Search results for: clinical profile

Authors: Junaid Ahmed, Nandita Shenoy

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Maintaining lifelong knowledge and skills is essential for safe clinical practice. Continuing Professional Development (CPD) is an established method that can facilitate lifelong learning. It focuses on maintaining or developing knowledge, skills and relationships to ensure competent practice.To date, relatively little has been done to comprehensively and systematically synthesize evidence to identify subjects of interest among practising dentist. Hence the aim of our study was to identify areas in clinical practice that would be favourable for continuing professional dental education amongst practicing dentists. Participants of this study consisted of the practicing dental surgeons of Mangalore, a city in Dakshina Kannada, Karnataka. 95% of our practitioners felt that regular updating as a one day program once in 3-6 months is required, to keep them abreast in clinical practice. 60% of subjects feel that CPD programs enrich their theoretical knowledge and helps in patient care. 27% of them felt that CPD programs should be related to general dentistry. Most of them felt that CPD programs should not be charged nominally between one to two thousand rupees. The acronym ‘CPD’ should be seen in a broader view in which professionals continuously enhance not only their knowledge and skills, but also their thinking,understanding and maturity; they grow not only as professionals, but also as persons; their development is not restricted to their work roles, but may also extend to new roles and responsibilities.

Keywords: continuing professional development, competent practice, dental education, practising dentist

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Authors: Clesse C., Lighezzolo-Alnot J., De Lavergne S.

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Considered as the most common surgical procedure worldwide, episiotomy can be defined as an incision around the vulva performed to enlarge it, in the aim of preventing the traumatic rupture of the perineum during childbirth. Rather mediatized, this practice raises many questions in the field of mental health, relayed by different users and health professionals. Today, is topicality is moderately hectic since many queries about the prophylactic exercise of episiotomy are subject to a relative consensus, particularly since WHO advocated in 1996 that only 10% of childbirths should involve an episiotomy. This indicator appeared after the publication of numerous results from randomized clinical trials. Unfortunately, these papers seem mostly centered about somatic impacts of episiotomy. From the side of psychological studies, they mostly integrate a major clinical methodological bias, especially considering that every primiparous woman is identical to the others face to the experience of parturition. In the aim to fill this lack of knowledge, we developed a longitudinal research starting in the 7th month of pregnancy and ending one year after delivery. We are studying in a comparative way different possible psychological consequences inherent to the use of episiotomy. To do this, we use a standardized methodology which combines semi-structured clinical interviews (IRMAG, IRMAN ...), free clinical interviews, a projective test (Rorschach) and five questionnaires (QIC, EPDS, CPQ WOMBLSQ4, SF36). Therefore, we can comprehend with shrewdness the question of psychic impacts of episiotomy in a qualitative and quantitative way by comparing it to other obstetric interventions. In this paper, we will present the first results obtained about a population of twenty-two primiparous women by focusing on body image, sexuality, quality of life, depressive affects, post-traumatic stress disorder and investment of the maternal role. Finally, we will consider the different implications and perspectives of this research which could improve the public health policies in the field of perinatal care.

Keywords: assessment, episiotomy, mental health, psychical impacts

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Authors: Ghoul Rachid Brahim

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Introduction: Degenerative disc disease is a process of premature and accelerated deterioration of the intervertebral disc; it is of multifactorial origin and is responsible for chronic low back pain. Objectives: Determine an epidemiological profile of patients with painful lumbar degenerative disc disease. Patients and methods: We performed a prospective study of 104 patients operated on for degenerative painful lumbar disc disease over a period of 25 months. The parameters analyzed were: age, sex, Body Mass Index (BMI), comorbidities, family history of low back pain, and difficulty with professional activity. Results: The average age was 43.3 years, with a clear predominance of men: 72 men for 32 women, the average BMI was 26.80Kg / m2, and 63.5% of the patients were overweight. The occurrence of disc degeneration in pathological conditions was noted in 14.4% of cases. The notion of familial low back pain was found in 49% of cases. The majority of patients perform more or less arduous work (51%) in the cases. Conclusion: In our series, degenerative painful lumbar disc disease predominates in the male subject, active obese who performs more or less painful work, in whom we find a family history of low back pain.

Keywords: degenerative disc disease, low back pain, body mass index, disque intervertebrale

