Search results for: patient safety incidents

Authors: Abdullah Al Mamoon, Niels E. Joergensen, Ataur Rahman, Hassan Qasem

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Intergovernmental Panel for Climate Change (IPCC) in its fourth Assessment Report AR4 predicts a more extreme climate towards the end of the century, which is likely to impact the design of engineering infrastructure projects with a long design life. A recent study in 2013 developed new design rainfall for Qatar, which provides an improved design basis of drainage infrastructure for the State of Qatar under the current climate. The current design standards in Qatar do not consider increased rainfall intensity caused by climate change. The focus of this paper is to update recently developed design rainfalls in Qatar under the changing climatic conditions based on IPCC's AR4 allowing a later revision to the proposed design standards, relevant for projects with a longer design life. The future climate has been investigated based on the climate models released by IPCC’s AR4 and A2 story line of emission scenarios (SRES) using a stationary approach. Annual maximum series (AMS) of predicted 24 hours rainfall data for both wet (NCAR-CCSM) scenario and dry (CSIRO-MK3.5) scenario for the Qatari grid points in the climate models have been extracted for three periods, current climate 2010-2039, medium term climate (2040-2069) and end of century climate (2070-2099). A homogeneous region of the Qatari grid points has been formed and L-Moments based regional frequency approach is adopted to derive design rainfalls. The results indicate no significant changes in the design rainfall on the short term 2040-2069, but significant changes are expected towards the end of the century (2070-2099). New design rainfalls have been developed taking into account climate change for 2070-2099 scenario and by averaging results from the two scenarios. IPCC’s AR4 predicts that the rainfall intensity for a 5-year return period rain with duration of 1 to 2 hours will increase by 11% in 2070-2099 compared to current climate. Similarly, the rainfall intensity for more extreme rainfall, with a return period of 100 years and duration of 1 to 2 hours will increase by 71% in 2070-2099 compared to current climate. Infrastructure with a design life exceeding 60 years should add safety factors taking the predicted effects from climate change into due consideration.

Keywords: climate change, design rainfalls, IDF, Qatar

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Authors: Yumeho Obata, Mariko Era, Takayoshi Kawahara, Takahide Kanyama, Hiroshi Morita

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Dermatophagoides farinae is major mite allergens in indoors. D. farinae is often swarm over powder products (e.g. wheat flour), because it feeds on starch or protein that are included in them. Eating powder products which are mixed D.farinae causes various allergic symptoms. Therefore, the creation of food additive agents with high safety and control of mite effect is required. Fatty acid salts and spices are known that have pesticidal activities. This study describes the effects of fatty acid salts and spices against Dermatophagoides farinae. Materials and Methods: Potassium salts of 9 fatty acids (C4:0, C6:0, C8:0, C10:0, C12:0, C14:0, C18:1, C18:2, C18:3) were prepared by mixing the fatty acid with the appropriate amount of KOH solution to a concentration of 175 mM and pH 10.5. C12Cu and C12Zn were selected as other fatty acid salts. Cayenne pepper, habanero, Japanese pepper, mustard, jalapeno pepper, curry aroma and cinnamon were selected as spices. D. farina, have been cultured in laboratory. To rear the mites, double-soled dishes containing of sterilized food were put on the big plastic container (30.0 × 20.0 × 20.0cm) which had 100% ammonium nitrate solution in the bottom. Plastic container was placed on incubator at 25 °C and 64 % relative humidity (RH) under dark condition. Sterilized food composed of dried bonito flakes and dried yeast (Ebios), 1:1 by weight. The antiproliferative method, sample and medium culture were mixed in double-soled dish and kept at 25 °C and 64 % RH. Decrease rates were determined 1 week and 4 week after treatment under microscope. D. farina was considered to be dead if appendages did not move when prodded with a pin. Results and Conclusions: The results show that the fatty acids potassium showed no antiproliferative effects against D. farinae. On the other hand, Japanese pepper, mustard, curry aroma and cinnamon were effective to decrease propagative rate (over 80 %) after treatment for 1 week against D. farina. Japanese pepper, curry aroma and cinnamon were effective to decrease propagative rate (approximately 100 %) after treatment for 4 weeks against D. farina. Especially, Japanese pepper and cinnamon showed the fasted and the most consecutive antiproliferative effects. These results indicate that Japanese pepper and cinnamon have high antiproliferative effects against D. farina and suggest spices will be used as a food additive agent.

Keywords: fatty acid salts, spices, antiproliferative effects, dermatophagoides farinae

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Authors: Ardiansyah I. Ryan, Ashsholih K. R., Fathurrohman G. R., Kurniadi M. R., Huda P. A

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The burden of brain-related disease is very high. There are a lot of brain-related diseases with limited treatment result and thus raise the burden more. The Parkinson Disease (PD), Mental Health Problem, or Paralysis of extremities treatments had risen concern, as the patients for those diseases usually had a low quality of life and low chance to recover fully. There are also many other brain or related neural diseases with the similar condition, mainly the treatments for those conditions are still limited as our understanding of the brain function is insufficient. Brain Implant Technology had given hope to help in treating this condition. In this paper, we examine the current update of the brain implant technology. Neurotechnology is growing very rapidly worldwide. The United States Food and Drug Administration (FDA) has approved the use of Deep Brain Stimulation (DBS) as a brain implant in humans. As for neural implant both the cochlear implant and retinal implant are approved by FDA too. All of them had shown a promising result. DBS worked by stimulating a specific region in the brain with electricity. This device is planted surgically into a very specific region of the brain. This device consists of 3 main parts: Lead (thin wire inserted into the brain), neurostimulator (pacemaker-like device, planted surgically in the chest) and an external controller (to turn on/off the device by patient/programmer). FDA had approved DBS for the treatment of PD, Pain Management, Epilepsy and Obsessive Compulsive Disorder (OCD). The target treatment of DBS in PD is to reduce the tremor and dystonia symptoms. DBS has been showing the promising result in animal and limited human trial for other conditions such as Alzheimer, Mental Health Problem (Major Depression, Tourette Syndrome), etc. Every surgery has risks of complications, although in DBS the chance is very low. DBS itself had a very satisfying result as long as the subject criteria to be implanted this device based on indication and strictly selection. Other than DBS, there are several brain implant devices that still under development. It was included (not limited to) implant to treat paralysis (In Spinal Cord Injury/Amyotrophic Lateral Sclerosis), enhance brain memory, reduce obesity, treat mental health problem and treat epilepsy. The potential of neurotechnology is unlimited. When brain function and brain implant were fully developed, it may be one of the major breakthroughs in human history like when human find ‘fire’ for the first time. Support from every sector for further research is very needed to develop and unveil the true potential of this technology.

Keywords: brain implant, deep brain stimulation (DBS), deep brain stimulation, Parkinson

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Authors: Jacklyn Yek, Clara Tong, Shin Yuet Chong, Yee Yian Ong

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Background: While emergency manuals and cognitive aids (CA) have been used in high-hazard industries for decades, this has been a nascent field in healthcare. CAs can potentially offset the large cognitive load involved in crisis resource management and possibly facilitate the efficient performance of key steps in treatment. A crisis manual was developed based on local guidelines and the latest evidence-based information and introduced to a tertiary hospital setting in Singapore. Hence, the objective of this study is to evaluate the effectiveness of the crisis manual in guiding response and management of critical events. Methods: 7 surgical teams were recruited to participate in a series of simulated emergencies in high-fidelity operating room simulator over the period of April to June 2018. All teams consisted of a surgical consultant and medical officer/registrar, anesthesia consultant and medical officer/registrar; as well as a circulating, scrub and anesthetic nurse. Each team performed a simulated operation in which 1 or more of the crisis events occurred. The teams were randomly assigned to a scenario of the crisis manual and all teams were deemed to be equal in experience and knowledge. Before the simulation, teams were instructed on proper checklist use but the use of the checklist was optional. Results: 7 simulation sessions were performed, consisting of the following scenarios: Airway fire, Massive Transfusion Protocol, Malignant Hyperthermia, Eclampsia, and Difficult Airway. Out of the 7 surgical teams, 2 teams made use of the crisis manual – of which both teams had encountered a ‘Malignant Hyperthermia’ scenario. These team members reflected that the crisis manual assisted allowed them to work in a team, especially being able to involve the surgical doctors who were unfamiliar with the condition and management. A run chart plotted showed a possible upward trend, suggesting that with increasing awareness and training, staff would become more likely to initiate the use of the crisis manual. Conclusion: Despite the high volume load in this tertiary hospital, certain crises remain rare and clinicians are often caught unprepared. A crisis manual is an effective tool and easy-to-use repository that can improve patient outcome and encourage teamwork. With training, familiarity would allow clinicians to be increasingly comfortable with reaching out for the crisis manual. More simulation training would need to be conducted to determine its effectiveness.

