposes of the course, 39.6% of them said that nurses' communication with students is not good. 37.8% of students stated that nurses did not provide orientation to students, 37.2% of them think that nurses are not role models for students. 53.7% of the students stated that the incentive and support for the student exchange program were insufficient., %48 of the students think that career planning services, %47.2 security services,%45.4 the advisor spent time with students are not enough. It has been determined that nursing students are most disturbed by the approach of the nurses in the clinical area within the undergraduate education program. The clinical area education which is considered as an integral part of nursing education is important and affect to student satisfaction.

Keywords: nursing education, student, clinical area, opinion

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Authors: Kudzanayi Chiteka, Wellington Makondo

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The whole world is on the drive to go green owing to the negative effects of burning fossil fuels. Therefore, there is immediate need to identify and utilise alternative renewable energy sources. Among these energy sources solar energy is one of the most dominant in Zimbabwe. Solar power plants used to generate electricity are entirely dependent on solar radiation. For planning purposes, solar radiation values should be known in advance to make necessary arrangements to minimise the negative effects of the absence of solar radiation due to cloud cover and other naturally occurring phenomena. This research focused on the prediction of Global Horizontal Irradiation values for the sixth day given values for the past five days. Artificial intelligence techniques were used in this research. Three models were developed based on Support Vector Machines, Radial Basis Function, and Feed Forward Back-Propagation Artificial neural network. Results revealed that Support Vector Machines gives the best results compared to the other two with a mean absolute percentage error (MAPE) of 2%, Mean Absolute Error (MAE) of 0.05kWh/m²/day root mean square (RMS) error of 0.15kWh/m²/day and a coefficient of determination of 0.990. The other predictive models had prediction accuracies of MAPEs of 4.5% and 6% respectively for Radial Basis Function and Feed Forward Back-propagation Artificial neural network. These two models also had coefficients of determination of 0.975 and 0.970 respectively. It was found that prediction of GHI values for the future days is possible using artificial intelligence-based predictive models.

Keywords: solar energy, global horizontal irradiation, artificial intelligence, predictive models

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Authors: Sizar Abed Mohammed, Zahraa Ghazi Sadeeq

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The use of the classic method, least squares (OLS) to estimate the linear regression parameters, when they are available assumptions, and capabilities that have good characteristics, such as impartiality, minimum variance, consistency, and so on. The development of alternative statistical techniques to estimate the parameters, when the data are contaminated with outliers. These are powerful methods (or resistance). In this paper, three of robust methods are studied, which are: Maximum likelihood type estimate M-estimator, Modified Maximum likelihood type estimate MM-estimator and Least Trimmed Squares LTS-estimator, and their results are compared with OLS method. These methods applied to real data taken from Duhok company for manufacturing furniture, the obtained results compared by using the criteria: Mean Squared Error (MSE), Mean Absolute Percentage Error (MAPE) and Mean Sum of Absolute Error (MSAE). Important conclusions that this study came up with are: a number of typical values detected by using four methods in the furniture line and very close to the data. This refers to the fact that close to the normal distribution of standard errors, but typical values in the doors line data, using OLS less than that detected by the powerful ways. This means that the standard errors of the distribution are far from normal departure. Another important conclusion is that the estimated values of the parameters by using the lifeline is very far from the estimated values using powerful methods for line doors, gave LTS- destined better results using standard MSE, and gave the M- estimator better results using standard MAPE. Moreover, we noticed that using standard MSAE, and MM- estimator is better. The programs S-plus (version 8.0, professional 2007), Minitab (version 13.2) and SPSS (version 17) are used to analyze the data.

Keywords: Robest, LTS, M estimate, MSE

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Authors: Hamidreza Hoshyarmanesh, Benjamin Durante, Alex Irwin, Sanju Lama, Kourosh Zareinia, Garnette R. Sutherland

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This study reports on a proposed method to evaluate the accuracy and precision of Excalibur I, a neurosurgery-specific haptic hand controller, designed and developed at Project neuroArm. Having an efficient and successful robot-assisted telesurgery is considerably contingent on how accurate and precise a haptic hand controller (master/local robot) would be able to interpret the kinematic indices of motion, i.e., position and orientation, from the surgeon’s upper limp to the slave/remote robot. A proposed test rig is designed and manufactured according to standard ASTM F2554-10 to determine the accuracy and precision range of Excalibur I at four different locations within its workspace: central workspace, extreme forward, far left and far right. The test rig is metrologically characterized by a coordinate measuring machine (accuracy and repeatability < ± 5 µm). Only the serial linkage of the haptic device is examined due to the use of the Structural Length Index (SLI). The results indicate that accuracy decreases by moving from the workspace central area towards the borders of the workspace. In a comparative study, Excalibur I performs on par with the PHANToM PremiumTM 3.0 and more accurate/precise than the PHANToM PremiumTM 1.5. The error in Cartesian coordinate system shows a dominant component in one direction (δx, δy or δz) for the movements on horizontal, vertical and inclined surfaces. The average error magnitude of three attempts is recorded, considering all three error components. This research is the first promising step to quantify the kinematic performance of Excalibur I.

