Search results for: Karla Kristine Bay

Authors: Beatriz Mella Lira, Karla Yohannessen, Robin Hickman

Abstract:

The aim of the paper is recognising inequalities through the self-assessment of health-related factors, in the context of daily mobilities in Santiago de Chile. Human capabilities will be used as the theoretical basis for the recognition and assessment of these factors regarding the functioning (what people are currently able to do) and capabilities (what people want to achieve and what is valuable for them), reflecting differences across social groups and among types of transport users. The self-assessment of health-related factors considers perceptions of stress, physical effort, proximity to other transport users, pollution, safety, and comfort. The types of transport users are classified as: private (cars, taxis, colectivos, motos), public (buses and metro) and active (bicycles and walking). The methodology follows a capability-based questionnaire, which was applied in different areas of Santiago de Chile, considering concepts extracted from the human capabilities list. The self-assessment of these health-related factors examines the context of peoples’ mobilities for performing their daily activities, considering socioeconomic differences as income, age, gender, disabilities, residence location and primary mode choice. The paper uses Relative Importance Index (RII) for weighting the relative influence or valuation of the factors. The respondents were asked to rate the importance of each factor on a scale from 1 to 5, in an ascending order of importance. The results suggest that these health-related factors impact not just the perceptions of users, but their well-being and their propensity for achieving their capabilities and the things they value in life. The paper is focused on the development of an applicable approach, measuring factors that should be included in transport project appraisal, as a more comprehensive and complementary method.

Keywords: active transport, health, human capabilities, Santiago de Chile, transport inequalities, transportation planning, urban planning

Procedia PDF Downloads 171

Authors: Kristine Tuliao

Abstract:

Although it is of primary concern to ensure that supervisors behave appropriately, research shows that unethical behaviors are prevalent and may cost organizations’ economic and reputational damages. Nevertheless, few studies have considered the roles of the different levels of values in shaping one’s ethicality, and the examination of the possible mediation in the process of their influence has been rarely done. To address this gap, this research employs Merton’s anomie theory in designing a mediation analysis to test the direct impacts of national cultural values on supervisors’ justification of unethical behaviors as well as their indirect impacts through personal values. According to Merton’s writings, individual behaviors are affected by the society’s culture given its role in defining the members’ goals as well as the acceptable methods of attaining those goals. Also, Merton’s framework suggests that individuals develop their personal values depending on the assimilation of their society’s culture. Using data of 9,813 supervisors across 30 countries, results of hierarchical linear modeling (HLM) indicated that national cultural values, specifically assertiveness, performance orientation, in-group collectivism, and humane orientation, positively affect supervisors’ unethical inclination. Some cultural values may encourage unethical tendencies, especially if they urge and pressure individuals to attain purely monetary success. In addition, some of the influence of national cultural values went through personal monetary and non-monetary success values, indicating partial mediation. These findings substantiated the assertions of Merton’s anomie theory that national cultural values influence supervisors’ ethics through their integration with personal values. Given that some of the results contradict Merton’s anomie theory propositions, complementary arguments, such as incomplete assimilation of culture, and the probable impact of job position in perceptions, values, and behaviors, could be the plausible rationale for these outcomes. Consequently, this paper advances the understanding of differences in national and personal values and how these factors impact supervisors’ justification of unethical behaviors. Alongside these contributions, suggestions are presented for the public and organizations to craft policies and procedures that will minimize the tendency of supervisors to commit unethical acts.

Keywords: mediation model, national culture, personal values, supervisors' ethics

Procedia PDF Downloads 179

Authors: Titilope F. Onaolapo, Christiana A. Breed, Maya Pasgaard, Kristine E. Jensen, Peta Brom

Abstract:

In the face of fast-growing urbanization in most of the world's developing countries, there is a need to understand and address the risk and consequences involved in the indiscriminate use of urban green space. Tshwane city in South Africa has the potential to become one of the world's top biodiversity cities as South Africa is ranked one of the mega countries in biodiversity conservation, and Tshwane metropolitan municipality is the city with the wealthiest biodiversity with grassland biomes. In this study, we focus on the potentials and challenges of urban green transitioning from the Global South perspective with Tshwane city as the case study. We also address the issue of management conflicts that have resulted in informal and illegal activities in and around green spaces, with consequences such as land degradation, loss of livelihoods and biodiversity, and socio-ecological imbalances. A desk study review of eight policy frameworks related to green urban planning and development was done based on four GI principles: multifunctionality, connectivity, interdisciplinary and social inclusion. We interviewed 15 key informants in related departments in the city and administered 200 survey questionnaires among residents. We also had several workshops the other researchers and experts on biodiversity and ecosystem. We found out there is no specific document dedicated to green space management, and where green infrastructure was mentioned, it was focused on as an approach to climate mitigation and adaptation. Also, residents perceive green and open spaces as extra land that could be developed at will. We demonstrated the use of collaborative learning approaches in ecological and development research and the tying research to the existing frameworks, programs, and strategies. Based on this understanding. We outlined the need to incorporate principles of green infrastructure in policy frameworks on spatial planning and environmental development. Furthermore, we develop a model for co-management of green infrastructures by stakeholders, such as residents, developers, policymakers, and decision-makers, to maximize benefits. Our collaborative, interdisciplinary projects pursue SDG multifunctionality of goals 11 and 15 by simultaneously addressing issues around Sustainable Cities and Communities, Climate Action, Life on Land, and Strong Institutions, and halt and reverse land degradation and biodiversity.