Keywords: crisis resource management, high fidelity simulation training, medical errors, visual aids

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Authors: Nji Queenta Ngum, Mwanza Mulunda

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Introduction Most African research reports on the frequent aflatoxin contamination of various foodstuffs, with researchers rarely specifying which of the Aspergillus species are present in these commodities. Numerous research works provide evidence of the ability of fungi to grow, thrive, and interact with other crop species and focus on the fact that these processes are largely affected by climatic variables. South Africa is a water-stressed country with high spatio-temporal rainfall variability; moreover, temperatures have been projected to rise at a rate twice the global rate. This weather pattern change may lead to crop stress encouraging mold contamination with subsequent mycotoxin production. In this study, the biodiversity and distribution of Aspergillus species with their corresponding toxins in maize from six distinct maize producing regions with different weather patterns in South Africa were investigated. Materials And Methods By applying cultural and molecular methods, a total of 1028 maize samples from six distinct agro-climatic regions were examined for contamination by the Aspergillus species while the high performance liquid chromatography (HPLC) method was applied to analyse the level of contamination by aflatoxins. Results About 30% of the overall maize samples were contaminated by at least one Aspergillus species. Less than 30% (28.95%) of the 228 isolates subjected to the aflatoxigenic test was found to possess at least one of the aflatoxin biosynthetic genes. Furthermore, almost 20% were found to be contaminated with aflatoxins, with mean total aflatoxin concentration levels of 64.17 ppb. Amongst the contaminated samples, 59.02% had mean total aflatoxin concentration levels above the SA regulatory limit of 20ppb for animals and 10 for human consumption. Conclusion In this study, climate variables (rainfall reduction) were found to significantly (p<0.001) influence the occurrence of the Aspergillus species (especially Aspergillus fumigatus) and the production of aflatoxin in South Africa commercial maize by maize variety, year of cultivation as well as the agro-climatic region in which the maize is cultivated. This included, amongst others, a reduction in the average annual rainfall of the preceding year to about 21.27 mm, and, as opposed to other regions whose average maximum rainfall ranged between 37.24 – 44.1 mm, resulted in a significant increase in the aflatoxin contamination of maize.

Keywords: aspergillus species, aflatoxins, diversity, drought, food safety, HPLC and PCR techniques

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Authors: Swee Kun Yap, Sachin Jangam, Suraj Vasudevan

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Experiential learning is dubbed as a highly effective way to enhance learning. Virtual reality (VR) is thus a helpful tool in providing a safe, memorable, and interactive learning environment. A class of 49 fluid mechanics students participated in starting up a pump, one of the most used equipment in the chemical industry, in VR. They experience the process in VR to familiarize themselves with the safety training and the standard operating procedure (SOP) in guided mode. Students subsequently observe their peers (in groups of 4 to 5) complete the same training. The training first brings each user through the personal protection equipment (PPE) selection, before guiding the user through a series of steps for pump startup. One of the most common feedback given by industries include the weakness of our graduates in pump design and operation. Traditional fluid mechanics is a highly theoretical module loaded with engineering equations, providing limited opportunity for visualization and operation. With VR pump, students can now learn to startup, shutdown, troubleshoot and observe the intricacies of a centrifugal pump in a safe and controlled environment, thereby bridging the gap between theory and practical application. Following the completion of the guided mode operation, students then individually complete the VR assessment for pump startup on the same day, which requires students to complete the same series of steps, without any cues given in VR to test their recollection rate. While most students miss out a few minor steps such as the checking of lubrication oil and the closing of minor drain valves before pump priming, all the students scored full marks in the PPE selection, and over 80% of the students were able to complete all the critical steps that are required to startup a pump safely. The students were subsequently tested for their recollection rate by means of an online quiz 3 weeks later, and it is again found that over 80% of the students were able to complete the critical steps in the correct order. In the survey conducted, students reported that the VR experience has been enjoyable and enriching, and 79.5% of the students voted to include VR as a positive supplementary exercise in addition to traditional teaching methods. One of the more notable feedback is the higher ease of noticing and learning from mistakes as an observer rather than as a VR participant. Thus, the cycling between being a VR participant and an observer has helped tremendously in their knowledge retention. This reinforces the positive impact VR has on learning.

Keywords: experiential learning, learning by doing, pump, unit operations, virtual reality

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Authors: Adela Mariana Vadastreanu, Adrian Bot, Andreea Maier, Dorin Maier

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This paper approaches the need for innovation management in the context of an existing integrated management system implemented in an organization. The road to success for companies in today’s economic environment is more demanding than ever and the capacity of adapting to the rapid changes is compensatory in order to resist on the market. The managers struggle, daily, with increasingly complex problems, caused by fierce competition in the market but also from the rising demands of customers. Innovation seems to be the solution for these problems. During the last decade almost all companies have been certificated according to various management systems, like quality management system, environmental management system, health and safety management system and others; furthermore many companies have implemented an integrated management system, by integrating two or more management systems. The problem rising today is how to integrate innovation in this integrated management systems. The challenge of the problem is that the development of an innovation management system is in the early phase. In this paper we have studied the possibility of integrating some of the innovation request in an existing management system, we have identify the innovation performance request and we proposed some recommendations regarding innovation management and its implementation as a part of an integrated management system. This paper lies down the bases for developing an model of integration management systems that include innovation as a main part of it. Organizations are becoming more aware of the importance of Integrated Management Systems (IMS). Integrating two or more management systems into an integrated management system can have much advantages.This paper examines various models of management systems integration in accordance with professional references ISO 9001, ISO 18001 and OHSAS 18001, highlighting strengths and weaknesses, creating a basis for future development of integrated management systems, and their involvement in various other processes within the organization, such as innovation management. The more and more demanding economic context emphasizes the awareness of the importance of innovation for organizations. This paper highlights the importance of the innovation for an organization and also gives some practical solution in order to improve the overall success of the business through a better approach of innovation. Various standards have been developed in order to certificate organizations that they respect the requirements. Applying an integrated standards model is shown to be a more effective way then applying the standards independently. The problem that arises is that in order to adopt the integrated version of standards there have to be made some changes at the organizational level. Every change that needs to be done has an effect on its activity, and in this sense the paper tries to deal with the changes needed for adopting an integrated management system and if those changes have an influence over the performance. After the analysis of the results, we can conclude that in order to improve the performance a necessary step is the implementation of innovation in the existing integrated management system.

Keywords: innovation, integrated management systems, innovation management, quality

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Authors: Danna Jia, Bin Li

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Background: Atopic dermatitis (AD) is a chronic and refractory inflammatory skin disease characterized by relapsing eczematous and pruritic skin lesions. The global prevalence of AD ranges from 1~ 20%, and its incidence rates are increasing. It affects individuals from infancy to adulthood, significantly impacting their daily lives and social activities. Despite its major health burden, the precise mechanisms underlying AD remain unknown. Understanding the genetic differences associated with AD is crucial for advancing diagnosis and targeted treatment development. This study aims to identify candidate genes of AD by using bioinformatics analysis. Methods: We conducted a comprehensive analysis of four pooled transcriptomic datasets (GSE16161, GSE32924, GSE130588, and GSE120721) obtained from the Gene Expression Omnibus (GEO) database. Differential gene expression analysis was performed using the R statistical language. The differentially expressed genes (DEGs) between AD patients and normal individuals were functionally analyzed using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment. Furthermore, a protein-protein interaction (PPI) network was constructed to identify candidate genes. Results: Among the patient-level gene expression datasets, we identified 114 shared DEGs, consisting of 53 upregulated genes and 61 downregulated genes. Functional analysis using GO and KEGG revealed that the DEGs were mainly associated with the negative regulation of transcription from RNA polymerase II promoter, membrane-related functions, protein binding, and the Human papillomavirus infection pathway. Through the PPI network analysis, we identified eight core genes: CD44, STAT1, HMMR, AURKA, MKI67, and SMARCA4. Conclusion: This study elucidates key genes associated with AD, providing potential targets for diagnosis and treatment. The identified genes have the potential to contribute to the understanding and management of AD. The bioinformatics analysis conducted in this study offers new insights and directions for further research on AD. Future studies can focus on validating the functional roles of these genes and exploring their therapeutic potential in AD. While these findings will require further verification as achieved with experiments involving in vivo and in vitro models, these results provided some initial insights into dysfunctional inflammatory and immune responses associated with AD. Such information offers the potential to develop novel therapeutic targets for use in preventing and treating AD.

