Search results for: clinically relevant

Authors: Afzaal Bashir, Sunaina Afzaal

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Background: Facial contour deformities associated with pigmentary changes are of major concern for plastic surgeons, both being important and difficult in treating such issues. No definite ideal treatment option is available to simultaneously address both the contour defect as well as related pigmentation. Objectives: The aim of the current study is to compare the long-term effects of conventional adipose tissue grafting and ex-vivo expanded Mesenchymal Stem Cells enriched adipose tissue grafting for the treatment of contour deformities with pigmentary changes on the face. Material and Methods: In this study, eighty (80) patients with contour deformities of the face with hyperpigmentation were recruited after informed consent. Two techniques i.e., conventional fat grafting (C-FG) and fat grafts enriched with expanded adipose stem cells (FG-ASCs), were used to address the pigmentation. Both techniques were explained to patients, and enrolled patients were divided into two groups i.e., C-FG and FG-ASCS, per patients’ choice and satisfaction. Patients of the FG-ASCs group were treated with fat grafts enriched with expanded adipose stem cells, while patients of the C-FGs group were treated with conventional fat grafting. Patients were followed for 12 months, and improvement in face pigmentation was assessed clinically as well as measured objectively. Patient satisfaction was also documented as highly satisfied, satisfied, and unsatisfied. Results: Mean age of patients was 24.42(±4.49), and 66 patients were females. The forehead was involved in 61.20% of cases, the cheek in 21.20% of cases, the chin in 11.20% of cases, and the nose in 6.20% of cases. In the GF-ASCs group, the integrated color density (ICD) was decreased (1.08×10⁶ ±4.64×10⁵) as compared to the C-FG group (2.80×10⁵±1.69×10⁵). Patients treated with fat grafts enriched with expanded adipose stem cells were significantly more satisfied as compared to patients treated with conventional fat grafting only. Conclusion: Mesenchymal stem cell-enriched autologous fat grafting is a preferred option for improving the contour deformities related to increased pigmentation of face skin.

Keywords: hyperpigmentation, color density, enriched adipose tissue graft, fat grafting, contour deformities, Image J

Procedia PDF Downloads 113

Authors: Lucie Matricon, Anne Roubaud, Geert Haarlemmer, Christophe Geantet

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Introduction: This case discusses the management of two floor of mouth (FOM) Squamous Cell Carcinomas (SCC) not identified upon initial biopsy. Case Report: A 51 year-old male presented with right FOM erythroleukoplakia. Relevant medical history included alcoholic dependence syndrome and alcoholic liver disease. Relevant drug therapy encompassed acamprosate, folic acid, hydroxocobalamin and thiamine. The patient had a 55.5 pack-year smoking history and alcohol dependence from age 14, drinking 16 units/day. FOM incisional biopsy and histopathological analysis diagnosed Carcinoma in situ. Treatment involved wide local excision. Specimen analysis revealed two separate foci of pT1 moderately differentiated SCCs. Carcinoma staging scans revealed no pathological lymphadenopathy, no local invasion or metastasis. SCCs had been excised in completion with narrow margins. MDT discussion concluded that in view of the field changes it would be difficult to identify specific areas needing further excision, although techniques such as Lugol’s Iodine were considered. Further surgical resection, surgical neck management and sentinel lymph node biopsy was offered. The patient declined intervention, primary management involved close monitoring alongside alcohol and smoking cessation referral. Discussion: Narrow excisional margins can increase carcinoma recurrence risk. Biopsy failed to identify SCCs, despite sampling an area of clinical concern. For gross field change multiple incisional biopsies should be considered to increase chance of accurate diagnosis and appropriate treatment. Coupling of tobacco and alcohol has a synergistic effect, exponentially increasing the relative risk of oral carcinoma development. Tobacco and alcoholic control is fundamental in reducing treatment‑related side effects, recurrence risk, and second primary cancer development.

Keywords: microalgae, biofuels, hydrothermal liquefaction, biomass

Procedia PDF Downloads 133

Authors: I. Wiemann, N. Weiß, E. Schlücker, M. Wensing, A. Kölpin

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Chemical storage of hydrogen by liquid organic hydrogen carriers (LOHC) is a very promising alternative to compression or cryogenics. These carriers have high energy density and allow at the same time efficient and safe storage of hydrogen under ambient conditions and without leakage losses. Another benefit of LOHC is the possibility to transport it using already available infrastructure for transport of fossil fuels. Efficient use of LOHC is related to a precise process control, which requires a number of sensors in order to measure all relevant process parameters, for example, to measure the level of hydrogen loading of the carrier. The degree of loading is relevant for the energy content of the storage carrier and represents simultaneously the modification in chemical structure of the carrier molecules. This variation can be detected in different physical properties like viscosity, permittivity or density. Thereby, each degree of loading corresponds to different viscosity values. Conventional measurements currently use invasive viscosity measurements or near-line measurements to obtain quantitative information. Avoiding invasive measurements has several severe advantages. Efforts are currently taken to provide a precise, non-invasive measurement method with equal or higher precision of the obtained results. This study investigates a method for determination of the viscosity of LOHC. Since the viscosity can retroactively derived from the degree of loading, permittivity is a target parameter as it is a suitable for determining the hydrogenation degree. This research analyses the influence of common physical properties on permittivity. The permittivity measurement system is based on a cavity resonator, an electromagnetic resonant structure, whose resonation frequency depends on its dimensions as well as the permittivity of the medium inside. For known resonator dimensions, the resonation frequency directly characterizes the permittivity. In order to determine the dependency of the permittivity on temperature and flow velocity, an experimental setup with heating device and flow test bench was designed. By varying temperature in the range of 293,15 K -393,15 K and flow velocity up to 140 mm/s, corresponding changes in the resonation frequency were measured in the hundredths of the GHz range.