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Authors: Mahla Azimi

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Introduction: Post-bladder catheter infection is a common and significant healthcare-associated infection that affects individuals with indwelling urinary catheters. These infections can lead to various complications, including urinary tract infections (UTIs), bacteremia, sepsis, and increased morbidity and mortality rates. This article aims to provide a comprehensive review of post-bladder catheter infections, including their causes, risk factors, clinical presentation, diagnosis, treatment options, and preventive measures. Causes and Risk Factors: Post-bladder catheter infections primarily occur due to the colonization of microorganisms on the surface of the urinary catheter. The most common pathogens involved are Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus species. Several risk factors contribute to the development of these infections, such as prolonged catheterization duration, improper insertion technique, poor hygiene practices during catheter care, compromised immune system function in patients with underlying conditions or immunosuppressive therapy. Clinical Presentation: Patients with post-bladder catheter infections may present with symptoms such as fever, chills, malaise, suprapubic pain or tenderness, and cloudy or foul-smelling urine. In severe cases or when left untreated for an extended period of time, patients may develop more severe symptoms like hematuria or signs of systemic infection. Diagnosis: The diagnosis of post-bladder catheter infection involves a combination of clinical evaluation and laboratory investigations. Urinalysis is crucial in identifying pyuria (presence of white blood cells) and bacteriuria (presence of bacteria). A urine culture is performed to identify the causative organism(s) and determine its antibiotic susceptibility profile. Treatment Options: Prompt initiation of appropriate antibiotic therapy is essential in managing post-bladder catheter infections. Empirical treatment should cover common pathogens until culture results are available. The choice of antibiotics should be guided by local antibiogram data to ensure optimal therapy. In some cases, catheter removal may be necessary, especially if the infection is recurrent or associated with severe complications. Preventive Measures: Prevention plays a vital role in reducing the incidence of post-bladder catheter infections. Strategies include proper hand hygiene, aseptic technique during catheter insertion and care, regular catheter maintenance, and timely removal of unnecessary catheters. Healthcare professionals should also promote patient education regarding self-care practices and signs of infection. Conclusion: Post-bladder catheter infections are a significant healthcare concern that can lead to severe complications and increased healthcare costs. Early recognition, appropriate diagnosis, and prompt treatment are crucial in managing these infections effectively. Implementing preventive measures can significantly reduce the incidence of post-bladder catheter infections and improve patient outcomes. Further research is needed to explore novel strategies for prevention and management in this field.

Keywords: post-bladder catheter infection, urinary tract infection, bacteriuria, indwelling urinary catheters, prevention

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Authors: Maggie Hall, Haley O'Neill

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The U.S. faces a severe shortage of abortion providers, exacerbated by the June 2022 Dobbs v. Jackson Women’s Health Organization decision. Midwives, especially certified nurse midwives, are well-positioned to fill this gap in abortion care. However, a lack of clinical education and training prevents midwives from exercising their full scope of practice. National and international organizations that set obstetrics and midwifery education standards, including the International Confederation of Midwives, American College of Obstetricians and Gynecologists, and American Public Health Association, call for expansion of midwifery-managed abortion care through the first trimester. In the U.S., midwifery programs are accredited based on compliance with ACME standards and compliance is a prerequisite for the American Midwifery Certification Board exams. We conducted a literature review of studies in the last five years regarding abortion didactic and clinical education barriers via CINAHL, EBSCO and PubMed database reviews. We gave preference for primary sources within the last five years; however, due to the rapid changes in abortion education and access, we also included literature from 2012-2022. We evaluated ACME-accredited programs in relation to their geography within abortion-protected or restricted states and assessed state-specific barriers to abortion care education and provision as clinical students. There are 43 AMCB-accredited midwifery schools in 28 states across the U.S. Twenty schools (47%) are in the 15 states in which advanced practice clinicians can provide non-surgical abortion care, such as medication abortion and MVA procedures. Twenty-four schools (56%) are in the 16 states in which abortion care provision is restricted to Licensed Physicians and cannot offer in-state clinical training opportunities for midwifery students. Six schools are in the five states in which abortion is completely banned and are geographically concentrated in the southernmost region of the U.S., including Alabama, Kentucky, Louisiana, Tennessee, and Texas. Subsequently, these programs cannot offer in-state clinical training opportunities for midwifery students. Notably, there are seven ACME programs in six states that do not restrict abortion access by gestational age, including Colorado, Connecticut, Washington, D.C., New Jersey, New Mexico, and Oregon. These programs may be uniquely positioned for midwifery involvement in abortion care beyond the first trimester. While the following states don’t house ACME programs, abortion care can be provided by advanced practice clinicians in Rhode Island, Delaware, Hawaii, Maine, Maryland, Montana, New Hampshire, and Vermont, offering clinical placement and/or new ACME program development opportunities. We identify existing barriers to clinical education and training opportunities for midwifery-managed abortion care, which are both geographic and institutional in nature. We recommend expansion and standardization of clinical education and training opportunities for midwifery-managed abortion care in ACME-accredited programs to improve access to abortion care. Midwifery programs and teaching hospitals need to expand education, training, and residency opportunities for midwifery students to strengthen access to midwife-managed abortion care. ACNM and ACME should re-evaluate accreditation criteria and the implications of ACME programs in states where students are not able to learn abortion care in clinical contexts due to state-specific abortion restrictions.

Keywords: midwifery education, abortion, abortion education, abortion access

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Authors: Cecile Garry, Katia Rovira, Julie Brisson

