Search results for: heart failure patient

Authors: Anirudh Sharma

Abstract:

Introduction: The Covid-19 pandemic necessitated a change in the manner outpatient fracture clinics are conducted due to the need to reduce footfall in hospital. While studies regarding virtual fracture clinics have shown these to be useful and effective, they focus exclusively on remote consultations. However, our service was bespoke to the patient – either a face-to-face or telephone consultation depending on patient need – a ‘hybrid virtual clinic (HVC).’ We report patient satisfaction and outcomes with this novel service. Methods: Patients booked onto our fracture clinics during the first 2 weeks of national lockdown were retrospectively contacted to assess the mode of consultations (virtual, face-to-face, or hybrid), patient experience, and outcome. Patient experience was assessed using the net promoter (NPS), customer effort (CES) and customer satisfaction scores (CSS), and their likelihood of using the HVC in the absence of a pandemic. Patient outcomes were assessed using the components of the EQ5D score. Results: Of 269 possible patients, 140 patients responded to the questionnaire. Of these, 66.4% had ‘hybrid’ consultations, 27.1% had only virtual consultations, and 6.4% had only face-to-face consultations. The mean overall NPS, CES, and CSS (on a scale of 1-10) were 7.27, 7.25, and 7.37, respectively. The mean likelihood of patients using the HVC in the absence of a pandemic was 6.5/10. Patients who had ‘hybrid’ consultations showed better effort scores and greater overall satisfaction than those with virtual consultations only and also reported superior EQ5D outcomes (mean 79.27 vs. 72.7). Patients who did not require surgery reported increased satisfaction (mean 7.51 vs. 7.08) and were more likely to use the HVC in the absence of a pandemic. Conclusion: Our study indicates that a bespoke HVC has good overall patient satisfaction and outcomes and is a better format of fracture clinic service than virtual consultations alone. It may be the preferred mode for fracture clinics in similar situations in the future. Further analysis needs to be conducted in order to explore the impact on resources and clinician experience of HVC in order to appreciate this new paradigm shift.

Keywords: hybrid virtual clinic, coronavirus, COVID-19, fracture clinic, remote consultation

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Authors: Elham Zarenezhad, Ali Zarenezhad, Mehdi Mardkhoshnood

Abstract:

We described the synthesis and biological study of O-oxime ethers having a-amino acid residues as new analogs of IPS-339. In this synthesis, the reaction of fluorene O-oxime with epichlorohydrin or epibromohydrin afforded the corresponding O-oxime ether adducts. The N-alkylation of valine amino acid with O-oxime ether adducts led to the synthesis of new analogs of IPS-339. The cardiovascular properties of the compound have been studied. In this regard, six clinically healthy same sex mongrel dogs were examined. The dogs were randomly divided into 3 groups of two members. 1 groups received 2 mg kg-1 body weight of compound (2-(3-(9H-fluoren-9-ylideneaminooxy)-2- hydroxypropylamino)-3-methylbutanoic acid) intravenously, whereas group 2 and 3 received only DMSO–water (distil.) and propranolol (Inderal) (2 mg kg-1), respectively. The electrocardiograph (ECG) was recorded with lead II. The recording was run successively by 5 min time interval on each dog before, simultaneously, and after compound infusion. Data after administration were taken from normal sinus beats that were closely related to the arrhythmias whenever they occurred. In general, no detectable arrhythmia was observed in all ECG records regardless of increasing the heart rate that likely caused by stress origin from invasive procedure just after infusion. Compound diminished the heart rate during study especially at 20th minute compared to propranolol as a reference drug. Compound (2-(3-(9H-fluoren-9-ylideneaminooxy)-2- hydroxypropylamino)-3-methylbutanoic acid) was the most effective compound with remarkable ability in declining of the heart rate.

Keywords: electrocardiograph (ECG), cardiovascular, IPS-339, dogs

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Authors: Mikhail O. Eremin

Abstract:

Present work is devoted to experimental study and numerical modelling of failure of rocks typical for Kuzbass coal basin (Russia). The main goal was to define strength and deformation characteristics of rocks on the base of uniaxial compression and three-point bending loadings and then to build a mathematical model of failure process for both types of loading. Depending on particular physical-mechanical characteristics typical rocks of Kuzbass coal basin (sandstones, siltstones, mudstones, etc. of different series – Kolchuginsk, Tarbagansk, Balohonsk) manifest brittle and quasi-brittle character of failure. The strength characteristics for both tension and compression are found. Other characteristics are also found from the experiment or taken from literature reviews. On the base of obtained characteristics and structure (obtained from microscopy) the mathematical and structural models are built and numerical modelling of failure under different types of loading is carried out. Effective characteristics obtained from modelling and character of failure correspond to experiment and thus, the mathematical model was verified. An Instron 1185 machine was used to carry out the experiments. Mathematical model includes fundamental conservation laws of solid mechanics – mass, impulse, energy. Each rock has a sufficiently anisotropic structure, however, each crystallite might be considered as isotropic and then a whole rock model has a quasi-isotropic structure. This idea gives an opportunity to use the Hooke’s law inside of each crystallite and thus explicitly accounting for the anisotropy of rocks and the stress-strain state at loading. Inelastic behavior is described in frameworks of two different models: von Mises yield criterion and modified Drucker-Prager yield criterion. The damage accumulation theory is also implemented in order to describe a failure process. Obtained effective characteristics of rocks are used then for modelling of rock mass evolution when mining is carried out both by an open-pit or underground opening.