Keywords: governance, green infrastructure, South Africa, sustainable development, urban planning, Tshwane

Procedia PDF Downloads 98

Authors: Lucas Caldas, Pablo Paulse, Karla Hora

Abstract:

Shipping containers are present in different Brazilian cities, firstly used for transportation purposes, but which become waste materials and an environmental burden in their end-of-life cycle. In the last decade, in Brazil, some buildings made partly or totally from shipping containers started to appear, most of them for commercial and office uses. Although the use of a reused container for buildings seems a sustainable solution, it is very important to measure the thermal and energy aspects when they are used as such. In this context, this study aims to evaluate the thermal and energy performance of an office building totally made from a 12-meter-long, High Cube 40’ shipping container in different Brazilian Bioclimatic Zones. Four different constructive solutions, mostly used in Brazil were chosen: (1) container without any covering; (2) with internally insulated drywall; (3) with external fiber cement boards; (4) with both drywall and fiber cement boards. For this, the DesignBuilder with EnergyPlus was used for the computational simulation in 8760 hours. The EnergyPlus Weather File (EPW) data of six Brazilian capital cities were considered: Curitiba, Sao Paulo, Brasilia, Campo Grande, Teresina and Rio de Janeiro. Air conditioning appliance (split) was adopted for the conditioned area and the cooling setpoint was fixed at 25°C. The coefficient of performance (CoP) of air conditioning equipment was set as 3.3. Three kinds of solar absorptances were verified: 0.3, 0.6 and 0.9 of exterior layer. The building in Teresina presented the highest level of energy consumption, while the one in Curitiba presented the lowest, with a wide range of differences in results. The constructive option of external fiber cement and drywall presented the best results, although the differences were not significant compared to the solution using just drywall. The choice of absorptance showed a great impact in energy consumption, mainly compared to the case of containers without any covering and for use in the hottest cities: Teresina, Rio de Janeiro, and Campo Grande. This study brings as the main contribution the discussion of constructive aspects for design guidelines for more energy-efficient container buildings, considering local climate differences, and helps the dissemination of this cleaner constructive practice in the Brazilian building sector.

Keywords: bioclimatic zones, Brazil, shipping containers, thermal and energy performance

Procedia PDF Downloads 145

Authors: Damian Stanislaw Nakonieczny, Grazyna Simha Martynkova, Marianna Hundakova, G. Kratosová, Karla Cech Barabaszova

Abstract:

The main aim of the research was to functionalize the surface of spherical aluminum silicates in the form of so-called cenospheres. Cenospheres are light ceramic particles with a density between 0.45 and 0.85 kgm-3 hat can be obtained as a result of separation from fly ash from coal combustion. However, their occurrence is limited to about 1% by weight of dry ash mainly derived from anthracite. Hence they are very rare and desirable material. Cenospheres are characterized by complete chemical inertness. Mohs hardness in range of 6 and completely smooth surface. Main idea was to prepare the surface by chemical etching, among others hydrofluoric acid (HF) and hydrogen peroxide, caro acid, silanization using (3-aminopropyl) triethoxysilane (APTES) and tetraethyl orthosilicate (TEOS) to obtain the maximum development and functionalization of the surface to improve chemical and mechanical connection with biomedically used polymers, i.e., polyacrylic methacrylate (PMMA) and polyetheretherketone (PEEK). These polymers are used medically mainly as a material for fixed and removable dental prostheses and PEEK spinal implants. The problem with their use is the decrease in mechanical properties over time and bacterial infections fungal during implantation and use of dentures. Hence, the use of a ceramic filler that will significantly improve the mechanical properties, improve the fluidity of the polymer during shape formation, and in the future, will be able to support bacteriostatic substances such as silver and zinc ions seem promising. In order to evaluate our laboratory work, several instrumental studies were performed: chemical composition and morphology with scanning electron microscopy with Energy-Dispersive X-Ray Probe (SEM/EDX), determination of characteristic functional groups of Fourier Transform Infrared Spectroscopy (FTIR), phase composition of X-ray Diffraction (XRD) and thermal analysis of Thermo Gravimetric Analysis/differentia thermal analysis (TGA/DTA), as well as assessment of isotherm of adsorption with Brunauer-Emmett-Teller (BET) surface development. The surface was evaluated for the future application of additional bacteria and static fungus layers. Based on the experimental work, it was found that orated methods can be suitable for the functionalization of the surface of cenosphere ceramics, and in the future it can be suitable as a bacteriostatic filler for biomedical polymers, i.e., PEEK or PMMA.