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Autism Spectrum Disorder (ASD) is defined by a qualitative and quantitative impairment of social interaction. Indeed early intervention programs, such as the Early Start Denver Model (ESDM), aimed at encouraging the development of social skills. In classroom, the children need to be socially engaged to learn. Early intervention programs can thus be implemented in kindergarten schools. In these schools, ASD children have more opportunities to interact with their peers or adults than in elementary schools. However, the preschool children with ASD are less socially engaged than their typically developing peers in the classroom. They initiate, respond and maintain less the social interactions. In addition, they produce more responses than initiations. When they interact, the non verbal communication is more used than verbal or symbolic communication forms and they are more engaged with adults than with peers. Nevertheless, communicative patterns may vary according to the clinical profiles of ASD children. Indeed, the ASD children with better cognitive skills interact more with their peers and use more symbolic communication than the ASD children with a low cognitive level. ASD children with the less severe symptoms use more the verbal communication than ASD children with the more severe symptoms. Small groups and structured activities encourage coordinated joint engagement episodes in ASD children. Our goal is to evaluate ASD children’s social engagement development in class, with their peers or adults, during dyadic or group activities. Participants were 19 preschool children with ASD aged from 3 to 6 years old that benefited of an early intervention in special kindergarten schools. Severity of ASD symptoms was measured with the CARS at the beginning of the follow-up. Classroom situations of interaction were recorded during 10 minutes (5 minutes of dyadic interaction and 5 minutes of a group activity), every 2 months, during 10 months. Social engagement behaviors of children, including initiations, responses and imitation, directed to a peer or an adult, were then coded. The Observer software (Noldus) that allows to annotate behaviors was the coding system used. A double coding was conducted and revealed a good inter judges fidelity. Results show that ASD children were more often and longer socially engaged in dyadic than in groups situations. They were also more engaged with adults than with peers. Children with the less severe symptoms of ASD were more socially engaged in groups situations than children with the more severe symptoms of ASD. Then, ASD children with the less severe symptoms of ASD were more engaged with their peers than ASD children with the more severe symptoms of ASD. However, the engagement frequency increased during the 10 month of follow-up but only for ASD children with the more severe symptoms at the beginning. To conclude, these results highlighted the necessity of individualizing early intervention programs according to the clinical profile of the child.

Keywords: autism spectrum disorder, preschool children, developmental psychology, early interventions, social interactions

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Authors: Ng Yen, Shafii Khamis, Rehir Bin Dahalan

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Cyclotrons in the energy range 10-30 MeV are widely used for the production of clincally relevant radiosiotopes used in positron emission tomography (PET) nuclear imaging. Positron emmision tomography is a powerful nuclear imaging tool that produces high quality 3-dimentional images of functional processes of body. The advantage of PET among all other imaging devices is that it allows the study of an impressive array of discrete biochemical and physiologic processes, within a single imaging session. The number of PET scanner increases every year globally due to high clinical demand. However, not all PET centers can afford a cyclotron, due to the expense associated with operation of an in-house cyclotron. Therefore, current research has also focused on the development of parent/daughter generators that can reliably provide PET nuclides. These generators (68Ge/68Ga generator, 62Zn/62Cu, 82Sr/82Rb, etc) can provide even short-lived radionuclides at any time on demand, without the need of an ‘in-house cyclotron’. The parent isotope is produced at a cyclotron/reactor facility, and can be shipped to remote clinical sites (regionally/overseas), where the daughter isotope is eluted, a model similar to the 99Mo/99mTc generator system. The specific aim for this presentation is to talk about the potential for both of the cyclotron and generator-produced PET radiopharmaceuticals used in clinical imaging.

Keywords: positron emission tomography, radiopharmaceutical, cyclotron, generator

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Authors: Célia Barreto Carvalho, Carolina da Motta, Marina Sousa, Joana Cabral, Ana Luísa Carvalho, Ermelindo Peixoto

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The aim of the current study was to develop and validate a Response to Stressful Situations Scale (RSSS) for the Portuguese population. This scale assesses the degree of stress experienced in scenarios that can constitute positive, negative and more neutral stressors, and also describes the physiological, emotional and behavioral reactions to those events according to their intensity. These scenario include typical stressor scenarios relevant to patients with schizophrenia, which are currently absent from most scale, assessing specific risks that these stressors may bring on subjects, which may prove useful in non-clinical and clinical populations (i.e. patients with mood or anxiety disorders, schizophrenia). Results from Principal Components Analysis and Confirmatory Factor Analysis of on two adult samples from general population allowed to confirm a three-factor model with good fit indices: χ2 (144)= 370.211, p = 0.000; GFI = 0.928; CFI = 0.927; TLI = 0.914, RMSEA = 0.055, P( rmsea ≤ 0.005) = 0.096; PCFI = 0.781. Further data analysis on the scale revealed that RSSS is an adequate assessment tool of stress response in adults to be used in further research and clinical settings, with good psychometric characteristics, adequate divergent and convergent validity, good temporal stability and high internal consistency.

Keywords: assessment, stress events, stress response, stress vulnerability

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Authors: Yutong Wan, John N. Wood

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Introduction: SCN9A encoded Nav1.7 is an ideal therapeutic target with minimal side effects for the pharmaceutical industry because SCN9A variants can cause both human gains of function pain-related mutations and loss of function pain-free mutations. This study reviews the clinical effectiveness of existing Nav1.7 inhibitors, which theoretically should be powerful analgesics. Methods: A systematic review is conducted on the effectiveness of current Nav1.7 blockers undergoing clinical trials. Studies were mainly extracted from PubMed, U.S. National Library of Medicine Clinical Trials, World Health Organization International Clinical Trials Registry, ISRCTN registry platform, and Integrated Research Approval System by NHS. Only studies with full text available and those conducted using double-blinded, placebo controlled, and randomised designs and reporting at least one analgesic measurement were included. Results: Overall, 61 trials were screened, and eight studies covering PF 05089771 (Pfizer), TV 45070 (Teva & Xenon), and BIIB074 (Biogen) met the inclusion criteria. Most studies were excluded because results were not published. All three compounds demonstrated insignificant analgesic effects, and the comparison between PF 05089771 and pregabalin/ibuprofen showed that PF 05089771 was a much weaker analgesic. All three drug candidates only have mild side effects, indicating the potentials for further investigation of Nav1.7 antagonists. Discussion: The failure of current Nav1.7 small molecule inhibitors might attribute to ignorance of the key role of endogenous systems in Nav1.7 null mutants, the lack of selectivity and blocking potency, and central impermeability. The synergistic combination of analgesic drugs, a recent UCL patent, combining a small dose of Nav1.7 blockers and opioids or enkephalinase inhibitors dramatically enhanced the analgesic effects. Conclusion: The current clinical testing Nav1.7 blockers are generally disappointing. However, the newer generation of Nav1.7 targeting analgesics has overcome the major constraints of its predecessors.

