Search results for: clinical evaluation

Authors: Yesim Sucullu Karadag, Pinar Kurt, Sule Bilen, Nese Subutay Oztekin, Fikri Ak

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Background: Primary cervical dystonia is thought to be a purely motor disorder. But recent studies revealed that patients with dystonia had additional non-motor features. Sensory and psychiatric disturbances could be included into the non-motor spectrum of dystonia. The Basal Ganglia receive inputs from all cortical areas and throughout the thalamus project to several cortical areas, thus participating to circuits that have been linked to motor as well as sensory, emotional and cognitive functions. However, there are limited studies indicating cognitive impairment in patients with cervical dystonia. More evidence is required regarding neurocognitive functioning in these patients. Objective: This study is aimed to investigate neurocognitive profile of cervical dystonia patients in comparison to healthy controls (HC) by employing a detailed set of neuropsychological tests in addition to self-reported instruments. Methods: Totally 29 (M/F: 7/22) cervical dystonia patients and 30 HC (M/F: 10/20) were included into the study. Exclusion criteria were depression and not given informed consent. Standard demographic, educational data and clinical reports (disease duration, disability index) were recorded for all patients. After a careful neurological evaluation, all subjects were given a comprehensive battery of neuropsychological tests: Self report of neuropsychological condition (by visual analogue scale-VAS, 0-100), RAVLT, STROOP, PASAT, TMT, SDMT, JLOT, DST, COWAT, ACTT, and FST. Patients and HC were compared regarding demographic, clinical features and neurocognitive tests. Also correlation between disease duration, disability index and self report -VAS were assessed. Results: There was no difference between patients and HCs regarding socio-demographic variables such as age, gender and years of education (p levels were 0.36, 0.436, 0.869; respectively). All of the patients were assessed at the peak of botulinum toxine effect and they were not taking an anticholinergic agent or benzodiazepine. Dystonia patients had significantly impaired verbal learning and memory (RAVLT, p<0.001), divided attention and working memory (ACTT, p<0.001), attention speed (TMT-A and B, p=0.008, 0.050), executive functions (PASAT, p<0.001; SDMT, p= 0.001; FST, p<0.001), verbal attention (DST, p=0.001), verbal fluency (COWAT, p<0.001), visio-spatial processing (JLOT, p<0.001) in comparison to healthy controls. But focused attention (STROOP-spontaneous correction) was not different between two groups (p>0.05). No relationship was found regarding disease duration and disability index with any neurocognitive tests. Conclusions: Our study showed that neurocognitive functions of dystonia patients were worse than control group with the similar age, sex, and education independently clinical expression like disease duration and disability index. This situation may be the result of possible cortical and subcortical changes in dystonia patients. Advanced neuroimaging techniques might be helpful to explain these changes in cervical dystonia patients.

Keywords: cervical dystonia, neurocognitive impairment, neuropsychological test, dystonia disability index

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Authors: Vanaja T., Sravya P. K.

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Cooking and eating qualities have major roles in determining the quality characteristics of rice. Traditional rice varieties are highly diversified with each other with respect to unique nutrient, cooking, and eating characteristics, which can be used as parents for the development of high-quality varieties. In order to gather vital information for upcoming rice breeding programs, a study was conducted to assess the diversity of the cooking attributes and sensory evaluation of 28 traditional rice genotypes of Kerala, India, conserved at Regional Agricultural Research Station, Pilicode of Kerala Agricultural University. The cultivars ‘Kochuvithu’, ‘Jeerakachamba’, and ‘Rajameni’ exhibited the highest volume expansion ratio. The highest Kernel elongation ratio was recorded for ‘Gandhakasala’, ‘Rajameni’, and ‘Avadi’. A shorter cooking time based on Alkali spread value was shown by the cultivars ‘Kozhivalan’, ‘Kunhikayama’, ‘Rasagadham’, ‘Jadathi’, ‘Japanviolet’, ‘Nooravella’, ‘Punchavella’, ‘Avadi’, ‘Vadakan vellarikayama’, ‘Punchaparuthi’, ‘Shyamala’, ‘China Silk’, ‘Marathondi’, and ‘Gandhakasala’. Sensory evaluation revealed that the cultivars ‘Japanviolet’, ‘Kunhukunhu’, and ‘Kalladiyaran’ can be categorized under moderate to very much.

Keywords: rice, traditional rice varieties, cooking qualities, sensory evaluation, consumer acceptance

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Authors: Druzhinenko-Silhan Daria, Metz Claire

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In this paper, we introduce the findings of the "Conjugal violence: mothers' parenting and court decisions" (VIC-PADEJ) study, focusing on the motherhood experiences of domestic violence victims. Utilizing a longitudinal research protocol that encompassed clinical interviews, projective methods, and various questionnaires, we detail the outcomes derived from seven clinical interviews with mothers alongside a comprehensive analysis. The findings reveal a pronounced decline in security and an imperative need for structuring both social and internal realities. The convergence of these findings indicates that parenting, post-experiencing domestic violence, may become an unattainable task due to the deficiency of internal resources.

Keywords: domestic violence, parenthood, mothers victims, projective methods, longitudinal research, alceste analysis

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Authors: Sabrina Azzi, Michal Iglewski, Véronique Nabelsi

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Diagnosis error problem is frequent and one of the most important safety problems today. One of the main objectives of our work is to propose an ontological representation that takes into account the diagnostic criteria in order to improve the diagnostic. We choose pneumonia disease since it is one of the frequent diseases affected by diagnosis errors and have harmful effects on patients. To achieve our aim, we use a semi-automated method to integrate diverse knowledge sources that include publically available pneumonia disease guidelines from international repositories, biomedical ontologies and electronic health records. We follow the principles of the Open Biomedical Ontologies (OBO) Foundry. The resulting ontology covers symptoms and signs, all the types of pneumonia, antecedents, pathogens, and diagnostic testing. The first evaluation results show that most of the terms are covered by the ontology. This work is still in progress and represents a first and major step toward a development of a diagnosis decision support system for pneumonia.