Keywords: liquid organic hydrogen carriers, measurement, permittivity, viscosity., temperature, flow process

Procedia PDF Downloads 100

Authors: Saif Al Ghafri, Thomas Hughes, Armand Karimi, Kumarini Seneviratne, Jordan Oakley, Michael Johns, Eric F. May

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Knowledge of the thermophysical properties of complex mixtures at extreme conditions of pressure and temperature have always been essential to the Liquefied Natural Gas (LNG) industry’s evolution because of the tremendous technical challenges present at all stages in the supply chain from production to liquefaction to transport. Each stage is designed using predictions of the mixture’s properties, such as density, viscosity, surface tension, heat capacity and phase behaviour as a function of temperature, pressure, and composition. Unfortunately, currently available models lead to equipment over-designs of 15% or more. To achieve better designs that work more effectively and/or over a wider range of conditions, new fundamental property data are essential, both to resolve discrepancies in our current predictive capabilities and to extend them to the higher-pressure conditions characteristic of many new gas fields. Furthermore, innovative experimental techniques are required to measure different thermophysical properties at high pressures and over a wide range of temperatures, including near the mixture’s critical points where gas and liquid become indistinguishable and most existing predictive fluid property models used breakdown. In this work, we present a wide range of experimental measurements made for different binary and ternary mixtures relevant to LNG processing, with a particular focus on viscosity, surface tension, heat capacity, bubble-points and density. For this purpose, customized and specialized apparatus were designed and validated over the temperature range (200 to 423) K at pressures to 35 MPa. The mixtures studied were (CH4 + C3H8), (CH4 + C3H8 + CO2) and (CH4 + C3H8 + C7H16); in the last of these the heptane contents was up to 10 mol %. Viscosity was measured using a vibrating wire apparatus, while mixture densities were obtained by means of a high-pressure magnetic-suspension densimeter and an isochoric cell apparatus; the latter was also used to determine bubble-points. Surface tensions were measured using the capillary rise method in a visual cell, which also enabled the location of the mixture critical point to be determined from observations of critical opalescence. Mixture heat capacities were measured using a customised high-pressure differential scanning calorimeter (DSC). The combined standard relative uncertainties were less than 0.3% for density, 2% for viscosity, 3% for heat capacity and 3 % for surface tension. The extensive experimental data gathered in this work were compared with a variety of different advanced engineering models frequently used for predicting thermophysical properties of mixtures relevant to LNG processing. In many cases the discrepancies between the predictions of different engineering models for these mixtures was large, and the high quality data allowed erroneous but often widely-used models to be identified. The data enable the development of new or improved models, to be implemented in process simulation software, so that the fluid properties needed for equipment and process design can be predicted reliably. This in turn will enable reduced capital and operational expenditure by the LNG industry. The current work also aided the community of scientists working to advance theoretical descriptions of fluid properties by allowing to identify deficiencies in theoretical descriptions and calculations.

Keywords: LNG, thermophysical, viscosity, density, surface tension, heat capacity, bubble points, models

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Authors: Snehal G. Teli, R. J. Shelke

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CNN and MultiUNet models are the framework for the proposed method for enhancing and reconstructing underwater images. Multiscale merging of features and regeneration are both performed by the MultiUNet. CNN collects relevant features. Extensive tests on benchmark datasets show that the proposed strategy performs better than the latest methods. As a result of this work, underwater images can be represented and interpreted in a number of underwater applications with greater clarity. This strategy will advance underwater exploration and marine research by enhancing real-time underwater image processing systems, underwater robotic vision, and underwater surveillance.

Keywords: convolutional neural network, image enhancement, machine learning, multiunet, underwater images

Procedia PDF Downloads 79

Authors: Christian Meinecke, Bernd Scholz-Reiter

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The integrated problem of production and distribution scheduling is relevant in many industrial applications. Thus, many heuristics to solve this integrated problem have been developed in the last decade. Most of these heuristics use a sequential working principal or a single decomposition and integration approach to separate and solve sub-problems. A heuristic using a multi-step decomposition and integration approach is presented in this paper and evaluated in a case study. The result show significant improved results compared with sequential scheduling heuristics.

Keywords: production and outbound distribution, integrated planning, heuristic, decomposition, integration

Procedia PDF Downloads 430

Authors: Heng W. Chang, Mao F. Sun

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Chronic Idiopathic Urticaria (CIU) and hypertension are rarely discussed together in modern and traditional Chinese medicine, and often belong to different medical departments. However, in traditional Chinese medicinal theory, the two diseases have some similar characters. For example, they are both relevant to 'wind'. This study conducted a literature review using the China National Knowledge Infrastructure to identify herbs yielding the same effect for the two diseases. The finding showed that the common herbs used most frequently is Rehmanniae. The conclusion is that the same TCM (Traditional Chinese Medicine) mechanism of the two diseases may be 'blood heat'. It requires further study to prove it in the future.

Keywords: urticaria, herbs, hypertension, Rehmanniae

Procedia PDF Downloads 156

Authors: Eric Lee G. Escobedo-Wu, Nidhi Rohatgi, Fouzel Dhebar

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It is challenging for patients to navigate through healthcare systems after-hours. This leads to delays in care, patient/provider dissatisfaction, inappropriate resource utilization, readmissions, and higher costs. It is important to provide patients and providers with effective clinical decision-making tools to allow seamless connectivity and coordinated care. In August 2015, patient-centric Stanford Health Care established Clinical Advice Services (CAS) to provide clinical decision support after-hours. CAS is founded on key Lean principles: Value stream mapping, empathy mapping, waste walk, takt time calculations, standard work, plan-do-check-act cycles, and active daily management. At CAS, Clinical Assistants take the initial call and manage all non-clinical calls (e.g., appointments, directions, general information). If the patient has a clinical symptom, the CAS nurses take the call and utilize standardized clinical algorithms to triage the patient to home, clinic, urgent care, emergency department, or 911. Nurses may also contact the on-call physician based on the clinical algorithm for further direction and consultation. Since August 2015, CAS has managed 228,990 calls from 26 clinical specialties. Reporting is built into the electronic health record for analysis and data collection. 65.3% of the after-hours calls are clinically related. Average clinical algorithm adherence rate has been 92%. An average of 9% of calls was escalated by CAS nurses to the physician on call. An average of 5% of patients was triaged to the Emergency Department by CAS. Key learnings indicate that a seamless connectivity vision, cascading, multidisciplinary ownership of the problem, and synergistic enterprise improvements have contributed to this success while striving for continuous improvement.