Keywords: chronic pain, Nav1.7 blockers, SCN9A, systematic review

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Authors: Harim Mohsin, Afshan Channa, Beena Saad

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The Kocher Debre Semelaigne Syndrome (KDSS) is known as cretinism muscular hypertrophy. It is an unusual presentation in intellectually deficit children, commonly associated with congenital or iatrogenic hypothyroidism. The creatinine phosphokinase (CPK) is usually elevated and it’s commonly found in males, consanguineous marriage and ages 18 months to 10 years. It might be misdiagnosed without the classical features of hypothyroidism at first presentation. We present a case of 15 year old intellectually deficit female with epilepsy managed on phenytoin. She had rigidity, myxedema, calf muscle hypertrophy and agitation. The patient was managed as Neuroleptic Malignant Syndrome due to raised CPK of 40,680 IU/L and mixed presentation. Nevertheless, no improvement was noticed and thyroid profile was done to exclude alternative resources. Thyroid stimulating hormone (TSH) was 74.5 IU, Free T3 1.22 ng/dl, and Free T4 0.43 ng/dl. Thyroxine was started along with change in antiepileptic leading to recovery. This case report highlights the inconsistent finding of KDSS. The female gender, non-consanguineous marriage, delayed onset with primarily neuromuscular symptoms, and raised CPK is a rare demonstration in KDSS. Additionally, thyroid profile is not routinely done, which can lead to misdiagnosis and mismanagement.

Keywords: cretinism, hypothyroidism, intellectual deficit, KDSS

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Authors: Mousa Saleh Daoud

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Rickets is a condition that affects the development of bones in children. It causes soft bones, which can become bowed or curved, this bending and curvature is evident in the age of Walking. The most common cause of rickets is dietary deficiency of vitamin D or Lack of exposure to sunlight or both together. The link between vitamin D and rickets has been known for many years and is well understood by doctors and scientists. If a child does not get enough of the vitamin D, the bones cannot form hard outer shells. This is why they become soft and weak. This study was conducted on children who reviewed by our medical clinic between the years 2011-2013. The study included 400 children, aged between one and six years. 11 children had clear clinical manifestations of rickets of varying degrees and all of them due to lack of vitamin D except for one case of rickets resistant to vitamin D. 389 cases ranged between natural and deficiency in vitamin D without clinical manifestations of Rickets.

Keywords: rickts, bone metabolic diseases, vitamin D, child

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Authors: Bhavani Veasuvalingam

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Case-based learning (CBL) is a popular instructional method aimed to bridge theory to clinical practice. This study aims to explore CBL mixed modality curriculum in influencing students’ learning styles and strategies that support learning. An explanatory sequential mixed method study was employed with initial phase, 44-itemed Felderman’s Index of Learning Style (ILS) questionnaire employed across year one medical students (n=142) using convenience sampling to describe the preferred learning styles. The qualitative phase utilised three focus group discussions (FGD) to explore in depth on the multimodal learning style exhibited by the students. Most students preferred combination of learning stylesthat is reflective, sensing, visual and sequential i.e.: RSVISeq style (24.64%) from the ILS analysis. The frequency of learning preference from processing to understanding were well balanced, with sequential-global domain (66.2%); sensing-intuitive (59.86%), active- reflective (57%), and visual-verbal (51.41%). The qualitative data reported three major themes, namely Theme 1: CBL mixed modalities navigates learners’ learning style; Theme 2: Multimodal learners active learning strategies supports learning. Theme 3: CBL modalities facilitating theory into clinical knowledge. Both quantitative and qualitative study strongly reports the multimodal learning style of the year one medical students. Medical students utilise multimodal learning styles to attain the clinical knowledge when learning with CBL mixed modalities. Educators’ awareness of the multimodal learning style is crucial in delivering the CBL mixed modalities effectively, considering strategic pedagogical support students to engage and learn CBL in bridging the theoretical knowledge into clinical practice.