Keywords: atopic dermatitis, bioinformatics, biomarkers, genes

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Authors: Elcin Timur Cakmak, Ayse Oguzlar

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This study presents the results of the tweets sent by Twitter users on social media about the Russia-Ukraine war by bigram and trigram methods. On February 24, 2022, Russian President Vladimir Putin declared a military operation against Ukraine, and all eyes were turned to this war. Many people living in Russia and Ukraine reacted to this war and protested and also expressed their deep concern about this war as they felt the safety of their families and their futures were at stake. Most people, especially those living in Russia and Ukraine, express their views on the war in different ways. The most popular way to do this is through social media. Many people prefer to convey their feelings using Twitter, one of the most frequently used social media tools. Since the beginning of the war, it is seen that there have been thousands of tweets about the war from many countries of the world on Twitter. These tweets accumulated in data sources are extracted using various codes for analysis through Twitter API and analysed by Python programming language. The aim of the study is to find the word sequences in these tweets by the n-gram method, which is known for its widespread use in computational linguistics and natural language processing. The tweet language used in the study is English. The data set consists of the data obtained from Twitter between February 24, 2022, and April 24, 2022. The tweets obtained from Twitter using the #ukraine, #russia, #war, #putin, #zelensky hashtags together were captured as raw data, and the remaining tweets were included in the analysis stage after they were cleaned through the preprocessing stage. In the data analysis part, the sentiments are found to present what people send as a message about the war on Twitter. Regarding this, negative messages make up the majority of all the tweets as a ratio of %63,6. Furthermore, the most frequently used bigram and trigram word groups are found. Regarding the results, the most frequently used word groups are “he, is”, “I, do”, “I, am” for bigrams. Also, the most frequently used word groups are “I, do, not”, “I, am, not”, “I, can, not” for trigrams. In the machine learning phase, the accuracy of classifications is measured by Classification and Regression Trees (CART) and Naïve Bayes (NB) algorithms. The algorithms are used separately for bigrams and trigrams. We gained the highest accuracy and F-measure values by the NB algorithm and the highest precision and recall values by the CART algorithm for bigrams. On the other hand, the highest values for accuracy, precision, and F-measure values are achieved by the CART algorithm, and the highest value for the recall is gained by NB for trigrams.

Keywords: classification algorithms, machine learning, sentiment analysis, Twitter

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Authors: Yudhitya Kusumawati, Yuki Mitsuya, Tomooki Shiba, Mitsuru Uesaka

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After the Fukushima Daiichi nuclear power reactor incident, there are a lot of unaccountable nuclear fuel debris in the reactor core area, which is subject to safeguard and criticality safety. Before the actual precise analysis is performed, preliminary on-site screening and mapping of nuclear debris activity need to be performed to provide a reliable data on the nuclear debris mass-extraction planning. Through a collaboration project with Japan Atomic Energy Agency, an on-site nuclear debris screening system by using dual energy X-Ray inspection and neutron energy resonance analysis has been established. By using the compact and mobile pulsed neutron source constructed from 3.95 MeV X-Band electron linac, coupled with Tungsten as electron-to-photon converter and Beryllium as a photon-to-neutron converter, short-distance neutron Time of Flight measurement can be performed. Experiment result shows this system can measure neutron energy spectrum up to 100 eV range with only 2.5 meters Time of Flightpath in regards to the X-Band accelerator’s short pulse. With this, on-site neutron Time of Flight measurement can be used to identify the nuclear debris isotope contents through Neutron Resonance Transmission Analysis (NRTA). Some preliminary NRTA experiments have been done with Tungsten sample as dummy nuclear debris material, which isotopes Tungsten-186 has close energy absorption value with Uranium-238 (15 eV). The results obtained shows that this system can detect energy absorption in the resonance neutron area within 1-100 eV. It can also detect multiple elements in a material at once with the experiment using a combined sample of Indium, Tantalum, and silver makes it feasible to identify debris containing mixed material. This compact neutron Time of Flight measurement system is a great complementary for dual energy X-Ray Computed Tomography (CT) method that can identify atomic number quantitatively but with 1-mm spatial resolution and high error bar. The combination of these two measurement methods will able to perform on-site nuclear debris screening at Fukushima Daiichi reactor core area, providing the data for nuclear debris activity mapping.

Keywords: neutron source, neutron resonance, nuclear debris, time of flight

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Authors: Jianlun Zhang, Christine Lim

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Local food is one of the most attractive elements to tourists. The role of local cuisine in destination branding is very important because it is the distinctive identity that helps tourists remember the destination. The objectives of this study are: (1) Test the direct relation between the cognitive image of destination food and tourists’ intention to eat local food. (2) Examine the mediating effect of tourists’ desire to try destination food on the relationship between the cognitive image of local food and tourists’ intention to eat destination food. (3) Study the moderating effect of tourists’ perceived difficulties in finding local food on the relationship between tourists’ desire to try destination food and tourists’ intention to eat local food. To achieve the goals of this study, Macanese cuisine is selected as the destination food. Macau is located in Southeastern China and is a former colonial city of Portugal. The taste and texture of Macanese cuisine are unique because it is a fusion of cuisine from many countries and regions of mainland China. As people travel to seek authentically exotic experience, it is important to investigate if the food image of Macau leaves a good impression on tourists and motivate them to try local cuisine. A total of 449 Chinese tourists were involved in this study. To analyze the data collected, partial least square-structural equation modelling (PLS-SEM) technique is employed. Results suggest that the cognitive image of Macanese cuisine has a direct effect on tourists’ intention to eat Macanese cuisine. Tourists’ desire to try Macanese cuisine mediates the cognitive image-intention relationship. Tourists’ perceived difficulty of finding Macanese cuisine moderates the desire-intention relationship. The lower tourists’ perceived difficulty in finding Macanese cuisine is, the stronger the desire-intention relationship it will be. There are several practical implications of this study. First, the government tourism website can develop an authentic storyline about the evolvement of local cuisine, which provides an opportunity for tourists to taste the history of the destination and create a novel experience for them. Second, the government should consider the development of food events, restaurants, and hawker businesses. Third, to lower tourists’ perceived difficulty in finding local cuisine, there should be locations of restaurants and hawker stalls with clear instructions for finding them on the websites of the government tourism office, popular tourism sites, and public transportation stations in the destination. Fourth, in the post-COVID-19 era, travel risk will be a major concern for tourists. Therefore, when promoting local food, the government tourism website should post images that show food safety and hygiene.

Keywords: cognitive image of destination food, desire to try destination food, intention to eat food in the destination, perceived difficulties of finding local cuisine, PLS-SEM

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Authors: Ayelet Hersch, Corrine Serfaty, Sigal Portnoy

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Stroke survivors commonly report persistent fatigue and sleep disruptions during rehabilitation and post-recovery. While limited research has explored the impact of stroke on a patient's chronotype, there is a gap in understanding the differences in cognitive performance based on treatment timing. Study objectives: (a) To characterize the sleep chronotype in sub-acute post-stroke individuals. (b) Explore cognitive task performance differences during preferred and non-preferred hours. (c) Examine the relationships between sleep quality and cognitive performance. For this intra-subject study, twenty participants (mean age 60.2±8.6) post-first stroke (6-12 weeks post stroke) underwent assessments at preferred and non-preferred chronotypic times. The assessment included demographic surveys, the Munich Chronotype Questionnaire, Montreal Cognitive Assessment (MoCA), Rivermead Behavioral Memory Test (RBMT), a fatigue questionnaire, and 4-5 days of actigraphy (wrist-worn wGT3X-BT, ActiGraph) to record sleep characteristics. Four sleep quality indices were extracted from actigraphy wristwatch recordings: The average of total sleep time per day (minutes), the average number of awakenings during the sleep period per day, the efficiency of sleep (total hours of sleep per day divided by hours spent in bed per day, averaged across the days and presented as percentage), and the Wake after Sleep Onset (WASO) index, indicating the average number of minutes elapsed from the onset of sleep to the first awakening. Stroke survivors exhibited an earlier sleep chronotype post-injury compared to pre-injury. Enhanced attention, as indicated by higher RBMT scores, occurred during preferred hours. Specifically, 30% of the study participants demonstrated an elevation in their final scores during their preferred hours, transitioning from the category of "mild memory impairment" to "normal memory." However, no significant differences emerged in executive functions, attention tasks, and MoCA scores between preferred and non-preferred hours. The Wake After Sleep Onset (WASO) index correlated with MoCA/RBMT scores during preferred hours (r=0.53/0.51, p=0.021/0.027, respectively). The number of awakenings correlated with MoCA letter task performance during non-preferred hours (r=0.45, p=0.044). Enhanced attention during preferred hours suggests a potential relationship between chronotype and cognitive performance, highlighting the importance of personalized rehabilitation strategies in stroke care. Further exploration of these relationships could contribute to optimizing the timing of cognitive interventions for stroke survivors.