Keywords: after hours phone calls, clinical advice services, nurse triage, Stanford Health Care

Procedia PDF Downloads 176

Authors: Pooja Kumari, Anandkumar Tengli

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Aurora kinase enzyme, a protein on overexpression, leads to metastasis and is extremely important for women’s health in terms of prevention or treatment. While creating a targeted technique, the aim of the work is to design purine molecules that inhibit in aurora kinase enzyme and helps to suppress breast cancer. Purine molecules attached to an amino acid in DNA block protein synthesis or halt the replication and metastasis caused by the aurora kinase enzyme. Various protein related to the overexpression of aurora protein was docked with purine molecule using Biovia Drug Discovery, the perpetual software. Various parameters like X-ray crystallographic structure, presence of ligand, Ramachandran plot, resolution, etc., were taken into consideration for selecting the target protein. A higher negative binding scored molecule has been taken for simulation studies. According to the available research and computational analyses, purine compounds may be powerful enough to demonstrate a greater affinity for the aurora target. Despite being clinically effective now, purines were originally meant to fight breast cancer by inhibiting the aurora kinase enzyme. In in-silico studies, it is observed that purine compounds have a moderate to high potency compared to other molecules, and our research into the literature revealed that purine molecules have a lower risk of side effects. The research involves the design, synthesis, and identification of active purine molecules against breast cancer. Purines are structurally similar to the normal metabolites of adenine and guanine; hence interfere/compete with protein synthesis and suppress the abnormal proliferation of cells/tissues. As a result, purine target metastasis cells and stop the growth of kinase; purine derivatives bind with DNA and aurora protein which may stop the growth of protein or inhibits replication and stop metastasis of overexpressed aurora kinase enzyme.

Keywords: aurora kinases, in silico studies, medicinal chemistry, combination therapies, chronic cancer, clinical translation

Procedia PDF Downloads 86

Authors: B. G. Sheeparamatti, Prashant Hanasi, Vanita Abbigeri

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The objective of this work is to carry out a critical comparison of different actuation mechanisms like electrostatic, thermal, piezoelectric, and magnetic with reference to a microcantilever. The relevant parameters like force generated, displacement are compared in actuation methods. With these results, they help in choosing the best actuation method for a particular application. In this study, Comsol/Multiphysics software is used. Modeling and simulation are done by considering the microcantilever of same dimensions as an actuator using all the above-mentioned actuation techniques. In addition to their small size, micro actuators consume very little power and are capable of accurate results. In this work, a comparison of actuation mechanisms is done to decide the efficient system in the micro domain.

Keywords: actuation techniques, microswitch, micro actuator, microsystems

Procedia PDF Downloads 410

Authors: Ratnakar Rao, Subair Khan, Hari Haran

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Posterior cruciate ligament (PCL) avulsion fractures is a rare condition and commonly mismanaged.Surgical reattachment has been shown to produce better result compared with conservative management.Only few techniques are reported in arthroscopic fixation of PCL Avulsion Fracture and they are complex.We describe a new technique in fixation of the PCL Avulsion fracture through a posterior trans septal portal using button fixation device (Mini Tight Rope). Eighteen patients with an isolated posterior cruciate ligament avulsion fracture were operated under arthroscopy. Standard Antero Medial Portal and Antero Lateral portals made and additional Postero Medial and Postero Lateral portals made and trans Septal portal established. Avulsion fracture identified, elevated, prepared. Reduction achieved using PCL Tibial guide (Arthrex) and fixation was achieved using Mini Tight Rope,Arthrex (2 buttons with a suture). Reduction confirmed using probe and Image intensifier. Postoperative assessment made clinically and radiologically. 15 patients had good to excellent results with no posterior sag or instability. The range of motion was normal. No complications were recorded per operatively. 2 patients had communition of the fragment while drilling, for one patient it was managed by suturing technique and the second patient PCL Reconstruction was done. One patient had persistent instability with poor outcome. Establishing trans septal portal helps in better visualization of the posterior compartment of the knee. Assessment of the bony fragment, preparation 0f the bone bed andit protects from injury to posterior neurovascular structures. Fixation using the button with suture (Mini Tight Rope) is stable and easily reproducible for PCL Avulsion fracture with single large fragment.

Keywords: PCL avulsion, arthroscopy, transeptal, minitight rope technique

Procedia PDF Downloads 258

Authors: Stoyanka Vladeva, Elena Kirilova, Nikola Kirilov

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Background: The creatinine clearance is a widely used value to estimate the GFR. Increased creatinine clearance is often called hyperfiltration and is usually seen during pregnancy, patients with diabetes mellitus preceding the diabetic nephropathy. It may also occur with large dietary protein intake or with plasma volume expansion. Renal injury in lupus nephritis is known to affect the glomerular, tubulointerstitial, and vascular compartment. However high creatinine clearance has not been found in patients with SLE, Target: Follow-up of creatinine clearance values in patients with systemic lupus erythematosus without history of kidney injury. Material and methods: We observed the creatinine, creatinine clearance, GFR and dipstick protein values of 7 women (with a mean age of 42.71 years) with systemic lupus erythematosus. Patients with active lupus have been monthly tested in the period of 13 months. Creatinine clearance has been estimated by Cockcroft-Gault Equation formula in ml/sec. GFR has been estimated by MDRD formula (The Modification of Diet in renal Disease) in ml/min/1.73 m2. Proteinuria has been defined as present when dipstick protein > 1+.Results: In all patients without history of kidney injury we found elevated creatinine clearance levels, but GFRremained within the reference range. Two of the patients were in remission while the other five patients had clinically and immunologically active Lupus. Three of the patients had a permanent presence of high creatinine clearance levels and proteinuria. Two of the patients had periodically elevated creatinine clearance without proteinuria. These results show that kidney disturbances may be caused by the vascular changes typical for SLE. Glomerular hyperfiltration can be result of focal segmental glomerulosclerosis caused by a reduction in renal mass. Probably lupus nephropathy is preceded not only by glomerular vascular changes, but also by tubular vascular changes. Using only the GFR is not a sufficient method to detect these primary functional disturbances. Conclusion: For early detection of kidney injury in patients with SLE we determined that the follow up of creatinine clearance values could be helpful.