Keywords: Clinical decision support system, Diagnostic errors, Ontology, Pneumonia

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Authors: Kang Sungjae

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This research proposes a gait stability evaluation technique based on the linear inverted pendulum model and moving support foot Zero Moment Point. With this, an improvement towards the gait analysis of the orthosis walk is validated. The application of Lagrangian mechanics approximation to the solutions of the dynamics equations for the linear inverted pendulum does not only simplify the solution, but it provides a smooth Zero Moment Point for the double feet support phase. The Zero Moment Point gait analysis techniques mentioned above validates reference trajectories for the center of mass of the gait orthosis, the timing of the steps and landing position references for the swing feet. The stability evaluation technique are tested with a 6 DOF powered gait orthosis. The results obtained are promising for implementations.

Keywords: locomotion, center of mass, gait stability, linear inverted pendulum model

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Authors: Milind D. Meshram

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Ascarids are the most frequent worm parasite of dogs and cats. There are two species that commonly infect dogs: Toxocara canis and Toxascaris leonina. Adult roundworms live in the stomach and intestines and can grow to 7 inches (18 cm) long. A female may lay 200,000 eggs in a day. The eggs are protected by a hard shell. They are extremely hardy and can live for months or years in the soil. A dog aged about 6 years, from Satara was referred to Teaching Veterinary Clinical Complex (TVCC) with a complaint of abdominal pain, anorexia, loss of condition and dull body coat with mucous pale membrane. The clinical examination revealed Anaemia, palpation of abdomen revealed enlargement of liver, slimy feel of the intestine loop, diarrhea.

Keywords: therapeutic management, Toxocara canis, induced hepatitis, dogs

Procedia PDF Downloads 592

Authors: F. O’Dowd, G. Murphy, M. Roche, E. Shudell, F. Keane, M. O’Kane

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Intoduction: Apremilast (Otezla®) is an oral phosphodiesterase-4 (PDE4) inhibitor indicated for treatment of adult patients with moderate to severe plaque psoriasis who have contraindications to have failed or intolerant of standard systemic therapy and/or phototherapy; and adult patients with active psoriatic arthritis. Apremilast influences intracellular regulation of inflammatory mediators. Two randomized, placebo-controlled trials evaluating apremilast in 1426 patients with moderate to severe plague psoriasis (ESTEEM 1 and 2) demonstrated that the commonest adverse reactions (AE’s) leading to discontinuation were nausea (1.6%), diarrhoea (1.0%), and headaches (0.8%). The overall proportion of subjects discontinuing due to adverse reactions was 6.1%. At week 16 these trials demonstrated significant more apremilast-treated patients (33.1%) achieved the primary end point PASI-75 than placebo (5.3%). We began prescribing apremilast in July 2015. Aim: To evaluate efficacy and tolerability of apremilast in an Irish teaching hospital psoriasis population. Methods: A proforma documenting clinical evaluation parameters, prior treatment experience and AE’s; was completed prospectively on all patients commenced on apremilast since July 2015 – July 2017. Data was collected at week 0,6,12,24,36 and week 52 with 20/71 patients having passed week 52. Efficacy was assessed using Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI). AE’s documented included GI effects, infections, changes in weight and mood. Retrospective chart review and telephone review was utilised for missing data. Results: A total of 71 adult subjects (38 male, 33 female; age range 23-57), with moderate to severe psoriasis, were evaluated. Prior treatment: 37/71 (52%) were systemic/biologic/phototherapy naïve; 14/71 (20%) has prior phototherapy alone;20/71 (28%) had previous systemic/biologic exposure; 12/71 (17%) had both psoriasis and psoriatic arthritis. PASI responses: mean baseline PASI was 10.1 and DLQI was 15.Week 6: N=71, n=15 (21%) achieved PASI 75. Week 12: N= 48, n=6 (13%) achieved a PASI 100%; n=16 (34.5%) achieved a PASI 75. Week 24: N=40, n=10 (25%) achieved a PASI 100; n=15 (37.5%) achieved a PASI 75. Week 52: N= 20, n=4 (20%) achieved a PASI 100; n= 16 (80%) achieved a PASI 75. (N= number of pts having passed the time point indicated, n= number of pts (out of N) achieving PASI or DLQI responses at that time). DLQI responses: week 24: N= 40, n=30 (75%) achieved a DLQI score of 0; n=5 (12.5%) achieved a DLQI score of 1; n=1 (2.5%) achieved a DLQI score of 10 (due to lack of efficacy). Adverse Events: The proportion of patients that discontinued treatment due to AE’s was n=7 (9.8%). One patient experienced nausea alleviated by dose reduction; another developed significant dysgeusia for certain foods, both continued therapy. Two patients lost 2-3 kg. Conclusion: Initial Irish patient experience of Apremilast appears comparable to that observed in trials with good efficacy and tolerability.

Keywords: Apremilast, introduction, Ireland, clinical audit

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Authors: Liane J. Ioannou, Jonathan Serpell, Joanne Dean, Cino Bendinelli, Jenny Gough, Dean Lisewski, Julie Miller, Win Meyer-Rochow, Stan Sidhu, Duncan Topliss, David Walters, John Zalcberg, Susannah Ahern

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Background: The occurrence of thyroid cancer is increasing throughout the developed world, including Australia and New Zealand, and since the 1990s has become the fastest increasing malignancy. Following the success of a number of institutional databases that monitor outcomes after thyroid surgery, the Australian and New Zealand Endocrine Surgeons (ANZES) agreed to auspice the development of a bi-national thyroid cancer registry. Objectives: To establish a bi-national population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand. Patients and Methods: The Australian and New Zealand Thyroid Cancer Registry (ANZTCR) captures clinical data for all patients, over the age of 18 years, diagnosed with thyroid cancer, confirmed by histopathology report, that have been diagnosed, assessed or treated at a contributing hospital. Data is collected by endocrine surgeons using a web-based interface, REDCap, primarily via direct data entry. Results: A multi-disciplinary Steering Committee was formed, and with operational support from Monash University the ANZTCR was established in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 30 sites expected to come on board across Australia and New Zealand in 2018. A modified-Delphi process was undertaken to determine the key quality indicators to be reported by the registry, and a minimum dataset was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery, and 30-day follow up. Conclusion: There are very few established thyroid cancer registries internationally, yet clinical quality registries have shown valuable outcomes and patient benefits in other cancers. The establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand the current practice in the treatment of thyroid cancer and reasons for variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer-term outcome data particularly for patients with the poor prognostic disease will add significant further value to the registry.

