Search results for: patient safety incidents

Authors: Neerja Bharti, Drishya P.

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Introduction: Thyroidectomies are extensive surgeries involving a significant degree of tissue handling and dissection and are associated with considerable postoperative pain. Regional anaesthesia techniques have immerged as possible inexpensive and safe alternatives to opioids in the management of pain after thyroidectomy. The front of the neck is innervated by branches from the cervical plexus, and hence, several approaches for superficial and deep cervical plexus block (CPB) have been described to provide postoperative analgesia after neck surgery. However, very few studies have explored the analgesic efficacy of intermediate CPB for thyroid surgery. In this study, we have evaluated the effects of ultrasound-guided bilateral intermediate CPB on perioperative opioid consumption in patients undergoing thyroidectomy under general anesthesia. Methods: In this prospective randomized controlled study, fifty ASA grade I-II adult patients undergoing thyroidectomy were randomly divided into two groups: the study group received ultrasound-guided bilateral intermediate CPB with 10 ml 0.5% ropivacaine on each side, while the control group received the same block with 10 ml normal saline on each side just after induction of anesthesia. Anesthesia was induced with propofol, fentanyl, and vecuronium and maintained with propofol infusion titrated to maintain the BIS between 40 and 60. During the postoperative period, rescue analgesia was provided with PCA fentanyl, and the pain scores, total fentanyl consumption, and incidence of nausea and vomiting during 24 hours were recorded, and overall patient satisfaction was assessed. Results: The groups were well-matched with respect to age, gender, BMI, and duration of surgery. The difference in intraoperative propofol and fentanyl consumption was not statistically significant between groups. However, the intraoperative haemodynamic parameters were better maintained in the study group than in the control group. The postoperative pain scores, as measured by VAS at rest and during movement, were lower, and the total fentanyl consumption during 24 hours was significantly less in the study group as compared to the control group. Patients in the study group reported better satisfaction scores than those in the control group. No adverse effects of ultrasound-guided intermediate CPB block were reported. Conclusion: We concluded that ultrasound-guided intermediate cervical plexus block is a safe and effective method for providing perioperative analgesia during thyroid surgery.

Keywords: thyroidectomy, cervical plexus block, pain relief, opioid consumption

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Authors: Youcef Amir

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The consumption of beverages continues to grow worldwide due to increasing demography, but pure fruit juices and high-quality nectars can induce protective effects on human health because of their natural bioactive components. In contrast, sodas and gaseous drinks containing synthetic food additives are considered as responsible for consumers of several pathologies such as obesity, diabetes, and non-alcoholic fatty liver disease. The nutritional and therapeutic virtues of fruit juices are generally a remarkable antioxidant power, anti-cancer activity linked to their richness of indigestible and indigestible sugars, vitamins, mineral salts, carotenoids and phenolic compounds. The main reasons, which led us to produce these fruit derivatives, are the non-availability of the fresh fruits mentioned above all along the year and also the existence of variations in the chemical composition of these different fruits as well as for the major or minor components. We tested, therefore, the physicochemical characteristics of each fruit juice and pulp apart and afterward those of the cocktails formulated. The fresh juices used during our experiments were obtained from the following fruits from north-central Algeria: prickly pear, pomegranate, melon, red oranges. The formulations of these fruit juices were tested after several trials comprising sensorial analysis, physicochemical factors (pH, titratable acidity, Brix degree, formal index, water content, total ash, total and reducing sugars, vitamin C, carotenoids, phenolic compounds) and microbial analysis after a storage period. To the pure juices proportions, citric acid E330, sucrose, and water were added followed by pasteurisation. These products were analysed from the physicochemical, microbial and sensorial viewpoints after a storage period of one month according to national legislation to evaluate their stability. The results of the physicochemical parameters of the prepared beverages had shown good physicochemical results, acceptable sensorial characteristics and microbial stability and safety before and after a storage period. We measured appreciable amounts of minor compounds with health properties.

Keywords: fruit juices, microbial analyses, nectars, physico chemical characteristics, sensorial analysis, storage period

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Authors: Sawyer Spurry

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Problem: Palliative care providers at an academic medical center in Maryland stated medical intensive care unit (MICU) patients are often referred late in their hospital stay. The MICU has performed well below the hospital quality performance metric of 80% of patients who expire with expected outcomes should have received a palliative care consult within 48 hours of admission. Purpose: The purpose of this quality improvement (QI) project is to increase palliative care utilization in the MICU through the implementation of a Nurse-Driven PalliativeTriggerTool to prompt the need for specialty palliative care consult. Methods: MICU nursing staff and providers received education concerning the implications of underused palliative care services and the literature data supporting the use of nurse-driven palliative care tools as a means of increasing utilization of palliative care. A MICU population specific criteria of palliative triggers (Palliative Care Trigger Tool) was formulated by the QI implementation team, palliative care team, and patient care services department. Nursing staff were asked to assess patients daily for the presence of palliative triggers using the Palliative Care Trigger Tool and present findings during bedside rounds. MICU providers were asked to consult palliative medicinegiven the presence of palliative triggers; following interdisciplinary rounds. Rates of palliative consult, given the presence of triggers, were collected via electronic medical record e-data pull, de-identified, and recorded in the data collection tool. Preliminary Results: Over 140 MICU registered nurses were educated on the palliative trigger initiative along with 8 nurse practitioners, 4 intensivists, 2 pulmonary critical care fellows, and 2 palliative medicine physicians. Over 200 patients were admitted to the MICU and screened for palliative triggers during the 15-week implementation period. Primary outcomes showed an increase in palliative care consult rates to those patients presenting with triggers, a decreased mean time from admission to palliative consult, and increased recognition of unmet palliative care needs by MICU nurses and providers. Conclusions: Anticipatory findings of this QI project would suggest a positive correlation between utilizing palliative care trigger criteria and decreased time to palliative care consult. The direct outcomes of effective palliative care results in decreased length of stay, healthcare costs, and moral distress, as well as improved symptom management and quality of life (QOL).

Keywords: palliative care, nursing, quality improvement, trigger tool

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Authors: E. Njuguna, S. Ilovi, P. Muiruri, K. Mutai, J. Kinuthia, P. Njoroge

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Introduction: Cervical cancer is the commonest cause of cancer-related morbidity and mortality among women in developing countries in Sub Saharan Africa. Screening for cervical cancer in all women regardless of HIV status is crucial for the early detection of cancer of the cervix when treatment is most effective in curing the disease. It is particularly more important to screen HIV infected women as they are more at risk of developing the disease and progressing faster once infected with HPV (Human Papilloma Virus). We aimed to determine the factors affecting the utilization of cervical cancer screenings among HIV infected women above 18 years of age at Kenyatta National Hospital (KNH) Comprehensive Care Center (CCC). Materials and Methods: A cross-sectional mixed quantitative and qualitative study involving randomly and purposefully selected HIV positive female respectively was conducted. Qualitative data collection involved 4 focus group discussions of eligible female participants while quantitative data were acquired by one to one interviewer administered structured questionnaires. The outcome variable was the utilization of cervical cancer screening. Data were entered into Access data base and analyzed using Stata version 11.1. Qualitative data were analyzed after coding for significant clauses and transcribing to determine themes arising. Results: We enrolled a total of 387 patients, mean age (IQ range) 40 years (36-44). Cervical cancer screening utilization was 46% despite a health care provider recommendation of 85%. The screening results were reported as normal in 72 of 81 (88.9%) and abnormal 7 of 81(8.6%) of the cases. Those who did not know their result were 2 of 81(2.5%). Patients were less likely to utilize the service with increasing number of years attending the clinic (OR 0.9, 95% CI 0.86-0.99, p-value 0.02), but more likely to utilize the service if recommendation by a staff was made (OR 10, 95% CI 4.2-23.9, p<0.001), and if cervical screening had been done before joining KNH CCC (OR 2.9, 95% CI 1.7-4.9, p < 0.001). Similarly, they were more likely to rate the services on cervical cancer screening as good (OR 5.0, 95% CI 1.7-3.4, p <0.001) and very good (OR 8.1, 95% CI 2.5-6.1, p<0.001) if they had utilized the service. The main barrier themes emerging from qualitative data included fear of screening due to excessive pain or bleeding, lack of proper communication on screening procedures and increased waiting time. Conclusions: Utilization of cervical cancer screening services was low despite health care recommendation. Patient socio-demographic characteristics did not influence whether or not they utilized the services, indicating the important role of the health care provider in the referral and provision of the service.