Keywords: bioceramics, composites, functionalization, surface development

Procedia PDF Downloads 102

Authors: Karla Lebedoff, Susan Walsh, Michelle Bain

Abstract:

Eczema is a chronic atopy condition requiring long-term daily management in children. Written action plans for other chronic atopic conditions, such as asthma and food allergies, are widely recommended and distributed to pediatric patients' parents and caregivers, seeking to improve clinical outcomes and become empowered to manage the patient's ever-changing symptoms. Written action plans for eczema, referred to as "asthma of the skin," are not routinely used in practice. Parents of children suffering from eczema rarely receive a written action plan to follow, and commendations supporting eczema action plans are inconsistent. Pediatric patients between birth and 18 years old who were followed for eczema at an urban Midwest community hospital were eligible to participate in this quality improvement project. At the initial visit, parents received instructions on individualized eczema action plans for their child and completed two validated surveys: Health Confidence Score (HCS) and Patient-Oriented Eczema Measure (POEM). Pre- and post-survey responses were collected, and clinical symptom presentation at follow-up were outcome determinants. Project implementation was guided by Institute for Healthcare Improvement's Step-up Framework and the Plan-Do-Study-Act cycle. This project measured clinical outcomes and parent confidence in self-management of their child's eczema symptoms with the responses from 26 participant surveys. Pre-survey responses were collected from 36 participants, though ten were lost to follow-up. Average POEM scores improved by 53%, while average HCS scores remained unchanged. Of seven completed in-person follow-up visits, six clinical progress notes documented improvement. Individualized eczema action plans can be seamlessly incorporated into primary and specialty care visits for pediatric patients suffering from eczema. Following a patient-specific eczema action plan may lessen the daily physical and mental burdens of uncontrolled eczema for children and parents, managing symptoms that chronically flare and recede. Furthermore, incorporating eczema action plans into practice potentially reduces the likely underestimated $5.3 billion economic disease burden of eczema on the U.S. healthcare system.

Keywords: atopic dermatitis, eczema action plan, eczema symptom management, pediatric eczema

Procedia PDF Downloads 118

Authors: Kristine Demilou Santiago

Abstract:

In a context of a developing nation, how important is the role of Corporate Social Responsibility health programs? Is there a possibility that this will render a large impact in a society where health benefits are insufficient? The Philippine government has been in an unceasing battle to provide its citizens competitive health benefits through launching various health programs. As the efforts are being claimed by the government, the numbers just show that all the health benefits being offered such as PhilHealth health cards, medical missions and other subsidized government health benefits are not effective and sufficient at the minimum level. This is a major characteristic of a developing nation which the Philippine government is focusing on addressing as it becomes a national concern under the effects of poverty. Industrial companies, through Corporate Social Responsibility, are playing an important role in the aspiration to resolve this problem on health programs as supposed to be basic services to citizens of the Philippine government. The rise of commitment by these industrial companies to render health programs to communities as part of their corporate citizenship has covered a large portion of the basic health services that the Filipino citizens are supposed to be receiving. This is the most salient subject that a developing nation should focus on determining the important contribution of industrial companies present in their country as part of the citizens’ access to basic health services. The use of survey forms containing quantitative and qualitative questions which aim to give numerical figures and support answers as to the role of CSR Health programs in helping the communities receive the basic health services they need was the methodological procedure followed in this research. A sample population in a community where the largest industrial company in a province of the Philippines was taken through simple random sampling. The assumption is that this sample population which represents the whole of the community has the highest opportunities to access both the government health services and the CSR health program services of the industrial company located in their community. Results of the research have shown a significant level of participation by industrial companies through their CSR health programs in the attainment of basic health services that should be rendered by the Philippine government to its citizens as part of the state’s health benefits. In a context of a developing nation such as the Philippines, the role of Corporate Social Responsibility is beyond the expectation of initiating to resolve environmental and social issues. It is moving deeper in the concept of the corporate industries being a pillar of the government in catering the support needed by the individuals in the community for its development. As such, the concept of the presence of an industrial company in a community is said to be a parallel progress: by which when an industrial company expands because it is becoming more profitable, so is the community gaining the same step of progress in terms of socioeconomic development.