Keywords: thyroid cancer, clinical registry, population health, quality improvement

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Authors: Eda Ozkara San

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Nurse educators have been charged by several nursing organizations and accrediting bodies to provide innovative and evidence-based educational experiences, both didactic and clinical, to help students to develop the knowledge, skills, and attitudes needed to provide culturally competent nursing care to patients. Clinical simulation, which offers the opportunity for students to practice nursing skills in a risk-free, controlled environment and helps develop self-efficacy (confidence) within the nursing role. As one simulation method, the standardized patients (SPs) simulation helps educators to teach nursing students variety of skills in nursing, medicine, and other health professions. It can be a helpful tool for nurse educators to enhance cultural competence of nursing students. An alarming gap exists within the literature concerning the effectiveness of SP strategy to enhance cultural competence development of diverse student groups, who must work with patients from various backgrounds. This grant-supported, longitudinal, one-group, pretest and post-test educational intervention study aimed to examine the effect of the Diverse Standardized Patient Simulation (DSPS) cultural competence education strategy on students’ (n = 53) transcultural self-efficacy (TSE). The researcher-developed multidimensional DSPS strategy involved careful integration of transcultural nursing skills guided by the Cultural Competence and Confidence (CCC) model. As a carefully orchestrated teaching and learning strategy by specifically utilizing the SP pedagogy, the DSPS also followed international guidelines and standards for the design, implementation, evaluation, and SP training; and had content validity review. The DSPS strategy involved two simulation scenarios targeting underrepresented patient populations (Muslim immigrant woman with limited English proficiency and Irish-Italian American gay man with his partner (Puerto Rican) to be utilized in a second-semester, nine-credit, 15-week medical-surgical nursing course at an urban public US university. Five doctorally prepared content experts reviewed the DSPS strategy for content validity. The item-level content validity index (I-CVI) score was calculated between .80-1.0 on the evaluation forms. Jeffreys’ Transcultural Self-Efficacy Tool (TSET) was administered as a pretest and post-test to assess students’ changes in cognitive, practical, and affective dimensions of TSE. Results gained from this study support that the DSPS cultural competence education strategy assisted students to develop cultural competence and caused statistically significant changes (increase) in students’ TSE perceptions. Results also supported that all students, regardless of their background, benefit (and require) well designed cultural competence education strategies. The multidimensional DSPS strategy is found to be an effective way to foster nursing students’ cultural competence development. Step-by-step description of the DSPS provides an easy adaptation of this strategy with different student populations and settings.

Keywords: cultural competence development, the cultural competence and confidence model, CCC model, educational intervention, transcultural self-efficacy, TSE, transcultural self-efficacy tool, TSET

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Authors: Koirala Abarodh, Maghaiya Ujjwal, Guragain Phani Raj

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This analysis focuses on defining the spectrum evaluation model for telecom operators in terms of total cost of ownership (TCO). A quantitative approach for specific case analysis research methodology was used for identifying the results. Specific input parameters like target User experience, year on year traffic growth, capacity site limit per year, target additional spectrum type, bandwidth, spectrum efficiency, UE penetration have been used for the spectrum evaluation process and desired outputs in terms of the number of sites, capex in USD and required spectrum bandwidth have been calculated. Furthermore, this study gives a comparison of capex investment for target growth with and without addition spectrum. As a result, the combination of additional spectrum bands of 700 and 2600 MHz has a better evaluation in terms of TCO and performance. It is our recommendation to use these bands for expansion rather than expansion in the current 1800 and 2100 bands.

Keywords: spectrum, capex planning, case study methodology, TCO

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Authors: Surekha Tony, Roshan Mevada

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Wiskott-Aldrich syndrome (WAS) is a primary immunodeficiency disease resulting in recurrent infections, eczema, and microthrombocytopenia. In its classical form, significant combined immune deficiency, autoimmune complications, and risk of hematological malignancy necessitate early correction, preferably before 2 years of age, with hematopoietic stem cell transplant (HSCT) or gene therapy. Clinical features and severity are varied, making the diagnosis difficult in milder cases. We report an Omani boy diagnosed in early infancy with WAS based on clinical presentation and confirmed by genetic diagnosis with cure by HSCT from an HLA-identical sibling donor.

Keywords: genetic diagnosis, hematopoietic stem cell transplant, infant, Wiskott-Aldrich syndrome

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Authors: Hirokatsu Kawashima

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In an attempt to elucidate relationships between listening to music and pronunciation learning, a classroom-based investigation was conducted with Japanese EFL learners (n=45). The subjects were instructed to listen to English songs they liked on YouTube, especially paying attention to phonologically similar vowel and consonant minimal pair words (e.g., live and leave). This kind of activity, which included taking notes, was regularly carried out in the classroom, and the same kind of task was given to the subjects as homework in order to reinforce the in-class activity. The duration of these activities was eight weeks, after which the program was evaluated on a 9-point scale (1: the lowest and 9: the highest) by learners’ self-evaluation. The main questions for this evaluation included 1) how good the learners had been at pronouncing vowel and consonant minimal pair words originally, 2) how often they had listened to songs good for pronouncing vowel and consonant minimal pair words, 3) how frequently they had moved their mouths to vowel and consonant minimal pair words of English songs, and 4) how much they thought the program would support and enhance their pronunciation learning of phonologically similar vowel and consonant minimal pair words. It has been found, for example, A) that the evaluation of this program is by no means low (Mean: 6.51 and SD: 1.23), suggesting that listening to music may support and enhance pronunciation learning, and B) that listening to consonant minimal pair words in English songs and moving the mouth to them are more related to the program’s evaluation (r =.69, p=.00 and r =.55, p=.00, respectively) than listening to vowel minimal pair words in English songs and moving the mouth to them (r =.45, p=.00 and r =.39, p=.01, respectively).