Keywords: accuracy, advanced metrology, hand controller, precision, robot-assisted surgery, tele-operation, workspace

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Authors: Charléa M. Smith, Raiden L. Schodowski, Arletty Pinel

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Due to the COVID-19 pandemic, the Faculty of Medical Sciences of The University of the West Indies (UWI) Mona in Kingston, Jamaica, had to rapidly migrate to digital and blended learning. Students in the preclinical stage of the program transitioned to full-time online learning, while students in the clinical stage experienced decreased daily patient contact and the implementation of a blend of online lectures and virtual clinical practice. Such sudden changes were coupled with the institutional pressure of the need to introduce a novel approach to education without much time for preparation, as well as additional strain endured by the faculty, who were overwhelmed by serving as frontline workers. During the period July 20 to August 23, 2021, this study surveyed preclinical and clinical students to capture their experiences with these changes and their recommendations for future use of digital modalities of learning to enhance medical education. It was conducted with a fellow student of the 2021 cohort of the MultiPod mentoring program. A questionnaire was developed and distributed digitally via WhatsApp to all medical students of the UWI Mona campus to assess students’ experiences and perceptions of the advantages, challenges, and impact on individual knowledge proficiencies brought about by the transition to predominantly digital learning environments. 108 students replied, 53.7% preclinical and 46.3% clinical. 67.6% of the total were female and 30.6 % were male; 1.8% did not identify themselves by gender. 67.2% of preclinical students preferred blended learning and 60.3% considered that the content presented did not prepare them for clinical work. Only 31% considered that the online classes were interactive and encouraged student participation. 84.5% missed socialization with classmates and friends and 79.3% missed a focused environment for learning. 80% of the clinical students felt that they had not learned all that they expected and only 34% had virtual interaction with patients, mostly by telephone and video calls. Observing direct consultations was considered the most useful, yet this was the least-used modality. 96% of the preclinical students and 100% of the clinical ones supplemented their learning with additional online tools. The main recommendations from the survey are the use of interactive teaching strategies, more discussion time with lecturers, and increased virtual interactions with patients. Universities are returning to face-to-face learning, yet it is unlikely that blended education will disappear. This study demonstrates that students’ perceptions of their experience during mobility restrictions must be taken into consideration in creating more effective, inclusive, and efficient blended learning opportunities.

Keywords: blended learning, digital learning, medical education, student perceptions

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Authors: Mohamed Wahba

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Objective: To build a comparative arm for product (X) in specific gene mutated advanced gastrointestinal cancer using real world evidence to fulfill HTA requirements in drug evaluation. Methods: Data for product (X) were collected from phase II clinical trial while real world data for (Y) and (Z) were collected from US database. Real-world (RW) cohorts were matched to clinical trial base line characteristics using weighting by odds method. Outcomes included progression-free survival (PFS) and overall survival (OS) rates. Study location and participants: Internationally (product X, n=80) and from USA (Product Y and Z, n=73) Results: Two comparisons were made: trial cohort 1 (X) versus real-world cohort 1 (Z), trial cohort 2 (X) versus real-world cohort 2 (Y). For first line, the median OS was 9.7 months (95% CI 8.6- 11.5) and the median PFS was 5.2 months (95% CI 4.7- not reached) for real-world cohort 1. For second line, the median OS was 10.6 months (95% CI 4.7- 27.3) for real-world cohort 2 and the median PFS was 5.0 months (95% CI 2.1- 29.3). For OS analysis, results were statistically significant but not for PFS analysis. Conclusion: This study provided the clinical comparative outcomes needed for HTA evaluation.

Keywords: real world evidence, pharmacoeconomics, HTA agencies, oncology

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Authors: Biruhi Tesfaye, Avinash M. Potdar

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The laboratory test process to determine the California bearing ratio (CBR) of black cotton soils is not only overpriced but also time-consuming as well. Hence advanced prediction of CBR plays a significant role as it is applicable In pavement design. The prediction of CBR of treated soil was executed by Artificial Neural Networks (ANNs) which is a Computational tool based on the properties of the biological neural system. To observe CBR values, combined eggshell and waste glass was added to soil as 4, 8, 12, and 16 % of the weights of the soil samples. Accordingly, the laboratory related tests were conducted to get the required best model. The maximum CBR value found at 5.8 at 8 % of eggshell waste glass powder addition. The model was developed using CBR as an output layer variable. CBR was considered as a function of the joint effect of liquid limit, plastic limit, and plastic index, optimum moisture content and maximum dry density. The best model that has been found was ANN with 5, 6 and 1 neurons in the input, hidden and output layer correspondingly. The performance of selected ANN has been 0.99996, 4.44E-05, 0.00353 and 0.0067 which are correlation coefficient (R), mean square error (MSE), mean absolute error (MAE) and root mean square error (RMSE) respectively. The research presented or summarized above throws light on future scope on stabilization with waste glass combined with different percentages of eggshell that leads to the economical design of CBR acceptable to pavement sub-base or base, as desired.