Keywords: case-based learning, learnign style, medical students, learning

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Authors: Mohamed Aly, Aliaa Rehan Youssef, Emad Sawerees, Mounir Guirgis

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Relevance: Osteoarthritis (OA) is the most common degenerative disease seen in all populations. It causes disability and substantial socioeconomic burden. Evidence supports that exercise are the most effective conservative treatment for patients with OA. Therapists experience and clinical judgment play major role in exercise prescription and scientific evidence for this regard is lacking. The development of clinical prediction rules to identify patients who are most likely benefit from exercise may help solving this dilemma. Purpose: This study investigated whether body mass index and functional ability at baseline can predict patients’ response to a selected exercise program. Approach: Fifty-six patients, aged 35 to 65 years, completed an exercise program consisting of open kinetic chain strengthening and passive stretching exercises. The program was given for 3 sessions per week, 45 minutes per session, for 6 weeks Evaluation: At baseline and post treatment, pain severity was assessed using the numerical pain rating scale, whereas functional ability was being assessed by step test (ST), time up and go test (TUG) and 50 feet time walk test (50 FTW). After completing the program, global rate of change (GROC) score of greater than 4 was used to categorize patients as successful and non-successful. Thirty-eight patients (68%) had successful response to the intervention. Logistic regression showed that BMI and 50 FTW test were the only significant predictors. Based on the results, patients with BMI less than 34.71 kg/m2 and 50 FTW test less than 25.64 sec are 68% to 89% more likely to benefit from the exercise program. Conclusions: Clinicians should consider the described strengthening and flexibility exercise program for patents with BMI less than 34.7 Kg/m2 and 50 FTW faster than 25.6 seconds. The validity of these predictors should be investigated for other exercise.

Keywords: clinical prediction rule, knee osteoarthritis, physical therapy exercises, validity

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Authors: David A. Padilla, Rodolfo Villamizar

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In recent years, closed loop control strategies have been developed in order to establish a healthy glucose profile in type 1 diabetic mellitus (T1DM) patients. However, the controller itself is unable to define a suitable reference trajectory for glucose. In this paper, a control strategy Is proposed where the shape of the reference trajectory is generated bases in the amount of carbohydrates present during the digestive process, due to the effect of carbohydrate intake. Since there no exists a sensor to measure the amount of carbohydrates consumed, an estimator is proposed. Thus this paper presents the entire process of designing a carbohydrate estimator, which allows estimate disturbance for a predictive controller (MPC) in a T1MD patient, the estimation will be used to establish a profile of reference and improve the response of the controller by providing the estimated information of ingested carbohydrates. The dynamics of the diabetic model used are due to the equations described by the UVA/Padova model of the T1DMS simulator, the system was developed and simulated in Simulink, taking into account the noise and limitations of the glucose control system actuators.

Keywords: estimation, glucose control, predictive controller, MPC, UVA/Padova

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Authors: Amit Singla, Amit Chauhan

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The non-circular journal bearings provide better thermal stability and lesser oil-film temperature rise as compared to circular journal bearings. Experimentation on simultaneous measurement of pressure and temperature of lubricated oil-film along the profile of the bearing will help the designer to design journal bearings. In this paper, pressure and temperature of oil-film along orthogonally displaced non-circular journal bearing have been measured on a designed journal bearing test rig. The orthogonal non-circular journal bearing has been fabricated by displacing two circular halves away from the centers in the orthogonal direction. The data acquisition for oil film pressure and temperature has been carried out at journal speed=3000 rpm and by increasing the static radial load from 500 N to 2000 N in steps of 500 N using three different grades of oil (ISOVG 32, 68, and 150) named as oil-1, oil-2, and oil-3 respectively. The results show that the oil-film pressure and temperature increases with increase in radial load and change of lubricating oil towards increasing viscosity. Further, two lobes in the pressure and temperature profiles have been obtained which accounts for better thermal stability as it reduces cavitation zone inside the bearing.

Keywords: cavitation, non-circular journal bearing, orthogonally displaced, thermal stability

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Authors: Shu Hwang Ang, Choo Yee Yu, Geik Yong Ang, Yean Yean Chan, Yatimah Binti Alias, And Sook Mei Khor

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With the high prevalence of Type 2 diabetes mellitus across the world, the morbidities and mortalities associated with Type 2 diabetes have significant impact on the production line for a nation. With routine scheduled clinical visits to manage Type 2 diabetes, diabetic patients with hectic lifestyles can have low clinical compliance. Hence, it often decreases the effectiveness of diabetic management personalized for each diabetic patient. Here, we report a useful developed point-of-care (POC) device that detect glycated hemoglobin (HbA1c, biomarker for long-term Type 2 diabetic management). In fact, the established POC devices certified to be used in clinical setting are not only expensive ($ 8 to $10 per test), they also require skillful practitioners to perform sampling and interpretation. As a paper-based biosensor, the developed HbA1c biosensor utilized lateral flow principle to offer an alternative for cost-effective (approximately $2 per test) and end-user friendly device for household testing. Requiring as little as 2 L of finger-picked blood, the test can be performed at the household with just simple dilution and washings. With visual interpretation of numbers of test lines shown on the developed biosensor, it can be interpreted as easy as a urine pregnancy test, aided with scale of intensity provided. In summary, the developed HbA1c immunosensor has been tested to have high selectivity towards HbA1c, and is stable with reasonably good performance in clinical testing. Therefore, our developed HbA1c immunosensor has high potential to be an effective diabetic management tool to increase patient compliance and thus contain the progression of the diabetes.

Keywords: blood, glycated hemoglobin (HbA1c), lateral flow, type 2 diabetes mellitus

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Authors: Peña A. Roland R., Lozano P. Jean P.