Keywords: minimal pair, music, pronunciation, song

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Authors: P.V. Lostelius, M.Mattebo, E. Thors Adolfsson, A. Söderlund, Å. Revenäs

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Adolescents are vulnerable in healthcare settings. Early detection of poor health in young people is important to support a good quality of life and adult social functioning. Youth Health Clinics (YHCs) in Sweden provide healthcare for young people ages 13-25 years old. Using an overall mixed methods approach, the project’s main objective was to develop and evaluate an electronic health system, including a health questionnaire, a case report form, and an evaluation questionnaire to assess young people’s health risks in early stages, increase health, and quality of life. In total, 72 young people, 16-23 years old, eleven healthcare professionals and eight researchers participated in the three project studies. Results from interviews with fifteen young people gave that an electronic health questionnaire should include questions about physical-, mental-, sexual health and social support. It should specifically include questions about self-harm and suicide risk. The young people said that the questionnaire should be appealing, based on young people’s needs and be user-friendly. It was important that young people felt safe when responding to the questions, both physically and electronically. Also, they found that it had the potential to support the face-to face-meeting between young people and healthcare professionals. The electronic health report system was developed by the researchers, performing a structured development of the electronic health questionnaire, construction of a case report form to present the results from the health questions, along with an electronic evaluation questionnaire. An Information Technology company finalized the development by digitalizing the electronic health system. Four young people, three healthcare professionals and seven researchers evaluated the usability using interviews and a usability questionnaire. The electronic health questionnaire was found usable for YHCs but needed some clarifications. Essentially, the system succeeded in capturing the overall health of young people; it should be able to keep the interest of young people and have the potential to contribute to health assessment planning and young people’s self-reflection, sharing vulnerable feelings with healthcare professionals. In advance of effect studies, a feasibility study was performed by collecting electronic questionnaire data from 54 young people and interview data from eight healthcare professionals to assess the feasibility of the use of the electronic evaluation questionnaire, the case report form, and the planned recruitment method. When merging the results, the research group found that the evaluation questionnaire and the health report were feasible for future research. However, the COVID-19 pandemic, commitment challenges and drop-outs affected the recruitment of young people. Also, some healthcare professionals felt insecure about using computers and electronic devices and worried that their workload would increase. This project contributes knowledge about the development and use of electronic health tools for young people. Before implementation, clinical routines need for using the health report system need to be considered.

Keywords: adolescent health, developmental studies, electronic health questionnaire, mixed methods research

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Authors: Sungwon Jung

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The percentage of 20 years or older apartment houses in South Korea is approximately 20% (1.55 million houses), and the explosive increase of aged houses is expected around the first planned new towns. Accordingly, we should prepare for social issues such as difficulty of housing lease and degradation of housing performance. The improvement of performance of aged houses is essential for achieving the national energy and carbon reduction goals, and we should develop techniques to respond to the changing construction environment. Furthermore, we should develop a performance evaluation system that is appropriate for the demands of residents such as the improvement of remodeling floor plan by performance improvement in line with the residence type of the housing vulnerable groups such as low-income group and elderly people living alone. For this purpose, remodeling techniques and business models optimized for the target complexes must be spread through the development of various business models. In addition, it is necessary to improve the remodeling business by improving the laws and systems related to the improvement of the residential performance and to prepare techniques to respond to the increasing business demands. In other words, performance improvement and evaluation and knowledge systems need to be researched as new issues related to remodeling that has not been addressed in the existing research.

Keywords: remodelling, performance evaluation, web-based system, big data

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Authors: M. Pagasa Nanette Rotairo

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The research focuses on the effectiveness, responsiveness, adequacy, and appropriateness of customer service of selected fast food restaurant using William Dunn’s four evaluation criteria tantamount to the focus of the research. Due to efficiency the fast food restaurants offer and the increasing demand for acquiring its services, the researcher conducted a study on the effectiveness of customer service of five popular restaurants in Metro Manila. Using descriptive method, the research is furthered in par with evaluation and implementation of different instruments effective for data gathering to further scientific judgment. Results of this research indicate that consumers consider the quality service as the major reason in patronizing fast food restaurants while they consider cleanliness and customer satisfaction as their least concern. Details of this study provided support on how the proposed operational model can further improve the services of fast food restaurants.

Keywords: customer satisfaction, customer service, restaurant management, business operations

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Authors: Erin Brands-Saliba

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In this evaluation study, we explore the efficacy and implementation of the five guiding principles of Bekaadendang “Being Peaceful,” a suite of services facilitated by our Anti-Human Trafficking Team, and a pivotal component of the Holistic Prevention Services department at NCFST. The guiding principles—trauma-informed care, cultural safety, 4-quadrant medicine wheel approach, harm reduction, and after-care peer support—are the foundation of Bekaadendang's mission to support at-risk individuals and survivors of human trafficking. This evaluation is of paramount importance given the profound impact of human trafficking on these communities and aims to ensure that Bekaadendang's principles are not only understood by staff but experienced by community members in a purposeful and meaningful manner. The issues at the heart of this evaluation are deeply entrenched in the historical and contemporary challenges faced by Indigenous communities, with a particular emphasis on Indigenous women and 2SLGBTQQIA+ individuals. Well-documented reports like the National Inquiry into Missing and Murdered Indigenous Women and Girls (MMIWG) have cast a glaring light on the disproportionately high rates of violence, exploitation, and trafficking experienced by these communities. The MMIWG report underlines the pressing need for holistic, culturally informed interventions like Bekaadendang. Furthermore, the research efforts of scholars, both Indigenous and non-Indigenous, shed light on the persistent systemic issues that make Indigenous individuals more vulnerable to trafficking and exploitation. Recognizing this broader context is crucial to truly grasp the importance of evaluating the guiding principles that underpin Bekaadendang's service model.