Keywords: basic health services, CSR health program, health services in a developing nation, Philippines health benefits

Procedia PDF Downloads 180

Authors: Gunta Resevica, Nikita Zrelovs, Ivars Silamikelis, Ieva Kalnciema, Helvijs Niedra, Gunārs Lācis, Toms Bartulsons, Inga Moročko-Bičevska, Arturs Stalažs, Kristīne Drevinska, Andris Zeltins, Ina Balke

Abstract:

Newly discovered viruses provide novel knowledge for basic phytovirus research, serve as tools for biotechnology and can be helpful in identification of epidemic outbreaks. Blackcurrant-associated rhabdovirus (BCaRV) have been discovered in USA germplasm collection samples from Russia and France. As it was reported in one accession originating from France it is unclear whether the material was already infected when it entered in the USA or it became infected while in collection in the USA. Due to that BCaRV was definite as non-EU viruses. According to ICTV classification BCaRV is representative of Blackcurrant betanucleorhabdovirus specie in genus Betanucleorhabdovirus (family Rhabdoviridae). Nevertheless, BCaRV impact on the host, transmission mechanisms and vectors are still unknown. In RNA-seq data pool from Ribes plants resistance gene study by high throughput sequencing (HTS) we observed differences between sample group gene transcript heat maps. Additional analysis of the whole data pool (total 393660492 of 150 bp long read pairs) by rnaSPAdes v 3.13.1 resulted into 14424 bases long contig with an average coverage of 684x with shared 99.5% identity to the previously reported first complete genome of BCaRV (MF543022.1) using EMBOSS Needle. This finding proved BCaRV presence in EU and indicated that it might be relevant pathogen. In this study leaf tissue from twelve asymptomatic blackcurrant cv. Mara Eglite plants (negatively tested for blackcurrant reversion virus (BRV)) from Dobele, Latvia (56°36'31.9"N, 23°18'13.6"E) was collected and used for total RNA isolation with RNeasy Plant Mini Kit with minor modifications, followed by plant rRNA removal by a RiboMinus Plant Kit for RNA-Seq. HTS libraries were prepared using MGI Easy RNA Directional Library Prep Set for 16 reactions to obtain 150 bp pair-end reads. Libraries were pooled, circularized and cleaned and sequenced on DNBSEQ-G400 using PE150 flow cell. Additionally, all samples were tested by RT-PCR, and amplicons were directly sequenced by Sanger-based method. The contig representing the genome of BCaRV isolate Mara Eglite was deposited at European Nucleotide Archive under accession number OU015520. Those findings indicate a second evidence on the presence of this particular virus in the EU and further research on BCaRV prevalence in Ribes from other geographical areas should be performed. As there are no information on BCaRV impact on the host this should be investigated, regarding the fact that mixed infections with BRV and nucleorhabdoviruses are reported.

Keywords: BCaRV, Betanucleorhabdovirus, Ribes, RNA-seq

Procedia PDF Downloads 167

Authors: Kristine Nore, Alexander Severnisen, Petter Arnestad, Dimitris Kraniotis, Roy Rossebø

Abstract:

Natural materials like wood, absorb and release moisture. Thus wood can buffer indoor climate. When used wisely, this buffer potential can be used to counteract the outer climate influence on the building. The mass of moisture used in the buffer is defined as the potential hygrothermal mass, which can be an energy storage in a building. This works like a natural heat pump, where the moisture is active in damping the diurnal changes. In Norway, the ability of wood as a material used for climate buffering is tested in several buildings with the extensive use of wood, including supermarkets. This paper defines the potential of hygrothermal mass in a supermarket building. This includes the chosen ventilation strategy, and how the climate impact of the building is reduced. The building is located above the arctic circle, 50m from the coastline, in Valnesfjord. It was built in 2015, has a shopping area, including toilet and entrance, of 975 m². The climate of the area is polar according to the Köppen classification, but the supermarket still needs cooling on hot summer days. In order to contribute to the total energy balance, wood needs dynamic influence to activate its hygrothermal mass. Drying and moistening of the wood are energy intensive, and this energy potential can be exploited. Examples are to use solar heat for drying instead of heating the indoor air, and raw air with high enthalpy that allow dry wooden surfaces to absorb moisture and release latent heat. Weather forecasts are used to define the need for future cooling or heating. Thus, the potential energy buffering of the wood can be optimized with intelligent ventilation control. The ventilation control in Valnesfjord includes the weather forecast and historical data. That is a five-day forecast and a two-day history. This is to prevent adjustments to smaller weather changes. The ventilation control has three zones. During summer, the moisture is retained to dampen for solar radiation through drying. In the winter time, moist air let into the shopping area to contribute to the heating. When letting the temperature down during the night, the moisture absorbed in the wood slow down the cooling. The ventilation system is shut down during closing hours of the supermarket in this period. During the autumn and spring, a regime of either storing the moisture or drying out to according to the weather prognoses is defined. To ensure indoor climate quality, measurements of CO₂ and VOC overrule the low energy control if needed. Verified simulations of the Valnesfjord building will build a basic model for investigating wood as a climate regulating material also in other climates. Future knowledge on hygrothermal mass potential in materials is promising. When including the time-dependent buffer capacity of materials, building operators can achieve optimal efficiency of their ventilation systems. The use of wood as a climate regulating material, through its potential hygrothermal mass and connected to weather prognoses, may provide up to 25% energy savings related to heating, cooling, and ventilation of a building.

