Search results for: decentralized clinical trials

Authors: Junaid Ahmed, Nandita Shenoy

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Maintaining lifelong knowledge and skills is essential for safe clinical practice. Continuing Professional Development (CPD) is an established method that can facilitate lifelong learning. It focuses on maintaining or developing knowledge, skills and relationships to ensure competent practice.To date, relatively little has been done to comprehensively and systematically synthesize evidence to identify subjects of interest among practising dentist. Hence the aim of our study was to identify areas in clinical practice that would be favourable for continuing professional dental education amongst practicing dentists. Participants of this study consisted of the practicing dental surgeons of Mangalore, a city in Dakshina Kannada, Karnataka. 95% of our practitioners felt that regular updating as a one day program once in 3-6 months is required, to keep them abreast in clinical practice. 60% of subjects feel that CPD programs enrich their theoretical knowledge and helps in patient care. 27% of them felt that CPD programs should be related to general dentistry. Most of them felt that CPD programs should not be charged nominally between one to two thousand rupees. The acronym ‘CPD’ should be seen in a broader view in which professionals continuously enhance not only their knowledge and skills, but also their thinking,understanding and maturity; they grow not only as professionals, but also as persons; their development is not restricted to their work roles, but may also extend to new roles and responsibilities.

Keywords: continuing professional development, competent practice, dental education, practising dentist

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Authors: Shasline Gedeon, Tiffany W. Ardley, Ying Wang, Nathan J. Gesmundo, Katarina A. Sarris, Ana L. Aguirre

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Drug discovery and delivery involve drug targeting, an approach that helps find a drug against a chosen target through high throughput screening and other methods by way of identifying the physical properties of the potential lead compound. Physical properties of potential drug candidates have been an imperative focus since the unveiling of Lipinski's Rule of 5 for oral drugs. Throughout a compound's journey from discovery, clinical phase trials, then becoming a classified drug on the market, the desirable properties are optimized while minimizing/eliminating toxicity and undesirable properties. In the pharmaceutical industry, the ability to generate molecules in parallel with maximum efficiency is a substantial factor achieved through sp²-sp² carbon coupling reactions, e.g., Suzuki Coupling reactions. These reaction types allow for the increase of aromatic fragments onto a compound. More recent literature has found benefits to decreasing aromaticity, calling for more sp³-sp² carbon coupling reactions instead. The objective of this project is to provide a comparison between various sp³-sp² carbon coupling methods and reaction conditions, collecting data on production of the desired product. There were four different coupling methods being tested amongst three cores and 4-5 installation groups per method; each method ran under three distinct reaction conditions. The tested methods include the Photoredox Decarboxylative Coupling, the Photoredox Potassium Alkyl Trifluoroborate (BF3K) Coupling, the Photoredox Cross-Electrophile (PCE) Coupling, and the Weix Cross-Electrophile (WCE) Coupling. The results concluded that the Decarboxylative method was very difficult in yielding product despite the several literature conditions chosen. The BF3K and PCE methods produced competitive results. Amongst the two Cross-Electrophile coupling methods, the Photoredox method surpassed the Weix method on numerous accounts. The results will be used to build future libraries.

Keywords: drug discovery, high throughput chemistry, photoredox chemistry, sp³-sp² carbon coupling methods

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Authors: Ijaz Ul Haq, Fiorenzo Franceschini

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The distributed manufacturing methodology brings a new concept of decentralized manufacturing operations close to the proximity of end users. A preliminary scale, to measure distributed capacity and evaluate positioning of firms, is developed in this research. In the first part of the paper, a literature review has been performed which highlights the explorative nature of the studies conducted to present definitions and classifications due to novelty of this topic. From literature, five dimensions of distributed manufacturing development stages have been identified: localization, manufacturing technologies, customization and personalization, digitalization and democratization of design. Based on these determinants a conceptual scale is proposed to measure the status of distributed manufacturing of a generic firm. A multiple case study is then conducted in two steps to test the conceptual scale and to identify the corresponding level of distributed potential in each case study firm.

Keywords: distributed manufacturing, distributed capacity, localized production, ordinal scale

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Authors: Maggie Hall, Haley O'Neill