Keywords: sleep chronotype, chronobiology, circadian rhythm, rehabilitation timing

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Authors: Nicholas McNamara, John Brookes, Michael Williams, Manish Mathew, Elizabeth Brookes, Tristan Yan, Paul Bannon

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Objective: Pericardial effusions are an uncommon but potentially fatal complication after cardiac surgery. The goal of this study was to describe the incidence and risk factors associated with the development of pericardial effusion requiring drainage after coronary artery bypass graft surgery (CABG). Methods: A retrospective analysis was undertaken using prospectively collected data. All adult patients who underwent CABG at our institution between 1st January 2017 and 31st December 2018 were included. Pericardial effusion was diagnosed using transthoracic echocardiography (TTE) performed for clinical suspicion of pre-tamponade or tamponade. Drainage was undertaken if considered clinically necessary and performed via a sub-xiphoid incision, pericardiocentesis, or via re-sternotomy at the discretion of the treating surgeon. Patient demographics, operative characteristics, anticoagulant exposure, and postoperative outcomes were examined to identify those variables associated with the development of pericardial effusion requiring drainage. Tests of association were performed using the Fischer exact test for dichotomous variables and the Student t-test for continuous variables. Logistic regression models were used to determine univariate predictors of pericardial effusion requiring drainage. Results: Between January 1st, 2017, and December 31st, 2018, a total of 408 patients underwent CABG at our institution, and eight (1.9%) required drainage of pericardial effusion. There was no difference in age, gender, or the proportion of patients on preoperative therapeutic heparin between the study and control groups. Univariate analysis identified preoperative atrial arrhythmia (37.5% vs 8.8%, p = 0.03), reduced left ventricular ejection fraction (47% vs 56%, p = 0.04), longer cardiopulmonary bypass (130 vs 84 min, p < 0.01) and cross-clamp (107 vs 62 min, p < 0.01) times, higher drain output in the first four postoperative hours (420 vs 213 mL, p <0.01), postoperative atrial fibrillation (100% vs 32%, p < 0.01), and pleural effusion requiring drainage (87.5% vs 12.5%, p < 0.01) to be associated with development of pericardial effusion requiring drainage. Conclusion: In this study, the incidence of pericardial effusion requiring drainage was 1.9%. Several factors, mainly related to preoperative or postoperative arrhythmia, length of surgery, and pleural effusion requiring drainage, were identified to be associated with developing clinically significant pericardial effusions. High clinical suspicion and low threshold for transthoracic echo are pertinent to ensure this potentially lethal condition is not missed.

Keywords: coronary artery bypass, pericardial effusion, pericardiocentesis, tamponade, sub-xiphoid drainage

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Authors: Daniela Magalhaes, Jorge Pedro, Pedro Souteiro, Joao S. Neves, Sofia Castro-Oliveira, Vanessa Guerreiro, Rita Bettencourt- Silva, Maria M. Costa, Ana Varela, Joana Queiros, Paula Freitas, Davide Carvalho

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Introduction: Obesity is an independent risk factor for renal dysfunction. Our aims were: (1) evaluate the impact of bariatric surgery (BS) on renal function; (2) clarify the factors determining the postoperative evolution of the glomerular filtration rate (GFR); (3) access the occurrence of oxalate-mediated renal complications. Methods: We investigated a cohort of 1448 obese patients who underwent bariatric surgery. Those with basal GFR (GFR0) < 30mL/min or without information about the GFR 2-year post-surgery (GFR2) were excluded. Results: We included 725 patients, of whom 647 (89.2%) women, with 41 (IQR 34-51) years, a median weight of 112.4 (IQR 103.0-125.0) kg and a median BMI of 43.4 (IQR 40.6-46.9) kg/m2. Of these, 459 (63.3%) performed gastric bypass (RYGB), 144 (19.9%) placed an adjustable gastric band (AGB) and 122 (16.8%) underwent vertical gastrectomy (VG). At 2-year post-surgery, excess weight loss (EWL) was 60.1 (IQR 43.7-72.4) %. There was a significant improve of metabolic and inflammatory status, as well as a significant decrease in the proportion of patients with diabetes, arterial hypertension and dyslipidemia (p < 0.0001). At baseline, 38 (5.2%) of subjects had hyperfiltration with a GFR0 ≥ 125mL/min/1.73m2, 492 (67.9%) had a GFR0 90-124 mL/min/1.73m2, 178 (24.6%) had a GFR0 60-89 mL/min/1.73m2, and 17 (2.3%) had a GFR0 < 60 mL/min/1.73m2. GFR decreased in 63.2% of patients with hyperfiltration (ΔGFR=-2.5±7.6), and increased in 96.6% (ΔGFR=22.2±12.0) and 82.4% (ΔGFR=24.3±30.0) of the subjects with GFR0 60-89 and < 60 mL/min/1.73m2, respectively ( p < 0.0001). This trend was maintained when adjustment was made for the type of surgery performed. Of 321 patients, 10 (3.3%) had a urinary albumin excretion (UAE) > 300 mg/dL (A3), 44 (14.6%) had a UAE 30-300 mg/dL (A2) and 247 (82.1%) has a UAE < 30 mg/dL (A1). Albuminuria decreased after surgery and at 2-year follow-up only 1 (0.3%) patient had A3, 17 (5.6%) had A2 and 283 (94%) had A1 (p < 0,0001). In multivariate analysis, the variables independently associated with ΔGFR were BMI (positively) and fasting plasma glucose (negatively). During the 2-year follow-up, only 57 of the 725 patients had transient urinary excretion of calcium oxalate crystals. None has records of oxalate-mediated renal complications at our center. Conclusions: The evolution of GFR after BS seems to depend on the initial renal function, as it decreases in subjects with hyperfiltration, but tends to increase in those with renal dysfunction. Our results suggest that BS is associated with improvement of renal outcomes, without significant increase of renal complications. So, apart the clear benefits in metabolic and inflammatory status, maybe obese adults with nondialysis-dependent CKD should be referred for bariatric surgery evaluation.

Keywords: albuminuria, bariatric surgery, glomerular filtration rate, renal function

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Authors: Lakmini Wijesooriya, Vicki Chalker, Jessica Day, Priyantha Perera, N. P. Sunil-Chandra

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M. pneumoniae has been identified as an etiology for exacerbation of asthma (EQA), although viruses play a major role in EOA. M. pneumoniae infection is treated empirically with macrolides, and its antibiotic sensitivity is not detected routinely. Characterization of the organism by genotyping and determination of macrolide resistance is important epidemiologically as it guides the empiric antibiotic treatment. To date, there is no such characterization of M. pneumoniae performed in Sri Lanka. The present study describes the characterization of M. pneumoniae detected from a child with EOA following a screening of 100 children with EOA. Of the hundred children with EOA, M. pneumoniae was identified only in one child by Real-Time polymerase chain reaction (PCR) test for identifying the community-acquired respiratory distress syndrome (CARDS) toxin nucleotide sequences. The M. pneumoniae identified from this patient underwent detection of macrolide resistance via conventional PCR, amplifying and sequencing the region of the 23S rDNA gene that contains single nucleotide polymorphisms that confer resistance. Genotyping of the isolate was performed via nested Multilocus Sequence Typing (MLST) in which eight (8) housekeeping genes (ppa, pgm, gyrB, gmk, glyA, atpA, arcC, and adk) were amplified via nested PCR followed by gene sequencing and analysis. As per MLST analysis, the M. pneumoniae was identified as sequence type 14 (ST14), and no mutations that confer resistance were detected. Resistance to macrolides in M. pneumoniae is an increasing problem globally. Establishing surveillance systems is the key to informing local prescriptions. In the absence of local surveillance data, antibiotics are started empirically. If the relevant microbiological samples are not obtained before antibiotic therapy, as in most occasions in children, the course of antibiotic is completed without a microbiological diagnosis. This happens more frequently in therapy for M. pneumoniae which is treated with a macrolide in most patients. Hence, it is important to understand the macrolide sensitivity of M. pneumoniae in the setting. The M. pneumoniae detected in the present study was macrolide sensitive. Further studies are needed to examine a larger dataset in Sri Lanka to determine macrolide resistance levels to inform the use of macrolides in children with EOA. The MLST type varies in different geographical settings, and it also provides a clue to the existence of macrolide resistance. The present study enhances the database of the global distribution of different genotypes of M. pneumoniae as this is the first such characterization performed with the increased number of samples to determine macrolide resistance level in Sri Lanka. M. pneumoniae detected from a child with exacerbation of asthma in Sri Lanka was characterized as ST14 by MLST and no mutations that confer resistance were detected.