Keywords: climate buffer, energy, hygrothermal mass, ventilation, wood, weather forecast

Procedia PDF Downloads 191

Authors: Kristine Demilou D. Santiago

Abstract:

An access to a high-quality health care system is what sets apart industrialized nations, such as the United States from other developing countries, which in this case is specifically pertaining to their older population. But what was the underrated factor in the sphere of quality healthcare rendered to elderly people in the Western context? Will this salient factor could push conviction to prorogue the existing gaps between self-denial patient-client and cheek by jowl medications? Are the natural socio-environmental approaches of caregiving the protracted remedy to healthcare disparities for aging population considering their day to day living? The conceptual framework of this model is primarily associated with addressing health and illness of human beings considering the biological, psychological and socio-environmental factors around them. The relevance of biopsychosocial formulation advancing each of the characteristics in the Biopsychosocial (BPS) model in a balance contemplation is the tumult of this study in an attempt to respond to prevailing disparities in caregiving services for old-aged patients on a day to day living. Caregiving services have been the medium path connecting between the patient and its prescribed medications. Moreover, caregivers serve as positive reinforcers in a patient’s environment. Therefore, caregivers play an important role in healthcare delivery to patients. They are considered significant people whom their acts will give an impact to a patient’s view in life. This research study intends to present the supreme importance of biopsychosocial assessment to old-aged patients with mental health illness and conditions. Biopsychosocial assessment will secure the quality of full medication to an old-aged adult suffering from a mental illness. This is because it offers a recognizably wholesome approach to medical healing of old-aged adult patients. The principle of biopsychosocial supersedes the biomedicine being offered to old-aged adults having mental illness, but it does not take away the high relevance of scientific biomedicine in healing patients. The framework presented an overlapping participation of each of its factors in its BPS model that affects in general a person’s health. The correlation between the biological (physiological), psychological (mental) and social (environment) in a person’s health condition requires equal attention according to BPS, and it always coexist with each other. Indisputably said, bio-medicine has been and is being in its unceasing endeavor to provide scientifically proven health care medications for every individual seeking medical treatments. As we grow older and eventually reach the other side of the median population, not only our physiological aspects change, our psychological and socio-environmental changes happen too. Caregiving is a salient responsibility taking place on these inevitable changes.

Keywords: biopsychosocial formulation, caregiving through natural approaches, US health care, BPS in caregiving, caregiving for aging population

Procedia PDF Downloads 80

Authors: Sandra Arango-Caro, Kristine Callis-Duehl

Abstract:

The Education Research and Outreach Lab at the Donald Danforth Plant Science Center established the Plant and Agriculture Augmented and Virtual Reality Learning Laboratory (PAVRLL) to promote science education through professional development, school programs, internships, and outreach events. Professional development is offered to high school and college science and agriculture educators on the use and applications of zSpace and Oculus platforms. Educators learn to use, edit, or create lesson plans in the zSpace platform that are aligned with the Next Generation Science Standards. They also learn to use virtual reality experiences created by the PAVRLL available in Oculus (e.g. The Soybean Saga). Using a cost-free loan rotation system, educators can bring the AVR units to the classroom and offer AVR activities to their students. Each activity has user guides and activity protocols for both teachers and students. The PAVRLL also offers activities for 3D plant modeling. High school students work in teams of art-, science-, and technology-oriented students to design and create 3D models of plant species that are under research at the Danforth Center and present their projects at scientific events. Those 3D models are open access through the zSpace platform and are used by PAVRLL for professional development and the creation of VR activities. Both teachers and students acquire knowledge of plant and agriculture content and real-world problems, gain skills in AVR technology, 3D modeling, and science communication, and become more aware and interested in plant science. Students that participate in the PAVRLL activities complete pre- and post-surveys and reflection questions that evaluate interests in STEM and STEM careers, students’ perceptions of three design features of biology lab courses (collaboration, discovery/relevance, and iteration/productive failure), plant awareness, and engagement and learning in AVR environments. The PAVRLL was established in the fall of 2019, and since then, it has trained 15 educators, three of which will implement the AVR programs in the fall of 2021. Seven students have worked in the 3D plant modeling activity through a virtual internship. Due to the COVID-19 pandemic, the number of teachers trained, and classroom implementations have been very limited. It is expected that in the fall of 2021, students will come back to the schools in person, and by the spring of 2022, the PAVRLL activities will be fully implemented. This will allow the collection of enough data on student assessments that will provide insights on benefits and best practices for the use of AVR technologies in the classrooms. The PAVRLL uses cutting-edge educational technologies to promote science education and assess their benefits and will continue its expansion. Currently, the PAVRLL is applying for grants to create its own virtual labs where students can experience authentic research experiences using real Danforth research data based on programs the Education Lab already used in classrooms.