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The U.S. faces a severe shortage of abortion providers, exacerbated by the June 2022 Dobbs v. Jackson Women’s Health Organization decision. Midwives, especially certified nurse midwives, are well-positioned to fill this gap in abortion care. However, a lack of clinical education and training prevents midwives from exercising their full scope of practice. National and international organizations that set obstetrics and midwifery education standards, including the International Confederation of Midwives, American College of Obstetricians and Gynecologists, and American Public Health Association, call for expansion of midwifery-managed abortion care through the first trimester. In the U.S., midwifery programs are accredited based on compliance with ACME standards and compliance is a prerequisite for the American Midwifery Certification Board exams. We conducted a literature review of studies in the last five years regarding abortion didactic and clinical education barriers via CINAHL, EBSCO and PubMed database reviews. We gave preference for primary sources within the last five years; however, due to the rapid changes in abortion education and access, we also included literature from 2012-2022. We evaluated ACME-accredited programs in relation to their geography within abortion-protected or restricted states and assessed state-specific barriers to abortion care education and provision as clinical students. There are 43 AMCB-accredited midwifery schools in 28 states across the U.S. Twenty schools (47%) are in the 15 states in which advanced practice clinicians can provide non-surgical abortion care, such as medication abortion and MVA procedures. Twenty-four schools (56%) are in the 16 states in which abortion care provision is restricted to Licensed Physicians and cannot offer in-state clinical training opportunities for midwifery students. Six schools are in the five states in which abortion is completely banned and are geographically concentrated in the southernmost region of the U.S., including Alabama, Kentucky, Louisiana, Tennessee, and Texas. Subsequently, these programs cannot offer in-state clinical training opportunities for midwifery students. Notably, there are seven ACME programs in six states that do not restrict abortion access by gestational age, including Colorado, Connecticut, Washington, D.C., New Jersey, New Mexico, and Oregon. These programs may be uniquely positioned for midwifery involvement in abortion care beyond the first trimester. While the following states don’t house ACME programs, abortion care can be provided by advanced practice clinicians in Rhode Island, Delaware, Hawaii, Maine, Maryland, Montana, New Hampshire, and Vermont, offering clinical placement and/or new ACME program development opportunities. We identify existing barriers to clinical education and training opportunities for midwifery-managed abortion care, which are both geographic and institutional in nature. We recommend expansion and standardization of clinical education and training opportunities for midwifery-managed abortion care in ACME-accredited programs to improve access to abortion care. Midwifery programs and teaching hospitals need to expand education, training, and residency opportunities for midwifery students to strengthen access to midwife-managed abortion care. ACNM and ACME should re-evaluate accreditation criteria and the implications of ACME programs in states where students are not able to learn abortion care in clinical contexts due to state-specific abortion restrictions.

Keywords: midwifery education, abortion, abortion education, abortion access

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Authors: Sigal Portnoy, Jason Friedman, Eitan Raveh

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Introduction: Sensory substitution is possible due to the capacity of our brain to adapt to information transmitted by a synthetic receptor via an alternative sensory system. Practical sensory substitution systems are being developed in order to increase the functionality of individuals with sensory loss, e.g. amputees. For upper limb prosthetic-users the loss of tactile feedback compels them to allocate visual attention to their prosthesis. The effect of adding vibrotactile feedback (VTF) to the applied force has been studied, however its effect on the allocation if visual attention during dual-tasking and the response during misleading visual feedback have not been studied. We hypothesized that VTF will improve the performance and reduce visual attention during dual-task assignments in healthy individuals using a robotic hand and improve the performance in a standardized functional test, despite the presence of misleading visual feedback. Methods: For the dual-task paradigm, twenty healthy subjects were instructed to toggle two keyboard arrow keys with the left hand to retain a moving virtual car on a road on a screen. During the game, instructions for various activities, e.g. mix the sugar in the glass with a spoon, appeared on the screen. The subject performed these tasks with a robotic hand, attached to the right hand. The robotic hand was controlled by the activity of the flexors and extensors of the right wrist, recorded using surface EMG electrodes. Pressure sensors were attached at the tips of the robotic hand and induced VTF using vibrotactile actuators attached to the right arm of the subject. An eye-tracking system tracked to visual attention of the subject during the trials. The trials were repeated twice, with and without the VTF. Additionally, the subjects performed the modified box and blocks, hidden from eyesight, in a motion laboratory. A virtual presentation of a misleading visual feedback was be presented on a screen so that twice during the trial, the virtual block fell while the physical block was still held by the subject. Results: This is an ongoing study, which current results are detailed below. We are continuing these trials with transradial myoelectric prosthesis-users. In the healthy group, the VTF did not reduce the visual attention or improve performance during dual-tasking for the tasks that were typed transfer-to-target, e.g. place the eraser on the shelf. An improvement was observed for other tasks. For example, the average±standard deviation of time to complete the sugar-mixing task was 13.7±17.2s and 19.3±9.1s with and without the VTF, respectively. Also, the number of gaze shifts from the screen to the hand during this task were 15.5±23.7 and 20.0±11.6, with and without the VTF, respectively. The response of the subjects to the misleading visual feedback did not differ between the two conditions, i.e. with and without VTF. Conclusions: Our interim results suggest that the performance of certain activities of daily living may be improved by VTF. The substitution of visual sensory input by tactile feedback might require a long training period so that brain plasticity can occur and allow adaptation to the new condition.

Keywords: prosthetics, rehabilitation, sensory substitution, upper limb amputation

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Authors: Magdalena Bury-Kaminska, Aneta Szudy-Szczyrek, Aleksandra Nowaczynska, Olga Jankowska-Lecka, Marek Hus, Klaudia Kot

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Introduction: The aim of the research was to determine the changes in cognitive functioning in patients with plasma cell myeloma by comparing patients’ state before the treatment and during chemotherapy as well as to determine the biological factors that can be used to predict patients’ cognitive state. Methods: The patients underwent the research procedure twice: before chemotherapy and after 4-6 treatment cycles. A psychological test and measurement of the following biological variables were carried out: TNF-α (tumor necrosis factor), IL-6 (interleukin 6), IL-10 (interleukin 10), BDNF (brain-derived neurotrophic factor). The following research methods were implemented: the Montreal Cognitive Assessment (MoCA), Battery of Tests for Assessing Cognitive Functions PU1, experimental and clinical trials based on the Choynowski’s Memory Scale, Stroop Color-Word Interference Test (SCWT), depression measurement questionnaire. Results: The analysis of the research showed better cognitive functions of patients during chemotherapy in comparison to the phase before it. Moreover, neurotrophin BDNF allows to predict the level of selected cognitive functions (semantic fluency and execution control) already at the diagnosis stage. After 4-6 cycles, it is also possible to draw conclusions concerning the extent of working memory based on the level of BDNF. Cytokine TNF-α allows us to predict the level of letter fluency during anti-cancer treatment. Conclusions: It is possible to presume that BDNF has a protective influence on patients’ cognitive functions and working memory and that cytokine TNF-α co-occurs with a diminished execution control and better material grouping in terms of phonological fluency. Acknowledgment: This work was funded by the National Science Center in Poland [grant no. 2017/27/N/HS6/02057.