Keywords: mycoplasma pneumoniae, Sri Lanka, characterization, macrolide resistance

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Authors: Rafid Mueen, Konstantin Konstantinov, Micheal Lerch, Zhenxiang Cheng

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In the past two decades, the concern for skin protection from ultraviolet (UV) radiation has attracted considerable attention due to the increased intensity of UV rays that can reach the Earth’s surface as a result of the breakdown of ozone layer. Recently, UVA has also attracted attention, since, in comparison to UVB, it can penetrate deeply into the skin, which can result in significant health concerns. Sunscreen agents are one of the significant tools to protect the skin from UV irradiation, and it is either organic or in organic. Developing of inorganic UV blockers is essential, which provide efficient UV protection over a wide spectrum rather than organic filters. Furthermore inorganic UV blockers are good comfort, and high safety when applied on human skin. Inorganic materials can absorb, reflect, or scatter the ultraviolet radiation, depending on their particle size, unlike the organic blockers, which absorb the UV irradiation. Nowadays, most inorganic UV-blocking filters are based on (TiO2) and ZnO). ZnO can provide protection in the UVA range. Indeed, ZnO is attractive for in sunscreen formulization, and this relates to many advantages, such as its modest refractive index (2.0), absorption of a small fraction of solar radiation in the UV range which is equal to or less than 385 nm, its high probable recombination of photogenerated carriers (electrons and holes), large direct band gap, high exciton binding energy, non-risky nature, and high tendency towards chemical and physical stability which make it transparent in the visible region with UV protective activity. A significant issue for ZnO use in sunscreens is that it can generate ROS in the presence of UV light because of its photocatalytic activity. Therefore it is essential to make a non-photocatalytic material through modification by other metals. Several efforts have been made to deactivate the photocatalytic activity of ZnO by using inorganic surface modifiers. The doping of ZnO by different metals is another way to modify its photocatalytic activity. Recently, successful doping of ZnO with different metals such as Ce, La, Co, Mn, Al, Li, Na, K, and Cr by various procedures, such as a simple and facile one pot water bath, co-precipitation, hydrothermal, solvothermal, combustion, and sol gel methods has been reported. These materials exhibit greater performance than undoped ZnO towards increasing the photocatalytic activity of ZnO in visible light. Therefore, metal doping can be an effective technique to modify the ZnO photocatalytic activity. However, in the current work, we successfully reduce the photocatalytic activity of ZnO through Na doped ZnO fabricated via sol-gel and hydrothermal methods.

Keywords: photocatalytic, ROS, UVA, ZnO

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Authors: Ophir Segal, Daniel Weltsch, Shay Tenenbaum, Ran Thein

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Purpose: Patients with lateral patellar dislocation (LPD) are not always referred to perform an MRI. This might be the case in first time LPD patients without surgical indications or in patients with recurrent LPD who had MRI in previous episodes. Unfortunately, in some cases, there are additional knee pathological findings, which include tearing of the collateral or cruciate ligaments and injury to the tendons or menisci. These findings might be overlooked during the physical examination or masked by nonspecific clinical findings like knee pain, effusion, or hemarthrosis. The prevalence of these findings, which can be revealed by MRI, is misreported in literature and is considered rare. In our practice, all patients with LPD are sent for MRI after LPD. Therefore, we have designed a retrospective comparative study to evaluate the prevalence of additional pathological findings in patients with acute traumatic LPD that had performed MRI, comparing different groups of patients according to age, sex, and Tibial Tuberosity-Trochlear Groove(TT-TG) distance. Methods: MRI of the knee in patients after traumatic LPD were evaluated for the presence of additional pathological findings such as injuries to ligaments: Anterior/Posterior cruciate ligament(ACL, PCL), Medial/Lateral collateral ligament(MCL, LCL), injuries to tendons(QUADICEPS, PATELLAR), menisci(Medial/Lateral meniscus(MM, LM)) and tibial plateau, by a fellowship-trained, senior musculoskeletal radiologist. A comparison between different groups of patients was performed according to age (age group < 25 years, age group > 25 years), sex (Male/Female group), and TT-TG distance (TT-TG<15 groups, TT-TG>15 groups). A descriptive and comparative statistical analysis was performed. Results: 150 patients were included in this study. All suffered from LPD between the years 2012-2017 (mean age 21.3( ± SD 8.9), 86 males). ACL, PCL, MCL, and LCL complete or partial tears were found in 17(11.3%), 3(2%), 22(14.6%), and 4(2.7%) of the patients, respectively. MM and LM tears were found in 10(6.7%) and 3(2%) of the patients, respectively. A higher prevalence of PCL injury, MM tear, and LM tear were found in the older age group compared to the younger group of patients (10.5% vs. 1.8%, 18.4% vs. 2.7%, and 7.9% vs. 0%, respectively, p<0.05). A higher prevalence of non-displaced MM tear and LCL injury was found in the male group compared to the female group (8.1% vs. 0% and 8.1% vs. 0% respectively, p<0.05). A higher prevalence of ACL injury was found in the normal TT-TG group compared to the pathologic TT-TG group (17.5% vs. 2.3%, p= 0.0184). Conclusions: Overall, 43 out of 150 (28.7%) of the patient's MRI’s were positive for additional pathological radiological findings. Interestingly, a higher prevalence of additional pathologies was found in the groups of patients with a lower risk for recurrent LPD, including males, patients older than 25, and patients with TT-TG lower than 15mm, and therefore might not be referred for an MRI scan. Thus, we recommend a strict physical examination, awareness to the high prevalence of additional pathological findings, and to consider performing an MRI in all patients after LPD.

Keywords: additional findings, lateral patellar dislocation (LPD), MRI scan, traumatic patellar dislocation, cruciate ligaments injuries, menisci injuries, collateral ligaments injuries

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Authors: Ahmed F. Ghanem, Marwa I. Wahba, Asmaa N. El-Dein, Mohamed A. EL-Raey, Ghada E.A. Awad

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Numerous attempts are being performed in order to formulate suitable packaging materials for meat products. However, to the best of our knowledge, the incorporation of free hibiscus extract or its microcapsules in the pure polyvinyl alcohol (PVA) matrix as packaging materials for meats is seldom reported. Therefore, this study aims at protection of the aqueous crude extract of hibiscus flowers utilizing spry drying encapsulation technique. Fourier transform infrared (FTIR), scanning electron microscope (SEM), and zetasizer results confirmed the successful formation of assembled capsules via strong interactions, spherical rough microparticles, and ~ 235 nm of particle size, respectively. Also, the obtained microcapsules enjoy high thermal stability, unlike the free extract. Then, the obtained spray-dried particles were incorporated into the casting solution of the pure PVA film with a concentration 10 wt. %. The segregated free-standing composite films were investigated, compared to the neat matrix, with several characterization techniques such as FTIR, SEM, thermal gravimetric analysis (TGA), mechanical tester, contact angle, water vapor permeability, and oxygen transmission. The results demonstrated variations in the physicochemical properties of the PVA film after the inclusion of the free and the extract microcapsules. Moreover, biological studies emphasized the biocidal potential of the hybrid films against microorganisms contaminating the meat. Specifically, the microcapsules imparted not only antimicrobial but also antioxidant activities to PVA. Application of the prepared films on the real meat samples displayed low bacterial growth with a slight increase in the pH over the storage time up to 10 days at 4 oC which further proved the meat safety. Moreover, the colors of the films did not significantly changed except after 21 days indicating the spoilage of the meat samples. No doubt, the dual-functional of prepared composite films pave the way towards combined active/smart food packaging applications. This would play a vital role in the food hygiene, including also quality control and assurance.

Keywords: PVA, hibiscus, extraction, encapsulation, active packaging, smart and intelligent packaging, meat spoilage

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Authors: Javier Alfonso Bonilla-Chávez, Angélica Lozano

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In North America, more than 2,000 people annually die in accidents related to railroad tracks. In 2020, collisions at grade crossings were the main cause of deaths related to railway accidents in Mexico. Railway networks have constant interaction with motor transport users, cyclists, and pedestrians, mainly in grade crossings, where is the greatest vulnerability and risk of accidents. Usually, accidents at grade crossings are directly related to risky behavior and non-compliance with regulations by motorists, cyclists, and pedestrians, especially in developing countries. Around the world, countries classify these crossings in different ways. In Mexico, according to their dangerousness (high, medium, or low), types A, B and C have been established, recommending for each one different type of auditive and visual signaling and gates, as well as horizontal and vertical signaling. This classification is based in a weighting, but regrettably, it is not explained how the weight values were obtained. A review of the variables and the current approach for the grade crossing classification is required, since it is inadequate for some crossings. In contrast, North America (USA and Canada) and European countries consider a broader classification so that attention to each crossing is addressed more precisely and equipment costs are adjusted. Lack of a proper classification, could lead to cost overruns in the equipment and a deficient operation. To exemplify the lack of a good classification, six crossings are studied, three located in the rural area of Mexico and three in Mexico City. These cases show the need of: improving the current regulations, improving the existing infrastructure, and implementing technological systems, including informative signals with nomenclature of the involved crossing and direct telephone line for reporting emergencies. This implementation is unaffordable for most municipal governments. Also, an inventory of the most dangerous grade crossings in urban and rural areas must be obtained. Then, an approach for improving the classification of grade crossings is suggested. This approach must be based on criteria design, characteristics of adjacent roads or intersections which can influence traffic flow through the crossing, accidents related to motorized and non-motorized vehicles, land use and land management, type of area, and services and economic activities in the zone where the grade crossings is located. An expanded classification of grade crossing in Mexico could reduce accidents and improve the efficiency of the railroad.