Keywords: cervical, cancer, HIV, women, comprehensive care center

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Authors: Simon B. N. Thompson

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Early indicator of neurological disease has been proposed by the expanded Thompson Cortisol Hypothesis which suggests that yawning is linked to rises in cortisol levels. Cortisol is essential to the regulation of the immune system and pathological yawning is a symptom of multiple sclerosis (MS). Electromyography activity (EMG) in the jaw muscles typically rises when the muscles are moved – extended or flexed; and yawning has been shown to be highly correlated with cortisol levels in healthy people. It is likely that these elevated cortisol levels are also seen in people with MS. The possible link between EMG in the jaw muscles and rises in saliva cortisol levels during yawning were investigated in a randomized controlled trial of 60 volunteers aged 18-69 years who were exposed to conditions that were designed to elicit the yawning response. Saliva samples were collected at the start and after yawning, or at the end of the presentation of yawning-provoking stimuli, in the absence of a yawn, and EMG data was additionally collected during rest and yawning phases. Hospital Anxiety and Depression Scale, Yawning Susceptibility Scale, General Health Questionnaire, demographic, and health details were collected and the following exclusion criteria were adopted: chronic fatigue, diabetes, fibromyalgia, heart condition, high blood pressure, hormone replacement therapy, multiple sclerosis, and stroke. Significant differences were found between the saliva cortisol samples for the yawners, t (23) = -4.263, p = 0.000, as compared with the non-yawners between rest and post-stimuli, which was non-significant. There were also significant differences between yawners and non-yawners for the EMG potentials with the yawners having higher rest and post-yawning potentials. Significant evidence was found to support the Thompson Cortisol Hypothesis suggesting that rises in cortisol levels are associated with the yawning response. Further research is underway to explore the use of cortisol as a potential diagnostic tool as an assist to the early diagnosis of symptoms related to neurological disorders. Bournemouth University Research & Ethics approval granted: JC28/1/13-KA6/9/13. Professional code of conduct, confidentiality, and safety issues have been addressed and approved in the Ethics submission. Trials identification number: ISRCTN61942768. http://www.controlled-trials.com/isrctn/

Keywords: cortisol, electromyography, neurology, yawning

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Authors: Arturo S. Daag, Ira Karrel D. L. San Jose, Mike Gabriel G. Pedrosa, Ken Adrian C. Villarias, Rayfred P. Ingeniero, Cyrah Gale H. Rocamora, Margarita P. Dizon, Roland Joseph B. De Leon, Teresito C. Bacolcol

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The province of Leyte consists of various geomorphological landforms: These are: a) landforms of tectonic origin transect large part of the volcanic centers in upper Ormoc area; b) landforms of volcanic origin, several inactive volcanic centers located in Upper Ormoc are transected by Philippine Fault; c) landforms of volcano-denudational and denudational slopes dominates the area where most of the earthquake-induced landslide occurred; and d) Colluvium and alluvial deposits dominate the foot slope of Ormoc and Jaro-Pastrana plain. Earthquake ground acceleration and geotechnical properties of various landforms are crucial for landslide studies. To generate the landslide critical acceleration model of sliding block, various data were considered, these are: geotechnical data (i.e., soil and rock strength parameters), slope, topographic wetness index (TWI), landslide inventory, soil map, geologic maps for the calculation of the factor of safety. Horizontal-to-vertical spectral ratio (HVSR) surveying methods, refraction microtremor (ReMi), and three-component microtremor (3CMT) were conducted to measure site period and surface wave velocity as well as to create a soil thickness model. Critical acceleration model of various geomorphological unit using Remote Sensing, field geotechnical, geophysical, and geospatial data collected from the areas affected by the 06 July 2017 M6.5 Leyte earthquake. Spatial analysis of earthquake-induced landslide from the 06 July 2017, were then performed to assess the relationship between the calculated critical acceleration and peak ground acceleration. The observed trends proved helpful in establishing the role of critical acceleration as a determining factor in the distribution of co-seismic landslides.

Keywords: earthquake-induced landslide, remote sensing, geomorphology, seismic response

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Authors: Petcharat  Kerdonfag, Surasak Taneepanichskul, Winai Wadwongtham

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Industrial noise is usually considered as the main impact of the environmental health and safety because its exposure can cause permanently serious hearing damage. Despite providing strictly hearing protection standards and campaigning extensively encouraging public health awareness among industrial workers in Thailand, hazard noise-induced hearing loss has dramatically been massive obstacles for workers’ health. The aims of the study were to explore and specify the hearing threshold levels among steel industrial workers responsible in which higher noise levels of work zone and to examine the relationships of hearing loss and workers’ age and the length of employment in Samut Prakan province, Thailand. Cross-sectional study design was done. Ninety-three steel industrial workers in the designated zone of higher noise (> 85dBA) with more than 1 year of employment from two factories by simple random sampling and available to participate in were assessed by the audiometric screening at regional Samut Prakan hospital. Data of doing screening were collected from October to December, 2016 by the occupational medicine physician and a qualified occupational nurse. All participants were examined by the same examiners for the validity. An Audiometric testing was performed at least 14 hours after the last noise exposure from the workplace. Workers’ age and the length of employment were gathered by the developed occupational record form. Results: The range of workers’ age was from 23 to 59 years, (Mean = 41.67, SD = 9.69) and the length of employment was from 1 to 39 years, (Mean = 13.99, SD = 9.88). Fifty three (60.0%) out of all participants have been exposing to the hazard of noise in the workplace for more than 10 years. Twenty-three (24.7%) of them have been exposing to the hazard of noise less than or equal to 5 years. Seventeen (18.3%) of them have been exposing to the hazard of noise for 5 to 10 years. Using the cut point of less than or equal to 25 dBA of hearing thresholds, the average means of hearing thresholds for participants at 4, 6, and 8 kHz were 31.34, 29.62, and 25.64 dB, respectively for the right ear and 40.15, 32.20, and 25.48 dB for the left ear, respectively. The more developing age of workers in the work zone with hazard of noise, the more the hearing thresholds would be increasing at frequencies of 4, 6, and 8 kHz (p =.012, p =.026, p =.024) for the right ear, respectively and for the left ear only at the frequency 4 kHz (p =.009). Conclusion: The participants’ age in the hazard of noise work zone was significantly associated with the hearing loss in different levels while the length of participants’ employment was not significantly associated with the hearing loss. Thus hearing threshold levels among industrial workers would be regularly assessed and needed to be protected at the beginning of working.