Keywords: chemobrain, cognitive impairment, non−central nervous system cancers, hematologic diseases

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Authors: Ng Yen, Shafii Khamis, Rehir Bin Dahalan

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Cyclotrons in the energy range 10-30 MeV are widely used for the production of clincally relevant radiosiotopes used in positron emission tomography (PET) nuclear imaging. Positron emmision tomography is a powerful nuclear imaging tool that produces high quality 3-dimentional images of functional processes of body. The advantage of PET among all other imaging devices is that it allows the study of an impressive array of discrete biochemical and physiologic processes, within a single imaging session. The number of PET scanner increases every year globally due to high clinical demand. However, not all PET centers can afford a cyclotron, due to the expense associated with operation of an in-house cyclotron. Therefore, current research has also focused on the development of parent/daughter generators that can reliably provide PET nuclides. These generators (68Ge/68Ga generator, 62Zn/62Cu, 82Sr/82Rb, etc) can provide even short-lived radionuclides at any time on demand, without the need of an ‘in-house cyclotron’. The parent isotope is produced at a cyclotron/reactor facility, and can be shipped to remote clinical sites (regionally/overseas), where the daughter isotope is eluted, a model similar to the 99Mo/99mTc generator system. The specific aim for this presentation is to talk about the potential for both of the cyclotron and generator-produced PET radiopharmaceuticals used in clinical imaging.

Keywords: positron emission tomography, radiopharmaceutical, cyclotron, generator

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Authors: Célia Barreto Carvalho, Carolina da Motta, Marina Sousa, Joana Cabral, Ana Luísa Carvalho, Ermelindo Peixoto

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The aim of the current study was to develop and validate a Response to Stressful Situations Scale (RSSS) for the Portuguese population. This scale assesses the degree of stress experienced in scenarios that can constitute positive, negative and more neutral stressors, and also describes the physiological, emotional and behavioral reactions to those events according to their intensity. These scenario include typical stressor scenarios relevant to patients with schizophrenia, which are currently absent from most scale, assessing specific risks that these stressors may bring on subjects, which may prove useful in non-clinical and clinical populations (i.e. patients with mood or anxiety disorders, schizophrenia). Results from Principal Components Analysis and Confirmatory Factor Analysis of on two adult samples from general population allowed to confirm a three-factor model with good fit indices: χ2 (144)= 370.211, p = 0.000; GFI = 0.928; CFI = 0.927; TLI = 0.914, RMSEA = 0.055, P( rmsea ≤ 0.005) = 0.096; PCFI = 0.781. Further data analysis on the scale revealed that RSSS is an adequate assessment tool of stress response in adults to be used in further research and clinical settings, with good psychometric characteristics, adequate divergent and convergent validity, good temporal stability and high internal consistency.

Keywords: assessment, stress events, stress response, stress vulnerability

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Authors: Aleksandar Jovanovic, Katarina Kukic, Ana Uzelac, Dusan Teodorovic

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Wisdom of the Crowd (WoC) is a decentralized method that uses the collective intelligence of humans. Individual guesses may be far from the target, but when considered as a group, they converge on optimal solutions for a given problem. We will utilize WoC to address the challenge of controlling traffic lights within intersections from the streets of Kragujevac, Serbia. The problem at hand falls within the category of NP-hard problems. We will employ an algorithm that leverages the swarm intelligence of bees: Bee Colony Optimization (BCO). Data regarding traffic signal timing at a single intersection will be gathered from citizens through a survey. Results obtained in that manner will be compared to the BCO results for different traffic scenarios. We will use Vissim traffic simulation software as a tool to compare the performance of bees’ and humans’ collective intelligence.

Keywords: wisdom of the crowd, traffic signal control, combinatorial optimization, bee colony optimization

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Authors: Shoeb Ahmed Adeel, Vivek Paul, K. Prajwal, Michael Fenelon

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Techniques have been used to tether and stabilize a multi-rotor MAV but carrying out the same process to a fixed wing MAV is a novel method which can be utilized in order to reduce damage occurring to the fixed wing MAVs while conducting flight test trials and PID tuning. A few sensors and on board controller is required to carry out this experiment in horizontal and vertical plane of the vehicle. Here we will be discussing issues such as sensitivity of the air vehicle, endurance and external load of the string acting on the vehicle.

Keywords: MAV, PID tuning, tethered flight, UAV

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Authors: Mousa Saleh Daoud

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Rickets is a condition that affects the development of bones in children. It causes soft bones, which can become bowed or curved, this bending and curvature is evident in the age of Walking. The most common cause of rickets is dietary deficiency of vitamin D or Lack of exposure to sunlight or both together. The link between vitamin D and rickets has been known for many years and is well understood by doctors and scientists. If a child does not get enough of the vitamin D, the bones cannot form hard outer shells. This is why they become soft and weak. This study was conducted on children who reviewed by our medical clinic between the years 2011-2013. The study included 400 children, aged between one and six years. 11 children had clear clinical manifestations of rickets of varying degrees and all of them due to lack of vitamin D except for one case of rickets resistant to vitamin D. 389 cases ranged between natural and deficiency in vitamin D without clinical manifestations of Rickets.