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The waterflooding process is an enhanced oil recovery (EOR) method that appears tremendously successful. This paper shows the importance of the role of the numerical modelling of waterflooding and how to provide a better description of the fluid flow during this process. The mathematical model is based on the mass conservation equations for the oil and water phases. Rock compressibility and capillary pressure equations are coupled to the mathematical model. For discretizing and linearizing the partial differential equations, we used the Finite Volume technique and the Newton-Raphson method, respectively. The results of three scenarios for waterflooding in porous media are shown. The first scenario was estimating the water saturation in the media without rock compressibility and without capillary pressure. The second scenario was estimating the front of the water considering the rock compressibility and capillary pressure. The third case is to compare different fronts of water saturation for three fluids viscosity ratios without and with rock compressibility and without and with capillary pressure. Results of the simulation indicate that the rock compressibility and the capillary pressure produce changes in the pressure profile and saturation profile during the displacement of the oil for the water.

Keywords: capillary pressure, numerical simulation, rock compressibility, two-phase flow

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Authors: Muhammad Sohail Sajid, Hafiz Muhammad Rizwan, Ashfaq Ahmad Chatta, Zafar Iqbal, Muhammad Saqib

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Changes in the climate are posing threats to the livestock community throughout the globe. Agro-grazing animals and natural vegetation as their forages are the most important components of animal production. Climate and local conditions not only determine the nature and kind of plants, their distribution, composition and nutritive value in different cropping belts and grazing sites but also influence number and kinds of grazing animals. Phytomineral supplementation can act as an indirect tool to boost-up immunological profile of animals leading to the development of resilience against parasitic infections. The present study correlates the trace element (Cu, Co, Mn, Zn) profile of grazing sheep, feedstuffs, respective soils and their GI helminths in a selected district of Sialkot, Punjab, Pakistan. Ten species of GI helminths were found during the survey. A significant (P < 0.05) variation in the concentrations (conc.) of Zn, Cu, Mn and Co was recorded in a total of 16 collected forages. During autumn, mean conc. of Cu, Zn and Co in sera were inversely proportional to the GI helminth burden; while, during spring, only Zn was inversely proportional to the GI helminth burden in grazing sheep. During autumn the highest conc. of Zn, Cu, Mn and Co were recorded in Echinochloa colona, Amaranthus viridis, Cannabis sativa, and Brachiaria ramose and during spring in Cichorium intybus, Cynodon dactylon, Parthenium hysterophorus and Coronopus didymus respectively. The trace element-rich forages, preferably Zn, found effective against helminth infection are advisable supplemental remedies to improve the trace element profile in grazing sheep. This mitigation strategy may ultimately improve the resilience against GI helminth infections especially in the resource poor countries like Pakistan.

Keywords: coprological examination, Trace elements, Sheep, Gastro-intestinal parasites, Prevalence, Sialkot, Pakistan

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Authors: Alvyra Galkienė, Ona Monkevičienė

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The full participation of all pupils in the overall educational process is defined by the concept of inclusive education, which is gradually evolving in education policy and practice. It includes the full participation of all pupils in a shared learning experience and educational practices that address barriers to learning. Inclusive education applying the principles of Universal Design for Learning (UDL), which includes promoting students' involvement in learning processes, guaranteeing a deep understanding of the analysed phenomena, initiating self-directed learning, and using e-tools to create a barrier-free environment, is a prerequisite for the personal success of each pupil. However, the sustainability of quality education is affected by the transformation of education systems. This was particularly evident during the period of the forced transition from contact to distance education in the COVID-19 pandemic. Research Problem: The transformation of the educational environment from real to virtual one and the loss of traditional forms of educational support highlighted the need for new research, revealing the individual profiles of teachers using UDL-based learning and the pathways of sustainable transfer of successful practices to non-conventional learning environments. Research Methods: In order to identify individual latent teacher profiles that encompass the essential components of UDL-based inclusive teaching and direct leadership of students' learning, the quantitative analysis software Mplius was used for latent profile analysis (LPA). In order to reveal proven, i.e., sustainable, pathways for the transit of the components of UDL-based inclusive learning to distance learning, latent profile transit analysis (LPTA) via Mplius was used. An online self-reported questionnaire was used for data collection. It consisted of blocks of questions designed to reveal the experiences of subject teachers in contact and distance learning settings. 1432 Lithuanian, Latvian, and Estonian subject teachers took part in the survey. Research Results: The LPA analysis revealed eight latent teacher profiles with different characteristics of UDL-based inclusive education or traditional teaching in contact teaching conditions. Only 4.1% of the subject teachers had a profile characterised by a sustained UDL approach to teaching: promoting pupils' self-directed learning; empowering pupils' engagement, understanding, independent action, and expression; promoting pupils' e-inclusion; and reducing the teacher's direct supervision of the students. Other teacher profiles were characterised by limited UDL-based inclusive education either due to the lack of one or more of its components or to the predominance of direct teacher guidance. The LPTA analysis allowed us to highlight the following transit paths of teacher profiles in the extreme conditions of the transition from contact to distance education: teachers staying in the same profile of UDL-based inclusive education (sustainable transit) or jumping to other profiles (unsustainable transit in case of barriers), and teachers from other profiles moving to this profile (ongoing transit taking advantage of the changed new possibilities in the teaching process).