Keywords: hearing threshold levels, hazard of noise, hearing loss, audiometric testing

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Authors: Chairul Fajar, Muhammad Nur Hidayat, Muksalmina

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The issue of Over Dimension Over Loading (ODOL) in Indonesia remains a significant challenge, causing traffic accidents, disrupting traffic flow, accelerating road damage, and potentially leading to bridge collapses. Klaten Regency, located on the slopes of Mount Merapi along the Woro River in Kemalang District, has potential Class C excavation materials such as sand and stone. Data from the Klaten Regency Transportation Department indicates that ODOL violations account for 72%, while non-violating vehicles make up only 28%. ODOL involves modifying factory-standard vehicles beyond the limits specified in the Type Test Registration Certificate (SRUT) to save costs and travel time. This study aims to develop a prototype ‘Sabrang’ monitoring system based on Arduino Mega to control and monitor ODOL freight transportation in the mining of Class C excavation materials in Klaten Regency. The prototype is designed to automatically measure the dimensions and weight of objects using a microcontroller. The data analysis techniques used in this study include the Normality Test and Paired T-Test, comparing sensor measurement results on scaled objects. The study results indicate differences in measurement validation under room temperature and ambient temperature conditions. Measurements at room temperature showed that the majority of H0 was accepted, meaning there was no significant difference in measurements when the prototype tool was used. Conversely, measurements at ambient temperature showed that the majority of H0 was rejected, indicating a significant difference in measurements when the prototype tool was used. In conclusion, the ‘Sabrang’ monitoring system prototype is effective for controlling ODOL, although measurement results are influenced by temperature conditions. This study is expected to assist in the monitoring and control of ODOL, thereby enhancing traffic safety and road infrastructure.

Keywords: over dimension over loading, prototype, microcontroller, Arduino, normality test, paired t-test

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Authors: Ahmed Slami, Med El Amine Brixi Nigassa, Nassima Labdelli, Sofiane Soulimane, Arnaud Pothier

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Many people suffer from diabetes, a disease marked by abnormal levels of sugar in the blood; 285 million people have diabetes, 6.6% of the world adult population (in 2010), according to the International Diabetes Federation. Insulin medicament is invented to be injected into the body. Generally, the injection requires the patient to do it manually. However, in many cases he will be unable to inject the drug, saw that among the side effects of hyperglycemia is the weakness of the whole body. The researchers designed a medical device that injects insulin too autonomously by using micro-pumps. Many micro-pumps of concepts have been investigated during the last two decades for injecting molecules in blood or in the body. However, all these micro-pumps are intended for slow infusion of drug (injection of few microliters by minute). Now, the challenge is to develop micro-pumps for fast injections (1 microliter in 10 seconds) with accuracy of the order of microliter. Recently, studies have shown that only piezoelectric actuators can achieve this performance, knowing that few systems at the microscopic level were presented. These reasons lead us to design new smart microsystems injection drugs. Therefore, many technological advances are still to achieve the improvement of materials to their uses, while going through their characterization and modeling action mechanisms themselves. Moreover, it remains to study the integration of the piezoelectric micro-pump in the microfluidic platform features to explore and evaluate the performance of these new micro devices. In this work, we propose a new micro-pump model based on piezoelectric actuation with a new design. Here, we use a finite element model with Comsol software. Our device is composed of two pumping chambers, two diaphragms and two actuators (piezoelectric disks). The latter parts will apply a mechanical force on the membrane in a periodic manner. The membrane deformation allows the fluid pumping, the suction and discharge of the liquid. In this study, we present the modeling results as function as device geometry properties, films thickness, and materials properties. Here, we demonstrate that we can achieve fast injection. The results of these simulations will provide quantitative performance of our micro-pumps. Concern the spatial actuation, fluid rate and allows optimization of the fabrication process in terms of materials and integration steps.

Keywords: COMSOL software, piezoelectric, micro-pump, microfluidic

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Authors: Shahnam Behnam Malekzadeh, Ian Kerr, Tyson Kaempffer, Teague Harper, Andrew Watson

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The Site C Hydroelectric dam is currently being constructed in north-eastern British Columbia on sub-horizontal sedimentary strata that dip approximately 15 meters from one bank of the Peace River to the other. More than 615 pressure sensors (Vibrating Wire Piezometers) have been installed on bedding planes (BPs) since construction began, with over 80 more planned before project completion. These pressure measurements are essential to monitor the stability of the rock foundation during and after construction and for dam safety purposes. BPs are identified by their clay gouge infilling, which varies in thickness from less than 1 to 20 mm and can be challenging to identify as the core drilling process often disturbs or washes away the gouge material. Without the use of depth predictions from nearby boreholes, stratigraphic markers, and downhole geophysical data, it is difficult to confidently identify BP targets for the sensors. In this paper, a Case-Based Reasoning (CBR) method was used to develop an empirical model called the Bedding Plane Elevation Prediction (BPEP) to help geologists and geotechnical engineers to predict geological features and bedding planes at new locations in a fast and accurate manner. To develop CBR, a database was developed based on 64 pressure sensors already installed on key bedding planes BP25, BP28, and BP31 on the Right Bank, including bedding plane elevations and coordinates. Thirteen (20%) of the most recent cases were selected to validate and evaluate the accuracy of the developed model, while the similarity was defined as the distance between previous cases and recent cases to predict the depth of significant BPs. The average difference between actual BP elevations and predicted elevations for above BPs was ±55cm, while the actual results showed that 69% of predicted elevations were within ±79 cm of actual BP elevations while 100% of predicted elevations for new cases were within ±99cm range. Eventually, the actual results will be used to develop the database and improve BPEP to perform as a learning machine to predict more accurate BP elevations for future sensor installations.

Keywords: case-based reasoning, geological feature, geology, piezometer, pressure sensor, core logging, dam construction

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Authors: Zeena Dcosta, Junaid Ahmed, Ceena Denny, Nandita Shenoy

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In the field of dentistry, there are many conditions which warrant the requirement of three-dimensional imaging that can aid in diagnosis and therapeutic management. Cone beam computed tomography (CBCT) is considered highly accurate in producing a three-dimensional image of an object and provides a complete insight of various findings in the captured volume. But, most of the clinicians focus primarily on the teeth and jaws and numerous unanticipated clinically significant incidental findings may be missed out. Rapid integration of CBCT into the practice of dentistry has led to the detection of various incidental findings. However, the prevalence of these incidental findings is still unknown. Thus, the study aimed to discern the reason for referral and to identify incidental findings on the referred CBCT scans. Patient’s demographic data such as age and gender was noted. CBCT scans of multiple fields of views (FOV) were considered. The referral for CBCT scans was broadly classified into two major categories: diagnostic scan and treatment planning scan. Any finding on the CBCT volumes, other than the area of concern was recorded as incidental finding which was noted under airway, developmental, pathological, endodontics, TMJ, bone, soft tissue calcifications and others. Few of the incidental findings noted under airway were deviated nasal septum, nasal turbinate hypertrophy, mucosal thickening and pneumatization of sinus. Developmental incidental findings included dilaceration, impaction, pulp stone and gubernacular canal. Resorption of teeth and periapical pathologies were noted under pathological incidental findings. Root fracture along with over and under obturation was noted under endodontics. Incidental findings under TMJ were flattening, erosion and bifid condyle. Enostosis and exostosis were noted under bone lesions. Tonsillolth, sialolith and calcified styloid ligament were noted under soft tissue calcifications. Incidental findings under others included foreign body, fused C1- C2 vertebrae, nutrient canals, and pneumatocyst. Maxillofacial radiologists should be aware of possible incidental findings and should be vigilant about comprehensively evaluating the entire captured volume, which can help in early diagnosis of any potential pathologies that may go undetected. Interpretation of CBCT is truly an art and with the experience, we can unravel the secrets hidden in the grey shades of the radiographic image.