Keywords: assessment, augmented reality, education, plant science, virtual reality

Procedia PDF Downloads 152

Authors: Jacqueline Y. Thompson, Sam Watson, Lee Middleton, Karla Hemming

Abstract:

Introduction: The odds ratio (estimated via logistic regression) is a well-established and common approach for estimating covariate-adjusted binary treatment effects when comparing a treatment and control group with dichotomous outcomes. Its popularity is primarily because of its stability and robustness to model misspecification. However, the situation is different for the relative risk and risk difference, which are arguably easier to interpret and better suited to specific designs such as non-inferiority studies. So far, there is no equivalent, widely acceptable approach to estimate an adjusted relative risk and risk difference when conducting clinical trials. This is partly due to the lack of a comprehensive evaluation of available candidate methods. Methods/Approach: A simulation study is designed to evaluate the performance of relevant candidate methods to estimate relative risks to represent conditional and marginal estimation approaches. We consider the log-binomial, generalised linear models (GLM) with iteratively weighted least-squares (IWLS) and model-based standard errors (SE); log-binomial GLM with convex optimisation and model-based SEs; log-binomial GLM with convex optimisation and permutation tests; modified-Poisson GLM IWLS and robust SEs; log-binomial generalised estimation equations (GEE) and robust SEs; marginal standardisation and delta method SEs; and marginal standardisation and permutation test SEs. Independent and identically distributed datasets are simulated from a randomised controlled trial to evaluate these candidate methods. Simulations are replicated 10000 times for each scenario across all possible combinations of sample sizes (200, 1000, and 5000), outcomes (10%, 50%, and 80%), and covariates (ranging from -0.05 to 0.7) representing weak, moderate or strong relationships. Treatment effects (ranging from 0, -0.5, 1; on the log-scale) will consider null (H0) and alternative (H1) hypotheses to evaluate coverage and power in realistic scenarios. Performance measures (bias, mean square error (MSE), relative efficiency, and convergence rates) are evaluated across scenarios covering a range of sample sizes, event rates, covariate prognostic strength, and model misspecifications. Potential Results, Relevance & Impact: There are several methods for estimating unadjusted and adjusted relative risks. However, it is unclear which method(s) is the most efficient, preserves type-I error rate, is robust to model misspecification, or is the most powerful when adjusting for non-prognostic and prognostic covariates. GEE estimations may be biased when the outcome distributions are not from marginal binary data. Also, it seems that marginal standardisation and convex optimisation may perform better than GLM IWLS log-binomial.

Keywords: binary outcomes, statistical methods, clinical trials, simulation study

Procedia PDF Downloads 92

Authors: Rosemary Saunders, Courtney Glass, Karla Seaman, Karen Gullick, Julie Andrew, Anne Wilkinson, Ashwini Davray

Abstract:

Current literature demonstrates that most Australians receive end-of-life care in a hospital setting, despite most hoping to die within their own home. The necessity for high quality end-of-life care has been emphasised by the Australian Commission on Safety and Quality in Health Care and the National Safety and Quality in Health Services Standards depict the requirement for comprehensive care at the end of life (Action 5.20), reinforcing the obligation for continual organisational assessment to determine if these standards are suitably achieved. Limited research exploring clinical staff perspectives of end-of-life care delivery has been conducted within an Australian private health context. This study aimed to investigate clinical staff member perceptions of end-of-life care delivery at a private hospital in Western Australia. The study comprised of a multi-faceted mixed-methods methodology, part of a larger study. Data was obtained from clinical staff utilising surveys and focus groups. A total of 133 questionnaires were completed by clinical staff, including registered nurses (61.4%), enrolled nurses (22.7%), allied health professionals (9.9%), non-palliative care consultants (3.8%) and junior doctors (2.2%). A total of 14.7% of respondents were palliative care ward staff members. Additionally, seven staff focus groups were conducted with physicians (n=3), nurses (n=26) and allied health professionals including social workers (n=1), dietitians (n=2), physiotherapists (n=5) and speech pathologists (n=3). Key findings from the surveys highlighted that the majority of staff agreed it was part of their role to talk to doctors about the care of patients who they thought may be dying, and recognised the importance of communication, appropriate training and support for clinical staff to provide quality end-of-life care. Thematic analysis of the qualitative data generated three key themes: creating the setting which highlighted the importance of adequate resourcing and conducive physical environments for end-of-life care and to support staff and families; planning and care delivery which emphasised the necessity for collaboration between staff, families and patients to develop care plans and treatment directives; and collaborating in end-of-life care, with effective communication and teamwork leading to achievable care delivery expectations. These findings contribute to health professionals better understanding of end-of-life care provision and the importance of collaborating with patients and families in care delivery. It is crucial that health care providers implement strategies to overcome gaps in care, so quality end-of-life care is provided. Findings from this study have been translated into practice, with the development and implementation of resources, training opportunities, support networks and guidelines for the delivery of quality end-of-life care.