Keywords: systemic Lupus erythematosus, kidney injury, elevated creatinine clearance level, normal glomerular filtration rate

Procedia PDF Downloads 271

Authors: D. W. M. S. Samarathunga, Isuru Dharmarathne

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In aphasia, various levels of symbolic language processing (semantics) are affected. It is shown that Persons with Aphasia (PWA) often experience more problems comprehending some categories of words than others. The study aimed to determine lexical semantic deficits seen in Auditory Comprehension (AC) and to describe lexical-semantic deficits across six selected word categories. Thirteen (n =13) persons diagnosed with post-stroke aphasia (PSA) were recruited to perform an AC task. Foods, objects, clothes, vehicles, body parts and animals were selected as the six categories. As the test stimuli, black and white line drawings were adapted from a picture set developed for semantic studies by Snodgrass and Vanderwart. A pilot study was conducted with five (n=5) healthy nonbrain damaged Sinhala speaking adults to decide familiarity and applicability of the test material. In the main study, participants were scored based on the accuracy and number of errors shown. The results indicate similar trends of lexical semantic deficits identified in the literature confirming ‘animals’ to be the easiest category to comprehend. Mann-Whitney U test was performed to determine the association between the selected variables and the participants’ performance on AC task. No statistical significance was found between the errors and the type of aphasia reflecting similar patterns described in aphasia literature in other languages. The current study indicates the presence of selectivity of lexical semantic deficits in AC and a hierarchy was developed based on the complexity of the categories to comprehend by Sinhala speaking PWA, which might be clinically beneficial when improving language skills of Sinhala speaking persons with post-stroke aphasia. However, further studies on aphasia should be conducted with larger samples for a longer period to study deficits in Sinhala and other Sri Lankan languages (Tamil and Malay).

Keywords: aphasia, auditory comprehension, selective lexical-semantic deficits, semantic categories

Procedia PDF Downloads 255

Authors: Qian Wang, Haibo Gu

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To drive practical interpretations and applications of various policies in building the transnational education joint-ventures, middle managers learn to navigate through uncertainties and ambiguities. However, the current literature views very little about those middle managers’ experiences, perceptions, and practices. This paper takes the empirical approach and aims to uncover the middle managers’ experiences by conducting interviews, campus visits, and document analysis. Following the qualitative research method approach, the researchers gathered information from a mixture of fourteen foreign and Chinese managers. Their perceptions of the China-foreign cooperation in higher education and their perceived roles have offered important, valuable insights to this group of people’s attitudes and management performances. The diverse cultural and demographic backgrounds contributed to the significance of the study. There are four key findings. One, middle managers’ immediate micro-contexts and individual attitudes are the top two influential factors in managers’ performances. Two, the foreign middle managers showed a stronger sense of self-identity in risk-taking. Three, the Chinese middle managers preferred to see difficulties as part of their assigned responsibilities. Four, middle managers in independent universities demonstrated a stronger sense of belonging and fewer frustrations than middle managers in secondary institutes. The researchers propose that training for managers in a transnational educational setting should consider these discoveries when select fitting topics and content. In particular, middle managers should be better prepared to anticipate their everyday jobs in the micro-environment; hence, information concerning sponsor organizations’ working culture is as essential as knowing the national and local regulations, and socio-culture. Different case studies can help the managers to recognize and celebrate the diversity in transnational education. Situational stories can help them to become aware of the diverse and wide range of work contexts so that they will not feel to be left alone when facing challenges without relevant previous experience or training. Though this research is a case study based in the Chinese transnational higher education setting, the implications could be relevant and comparable to other transnational higher education situations and help to continue expanding the potential applications in this field.

Keywords: educational management, middle manager performance, transnational higher education

Procedia PDF Downloads 167

Authors: Ferhat Mohamed Amine, Boukhatem Mohamed Nadjib, Chemat Farid

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The Lamiaceae family is widely spread in Algeria. Due to the application of Thymus species growing wild in Algeria as a culinary herb and in folk medicine, the purpose of the present work was to evaluate antimicrobial activities of their essential oils and relate them with their chemical composition, for further application in food and pharmaceutical industries as natural valuable products. The extraction of the Thymus vulgaris L. essential oil (TVEO) was obtained by steam distillation. Chemical composition of the TVEO was determined by Gas Chromatography. A total of thirteen compounds were identified. Carvacrol (83.8%) was the major component, followed by cymene (8.15%) and terpinene (4.96%). Antibacterial action of the TVEO against 23 clinically isolated bacterial strains was determined by using agar disc diffusion and vapour diffusion methods at different doses. By disc diffusion method, TVEO showed potent antimicrobial activity against gram-positive bacteria more than gram-negative strains and antibiotic discs. The Diameter of Inhibition Zone (DIZ) varied from 25 to 60 mm for S. aureus, B. subtilisand E. coli. However, the results obtained by both agar diffusion and vapour diffusion methods were different. Significantly higher antibacterial effect was observed in the vapour phase at lower doses. S. aureus and B. subtilis were the most susceptible strains to the oil vapour. Therefore, smaller doses of EO in the vapour phase can be inhibitory to pathogenic bacteria. There is growing evidence that TVEO in vapour phase are effective antiseptic systems and appears worthy to be considered for practical uses in the treatment of human infections oras air decontaminants in hospital. TVEO has considerable antibacterial activity deserving further investigation for clinical applications. Also whilst the mode of action remains mainly undetermined, this experimental approach will need to continue.

Keywords: antimicrobial drugs, carvacrol, disc diffusion, Thymus vulgaris, vapour diffusion

Procedia PDF Downloads 375

Authors: Alba Prats-Bisbe, Jaume López-Carballo, David Leno-Colorado, Alberto García Molina, Alicia Romero Marquez, Elena Hernández Pena, Eloy Opisso Salleras, Raimon Jané Campos