Keywords: cone beam computed tomography, incidental findings, maxillofacial region, radiologist

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Authors: Clara T. Fatoye, April Betts, Abayomi Odeyemi, Francis A. Fatoye, Isaac O. Odeyemi

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Background: The post-launch stage is the last stage in the development of a pharmaceutical product. It is important to involve patients in the development of pharmaceutical products at the post-launch stage, as patients are the end-users of pharmaceutical products. It is expected that involving them might ensure an effective working relationship among the various stakeholders. However, involving patients in the development of pharmaceutical products comes with its problems. Hence, this study examined how to resolve problems experienced by involving patients in the developments of pharmaceutical products’ at post-launch consisting of Positioning of pharmaceutical products (POPP), detailing of pharmaceutical products (DOPP) and reimbursement and Formulary Submission (R&FS). Methods: A questionnaire was used for the present study. It was administered at the ISPOR Glasgow 2017 to 104 participants, all of which were professionals from Market access (MA) and health economics and outcomes research (HEOR) backgrounds. They were asked how the issues experienced by patients can be resolved. Participants responded under six domains as follows: communication, cost, effectiveness, external factors, Quality of life (QoL) and safety. Thematic analysis was carried out to identify strategies to resolve issues experienced by patients at the post-launch stage. Results: Three (3) factors cut across at POPP, DOPP, and R&FS that is (external factors, communication and QoL). The first resolution method was an external factor that is, the relationship with stakeholders and policymakers. Communication was also identified as a resolution method that can help to resolve problems experienced by patients at the post-launch stage. The third method was QoL as perceived by the patients based on professionals’ opinions. Other strategies that could be used to resolve problems experienced were the effectiveness of pharmaceutical products at the DOPP level and cost at R&FS. Conclusion: The study showed that focusing on external factors, communication, and patients’ QoL are methods for resolving issues experienced by involving patients at the post-launch stage of pharmaceutical product development. Hence, effective working relationships between patients, policymakers and stakeholders may help to resolve problems experienced at the post-launch stage. Healthcare policymakers are to be aware of these findings as they may help them to put appropriate strategies in place to enhance the involvement of patients in pharmaceutical product development at the post-launch stage, thereby improving the health outcomes of the patients.

Keywords: patients, pharmaceutical products, post-launch stage, quality of life, QoL

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Authors: Valeria Abreu Minero, Edward Barker, Hannah Dickson, Francois Husson, Sandra Flynn, Jennifer Shaw

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Purpose – The purpose of this paper is to identify offender typologies based on aspects of the offenders’ psychopathology and their associations with crime scene behaviours using data derived from the National Confidential Enquiry into Suicide and Safety in Mental Health concerning homicides in England and Wales committed by offenders in contact with mental health services in the year preceding the offence (n=759). Design/methodology/approach – The authors used multiple correspondence analysis to investigate the interrelationships between the variables and hierarchical agglomerative clustering to identify offender typologies. Variables describing: the offender’s mental health history; the offenders’ mental state at the time of offence; characteristics useful for police investigations; and patterns of crime scene behaviours were included. Findings – Results showed differences in the offender’s histories in relation to their crime scene behaviours. Further, analyses revealed three homicide typologies: externalising, psychosis and depression. Analyses revealed three homicide typologies: externalising, psychotic and depressive. Practical implications – These typologies may assist the police during homicide investigations by: furthering their understanding of the crime or likely suspect; offering insights into crime patterns; provide advice as to what an offender’s offence behaviour might signify about his/her mental health background; findings suggest information concerning offender psychopathology may be useful for offender profiling purposes in cases of homicide offenders with schizophrenia, depression and comorbid diagnosis of personality disorder and alcohol/drug dependence. Originality/value – Empirical studies with an emphasis on offender profiling have almost exclusively focussed on the inference of offender demographic characteristics. This study provides a first step in the exploration of offender psychopathology and its integration to the multivariate analysis of offence information for the purposes of investigative profiling of homicide by identifying the dominant patterns of mental illness within homicidal behaviour.

Keywords: offender profiling, mental illness, psychopathology, multivariate analysis, homicide, crime scene analysis, crime scene behviours, investigative advice

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Authors: Jessica Ding

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The field of global health is currently advocating for a resurgence in the use of traditional medicines to improve people-centered care. Healthcare policies are rapidly changing in response; in China, the increasing presence of TCM in the same spaces as biomedicine has led to a new term: integrative medicine. However, the existence of TCM as a part of integrative medicine creates a pressing paradoxical tension where TCM is both seen as a marginalized system within ‘modern’ hospitals and as a modality worth integrating. Additionally, the impact of such shifts has not been fully explored: the World Health Organization for one focuses only on three angles —practices, products, and practitioners— with regards to traditional medicines. Through ten weeks of fieldwork conducted at an urban hospital in Shanghai, China, this research expands the perspective of existing strategies by looking at integrative care through a fourth lens: patients and families. The understanding of self-care, health-seeking behavior, and non-professional caregiving structures are critical to grasping the significance of traditional medicine for people-centered care. Indeed, those individual and informal health care expectations align with the very spaces and needs that traditional medicine has filled before such ideas of integration. It specifically looks at this issue via three processes that operationalize experiences of care: (1) how aspects of TCM are valued within integrative medicine, (2) how negotiations of care occur between patients and doctors, and (3) how 'good quality' caregiving presents in integrative clinical spaces. This research hopes to lend insight into how culturally embedded traditions, bureaucratic and institutional rationalities, and social patterns of health-seeking behavior influence care to shape illness experiences at the intersection of two medical modalities. This analysis of patients’ clinical and illness experiences serves to enrich the narratives of integrative medical care’s ability to provide patient-centered care to determine how international policies are realized at the individual level. This anthropological study of the integration of Traditional Chinese medicine in local contexts can reveal the extent to which global strategies, as promoted by the WHO and the Chinese government actually align with the expectations and perspectives of patients receiving care. Ultimately, this ethnographic analysis of a local Chinese context hopes to inform global policies regarding the future use and integration of traditional medicines.

Keywords: emergent systems, global health, integrative medicine, traditional Chinese medicine, TCM

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Authors: Chia-Chen Wu, Chih-Fu Wu, Pey-Weng Lien, Kai-Chieh Lin

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In the past, the most comprehensively adopted light source was incandescent light bulbs, but with the appearance of LED light sources, traditional light sources have been gradually replaced by LEDs because of its numerous superior characteristics. However, many of the standards do not apply to LEDs as the two light sources are characterized differently. This also intensifies the significance of studies on LEDs. As a Kansei design study investigating the visual glare produced by traffic arrows implemented with LEDs, this study conducted a semantic analysis on the styles of traffic arrows used in domestic and international occasions. The results will be able to reduce drivers’ misrecognition that results in the unsuccessful arrival at the destination, or in traffic accidents. This study started with a literature review and surveyed the status quo before conducting experiments that were divided in two parts. The first part involved a screening experiment of arrow samples, where cluster analysis was conducted to choose five representative samples of LED displays. The second part was a semantic experiment on the display of arrows using LEDs, where the five representative samples and the selected ten adjectives were incorporated. Analyzing the results with Quantification Theory Type I, it was found that among the composition of arrows, fletching was the most significant factor that influenced the adjectives. In contrast, a “no fletching” design was more abstract and vague. It lacked the ability to convey the intended message and might bear psychological negative connotation including “dangerous,” “forbidden,” and “unreliable.” The arrow design consisting of “> shaped fletching” was found to be more concrete and definite, showing positive connotation including “safe,” “cautious,” and “reliable.” When a stimulus was placed at a farther distance, the glare could be significantly reduced; moreover, the visual evaluation scores would be higher. On the contrary, if the fletching and the shaft had a similar proportion, looking at the stimuli caused higher evaluation at a closer distance. The above results will be able to be applied to the design of traffic arrows by conveying information definitely and rapidly. In addition, drivers’ safety could be enhanced by understanding the cause of glare and improving visual recognizability.