Keywords: accidents, grade crossing, railroad, traffic safety

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Authors: Irene Kretchy, Frances Owusu-Daaku, Samuel Danquah

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Hypertension is the leading risk factor for cardiovascular diseases, and a major cause of death and disability worldwide. This study examined whether psychosocial variables influenced patients’ perception and experience of side effects of their medicines, how they coped with these experiences and the impact on mental health and medication adherence to conventional hypertension therapies. Methods: A hospital-based mixed methods study, using quantitative and qualitative approaches was conducted on hypertensive patients. Participants were asked about side effects, medication adherence, common psychological symptoms, and coping mechanisms with the aid of standard questionnaires. Information from the quantitative phase was analyzed with the Statistical Package for Social Sciences (SPSS) version 20. The interviews from the qualitative study were audio-taped with a digital audio recorder, manually transcribed and analyzed using thematic content analysis. The themes originated from participant interviews a posteriori. Results: The experiences of side effects – such as palpitations, frequent urination, recurrent bouts of hunger, erectile dysfunction, dizziness, cough, physical exhaustion - were categorized as no/low (39.75%), moderate (53.0%) and high (7.25%). Significant relationships between depression (x 2 = 24.21, P < 0.0001), anxiety (x 2 = 42.33, P < 0.0001), stress (x 2 = 39.73, P < 0.0001) and side effects were observed. A logistic regression model using the adjusted results for this association are reported – depression [OR = 1.9 (1.03 – 3.57), p = 0.04], anxiety [OR = 1.5 (1.22 – 1.77), p = < 0.001], and stress [OR = 1.3 (1.02 – 1.71), p = 0.04]. Side effects significantly increased the probability of individuals to be non-adherent [OR = 4.84 (95% CI 1.07 – 1.85), p = 0.04] with social factors, media influences and attitudes of primary caregivers further explaining this relationship. The personal adoption of medication modifying strategies, espousing the use of complementary and alternative treatments, and interventions made by clinicians were the main forms of coping with side effects. Conclusions: Results from this study show that contrary to a biomedical approach, the experience of side effects has biological, social and psychological interrelations. The result offers more support for the need for a multi-disciplinary approach to healthcare where all forms of expertise are incorporated into health provision and patient care. Additionally, medication side effects should be considered as a possible cause of non-adherence among hypertensive patients, thus addressing this problem from a Biopsychosocial perspective in any intervention may improve adherence and invariably control blood pressure.

Keywords: biopsychosocial, hypertension, medication adherence, psychological disorders

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Authors: Manuel Salado, Mikel Rincón, Arkaitz Fidalgo, Roberto Fernandez, Senentxu Lanceros-Méndez

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Lithium-ion batteries (LIBs) are a promising technology for energy storage, but they suffer from safety concerns due to the use of flammable organic solvents in their liquid electrolytes. Solid-state electrolytes (SSEs) offer a potential solution to this problem, but they have their own limitations, such as poor ionic conductivity and high interfacial resistance. The aim of this research was to develop a new type of SSE based on metal-organic frameworks (MOFs) and ionic liquids (ILs). MOFs are porous materials with high surface area and tunable electronic properties, making them ideal for use in SSEs. ILs are liquid electrolytes that are non-flammable and have high ionic conductivity. A series of MOFs were synthesized, and their electrochemical properties were evaluated. The MOFs were then infiltrated with ILs to form a quasi-solid gel and solid xerogel SSEs. The ionic conductivity, interfacial resistance, and electrochemical performance of the SSEs were characterized. The results showed that the MOF-IL SSEs had significantly higher ionic conductivity and lower interfacial resistance than conventional SSEs. The SSEs also exhibited excellent electrochemical performance, with high discharge capacity and long cycle life. The development of MOF-IL SSEs represents a significant advance in the field of solid-state electrolytes. The high ionic conductivity and low interfacial resistance of the SSEs make them promising candidates for use in next-generation LIBs. The data for this research was collected using a variety of methods, including X-ray diffraction, scanning electron microscopy, and electrochemical impedance spectroscopy. The data was analyzed using a variety of statistical and computational methods, including principal component analysis, density functional theory, and molecular dynamics simulations. The main question addressed by this research was whether MOF-IL SSEs could be developed that have high ionic conductivity, low interfacial resistance, and excellent electrochemical performance. The results of this research demonstrate that MOF-IL SSEs are a promising new type of solid-state electrolyte for use in LIBs. The SSEs have high ionic conductivity, low interfacial resistance, and excellent electrochemical performance. These properties make them promising candidates for use in next-generation LIBs that are safer and have higher energy densities.

Keywords: energy storage, solid-electrolyte, ionic liquid, metal-organic-framework, electrochemistry, organic inorganic plastic crystal

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Authors: Silas Webb, Joseph Hartland

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Background: Long-term retention of patients on ART has become a major health challenge in Sub-Saharan Africa (SSA). In 2010 a systematic review of 39 papers found that 30% of patients were no longer taking their ARTs two years after starting treatment. In the same review, it was noted that there was a paucity of data as to why patients become lost to follow-up (LTFU) in SSA. This project was performed in Mulanje Mission Hospital in Malawi as part of Swindon Academy’s Global Health eSSC. The HIV prevalence for Malawi is 10.3%, one of the highest rates in the world, however prevalence soars to 18% in the Mulanje. Therefore it is essential that patients at risk of being LTFU are identified early and managed appropriately to help them continue to participate in the service. Methodology: All patients on adult antiretroviral formulations at MMH, who were classified as ‘defaulters’ (patients missing a scheduled follow up visit by more than two months) over the last 12 months were included in the study. Demographic varibales were collected from Mastercards for data analysis. A comparison group of patients currently not lost to follow up was created by using all of the patients who attended the HIV clinic between 18th-22nd July 2016 who had never defaulted from ART. Data was analysed using the chi squared (χ²) test, as data collected was categorical, with alpha levels set at 0.05. Results: Overall, 136 patients had defaulted from ART over the past 12 months at MMH. Of these, 43 patients had missing Mastercards, so 93 defaulter datasets were analysed. In the comparison group 93 datasets were also analysed and statistical analysis done using Chi-Squared testing. A higher proportion of men in the defaulting group was noted (χ²=0.034) and defaulters tended to be younger (χ²=0.052). 94.6% of patients who defaulted were taking Tenofovir, Lamivudine and Efavirenz, the standard first line ART therapy in Malawi. The mean length of time on ART was 39.0 months (RR: -22.4-100.4) in the defaulters group and 47.3 months (RR: -19.71-114.23) in the control group, with a mean difference of 8.3 less months in the defaulters group (χ ²=0.056). Discussion: The findings in this study echo the literature, however this review expands on that and shows the demographic for the patient at most risk of defaulting and being LTFU would be: a young male who has missed more than 4 doses of ART and is within his first year of treatment. For the hospital, this data is important at it identifies significant areas for public health focus. For instance, fear of disclosure and stigma may be disproportionately affecting younger men, so interventions can be aimed specifically at them to improve their health outcomes. The mean length of time on medication was 8.3 months less in the defaulters group, with a p-value of 0.056, emphasising the need for more intensive follow-up in the early stages of treatment, when patients are at the highest risk of defaulting.