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Neurological disorders are a leading cause of disability and premature mortality worldwide. Neurorehabilitation (NRHB) is a clinical process aimed at reducing functional impairment, promoting societal participation, and improving the quality of life for affected individuals. Virtual reality (VR) technology is emerging as a promising NRHB support tool. Its immersive nature fosters a strong sense of agency and embodiment, motivating patients to engage in meaningful tasks and increasing adherence to therapy. However, the clinical benefits of VR interventions are challenging to determine due to the high heterogeneity among health applications. This study explores a stepwise development approach for creating VR-based tools to assist individuals with neurological disorders in medical practice, aiming to enhance reproducibility, facilitate comparison, and promote the generalization of findings. Building on previous research, the step-by-step methodology encompasses: Needs Identification– conducting cross-disciplinary meetings to brainstorm problems, solutions, and address barriers. Intervention Definition– target population, set goals, and conceptualize the VR system (equipment and environments). Material Selection and Placement– choose appropriate hardware and software, place the device within the hospital setting, and test equipment. Co-design– collaboratively create VR environments, user interfaces, and data management strategies. Prototyping– develop VR prototypes, conduct user testing, and make iterative redesigns. Usability and Feasibility Assessment– design protocols and conduct trials with stakeholders in the hospital setting. Efficacy Assessment– conduct clinical trials to evaluate outcomes and long-term effects. Cost-Effectiveness Validation– assess reproducibility, sustainability, and balance between costs and benefits. NRHB is complex due to the multifaceted needs of patients and the interdisciplinary healthcare architecture. VR has the potential to support various applications, such as motor skill training, cognitive tasks, pain management, unilateral spatial neglect (diagnosis and treatment), mirror therapy, and ecologically valid activities of daily living. Following this methodology was crucial for launching a VR-based system in a real hospital environment. Collaboration with neuropsychologists lead to develop A) a VR-based tool for cognitive rehabilitation in patients with acquired brain injury (ABI). The system comprises a head-mounted display (HTC Vive Pro Eye) and 7 tasks targeting attention, memory, and executive functions. A desktop application facilitates session configuration, while database records in-game variables. The VR tool's usability and feasibility were demonstrated in proof-of-concept trials with 20 patients, and effectiveness is being tested through a clinical protocol with 12 patients completing 24-session treatment. Another case involved collaboration with nurses and paediatric physiatrists to create B) a VR-based distraction tool during invasive techniques. The goal is to alleviate pain and anxiety associated with botulinum toxin (BTX) injections, blood tests, or intravenous placements. An all-in-one headset (HTC Vive Focus 3) deploys 360º videos to improve the experience for paediatric patients and their families. This study presents a framework for developing clinically relevant and technologically feasible VR-based support tools for hospital settings. Despite differences in patient type, intervention purpose, and VR system, the methodology demonstrates usability, viability, reproducibility and preliminary clinical benefits. It highlights the importance approach centred on clinician and patient needs for any aspect of NRHB within a real hospital setting.

Keywords: neurological disorders, neurorehabilitation, stepwise development approach, virtual reality

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Authors: Yi Sun, George Ed Rainger, Steve P. Watson

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Background: Beyond the classical roles in haemostasis and thrombosis, platelets are important in the initiation and development of various thrombo-inflammatory diseases. In atherosclerosis and deep vein thrombosis, for example, platelets bridge monocytes with endothelium and form heterotypic aggregates with monocytes in the circulation. This can alter monocyte phenotype by inducing their activation, stimulating adhesion and migration. These interactions involve cell surface receptor-ligand pairs on both cells. This list is likely incomplete as new interactions of importance to platelet biology are continuing to be discovered as illustrated by our discovery of PEAR-1 binding to FcεR1α. Results: We have developed a highly sensitive avidity-based assay to identify novel extracellular interactions among 126 recombinantly-expressed platelet cell surface and secreted proteins involved in platelet aggregation. In this study, we will use this method to identify novel platelet-monocyte interactions. We aim to identify ligands for orphan receptors and novel partners of well-known proteins. Identified interactions will be studied in preliminary functional assays to demonstrate relevance to the inflammatory processes supporting atherogenesis. Conclusions: Platelet-monocyte interactions are essential for the development of thromboinflammatory disease. Up until relatively recently, technologies only allow us to limit our studies on each individual protein interaction at a single time. These studies propose for the first time to study the cell surface platelet-monocyte interactions in a systematic large-scale approach using a reliable screening method we have developed. If successful, this will likely to identify previously unknown ligands for important receptors that will be investigated in details and also provide a list of novel interactions for the field. This should stimulate studies on developing alternative therapeutic strategies to treat vascular inflammatory disorders such as atherosclerosis, DVT and sepsis and other clinically important inflammatory conditions.

Keywords: membrane proteins, large-scale screening, platelets, recombinant expression

Procedia PDF Downloads 152

Authors: Prem, Norhaya, Vwrene C., Mohammad Harris A., Amarjit, Fazir M.

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Upper limb surgery is a common orthopedic procedure. After surgery, it is necessary to raise the patient's arm to reduce limb swelling and promote recovery. After an injury or surgery, swelling (edema) in the limbs is common. This swelling can be painful, cause stiffness, and affect movement and ability to do daily activities. One of the easiest ways to manage swelling is to elevate the swollen limb. The goal is to elevate the swollen limb slightly above the level of the heart. This helps the extra fluid move back towards the heart for circulation to the rest of the body. Conventional arm sling or pillows are usually placed under the arm to raise it, but in this way the arm cannot be fixed well and easily slide down, without ideal raising effect. Conventional arm sling need experience to tie the sling and this delay in the application process. To reduce the waiting time and cost, modified Norhaya upper limb elevation sling was designed and made readily available. The sling is made from calico fabric, readily available in the ward. Measurements of patients’ arm lengths are obtained, and fabric sizes are cut into the average arm lengths, as well as 1 size above and below. The cut calico fabric is then sewn together with thick sewing threads. Its application is easy and junior most staff or doctor will be able to apply it on patient. The time taken to set up the sling is also reduced. Feedback gathered from ground staff regarding ease of setting up the sling was tremendous and patient also feel comfort in the modified Norhaya sling. The device can freely adjust the raising height of the affected limb and effectively fix the affected limb to reduce its swelling, thus promoting recovery. This device is worthy to be clinically popularized and applied. The Modified Norhaya upper limb elevation sling is the quickest to set up and the delay in elevating the patient’s hand is significantly reduced. Moreover, it is reproducible and there is also significant cost savings.

Keywords: elevate, effective, sling, timely

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Authors: S. Anastasiou, C. Nathanailides

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The purpose of this study is to examine the possible link between employee and customer satisfaction. The service provided by employees, help to build a good relationship with customers and can help at increasing their loyalty. Published data for job satisfaction and indicators of customer services were gathered from relevant published works which included data from five different countries. The reviewed data indicate a significant correlation between indicators of customer and employee satisfaction in the Banking sector. There was a significant correlation between the two parameters (Pearson correlation R2=0.52 P<0.05) The reviewed data provide evidence that there is some practical evidence which links these two parameters.