Keywords: LED, arrow, Kansei research, preferred imagery

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Authors: Shau-Ping Shiu, Shu-Ling Lin

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Pregnancy lead a process of changing in the endocrine system. Either pregnancy itself or the surrounding affect such as the attitude of family to the pregnant lady can bring lots of stress. Sever stress may lead pregnant women display serious mental problem such as mood swings, impulsivity, and abnormal behavior. A method of self management of stress(SMS) has been proved that help patient of cancer in release their stress. This study were going to use SMS to help pregnant women. Methods: In this study, 42 ladies in the first to third months of pregnancy process applied to join SMS of program have divided into 21 participants in both control and experimental group by draw. 24 sessions of Yoga program were conducted once a week for 6 months for experimental group. Verbatim used to gather more feedbacks from the interview followed by each Yoga sessions. Brief symptom Rating scale also conducted pre and post experiment for 42 participations. Results: Overall score of Brief Symptom Rating Scale reduced 17.82 points and suicide drop 9 points in experimental group, compared to the control group increasing 10.24 point of overall score and suicide add 7 points. Feedback from interviews showed participations improved in emotion, physical health and stress management. They indicated having more positive emotion daily, having better gastrointestinal peristalsis movement, releasing back tention, well weight control, reducing stress and changing the quality of interpersonal relationships. Conclusion: SMS of Yoga program in this study included four key training directions which were stimulation, relaxation, awareness and pranayama lead a great improvment of stress management for pregnant lady. Throughout this Yoga program, women learned to ignite eustress, remove distress, create calmness and breath slows down. As the result, Yoga program has helped women in experiment group lower their tension, and bring the extra benifits in emotion and relationships. It support women to overcome their pregnancy. Suggestion: An unexpected result of this study showed all participants had no morning sickness since they engaged in SMS program, and no one absent from course due to the benefits of it. We strongly suggest that SMS of Yoga program can be a add of medication for women in pregnancy, however, the position of Forward in the SMS sequence has been point out pressing participant’s stomach, which can be replace to Bridge position to comfort participants.

Keywords: self-management of stress(SMS), yoga program, pregnant women, early pregnancy

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Authors: Abdulrazak Jinadu Otaru, Ahmed Almulhim, Hassan Alhassan, Mohammed Sabri

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Saudi Arabia is host to a state-owned oil and gas corporation, known as Saudi ARAMCO, that is responsible for the highest emissions of carbon dioxide (CO₂) due to the heavy reliance on fossil fuels as an energy source for various sectors such as transportation, aerospace, manufacturing, and residential use. Unfortunately, the detrimental consequences of CO₂ emissions include escalating temperatures in the Middle East region, posing significant obstacles in terms of food security and water scarcity for the Kingdom of Saudi Arabia. As part of the Saudi Vision 2030 initiative, which aims to reduce the country's reliance on fossil fuels by 50 %, this study focuses on designing a plant that will produce approximately 100,000 metric tons per year (MTPY) of green hydrogen (H₂) using brine as the primary feedstock. The proposed facility incorporates a double electrolytic technology that first separates brine or sodium chloride (NaCl) into sodium hydroxide, hydrogen gas, and chlorine gas. The sodium hydroxide is then used as an electrolyte in the splitting of water molecules through the supply of electrical energy in a second-stage electrolyser to produce green hydrogen. The study encompasses a comprehensive analysis of process descriptions and flow diagrams, as well as materials and energy balances. It also includes equipment design and specification, cost analysis, and considerations for safety and environmental impact. The design capitalizes on the abundant brine supply, a byproduct of the world's largest desalination plant located in Al Jubail, Saudi Arabia. Additionally, the design incorporates the use of available renewable energy sources, such as solar and wind power, to power the proposed plant. This approach not only helps reduce carbon emissions but also aligns with Saudi Arabia's energy transition policy. Furthermore, it supports the United Nations Sustainable Development Goals on Sustainable Cities and Communities (Goal 11) and Climate Action (Goal 13), benefiting not only Saudi Arabia but also other countries in the Middle East.

Keywords: plant design, electrolysis, brine, sodium hydroxide, chlorine gas, green hydrogen

Procedia PDF Downloads 49

Authors: Jill Steel

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The interlinked issues of emotional wellbeing and attainment continue to dominate international educational discourse. Reading skills are particularly important to attainment in all areas of the curriculum, and illiteracy is associated with reduced wellbeing and life prospects, with serious ramifications for the wider economy and society. Research shows that reading attainment is influenced by reading motivation and frequency. Reading to Dogs (RTD) is increasingly applied to promote reading motivation and frequency in schools despite a paucity of empirical evidence, specifically examining the influence of RTD on emotional wellbeing and engagement with reading. This research aims to examine whether RTD is effective in promoting these positive outcomes among children aged eight to nine years. This study also aims to inform much needed regulation of the field and standards of practice, including both child and dog welfare. Therefore, ethical matters such as children’s inclusion and safety, as well as the rights and wellbeing of dogs infuse the study throughout. The methodological design is a mixed method longitudinal study. A UK wide questionnaire will be distributed to teachers between January and June 2020 to understand their perceptions of RTD. Following this, a randomised controlled trial (N = 100) will begin in August 2020 in two schools of a comparable demographic, with N= 50 in the intervention school, and N= 50 in a waiting list control school. Reading and wellbeing assessments will be conducted prior to and immediately post RTD, and four weeks after RTD to measure sustained changes. The reading assessments include New Group Reading Test, Motivation to Read Profile (Gambrell et al., 1995), as well as reading frequency and reading anxiety assessments specifically designed for the study. Wellbeing assessments include Goodman’s SDQ, (1997) and pupil self-reporting questionnaires specifically designed for the study. Child, class teacher, and parent questionnaires and interviews prior to, during and post RTD will be conducted to measure perceptions of the impact of RTD on mood and motivation towards reading. This study will make a substantial contribution to our understanding of the effectiveness of RTD and thus have consequences for the fields of education and anthrozoology.

Keywords: animal assisted intervention, reading to dogs, welfare, wellbeing

Procedia PDF Downloads 181

Authors: Navpreet Kaur, Himkusha Thakur, Nirmal Prabhakar

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One of the most publicized and controversial issue in crop production is the use of agrichemicals- also known as pesticides. This is evident in many reports that Organophosphate (OP) insecticides, among the broad range of pesticides are mainly involved in acute and chronic poisoning cases. Therefore, detection of OPs is very necessary for health protection, food and environmental safety. In our study, a nanocomposite of poly (3,4 ethylenedioxythiophene) (PEDOT) and multi-walled carbon nanotubes (MWCNTs) has been deposited electrochemically onto the surface of fluorine doped tin oxide sheets (FTO) for the analysis of malathion OP. The -COOH functionalization of MWCNTs has been done for the covalent binding with amino groups of AChE enzyme. The use of PEDOT-MWCNT films exhibited an excellent conductivity, enables fast transfer kinetics and provided a favourable biocompatible microenvironment for AChE, for the significant malathion OP detection. The prepared PEDOT-MWCNT/FTO and AChE/PEDOT-MWCNT/FTO nano-biosensors were characterized by Fourier transform infrared spectrometry (FTIR), Field emission-scanning electron microscopy (FE-SEM) and electrochemical studies. Electrochemical studies were done using Cyclic Voltammetry (CV) or Differential Pulse Voltammetry (DPV) and Electrochemical Impedance Spectroscopy (EIS). Various optimization studies were done for different parameters including pH (7.5), AChE concentration (50 mU), substrate concentration (0.3 mM) and inhibition time (10 min). The detection limit for malathion OP was calculated to be 1 fM within the linear range 1 fM to 1 µM. The activity of inhibited AChE enzyme was restored to 98% of its original value by 2-pyridine aldoxime methiodide (2-PAM) (5 mM) treatment for 11 min. The oxime 2-PAM is able to remove malathion from the active site of AChE by means of trans-esterification reaction. The storage stability and reusability of the prepared nano-biosensor is observed to be 30 days and seven times, respectively. The application of the developed nano-biosensor has also been evaluated for spiked lettuce sample. Recoveries of malathion from the spiked lettuce sample ranged between 96-98%. The low detection limit obtained by the developed nano-biosensor made them reliable, sensitive and a low cost process.