Keywords: anti-retroviral therapy, ART, HIV, lost to follow up, Malawi

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Authors: B. K. Manjunatha Goud, Aruna Chanu Oinam

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The undergraduate medical curriculum is oriented towards training the students to undertake the responsibilities of a physician. During the training period, adequate emphasis is placed on inculcating logical and scientific habits of thought; clarity of expression and independence of judgment; and ability to collect and analyze information and to correlate them. At Ras Al Khaimah Medical and Health Sciences University (RAKMHSU), Biochemistry a basic medical science subject is taught in the 1st year of 5 years medical course with vertical interdisciplinary interaction with all subjects, which needs to be taught and learned adequately by the students to be related to clinical case or clinical problem in medicine and future diagnostics so that they can practice confidently and skillfully in the community. Based on these facts study was done to know the extent of usage of library resources by the students and the impact of study materials on their preparation for examination. It was a comparative cross sectional study included 100 and 80 1st and 2nd-year students who had successfully completed Biochemistry course. The purpose of the study was explained to all students [participants]. Information was collected on a pre-designed, pre-tested and self-administered questionnaire. The questionnaire was validated by the senior faculties and pre tested on students who were not involved in the study. The study results showed that 80.30% and 93.15% of 1st and 2nd year students have the clear idea of course outline given in course handout or study guide. We also found a statistically significant number of students agreed that they were benefited from the practical session and writing notes in the class hour. A high percentage of students [50% and 62.02%] disagreed that that reading only the handouts is enough for their examination as compared to other students. The study also showed that only 35% and 41% of students visited the library on daily basis for the learning process, around 65% of students were using lecture notes and text books as a tool for learning and to understand the subject and 45% and 53% of students used the library resources (recommended text books) compared to online sources before the examinations. The results presented here show that students perceived that e-learning resources like power point presentations along with text book reading using SQ4R technique had made a positive impact on various aspects of their learning in Biochemistry. The use of library by students has overall positive impact on learning process especially in medical field enhances the outcome, and medical students are better equipped to treat the patient. But it’s also true that use of library use has been in decline which will impact the knowledge aspects and outcome. In conclusion, a student has to be taught how to use the library as learning tool apart from lecture handouts.

Keywords: medical education, learning resources, study guide, biochemistry

Procedia PDF Downloads 173

Authors: Natela Gerliani, Mohammed Aider

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Nowadays, the interest of using sustainable technologies for protein extraction from underutilized oilseeds is growing. Currently, a major disposal problem for the oil industry is by-products of plant food processing such as soybean meal. That is why valorization of soybean meal is important for the oil industry since it contains high-quality proteins and other valuable components. Generally, soybean meal is used in livestock and poultry feed but is rarely used in human feed. Though chemical composition of this meal compensate nutritional deficiency and can be used to balance protein in human food. Regarding the efficiency of soybean meal valorization, extraction is a key process for obtaining enriched protein ingredient, which can be incorporated into the food matrix. However, most of the food components such as proteins extracted from oilseeds by-products imply the utilization of organic and inorganic chemicals (e.g. acids, bases, TCA-acetone) having a significant environmental impact. In a context of sustainable production, the use of an electro-activation technology seems to be a good alternative. Indeed, the electro-activation technology requires only water, food grade salt and electricity as main materials. Moreover, this innovative technology helps to avoid special equipment and trainings for workers safety as well as transport and storage of hazardous materials. Electro-activation is a technology based on applied electrochemistry for the generation of acidic and alkaline solutions on the basis of the oxidation-reduction reactions that occur at the vicinity electrode/solution interfaces. It is an eco-friendly process that can be used to replace the conventional acidic and alkaline extraction. In this research, the electro-activation technology for protein extraction from soybean meal was carried out in the electro-activation reactor. This reactor consists of three compartments separated by cation and anion exchange membranes that allow creating non-contacting acidic and basic solutions. Different current intensities (150 mA, 300 mA and 450 mA) and treatment durations (10 min, 30 min and 50 min) were tested. The results showed that the extracts obtained by the electro-activation method have good quality in comparison to conventional extracts. For instance, extractability obtained with electro-activation method was 55% whereas with the conventional method it was only 36%. Moreover, a maximum protein quantity of 48 % in the extract was obtained with the electro-activation technology comparing to the maximum amount of protein obtained by conventional extraction of 41 %. Hence, the environmentally sustainable electro-activation technology seems to be a promising type of protein extraction that can replace conventional extraction technology.

Keywords: by-products, eco-friendly technology, electro-activation, soybean meal

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Authors: Carlos Y. Soto, Camila A. Lota, G. Astrid Garzón

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Bacterial biofilms cause an ongoing problem for food safety. They are formed when microorganisms aggregate to form a community that attaches to solid surfaces. Biofilms increase the resistance of pathogens to cleaning, disinfection and antibacterial products. This resistance gives rise to problems for human health, industry, and agriculture. At present, plant extracts rich in polyphenolics are being investigated as natural alternatives to degrade bacterial biofilms. The pomace of the tropical Berry Vaccinium meridionale S. contains high amounts of phenolic compounds. Therefore, in the current study, the antimicrobial and antibiofilm effects of extracts from the pomace of Vaccinium meridionale S. were tested on three foodborne pathogens: Enterohaemorrhagic Escherichia coli O157:H7 (ATCC®700728TM), Staphylococcus aureus subsp. aureus (ATCC® 6538TM), and Salmonella enterica serovar Enteritidis (ATCC® 13076TM). Microwave-assisted extraction was used to extract polyphenols with aqueous methanol (80% v/v) at a solid to solvent ratio of 1:10 (w/v) for 20 min. The magnetic stirring was set at 400 rpm, and the microwave power was adjusted to 400 W. The antimicrobial effect of the extract was assessed by determining the half maximal inhibitory concentration (IC50) against the three food poisoning pathogens at concentrations ranging from 50 to 2,850 μg gallic acid equivalents (GAE)/mL of the extract. Biofilm inhibition was assessed using a crystal violet assay applying the same range of concentration. Three replications of the experiments were carried out, and all analyses were run in triplicate. IC50 values were determined using the GraphPad Prism8® program. Significant differences (P<0.05) among means were identified using one-factor analysis of variance (ANOVA) and the post-hoc least significant difference (LSD) test using the Statgraphics plus program, version 2.1.There was significant difference among the mean IC50 values for the tested bacteria. The IC50 for S. aureus was 48 ± 9 μg GAE/mL, followed by 123 ± 49 μg GAE/mL for Salmonella and 376 ± 32 μg GAE/mL for E. coli. The percent inhibition of the extract on biofilm formation was significantly higher for S. aureus (85.8  0.3), followed by E. coli (74.5  1.0) and Salmonella (53.6  9.7). These findings suggest that polyphenolic extracts obtained from the pomace of V. meridionale S. might be used as natural antimicrobial and anti-biofilm natural agents, effective against S. aureus, E. coli and Salmonella enterica.

Keywords: antibiofilm, antimicrobial, E. coli, S. aureus, salmonella, IC50, pomace, V. meridionale

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Authors: Jesus Salmeron, Carmen De Vega, Maria Soledad Vicente, Mireia Olabarria, Olaia Martinez

Abstract:

Dysphagia or difficulty in swallowing affects mostly elder people: 56-78% of the institutionalized and 44% of the hospitalized. Liquid food thickening is a necessary measure in this situation because it reduces the risk of penetration-aspiration. Until now, and as proposed by the American Dietetic Association in 2002, possible consistencies have been categorized in three groups attending to their viscosity: nectar (50-350 mPa•s), honey (350-1750 mPa•s) and pudding (>1750 mPa•s). The adequate viscosity level should be identified for every patient, according to her/his impairment. Nevertheless, a systematic review on dysphagia diet performed recently indicated that there is no evidence to suggest that there is any transition of clinical relevance between the three levels proposed. It was also stated that other physical properties of the bolus (slipperiness, density or cohesiveness, among others) could influence swallowing in affected patients and could contribute to the amount of remaining residue. Texture parameters need to be evaluated as possible alternative to viscosity. The aim of this study was to evaluate the instrumental extrusion-compression test as a possible tool to characterize changes along time in water thickened with various products and in the three theoretical consistencies. Six commercial thickeners were used: NM® (NM), Multi-thick® (M), Nutilis Powder® (Nut), Resource® (R), Thick&Easy® (TE) and Vegenat® (V). All of them with a modified starch base. Only one of them, Nut, also had a 6,4% of gum (guar, tara and xanthan). They were prepared as indicated in the instructions of each product and dispensing the correspondent amount for nectar, honey and pudding consistencies in 300 mL of tap water at 18ºC-20ºC. The mixture was stirred for about 30 s. Once it was homogeneously spread, it was dispensed in 30 mL plastic glasses; always to the same height. Each of these glasses was used as a measuring point. Viscosity was measured using a rotational viscometer (ST-2001, Selecta, Barcelona). Extrusion-compression test was performed using a TA.XT2i texture analyzer (Stable Micro Systems, UK) with a 25 mm diameter cylindrical probe (SMSP/25). Penetration distance was set at 10 mm and a speed of 3 mm/s. Measurements were made at 1, 5, 10, 20, 30, 40, 50 and 60 minutes from the moment samples were mixed. From the force (g)–time (s) curves obtained in the instrumental assays, maximum force peak (F) was chosen a reference parameter. Viscosity (mPa•s) and F (g) showed to be highly correlated and had similar development along time, following time-dependent quadratic models. It was possible to predict viscosity using F as an independent variable, as they were linearly correlated. In conclusion, compression-extrusion test could be an alternative and a useful tool to assess physical characteristics of thickened liquids.