Keywords: clinical staff, end-of-life care, mixed-methods, private hospital.

Procedia PDF Downloads 126

Authors: Raj Chandran, Saul Datwyler, Jaime Marino, Daniel West, Karla Grasso, Adam Buss, Hina Syed, Zina Al Sahouri, Jennifer Yen, Krista Caudle, Beth McQuiston

Abstract:

The Alinity i TBI test is Therapeutic Goods Administration (TGA) registered and is a panel of in vitro diagnostic chemiluminescent microparticle immunoassays for the measurement of glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) in plasma and serum. The Alinity i TBI performance was evaluated in a multi-center pivotal study to demonstrate the capability to assist in determining the need for a CT scan of the head in adult subjects (age 18+) presenting with suspected mild TBI (traumatic brain injury) with a Glasgow Coma Scale score of 13 to 15. TBI has been recognized as an important cause of death and disability and is a growing public health problem. An estimated 69 million people globally experience a TBI annually1. Blood-based biomarkers such as glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) have shown utility to predict acute traumatic intracranial injury on head CT scans after TBI. A pivotal study using prospectively collected archived (frozen) plasma specimens was conducted to establish the clinical performance of the TBI test on the Alinity i system. The specimens were originally collected in a prospective, multi-center clinical study. Testing of the specimens was performed at three clinical sites in the United States. Performance characteristics such as detection limits, imprecision, linearity, measuring interval, expected values, and interferences were established following Clinical and Laboratory Standards Institute (CLSI) guidance. Of the 1899 mild TBI subjects, 120 had positive head CT scan results; 116 of the 120 specimens had a positive TBI interpretation (Sensitivity 96.7%; 95% CI: 91.7%, 98.7%). Of the 1779 subjects with negative CT scan results, 713 had a negative TBI interpretation (Specificity 40.1%; 95% CI: 37.8, 42.4). The negative predictive value (NPV) of the test was 99.4% (713/717, 95% CI: 98.6%, 99.8%). The analytical measuring interval (AMI) extends from the limit of quantitation (LoQ) to the upper LoQ and is determined by the range that demonstrates acceptable performance for linearity, imprecision, and bias. The AMI is 6.1 to 42,000 pg/mL for GFAP and 26.3 to 25,000 pg/mL for UCH-L1. Overall, within-laboratory imprecision (20 day) ranged from 3.7 to 5.9% CV for GFAP and 3.0 to 6.0% CV for UCH-L1, when including lot and instrument variances. The Alinity i TBI clinical performance results demonstrated high sensitivity and high NPV, supporting the utility to assist in determining the need for a head CT scan in subjects presenting to the emergency department with suspected mild TBI. The GFAP and UCH-L1 assays show robust analytical performance across a broad concentration range of GFAP and UCH-L1 and may serve as a valuable tool to help evaluate TBI patients across the spectrum of mild to severe injury.

Keywords: biomarker, diagnostic, neurology, TBI

Procedia PDF Downloads 46

Authors: Fernanda Gonçalves, Karla Alcântara, Vanessa Moura, Patrícia Nolasco, Jorge Kalil, Maristela Hernandez

Abstract:

Introduction: Atherosclerosis is a chronic disease where two striking features are observed: retention of lipids and inflammation. Understanding the interaction between immune cells and lipoproteins involved in atherogenesis are urgent challenges, since cardiovascular diseases are the leading cause of death worldwide. Macrophages are critical to the development of atherosclerotic plaques and in the perpetuation of inflammation in these lesions. These cells are also directly involved in unstable plaque rupture. Recently different populations of macrophages are being identified in atherosclerotic lesions. Although the presence of M2 macrophages (macrophages activated by the alternative pathway, eg. The IL-4) has been identified, the function of these cells in atherosclerosis is not yet defined. M2 macrophages have a high endocytic capacity, they promote remodeling of tissues and to have anti-inflammatory activity. However, in atherosclerosis, especially unstable plaques, severe inflammatory reaction, accumulation of cellular debris and intense degradation of the tissue is observed. Thus, it is possible that the M2 macrophages have altered function (phenotype) in atherosclerosis. Objective: Our aim is to evaluate if the presence of oxidized LDL alters the phenotype and function of M2 macrophages in vitro. Methods: For this, we will evaluate whether the addition of lipoprotein in M2 macrophages differentiated in vitro with IL -4 induces 1) a reduction in the secretion of anti-inflammatory cytokines (CBA and ELISA), 2) secretion of inflammatory cytokines (CBA and ELISA), 3) expression of cell activation markers (Flow cytometry), 4) alteration in gene expression of molecules adhesion and extracellular matrix (Real-Time PCR) and 5) Matrix degradation (confocal microscopy). Results: In oxLDL stimulated M2 macrophages cultures we did not find any differences in the expression of the cell surface markers tested, including: HLA-DR, CD80, CD86, CD206, CD163 and CD36. Also, cultures stimulated with oxLDL had similar phagocytic capacity when compared to unstimulated cells. However, in the supernatant of these cultures an increase in the secretion of the pro-inflammatory cytokine IL-8 was detected. No significant changes where observed in IL-6, IL-10, IL-12 and IL-1b levels. The culture supernatant also induced massive extracellular matrix (produced by mouse embryo fibroblast) filaments degradation. When evaluating the expression of 84 extracellular matrix and adhesion molecules genes, we observed that the stimulation of oxLDL in M2 macrophages decreased 47% of the genes and increased the expression of only 3% of the genes. In particular we noted that oxLDL inhibit the expression of 60% of the genes constituents of extracellular matrix and collagen expressed by these cells, including fibronectin1 and collagen VI. We also observed a decrease in the expression of matrix protease inhibitors, such as TIMP 2. On the opposite, the matricellular protein thrombospondin had a 12 fold increase in gene expression. In the presence of native LDL 90% of the genes had no altered expression. Conclusion: M2 macrophages stimulated with oxLDL secrete the pro-inflammatory cytokine IL-8, have an altered extracellular matrix constituents gene expression, and promote the degradation of extracellular matrix. M2 macrophages may contribute to the perpetuation of inflammation in atherosclerosis and to plaque rupture.

Keywords: atherosclerosis, LDL, macrophages, m2

Procedia PDF Downloads 314

Authors: Carlos E. Rodríguez-Rodríguez, Karla Ruiz-Hidalgo, Kattia Madrigal-Zúñiga, Juan Salvador Chin-Pampillo, Mario Masís-Mora, Elizabeth Carazo-Rojas

Abstract:

One of the main causes of contamination linked to agricultural activities is the spillage and disposal of pesticides, especially during the loading, mixing or cleaning of agricultural spraying equipment. One improvement in the handling of pesticides is the use of biopurification systems (BPS), simple and cheap degradation devices where the pesticides are biologically degraded at accelerated rates. The biologically active core of BPS is the biomixture, which is constituted by soil pre-exposed to the target pesticide, a lignocellulosic substrate to promote the activity of ligninolitic fungi and a humic component (peat or compost), mixed at a volumetric proportion of 50:25:25. Considering the known ability of lignocellulosic fungi to degrade a wide range of organic pollutants, and the high amount of lignocellulosic waste used in biomixture preparation, the bioaugmentation of biomixtures with these fungi represents an interesting approach for improving biomixtures. The present work aimed at evaluating the effect of the bioaugmentation of rice husk based biomixtures with the fungus Trametes versicolor in the removal of the insectice/nematicide carbofuran (CFN) and to optimize the composition of the biomixture to obtain the best performance in terms of CFN removal and mineralization, reduction in formation of transformation products and decrease in residual toxicity of the matrix. The evaluation of several lignocellulosic residues (rice husk, wood chips, coconut fiber, sugarcane bagasse or newspaper print) revealed the best colonization by T. versicolor in rice husk. Pre-colonized rice husk was then used in the bioaugmentation of biomixtures also containing soil pre-exposed to CFN and either peat (GTS biomixture) or compost (GCS biomixture). After spiking with 10 mg/kg CBF, the efficiency of the biomixture was evaluated through a multi-component approach that included: monitoring of CBF removal and production of CBF transformation products, mineralization of radioisotopically labeled carbofuran (14C-CBF) and changes in the toxicity of the matrix after the treatment (Daphnia magna acute immobilization test). Estimated half-lives of CBF in the biomixtures were 3.4 d and 8.1 d in GTS and GCS, respectively. The transformation products 3-hydroxycarbofuran and 3-ketocarbofuran were detected at the moment of CFN application, however their concentration continuously disappeared. Mineralization of 14C-CFN was also faster in GTS than GCS. The toxicological evaluation showed a complete toxicity removal in the biomixtures after 48 d of treatment. The composition of the GCS biomixture was optimized using a central composite design and response surface methodology. The design variables were the volumetric content of fungally pre-colonized rice husk and the volumetric ratio compost/soil. According to the response models, maximization of CFN removal and mineralization rate, and minimization in the accumulation of transformation products were obtained with an optimized biomixture of composition 30:43:27 (pre-colonized rice husk:compost:soil), which differs from the 50:25:25 composition commonly employed in BPS. Results suggest that fungal bioaugmentation may enhance the performance of biomixtures in CFN removal. Optimization reveals the importance of assessing new biomixture formulations in order to maximize their performance.

Keywords: bioaugmentation, biopurification systems, degradation, fungi, pesticides, toxicity

Procedia PDF Downloads 289