Keywords: PEDOT-MWCNT, malathion, organophosphates, acetylcholinesterase, nano-biosensor, oxime (2-PAM)

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Authors: Mansi Patel, Priti Mehta

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Background: Ionizing radiations have detrimental effects on humans, and the growing technological encroachment has increased human exposure to it enormously. So, the safety issues have emphasized researchers to develop radioprotector from natural resources having minimal toxicity. A substance having anti-inflammatory, antioxidant, and immunomodulatory activity can be a potential candidate for radioprotection. One such plant with immense potential i.e. Bamboo was selected for the present study. Purpose: The study aims to evaluate the potential of Indian bamboo leaves for protection against the clastogenic effect of gamma radiation. Methods: The protective effect of bamboo leaf extract against gamma radiation-induced genetic damage in human peripheral blood lymphocytes (HPBLs) was evaluated in vitro using Cytokinesis blocked micronuclei assay (CBMN). The blood samples were pretreated with varying concentration of extract 30 min before the radiation exposure (4Gy & 6Gy). The reduction in the frequency of micronuclei was observed for the irradiated and control groups. The effect of various concentration of bamboo leaf extract (400,600,800 mg/kg) on the development of radiation induced sickness and altered mortality in mice exposed to 8 Gy of whole-body gamma radiation was studied. The developed symptoms were clinically scored by multiple endpoints for 30 days. Results: Treatment of HPBLs with varying concentration of extract before exposure to a different dose of γ- radiation resulted in significant (P < 0.0001) decline of radiation induced micronuclei. It showed dose dependent and concentration driven activity. The maximum protection ~ 70% was achieved at nine µg/ml concentration. Extract treated whole body irradiated mice showed 50%, 83.3% and 100% survival for 400, 600, and 800mg/kg with 1.05, 0.43 and 0 clinical score respectively when compared to Irradiated mice having 6.03 clinical score and 0% survival. Conclusion: Our findings indicate bamboo leaf extract reduced the radiation induced cytogenetic damage. It has also increased the survival ratio and reduced the radiation induced sickness and mortality when exposed to a lethal dose of gamma radiation.

Keywords: bamboo leaf extract, Cytokinesis blocked micronuclei (CBMN) assay, ionizing radiation, radio protector

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Authors: Marta Fernández Batalla, José María Santamaría García, Maria Lourdes Jiménez Rodríguez, Roberto Barchino Plata, Adriana Cercas Duque, Enrique Monsalvo San Macario

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Background: Primary Care Nursing is taking more autonomy in clinical decisions. One of the most frequent therapies to solve is related to the problems of maintaining a sufficient supply of food. Nursing diagnoses related to food are addressed by the nurse-family and community as the first responsible. Objectives and interventions are set according to each patient. To improve the goal setting and the treatment of these care problems, a technological tool is developed to help nurses. Objective: To evaluate the computational tool developed to support the clinical decision in feeding problems. Material and methods: A cross-sectional descriptive study was carried out at the Meco Health Center, Madrid, Spain. The study population consisted of four specialist nurses in primary care. These nurses tested the tool on 30 people with ‘need for nutritional therapy’. Subsequently, the usability of the tool and the satisfaction of the professional were sought. Results: A simple and convenient computational tool is designed for use. It has 3 main entrance fields: age, size, sex. The tool returns the following information: BMI (Body Mass Index) and caloric consumed by the person. The next step is the caloric calculation depending on the activity. It is possible to propose a goal of BMI or weight to achieve. With this, the amount of calories to be consumed is proposed. After using the tool, it was determined that the tool calculated the BMI and calories correctly (in 100% of clinical cases). satisfaction on nutritional assessment was ‘satisfactory’ or ‘very satisfactory’, linked to the speed of operations. As a point of improvement, the options of ‘stress factor’ linked to weekly physical activity. Conclusion: Based on the results, it is clear that the computational tools of decision support are useful in the clinic. Nurses are not only consumers of computational tools, but can develop their own tools. These technological solutions improve the effectiveness of nutrition assessment and intervention. We are currently working on improvements such as the calculation of protein percentages as a function of protein percentages as a function of stress parameters.

Keywords: feeding behavior health, nutrition therapy, primary care nursing, technology assessment

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Authors: H. Yanar, G. Purcek, H. H. Ayar

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The ingredients of composite materials used for the production of composite brake pads play an important role in terms of safety braking performance of automobiles and trains. Therefore, the ingredients must be selected carefully and used in appropriate ratios in the matrix structure of the brake pad materials. In the present study, a non-asbestos organic composite brake pad materials containing binder resin, space fillers, solid lubricants, and friction modifier was developed, and its fillers content was optimized by adding natural rubber with different rate into the specified matrix structure in order to achieve the best combination of tribo-performance and mechanical properties. For this purpose, four compositions with different rubber content (2.5wt.%, 5.0wt.%, 7.5wt.% and 10wt.%) were prepared and then test samples with the diameter of 20 mm and length of 15 mm were produced to evaluate the friction and mechanical behaviors of the mixture. The friction and wear tests were performed using a pin-on-disc type test rig which was designed according to NF-F-11-292 French standard. All test samples were subjected to two different types of friction tests defined as periodic braking and continuous braking (also known as fade test). In this way, the coefficient of friction (CoF) of composite sample with different rubber content were determined as a function of number of braking cycle and temperature of the disc surface. The results demonstrated that addition of rubber into the matrix structure of the composite caused a significant change in the CoF. Average CoF of the composite samples increased linearly with increasing rubber content into the matrix. While the average CoF was 0.19 for the rubber-free composite, the composite sample containing 20wt.% rubber had the maximum CoF of about 0.24. Although the CoF of composite sample increased, the amount of specific wear rate decreased with increasing rubber content into the matrix. On the other hand, it was observed that the CoF decreased with increasing temperature generated in-between sample and disk depending on the increasing rubber content. While the CoF decreased to the minimum value of 0.15 at 400 °C for the rubber-free composite sample, the sample having the maximum rubber content of 10wt.% exhibited the lowest one of 0.09 at the same temperature. Addition of rubber into the matrix structure decreased the hardness and strength of the samples. It was concluded from the results that the composite matrix with 5 wt.% rubber had the best composition regarding the performance parameters such as required frictional and mechanical behavior. This composition has the average CoF of 0.21, specific wear rate of 0.024 cm³/MJ and hardness value of 63 HRX.

Keywords: brake pad composite, friction and wear, rubber, friction materials

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Authors: Noah Odion, Honest Jimu, Blessing Atinuke Afuape

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Introduction: Motor control and gait abnormalities are commonly observed in individuals with autism spectrum disorder (ASD), affecting their mobility and coordination. Understanding the underlying neurological and biomechanical factors is essential for designing effective interventions. This study focuses on developing microchip-integrated wearable devices to capture real-time movement data from individuals with autism. By applying computational models to the collected data, we aim to analyze motor control patterns and gait abnormalities, bridging a crucial knowledge gap in autism-related motor dysfunction. Methods: We designed microchip-enabled wearable devices capable of capturing precise kinematic data, including joint angles, acceleration, and velocity during movement. A cross-sectional study was conducted on individuals with ASD and a control group to collect comparative data. Computational modelling was applied using machine learning algorithms to analyse motor control patterns, focusing on gait variability, balance, and coordination. Finite element models were also used to simulate muscle and joint dynamics. The study employed descriptive and analytical methods to interpret the motor data. Results: The wearable devices effectively captured detailed movement data, revealing significant gait variability in the ASD group. For example, gait cycle time was 25% longer, and stride length was reduced by 15% compared to the control group. Motor control analysis showed a 30% reduction in balance stability in individuals with autism. Computational models successfully predicted movement irregularities and helped identify motor control deficits, particularly in the lower limbs. Conclusions: The integration of microchip-based wearable devices with computational models offers a powerful tool for diagnosing and treating motor control deficits in autism. These results have significant implications for patient care, providing objective data to guide personalized therapeutic interventions. The findings also contribute to the broader field of neuroscience by improving our understanding of the motor dysfunctions associated with ASD and other neurodevelopmental disorders.