Keywords: compression-extrusion test, dysphagia, texture analyzer, thickener

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Authors: Minh Huynh, Aaron Heuser, Luke Patterson, Chris Zhang, Mason Miller, Daniel Wang, Sandeep Shetty, Mike Trinh, Abigail Miller, Adaeze Enekwechi, Tenille Daniels, Lu Huynh

Abstract:

Machine learning and text analytics have been used to analyze child abuse, cyberbullying, domestic abuse and domestic violence, and hate speech. However, to the authors’ knowledge, no research to date has used these methods to study elder abuse in nursing homes or skilled nursing facilities from field inspection reports. We used machine learning and text analytics methods to analyze 356,000 inspection reports, which have been extracted from CMS Form-2567 field inspections of US nursing homes and skilled nursing facilities between 2016 and 2021. Our algorithm detected occurrences of the various types of abuse, including physical abuse, psychological abuse, verbal abuse, sexual abuse, and passive and active neglect. For example, to detect physical abuse, our algorithms search for combinations or phrases and words suggesting willful infliction of damage (hitting, pinching or burning, tethering, tying), or consciously ignoring an emergency. To detect occurrences of elder neglect, our algorithm looks for combinations or phrases and words suggesting both passive neglect (neglecting vital needs, allowing malnutrition and dehydration, allowing decubiti, deprivation of information, limitation of freedom, negligence toward safety precautions) and active neglect (intimidation and name-calling, tying the victim up to prevent falls without consent, consciously ignoring an emergency, not calling a physician in spite of indication, stopping important treatments, failure to provide essential care, deprivation of nourishment, leaving a person alone for an inappropriate amount of time, excessive demands in a situation of care). We further compare the prevalence of abuse before and after Covid-19 related restrictions on nursing home visits. We also identified the facilities with the most number of cases of abuse with no abuse facilities within a 25-mile radius as most likely candidates for additional inspections. We also built an interactive display to visualize the location of these facilities.

Keywords: machine learning, text analytics, elder abuse, elder neglect, nursing home abuse

Procedia PDF Downloads 137

Authors: Marlin Mubarak

Abstract:

Background: Endometriosis is a complex disabling disease affecting young females in the reproductive period mainly. The aim of this project is to generate a diagnostic model to predict severity and stage of endometriosis prior to Laparoscopic surgery. This will help to improve the pre-operative diagnostic accuracy of stage 3 & 4 endometriosis and as a result, refer relevant women to a specialist centre for complex Laparoscopic surgery. The model is based on the British Society of Gynaecological Endoscopy (BSGE) pain questionnaire, clinical examination and ultrasound scan. Design: This is a prospective, observational, study, in which women completed the BSGE pain questionnaire, a BSGE requirement. Also, as part of the routine preoperative assessment patient had a routine ultrasound scan and when recto-vaginal and deep infiltrating endometriosis was suspected an MRI was performed. Setting: Luton & Dunstable University Hospital. Patients: Symptomatic women (n = 56) scheduled for laparoscopy due to pelvic pain. The age ranged between 17 – 52 years of age (mean 33.8 years, SD 8.7 years). Interventions: None outside the recognised and established endometriosis centre protocol set up by BSGE. Main Outcome Measure(s): Sensitivity and specificity of endometriosis diagnosis predicted by symptoms based on BSGE pain questionnaire, clinical examinations and imaging. Findings: The prevalence of diagnosed endometriosis was calculated to be 76.8% and the prevalence of advanced stage was 55.4%. Deep infiltrating endometriosis in various locations was diagnosed in 32/56 women (57.1%) and some had DIE involving several locations. Logistic regression analysis was performed on 36 clinical variables to create a simple clinical prediction model. After creating the scoring system using variables with P < 0.05, the model was applied to the whole dataset. The sensitivity was 83.87% and specificity 96%. The positive likelihood ratio was 20.97 and the negative likelihood ratio was 0.17, indicating that the model has a good predictive value and could be useful in predicting advanced stage endometriosis. Conclusions: This is a hypothesis-generating project with one operator, but future proposed research would provide validation of the model and establish its usefulness in the general setting. Predictive tools based on such model could help organise the appropriate investigation in clinical practice, reduce risks associated with surgery and improve outcome. It could be of value for future research to standardise the assessment of women presenting with pelvic pain. The model needs further testing in a general setting to assess if the initial results are reproducible.

Keywords: deep endometriosis, endometriosis, minimally invasive, MRI, ultrasound.

Procedia PDF Downloads 342

Authors: Deepali Rastogi, Akanksha Rastogi

Abstract:

Comfort and safety are two essential factors in a newborn’s clothing. Natural dyes are considered safe for infant clothes because they are non-toxic and have medicinal properties. Natural dyes are sensitive to pH and may show changes in hue under different pH conditions. Infant garments face treatments different than adult clothing, for instance, exposure to infant’s saliva, milk, and urine. The present study was designed to study the suitability of natural dyes for infant clothes. Cotton fabric was dyed using fifteen natural dyes and two mordants, alum, and ferrous sulphate. The dyed samples were assessed for colour fastness to washing, rubbing, perspiration and light. In addition, fastness to milk, saliva, and urine was also tested. Simulated solutions of saliva and urine were prepared for the study. For milk, one of the commercial formulations for infants was taken and used as per the directions. A wide gamut of colours was obtained after dyeing the cotton with different natural dyes and mordants. The colour strength of all the dyed samples was determined in terms of K/S values. Most of the ferrous sulphate mordanted dyes gave higher K/S values than alum mordanted samples. The wash fastness of dyed cotton fabrics ranged from 3/4 -5. Perspiration fastness test for the samples was done in both acidic and alkaline mediums. The ratings ranged from 3-5, with most of the dyes falling in the range of 4-5. The rubbing fastness of the dyed samples was tested in dry and wet conditions. The results showed excellent rub fastness ranging between 4-5. Light fastness was found to be good to moderate. The main food for infants is milk, and this becomes one of the main agents to spot infants' garments. All dyes showed excellent fastness properties against milk with a grey scale rating of 4-5. Fastness against saliva is recommended by various eco-labels, standards, and organizations for fabrics of infants or babies. The fastness of most of the dyes was found to be satisfactory against saliva. Infant garments get frequently soiled with urine. Most of the natural dyes on cotton fabric had good to excellent fastness to simulated urine. The grey scale ratings ranged from 3/4 – 5. Thus, it can be concluded that most of the natural dyes can be successfully used for infant wear and accessories and are fast to various liquids to which infant wear are exposed. Therefore, we can surround little ones with beautiful hues from nature's garden and clothe them in natural fibres dyed with natural dyes.

Keywords: fastness properties, infant wear, mordants, natural dyes

Procedia PDF Downloads 128

Authors: Mclee Kerolle

Abstract:

For more than 50 years, the state of Hawaii has had the beginnings of a burgeoning commercial aerospace presence statewide. While Hawaii provides the aerospace industry with unique assets concerning geographic location, lack of range safety issues and other factors critical to aerospace development, Hawaii’s strategy and commitment for aerospace have been unclear. For this reason, this paper presents a comparative analysis of Hawaii’s space sector with two of the world’s leading space sectors, Colorado and the Netherlands, in order to provide a strategic plan that establishes a firm position going forward to support Hawaii’s aerospace development statewide. This plan will include financial and other economic incentives legislatively supported by the State to help grow and diversify Hawaii’s aerospace sector. The first part of this paper will examine the business model adopted by the Colorado Space Coalition (CSC), a group of industry stakeholders working to make Colorado a center of excellence for aerospace, as blueprint for growth in Hawaii’s space sector. The second section of this paper will examine the business model adopted by the Netherlands Space Business Incubation Centre (NSBIC), a European Space Agency (ESA) affiliated program that offers business support for entrepreneurs to turn space-connected business ideas into commercial companies. This will serve as blueprint to incentivize space businesses to launch and develop in Hawaii. The third section of this paper will analyze the current policies both CSC, and NSBIC implores to promote industry expansion and legislative advocacy. The final section takes the findings from both space sectors and applies their most adaptable features to a Hawaii specific space business model that takes into consideration the unique advantage and disadvantages found in developing Hawaii’s space sector. The findings of this analysis will show that the development of a strategic plan based on a comparative analysis that creates high technology jobs and new pathways for a trained workforce in the space sector, as well as elicit state support and direction, will achieve the goal of establishing Hawaii as a center of space excellence. This analysis will also serve as a signal to the federal, private sector and international community that Hawaii is indeed serious about developing its’ aerospace industry. Ultimately this analysis and subsequent aerospace development plan will serve as a blueprint for the benefit of all space-faring nations seeking to develop their space sectors.

Keywords: Colorado, Hawaii, Netherlands, space policy

Procedia PDF Downloads 155