Keywords: distance education, latent teacher profiles, sustainable transit, UDL

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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: 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

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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

Procedia PDF Downloads 172

Authors: Patricia O. Carvalho, Marcia C. F. Messias, Salvador Sanchez Vinces, Caroline F. A. Gatinoni, Vitor P. Iordanu, Carlos A. R. Martinez

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Lipidomics methods are widely used in the identification and validation of disease-specific biomarkers and therapy response evaluation. The present study aimed to identify a panel of potential lipid biomarkers to evaluate response to neoadjuvant chemoradiotherapy in rectal adenocarcinoma (RAC). Liquid chromatography–mass spectrometry (LC-MS)-based untargeted lipidomic was used to profile human serum samples from patients with clinical stage T2 or T3 resectable RAC, after and before chemoradiotherapy treatment. A total of 28 blood plasma samples were collected from 14 patients with RAC who recruited at the São Francisco University Hospital (HUSF/USF). The study was approved by the ethics committee (CAAE 14958819.8.0000.5514). Univariate and multivariate statistical analyses were applied to explore dysregulated metabolic pathways using untargeted lipidic profiling and data mining approaches. A total of 36 statistically significant altered lipids were identified and the subsequent partial least-squares discriminant analysis model was both cross validated (R2, Q2) and permutated. Lisophosphatidyl-choline (LPC) plasmalogens containing palmitoleic and oleic acids, with high variable importance in projection score, showed a tendency to be lower after completion of chemoradiotherapy. Chemoradiotherapy seems to change plasmanyl-phospholipids levels, indicating that these lipids play an important role in the RAC pathogenesis.

Keywords: lipidomics, neoadjuvant chemoradiotherapy, plasmalogens, rectal adenocarcinoma

Procedia PDF Downloads 112

Authors: K. Kamal

Abstract:

Structural sandwich panels with core of Advanced Composites Laminates l Honeycombs / PU-foams are used in aerospace applications and are also fabricated for use now in some civil engineering applications. An all Advanced Composites Foot Over Bridge (FOB) system, designed and developed for pedestrian traffic is one such application earlier, may be cited as an example here. During development stage of this FoB, a profile of its decks was then spurred as a single corrugate sheet core sandwiched between two Glass Fibre Reinforced Plastics(GFRP) flat laminates. Once successfully fabricated and used, these decks did prove suitable also to form other structure on assembly, such as, erecting temporary shelters. Such corrugated sheet core profile sandwiched panels were then also tried using the construction materials but any conventional method of construction only posed certain difficulties in achieving the required core profile monolithically within the sandwiched slabs and hence it was then abended. Such monolithic construction was, however, subsequently eased out on demonstration by dispensing building materials mix through a suitably designed multi-dispenser system attached to a 3D Printer. This study conducted at lab level was thus reported earlier and it did include the fabrication of a 3D printer in-house first as ‘3DcMP’ as well as on its functional operation, some required sandwich core profiles also been 3D-printed out producing panels hardware. Once a number of these sandwich panels in single corrugated sheet core monolithically printed out, panels were subjected to load test in an experimental set up as also their structural behavior was studied analytically, and subsequently, these results were correlated as reported in the literature. In achieving the required more depths and also to exhibit further the stronger and creating sandwiched decks of better structural and mechanical behavior, further more complex core configuration such as stack corrugate sheets core with a flat mid plane was felt to be the better sandwiched core. Such profile remained as an outcome that turns out merely on stacking of two separately printed out monolithic units of single corrugated sheet core developed earlier as above and bonded them together initially, maintaining a different orientation. For any required sequential understanding of the structural behavior of any such complex profile core sandwiched decks with special emphasis to study of the effect in the variation of corrugation orientation in each distinct tire in this core, it obviously calls for an analytical study first. The rectangular,simply supported decks have therefore been considered for analysis adopting the ‘Advanced Composite Technology(ACT), some numerical results along with some fruitful findings were obtained and these are all presented here in this paper. From this numerical result, it has been observed that a mid flat layer which eventually get created monolethically itself, in addition to eliminating the bonding process in development, has been found to offer more effective bending resistance by such decks subjected to UDL over them. This is understood to have resulted here since the existence of a required shear resistance layer at the mid of the core in this profile, unlike other bending elements. As an addendum to all such efforts made as covered above and was published earlier, this unique stack corrugate sheet core profile sandwiched structural decks, monolithically construction with ease at the site itself, has been printed out from a 3D Printer. On employing 3DcMP and using some innovative building construction materials, holds the future promises of such research & development works since all those several aspects of a 3D printing in construction are now included such as reduction in the required construction time, offering cost effective solutions with freedom in design of any such complex shapes thus can widely now be realized by the modern construction industry.

Keywords: advance composite technology(ACT), corrugated laminates, 3DcMP, foot over bridge (FOB), sandwiched deck units

Procedia PDF Downloads 153

Authors: Kaiying Lai, Suiping Wang, Luodi Yu, Yang Zhang, Pengmin Qin

Abstract:

Abnormalities in auditory processing are one of the most commonly reported sensory processing impairments in children with Autism Spectrum Disorder (ASD). Tonal language speaker with autism has enhanced neural sensitivity to pitch changes in pure tone. However, not all children with ASD exhibit the same performance in pitch processing due to different auditory sensitivity. The current study aimed to examine auditory change detection in ASD with different auditory sensitivity. K-means clustering method was adopted to classify ASD participants into two groups according to the auditory processing scores of the Sensory Profile, 11 autism with hypersensitivity (mean age = 11.36 ; SD = 1.46) and 18 with hypo-sensitivity (mean age = 10.64; SD = 1.89) participated in a passive auditory oddball paradigm designed for eliciting mismatch negativity (MMN) under the pure tone condition. Results revealed that compared to hypersensitive autism, the children with hypo-sensitivity showed smaller MMN responses to pure tone stimuli. These results suggest that ASD with auditory hypersensitivity and hypo-sensitivity performed differently in processing pure tone, so neural responses to pure tone hold promise for predicting the auditory sensitivity of ASD and targeted treatment in children with ASD.