Keywords: human trafficking, indigenous healing, MMIWG, program evaluation

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Authors: Tatiana Butkova, Nikolai Kibrik, Kristina Malsagova, Alexander Izotov, Alexander Stepanov, Anna Kaysheva

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Relevance. The genetic risk of developing schizophrenia is determined by two factors: single nucleotide polymorphisms and gene copy number variations. The search for serological markers for early diagnosis of schizophrenia is driven by the fact that the first five years of the disease are accompanied by significant biological, psychological, and social changes. It is during this period that pathological processes are most amenable to correction. The aim of this study was to analyze single nucleotide polymorphisms (SNPs) that are hypothesized to potentially influence the onset and development of the endogenous process. Materials and Methods It was analyzed 73 single nucleotide polymorphism variants. The study included 48 patients undergoing inpatient treatment at "Psychiatric Clinical Hospital No. 1" in Moscow, comprising 23 females and 25 males. Inclusion criteria: - Patients aged 18 and above. - Diagnosis according to ICD-10: F20.0, F20.2, F20.8, F21.8, F25.1, F25.2. - Voluntary informed consent from patients. Exclusion criteria included: - The presence of concurrent somatic or neurological pathology, neuroinfections, epilepsy, organic central nervous system damage of any etiology, and regular use of medication. - Substance abuse and alcohol dependence. - Women who were pregnant or breastfeeding. Clinical and psychopathological assessment was complemented by psychometric evaluation using the PANSS scale at the beginning and end of treatment. The duration of observation during therapy was 4-6 weeks. Total DNA extraction was performed using QIAamp DNA. Blood samples were processed on Illumina HiScan and genotyped for 652,297 markers on the Infinium Global Chips Screening Array-24v2.0 using the IMPUTE2 program with parameters Ne=20,000 and k=90. Additional filtration was performed based on INFO>0.5 and genotype probability>0.5. Quality control of the obtained DNA was conducted using agarose gel electrophoresis, with each tested sample having a volume of 100 µL. Results. It was observed that several SNPs exhibited gender dependence. We identified groups of single nucleotide polymorphisms with a membership of 80% or more in either the female or male gender. These SNPs included rs2661319, rs2842030, rs4606, rs11868035, rs518147, rs5993883, and rs6269.Another noteworthy finding was the limited combination of SNPs sufficient to manifest clinical symptoms leading to hospitalization. Among all 48 patients, each of whom was analyzed for deviations in 73 SNPs, it was discovered that the combination of involved SNPs in the manifestation of pronounced clinical symptoms of schizophrenia was 19±3 out of 73 possible. In study, the frequency of occurrence of single nucleotide polymorphisms also varied. The most frequently observed SNPs were rs4849127 (in 90% of cases), rs1150226 (86%), rs1414334 (75%), rs10170310 (73%), rs2857657, and rs4436578 (71%). Conclusion. Thus, the results of this study provide additional evidence that these genes may be associated with the development of schizophrenia spectrum disorders. However, it's impossible cannot rule out the hypothesis that these polymorphisms may be in linkage disequilibrium with other functionally significant polymorphisms that may actually be involved in schizophrenia spectrum disorders. It has been shown that missense SNPs by themselves are likely not causative of the disease but are in strong linkage disequilibrium with non-functional SNPs that may indeed contribute to disease predisposition.

Keywords: gene polymorphisms, genotyping, single nucleotide polymorphisms, schizophrenia.

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Authors: J. S. M. Yang, G. E. T. Chua

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Diploma in Optometry (OPT) course is a three-year program offered by Ngee Ann Polytechnic (NP) to train students to provide primary eye care. Students are equipped with foundational conceptual knowledge and practical skills in the first three semesters before clinical modules in fourth to six semesters. In the clinical modules, students typically have difficulties in integrating the acquired knowledge and skills from the past semesters to perform general eye examinations on public patients at NP Optometry Centre (NPOC). To help the students overcome the challenge, a web-based game Virtual Optometrist (VO) was developed to help students apply their skills and knowledge through scenario-based learning. It consisted of two interfaces, Optical Practice Counter (OPC) and Optometric Consultation Room (OCR), to provide two simulated settings for authentic learning experiences. In OPC, students would recommend and provide appropriate frame and lens selection based on virtual patient’s case history. In OCR, students would diagnose and manage virtual patients with common ocular conditions. Simulated scenarios provided real-world clinical situations that required contextual application of integrated knowledge from relevant modules. The stages in OPC and OCR are of increasing complexity to align to expected students’ clinical competency as they progress to more senior semesters. This prevented gameplay fatigue as VO was used over the semesters to achieve different learning outcomes. Numerous feedback opportunities were provided to students based on their decisions to allow individualized learning to take place. The game-based learning element in VO was achieved through the scoreboard and leader board to enhance students' motivation to perform. Scores were based on the speed and accuracy of students’ responses to the questions posed in the simulated scenarios, preparing the students to perform accurately and effectively under time pressure in a realistic optometric environment. Learning analytics was generated in VO’s backend office based on students’ responses, offering real-time data on distinctive and observable learners’ behavior to monitor students’ engagement and learning progress. The backend office allowed versatility to add, edit, and delete scenarios for different intended learning outcomes. Likert Scale was used to measure students’ learning experience with VO for OPT Year 2 and 3 students. The survey results highlighted the learning benefits of implementing VO in the different modules, such as enhancing recall and reinforcement of clinical knowledge for contextual application to develop higher-order thinking skills, increasing efficiency in clinical decision-making, facilitating learning through immediate feedback and second attempts, providing exposure to common and significant ocular conditions, and training effective communication skills. The results showed that VO has been useful in reinforcing optometry students’ learning and supporting the development of higher-order thinking, increasing efficiency in clinical decision-making, and allowing students to learn from their mistakes with immediate feedback and second attempts. VO also exposed the students to diverse ocular conditions through simulated real-world clinical scenarios, which may otherwise not be encountered in NPOC, and promoted effective communication skills.