Keywords: damage accumulation, Drucker-Prager yield criterion, failure, mathematical modelling, three-point bending, uniaxial compression

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Authors: Fatai Shola Afolabi

Abstract:

The study identified and evaluates the causes of building failure and examined the effects of building failure with respect to cost in Lagos State, Nigeria. The method employed in the collection of data includes the administration of questionnaire to professionals in the construction industry and case studies for the sites. A purposive sampling technique was used for selecting the sites visited, and selecting the construction professionals. Descriptive statistical techniques such as frequency distribution and percentages and mean response analysis were used to analyze data. The study revealed that the major causes of building failures were bad design, faulty construction, over loading, non-possession of approved drawings, Possession of approved drawings but non-compliance, and the use of quarks. In the two case studies considered, the total direct loss to the building owners was thirty eight million three hundred and eight five thousand, seven hundred and twenty one naira (38,385,721) which is about One hundred and ninety four thousand, eighty hundred and fifty one dollars ($194,851) at one hundred and ninety seven naira to one US dollars, central bank Nigeria of exchange rate as at 14th March, 2015.

Keywords: building structures, building failure, building collapse, structural failure, cost, direct loss

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Authors: Ageliki I. Katsarou, Andriana C. Kaliora, Antonia Chiou, Apostolos Papalois, Nick Kalogeropoulos, Nikolaos K. Andrikopoulos

Abstract:

Oxidative stress is a major mechanism underlying CVDs while inflammation, an intertwined process with oxidative stress, is also linked to CVDs. Extra virgin olive oil (EVOO) is widely known to play a pivotal role in CVD prevention and CVD reduction. However, in most studies, olive oil constituents are evaluated individually and not as part of the native food, hence potential synergistic effects as drivers of EVOO beneficial properties may be underestimated. In this study, EVOO lipidic and polar phenolics fractions were evaluated for their effect on inflammatory (TNF-alpha) and oxidation (malondialdehyde/MDA) markers, in cholesterol-fed rats. Thereat, oils with discernible lipidic profile and polar phenolic content were used. Wistar rats were fed on either a high-cholesterol diet (HCD) or a HCD supplemented with oils, either commercially available, i.e. EVOO, sunflower oil (SO), or modified as to their polar phenol content, i.e. phenolics deprived-EVOO (EVOOd), SO enriched with the EVOO phenolics (SOe). After 9 weeks of dietary intervention, heart and blood samples were collected. HCD induced dylipidemia shown by increase in serum total cholesterol, low-density lipoprotein cholesterol (LDL-c) and triacylglycerols. Heart tissue has been affected by dyslipidemia; oxidation was indicated by increase in MDA in cholesterol-fed rats and inflammation by increase in TNF-alpha. In both cases, this augmentation was attenuated in EVOO and SOe diets. With respect to oxidation, SO enrichment with the EVOO phenolics brought its lipid peroxidation levels as low as in EVOO-fed rats. This suggests that phenolic compounds may act as antioxidant agents in rat heart. A possible mechanism underlying this activity may be the protective effect of phenolics in mitochondrial membrane against oxidative damage. This was further supported by EVOO/EVOOd comparison with the former presenting lower heart MDA content. As for heart inflammation, phenolics naturally present in EVOO as well as phenolics chemically added in SO, exhibited quenching abilities in heart TNF-alpha levels of cholesterol-fed rats. TNF-alpha may have played a causative role in oxidative stress induction while the opposite may have also happened, hence setting up a vicious cycle. Overall, diet supplementation with EVOO or SOe attenuated hypercholesterolemia-induced increase in MDA and TNF-alpha in Wistar rat hearts. This is attributed to phenolic compounds either naturally existing in olive oil or as fortificants in seed oil.

Keywords: extra virgin olive oil, hypercholesterolemic rats, MDA, polar phenolics, TNF-alpha

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Authors: Benedikt Munzar, Jagraj Singh, Alice Mei, David Musheyev, Sandeep Gandhi

Abstract:

Clostridium is a gram-positive, anaerobic, spore-forming rod that is not commonly identified as a primary human pathogen. Here is presented a case of a 60-year-old patient with a history of opioid use disorder who underwent a number of abdominal surgeries for small bowel obstruction. His hospital course was complicated by Clostridium glycolicum infection, resulting in an acute abdomen. The patient clinically improved with antibiotic therapy. A thorough review of the National Institute of Health database revealed that only a small number of cases have been reported since 2007, with the last postsurgical cases documented in 2009 and the last clinical case documented in 2012. Clostridium glycolicum infections have been noted in patients with immunosuppressive conditions or those undergoing medical treatments that compromise immune function. This case was unusual due to the patient being immunocompetent. We suggest that a case of an acute abdomen should consider this organism as an etiological agent.

Keywords: acute abdomen, bacterial infection, clostridium glycolicum, Meckel’s diverticulum, pneumoperitoneum, small bowel obstruction

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Authors: Abrar R. Al-Hasan

Abstract:

Despite the widespread use of social media by consumers and marketers, empirical research investigating their economic value in the healthcare industry still lags. This study explores the impact of the use of social media marketing efforts on a hospital's brand equity and, ultimately, consumer response. Using social media data from Twitter and Facebook, along with an online and offline survey methodology, data is analyzed using logistic regression models. A random sample of (728) residents of the Kuwaiti population is used. The results of this study found that social media marketing efforts (SMME) in terms of use and validation lead to higher hospital brand equity and in turn, patient loyalty and patient visit. The study highlights the impact of SMME on hospital brand equity and patient response. Healthcare organizations should guide their marketing efforts to better manage this new way of marketing and communicating with patients to enhance their consumer loyalty and financial performance.