Keywords: motor control, gait abnormalities, autism, wearable devices, microchips, computational modeling, kinematic analysis, neurodevelopmental disorders

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Authors: Lu-Chiu Huang, Pei-Pei Chen, Li-Chin Yu, Chiao-Wen Kuo, Tsui-Tao Liu, Rung-Chuang Feng

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Purpose: People put increasing emphasis on demands of medical quality and protecting their interests. Patients' or family's dissatisfaction with medical care may easily lead to medical dispute. Physician-family communication plays an essential role in medical care. A sound communication cannot only strengthen patients' belief in the medical team but make patient have definite insight into treatment course of the disease. A family meeting provides an effective platform for communication between clinical staff, patients and family. Decisions and consensuses formed in family meetings can promote patients' or family's satisfaction with medical care. Clinical staff's attitudes toward family meeting may determine behavioral intentions to hold family meeting. This study aims to explore clinical staff's difficulties in holding family meeting and evaluate how their attitudes and behavior influence the effect of family meetings. Methods: This was a cross-sectional study. It was conducted at a regional teaching hospital in Taipei city. The research team developed its own structural questionnaires, whose expert validity was checked by the nursing experts. Participants filled in the questionnaires online. Data were collected by convenience sampling. A total of 568 participants were invited. They included doctors, nurses, social workers, and so on. Results: 1) The average score of ‘clinical staff’s attitudes to family meetings’ was 5.15 (SD=0.898). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It indicated that clinical staff had positive attitudes toward family meetings, 2) The average score of ‘clinical staff’s behavior to family meetings’ was 5.61 (SD=0.937). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It meant clinical staff tended to have positive behavior at the family meeting, and 3) The average score of ‘Difficulty in conducting family meetings’ was 5.15 (SD=0.897). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. The higher the score was, the less difficulty the clinical staff felt. It demonstrated clinical staff felt less difficulty in conducting family meetings. Clinical staff's identification with family meetings brought favored effects. Persistent and active promotion for family meetings can bring patients and family more benefits. Implications for practice: Understanding clinical staff's difficulty in participating family meeting and exploring their attitudes or behavior toward physician-family communication are helpful to develop modes of interaction. Consequently, quality and satisfaction of physician-family communication can be increased.

Keywords: clinical staff, communication, family meeting, physician-family

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Authors: Kangana Sengar, Sanjay Deb, Ramesh Dawar

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Introduction: Ki-67 can be a useful marker in determining proliferative activity in patients with multiple myeloma (MM). However, using Ki-67 alone results in the erroneous inclusion of non-myeloma cells leading to false high counts. We have used Dual IHC (immunohistochemistry) staining with Ki-67 and CD138 to enhance specificity in assessing proliferative activity of bone marrow plasma cells. Aims and objectives: To estimate the proportion of proliferating (Ki-67 expressing) plasma cells in patients with MM and correlation of Ki-67 with other known prognostic parameters. Materials and Methods: Fifty FFPE (formalin fixed paraffin embedded) blocks of trephine biopsies of cases diagnosed as MM from 2010 to 2015 are subjected to H & E staining and Dual IHC staining for CD 138 and Ki-67. H & E staining is done to evaluate various histological parameters like percentage of plasma cells, pattern of infiltration (nodular, interstitial, mixed and diffuse), routine parameters of marrow cellularity and hematopoiesis. Clinical data is collected from patient records from Medical Record Department. Each of CD138 expressing cells (cytoplasmic, red) are scored as proliferating plasma cells (containing a brown Ki¬67 nucleus) or non¬proliferating plasma cells (containing a blue, counter-stained, Ki-¬67 negative nucleus). Ki-67 is measured as percentage positivity with a maximum score of hundred percent and lowest of zero percent. The intensity of staining is not relevant. Results: Statistically significant correlation of Ki-67 in D-S Stage (Durie & Salmon Stage) I vs. III (p=0.026) and ISS (International Staging System) Stage I vs. III (p=0.019), β2m (p=0.029) and percentage of plasma cells (p < 0.001) is seen. No statistically significant correlation is seen between Ki-67 and hemoglobin, platelet count, total leukocyte count, total protein, albumin, S. calcium, S. creatinine, S. LDH, blood urea and pattern of infiltration. Conclusion: Ki-67 index correlated with other known prognostic parameters. However, it is not determined routinely in patients with MM due to little information available regarding its relevance and paucity of studies done to correlate with other known prognostic factors in MM patients. To the best of our knowledge, this is the first study in India using Dual IHC staining for Ki-67 and CD138 in MM patients. Routine determination of Ki-67 will help to identify patients who may benefit with more aggressive therapy. Recommendation: In this study follow up of patients is not included, and the sample size is small. Studying with larger sample size and long follow up is advocated to prognosticate Ki-67 as a marker of survival in patients with multiple myeloma.

Keywords: bone marrow, dual IHC, Ki-67, multiple myeloma

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Authors: Shalini TV, Gangadharan GG, Sriranjini S Jaideep, ASN Seshasayee, Awadhesh Pandit

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Introduction: Prakriti (body-mind constitution of an individual) is a conventional, customized and unique understanding of which is essential for the personalized medicine described in Ayurveda, Indian System of Medicine. Based on the Doshas( functional, bio humoral unit in the body), individuals are categorized into three major Prakriti- Vata, Pitta, and Kapha. The human gut microbiome hosts plenty of highly diverse and metabolically active microorganisms, mainly dominated by the bacteria, which are known to influence the physiology of an individual. Few researches have shown the correlation between the Prakriti and the biochemical parameters. In this study, an attempt was made to explore any correlation between the Prakriti (phenotype of an individual) with the Genetic makeup of the gut microbiome in healthy individuals. Materials and methods: 270 multi-ethnic, healthy volunteers of both sex with the age group between 18 to 40 years, with no history of antibiotics in the last 6 months were recruited into three groups of Vata, Pitta, and Kapha. The Prakriti of the individual was determined using Ayusoft, a software designed by CDAC, Pune, India. The volunteers were subjected to initial screening for the assessment of their height, weight, Body Mass Index, Vital signs and Blood investigations to ensure they are healthy. The stool and saliva samples of the recruited volunteers were collected as per the standard operating procedure developed, and the bacterial DNA was isolated using Qiagen kits. The extracted DNA was subjected to 16s rRNA sequencing using the Illumina kits. The sequencing libraries are targeting the variable V3 and V4 regions of the 16s rRNA gene. Paired sequencing was done on the MiSeq system and data were analyzed using the CLC Genomics workbench 11. Results: The 16s rRNA sequencing of the V3 and V4 regions showed a diverse pattern in both the oral and stool microbial DNA. The study did not reveal any specific pattern of bacterial flora amongst the Prakriti. All the p-values were more than the effective alpha values for all OTUs in both the buccal cavity and stool samples. Therefore, there was no observed significant enrichment of an OTU in the patient samples from either the buccal cavity or stool samples. Conclusion: In healthy volunteers of multi-ethnicity, due to the influence of the various factors, the correlation between the Prakriti and the gut microbiome was not seen.