Keywords: authentic learning, game-based learning, scenario-based learning, simulated clinical scenarios

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Authors: Avishkar Gawade, Omkar Bansode, Ketan Bhambure, Bhargav Deore

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In recent year wide range of business intelligence technology have been applied to different area in order to support decision making process BI enables extraction of knowledge from data store. BI tools usually used in public health field for financial and administrative purposes.BI uses a dashboard in presentation stage to deliver information to information to end users.In this paper,we intend to analyze some open source BI tools on the market and their applicability in the clinical sphere taking into consideration the general characteristics of the clinical environment.A pervasive BI platform was developed using a real case in order to prove the tool viability.Analysis of various BI Tools in done with the help of several parameters such as data security,data integration,data quality reporting and anlaytics,performance,scalability and cost effectivesness.

Keywords: CDSS, EHR, business intelliegence, tools

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Authors: Maneka Marianne Britto, Hansraj Riteesh Bookun

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The ability of a junior doctor to deliver complex multi-disciplinary care to patients in a paradigm of respect and collaboration requires a multitude of interpersonal skills and competencies. A short survey was used to explore the perspective of allied health staff on the desirable attributes of a junior doctor which are conducive to good teamwork. 23 allied health professionals (14 nurses, 4 physiotherapists, 2 dietitians, 1 occupational therapist, 1 speech therapist and 1 audiologist) responded to this 17-item survey. There were 17 females. The mean age of the respondents was 34.9 ± 10.1 years. The salient findings of our survey are that 95% of our respondents rated friendliness and non-clinical small talk with average importance or greater. 45% of them viewed these 2 items as very important or absolutely essential. A single respondent viewed these 2 items with little importance. The other criteria which were rated with high levels of importance were the acknowledgment of allied health suggestions and good ward organizational skills. Training these collaborative skills is challenging, and an enhanced understanding of interprofessional perspectives will help a junior doctor to achieve better clinical outcomes. It is hoped that this paper will further stimulate discussion in this area and will encourage junior doctors to engage in non-clinical conversations with allied health staff in the spirit of promoting effective teamwork.

Keywords: allied health, collaboration, doctor, medicine, surgery

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Authors: Joanne M. Emmens

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This paper makes use of the case notes of a single psychoanalytically informed psychotherapy of a now 72-year-old man over a four-year period to explore the potential of qualitative data to be incorporated into a research methodology that can contribute theory and knowledge to the wider professional community involved in mental health care. The clinical material arising out of any psychoanalysis provides a potentially rich source of clinical data that could contribute valuably to our historical understanding of both individual and societal traumata. As psychoanalysis is primarily an investigation, it is argued that clinical case material is a rich source of qualitative data which has relevance for sociological and historical understandings and that it can potentially aluminate important ‘gaps’ and collective blind spots that manifest unconsciously and are a contributing factor in the transmission of trauma, silently across generations. By attending to this case material the hope is to illustrate the value of using a psychoanalytic centred methodology. It is argued that the study of individual defences and the manner in which they come into consciousness, allows an insight into group defences and the unconscious forces that contribute to the silencing or un-noticing of important sources (or originators) of mental suffering.

Keywords: dream furniture (Bion) and psychotic functioning, reverie, screen memories, selected fact

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Authors: Hatim Bastawi

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Three varieties of potatoes, namely Agria, Alpha and Diamant were evaluated for their suitability for industrial production of French fries. The evaluation was under taken after testing quality parameters of specific gravity, dry matter, peeling ratio, and defect after frying and panel test. The variety Agria ranked the best followed by Alpha with regard to the parameters tested. On the other hand, Diamant showed significantly higher defect percentage than the other cultivars. Also, it was significantly judged of low acceptance by panelists.

Keywords: cultivars, crisps, French fries

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Authors: F. Gallop, C. Ward, M. Zaky, M. Vaghela, R. Sabaratnam

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Nitrous oxide (N₂O) has been used in anaesthesia for over 150 years owing to advantageous physical and pharmacological properties. However, with a global warming potential of 310, we have an urgent responsibility to reduce its usage and emission. Anecdotal evidence in our hospital trust suggests minimal N₂O usage, yet our theatres receive a staggering supply. This warranted further investigation. We used a data collection tool to prospectively capture quantitative and qualitative data regarding N₂O cases during one week: this recorded demographics, N₂O indications, clinical management, and total N₂O consumption in litres. In addition, N₂O usage in dental sedation suites and paediatric theatres was separately quantified. Pipeline supply data was acquired from British Oxygen Company accounts. We captured 490 cases. 4% (n=19) used N₂O, 63% (n=12) of these in dental theatres. Common N₂0 indications were induction speed (37%) and rapidly increasing anaesthesia depth (32%). In adult cases, N₂O was always used intraoperatively rather than solely at induction. 74% (n=14) of anaesthetists reported environmental concern over using N₂O. The week’s total N₂O usage was 8109 litres, amounting to 421,668 litres annually. However, the annual N₂O pipeline supply is 2,997,000 litres; an enormous 1.8 million Kg of CO₂. Our results supportively demonstrate that the N₂O pipeline supply greatly exceeds its clinical use. Acknowledging clinical areas not audited, the discrepancy between supply and usage suggests approximately 2.5 million litres of yearly wastage. We consequently recommend terminating the N₂O pipeline supply in minimally used areas, eliminating 1.5 million Kg of CO₂ emissions. High usage clinical areas could consider portable N₂O cylinders as an alternative. In Sweden, N₂O destruction technology is routinely used to minimise CO₂ emissions. Our results support National Health System investment in similar infrastructure.