Keywords: rickts, bone metabolic diseases, vitamin D, child

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Authors: Bhavani Veasuvalingam

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Case-based learning (CBL) is a popular instructional method aimed to bridge theory to clinical practice. This study aims to explore CBL mixed modality curriculum in influencing students’ learning styles and strategies that support learning. An explanatory sequential mixed method study was employed with initial phase, 44-itemed Felderman’s Index of Learning Style (ILS) questionnaire employed across year one medical students (n=142) using convenience sampling to describe the preferred learning styles. The qualitative phase utilised three focus group discussions (FGD) to explore in depth on the multimodal learning style exhibited by the students. Most students preferred combination of learning stylesthat is reflective, sensing, visual and sequential i.e.: RSVISeq style (24.64%) from the ILS analysis. The frequency of learning preference from processing to understanding were well balanced, with sequential-global domain (66.2%); sensing-intuitive (59.86%), active- reflective (57%), and visual-verbal (51.41%). The qualitative data reported three major themes, namely Theme 1: CBL mixed modalities navigates learners’ learning style; Theme 2: Multimodal learners active learning strategies supports learning. Theme 3: CBL modalities facilitating theory into clinical knowledge. Both quantitative and qualitative study strongly reports the multimodal learning style of the year one medical students. Medical students utilise multimodal learning styles to attain the clinical knowledge when learning with CBL mixed modalities. Educators’ awareness of the multimodal learning style is crucial in delivering the CBL mixed modalities effectively, considering strategic pedagogical support students to engage and learn CBL in bridging the theoretical knowledge into clinical practice.

Keywords: case-based learning, learnign style, medical students, learning

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Authors: Mohamed Aly, Aliaa Rehan Youssef, Emad Sawerees, Mounir Guirgis

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Relevance: Osteoarthritis (OA) is the most common degenerative disease seen in all populations. It causes disability and substantial socioeconomic burden. Evidence supports that exercise are the most effective conservative treatment for patients with OA. Therapists experience and clinical judgment play major role in exercise prescription and scientific evidence for this regard is lacking. The development of clinical prediction rules to identify patients who are most likely benefit from exercise may help solving this dilemma. Purpose: This study investigated whether body mass index and functional ability at baseline can predict patients’ response to a selected exercise program. Approach: Fifty-six patients, aged 35 to 65 years, completed an exercise program consisting of open kinetic chain strengthening and passive stretching exercises. The program was given for 3 sessions per week, 45 minutes per session, for 6 weeks Evaluation: At baseline and post treatment, pain severity was assessed using the numerical pain rating scale, whereas functional ability was being assessed by step test (ST), time up and go test (TUG) and 50 feet time walk test (50 FTW). After completing the program, global rate of change (GROC) score of greater than 4 was used to categorize patients as successful and non-successful. Thirty-eight patients (68%) had successful response to the intervention. Logistic regression showed that BMI and 50 FTW test were the only significant predictors. Based on the results, patients with BMI less than 34.71 kg/m2 and 50 FTW test less than 25.64 sec are 68% to 89% more likely to benefit from the exercise program. Conclusions: Clinicians should consider the described strengthening and flexibility exercise program for patents with BMI less than 34.7 Kg/m2 and 50 FTW faster than 25.6 seconds. The validity of these predictors should be investigated for other exercise.

Keywords: clinical prediction rule, knee osteoarthritis, physical therapy exercises, validity

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Authors: Sutapa Som Chaudhury, Chitrangada Das Mukhopadhyay

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Alzheimer’s disease is a well-known form of dementia since its discovery in 1906. Current Food and Drug Administration approved medications e.g. cholinesterase inhibitors, memantine offer modest symptomatic relief but do not play any role in disease modification or recovery. In last three decades many small molecules, chaperons, synthetic peptides, partial β-secretase enzyme blocker have been tested for the development of a drug against Alzheimer though did not pass the 3rd clinical phase trials. Here in this study, we designed a PEGylated, aminogenic, tripeptidic polymer with two different molecular weights based on the aggregation prone amino acid sequence 17-20 in amyloid beta (Aβ) 1-42. Being conjugated with poly-ethylene glycol (PEG) which self-assembles into hydrophilic nanoparticles, these PEGylated tripeptides constitute a very good drug delivery system crossing the blood brain barrier while the peptide remains protected from proteolytic degradation and non-specific protein interactions. Moreover, being completely aminogenic they would not raise any side effects. These peptide inhibitors were evaluated for their effectiveness against Aβ42 fibrillation at an early stage of oligomer to fibril formation as well as preformed fibril clearance via Thioflavin T (ThT) assay, dynamic light scattering analyses, atomic force microscopy and scanning electron microscopy. The inhibitors were proved to be safe at a higher concentration of 20µM by the reduction assay of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) dye. Moreover, SHSY5Y neuroblastoma cells have shown a greater survivability when treated with the inhibitors following Aβ42 fibril and oligomer treatment as compared with the control Aβ42 fibril and/or oligomer treated neuroblastoma cells. These make the peptidic inhibitors a promising compound in the aspect of the discovery of alternative medication for Alzheimer’s disease.