Keywords: job satisfaction, job performance, customer’ service, banks, human resources management

Procedia PDF Downloads 323

Authors: Mariam Matiashvili

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Argumentation is an integral part of our daily communications - formal or informal. Argumentative reasoning, techniques, and language tools are used both in personal conversations and in the business environment. Verbalization of the opinions requires the use of extraordinary syntactic-pragmatic structural quantities - arguments that add credibility to the statement. The study of argumentative structures allows us to identify the linguistic features that make the text argumentative. Knowing what elements make up an argumentative text in a particular language helps the users of that language improve their skills. Also, natural language processing (NLP) has become especially relevant recently. In this context, one of the main emphases is on the computational processing of argumentative texts, which will enable the automatic recognition and analysis of large volumes of textual data. The research deals with the linguistic analysis of the argumentative structures of Georgian political speeches - particularly the linguistic structure, characteristics, and functions of the parts of the argumentative text - claims, support, and attack statements. The research aims to describe the linguistic cues that give the sentence a judgmental/controversial character and helps to identify reasoning parts of the argumentative text. The empirical data comes from the Georgian Political Corpus, particularly TV debates. Consequently, the texts are of a dialogical nature, representing a discussion between two or more people (most often between a journalist and a politician). The research uses the following approaches to identify and analyze the argumentative structures Lexical Classification & Analysis - Identify lexical items that are relevant in argumentative texts creating process - Creating the lexicon of argumentation (presents groups of words gathered from a semantic point of view); Grammatical Analysis and Classification - means grammatical analysis of the words and phrases identified based on the arguing lexicon. Argumentation Schemas - Describe and identify the Argumentation Schemes that are most likely used in Georgian Political Speeches. As a final step, we analyzed the relations between the above mentioned components. For example, If an identified argument scheme is “Argument from Analogy”, identified lexical items semantically express analogy too, and they are most likely adverbs in Georgian. As a result, we created the lexicon with the words that play a significant role in creating Georgian argumentative structures. Linguistic analysis has shown that verbs play a crucial role in creating argumentative structures.

Keywords: georgian, argumentation schemas, argumentation structures, argumentation lexicon

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Authors: Mohammed M. Mahdy Tawfeek

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Objective: The aim of this work is to compare the outcome of photoactivated chromophore for keratitis-cross linking (PACK-CXL) window absorption (WA) alone with combined PACK-CXL WA and standard anti-microbial therapy (SAT) for the treatment of infectious keratitis. Patients and Methods: This is a randomized prospective comparative clinical trial. Thirty eyes with clinically suspected infectious keratitis were randomly assigned into two equal groups of 15 eyes each: Group (A) was treated by PACK-CXL WA alone and group (B) was treated by PACK-CXL WA combined with SAT. Identification of organisms was made by lab study before treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT (AS-OCT). Written informed consent was obtained from all participants and the study was approved by the research ethics committee of the Faculty of Medicine, Zagazig University. The work has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for studies involving humans. Results: Complete healing and resolution (Successful treatment) were observed in 10 eyes (66.7%) of a group (A) and 14 eyes (93.3%) of group (B) and failure was observed in 5 eyes (33.3%) of a group (A) and one eye (6.67%) of group (B). They were statistically significant (P =0.042 and 0.003) in a comparison between both groups regarding success and failure of treatment, respectively. Complete corneal healing was reported in the third month postoperatively in 10 eyes (66.7%) of group (A) and 14 eyes (93.3%) of group (B). Complications were absent in 12 patients (80%) in group (A) and 14 patients (93.3%) of group (B); however, perforation and impending perforation were found in 3 patients of group (A) and only one patient of group (B). Conclusion: PACK-CXL is a promising, non-invasive treatment option for infectious keratitis, especially when performed with the window absorption (WA) technique, either alone or combined with SAT. It has a synergistic effect with a standard antimicrobial treatment that gives good outcome results in the treatment of infectious keratitis. Also, it avoids the antibiotics resistance that has become rapidly spreading worldwide.

Keywords: corneal cross linking, infectious keratitis, PACK-CXL, window absorption

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Authors: Fanniyah Anis, Bram Kilapong

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Myocardial reperfusion injury is defined as the cellular damage that results from a period of ischemia, followed by the reestablishment of the blood supply to the infarcted tissue. Ventricular tachycardia is one of the most commonly encountered reperfusion arrhythmia as one of the types of myocardial perfusion injury. Prompt and early treatment can reduce mortality, despite limited resources of the hospital in high risk patients with history of triple vessel disease. Case report, Male 53 years old has been diagnosed with NSTEMI with 3VD and comorbid disease of Hypertension and has undergone revascularization management with Percutaneous coronary intervention. Ventricular tachycardia leading to cardiac arrest occurred right after the stent was inserted. Resuscitation was performed for almost 2 hours until spontaneous circulation returned. Patient admitted in ICU with refractory cardiac shock despite using combination of ionotropic and vasopressor agents under standard non-invasive monitoring due to the limitation of the hospital. Angiography was performed again 5 hours later to exclude other possibilities of blockage of coronary arteries and conclude diagnosis of myocardial reperfusion injury. Patient continually managed with combination of antiplatelet agents and maintenance dose of anti-arrhythmia agents. The handling of the patient was to focus more on supportive and preventive from further deteriorating of the condition. Patient showed clinically improvement and regained consciousness within 24 hours. Patient was successfully discharged from ICU within 3 days without any neurological sequela and was discharge from hospital after 3 days observation in general ward. Limited Resource of hospital did not refrain the physician from attaining a good outcome for this myocardial reperfusion injury case and angiography alone can be used to confirm the diagnosis of myocardial reperfusion injury.

Keywords: limited resources hospital, myocardial reperfusion injury, prolonged resuscitation, refractory cardiogenic shock, reperfusion arrhythmia, revascularization, triple-vessel disease

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Authors: Muwanga Zake, Johnnie Wycliffe Frank

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Developing communities accommodating institutions of Higher Education (HE) often have no capacity to pay for HE and so do not contribute values and do not participate in Quality Assurance. Only governments, academia, employers and professional organisations determine values, QA and curricula in HE. A gap between the values in HE and those desirable in local communities and environments leads to erroneous conceptions of the purposes of HE, and to graduates who hardly fit into those local communities. Unemployment and under-utilization of local resources are thus expected. As a way to improve and make HE more relevant for local communities and environment, public perceptions, values and needs should be researched and HE courses should relate with local values and environments. Communities should participate in QA.