Keywords: anaesthesia, environment, medical gases, nitrous oxide, sustainability

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Authors: Mohammed Saif Al-Saidi, John P. T. Mo

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Modern engineering assets are complex and very high in value. They are expected to function for years to come, with ability to handle the change in technology and ageing modification. The aging of an engineering asset and continues increase of vendors and contractors numbers forces the asset operation management (or Owner) to design an asset system which can capture these changes. Furthermore, an accurate performance measurement and risk evaluation processes are highly needed. Therefore, this paper explores the nature of the asset management system performance evaluation for an engineering asset based on the System Support Engineering (SSE) principles. The research work explores the asset support system from a range of perspectives, interviewing managers from across a refinery organisation. The factors contributing to complexity of an asset management system are described in context which clusters them into several key areas. It is proposed that SSE framework may then be used as a tool for analysis and management of asset. The paper will conclude with discussion of potential application of the framework and opportunities for future research.

Keywords: asset management, performance, evaluation, modern engineering, System Support Engineering (SSE)

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Authors: Christoph Schuler, Oriana Ponta

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Public Financial Management (PFM) reforms are promoted by various international organizations such as the International Monetary Fund (IMF) or the World Bank, local development banks and the donor country community to strengthen governance and accountability in developing countries across the world. Reform efforts undertaken are often systematically measured against international best practice by the application of standardized analytical instruments such as the Public Expenditure and Financial Accountability Framework (PEFA) or the Poverty Reduction Action Plan (PARP). While those instruments analyze direct achievements of PFM reforms, the long-term benefits of such reforms for society remain untapped. This gives rise to the question why the concept of impact evaluation with its experimental or quasi-experimental settings in the form of randomized control trials has rarely been applied in the context of PFM reforms. To close this gap, this study provides examples where the concept of impact evaluation can be applied to PFM reforms and thereby shifting the focus from outcome towards a long-term impact. As it is a new approach, this study does not attempt to conduct a fully flagged impact evaluation of a certain PFM reform. However, it will outline, as a form of pre-test the applicability of the impact evaluation methodology in this context, for example, by more closely analyzing the commonly used indicators (for example within PEFA or PARP). This would mean to scrutinize these indicators as to how they were designed and how they are related to the long-term impact, they should be producing. The analysis of PFM reform indicators and their relation to long-term impacts should provide practitioners and scholars alike with new insights on how to strengthen the accountability of public service delivery through successful and sustainable PFM reforms.

Keywords: accountability, impact evaluation, PFM reforms, public financial management

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Authors: Kittivate Boonyopakorn

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The purposes of this study were to find the English competence of the public health volunteers and to develop the use of their English. The samples for the study were 41 public health village volunteers at Ban Prasukchai, in Thailand. The findings showed that the sum of all scores for the pre-test was 452, while the score for the post-test was 1,080. Therefore, the results of the experiment confirm that the post-test scores (1,080) significantly are higher than the pre-test (452). The mean score (N=41) for the pre-test was 11.02 while the mean score (N=41) for the post-test was 18.10. The standard deviation for the pre-test was 2.734; however, for the post-test it was 1.934. In addition to the experts-evaluated research tools, the results of the evaluation for the structured interviews (IOC) were 1 in value. The evaluation of congruence for the content with learning objectives (IOC) were 0.66 to 1.00 in value. The evaluation of congruence for the pre and post-test with learning objectives (IOC) are 1 in value.

Keywords: finding the English competency, developing public health, village volunteers

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Authors: Mamta Thakur, Dr. Shashi Mawar, Ms. Levis Murry, Dr. D.k.sharma

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Aim: The aim of this study is to develop nephrology nursing procedure protocol after clinical audit of current nephrology nursing practices. Materials and methods: This descriptive observational study was conducted on 40 nurses who were working in Nephrology Department of AIIMS, New Delhi to observe their current practices to assess the existing gaps in the practice. The nurses were enrolled through total enumerative sampling. Sociodemographic profile of nurses and clinical profile for site of procedure was collected. Observation checklist was formed on the basis of standard nursing practices, which included 7 dimensions for hemodialysis procedure and 3 dimensions for procedure of assisting renal biopsy. Based on the gaps identified, nephrology nursing procedure protocol will be developed. Nurses were observed during two shifts, and each nurse was observed once. Scoring of items were done in each dimension, and for acceptable practices, nurses have to score ≥80% in each dimension. Results: Data was analyzed using descriptive statistics. Majority of nurses (73.7%) in nephrology ward and (80.9%) in hemodialysis unit have not undergone any special training in nephrology. Most of nurses (80.9%) followed the acceptable nursing practices for procedure of connection for hemodialysis. None of nurses followed the acceptable level (≥80%) of nursing practices for the procedure of predialysis assessment, the procedure for site preparation, during dialysis assessment and post dialysis assessment. None (100%) showed the acceptable level of nursing practices for all the dimensions of assisting renal biopsy procedure. Nephrology nursing procedure protocol was developed by researcher following a rigorous process, and this will reduce the gaps in the nursing practice. Conclusion: Clinical audit found that there were gaps in the existing nursing practices compared to the standardised nursing practices for procedure of hemodialysis and assisting renal biopsy, and these gaps have been addressed by the development of the protocol.