Keywords: Alzheimer’s disease, alternative medication, amyloid beta, PEGylated peptide

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Authors: Shu Hwang Ang, Choo Yee Yu, Geik Yong Ang, Yean Yean Chan, Yatimah Binti Alias, And Sook Mei Khor

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With the high prevalence of Type 2 diabetes mellitus across the world, the morbidities and mortalities associated with Type 2 diabetes have significant impact on the production line for a nation. With routine scheduled clinical visits to manage Type 2 diabetes, diabetic patients with hectic lifestyles can have low clinical compliance. Hence, it often decreases the effectiveness of diabetic management personalized for each diabetic patient. Here, we report a useful developed point-of-care (POC) device that detect glycated hemoglobin (HbA1c, biomarker for long-term Type 2 diabetic management). In fact, the established POC devices certified to be used in clinical setting are not only expensive ($ 8 to $10 per test), they also require skillful practitioners to perform sampling and interpretation. As a paper-based biosensor, the developed HbA1c biosensor utilized lateral flow principle to offer an alternative for cost-effective (approximately $2 per test) and end-user friendly device for household testing. Requiring as little as 2 L of finger-picked blood, the test can be performed at the household with just simple dilution and washings. With visual interpretation of numbers of test lines shown on the developed biosensor, it can be interpreted as easy as a urine pregnancy test, aided with scale of intensity provided. In summary, the developed HbA1c immunosensor has been tested to have high selectivity towards HbA1c, and is stable with reasonably good performance in clinical testing. Therefore, our developed HbA1c immunosensor has high potential to be an effective diabetic management tool to increase patient compliance and thus contain the progression of the diabetes.

Keywords: blood, glycated hemoglobin (HbA1c), lateral flow, type 2 diabetes mellitus

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Authors: Druzhinenko-Silhan Daria, Metz Claire

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In this paper, we introduce the findings of the "Conjugal violence: mothers' parenting and court decisions" (VIC-PADEJ) study, focusing on the motherhood experiences of domestic violence victims. Utilizing a longitudinal research protocol that encompassed clinical interviews, projective methods, and various questionnaires, we detail the outcomes derived from seven clinical interviews with mothers alongside a comprehensive analysis. The findings reveal a pronounced decline in security and an imperative need for structuring both social and internal realities. The convergence of these findings indicates that parenting, post-experiencing domestic violence, may become an unattainable task due to the deficiency of internal resources.

Keywords: domestic violence, parenthood, mothers victims, projective methods, longitudinal research, alceste analysis

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Authors: Milind D. Meshram

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Ascarids are the most frequent worm parasite of dogs and cats. There are two species that commonly infect dogs: Toxocara canis and Toxascaris leonina. Adult roundworms live in the stomach and intestines and can grow to 7 inches (18 cm) long. A female may lay 200,000 eggs in a day. The eggs are protected by a hard shell. They are extremely hardy and can live for months or years in the soil. A dog aged about 6 years, from Satara was referred to Teaching Veterinary Clinical Complex (TVCC) with a complaint of abdominal pain, anorexia, loss of condition and dull body coat with mucous pale membrane. The clinical examination revealed Anaemia, palpation of abdomen revealed enlargement of liver, slimy feel of the intestine loop, diarrhea.

Keywords: therapeutic management, Toxocara canis, induced hepatitis, dogs

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Authors: Liane J. Ioannou, Jonathan Serpell, Joanne Dean, Cino Bendinelli, Jenny Gough, Dean Lisewski, Julie Miller, Win Meyer-Rochow, Stan Sidhu, Duncan Topliss, David Walters, John Zalcberg, Susannah Ahern

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Background: The occurrence of thyroid cancer is increasing throughout the developed world, including Australia and New Zealand, and since the 1990s has become the fastest increasing malignancy. Following the success of a number of institutional databases that monitor outcomes after thyroid surgery, the Australian and New Zealand Endocrine Surgeons (ANZES) agreed to auspice the development of a bi-national thyroid cancer registry. Objectives: To establish a bi-national population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand. Patients and Methods: The Australian and New Zealand Thyroid Cancer Registry (ANZTCR) captures clinical data for all patients, over the age of 18 years, diagnosed with thyroid cancer, confirmed by histopathology report, that have been diagnosed, assessed or treated at a contributing hospital. Data is collected by endocrine surgeons using a web-based interface, REDCap, primarily via direct data entry. Results: A multi-disciplinary Steering Committee was formed, and with operational support from Monash University the ANZTCR was established in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 30 sites expected to come on board across Australia and New Zealand in 2018. A modified-Delphi process was undertaken to determine the key quality indicators to be reported by the registry, and a minimum dataset was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery, and 30-day follow up. Conclusion: There are very few established thyroid cancer registries internationally, yet clinical quality registries have shown valuable outcomes and patient benefits in other cancers. The establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand the current practice in the treatment of thyroid cancer and reasons for variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer-term outcome data particularly for patients with the poor prognostic disease will add significant further value to the registry.

Keywords: thyroid cancer, clinical registry, population health, quality improvement