Keywords: values, quality assurance, higher education, utilization

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Authors: Zarine Avetisyan

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Both in language and literature there exists the theory of recurrence of text and talk chunks which brings us to the notion of precedence. It must be stated that precedence as a pragma-linguistic phenomenon is yet underknown and it is the main objective of the present research to revisit and reveal it thoroughly. In line with the main research objective, analysis of political text and talk provides abundant relevant data for the illustration of the phenomenon of precedence. The analysis focuses on certain pragmatic universals (e.g. intention) and categories (e.g. speech techniques) which lead to the disclosure of the present object of study.

Keywords: intention, precedence, political discourse, pragmatic universals

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Authors: Yenisleidy Martinez Martinez, Yannay Casas-Ledon, Jo Dewulf

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The ecosystem services (ES) concept has contributed to draw attention to the benefits ecosystems generate for people and how necessary natural resources are for human well-being. The identification and prioritization of the ES constitute the first steps to undertake conservation and valuation initiatives on behalf of people. Additionally, mapping the supply of ES is a powerful tool to support decision making regarding the sustainable management of landscape and natural resources. In this context, the present study aimed to identify, prioritize and map the primary ES in Biobio and Nuble regions using a methodology that combines expert judgment, multi-attribute evaluation methods, and Geographic Information Systems (GIS). Firstly, scores about the capacity of different land use/cover types to supply ES and the importance attributed to each service were obtained from experts and stakeholders via an online survey. Afterward, the ES assessment matrix was constructed, and the weighted linear combination (WLC) method was applied to mapping the overall capacity of supply of provisioning, regulating and maintenance, and cultural services. Finally, prioritized ES for the study area were selected and mapped. The results suggest that native forests, wetlands, and water bodies have the highest supply capacities of ES, while urban and industrial areas and bare areas have a very low supply of services. On the other hand, fourteen out of twenty-nine services were selected by experts and stakeholders as the most relevant for the regions. The spatial distribution of ES has shown that the Andean Range and part of the Coastal Range have the highest ES supply capacity, mostly regulation and maintenance and cultural ES. This performance is related to the presence of native forests, water bodies, and wetlands in those zones. This study provides specific information about the most relevant ES in Biobio and Nuble according to the opinion of local stakeholders and the spatial identification of areas with a high capacity to provide services. These findings could be helpful as a reference by planners and policymakers to develop landscape management strategies oriented to preserve the supply of services in both regions.

Keywords: ecosystem services, expert judgment, mapping, multi-criteria decision making, prioritization

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Authors: Moiseenko F. V., Volkov N. M., Zhabina A. S., Stepanova E. O., Kirillov A. V., Myslik A. V., Artemieva E. V., Agranov I. R., Oganesyan A. P., Egorenkov V. V., Abduloeva N. H., Aleksakhina S. Yu., Ivantsov A. O., Kuligina E. S., Imyanitov E. N., Moiseyenko V. M.

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Analysis of ctDNA in patients with NSCLC is an emerging biomarker. Multiple research efforts of quantitative or at least qualitative analysis before and during the first periods of treatment with TKI showed the prognostic value of ctDNA clearance. Still, these important results are not incorporated in clinical standards. We evaluated the role of ctDNA in EGFR-mutated NSCLC receiving first-line TKI. Firstly, we analyzed sequential plasma samples from 30 patients that were collected before intake of the first tablet (at baseline) and at 6, 12, 24, 36, and 48 hours after the “starting point.” EGFR-M+ allele was measured by ddPCR. Afterward, we included sequential qualitative analysis of ctDNA with cobas® EGFR Mutation Test v2 from 99 NSCLC patients before the first dose, after 2 and 4 months of treatment, and on progression. Early response analysis showed the decline of EGFR-M+ level in plasma within the first 48 hours of treatment in 11 subjects. All these patients showed objective tumor response. 10 patients showed either elevation of EGFR-M+ plasma concentration (n = 5) or stable content of circulating EGFR-M+ after the start of the therapy (n = 5); only 3 of these patients achieved an objective response (p = 0.026) when compared to the former group). The rapid decline of plasma EGFR-M+ DNA concentration also predicted for longer PFS (13.7 vs. 11.4 months, p = 0.030). Long-term ctDNA monitoring showed clinically significant heterogeneity of EGFR-mutated NSCLC treated with 1st line TKIs in terms of progression-free and overall survival. Patients without detectable ctDNA at baseline (N = 32) possess the best prognosis on the duration of treatment (PFS: 24.07 [16.8-31.3] and OS: 56.2 [21.8-90.7] months). Those who achieve clearance after two months of TKI (N = 42) have indistinguishably good PFS (19.0 [13.7 – 24.2]). Individuals who retain ctDNA after 2 months (N = 25) have the worst prognosis (PFS: 10.3 [7.0 – 13.5], p = 0.000). 9/25 patients did not develop ctDNA clearance at 4 months with no statistical difference in PFS from those without clearance at 2 months. Prognostic heterogeneity of EGFR-mutated NSCLC should be taken into consideration in planning further clinical trials and optimizing the outcomes of patients.

Keywords: NSCLC, EGFR, targeted therapy, ctDNA, prognosis

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Authors: Kyere Francis, Sun Dongying, Asante Dennis, Nkrumah Nana Kwame Edmund, Naana Yaa Gyamea Kumah

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With a focus on renewable energy to achieve low-carbon transition objectives, there is a greater demand for effective collaborative strategies for planning, strategic decision mechanisms, and long-term policy designs to steer the transitions. Government agencies, NGOs, the private sector, and individual citizens play an important role in sustainable energy production. In Ghana, however, such collaboration is fragile in the fight against climate change. This current study seeks to re-examine the position or potential of network governance in Ghana's renewable energy transition. The study adopted a qualitative approach and employed semi-structured interviews for data gathering. To explore network governance and low carbon transitions in Ghana, we examine key themes such as political environment and impact, actor cooperation and stakeholder interactions, financing and the transition, market design and renewable energy integration, existing regulation and policy gaps for renewable energy transition, clean cooking accessibility, and affordability. The findings reveal the following; Lack of comprehensive consultations with relevant stakeholders leads to lower acceptance of the policy model and sometimes lack of policy awareness. Again, the unavailability and affordability of renewable energy technologies and access to credit facilities is a significant hurdle to long-term renewable transition. Ghana's renewable energy transitions require strong networking and interaction among the public, private, and non-governmental organizations. The study participants believe that the involvement of relevant energy experts and stakeholders devoid of any political biases is instrumental in accelerating renewable energy transitions, as emphasized in the proposed framework. The study recommends that the national renewable energy transition plan be evident to all stakeholders and political administrators. Such policy may encourage renewable energy investment through stable and fixed lending rates by the financial institutions and build a network with international organizations and corporations. These findings could serve as valuable information for the transition-based energy process, primarily aiming to govern sustainability changes through network governance.