Keywords: nursing practice, nephrology nursing procedure, nursing protocol, renal biopsy, hemodialysis

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Authors: Alice Huffman, Joseph Hartland, Sam Gibbs

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Dermatology is often a neglected specialty in low-resource settings, despite the high morbidity associated with skin disease. This becomes even more significant when associated with HIV infection, as dermatological conditions are more common and aggressive in HIV positive patients. African countries have the highest HIV infection rates and skin conditions are frequently misdiagnosed and mismanaged, because of a lack of dermatological training and educational material. The frequent lack of diagnostic tests in the African setting renders basic clinical skills all the more vital. This project aimed to improve diagnosis and treatment of skin disease in the HIV population in a district hospital in Malawi. A basic dermatological clinical tool was developed and produced in collaboration with local staff and based on available literature and data collected from clinics. The aim was to improve diagnostic accuracy and provide guidance for the treatment of skin disease in HIV positive patients. A literature search within Embase, Medline and Google scholar was performed and supplemented through data obtained from attending 5 Antiretroviral clinics. From the literature, conditions were selected for inclusion in the resource if they were described as specific, more prevalent, or extensive in the HIV population or have more adverse outcomes if they develop in HIV patients. Resource-appropriate treatment options were decided using Malawian Ministry of Health guidelines and textbooks specific to African dermatology. After the collection of data and discussion with local clinical and pharmacy staff a list of 15 skin conditions was included and a booklet created using the simple layout of a picture, a diagnostic description of the disease and treatment options. Clinical photographs were collected from local clinics (with full consent of the patient) or from the book ‘Common Skin Diseases in Africa’ (permission granted if fully acknowledged and used in a not-for-profit capacity). This tool was evaluated by the local staff, alongside an educational teaching session on skin disease. This project aimed to reduce uncertainty in diagnosis and provide guidance for appropriate treatment in HIV patients by gathering information into one practical and manageable resource. To further this project, we hope to review the effectiveness of the tool in practice.

Keywords: dermatology, HIV, Malawi, skin disease

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Authors: Johanna Renny Octavia, Kamila Okta Saarah

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Smartphone nowadays is widely used by many people all over the world. However, people with vision impairment may experience difficulties that interfere with the proper usage of the smartphone. In Indonesia, the population of visually impaired is about 13 million people (estimated 285 million people worldwide). There are a number of mobile applications developed to enhance the use of smartphone by visually impaired. This paper discusses the usability evaluation of a mobile application, namely Ray Vision, designed to help visually impaired in using smartphone. A series of usability testing with a number of Indonesian visually impaired revealed 28 usability problems in the mobile application that led to 14 design recommendations. The redesigned application was then re-evaluated through another usability testing series. The results showed that all five usability criteria assessed were increased (usefulness by 13%, effectiveness by 27%, efficiency by 27%, satisfaction by 23%, and learnability by 12%). The System Usability Score (SUS) was also increased by 14.92%.

Keywords: mobile application, smartphone, usability evaluation, vision impaired

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Authors: Thais O. de Paula, Marjorie R. A. Sarmiento, Francis M. Borges, Alessandra B. Ferreira-Machado, Juliana A. Resende, Dioneia E. Cesar, Vania L. Silva, Claudio G. Diniz

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Obesity is currently a worldwide public health threat, being considered a pandemic multifactorial disease related to the human gut microbiota (GM). Add to that GM is considered an important reservoir of antimicrobial resistance genes (ARG) and little is known on GM and ARG in obesity, considering the altered physiology and xenobiotics intake. As regional and social behavior may play important roles in GM modulation, and most of the studies are based on small sample size and various methodological approaches resulting in difficulties for data comparisons, this study was focused on the investigation of GM bacterial diversity in obese (OB), overweight (OW) and eutrophic individuals (ET) considering their nutritional, clinical and social characteristics; and comparative screening of AGR related to their physiology and xenobiotics intake. Microbial community was accessed by FISH considering phyla as a taxonomic level, and PCR-DGGE followed by dendrograms evaluation (UPGMA method) from fecal metagenome of 72 volunteers classified according to their body mass index (BMI). Nutritional, clinical, social parameters and xenobiotics intake were recorded for correlation analysis. The fecal metagenome was also used as template for PCR targeting 59 different ARG. Overall, 62% of OB were hypertensive, and 12% or 4% were, regarding the OW and ET individuals. Most of the OB were rated as low income (80%). Lower relative bacterial densities were observed in the OB compared to ET for almost all studied taxa (p < 0.05) with Firmicutes/Bacteroidetes ratio increased in the OB group. OW individuals showed a bacterial density representative of GM more likely to the OB. All the participants were clustered in 3 different groups based on the PCR-DGGE fingerprint patterns (C1, C2, C3), being OB mostly grouped in C1 (83.3%) and ET mostly grouped in C3 (50%). The cluster C2 showed to be transitional. Among 27 ARG detected, a cluster of 17 was observed in all groups suggesting a common core. In general, ARG were observed mostly within OB individuals followed by OW and ET. The ratio between ARG and bacterial groups may suggest that AGR were more related to enterobacteria. Positive correlations were observed between ARG and BMI, calories and xenobiotics intake (especially use of sweeteners). As with nutritional and clinical characteristics, our data may suggest that GM of OW individuals behave in a heterogeneous pattern, occasionally more likely to the OB or to the ET. Regardless the regional and social behaviors of our population, the methodological approaches in this study were complementary and confirmatory. The imbalance of GM over the health-disease interface in obesity is a matter of fact, but its influence in host's physiology is still to be clearly elucidated to help understanding the multifactorial etiology of obesity. Although the results are in agreement with observations that GM is altered in obesity, the altered physiology in OB individuals seems to be also associated to the increased xenobiotics intake and may interfere with GM towards antimicrobial resistance, as observed by the fecal metagenome and ARG screening. Support: FAPEMIG, CNPQ, CAPES, PPGCBIO/UFJF.

Keywords: antimicrobial resistance, bacterial diversity, gut microbiota, obesity

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