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Authors: Laïd Boukraâ

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Complementary and Alternative Medicine is an inclusive term that describes treatments, therapies, and modalities that are not accepted as components of mainstream education or practice, but that are performed on patients by some practitioners. While these treatments and therapies often form part of post-graduate education, study and writing, they are generally viewed as alternatives or complementary to more universally accepted treatments. Ancient civilizations used bee products and medicinal plants, but modern civilization and ‘education’ have seriously lessened our natural instinctive ability and capability. Despite the fact that the modern Western establishment appears to like to relegate apitherapy and aromatherapy to the status of 'folklore' or 'old wives' tales', they contain a vast spread of pharmacologically-active ingredients and each one has its own unique combination and properties. They are classified in modern herbal medicine according to their spheres of action. Bee products and medicinal plants are well-known natural product for their healing properties and their increasing popularity recently as they are widely used in wound healing. Honey not only has antibacterial properties which can help as an antibacterial agent but also has chemical properties which may further help in the wound healing process. A formulation with honey as its main component was produced into a honey gel. This new formulation has enhanced texture and is more user friendly for usage as well. This new formulation would be better than other formulas as it is hundred percent consisting of natural products and has been made into a better formulation. In vitro assay, animal model study and clinical trials have shown the effectiveness of LEADERMAX for the treatment of diabetic foot, burns, leg ulcer and bed sores. This one hundred percent natural product could be the best alternative to conventional products for wound and burn management. The advantages of the formulation are: 100% natural, affordable, easy to use, strong power of absorption, dry surface on the wound making a film, will not stick to the wound bed; helps relieve wound pain, inflammation, edema and bruising while improving comfort.

Keywords: bed sore bee products, burns, diabetic foot, medicinal plants, leg ulcer, wounds

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Authors: Mert Turanli, Hakan Temeltas

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In this paper, we present an adaptive controller for decentralized coordination problem of multiple non-holonomic agents. The performance of the presented Multi-Agent Bounded Gain Forgetting (BGF) Composite Adaptive controller is compared against the tracking error criterion with a Feedback Linearization controller. By using the method, the sensor nodes move and reconfigure themselves in a coordinated way in response to a sensed environment. The multi-agent coordination is achieved through Centroidal Voronoi Tessellations and Coverage Control. Also, a consensus protocol is used for synchronization of the parameter vectors. The two controllers are given with their Lyapunov stability analysis and their stability is verified with simulation results. The simulations are carried out in MATLAB and ROS environments. Better performance is obtained with BGF Adaptive Controller.

Keywords: adaptive control, centroidal voronoi tessellations, composite adaptation, coordination, multi robots

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Authors: Hae-Won Seo, Yong-Gu Lee

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Recent progress in the next generation of automobile technology is geared towards incorporating information technology into cars. Collectively called smart cars are bringing intelligence to cars that provides comfort, convenience and safety. A branch of smart cars is connected-car system. The key concept in connected-cars is the sharing of driving information among cars through decentralized manner enabling collective intelligence. This paper proposes a foundation of the information model that is necessary to define the driving information for smart-cars. Road conditions are modeled through a unique data structure that unambiguously represent the time variant traffics in the streets. Additionally, the modeled data structure is exemplified in a navigational scenario and usage using UML. Optimal driving route searching is also discussed using the proposed data structure in a dynamically changing road conditions.

Keywords: connected-car, data modeling, route planning, navigation system

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Authors: J. S. M. Yang, G. E. T. Chua

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Diploma in Optometry (OPT) course is a three-year program offered by Ngee Ann Polytechnic (NP) to train students to provide primary eye care. Students are equipped with foundational conceptual knowledge and practical skills in the first three semesters before clinical modules in fourth to six semesters. In the clinical modules, students typically have difficulties in integrating the acquired knowledge and skills from the past semesters to perform general eye examinations on public patients at NP Optometry Centre (NPOC). To help the students overcome the challenge, a web-based game Virtual Optometrist (VO) was developed to help students apply their skills and knowledge through scenario-based learning. It consisted of two interfaces, Optical Practice Counter (OPC) and Optometric Consultation Room (OCR), to provide two simulated settings for authentic learning experiences. In OPC, students would recommend and provide appropriate frame and lens selection based on virtual patient’s case history. In OCR, students would diagnose and manage virtual patients with common ocular conditions. Simulated scenarios provided real-world clinical situations that required contextual application of integrated knowledge from relevant modules. The stages in OPC and OCR are of increasing complexity to align to expected students’ clinical competency as they progress to more senior semesters. This prevented gameplay fatigue as VO was used over the semesters to achieve different learning outcomes. Numerous feedback opportunities were provided to students based on their decisions to allow individualized learning to take place. The game-based learning element in VO was achieved through the scoreboard and leader board to enhance students' motivation to perform. Scores were based on the speed and accuracy of students’ responses to the questions posed in the simulated scenarios, preparing the students to perform accurately and effectively under time pressure in a realistic optometric environment. Learning analytics was generated in VO’s backend office based on students’ responses, offering real-time data on distinctive and observable learners’ behavior to monitor students’ engagement and learning progress. The backend office allowed versatility to add, edit, and delete scenarios for different intended learning outcomes. Likert Scale was used to measure students’ learning experience with VO for OPT Year 2 and 3 students. The survey results highlighted the learning benefits of implementing VO in the different modules, such as enhancing recall and reinforcement of clinical knowledge for contextual application to develop higher-order thinking skills, increasing efficiency in clinical decision-making, facilitating learning through immediate feedback and second attempts, providing exposure to common and significant ocular conditions, and training effective communication skills. The results showed that VO has been useful in reinforcing optometry students’ learning and supporting the development of higher-order thinking, increasing efficiency in clinical decision-making, and allowing students to learn from their mistakes with immediate feedback and second attempts. VO also exposed the students to diverse ocular conditions through simulated real-world clinical scenarios, which may otherwise not be encountered in NPOC, and promoted effective communication skills.