Keywords: actors, development, sustainable energy, network governance, renewable energy transition

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Authors: Zoran Veršić, Josip Galić, Marin Binički, Lucija Stepinac

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With the current increase in CO₂ emissions and global warming, the sustainability of both existing and new solutions must be assessed on a wide scale. As the implementation of closed cavity facades (CCF) is on the rise, a variety of factors must be included in the analysis of new types of CCF. This paper aims to cover the relevant factors included in the sustainability assessment of new types of CCF. Several mathematical models are being used to describe the physical behavior of CCF. Depending on the type of CCF, they cover the main factors which affect the durability of the façade: thermal behavior of various elements in the façade, stress, and deflection of the glass panels, pressure inside a cavity, exchange rate, and the moisture buildup in the cavity. CCF itself represents a complex system in which all mentioned factors must be considered mutually. Still, the façade is only an envelope of a more complex system, the building. Choice of the façade dictates the heat loss and the heat gain, thermal comfort of inner space, natural lighting, and ventilation. Annual consumption of energy for heating, cooling, lighting, and maintenance costs will present the operational advantages or disadvantages of the chosen façade system in both the economic and environmental aspects. Still, the only operational viewpoint is not all-inclusive. As the building codes constantly demand higher energy efficiency as well as transfer to renewable energy sources, the ratio of embodied and lifetime operational energy footprint of buildings is changing. With the drop in operational energy CO₂ emissions, embodied energy emissions present a larger and larger share in the lifecycle emissions of the building. Taken all into account, the sustainability assessment of a façade, as well as other major building elements, should include all mentioned factors during the lifecycle of an element. The challenge of such an approach is a timescale. Depending on the climatic conditions on the building site, the expected lifetime of CCF can exceed 25 years. In such a time span, some of the factors can be estimated more precisely than others. The ones depending on the socio-economic conditions are more likely to be harder to predict than the natural ones like the climatic load. This work recognizes and summarizes the relevant factors needed for the assessment of new types of CCF, considering the entire lifetime of a façade element and economic and environmental aspects.

Keywords: assessment, closed cavity façade, life cycle, sustainability

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Authors: Brindusa Grigoriu

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Inscribing itself in the field of the history of multilingual communities with a focus on the evolution of language didactics, our paper aims at providing a pragmatic-interactional approach on a corpus proposing to scholars of the international scientific community a relevant text of early modern European literature: the first romance in French, The Conte of Flore and Blanchefleur by Robert d’Orbigny (1150). The multicultural context described by the romance is one in which an Arab-speaking prince, Floire, and his Francophone protégée, Blanchefleur, learn Latin together at the court of Spain and become fluent enough to turn it into the language of their love. This learning process is made up of interactional patterns of affective relevance, in which the proficiency of the protagonists in the domain of emotive acts becomes a matter of linguistic and pragmatic emulation. From five to ten years old, the pupils are efficiently stimulated by their teacher of Latin, Gaidon – a Moorish scholar of the royal entourage – to cultivate their competencies of oral expression and reading comprehension (of Antiquity classics), while enjoying an ever greater freedom of written expression, including the composition of love poems in this second language of culture and emotional education. Another relevant parameter of the educational process at court is that Latin shares its prominent role as a language of culture with French, whose exemplary learner is the (Moorish) queen herself. Indeed, the adult 'First lady' strives to become a pupil benefitting from lifelong learning provided by a fortuitous slave-teacher with little training, her anonymous chambermaid and Blanchefleur’s mother, who, despite her status of a war trophy, enjoys her Majesty’s confidence as a cultural agent of change in linguistic and theological fields. Thus, the two foreign languages taught at Spains’s court, Latin and French – as opposed to Arabic -, suggest a spiritual authority allowing the mutual enrichment of intercultural pioneers of cross-linguistic communication, in the aftermath of religious wars. Durably, and significantly – if not everlastingly – the language of physical violence rooted in intra-cultural solipsism is replaced by two Romance languages which seem to embody, together and yet distinctly, the parlance of peace-making.

Keywords: multilingualism, history of European language learning, French and Latin learners, multicultural context of medieval romance

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Authors: Shizrah Jamal, Robia Ghafoor, Farhan Raza

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Porcelain fused to metal crown is the most versatile variety of crown that is commonly placed worldwide. Various complications have been reported in the PFM crowns with use over the period of time. These include chipping of the porcelain, recurrent caries, loss of retention, open contacts, and tooth fracture. The objective of the present study was to determine the frequency of these complications in crowns cemented over a period of five years in a tertiary care hospital and also to report the survival of these crowns. A retrospective study was conducted in Dental clinics, Aga Khan University Hospital in which 150 PFM crowns cemented over a period of five years were evaluated. Patient demographics, oral hygiene habits, para-functional habits, crown insertion and follow-up dates were recorded in a specially designed proforma. All PFM crowns fulfilling the inclusion criteria were assessed both clinically and radiographically for the presence of any complication. SPSS version 22.0 was used for statistical analysis. Frequency distribution and proportion of complications were determined. Chi-square test was used to determine the association of complications of PFM crowns with multiple variables including tooth wear, opposing dentition and betel nut chewing. Kaplan- meier survival analysis was used to determine the survival of PFM crowns over the period of five years. Level of significance was kept at 0.05. A total of 107 patients, with a mean age of 43.51 + 12.4 years, having 150 PFM crowns were evaluated. The most common complication observed was open proximal contacts (8.7%) followed by porcelain chipping (6%), decementation (5.3%), and abutment fracture (1.3%). Chi square test showed that there was no statistically significant association of PFM crown complication with tooth wear, betel nut and opposing dentition (p-value <0.05). The overall success and survival rates of PFM crowns turned out to be 78.7 and 84.7% respectively. Within the limitations of the study, it can be concluded that PFM crowns are an effective treatment modality with high success and survival rates. Since it was a single centered study; the results should be generalized with caution.

Keywords: chipping, complication, crown, survival rate

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