Keywords: brand equity, healthcare marketing, patient visit, social media, SMME

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Authors: Aboozar Aghaei

Abstract:

In the present work, the dissimilar Monel400 and SS316 were joined by friction stir welding (FSW). The applied rotating speed was 400 rpm, whereas the traverse speed varied between 50 and 150 mm/min. At a constant rotating speed, the sound welds were obtained at the welding speeds of 50 and 100 mm/min. However, a groove-like defect was formed when the welding speed exceeded 100 mm/min. The mechanical properties of the joints were evaluated using tensile and fatigue tests. The fatigue strength of dissimilar FSWed specimens was higher than that of both Monel400 and SS316. To study the failure behavior of FSWed specimens, the fracture surfaces were analyzed using a scanning electron microscope (SEM). The failure analysis indicates that different mechanisms may contribute to the fracture of welds. This was attributed to the dissimilar characteristics of dissimilar materials exhibiting different failure behaviors.

Keywords: frictions stir welding (FSW), stainless steel, mechanical properties, Monel400

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Authors: Yen-Hsia Lin, Ya-Fang Cheng, Hui-Zhu Chen, Chi-Hui Tiao

Abstract:

This is a case study of a 70-year-old man suffering from Type 2 diabetes mellitus and hyperglycemia hyperosmolarity state. He was admitted into the intensive care unit from the 20th to 26th of October, 2015. After receiving relevant information through open-ended conversations, observation, and physical assessment, as well as the psychological, social and spiritual holistic nursing assessment, several clinical health problems such as unstable blood sugar, impaired skin integrity and lack of self-care management knowledge were identified by the author. During the period of care, the patient was encouraged to share and express his feelings, an active listening and initiating approach from the nursing team had led to the understanding of why the patient refused to use insulin. This knowledge enabled the nursing team to manage patient care by educating the patient with self-care management skills, such as foot wound care and insulin injection skills to slow the deterioration of complications. Also, the implementation of appropriate diet and exercise routine to improve patients’ style. By enhancing self-care ability in diabetic patients, they are able to return home with the skill to improve better quality life style.

Keywords: hyperglycemia hyperosmolar state, type2 diabetes Mellitu, diabetes Mellitu foot care, intensive care

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Authors: N. Abbas, S. Lagomarsino, S. Cattari

Abstract:

Examining existing experimental results for shallow rigid foundations subjected to vertical centric load (N), accompanied or not with a bending moment (M), two main non-linear mechanisms governing the cyclic ‎response of the soil-foundation system can be distinguished: foundation uplift and soil yielding. A soil-foundation failure limit, is defined as a domain of resistance in the two dimensional (2D) load space (N, M) inside of which lie all the admissible combinations of loads; these latter correspond to a pure elastic, non-linear elastic or plastic behavior of the soil-foundation system, while the points lying on the failure limit correspond to a combination of loads leading to a failure of the soil-foundation system. In this study, the proposed resistance domain is constructed analytically based on mechanics. Original elastic limit, uplift initiation ‎limit and iso-uplift limits are constructed inside this domain. These limits give a prediction ‎of the mechanisms activated for each combination of loads applied to the ‎foundation. A comparison of the proposed failure limit with experimental tests existing in the literature shows interesting results. Also, the developed uplift initiation limit and iso-uplift curves are confronted with others already proposed in the literature and widely used due to the absence of other alternatives, and remarkable differences are noted, showing evident errors in the past proposals and relevant accuracy for those given in the present work.

Keywords: foundation uplift, iso-uplift curves, resistance domain, soil yield

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Authors: Arvind Aggarwal

Abstract:

We have developed a comprehensive global healthcare delivery System based on information technology. It has medical consultation system where a virtual consultant can give medical consultation to the patients and Doctors at the digital medical centre after reviewing the patient’s EMR file consisting of patient’s history, investigations in the voice, images and data format. The system has the surgical operation system too, where a remote robotic consultant can conduct surgery at the robotic surgical centre. The instant speech and text translation is incorporated in the software where the patient’s speech and text (language) can be translated into the consultant’s language and vice versa. A consultant of any specialty (surgeon or Physician) based in any country can provide instant health care consultation, to any patient in any country without loss of time. Robotic surgeons based in any country in a tertiary care hospital can perform remote robotic surgery, through patient friendly telemedicine and tele-surgical centres. The patient EMR, financial data and data of all the consultants and robotic surgeons shall be stored in cloud. It is a complete comprehensive business model with healthcare medical and surgical delivery system. The whole system is self-financing and can be implemented in any country. The entire system uses paperless, filmless techniques. This eliminates the use of all consumables thereby reduces substantial cost which is incurred by consumables. The consultants receive virtual patients, in the form of EMR, thus the consultant saves time and expense to travel to the hospital to see the patients. The consultant gets electronic file ready for reporting & diagnosis. Hence time spent on the physical examination of the patient is saved, the consultant can, therefore, spend quality time in studying the EMR/virtual patient and give his instant advice. The time consumed per patient is reduced and therefore can see more number of patients, the cost of the consultation per patients is therefore reduced. The additional productivity of the consultants can be channelized to serve rural patients devoid of doctors.