Keywords: CBR, artificial neural network, liquid limit, plastic limit, maximum dry density, OMC

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Authors: Mohammad J. Rezai, Fereshteh Davarpanah

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Producing a text in a language which is not one’s mother tongue can be a demanding task for language learners. Examining lexical errors committed by EFL learners is a challenging area of investigation which can shed light on the process of second language acquisition. Despite the considerable number of investigations into grammatical errors, few studies have tackled formal and semantic errors of lexis committed by EFL learners. The current study aimed at examining Persian learners’ formal and semantic errors of lexis in English. To this end, 60 students at three different proficiency levels were asked to write on 10 different topics in 10 separate sessions. Finally, 600 essays written by Persian EFL learners were collected, acting as the corpus of the study. An error taxonomy comprising formal and semantic errors was selected to analyze the corpus. The formal category covered misselection and misformation errors, while the semantic errors were classified into lexical, collocational and lexicogrammatical categories. Each category was further classified into subcategories depending on the identified errors. The results showed that there were 2583 errors in the corpus of 9600 words, among which, 2030 formal errors and 553 semantic errors were identified. The most frequent errors in the corpus included formal error commitment (78.6%), which were more prevalent at the advanced level (42.4%). The semantic errors (21.4%) were more frequent at the low intermediate level (40.5%). Among formal errors of lexis, the highest number of errors was devoted to misformation errors (98%), while misselection errors constituted 2% of the errors. Additionally, no significant differences were observed among the three semantic error subcategories, namely collocational, lexical choice and lexicogrammatical. The results of the study can shed light on the challenges faced by EFL learners in the second language acquisition process.

Keywords: collocational errors, lexical errors, Persian EFL learners, semantic errors

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Authors: Jitendra Jain, Cassandra Hidajat, Hansraj Riteesh Bookun

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Graft patency underpins long-term prognosis after coronary artery bypass grafting surgery (CABG). The benefits of the combined use of only the left internal mammary artery and radial artery, referred to as total arterial revascularisation (TAR), on long-term clinical outcomes and quality of life are relatively unknown. The aim of this study was to identify whether there were differences in long term clinical outcomes between recipients of TAR compared to a cohort of mostly arterial revascularization involving the left internal mammary, at least one radial artery and at least one saphenous vein graft. A retrospective analysis was performed on all patients who underwent TAR or were re-vascularized with supplementary saphenous vein graft from February 1996 to December 2004. Telephone surveys were conducted to obtain clinical outcome parameters including major adverse cardiac and cerebrovascular events (MACCE) and Short Form (SF-36v2) Health Survey responses. A total of 176 patients were successfully contacted to obtain postop follow up results. The mean follow-up length from time of surgery in our study was TAR 12.4±1.8 years and conventional 12.6±2.1. PCS score was TAR 45.9±8.8 vs LIMA/Rad/ SVG 44.9±9.2 (p=0.468) and MCS score was TAR 52.0±8.9 vs LIMA/Rad/SVG 52.5±9.3 (p=0.723). There were no significant differences between groups for NYHA class 3+ TAR 9.4% vs. LIMA/Rad/SVG 6.6%; or CCS 3+ TAR 2.35% vs. LIMA/Rad/SVG 0%.

Keywords: CABG; MACCEs; quality of life; total arterial revascularisation

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Authors: Fakhrosadat Sajjadian, Ramin Ghasemi Shayan

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The tumor microenvironment plays an fundamental part in tumor start, movement, metastasis, and treatment resistance. It varies from ordinary tissue in terms of its extracellular network, vascular and lymphatic arrange, as well as physiological conditions. The clinical application of atomic cancer imaging is regularly prevented by the tall commercialization costs of focused on imaging operators as well as the constrained clinical applications and little showcase measure of a few operators. . Since numerous cancer types share comparable characteristics of the tumor microenvironment, the capacity to target these biomarkers has the potential to supply clinically translatable atomic imaging advances for numerous types encompassing cancer and broad clinical applications. Noteworthy advance has been made in focusing on the tumor microenvironment for atomic cancer imaging. In this survey, we summarize the standards and methodologies of later progresses in atomic imaging of the tumor microenvironment, utilizing distinctive imaging modalities for early discovery and conclusion of cancer. To conclude, The tumor microenvironment (TME) encompassing tumor cells could be a profoundly energetic and heterogeneous composition of safe cells, fibroblasts, forerunner cells, endothelial cells, flagging atoms and extracellular network (ECM) components.

Keywords: molecular, imaging, TME, medicine

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