Keywords: authentic learning, game-based learning, scenario-based learning, simulated clinical scenarios

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Authors: Carie Cunningham, Krsiten Lynch

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Despite a viewer’s thought that they may be paying attention, many times they are missing out on their surrounds-- a phenomenon referred to as inattentional blindness. Inattention blindness refers to the failure of an individual to orient their attention to a particular item in their visual field. This well-defined in the psychology literature. Similarly, this phenomenon has been evaluated in media types in advertising. In advertising, not comprehending/remembering items in one’s field of vision is known as banner blindness. On the other hand, banner blindness is a phenomenon that occurs when individuals habitually see a banner in a specific area on a webpage, and thus condition themselves to ignore those habitual areas. Another reason that individuals avoid these habitual areas (usually on the top or sides of a webpage) is due to the lack of personal relevance or pertinent information to the viewer. Banner blindness, while a web-based concept, may also relate this inattention blindness. This paper is proposing an analysis of the true similarities and differences between these concepts bridging the two dimensions of thinking together. Forty participants participated in an eye-tracking and post-survey experiment to test attention and memory measures in both a banner blindness and inattention blindness condition. The two conditions were conducted between subjects semi-randomized order. Half of participants were told to search through the content ignoring the advertising banners; the other half of participants were first told to search through the content ignoring the distractor icon. These groups were switched after 5 trials and then 5 more trials were completed. In review of the literature, sustainability communication was found to have many inconsistencies with message production and viewer awareness. For the purpose of this study, we used advertising materials as stimuli. Results suggest that there are gaps between the two concepts and that more research should be done testing these effects in a real world setting versus an online environment. This contributes to theory by exploring the overlapping concepts—inattention blindness and banner blindness and providing the advertising industry with support that viewers can still fall victim to ignoring items in their field of view even if not consciously, which will impact message development.

Keywords: attention, banner blindness, eye movement, inattention blindness

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Authors: Avishkar Gawade, Omkar Bansode, Ketan Bhambure, Bhargav Deore

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In recent year wide range of business intelligence technology have been applied to different area in order to support decision making process BI enables extraction of knowledge from data store. BI tools usually used in public health field for financial and administrative purposes.BI uses a dashboard in presentation stage to deliver information to information to end users.In this paper,we intend to analyze some open source BI tools on the market and their applicability in the clinical sphere taking into consideration the general characteristics of the clinical environment.A pervasive BI platform was developed using a real case in order to prove the tool viability.Analysis of various BI Tools in done with the help of several parameters such as data security,data integration,data quality reporting and anlaytics,performance,scalability and cost effectivesness.

Keywords: CDSS, EHR, business intelliegence, tools

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Authors: Maneka Marianne Britto, Hansraj Riteesh Bookun

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The ability of a junior doctor to deliver complex multi-disciplinary care to patients in a paradigm of respect and collaboration requires a multitude of interpersonal skills and competencies. A short survey was used to explore the perspective of allied health staff on the desirable attributes of a junior doctor which are conducive to good teamwork. 23 allied health professionals (14 nurses, 4 physiotherapists, 2 dietitians, 1 occupational therapist, 1 speech therapist and 1 audiologist) responded to this 17-item survey. There were 17 females. The mean age of the respondents was 34.9 ± 10.1 years. The salient findings of our survey are that 95% of our respondents rated friendliness and non-clinical small talk with average importance or greater. 45% of them viewed these 2 items as very important or absolutely essential. A single respondent viewed these 2 items with little importance. The other criteria which were rated with high levels of importance were the acknowledgment of allied health suggestions and good ward organizational skills. Training these collaborative skills is challenging, and an enhanced understanding of interprofessional perspectives will help a junior doctor to achieve better clinical outcomes. It is hoped that this paper will further stimulate discussion in this area and will encourage junior doctors to engage in non-clinical conversations with allied health staff in the spirit of promoting effective teamwork.

Keywords: allied health, collaboration, doctor, medicine, surgery

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Authors: Joanne M. Emmens

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This paper makes use of the case notes of a single psychoanalytically informed psychotherapy of a now 72-year-old man over a four-year period to explore the potential of qualitative data to be incorporated into a research methodology that can contribute theory and knowledge to the wider professional community involved in mental health care. The clinical material arising out of any psychoanalysis provides a potentially rich source of clinical data that could contribute valuably to our historical understanding of both individual and societal traumata. As psychoanalysis is primarily an investigation, it is argued that clinical case material is a rich source of qualitative data which has relevance for sociological and historical understandings and that it can potentially aluminate important ‘gaps’ and collective blind spots that manifest unconsciously and are a contributing factor in the transmission of trauma, silently across generations. By attending to this case material the hope is to illustrate the value of using a psychoanalytic centred methodology. It is argued that the study of individual defences and the manner in which they come into consciousness, allows an insight into group defences and the unconscious forces that contribute to the silencing or un-noticing of important sources (or originators) of mental suffering.

Keywords: dream furniture (Bion) and psychotic functioning, reverie, screen memories, selected fact

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Authors: F. Gallop, C. Ward, M. Zaky, M. Vaghela, R. Sabaratnam