Keywords: e-health, telemedicine, telecare, IT-based healthcare

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Authors: Stephen V. Crowder, Jonathan W. Lane

Abstract:

With short production development times, there is an increased need to demonstrate product reliability relatively quickly with minimal testing. In such cases there may be few if any observed failures. Thus it may be difficult to assess reliability using the traditional reliability test plans that measure only time (or cycles) to failure. For many components, degradation measures will contain important information about performance and reliability. These measures can be used to design a minimal test plan, in terms of number of units placed on test and duration of the test, necessary to demonstrate a reliability goal. In this work we present a case study involving an electronic component subject to degradation. The data, consisting of 42 degradation paths of cycles to failure, are first used to estimate a reliability function. Bootstrapping techniques are then used to perform power studies and develop a minimal reliability test plan for future production of this component.

Keywords: degradation measure, time to failure distribution, bootstrap, computational science

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Authors: Ting-I Lin

Abstract:

Objective: This article explores the nursing care experience of a 51-year-old terminal lung cancer patient admitted to the intensive care unit (ICU) following an upper right lobectomy. The patient initially sought emergency treatment due to worsening cough and dyspnea, which led to the placement of an endotracheal tube following sudden deterioration. Subsequent CT scans and chest X-rays revealed a tumor in the upper right lung with metastases to the lungs, liver, bones, and adrenal glands. The patient underwent a right upper lobectomy and a wedge resection of the right middle lobe. Pathology staging: T4N3M1c and the patient was diagnosed with advanced cancer postoperatively. Method: During the care period, nursing staff continuously monitored the patient’s physiological data through observations, direct care, interviews, physical assessments, and review of the patient’s medical records. The nursing team collaborated with the critical care team and the palliative care team, using Gordon's Eleven Functional Health Patterns to conduct a comprehensive assessment. The key health problems identified included pain related to postoperative cancer resection and invasive devices, fear of death due to rapid disease progression, and altered tissue perfusion associated with hemodynamic instability. Results: Postoperatively, the patient experienced pain from the surgical wound and dyspnea due to extensive metastasis, often leading to confusion. Through the adjustment of pain medication, the patient’s discomfort was alleviated, using Morphine 8 mg in 0.9% normal saline 60 ml IV drip q6h prn, and Ultracet 37.5 mg/325 mg 1# PO q6h. Additionally, lavender essential oil inhalation and limb massage were provided for 15 minutes four times a day. The patient’s FLACC pain score decreased from 7 to below 3. After respiratory training, the endotracheal tube was successfully removed, and the patient was weaned off the ventilator. Triflow exercises were used to promote alveolar expansion, with the goal of achieving 2 balls for 10 seconds, 5 repetitions per session, 6-8 times a day. The patient’s breathing stabilized at 16-18 breaths per minute, body temperature remained between 35.8°C and 36.1°C, and the mean arterial pressure was maintained between 60-80 mmHg. Conclusion: The critical care team and the palliative care team held a family meeting to discuss not only the patient’s care but also the emotional well-being of the family. Visiting hours were increased to two times per day, one hour each time, allowing the patient and family to express love and gratitude, which strengthened their emotional connection and reduced the patient’s anxiety from severe to mild. The family expressed that they had no regrets. After the patient was transferred to the general ward, the nursing team continued to provide end-of-life care with genuine empathy, compassion, and religious support, helping both the patient and family through the final stage of life.

Keywords: multiple metastases, lung cancer, palliative care, nursing experience

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Authors: Thu Nguyen, Jane Daugherty-Luck

Abstract:

Falx subdural hematoma is a life-threatening condition associated with high mortality. We present a patient case who had fallen with no head injury or loss of conspicuousness. She had tenderness along cervical and thoracic lumbar spine. CT head revealed falx subdural hematoma. The patient was managed medically. The pathophysiology of falx subdural hematoma is linked to laceration of bridging veins provoked by frontal or occipital impact. Posttraumatic subdural hematoma is commonly caused by inertia instead of facture or cerebral contusion resulting from direct impact. The theory is consistent with the lack of fracture in most cases in the literature. Our patient had neither contusion nor fracture.

Keywords: falx subdural hematoma, traumatic head injury, CT head scan, bridging veins, inertia

Procedia PDF Downloads 140

Authors: Yuhan Wu, CTB (Kees) Ahaus, Martina Buljac-Samardzic

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Patient aggression and violence is a complex occupational hazards for physicians working in hospitals, and it can have multiple severe negative effects for physicians and hospitals. Although there is a range of interventions in the healthcare sector applied in various countries, China lacks a comprehensive set of interventions at the hospital level in this area. Therefore, due to cultural differences, this study investigates whether international interventions are important and feasible in the Chinese cultural context by conducting a Delphi study. Based on a literature search, a list of 47 hospital interventions to prevent and manage patient aggression and violence was constructed, including 8 categories: hospital environment design, access and entrance, staffing and work practice, training and education, leadership and culture, support, during/after-the-event actions, and hospital policy. The list of interventions will be refined, extended and brought back during a three-round Delphi study. The panel consists of 17 Chinese experts, including physicians experiencing patient aggression and violence, hospital management team members, scientists working in this research area, and policymakers in the healthcare sector. In each round, experts will receive the possible interventions with the instruction to indicate the importance and feasibility of each intervention for preventing and managing patient violence and aggression in Chinese hospitals. Experts will be asked about the importance and feasibility of interventions for patient violence and aggression at the same time. This study will exclude or include interventions based on the score of importance. More specifically, an intervention will be included after each round if >80% of the experts judged it as important or very important and excluded if >50% judged an intervention as not or moderately important. The three-round Delphi study will provide a list of included interventions and assess which of the 8 categories of interventions are considered as important. It is expected that this study can bring new ideas and inspiration to Chinese hospitals in the prevention and management of patient aggression and violence.