Keywords: ASD, sensory profile, pitch processing, mismatch negativity, MMN

Procedia PDF Downloads 364

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: Mabtho Moreroa-Monyelo, Grace Ijoma, Rosina Nkuna, Tonderayi Matambo

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A moving bed biofilm reactor (MBBR) was used for the bioremediation of high strength chemical oxygen demand (COD) Fisher-Tropsch (FT) wastewater. The aerobic MBBR system was operated over 60 days. For metagenomics profile assessment of the targeted 16S sequence of bacteria involved in the bioremediation of the chemical compounds, sludge samples were collected every second day of operation. Parameters such as pH and COD were measured daily to compare the system efficiency as the changedin microbial diversity progressed. The study revealed that pH was a contributing factor to microbial diversity, which further affected the efficiency of the MBBR system. The highest COD removal rate of 86.4% was achieved at pH 8.3. It was observed that when there was more, A higher bacterial diversity led to an improvement in the reduction of COD. Furthermore, an OTUof 4530 was obtained, which were divided into 12 phyla, 27 classes, 44 orders, 74 families, and 138 genera across all sludge samples from the MBBR. A determination of the relative abundance of microorganisms at phyla level indicates that the most abundant phylum on day it was Firmicutes (50%); thereafter, the most abundant phylum changed toProteobacteria.

Keywords: biodegradation, fischer-tropsch wastewater, metagenomics, moving bed biofilm reactor

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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

Procedia PDF Downloads 117

Authors: Souheila Zemmouchi

Abstract:

Introduction: Diabetes is currently the leading cause of end-stage chronic kidney disease and dialysis, so it adds additional complexity to the management of chronic hemodialysis patients. These patients are extremely fragile because of their multiple cardiovascular and metabolic comorbidities. Clear and complete description of the experience: the management of a diabetic on hemodialysis is particularly difficult due to frequent hypoglycaemia and significant inter and perdialyticglycemic variability that is difficult to predict. The aim of our study is to describe the clinical-biological profile and to assess the cardiovascular risk of diabetics undergoing chronic hemodialysis, and compare them with non-diabetic hemodialysis patients. Methods: This cross-sectional, descriptive, and analytical study was carried out between January 01 and December 31, 2018, involving 309 hemodialysis patients spread over 4 centersThe data were collected prospectively then compiled and analyzed by the SPSS Version 10 software The FRAMINGHAM RISK SCORE has been used to assess cardiovascular risk in all hemodialysis patients Results: The survey involved 309 hemodialysis patients, including 83 diabetics, for a prevalence of 27% The average age 53 ± 10.2 years. The sex ratio is 1.5. 50% of diabetic hemodialysis patients retained residual diuresis against 32% in non-diabetics. In the group of diabetics, we noted more hypertension (70% versus 38% non-diabetics P 0.004), more intradialytichypoglycemia (15% versus 3% non-diabetics P 0.007), initially, vascular exhaustion was found in 4 diabetics versus 2 non-diabetics. 70% of diabetics with anuria had postdialytichyperglycemia. The study found a statistically significant difference between the different levels of cardiovascular risk according to the diabetic status. Conclusion: There are many challenges in the management of diabetics on hemodialysis, both to optimize glycemic control according to an individualized target and to coordinate comprehensive and effective care.

Keywords: hemodialysis, diabetes, chronic renal failure, glycemic control

Procedia PDF Downloads 139

Authors: Farshad Ghazalian, Laleh Hakemi, Lotfali Pourkazemi, Maryam Ameri, Seyed Hossein Alavi

Abstract:

Background: The use of whole body vibration (WBV) as an exercise method has rapidly increased over the last decade. The aim of this study was to evaluate long term effects of different amplitudes of whole body vibration training with progressive frequencies on lipid profile of young healthy men. Materials and methods: Thirty three healthy male students were divided randomly in three groups: high amplitude vibration group (n=11), low amplitude vibration group (n=11), and control group (n=11). The vibration training consisted of 5 week whole-body vibration 3 times a week with amplitudes 4 and 2 mm and progressive frequencies from 25 Hz with increments of 5 Hz weekly. Concentrations TG, HDL, LDL, cholesterol, and VLDL before and after 5 weeks of training were measured in plasma samples. Statistical analysis was done using one way analysis of variance. P<0.05 was considered statistically significant. Results: The most important result of the present study is finding no favorable changes of 5-week vibration training with different amplitudes on blood lipid profiles. Discussion and conclusions: It was emphasized that in vibration training there should be a relationship between intensity and volume of exercise and lipid responses in order to improve blood lipoprotein profiles.

Keywords: long term, body, vibration training, lipid

Procedia PDF Downloads 397