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Nitrous oxide (N₂O) has been used in anaesthesia for over 150 years owing to advantageous physical and pharmacological properties. However, with a global warming potential of 310, we have an urgent responsibility to reduce its usage and emission. Anecdotal evidence in our hospital trust suggests minimal N₂O usage, yet our theatres receive a staggering supply. This warranted further investigation. We used a data collection tool to prospectively capture quantitative and qualitative data regarding N₂O cases during one week: this recorded demographics, N₂O indications, clinical management, and total N₂O consumption in litres. In addition, N₂O usage in dental sedation suites and paediatric theatres was separately quantified. Pipeline supply data was acquired from British Oxygen Company accounts. We captured 490 cases. 4% (n=19) used N₂O, 63% (n=12) of these in dental theatres. Common N₂0 indications were induction speed (37%) and rapidly increasing anaesthesia depth (32%). In adult cases, N₂O was always used intraoperatively rather than solely at induction. 74% (n=14) of anaesthetists reported environmental concern over using N₂O. The week’s total N₂O usage was 8109 litres, amounting to 421,668 litres annually. However, the annual N₂O pipeline supply is 2,997,000 litres; an enormous 1.8 million Kg of CO₂. Our results supportively demonstrate that the N₂O pipeline supply greatly exceeds its clinical use. Acknowledging clinical areas not audited, the discrepancy between supply and usage suggests approximately 2.5 million litres of yearly wastage. We consequently recommend terminating the N₂O pipeline supply in minimally used areas, eliminating 1.5 million Kg of CO₂ emissions. High usage clinical areas could consider portable N₂O cylinders as an alternative. In Sweden, N₂O destruction technology is routinely used to minimise CO₂ emissions. Our results support National Health System investment in similar infrastructure.

Keywords: anaesthesia, environment, medical gases, nitrous oxide, sustainability

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Authors: Abdullah A. Al Orainy

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Small cell backhaul solutions need to be cost-effective, scalable, and easy to install. This paper presents an overview of small cell backhaul technologies. Wireless solutions including TV white space, satellite, sub-6 GHz radio wave, microwave and mmWave with their backhaul characteristics are discussed. Recent research on issues like beamforming, backhaul architecture, precoding and large antenna arrays, and energy efficiency for dense small cell backhaul with mmWave communications is reviewed. Recent trials of 5G technologies are summarized.

Keywords: backhaul, small cells, wireless, 5G

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Authors: Mamta Thakur, Dr. Shashi Mawar, Ms. Levis Murry, Dr. D.k.sharma

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Aim: The aim of this study is to develop nephrology nursing procedure protocol after clinical audit of current nephrology nursing practices. Materials and methods: This descriptive observational study was conducted on 40 nurses who were working in Nephrology Department of AIIMS, New Delhi to observe their current practices to assess the existing gaps in the practice. The nurses were enrolled through total enumerative sampling. Sociodemographic profile of nurses and clinical profile for site of procedure was collected. Observation checklist was formed on the basis of standard nursing practices, which included 7 dimensions for hemodialysis procedure and 3 dimensions for procedure of assisting renal biopsy. Based on the gaps identified, nephrology nursing procedure protocol will be developed. Nurses were observed during two shifts, and each nurse was observed once. Scoring of items were done in each dimension, and for acceptable practices, nurses have to score ≥80% in each dimension. Results: Data was analyzed using descriptive statistics. Majority of nurses (73.7%) in nephrology ward and (80.9%) in hemodialysis unit have not undergone any special training in nephrology. Most of nurses (80.9%) followed the acceptable nursing practices for procedure of connection for hemodialysis. None of nurses followed the acceptable level (≥80%) of nursing practices for the procedure of predialysis assessment, the procedure for site preparation, during dialysis assessment and post dialysis assessment. None (100%) showed the acceptable level of nursing practices for all the dimensions of assisting renal biopsy procedure. Nephrology nursing procedure protocol was developed by researcher following a rigorous process, and this will reduce the gaps in the nursing practice. Conclusion: Clinical audit found that there were gaps in the existing nursing practices compared to the standardised nursing practices for procedure of hemodialysis and assisting renal biopsy, and these gaps have been addressed by the development of the protocol.

Keywords: nursing practice, nephrology nursing procedure, nursing protocol, renal biopsy, hemodialysis

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Authors: Alice Huffman, Joseph Hartland, Sam Gibbs

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Dermatology is often a neglected specialty in low-resource settings, despite the high morbidity associated with skin disease. This becomes even more significant when associated with HIV infection, as dermatological conditions are more common and aggressive in HIV positive patients. African countries have the highest HIV infection rates and skin conditions are frequently misdiagnosed and mismanaged, because of a lack of dermatological training and educational material. The frequent lack of diagnostic tests in the African setting renders basic clinical skills all the more vital. This project aimed to improve diagnosis and treatment of skin disease in the HIV population in a district hospital in Malawi. A basic dermatological clinical tool was developed and produced in collaboration with local staff and based on available literature and data collected from clinics. The aim was to improve diagnostic accuracy and provide guidance for the treatment of skin disease in HIV positive patients. A literature search within Embase, Medline and Google scholar was performed and supplemented through data obtained from attending 5 Antiretroviral clinics. From the literature, conditions were selected for inclusion in the resource if they were described as specific, more prevalent, or extensive in the HIV population or have more adverse outcomes if they develop in HIV patients. Resource-appropriate treatment options were decided using Malawian Ministry of Health guidelines and textbooks specific to African dermatology. After the collection of data and discussion with local clinical and pharmacy staff a list of 15 skin conditions was included and a booklet created using the simple layout of a picture, a diagnostic description of the disease and treatment options. Clinical photographs were collected from local clinics (with full consent of the patient) or from the book ‘Common Skin Diseases in Africa’ (permission granted if fully acknowledged and used in a not-for-profit capacity). This tool was evaluated by the local staff, alongside an educational teaching session on skin disease. This project aimed to reduce uncertainty in diagnosis and provide guidance for appropriate treatment in HIV patients by gathering information into one practical and manageable resource. To further this project, we hope to review the effectiveness of the tool in practice.

Keywords: dermatology, HIV, Malawi, skin disease

Procedia PDF Downloads 163