Keywords: patient aggression and violence, hospital interventions, feasibility, importance

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Authors: Caroline Lindlar, Eva Jakob

Abstract:

Female entrepreneurs often face significant barriers in accessing funding due to biases from business angels, venture capitalists, and financial institutions, which tend to favor male entrepreneurs. These biases contribute to persistent funding disparities, with female entrepreneurs receiving less financial support than their male counterparts. The situation worsens when female entrepreneurs have prior experiences with venture failure, which diminishes their attractiveness to traditional investors. Venture failure, defined as the cessation of operations due to declining revenues, rising costs, or ownership changes, plays a substantial role in shaping funding opportunities. In response, female entrepreneurs frequently turn to alternative funding sources such as crowdlending, where gender biases are often reversed in favor of women, particularly when their ventures emphasize social value creation. While existing research highlights the positive impact of gender on crowdfunding success, it remains unclear how venture failure, known to negatively bias female entrepreneurs in traditional funding contexts, interacts with the positive effects of gender in crowdlending. This interaction is particularly relevant because crowdlending often involves non-professional funders who make repeated investment decisions under uncertainty, based on limited information and past experiences. Given that approximately one-third of ventures fail to deliver promised returns, the role of gender bias after failure in crowdlending is an important area of investigation. This study addresses How failure affects crowd funders’ gender bias in future funding decisions? Drawing on social role and role congruity theory, we posit that societal perceptions of women as more communal conflict with the agentic qualities traditionally associated with entrepreneurship. This incongruence may result in reduced confidence in the success of female entrepreneurs after failure, limiting their access to future funding. However, we also hypothesize that social framing may mitigate this bias by aligning perceptions of female entrepreneurs with traits such as warmth and caring, enhancing their appeal after failure. To test these assertions, it conducted a between-subject audio vignette experiment with 155 participants who listened to entrepreneur pitches manipulated by gender (male vs. female) and venture framing (social vs. commercial). Participants made initial investment decisions, received failure-related news about the venture, and then made subsequent investment decisions. Pre-tests with 159 participants ensured the validity and reliability of the experimental manipulations. Moreover, we did a metric conjoint analysis with 100 participants, and they had to decide between different crowdfunding campaigns based on the attributes of previous failure, gender, and venture mission. it findings reveal that failure activates gender biases in crowdlending. Female-led ventures receive significantly less funding after failure compared to male-led ventures, suggesting the positive bias toward female entrepreneurs in the pre-funding phase does not persist post-failure. Moreover, framing a venture as socially oriented exacerbates the negative effect of failure for female entrepreneurs, as they secure fewer funds after failure compared to male entrepreneurs leading similar social ventures. This indicates that role-congruent framing does not mitigate gender bias after failure. This study contributes to research on gender in entrepreneurship by exploring how failure impacts future funding for female entrepreneurs. It also expands social crowdfunding literature by examining social value framing and adds to the entrepreneurial failure literature by focusing on crowd funders’ post-failure behavior.

Keywords: gender bias, crowdfunding, investment failure, investment behavior, social entrepreneurship

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Authors: Hilary P. Stevenson, Alexander J. Hayek, Amie Dereczyk

Abstract:

In this case report, we provide an example of an asymptomatic COVID-19 positive patient who presented with new-onset psychosis with severe paranoid delusions. He was seen in our ED after ingesting isopropyl alcohol which he reported was an attempt to escape presumed attackers, which at the time was logical to the patient. The patient’s family had COVID-19 symptoms that corresponded to those typically observed from the Omicron variant. The patient was treated successfully, within ten days, with Risperdal twice-daily dosing resulting in the resolution of the patient’s delusions and improved insight regarding the events that led to his hospitalization. In this work, we examine possible contributing factors to new-onset psychosis in the context of COVID-19, a phenomenon that is becoming increasingly notable in the literature. One area of importance is the already established inflammatory hypothesis of psychosis in which defects in the innate immune system, which result in its overactivation, may play a role in a typical first-episode psychosis, in addition to subsequent episodes. Given that COVID-19 is known to cause derangements in the innate immune system, such as cytokine storm reactions, this link may be critical in further understanding the etiologies of new-onset COVID-19 psychosis and its risk factors. Also included in this work is a brief review of antipsychotic interventions that have been described in the literature to date for the first episode of COVID-19-related psychosis. This will explore the potential of some antipsychotics to innately diminish the production of pro-inflammatory cytokines, further enhancing their usefulness in COVID-19 first-episode psychosis patients.