Keywords: gut microbiome, ayurveda Prakriti, sequencing, multi-ethnic urban population

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Authors: Denise Levy, Anna Lucia C. H. Villavicencio

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Food irradiation is a processing and preservation technique to eliminate insects and parasites and reduce disease-causing microorganisms. Moreover, the process helps to inhibit sprouting and delay ripening, extending fresh fruits and vegetables shelf-life. Nevertheless, most Brazilian consumers seem to misunderstand the difference between irradiated food and radioactive food and the general public has major concerns about the negative health effects and environmental contamination. Society´s judgment and decision making are directly linked to perceived benefits and risks. The web-based project entitled ‘Scientific information about food irradiation: Internet as a tool to approach science and society’ was created by the Nuclear and Energetic Research Institute (IPEN), in order to offer an interdisciplinary approach to science education, integrating economic, ethical, social and political aspects of food irradiation. This project takes into account that, misinformation and unfounded preconceived ideas impact heavily on the acceptance of irradiated food and purchase intention by the Brazilian consumer. Taking advantage of the potential value of the Internet to enhance communication and education among general public, a research study was carried out regarding the possibilities and trends of Information and Communication Technologies among the Brazilian population. The content includes concepts, definitions and Frequently Asked Questions (FAQ) about processes, safety, advantages, limitations and the possibilities of food irradiation, including health issues, as well as its impacts on the environment. The project counts on eight self-instructional interactive web courses, situating scientific content in relevant social contexts in order to encourage self-learning and further reflections. Communication is a must to improve public understanding of science. The use of information technology for quality scientific divulgation shall contribute greatly to provide information throughout the country, spreading information to as many people as possible, minimizing geographic distances and stimulating communication and development.

Keywords: food irradiation, multimedia learning tools, nuclear science, society and education

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Authors: Noreen Pulte

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Prior to the 'Back to Sleep' Campaign in 1992, 1 of every 300 infants seen by Advanced Practice Providers had plagiocephaly. Insufficient attention is given to plagiocephaly and brachycephaly diagnoses in practice and pediatric education. In this talk, Nurse Practitioners and Pediatric Providers will be able to: (1) identify red flags associated with head shape abnormalities, (2) learn techniques they can teach parents to prevent head shape abnormalities, and (3) differentiate between plagiocephaly, brachycephaly, and craniosynostosis. The presenter is a Primary Care Pediatric Nurse Practitioner at Ann & Robert H. Lurie Children's Hospital of Chicago and the primary provider for its head shape abnormality clinics. She will help participants translate key information obtained from birth history, review of systems, and developmental history to understand risk factors for head shape abnormalities and progression of deformities. Synostotic and non-synostotic head shapes will be explained to help participants differentiate plagiocephaly and brachycephaly from synostotic head shapes. This knowledge is critical for the prompt referral of infants with craniosynostosis for surgical evaluation and correction. Rapid referral for craniosynostosis can possibly direct the patient to a minimally invasive surgical procedure versus a craniectomy. As for plagiocephaly and brachycephaly, this timely referral can also aid in a physical therapy referral if necessitated, which treats torticollis and aids in improving head shape. A well-timed referral to a head shape clinic can possibly eliminate the need for a helmet and/or minimize the time in a helmet. Practitioners will learn the importance of obtaining head measurements using calipers. The presenter will explain head calculations and how the calculations are interpreted to determine the severity of the head shape abnormalities. Severity defines the treatment plan. Participants will learn when to refer patients to a head shape abnormality clinic and techniques they should teach parents to perform while waiting for the referral appointment. The purpose, mechanics, and logistics of helmet therapy, including optimal time to initiate helmet therapy, recommended helmet wear-time, and tips for helmet therapy compliance, will be described. Case scenarios will be incorporated into the presenter's presentation to support learning. The salient points of the case studies will be explained and discussed. Practitioners will be able to immediately translate the knowledge and skills gained in this presentation into their clinical practice.

Keywords: plagiocephaly, brachycephaly, craniosynostosis, red flags

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Authors: Beatriz Martinez-Pastor, Maria Nogal, Alan O'Connor

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During the last years, the number of extreme weather events has increased. A variety of extreme weather events, including river floods, rain-induced landslides, droughts, winter storms, wildfire, and hurricanes, have threatened and damaged many different regions worldwide. These events have a devastating impact on critical infrastructure systems resulting in high social, economical and environmental costs. These events have a huge impact in transport systems. Since, transport networks are completely exposed to every kind of climatological perturbations, and its performance is closely related with these events. When a traffic network is affected by a climatological hazard, the quality of its service is threatened, and the level of the traffic conditions usually decreases. With the aim of understanding this process, the concept of resilience has become most popular in the area of transport. Transport resilience analyses the behavior of a traffic network when a perturbation takes place. This holistic concept studies the complete process, from the beginning of the perturbation until the total recovery of the system, when the perturbation has finished. Many concepts are included in the definition of resilience, such as vulnerability, redundancy, adaptability, and safety. Once the resilience of a transport network can be evaluated, in this case, the methodology used is a dynamic equilibrium-restricted assignment model that allows the quantification of the concept, the next step is its improvement. Through the improvement of this concept, it will be possible to create transport networks that are able to withstand and have a better performance under the presence of climatological hazards. Analyzing the impact of a perturbation in a traffic network, it is observed that the response of the different links, which are part of the network, can be completely different from one to another. Consequently and due to this effect, many questions arise, as what makes a link more critical before an extreme weather event? or how is it possible to identify these critical links? With this aim, and knowing that most of the times the owners or managers of the transport systems have limited resources, the identification of the critical links of a transport network before extreme weather events, becomes a crucial objective. For that reason, using the available resources in the areas that will generate a higher improvement of the resilience, will contribute to the global development of the network. Therefore, this paper wants to analyze what kind of characteristic makes a link a critical one when an extreme weather event damages a transport network and finally identify them.

Keywords: critical links, extreme weather events, hazard, resilience, transport network

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Authors: Krytskyy T.

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Introduction: The role of androgen deficiency in men as a factor in the pathogenesis of many somatic diseases is unmistakable. The interaction of thyroid and sex hormones with hypothyroidism in men is still the subject of discussions. The purpose of the study is to assess the androgen status of men with primary hypothyroidism, depending on its duration and the state of compensation. Materials and methods: 45 men with primary hypothyroidism aged 35 to 60 years, as well as 25 healthy men, who formed a control group, were under supervision. A selection of men for examination was conducted in the process of outpatient and in-patient treatment at the endocrinology department of the University Hospital in Ternopil. The functional state of the pituitary-gonadal system was evaluated in order to characterize the androgen status of patients. The concentration of follicle stimulating hormone, luteinizing hormone, prolactin, thyroid-stimulating hormone was determined in blood with the help of enzyme-linked method. Also, the content of hormones: total testosterone, linking sex hormones globulin were determined. Results: Reduced total testosterone (TT) content was found in 42.2% of patients with hypothyroidism. Herewith in 17.8% of patients, blood TT levels were lower than 8.0 nmol / L, and in 11 (24.4%) men, the rate was in the range of 8.0 to 12.0 nmol / L. Based on the results of the determination of the content of free testosterone (FT), the frequency of laboratory hypogonadism in men with hypothyroidism was higher than the results of the determination of TT. The degree of compensation of hypothyroidism probably did not affect the average levels of gonadotropic and sex hormones. Conclusions: Reduced total testosterone content was found in 42.2% of patients with primary hypothyroidism. Herewith, in 17.8% of patients blood TT levels were lower than 8.0 nmol / L, which is a sign of absolute deficiency of testosterone, and in 24.4% of men the rate ranged from 8.0 to 12.0 nmol / l , indicating partial androgen deficiency. Linking sex hormones globulin levels were believed to be lower in 46.7% of patients with hypothyroidism compared to control group. The average levels of E2 in the examined patients did not significantly differ from the mean of control group. FSH, LH, and prolactin levels in men with hypothyroidism were within the normal age limits and probably did not differ from those of control group. The degree of compensation of hypothyroidism probably did not affect the average levels of gonadotropic and sex hormones. The mean LH content in the blood was significantly increased in men with a duration of hypothyroidism up to 5 years and did not differ from that of the control group and in men with a duration of hypothyroidism over 5 years. In men with hypothyroidism, a probable reduction in T / LH coefficient is found. The obtained data may indicate a combined lesion of the central and peripheral parts of the pituitary-gonadal system in men with hypothyroidism.

Keywords: androgenic status, hypothyroidism, testosterone, linking sex hormones globulin

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