Keywords: COVID-19, first break psychosis, inflammatory hypothesis of psychosis, Risperdal

Procedia PDF Downloads 98

Authors: Aboozar Aghaei, Kamran Dehghani

Abstract:

In the present work, the dissimilar Monel400 and SS316 were joined by friction stir welding (FSW). The applied rotating speed was 400 rpm, whereas the traverse speed varied between 50 and 150 mm/min. At a constant rotating speed, the sound welds were obtained at the welding speeds of 50 and 100 mm/min. However, a groove-like defect was formed when the welding speed exceeded 100 mm/min. The mechanical properties of the joints were evaluated using tensile and fatigue tests. The fatigue strength of dissimilar FSWed specimens was higher than that of both Monel400 and SS316. To study the failure behavior of FSWed specimens, the fracture surfaces were analyzed using a scanning electron microscope (SEM). The failure analysis indicates that different mechanisms may contribute to the fracture of welds. This was attributed to the dissimilar characteristics of dissimilar materials exhibiting different failure behaviors.

Keywords: frictions stir welding, stainless steel, Monel400, mechanical properties

Procedia PDF Downloads 87

Authors: Belén Vinaixa Kinnear, Arturo Hidalgo López, Bernardo Elembo Wilasi, Pablo Fernández Pérez, Cecilia Hernández Fuentealba

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The expanded use of risk assessment in legislative and corporate decision-making has increased the role of expert judgement in giving data for security-related decision-making. Expert judgements are required in most steps of risk assessment: danger recognizable proof, hazard estimation, risk evaluation, and examination of choices. This paper presents a fault tree analysis (FTA), which implies a probabilistic failure analysis applied to leakage of oil in a subsea production system. In standard FTA, the failure probabilities of items of a framework are treated as exact values while evaluating the failure probability of the top event. There is continuously insufficiency of data for calculating the failure estimation of components within the drilling industry. Therefore, fuzzy hypothesis can be used as a solution to solve the issue. The aim of this paper is to examine the leaks from the Zafiro West subsea oil facility by using fuzzy fault tree analysis (FFTA). As a result, the research has given theoretical and practical contributions to maritime safety and environmental protection. It has been also an effective strategy used traditionally in identifying hazards in nuclear installations and power industries.

Keywords: expert judgment, probability assessment, fault tree analysis, risk analysis, oil pipelines, subsea production system, drilling, quantitative risk analysis, leakage failure, top event, off-shore industry

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Authors: Onder Yakut, Serdar Solak, Emine Dogru Bolat

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Measuring the Electrocardiogram (ECG) signal is an essential process for the diagnosis of the heart diseases. The ECG signal has the information of the degree of how much the heart performs its functions. In medical diagnosis and treatment systems, Decision Support Systems processing the ECG signal are being developed for the use of clinicians while medical examination. In this study, a modular wireless ECG (WECG) measuring and recording system using a single board computer and e-Health sensor platform is developed. In this designed modular system, after the ECG signal is taken from the body surface by the electrodes first, it is filtered and converted to digital form. Then, it is recorded to the health database using Wi-Fi communication technology. The real time access of the ECG data is provided through the internet utilizing the developed web interface.

Keywords: ECG, e-health sensor shield, Raspberry Pi, wiFi technology

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Authors: Temitope O. Tokosi, Visvanathan Naicker

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Patient health records contain sensitive information for which an electronic patient record (EPR) system can safely secure and transmit amongst clinicians for use in improving health delivery. Clinician’s use of the behaviour of these systems is under scrutiny to assess their attributes towards health technology. South Africa (SA) clinicians responded to a pilot study survey to assess their understanding of EPR, what attributes are important towards technology use and more importantly streamlining the survey for a larger study. Descriptive statistics using mean scores was used because of the small sample size of 11 clinicians who completed the survey. Nine (9) constructs comprising 62 items were used and a Cronbach alpha score of 0.883 was obtained. Limitations and discussions conclude the study.

Keywords: EPR, clinicians, pilot study, South Africa

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Authors: Matthew Scott Lau

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This study addresses the research question: How effective has the Community Health Assist Scheme (CHAS) been in reducing market failure in Singapore’s healthcare sector? The CHAS policy, introduced in 2012 in Singapore, aims to improve accessibility and affordability of healthcare by offering subsidies to low and middle-income groups and elderly individuals for general practice consultations and healthcare. The investigation was undertaken by acquiring and analysing primary and secondary research data from 3 main sources, including handwritten survey responses of 334 individuals who were valid CHAS subsidy recipients (CHAS cardholders) from 5 different locations in Singapore, interview responses from two established general practitioner doctors with working knowledge of the scheme, and information from literature available online. Survey responses were analysed to determine how CHAS has affected the affordability and consumption of healthcare, and other benefits or drawbacks for CHAS users. The interview responses were used to explain the benefits of healthcare consumption and provide different perspectives on the impacts of CHAS on the various parties involved. Online sources provided useful information on changes in healthcare consumerism and Singapore’s government policies. The study revealed that CHAS has been largely effective in reducing market failure as the subsidies granted to consumers have improved the consumption of healthcare. This has allowed for the external benefits of healthcare consumption to be realized, thus reducing market failure. However, the study also revealed that CHAS cannot be fully effective in reducing market failure as the scope of CHAS prevents healthcare consumption from fully reaching the socially optimal level. Hence, the study concluded that CHAS has been effective to a large extent in reducing market failure in Singapore’s healthcare sector, albeit with some benefits to third parties yet to be realised. There are certain elements of the investigation, which may limit the validity of the conclusion, such as the means used to determine the socially optimal level of healthcare consumption, and the survey sample size.

Keywords: healthcare consumption, health economics, market failure, subsidies

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Authors: Hossein Javidnia, Salehe Taheri

Abstract:

The Electrocardiogram (ECG) is the recording of the heart’s electrical potential versus time. ECG signals are often contaminated with noise such as baseline wander and muscle noise. As these signals have been widely used in clinical studies to detect heart diseases, it is essential to filter these noises. In this paper we compare performance of Wiener Filtering and Median Filtering methods to filter Additive White Gaussian (AWG) noise with the determined signal to noise ratio (SNR) ranging from 3 to 5 dB applied to long-term ECG recordings samples. Root mean square error (RMSE) and coefficient of determination (R2) between the filtered ECG and original ECG was used as the filter performance indicator. Experimental results show that Wiener filter has better noise filtering performance than Median filter.

Keywords: ECG noise filtering, Wiener filtering, median filtering, Gaussian noise, filtering performance

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Authors: Niloufar Khoshbakht, Peggi L. Clouston, Sanjay R. Arwade, Alexander C. Schreyer

Abstract:

Laminated veneer bamboo (LVB) is a structural engineered composite made from glued layers of bamboo. A relatively new building product, LVB is currently employed in similar sizes and applications as dimensional lumber. This study describes the results of a 3D elastic Finite Element model for halfhole specimens when loaded in compression parallel-to-grain per ASTM 5764. The model simulates LVB fracture initiation due to shear stresses in the dowel joint and predicts displacement at failure validated through comparison with experimental results. The material fails at 1mm displacement due to in-plane shear stresses. The paper clarifies the complex interactive state of in-plane shear, tension perpendicular-to-grain, and compression parallel-to-grain stresses that form different distributions in the critical zone beneath the bolt hole for half-hole specimens. These findings are instrumental in understanding key factors and fundamental failure mechanisms that occur in LVB dowel connections to help devise safe standards and further LVB product adoption and design.

Keywords: composite, dowel connection, embedment strength, failure behavior, finite element analysis, Moso bamboo

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Authors: Sorayya Kazemi, Hamed Kharrati, Mehdi Abedinpour Fallah

Abstract:

This paper presents the design and implementation of a novel electric pressure-sensitive toothbrush, capable of measuring the forces applied to the head of the brush. The developed device is used for gum recession measurement. In particular, the percentage of gum recession is measured by a Programmable Automation controller (PAC). Moreover, the brushing forces are measured by a Force Sensing Resistor (FSR) sensor. These forces are analog inputs of PAC. According to the applied forces during patient’s brushing and the patient’s percentage of gum recession, dentist sets the standard force range. The instrument alarms when the patient applies a force over the set range.

Keywords: gum recession, force sensing resistor, controller, toothbrush

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Authors: Mustapha Kamel Mihoubi, Mohamed Essadik Kerkar

Abstract:

Probabilistic risk analysis models are used to provide a better understanding of the reliability and structural failure of works, including when calculating the stability of large structures to a major risk in the event of an accident or breakdown. This work is interested in the study of the probability of failure of concrete dams through the application of reliability analysis methods including the methods used in engineering. It is in our case, the use of level 2 methods via the study limit state. Hence, the probability of product failures is estimated by analytical methods of the type first order risk method (FORM) and the second order risk method (SORM). By way of comparison, a level three method was used which generates a full analysis of the problem and involves an integration of the probability density function of random variables extended to the field of security using the Monte Carlo simulation method. Taking into account the change in stress following load combinations: normal, exceptional and extreme acting on the dam, calculation of the results obtained have provided acceptable failure probability values which largely corroborate the theory, in fact, the probability of failure tends to increase with increasing load intensities, thus causing a significant decrease in strength, shear forces then induce a shift that threatens the reliability of the structure by intolerable values of the probability of product failures. Especially, in case the increase of uplift in a hypothetical default of the drainage system.

Keywords: dam, failure, limit-state, monte-carlo, reliability, probability, simulation, sliding, taylor

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Authors: Azim Khodadadi, Sahar Sadaat Vakili, Ebrahim Babaei

Abstract:

This study presents a numerical method to optimize the failure rate and repair time of a typical radial distribution system. Failure rate and repair time are effective parameters in customer and energy based indices of reliability. Decrease of these parameters improves reliability indices. Thus, system stability will be boost. The penalty functions indirectly reflect the cost of investment which spent to improve these indices. Constraints on customer and energy based indices, i.e. SAIFI, SAIDI, CAIDI and AENS have been considered by using a new method which reduces optimization algorithm controlling parameters. Imperialist Competitive Algorithm (ICA) used as main optimization technique and particle swarm optimization (PSO), simulated annealing (SA) and differential evolution (DE) has been applied for further investigation. These algorithms have been implemented on a test system by MATLAB. Obtained results have been compared with each other. The optimized values of repair time and failure rate are much lower than current values which this achievement reduced investment cost and also ICA gives better answer than the other used algorithms.

Keywords: imperialist competitive algorithm, failure rate, repair time, radial distribution network

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Authors: Katie Dolaghan, Christina Tran, Kim Hamilton, Amanda Beresford, Vicky Adams, Jamie Toole, John Marley

Abstract:

During the Covid 19 pandemic routine outpatient appointments were not possible face to face. That resulted in many branches of healthcare starting virtual clinics. These clinics have continued following the return to face to face patient appointments. With these new types of clinic it is important to ensure that a high standard of patient care is maintained. In order to improve patient and clinician experience of the telephone clinics a quality improvement project was carried out to ensure the patient and clinician experience of these clinics was enhanced whilst remaining a safe, effective and an efficient use of resources. The project began by developing a process map for the consultation process and agreed on the design of a driver diagram and tests of change. In plan do study act (PDSA) cycle1 a single consultant completed an online survey after every patient encounter over a 5 week period. Baseline patient responses were collected using a follow-up telephone survey for each patient. Piloting led to several iterations of both survey designs. Salient results of PDSA1 included; patients not receiving appointment letters, patients feeling more anxious about a virtual appointment and many would prefer a face to face appointment. The initial clinician data showed a positive response with a provisional diagnosis being reached in 96.4% of encounters. PDSA cycle 2 included provision of a patient information sheet and information leaflets relevant to the patients’ conditions were developed and sent following new patient telephone clinics with follow-up survey analysis as before to monitor for signals of change. We also introduced the ability for patients to send an images of their lesion prior to the consultation. Following the changes implemented we noted an improvement in patient satisfaction and, in fact, many patients preferring virtual clinics as it lead to less disruption of their working lives. The extra reading material both before and after the appointments eased patients’ anxiety around virtual clinics and helped them to prepare for their appointment. Following the patient feedback virtual clinics are now used for review patients as well, with all four consultants within the department continuing to utilise virtual clinics. During this presentation the progression of these clinics and the reasons that these clinics are still operating following the return to face to face appointments will be explored. The lessons that have been gained using a QI approach have helped to deliver an optimal service that is valid and reliable as well as being safe, effective and efficient for the patient along with helping reduce the pressures from ever increasing waiting lists. In summary our work in improving the quality of virtual clinics has resulted in improved patient satisfaction along with reduced pressures on the facilities of the health trust.

Keywords: clinic, satisfaction, telephone, virtual

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Authors: Reza Fardid, Aliyeh Alipour

Abstract:

Introduction: Coronary heart disease (CHD) is the most common and deadliest diseases. A coronary angiography is an important tool for the diagnosis and treatment of this disease. Because angiography is performed by exposure to ionizing radiation, it can lead to harmful effects. Ionizing radiation induces double-stranded breaks in DNA, which is a potentially life-threatening injury. The purpose of the present study is an investigation of the phosphorylation of histone H2AX in the location of the double-stranded break in Peripheral blood lymphocytes as an indication of Biological effects of radiation on angiography patients. Materials and Methods: This method is based on measurement of the phosphorylation of histone (gamma-H2AX, gH2AX) level on serine 139 after formation of DNA double-strand break. 5 cc of blood from 24 patients with angiography were sampled before and after irradiation. Blood lymphocytes were removed, fixed and were stained with specific ϒH2AX antibodies. Finally, ϒH2AX signal as an indicator of the double-strand break was measured with Flow Cytometry Technique. Results and discussion: In all patients, an increase was observed in the number of breaks in double-stranded DNA after irradiation (20.15 ± 14.18) compared to before exposure (1.52 ± 0.34). Also, the mean of DNA double-strand break was showed a linear correlation with DAP. However, although induction of DNA double-strand breaks associated with radiation dose in patients, the effect of individual factors such as radiosensitivity and regenerative capacity should not be ignored. If in future we can measure DNA damage response in every patient angiography and it will be used as a biomarker patient dose, will look very impressive on the public health level. Conclusion: Using flow cytometry readings which are done automatically, it is possible to detect ϒH2AX in the number of blood cells. Therefore, the use of this technique could play a significant role in monitoring patients.

Keywords: coronary angiography, DSB of DNA, ϒH2AX, ionizing radiation

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Authors: Rachel Ashwell, Sally Millett

Abstract:

Introduction: Adequate post-operative pain relief is a key priority in the delivery of caesarean sections. This improves patient experience, reduces morbidity and enables optimal mother-infant interaction. Recommendations outlined in the NICE guidelines for caesarean section (CS) include offering peri-operative intrathecal/epidural diamorphine and post-operative opioid analgesics; offering non-steroidal anti-inflammatory drugs (NSAIDs) unless contraindicated and taking hourly observations for 12 hours following intrathecal diamorphine. Method: This audit assessed the provision of post-CS analgesia in 29 women over a two-week period. Indicators used were the use of intrathecal/epidural opioids, use of post-operative opioids and NSAIDs, frequency of observations and patient satisfaction with pain management on post-operative days 1 and 2. Results: All women received intrathecal/epidural diamorphine, 97% were prescribed post-operative opioids and all were prescribed NSAIDs unless contraindicated. Hourly observations were not maintained for 12 hours following intrathecal diamorphine. 97% of women were satisfied with their pain management on post-operative day 1 whereas only 75% were satisfied on day 2. Discussion: This service meets the proposed standards for the provision of post-operative analgesia, achieving high levels of patient satisfaction 1 day after CS. However, patient satisfaction levels are significantly lower on post-operative day 2, which may be due to reduced frequency of observations. The lack of an official audit standard for patient satisfaction on postoperative day 2 may result in reduced incentive to prioritise pain management at this stage.

Keywords: Caesarean section, analgesia, postoperative care, patient satisfaction

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